Courts Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/courts/ Ñî¹óåú´«Ã½Ò•îl Health News produces in-depth journalism on health issues and is a core operating program of KFF. Fri, 18 Sep 2026 12:07:42 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.9 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Courts Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/courts/ 32 32 257378068 Outcome of Suit Against Department of Labor Could Boost Skimpy Employer Health Plans /courts/department-labor-employer-health-plans-aca-limited-partnership-settlement/ Wed, 16 Sep 2026 09:00:00 +0000 /?p=2283210 A long-running lawsuit challenging what it means to be an employee and therefore have access to work-based health plans is being closely watched by health policy analysts. Its outcome could spur the availability of lower-cost but potentially skimpier health coverage that skirts some consumer protections.

Court papers indicate a settlement in the case against the Department of Labor , although the parameters of any such deal are unknown.

It would come amid premium surges on Affordable Care Act marketplaces that have led millions to drop coverage this year. The Trump administration has also been sharply focused on expanding access to alternative coverage, such that avoid ACA rules on preexisting conditions and benefit requirements.

“Depending on what happens with the settlement, this could be an even bigger expansion,” said , director of the Center for Health Policy and the Law at the Georgetown University Law Center. “People are worried that it is the opening salvo into promoting junk plans that don’t meet the ACA requirements.”

The plaintiff, Data Marketing Partnership, against the Department of Labor in 2019, during the first Trump administration. It wants official recognition as an employer so it can continue to allow its limited partners to buy into a type of job-based health insurance that doesn’t have to comply with state insurance rules or offer coverage as robust as required under the ACA.

But to grasp the claim, one also has to understand how the coverage works.

A consumer shopping for health insurance may come across information online or from a marketer about this concept, sometimes called “limited partnership” coverage. The pitch? Buy insurance offered through Data Marketing Partnership and handled by LP Management Services. To qualify, the consumer must download an app that tracks their internet searches. The company could then sell that data.

Some potential consumers may be turned off by the thought of their internet searches being tracked, but others may find it appealing because it allows them to become a limited partner eligible to buy into the company’s employee health insurance plans. But can these partners be considered employees?

The court’s answer has potential implications for regulators and consumers. Some health policy and market experts warn that a green light could lead to a proliferation of aggressively marketed and potentially questionable insurance with limited recourse for consumers because the plans would be exempt from state oversight.

“If this took off, you logically could see the rise of a whole bunch of what, functionally, would be unregulated insurance companies,” said , who was the principal deputy assistant secretary of the Department of Labor’s Employee Benefits Security Administration during Joe Biden’s presidency and now runs his own consulting outfit.

No one knows if the department is going to change its long-running stance defending the case. But any settlement could add more uncertainty to insurance markets.

Already insurers are requesting double-digit increases in ACA premiums again next year, partly because declining enrollment often means that the healthiest policyholders are leaving. That trend could accelerate in coming years as more people are drawn into alternatives such as limited-partnership policies.

States Act as Federal Case Plays Out

The Department of Labor defended the case throughout the first Trump administration and the Biden era, issuing a sharply worded in early 2020 stating that people who simply download software to “capture data as they browse the Internet” are not “employees or bona fide partners.”

A district court judge in Texas, the ACA unconstitutional in a decision ultimately rejected by the Supreme Court, called the advisory opinion “” in a 2020 ruling in favor of the data marketer. The U.S. Court of Appeals for the largely upheld the lower court’s decision but ordered it whether someone who downloads software is either a “working owner” or a “bona fide partner.”

The employer-employee relationship is at the heart of the case because of a designed to help large, self-insured employers offer retirement and health benefits to workers without having to meet varying rules from multiple states.

That law — the Employee Retirement Income Security Act — allows such plans to avoid most rules set by the states, which generally regulate most other types of insurance and assist consumers who report problems with their policies. As self-insured employer plans, the policies also don’t have to comply with some ACA rules, such as the 10 broad categories of “essential health benefits.”

“If the case goes the wrong way, it could impact consumers or hamstring the states,” said Marie Grant, Maryland’s insurance commissioner.

Arguments over what constitutes an employer plan are not new, and other organizations have tried offering such coverage. Some states have taken action against purveyors of limited-partner policies.

Maryland in 2024 , The Vitamin Patch, for offering limited-partnership insurance after investigating complaints and determining it was not licensed to sell coverage in the state.

Washington in 2021 to stop offering its plans in the state and fined it $25,000.

and in 2024 warned consumers about this type of coverage.

“These plans do not provide comprehensive medical coverage and can leave consumers with large, unpaid medical bills,” according to Connecticut’s notice.

Maine’s announcement noted that entities offering these types of health insurance included The Vitamin Patch as well as Affiliated Workers Alliance, Consumer Data Partners, Employers Business Alliance, Socios Buenos, and Strategic Limited Partners.

State insurance commissioners in the Department of Labor case citing their concerns about losing the ability to enforce consumer protections.

“This is not a Republican-Democrat thing,” Khawar said. “It’s really a story about state authority, the way such authority would be significantly undermined in insurance markets.”

What’s the Risk?

Still, these limited-partnership plans are viewed by proponents as a needed additional choice for consumers, at potentially lower cost than ACA plans.

When the case was filed, attorneys general , for example, urged the Department of Labor to back Data Marketing’s request to designate its limited partners as employees. That would provide an option for people who “earn too much to qualify” for ACA subsidies and be an interim solution until the ACA could be repealed and replaced, they wrote. They argued that states would retain some regulatory authority and added that the Department of Labor, which oversees self-insured employer plans, could set requirements to “encourage” stable companies to enter the market.

Critics, the attorneys general wrote, might fear that ACA alternatives will draw away younger or healthier people, thus affecting those who remain, but they argued that had already happened.

Data Marketing’s attorneys emailed Ñî¹óåú´«Ã½Ò•îl Health News that they could not provide a comment for this article because the case is in active litigation. Neither the White House nor the Centers for Medicare & Medicaid Services, which oversees the ACA marketplaces, responded to questions from Ñî¹óåú´«Ã½Ò•îl Health News about whether the Department of Labor has changed its stance and how the administration views limited-partnership health plans.

In court filings, however, Data Marketing said that without an employer designation, it would have to end the insurance coverage, affecting about 50,000 policyholders. That would also hurt its ability to generate revenue, it argued, because offering insurance is “a significant attractor” to get people to join its partnership and let it access their electronic data.

, who helped oversee ACA implementation in the Biden administration and is now a managing director at consultancy Manatt Health, had a different take. “The only reason why these sorts of products exist is because they aren’t beholden to consumer protection rules of the ACA and can essentially make money by attracting good risk, people who are healthy,” she said.

Maryland’s Grant echoed this warning, saying that proliferation of such plans could lead to even higher premiums in the ACA markets, if those who remain are older or sicker than those who leave.

Nineteen patient advocacy groups to the Department of Labor Aug. 11 urging it to continue its defense in the case, warning that a settlement that says such arrangements create an employer-employee relationship could “significantly” undermine “both state regulatory authority and decades of bipartisan efforts to promote stable, well-functioning health insurance markets.” Some of those groups in support of the department in 2021.

Days after the August letter, U.S. Rep. Bobby Scott (D-Va.), the ranking member of the House education and workforce committee, warned the department against increasing the availability of “questionable employment relationships” and the insurance they offer.

He cited reports of call centers’ misleading consumers “who think they are enrolling in comprehensive health insurance but instead sign up for junk coverage under the guise of creating an employment relationship with what the consumer believed to be a traditional health insurer.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2283210 Anger Over Health Costs Clouds Midterms /podcast/what-the-health-462-affordability-high-costs-midterms-abortion-pill-september-10-2026/ Thu, 10 Sep 2026 19:05:00 +0000 /?p=2282675&post_type=podcast&preview_id=2282675 The Host
Julie Rovner photo
Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Affordability is top of mind for most voters this fall, and the high cost of healthcare is near the top of affordability complaints. And the news keeps getting worse: All indications are that insurance premiums will go up and benefits will go down in 2027.

Meanwhile, a U.S. appeals court this week heard arguments in a case that could severely limit the availability of the abortion pill mifepristone, not just in states with abortion bans but also in those where abortion is still legal.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Sandhya Raman of Bloomberg Law, and Amanda Seitz of Ñî¹óåú´«Ã½Ò•îl Health News.

Panelists

Joanne Kenen photo
Joanne Kenen Johns Hopkins University and Politico
Sandhya Raman photo
Sandhya Raman Bloomberg Law
Amanda Seitz photo
Amanda Seitz Ñî¹óåú´«Ã½Ò•îl Health News aseitz@kff.org Read Amanda's stories.

Among the takeaways from this week’s episode:

  • Inflation, rising rates of uninsured Americans, as well as industry consolidation are contributing to some of the steepest increases in healthcare costs since the early 2000s. Frustrations back then built momentum for passage of the Affordable Care Act. Today, they’re the backdrop for the midterm elections, though the GOP is focusing on fraud and most Democrats are campaigning on adjustments to existing programs such as the ACA and Medicaid.
  • Several recent news stories have shed light on controversies at the intersection of health and politics. Sen. Roger Marshall (R-Kan.), a physician who could lead the Senate’s health committee next year, is facing scrutiny for suing hundreds of patients over unpaid medical debts, some of whom were arrested for missing court dates. Other stories document allegedly disparaging remarks by Sen. John Fetterman (D-Pa.) to staff about meeting with representatives of a children’s hospital and, separately, a call by Sen. Ron Wyden (D-Ore.) for Health and Human Services Secretary Robert F. Kennedy Jr. to be criminally investigated for allegedly lying to Congress.
  • Meanwhile, a federal appeals court in Louisiana continues to consider a case challenging regulations on the abortion pill mifepristone as President Donald Trump’s latest nominee to lead the Food and Drug Administration awaits confirmation.
  • And the fallout continues from two measles-related deaths in Pennsylvania, leaving Americans with further mixed signals about how to protect themselves and their children.

Also this week, Rovner interviews Ñî¹óåú´«Ã½Ò•îl Health News’ Lauren Sausser, who wrote the latest “Bill of the Month,” about when a preventive service isn’t preventive enough to qualify for zero-cost coverage. If you have a bill that’s baffling, infuriating, or indecipherable, you can share it with us here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: NBC News’ “,” by Mike Hixenbaugh.  

Sandhya Raman: Bloomberg Government’s “,” by Erin Durkin and Claire Hebert.  

Joanne Kenen: ProPublica’s “,” by Audrey Dutton.  

Amanda Seitz: Ñî¹óåú´«Ã½Ò•îl Health News’ “A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back,” by Noam N. Levey and Hannah Norman, and Stat’s “,” by Daniel Payne.  

Also mentioned in this week’s podcast:

  • The Wall Street Journal’s “,” by Peter Loftus.
  • The New York Times’ “,” by Sarah Kliff.
  • The Wall Street Journal’s “,” by Will Hobson and Siobhan Hughes.
  • The Guardian’s “,” by Michelle R Smith.
  • Nature’s “,” by Max Kozlov.
  • ProPublica’s “,” by Andrea Suozzo and Agnel Philip.
Click to open the transcript Transcript: Anger Over Health Costs Clouds Midterms

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

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

Sandhya Raman: Hello, everyone. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my colleague Amanda Seitz of Ñî¹óåú´«Ã½Ò•îl Health News. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have my interview with Lauren Sausser, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” It’s about a breast cancer screening that’s not necessarily considered covered preventive care. But first, this week’s news. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: They’ve had lots of practice. 

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

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

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

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

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

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

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

Rovner: That’s right. 

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

Rovner: I think it was. Sandhya, sorry. 

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

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

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

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

Kenen: Particularly a children’s hospital! 

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

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

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

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

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

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

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

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

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

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

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Children’s Hospital of Philadelphia, yes. 

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

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

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

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

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

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

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

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

I am pleased to welcome back to the podcast my colleague Lauren Sausser, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” Hi, Lauren. 

Lauren Sausser: Hi. 

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

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

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

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

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

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

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

Sausser: Exactly, exactly. 

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

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

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

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

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

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

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

Sausser: Of course. Thanks for having me. 

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

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

Rovner: It is. Joanne. 

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

Rovner: Amanda. 

Seitz: Yeah, I have two extra credits this week, but they both touch on the same topic. The first is “,” by Daniel Payne at Stat News. This story looks at how, ahead of all these Medicaid cuts, rural hospitals are sort of clinging on for dear life by getting the backing of a larger hospital system. They’re often out of town, and, actually, one of the hospitals my own mom works at, so that was kind of cool. But the article does a great job of raising the balance here — that while this approach is saving hospitals from closing, it changes the care that people are getting, and it could make it more expensive. And then my second article is by our Ñî¹óåú´«Ã½Ò•îl Health News colleagues Noam [N.] Levy and Hannah Norman. They published an article: A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back.” That looks at how this hospital in a small town of Troy, New York, was instructed to close its birthing center by the multibillion-dollar health system that’s out of town that it’s owned by. And there was this sort of herculean, bipartisan pushback over the proposed closure that stretched from, like, the local city to the state. Both of these articles just do a really great job, I thought, of showing the local impact of hospital consolidation and corporatization of those systems. 

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

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

Seitz: I am also on X . 

Rovner: Joanne? 

Kenen: I’m mostly on and . 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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

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]]> 2282675 A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back. /courts/troy-new-york-hospital-birthing-center-bipartisan-fight/ Wed, 09 Sep 2026 09:00:00 +0000 /?p=2281344 TROY, N.Y. — Like many residents of this aging industrial city on the Hudson River, Starletta Washington was stunned when she heard Troy’s last remaining hospital planned to close its birthing center.

“It was devastating,” said Washington, who heads the local YWCA. Washington was born at the hospital and had her children there. She couldn’t believe families would now have to get to a hospital half an hour away or face the prospect of an emergency delivery.

“Nobody else was going to be born in the city of Troy unless they were born on a city bus, in the back of a cab, or, disgustingly, on the side of the street?” Washington said. “Blew my mind.”

Troy wasn’t the first community to face this prospect. Since 2010, hospitals have as cities and towns shrink and hospitals consolidate into larger systems.

Troy found a more hopeful ending.

A group of women and one man stand holding signs that say "Save Burdett Birth Center" with a yellow "SAVED" sticker added to the front.
State Assembly member John T. McDonald III (center), a Democrat, worked to secure $5 million in state funding to help keep the Burdett Birth Center open in Troy, New York. (Katherine Bruno/Upper Hudson Planned Parenthood)
A woman in business formal attire sits at a desk with two American flags behind her.
Carmella Mantello, the Republican mayor of Troy, New York, says even nonprofit hospitals seem to have become more corporate. “The whole hospital scene has changed,” she says. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)
A woman wearing a black T-shirt looks towards the camera. She wears a necklace with a tiny star on it, with earrings to match.
Starletta Washington, who heads the YWCA in Troy, was born at the hospital where Burdett Birth Center is located. Like many in the community, she says she was blindsided by Trinity Health’s plan to close the center. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Elected officials from both major parties joined patient advocates, mothers, midwives, doulas, and community leaders like Washington to challenge Trinity Health, the large Catholic health system that owns Troy’s hospital and birthing center. The campaign even united Planned Parenthood and the .

“Whether you were Republican or Democrat, or if you didn’t vote, it literally brought everyone together,” said Carmella Mantello, the city’s Republican mayor. “Everyone just said, ‘We can’t let this happen.’”

Throughout the country, healthcare remains a flash point as politicians square off ahead of November’s elections. But in many places, Americans are also quietly finding common ground.

In this small city, residents were brought together by frustration over large, corporate health systems that can seem to put profits over patients. And they resolved to work together to keep critical medical services in their community.

A Community Institution

Babies have been delivered at Samaritan Hospital on a hill above Troy since this city’s once bustling factories produced most of America’s shirt collars a century ago.

More recently, Samaritan’s Burdett Birth Center had become a model for patient-focused care. Midwives and doulas work alongside OB-GYNs and support mothers who want to avoid a delivery by cesarean section unless necessary.

Patient safety advocates have pushed for years to reduce surgical deliveries, which can lead to complications. At Burdett, only about a quarter of newborns are delivered by C-section, compared with about a third statewide, according to 2025 hospital data. Burdett also had fewer preterm births and fewer babies with low birth weights.

“I wouldn’t go anywhere else,” said Lidia Zambrano-Madera, who gave birth to both her children at Burdett with the help of a midwife.

A woman who just gave birth holds her infant while lying in a hospital bed. Three adult family members and one child stand around her.
Lidia Zambrano-Madera, a Troy resident, gave birth to both her children at the Burdett Birth Center with the help of a midwife. “I wouldn’t go anywhere else,” she says. (Jayana Espinoza)

For Zambrano-Madera, who recently opened a children’s play center in Troy, Burdett offered another advantage: It was just five minutes from home.

But three years ago, Trinity Health, a multibillion-dollar Michigan-based hospital system, said the birth center was losing money and would close. Families from Troy and surrounding Rensselaer County would have to deliver at another Trinity hospital in Albany, up to a half-hour’s drive away. The hospitals are branded under St. Peter’s Health Partners in the Albany region.

“We’ve been frantic about trying not to cut the care at the bedside,” said Steven Hanks, a physician who oversees Trinity hospitals in New York and New England. “But, you know, you get to a point where you can only consolidate so much. You can only spread people so thin, and then you have to start taking harder looks at your actual services.”

Corporate Backlash

Trinity’s plans — news of which — came without warning, surprising the obstetrical staff and community leaders. They set off a firestorm.

Within days, midwives, mothers, community leaders, and politicians held a rally at the YWCA in downtown Troy. Others would follow. Volunteers led by doulas and midwives made T-shirts and handed out pink “Save Burdett” signs at the local farmers market.

Activists were outraged that the hospital hadn’t adequately assessed the impact of the closure, particularly on low-income families. They conducted a community survey that found 1 in 4 Troy residents didn’t have access to a car and would have trouble getting to Albany.

The campaign drew on deep connections that many residents had to Burdett. “They realized what a gem Burdett is, and what a great community service they provide,” said Jessica Hayek, a doula and birth educator who helped lead the campaign.

A woman stands beside a bed with a quilt looks away from the camera with a subtle smile.
Jessica Hayek, a doula and birth educator, helped lead the campaign to stop Trinity Health from closing the Burdett Birth Center. She says Michigan-based Trinity didn’t appreciate how important the center was to the Troy community. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Hayek and others also tapped into deep-seated frustration with Trinity, a healthcare behemoth that and last year recorded more than $25 billion in revenue and a healthy operating margin that topped 5%.

“Trinity Health is in the Midwest, and they are not in the community,” Hayek said. “So when you’re looking at just the numbers from an office in the Midwest somewhere, they’re not looking at the benefit that this place has on the community.”

Hayek describes herself as a liberal Democrat. But Trinity’s focus on its bottom line also irked many Republicans, including Mantello, who was the City Council president at the time.

“The whole hospital scene has changed,” Mantello said. “It was very personable. You had nurses and doctors who were able to give more care and spend more time with patients.” Now, by contrast, many hospitals have what she described as a “more corporate type of atmosphere.”

Even the Catholic bishop decried the planned closure of the birthing center as out of step with the values of his faith and the hospital system’s.

“Nothing is more central to the Catholic healthcare mission than supporting life and all those who bring it into the world,” Bishop Edward Scharfenberger said after Trinity announced the closure plan. Scharfenberger has since retired.

A Bipartisan Solution

Despite the backlash, Trinity Health executives for months insisted they had no choice. The system even sued the state to push through the closure.

Ultimately, though, powerful state officials, including New York Attorney General Letitia James, a Democrat, joined the fight to save the birthing center, launching an investigation into the proposed closure and hosting a daylong hearing in Troy.

State Assembly member John T. McDonald III, a Democrat who represents Troy, worked with Republican elected officials, including the county executive and the state senator representing Troy, to secure $5 million in state funding to help keep Burdett open.

 “You had a Democrat and a bunch of Republicans all working together on the same issue,” McDonald said, “because, at the end of the day, our job is to listen to what the public has to say.”

A crowd of people of various genders, ethnicities, and ages stand with signs that say "Save Burdett Birth Center."
Community leaders, politicians, midwives, doulas, and families from Troy rallied for months to stop the Burdett Birth Center from closing, including at the state Capitol in Albany. (Katherine Bruno/Upper Hudson Planned Parenthood)
A plastic lawn sign with white text and a bright pink background reads, "Midwives Save Lives / Save Burdett Birth Center / SAVED!"
Community volunteers in Troy celebrated the success of their campaign to save the Burdett Birth Center by adding a yellow tag to the pink protest signs. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Nearly a year after announcing the closure, Trinity reversed itself and said Burdett would remain open.

Lois Uttley, a New York City-based researcher and activist who has worked with communities facing hospital consolidation, said Troy’s success reflects a growing bipartisan suspicion of corporate healthcare organizations.

“The executives of these health systems will tell the community that joining a big health system will be good, that the quality of care will improve, that efficiencies will mean they can keep the costs low,” Uttley said. “But what I have seen over the last 30 years of work is that those promises often are broken.”

As hospitals close or downsize, she said, communities are catching on. “They’re becoming more skeptical.”

There’s another, more hopeful lesson in Troy’s success, said McDonald, the state lawmaker.

“If we take down our swords,” he said, “and put out our arms, maybe we can get something done.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2281344 California Weighs Penalties for Healthcare Providers That Don’t Rein In Costs /health-industry/high-healthcare-costs-hospitals-state-spending-limits-california-fines/ Mon, 24 Aug 2026 13:58:42 +0000 /?p=2276649 California is weighing stiff penalties for hospitals and other healthcare entities that don’t stay under state spending limits, potentially levying hundreds of millions of dollars in fines if these providers don’t take steps to rein in rising healthcare costs.

If the state Office of Health Care Affordability adopts the fines next week, hospitals, medical groups, insurers, and others could face penalties that amount to as much as 125% of the total they spend above the state’s annual growth targets.

The penalty proposal comes after healthcare entities in California were asked to limit growth by 3.5% last year and ramp down to 3% by 2029. Seven hospitals that state officials consider particularly expensive face even smaller growth targets: 1.8% in 2026, dropping to 1.6% by 2029.

Consumer advocates argue that state financial deterrents are critical to bring relief to millions of Californians struggling with high insurance premiums and out-of-pocket expenses. Hospitals accounted for in U.S. health spending from 2022 to 2024, compared with 11% from retail prescription drugs. But adding teeth to those targets sets up a fight with the powerful hospital industry, which has a challenging the spending limits as unreasonable. Hospitals warned that they will cut back on vital services, including in emergency rooms, obstetrics, and behavioral health.

Healthcare industry representatives said the state affordability office hasn’t accounted for year-to-year volatility or other factors beyond the industry’s control, such as rising minimum wages, state earthquake retrofit requirements, and expensive new drugs.

“They’re building the plane while flying it,” said Ben Johnson, group vice president for financial policy at the California Hospital Association. “We know improvements in affordability are needed, but we have serious questions about how and about what the unintended consequences could be under OHCA’s rather stringent approaches.”

When calculating penalties, California regulators would consider various factors, including a healthcare entity’s financial situation, its market impact, and the gravity and number of offenses, according to a in June. And entities would first be given opportunities to implement performance improvement plans to bring their spending into line before penalties are imposed. For those that don’t comply, the board is considering penalties of $10,000 a day or a flat $500,000.

The penalties, which the affordability office’s eight-member board is required by to adopt, are slated for discussion, and a potential vote, at the board’s . The soonest healthcare providers would be subject to penalties is 2028, because it’s expected it will take two years to collect and publicly report spending data to measure against the 2026 targets. The state is still collecting data on how entities performed against the 2025 targets, which aren’t enforceable, according to Andrew DiLuccia, a spokesperson for the California Department of Health Care Access and Information.

States Set Targets

California is one of at least eight states that have set spending targets as part of an expanding effort to curb soaring healthcare spending across the nation. Connecticut, Massachusetts, Oregon, and Rhode Island have also authorized the use of some type of financial penalty. The specifics of each vary widely, although so far no state has applied them.

A by the California Health Care Foundation found that 4 out of 10 state residents said they had medical debt, and 6 in 10 reported that they or a family member had skipped or delayed medical care in the previous 12 months because of cost. Nationwide, about say it is difficult to afford healthcare costs.

After Rosalyn Book got stiches on her chin, the elementary school teacher received a $15,000 ER bill from a local hospital, despite having insurance. Many teachers in her district leave because they can’t afford the cost of healthcare and insurance premiums, she said.

“The healthcare charges are just insanity, and what we get as patients for the care, it’s not the best either,” said Book, president of the Monterey Bay Teachers Association. “If you’re a working, regular individual in terms of how much you make, the cost of living and especially the healthcare is just not doable.”

Meanwhile, hospitals are warning there’s a risk of more closures. According to Yale University’s , 17 hospitals have closed in the state since 2016, compared with only six openings.

Hospitals and other healthcare providers have said the proposed multimillion-dollar penalties are too steep and could destabilize their operations at a time when they’re facing funding challenges, including massive federal cuts to Medicaid, the end of enhanced federal subsidies for Affordable Care Act plans, and a sharp rise in uninsured patients. The One Big Beautiful Bill Act, passed by congressional Republicans and signed by President Donald Trump last summer, is expected to reduce federal Medicaid spending by more than — including by in California — and increase the rolls of the uninsured in the U.S. by over a decade.

Johnson said hospitals raise prices on commercial payers to offset the expense of treating uninsured patients, as well as patients on Medicaid and Medicare, which can reimburse care providers at rates that fall short of treatment costs.

In addition, said Anete Millers, vice president of legal and regulatory affairs at the California Association of Health Plans, tax increases on managed-care plans recently to offset federal Medicaid cuts will force plans to increase their prices for consumers.

“Some spending pressures originate outside of the control of health plans and are the result of public policy decisions rather than underlying changes in healthcare utilization or efficiency,” she told the affordability office’s .

Kristof Stremikis, the director of market analysis and insight at the nonprofit California Health Care Foundation, acknowledged that external forces can drive costs but said that plenty of unnecessary spending is within the healthcare system’s control, such as administrative waste and duplicative tests and procedures. of U.S. healthcare spending is considered wasteful, according to .

Elizabeth Mitchell, a former Office of Health Care Affordability board member whose term ended in May, agreed.

“Every business has external challenges,” said Mitchell, who is now president and CEO of Purchaser Business Group on Health, a nonprofit coalition representing large employers. “The hospital industry has not taken accountability to actually manage costs. I have heard those excuses for decades, and at some point, they have to make changes.”

First Step To Bring Down Costs

of five states with cost growth benchmarks, published in June, found that some have succeeded in modestly slowing healthcare spending, particularly those with enforcement mechanisms. However, spending growth in most states has still set. 

Jeremy Vandehey, a consultant with the Peterson-Milbank Program for Sustainable Health Care Costs, said setting benchmarks and collecting data to analyze which entities meet them is only a first step. Armed with information about what and who is driving up costs, states are more empowered to take additional action, such as imposing penalties or regulating prices, to bring down costs, he said.

“I don’t think anybody in any state is declaring victory on healthcare costs, but I wouldn’t say that that means the programs are a failure,” Vandehey said. “In all of these states, there’s much more robust conversations happening about, OK, we haven’t solved our cost crisis, so we need additional action.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2276649 New DOJ Guidance Could Give States Cover To Cut Disability Services /medicaid/wamu-health-hub-disability-services-funding-justice-department/ Fri, 21 Aug 2026 09:00:00 +0000 /?p=2276525&preview=true&preview_id=2276525 People with disabilities have long fought for the right to live at home rather than in institutions. Now, the Department of Justice says states don’t have to help make that happen.

The decision by the Trump administration comes amid massive cuts in federal funding for Medicaid. Advocates worry this could be a one-two punch for disabled Americans who want to live independently.

Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Stephanie Armour joined WAMU’s Health Hub on Aug. 19 to explain what this change means for Americans with disabilities and their loved ones.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2276525 Headless FDA Gets a New Nominee /podcast/what-the-health-460-fda-nominee-trump-heidi-overton-august-20-2026/ Thu, 20 Aug 2026 20:02:39 +0000 /?p=2275237&post_type=podcast&preview_id=2275237 The Host
Julie Rovner photo
Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Heidi Overton, a physician and White House domestic policy adviser, is President Donald Trump’s choice to be the next head of the Food and Drug Administration. Overton, an abortion opponent and supporter of Trump’s proposed changes to the childhood vaccine schedule, has made enemies while working on health policy from the White House and could face some tough questioning from senators.

Meanwhile, prescription drug prices are dropping for some people, and the wholesale retailer Costco is entering the Medicare market. Still, overall, the problem of healthcare being too expensive remains stubbornly hard to solve.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Shefali Luthra of The 19th, and Alice Miranda Ollstein of Politico.

Panelists

Joanne Kenen photo
Joanne Kenen Johns Hopkins University and Politico
Shefali Luthra photo
Shefali Luthra The 19th
Alice Miranda Ollstein photo
Alice Miranda Ollstein Politico

Among the takeaways from this week’s episode:

  • Trump’s selection of Overton to lead the FDA is prompting concerns from a diverse crowd of skeptics that includes Sen. Bill Cassidy (R-La.) and adherents to the Make America Healthy Again movement. Her lack of managerial experience and history of controversial writings could be liabilities during the confirmation process, though Trump has a decent track record of clearing nominees through a hesitant Senate.
  • Grant money continues to be held up at the National Institutes of Health pending political reviews, and new reporting sheds light on “zombie programs” at the Centers for Disease Control and Prevention, where money has been appropriated but there’s no staff to use it. Plus, the trend of declining childhood immunizations continues, with vaccine exemptions for kindergartners jumping to another high.
  • New data shows the largest drop in prescription drug prices since the 1960s, and while the Trump administration is taking credit, it’s unclear what exactly caused it. Meanwhile, the federal government is investigating major health companies for allegedly dodging taxes or engaging in anticompetitive practices. And the wholesaler Costco is getting into the health insurance game, partnering with a nonprofit insurer to provide Medicare Advantage or Medigap plans in a few states.

Also this week, as part of the “How Would You Fix It?” series, Rovner interviews billionaire businessman Mark Cuban, who has already reshaped the generic drug market and now has his eye on the rest of the healthcare system.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: Mother Jones’ “,” by Sophie Hurwitz.

Shefali Luthra: The 19th’s “,” by Barbara Rodriguez.

Alice Miranda Ollstein: The Texas Observer’s “,” by Mary Tuma.

Joanne Kenen: Politico’s “,” by Owen Dahlkamp.

Also mentioned in this week’s podcast:

Click to open the transcript Transcript: Headless FDA Gets a New Nominee

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 20, 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: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have another “How Would You Fix It?” interview, from his car, with businessman and entrepreneur Mark Cuban, who’s now devoting most of his professional attention to the mess that is U.S. healthcare. But first, this week’s news. So, we finally have a nominee to lead the Food and Drug Administration, which has been without a Senate-confirmed commissioner since Marty Makary resigned in May — officially, over a dispute about flavored vapes. The winner of the search is Heidi Overton, a 37-year-old physician and former protégé of Makary’s from Johns Hopkins, who currently oversees the health portfolio at the White House Domestic Policy Council. What do we know about Dr. Overton, and what are her prospects for confirmation? We’ve already seen HELP [Health, Education, Labor, and Pensions] Committee Chairman Bill Cassidy say on social media that he has “concerns” about her, but he’s voted for nominees about whom he’s had concerns as recently as — checks notes — earlier this month. 

Kenen: I mean, Cassidy’s saying he has concerns is not indicative of where this ends up. At the end of the day, President [Donald] Trump has gotten most of his choices through a Senate that often begins hesitant to recalcitrant and usually gives him what he wants. So … sometimes it doesn’t. I mean, it’s not 100%. So, Cassidy is in a different position politically since he’s about to leave the Senate, and partly because President Trump. So we just don’t know where Cassidy is. But it’s not a great start. But it doesn’t mean … it’s the end. 

Rovner: What do we know about Heidi Overton, though? Everything I’ve read about her, she’s either pro-MAHA [Make America Healthy Again] or the MAHA people don’t like her, or she’s, you know, of Marty Makary or not of Marty McCarry. 

Ollstein: Yeah. So my colleagues and I wrote about this yesterday, and a lot of the leading MAHA activists view her as having been a roadblock in the White House to their efforts around pesticides, around vaccines, and other things, and so they are up in arms about the pick. They are, you know, saying she’s … part of the swamp and not part of, you know, the movement that they want to see sweep aside some of these government practices. And I think that her time in the White House and her previous work for the America First Policy Institute could really come back to haunt her. She wrote a lot of papers and op-eds with some controversial takes and policy positions, and I think everybody is sort of scrambling to go over that. People are also talking about her lack of managerial experience. You know, managing a huge agency with a huge staff, and you know, obviously, we have seen recent examples of people who lack that experience being appointed. So that’s also not a deal-breaker necessarily. But all of these things could add up to be problematic for her in the confirmation process. And then what I focused on was her anti-abortion record, which, you know, both could help and hurt her depending on whose votes we’re talking about. 

Rovner: That’s right. I mean, we saw [Sen.] Patty Murray, senior member of the HELP Committee, come out and, you know, and say, Not somebody that I could ever vote for. And also, I mean, she was at the signing of the vaccine executive order that the president had. So that puts her — whether, whatever she says in her confirmation hearings — that sort of puts her with the “Let’s change the vaccine schedule” group. I mean, she seems to fit in nowhere. I guess that’s sort of my question here. 

Luthra: That’s what’s so interesting about her is that there are these sorts of different interests and constituencies that have concerns about her, but sometimes they feel as if they could be contradictory. You obviously have, I mean, Patty Murray — I don’t know if she was ever going to vote for whoever Trump picked — but then you have Susan Collins in a very difficult reelection race, where abortion is a concern. You now have these concerns about vaccines. You have people saying maybe she’s not MAHA enough. And I mean, I think to Joanne’s point, Trump has gotten most people he has wanted. However, this does feel like this could get very complicated, just given how many people may be bringing different criticism from different vantages that could ultimately add up. 

Kenen: I’m not sure we’ve ever seen anything on the Senate floor where she’s going to be called anti-abortion and pro-pesticide. If it gets to the floor, I mean, it’s a weird one. But at the end of the day, you know, does it go through? You know, if you made me bet, my bet would be yes, but I wouldn’t want to bet a whole lot of money. 

Rovner: Well … we’re going to talk about reproductive health later in the podcast, but I do want to talk about abortion right now in the context of this nomination because, Alice, as you point out, Overton is known to be a fairly strident abortion opponent, and if she is confirmed, she’ll take over the study of the safety of the abortion pill mifepristone, which, as we have mentioned many, many, many times, the administration has sort of backbenched, if you will. Given that the new attorney general, Todd Blanche, has raised the specter of invoking the 1873 Comstock Act to bar the mailing of abortion pills, or anything else used for abortions, what is the outlook for medication abortion if Overton actually becomes the FDA commissioner? 

Ollstein: Well, it’s hard to say because we’ve really seen decision-making centralized in the White House, and so often it doesn’t matter what the Cabinet secretaries want to do. It’s about what the White House wants. And the White House, I think, has made it pretty clear that this is not a top, you know, restricting abortion is not a top priority for them. They are certainly sensitive to the politics of it, and so there is speculation that, you know, there’s a delay until after the midterms for anything meaningful on this front, so as not to risk the kind of backlash we saw in 2022 after the fall of Roe v. Wade. But I think it’s also pretty clear that this is just not a top priority for the White House. That doesn’t mean they won’t allow some of these, you know, former activists to do what they want to do — so Blanche, and now Overton potentially. But I think it’s not really a given either way. 

Rovner: Yeah. All right. Well, meanwhile, in administration news that we’ve talked about before but is still relevant, we’re just over a month from the end of the fiscal year, and grant money is still being held up at the National Institutes of Health, according to our podcast pal Paige [Winfield] Cunningham at NOTUS. Despite pressure from Congress, the agency is still delaying funds for already-approved grants while it conducts searches for keywords that could signal that the grant does not adhere to the administration’s political priorities. And it’s not just keywords. Reading from : “In multiple flagged grants, officials expressed concerns that they weren’t worth funding because their only practical use might be to support the writing of new laws.” Now, this is going on against the backdrop of a proposal from the Office of Management and Budget that would officially insert political approval into grant funding. That’s something the Senate has voted to at least temporarily block, but the House hasn’t weighed in on it yet. This could not only have huge implications for federally funded research going forward, but you could argue it’s having implications now. We’re seeing researchers, you know, taking opportunities overseas because they don’t know what their, you know, grant funding continuation is going to look like, and students not going to graduate school or not pursuing research careers. I mean, this is … even some of these sort of small things are having these bigger potential ripples as they go outward, right? 

Kenen: Colleagues who are grant-funded, NIH-funded, or other government-funded. I mean, they try to track the ever-changing rules. First of all, it’s very murky. It is changing. They keep adding things. Basically, they don’t want — not just the banned words — they don’t want research that can be bad, that can be used for policy …  

Rovner: For things they disagree with, for policies they disagree with. 

Kenen: They don’t say it … right. Guidance doesn’t come out and say “policy that you know we don’t like.” It just says “policy.” But it’s really vast and confusing. It’s not new. What Paige wrote about is an update. I mean, this is still happening. It’s been happening since the beginning of the Trump administration. NIH is the biggie. There are some smaller agencies, like Agency for Healthcare Quality and Research [sic], AHRQ, right? 

Rovner: Research and Quality. 

Kenen: Agency for Healthcare Research and Quality. That’s pretty much defunct now. But those grants, the money stopped going out the door many months ago. So …  

Rovner: And the National Science Foundation. I mean, NIH is sort of the biggest of them. Yeah. 

Kenen: It has to have the word “science.” … NIH is the biggie, right? I mean, and it’s also the bench science, the science that the drug industry … people don’t understand, they say, Let the drug industry do it. They can’t do this kind of basic bench research. They take this research and develop drugs, but the fundamental cellular level is NIH, or NIH-funded. And it’s really, I mean, clinical trials have been stopped in the middle — really promising research that is not partisan. … Disease doesn’t care. It’s cliché, and it’s also true. It just stopped, and work has been lost. But people haven’t done things that are several years in. … The deadline, also, for fiscal year spending is, if it’s not out the door, which is Sept 30, anything that’s out that door is, like, that’s done. It’s it. Bye-bye. The money isn’t gonna, unless it would go through a whole new process next year, which is unlikely in these grants, that’s the end of that. 

Rovner: Yeah, and that’s, I mean, my point in wanting to bring this up again — and you’re right, it is sort of an update of what we’ve seen — is that every time one of these top administration officials comes to Congress, they say, You’re supposed to be spending the money that we have appropriated, and they say, Oh yeah, not a problem. We’re going to spend the money that you’ve appropriated. And yet we keep seeing these stories that they are not spending money that Congress has appropriated. 

Kenen: Yeah, and historically NIH has been reasonably bipartisan. There have been years when there have been fights. There’s obviously stem cells and sort of certain issues have been, you know, very hot potato. But the basic enterprise of U.S. science, health science, has been largely bipartisan. Again, not every appropriation season, not every bill. But if you look at the overall arc, it’s bipartisan. 

Rovner: It was Republicans who doubled NIH funding in the 1990s — who led it.  

Kenen: [Arlen] Specter. 

Rovner: It was Newt Gingrich, actually. I mean. 

Kenen: Yeah, Gingrich, too, was very into health tech and things like that before his time. I mean, the War on Cancer was federal, right? That was [President Richard] Nixon. So, but we’re now in a …  

Rovner: Different place. 

Kenen: Yeah, frozen. 

Rovner: Yeah. Meanwhile, Mike Stobbe at the AP is at the Centers for Disease Control and Prevention — again, where money’s been appropriated, but there is literally nobody at home. At the agency’s Office on Smoking and Health, and offices on Alzheimer’s disease, epilepsy, and sickle cell data collection, funds are allocated, but all the staffers have either been laid off or are still on administrative leave. So they’re being paid, but they are banned from working. This is yet another immediate challenge for new CDC Director Erica Schwartz, who had her first meeting with CDC staff yesterday. What do we expect her to take on first? 

Luthra: I don’t envy her. It, frankly, seems very difficult to figure out what your priorities are or should be, if you perhaps don’t have staff. It does seem like, from the reporting, perhaps a priority that she has outlined might be morale. And we know that morale has been very low in a lot of government agencies and the executive — especially places like the CDC, where you have a lot of career people who are mission-oriented, really believe in doing things for public health, and have seen that really attacked. And so I don’t know if that is enough to actually translate into things that are supposed to happen actually happening. But that seems like probably a place where it makes sense to start, right?, is just to help people feel confident that they actually will be able to do the work that they signed up to do. 

Rovner: Yeah, and you know, as you say, CDC is perhaps the most mission-oriented of all the HHS agencies. And because they’re in Atlanta, and you know not in the Washington area the way most of the rest of HHS is, they do often feel cut off. So she does have … she has a lot on her plate. And speaking of the CDC, the agency put out a rather cryptic press release this week on vaccine uptake among kindergartners entering school, noting that “CDC continues to encourage parents to discuss vaccination options with their doctors.” Meanwhile, the data linked to in the press release shows a small increase in parents opting out of having their children vaccinated nationwide. But that masks a much larger increase in some states. In Idaho, for example, just 75% of kindergartners entering school have had the MMR [measles, mumps, and rubella] vaccine. That’s obviously well below the 95% needed to provide herd immunity for measles. As my friend Jonathan Cohn put it in his piece for The Bulwark. “The scientific term for that is yikes.” Yikes indeed. 

Kenen: And it’s even within states … and some rural counties … there’s a lot of variation. The trend … for a number of years now has been dropping vaccine rates. Period. So I mean, whether CDC wants to engage in this as their first issue, they’re going to be asked about it. … They track it … can’t avoid it, because they have to approve and recommend, and, you know, insurance coverage, all sorts of things are imminent. So decisions have to be made. … Back to school’s already started in some parts of the country. 

Rovner: And so … I would say new CDC Director Schwartz was rather pointedly not in the room when the president signed the executive order on vaccines, even though now-FDA nominee Heidi Overton was. 

Kenen: She cannot put her head in the sand on this one. She’s going to have to … 

Rovner: “She” Schwartz?  

Kenen: Yeah. So she’s she says, I mean, what we know so far is she’s been quite, you know, she went to the CDC, and the reports are that she came out and said, you know, I’m going to stick to the science, and the science supports vaccines.  

Ollstein: I thought what was really interesting about the recent reports is that, you know, the executive order the Trump administration signed doesn’t actually change anything legally, but it’s designed to put pressure on states to change their recommendations. And it’s been fascinating to me to see that even the reddest states really aren’t going for it yet. But that doesn’t mean that everything’s fine and everyone’s getting vaccinated. What we are seeing is, you know, individual parents making these moves away from vaccination. And so even without the state officially changing its requirements, the environment is just shifting, and using the bully pulpit in this way is changing people’s behavior — building on trends that were already happening: distrust and misinformation, and all of that. And so … even a small, small decline in the vaccination rate can have huge negative effects. I mean, the difference between having 97% vaccination vs. 91% — it may not seem like a big deal, but that’s the difference between herd immunity and people really being vulnerable. 

Rovner: And lots and lots more cases of measles, as we are seeing already this year. I mean, it’s, you know, talk about things that were completely predictable. Well, meanwhile, as my Ñî¹óåú´«Ã½Ò•îl Health News colleagues Amanda Seitz and Stephanie Armour point out this week, all of this public pronouncing by the president and other health officials about the supposed dangers of vaccines comes as HHS Secretary RFK Jr. blows past deadline after deadline to uncover the promised cause of the rising cases of autism. The story notes that the secretary “has looking for root causes in a research effort that’s offered no public status updates and few details about who, or even which agency, is leading the effort.” We do know that one of the people working on the project is Reyn Archer — he’s a noted vaccine critic, son of a former House Ways and Means Committee chairman, and was head of the Title X Family Planning Program during the George H.W. Bush administration in the early 1990s — even as he was publicly opposing legalized birth control, which of course is what the Title X program does. He later served as Texas’ state health commissioner under then-Gov. George W. Bush, although he was eventually fired for making racist remarks to a subordinate. I had not heard his name since, until now. But he’s going to uncover the root causes of autism, am I right? That’s the plan? 

Kenen: More power to him. I mean, autism. It’s not like there’s no research, and the conclusion is that it’s multi-causal. That there’s not one cause. That’s the current state of the science, which can always evolve. But the current belief is there’s probably a genetic component, but it’s a mix of factors that we don’t fully understand. But vaccines is not one of them. 

Rovner: Or at least so every study, every big study, we have seen continues to say. Well, moving on, lots of news about healthcare prices this week, which remain a pressing issue for both Republican and Democratic voters as the midterms draw near. One interesting story this week noted that prescription drug prices fell year over year by more than 3% — that’s the largest drop since the early 1960s — but it’s not entirely clear why. The Trump administration, of course, says it was their efforts, particularly to bring down the price of those popular but very expensive GLP-1 weight loss drugs. Analysts say it’s more likely the result of the Biden-era Medicare drug price negotiations, which involved more widely used medications. Whichever, I imagine if you’re not seeing your prices drop at the pharmacy, and those drops may well be absorbed by insurers and middlemen and all the people we talk about, will this good news even have much of an impact when people go to the polls? 

Luthra: I can’t imagine it necessarily would be that meaningful because overall the macro trends remain pretty bad. Health insurance is still getting very expensive. Employers are really struggling — those that offer it — they are largely passing more costs to consumers. And so people are getting to have to pay more for healthcare, even if their drug prices may be decreasing in the aggregate. And so it’s just hard to really suggest that this good news could really outweigh those other factors, especially when you think about the broader sort of angst that exists around costs and costs continuing to go up. 

Rovner: Yeah, well, in wonky news that could actually have a larger impact on what people pay for medical care, the Trump administration is actually going after some deep-pocketed healthcare providers. Stat News reports, in separate stories, first that the — that’s the parent of UnitedHealthcare, the insurer, and Optum, the services and tech arm — for allegedly underpaying taxes by funneling money through a foreign subsidiary. And second, the for potential antitrust violations. State attorneys general are also looking at Epic’s alleged anticompetitive practices. Cracking down on some of the monopolistic practices of the largest payers in the healthcare system actually could end up saving the system money, right? I mean, this was … something that we saw a fair bit of during the Biden administration, particularly from the Federal Trade Commission, and not so much of during the Trump administration, which has seemed to have been more favorable, if you will, to big companies. 

Luthra: I guess there’s still that question about providers, and obviously bringing down prices and addressing consolidation in payers, amongst things like electronic health record companies, can be effective, but we probably also would want to see meaningful movement in terms of provider consolidation as well, and that just seems potentially like a bigger hill to climb. 

Rovner: But this is a start. One would say, particularly this administration, going after United, which is sort of the the biggest … United’s power threatens the federal government’s bargaining power at this point. I was interested to see, you know, this story, if nothing else, made public, because obviously somebody leaked it. We will see how these all shake out. Well, finally, Costco, home of the cheap rotisserie chicken and the $1.50 hot dog and soda, is entering the Medicare market, . According to the Journal, Costco will partner with the nonprofit SCAN Group to offer Medicare Advantage plans in two states and a Medicare supplement, Medigap, plan in a third state. Could this eventually make a dent in the private Medicare market? Costco already does big business selling discount prescription drugs, eyeglasses, and hearing aids. I get my dog’s flea and tick medication at Costco. It costs half of what it does at my vet’s office. One presumes this could be, you know, a leader. We’ve not seen this before, right? 

Kenen: The head of SCAN, which is a pretty reputable insurance company … 

Rovner: Nonprofit insurance company. 

Kenen: Nonprofit insurance, and I should say I know … personally the current CEO, president, whatever his post is. I mean, but you know, I’ve written a lot about aging over the years, and it’s basically considered … one of the higher-quality, more reliable elderly-focused health plans. And he has something interesting to write when he announced it or wrote about on LinkedIn about how he personally, like, is a big Costco guy. But he talked about trust, which we’re all talking all the time about how there’s a lack of trust in healthcare. There’s a lot of trust in Costco, and he talked about how branding, SCAN, and Costco, you know … obviously it’s a business decision he made, but he’s also, like, this big Costco guy and who worries — I know him through conferences on trust, actually, that’s where I met him — and he’s thinking, OK, Costco, in addition to, like, giving you way too much of whatever it is you thought you needed, it can also fix the trust crisis in America. Right? 

Rovner: Hey! 

Kenen: And they’re efficient, right? I mean, I don’t know if all four of us are Costco people, but the, you know … 

Rovner: I am. 

Kenen: I saw her. I ran into her buying her veterinarian [unintelligible, through laughter] … I was in the photo section. … It is a trusted brand, and it’s an interesting — and they have national reach in there, you know. 

Rovner: And you will hear in my conversation with Mark Cuban that trust is a really big deal in healthcare right now. I mean, we obviously talk about this every week. I mean, I’m, obviously this is a very small step, but I’m really interested in where it turns out. 

Kenen: It’s a smart business move, and it’s a talker, too. Like, people are gonna see this headline and pay attention to it because it’s, like, just a thing. 

Rovner: Yeah, it is. All right, we’re going to take a quick break. We will be right back. 

So, a good bit of reproductive health news this week. Glad to have both Alice and Shefali here. We will start in Idaho, where a federal district court judge ruled that the state’s abortion ban cannot be used to prosecute doctors who perform abortions to protect the pregnant person’s health, not just her life. Of course, abortion opponents vehemently oppose health exceptions, as they’re called, because they say health includes mental health, and that becomes a loophole so big that it basically eviscerates the ban. The state’s attorney general, former congressman Raúl Labrador, said he would appeal and was confident the decision would be overturned. I would imagine that he’s probably right. Is the Supreme Court eventually going to have to spell this out? I wouldn’t be that surprised if they wanted to. 

Ollstein: I think this gets into some of the same EMTALA [Emergency Medical Treatment and Active Labor Act] territory, where we have seen the Supreme Court sort of back away from in recent years. But again, we just keep circling around and around the same question, which is, when is an abortion OK for a medical emergency purpose? How close to dying does a woman have to get before a doctor can perform an abortion? And we’ve seen again and again in Idaho that doctors are scared and confused, and even when they think that they should have the right to perform the procedure, you know, they’re still putting women on these dangerous life flights to other states in order to get care, leading to hours and hours of delays and potential complications. And so, you know, this court case and this court ruling was sort of aimed at clarifying that and giving doctors the confidence to be able to intervene when they feel it’s medically necessary. But now we’re seeing the state challenge that, and we’re just going around and around. And, you know, there have been similar cases in other states, just a whole mix of rulings, one way or the other, and that just creates more of a patchwork where, you know, some somebody’s ability to get care varies completely between states — and even within states, between hospitals, based on how much you know institutional backing doctors feel like they have. You know, will their hospital’s lawyers go to the mat for them or not? Do they work in a private practice vs. a big hospital system? All of these things come into play, 

Rovner: And, of course, we’ve also seen doctors, particularly in Idaho, leaving the state because they’re afraid that they can’t practice. I mean, they can’t adequately care for their patients. Shefali, I see you nodding. 

Luthra: Yeah, and what’s interesting about this case, other than the fact that Idaho will actually have an abortion ballot measure this November, is that we do have a federal judge here saying, in particular contexts, I see a right to an abortion. And I was talking to some abortion legal scholars about this, and they made the point that, in a way, this runs afoul of the Dobbs decision, because you do have a federal judge saying people are actually entitled to abortions, and that is a right that they have, even if it is much narrower than what Roe v. Wade guaranteed. And obviously, this is going to be appealed. This is going to continue to be litigated. We may not see immediate change for people’s ability to get healthcare in Idaho or other places with very strict bans, but it does underscore how unsettled these legal questions remain — how there remains a lot of debate over whether Dobbs was actually a correct interpretation of constitutional law. And I think it really takes us back to the argument we heard from some of the conservative majority that this would now settle every question about abortion. Obviously, it has not. Obviously, many more questions will continue to be argued and litigated in the courts. 

Rovner: Yeah. Well, meanwhile, in other breaking news, a federal judge here in Washington blocked the Trump administration’s changes to the teen pregnancy prevention program that funds classes on contraception and abstinence, among other things. But they’re still not necessarily getting the money appropriated by Congress, right, Alice? 

Ollstein: So a judge in D.C. is blocking the administration from using its very strict new guidance going forward when it doles out money for the program, but it’s not ordering the administration to give back the money that was already cut earlier this summer from all of these grantees around the country. And, by the way, the money was cut both from grantees like Planned Parenthood, where you would say, “Oh, well, that sort of makes sense that the administration would go after their money.” But they’re also cutting funding from, you know, faith-based programs, abstinence-only programs in very red states, and prompting a fair amount of backlash that I’ve been covering. You know, places like Texas and South Carolina and West Virginia have also lost funding. And, of course, all the programs in those states had to abide by state restrictions around what can be taught. And so they were already following these very conservative guidelines. But that’s not conservative enough for the administration, which put out this guidance saying, you know, while abstinence-only was an option before, now it is basically mandatory. And so that guidance is on hold, but, again, the judge said that he didn’t know if he had the authority to order them to give back the money, or if some other jurisdiction could handle that. And so, this is just a preliminary injunction, which means there’s going to be months and months of litigation going forward. 

Rovner: Finally, this week, a story from the “Who Could Ever Have Imagined This?” files: A California couple hired a surrogate in Alaska to carry their pregnancy. After the fetus was diagnosed with a life-threatening heart condition, the couple exercised their option in the surrogacy contract to terminate the pregnancy. But the surrogate refused to have an abortion, and she traveled to Texas, where abortion is illegal, and gave birth to a baby boy last week. News reports say the baby, who is now in the custody of the couple who are biologically his parents, had the first of several surgeries needed to treat the heart condition. But this is a genuinely wrenching situation. Who gets to decide what here and under which state’s laws? Bioethicist Arthur Caplan told Houston Public Media that there are so many ethical issues here, he could spend an entire semester’s course teaching it. 

Luthra: And I think what is important about this case as well is, I mean, it’s obviously just like so, so, so sad, and this poor family is just having to deal with something really heartbreaking that no one should have to navigate under the national spotlight in Texas. It is really energizing conservatives who want to ban surrogacy, and we have already heard from lawmakers in the state legislature say they will be looking at surrogacy specifically when they convene next year. I have talked to anti-abortion activists in the state who are very hopeful that this case will give them new impetus to ban, at the very least, commercial surrogacy. They would love to ban all forms of surrogacy. And it is seen by a lot of anti-abortion folks who oppose fertility treatment, including IVF [in vitro fertilization], as something maybe easier to target. And I think it’s politically really complicated, because Americans don’t know as many people who get pregnant through surrogacy as they do people who might use IVF. But when I was talking to, again, legal experts about this, one point they made is that if surrogacy restrictions do take off in a meaningful way, often, the intellectual framework and arguments being made are ultimately the ones that would be used for IVF restrictions as well. And so, there is a possibility of a real slippery slope and more of that opening the door to fertility treatment restrictions that could affect a lot of people. 

Kenen: I think there’s a lot of public misunderstanding about what a gestational carrier is. When surrogacy became, not common, but sort of emerged in the public eye, there were a couple of really high-profile court cases. This was in the late ’80s. The “Baby M” was the most famous. And these were situations, at that point, where the woman carrying the child, it was her egg. So in the Baby M case, it was a couple that couldn’t have children. She was-— I don’t even know if that was — that wasn’t probably IVF. That was probably some other kind of artificial insemination. But the woman who decided she didn’t want to give up the baby after carrying it — it was, in fact, her biological child — and the practice became not to let, to separate the surrogate carrier from the egg donor. It’s not 100%. It’s not that it never happens, particularly if there’s family situations where maybe an aunt carries, etc. In this case, we’re really, based on public record, because I did a little reading on it this morning, it’s not clear, of the “biological parents,” it’s his baby. It’s not 100% clear on the public record that it’s actually her egg, the wife’s egg. But it is not the carrier’s egg. The woman suing to keep the child, saying she wants to have the baby, it is not her, it was not her egg. State law varies. Most states say that the surrogate in this kind of situation does not have maternal rights; that it’s the couple that hired her. Texas is, I believe, more blurry. There are a few states that it is more ambiguous, and also remember that this is a really tight, unusually and unexpectedly tight Senate race in Texas, where a very anti-abortion state, obviously, and also in this case the couple says they didn’t even ask for the abortion, but that’s he-said-she-said-they-said, we don’t know. I don’t know, at least, right? But abortion is a huge political driver in Texas; it’s a close race. [Ken] Paxton, who is the state attorney general, who is taking the side of the surrogate mother, is also the Senate candidate. You know, this is, you know, we’re 2½ months out, whatever, from the election. Three, I guess, closer to three still. But it’s very political in a state that probably has more politics around abortion than probably any other state. 

Rovner: Just what we needed: another thorny issue to throw into this mix. All right, that is this week’s news, or at least as much of it as we could get to. Now we will play my in-the-car interview with Mark Cuban, and then we’ll come back and do our extra credits. 

I am so pleased to welcome businessman and entrepreneur Mark Cuban to “How Would You Fix It?” Mark is probably best known to most people as a former shark on the TV show Shark Tank and the former [co-]owner of the Dallas Mavericks NBA team. But he’s also the co-founder of the Mark Cuban Cost Plus Drugs company, which sells generic medications directly to consumers at transparent prices and big discounts. More recently, he’s been talking about even bigger reforms to the healthcare system, which is why I’m so excited to have him here. Mark Cuban, thank you so much for joining us. 

Mark Cuban: Thanks for having me. 

Rovner: I’m curious: Your background’s been mostly in tech and in sports. How did you come to make healthcare such a priority? 

Cuban: I got a cold email from my now co-founder, Dr. Alex Oshmyansky, and he wanted to build a compounding pharmacy that made sterile injectables that are on the FDA short-supply list — which it’s crazy that there is a short-supply list for generic injectables. So that was great, but it wasn’t big enough. And as I looked into it, it was right around the time that “pharma bro” [Martin Shkreli] was going to jail, and I was like, “How can this dude jack up the price of a generic medication to the detriment of so many people?” And then it became obvious that nobody knew what a medication costs, nobody knew why it cost what it costs, and nobody understood why everybody paid a different price for the same medication. That list led to us launching costplusdrugs.com in January of 2022, and it’s just been growing like a weed ever since. 

Rovner: For decades now, the big debate in health policy has been whether the system should be more run by the government or more run by the private sector. Is that even the right way to focus on this anymore? Now everything is sort of hybrid and a mess. 

Cuban: Yeah, no, it’s not, because if the government doesn’t have data, and the government can’t trust the vendors that they’re working with, it doesn’t matter that it’s the government doing all the negotiating. And you see that in other countries. For instance, we get emails from countries around the world — from Canada, England — asking to buy generics from us ’cause our prices for generics, particularly specialty generics, are less expensive than what they sell for in countries that have single-payer or universal care. And so, while I’m not opposed to single-payer or universal healthcare at all, and kind of the analogy I use is: If healthcare costs $1 per person per year — yeah, great, taxpayers would pay that. But it would be a set $1 and it’d be obviously inexpensive. But when you don’t know all the costs, when there’s no transparency, it’s impossible to determine if it’s a better solution or not. 

Rovner: Are there segments of the healthcare industry that would work better if the private sector ran them, and better if the government ran them? I’m thinking, you know, hospitals, doctors, drugs.  

Cuban: I don’t think it’s like that at all. I think it depends on how much transparency there is. The fundamental issue is transparency and trust. If you don’t know … like, there are a lot of hospitals, and you know this better than anybody, that don’t know their costs. And if you just hire the same people and just say, “Look, we’re going to pay Medicare pricing to Mayo Clinic, and Mayo Clinic doesn’t know all their costs,” or “We’re going to take an urban hospital and continue to pay them Medicare and Medicaid because that’s most of their business,” and they don’t know their cost, they just know their cash balance, it doesn’t matter who runs it. 

Rovner: So, what do you fix first? 

Cuban: Transparency. You have to be able to publish contracts so that any contract that’s signed with a federal agency, the federal government, a state agency, a city, not only are the terms of the contract published, but the prices are published, so that Tricare would be required to publish their prices. By seeing the actual contract, you can see where the city-state agency is getting ripped off. Because right now there’s confidentiality requirements, and the companies, like the big insurance conglomerates, they say, you know, we can’t do this. We can’t show this, it’s proprietary information, which is nonsense. You’ve got hundreds of thousands of companies. You’ve got hundreds of agencies and states and cities that negotiate the same contracts. So lots of people know, but they do it to make it more complicated. And so, as a result, nobody knows how the deals are structured. And if you don’t know how the deals are structured, it’s impossible to negotiate better ones. And if they’ll sue you for discussing it with their peers, then nobody … it’s like Fight Club. The No. 1 rule [of] Fight Club is you can’t talk about Fight Club. The No. 1 rule of healthcare contracts is you can’t talk about healthcare contracts. 

Rovner: Yeah, and we’ve, you know, Congress has passed laws. The president has pushed a lot of these transparency rules, and basically, the health industry has said, “Yep, sorry, we can’t do it,” or “We’re going to do it in such a way that you can’t find it out anyway.” 

Cuban: Correct. 

Rovner: “We’re going to send you reams and reams and reams of data, and you can go digging if you would like.” 

Cuban: Correct. And so you take that to the next step. The big healthcare companies — first of all, they’re vertically integrated. They have hundreds, if not thousands, of subsidiaries. People don’t even know what the subsidiaries are when they do business with them, right? And so, when that happens, there’s just no way for any of the states, cities, federal government to enforce the laws. The big healthcare companies have more lawyers, move faster, are better able to find loopholes than the government and the agencies that enforce it are able to enforce it. And so, what ends up happening. You see all these fines. This PBM, this insurance company, whatever got fined for A, B, or C, and then they just go right back to doing business with them. So when I talk to governors, one of the first things I say in terms of reform is A) publish the contracts, and B) if you are doing business with a vertically integrated healthcare company, and they are fined by any federal agency or any state government, they get one mulligan. If they are fined a second time, they can’t do business with you for five years. That will act as the enforcement mechanism to keep them in line. And then the third thing that I always push is that anybody is able to go out and make a cash purchase, whether it’s medical or pharmacy, as long as it’s less expensive than their out-of-pocket, and have it by law count towards their deductible and max out-of-pocket. When you do that, you give them the opportunity to shop. When something is shoppable — not everything is — but you give them the opportunity to shop, and that helps force down prices. 

Rovner: So, I’ve been doing this since the 1980s, and it’s always been the Democrats beating up on the big insurance companies, and the Republicans basically defending them. Now that Republicans are beating up on the big insurance companies, are we kind of inevitably going towards a government-run single-payer? 

Cuban: No. Like, if you look up, if you look at the Break Up Big Medicine bill that was introduced by Josh Hawley, a Republican, and Elizabeth Warren, to me that’s the first step. So the good news: It was introduced on a bipartisan basis. Because if you break up these big, huge conglomerates, everything changes. The price of everything drops like a rock. But the problem is, nobody else, no senators have supported it, and nobody in the House has introduced a comparable bill. Everybody just chickened out. And so that’s the first step. Put aside the economics. Put aside that we don’t know the cost. Put aside that we have no transparency. All those things are important, but making sure we have health care for everybody is more important. That’s the difference. I think that also should be an American dream. As an entrepreneur, I’m a big fan of the American dream. But being able to be healthy and not be afraid that you can’t afford what you need or your family needs, that’s wrong in our American dream. And you know, when we talk about healthcare as a right, doctors freak out because they presume that they’re going to be paid Medicare rates, and they lose control of their life, right? And they talk about opting out and not doing it, you know. And so you need to get all these stakeholders accounted for. And until you start to do that and put together a plan that people will accept, we’re not going to ever be in a position to take care of people like so many of us hope to do. 

Rovner: And yet that would require both parties to basically lay down their arms.  

 

Cuban: Yes, which I think is possible. I think it’s doable because the No. 1 thing that, in every poll, people are concerned about healthcare costs. It’s not the quality of healthcare. Nobody really complains about the quality. Our doctors are great. Our systems are great. It’s the economic side. And who defines the economic side? Those humongous healthcare conglomerates. And what’s the best way to get to a point where we have transparency at the contract level, you know, flexibility and understanding, etc., all the things I mentioned? You break up those huge conglomerates that have thousands of subsidiaries that do $150-plus billion in intercompany transfers, that game the medical loss ratio. I mean, all these things happen because those big companies have more control over the economics of our healthcare system than the government does. 

Rovner: Well, I hope we actually get to that point, and I hope you’re around to help with some of these stakeholder conversations. 

Cuban: Oh, hopefully I’m not going anywhere. 

Rovner: Thank you so much. 

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

Luthra: Sure. My story is from The 19th by my colleague Barbara Rodriguez. The headline is “.” And I love this whole genre of story. The GLP-1 market is exploding because these drugs can be so expensive to get from your healthcare provider. You see advertisements everywhere, all over social media, people promising to sell you a GLP-1. And as Barbara’s story gets into, often they are not actually GLP-1s. It is something fake. It is not actually going to help you lose weight, but it is going to take your money. And I just think that this is such an exploding market. So much has changed that we can’t read enough about how the, just the growth of options, or not legitimate options, is affecting people, and I’m really glad she did this story. 

Rovner: Yeah, it was a really good story. Alice. 

Ollstein: I have a story from The Texas Observer by Mary Tuma, and it’s called “.” So this is taking a deep dive on the situation in Texas, but the article does a good job of pointing out that this is a trend across several states that implemented abortion bans, where there was, you know, efforts to pause or revamp, or obscure, or change in some way the groups in every, that exist in every state that study maternal deaths. And there is just a suspicion that this is an attempt to hide from the public the impact of the abortion ban on maternal mortality. You have a lot of experts quoted in this piece. You have the family members who have lost their wives and mothers to pregnancy-related deaths, and so this is just an ongoing fight. And, you know, doctors say we really need this data and this analysis to know how to better provide care in the future. It’s not just a political football; it’s actual medical knowledge that we need to build. 

Rovner: Yeah, I think ProPublica did this for Georgia, I think, last year, so yet another in these series. Joanne. 

Kenen: There’s a story in Politico by Owen Dahlkamp: “.” This is not unique to health law, but given how complicated health law is and how much health law Congress deals with in any given year, it’s quite relevant to health law. So staffers are using AI to actually draft legislation, not just to research something. And I mean, it’s hard to get away from AI now. It’s, like, even pops up on people’s phones, right? But drafting legislation is very precise and complicated, and AI is apparently not very good at it. So the House counsel, which is the Office of Legal Counsel, which actually has to make sure the legislative language is correct and doesn’t accidentally reveal the wrong thing, they’re having a hard time. Although they have now created their own tool to try to correct the AI slop, but they’re getting overwhelmed. There’s, you know, we’ve all seen stories, we’ve all gotten pitches about, you know, so-and-so introduced a law. What the general public doesn’t understand is introducing a law, you know, it’s good for a press release — introducing a bill, excuse me. Introducing a bill does not mean a whole hell of a lot, except that you’re satisfying some constituent or constituent group, right? But congresspeople and senators like to say they introduce this and they introduce that and they introduce the other thing. So the number of bills being introduced was already rising spectacularly, and now with the slop, there’s like the slopth degree of it. So it’s messy. 

Rovner: It is messy, and it does, I mean, it sort of prevents the real work of actually drafting legislation that’s going to become law from getting done. 

Kenen: There’s going to be something, like, really bad that comes out that somebody in the poor OLC office doesn’t catch, and it’s going to repeal, like, you know, the flag. 

Rovner: Yeah. We will see. All right my extra credit this week is from Mother Jones by Sophie Hurwitz. It’s called “.” And you may have heard that ICE [Immigration and Customs Enforcement] is spending $20 million to buy these gloves, which administer an electric shock at the touch of a button on the wrist for their officers. What makes them better than a Taser or other non-[lethal] device? Well, one Missouri police officer whose force uses them said the gloves “allow their wearer to inflict pain without leaving the sort of marks that could look bad to witnesses or leave an officer vulnerable to lawsuits.” In other words, they make it easier for people to inflict pain on others, whether warranted or not, without likely recourse. How very 2026. 

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

Ollstein: on Bluesky and on X. 

Rovner: Shefali. 

Luthra: on Bluesky. 

Rovner: Joanne. 

Kenen: Mostly on and on . 

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

Credits

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Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2275237 Watch: Why Abortions Are on the Rise Since ‘Roe’ Was Overturned /courts/video-five-things-abortions-increase-since-roe-overturned/ Fri, 07 Aug 2026 09:00:00 +0000 /?p=2264199 Say you live in deep-red Louisiana, a state that has effectively banned abortion. It may be easier for you to get abortion pills now than before the Supreme Court overturned Roe v. Wade. Here’s why — and what it means for future battles over abortion access.

And as a federal court mulls a case that could result in significant restrictions on a pill used in most abortions, healthcare providers say they have alternatives to preserve access even in states with bans in place. Read more here.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2264199 People With Disabilities Fear Service Cuts as Trump’s DOJ Questions Legal Protections /news/people-with-disabilities-fear-service-cuts-as-trumps-doj-questions-legal-protections/ Mon, 03 Aug 2026 09:00:00 +0000 /?p=2266682 Amanda DeSimone-Shabrack relies on a home healthcare aide to help her high-needs autistic 12-year-old son. Virginia’s Medicaid program covers the assistance, enabling her to work as both an education technology specialist and a professor, run errands, and keep Mason in the home.

That could change. In June, the Department of Justice issued saying federal disability rights laws don’t require states to provide services that allow people with disabilities to remain in their homes rather than institutions.

It’s a sharp reversal from 1999, when a held that unjustified institutionalization constituted discrimination under the Americans with Disabilities Act. Previous administrations have relied on that ruling to enforce civil rights for disabled people, but the Trump administration says that long-held interpretation is wrong.

Advocacy groups say legal protections for about and 5 million children who have disabilities could be undermined, and they worry that the new interpretation may herald a return to forced institutionalization.

The stage is also now set for a legal fight between advocates, states, and the federal government. Some states with ongoing lawsuits challenging disability rights requirements are already citing the DOJ opinion in hopes it will help them prevail.

In a case in Texas, for example, that a rule instituting a 1973 civil rights law that led to community and home integration of people with disabilities is costly and infringes on states’ rights.

People like DeSimone-Shabrack are especially worried because, they say, the opinion follows a spate of White House and Republican-led initiatives that have already begun eroding hard-won protections for people with disabilities.

“I’m worried. Am I going to have to put him in an institution, and what’s that going to be like for him?” said DeSimone-Shabrack, whose personal home care help was recently reduced from 30 to 18 hours a week by the state. “As he gets older, am I going to be able to care for him without this support?”

The Department of Health and Human Services remains steadfast in enforcing federal civil rights laws, agency spokesperson Emily Hilliard said in an email.

“Our commitment to ensuring that individuals with disabilities are treated with dignity, afforded equal opportunity, and are able to meaningfully access community services remains unchanged,” she said.

But advocacy groups say the DOJ opinion could have sweeping repercussions. The opinion doesn’t change existing law, but advocates worry that HHS and the DOJ could begin that mandate integration for people with disabilities.

They’re concerned that agencies will stop enforcing disability laws that ensure people aren’t. HHS, for example, has historically investigated disability discrimination claims at hospitals and in states that get federal funding, enforcing compliance with home and community integration through . Disability rights experts say those agreements could now be imperiled.

And some states facing financial pressures may roll back Medicaid services that enable people with disabilities to stay in their homes and communities — a trend that’s already happening following last year’s passage of the One Big Beautiful Bill Act, which cuts a projected from the safety net program over a decade.

Democrats are seizing on the opinion, which was released in a DOJ memo, to portray President Donald Trump and Republicans as a threat to people with disabilities. Sen. Tammy Duckworth (D-Ill.) and other Senate Democrats led the calling on the DOJ to rescind the opinion.

“The Trump Administration’s memo is an outrageous attack on the rights and independence of the disability community,” Duckworth said in a statement.

The DOJ didn’t return emails seeking comment.

According to the DOJ’s interpretation, regulations that give disabled people the right to demand certain services for daily living — bathing, mental health counseling, and financial budgeting help, for instance — and that require states to extend to mentally disabled individuals are unlawful, a view the agency acknowledged “is out of step with the common understanding of that decision within the federal courts.”

States may have legitimate reason to treat mentally disabled people in institutions, “including resource constraints, capacity limitations in community-based facilities, and safety concerns for both the patient and the community,” the memo reads.

The Supreme Court case, Olmstead v. L.C., has long shaped federal policy. And while it remains to be seen how courts will respond to the DOJ, some states seeking to curtail disability protections see the opinion as significant.

Consider the in federal court in the Northern District of Texas by Republican-led states arguing that an HHS rule about the integration mandate is unlawful. The lawsuit began with broader claims and 17 state plaintiffs. Following significant advocacy from the disability community, only Texas, Alaska, and Florida remain.

Following the new DOJ interpretation, the states filed documentation to inform the court about the memo as a new and relevant development. Similar documentation citing the memo has been filed in disability rights cases in Florida and New Hampshire, according to The Arc of the United States, a disability advocacy group.

Advocates for people with disabilities say the speed at which plaintiffs are citing the opinion underscores how it may be used to justify the erosion of protections.

“The administration’s attempt to dismantle decades of progress in community integration is alarming and inconsistent with federal disability rights laws and Supreme Court precedent as well as the critical enforcement work of prior administrations,” said , senior executive officer of legal advocacy and general counsel at The Arc.

Forced institutionalization led to human rights violations, segregation, and a eugenics movement in the late 19th and early 20th centuries that included involuntary sterilization.

Exposure of the abuses, legal battles, and an caused a major shift toward integration. Fewer than 1% of people with intellectual or developmental disabilities lived in state-run facilities in 2021, down from almost 30% in 1967, from the University of Minnesota’s , which maintains metrics on such long-term services and supports.

The Trump administration has already taken steps to reverse that trend, advocates say.

Trump signed that addresses homelessness by expanding involuntary treatment and institutionalization, reversing a championed by the Biden administration.

Much of the special education program office is moving from the Department of Education to HHS, raising concerns among advocates that the administration is reverting to a view that disabilities are a medical issue to be fixed rather than differences that can be accommodated.

And cuts in federal funding for Medicaid, a federal-state insurance program for people with low incomes or disabilities, also portend fewer resources and services. States have responded by reducing some optional benefits such as home health aides and support. In addition, qualifying for an exemption from the program’s work requirements, which take effect Jan. 1 in most states, will pose significant hurdles for people with disabilities.

The June DOJ opinion, advocates say, could accelerate the shift and result in court rulings that chip away at disability rights.

“While it doesn’t overnight change the law, it’s very troubling and very dangerous,” said , director of the Disability Rights Program at the American Civil Liberties Union. “It reflects a really deeply held disrespect for disabled people from this administration and a total lack of awareness of the lived experiences of people with disabilities who are living in their homes.”

Data shows there can be benefits to involuntary institutionalization. Relative to those voluntarily admitted, people with psychiatric illness who were involuntarily admitted “experienced greater improvements in symptoms and function,” according to a in Psychiatry, Psychology and Law, a peer-reviewed academic journal.

Deinstitutionalization has created new challenges. More hospitals have been forced to board people with psychiatric illness in emergency rooms because of a dearth of available beds. And moving people into home- and community-based living was supposed to be accompanied by an increase in outpatient care and treatment that never materialized, creating gaps in support.

But advocates for the disabled community say involuntary institutionalization and poses a higher risk of neglect and abuse.

, 57, of Cleveland, spent two years in a nursing home. She has spinal muscular atrophy, a genetic disease that kills motor neurons, leaving her able to move only part of her left arm and her head.

At the institution, she said, she felt bored and trapped and developed intense itching from scabies, which is caused by microscopic mites.

For more than a decade, however, she has lived in an apartment with the help of caregivers who come in the morning to get her dressed and ready and return to put her to bed. She works at a disability rights group, and her care is covered by Medicaid.

“The two years I lived in the nursing home, it was the most horrible time in my life,” said Kucera, who worries about the DOJ opinion on Olmstead. “My future is a shaking floor beneath me. With the stroke of a pen, they could get rid of everything I’ve built for myself.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2266682 The Politics of Grant Cuts /podcast/what-the-health-457-trump-grant-cuts-fauci-hearing-covid-july-30-2026/ Thu, 30 Jul 2026 18:30:15 +0000 /?p=2266610&post_type=podcast&preview_id=2266610 The Host
Julie Rovner photo
Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

The Trump administration has conceded in court documents that it used purely political considerations to cancel grant funding previously approved by Congress. But that has provoked a surprisingly muted response from lawmakers, who under the Constitution control the power of the purse.

Meanwhile, Republicans in the Senate summoned former National Institutes of Health and White House official Anthony Fauci to testify — again — about his handling of the covid pandemic. Fauci, however, refused to answer questions, citing the advice of his attorneys.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Rachel Cohrs Zhang of Bloomberg News, Shefali Luthra of The 19th, and Liz Essley Whyte of The Wall Street Journal.

Panelists

Rachel Cohrs Zhang photo
Rachel Cohrs Zhang Bloomberg News
Shefali Luthra photo
Shefali Luthra The 19th
Liz Essley Whyte photo
Liz Essley Whyte The Wall Street Journal

Among the takeaways from this week’s episode:

  • Recent court filings shed light on how the Trump administration has used politics to justify its decisions to cancel federal grants. While similar revelations may have been explosive under other presidents, the filings have triggered muted, if any, responses from lawmakers.
  • The Trump administration announced this week that it would end the temporary Medicare Part D subsidies, introduced under the Biden administration, that help lower the monthly premiums older Americans pay for drug coverage. While next year’s premiums probably would have increased anyway, the change — which many will notice when they shop for plans later this year, shortly before the midterm elections — may not help Republicans in the voting booth.
  • Meanwhile, Sen. Rand Paul (R-Ky.) brought Fauci before the committee he chairs to address accusations related to his role in the nation’s covid response as a key adviser to Presidents Donald Trump and Joe Biden. But little of substance was said, with the hearing quickly devolving into political grandstanding as Fauci asserted his constitutional right not to self-incriminate.
  • An FDA advisory panel voted to recommend the agency make it easier for Americans to obtain several previously banned compounds known as peptides — even as FDA staff caution that there’s no evidence they are safe. The panel included members who stand to profit from expanded access to peptides.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: The Arkansas Times’ “,” by Byron Tate.  

Rachel Cohrs Zhang: Ñî¹óåú´«Ã½Ò•îl Health News’ “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir.  

Liz Essley Whyte: Stat’s “,” by J. Todd R. Lawrence and Madison A. Kesler.  

Shefali Luthra: The Washington Post’s “,” by Aaron E. Carroll.  

 Also mentioned in this week’s podcast:

  • The New York Times’ “,” by Tony Romm and Brad Plumer.
  • CalMatters’ “,” by Mikhail Zinshteyn.
  • The Wall Street Journal’s “,” by Liz Essley Whyte.
  • Bloomberg News’ “,” by Rachel Cohrs Zhang.
  • Ñî¹óåú´«Ã½Ò•îl Health News’ “Trump Has Quietly Throttled an Agency Devoted to the Safety of American Healthcare,” by Arthur Allen.
  • The Washington Post’s “,” by Lauren Weber.
  • Politico’s “,” by Alice Miranda Ollstein and Ariel Wittenberg.
Click to expand the transcript Transcript: The Politics of Grant Cuts

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 30, 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 Rachel Cohrs Zhang of Bloomberg News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: Liz Essley Whyte of The Wall Street Journal. 

Liz Essley Whyte: Hello. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: No interview this week, but more than enough news, so we’ll get right to it. I want to start with a story that I feel like is getting a little bit buried because it broke last Friday.  on a federal court filing in which the Trump administration admitted that it canceled $7.5 billion in clean-energy grants solely because they were located in states represented by Democrats that voted for Kamala Harris in 2024. In other words, the actions were purely political. Now, this is before the administration finalizes proposed rules that would give political appointees still more power over how grant funding is distributed. I heard one pundit say on cable news that in any other administration, this sort of information would lead to an immediate impeachment inquiry. But these days, it’s just another day that ends in “y.” Is the lack of public outcry about this because everyone already assumes that everything this administration does is political? Or is this considered just too inside baseball for most voters?  

Whyte: Well, I was gonna say I think this has long been people’s suspicions about why certain grants are cut in the way that they are, or some of these Medicare/Medicaid investigations are the way that they are. And so I think maybe the lack of outcry was just people shrugging their shoulders and saying, I mean, yeah, we guessed that, you know. I don’t know. 

Cohrs Zhang: It was really chaotic too, and hard to keep track of all these different things for people whose job it is to do so. So I feel like the fact that this is protracted for so long, we’re like, which DOGE [Department of Government Efficiency] cuts were those? And I think it is important, certainly, and I’m glad there’s been coverage of it, just for the record, and just kind of for history purposes and just understanding the limits of that kind of change to government at that speed. But yeah, I think it is just hard to break through in this news cycle, and it was very chaotic and confusing for everyone.  

Luthra: One thing I have been thinking about, though, is when you think about these states where grants were canceled, there are a lot of people who live there who did, in fact, vote for Donald Trump. And depending on the size of the state, you probably have members of Congress who are actually in Republican districts. And that, I think, is really interesting. And I just wonder if eventually there is some sort of conversation. Those are probably in some cases members who might be a little bit more on the defensive in other ways, just given the political environment we are in. And is this an issue that Democrats can talk about and highlight and sort of bring to voters and say, you know, your representative is not here defending your interests because of these broader sort of punitive measures being taken by the White House. I think that’s an interesting thing that we don’t know the answer to yet. 

Rovner: I know I keep saying this, but I can’t believe that Republicans on the [Senate] Appropriations Committee aren’t being louder about this. This is the one power that they have. It’s why you get on the Appropriations Committee, is you get to steer money to your state or your district. That is the great perquisite of being in Congress, and the administration is basically taking it away. And they’re just letting them. I mean, Susan Collins told Politico, quote, “I obviously think that’s wrong.” But she doesn’t seem willing to do anything about this. I mean, she’s the chairman of the Senate Appropriations Committee! 

Cohrs Zhang: I think we’re, like, testing the checks-and-balances system to its fullest extent. This administration. They can only pick so many fights, you know. 

Whyte: Yeah, Susan Collins, especially, this whole administration has had to choose about when to say something and when to push behind closed doors, push publicly. I mean, there’s been lots of stuff that she hasn’t liked. 

Rovner: Yeah, for sure. Well, this is not the only case where the government has admitted to canceling grants for political reasons. In a case brought by researchers from the University of California, the administration confirmed it canceled some grants because  like “diversity,” “gender,” and “vaccine hesitancy” to cut off funding. The plaintiffs in that case argue that it’s a First Amendment violation. Again, we’ve known for some time that this has been happening. Are the courts just too slow to be able to deal with it, Rachel? That’s kind of what you were intimating. This has been dragging out, sort of bit by bit by bit. 

Cohrs Zhang: Yeah, I think it’s hard. And I â€” just like with these grants dragging out too, it has impact for the people who are supposed to be receiving this funding and how their cycles work and hiring and just all the â€¦ that grant process. But I think it’s hard to make that connection, back to the individual voter. And I think that’s just a tough hill to climb in terms of public communications. So I think, yeah, we’re seeing these similar themes play out. 

Luthra: And one thing that I think is really relevant that I keep coming back to is we did see a test run of this with the USAID [United States Agency for International Development] cuts at the beginning of the administration. Those happened very quickly. The courts took a very, very long time, and by the time there was any kind of real momentum in any direction, it was too late. People did not have money, firms had downsized, people had left their jobs, left the industry altogether. And, at the time, that seemed to me like a really striking test. If this is able to happen here, and it shows that things just continue, why not happen in other areas as well, where you have these grants being put out there that have maybe ideological tension with where the administration wants to be going? 

Rovner: So I wanted to talk about some specific impacts on health policy, notably AHRQ, the Agency for Healthcare Quality and Research, which, like USAID, the administration has all but eliminated, despite the fact that it was appropriated nearly $350 million for this year in a bill signed by President Trump. AHRQ, which is down to a fraction of its original staff and hasn’t funded any grants in more than a year, is actually a completely bipartisan creation from the 1990s. It was established to study healthcare quality and access issues, many of which go neatly hand in hand with the “Make America Healthy Again” agenda. Earlier this month, the administration stopped funding more than 100 grants, and an HHS [Department of Health and Human Services] spokeswoman told my Ñî¹óåú´«Ã½Ò•îl Health News colleague Arthur Allen only that the agency plans to establish a new, quote, “framework,” which I thought was the job of Congress. Again, too small to attract much notice? 

Luthra: Probably. I mean, voters don’t know what AHRQ is. Like, we know about it because of our jobs, but this is not something people wake up and think about or talk to their neighbors about. It just feels very divorced from a lot of people’s realities. Even though, to your point, the consequences are far-reaching. They are long-term, and, also, the significance in terms of, as Rachel pointed out, separation of powers, checks and balances are also very striking.  

Rovner: I mean, AHRQ studies things like patient safety. I’m old enough to remember when the, you know, the big Institute of Medicine [now National Academy of Science] report came out that said how many people were injured by medical errors. It was a huge, huge issue. I mean, for years. And that’s basically what AHRQ does, and that’s what this administration says that they care about. They care about gold-standard science. They care about fraud. They care about making the health system safer. And yet, you know, AHRQ is just, well, we don’t know what it is, so we’re going to make it go away, basically. 

Whyte: Obviously, the HHS has not been as clear on this as you might hope and expect for the “most transparent administration in history.” But it is clear that, like, Kennedy is looking for pots of money to do the things that he wants to do. And it seems like this is one of the pots they’ve landed on as something that can be shifted around. 

Rovner: Yeah, so it does. Well, one cut that is likely to be noticed is the administration’s decision to end the temporary subsidy for Medicare Part D that prevented the addition of an out-of-pocket cap on how much enrollees have to spend each year on prescription drugs from spiking those monthly premiums. This will almost certainly raise premiums for many, if not most, of the 25 million seniors who have stand-alone Part D drug plans. And they will see those increases right before Election Day, because Medicare open enrollment starts Oct. 15. And, by the way, seniors vote in disproportionate numbers in midterm elections. If I was a political adviser for this administration, I don’t think I would have advised doing this. Am I missing something here? 

Cohrs Zhang: I think you are seeing there’s an interesting shift happening in terms of the power of the fiscal conservative wing of the administration. And I think we’ll continue to see that play out. I will say it’s unclear, like, how much premiums would have increased anyway without this subsidy program ending, given that the premium increases are capped by statute, in the Inflation Reduction Act through 2029. So, I mean, there is a chance that they might have gone up 6% anyway. We’re maxing out that increase. But the messaging certainly was not stellar for them. And I think we saw some cleanup efforts on that, for them trying to say that, you know, most seniors will see, you know, no increase or an increase of less than $10 a month. 

Rovner: Or they’ll have, I think Dr. [Mehmet] Oz said, they’ll still have an option for a cheaper plan. Of course, that cheaper plan might not cover all their drugs, but â€¦ 

Cohrs Zhang: Yes. So I think that’s just like a â€¦ this is one, I think, data point in this larger theme I’m thinking about. And how do we see â€” as we move past the midterm elections and affordability may not be top of mind if there’s no electoral accountability for it â€” how does that change what we’re seeing out of these agencies? 

Rovner: I’m just old enough to remember when, you know, you don’t raise costs for Medicare beneficiaries right before a midterm election, which is what this will do. Well, it isn’t all cuts. The administration this week finally released the $600 million that Congress had appropriated for the global Vaccine Initiative, Gavi. That was money for last year and this year. The funding had been blocked by HHS Secretary Robert F. Kennedy Jr. even though it goes through the State Department, not the Department of Health and Human Services. Kennedy had been concerned that Gavi was paying for vaccines containing the preservative thimerosal, which has been accused, and cleared, of causing autism. Do we know what finally sprung this money loose? 

Cohrs Zhang: I think there was a deadline of Sept. 30, and the funding would have expired. And we did see kind of an exchange with Secretary of State Marco Rubio and Susan Collins, where he said, “You know, I’m going to take ownership of this, and we’re going to get it done.” And so I think there was a push by administration officials to get this funding pried loose. And I think there are questions about whether Gavi was kind of heading this way already with some of these vaccines. I think they were starting the transition, but I think there â€¦ we’ll see how the implementation works on it. But I think there might be an argument that maybe this transition might have happened maybe faster â€¦ or to a broader degree. 

Rovner: The transition away from using thimerosal. 

Cohrs Zhang: Yes, the states â€¦ there’s one hexavalent vaccine where countries could already apply to transition to a different formulation without thimerosal starting in 2023. So, but maybe an option would be broader. Just there’s kind of a lot up in the air as to actually how this gets operationalized in the timeline. 

Rovner: Yeah, I was thinking, though, this might have been one of the cases where Congress complaining, both publicly and privately, did actually have some impact. But also, I know a lot of it was Marco Rubio stepping in and saying, “Hey, this is a State Department thing.” And finally, you know, I say a year and eight months later, the money gets distributed. All right, we’re going to take a quick break. We will be right back.  

Well, speaking of things that may or may not be good politics, Republican Sen. Rand Paul of Kentucky called former NIH [National Institutes of Health] and White House science official Tony Fauci before his Homeland Security Committee Wednesday to rake him over the coals again over his handling of the covid pandemic. Fauci, who received a preemptive pardon from President Joe Biden as Biden was walking out of the Oval Office door in 2025, did not take the bait. He pleaded the Fifth, lest anything he said be used for a new prosecution for lying to Congress. Meanwhile, Paul says he’ll try to find Fauci in contempt of Congress, which, by the way, would take 60 votes, which feels a little unlikely. Separately, several red-state attorneys general say they now want to investigate Fauci since his pardon doesn’t cover state prosecutions. First, prosecute him for what? And is relitigating covid origins and lockdowns really good politics for Republicans? I’m sure it riles up the base, but it’s hard to see them running on this as their health agenda. 

Whyte: So Rand Paul actually said on TV last night that he just thinks his committee needs to do the contempt of Congress vote, and then they can refer it to the DOJ [Department of Justice]. So they may not need 60 votes. So that will be interesting. Meanwhile, [Sen.] Ron Johnson [R-Wis.] has also threatened to subpoena Fauci. And the Florida attorney general is opening an investigation. And Alabama Sen. Tommy Tuberville says if he becomes governor, he’s going to try to figure out a way to prosecute Fauci in Alabama. So there’s definitely a lot of focus on Dr. Fauci. 

Rovner: I repeat, though, prosecute him for what? 

Whyte: Well, you know, before the hearing, Rand Paul was saying, Yeah, his preemptive pardon covers stuff in the past, but if he lies again at this hearing, then we will, you know, go after him or whatever. 

Rovner: Right, and that’s why he didn’t, that’s why he pleaded the Fifth.  

Whyte: Right, which is why it was viewed as an â€¦ entrapment situation that he should probably steer clear of, and why he would not even answer, like, what is the color of the carpet. 

Rovner: And what color his tie was, or was it Sen. [Josh] Hawley’s tie? 

Whyte: Yeah, and what day of the week it was, yeah. Whether it’s good politics for Republicans, I think we’ll have to see. There’s an Ohio candidate that they’ve tried to get for being, you know, covid czar or whatever, and that really hasn’t gone anywhere in Ohio. She’s polling OK. So I think that’s a good question on whether voters still care about this or not. I think obviously a lot of them do, but, like, the suburban women who are, you know, the famous swing voters, what do they think about Dr. Fauci? Will be interesting to see. 

Rovner: Yeah, I mean, I guess just for watching the questioning, it seemed that they’re trying to, you know, that we know that Democrats have more enthusiasm going into this midterm than Republicans. And it looked like the Republicans were trying to, you know, reactivate the angry covid base, if you will, to get them to come out and vote. It’s just hard to know how many people are angry enough to come out, you know, six years later.  

All right. Well, speaking of buzzy stories, Liz, you  about how Trump might be pushing RFK Jr. on childhood vaccine policy rather than what we all assumed was the other way around. So tell us about it. 

Whyte: Yeah, this is a bit of a counterintuitive news development for two reasons. One, because everybody thinks RFK Jr. is the big vaccine skeptic in the administration. And two, because the White House had, you know, is widely reported that they were telling HHS to “ix-nay on the accines-vay” ahead of the midterms â€” like, just dial it down a little bit because of polling they had from the winter that showed while food and ag [agricultural] stuff was really popular, the other MAHA stuff, vaccine skepticism, was not, and they kind of wanted to tone it down. But the president does what he wants. He does not always listen to the polling. And he has been telling Kennedy since at least May, why aren’t you doing more to probe the connection, in his mind, between vaccines and autism? And this took Kennedy aback, actually, at a golf course lunch in May. He was surprised because he was still under the impression they were supposed to be dialing back. And President Trump told him, “You have the yips,” which I just think is such a funny word. 

Rovner: It’s a golf term. 

Whyte: Yes, it’s a golf term. And that has continued to be, actually, a point of tension between the two men, with the president venting his frustration to Kennedy at a mid-June Oval Office meeting. And part of the reason we’re seeing some of this increased action, even if it’s not, you know, really talked about much, but appeals to the federal appeals court to speed up the decision for the key vaccine advisory panel of the CDC [Centers for Disease Control and Prevention], and then also there was that EO [executive order] in May that Trump put out on the childhood vaccine schedule, and just kind of general scrambling behind the scenes to figure out, like, what they can deliver for the president, who is, I’m told, a results guy and wants to see results and thinks, you know, it’s been a year and a half, and why aren’t there results? So, we’ll see where that leads. 

Rovner: Well, meanwhile, if this puts Kennedy in hot water with the president,  what the newest, who the newest likely candidate is should RFK Jr. leave his post, either voluntarily or not so voluntarily. Tell us about your story. 

Cohrs Zhang: So I have been working on this story for a very long time. But I think we’ve seen kind of this surprise in Washington that Dr. Oz, who’s leading Medicare and Medicaid, has actually like navigated the Trump administration with great skill, and I think we were finally able to capture the scope of that, him translating that skill into personal relationships with the president, with the secretary, and getting himself a seat at the table on far more policy issues than a CMS [Centers for Medicare & Medicaid Services] administrator would normally get. And I think we saw, those of us who remember the first Trump administration, how ugly things got between HHS and CMS â€” was like very adversarial, like a really bad time in there, very toxic. But I think we’ve seen him take a more, like, cooperative approach. He wields his influence, is more explaining things. He is a medical doctor, his training, unlike the secretary. And I think there is just, like, a general trust and, like, personal friendship between the two of them that has translated into this interesting dynamic, where Dr. Oz kind of serves as a go-between on some of these issues between the White House and the secretary and gets everybody kind of to the place where they need to go. And he’s just a good communicator and has built a lot of trust and parlayed that into getting himself a seat at the table. 

Rovner: Yeah, and Liz â€¦ your story about Kennedy and Trump also suggested that Oz’s favor is rising, shall we say? 

Whyte: Yeah, the White House staff love Oz because they know they can send him to the Hill. They can put him on TV. Like, he’s going to do a great job. Rachel had this too. You know, the president calling and texting Oz and saying, you know, what about this issue? and it has nothing to do with CMS. He’s, you know, being called upon to do other stuff that is not in his portfolio. So yeah, every lobbyist is just, like, watching their clock and seeing when Oz takes over. I don’t know that it’s that straightforward. I think the president and secretary have a very warm friendship, and it took a lot for Kristi Noem to get let go, and I don’t think we’re anywhere near that. So we’ll have to see if the mood changes after the midterms. But it doesn’t seem to me that anything would be imminent. 

Rovner: I would add that I know Oz is the one person practically in the entire administration, not just at HHS, who actually does well when he goes to the Hill. Who, you know, is respectful and sort of understands how administration officials are supposed to conduct themselves when they are in front of the people who theoretically are responsible for them having their jobs.  

Whyte: Yeah, you’ll find the Democrat staffers are like, Oh, we actually like Oz, which is funny, I think.  

Rovner: He’s a good politician! What can I say? Rachel, do you want to add something? 

Cohrs Zhang: I will say, though, he did play a role in selling all these Medicaid cuts that are going to be coming down the pike. 

Rovner: He did. 

Cohrs Zhang: And so I think he is going to be the face of this when they actually go to implement it.  

Rovner: He will. 

Cohrs Zhang: So yeah, we’ll see how that goes.  

Rovner: We’ll see how that goes.  

Cohrs Zhang: What time frame they’ll be doing that in. But yeah, certainly. Yeah, it’s interesting. 

Whyte: They’ve kind of given up selling that, too. You know, it’s not something they’re being like, Oh, look at all the great stuff we did with Medicaid in the One Big Beautiful Bill. It’s very much pivoted to fraud.  

Rovner: Yeah, but when it starts, when it takes effect next year, I think there’s going to be, there will be lots of questions to answer. Shefali, do you want to add something before we move on? 

Luthra: The only thing that really just I keep thinking about is the long history of this relationship between Dr. Oz and the president, and, in particular, when during the 2016 campaign he was the one to talk about the president’s testosterone levels on TV and how they were excellent. And I just think it’s really special that we’ve come full circle in this way. 

Rovner: Yes, yes, it is, and we have. All right, moving on. One thing that Secretary RFK Jr. said this week that’s pretty clearly not true is that the department has the cyclospora parasite outbreak, quote, “under control.” A former deputy commissioner of food at the FDA under both the first Trump administration and President Biden told Politico this week that, quote, “it is starting to approach a catastrophic level in terms of how mismanaged it’s been on multiple fronts.” Rachel, you’re keeping an eye on this. What is the latest? What do we know about cyclospora and where it’s coming from? And are the recalls that are in existence enough to stop it? 

Cohrs Zhang: I don’t think they’re stopping it, by any means, especially with an incubation period of two weeks. I think we are continuing to see more cases reported, and I think, like you mentioned, there’s, I think, fingers pointing in all directions. Our team and others have done reporting on just how Taylor Farms has handled themselves behind the scenes. The public spat between Taylor Farms and the FDA was not something you usually see in an outbreak of this kind. It’s just worth probably pointing out that the FDA did DOGE much of its communications staff that has experience with this sort of outbreak. We have, you know, officials shifting around, and there’s some key vacancies at the FDA as well in a lot of these leadership positions. So I think there’s been complaints, certainly, at, like, the report you mentioned about the federal response, but also about the company and their speed and their clarity and communication, and whether that’s truly serving the public interest or not. And I think there are, if I’m not mistaken, some ongoing investigations into other potential causes. But we are seeing a lot of these cases tied back to lettuce from a specific part of Mexico. So I think they have gotten the word out now, but just the confusion and the back-and-forth. And I think former FDA commissioner Scott Gottlieb got on CNBC and said he would have expected more communication from the FDA on this issue. But it’s kind of a tough one when it’s a voluntary recall, and there’s a company, and they’ve used some restrictions, you know, and what they’re supposed to be talking about publicly. But I think there has just been so much consumer confusion, and that’s not in anyone’s interest. 

Rovner: And as we said, this is not a simple thing to track. It’s not like E. coli; you can’t really find it. Liz, you and your colleagues reported, though, on, you know, Taylor Farms going straight to the White House to try and sort of go over the heads of the FDA on this. 

Whyte: Yeah, Bloomberg and The Wall Street Journal had stories with different pieces of this, and it was, you know, in our story, you could see that they were trying to distance themselves from the outbreak before they got named publicly, which is kind of this new wild West of lobbying that we’re in, where it makes a lot of sense for companies to go straight to the White House and skip over dealing with career officials. And what was interesting was that the way all that played out with the communications is Taylor was able to say, FDA apologized to us, made this like really confusing statement. And the FDA, maybe because it didn’t have the comms folks with experience, like Rachel was talking about, at the FDA with, you know, various layers of people who have done this before, you know, it took them till the next day to say: By the way, our epidemiology on this is really good. It’s definitely still Taylor Farms. We just, like, had that one false positive. It was crazy to me how, like, twisted and turned that got. 

Rovner: It was not well handled from a public communications standpoint, shall we say? All right. Well, one thing that we know that RFK Jr. thinks highly of are peptides; those are the amino acids that wellness influencers say can build muscle, heal injuries, and burn fat, among other things. Last week, an FDA advisory committee voted, over the objections of FDA’s own scientists â€” who say evidence on the benefits of peptides is either skimpy or nonexistent — to nonetheless make it easier for compounding pharmacies to make and sell products containing several different specific peptides. Now, this is not just a scientific disagreement. Several members of this advisory panel are actual sellers of this product, right? 

Whyte: Yeah, the panel was a bunch of members who either worked for companies that sell peptides or had a clinic that offers them. And the HHS said these people went through a conflict process. It doesn’t seem like it could have been as rigorous as the previous conflict processes that were in place. I haven’t seen a ton of reporting on that. But, you know, predictably they greenlighted most of the peptides that they looked at over and against the strong recommendations from FDA staff scientists who said we don’t have evidence that these are safe. Like, this is kind of unprecedented. The argument in favor was, well, you know, we do something similar with supplements. You know, Secretary Kennedy has said people should be free to try these out, and you know he wants to end the war on peptides. And meanwhile, scientists with a traditional background in looking at risk and benefits are saying the risks are there, the benefits are not proven, and this almost creates a different paradigm for how we’re looking at medical interventions now. 

Rovner: Yeah, and I think we’ve seen this across the FDA and across HHS. I mean, this is basically what they’re, you know, calling gold-standard science. That there’s a lot of people â€¦ go ahead, Rachel. 

Cohrs Zhang: I was just gonna say, and I’m â€¦ I think, looking forward, this creates a split decision, right, between the FDA scientists and the ag comm, and that’s gonna put the FDA in a tough position as to who what they’re going to choose because former commissioner Marty Makary loved to say he was siding with the career scientists, and now we have this forum to hear what they actually think, like, presented to the public. So I think that’s going to be a tough decision ahead, and that’ll tell us how things are working inside. 

Rovner: And of course, we only have an acting commissioner of FDA right now, so â€¦  

Cohrs Zhang: Yes, with instructions to not make news. 

Rovner: Finally, this week, news on reproductive health â€” because there is always news on reproductive health. Shefali, we had a decision in one of the court cases challenging how the FDA regulates the abortion pill mifepristone, but it’s not the case that we’ve all been watching, right? 

Luthra: No, this was the Virginia case. And what it reminds us is that there’s actually a million different mifepristone cases because you have people looking for more restrictions on mifepristone, and you also have people looking for fewer restrictions on mifepristone. And a lot of the folks who provide the drug, the doctors and manufacturers, have argued that, in fact, there are more restrictions than are actually appropriate. That this is actually much safer, and it does not need to be so hard to get because, for all of the concerns from conservatives and abortion opponents, it actually is very difficult to prescribe and make mifepristone available without going through a lot of hoops of certification. And so we see, right, in some cases, like here, an effort to try and loosen those restrictions a bit and say this could be more available, especially, I mean, people when they have miscarriages, it is actually very hard to get mifepristone, even though it actually would be very beneficial for management. But I think what this does, practically, is again not much changes for now because we have so much going through so many courts in different ways. Realistically, I mean, access to the drug stays as what it is: available in some places, not available in others. And the big case that we’re all waiting for, the Louisiana one, that could possibly bring restrictions in, that very briefly did bring restrictions in mifepristone earlier this year â€” we’ll probably see more on that closer to the election. And that could be very interesting because, as we’ve talked about so many times, this is not really an issue the White House or a lot of Republicans, frankly, would like to be in the news, because they know that restrictions on abortion just remain so unpopular and continue to be for a long time. 

Rovner: And this is almost certainly heading for the Supreme Court, right? We now have a court, you know, a lower court saying that the Biden administration’s restrictions were too tight, and one assumes that coming out of Louisiana, we will have a decision that says that they’re not tight enough. 

Luthra: I would be stunned if the Supreme Court did not hear a mifepristone case in the coming few years. It just seems like we’ve been building in this direction for a very long time. You’re totally right. The split circuit looming makes that more likely. And I mean, realistically, if I supported abortion rights, if I wanted to make this pill more available, as the folks arguing against the Biden restrictions are, I don’t know that I would be thrilled about this being something before the Supreme Court because this is known to be a more conservative court. A lot of members who think abortion should be far less available than it is â€” this is the same court that overturned Roe v. Wade. And so I think there’s a real possibility that as we see more and more abortion decisions make their way to the Supreme Court, the restrictions we have become even more so, and where we are now becomes a baseline for making this even more difficult for people to obtain. 

Rovner: We will have to see. Meanwhile, our podcast pal Alice [Miranda] Ollstein has a co-bylined story at Politico this week about how anti-abortion groups are pulling out all the stops to try to show that the increased use of . Now they have a study, commissioned by the group Students for Life, claiming that mifepristone is showing up in, quote, “significant levels” in waterways in Austin, Texas; Blacksburg, Virginia; and Carbondale, Illinois â€” all major college towns, not coincidentally. And while the science behind this remains questionable, the politics don’t, right? 

Luthra: Right. And this is a strategy they’ve been working on for quite some time, putting bills in state legislatures, talking to anyone who will listen about this, and saying, If we care about the environment, the left cares about the environment,why don’t we care about what they say is this mifepristone pollution in the water that they say is caused by medication abortions? And they want to use this argument as a different prong on the way to stop people from having mifepristone made available, of making medication abortions harder to obtain. We haven’t really seen this really yield fruit yet. However, this is part of, again, a longer-term strategy to lay groundwork. And studies like this, they create an intellectual groundwork as well. We saw that with the telehealth studies, the mifepristone safety and efficacy studies â€” and I perhaps should do “studies” in air quotes because a lot of mainstream researchers call these not very good science. But if you create a large-enough body to point to, then ultimately you can have people in positions of power say, “Well, we’ve looked at the evidence from all sides, and we see these real concerns, and we’re going to use them to inform policy.” I don’t know that that will happen anytime soon, but it’s certainly a goal that they’re building toward. 

Rovner: They’re talking points, basically. 

Luthra: Absolutely. 

Rovner: All right. Well, 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. Rachel, why don’t you go first this week? 

Cohrs Zhang: Mine is from Ñî¹óåú´«Ã½Ò•îl Health News. The headline is “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. I think this is one installment, and that this broader arc of coverage that they have really owned â€” it’s so diffuse. There’s like states, and there’s providers, and there’s government officials involved, but I think it really illuminates kind of like where is the Trump administration looking for data? I think this is something that started during the DOGE era, where you had DOGE employees trying to get data from different government agencies. But you’re seeing it as, I think, we’ve talked about previously, like, there’s a desire for studies and, you know, things to move faster. Like, where are we looking for data? I think this whole arc of coverage has been really valuable in illuminating: Where are they looking. Is this precedented? Kind of how could these datasets be used? What are the patient potential issues? Are there privacy issues? Can this data be protected? That I think are going to be really important as we kind of look into the rest of this administration, because we’re only a year and a half in. Like, we got a ways to go. 

Rovner: And, oh I mean we say over many, many, many years it’s always been Republicans who have been, you know, very much into the federal government shouldn’t have its hands in people’s personal data, and yet here we have an administration that’s trying to get personal data from every single possible place. 

Cohrs Zhang: Right, it’s fascinating. And this just makes it so concrete. And I think it’s great accountability work, and they’ve clearly developed great sourcing on this. 

Rovner: Yeah. Liz. 

Whyte: Mine is a  by two doctors who are concerned about the burgeoning pediatric public health emergency, as they call it, about e-bikes and e-scooters. And I’ve been wondering about this for a long time because I see kids doing two, three kids on these scooters going so fast with no helmets. It’s always boggling my mind, but it’s apparently gotten really bad. They looked at data from 2020 to 2021 and saw an increase in injuries, up 71% in just one year â€” kid injuries with e-scooters and e-bikes. So that was 8,545 of those injuries in 2021. And the doctors discuss how, you know, these injury patterns that these kids get â€” I mean, they’re going up to like 28 mph â€” look very similar to when a child gets hit by a car. And that’s, it’s just real sad. So TBD on whether anybody does any kind of age-appropriate access standards or something like that that can help dial back these injuries. And then I guess I’m cheating Julie, but a shoutout to  recently, about how peptide med spa clinics have less regulation at the state level than your local restaurant or hair salon. She contacted all 50 states, and I thought it was just a really good supplement to the peptide news that we saw recently. 

Rovner: It was, and â€¦ forgive me for not mentioning it, and we will link to that one too. But I’m so glad you did the e-bike thing because if you hadn’t done that, I was going to, because the number of kids just in my neighborhood, little kids on motorized vehicles, it’s like: Shouldn’t they have to have driver’s licenses to do this? Anyway. Shefali. 

Luthra: My piece is by Aaron Carroll. It is an op-ed in The Washington Post. The headline is: “.” And what he talks about, I think, is just so smart. It’s about how it actually would be great if we had better and more research on SSRIs. However, the point he makes is that the government is actually not really approaching this from that kind of vantage. And instead the idea is to try and just cut back access to SSRIs, rather than learn more about them, learn how to make them work better, if they are as effective as they want them to be. And the point that he gets at the end as well is that while it is really good and worthwhile to investigate and study how well SSRIs work, one thing that we are actually getting into, which is really problematic, is stigmatizing use of them. And he talks about why that’s actually not good, and that is not actually helpful when it comes to thinking about how to make treatment for depression better and better and better. And I love this framing because we should try and make medications better for people. We should always be looking at treatments we have and saying, yes, they work. But what if we made them work better and better? What if we had fewer side effects? What if we made them more effective? That would be awesome. And I really love that he is putting those questions out there in a way that is smart and productive and forward-looking. 

Rovner: And not partisan. This has never been partisan. This is just so â€¦  it’s all so unprecedented. All right. My extra credit this week is from The Arkansas Times. It’s called “,” by Byron Tate. And it’s about exactly what the headline says. Since Congress gave states the option to extend Medicaid coverage to postpartum women for a full year after they give birth, 49 states have exercised that option â€” all but Arkansas, where that coverage still ends after 60 days. And Arkansas has one of the nation’s highest maternal mortality rates. So who’s against it? Apparently, the governor, Republican Sarah Huckabee Sanders, herself a mom. She says these women should be transitioning to other coverage, except apparently most of them are not. According to one study, 94% of those losing postpartum Medicaid are becoming uninsured instead. 

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

Cohrs Zhang: I’m on X  and also on . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Liz. 

Whyte: I am on X  â€” with a “Y,” W-H-Y-T-E â€” and . You can Google me. 

Rovner: I’m sure people can find you. All right, we’ll be back in your feed next week. Until then, be healthy. 

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]]> 2266610 Abortion Drug Law in Louisiana Heightens Hemorrhage Risk for Pregnant Patients /courts/abortion-drug-access-misoprostol-louisiana-law-pregnancy-hemorrhage-risk/ Thu, 30 Jul 2026 09:00:00 +0000 /?p=2262962 Over the past decade, Louisiana hospitals began stocking specialized carts designed to treat hemorrhages, one of the in the state. The plug-in cart can be wheeled from room to room and holds surgical tools and lifesaving medications to stem blood loss.

A passed in 2024 forced hospitals to remove a key drug — misoprostol — from the medical cart and keep it locked in a secure room designated for controlled substances.

For physicians like New Orleans obstetrician-gynecologist Nicole Freehill, misoprostol is the go-to medication to treat hemorrhages. The drug is uniquely cheap, safe, and shelf-stable, she said.

But it’s also the second in a two-pill procedure that millions of people have used to have medical abortions. Because of that use, Louisiana lawmakers reclassified misoprostol as a controlled substance, a category typically reserved for addictive drugs.

Now, physicians like her have gone from reaching over to the cart to grab misoprostol to waiting at least two minutes while a nurse sprints to retrieve the medication, Freehill said.

“ You could literally have someone lose, like, a liter of blood or more in that time frame,” Freehill said. “You could have a significantly worse hemorrhage for literally someone running to this medicine and running back because it can’t be on that cart 2 feet from you while you’re treating the hemorrhage.”

She said the reclassification of misoprostol as a controlled substance has set back progress to decrease the frequency of postpartum hemorrhage and blood transfusions. Under the law, her preliminary research found, hemorrhage rates have worsened statewide, she said.

Although the cart includes alternative drugs to treat hemorrhages, they can’t be used if a patient has certain preexisting conditions like asthma or high blood pressure. They’re also more costly.

“ There’s unfortunately a lot of patients nowadays that have these conditions that we might be forced to go straight to misoprostol first without any other real good option because of their medical history,” Freehill said.

Misoprostol has other uses in reproductive healthcare. It prepares women’s cervixes ahead of common, sometimes painful procedures such as inserting an IUD. It also plays a critical role in inducing labor and managing failed pregnancies.

In medication abortions, misoprostol is combined with a medication called mifepristone, which Louisiana also reclassified as a controlled substance. Both mifepristone and misoprostol have uses outside reproductive healthcare, including treating Cushing’s syndrome and preventing stomach ulcers caused by anti-inflammatory drugs.

When Louisiana passed a near-total ban on abortions after Roe v. Wade was overturned in 2022, the number of abortion procedures performed in the state dropped from 7,444 in 2021 to . Similar trends occurred in other states that largely banned abortions that year.

However, in the years since, the number of abortions has largely remained the same in Louisiana and nationally as people receive medication abortions through telemedicine and pills sent across state lines. More than 7,500 Louisianans received medication abortions in 2024, the year the law passed, according to the .

Since then, states with abortion bans have tried to to medication abortions prescribed in telehealth appointments and shipped by mail, looking to close what they saw as a loophole through legislation and lawsuits.

Kimya Forouzan, the state policy adviser for the Guttmacher Institute, a nonprofit reproductive rights advocacy group, said the assault on medication abortions comes as more states that have maintained abortion rights pass laws to shield prescribing providers from prosecution.

“This has been a really important lifeline for a lot of people in states with total bans who are looking to access abortion,” Forouzan said. “However, I think a lot of the restrictive states know that this is happening, and they have wanted to increase the threat and the threat of liability to providers who are doing this.”

Louisiana’s controlled-substance law became one way to do so, though it was originally passed to ensure strict penalties for coerced abortions. Republican state Sen. Thomas Pressly of Shreveport, who introduced the bill, said he did so after his brother-in-law fed his sister the pills to cause an abortion . She gave birth to the baby, and the husband was sentenced to six months in prison after the failed attempt.

The bill was later amended in the legislature to add more restrictions and monitoring of mifepristone and misoprostol by classifying them as controlled substances.

Last October, Louisiana also tried to halt medication abortions by telehealth with a against the FDA. The case is pending before the U.S. Supreme Court.

The New Orleans Health Department called for the repeal of the law in a last September, based on surveys of patients, doctors, and pharmacists. Patients reported delays in treatment while hemorrhaging after birth. Fewer pharmacies filled prescriptions for misoprostol, frustrating doctors.

“ There’s no evidence that it is reducing elective abortions in Louisiana. There’s no evidence that it is helping anybody. There’s only evidence of harm,” said Dara Kass, an emergency physician and a professor at Brown University.

Since Louisiana’s law passed, similar legislation has been introduced in at least nine states, despite established abortion bans.

But so far, no other states have reclassified the medications. Pushback from the medical community and reproductive health advocates over implementation has surprisingly stifled any other attempts, said Alina Salganicoff, director of the women’s health policy program at KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

“This puts a risk  inside the healthcare system and potentially could delay really extremely time-sensitive lifesaving care,” Salganicoff said. “Especially where we have situations where we have really an unacceptably high maternal mortality situation in the United States.”

Instead of being a model for other states, Louisiana’s law has served as a cautionary tale. Freehill, the New Orleans OB-GYN, said her colleagues have also had patients struggle to fill their misoprostol prescriptions ahead of uterus examinations intended to help with their fertility.

“ So it’s having the complete opposite effect of what it’s been intended,” she said.

According to the New Orleans Health Department’s report, some pharmacists said they were too afraid to release the medication to the patient, confused about what’s required under the law. Others refused to fill prescriptions and stock the medication because they preferred to “stay away from any abortion pills.”

Tehmi Chassion, a pharmacist and a Democratic state representative in Lafayette, is pushing the state to study the law’s impact, given the loss of access to the medications.

Louisiana allows pharmacists to choose not to dispense medication if they are uncomfortable doing so, but Chassion said some pharmacists may be crossing a line by blocking access to medication based on their personal beliefs.

“ Those medications have helped save thousands of lives, and we just need to get to a safe space where prescribers and patients don’t have any worries,” Chassion said.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

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