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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 20, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Research and Quality. 

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

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

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

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

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

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

Kenen: [Arlen] Specter. 

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

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

Rovner: Different place. 

Kenen: Yeah, frozen. 

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

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

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

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

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

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

Rovner: “She” Schwartz?  

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

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

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

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

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

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

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

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

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

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

Rovner: Nonprofit insurance company. 

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

Rovner: Hey! 

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

Rovner: I am. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mark Cuban: Thanks for having me. 

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

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

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

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

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

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

Rovner: So, what do you fix first? 

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

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

Cuban: Correct. 

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

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

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

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

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

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

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

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

Rovner: Thank you so much. 

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

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

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

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

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

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

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

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

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

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

Ollstein: on Bluesky and on X. 

Rovner: Shefali. 

Luthra: on Bluesky. 

Rovner: Joanne. 

Kenen: Mostly on and on . 

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

[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. 13, 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 Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my “Bill of the Month” interview with Paula Andalo. But first, this week’s news. We’ll start this week with vaccine policy — more specifically, vaccine policy being made from the Oval Office. On Monday, President [Donald] Trump, surrounded by HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr., and other health officials, signed an executive order calling for “gold-standard” childhood vaccine recommendations. The order calls for the current federal childhood vaccine schedule to be divided into three parts: one with a shorter list of shots recommended for all children, another list for high-risk populations, and a final list of vaccines to be given as a result of “shared decision-making” between doctors and parents. The president also wants to separate the combination measles, mumps, and rubella vaccine into three separate shots, which don’t actually exist in the U.S. at the moment. That would necessitate more visits for parents and more individual sticks for kids. While the order itself has no force of law, it does direct each executive department and agency to “take [any] appropriate steps to advance them, to the fullest extent allowable by law.” So, what’s the immediate impact of this? Besides a whole lot of confusion, because when RFK Jr. tried to do essentially this, back last year, it was blocked by a federal judge. 

Edney: Yeah, I think confusion is the main impact of this right now. You know, this comes in the news every so often because President Trump has not wanted to let this go, even though we kind of thought he was — or at least RFK Jr. was — directed to let it go because of the midterms and how that was looking. But this is something that President Trump has really had on his agenda and not let go. And I think that there is not really a possibility for an immediate impact, say, with breaking up the shots. Like it doesn’t, like you said, it doesn’t exist here. Merck, which is a company that makes these MMR shots, said that could take up to 10 years. It’s not just a simple thing for them to do. So, in the meantime, you have some parents who are wondering, Well, is this bad? Like, what should I be doing? How … you know. So I think confusion is the No. 1 impact here. 

Rovner: Yeah, I want to break this down into sort of what it means for health and what it means for policy and what it means for politics. So, in terms of health, the U.S. is already in the midst of its worst measles outbreak since 1991, and we’re seeing more cases of other vaccine-preventable diseases, including whooping cough and even tetanus. And pediatricians are already slammed. How are they ever going to make room for all these extra appointments and parent discussions of these vaccines that used to be sort of generally recommended and now are going to have to be the subject of individual discussions? Anna, you’re the mom on the panel. 

Edney: Yeah, I was thinking that from the parents’ side, but yes, from the pediatricians’ side as well. I mean, they’re already overwhelmed. They already have a huge list of patients trying to get in for many things. And from the parents’ side and the child’s side, this is, like you had mentioned, more sticks. … The children will have to be given more shots in this case, and a lot of times that can mean missed shots because going once kind of gets everything done. We all like to have a one-stop shop versus having to go to a bunch of different times. And so, besides the confusion, [it] could decrease vaccine adherence because people just might miss those shots. You know, they’re going into the first year of childhood, so many parents, even in the first couple weeks or months, are back at work and are having to carve out time for this. So it could, you know, it could really overwhelm the physician, the pediatricians’ offices, with these conversations, and you know, kind of just lead to actually less protection for children. 

Rovner: And hence, I’d say, the increase in vaccine-preventable diseases that we’re actually seeing. Go ahead, Maya. 

Goldman: I was just going to say there are also all these other logistical concerns — like we mentioned, these shots don’t even exist yet in the U.S. So that’s, you know, step one. But then you need more storage at the pediatrician’s office for a shot that’s three separate shots instead of one combination. You need more people working at the office to accommodate all the extra appointments that are already in a shortage of pediatricians in a lot of places in the country, and healthcare support workers. And so it’s just this huge cascade of side effects. 

Edney: Yeah, and I think we should add to that: When President Trump talked about this from the Oval Office, he linked wanting to separate these shots to the rise in autism, and there is evidence that’s showing that that is an issue, and that the shots should be separated for that reason. 

Rovner: And just last week, we had another large-scale study that showed no increase in autism due to childhood vaccines. I want to talk about policy, too. There’s one particularly ominous phrase in the EO [executive order] that says that states, who set the rules on which vaccines are required for school attendance, are “advised to review” the recommendations and “consider updating relevant laws and regulations that define the scope of immunization requirements.” On a brief call with reporters on Monday, one administration official suggested that newly sworn-in Attorney General Todd Blanche could go after states that don’t provide enough exceptions to their immunization policies with violating federal religious freedom laws. Is this really good policy or good politics? I mean, most states — I did go back and look — most states have exceptions, have medical exceptions; obviously, if a kid can’t take a shot, a kid can’t take the shot. Most of them also have religious exceptions. But it’s not clear how broad this administration wants those exceptions to be, and what it might do about states that don’t allow exceptions. I would note that one of the few states that has almost no exceptions is West Virginia, which is a very red state. 

Raman: I think this is really the area to watch on this. I mean, a lot of the other pieces of this executive order are broader, and I think a little bit more, you know, messaging to the political base based on some of these logistical issues that we’ve outlined. But this is a direct action to three different agencies, you know, to look at these exemptions. And this is already something that they’ve been investigating … there are already some lawsuits about some of these exceptions in the five states that don’t have, as you know, the same exemptions as other states. So I think here is really the area to look, especially with Blanche now confirmed, and just keeping an eye on some of the existing cases that are already there challenging some of these exceptions. Because this is really where we could see movement, or, just even on the state level, for them passing additional laws. You know, that was something mentioned in the presser too, that they were going to encourage states to do this. So I think state level is somewhere to really look, especially … vaccine requirements come down to schools, and those are on a state-by-state level done by [the Department of] Education, not HHS. So that’s where I would be watching. 

Rovner: Yeah, there’s more to come, I suspect, here. Before we leave this, though, I want to talk a little bit about the politics. I mean, Anna, you mentioned this. There were polls that showed that going after vaccines was not very popular with Democrats or Republicans, and that Secretary Kennedy was told earlier this year to focus on other things instead. Why is Trump bringing this up two months before the midterms? I mean, who — what politics is this aimed at? I guess is my question, because I certainly don’t know. 

Edney: From the reporting that I’ve read, and you know, , and Politico. This is just something that Trump himself believes and does not want to let go. He’s talked to the HHS secretary about it time and time again, saying, you know, basically needling him to get on it, even though others have told him not to do that. And so it seems like something that the president really wanted to happen. And just given this discussion we just had, I think it’s pretty evident that most of it is kind of a “We let him do his thing.” He got to talk about it in the Oval Office, and, like, hopefully he’ll shut up about it now, and nothing will actually happen. I think that that is a possibility. 

Rovner: We’ll see if nothing actually happens. But one more thing before we leave the vaccine wars topic, a story from last week that caught my eye: Texas Attorney General Ken Paxton, who is also Texas Republican Senate candidate Ken Paxton, announced in his AG role that he has opened an investigation into the American Academy of Pediatrics. That’s the group that’s led the charge to preserve the immunization schedule, according to, you know, science. Paxton, in a press release, says his office is looking into “concerns that the organization may be promoting and recommending childhood vaccines for financial gain.” Now, given that most pediatricians lose money on giving vaccines, that feels like a bit of a stretch. Or am I missing something here? 

Goldman: Yeah, I think, what I interpreted from that announcement was, you know, he’s concerned about the organization of AAP, which has some big funders in the pharmaceutical companies. So maybe he’s claiming that the organization is worried they’re going to lose that funding, as opposed to individual pediatricians making money off vaccines. But I think it’s really from AAP’s perspective: damned if you do, damned if you don’t, right? This is something that they have done the science on, looked into, and that’s what their basis is. Be very interesting to see if this actually goes to court and if there’s, you know, a legal argument to be made here. I think this is, like, something that is just starting to unfold. 

Raman: What struck me was it’s similar to what we’ve seen in other areas as well. It’s the same kind of rationale we’ve had going after some of the transgender medical professional groups. You know, saying that they’ve made various recommendations about gender-affirming care for financial gain, and questioning some of those decisions. So in that way it’s not unique, especially since Texas has kind of led the charge on some of those. But I do think it’s interesting that we’re going after some of the same organizations for this again and again. 

Rovner: Yeah, I’m wondering sort of the political benefit for Paxton of going after the American Academy of Pediatrics, but we shall see. All right, speaking of politics, the Centers for Disease Control and Prevention got a new director this week — at least according to its website; I have not seen that she’s actually been sworn in — a year after its old director was ousted for refusing to rubber-stamp Secretary Kennedy’s handpicked vaccine advisers’ recommendations. Erica Schwartz, a former deputy surgeon general, told the Senate HELP [Health, Education, Labor, and Pensions] Committee during her confirmation hearings that she supports the vaccine schedule and would “never betray the science.” She’s about to get tested on that, isn’t she? 

Raman: I think it was a really interesting choice they didn’t swear her in before they held that event and bring her out there. You know, we did have [Jay] Bhattacharya as the acting official, but they could have easily brought her in there to speak on that, and they didn’t. I think that was a conscious decision. 

Goldman: I was just going to say they waited until she got confirmed. 

Rovner: I would say she got confirmed last week, and the event was on Monday, so they could have sworn her in in time for the event. 

Goldman: Right, they did the event after they confirmed her, but before they swore her in. 

Rovner: Right. 

Goldman: To shore up support in the Senate. 

Rovner: Fair point. Yes, rather than rub it in [Sen. Bill] Cassidy’s face right before he voted to confirm her; that is an excellent point in terms of the timing. Well, meanwhile, things at the CDC are still apparently not great. It’s been almost exactly a year, not just since the last director was ousted, but since a gunman literally shot up the building, killing a security officer because the gunman’s father said he believed that the covid vaccine had made him suicidal. Secretary Kennedy went to visit the CDC campus in Atlanta for a memorial for the officer last week and held a fireside chat with CDC staff, who were, shall we say, not very impressed with his fireside manner. Among other things, according to a transcript of the meeting, he repeated that scientists are not trustworthy. All this comes at a time when CDC is fighting an Ebola outbreak in Africa, several foodborne outbreaks here in the U.S., and the aforementioned spike in vaccine-preventable diseases. It’s not a great time for the CDC, is it? 

Goldman: It’s really not. And there’s a this week by an anonymous CDC staffer that sort of outlines all of the different things that, you know, I’ve even forgotten the CDC has gone through in the last year — thinking about Ebola and funding cuts and just, this person said, that they can still see damage from the bullet holes when they’re sitting in their office it hasn’t been fixed. And you really have to feel for these workers that are trying to do their best but not being given the resources or support to do it. 

Rovner: Yeah, and I will say, you know, after decades of covering the CDC, the people who work for CDC are, you know, among the most mission-driven people in healthcare. I mean, they toil in sort of the, you know, most difficult parts of the healthcare system and are, like, constantly fighting uphill battles and not getting a lot of support, I would suggest, from the current administration. Well, meanwhile, the never-ending Medicaid news keeps on coming. This week, the Trump administration issued final rules banning certain gender-affirming care for minors. Now, this is separate from its rules for hospitals, right, Sandhya? You wrote about this, yes? 

Raman: Yeah. So the rule this time is related to Medicaid for under 18, and for states that also fund the CHIP [Children’s Health Insurance Program], under 19 they would also have to comply with this rule. And kind of what struck me was that we, you know, just on this podcast, I think, maybe a month or so ago there was this, you know, is the administration going to pull this back or not? And there had been reporting saying that they were, and then HHS said, Yes, we are still going ahead with this rule. So indeed, they did. I think this is part of the broader framework, like you said, of different things related to them wanting to emphasize biological sex in their various rulemaking. 

Goldman: Yeah, I think an important distinction about this particular policy is that it strips federal funding, federal Medicaid funding, from states to cover gender-affirming care for minors. So states can still use their own state dollars if they choose to. Private insurance can still cover this, no problem. This is not a ban on gender-affirming care, but it will certainly make things more difficult for children on Medicaid who need this care, want this care. And, especially as states are facing so many other cost pressures, it’s going to be hard to come up with money to patch this hole if they want to do that. 

Rovner: And, to be clear, we’re not talking about surgery here. I mean, we’re talking about all kinds of care, including counseling, right? 

Goldman: Counseling actually is not included in this one. 

Rovner: Oh, OK. 

Goldman: They can still use federal Medicaid funding to cover counseling. 

Rovner: But not other forms of nonsurgical gender-affirming care. 

Goldman: Yes, hormone therapy, puberty blockers, exactly, which are recommended for kids with gender dysphoria by most major medical associations. 

Rovner: Including the aforementioned American Academy of Pediatrics. All right, next in the Medicaid realm: those work requirements that begin next January. We’ve talked at some length about how the federal government is going to give people an extra year to self-attest that they are too sick to work before they have to get proof from a medical professional. But points out that some states aren’t taking that option. Eight Republican-dominated states, including Arkansas, Idaho, Ohio, and Indiana, are declining that grace period and making their work rules even stricter than the administration is otherwise requiring. What’s the likely impact of this? That in January they’re going to have to start proving immediately that they’re either too sick to work or they could lose their Medicaid. 

Edney: Well, I think the, usually, at least the point of doing a rollout, I guess, is giving states time to figure it all out and giving people time to understand what they need to do. So those states are choosing not to do that. So it seems like this could create a lot more chaos than even was anticipated in the first place, and maybe potentially a lot more people coming off the rolls than when maybe they shouldn’t have been, just because of paperwork errors or misunderstandings and things like that. 

Rovner: And much like pediatricians who are worried about having to break up vaccine appointments into multiple appointments, doctors are kind of freaked out about having to see all these patients so they can, you know, write them notes to excuse them from the work requirements, which is another burden that I don’t know that Congress really fully accepted when it was deciding, and the administration was deciding, how to implement these work rules. 

Edney: You know, that’s not something they normally do assess, whether someone can go back to work. So I’m sure they would probably prefer not to be doing that, but if they, you know, without the time and the ability to figure this out, it could be even tougher, and people will be trying to rush to get in there to get this done. 

Rovner: Well, I guess we’ll be watching these as “the early states,” when this all begins. All right, we’re going to take a quick break. We’ll be right back. 

So, the vaccine executive order from the president very much overshadowed what I think HHS Secretary Kennedy had hoped would be the big HHS story this week: the unveiling of proposed new standards for food additives that have been deemed “generally recognized as safe,” or GRAS. The rules, which have been a long time coming, as in several administrations long, wouldn’t so much make it harder for companies to use food additives like thickeners and stabilizers that are often seen in highly processed foods, but it would require companies to tell the FDA how it’s using those substances. And it stops well short of what former Republican FDA commissioner David Kessler had been urging in a citizen petition, that he filed more than a year ago, that would have made companies actually prove that those products are safe before they can put them in the food supply. Why are these rules so timid? Isn’t, you know, making the food supply safer Kennedy’s, one of his biggest MAHA [Make America Healthy Again] goals? 

Edney: It seemed to me that the way the FDA put it was that they needed Congress basically to step in to boost their ability maybe to do more. Sometimes that’s an excuse not to do more. Sometimes it really is true that they could really open themselves up to challenges from Big Food and court challenges that they don’t want to fight. And so they do the thing that they think they’re able to, and then tell Congress, you know, we need you to go the rest of the way. 

Rovner: Interesting, because they don’t seem to be afraid of court challenges or, you know, stepping on Congress’ toes on lots of other things. I mean, is this really just emblematic of the power of Big Food? I mean, we’ve already seen, you know, Kennedy be sort of squashed by the power of Big Pesticide. 

Edney: Yeah, I think that that’s absolutely the case — that Big Food, you know, they put their lobbying to work, and they talked about how this could stop them from being able to innovate and being able to get newer things into our food, and that basically we should trust them — what they’re putting in there is safe. And so that has had some sway. Particularly, there have been a lot of industries that have been able to go to the White House and make those cases and kind of water down things that RFK or, like you said, former FDA commissioner [Marty] Makary had said they were going to do. 

Goldman: I’ve also seen some statements from, quote-unquote, “Big Food” lobbying groups arguing that this is an affordability issue. You know, if they have to comply with all these extra rules and regulations and pre-market reviews, that could tank the president’s affordability agenda, is something that I saw. 

Rovner: I would say we’re all still waiting for the new definition of highly processed food, so we will see what that ends up. On another subject regulated by HHS, Secretary Kennedy also announced major action to start the process of decertifying the organ procurement organization that coordinates organ transplants for the region that includes Kentucky and parts of Indiana, Ohio, and West Virginia. OPOs are the go-betweens between medical professionals who care for patients who become organ donors and those who care for the transplant recipients. There’s been a lot of attention to some pretty big failings in the organ transplant network over the past couple of years. This case cites instances where potential donors were not yet dead. That’s a big problem. But you have to wonder if the public is going to wonder whether dramatic action like this is warranted because the OPO really is deficient, or whether it’s political, since we’ve seen this administration going after some states and some organizations for what they say is fraud that looks like it might more be about electoral politics. 

Raman: I think this is a little different. With this organization, Network for Hope, we’ve had a lot of action over the past year or so on this organization in general. We had congressional hearings about it. We had letters from lawmakers with concerns about this, and it’s not the first time that they’ve moved to decertify. You know, there was a division of University of Miami Health System that they decertified last year. Again, documented problems about this, and even if you listen to some of the statements from Democratic lawmakers, they are not against this. I think that, you know, it’s a recognized problem across political lines, which is a little different than some of the issues where fraud is being, you know, viewed more through one lens than another. 

Rovner: There is a point at which HHS is supposed to regulate organizations. I mean … when they find evidence of an organization not doing what it’s supposed to, they’re supposed to take action. That’s kind of how the government works. Sorry. 

Edney: You know, The New York Times has done a lot of great reporting on the organ procurement system and showing many, many flaws. But I think for this one, specifically, when I read about what made HHS look into it, it is shocking and a little scary. So I do understand. You know, what happened was there was a man who overdosed and he wasn’t quite dead, but they were starting the procurement process, and he was waking up. And it just seemed like they kept going on this a little too far. He survived; they didn’t get any organs out of him. But if you sign that form that says you’re an organ donor, it’s not something you want to think about: If something happens to you and you’re not quite dead, that they might decide to go ahead. And then HHS did find that this had happened on many occasions. So I think that it seems like something that the government should have stepped in on. 

Rovner: Yeah, there were some pretty serious deficiencies here. All right, well that is this week’s news, or at least as much as we could get to. Now we’ll play my “Bill of the Month” interview with Paula Andalo, and then we will come back and do our extra credits. 

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

Paula Andalo: Hi. How are you? 

Rovner: So this month’s patient is kind of a success story, right? Someone with a nonemergency condition and no health insurance who was nonetheless able to shop around for the best price? Tell us who he is, where he lives, and what kind of care he needed. 

Andalo: Yeah, his name is Ronmel Rangel, and he’s from Venezuela. He moved to the U.S. in 2019 to live with one of [his] daughters that live[s] in Portland, Maine, and he has been living there since. 

Rovner: And then he got sick and needed …  

Andalo: So it was interesting because 25 years ago he had an inguinal hernia and he had surgery in Venezuela. And at the end of last year, he began to feel a pain on the other side of the body. Again, it was a hernia, so he needed surgery. 

Rovner: So he’d been through this before. 

Andalo: Yeah, yeah, in a different health system. So he doesn’t have insurance, although he’s a green-card holder, so he can have insurance. But when he moved here — now he’s 64, so it was six, seven years ago — and he was looking around, you know, the Obamacare and all the stuff. But he realized that for his age, the prices were crazy. He’s a pretty healthy person, so he decided to not have insurance. Instead, he began to see a doctor in a concierge medicine. You know these kind of practices that charge as little as $70 per month to unlimited visits and some small procedures like stitches or …  

Rovner: But not hernia repair. 

Andalo: Not hernia. So at that moment he needed surgery. 

Rovner: Right. So he did the medical tourism thing, looking both here in the U.S. and in some other countries, where he had family that he could stay with. And, a bit surprisingly to me, at least, he found the best price here in the U.S.? 

Andalo: Yeah, it was like a miracle. Yeah, he looked in Oklahoma, but it was far away. Also, he has a daughter living in Santiago, in Chile, and he looked there, and it was very expensive, adding also the cost of traveling to Chile. So, he finally found his place in Maryland. In Rockville, Maryland, in a place called Affordable Surgery Center. He had his procedure in April. 

Rovner: And how much did he end up paying — I guess both for the travel and for the hernia repair? 

Andalo: Well, the first estimate that he had was in his state in a big health system, and at that moment the estimate was $23,000 for a laparoscopic procedure. In this center in Maryland, the total cost, including anesthesia, was $2,900. 

Rovner: Wow. 

Andalo: So, adding the cost of tickets for him and his wife and one night of hotel, etc., it was less than $5,000. 

Rovner: Wow. So that’s a whole lot less, even than he could have gotten at home in Maine. 

Andalo: Yeah, exactly. 

Rovner: So what’s the takeaway here, other than that medical tourism doesn’t have to mean a trip to another country to find the most cost-effective care? 

Andalo: Well, the takeaway is that you can shop around, especially if you have an elective procedure, so you have time. Because if you have an emergency, you don’t have time. But with these kinds of procedures that are pretty common, and there are different options to do it, you can shop around and look for the best place. He had the help of his family doctor — that was very helpful, you know, helping him with lists of places. But he has had time to shop around, to look for prices, and to take care of his hernia. 

Rovner: And I guess it’s important to remember that the most expensive isn’t always the best, but the cheapest also isn’t always the best. 

Andalo: Exactly. So one advice is, the expert says, that you need to look at the reviews of the place and do your homework to realize that if it’s a good place. Although the research says that sometimes higher prices doesn’t mean better care, but in these kinds of procedures, you can pay much less if you shop around. 

Rovner: Well, nice to have a happy ending for a change. Paula Andalo, thank you so much. 

Andalo: Thank you. 

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

Goldman: Sure. My extra credit this week is an article titled “.” This one is in The New York Times by Mark Arsenault. I am a University of Michigan alum, just like Julie, and so this one caught my eye. But it’s also very interesting to hear what, you know, universities are taking student mental health seriously to the point where they’re making big policy changes or, at least in this case, piloting policy changes to try to get at the root of the problem. I have my own skepticism that this is, you know, the root of the problem. Academic pressures are certainly a big stressor for students adjusting to college, and so maybe this could help. But I think that this is a multifaceted problem, and I’m interested to see how they’re going to measure the success of this. But this isn’t the first university to have done it. There are a couple others: MIT, Brown. The University of Michigan is a massive school with a lot more students, though, so I think it’ll be interesting to see if other schools of that ilk follow suit. 

Rovner: I would just point out that I went to the University of Michigan in the 1970s, and even then we could take classes pass/fail if we wanted to. It’s not really all that new. But yes, I’ve seen a lot of rolled eyes this week about this story. Anna, why don’t you go next? 

Edney: Mine is from CBS News by Julia Ingram: “.” I thought it was a smart thing to look at, that this farm had not been inspected since 2019. And not just that, but that the FDA has been really lagging on all of their foreign food safety inspections, not even meeting 10% of the goal that Congress had set for them about a decade ago. And I thought that was just a great way to get into this story and talk about inspections and how the FDA is struggling. They’ve struggled for a while to meet these kinds of mandates, but showing how it’s now gotten even worse since there have been lots of cuts within the agency. 

Rovner: Yep, that we’ve been talking about, and these are the result of those cuts. Sandhya. 

Raman: My pick this week comes from NOTUS, and it’s from Margaret Manto, and it’s called “.” I am from West Virginia, so was a reason why I was really intrigued by reading this story. But it’s really good. It looks at the work of a pediatrician in the small town of Summersville, and West Virginia has some of the highest childhood vaccine rates in the U.S. And the county where Summersville is has some really high rates compared to some of the more populous counties that are around it. This is a county that voted three times for President Trump. And just looking a lot at the changing climate regarding, you know, vaccination and attitudes there, and, you know, rural health more broadly. 

Rovner: It’s a really good story. Well, my extra credit this week is from the journal Health Affairs by my soon-to-be boss here at KFF, Mollyann Brodie. It’s a to one of her, and my, health policy heroes, Bob Blendon, the Harvard health policy professor who passed away earlier this summer. Molly was lucky enough to have studied under Bob, which I never got to do. But I still feel like one of his students, as he was always so generous with his time and so very quotable, and contributed so much to my personal understanding of the intersection of health policy and politics, which I try to share with all of you every week. We miss Bob already. May his memory be a blessing, and may he live on in those that he taught. 

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

Goldman: I’m mostly hanging out on under my name. 

Rovner: Anna? 

Edney: , , @annaedney. 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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