[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. 24, 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 Tami Luhby of CNN. 

Tami Luhby: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my Ñî¹óåú´«Ã½Ò•îl Health News colleague Sarah Jane Tribble. 

Sarah Jane Tribble: Good to be here. 

Rovner: No interview this week, but plenty of news. So let’s dive right in. We’re less than six weeks away from the midterm elections, and healthcare, particularly its rising cost, is shaping up as a top issue for voters. Sarah, I want to start with you this week because you’re part of a new polling project that KFF is doing with the AP, looking at rural voters. What did our new poll find about rural voters and their views on healthcare? 

Tribble: Yeah. Well, the big headline is that 48% of rural voters believe the economy is worse off now, and that leads into healthcare because their key pain points are, not surprisingly, gas, groceries, and healthcare. Those all rank right up above 60% of those who are polled. They polled about 2,200 roughly rural Americans across the U.S. in August, mid-August. So this is a very fresh poll, only focused on rural Americans, which, as we know, is a key voting bloc for [President Donald] Trump and the Republican Party. 

Rovner: So … the rural voters tend to be more heavily Republican, right? 

Tribble: Yeah, they tend to skew Republican. Yep. 

Rovner: But there are fewer of them. So, but they’re a key voting bloc. … What did they find in terms of, you know, their continued support for President Trump and Republicans in general? 

Tribble: Yeah. So, you know, it was an interesting survey in the nuance. And what I love about this, and I’ve been covering rural America for four or five years now, exclusively, and there is a lot of nuance in rural America. It’s not a monolith, right? There’s lots of different people. So, while 48% of rural voters believe the economy is worse off now, about half also still approve of Trump’s job performance. And so what we’re finding is the Republicans — I talked to one expert, Tim Slack at the Louisiana State University. He’s a sociology professor. He’s written some books. What he said was he expects Republicans to sit this one out. And we talked to an array of Republicans, and that’s sort of what we heard. And you’ll have to read our story, but that’s pretty much what’s in there. 

Rovner: I will link to the story. But that’s really important because I mean one of the things we know about midterms, it’s not just who supports who and who opposes who, but who actually shows up to vote, right? 

Tribble: Right. Yeah. And what was really interesting for me, personally — and it’s, like, one of my colleagues and I were talking, and he was like, “You have a front-row seat to the elections,” because, you know, rural Americans, they too tend to come out to vote. They skew older, and they tend to be voters, right? But when I talked to the Democrats, they were certainly going to the polls. They definitely knew who they were voting for. But the Republicans I talked to, for the most part, were very sort of like, Well, I’ll definitely vote for this Republican, but maybe not my Senate seat, because I’m not happy with them. So it was a really interesting sort of pause that they would give. 

Rovner: So yeah, it’s an early indication, as we say. Well, healthcare is also playing a role in several high-profile Senate races. Michigan, of course, is a top one, pitting Democrat Abdul El-Sayed, a longtime backer of “Medicare for All,” against Republican Mike Rogers, a former House member who is touting price transparency as his health platform. But health is also showing up in Iowa, where Republican Rep. Ashley Hinson says she’ll fight Big Insurance, while Democrat Josh Turek says he’ll fight Big Pharma. And in Ohio, where Democratic former senator and Affordable Care Act sponsor Sherrod Brown is pushing to rein in insurance company denials, while Republican opponent Jon Husted is both vowing to overhaul the Affordable Care Act and restore the expanded subsidies that expired last year, at least temporarily. So it looks like , but in many different pieces. Am I sort of reading this right? 

Kenen: I think, rather than being a healthcare election in great big capital letters — which we’ve all lived through a number of those, both in the primaries and in the generals — I think it’s falling under this larger affordability issue. Like, I think that it now has a whole bunch of dollar signs instead of vowels. And I think healthcare is a big concern for people. We hear about it every day, but it’s part of this longer, Oh my God, life is just too, too, too expensive. And then there’s also this big … distrust of big things, including Big Pharma, Big Insurance, big everything. Right? At the same time, this is a really fast-moving political environment. Well, we all know that since, you know, by the end of the day, it feels like 20 years. And the issue, which started out as the data center issues; it’s now a larger existential fear of AI, and what is going to be done about it, and who is afraid. So this is a really shifting election. Like, what is going to motivate people? And what happens is even more un- … I mean, elections are unpredictable by definition, and this is going to be … like, if it was right today, the Democrats would be extremely happy. But who knows how many news cycles we go through between today and tomorrow? So yes, it’s a healthcare election, but we’re not calling it a healthcare election. 

Rovner: I was more thinking that it’s … 

Kenen: I mean, existential, getting wiped out is a health issue! 

Rovner: I was more thinking, though, that neither party actually has a health platform. I’m sort of struck by how Democrats and Republicans are all talking about health, but they’re all talking about different pieces of it, because we know that within each party there are differences in what they want to do about healthcare. 

Luhby: Right, and I think that’s one of the main issues. I mean, the Democrats are talking about how they want to extend the expired Affordable Care Act premium subsidies, which caused a lot of premiums to go up for many millions of people, but they also want to reverse the Medicaid cuts and the [One] Big Beautiful Bill. But then you also have the other side, where they’re talking about Medicare for All among the progressives, so they’re sort of split within themselves, and they don’t have exactly a unified message. And the Republicans are on the ropes this year on healthcare, as they have been in other elections. And this year, you know, they don’t want to highlight all of the cuts that they’ve made. So they’re highlighting, you know, their efforts to fight fraud. We saw [Vice President JD] Vance’s announcement earlier this week, and they’re touting, many of them are touting the Rural Health Transformation Fund, the $50 billion fund that was in the Big Beautiful Bill, without saying that the Medicaid cuts are going to affect rural America far more than the transformation fund will help them. 

Tribble: Yeah, one of the interesting findings in the research study — so, this Rural Health Transformation Program is something I’ve been following pretty closely — and one of the interesting findings in it for rural America is they pretty much hadn’t heard of it. 

Rovner: So for all of that effort! 

Luhby: Yeah, that’s surprising because so many of the candidates in that, you know, area are touting it on the trail. 

Tribble: Yeah, well, and at the same time, though, they also pretty much hadn’t heard of Medicaid changes either. Even people I talked to who had kids enrolled in Medicaid said they were pretty much unaware — maybe some cuts were coming. I did talk to a former hospital worker who said, “Yeah, it’s going to hurt a lot of people.” But she was a Democrat. Most of the people I talked to were unaware of Medicaid, and they also were unaware of the Rural Health Transformation Program and its impact. So I don’t know where that leaves the Republicans, but their messaging just isn’t getting out there on at least the RHT. 

Rovner: Well, to pick up on what Tami … oh, Joanne, go ahead. 

Kenen: I think people are just very overwhelmed, like, I don’t think — it’s really hard to know, like, people have these gut feelings and these sort of ideological identities, but everybody’s so overwhelmed by everything right now. I even wonder with the polls, like, who even answers their cellphone for it? We already made the shift from landline to cellphones, right? I mean, everybody is just swamped, and some people have just tuned out, and some people just can’t absorb everything that’s out there. So I don’t think voters are that well informed about the facts. I think a lot of people vote on guts and, you know, sort of gut feelings, and I think that’s always been true to a certain extent. But … you can’t poll on whether people are paying attention to polls. 

Luhby: One thing that an expert told me a couple of years ago that I thought was really, you know, insightful was the fact that people see their gas prices every time they fill up or every time they pass the gas station. They see the increase in grocery prices every time they go to, you know, buy food or go to a restaurant or so. But they only see their healthcare increases when they need care, or maybe once a month for the premium. So, you know, I think you were right, Joanne, when you said that the healthcare is now sort of lumped into a larger issue of affordability. But the affordability crisis that people are really seeing daily or weekly are gas and groceries, not necessarily healthcare. 

Tribble: In my interviews, what I noticed was people — I would like call people, and they were … one guy was at the gas station who was filling up his truck, right? A grandmother talked about how much her groceries were and how her gas and grocery bill every week was $200, which was just a lot for just her, right, in Iowa. And so it’s very salient to them and very tangible, like you said, Tami, that those costs are right in front of them. And, frankly, it should not be overlooked that for a lot of people, they don’t pay attention to diesel prices, but diesel prices have a huge impact on people in rural America, especially, not only because they’re using it for their trucks and the farming equipment, but they just use it more. So these affordability issues, these pocketbook issues and concerns, the messaging on that is not positive for either party right now. 

Kenen: And you don’t have to message. You just have to pull out your wallet, right? I mean, all of us can afford our groceries, but I’m aware. I mean, when you go into the store, you see. I mean, I think even people who are not pressed are shopping differently, and thinking differently. So, I mean, I think people aren’t necessarily paying attention to the messaging, but they are paying attention to the lived experience, which, as Tami said, you see on every gas station every time you drive by. Even if you’re in an EV [electric vehicle], you’re aware of it. 

Rovner: So, also, as Tami said, the administration seems to be pushing its fraud agenda as its big health issue. As you mentioned, Vice President JD Vance had a press conference Tuesday to announce that the administration is canceling the ACA [Affordable Care Act] policies of more than three-quarters of a million people, who the administration suspects are fraudulently enrolled in the program. Now, one of their indications is that these enrollees haven’t filed a claim. But I did a little digging, and, according to our Peterson-Ñî¹óåú´«Ã½Ò•îl Health [System] Tracker, it’s not at all unusual for people not to file a claim. First of all, most people are healthy most of the time. The bottom half of the population only accounts for 3% of healthcare spending. By comparison, the top 5% account for 50% of healthcare spending. Also, those with the cheapest plans tend to have the biggest deductibles, and now the average Affordable Care Act deductible is nearly $4,000. So even if you do have a medical expense, you’re likely not to bother to file a claim that you know isn’t going to be covered. So I know fraud is one of the really big Republican answers to rising healthcare costs this year, but is it really good politics to announce you’re taking away people’s health insurance, like, the month before people go to the polls? 

Luhby: Well, I mean, again, they’re saying that they’re actually not taking away health insurance. If you listen to the press conference, both Vice President Vance and CMS [Centers for Medicare & Medicaid Services] Administrator Mehmet Oz said that a lot of these people are phantom enrollees. That this is all just fraud. That brokers and agents, you know, seeking higher commissions, signed up people who don’t necessarily exist. And they argued that other people may not have known that they had ACA insurance, or they may not be eligible, so therefore they don’t qualify. Now, I’m not necessarily justifying that, but that’s what they’re arguing. They’re not saying they’re ripping it away from, you know, people who, you know, should be on the plans. And then, you know, they are taking some measures against fraud. They’re suspending brokers and agents who are suspected of fraud. They’re going to be more strict with the guidelines. But interestingly, they’re also putting a moratorium on new brokers and agents, which could make it harder for people to sign up in coming months. You know, as you said, Julie, open enrollment. Well, you had said it’s right before the election. It’s also right before open enrollment starts on Nov. 1. So, you know, I think there are probably a lot of brokers and agents, and, of course, the government navigators out there to help people. But, you know, it’s possible that some people may not be able to be helped as quickly because there is now this moratorium. But the discussion of the nonmedical claims, which Dr. Oz also really focused on, is coming from Paragon [Health Institute], which is run by Brian Blase, who was, you know, is a conservative health policy leader and was involved in the first Trump administration, and he’s definitely very involved in this administration as well. 

Rovner: And I actually saw some pushback about that, you know, how they are counting people who don’t file a claim. I saw some pushback from the insurance industry that said, you know, they’re double-counting some of these. If you’ve changed plans, if you, you know, even if you were only in a plan for a month and you didn’t file a claim, they’re looking at that as you having been enrolled in that plan all year. So yes, there definitely is some fraud. We’ve known this since my colleague Julie Appleby helped uncover what was going on back in, I think, 2023, definitely in 2024. The Biden administration addressed this; the Trump administration has also already addressed this. But it seems unlikely that they’re going to revoke, you know, 750,000 policies and all of those are going to be phantom enrollees, or people who didn’t know they had coverage. There’s going to be some number of those people who have insurance and assume they have insurance, or who assumed they had insurance and may go to use their insurance and find they no longer have it. 

Luhby: Right, and that is, I mean, people have definitely been concerned that some, you know, legitimate enrollees will be caught up on this. And you know that was a question that actually came up in the press conference, and they said, “Well, you know, we worked really hard. We sent FedEx letters. We tried to contact them. We knocked on doors. We went to their houses.” You know, I don’t know if they or the insurers actually did that, but yeah, there are people who are concerned that just giving people 30 days to respond and prove they’re real may not be enough. 

Kenen: On the politics level, there’s the two fighting messages, which is, you know, We’re getting rid of the crooks and the fraudsters, right? And then there’s the, more on the Democratic side, They’re taking, they’re ripping health insurance out of people’s hands. And the truth is, there’s, you know, Julie, you all just said, you know, there is fraud out there, and we all know that, and none of us are, I mean, we don’t want to be endorsing fraud. But there’s a policy reason, too. Some of these people who are supposedly not making claims are healthy. You know, like, they just didn’t get sick this year. Doesn’t mean they won’t get sick next year or be in a car accident, or what else? But right now, it’s good for insurance risk pools, it’s good for the ACA, to have healthy people in it. So the idea that we’re going to look for people who don’t have health claims and kick out the healthiest ones is just going to raise costs for the sick ones. It’s what they call the death spiral, right, or the insurance death spiral. So …  

Rovner: And it already is raising costs. We know that. 

Kenen: Right. Right. So, I mean, there’s something like, on a policy basis, yes, go for the fraud. Make sure it’s really fraud. Stop talking about the individual — although the CMS press release was balanced, it was really, it did not talk about crooked recipients. It really did talk … I went back and read it, because politicians talk about it differently. But the CMS press release was about brokers and fraud on the business side. It wasn’t blaming the individuals. But people hear “fraud,” and, you know, get away from that. Figure out where the fraud is and where the need is and what the smart economic policy — knowing what we know about insurance — is, and don’t do things that are going to raise costs as you scream “fraud.” 

Tribble: I guess the question I had actually was, you know, I did not cover this announcement, and, Tami, it sounds like maybe you did, but did they say they were cutting subsidies, or are they canceling the arrangements with the individuals? Like, are they working with the insurance companies, or are they just canceling? I don’t quite understand the actual practical implication of it, basically, what’s happening. 

Luhby: That’s also one thing that’s not 100% clear. 

Rovner: Yeah, I went back and watched, and yeah, it was all a little bit vague. So, we will see how this plays out. But I guarantee there are going to be people who are not fraudulent who are going to get caught up in this, because there always are. All right. 

Kenen: And there’s some people who don’t exist. I mean, there probably really are some phantoms. 

Rovner: And absolutely, I mean, I’m sure there are a lot of phantoms. I don’t doubt that. 

Tribble: And before you leave the topic, Julie, I think it bears pointing out that all of this is happening, this announcement comes just as people are looking at that open enrollment and looking at their premiums and deductibles and copays going up on the marketplace as well. So it’s just an onslaught against these ACA plans at this point. 

Rovner: That’s right. And one of the things we know is that it’s not the greedy insurance companies, as some politicians are saying. Healthcare costs are going up, and therefore premiums across the board in the ACA, in Medicare, in employer health insurance, premiums are going up everywhere. We’re seeing that this year.  

All right, moving on. Over the summer, we talked about a regulation from the White House Office of Management and Budget that would impose a layer of political oversight over the grant process, pretty much across the government. Congress has blocked that regulation, at least until December. But late last week, The Washington Post reported that the administration was preparing an executive order to create a political oversight committee just for grants from the National Institutes of Health, basically trying to ensure that all biomedical research funding advances the president’s priorities. It appears, as of Wednesday, the administration is backing off on that, after Senate Appropriations Committee Chair Susan Collins of Maine, who’s battling to keep her seat and with it the possible Republican majority in the entire Senate, she complained publicly about this. But what would it mean if the administration actually follows through with such an overt politicization of the scientific grant process? 

Tribble: I mean the power to veto the awards that the National Institutes of Health gives, the huge research portfolio that they have, and use politics to veto that, I mean, it’s just a really interesting battle going on because [NIH Director Jay] Bhattacharya, he, you know, he has long been an advocate of some of these policies that, or these research programs, that are focused on minority populations. So it’s interesting to watch play out. It’ll be interesting to see what the next step is for the administration. 

Rovner: Yeah, I mean, according to several news sources, I think this was , there was a big fight in the Oval Office last week with Jay Bhattacharya, the head of NIH, a former researcher who’s received NIH grants, and Russell Vought, the head of the Office of Management and Budget, who’s behind this effort to put a political layer of approval on top of the grant-making process. And, according to the stories, Vought won. Although now … after Susan Collins wrote a strongly worded letter, that I actually snidely said, “Well, this isn’t going to have much impact.” Clearly, it did. So I was wrong. And again, as I point out, Collins is also is embattled right now and needs to keep her seat. And it would behoove the administration for Collins to keep her seat and keep the Republican majority. But, you know, there seems to be a lot of pushing and pulling in this administration about, you know, how much they want to try and basically take away Congress’ ability to determine how this money gets spent. It’s $47 billion for NIH every year, and Congress has long, you know, bipartisanly, maintained that they get to determine how that money is spent, not the administration. They say, You’re going to spend it this way. The administration’s job is to do that. 

Kenen: The other thing is this fight, you know, which Collins has won for now, this panel overseeing your final review of grants, is not the politicization of science. The politicization of science started on Jan. 20 of 2025. NIH grants have been cut. We’ve all seen the wars. You know, like, “wars” is not too strong a word between the administration and leading research universities. The funding that’s been cut. Those are very NIH-funded institutions — Harvard being the one that’s sort of most in the headlines consistently, but it’s not just Harvard. There’s a list of banned words that if, you know, “diversity” and things like that, that you can’t get funded for. So there’s all sorts of politicization of science that has already occurred, that has been, is occurring every single day. This would have taken it to another level. Collins, for now, has won, and she has some — there’s a few other voices speaking up. I noticed that Sen. [Dave] McCormick, from — I believe … I’m saying his name right, Julie, correct me. I’m going to say that again. If it’s wrong, tell me later. I believe Sen. McCormick of Pennsylvania, a Republican of Pennsylvania, has and some statements saying, you know, science is important. Science cures. Science also is great for our economy. Science is a driver of … the ROI [return of investment] on NIH is high. So the politicization isn’t starting. … This was an attempt to escalate it, and we’ll see where it goes. I mean, Collins has been pretty consistent on this. She did get the temporary blockage of related proposals … 

Rovner: The regulation, yeah. 

Kenen: Yeah. So this has been a consistent issue for her, and, you know, I think she’s been successful so far. 

Rovner: Well, I think, and I’m so glad that you said that. You know, this all, the politicization of science started when this administration, you know, took office because I think that’s been one of the undercovered stories, really, of last year and this year, about how the nation’s entire biomedical research establishment is struggling under not just the cuts and the delays imposed by the administration, but the uncertainty and their inability to plan. The Harvard Crimson has two interesting stories this week related to this. In one, the Harvard School of Public Health is considering approaching some major health corporations, including UnitedHealthcare and CVS/Aetna, to help make up for the federal funding cuts that they’ve seen. Just two days later, the Crimson reported that three current and former Harvard researchers, one each from the medical school, the School of Public Health, and the Kennedy School of Government, are all leaving Harvard to go to Canadian universities. We’ve talked about a potential brain drain before, as European universities kind of upped their recruiting of American scientists. Are we actually seeing this exodus start? I mean, biomedical research, as you pointed out, Joanne, you know, the return on investment for biomedical research in this country has been huge. This is an enormous and bipartisan engine of economic development in this country, and people are sort of not paying attention as it’s kind of crumbling. 

Kenen: It’s not just scientists either. I mean, first of all, it’s not just Harvard. There are academics from across the country. I do not have the numbers. I can’t cite you an … accurate number. But scientists, researchers, and the social sciences and humanities too. I mean, there are academics, not just the international ones, who have to go home for some of the students, but the American academics in science and non-science have left the country in numbers that are worth paying attention to. Although it’s not like they’ve all gotten into, like, you know Noah’s Ark. … But the other thing is it’s not just future science. They have cut large numbers of clinical trials that were already underway, which means that we’ve lost the investment we already made, and that people, you know, who’ve been given their time and volunteered for these trials also don’t get, they got cut off from them. So, I mean, I just — it’s not a left-right thing. I just don’t understand the common sense of stopping a cancer trial midway or stopping an Alzheimer’s trial or anything else midway and throwing out the money and the knowledge, because these are not partisan. Republicans and Democrats agree that cancer is bad, you know, like Republicans and Democrats, and I dare say independents, don’t want to get Alzheimer’s or see their loved ones get Alzheimer’s. I’ve just never totally understood why this has been seen by top officials in the Trump administration as a good thing. 

 

Tribble: I mean, I think we need to go back to what you said, Joanne, which is January 2025. There were two executive orders on “woke” things, right? Diversity, inclusion, and all that. And I have not been focused on these particular grants, but I’ve been writing about the Digital Equity Act from a broadband standpoint that affects, you know, tons of rural Americans and their ability to do telehealth, for example, and things like that. And that act has been under fire from President Trump, and they have been using those executive orders as a way to sort of attack not only science and research and the things that we watch here with the federal agencies, but across the board in the administration. If it’s considered a “woke” mandate, they’ve gone after it. So I think we do have to go back to that and look at those executive orders and say that’s the game plan. Right? And so I just wanted to note that. I do think these grants have been undercovered. I think this research has been undercovered. But I also think across the board with this administration, those executive orders have had a large impact. 

Rovner: Yeah, you know, we talk about how executive orders don’t have the power of law. Although, I will say, in this administration, executive orders have had a lot of power to actually do things, as we’ve pointed out, sometimes maybe not legally. You know, sometimes we’ve had courts step in to stop them. But this administration has always been: Do it first and ask permission later. All right, we’re going to take a quick break. We’ll be right back. 

So I am old enough to remember when we were told that Republican pollsters told the White House to stop talking about — and stop HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. from talking about — vaccines, because anti-vax sentiment wasn’t popular with voters. Well, that advice didn’t seem to age well. Last week, we had RFK Jr. giving the keynote at a conference of the group Children’s Health Defense. That’s the anti-vax organization he helped found. In his hourlong-plus speech, Kennedy told the group that it has a “strong and steadfast friend” in Donald Trump, among other things, and promised new studies into the effects of electromagnetic fields and contrails, the water vapor clouds emitted by jets. Meanwhile, Trump himself doubled down on his earlier vaccine comments — this time, urging the drugmakers divide regular doses of vaccines into five separate doses. It’s not clear which vaccines he was talking about. In an effort to reduce autism, this, despite the fact that vaccine doses are carefully tested already, and there is no evidence that any vaccine or combination of vaccines has anything to do with causing autism. Do they care more about the anti-vaccine base and maybe getting them out to vote, or do they just not care that much about the majority of voters who believe that vaccines are, on balance, you know, a good thing? 

Tribble: I mean, I think that they are out campaigning, right? Like they are worried about the midterms, and they have sent Kennedy out to rural areas, in particular, which is why I know about this, to campaign on this. He’s been in Iowa trying to draw that MAHA crowd. So the anti-vax movement is part of the Make America Healthy Again movement, and it’s true that more people tend to believe that they can favor Make America Healthy Again — they tend to be folks who are also in the Make America Great Again camp, too, and have that identity. So if they can gin up the base, then I think they’re going to try to do that before November. 

Rovner: Yeah, back to what we were talking about at the beginning. It’s all a matter of who turns out. 

Kenen: The health part of, not MAGA, but MAHA is not all anti-vax, right? And some surveys have shown that many of them do vaccinate their children. And they’re concerned about pesticides. They’re concerned about ultraprocessed foods. They’re concerned about other things that, you know, many people would actually agree on, although they may identify more with the MAHA movement. So even within MAHA … they don’t all agree with Kennedy on vaccines. But I mean, I agree with Sarah. The timing of this and the intensity of this, as people are dying from measles, which Kennedy says they’re not — I think they see that in certain counties or areas of the country, the rejuvenation of the anti-vax conversation and orders and so forth is probably a voter intensity issue for them. Trump has never called for no vaccines. Trump has never said polio vaccine was a fake. I mean, he hasn’t gone anywhere near. He’s really in that, sort of, we have to change how we vaccinate, rather than we don’t want any vaccinations. He’s the changing the dose, smaller, you know. And of course, he exaggerates it. You know, those of us who have kids, they’ve never had a syringe the size of a vat. We don’t put vats of chemicals into our children. … I mean, how would they fit? I mean, very small babies. You know, you can put the baby in a vat, but you can’t put a vat in a baby. I mean, I agree that the timing is very political, and, you know, there were rumors a few months ago — not even a few months ago — there were rumors a few weeks ago that Kennedy would be out after the elections, and that, you know, Oz might go in. Now, interestingly, Oz has gone on TV and said the measles vaccine is good. Your child, you know, there’s measles out there. Get your kid vaccinated. But he’s not as loud as Kennedy. 

Rovner: Or as visible. Well, meanwhile, as we are taping today, the president’s nominee to lead the Food and Drug Administration, White House health policy aide Heidi Overton, is appearing before the Senate HELP [Health, Education, Pensions, and Labor] Committee for her confirmation hearing. It’s only just starting, so we will pick up on what happened there next week.  

Next up are drug prices. President Trump last Friday held yet another event at which he bragged about lowering drug prices. But I keep wondering: Has he really? Yes, drug prices are down a bit — not the 80% or 90% that Trump likes to say. It’s more like 3%. And analysts say at least some of that is due to the Medicare negotiations that were put in place under President [Joe] Biden, but are just now taking effect. So it’s not at all clear how much is due to the deals the president says he’s striking with these drug companies. Public Citizen actually got hold of some of the documents, and the agreements are pretty vague. I guess the big question is whether the public will believe the president when he says he’s lowered drug prices or whether they’ll believe what they see when they go to the pharmacy counter. Back to, again, back to what we were saying earlier. You know, it’s hard to talk about gas prices going down when every time you get in your car and drive, you see them on a big sign. I mean, I guess drug prices might be a little bit easier because not everybody takes drugs. But I’m wondering whether the people who do are believing him when he says this. 

Luhby: Right, and this has been, you know, one of his mantras in the first administration as well as now. And I fact-checked both his comments on that drug prices have been down this year and that we have the lowest prices in the world now, which is another thing that he loves to say. He loves to say that he’s strong-armed Germany and France and other European countries to lower their drug prices, which …  

Rovner: No, to raise their drug prices. 

Luhby: I’m sorry, to raise their drug prices, right? That we’re benefiting because now other countries are paying more and, you know, shouldering more of the burden. And, you know, the international experts that I’ve spoken to say there’s no evidence of that. So no, generally … you mentioned that the drug prices are down a little bit, 3% That’s from the CPI [Consumer Price Index], from the inflation index. But, you know, most experts don’t use that. People I spoke to said that that’s a very faulty measure. It shows the total cost at the pharmacy, but that’s also what insurers pay. So, you know, whether people are paying less, it’s hard to say. And as we know … what people pay at the pharmacy counter depends on their insurance. I mean, yes, there’s deductible issues and all of that, and copay issues, but, you know, that’s a yearlong contract typically, and it depends. And even today, in fact, showing that on TrumpRx — they looked at, I think, 32 drugs, and only about half of them actually did have lower prices than, you know, another comparable country. So it’s very murky. We did get some details from the Pfizer and Eli Lilly disclosures that Public Citizen got, but it’s also very heavily redacted. And [The] Washington Post, that , said that they omit key financial terms, the negotiated prices for drugs, and other provisions, making it difficult to independently assess the agreement’s values to taxpayers or the companies. You know, and I’m sure also to patients. So, you know, it’s unclear. 

Rovner: And another thing we know is that people who follow the stock prices of these companies have suggested that it’s not going to hurt the companies very much, which suggests that it’s not going to lower the prices very much. I mean, you can’t — again, we don’t know a lot of specifics, but that’s certainly an indicator that the companies don’t think that they’re going to have to lower their prices enough to hurt their profitability. Let’s put it that way. 

Luhby: Right. Some companies have mentioned some headwinds from U.S. pricing and MFN [most-favored-nation], but it’s not been a huge issue for them. 

Rovner: Yeah. 

Luhby: And from the beginning, I mean, you would think that when Pfizer started this out in September, oh, you know, if this was really a huge issue for Pfizer, their stock price would have plummeted, and, you know, that’s not the case. 

Rovner: It has not. Finally, this week, an update on that very sad and strange surrogacy case in California and Alaska and Texas. That’s where a surrogate, who was carrying a baby for a couple, wanted to keep the baby who was born with severe cardiac birth defects. That was after she, the surrogate, refused a request from the couple to terminate the pregnancy after the heart defect was detected in utero. This week, Supreme Court Justice Elena Kagan refused to overturn a lower-court decision allowing the baby to remain in the custody of his biological parents. This may or may not be the last word in this particular case, but I’m sure this is an issue that eventually will get heard by the high court. And good luck to the justices sorting it all out. You know, one of the difficulties that we have seen with some of these cases, with, you know, who really are parents? Is it the people who provide the genetic material or the people who carry the fetus determine what are we going to do when we have artificial wombs? And I think we’re going to go on. And Joanne, did you want to add something? 

Kenen: Yeah, most of these are state laws. Most of these surrogate cases are basically a state law, and maybe we’ll see that change. But I also think it’s important to point out that this child, the baby, was born. It does, in fact, have a heart defect, and the biological parents who got the custody, according to the court, are taking care of the baby — I forgot whether it’s a he or she — in the hospital.  

Rovner: It’s a he. 

Kenen: It’s a he, in the hospital getting the heart care. I don’t think the prognosis is great, but they are doing everything you can to make the baby as healthy and comfortable — from the press reports, I’m not in that hospital room. But this is a family that did not want to have a child with this really serious heart defect born. That is a fact. They wanted the abortion. They didn’t succeed. The courts prevented them from getting the abortion. The woman, the carrier, the gestational carrier, won that. But it is important to note that this couple is doing what I think all of us would, you know, agree: The child is getting medical care. 

Rovner: Yes. They have a baby, and they’re doing everything they can to keep him alive and get him well. 

Kenen: Other decisions get made down the road, and it’ll be their decision, you know. Hopefully, it’ll have as good an outcome as possible. It’s obviously not easy for anyone who has — I have never had a seriously ill child, but I have had friends who have. It’s unfortunate that the extra legal battle gets imposed on top of what’s, obviously, this is a family that, this is a couple who really wanted kids. You know, surrogacy is not cheap or easy or emotionally, you know, it’s difficult. And this is not a happy story for anybody. 

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

Luhby: OK. Well, my extra credit is an exclusive Wall Street Journal story titled “,” by Liz Essley Whyte. And, you know, we were talking about where the grant money goes. Well, some of it apparently is going for RFK security. So she noted in the story that the cost of the health secretary’s security jumped from about $10 million in the last fiscal year to $17 million this year. And what she said was striking was that HHS told Congress earlier this year that it was moving about $12 million from its Office of Minority Health to help cover the increased security costs. Now, Liz spoke to some internal unnamed sources, who told her that the secretary’s office had discretionary funds that it could have used instead, but it took the $12 million from the minority health fund to deal with across-the-board budget cuts. Now, I didn’t actually realize that this Office of Minority Health was created by President Ronald Reagan after a landmark report found that Black infants in the U.S. were more likely to die than white babies, and you know, among other disparities. And this, the office actually funds grants and efforts to close these gaps. Its budget, its annual budget, is about $74 million. So the other thing that the story noted, as we were discussing, a little different than NIH, but it said that HHS notified 16 nonprofits and universities in August that grants from the Office of Minority Health had been canceled. They were telling the nonprofits that the cancellations were due to limited funding and new priorities, and those new priorities include the root causes of infertility and reproductive health conditions, including low sperm count and erectile dysfunction. So that’s the story. I will say that an HHS spokeswoman told The Wall Street Journal: Secretary Kennedy faces much more serious, a different security environment, and that his protection reflects the threats he faces, his extensive travel, and the security required for him to safely carry out his duties nationwide. 

Rovner: OK. Joanne. 

Kenen: My friend, colleague, and co-author, Josh Sharfstein at [Johns] Hopkins, flagged this story for me, and he might have used as many exclamation points as I usually use in my email to him. It’s a Slate story. It’s quite a story. A Slate story by Molly Olmstead, and the headline is just called “” This is a long, involved story where each paragraph gets darker and more mind-boggling than the prior paragraph. The medbeds, in case any of you don’t know, are these fictitious things that Trump tweeted about — or maybe it was, I think, it was Truth Social — about a year ago, and then deleted it the next day. There’s never been an explanation. Medbeds do not exist, but they are believed, by people who think they exist, to cure all illnesses and make us all whole, healthy, probably happy … 

Rovner: And long lives!  

Kenen: … etc. Right. It’s — as the author, she calls it — a dark fantasy that we will be pain-free, that we will have forbidden knowledge, etc., etc. … Molly Olmstead decided to trace where did this come from. And her first thought was like QAnon, and then, so there’s a section about QAnon, and then .. she goes back. It wasn’t QAnon. Then she goes through New Age. She went to a yurt in Sedona, and she learned about subatomic tachyon, I’m not pronouncing it, particles, and it turns out it wasn’t even New Age. Without being a spoiler, it actually goes back to some people with rather ahead-of-their-time crazy beliefs in the 1960s! So just go read it. 

Rovner: Yeah, it’s quite the read. Sarah. 

Tribble: First, I just want to say, you know, reporters like the ones you’re mentioning are just amazing. Like, the work they’re doing and that digging into the agency spending and following those trails, and that’s why I picked this other one, John Wilkerson at Stat. My extra credit is “.” Now, the reason I really like this story is John knows Medicare. He knows MedPAC [the Medicare Payment Advisory Commission]. If you’ve ever sat in that room watching MedPAC discuss things, and then you talk to the experts … find out that Medicare Advantage was supposed to save Medicare money, but never has. Right? I say go read this story. It’s a very interesting analysis, basically, of how it could help insurers, but may not actually decrease Medicare Advantage payments at all anyway. So it’s just another ball down that road, but it’s definitely worth following. And kudos to John for writing it in a way that’s a fun read. 

Rovner: My story is also from a colleague who likes to dig for things. It’s from my Ñî¹óåú´«Ã½Ò•îl Health News colleague and cubicle mate, David Hilzenrath. It’s called “The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren’t Done.” It’s one of those stories that has been done before but needs to be repeated every so often: that when the FDA approves something with the requirement for postmarket follow-up, that follow-up often does not happen. The FDA has, for generations, tried to walk the fine line between getting promising treatments into the hands of patients as fast as possible while still ensuring that they are safe and effective. An analysis of FDA data found that nearly 600 postmarket studies that were supposed to have [been] done have been delayed, often by years. Which means not just that some products on the market may be causing problems, but even if they’re not, they might not actually be working, which wastes money and keeps patients sick. So, hats off to my colleagues who did this analysis, too. 

All right, that is this week’s show. Thanks to our editor this week, Stephanie Stapleton, 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. You can still find me on X , or on Bluesky . Where do you folks hang around these days on the socials? Sarah? 

Tribble: I’m mostly on LinkedIn, actually. So look for me on LinkedIn: . 

Rovner: Joanne. 

Kenen: I’m more on LinkedIn than anywhere else, too: JoanneKenen on . I’m a little bit on , and I still haven’t fixed my Twitter authenticator. 

Rovner: Tami. 

Luhby: You can find me at . 

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

[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. 

[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. 27, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.  

Today we are joined via video conference by Margot Sanger-Katz of The New York Times. 

Margot Sanger-Katz: Hello, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello! 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi. 

Rovner: Later in this episode, we’ll have my interview with Dean Rosen about his time working for Kansas Republican Sen. Nancy Landon Kassebaum, who died last week at the age of 94, and how she represented a type of lawmaker we don’t see that much anymore. But first, this week’s news. So we’re taking the next week off for a needed break for our entire team, which makes this the last podcast of the technical summer. And I thought I’d do something just a little bit different. I’m going to break the discussion up into what I’m calling “The Themes of the Summer” — things we’ve talked about nearly every week. I hope it gives some of you the realization that I get from putting this together every week, that we’re looking less at a long list of separate events and items and more at pieces of a much larger picture that we don’t often see. 

So, theme No. 1 this week is declining health coverage. When Republicans passed their big budget bill last summer, they thought they were being clever by backdating most of the Medicaid cuts so they wouldn’t happen before the 2026 midterms. Well, the problem for them is that states and health systems are already making their own cuts in anticipation of those federal cuts to come, and people are already starting to feel them. This week’s evidence is from a Stat News piece called “,” and it includes ways that access is shrinking overall, particularly in heavily rural states like Maine and Louisiana, as the number of people without insurance goes up and the money from the government goes down. Is it really possible that Republicans didn’t see this coming? Or did they really believe they could take a trillion dollars out of the nation’s healthcare system and not have people notice? 

Sanger-Katz: I think that many of them were not paying very close attention. I think it may be accurate to say that they were indifferent to this possibility and are, in fact, surprised now to see the way that it is working out. I just, you know, for context, this bill that made these very large cuts to Medicaid and some smaller cuts to Obamacare funding was part of this huge package that included, you know, major tax cuts and tax reforms that were a big priority for Republicans, changes to energy policy, changes to other social welfare programs, changes to education policy, and, you know, they called it the One Big Beautiful Bill. And I think the bigness of it is easy to forget, in retrospect. But I think for a lot of lawmakers, they were really focused on the parts of the bill that they really cared about. For many of them, it was the tax part of the package. And the president and their leadership repeatedly told them not to worry about the Medicaid changes, characterized them as not being cuts. And I think, you know, a good, responsible lawmaker ought to do some diligence about that. But I think that many of them maybe took their eye off of the healthcare parts of the bill, were focused more on these other parts of the bill, and now are really starting to see what is happening in their home states as these policies are starting to roll out. 

Roubein: And I also think it’s true that, like, some of the full impacts, as I think Daniel Payne pointed out in his Stat piece, won’t be felt for years to come, particularly as the Medicaid work requirements do kick in next year. So once there are more concrete human faces and examples, that tends to come to more the forefront and, like, you know, the political mind. So yes, those changes a lot of them are not fully going into effect till after the midterms. 

Rovner: I do think that one thing that lawmakers really didn’t appreciate was how much this might impact not just people who would be losing coverage, but people who would be losing access. I mean, people who still have coverage, but, you know, if a hospital can’t keep its door open, or a clinic can’t keep its door open, or a doctor can’t, you know, keep the practice going, that’s going to impact people with insurance as well as people who are losing their insurance. I mean, that’s, I think, that’s part of why this piece went to explore some of these more rural places, where people are going to feel this first. Shefali, I see you nodding. 

Luthra: Yeah, one thing I’ve been thinking about a lot is you do hear Republicans, especially someone like [Maine Sen.] Susan Collins, really trying to tout the rural health fund that was part of this, right, and that was meant to, at least rhetorically, offset these massive healthcare cuts. Obviously, you look at math, you look at numbers, and one doesn’t really undo the other. But …  

Rovner: Yeah, the rural health fund is, what, $150 billion of $1 trillion … ? 

Sanger-Katz: $50 billion, I think. 

Rovner: Or, oh, it was even less. 

Luthra: And so, yeah. I mean, I think what maybe people didn’t fully appreciate is that voters are less compelled, perhaps, by [lawmakers] saying I voted for this funding, and more compelled by what they see happening around them, which is these massive cuts resulting in major changes to what is often the biggest employer, what is often the only source of healthcare for miles, something that is very intimate, very much of the community. And that’s why this is just such a potent issue, especially in a lot of these really close Senate races now. 

Roubein: I mean, we’ve seen in the past how rural healthcare can impact politics. With Medicaid expansion, Republicans were really, really, really against it, and then you saw some begin to change their mind — North Carolina being a notable example, and just all of the ballot measures in red states — Oklahoma, for instance. 

Rovner: Idaho. 

Sanger-Katz: I think it’s worth just pointing out how much is still to come. I think a lot of what we’re seeing right now is hospitals and other healthcare organizations that were kind of in a difficult financial situation going into this change in policy. They’re looking around, they’re already in the red, and they see they’re not going to get more money in the future; they’re going to get less money. And so I think a lot of them are accelerating changes that they were hoping to stave off. But the real cuts in almost all cases have not come yet. So, you know, the work requirements, as Rachel noted, are going to reduce the number of people who are covered by Medicaid. So that means that a lot of these healthcare organizations are going to have to absorb uncompensated care that was previously paid for. But then, further down the road, there are actually much larger cuts that are coming to state Medicaid budgets that are done in these kind of complicated, a little bit obscure, formulaic ways. But there are these reductions on how much the state can directly pay hospitals for care. There are reductions in how much states can raise through Medicaid taxes that then get transferred back. And there, I think, have been very valid criticisms of these funding mechanisms for Medicaid. They are this kind of Rube Goldberg complicated ways of financing the program, but they’ve been around for decades, and these healthcare organizations and these state budgets have really been built on the foundation of these funding streams. And so, as that money starts to go away, I think, then we may see even larger impacts because, again, the things that are happening now are healthcare organizations looking down the road and thinking, Ooh, it’s going to get messy. Maybe I should start adjusting now. But down the road, it will start getting messy for them, and I think there are going to be potentially some much harder choices for some of these organizations. 

Rovner: Well, continuing along that theme, , we talked earlier this summer about a new rule from the Centers for Medicare & Medicaid Services to enforce the administration’s ban on the use of the Medicaid or CHIP [Children’s Health Insurance] Program to pay for gender-affirming care for minors. But it seems that the mechanism CMS is using could open the door to denying coverage for other drugs too, or at least some uses of other drugs. Now, this isn’t in the Stat story, but, Shefali, when I read it, I wondered if one goal here is to cut back on the use of drugs like misoprostol, which is used for a lot of things, but also for medication abortion. 

Luthra: That’s a really good question, and I think one that we still don’t really know. And obviously, a lot of states’ Medicaid doesn’t cover abortion to begin with. That really only happens in states that have actively made an effort. But, I mean, misoprostol is not only used for abortion; it is used for miscarriage management. And I think it’s just something really important for us to keep in mind what happens when you see these sorts of approaches to just, like, carving out individual forms of healthcare. And obviously, it’s very interesting as well because drugs used for gender-affirming care are also used for other things. RFK [Robert F. Kennedy] Jr. really loves hormone therapy for many people, just not trans people. And so I think there’s just a lot of questions that we don’t really have answers to about just how sweeping the implications of something like this could be. 

Rovner: Yeah, we will see as it goes. Well, it’s not just Medicaid. that CMS is clawing back billions of dollars in Affordable Care Act premium subsidies from insurers who have allegedly phantom enrollees, people with zero premium plans who don’t file claims. And while that is a known problem, a lot of those people might be actual enrollees who just haven’t needed their insurance yet, as in young, healthy folks who have health insurance just in case, or because their parents told them that they should, and, by the way, they could get a plan with a zero premium. And stripping these people from the rolls is likely to boost premiums overall by making risk pools sicker, in general. I feel like this administration might not be familiar with the bizarre and sometimes illogical way the health insurance market works? 

Sanger-Katz: I think there’s a delicate balance going on here, where if there are people who are enrolled in these plans who are fake, are not real people, do not know that they have insurance, never plan to use their insurance, you know, that is a waste of federal dollars to subsidize those premiums and just give that money to insurance companies. But I don’t think that there’s very strong evidence that there are a lot of these people. And I also think that the mere fact that someone has not used their health insurance yet, in a year, is not by itself evidence that they are a fake person or that their enrollment is fraudulent. As you said, Julie, there are a lot of reasons why people in this market may not have used their insurance. You know, a lot of the people who have become newly enrolled are relatively young and healthy. That is good for the risk pool, but it may mean they don’t have a lot of healthcare needs. There’s also, just because of the nature of the individual market, you know, one expert pointed out to me, there’s just a lot of churn. You know, someone loses their job, they sign up for a plan, then they get a different plan, or, you know, people who are in this market may only be in this market for a short period of time, and that may also explain why there’s a higher share of them who don’t make any claims, because they haven’t sort of gotten through the whole year, they haven’t had a healthcare need yet. So I think deciding to just disenroll people on this basis does risk disenrolling people who are legitimately insured, who are not phantoms, and who are not committing any kind of fraud. To the degree that there is fraudulent enrollment, and I think there’s evidence that there’s some of it, there are, you know, I think that is a valid concern, and I think the federal government is certainly within its rights to try to address that and make sure that these federal tax subsidies are being appropriately spent. 

Rovner: Yeah, I think “delicate balance” is exactly the right word. I mean, that’s, you know, with the work requirements too. I mean, the idea is to make sure that people are doing things. But if you make the administrative requirements so burdensome, then you’re going to throw off people who are legitimately enrolled. 

Moving on to the next theme of the summer: the resurgence of measles, and the continuing fight over vaccine policy. Until this week, the Trump administration had boasted that while measles cases have been rising pretty precipitously — they’re at the highest level in more than three decades — the U.S. was actually doing better than most other countries with outbreaks, and besides, no one had died of measles yet this year. Well, that worked until Tuesday, when the Pennsylvania Department of Health announced two measles-related deaths in Lancaster County — although we have few details other than that both people were unvaccinated and one was an infant. The announcement touched off a rather nasty war of words between Pennsylvania governor (and possible 2028 presidential candidate) Democrat Josh Shapiro and HHS Secretary Robert F. Kennedy Jr., who said that the state was not cooperating with federal health officials, and maybe the people didn’t actually die of measles after all. This isn’t really going to get more people vaccinated, I would suggest — this just sort of fighting back and forth, right? 

Luthra: It’s a good question. It certainly doesn’t help. I think one thing I was thinking about this morning, and this is not measles-specific, but there’s a really great New Yorker piece from this week looking at the actual vaccine data over the past year and a half, and obviously people are affected by public rhetoric, but the declines in vaccination are not as big as one might have feared when RFK Jr. was initially nominated and really made a point of highlighting anti-vaccine beliefs. And so obviously, like, this is, the fact that people are dying is very bad. The fact that they’re sowing confusion … 

Rovner: The fact that people are getting measles is very bad! 

Luthra: Yes, it’s very, very bad. It’s not, none of it is good. But that was actually really striking to me that amidst all of this, like, really terrible news, there is a bright spot, which is that things could be a lot worse. That is something that I hadn’t thought about. 

Roubein: I mean, if, I think … I’ve been thinking about this today, like, if you kind of step back from the really high-level view, I think Americans who are watching this are confused. They are not sure who to trust. There are, you know, Republicans are saying one thing, Kennedy allies are saying one thing, the Department of Health [and Human Services] and Gov. Shapiro, Democrats are saying another thing. You’re seeing a, you know, a war of words between, like, Republican and Democratic county commissioners on this, you know, just from a public health messaging standpoint. 

Rovner: Yeah, it has not been a great job of communication all the way around. I think there, I mean, there are even, you know, public health defenders who are saying, Why don’t we know more about these two deaths yet? There’s been not a lot of information, and that has, of course, as we saw, you know, during covid, the more noninformation you have, the more people try to fill in their own information, whether it’s true or not.  

Well, even before the Pennsylvania news, we had a somewhat excruciating pair of appearances on CBS’ Sunday show Face the Nation this week. First, CMS Administrator Dr. [Mehmet] Oz needed three separate tries to be able to say that, no, President [Donald] Trump was incorrect when he said in his Oval Office vaccine event that the measles, mumps, rubella combination shot was lethal. Spoiler: It is not. Then Florida Republican congressman Byron Donalds, who’s now the Republican candidate for governor, said the measles outbreak there has been caused by illegal immigration rather than residents not getting their children vaccinated. What happened to the idea we heard last winter that being anti-vax wasn’t good politics? I think this speaks to what you were just saying, Shefali. You know, I think in January and February we thought that Republicans were going to sort of leave this alone and focus on other things. 

Sanger-Katz: Well, I think one thing that we’ve learned recently is that while a lot of the president’s advisers and political staff, I think, were concerned that an anti-vaccine message was damaging, what we’ve seen is that the president himself sincerely has anti-vaccine views and has been saying them out in public. And so I think it does put other Republican political figures in a difficult bind, and certainly puts folks like Dr. Oz, who work in the administration, in a difficult place. Whatever his genuine views are, whatever his political advisers and his public health advisers are telling him, he works for President Trump, and President Trump has made it pretty clear what he thinks. And so I think that’s why we are now seeing this kind of new round of muddled messaging around vaccines, when I do think for a little while there was kind of a pullback on the most overt anti-vaccine rhetoric, and, you know, we saw RFK talking less about it, for example, in public. Now, I think we’re in a little bit of a new phase, where the president is leading the way back. 

Roubein: Yeah, I mean, I think that’s exactly right, and I mean, Trump has, you know, privately questioned why his administration had yet to release new vaccine recommendations, , with Lena [H. Sun] and my colleague Dan [Diamond]. And that’s, you know, some of what, a lot of what drove the executive order that we saw from just a few weeks ago to reduce the childhood vaccine schedule. Trump says he wants to break up the MMR shot. That’s not something that is currently available, but, you know, he has driven that by pushing some of his advisers. 

Rovner: Yeah, absolutely. Well, meanwhile, demonstrating just how expensive it is to track, trace, and quarantine people after a confirmed case of measles. One Denver outbreak that ended up being just 10 cases still cost state and local agencies nearly a half a million dollars, almost 7,000 hours of work from 189 staff members, not to mention 91 people being quarantined and 500 days of school being missed. We may call public health invisible when it works, but it is certainly not cheap. 

Roubein: Yeah, I mean we don’t talk about the economics of it very often. I mean, public health officials always say that they are underfunded, but just, in general, the talk of the economics here is generally not a huge part of the conversation. 

Sanger-Katz: And measles is just such a difficult disease to contain because it is so contagious. It is one of the most contagious infectious diseases out there. And so that means that any person who has measles just has the potential to spread it to so many people. And I think that really strains these traditional public health approaches of trying to track, trace, and quarantine because you have to find so many contacts. 

Rovner: Yeah, just a reminder, I mean, measles can linger in the air after the infected person has left for, I think it’s like, two hours. So it’s, you know, anybody who’s been in a place where somebody with measles has been is potentially at risk if they’re not vaccinated. 

Sanger-Katz: I mean, we remember how hard this was with covid. Of course, in the early days, no one was vaccinated, so there were more people who were susceptible to covid. But measles is substantially more contagious even than covid. 

Rovner: Yeah. Well, as yet, as the debate continues to rage over vaccines, the evidence continues to pile up that vaccines are actually, on balance, a very good thing. Just this week, we have two more studies. of 4 million teens and young adults that found that those who received that controversial mRNA-based covid vaccine were less likely than those who just got covid to develop myocarditis or other heart problems. That was something that people were worried about with young people getting this vaccine. appears to confirm that the shingles vaccine, Shingrix, appears to not only have a protective effect against dementia, something we reported earlier this year, but also against cardiovascular disease. How do we get to a place where vaccines have become controversial again? I assume, I mean, I want to go back, Margot, to what you were saying that it does seem that President Trump himself has anti-vax views that I think we didn’t appreciate until this year. I mean, I think most of us thought that this was all being driven by RFK Jr., who’d obviously made a career of being anti-vax. But when he backed off, we saw the president basically fill right in, and that’s kind of where we are? 

Sanger-Katz: And I also think this is a reminder to us, both of these studies and others that have come out recently, that, you know, vaccines have some risks. They do. But infectious disease can be really dangerous for people, and it can have lingering and downstream effects that are not obvious. It’s not just that you get sick in the moment that you get sick, but having that disease affects your body in ways that may show up much later. And I think some of these longer-term studies that are following people — you know, not just in the weeks and months after they get a vaccine, but what happens years later to their heart or to other major organ systems —really shows that preventing people from getting serious illness is good for their long-term health. 

Rovner: Yeah. 

Roubein: And I mean, Secretary Kennedy, just to go back to last year, he did drive changes. He fired CDC’s [the Centers for Disease Control and Prevention’s] vaccine advisers, who had made changes to vaccines. The health department did release a new childhood, slimmed-down childhood immunization schedule earlier this year. A lot of those changes, though, have been on hold from a federal judge. 

Rovner: Yeah, he also fired the head of the CDC, who refused to rubber-stamp his vaccine changes. So, he was busy before he got sort of unbusy with this. All right, we are going to take a quick break. We will be right back. 

OK, our next theme of the summer are the continued cutbacks by the Trump administration to federal health programs, including some of those that have been specifically funded by Congress. First up is a story from Ñî¹óåú´«Ã½Ò•îl Health News this week about how, at the same time President Trump can’t stop talking about the increasing rates of autism and what a problem it is, the administration is scaling back enforcement of civil rights protections for people with autism, research into the education needs of people with all sorts of disabilities, and even data collection efforts. So, on the one hand, the president keeps pressuring RFK Jr. to find a definite cause of autism, but at the same time, this administration is doing less to help those who are already diagnosed? 

Luthra: I think what I find really interesting every time we talk about this is the really, really long tail of funding cuts, because this is something on, like, a broad macro scale that began at the beginning of this administration, right? Just massive funding cuts and freezes across the board and have continued. And because of the way grant-making works, because of the way research works, we keep seeing the consequences. We keep getting more people reporting, “Oh, my funding didn’t come,” or “This was held up,” or “This project I was working on no longer can.” And what I think is also really interesting is we see how slow the ability to respond is because of the long tail of funding cuts. I mean, courts take a long time, finding new funding when you suddenly lose yours actually is very difficult. And this is something that we’re just going to keep coming back to. We are going to be seeing the consequences of these funding cuts for months and years, as we’ve been talking, but also for much longer as the consequences in terms of research, of cures developed or not developed, becomes even more clear. 

Rovner: Yeah, although sometimes I think it’s going to be hard to connect the dots to get from, you know, from you cut this so this didn’t happen. It’s almost going to be like proving a negative at some point. 

Well, another big theme this summer has been drug prices, particularly prices for those expensive GLP-1 weight loss drugs. As part of the administration’s push to make those drugs less expensive for the end users, CMS offered states the option to participate in its direct negotiations with the drug manufacturers if they would offer them through their Medicaid programs. Only, , so far only one state has taken up the offer, and more states are actually cutting back on their GLP-1 coverage through Medicaid that they have been offering because it’s been such a financial strain on their programs. Several state officials told Politico that they worry about the long-term financial sustainability of the program. I know it’s also a worry for the Medicare GLP-1 program, which is basically at this point a year-and-a-half-long pilot for drugs that, as far as we know, need to be taken indefinitely. Is it fair to say that the president has not really been able to keep his promise to make these drugs cheaper and much more widely available, or that if he has, people may end up getting them yanked out from underneath of them? 

Sanger-Katz: I think it’s complicated. I think it’s hard to know how much credit the president should get. But I will say that the prices for these drugs — the kind of cash-pay prices, that he was able to negotiate allegedly, and that he was able to announce certainly a few months ago — were substantially lower than what individuals and insurers, including some public insurers, were paying for those drugs. So we are now seeing a kind of cash price for the main anti-obesity drugs that is much more affordable than it had been in the past. I think some of that was driven by market pressures and would have happened regardless of the president’s intervention. But I think certainly his pushing these companies, his threatening of these companies, his cajoling of these companies probably maybe did induce them to sort of do it at the same time, to do it faster, and to do it more prominently. 

Rovner: Well, some of it already had happened, before he got in. The self-pay cost had already gone down because so many insurers had stopped covering it. 

Sanger-Katz: It had gone down, but it then went down again.  

Rovner: It did. 

Sanger-Katz: The prices that are available now that the president announced are lower than what we had seen in the past, and they are a major discount even compared to the previously lowered prices that had been public. So I think that is a real thing. Whether or not those prices were meaningfully lower than the price that the Medicaid programs in states were already paying is a little bit of an unanswered question. But my understanding from talking to some Medicaid officials is that Medicaid was already getting very similar prices, even before the president announced these discounts. And that’s because Medicaid has, by law, gets the best price for drugs. They get discounts that are not available to other purchasers. And Medicaid budgets are quite tight. You know, as we were just discussing, all of these state Medicaid programs are facing very substantial cuts that are coming down as the rollout of the big tax-and-spending bill is implemented. And the states that went early and did cover GLP-1 drugs for obesity, I think that they saw that interest and uptake really exceeded their expectations. There were a lot of people in the Medicaid population who stood to benefit from these drugs, and that when so many of them enrolled at once and started taking these drugs at once, it did create, I think, an unanticipated budget strain. So I think states are in a difficult position. This pilot is offering them this cash price for their Medicaid programs, and I think a lot of them are looking at that, and they’re saying, “Well, this is, like, a good price. It’s not that much better than what we could have gotten before, and we weren’t doing it before because we didn’t think that we could afford it.” And so I think those circumstances really haven’t changed. It will be interesting to see what happens over time. It does seem like there is huge potential public health benefit for Medicaid populations if these programs can find a way to cover these drugs. You know, the evidence about the health benefits of these drugs for people who have obesity are just really tremendous, and we’re seeing them over numerous, different health conditions and body systems. And, you know, in my own reporting on North Carolina’s Medicaid program, which was one of the early ones to cover these drugs, you know, I just talked to a lot of people who were really excited about having this opportunity to take this drug. People who had really struggled with their weight and related illnesses, and, you know, were glad that the state was offering it to them. And now, you know, North Carolina has had, is one of the states that’s had to roll back. 

Rovner: Yep. All right. Well, finally, this week, a word about Dolly Parton, possibly the only person in America who was pretty literally loved by everyone. The country and pop music superstar and actress who was known for her genuine kindness and generosity was, in fact, also an important healthcare philanthropist. A lot of people probably remember she gave a million dollars to Vanderbilt University in 2020 to help develop the aforementioned mRNA-based covid vaccine. What people might not remember is that she also used her own money to fund pediatric infectious disease research, underwrite a women’s healthcare center in the East Tennessee county where she was raised, and help train pediatric health professionals. There are celebrities who lend their name and their time and sometimes their money to causes to help burnish their personal PR, and then there are those who clearly do it because they want to give back. I think it’s fair to say that Dolly Parton was one of the latter, and I think she’s going to really be remembered for a lot of the work that she did on bringing healthcare to more people, right? 

Luthra: Yeah, yeah. It’s very sad. 

Rovner: It is. And healthcare owes her a debt. All right, that is this week’s news. Now we’ll play my interview with Dean Rosen, and we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast Dean Rosen. Dean is a partner at Mehlman Consulting, where he landed after a long career on both sides of Capitol Hill, during which he helped shape some of the most important health legislation of the 1990s and early 2000s, including President George W. Bush’s HIV/AIDS program, PEPFAR; the Medicare prescription drug law; and the 1997 Balanced Budget Act. But before all those things, Dean was the top health aide to Sen. Nancy Landon Kassebaum, the Kansas Republican who passed away last week at the age of 94. After Republicans took over Congress in the wave election of 1994, Kassebaum chaired the then-Senate Labor and Human Resources Committee, now the HELP [Health, Education, Labor, and Pensions] Committee, and stewarded the surprisingly difficult path to law of what was originally a very bipartisan bill, the Health Insurance Portability and Accountability Act of 1996, or HIPAA. Dean Rosen, welcome. 

Dean Rosen: Thanks, Julie. I’m honored to be here, and I’m a longtime fan of What the Health? — so this is a real great opportunity. Excited to be with you. 

Rovner: Great. So, HIPAA, which was known at the time as Kassebaum-Kennedy for its bipartisan Senate sponsors — your boss and the late Edward M. Kennedy, a Democrat of Massachusetts — is today mostly known for its medical records confidentiality provisions. But that’s not how it started out, right? It was really an effort to do something bipartisan in the wake of the failed Bill Clinton very partisan health plan. Talk about how it kind of came to be. 

Rosen: Yeah, that’s exactly right. It sort of started in the Senate and then moved to the House and then moved to a traditional conference committee, which we don’t seem to do very much of, either, anymore these days. But when it started off, it really did start, as you said, as a health insurance portability bill, and just a really, in some ways, minimalist solutions-oriented legislative proposal that was designed to try to get at what was really, I think, the core concern, or one of the core concerns, at the time, which was people’s ability to get and maintain health insurance if they had preexisting conditions.  

And really what happened was the Clinton plan had kind of imploded spectacularly, as you know, despite the fact that there were huge Democratic majorities in the House and the Senate — not filibuster-proof, but close in the Senate — and the Democrats just couldn’t … get it done. And they couldn’t get any Republican support. They couldn’t get enough Democratic support. And then in the 1994 election, something unexpected happened. I guess polling was a little less sophisticated at the time, but you had the “Republican Revolution” led by [who] was to be Speaker [Newt] Gingrich in the House, and you had the Senate — which had changed hands before, but the House, which had not changed hands and had been in Democratic control for 40 years — switch, and Republicans were ascendant. Bill Clinton was still president. I think probably some of the fact that there was such a gain of seats had something to do with the failure of health reform. And Republicans were getting ready to move a very aggressive deregulatory agenda. And Ted Kennedy, who was a liberal lion of the Senate, who you know was a champion of universal coverage and other liberal causes, moved from the majority side of the dais and having the gavel at the Senate Labor Committee, now the HELP Committee, to the minority side. And Sen. Kassebaum, who had hired me just a few months before that, all of a sudden became the first woman to chair a major committee in the Senate, a standing committee in the Senate. And really, what started it, was that Sen. Kennedy and his team came over and met with us, and somewhat surprisingly, said, “Hey, I know I’m for universal coverage, but I’m willing to do something that’s much more modest,” and shared with Sen. Kassebaum and me and the team a chart that they had put together showing where, not had there been disagreement, but where actually there had been agreement among the major plans, ranging from the most liberal, the Clinton plan, to some of the most conservative plans. And the heart of that, Julie, was health insurance portability, preexisting condition protections at access, and that was the bill that started off in the Senate, and that’s the one that gained traction and passed until we got to the House. 

Rovner: So, Sen. Kassebaum was one of those legislators who actually believed in passing laws, even if it meant compromising — so you only achieved a few of your goals at a time. Why are there so few people like that on either side anymore? 

Rosen: Yeah, well, you know, I think I would say also about HIPAA that it … she was an incrementalist. I think she was one of the reasons … she was considered a moderate Republican in the day, and I think now even more moderate. But she was at her heart a conservative in the sense of she believed that the best legislating was done sort of inch by inch, step by step, as opposed to in one bill. And you sort of saw that proof come to be when the Clinton plan failed, because it tried to really do everything in the healthcare system; it was huge. I think to your question: Today, it’s harder because there’s just less overlap, and the incentives are such that, you know, as one current member of Congress, very senior, told me a couple years ago, if you’re a Republican, you’re looking over your right shoulder. If you’re a Democrat, you’re looking over your left shoulder. And I think that the venerable, you know, Cook Political Report says that in this election, there are only truly 18 toss-up seats in the House out of 435. And so, what it means is that, you know, 5% of the country is going to decide who controls the House ultimately, and the incentives are not to put together bipartisan bills, big or small, healthcare or not healthcare. But the incentive is, frankly, to play to your base, particularly in a midterm election. Now, that’s not always the case. You do have examples of bipartisanship, but I think it’s harder because of those incentives, which we’ve seen become more and more true as politics has changed, and, frankly, as the country’s changed. 

Rovner: You wrote a really lovely tribute to the senator about going to the White House for the signing of HIPAA by Bill Clinton, which I think just showed sort of the generosity of spirit of Sen. Kassebaum. Tell us about it? 

Rosen: Yeah, so, you know, after Nancy passed away, there’s a group of us who’ve been keeping up through chat over the years, and her family, actually granddaughter and stepdaughter, had informed us all before they informed the press over the weekend that she had passed away. And I suddenly was sitting there over the weekend and realizing, Julie, that it had been — she had died 30 years to the day since HIPAA was signed by Bill Clinton. And, you know, to your point of bipartisanship, that bill passed the House with only two dissenting votes and the Senate unanimously. So not only was it bipartisan, but it passed unanimously. 

So we went over to the White House — to kind of tell a little bit of the story — I’d never been to the White House before. This was, like, my first job on Capitol Hill. I was much younger then, and — obviously — and the senator made sure I was on the invitation list. And this was, you know, Sen. Kassebaum was not really known as a legislator who was someone who passed, you know, tons of major bills. This was really, if you read all the obituaries, the health insurance portability law is one of the two bills they mention — the other one being a general aviation bill, and her work internationally, which was significant around apartheid. But they mention this health insurance bill as her signature achievement. So we go to the White House. It’s a hot August day, and as I said, I realized that she died 30 years to the day after this bill was signed. And I was reflecting on the fact of something that I never really shared publicly before, that at the signing ceremony, it’s traditional — as you know, you’ve probably been to many, many, many of these — that the presidents will sign these bills, they’ll use multiple pens, as Bill Clinton did, and he handed one of the pens to Sen. Kennedy, and he handed another one to Sen. Kassebaum — we’re standing over each of his shoulders. And we’re walking out of the Rose Garden, and Sen. Kassebaum came over to me, and it was just the two of us, and she said, “Here, I want you to have the pen. You wrote the bill.” And, you know, I guess as a staff person you do, but I didn’t think of it that way. I thought of the fact that she was giving away to me really one of the most tangible symbols of her signature bill, and I said, “I can’t take this. This is your bill. This is one of your crowning achievements. You worked so hard to get this done.” And she insisted that I keep it.  

And as I said in the piece that I wrote, you know, it struck me that that was just essential Nancy Kassebaum, that not only in the legislation could she find ways to work with Ted Kennedy, who, she said, in subsequent interviews, coming from Kansas — and folks will appreciate this with Wicked being out — that I think a lot of Kansans thought that Ted Kennedy was the Wicked Witch of the East. But working with Ted Kennedy to get something passed into law, and then coming over to me with no ceremony, with no one around, with no political advantage, and just saying, “Here, I’d like to give you credit, as opposed to taking credit for myself,” I think said a lot about her character, and I shared that story with her family, and they gave me permission to share it publicly. I think it just goes to her character and who she was, which, as I said, I think is, much more important than the legislative achievement, was just the kind of person that it takes to get things like that done in Washington today, and, frankly, in Washington then. 

Rovner: Any chance we’re going to get back to seeing those kinds of legislators on Capitol Hill? We’re both in this for the long run. 

Rosen: Yeah, you know, I have to say, you know, I prefer to be somebody, Julie, who looks forward. I mean, you know, you can look back and wring your hands and be pessimistic. But, you know, I came to Washington as a [Ronald] Reagan Republican, and Reagan always said that he felt like American optimism was the heart of the country, and that our best days were ahead. And I really do feel optimistic about the country. We’ve survived a lot over the last 250 years, and you’ve got examples of bipartisan legislation. You’ve got, you know, Dr. [John] Joyce and [Rep. Greg] Murphy, and [Rep. Kim] Schrier, a bipartisan bill in the House that takes on the difficult and expensive issue of Medicare physician reform. You’ve got a bill by Sen. [Chuck] Grassley and [Catherine] Cortez Masto and others in the Senate that got introduced a couple weeks ago on fraud and abuse at a time when that issue could be really political. 

So to me, I do see people of goodwill in both parties who want to get things done. I think we’ve got to recognize, as we talked about a moment ago, that the broader incentives in our country and in our political environment and in our institutions are pulling people apart. And I think it is going to take people of goodwill to find things to do where they can compromise without losing their principles and find ways to make progress. And I do see hopeful signs of that. You know, I’m not sure we’re going to get back to the day where there’s tremendous overlap and a huge number of moderates in either party, but I think it makes it even more important that people of goodwill who come to Washington as citizen legislators and want to solve things find ways to do that. And in this divided government, where we’ve seen 12 change elections of the last 14 and extremely narrow historic margins, it’s going to take both sides to get things done. 

Rovner: We will keep watching, Dean Rosen. Thank you so much. 

Rosen: Thanks, Julie. Thanks for having me. 

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

Roubein: My extra credit is from The New York Times. The headline is “,” by Noah Daly and Andrew Jacobs. And the story is about how Americans are traveling abroad, often to Latin America, for psychedelics, a form of medical tourism, and the authors write that this could carry substantial risks. There’s no official tally of injuries, deaths, or adverse events at the overseas psychedelic clinics. But The New York Times interviewed more than two dozen patients and researchers, who cited just a litany of troubling episodes. Basically, the field of psychedelics is in its infancy, so researchers have found this sort of patchwork of standards and rules. And, just for context, here in the United States, the FDA hasn’t approved a psychedelic as of yet, but the idea has really gained traction in recent years for mental health conditions, but particularly, this spring, when President Trump signed an executive order that was aimed at accelerating research into the drugs and also fast-tracking federal reviews of psychedelic medicines. But advocates for these drugs do have concerns about adverse events at overseas clinics because they don’t want it to, you know, kind of spark a backlash that could hamper this trajectory. The Times did speak to a practitioner who said that his prescribing practices were informed by a patient’s self-reported medical history. But I thought this was a really interesting look at what’s happening overbroad given there’s been so much chatter about psychedelics in the United States. 

Rovner: Something else to worry about. Margot. 

Sanger-Katz: I wanted to recommend an article in Stat from Anil Oza. Headline is “.” And this story outlines that a number of people who had submitted comments on a rule about science funding suddenly found their comments removed from the public record. And it appears that the reason is because they were making reference to Russell Vought, the OMB [Office of Management and Budget] head, who, you know, was behind this rule. He has a child with cystic fibrosis who has benefited from a [National Institutes of Health] NIH-funded drug, and I think a lot of them were making reference to that as part of a personal plea for him not to implement this policy. But it’s a little bit puzzling why OMB removed them, on what basis. They haven’t been transparent about it, and there have been basically no explanations. And I think, you know, Secretary Kennedy, during his confirmation hearings, talked about radical transparency in the HHS process and policymaking. And I think this is one of many examples where that really hasn’t happened. There has been a reluctance, I think, by HHS to go through notice-and-comment rulemaking in situations where it is not necessary. There has been a reluctance sometimes to answer questions from the public, from reporters, and I do think that the kind of deletion without explanation of these comments is part of that broader pattern. There is obviously this personal sensitivity here that is part of it, and there may be some valid reason why this public official’s child should not be in the federal record. But it would be nice if someone would explain. 

Rovner: Yeah, and also props not just to Stat, but to the people who actually have been tracking these comments and noticed that they were taken down. Shefali. 

Luthra: All right. My story is from LJ Dawson. It is a collaboration between Ñî¹óåú´«Ã½Ò•îl Health News and The Washington Post. The headline is “.” This story combines many of my interests, like European vacations, Greece, and fertility treatment. And I think it’s a really, really, like, interesting and useful look into just how expensive this can be for Americans, especially if insurance doesn’t cover it, and the lengths to which people go to become pregnant. And the family that the story follows, they live in Florida. They could only get pregnant through IVF [in vitro fertilization]. They were quoted close to $40,000 for a round, and they were like, This is nowhere near what we can afford. They realized it was much cheaper to travel to Greece, to literally go on vacation in Greece and get IVF done there. And this is a thing that people genuinely do. Like, I know many people who have looked into the costs of IVF in different European countries, including Scandinavian ones. And I think it’s just a really helpful, dramatic look at what happens when people really, really would benefit from a medical treatment for achieving their fertility goals, their reproductive goals, etc., but it is simply not affordable. And I think this is also interesting because there has been so much chatter about making IVF more affordable, but, in fact, it is more expensive than ever and more in demand than ever because people are having children later, more likely to need fertility treatment, and we don’t really have a good solution yet in sight. 

Rovner: No, except that our system is way too expensive. Well, you may have noticed that in my themes of the summer, I left out the unusual spate of foodborne illnesses. Well, fear not. My extra credit this week is also from The Washington Post. It’s by Tamar Haspel. It’s called “.” And it makes a pretty good case that lettuce and its leafy green cousins are not only the foods most likely to result in foodborne illness, but it’s also not got much to offer nutritionally. It doesn’t store very well, and the land that we use to cultivate it could be better used for, well, better food. I have to say, I stopped buying lettuce a long time ago, mostly because it doesn’t keep very well, and I live by myself. And while I do eat plenty of salad, it’s mostly cucumbers, peppers, and tomatoes. Now, you guys all do you, but I can just say that I haven’t contracted cyclospora this summer. 

All right, 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 , or on Bluesky . Where are you guys hanging these days? Shefali. 

Luthra: I’m on Bluesky . 

Rovner: Margot. 

Sanger-Katz: I am all the places , and on Signal at sangerkatz.01. 

Rovner: Rachel. 

Roubein: Several places: on X, ; Bluesky, ; ; Signal; etc. 

Rovner: As I mentioned at the top, we’re taking next week off. You should too, if you can. It’s going to be a busy fall. We will be back in your feed on Sept. 10. Until then, be healthy.