Tulane University researchers have developed a first-of-its-kind handheld diagnostic device that can deliver rapid, accurate tuberculosis diagnoses in under an hour, according to a study published in Science Translational Medicine.

The smartphone-sized, battery-powered lab-in-tube assay (LIT) provides a cost-effective tool that can improve TB diagnoses, particularly in resource-limited rural areas where health care facilities and lab equipment are less accessible. Over 90% of new TB cases occur in low- and middle-income countries.

This point-of-care device is the first to detect Mycobacterium tuberculosis (Mtb) DNA in saliva, in addition to blood and sputum samples. Saliva is easier to obtain than blood or sputum, and the ability to non-invasively obtain samples that yield accurate results is critical for successfully testing children. More than 1 million children fall ill with TB each year and more than half go undiagnosed or unreported, according to the World Health Organization.

Tuberculosis is the world’s deadliest infectious disease, infecting an estimated 10 million people a year. The current resurgence of TB cases, exacerbated by recent disruptions in healthcare services, underscores the urgent need for effective, accessible diagnostic tools.

“TB remains a critical public health concern in low-income countries and diagnosis using a cheap, simple test like we’ve developed is needed not only to treat patients with TB but prevent further spread of the disease,” said senior author Tony Hu, PhD, Weatherhead Presidential Chair in Biotechnology Innovation and director of the Tulane Center for Cellular & Molecular Diagnostics. “An estimated 4.2 million TB cases were undiagnosed or unreported in 2021, largely due to limitations and costs of testing in areas with high disease burden.”

Current testing devices are larger, expensive and require either extensive on-site technology or shipment of samples to a laboratory elsewhere. The LIT test is designed to offer a low-cost TB testing solution, with each device costing less than $800 and less than $3 per test. In comparison, another commonly used TB testing device costs at minimum $19,000 and the cost per test is around $100 in certain countries.

In the study, the LIT device demonstrated high accuracy in testing blood samples from children in the Dominican Republic, outperforming the more expensive machine – 81% sensitivity compared to 68% – and meeting the WHO criteria for TB diagnostics. Blood serum-based testing – testing that utilizes the liquid part of drawn blood after coagulation – is particularly important in children and patients living with HIV who often cannot produce sputum. The LIT assay results suggest that blood samples could be used to monitor TB treatment progress, as they closely align with the improvement in patient symptoms.

“This system reduces the expertise and equipment required for TB diagnosis which is essential for point-of-care application,” said lead author, Brady Youngquist, a graduate student in the Tulane University Center for Cellular and Molecular Diagnostics. “Saliva-based testing for TB is particularly exciting because it can be easily obtained in all patients and can be used for portable testing without the need for blood draw. And sputum is often not produced in children and patients living with HIV, a common co-infection.”

Reference:

Brady M. Youngquist et al. ,Rapid tuberculosis diagnosis from respiratory or blood samples by a low cost, portable lab-in-tube assay.Sci. Transl. Med.17,eadp6411(2025).DOI:10.1126/scitranslmed.adp6411.

USA: Preliminary results from the PANDOME study, published in The Journal of Clinical Endocrinology & Metabolism, have spotlighted deteriorating diabetes (DD) as a significant early warning sign for pancreatic cancer (PC), especially in individuals over the age of 50. Conducted by Dr. Richard C. Frank and colleagues from the Department of Medicine, Division of Hematology/Oncology at Nuvance Health, Norwalk, Connecticut, the study aimed to evaluate the feasibility and utility of screening for pancreatic cancer in high-risk diabetic subgroups.

Pancreatic cancer remains one of the most lethal malignancies, primarily because it often goes undetected until advanced stages. However, earlier studies have shown that people over 50 who develop new-onset diabetes (NOD) have a six-to-eight-fold higher risk of developing pancreatic cancer. In light of emerging data, researchers also considered worsening or deteriorating diabetes, a condition marked by rapid glycemic decline, as a potential predictor of pancreatic cancer.

Over a span of six years, the PANDOME team screened 625 individuals aged over 50, ultimately enrolling 109 participants. Among them, 97 were diagnosed with NOD and 12 with DD. All participants underwent magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), alongside routine monitoring for psychological well-being, blood biobanking, and documentation of physician referrals and glycemic indicators.

The study revealed the following findings:

• The DD cohort showed more severe clinical features compared to the NOD group.
• Individuals with DD had significantly higher HbA1c levels.
• There was a greater weight loss in the DD group.
• Insulin dependency was more common among those with DD.
• These signs point to a more aggressive pattern of metabolic deterioration in DD patients.
• Endocrinologists were the main source of referrals for individuals in the DD cohort.
• Out of 109 participants, four underwent pancreatic biopsies following suspicious imaging findings.
• One person from the DD group was diagnosed with early-stage pancreatic ductal adenocarcinoma.
• This corresponded to a pancreatic cancer detection rate of 0.9%.
• The imaging procedures did not raise any safety concerns.
• Several benign or incidental pancreatic findings were identified without complications.

This marks the first instance of a screen-detected, early-stage pancreatic cancer case in a sporadic, high-risk cohort. The researchers emphasized that this finding supports including patients with deteriorating diabetes in future screening protocols. By identifying and closely monitoring this subgroup, healthcare providers may have a unique window to detect pancreatic malignancies at a curable stage.

The authors concluded, "The PANDOME study sheds light on a promising strategy for early pancreatic cancer detection by targeting individuals over 50 with newly emerging or worsening diabetes. As the study continues, these initial insights could pave the way for broader, more refined screening efforts aimed at improving survival rates for this deadly disease."

Reference:

Frank, R. C., Shim, B., Lo, T., Pandya, D., Krebs, T. L., Ma, C., Labow, D., Denowitz, J., Anand, N., Krumholtz, P., Sullivan, K., Sanchez, M., Dong, X. E., Seshadri, R., Trinidad, A., & Jin, D. Pancreatic Cancer Screening in New-Onset and Deteriorating Diabetes: Preliminary Results from the PANDOME Study. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgaf319

Dr Ram Manohar Lohia Hospital, formerly known as Willingdon Hospital, was established by the British for their staff and had only 54 beds. After independence, its control was shifted to New Delhi Municipal Committee. In 1954, its control was again transferred to the Central Government of Independent India.

RML Hospital Vacancy Details:

Total no of vacancies: 31

The Vacancies are in the Department of Anaesthesia, Cardiac Anaesthesia, Dermatology, Endocrinology, Medicine, Neonatology, Paediatrics, Paediatrics Cardiology, Paediatrics Surgery, Transfusion Medicine, CTVS, Orthopaedics, and Neurosurgery.

The Walk-In-Interview is started from 16th to 19th June 2025.

Venue and Reporting Time:- Room No. 104, 1st Floor, Administrative Block, ABVIMS on 9.30 a.m. to 10:45 a.m.

For more details about Qualifications, Age, Pay Allowance, and much more, click on the given link:https://medicaljob.in/jobs.php?post_type=&job_tags=RML+Hospital&location=&job_sector=all

Eligible Candidates (How to Apply)?

Suitable and willing candidate may report in Room No. 104, Floor, Administrative Block, ABVIMS for walk-in-interview between 9.30 a.m. to 10:45 a.m. on the aforesaid dates along with duly filled in application form (2 copies of Annexure-I), 4 passport size photographs, original and two set of photocopies of relevant documents. No TA/DA is admissible for attending the interview.

It is requested that the enclosed advertisement may kindly be uploaded on the website www.rmlh.nic.in immediately.

All the EWS candidates are requested to submit Income and Asset Certificate issued by any one of the following authorities in the prescribed format as given in Annexure-I.

• District Magistrate/ Additional District Magistrate/ Collector/ Deputy Commissioner/ Additional Deputy Commissioner/ It Class Stipendiary Magistrate/ Sub-Divisional Magistrate/ Taluka Magistrate/ Executive Magistrate/ Extra Assistant Commissioner.

• Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/ Presidency Magistrate

• Revenue Officer not below the rank of Tehsildar and Sub-Divisional Officer or the area where the candidate and/ or his family normally resides.

Also Read:JIPMER Jobs 2025: SR Post Via Walk In Interview, Here's All Details

Here are the top medical news for the day:

New mRNA Vaccine May Be More Effective Against Evolving Viruses

A new type of mRNA vaccine is more scalable and adaptable to continuously evolving viruses such as SARS-CoV-2 and H5N1, according to a study by researchers at University of Pittsburgh School of Public Health and the Pennsylvania State University. The study was published in npj Vaccines.

Current mRNA vaccines, such as those used to prevent COVID-19, present two significant challenges: the high amount of mRNA needed to produce them and the constantly evolving nature of the pathogen.

To address these challenges, the researchers created a proof-of-concept COVID-19 vaccine using what's known as a "trans-amplifying" mRNA platform.

In this approach, the mRNA is separated into two fragments -- the antigen sequence and the replicase sequence -- the latter of which can be produced in advance, saving crucial time in the event a new vaccine must be developed urgently and produced at scale.

Additionally, the researchers analyzed the spike-protein sequences of all known variants of the SARS-CoV-2 for commonalities, rendering what's known as a "consensus spike protein" as the basis for the vaccine's antigen.

In mice, the vaccine induced a robust immune response against many strains of SARS-CoV-2.

"This has the potential for more lasting immunity that would not require updating, because the vaccine has the potential to provide broad protection," said senior author Suresh Kuchipudi, Ph.D., chair of Infectious Diseases and Microbiology at Pitt Public Health.

"Additionally, this format requires an mRNA dose 40 times less than conventional vaccines, so this new approach significantly reduces the overall cost of the vaccine."

Reference: Abhinay Gontu, Sougat Misra, Shubhada K. Chothe, Santhamani Ramasamy, Padmaja Jakka, Maurice Byukusenge, Lindsey C. LaBella, Meera Surendran Nair, Bhushan M. Jayarao, Marco Archetti, Ruth H. Nissly, Suresh V. Kuchipudi. Trans amplifying mRNA vaccine expressing consensus spike elicits broad neutralization of SARS CoV 2 variants. npj Vaccines, 2025; 10 (1) DOI: 10.1038/s41541-025-01166-1

Statins Linked to Lower Sepsis Mortality: Study Finds

A large cohort study published in Frontiers in Immunology has found that statins may significantly improve survival rates in critically ill patients with sepsis. The study, based on data from over 12,000 patients, reported a 39% lower death rate within 28 days among those treated with statins, raising potential for supplementary therapies in one of the most life-threatening conditions in intensive care.

Sepsis occurs when the body’s immune system responds to an infection with an overwhelming inflammatory reaction, leading to organ failure.

Standard treatment for sepsis includes antibiotics, intravenous fluids, and vasopressors to stabilize blood pressure. However, this new study, led by Dr. Caifeng Li of Tianjin Medical University General Hospital in China, suggests statins, widely used to lower cholesterol, may offer additional survival benefits.

The researchers used data from the MIMIC-IV database, which contains anonymized health records of 265,000 patients admitted to intensive care at the Beth Israel Deaconess Medical Center in Boston between 2008 and 2019. They included adults hospitalized with sepsis for over 24 hours and applied a statistical technique called propensity score matching to minimize bias in treatment allocation. This yielded two matched groups of 6,070 patients each—those who received statins and those who did not.

The statin group had a 28-day all-cause mortality rate of 14.3%, compared to 23.4% in the non-statin group. However, statin-treated patients also showed slightly longer durations on mechanical ventilation and renal therapy, potentially indicating a tradeoff between survival and recovery time.

“These results strongly suggest that statins may provide a protective effect and improve clinical outcomes for patients with sepsis,” concluded Li. The findings were consistent across patients with normal, overweight, or obese BMI, though not among underweight individuals.

Reference: Li, C., Zhao, K., Ren, Q., Chen, L., Zhang, Y., Wang, G., & Xie, K. Statin use during Intensive Care Unit Stay Is Associated with Improved Clinical Outcomes in Critically Ill Patients with Sepsis: A Cohort Study. Frontiers in Immunology, 16, 1537172.

Not Losing Weight? Study Finds Healthy Diet May Still Bring Major Health Gains

A new study published in the European Journal of Preventive Cardiology reveals that nearly one-third of individuals who followed a healthy diet did not lose weight, yet still experienced significant improvements in key cardiometabolic health markers.

The study focused on 761 adults with abdominal obesity who participated in three long-term workplace-based nutrition clinical trials—DIRECT, CENTRAL, and DIRECT-PLUS—in Israel. Participants were randomly assigned to follow various healthy dietary patterns, including low-fat, low-carbohydrate, Mediterranean, and Green-Mediterranean diets for 18 to 24 months. High adherence and comprehensive metabolic profiling made these trials particularly robust.

Despite following their assigned diets, 28% of participants did not lose any weight or even gained some. However, these “weight loss-resistant” individuals still saw notable health improvements, including increased levels of HDL (good) cholesterol, lower leptin levels—suggesting improved hunger signaling—and a reduction in visceral fat, the harmful fat stored deep in the abdomen.

While the study was predominantly male, researchers emphasize the need for future trials focused more on women to better understand gender-specific responses.

The study also uncovered a groundbreaking biological insight: Using advanced omics tools, researchers identified 12 specific DNA methylation sites that strongly predict long-term weight loss success.

“This novel finding shows that some people may be biologically wired to respond differently to the same diet,” said corresponding author Iris Shai principal investigator of the nutrition trials and adjunct professor of nutrition at Harvard Chan School. “This isn’t just about willpower or discipline—it’s about biology.”

These findings highlight that meaningful health improvements can occur without weight loss—offering a new, more inclusive definition of dietary success.

Reference: Anat Yaskolka Meir, Gal Tsaban, Ehud Rinott, Hila Zelicha, Dan Schwarzfuchs, Yftach Gepner, Assaf Rudich, Ilan Shelef, Matthias Blüher, Michael Stumvoll, Uta Ceglarek, Berend Isermann, Nora Klöting, Maria Keller, Peter Kovacs, Lu Qi, Dong D Wang, Liming Liang, Frank B Hu, Meir J Stampfer, Iris Shai, Individual response to lifestyle interventions: a pooled analysis of three long-term weight loss trials, European Journal of Preventive Cardiology, 2025;, zwaf308, https://doi.org/10.1093/eurjpc/zwaf308

Health and Human Services Secretary Robert F. Kennedy Jr. recently revealed on a health influencer podcast that he received unproven stem cells at a clinic in Antigua for his throat condition, spasmodic dysphonia. He also suggested that he wants to give the public much broader access to such unproven therapies, which would be extremely risky.

This revelation confirms what I had suspected for months about Kennedy. It also raises new concerns about a possible upcoming wave of reckless cell therapy deregulation from this administration.

Continue to STAT+ to read the full story…

The Host

Julie Rovner
KFF Health News

@jrovner

@julierovner.bsky.social

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

After narrowly passing in the House in May, President Donald Trump’s “One Big Beautiful Bill” has now arrived in the Senate, where Republicans are struggling to decide whether to pass it, change it, or — as Elon Musk, who recently stepped back from advising Trump, is demanding — kill it. 

Adding fuel to the fire, the Congressional Budget Office estimates the bill as written would increase the number of Americans without health insurance by nearly 11 million over the next decade. That number would grow to approximately 16 million should Republicans also not extend additional subsidies for the Affordable Care Act, which expire at year’s end. 

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists

Jessie Hellmann
CQ Roll Call

@jessiehellmann

@jessiehellmann.bsky.social

Read Jessie's stories.

Alice Miranda Ollstein
Politico

@AliceOllstein

@alicemiranda.bsky.social

Read Alice's stories.

Lauren Weber
The Washington Post

@LaurenWeberHP

Read Lauren's stories.

Among the takeaways from this week’s episode:

• Even before the CBO released estimates of how many Americans stand to lose health coverage under the House-passed budget reconciliation bill, Republicans in Washington were casting doubt on the nonpartisan office’s findings — as they did during their 2017 Affordable Care Act repeal effort.
• Responding to concerns about proposed Medicaid cuts, Iowa Sen. Joni Ernst, a Republican, this week stood behind her controversial rejoinder at a town hall that “we’re all going to die.” The remark and its public response illuminated the problematic politics Republicans face in reducing benefits on which their constituents rely — and may foreshadow campaign fights to come.
• Journalists revealed that Health and Human Services Secretary Robert F. Kennedy Jr.’s report on children’s health may have been generated at least in part by artificial intelligence. The telltale signs in the report of what are called “AI hallucinations” included citations to scientific studies that don’t exist and a garbled interpretation of the findings of other research, raising further questions about the validity of the report’s recommendations.
• And the Trump administration this week revoked Biden-era guidance on the Emergency Medical Treatment and Active Labor Act. Regardless, the underlying law instructing hospitals to care for those experiencing pregnancy emergencies still applies.

Also this week, Rovner interviews KFF Health News’ Arielle Zionts, who reported and wrote the latest “Bill of the Month” feature, about a Medicaid patient who had an emergency in another state and the big bill he got for his troubles. If you have an infuriating, outrageous, or baffling medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: KFF Health News’ “Native Americans Hurt by Federal Health Cuts, Despite RFK Jr.’s Promises of Protection,” by Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts.

Alice Miranda Ollstein: Politico’s “‘They’re the Backbone’: Trump’s Targeting of Legal Immigrants Threatens Health Sector,” by Alice Miranda Ollstein.

Lauren Weber: The New York Times’ “Take the Quiz: Could You Manage as a Poor American?” by Emily Badger and Margot Sanger-Katz.

Jessie Hellmann: The New York Times’ “A DNA Technique Is Finding Women Who Left Their Babies for Dead,” by Isabelle Taft.

Also mentioned in this week’s podcast:

• NOTUS.org’s “The MAHA Report Cites Studies That Don’t Exist,” by Emily Kennard and Margaret Manto.
• The Washington Post’s “White House MAHA Report May Have Garbled Science by Using AI, Experts Say,” by Lauren Weber and Caitlin Gilbert.

click to open the transcript

Transcript: Trump’s ‘One Big Beautiful Bill’ Lands in Senate. Our 400th Episode!

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, June 5, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Hi there. 

Rovner: Later in this episode we’ll have my interview with my colleague Arielle Zionts, who reported and wrote the KFF Health News “Bill of the Month,” about a Medicaid patient who had a medical emergency out of state and got a really big bill to boot. But first the news. And buckle up — there is a lot of it. 

We’ll start on Capitol Hill, where the Senate is back this week and turning its attention to that “Big Beautiful” budget reconciliation bill passed by the House last month, and we’ll get to the fights over it in a moment. But first, the Congressional Budget Office on Wednesday finished its analysis of the House-passed bill, and the final verdict is in. It would reduce federal health care spending by more than a trillion dollars, with a T, over the next decade. That’s largely from Medicaid but also significantly from the Affordable Care Act. And in a separate letter from CBO Wednesday afternoon, analysts projected that 10.9 million more people would be uninsured over the next decade as a result of the bill’s provisions. 

Additionally, 5.1 million more people would lose ACA coverage as a result of the bill, in combination with letting the Biden-era enhanced subsidies expire, for a grand total of 16 million more people uninsured as a result of Congress’ action and inaction. I don’t expect that number is going to help this bill get passed in the Senate, will it? 

Ollstein: We’re seeing a lot of what we saw during the Obamacare repeal fight in that, even before this report came out, Republicans were working to discredit the CBO in the eyes of the public and sow the seeds of mistrust ahead of time so that these pretty damaging numbers wouldn’t derail the effort. They did in that case, among other things. And so they could now, despite their protestations. 

But I think they’re saying a combination of true things about the CBO, like it’s based on guesses and estimates and models and you have to predict what human behavior is going to be. Are people going to just drop coverage altogether? Are they going to do this? Are they going to do that? But these are the experts we have. This is the nonpartisan body that Congress has chosen to rely on, so you’re not really seeing them present their own credible sources and data. They’re more just saying, Don’t believe these guys. 

Rovner: Yeah, and some of these things we know. We’ve seen. We’ve talked about the work requirement a million times, that when you have work requirements in Medicaid, the people who lose coverage are not people who refuse to work. It’s people who can’t navigate the bureaucracy. And when premiums go up, which they will for the Affordable Care Act, not just because they’re letting these extra subsidies expire but because they’re going back to the way premiums were calculated before 2017. The more expensive premiums get, the fewer people sign up. So it’s not exactly rocket science figuring out that you’re going to have a lot more people without health insurance as a result of this. 

Ollstein: Honestly, it seems from the reactions so far that Republicans on the Hill are more impacted by the CBO’s deficit increase estimates than they are by the number of uninsured-people increase estimates. 

Rovner: And that frankly feels a little more inexplicable to me that the Republicans are just saying, This won’t add to the deficit. And the CBO — it’s arithmetic. It’s not higher math. It’s like if you cut taxes this much so there’s less money coming in, there’s going to be less money and a bigger deficit. I’m not a math person, but I can do that part, at least in my head. 

Jessie, you’re on the Hill. What are you seeing over in the Senate? We don’t even have really a schedule for how this is going to go yet, right? We don’t know if the committees are going to do work, if they’re just going to plunk the House bill on the floor and amend it. It’s all sort of a big question mark. 

Hellmann: Yeah, we don’t have text yet from any of the committees that have health jurisdiction. There’s been a few bills from other committees, but obviously Senate Finance has a monumental task ahead of them. They are the ones that have jurisdiction over Medicaid. Their members said that they have met dozens of times already to work out the details. The members of the Finance Committee were at the White House yesterday with President [Donald] Trump to talk about the bill. 

It doesn’t seem like they got into the nitty-gritty policy details. And the message from the president seemed to mostly be, like, Just pass this bill and don’t make any major changes to it. Which is a tall order, I think, for some of the members like [Sens.] Lisa Murkowski of Alaska and Susan Collins of Maine, and even a few others that are starting to come out and raise concerns about some of the changes that the House made, like to the way that states finance their share of Medicaid spending through the provider tax. 

Lisa Murkowski has raised concerns about how soon the work requirements would take effect, because, she was saying, Alaska doesn’t have the infrastructure right now and that would take a little bit to work out. So there are clearly still a lot of details that need to be worked out. 

Rovner: Well, I would note that Senate Republicans were already having trouble communicating about this bill even before these latest CBO numbers came out. At a town hall meeting last weekend in Iowa, where nearly 1 in 5 residents are on Medicaid, Republican Sen. Joni Ernst had an unfortunate reaction to a heckler in the audience, and, rather than apologize — well, here’s what she posted on Instagram. 

Sen. Joni Ernst: Hello, everyone. I would like to take this opportunity to sincerely apologize for a statement that I made yesterday at my town hall. See, I was in the process of answering a question that had been asked by an audience member when a woman who was extremely distraught screamed out from the back corner of the auditorium, “People are going to die!” And I made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth. 

So I apologize. And I’m really, really glad that I did not have to bring up the subject of the tooth fairy as well. But for those that would like to see eternal and everlasting life, I encourage you to embrace my Lord and Savior, Jesus Christ. 

Rovner: And what you can’t see, just to add some emphasis, Ernst recorded this message in a cemetery with tombstones visible behind her. I know it is early in this debate, but I feel like we might look back on this moment later like [Sen. John] McCain’s famous thumbs-down in the 2017 repeal-and-replace debate. Or is it too soon? Lauren. 

Weber: For all the messaging they’ve tried to do around Medicaid cuts, for all the messaging, We’re all going to die I cannot imagine was on the list of approved talking points. And at the end of the day, I think it gets at how uncomfortable it is to face the reality of your constituents saying, I no longer have health care. This has been true since the beginning of time. Once you roll out an entitlement program, it’s very difficult to roll it back. 

So I think that this is just a preview of how poorly this will go for elected officials, because there will be plenty of people thrown off of Medicaid who are also Republicans. That could come back to bite them in the midterms and in general, I think, could lead — combine it with the anti-DOGE [Department of Government Efficiency] fervor— I think you could have a real recipe for quite the feedback. 

Rovner: Yes, and we’re going to talk about DOGE in a second. As we all now know, Elon Musk’s time as a government employee has come to an end, and we’ll talk about his legacy in a minute. But on his way out the door, he let loose a barrage of criticism of the bill, calling it, among other things, a, quote “disgusting abomination” that will saddle Americans with, quote, “crushingly unsustainable debt.” 

So basically we have a handful of Republicans threatening to oppose the bill because it adds to the deficit, another handful of Republicans worried about the health cuts — and then what? Any ideas how this battle plays out. I think in the House they managed to get it through by just saying, Keep the ball rolling and send it to the Senate. Now the Senate, it’s going to be harder, I think, for the Senate to say, Oh, we’ll keep the ball rolling and send it back to the House. 

Ollstein: Well, and to jump off Lauren’s point, I think the political blowback is really going to be because this is insult on top of injury in terms of not only are people going to lose Medicaid, Republicans, if this passes, but they’re being told that the only people who are going to lose Medicaid are undocumented immigrants and the undeserving. So not only do you lose Medicaid because of choices made by the people you elected, but then they turn around and imply or directly say you never deserved it in the first place. That’s pretty tough. 

Rovner: And we’re all going to die. 

Ollstein: And we’re all going to die. 

Weber: Just to add onto this, I do think it’s important to note that work requirements poll very popularly among the American people. A majority of Americans here “work requirements” and say, Gee, that sounds like a commonsense solution. What the reality that we’ve talked about in this podcast many, many times is, that it ends up kicking off people for bureaucratic reasons. It’s a way to reduce the rolls. It doesn’t necessarily encourage work. 

But to the average bear, it sounds great. Yes, absolutely. Why wouldn’t we want more people working? So I do think there is some messaging there, but at the end of the day, like Alice said, like I pointed out, they have not figured out the messaging enough, and it is going to add insult to injury to imply to some of these folks that they did not deserve their health care. 

Ollstein: And what’s really baffling is they are running around saying that Medicaid is going to people who should never have been on the program in the first place, able-bodied people without children who are not too young and not too old, sort of implying that these people are enrolling against the wishes of the program’s creators. 

But Congress explicitly voted for these people to be eligible for the program. And then after the Supreme Court made it optional, all of these states, most states, voted either by a direct popular vote or through the legislature to extend Medicaid to this population. And now they’re turning around and saying they were never supposed to be on it in the first place. We didn’t get here by accident or fraud. 

Rovner: Or by executive order. 

Ollstein: Exactly. 

Rovner: Well, even before the Senate digs in, there’s still a lot of stuff that got packed into that House bill, some of it at the last minute that most people still aren’t aware of. And I’m not talking about [Rep.] Marjorie Taylor Greene and AI, although that, too, among other things. And shout out here to our podcast panelist Maya Goldman over at Axios. The bill would reduce the amount of money medical students could borrow, threatening the ability of people to train to become doctors, even while the nation is already suffering a doctor shortage. 

It would also make it harder for medical residents to pay their loans back and do a variety of other things. The idea behind this is apparently to force medical schools to lower their tuition, which would be nice, but this feels like a very indirect way of doing it. 

Weber: I just don’t think it’s very popular in an era in which we’re constantly talking about physician shortages and encouraging folks that are from minority communities or underserved communities to become primary care physicians or infectious disease physicians, to go to the communities that need them, that reflect them, to then say, Look, we’re going to cut your loans. And what that’s going to do — short of RFK [Robert F. Kennedy Jr.], who has toyed with playing with the code. So who knows? We could see. 

But as the current structure stands, here’s the deal: You have a lot of medical debt. You are incentivized to go into a more lucrative specialty. That means that you’re not going into primary care. You’re not going into infectious disease care. You’re not going to rural America, because they can’t pay you what it costs to repay all of your loans. So, I do think — and, it was interesting. I think the Guardian spoke to some of the folks from the study that said that this could change it. That study was based off of metrics from 2006, and for some reason they were like, The financial private pay loans are not really going to cut it today. 

I find it hard to believe this won’t get fixed, to be quite honest, just because I think hating on medical students is usually a losing battle in the current system. But who knows? 

Rovner: And hospitals have a lot of clout. 

Weber: Yeah. 

Rovner: Although there’s a lot of things in this bill that they would like to fix. And, I don’t know. Maybe— 

Weber: Well, and hospitals have a lot of financial incentive, because essentially they make medical residents indentured servants. So, yeah, they also would like them to have less loans. 

Rovner: As I mentioned earlier, Elon Musk has decamped from DOGE, but in his wake is a lot of disruption at the Department of Health and Human Services and not necessarily a lot of savings. Thousands of federal workers are still in limbo on administrative leave, to possibly be reinstated or possibly not, with no one doing their jobs in the meantime. Those who are still there are finding their hands tied by a raft of new rules, including the need to get a political-appointee sign-off for even the most routine tasks. 

And around the country, thousands of scientific grants and contracts have been summarily frozen or terminated for no stated cause, as the administration seeks to punish universities for a raft of supposed crimes that have nothing to do with what’s being studied. I know that it just happened, but how is DOGE going to be remembered? I imagine not for all of the efficiencies that it has wrung out of the health care system. 

Ollstein: Well, one, I wouldn’t be so sure things are over, either between Elon and the Trump administration or what the amorphous blob that is DOGE. I think that the overall slash-and-burn of government is going to continue in some form. They are trying to formalize it by sending a bill to Congress to make these cuts, that they already made without Congress’ permission, official. We’ll see where that goes, but I think that it’s not an ending. It’s just morphing into whatever its next iteration is. 

Rovner: I would note that the first rescission request that the administration has sent up formally includes getting rid of USAID [the U.S. Agency for International Development] and PEPFAR [the President’s Emergency Plan for AIDS Relief] and public broadcasting, which seems unlikely to garner a majority in both houses. 

Ollstein: Except, like I said, this is asking them to rubber-stamp something they’re already trying to do without them. Congress doesn’t like its power being infringed on, especially appropriators. They guard that power very jealously. Now, we have seen them a little quieter in this administration than maybe you would’ve thought, but I think there are some who, even if they agree on the substance of the cuts, might object to the process and just being asked to rubber-stamp it after the fact. 

Rovner: Well, meanwhile, Health and Human Services Secretary Kennedy continues to try to remake what’s left of HHS, although his big reorganization is currently blocked by a federal judge. And it turns out that his big MAHA, “Make America Healthy Again,” report may have been at least in part written by AI, which apparently became obvious when the folks at the news service NOTUS decided to do something that was never on my reporting bingo card, which is to check the footnotes in the report to see if they were real, which apparently many are not. Then, Lauren, you and your colleagues took that yet another step. So tell us about that. 

Weber: Yeah. NOTUS did a great job. They went through all the footnotes to find out that several of the studies didn’t exist, and my colleagues and I saw that and said, Hm, let’s look a little closer at these footnotes and see. And what we were able to do in speaking with AI experts is find telltale signs of AI. It’s basically a sign of artificial intelligence when things are hallucinated — which is what they call it — which is when it sounds right but isn’t completely factual, which is one of the dangers of using AI. 

And it appears that some of AI was used in the footnotes of this MAHA report, again, to, as NOTUS pointed out, create studies that don’t exist. It also kind of garbled some of the science on the other pieces of this. We found something called “oaicite,” which is a marker of OpenAI system, throughout the report. And at the end of the day, it casts a lot of questions on the report as a whole and: How exactly did it get made? What is the science behind this report? 

And even before anyone found any of these footnotes of any of this, a fair amount of these studies that this report cites to back up its thesis are a stretch. Even putting aside the fake studies and the garbled studies, I think it’s important to also note that a lot of the studies the report cites, a lot of what Kennedy does, take it a lot further than what they actually say. 

Rovner: So, this is all going well. Meanwhile, there is continuing confusion in vaccine land after Secretary Kennedy, flanked by FDA [Food and Drug Administration] Commissioner Marty Makary and NIH [National Institutes of Health] Director Jay Bhattacharya, announced in a video on X that the department would no longer recommend covid vaccines for pregnant women and healthy children, sidestepping the expert advice of the Centers for Disease Control and Prevention and its advisory committee of experts. 

The HHS officials say people who may still be at risk can discuss whether to get the vaccine with their doctors, but if the vaccines are no longer on the recommended list, then insurance is less likely to cover them and medical facilities are less likely to stock them. Paging Sen. [Bill] Cassidy, who still, as far as I can tell, hasn’t said anything about the secretary’s violation of his promise to the senator during his confirmation hearings that he wouldn’t mess with the vaccine schedule. Have we heard a peep from Sen. Cassidy about any of this? 

Ollstein: I have not, but a lot of the medical field has been very vocal and very upset. I was actually at the annual conference of the American College of Obstetricians and Gynecologists when this news broke, and they were just so confused and so upset. They had seen pregnant patients die of covid before the vaccines were available, or because there was so much misinformation and mistrust about the vaccines’ safety for pregnant people that a lot of people avoided it, and really suffered the consequences of avoiding it. 

A lot of the issue was that there were not good studies of the vaccine in pregnant people at the beginning of the rollout. There have since been, and those studies have since shown that it is safe and effective for pregnant people. But it was, in a lot of people’s minds, too late, because they already got it in their head that it was unsafe or untested. So the OB-GYNs at this conference were really, really worried about this. 

Rovner: And, confusingly, the CDC on its website amended its recommendations to leave children recommended but not pregnant women, which is kind of the opposite of, I think, what most of the medical experts were recommending. Jessie, you were about to add something. 

Hellmann: I just feel like the confusion is the point. I think Kennedy has made it a pattern now to get out ahead of an official agency decision and kind of set the narrative, even if it is completely opposite of what his agencies are recommending or are stating. He’s done this with a report that the CDC came out with autism, when he said rising autism cases aren’t because of more recognition and the CDC report said it’s a large part because of more recognition. 

He’s done this with food dyes. He said, We’re banning food dyes. And then it turns out they just asked manufacturers to stop putting food dyes into it. So I think it’s part of, he’s this figurehead of the agency and he likes to get out in front of it and just state something as fact, and that is what people are going to remember, not something on a CDC webpage that most people aren’t going to be able to find. 

Rovner: Yeah, it sounds like President Trump. It’s like, saying it is more important than doing it, in a lot of cases. So of course there’s abortion news this week, too. The Trump administration on Tuesday reversed the Biden administration guidance regarding EMTALA, the Emergency Medical Treatment and Active Labor Act. Biden officials, in the wake of the overturn of Roe v. Wade three years ago, had reminded hospitals that take Medicare and Medicaid, which is all of them, basically, that the requirement to provide emergency care includes abortion when warranted, regardless of state bans. Now, Alice, this wasn’t really unexpected. In fact, it’s happening later than I think a lot of people expected it to happen. How much impact is it going to have, beyond a giant barrage of press releases from both sides in the abortion debate? 

Ollstein: Yeah, so, OK, it’s important for people to remember that what the Biden administration, the guidance they put out was just sort of an interpretation of the underlying law. So the underlying law isn’t changing. The Biden administration was just saying: We are stressing that the underlying law means in the abortion context, in the post-Dobbs context, blah, blah, blah, blah, blah, that hospitals cannot turn away a pregnant woman who’s having a medical crisis. And if the necessary treatment to save her life or stabilize her is an abortion, then that’s what they have to do, regardless of the laws in the state. 

In a sense, nothing’s changed, because EMTALA itself is still in place, but it does send a signal that could make hospitals feel more comfortable turning people away or denying treatment, since the government is signaling that they don’t consider that a violation. Now, I will say, you’re totally right that this was expected. In the big lawsuit over this that is playing out now in Idaho, one of the state’s hospitals intervened as a plaintiff, basically in anticipation of this happening, saying, The Trump administration might not defend EMTALA in the abortion context, so we’re going to do it for them, basically, to keep this case alive. 

Rovner: And I would point out that ProPublica just won a Pulitzer for its series detailing the women who were turned away and then died because they were having pregnancy complications. So we do know that this is happening. Interestingly, the day before the administration’s announcement, the American College of Obstetricians and Gynecologists put out a new, quote, “practice advisory” on the treatment of preterm pre-labor rupture of membranes, which is one of the more common late-pregnancy complications that result in abortion, because of the risk of infection to the pregnant person. 

Reading from that guidance, quote, “the Practice Advisory affirms that ob-gyns and other clinicians must be able to intervene and, in cases of previable and periviable PPROM” — that’s the premature rupture of membranes — “provide abortion care before the patient becomes critically ill.” Meanwhile, this statement came out Wednesday from the American College of Emergency Physicians, quote, ,“Regardless of variances in the regulatory landscape from one administration to another, emergency physicians remain committed not just by law, but by their professional oath, to provide this care.” 

So on the one hand, professional organizations are speaking out more strongly than I think we’ve seen them do it before, but they’re not the ones that are in the emergency room facing potential jail time for, Do I obey the federal law or do I obey the state ban? 

Ollstein: And when I talk to doctors who are grappling with this, they say that even with the Biden administration’s interpretation of EMTALA, that didn’t solve the problem for them. It was some measure of protection and confidence. But still, exactly like you said, they’re still caught in between seemingly conflicting state and federal law. And really a lot of them, based on what they told me, were saying that the threat of the state law is more severe. It’s more immediate. 

It means being charged with a felony, being charged with a crime if they do provide the abortion, versus it’s a federal penalty, it’s not on the doctor itself. It’s on the institution. And it may or may not happen at some point. So when you have criminal charges on one side and maybe some federal regulation or an investigation on the other side, what are you going to choose? 

Rovner: And it’s hard to imagine this administration doing a lot of these investigations. They seem to be turning to other things. Well, we will watch this space, and obviously this is all still playing out in court. All right, that is this week’s news, or at least as much as we could squeeze in. Now we’ll play my “Bill of the Month” interview with Arielle Zionts, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast KFF Health News’ Arielle Zionts, who reported and wrote the latest KFF Health News “Bill of the Month.” Arielle, welcome back. 

Arielle Zionts: Hi. Thanks for having me. 

Rovner: So this month’s patient has Medicaid as his health insurance, and he left his home state of Florida to visit family in South Dakota for the holidays, where he had a medical emergency. Tell us who he is and what happened that landed him in the hospital. 

Zionts: Sure. So I spoke with Hans Wirt. He was visiting family in the Black Hills. That’s where Mount Rushmore is and its beautiful outdoors. He was at a water park, following his son up and down the stairs and getting kind of winded. And at first he thought it might just be the elevation difference, because in Florida it’s like 33 feet above sea level. Here it’s above 3,000 in Rapid City. 

But then they got him back to the hotel room and he was getting a lot worse, his breathing, and then he turned pale. And his 12-year-old son is the one who called 911. And medics were like, Yep, you’re having a heart attack. And they took him to the hospital in town, and that is the only place to go. There’s just one hospital with an ER in Rapid City. 

Rovner: So the good news is that he was ultimately OK, but the bad news is that the hospital tried to stick them with the bill. How big was it? 

Zionts: It was nearly $78,000. 

Rovner: Wow. So let’s back up a bit. How did Mr. Wirt come to be on Medicaid? 

Zionts: Yeah. So it is significant that he is from Florida, because that is one of the 10 states that has not opted in to expand Medicaid. So in Florida, if you’re an adult, you can’t just be low-income. You have to also be disabled or caring for a minor child. And Hans says that’s his case. He works part time at a family business, but he also cares for his 12-year-old son, who is also on Medicaid. 

Rovner: So Medicaid patients, as we know, are not supposed to be charged even small copays for care in most cases. Is that still the case when they get care in other states? 

Zionts: So Medicaid will not pay for patient care if they are getting more of an elective or non-medically necessary kind of optional procedure or care in another state. But there are several exceptions, and one of the exceptions is if they have an emergency in another state. So federal law says that state Medicaid programs have to reimburse those hospitals if it was for emergency care. 

Rovner: And presumably a heart attack is an emergency. 

Zionts: Yes. 

Rovner: So why did the hospital try to bill him anyway? They should have billed Florida Medicaid, right? 

Zionts: So what’s interesting is while there’s a law that says the Medicaid program has to reimburse the hospital, there’s no law saying the hospital has to send the bill to Medicaid. And that was really interesting to learn. In this case, the hospital, it’s called Monument Health, and they said they only bill plans in South Dakota and four of our bordering states. So basically they said for them to bill for the Medicaid, they would have to enroll. 

And they say they don’t do that in every state, because there is a separate application process for each state. And their spokesperson described it as a burdensome process. So in this case, they billed Hans instead. 

Rovner: So what eventually happened with this bill? He presumably didn’t have $78,000 to spare. 

Zionts: Correct. Yeah. And he had told them that, and he said they only offered, Hey, you can set up a payment plan. But that would’ve still been really expensive, the monthly payments. So he reached out to KFF Health News, and I had sent my questions to the hospital, and then a few days later I get a text from Hans and he says, Hey, my balance is at zero now. He and I both eventually learned that that’s because the hospital paid for his care through a program called Charity Care. 

All nonprofit hospitals are required to have this program, which provides free or very discounted pricing for patients who are uninsured or very underinsured. And the hospital said that they screen everyone for this program before sending them to collections. But what that meant is that for months, Hans was under the impression that he was getting this bill. And he was, got a notice saying, This is your last warning before we send you to collection. 

Rovner: So, maybe they would’ve done it anyway, or maybe you gave them a nudge. 

Zionts: They say they would’ve done it anyways. 

Rovner: OK. So what’s the takeaway here? It can’t be that if you have Medicaid, you can’t travel to another state to visit family at Christmas. 

Zionts: Right. So Hans made that same joke. He said, quote, “If I get sick and have a heart attack, I have to be sure that I do that here in Florida now instead of some other state.” Obviously, he’s kidding. You can’t control when you have an emergency. So the takeaway is that you do risk being billed and that if you don’t know how to advocate yourself, you might get sent to collections. But I also learned that there’s things that you can do. 

So you could file a complaint with your state Medicaid program, and also, if you have a managed-care program, and they might have — you should ask for a caseworker, like, Hey, can you communicate with the hospital? Or you can contact an attorney. There’s free legal-aid ones. An attorney I spoke with said that she would’ve immediately sent a letter to the hospital saying, Look, you need to either register with Florida Medicaid and submit it. If not, you need to offer the Charity Care. So that’s the advice. 

Rovner: So, basically, be ready to advocate for yourself. 

Zionts: Yes. 

Rovner: OK. Arielle Zionts, thank you so much. 

Zionts: Thank you. 

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

Hellmann: My story is from The New York Times. It’s called “A [DNA] Technique Is Finding Women Who Left Their Babies for Dead,” which I don’t know how I feel about that headline, but the story was really interesting. It’s about how police departments are using DNA technology to find the mothers of infants that had been found dead years and years ago. And it gets a little bit into just the complicated situation. 

Some of these women have gone on to have families. They have successful careers. And now some of them are being charged with murder, and some who have been approached about this have unfortunately died by suicide. And it just gets into the ethics of the issue and what police and doctors, families, should be considering about the context around some of these situations, about what the circumstances were, in some cases, 40 years ago and what should be done with that. 

Rovner: Really thought-provoking story. Lauren. 

Weber: With credit to Julie, too, because she brought this up again, was brought back to a classic from The New York Times back in 2020, which is called “Take a Quiz: Could You Manage as a Poor American?” And here are the questions: I will read them for the group. 

Rovner: And I will point out that this is once again relevant. That’s why it was brought back. 

Weber: It’s once again relevant, and one of them is, “Do you have paper mail you plan to read that has been unopened for more than a week?” Yes. I’m looking at paper mail on my desk. “Have you forgotten to pay a utility bill on time?” If I didn’t set up auto pay, I probably would forget to pay a utility bill on time. “Have you received a government document in the mail that you did not understand?” Many times. “Have you missed a doctor’s appointment because you forgot you scheduled it or something came up?” 

These are the basic facts that can derail someone from having access to health care or saddle them, because they lose access to health care and don’t realize it, with massive hospital bills. And this is a lot of what we could see in the coming months if some of these Medicaid changes come through. And I just, I think I would challenge a lot of people to think seriously about how much mail they leave unopened and what that could mean for them, especially if you are living in different homes, if you are moving frequently, etc. This paperwork burden is something to definitely be considered. 

Rovner: Yeah, I think we should sort of refloat this every time we have another one of these debates. Alice. 

Ollstein: So I wanted to recommend something I wrote [“‘They’re the Backbone’: Trump’s Targeting of Legal Immigrants Threatens Health Sector”]. It was my last story before taking some time off this summer. It is about the intersection of Trump’s immigration policies and our health care system. And so this is jumping off the Supreme Court allowing the Trump administration to strip legal status from hundreds of thousands of immigrants. Again, these are people who came legally through a designated program, and they are being made undocumented by the Trump administration, with the Supreme Court’s blessing. And tens of thousands of them are health care workers. 

And so I visited an elder care facility in Northern Virginia that was set to lose 65 staff members, and I talked to the residents and the other workers about how this would affect them, and the owner. And it was just a microcosm of the damage this could have on our health sector more broadly. Elder care is especially immigrant-heavy in its workforce, and everyone there was saying there just are not the people to replace these folks. 

And not only is that the case right now, but as the baby boomer generation ages and requires care, the shortages we see now are going to be nothing compared to what we could see down the road. With the lower birth rates here, we’re just not producing enough workers to do these jobs. The piece also looks into how public health and management of infectious diseases is also being worsened by these immigration raids and crackdowns and deportations. So, would love people to take a look. 

Rovner: I’m so glad you did this story, because it’s something that I keep running up and down screaming. And you can tell us why you’re taking some time off this summer, Alice. 

Ollstein: I’m writing a book. Hopefully it will be out next year, and I can’t wait to tell everyone more about it. 

Rovner: Excellent. All right. My extra credit this week is from my KFF Health News colleagues Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts, who you just heard talking about her “Bill of the Month,” and it’s called “Native Americans Hurt by Federal Health Cuts, Despite RFK Jr.’s Promises of Protection.” And that sums it up pretty well. The HHS secretary had a splashy photo op earlier this year out west, where he promised to prioritize Native American health. But while he did spare the Indian Health Service from personnel cuts, it turns out that the Native American population is also served by dozens of other HHS programs that were cut, some of them dramatically, everything from home energy assistance to programs that improve access to healthy food, to preventing overdoses. The Native community has been disproportionately hurt by the purging of DEI [diversity, equity, and inclusion] programs, because Native populations have systematically been subjected to unequal treatment over many generations. It’s a really good if somewhat infuriating story. 

OK. That is this week’s show. Before we go, if you will indulge me for a minute, this is our 400th episode of “What the Health?” We launched in 2017 during that year’s repeal-and-replace debate. I want to thank all of my panelists, current and former, for teaching me something new every single week. And everyone here at KFF Health News who makes this podcast possible. That includes not only my chief partners in crime, Francis Ying and Emmarie Huetteman, but also the copy desk and social media and web teams who do all the behind-the-scenes work that brings our podcast to you every week. And of course, big thanks to you, the listeners, who have stuck with us all these years. 

I won’t promise you 400 more episodes, but I will keep doing this as long as you keep wanting it. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, @jrovner, or on Bluesky, @julierovner. Where are you folks these days? Jessie? 

Hellmann: @jessiehellmann on X and Bluesky, and LinkedIn. 

Rovner: Lauren. 

Weber: I’m @LaurenWeberHP on X and on Bluesky, shockingly, now. 

Rovner: Alice. 

Ollstein: @alicemiranda on Bluesky and @AliceOllstein on X. 

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

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