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Julie Rovner
KFF Health News

@jrovner

@julierovner.bsky.social

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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.

With only a single vote to spare, the House passed a controversial budget bill that includes billions of dollars in tax cuts for the wealthy, along with billions of dollars of cuts to Medicaid, the Affordable Care Act, and the food stamp program — most of which will affect those at the lower end of the income scale. But the bill faces an uncertain future in the Senate.

Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. released a report from his commission to “Make America Healthy Again” that described threats to the health of the American public — but notably included nothing on threats from tobacco, gun violence, or a lack of health insurance.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico.

Panelists

Anna Edney
Bloomberg News

@annaedney

@annaedney.bsky.social

Read Anna's stories.

Sarah Karlin-Smith
Pink Sheet

@SarahKarlin

@sarahkarlin-smith.bsky.social

Read Sarah's stories.

Alice Miranda Ollstein
Politico

@AliceOllstein

@alicemiranda.bsky.social

Read Alice's stories.

Among the takeaways from this week’s episode:

• House Republicans passed their “big, beautiful” bill 215-214 this week, with one Republican critic voting present. But the Senate may have its own “big, beautiful” rewrite. Some conservative senators who worry about federal debt are concerned that the bill is not fully paid for and would add to the budget deficit. Others, including some red-state Republicans, say the bill’s cuts to Medicaid and food assistance go too far and would hurt low-income Americans. The bill’s cuts would represent the biggest reductions to Medicaid in the program’s 60-year history.
• Many of the bill’s Medicaid cuts would come from adding work requirements. Most people receiving Medicaid already work, but such requirements in Arkansas and Georgia showed that people often lose coverage under these rules because they have trouble documenting their work hours, including because of technological problems. The nonpartisan Congressional Budget Office estimated an earlier version of the bill would reduce the number of people with Medicaid by at least 8.6 million over a decade. The requirements also could add a burden for employers. The bill’s work requirements are relatively broad and would affect people who are 19 to 64 years old. 
• People whose Medicaid coverage is canceled also would no longer qualify for ACA subsidies for marketplace plans. Medicare also would be affected, because the bill would be expected to trigger an across-the-board sequestration cut.
• The bill also would impact abortion by effectively banning it in ACA marketplace plans, which would disrupt a compromise struck in the 2010 law. And the bill would block funding for Planned Parenthood in Medicaid, although that federal money is used for other care such as cancer screenings, not abortions. In the past, the Senate parliamentarian has said that kind of provision is not allowed under budget rules, but some Republicans want to take the unusual step of overruling the parliamentarian.
• This week, FDA leaders released covid-19 vaccine recommendations in a medical journal. They plan to limit future access to the vaccines to people 65 and older and others who are at high risk of serious illness if infected, and they want to require manufacturers to do further clinical trials to show whether the vaccines benefit healthy younger people. There are questions about whether this is legal, which products would be affected, when this would take effect, and whether it’s ethical to require these studies. 
• HHS released a report on chronic disease starting in childhood. The report doesn’t include many new findings but is noteworthy in part because of what it doesn’t discuss — gun violence, the leading cause of death for children and teens in the United States; tobacco; the lack of health insurance coverage; and socioeconomic factors that affect access to healthy food.

Also this week, Rovner interviews University of California-Davis School of Law professor and abortion historian Mary Ziegler about her new book on the past and future of the “personhood” movement aimed at granting legal rights to fetuses and embryos.

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

Julie Rovner: The Washington Post’s “White House Officials Wanted To Put Federal Workers ‘in Trauma.’ It’s Working,” by William Wan and Hannah Natanson.

Alice Miranda Ollstein: NPR’s “Diseases Are Spreading. The CDC Isn’t Warning the Public Like It Was Months Ago,” by Chiara Eisner.

Anna Edney: Bloomberg News’ “The Potential Cancer, Health Risks Lurking in One Popular OTC Drug,” by Anna Edney.

Sarah Karlin-Smith: The Farmingdale Observer’s “Scientists Have Been Studying Remote Work for Four Years and Have Reached a Very Clear Conclusion: ‘Working From Home Makes Us Happier,’” by Bob Rubila.

Also mentioned in this week’s podcast:

• The New York Times’ “As Congress Debates Cutting Medicaid, a Major Study Shows It Saves Lives,” by Sarah Kliff and Margot Sanger-Katz.
• NBC News’ “Georgia Mother Says She Is Being Forced To Keep Brain-Dead Pregnant Daughter Alive Under Abortion Ban Law,” by Minyvonne Burke.
• The Washington Post’s “Trump and GOP’s Tax Bill Would Force Cuts to Medicare, CBO Says,” by Jacob Bogage and Abha Bhattarai.
• The New England Journal of Medicine’s “An Evidence-Based Approach to Covid-19 Vaccination,” by Vinay Prasad and Martin A. Makary.

click to open the transcript

Transcript: Bill With Billions in Health Program Cuts Passes House

[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 Friday, May 23, at 10 a.m. As always, and particularly this week, 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: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: And Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hello there. 

Rovner: Later in this episode we’ll have my interview with law professor and abortion historian Mary Ziegler, who has a new book out on the history and possible future of the “personhood” movement. But first, this week’s news. 

So, against all odds and many predictions, including my own, the House around 7 a.m. Thursday morning, after being in session all night, passed President [Donald] Trump’s One Big Beautiful Bill — that is its actual, official name — by a vote of 215-214, with one Republican voting present. Before we get into the details of the House-passed bill, what are the prospects for this budget reconciliation bill in this form in the Senate? Very different, I would think. 

Ollstein: Yeah, this is not going to come out the way it went in. Senate is already openly talking about a “‘One, Big Beautiful’ Rewrite” — that was the headline at Politico. 

And you’re going to see some of the same dynamics. You’re going to see hard-liners saying this doesn’t go far enough, this actually adds a lot to the deficit even with all of the deep cuts to government programs. And you’re going to have moderates who have a lot of people in their state who depend on Medicaid and other programs that are set to be cut who say this goes too far. And so you’re going to have that same push and pull. And the House, barely, by one vote, got this through. And so we’ll see if the Senate is able to do the same. 

Rovner: Yeah, so all eyes on [Sen.] John McCain in 2017. This year it could be all eyes on Josh Hawley, I suspect, the very conservative senator from Missouri who keeps saying “Don’t touch Medicaid.” 

But back to the House bill. We don’t have official scores yet from the Congressional Budget Office, and we won’t for a while, I suspect. But given some last-minute changes made to pacify conservatives who, as Alice pointed out, said this bill didn’t cut deeply enough, I think it’s clear that if it became law in this form, it would represent the biggest cuts to federal health programs in the 60-year history of Medicare and Medicaid. 

Those last-minute changes also took pretty square aim at the Affordable Care Act, too, so much that I think it’s safe to call this even more than a partial repeal of the health law. And Medicare does not go unscathed in this measure, either, despite repeated promises by President Trump on the campaign trail and since he took office. 

Let’s take these one at a time, starting with Medicaid. I would note that at a meeting with House Republicans on Tuesday, President Trump told them not to expletive around with Medicaid. You can go look up the exact quote yourself if you like. But apparently he’s OK with the $700 billion plus that would be cut in the bill, which Republicans say is just waste, fraud, and abuse. Where does that money come from? And would Medicaid really continue to cover everyone who’s eligible now, which is kind of what the president and moderate Republicans are promising? 

Edney: Well, it sounds like the bulk of it is coming from the work requirements that Alice mentioned earlier. And would it be able to cover them? Sure, but will it? No, in the sense that, as Alice has talked about often on this podcast, it’s basically a time tax. It’s not easy to comply with. All federal regulations, they’re not going to a website and putting in what you did for work. Particularly, if you are a freelancer or something, it can be really difficult to meet all the requirements that they’re looking for. And also, for some people, they just don’t have the ability, even the internet, to be able to do that reliably. So they’re going to save money because people are going to lose their health care. 

Rovner: I saw a lot of people referring to them this week not as work requirements anymore but as work reporting requirements. Somebody suggested it was like the equivalent of having to file your income taxes every month. It’s not just check a box and say, I worked this month. It’s producing documentation. And a lot of people have jobs that are inconsistent. They may work some hours some week and other hours the other week. And even people who work for small businesses, that would put an enormous burden on the employers to come up with all this. 

Obviously, the CBO thinks that a lot of people won’t be able to do this and therefore people are going to lose their health insurance. But Alice, as you have told us numerous times when we did this in Arkansas, it’s not that people aren’t working — it’s that people aren’t successfully reporting their work. 

Ollstein: Right. And we’ve seen this in Georgia, too, where this has been implemented, where there are many different ways that people who are working lose their insurance with this. People who don’t have good internet access struggle. People who have fluctuating work schedules, whether it’s agricultural work, tourism work, things that are more seasonal, they can’t comply with this strict monthly requirement. 

So there are numerous reports from the ground of people who should be eligible losing their coverage. And I’ll note that one of the last-minute changes the House made was moving up the start date of the requirements. And I’m hearing a lot of state officials and advocates warn that that gives states less time to set up a system where people won’t fall through the cracks. And so the predicted larger savings is in part because they imagine more people will be kicked off the program. 

Rovner: It’s also the most stringent work requirement we’ve seen. It would cover people from age 19 through age 64, like right up until you’re eligible for Medicare. And if you lose Medicaid because you fail to meet these reporting requirements, you’re no longer eligible for a subsidy to buy insurance in the ACA exchange. Is there a policy point to this? Or are they just trying to get the most people off the program so they can get the most savings? 

Edney: If you ask Republicans, they would tell you: We’re going to get people back working. We’re going to give them the pride of working — as if people don’t want that on their own. But the actual outcome is not that people end up working more. And there are cases even where they lose their health insurance and can’t work a job they already had. On the surface, and this is why it’s such a popular program, because it seems like it would get more people working. Even a large swath of Democrats support the idea when they just hear the name — of voters. But the actual outcome, that doesn’t happen. People aren’t in Medicaid because they aren’t working. 

Rovner: Right. And I get to say for the millionth time, nobody is sitting on their couch living on their Medicaid coverage. 

Edney: Right, right. 

Rovner: There’s no money that comes with Medicaid. It’s just health insurance. The health providers get paid for Medicaid and occasionally the managed-care companies. But there’s no check to the beneficiary, so there’s no way to live on your Medicaid. 

As Alice points out, most of the people who are working and have Medicaid are working at jobs, obviously, that don’t offer employer health insurance. So having, in many cases, as you say, Anna, having Medicaid is what enables you to work. 

All right, well, our podcast pals Margot Sanger-Katz and Sarah Kliff have an excellent Medicaid story out this week on a new study that looks very broadly at Medicaid and finds that it actually does improve the health of its beneficiaries. Now this seems logical, but that has been quite a talking point for Republicans for many years, that we spend all this money and it doesn’t produce better health, because we’ve had a lot of studies that have been kind of neither here nor there on this. 

Do we finally have proof that Democrats need? Because I have heard, over many years — there was a big Oregon study in 2011 that found that it helped people financially and that it helped their mental health, but there was not a lot of physical health benefit that they saw. Of course, it was a brief. It was like two years. And it takes a longer time to figure out the importance of health insurance. But I’m wondering if maybe the Democrats will finally be able to put down that talking point. I didn’t hear it, actually, as much this week as I have in years past: Why are we spending all this money on Medicaid when we don’t know whether it’s producing better health? 

Karlin-Smith: One of the interesting things I thought about this study and sort of the timing of it, post-Obamacare expansion of Medicaid and more younger people being covered, is that it seems to really show that, not only does this study show it saves lives, but it’s really helping these younger populations. 

And I think there are some theories as to why it might have been harder to show the economic cost-effectiveness benefits people were looking for before, when you had Medicaid covering populations that were already either severely ill or older. Which doesn’t mean it’s not valuable, right? To provide health coverage to somebody who’s 75 or 80, but unfortunately we have not found the everlasting secret to life yet. 

So, but I think for economists who want to be able to show this sort of, as they show in this paper, this “quality-adjusted life year” benefit, this provides some really good evidence of what that expansion of Medicaid — which is a lot of what’s being rolled back, potentially, under the reconciliation process — did, which is, helps younger people be healthier and thus, right, hopefully, ideally, live a higher quality of life, and where you need less health coverage over time, and cost the government less. 

It’s quite interesting, for people who want to go look at the graph The New York Times put in their story, of just where Medicaid fits, in terms of other sort of interventions we spend a lot of money on to help save lives. Because I was kind of surprised, given how much health insurance does cover, that it comes out on sort of the lower end, as being a pretty good bargain. 

Rovner: Yeah. Well, we don’t have time to get into everything that’s in this bill, and there is a lot. It also includes a full ban of Medicaid coverage for gender-affirming care for both minors and adults. And it cuts reimbursement to states that use their own funds to provide coverage to undocumented people. Is this a twofer for Republicans, saving money while fighting the culture wars? 

Edney: Certainly. And I was surprised to see some very liberal states on the immigration front saying: We just have to deal with this. And this really sucks, but we have to balance our budget. And if we’re not going to get those tax dollars, then we aren’t going to be able to offer health insurance to people who are undocumented, or Medicaid to people who are undocumented. 

Rovner: Yeah, California, most notably. 

Edney: Yeah, California for sure. And they found a way to do it, hit them in the pocketbook, and that that’s a way for them to win the culture war, for sure. 

Rovner: Alice, you’ve spent a lot of time looking at gender-affirming care. Were you surprised to see it banned for adults, too? Obviously the gender-affirming care for minors has been a continuing issue for a while. 

Ollstein: Yeah, I would say not surprised, because this is sort of a common pattern that we see across different things, including in the abortion space, where first policies are targeted just at minors. That often is more politically palatable. And then it gets expanded to the general population. And so I think, given the wave of state bans on care for minors that we’ve seen, I think a lot of people had been projecting that this was the trajectory. 

I think that there’s been some really good reporting from The 19th and other outlets about what an impact this would have. Trans people are disproportionately low-income and dependent on Medicaid, and so this would have really sweeping impacts on a lot of people. 

Rovner: Well, turning to the Affordable Care Act, if you thought Republicans weren’t going to try to repeal the health law this time around, you thought wrong. There are a bucket of provisions in this bill that will make the Affordable Care Act coverage both more expensive and harder to get, so much that some analysts think it could reduce enrollment by as much as half of the 24 million people who have it now. Hasn’t someone told Republicans that many of these people are their voters? 

Edney: Yeah, that’s a good question. I don’t know what the Republican strategists are telling them. But certainly they needed to save money. And so they found their loopholes and their different things that they thought they could scrape from. And maybe no one will notice? But I don’t think that’s going to happen. 

A lot of people suddenly have much higher ACA premiums because of the way they’re going to take away this ability that the insurers have had to silver-load, essentially, the way that they deal with the premium tax credits by setting some of the savings, kind of the cost sharing that they need to do, right into the silver plan, because the silver plan is where the premiums are set off of. And so they were able to offer the plans with lower premiums, essentially, but still get paid for cost-sharing reductions. So they were able to still get that money taken away from them. 

Rovner: So let me see if I can do it. It was, and this was something that Trump tried to do in 2017, that he thought was going to hurt the marketplace plans. And it ended up doing the opposite— 

Edney: Right. 

Rovner: —because it basically shifted money from the insurance companies and the beneficiaries back to the federal government, because it made the premium subsidies bigger. 

So I think the point I want to make is that we’ve been talking all year about these extra subsidies that are going to expire, and that will make premiums go up, and the Republicans did not move to extend those subsidies. But this going back to the government paying these cost-sharing reduction payments is going to basically reverse the accidental lowering of premiums that Trump did in 2017. And therefore, raise them again. 

So now we have a double whammy. We have premiums going up because the extra subsidies expire, and then we’ll have premiums going up even more because they’re going back to this original cost-sharing reduction. And yet, as we have said many times, a lot of these additional people who are now on the Affordable Care Act are people in the very red states that didn’t expand Medicaid. These are Republican voters. 

Karlin-Smith: We haven’t talked a lot about the process of how they got this bill through this week. It was incredibly fast and done literally in the dead of night. 

Ollstein: Multiple nights. 

Karlin-Smith: So you have to wonder, particularly, if you think back to the last time Republicans tried to overturn Obamacare — and they did come pretty close — eventually, I think, that unpalatableness of taking away health care from so many of their own constituents came back to really hurt them. And you do have to wonder if the jamming was in part to make more people unaware of what was happening. You’d still think there’d be political repercussions later down the line when they realize it. But I think, especially, again, just thinking back on all the years when Republicans were saying Democrats were pushing the ACA through too fast and nobody could read the bill, or their CBO scores. This was a much, much faster version of that, with a lot less debate and public transparency and so forth. 

Rovner: Yeah, they went to the Rules Committee at 1 a.m. Wednesday, so Tuesday night. The Rules Committee went until almost 9 o’clock the next evening, just consecutively. And shout out to Rules Committee chairman Virginia Foxx, who sat there for, I think, the entire time. And then they went straight from rules to the floor. 

So it’s now Wednesday night at 10 o’clock at night, and then went all the way through and voted, I think, just before 7 a.m. I’ve done a lot of all-nighters in the Capitol. I haven’t seen one that was two nights in a row like this. And I have great admiration for the people who really were up for 48 hours to push this thing through. 

Well, finally, let’s remember President Trump’s vow not to touch Medicare. Well, Medicare gets touched in this bill, too. In addition to restricting eligibility for some legal immigrants who are able to get coverage now, and making it harder for some low-income Medicare beneficiaries to get extra financial help, mostly through Medicaid, the bill as a whole is also likely to trigger a 4% Medicare sequester. Because, even all those other health cuts and food stamp cuts and other cuts don’t pay for all the huge tax breaks in the bill. Alice, you pointed that out. Is there any suggestion that this part might give people some pause, maybe when it gets to the Senate? 

Edney: I’ve heard the Senate mostly seem upset about Medicaid. And I also feel like this idea that sequestration is coming back up into our consciousness is a little bit new. Like you said, it was pushed through and it was like, Oh, wait, this is enough to trigger sequestration. I think it certainly could become a talking point, because Trump said he would not cut Medicare. I don’t think, if senators are worried about Medicaid — and I think maybe some of us were a little surprised that that is coming from some red-state senators. Medicare is a whole different thing, and in the sense of being even more wildly popular with a lot of members of Congress. 

Rovner: Yeah, I think this whole thing hasn’t, you’re right, sort of seeped into the general consciousness yet. Alice, did you want to say something? 

Ollstein: Yeah, so a couple things, a couple patterns we’ve seen. So one, there are a lot of lawmakers on the right who have been discrediting the CBO, even in advance of estimates coming out, basically disparaging their methodology and trying to convince the public that it’s not accurate. And so I think that’s both around the deficit projections as well as how many people would be uninsured under different policies. So that’s been one reaction to this. 

We’ve seen a pattern over many administrations where certain politicians are very concerned about things adding to the deficit when the opposition party is in power. And suddenly those concerns evaporate when their own party is in power and they don’t mind running up the deficit if it’s to advance policies that they want to advance. And so I think, yes, this could bother some fiscal hawks, and we saw that in the House, but I think, also, these other factors are at play. 

Rovner: Yeah, I think this has a long way to go. There’s still a lot that people, I think you’re right, have not quite realized is in there. And we will get to more of it in coming weeks, because this has a long process in the Senate. 

All right, well, segueing to abortion, the One Big Beautiful Bill also includes a couple of pretty significant abortion provisions. One would effectively ban abortion and marketplace plans for people with lower incomes. Affordable Care Act plans are not currently a big source of insurance coverage for abortion. Many states already ban abortion from coverage in these plans. But this would disrupt one of the big compromises that ultimately got the ACA passed in 2010. 

The other provision would evict Planned Parenthood from the Medicaid program, even though federal Medicaid funds don’t and never have been used for abortions. Many, many Medicaid patients use Planned Parenthood for routine medical care, including contraception and cancer screenings, and that is covered by Medicaid. 

But while I see lots of anti-abortion groups taking victory laps over this, when the House passed a similar provision in 2017 as part of its repeal bill, the Senate parliamentarian ruled that it could not go in a budget reconciliation bill, because its purpose was not, quote, “primarily budgetary.” So is this all for show? Or is there a belief that something different might happen this time? 

Ollstein: Well, I think there is more interest in ignoring or overruling the parliamentarian among Senate Republicans than there has been in the past. We’re seeing that now on an unrelated environmental issue. And so that could signal that they’re willing to do it more in the future. Of course, things like that cut both ways, and that raises the idea that the Democrats could also do that the next time they’re in power. 

Rovner: And we should say, that if you overrule the parliamentarian in reconciliation — it’s a she right now — when she says it can’t go in reconciliation, that is equivalent to getting rid of the filibuster. 

Ollstein: Correct. 

Rovner: So I mean, that’s why both parties say, We want to keep the filibuster. But the moment you say, Hey, parliamentarian, we disagree with you and we’re just going to ignore that, that has ramifications way beyond budget reconciliation legislation. 

Ollstein: That’s right. And so that’s been a line that a lot of senators have not been willing to cross, but I think you’re seeing more willingness than before. So that’s definitely something to watch on that. But I think, in terms of abortion, I think this is a real expansion of trends that were already underway, in ever-expanding the concept of what federal dollars going to abortion means. And it’s now in this very indirect way, where it’s reaching into the private insurance market, and it’s using federal funding as a cudgel to prevent groups like Planned Parenthood, and then also these private plans, from using other non-federal money to support abortions. And so it’s a real expansion beyond just you can’t use federal money to pay directly for abortions. 

Rovner: Well, meanwhile, two other reproductive-associated health stories worth mentioning. In California, a fertility clinic got bombed. The bomber apparently died in the explosion, but this is the first time I can remember a purposeful bombing to a health center that was not an abortion clinic. How significant is it to the debate, that we’re now seeing fertility clinics bombed as well? And what do we know, if anything, about why the bomber went after a fertility clinic? 

Karlin-Smith: There has been, obviously, some pressure on the right, I think, to go after fertility processes, and IVF [in vitro fertilization], and lump that in with abortion. Although, I think Trump and others have pushed back a bit on that, realizing how common and popular some of these fertility treatments are. And also it conflicts, I think, to some extent with their desire to grow the American population. 

The motives of this particular person don’t seem aligned with, I guess, the anti-abortion movement. He sort of seems more anti-natalist movement and stuff. So from that perspective, I didn’t see it as being aligned with kind of a bigger, more common political debate we’ve had recently, which is, again, does the Republican Party want to expand the anti-abortion debate even further into fertility treatments and stuff. 

Rovner: I was going to say, it certainly has drawn fertility clinics into the abortion debate, even if neither side in the abortion debate would presumably have an interest in blowing up a fertility clinic. But it is now sort of, I guess, in the general consciousness of antisocial people, if you will, that’s out there. 

The other story in the news this week is about a woman named Adriana Smith, a nurse and mother from Georgia who was nine weeks pregnant in February when she was declared brain-dead after a medical emergency. Smith has been kept alive on life support ever since, not because her family wants that but because her medical team at Emory University Hospital is worried about running afoul of Georgia’s abortion ban, which prohibits terminations after cardiac activity can be detected. Even if the mother is clinically dead? I feel like this case could have really ominous repercussions at some point. 

Ollstein: Well, I just want to point out that, yes, the state’s abortion ban is playing a role here, but this was happening while Roe v. Wade was still in place. There were cases like this. Some of it has to do with legislation around advanced directives and pregnancy. So I will point out that this is not solely a post-Dobbs phenomenon. 

Rovner: Yeah, I think it also bears watching. Well, there was lots of vaccine news this week — I’m so glad we have Anna and Sarah here — with both the HHS [Department of Health and Human Services] and FDA [Food and Drug Administration] declaring an end to recommending covid vaccines for what seems to be most of the population. Sarah, what did they do? And what does this mean? 

Karlin-Smith: So the new director of FDA’s biologics center and the FDA commissioner released a framework for approving covid shots moving forward. And basically they are saying that, because covid, the virus, shifts, and we want to try and update our vaccines at least yearly, usually, to keep up with the changing viruses, but we want to do that in a reasonable time so that by the time when you update the vaccine it’s actually available within that time — right? — FDA has allowed companies to do studies that don’t require full clinical trials anymore, because we sort of have already done those trials. We know these vaccines are safe and effective. We’re making minor tweaks to them, and they do immunogenicity studies, which are studies that basically show they mount the proper immune response. And then they approve them. 

FDA is now, seems to be, saying, We’re only going to allow those studies to approve new covid vaccine updates for people who are over 65, or under 65 and have health conditions, because they are saying, in their mind, the risk-benefit balance of offering these shots doesn’t necessarily pan out favorably for younger, healthier populations, and we should do clinical trials. 

It’s not entirely clear yet, despite them rolling out a framework, how this will actually play out. Can they relabel shots already approved? Will this only impact once companies do need to do a strain change next as the virus adapts? Did they go about doing this in a sort of legal manner? It came out through a journal kind of editorial commentary piece, not through the Federal Register or formal guidance. There’s been no notice of comment. 

So there’s a lot of questions to remain as to how this will be implemented, which products it would affect, and when. But there is a lot of concern that there may be reduced access to the products moving forward. 

Rovner: That’s because the vaccine makers aren’t going to — it’s not probably worth it financially to them — to remount all these studies. Right? 

Karlin-Smith: First off, a lot of people I’ve talked to, and this came up yesterday at a meeting FDA had, don’t believe it’s actually ethical to do some of the studies FDA is now calling for. Even though the benefits, particularly when you’re talking about boosting people who already had a primary vaccination series for covid, or some covid, is not the same as the benefits of getting an original covid vaccine series. 

There still are benefits, and there still are benefits for pretty much everybody that outweigh the risks. On average, these are extremely safe shots. We know a lot about their safety, and the balance is positive. So people are saying, once that exists, you cannot ethically test it on placebo. Even as [FDA Commissioner Marty] Makary says, Well, so many Americans are declining to take the shot, so let’s test it and see. A lot of ethicists would say it’s actually, even if people are willing to do something that may not be ideal for their health, that doesn’t mean it’s ethical to test it in a trial. 

So, I think there’s questions about, just, ethics, but also, right, whether companies would want to invest the time and money it would take to achieve and try to do them under this situation. So that is a big elephant in the room here. And I think some people feel like this is just sort of a push by Makary and his new CBER [Center for Biologics Evaluation and Research] director, essentially, to cut off vaccine access in a little bit of a sneaky way. 

Rovner: Well, I did see, also this week, was I think it was Moderna, that was going to make a combination flu covid vaccine, has decided not to. I assume that’s related to all of this? 

Karlin-Smith: Right. So Moderna had a, what people call a next-generation vaccine, which is supposed to be an improved update over the original shot, which is a bigger deal than just making a strain change. They actually think they provide a better response to protecting against the virus. And then they also added flu vaccine into it to sort of make it easier for people to get protected from both, and also provided solid data to show it would work well for flu. 

And they seem to have probably pulled their application at this point over, again, these new concerns, and what we know Novavax went through in trying to get their covid vaccine across the finish line dealing with this new administration. So I think people have their sort of alert lights up going forward as to how this administration is going to handle vaccine approvals and what that will mean for access going forward. 

Rovner: Well, in somewhat related news, we got the long-awaited report from Health and Human Services Secretary Robert F. Kennedy Jr.’s Make America Healthy Again Commission, which is supposed to lay out a blueprint for an action plan that will come later this summer. Not much in the 68-page report seems all that surprising. Some is fairly noncontroversial, calling for more study of ultra-processed foods and less screen time and more physical activity for kids. 

And some is controversial but at this point kind of predictable, calling for another look at the childhood vaccine schedule, including, as we just discussed, more placebo studies for vaccines, and also less fluoride available, except in toothpaste. Anything jump out at you guys from the report that we should keep an eye on? 

Karlin-Smith: I think one thing to think about is what it doesn’t address and doesn’t talk about. It’s not surprising the issues they call out for harming health in America, and some of them are debatable as to how much they do or don’t harm health, or whether their solutions would actually address those problems. 

But they never talk about the U.S.’ lack of a health insurance system that assures people have coverage. They don’t mention the Republican Party’s and likely president’s willingness to sign onto a major bill that’s going to impact health. They don’t really talk about the socioeconomic drivers that impact health, which I find particularly interesting when they talk about food, because, obviously, the U.S. has a lot of healthy and unhealthy food available. And a lot of people know sort of how they could make better choices, but there are these situational factors outside of, often, an individual’s control to lead to that. 

And I think the other thing that jumped out to me is, I think The Washington Post had a good line in their paragraph about just how many of the points are either overstated or misstated scientific findings. And they did a pretty good job of going through some of those. And it’s a difficult situation, I think, for the public to grapple with when you have leadership and the top echelons of our health department that is pushing so much misinformation, often very carefully, and having to weed out what is correct, where is the grains of truth, where does it go off into misinformation. 

I don’t know. I find it really hard as a journalist. And so I do worry about, again, how this all plays into public perception and misunderstanding of these topics. 

Rovner: And apparently they forgot about gun violence in all of this, which is rather notably not there. 

Ollstein: Cars and guns are the big killers. And yeah, no mention of that. 

Edney: I thought another glaring omission was tobacco. Kids are using e-cigarettes at high rates. We don’t really know much about them. And to Sarah’s point about misinformation, too, I think the hard part of being able to discern a lot of this, even as a member of the public, is everything they’ve done so far is only rhetoric. There hasn’t been actual regulation, or — this could be anything that you’re talking about. It could be food dyes. It could be “most favored nations.” We don’t know what they actually want to implement and what the potential for doing so — I think maybe on vaccines we’re seeing the most action. But as Sarah mentioned, we don’t know how that, whether it legally is going to be something that they can continue doing. 

So even with this report, it was highly anticipated, but I don’t think we got anything beyond what I probably heard Kennedy say over and over throughout the campaign and in his bid for health secretary. So I am wondering when they actually decide to move into the policymaking part of it, instead of just telling us they’re going to do something. 

Rovner: And interestingly, Secretary Kennedy was interviewed on CNN last night and walked back some of the timelines, even, including that vow that they were going to know the cause of autism by September and that they were going to have an action plan for this ready in another, I think, a hundred days. So this is going to be a hurry-up-and-wait. 

All right, well, that is as much news as we have time for in this incredibly busy week. Now we will play my interview with law professor and abortion historian Mary Ziegler, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast Mary Ziegler, the Martin Luther King Jr. professor of law at the University of California-Davis. She’s also a historian of the abortion movement. And her newest book, just out, is called “Personhood: The New Civil War Over Reproduction.” 

Mary Ziegler, thanks for joining us again. 

Mary Ziegler: Thanks for having me. 

Rovner: So we’ve talked about personhood a lot on our podcast, including with you, but it means different things to different people. What’s your working definition, at least for the purpose of this book? 

Ziegler: Yeah, I’m interested in this book in the legal fight for personhood, right? Some people have religious ideas of personhood. Bioethicists have ideas of personhood. Philosophers debate personhood. But I’m really interested in the legal claim that the word “person” in the 14th Amendment, which gives us liberty and equality, applies the moment an egg is fertilized. Because it’s that legal claim that’s had a lot of knock-on effects with abortion, with IVF, and potentially even beyond. 

Rovner: So if we as a society were to accept that fetuses or embryos or zygotes were people with full constitutional rights at the moment of creation, that can impact things way beyond abortion, right? 

Ziegler: Definitely, yeah, especially if you make the moves that the anti-abortion movement, or the pro-life movement, in the United States has made, right? So one of the other things that’s probably worth saying is, if you believe the claim I laid out about fetal personhood, that doesn’t mean you necessarily think abortion should be criminalized or that IVF should be criminalized, either. 

But the people who are leading the anti-abortion movement do, in large part, right? So it would have ramifications in lots of other contexts, because there’s a conclusion not only that human life begins at fertilization and that constitutional rights begin at fertilization but that the way you honor those constitutional rights is primarily by restricting or criminalizing certain things that threaten that life, in the views of the people who advocate for it. 

Rovner: Right. And that includes IVF and forms of contraception. That’s where we sort of get to this idea that an abortion is murder or that, in this case, doing anything that harms even a zygote is murder. 

Ziegler: Yeah. And it gets us to the Adriana Smith case in Georgia, too. So there’s sort of end-of-life cases that emerge. So, it obviously would have a big impact on abortion. So it’s not wrong to think about abortion in this context. It’s just that would definitely not be the stopping point. 

Rovner: So, many people have only talked about personhood, really, since the Supreme Court overturned Roe in 2022, but the concept is a lot older than that. I started covering personhood in like 2010, I think, when a couple of states were trying to vote on it. I didn’t realize until I read your book that it goes back well beyond even that. 

Ziegler: Yeah. So I think a lot of people had that conception. And in the 2010s, there were state constitutional amendment efforts to write the idea of fetal personhood into state constitutions. And they all failed. So I think the narrative coming out of that was that you had the anti-abortion movement on the one hand, and then you had this more extreme fetal personhood movement on the other hand. 

And that narrative fundamentally is wrong. There is no one in the anti-abortion movement who’s opposed to fetal personhood. There are disagreements about how and when it can be recognized. There’s strategic disagreements. There are no substantive disagreements much to speak of on the basics of fetal personhood. 

So the idea goes all the way back to the 1960s, when states were first reforming the 19th-century criminal laws you sometimes see coming back to life as zombie laws. And initially it started as a strategic necessity, because it was very hard for the early anti-abortion movement to stop this reform wave, right? They were saying things like, Oh, abortion is going to lead to more sexual promiscuity, or, No one really needs abortion, because pregnancy is no longer dangerous. And that just wasn’t getting the job done. 

So they began to argue that no one had a choice to legalize abortion in worse circumstances, because it would violate the rights of the unborn child. What’s interesting is that argument went from being this kind of strategic expedient to being this tremendously emotionally resonant long-term thing that has lived on the American right for now like a half-century. Even in moments when, I think arguably like right now, when it’s not politically smart to be making the argument, people will continue to, because this speaks to something, I think, for a lot of people who are opposed to abortion and other things like IVF. 

Rovner: I know you’ve got access in writing this book to a lot of internal documents from people in the anti-abortion movement. I’m jealous, I have to say. Was there something there that surprised you? 

Ziegler: Yeah, I think I was somewhat surprised by how much people talked this language of personhood when they were alone, right? This was not just something for the consumption of judges, or the consumption of politicians, or sort of like a nicer way to talk about what people really wanted. This was what people said when there was no one else there. 

That didn’t mean they didn’t say other things that suggested that there were lots of other values and beliefs underlying this concept of personhood. But I think one of the important lessons of that is if you’re trying to understand people who are opposed to abortion, just assuming that everything they’re saying is just pure strategy is not helpful, right? Any more than it would be for people who support reproductive rights, to have it assume that everything they’re saying is not genuine. You just fail to understand what people are doing, I think. And I think that was probably what I was the most surprised about. 

Rovner: I was struck that you point out that personhood doesn’t have to begin and end with the criminalization of abortion. How could more acceptance of the rights of the unborn change society in perhaps less polarized ways? 

Ziegler: Yeah, one of the things that’s really striking is that there are other countries that recognize a right to life for a fetus or unborn child that don’t criminalize abortion or don’t enforce criminal abortion laws. And often what they say is that it’s not OK for the state to start with criminalization when it isn’t doing things to support pregnant women, who after all are necessary for a fetus or unborn child to survive, right? 

So there are strategies that you could use to reduce infant mortality, for example, to reduce neonatal mortality, to reduce miscarriage and stillbirth, to improve maternal health, to really eliminate some of the reasons that people who may want, all things being equal, to carry a child to term. That’s not, obviously, going to be everybody. Some people don’t want to be parents at all. 

But there are other people for whom it’s a matter of resources, or it’s a matter of overcoming racial discrimination, or it’s a matter of leaving an abusive relationship. And if governments were more committed to doing some of those things, it’s reasonable to assume that a subset of those people would carry pregnancies to term, right? 

So there are lots of ways that if a state were serious about honoring fetal life, that it could. I think one of the other things that’s striking that I realized in writing the book is that that tracks with what a subset of Americans think. You’ll find these artifacts in polls where you’ll get something like 33% of people in Pew Forum’s 2022 poll saying they thought that life and rights began at conception, but also that abortion shouldn’t be criminalized. 

So there are a subset of Americans who, whether they’re coming from a place of faith or otherwise, can hold those two beliefs at once. So I think an interesting question is, could we have a politics that accommodates that kind of belief? And at the moment the answer is probably not, but it’s interesting to imagine how that could change. 

Rovner: It’s nice to know that there is a place that we can hope to get. 

Ziegler: Yeah, exactly. 

Rovner: Mary Ziegler, thank you so much for joining us again. 

Ziegler: Thanks for having me. 

Rovner: OK, we’re back. And 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 put the links in our show notes on your phone or other mobile devices. Sarah, you chose first this week. You go first. 

Karlin-Smith: I purposely chose a sort of light story from Australia, where scientists studied remote work, and the headline is “[Scientists Have Been Studying Remote Work for Four Years and Have] Reached a Very Clear Conclusion: ‘Working From Home Makes Us Happier.’” And it just goes through some of the benefits and perks people have found from working remotely, including more sleep, more time with friends and family, things like that. And it just felt like a nice, interesting read in a time where there’s a lot of heavy health news. 

Rovner: Also, scientific evidence of things that I think we all could have predicted. Anna. 

Edney: Apologies for going the other direction here, but it’s a story that I wrote this week, an investigation that I’ve been working on for a long time, “The Potential Cancer, Health Risks Lurking in One Popular OTC Drug.” So this is one, in particularly a lot of women have used. You can go in any CVS, Target, Walmart, stores like that, and buy it. Called Azo, for urinary tract infections. And all these stores sell their own generic versions as well, under phenazopyridine. 

And this drug, I was kind of shocked to learn, is not FDA-approved. There are prescription versions that are not FDA-approved, either. It’s just been around so long that it’s been grandfathered in. And that may not be a big deal, except that this one, the FDA has raised questions about whether it causes cancer and whether it needs a stronger cancer warning, because the National Cancer Institute found in 1978 that it causes tumors in rats and mice. But no other work has been done on this drug, because it hasn’t been approved. So no one’s looked at it in humans. And it masks issues that really need antibiotics and causes a host of other issues. 

There were — University of Virginia toxicologists told me they found, in the last 20 years, at least 200 suspected teen suicides where they used this drug, because of how dangerous this drug can be in any higher amounts than what’s on the box. So I went through this drug, but there are other ones on the market as well that are not approved. And there’s this whole FDA system that has allowed the OTC [over-the-counter] market to be pretty lax. 

Rovner: OK, that’s terrifying. But thank you for your work. Alice. 

Ollstein: Speaking of terrifying, I chose a piece from NPR called, “Diseases Are Spreading. The CDC Isn’t Warning the Public Like It Was Months Ago.” And this is a look at all of the ways our public health agency that is supposed to be letting us know when outbreaks are happening, and where, and how to protect ourselves, they’ve gone dark. They are not posting on social media. They are not sending out alerts. They are not sending out newsletters. And it walks through the danger of all of that happening, with interviews with people who are still on the inside and on the outside experiencing the repercussions. 

Rovner: Well, my extra credit, it helps explain why Alice’s extra credit, because it’s about all the people who were doing that who have been fired or laid off from the federal government. It’s called, “White House Officials Wanted To Put Federal Workers ‘in Trauma.’ It’s Working,” by William Wan and Hannah Natanson. 

And it’s the result of interviews with more than 30 current and former federal workers, along with the families of some who died or killed themselves. And it’s a review of documents to confirm those stories. It’s a super-depressing but beautifully told piece about the dramatic mental health impact of the federal DOGE [Department of Government Efficiency] layoffs and firings, and the impact that that’s been having on these workers, their families, and their communities. 

OK, that is this week’s show. 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. Thanks to our fill-in editor this week, Rebecca Adams, and our producer, Francis Ying. 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 guys hanging these days? Anna? 

Edney: Both of those [X and Bluesky], @annaedney. 

Rovner: Sarah. 

Karlin-Smith: Everywhere — X, Bluesky, LinkedIn, @SarahKarlin or @sarahkarlin-smith. 

Rovner: Alice. 

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

Rovner: I am off to California next week, where we’ll be taping the podcast at the annual meeting of the Association for Health Care Journalists, which we won’t post until the following Monday. So everyone please have a great Memorial Day holiday week. And until then, be healthy. 

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Emrelis, an antibody drug conjugate developed by AbbVie, is now FDA approved for patients whose non-small cell lung cancer overexpresses the protein c-Met. The pharma company said this ADC is its first internally developed solid tumor medicine as well as its first solid tumor FDA approval in lung cancer.

The post AbbVie’s Solid Tumor Strategy Gets a Win With Accelerated FDA Approval in Lung Cancer appeared first on MedCity News.

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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 a budget resolution this spring foreshadowing major Medicaid cuts, Republicans in Congress are having trouble agreeing on specific ways to save billions of dollars from a pool of funding that pays for the program without cutting benefits on which millions of Americans rely. Moderates resist changes they say would harm their constituents, while fiscal conservatives say they won’t vote for smaller cuts than those called for in the budget resolution. The fate of President Donald Trump’s “one big, beautiful bill” containing renewed tax cuts and boosted immigration enforcement could hang on a Medicaid deal.

Meanwhile, the Trump administration surprised those on both sides of the abortion debate by agreeing with the Biden administration that a Texas case challenging the FDA’s approval of the abortion pill mifepristone should be dropped. It’s clear the administration’s request is purely technical, though, and has no bearing on whether officials plan to protect the abortion pill’s availability.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Maya Goldman of Axios, and Sandhya Raman of CQ Roll Call.

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Anna Edney
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Maya Goldman
Axios

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Sandhya Raman
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Among the takeaways from this week’s episode:

• Congressional Republicans are making halting progress on negotiations over government spending cuts. As hard-line House conservatives push for deeper cuts to the Medicaid program, their GOP colleagues representing districts that heavily depend on Medicaid coverage are pushing back. House Republican leaders are eying a Memorial Day deadline, and key committees are scheduled to review the legislation next week — but first, Republicans need to agree on what that legislation says.
• Trump withdrew his nomination of Janette Nesheiwat for U.S. surgeon general amid accusations she misrepresented her academic credentials and criticism from the far right. In her place, he nominated Casey Means, a physician who is an ally of HHS Secretary Robert F. Kennedy Jr.’s and a prominent advocate of the “Make America Healthy Again” movement.
• The pharmaceutical industry is on alert as Trump prepares to sign an executive order directing agencies to look into “most-favored-nation” pricing, a policy that would set U.S. drug prices to the lowest level paid by similar countries. The president explored that policy during his first administration, and the drug industry sued to stop it. Drugmakers are already on edge over Trump’s plan to impose tariffs on drugs and their ingredients.
• And Kennedy is scheduled to appear before the Senate’s Health, Education, Labor and Pensions Committee next week. The hearing would be the first time the secretary of Health and Human Services has appeared before the HELP Committee since his confirmation hearings — and all eyes are on the committee’s GOP chairman, Sen. Bill Cassidy of Louisiana, a physician who expressed deep concerns at the time, including about Kennedy’s stances on vaccines.

Also this week, Rovner interviews KFF Health News’ Lauren Sausser, who co-reported and co-wrote the latest KFF Health News’ “Bill of the Month” installment, about an unexpected bill for what seemed like preventive care. If you have an outrageous, baffling, or infuriating 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 this week that they think you should read, too: 

Julie Rovner: NPR’s “Fired, Rehired, and Fired Again: Some Federal Workers Find They’re Suddenly Uninsured,” by Andrea Hsu. 

Maya Goldman: Stat’s “Europe Unveils $565 Million Package To Retain Scientists, and Attract New Ones,” by Andrew Joseph. 

Anna Edney: Bloomberg News’ “A Former TV Writer Found a Health-Care Loophole That Threatens To Blow Up Obamacare,” by Zachary R. Mider and Zeke Faux. 

Sandhya Raman: The Louisiana Illuminator’s “In the Deep South, Health Care Fights Echo Civil Rights Battles,” by Anna Claire Vollers. 

Also mentioned in this week’s podcast:

• ProPublica’s series “Life of the Mother: How Abortion Bans Lead to Preventable Deaths,” by Kavitha Surana, Lizzie Presser, Cassandra Jaramillo, and Stacy Kranitz, and the winner of the 2025 Pulitzer Prize for public service journalism.
• The New York Times’ “G.O.P. Targets a Medicaid Loophole Used by 49 States To Grab Federal Money,” by Margot Sanger-Katz and Sarah Kliff.
• KFF Health News’ “Seeking Spending Cuts, GOP Lawmakers Target a Tax Hospitals Love to Pay,” by Phil Galewitz.
• Axios’ “Out-of-Pocket Drug Spending Hit $98B in 2024: Report,” by Maya Goldman.

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Transcript: Cutting Medicaid Is Hard — Even for the GOP

[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, May 8, 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 a videoconference 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 CQ Roll Call. 

Sandhya Raman: Good morning, everyone. 

Rovner: Later in this episode we’ll have my “Bill of the Month” interview with my KFF Health News colleague Lauren Sausser. This month’s patient got preventive care they assumed would be covered by their Affordable Care Act health plan, except it wasn’t. But first, this week’s news. 

We’re going to start on Capitol Hill, where Sandhya is coming directly from, where regular listeners to this podcast will be not one bit surprised that Republicans working on President [Donald] Trump’s one “big, beautiful” budget reconciliation bill are at an impasse over how and how deeply to cut the Medicaid program. Originally, the House Energy and Commerce Committee was supposed to mark up its portion of the bill this week, but that turned out to be too optimistic. Now they’re shooting for next week, apparently Tuesday or so, they’re saying, and apparently that Memorial Day goal to finish the bill is shifting to maybe the Fourth of July? But given what’s leaking out of the closed Republican meetings on this, even that might be too soon. Where are we with these Medicaid negotiations? 

Raman: I would say a lot has been happening, but also a lot has not been happening. I think that anytime we’ve gotten any little progress on knowing what exactly is at the top of the list, it gets walked back. So earlier this week we had a meeting with a lot of the moderates in Speaker [Mike] Johnson’s office and trying to get them on board with some of the things that they were hesitant about, and following the meeting, Speaker Johnson had said that two of the things that have been a little bit more contentious — changing the federal match for the expansion population and instituting per capita caps for states — were off the table. But the way that he phrased it is kind of interesting in that he said stay tuned and that it possibly could change. 

And so then yesterday when we were hearing from the Energy and Commerce Committee, it seemed like these things are still on the table. And then Speaker Johnson has kind of gone back on that and said, I said it was likely. So every time we kind of have any sort of change, it’s really unclear if these things are in the mix, outside the mix. When we pulled them off the table, we had a lot of the hard-line conservatives get really upset about this because it’s not enough savings. So I think any way that you push it with such narrow margins, it’s been difficult to make any progress, even though they’ve been having a lot of meetings this week. 

Rovner: One of the things that surprised me was apparently the Senate Republicans are weighing in. The Senate Republicans who aren’t even set to make Medicaid cuts under their version of the budget resolution are saying that the House needs to go further. Where did that come from? 

Raman: It’s just been a difficult process to get anything across. I mean, in the House side, a lot of it has been, I think, election-driven. You see the people that are not willing to make as many concessions are in competitive districts. The people that want to go a little bit more extreme on what they’re thinking are in much more safe districts. And then in the Senate, I think there’s a lot more at play just because they have longer terms, they have more to work with. So some of the pushback has been from people that it would directly affect their states or if the governors have weighed in. But I think that there are so many things that they do want to get done, since there is much stronger agreement on some of the immigration stuff and the taxes that they want to find the savings somewhere. If they don’t find it, then the whole thing is moot. 

Rovner: So meanwhile, the Congressional Budget Office at the request of Democrats is out with estimates of what some of these Medicaid options would mean for coverage, and it gives lie to some of these Republican claims that they can cut nearly a trillion dollars from Medicaid without touching benefits, right? I mean all of these — and Maya, your nodding. 

Goldman: Yeah. 

Rovner: All of these things would come with coverage losses. 

Goldman: Yeah, I think it’s important to think about things like work requirements, which has gotten a lot of support from moderate Republicans. The only way that that produces savings is if people come off Medicaid as a result. Work requirements in and of themselves are not saving any money. So I know advocates are very concerned about any level of cuts. I talked to somebody from a nursing home association who said: We can’t pick and choose. We’re not in a position to pick and choose which are better or worse, because at this point, everything on the table is bad for us. So I think people are definitely waiting with bated breath there. 

Rovner: Yeah, I’ve heard a lot of Republicans over the last week or so with the talking points. If we’re just going after fraud and abuse then we’re not going to cut anybody’s benefits. And it’s like — um, good luck with that. 

Goldman: And President Trump has said that as well. 

Rovner: That’s right. Well, one place Congress could recoup a lot of money from Medicaid is by cracking down on provider taxes, which 49 of the 50 states use to plump up their federal Medicaid match, if you will. Basically the state levies a tax on hospitals or nursing homes or some other group of providers, claims that money as their state share to draw down additional federal matching Medicaid funds, then returns it to the providers in the form of increased reimbursement while pocketing the difference. You can call it money laundering as some do, or creative financing as others do, or just another way to provide health care to low-income people. 

But one thing it definitely is, at least right now, is legal. Congress has occasionally tried to crack down on it since the late 1980s. I have spent way more time covering this fight than I wish I had, but the combination of state and health provider pushback has always prevented it from being eliminated entirely. If you want a really good backgrounder, I point you to the excellent piece in The New York Times this week by our podcast pals Margot Sanger-Katz and Sarah Kliff. What are you guys hearing about provider taxes and other forms of state contributions and their future in all of this? Is this where they’re finally going to look to get a pot of money? 

Raman: It’s still in the mix. The tricky thing is how narrow the margins are, and when you have certain moderates having a hard line saying, I don’t want to cut more than $500 billion or $600 billion, or something like that. And then you have others that don’t want to dip below the $880 billion set for the Energy and Commerce Committee. And then there are others that have said it’s not about a specific number, it’s what is being cut. So I think once we have some more numbers for some of the other things, it’ll provide a better idea of what else can fit in. Because right now for work requirements, we’re going based on some older CBO [Congressional Budget Office] numbers. We have the CBO numbers that the Democrats asked for, but it doesn’t include everything. And piecing that together is the puzzle, will illuminate some of that, if there are things that people are a little bit more on board with. But it’s still kind of soon to figure out if we’re not going to see draft text until early next week. 

Goldman: I think the tricky thing with provider taxes is that it’s so baked into the way that Medicaid functions in each state. And I think I totally co-sign on the New York Times article. It was a really helpful explanation of all of this, and I would bet that you’ll see a lot of pushback from state governments, including Republicans, on a proposal that makes severe changes to that. 

Rovner: Someday, but not today, I will tell the story of the 1991 fight over this in which there was basically a bizarre dealmaking with individual senators to keep this legal. That was a year when the Democrats were trying to get rid of it. So it’s a bipartisan thing. All right, well, moving on. 

It wouldn’t be a Thursday morning if we didn’t have breaking federal health personnel news. Today was supposed to be the confirmation hearing for surgeon general nominee and Fox News contributor Janette Nesheiwat. But now her nomination has been pulled over some questions about whether she was misrepresenting her medical education credentials, and she’s already been replaced with the nomination of Casey Means, the sister of top [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] aide Calley Means, who are both leaders in the MAHA [“Make America Healthy Again”] movement. This feels like a lot of science deniers moving in at one time. Or is it just me? 

Edney: Yeah, I think that the Meanses have been in this circle, names floated for various things at various times, and this was a place where Casey Means fit in. And certainly she espouses a lot of the views on, like, functional medicine and things that this administration, at least RFK Jr., seems to also subscribe to. But the one thing I’m not as clear on her is where she stands with vaccines, because obviously Nesheiwat had fudged on her school a little bit, and— 

Rovner: Yeah, I think she did her residency at the University of Arkansas— 

Edney: That’s where. 

Rovner: —and she implied that she’d graduated from the University of Arkansas medical school when in fact she graduated from an accredited Caribbean medical school, which lots of doctors go to. It’s not a sin— 

Edney: Right. 

Rovner: —and it’s a perfectly, as I say, accredited medical school. That was basically — but she did fudge it on her resume. 

Edney: Yeah. 

Rovner: So apparently that was one of the things that got her pulled. 

Edney: Right. And the other, kind of, that we’ve seen in recent days, again, is Laura Loomer coming out against her because she thinks she’s not anti-vaccine enough. So what the question I think to maybe be looking into today and after is: Is Casey Means anti-vaccine enough for them? I don’t know exactly the answer to that and whether she’ll make it through as well. 

Rovner: Well, we also learned this week that Vinay Prasad, a controversial figure in the covid movement and even before that, has been named to head the FDA [Food and Drug Administration] Center for Biologics and Evaluation Research, making him the nation’s lead vaccine regulator, among other things. Now he does have research bona fides but is a known skeptic of things like accelerated approval of new drugs, and apparently the biotech industry, less than thrilled with this pick, Anna? 

Edney: Yeah, they are quite afraid of this pick. You could see it in the stocks for a lot of vaccine companies, for some other companies particularly. He was quite vocal and quite against the covid vaccines during covid and even compared them to the Nazi regime. So we know that there could be a lot of trouble where, already, you know, FDA has said that they’re going to require placebo-controlled trials for new vaccines and imply that any update to a covid vaccine makes it a new vaccine. So this just spells more trouble for getting vaccines to market and quickly to people. He also—you mentioned accelerated approval. This is a way that the FDA uses to try to get promising medicines to people faster. There are issues with it, and people have written about the fact that they rely on what are called surrogate endpoints. So not Did you live longer? but Did your tumor shrink? 

And you would think that that would make you live longer, but it actually turns out a lot of times it doesn’t. So you maybe went through a very strong medication and felt more terrible than you might have and didn’t extend your life. So there’s a lot of that discussion, and so that. There are other drugs. Like this Sarepta drug for Duchenne muscular dystrophy is a big one that Vinay Prasad has come out against, saying that should have never been approved, because it was using these kind of surrogate endpoints. So I think biotech’s pretty — thinking they’re going to have a lot tougher road ahead to bring stuff to market. 

Rovner: And I should point out that over the very long term, this has been the continuing struggle at FDA. It’s like, do you protect the public but make people wait longer for drugs or do you get the drugs out and make sure that people who have no other treatments available have something available? And it’s been a constant push and pull. It’s not really been partisan. Sometimes you get one side pushing and the other side pushing back. It’s really nothing new. It’s just the sort of latest iteration of this. 

Edney: Right. Yeah. This is the pendulum swing, back to the Maybe we need to be slowing it down side. It’s also interesting because there are other discussions from RFK Jr. that, like, We need to be speeding up approvals and Trump wants to speed up approvals. So I don’t know where any of this will actually come down when the rubber meets the road, I guess. 

Rovner: Sandhya and Maya, I see you both nodding. Do you want to add something? 

Raman: I think this was kind of a theme that I also heard this week in the — we had the Senate Finance hearing for some of the HHS [Department of Health and Human Services] nominees, and Jim O’Neill, who’s one of the nominees, that was something that was brought up by Finance ranking member Ron Wyden, that some of his past remarks when he was originally considered to be on the short list for FDA commissioner last Trump administration is that he basically said as long as it’s safe, it should go ahead regardless of efficacy. So those comments were kind of brought back again, and he’s in another hearing now, so that might come up as an issue in HELP [the Senate Committee on Health, Education, Labor and Pensions] today. 

Rovner: And he’s the nominee for deputy secretary, right? Have to make sure I keep all these things straight. Maya, you wanting to add something? 

Goldman: Yeah, I was just going to say, I think there is a divide between these two philosophies on pharmaceuticals, and my sense is that the selection of Prasad is kind of showing that the anti-accelerated-approval side is winning out. But I think Anna is correct that we still don’t know where it’s going to land. 

Rovner: Yes, and I will point out that accelerated approval first started during AIDS when there was no treatments and basically people were storming the — literally physically storming — the FDA, demanding access to AIDS drugs, which they did finally get. But that’s where accelerated approval came from. This is not a new fight, and it will continue. 

Turning to abortion, the Trump administration surprised a lot of people this week when it continued the Biden administration’s position asking for that case in Texas challenging the abortion pill to be dropped. For those who’ve forgotten, this was a case originally filed by a bunch of Texas medical providers demanding the judge overrule the FDA’s approval of the abortion pill mifepristone in the year 2000. The Supreme Court ruled the original plaintiff lacked standing to sue, but in the meantime, three states —Missouri, Idaho, and Kansas — have taken their place as plaintiffs. But now the Trump administration points out that those states have no business suing in the Northern District of Texas, which kind of seems true on its face. But we should not mistake this to think that the Trump administration now supports the current approval status of the abortion bill. Right, Sandhya? 

Raman: Yeah, I think you’re exactly right. It doesn’t surprise me. If they had allowed these three states, none of which are Texas — they shouldn’t have standing. And if they did allow them to, that would open a whole new can of worms for so many other cases where the other side on so many issues could cherry-pick in the same way. And so I think, I assume, that this will come up in future cases for them and they will continue with the positions they’ve had before. But this was probably in their best interest not to in this specific one. 

Rovner: Yeah. There are also those who point out that this could be a way of the administration protecting itself. If it wants to roll back or reimpose restrictions on the abortion pill, it would help prevent blue states from suing to stop that. So it serves a double purpose here, right? 

Raman: Yeah. I couldn’t see them doing it another way. And even if you go through the ruling, the language they use, it’s very careful. It’s not dipping into talking fully about abortion. It’s going purely on standing. Yeah. 

Rovner: There’s nothing that says, We think the abortion pill is fine the way it is. It clearly does not say that, although they did get the headlines — and I’m sure the president wanted — that makes it look like they’re towing this middle ground on abortion, which they may be but not necessarily in this case. 

Well, before we move off of reproductive health, a shoutout here to the incredible work of ProPublica, which was awarded the Pulitzer Prize for public service this week for its stories on women who died due to abortion bans that prevented them from getting care for their pregnancy complications. Regular listeners of the podcast will remember that we talked about these stories as they came out last year, but I will post another link to them in the show notes today. 

OK, moving on. There’s even more drug price news this week, starting with the return of, quote, “most favored nation” drug pricing. Anna, remind us what this is and why it’s controversial. 

Edney: Yeah. So the idea of most favored nation, this is something President Trump has brought up before in his first administration, but it creates a basket, essentially, of different prices that nations pay. And we’re going to base ours on the lowest price that is paid for— 

Rovner: We’re importing other countries’— 

Edney: —prices. 

Rovner: —price limits. 

Edney: Yeah. Essentially, yes. We can’t import their drugs, but we can import their prices. And so the goal is to just basically piggyback off of whoever is paying the lowest price and to base ours off of that. And clearly the drug industry does not like this and, I think, has faced a number of kind of hits this week where things are looming that could really come after them. So Politico broke that news that Trump is going to sign or expected to sign an executive order that will direct his agencies to look into this most-favored-nation effort. And it feels very much like 2.0, like we were here before. And it didn’t exactly work out, obviously. 

Rovner: They sued, didn’t they? The drug industry sued, as I recall. 

Edney: Yeah, I think you’re right. Yes. 

Goldman: If I’m remembering— 

Rovner: But I think they won. 

Goldman: If I’m remembering correctly, it was an Administrative Procedure Act lawsuit though, right? So— 

Rovner: It was. Yes. It was about a regulation. Yes. 

Goldman: —who knows what would happen if they go through a different procedure this time. 

Rovner: So the other thing, obviously, that the drug industry is freaked out about right now are tariffs, which have been on again, off again, on again, off again. Where are we with tariffs on — and it’s not just tariffs on drugs being imported. It’s tariffs on drug ingredients being imported, right? 

Edney: Yeah. And that’s a particularly rough one because many ingredients are imported, and then some of the drugs are then finished here, just like a car. All the pieces are brought in and then put together in one place. And so this is something the Trump administration has began the process of investigating. And PhRMA [Pharmaceutical Research and Manufacturers of America], the trade group for the drug industry, has come out officially, as you would expect, against the tariffs, saying that: This will reduce our ability to do R&D. It will raise the price of drugs that Americans pay, because we’re just going to pass this on to everyone. And so we’re still in this waiting zone of seeing when or exactly how much and all of that for the tariffs for pharma. 

Rovner: And yet Americans are paying — already paying — more than they ever have. Maya, you have a story just about that. Tell us. 

Goldman: Yeah, there was a really interesting report from an analytics data firm that showed the price that Americans are paying for prescriptions is continuing to climb. Also, the number of prescriptions that Americans are taking is continuing to climb. It certainly will be interesting to see if this administration can be any more successful. That report, I don’t think this made it into the article that I ended up writing, but it did show that the cost of insulin is down. And that’s something that has been a federal policy intervention. We haven’t seen a lot of the effects yet of the Medicare drug price negotiations, but I think there are signs that that could lower the prices that people are paying. So I think it’s interesting to just see the evolution of all of this. It’s very much in flux. 

Rovner: A continuing effort. Well, we are now well into the second hundred days of Trump 2.0, and we’re still learning about the cuts to health and health-related programs the administration is making. Just in this week’s rundown are stories about hundreds more people being laid off at the National Cancer Institute, a stop-work order at the National Institute of Allergy and Infectious Diseases research lab at Fort Detrick, Maryland, that studies Ebola and other deadly infectious diseases, and the layoff of most of the remaining staff at the National Institute for Occupational Safety and Health. 

A reminder that this is all separate from the discretionary-spending budget request that the administration sent up to lawmakers last week. That document calls for a 26% cut in non-mandatory funding at HHS, meaning just about everything other than Medicare and Medicaid. And it includes a proposed $18 billion cut to the NIH [National Institutes of Health] and elimination of the $4 billion Low Income Home Energy Assistance Program, which helps millions of low-income Americans pay their heating and air conditioning bills. Now, this is normally the part of the federal budget that’s deemed dead on arrival. The president sends up his budget request, and Congress says, Yeah, we’re not doing that. But this at least does give us an idea of what direction the administration wants to take at HHS, right? What’s the likelihood of Congress endorsing any of these really huge, deep cuts? 

Raman: From both sides— 

Rovner: Go ahead, Sandhya. 

Raman: It’s not going to happen, and they need 60 votes in the Senate to pass the appropriations bills. I think that when we’re looking in the House in particular, there are a lot of things in what we know from this so-called skinny budget document that they could take up and put in their bill for Labor, HHS, and Education. But I think the Senate’s going to be a different story, just because the Senate Appropriations chair is Susan Collins and she, as soon as this came out, had some pretty sharp words about the big cuts to NIH. They’ve had one in a series of two hearings on biomedical research. Concerned about some of these kinds of things. So I cannot necessarily see that sharp of a cut coming to fruition for NIH, but they might need to make some concessions on some other things. 

This is also just a not full document. It has some things and others. I didn’t see any to FDA in there at all. So that was a question mark, even though they had some more information in some of the documents that had leaked kind of earlier on a larger version of this budget request. So I think we’ll see more about how people are feeling next week when we start having Secretary Kennedy testify on some of these. But I would not expect most of this to make it into whatever appropriations law we get. 

Goldman: I was just going to say that. You take it seriously but not literally, is what I’ve been hearing from people. 

Edney: We don’t have a full picture of what has already been cut. So to go in and then endorse cutting some more, maybe a little bit too early for that, because even at this point they’re still bringing people back that they cut. They’re finding out, Oh, this is actually something that is really important and that we need, so to do even more doesn’t seem to make a lot of sense right now. 

Rovner: Yeah, that state of disarray is purposeful, I would guess, and doing a really good job at sort of clouding things up. 

Goldman: One note on the cuts. I talked to someone at HHS this week who said as they’re bringing back some of these specialized people, in order to maintain the legality of, what they see as the legality of, the RIF [reduction in force], they need to lay off additional people to keep that number consistent. So I think that is very much in flux still and interesting to watch. 

Rovner: Yeah, and I think that’s part of what we were seeing this week is that the groups that got spared are now getting cut because they’ve had to bring back other people. And as I point out, I guess, every week, pretty much all of this is illegal. And as it goes to courts, judges say, You can’t do this. So everything is in flux and will continue. 

All right, finally this week, Health and Human Services Secretary Robert F. Kennedy Jr., who as of now is scheduled to appear before the Senate Health, Education, Labor, and Pensions Committee next week to talk about the department’s proposed budget, is asking CDC [the Centers for Disease Control and Prevention] to develop new guidance for treating measles with drugs and vitamins. This comes a week after he ordered a change in vaccine policy you already mentioned, Anna, so that new vaccines would have to be tested against placebos rather than older versions of the vaccine. These are all exactly the kinds of things that Kennedy promised health committee chairman Bill Cassidy he wouldn’t do. And yet we’ve heard almost nothing from Cassidy about anything the secretary has said or done since he’s been in office. So what do we expect to happen when they come face-to-face with each other in front of the cameras next week, assuming that it happens? 

Edney: I’m very curious. I don’t know. Do I expect a senator to take a stand? I don’t necessarily, but this— 

Rovner: He hasn’t yet. 

Edney: Yeah, he hasn’t yet. But this is maybe about face-saving too for him. So I don’t know. 

Rovner: Face-saving for Kennedy or for Cassidy? 

Edney: For Cassidy, given he said: I’m going to keep an eye on him. We’re going to talk all the time, and he is not going to do this thing without my input. I’m not sure how Cassidy will approach that. I think it’ll be a really interesting hearing that we’ll all be watching. 

Rovner: Yes. And just little announcement, if it does happen, that we are going to do sort of a special Wednesday afternoon after the hearing with some of our KFF Health News colleagues. So we are looking forward to that hearing. All right, that is this week’s news. Now we will play my “Bill of the Month” interview with Lauren Sausser, and then we will come back and do our extra credits. 

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

Lauren Sausser: Thank you. Thanks for having me. 

Rovner: So this month’s patient got preventive care, which the Affordable Care Act was supposed to incentivize by making it cost-free at the point of service — except it wasn’t. Tell us who the patient is and what kind of care they got. 

Sausser: Carmen Aiken is from Chicago. Carmen uses they/them pronouns. And Carmen made an appointment in the summer of 2023 for an annual checkup. This is just like a wellness check that you are very familiar with. You get your vaccines updated. You get your weight checked. You talk to your doctor about your physical activity and your family history. You might get some blood work done. Standard stuff. 

Rovner: And how big was the bill? 

Sausser: The bill ended up being more than $1,400 when it should, in Carmen’s mind, have been free. 

Rovner: Which is a lot. 

Sausser: A lot. 

Rovner: I assume that there was a complaint to the health plan and the health plan said, Nope, not covered. Why did they say that? 

Sausser: It turns out that alongside with some blood work that was preventive, Carmen also had some blood work done to monitor an ongoing prescription. Because that blood test is not considered a standard preventive service, the entire appointment was categorized as diagnostic and not preventive. So all of these services that would’ve been free to them, available at no cost, all of a sudden Carmen became responsible for. 

Rovner: So even if the care was diagnostic rather than strictly preventive — obviously debatable — that sounds like a lot of money for a vaccine and some blood test. Why was the bill so high? 

Sausser: Part of the reason the bill was so high was because Carmen’s blood work was sent to a hospital for processing, and hospitals, as you know, can charge a lot more for the same services. So under Carmen’s health plan, they were responsible for, I believe it was, 50% of the cost of services performed in an outpatient hospital setting. And that’s what that blood work fell under. So the charges were high. 

Rovner: So we’ve talked a lot on the podcast about this fight in Congress to create site-neutral payments. This is a case where that probably would’ve made a big difference. 

Sausser: Yeah, it would. And there’s discussion, there’s bipartisan support for it. The idea is that you should not have to pay more for the same services that are delivered at different places. But right now there’s no legislation to protect patients like Carmen from incurring higher charges. 

Rovner: So what eventually happened with this bill? 

Sausser: Carmen ended up paying it. They put it on a credit card. This was of course after they tried appealing it to their insurance company. Their insurance company decided that they agreed with the provider that these services were diagnostic, not preventive. And so, yeah, Carmen was losing sleep over this and decided ultimately that they were just going to pay it. 

Rovner: And at least it was a four-figure bill and not a five-figure bill. 

Sausser: Right. 

Rovner: What’s the takeaway here? I imagine it is not that you should skip needed preventive/diagnostic care. Some drugs, when you’re on them, they say that you should have blood work done periodically to make sure you’re not having side effects. 

Sausser: Right. You should not skip preventive services. And that’s the whole intent behind this in the ACA. It catches stuff early so that it becomes more treatable. I think you have to be really, really careful and specific when you’re making appointments, and about your intention for the appointment, so that you don’t incur charges like this. I think that you can also be really careful about where you get your blood work conducted. A lot of times you’ll see these signs in the doctor’s office like: We use this lab. If this isn’t in-network with you, you need to let us know. Because the charges that you can face really vary depending on where those labs are processed. So you can be really careful about that, too. 

Rovner: And adding to all of this, there’s the pending Supreme Court case that could change it, right? 

Sausser: Right. The Supreme Court heard oral arguments. It was in April. I think it was on the 21st. And it is a case that originated out in Texas. There is a group of Christian businesses that are challenging the mandate in the ACA that requires health insurers to cover a lot of these preventive services. So obviously we don’t have a decision in the case yet, but we’ll see. 

Rovner: We will, and we will cover it on the podcast. Lauren Sausser, thank you so much. 

Sausser: Thank you. 

Rovner: OK, we’re back. Now 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. Maya, you were the first to choose this week, so why don’t you go first? 

Goldman: My extra credit is from Stat. It’s called “Europe Unveils $565 Million Package To Retain Scientists, and Attract New Ones,” by Andrew Joseph. And I just think it’s a really interesting evidence point to the United States’ losses, other countries’ gain. The U.S. has long been the pinnacle of research science, and people flock to this country to do research. And I think we’re already seeing a reversal of that as cuts to NIH funding and other scientific enterprises is reduced. 

Rovner: Yep. A lot of stories about this, too. Anna. 

Edney: So mine is from a couple of my colleagues that they did earlier this week. “A Former TV Writer Found a Health-Care Loophole That Threatens To Blow Up Obamacare.” And I thought it was really interesting because it had brought me back to these cheap, bare-bones plans that people were allowed to start selling that don’t meet any of the Obamacare requirements. And so this guy who used to, in the ’80s and ’90s, wrote for sitcoms — “Coach” or “Night Court,” if anyone goes to watch those on reruns. But he did a series of random things after that and has sort of now landed on selling these junk plans, but doing it in a really weird way that signs people up for a job that they don’t know they’re being signed up for. And I think it’s just, it’s an interesting read because we knew when these things were coming online that this was shady and people weren’t going to get the coverage they needed. And this takes it to an extra level. They’re still around, and they’re still ripping people off. 

Rovner: Or as I’d like to subhead this story: Creative people think of creative things. 

Edney: “Creative” is a nice word. 

Rovner: Sandhya. 

Raman: So my pick is “In the Deep South, Health Care Fights Echo Civil Rights Battles,” and it’s from Anna Claire Vollers at the Louisiana Illuminator. And her story looks at some of the ties between civil rights and health. So 2025 is the 70th anniversary of the bus boycott, the 60th anniversary of Selma-to-Montgomery marches, the Voting Rights Act. And it’s also the 60th anniversary of Medicaid. And she goes into, Medicaid isn’t something you usually consider a civil rights win, but health as a human right was part of the civil rights movement. And I think it’s an interesting piece. 

Rovner: It is an interesting piece, and we should point out Medicare was also a huge civil rights, important piece of law because it desegregated all the hospitals in the South. All right, my extra credit this week is a truly infuriating story from NPR by Andrea Hsu. It’s called “Fired, Rehired, and Fired Again: Some Federal Workers Find They’re Suddenly Uninsured.” And it’s a situation that if a private employer did it, Congress would be all over them and it would be making huge headlines. These are federal workers who are trying to do the right thing for themselves and their families but who are being jerked around in impossible ways and have no idea not just whether they have jobs but whether they have health insurance, and whether the medical care that they’re getting while this all gets sorted out will be covered. It’s one thing to shrink the federal workforce, but there is some basic human decency for people who haven’t done anything wrong, and a lot of now-former federal workers are not getting it at the moment. 

OK, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate if you left us a review. That helps other people find us, too. Thanks as always to our editor, Emmarie Huetteman, and our producer, Francis Ying. 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, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Sandhya? 

Raman: I’m on X, @SandhyaWrites, and also on Bluesky, @SandhyaWrites at Bluesky. 

Rovner: Anna. 

Edney: X and Bluesky, @annaedney. 

Rovner: Maya. 

Goldman: I am on X, @mayagoldman_. Same on Bluesky and also increasingly on LinkedIn. 

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

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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.

A week into the reorganization of the Department of Health and Human Services announced by Secretary Robert F. Kennedy Jr., the scope of the staff cuts and program cutbacks is starting to become clear. Among the biggest targets for reductions were the nation’s premier public health agencies: the Centers for Disease Control and Prevention, the National Institutes of Health, and the FDA.

Meanwhile, Kennedy did not show up as invited to testify before the Senate Health, Education, Labor and Pensions Committee, known as HELP, but he did visit families in Texas whose unvaccinated children died of measles in the current outbreak and called for an end to water fluoridation during a stop in Utah.

This week’s panelists are Julie Rovner of KFF Health News, Victoria Knight of Axios, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

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Victoria Knight
Axios

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Read Victoria's stories.

Alice Miranda Ollstein
Politico

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Read Alice's stories.

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Amid a dearth of public information about federal health cutbacks, HHS employees currently on administrative leave report they were given no opportunity to hand off their responsibilities, suggesting important work will simply be discontinued. Critical staff members have been cut from the FDA offices funded by user fees, for instance — affecting the drugmakers that pay the fees in exchange for timely evaluation of their products, as well as the patients hoping for access to those drugs. Even if the cuts were reversed, the damage could linger, especially in areas where there will be gaps in data such as disease surveillance.
• Meanwhile, the temporary public communications freeze implemented in the Trump administration’s early days apparently has not ended. State officials, desperate for information from federal health officials about ongoing programs, are receiving no response as they seek guidance from offices in which most or all staffers were laid off.
• President Donald Trump issued an executive order this week that instructs federal department heads to summarily repeal any regulation they deem “unlawful.” The order threatens to effectively short-circuit the federal regulatory process, which involves public notices and opportunities to comment. Businesses rely on that process to make decisions, and Trump’s order could create further instability for health care and other industries.
• And Kennedy traveled West this week, using his public appearances to call for removing fluoride from the water supply and to discuss the measles outbreak. He issued his strongest endorsement of the measles vaccine yet, but he also praised doctors who have used alternative and unapproved remedies to treat measles patients. Senators had called him to testify before Congress this week about the ongoing upheaval at HHS, but the hearing was canceled.
• Legislators in a growing number of states are introducing abortion bans that would punish women seeking abortions as well as abortion providers, suggesting a long game for abortion opponents that goes well beyond overturning a nationwide right to the procedure.

Also this week, Rovner interviews Georgetown Law School professor Stephen Vladeck about the limits of presidential power.

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: The New York Times’ “Why the Right Still Embraces Ivermectin,” by Richard Fausset.  

Victoria Knight: Wired’s “Dr. Oz Pushed for AI Health Care in First Medicare Agency Town Hall,” by Leah Feiger and Steven Levy.  

Alice Miranda Ollstein: The Guardian’s “‘We Are Failing’: Doctors and Students in the US Look to Mexico for Basic Abortion Training,” by Carter Sherman.  

Sandhya Raman: CQ Roll Call’s “In Sweden, a Focus on Smokeless Tobacco,” by Sandhya Raman. 

Also mentioned in this week’s podcast:

• The New York Times’ “The Three States That Are Especially Stuck if Congress Cuts Medicaid,” by Sarah Kliff and Margot Sanger-Katz.
• The AP’s “Ex-Official Says He Was Forced out of FDA After Trying To Protect Vaccine Safety Data From RFK Jr.,” by Matthew Perrone.

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Transcript: The Dismantling of HHS

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

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

Alice Miranda Ollstein: Hello. 

Rovner: Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning, everyone. 

Rovner: And Victoria Knight of Axios news. 

Victoria Knight: Hello, everyone. 

Rovner: Later in this episode we’ll have my interview with Georgetown University law professor Stephen Vladeck, who will talk about the limits of presidential power — if there are any left. But first, this week’s news. 

So the dust is starting to settle, sort of, in that ginormous reorganization of the Department of Health and Human Services launched by Secretary Robert F. Kennedy Jr. last week, which I am now calling “The Great Dismantling.” Here’s some of what we know about the casualties at the CDC [Centers for Disease Control and Prevention]. Offices that worked on sexually transmitted disease prevention, injury prevention, lead poisoning surveillance, and tobacco were basically gutted. At NIH [the National Institutes of Health], the chronic pain division was eliminated, as was the Office of Long Covid. And at the FDA [Food and Drug Administration], offices handling veterinary medicine, generic drugs, and food safety were dramatically reduced. Now that we’ve had a week to absorb what’s been done and, despite claims of the contrary from Secretary Kennedy, we are told there is no plan to hire back some of those workers who were apparently let go in error, what are you guys hearing about where we are? 

Ollstein: Yeah, there’s a lot of people who were put on administrative leave, which is going to run out in a few weeks. By and large, they are not expecting to be called back. They are holding out hope. They would love to be called back. They keep telling me that they would love to get back to the work they were doing. They’re really worried about it not continuing without them, but they’re mostly assuming that these cuts are permanent for now. And contrary to claims from HHS that work isn’t being eliminated, it’s just being consolidated or folded in or there’s different words they’re using, all of these different laid-off workers told me from different divisions that they were basically given no opportunity to hand over their ongoing projects to anyone else, to train anyone else, to make sure it keeps going. So as far as they know, a lot of this surveillance work, research work, coordination work is just not going to be happening going forward. 

Rovner: As far as I can tell, money that’s supposed to be going out the door from places like the NIH isn’t. 

Knight: Yeah, you hit some of the offices, programs that have been cut, but also I think at FDA, we did some reporting this week on the user drug fee program and how staff that do the evaluating drugs and things like that have been cut. And it’s interesting because pharmaceutical companies pay these fees hoping that they’ll get timely evaluations of their drugs, and also— 

Rovner: They pay these fees and are told they will get timely evaluation of these drugs in exchange. That’s the deal. 

Knight: Exactly. And I know pharmaceutical companies are definitely concerned about this, and it’s also concerning for patients who may be waiting for certain drugs to be approved and things like that. And I think it’s interesting, also, Republicans like to talk a lot about innovation and getting new drugs approved and things like that, and this would harm that process if the staff are not rehired. I haven’t really heard an update on that, so— 

Raman: I would also add that part of it is that we just don’t have a lot of information, right? We had Secretary Kennedy invited to come testify before the Senate HELP Committee this week and go through some of these things and explain the rationale and get into that, and that did not happen. 

Rovner: Yeah, we’ll get to that. 

Raman: Yes, and I think, at the same time, a lot of those cuts were also to the communications folks within those agencies that could be disseminating this information to external folks, to internal folks to provide more clarity about where things would be going. And we don’t have those there now, so it will take some time to kind of see where things are going, and even when there’s going to be a delay in some of that stuff, getting that information out is going to be difficult. 

Ollstein: Sandhya is absolutely right about the communications issue here, and I’m just hearing that on so many fronts. States are desperate to get in contact with someone in the federal government to understand what’s going on. Do they have to keep collecting data and sending it to the federal government even though there’s no one left to compile and process it? They’re reaching out asking: Are certain grants going to continue or not? What should we do? Are we going to be in legal trouble if we continue some of this work? And there’s just no one answering, sometimes because all the people that would’ve answered have been let go. But also the communications freeze that was supposed to be temporary at the very beginning of the administration, a lot of federal workers told me that never really ended. 

So there are these email accounts that they were ordered to stop checking and responding to. So one example is the entire team that worked on IVF [in vitro fertilization], evaluating which IVF clinics had the best pregnancy success rates, monitoring safety, all of that — they were all eliminated. And one consequence of that is that there was this email account that doctors, patients, anybody could reach out to for information and to ask questions, and no one’s checking it, no one’s responding. 

Rovner: I don’t know about you guys. I am starting to hear from health care stakeholders. The federal government is so intertwined in, basically it’s a fifth of the economy, what we spend on health care, and it’s creating so much uncertainty. As you were saying, people don’t know if they’re going to get in trouble for not doing things or for doing things. But we do know, as we said, we talked about last week, FDA missed a deadline to rule on a Novavax vaccine. This is going to have ramifications way beyond just the people who are losing their jobs in the federal government, right? 

Raman: There’s so many people that receive the services that we contract out, that we put grants through across the country. And I think that even in speaking to some of these employees that have lost their jobs, one of the top concerns is not even for their own job but that no one else can do the work that they did. Or in some cases, the only person that could have done that work has also already been let go. And just that those things are going to fall through the cracks for a lot of vulnerable communities. 

Ollstein: Some of the folks also told me that even if this is reversed in the future, the damage will just be there for a very long time, especially on things like surveillance and data collection. If you have a gap in there, that skews things. That messes things up for the future. It makes it harder to make comparisons. It makes it harder to know if things are getting better or worse on, like, asthma rates and levels of lead in people’s blood, all kinds of things, things that are not politically controversial or partisan. And so it’ll just be really difficult going forward to know which programs are working, which interventions are working or not working. 

Rovner: So things are happening almost too fast to keep track of. But in his latest round of executive orders on Wednesday, President [Donald] Trump signed one called Directing the Repeal of Unlawful Regulations, in which he basically instructs the heads of all departments to repeal rules they consider unlawful, without notice or comment, which is not how this is supposed to work. I’m not sure even, though, quite what to make of all this. And it seems to be going mostly unnoticed in all of the attention, deservedly, to the other news that’s happening, some of which we’ll get to. But repealing rules basically on a whim could be as important to how the federal government functions as firing all these people, right? 

Raman: Yeah, there’s a reason that the rulemaking process is the way it is, that it takes a certain amount of time. You allow stakeholders to weigh in, to meet, to revise, and that the things aren’t changing too drastically. And there are some rules that go back and forth between the administrations, but a lot of things last over time, and the process is the way it is to make sure that you get the best possible result for whatever you’re changing and— 

Rovner: That you get stability. 

Raman: Yes. 

Rovner: I think that’s the theme here, is that that’s what we’re lacking right now. Nobody can count on what the rules are. 

Knight: And I was going to say, from an industry perspective, industries make decisions based on these rules and knowing when they’re going to come out and when they might change. Think about the insurance industry, physicians, people within the health care industry. And so that could really impact those groups as well a lot. So, and exactly, going back to what you said about stability, so it’ll make it really hard to make business decisions. 

Rovner: Right. So this goes along with the stuff with the tariffs, is that we have no idea what the rules of the road are going to be going forward if rules can be sort of disappeared in a matter of days the way staff is being. Well, let’s move to Congress. Remember Congress? Late last Friday, or I guess it was technically early Saturday, the Senate passed what was supposed to be a compromise Republican budget resolution between the House and the Senate. For those who have forgotten, while the House passed a resolution that would lead to a single gigantic budget reconciliation bill, including tax cuts and likely big cuts to Medicaid, the Senate’s original budget resolution would only have led to a bill on immigration and energy, saving the tax and health fights for later in the year. 

Well, it seems like the compromise, which is kind of a vaguer version of the House blueprint, didn’t go over so well in the House, where Speaker Mike Johnson had hoped to push it through this week. A vote was scheduled for Wednesday, then it got delayed, then it got shelved, at least for the night. They’re apparently trying to regroup and do this this morning. Where are we in this? 

Knight: Yeah, so you gave a pretty good rundown. I was here late last night talking to Freedom Caucus members, the House Freedom Caucus, the hard-liners. Their concerns with, this is basically a Senate amendment to the House’s resolution. And so what the Senate passed was an amendment, and it technically really just gives instructions for the Senate. It didn’t touch the House’s resolution. So the House’s budget resolution they passed is the same thing, but House Freedom Caucus members had issue that the Senate ceilings for cuts is much lower than the House’s. And so they’re saying— 

Rovner: It’s in the billions instead of trillions. 

Knight: Exactly. Exactly. So coming out, they holed up with Speaker Johnson last night and House GOP leadership and were saying, We need more binding cuts on the Senate side, and were like: We need you guys to commit to this, otherwise we’re unhappy with this amount of cuts. This is going to increase spending. There’s been a lot of discussion on how to do the budget math for these things, but it’s pretty clear the Senate’s resolution would not cut spending as much as the House’s. So that was what they came out demanding last night. This morning, Speaker Johnson and Senate Majority Leader John Thune came out, did a press conference, and said: We’re going to proceed with this. We’ll see if that changes. But it was interesting to note that Thune said, he noted that there are Senate Republicans that do want cuts that may be up to the $1.5 trillion, but he did not commit to making cuts on his side. So we’ll see how this goes. That seems to be the state of play. It’s very in flux. That could change over time. So if anyone has anything to add, I think that’s a rundown. 

Rovner: Yeah, it feels like they’re kind of buying time to see if they can keep together what’s clearly a very fractious group here. 

Knight: Yeah, and jet fumes are always a good motivator, and also holidays. So there’s supposed to be a two-week recess right after this, and Passover starts this weekend and Easter next weekend, so we’ll see if that motivates people to vote for it. I will say, an argument that we’ve heard from a lot of the moderates that are concerned about the Medicaid cuts, when they voted for these, they’ve said: This is just an outline. It’s just a blueprint. It’s not committing us to anything. But hard-liners don’t seem to like that argument as much. So can they convince them that way? I don’t know. 

Rovner: Well, let’s talk about those Medicaid cuts for a minute, which, by the way, as you pointed out, Victoria, is not really what’s holding up the vote in the House. Our New York Times podcast pals Sarah Kliff and Margot Sanger-Katz had a really interesting story over the weekend about three red states that would really be stuck if Medicaid gets cut. Oklahoma, Missouri, and South Dakota all passed their Medicaid expansions by ballot measure, including it as part of their state constitutions. Now this is exactly the opposite of those states that would immediately cancel their expansions if Congress cuts the Medicaid match. These three states would be totally stuck, unless they could have another ballot measure that would then eliminate what they added. I guess that helps explain why very conservative Missouri Republican Sen. Josh Hawley says he is so opposed to reducing the Medicaid match. But he seems OK with Medicaid work requirements that would also cut people off the rolls, just not necessarily in a way that would cost the state so much money, right? 

Ollstein: Yeah, I think we’re going to see a lot of interesting semantic games going forward. I think we’re going to see a lot of different interpretations of what a cut is. We’re going to see a lot of claims made about who does and doesn’t deserve Medicaid coverage. We’ve been seeing this for a long time, but as these tough decisions have to be made on the Hill, I think a lot of that is going to come to a head. And so I think you see a lot of conservatives wrestling with believing very strongly in cutting government spending but also recognizing that a lot of their constituents could be harmed by these policies and they would be very angry with their members if that happened. 

And so trying to thread that needle, we’ll see how they do it, whether they can do it successfully without getting a lot of political blowback. Even though there has been a lot of turnover in Congress, you have a decent number of folks who were there last time Congress tried to take a big whack at Medicaid in the Affordable Care Act repeal fight. 

Rovner: In 2017. 

Ollstein: Exactly. Exactly. And the impact on Medicaid is one of the biggest things that garnered a backlash. And Capitol Hill was covered in folks with disabilities protesting, and it was a really bad look, and it contributed to that effort failing. 

Knight: And I think interesting talking about Hawley, but also the Republican Governors Association joined up with some other conservative groups this week to start an ad saying, Don’t cut Medicaid, basically. And so we’re starting to hear that from the states. States are really concerned how this could affect their budgets. They’ve already expanded the program. It would be really hard for them to have to make up in the state that amount of money if the federal government takes away money from the Medicaid program for them or caps it or whatever. It’s interesting to see people walk that line. And House GOP moderates, they are more likely to fold, I think, than hard-liners, but they keep telling me when I talk to them, We’re OK with work requirements, but anything past that might be really hard for us to vote for. But who knows? They could fold if they have enough pressure, but they’re trying to walk the line at this moment. 

Rovner: This is going to be a very different Medicaid fight than it was in 2017. Well, turning to this week in “Make America Healthy Again,” I think we mentioned last week that HHS Secretary RFK Jr. had been invited to testify before the Senate Health, Education, Labor, and Pensions Committee today. Well, as Sandhya pointed out, that did not happen. We’re not entirely sure why, but the secretary continues to do things, well, things he kind of promised senators that he wouldn’t, like saying that he’s going to order the CDC to stop recommending adding fluoride to public water supplies, which he did on a trip to Utah this week. Once more for those in the back, why do most public health professionals support water fluoridation? 

Raman: It really reduces dental decay, by like 25%. ADA [the American Dental Association] has been recommending fluoride for years. So it’s a big proponent of that. 

Rovner: And as someone pointed out, it’s against dentists’ interests to be recommending something that gives them less work and yet they’re still recommending it. 

Ollstein: And even though we have a very silly system in the U.S. where dental care is siloed off from the rest of health care, it does impact your overall health a lot. So it could lead to lung issues, heart issues, all kinds of things if you have dental issues. So it’s not just a cosmetic problem, it can be a very serious health problem. And I will say, too, people should keep in mind that there’s a lot of pointing at studies about negative health impacts from excessive consumption of fluoride, but those studies have a level that is much, much higher than what’s in the U.S. tap water right now. So anything in excess can be bad for you — even just plain water can kill you if you have too much of it. And so I think that people should keep that in mind and remain skeptical about claims being made. 

Rovner: Well, RFK Jr. also continues to make news in his handling of the measles outbreak in Texas, which is now the largest in the nation in the past 30 years, having sickened nearly 600 people, mostly unvaccinated children. Kennedy traveled to the heart of the outbreak last week and visited with the families of the two children that we know have died so far of the virus. He also praised the measles vaccine, but then just hours later posed with and praised two doctors who are using unapproved treatments for measles, including one who was disciplined by Texas medical regulators. Meanwhile, Peter Marks, the FDA vaccine official forced to resign last month, is speaking out, calling Kennedy’s actions thus far, quote, “very scary” in an interview with The Wall Street Journal and telling the AP [Associated Press] that he got fired for trying to keep Kennedy’s team from editing or possibly erasing the very sensitive Vaccine Adverse Event Reporting System kept by the FDA. Is there any way we didn’t see all of this coming? 

Knight: Well, going back to the congressional aspect. The HELP chair, [Sen.] Bill Cassidy, he had both the HELP hearing and the Senate Finance hearing where he questioned Kennedy repeatedly about his views on vaccines, his views on the link between vaccines and autism, I think also measles and autism. And he didn’t really ever get a super substantial answer from Kennedy. And yet the compromise was somewhat that Cassidy said, You’ll have to come quarterly before the HELP Committee and testify about what’s going on, what your views are. And we saw Cassidy try to do that last week. And Kennedy has, as far as I know, the latest is that he received the request but he hasn’t accepted it yet, and unclear if he will. 

So that congressional oversight was supposed to be the way to keep him in check, somewhat. And that’s not happening. It’s not really that enforceable. So I think it’s pretty predictable what’s happening. I think what will be interesting is if the White House gets unhappy with some of Kennedy’s things that he’s doing. There’s been some stories of how they’re having to take over his communications because there’s been no communications from HHS on it, and so they’re kind of unhappy with that. We’ll see if that reaches to a level where they could change leadership or something. But, not there yet, certainly, but something to watch. 

Rovner: Again, so much going on. I think this would normally rise to a higher level than it has given all of the other news that’s happening. Moving on to abortion. We talked last week, or maybe it was the week before, about the Overton window moving towards criminalizing women who have or even seek abortions. That’s apparently the point of a bill introduced in the Alabama Legislature. In North Carolina, a new bill could subject anyone convicted of performing or receiving an abortion to life in prison. We talked a few weeks ago about a similar bill in Georgia that got a legislative hearing. Even if none of these bills pass — and it seems that none of them will pass, at least this year — it certainly seems that claims by the anti-abortion movement that they don’t want to punish women are either not true or falling on deaf ears. 

Ollstein: So the anti-abortion movement, just like the pro-abortion-rights movement, is not a monolith. And just like the political parties, there are moderates and hard-liners. There are people who disagree on tactics. And so I think for so long the movement appeared united because their main goal was just overturning Roe v. Wade. And they were able to paper over other divisions by focusing pretty exclusively on that, or not exclusively but that being the overriding goal. And now that they’ve accomplished that and now that there are a lot more opportunities for them, you’re seeing these divisions. And we’ve seen that over the past few years. There were people who said, OK, a 15-week ban is better than nothing, and we can build on it. And there are people who say: No, that’s an unacceptable compromise, and it has to be a total ban or nothing. And if you do a 15-week ban, you’re endorsing the murder of most babies, because most abortions happen before 15 weeks of pregnancy. 

So I think this is a continuation of that. And it’s also a reflection that there is a lot of frustration in the anti-abortion movement that not only have abortions not ceased when states enact bans, in some cases they’ve gone up, nationally. And that’s a combination of people traveling, that’s a combination of people using telehealth and getting pills mailed to them. That’s become a huge thing that people rely on. And so looking at ways to crack down on those things, including this kind of criminalization of the pregnant patient that’s been sort of a third rail that is now more in the conversation. Of course, people have been proposing such things for a while now, but it’s getting more prominent attention than before. 

Rovner: Yeah. And that was my question, is it used to be a real outlier, and now we’ve seen legislation introduced in 10 states that would criminalize the woman in some way, shape, or form. Sandhya, you wanted to add something. 

Raman: I was going to say it’s also a long game. There are things that we’ve had proposed years ago that I think garnered attention then as being very outside the realm of something that people would consider. And then a few years later, when we first saw some of these personhood bills years ago, I think those got attention as being a little different than some of the other things that were being considered. And now that has become more mainstream. We see that in a lot of states now. And I think that something like this, even though it is very different than the messaging we’ve seen in the past, it doesn’t mean that, down the line, a greater portion of the movement pivots toward this. Because we’ve seen so much of this throw the spaghetti at the wall with seeing different things that they can see, what can pass, what doesn’t get litigated, that kind of thing. So a lot of this is kind of a long game. 

Ollstein: Yeah. And there is an imbalance between the two sides where the right is much more willing to throw spaghetti at the wall and see what sticks, much more willing to throw out things that could anger people, could generate controversy, could generate backlash, but they do believe will advance the goal. And you’re not really seeing the same willingness on the left. You’re not really seeing states propose, Let’s get rid of all abortion restrictions in total. And so you have this imbalance of what each side is willing to even consider, where the left has been, overall, not exclusively, but overall much more cautious and much more consensus-seeking. 

Rovner: Well, meanwhile, in Texas, where over the past few years we’ve had story after story about women with wanted pregnancies nearly dying from complications, the legislature finally has before it a compromise bill that would better define when doctors can end a doomed pregnancy without risking going to prison, except it’s turning out to be not as much of a compromise as its backers had hoped. Is there any way to actually find a compromise on what is a necessary abortion and what is saving the woman’s life? They write these things and they say: Well, look. Here are the exceptions, and they should work. But now they’re trying to spell out the exceptions and they can’t seem to agree on those, either. 

Ollstein: So it’s really a catch-22. And I was just in Texas. I was interviewing OB-GYNs, and they were explaining — and those in other states with bans have said the same thing — that, look, it’s really tough, because if a law is too broad and too vague, then doctors don’t feel comfortable doing even things they feel are absolutely medically necessary. But if a law is too prescriptive — if, for example, it tries to list every single possible condition that would necessitate an emergency abortion or an abortion to save someone’s life for health — you’re never going to be able to list everything. So many things can go wrong during a pregnancy, and so any attempt to be comprehensive will inevitably leave something out. And so if you go the route of listing specific conditions and someone comes in with a condition that’s not on the list, doctors won’t feel comfortable, because they’ll feel that, Oh, well, because the law lists these other conditions, that must mean that anything else is not allowed. 

But on the other hand, if it’s too vague, you have the opposite problem. And so really a lot of mainstream medical groups like ACOG, the American College of Obstetricians and Gynecologists, have really come down on, like: Just don’t legislate this at all. Just let us do our jobs. Because they are in this conundrum. I will say, there are divides within the medical community despite that, where some feel like, OK, well, if we can add a few more exceptions and that can even help a few more people, that’s at least something to consider, where others think, OK, no, if we endorse these quote-unquote “fixes,” that kind of in a way is endorsing the underlying ban, and we don’t want to do that. And so there’s some tension there as well. 

Rovner: Yeah, this is going to continue to be an issue going forward. All right, well, finally this week there is some other policy news. The Trump administration last week reversed a Biden administration decision to start covering those GLP-1 [glucagon-like peptide 1] drugs for people with obesity as well as those with diabetes. According to The New York Times, the administration didn’t attribute the decision to Secretary Kennedy’s known dislike of the drugs, which he has said are inferior to people just, you know, eating better, and that it may reconsider the decision in the future. But obviously cost is a huge issue here. These drugs are less expensive than they were, but they are still super expensive if they’re going to be taken by the millions of people who would qualify for an indefinite period of time. Is there any talk of finding a way to bring that cost down? That would obviously be popular and something that President Trump has said he wants to do in terms of drug prices overall. 

Raman: I have not heard of anything on bringing the cost down. I think that the only discussions that really come about are really tailoring who would qualify within that bucket, and to narrow that as a piece to bring the cost down rather than the cost of the specific drugs. And we’ve been — yeah. 

Rovner: I would say, I know that Ozempic is on the list of Medicare drugs to be negotiated this year, but I think that’s only for the diabetic indication. So on the one hand, that could bring down the cost for— 

Ollstein: And that wouldn’t help people for years and years. Yeah. 

Rovner: Exactly. So I mean we might — if you have diabetes, Medicare could start saving money on one of the GLP drugs, but I guess it’s going to be a while before we see the cost fall. And of course, we didn’t even talk about the potential tariffs on prescription drugs, because we’re not going to talk about that this week. 

That is this week’s news. Now we will play my interview with law professor Stephen Vladeck, then we will come back and do our extra credits. 

I am so pleased to welcome to the podcast Stephen Vladeck, professor at Georgetown University Law School and author of the invaluable Substack “One First,” which helps explain the workings of the Supreme Court to us lay folks. Steve Vladeck, welcome to “What the Health?” 

Stephen Vladeck: Thanks, Julie. Great to be with you. 

Rovner: So I’ve asked you to help us with the next in a series I’m calling “How Things Are Supposed to Work in Health Policy.” And I’m particularly interested in how much power the president has vis-à-vis Congress and the courts. Is there kind of a 30-second law school description of who has the power to do what? 

Vladeck: It’s a little longer than 30 seconds, but to make the long version shorter: Congress makes laws, the president carries those laws into effect, and the courts decide whether everyone’s playing by the rules and abiding by those laws. That’s how it’s supposed to go — and if only that were how it actually was. 

Rovner: Now, I’m not a lawyer, but I have been at this for a long time, and I always understood that executive orders from presidents were mostly for show. They were expressions of intent that needed to be carried out by someone else in the executive branch most of the time, usually using the formal regulatory process. But that is not at all what this administration is doing with its executive orders, right? 

Vladeck: So, Julie, I think part of the problem is that we really are at the apex of something that’s been building for a while, which is that as Congress has stopped doing its job, as Congress has stopped passing statutes to respond to our pressing issues of the day, presidents of both parties have been left to govern more and more aggressively based on increasingly, for lack of a better word, creative interpretations of old statutes and constitutional authorities. And so, yes, I think we’re seeing differences in both degree and kind from President Trump, but some of this has been building for a while where, we haven’t had meaningful immigration reform since 1986. We haven’t had meaningful financial systems reform in 25 years. And so in those spaces, presidents are going to do what they can to try to accomplish their policy goals, which means more and more executive orders where the presidents are at least purporting to interpret authorities that they’ve been given, either by statute or the Constitution, as we get further and further away from those authorities themselves. 

Rovner: So this is the unitary executive theory that we’ve, those of us who play to be lawyers sometimes, have heard about. But how abnormal is what Trump is doing now? Is this even legal, a lot of what he’s doing? 

Vladeck: So a lot of what he’s doing is not legal, but some of it is legal. And one of the complications is that the illegalities are at scales and in ways that we haven’t really seen before and that therefore our existing legal processes aren’t necessarily well set up to respond to. I would break Trump’s behavior into a couple of categories. So I think there’s the internal stuff, which is firing tons of people, hollowing out the bureaucracy, demanding political fealty from even those who are civil servants. And we’ve seen, Julie, I think, flash points of those before. What’s novel about what’s happening now is just the sheer scale on which it’s happening. I think the biggest area of real novel action is the effort by Trump really to sort of change how all federal money is spent, right? Money is supposed to be Congress’s, like, superpower. Not only is appropriations Congress’ most important function, but it’s actually the only thing that the Constitution specifically says only Congress can do. 

And yet we’re seeing really novel assertions by the president of the power to not spend money Congress has appropriated, of the power to stop paying for contracts where the work has already been performed, of the power to threaten Maine and other jurisdictions with the withholding of federal funds if they don’t just bend the knee to Trump. And that is really, I think, both shocking and dangerous because it basically means that the president’s trying to seize unilateral control over what has historically been Congress’ principal vehicle for doing policy. And at that point, you don’t really have much of a separation of powers anymore. You’ve just got a president. 

Rovner: Could Congress take back this authority if it wanted to? 

Vladeck: Sure. But just before letting folks get too optimistic, one of the problems is that taking back this authority probably means, at the very least, passing new statutes, and Trump’s not going to sign those statutes. So one of the things that has been a fear of separation-of-power scholars for a long time is that when Congress delegates authority to the president, or when Congress acquiesces in the drift of power to the president, it’s actually really hard for Congress to get that power back, because it’s usually going to require veto-proof supermajorities, and really hard to see in our current political climate a veto-proof supermajority agreeing even to the fact that today is Tuesday, let alone that we should take back power from the president. So Congress could do tons of things. The problem is that assuming Congress won’t, we really are left to these series of confrontations between the president and the courts, because the courts are all that’s left. 

Rovner: Which brings me to something that I think most people would think would be not really health-policy-related but really is, which are all these threats against these big law firms. How does that play into this whole thing? 

Vladeck: So I think it’s a big piece of the puzzle because what the threats, I think, are really intended to do is to cow law firms into submission, to try to increase the cost both economically and politically of bringing lawsuits challenging what the federal government’s doing. And Julie, I think that the long-term idea is to chill people from suing the federal government, to chill people from hiring folks who worked in administrations from the wrong party in ways that I think are really disruptive not just to the economics of law firms but to the courts. The courts depend upon a strong, robust, and independent bar that is able to actually move freely when it comes to challenging the government. Courts can’t go out and find cases. Lawyers bring the cases to them. And if the lawyers are for some reason disincentivized from bringing those cases, part of the separation of powers breaks down even further. 

Rovner: Or basically, in this case, I guess they’re promising not to bring cases that the administration doesn’t like. 

Vladeck: Exactly. We should be terrified. No matter what you think of lawyers, no matter what you think of the administration, we should want a world in which there’s no disincentive to challenge what the government’s doing in court. We should want a world, as James Madison put it, where ambition is counteracting ambition, where the branches are pushing up against each other, not where they are stunned into submission. 

Rovner: And finally, you’re an expert in the Supreme Court. Is there any chance that the Supreme Court’s going to rescue us here? 

Vladeck: No, but I think what I would say — to try to both be a little more optimistic and to try to put a little more depth into my one-word answer — it’s not the Supreme Court’s job to rescue us. It’s the Supreme Court’s job to protect the separation of powers. And as you and I are sitting here, we’ve seen a couple of early rulings from the court that have kind of sided with Trump in these sort of very, very fleeting technical emergency postures without actually saying anything about what he’s doing is legal. I have at least a modicum of faith, Julie, that when the courts get to the legality questions, they’re going to find that most of this stuff actually is illegal. 

I think the question is, what happens then? And this is why, although I’m as big a believer in a powerful and independent judiciary as anyone, the courts alone can’t save us, right? What we need is we need the courts backed by Congress, by the people, by our other institutions, universities, law firms. I mean it should be all of the institutions of our civil society, not opposing Trump to oppose Trump but standing up for the notion that our institutions matter and that the way that we can be confident that the government is working the way it’s supposed to is when the institutions are pushing up against each other with all their might and without the fear of what’s going to happen to them if they lose. 

Rovner: I feel like one of the bright spots out of this is that finally the nation is getting the lesson in civics that it’s needed for a while. 

Vladeck: I couldn’t agree more. I think we are seeing the very, very real costs of generations of insufficient civics education, but I also think this opens the door to real conversation about how to fix this. And in the short term, some of it is about stopping a lot of what Trump is doing, and that’s what a lot of these lawsuits are about. When we talk about, Julie, building back institutions, whether it’s in the public health space or more broadly, I hope that we keep having the civics lesson, and I hope that we don’t forget that it’s actually really important to have independent agencies, and it’s important to have a civil service, and it’s important to have institutions that are actually not just subject to the whims of whoever happens to be the current president. And the more that we can build off of that going forward, maybe the more that we can prevent what has happened already over the first 11 weeks of the second Trump administration from becoming a permanent feature of our constitutional system. 

Rovner: Well, we will keep at it. I hope you’ll come back and join us again. 

Vladeck: I’d love to. Thanks for having me. 

Rovner: OK, we’re back. Now 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’ll put the links in our show notes on your phone or other mobile device. Sandhya, why don’t you go first this week? 

Raman: So my piece for extra credit is from me, on Roll Call. It’s called “In Sweden, a Focus on Smokeless Tobacco,” and it’s the first in my series I’m doing through the Association of Health Care Journalists, where I went to Sweden to learn about smoking cessation and public health between Sweden and what we can learn in the U.S. And the story looks at the different political factions of the Parliament over there and how they found some common ground in areas to become hopefully the first country in Europe below 5% daily smokers, and just what lessons the U.S. can learn as they’re trying to reduce smoking here as well. 

Rovner: So jealous that you got to do this. Alice, why don’t you go next? 

Ollstein: I chose a piece from The Guardian by Carter Sherman [“‘We Are Failing’: Doctors and Students in the US Look to Mexico for Basic Abortion Training”] on an issue that has interested me for a long time, which is how U.S. residents are learning how to provide abortions when their training opportunities have been eliminated in so many states. I’ve been covering those who have been traveling to different U.S. states, but this piece is about a small but growing number who are traveling to Mexico for this training. Mexico, like many countries in Latin America and really around the world over the last few years, has moved in the direction of decriminalizing abortion as the U.S. has moved in the opposite direction and is very eager to help train more people. 

But the article stresses that this is not a solution for everyone in the U.S. who needs this training, because you have to be able to speak fluent Spanish in order to do it. You have to already have some abortion experience, which not every medical resident has. And it’s also expensive. There are fellowships, but the trip and the training and everything costs thousands of dollars. And so I think it’s a very interesting opportunity for some people. And the article also talks about folks who are doing some training in the U.K., as well. And so I wonder if these international opportunities will become more of a piece of the puzzle in the future. 

Rovner: Victoria. 

Knight: OK, my extra credit for this week is an article in Wired called “Dr. Oz Pushed for AI Health Care in First Medicare Agency Town Hall.” So basically this was Dr. [Mehmet] Oz’s first town hall talking to CMS [Centers for Medicare & Medicaid Services] staff, and he talked about a lot of his personal story and not as much of the goals of the agency, seemed to be the vibe of the meeting. But also, interestingly, he talked about using AI avatars instead of actual people. So that’s like people that do simple health diagnoses using AI instead to diagnose people, is kind of what it sounded like. And that’s in part because— 

Rovner: My comment to this story was: Not at all creepy. Sorry. 

Knight: Right. And— 

Rovner: I interrupted you, Victoria. 

Knight: No, no, that’s OK. But he was saying the benefit of this is that it could cost less because it could only cost maybe like $2 an hour versus a doctor could be a hundred dollars for a consult. And so people interviewed in the story were CMS employees that felt very concerned about that and also felt like it could come off a bit tone-deaf when there have been a bunch of CMS staff also just recently let go. And CMS was actually on the agencies that was hit with less workforce cuts. But even so, people are still upset about it. And so, it was like, Why are you replacing great people that worked here with AI? It was just an interesting look at his first week at the agency 

Rovner: Yeah. And it’s a big agency with a lot of money. All right, my extra credit this week is from The New York Times. It’s called “Why the Right Still Embraces Ivermectin,” by Richard Fausset. And it’s a pretty hair-raising story of medical malfeasance, foisted on people by those seeking political or financial gain or both. Quoting from the story: “Ivermectin has become a sort of enduring pharmacological MAGA hat: a symbol of resistance to what some of the movement described as an elitist and corrupt cabal of politicians, scientists and medical experts.” This is another in a long list of unproven remedies people take just to thumb their noses at treatments that have, you know, actual scientific evidence behind them. It’s a really interesting read. 

OK, that is this week’s show. 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. Thanks as always to our producer, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me at X, @jrovner, and at Bluesky, @julierovner. Where are you folks these days? Alice, you’re the birthday girl. Where can we all wish you a happy birthday? 

Ollstein: Mainly on Bluesky, @alicemiranda, but still hanging on X, @AliceOllstein. 

Rovner: Sandhya. 

Raman: On X and Bluesky, @sandhyawrites. 

Rovner: Victoria. 

Knight: I’m just on X, @victoriaregisk. 

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

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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.

The Department of Health and Human Services underwent an unprecedented purge this week, as thousands of employees from the National Institutes of Health, the FDA, the Centers for Disease Control and Prevention, and other agencies across the department were fired, placed on administrative leave, or offered transfers to far-flung Indian Health Service facilities in such places as New Mexico, Montana, and Alaska. Altogether, the layoffs mean the federal government, in a single day, shed hundreds if not thousands of years of health and science expertise.

Meanwhile, the Supreme Court heard a case about whether states can bar Planned Parenthood from providing non-abortion-related services to Medicaid patients. But by the time the case is settled, it’s unclear how much of Medicaid or the Title X Family Planning Program will remain intact.

 This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Lauren Weber of The Washington Post.

Panelists

Rachel Cohrs Zhang
Bloomberg News

@rachelcohrs

Sarah Karlin-Smith
Pink Sheet

@SarahKarlin

Read Sarah's stories.

Lauren Weber
The Washington Post

@LaurenWeberHP

Read Lauren's stories.

Among the takeaways from this week’s episode:

• As details trickle out about the major staffing purge underway at HHS, long-serving and high-ranking health officials are among those who have been shown the door: in particular, senior scientists at FDA, including the top vaccine regulator, and even the head veterinarian working on bird flu response.
• The Trump administration has also gutted entire offices, including the FDA’s tobacco division — even though the division’s elimination would not save taxpayer money because it’s not funded by taxpayers. Still, the tobacco industry stands to benefit from less regulatory oversight. Many health agencies have their own examples of federal jobs cut under the auspices of saving taxpayer money when the true effect will be undermining federal health work.
• Democratic Sen. Cory Booker of New Jersey set a record this week during a marathon, 25-hour-plus chamber floor speech railing against Trump administration actions, and he used much of his time discussing the risks posed to Americans’ health care. With Republicans considering deep cuts that could hit Medicaid hard, it’s possible that health changes could be the area that resonates most with Americans and garner key support for Democrats come midterm elections.
• And the tariffs unveiled by President Donald Trump this week reportedly touch at least some pharmaceuticals, leaving the drug industry scrambling to sort out the impact. It seems likely tariffs would raise the prices Americans pay for drugs, as tariffs are expected to do for other consumer products — leaving it unclear how Americans stand to benefit from the president’s decision to upend global trade.

Also this week, Rovner interviews KFF Health News’ Julie Appleby, whose latest “Bill of the Month” feature is about a short-term health plan and a very expensive colonoscopy. Do you have a baffling, confusing, or outrageous medical bill to share with us? You can do that here.

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

Julie Rovner: Stat’s “Uber for Nursing Is Here — And It’s Not Good for Patients or Nurses,” by Katie J. Wells and Funda Ustek Spilda.

Sarah Karlin-Smith: MSNBC’s “Florida Considers Easing Child Labor Laws After Pushing Out Immigrants,” by Ja’han Jones.

Lauren Weber: The Atlantic’s “Miscarriage and Motherhood,” by Ashley Parker.

Rachel Cohrs Zhang: The Wall Street Journal’s “FDA Punts on Major Covid-19 Vaccine Decision After Ouster of Top Official,” by Liz Essley White.

Also mentioned in this week’s podcast:

• Stat’s “Laid-Off HHS Leaders Offered Transfers to Remote Indian Health Service Regions,” by Usha Lee McFarling.
• The Washington Post’s “Fired Health Workers Were Told To Contact an Employee. She’s Dead.” By Lauren Weber.
• Georgia Recorder’s “Bill That Criminalizes Abortion, Undermines IVF Access Gets Georgia House Panel Hearing,” by Jill Nolin.

Click to open the transcript

Transcript: American Health Gets a Pink Slip

[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, April 3, 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 Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, Julie. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello hello. 

Rovner: And we welcome back to the podcast Rachel Cohrs Zhang, now at Bloomberg News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: Later in this episode we’ll have my interview with my colleague Julie Appleby, who reported and wrote the latest KFF Health News “Bill of the Month,” about yet another very expensive colonoscopy. But first, this week’s news. 

We’re going to start this week, as usual, with the latest changes to the Department of Health and Human Services from the Trump administration. But before we dive in, I want to exercise my host prerogative to make a personal observation for those who think that what’s happening here is, quote, “politics as usual.” I am now a month into my 40th year of covering health policy in Washington and HHS in particular. When I began, Ronald Reagan was still president. So I’ve been through Democratic and Republican administrations, and Democratic- and Republican-controlled Congresses, and all the changeovers that have resulted therefrom. 

And obviously the HHS I cover today is far different from the one I covered in 1986, but I can safely say I have never seen such a swift and sweeping dismantling of the structure that oversees the U.S. health system as we’ve witnessed these past 60 days. Agencies and programs that were the result of years of expert consultations and political compromises have been summarily eliminated, and health and science professionals with thousands of years of combined experience cut loose via middle-of-the-night form emails. To call the scope and speed of the changes breathtaking is an understatement, and while I won’t take any more personal time here, if you want to hear me expand further on just how different this all really is, I’m on this week’s episode of my friend Dan Gorenstein’s “Tradeoffs” podcast, which you should all be listening to anyway. 

All right. That said, now let’s dive in. I suppose it was inevitable that we would see the results of last week’s announced reorganization of HHS on April Fools’ Day. Let’s start with who was let go. While the announcement last week suggested it would mostly be redundancies and things like IT and HR and procurement, there were a bunch of longtime leaders included in this purge, right? 

Karlin-Smith: Yeah. At FDA [the Food and Drug Administration] there were some of the most senior scientists, like their Office of New Drugs directors, their chief medical officer, almost everybody who works on policy, legislative affairs, entire communications offices, external affairs. And even in the case where they are laying off people whose job titles might sound extraneous, or not as important to the health of people in the U.S., I think you can sort of debate that, but they did it in such a way that they laid off so many people in those departments that the people they said, We are protecting, because we do at least understand these jobs are important, cannot actually fully do their jobs. So scientists are not able to access the supplies they need. It’s not even clear how people at FDA are going to get paid and do their timesheets and track time given how many people they laid off. 

And it also just seems like there’s been a ton of, again, to the extent they were trying to protect certain positions that they deemed more critical to U.S. health and well-being, like medical reviewers or inspectors, they didn’t quite understand who actually is critical to doing that work, because it’s not just somebody who has, like, “inspector” in the title. Vanity Fair had a great piece about this man who really has saved people in the U.S. from going blind by helping inspectors catch sterility issues in eye drops, and they walk through very clearly how people like him do not have a title of inspector but are absolutely needed to ensure we have drugs that are safe for people in the U.S. So, probably not surprising to people who’ve tracked the administration so far, but it’s been a lot of the move-fast -break-things, and then realize on the back end that they maybe broke things they didn’t necessarily mean to, or don’t actually care as much about whether it’s broken. 

Rovner: Lauren. 

Weber: They got rid of the head veterinarian on the bird flu response. That would seem to be a thing that is surprising. I spoke to a congressman yesterday who said that seems very dumb. It’s not just that. They also eliminated entire swaths of the CDC [Centers for Disease Control and Prevention], small agencies that maybe a lot of people have no idea alphabetically what they do but are pivotal in preventing injury deaths, and in really the preventative and chronic disease care that RFK [Robert F. Kennedy Jr.] has said is really vital to getting America back on track. When we talk about dollars and cents saved in health care, a lot of that is in chronic disease and in preventative care. And to see some of these places get hit so broadly is quite shocking considering the end goal is allegedly to save money. 

Rovner: There are also a lot of things that seem sort of at odds with [President Donald] Trump’s own agenda. David Kessler, the former FDA commissioner, was on TV last night talking about how the people who answer the phones when a doctor wants to get an emergency use authorization for a drug that’s not yet approved. That’s something that’s been a very big deal for Donald Trump. The people who answer the phones got fired. So, when a doctor has a patient who, nothing else will work and they need an experimental drug, and they’re supposed to be able to call FDA. And I think there are rules about how fast FDA is supposed to respond. But now there’s nobody to actually answer the phone and take those requests. 

Karlin-Smith: Yeah, I think the list of things that don’t seem to align is very long. One thing I was talking to somebody about yesterday who said, well, pretty much everybody who deals with tracking pesticides in foods, and food safety at the FDA in regards to pesticides was let go. And making our food system healthier and safer, and concerns about pesticides, has actually been a big focus of RFK. Similarly, Martin Makary talked a lot in his opening speech to FDA employees yesterday about obesity, and they are basically gutting offices that work on pediatrics, minority health. They’ve laid off lots of people in their tobacco division at FDA, and FDA’s tobacco division actually is not funded at all by taxpayer funding. So, I have a hard time understanding how anybody besides the tobacco industry really benefits from this loss. As Lauren said, it’s like every health agency, you can kind of find examples of that. They say America is not healthy, but they’re cutting these top researchers that have found incredible advances in Parkinson’s and some of the chronic diseases he’s most cared about. 

Rovner: They also, I mean, there are some big names who were let go. We didn’t even — the Peter Marks firing at FDA happened last week after we taped, so we haven’t even talked about that. Somebody tell us who Peter Marks is and why everybody’s all freaked out about that. 

Cohrs Zhang: Well, Peter Marks was head of the division of biologics and the top regulator of vaccines, and complicated injectable medicines like insulin products, too, fell under his purview. And I think we saw markets react in a panic on Monday. The shares of vaccine makers like Moderna were falling. And we saw companies selling gene therapies that Peter Marks has been really involved in regulating and championing through some of those processes, they were kind of freaked out because it just creates uncertainty as to kind of what the new philosophy toward these medicines will be. And the Trump administration, we’ve seen, especially on the Marks being pushed out, I think they’ve tried to highlight some of his more controversial actions in the past. 

We saw a White House adviser, Calley Means, was personally attacking Marks for some conflicts he had with vaccine regulators during debate over the covid booster approvals, and just his decisions to overrule recommendations by FDA experts on some innovative medications that some people disagreed with. But the perspective from former officials has been that, like Peter Marks or not, the idea that scientific expertise is being purged in this way is concerning. And it wasn’t just Peter Marks. There’s another regulator at the Office of New Drugs, Peter Stein. who was pushed out. We have Anthony Fauci’s successor at NIH [the National Institutes of Health] was pushed out, Jeanne Marrazzo, as well as a couple other heads of scientific research institutes at NIH. 

Rovner: Anthony Fauci’s wife was pushed out— 

Cohrs Zhang: Yeah. Yeah. 

Rovner: —as the head of the office of bioethics at NIH. 

Cohrs Zhang: Truly, and I think we had heard that some of these more politically sensitive center leader positions would be at risk. We’ve heard this for a very long time, but it seems like they took advantage of the chaos to implement some of these high-level cuts to people that they may have disagreed with. But, like, people will be filling those positions. I don’t know that there’s a cost-saving argument there. But it certainly seems like they were trying to push out senior leaders with a lot of experience. 

Rovner: It also feels like, the way that people were let go seems, to put it bluntly, purposely cruel, like sending out RIF [reduction in force] notices at 5 a.m. and then having people find out they’ve been let go when they stand in long lines only to find out that their IDs no longer work, or CMS [Centers for Medicare & Medicaid Services] employees being directed to contact a person who died last year. Is there a strategy here? Lauren, you wanted to add something. 

Weber: I wrote a story on the CMS employees being told to contact someone who was dead. And I spoke to one of this woman Anita Pinder’s former colleagues who said she was just heartbroken. She said CMS employees who got that email had gone to this woman’s funeral, and what a gut punch. She said, Look — this person who was talking to me is a former CMS employee — said: Look, you know, there always is a way to reorganize. It’s not that there isn’t waste or ability to consolidate or streamline in the federal government. She’s like, That’s not my problem. My problem, this woman told me, was that it was done in such a way that you really can’t take that back. People getting a dead woman’s name as their point of contact to contest their firings is something that is difficult to take back. 

Rovner: I guess my question is: Is this just sloppy, or are they actually trying to be cruel in this? Because it certainly feels like they’re trying to be cruel. 

Karlin-Smith: I think it’s possible. It’s both, a combination, one or the other. Again, it seems like the people who are doing this are not expert, right? They didn’t actually take the time to assess HHS and all what the agency does to understand what people do for the government beyond just looking at their job titles. And so some of it may be intentional cruelty, and some of it just may be really just rushing and not understanding the process. I mean, there were other notices at FDA that were signed by somebody that no longer worked there. People’s performance scores were wrong. The sense is they didn’t follow the normal process of, like, when you do a RIF, you have to give — there’s certain people that get preferences and who stays and who goes and whether it’s veteran status, disability, all those things. 

And I think some of that will probably result in legal challenges down the line, including they got rid of certain offices, or everybody in them, that were mandated by Congress. So some of it’s probably sloppy, but some of it is — right? — they don’t really care how they treat people, because there is like a very clear message that comes from their rhetoric of kind of lack of respect for government bureaucracy. 

Rovner: And I know some of these senior leaders, they figured out that they can’t just summarily fire them. So a number of them were offered transfers to the Indian Health Service in places like Alaska and Montana, and they were given 36 hours to decide whether they would accept the transfer. And we are told that Secretary Kennedy is very concerned about Native populations and the Indian Health Service, which is short of workers in a lot of places. But this seemed to be insulting to both the people who were given these quote-unquote “transfers” and to the Indian Health Service, because it wasn’t sending the Indian Health Service what it actually needs, which are practitioners, doctors and nurses, and laboratory workers. It was sending research analysts and bench scientists and people whose qualifications do not match what the IHS needs. 

Karlin-Smith: Right. They wanted to send, I think, the FDA’s tobacco head to the IHS to do, I think, medical care. So it enraged people in the IHS. 

Rovner: Yeah, I don’t think the Native population was really thrilled about this, either. Lauren, you wanted to add something. 

Weber: Yeah, I would just say that this is a playbook the Trump administration has executed in other government agencies. Members of the FBI, top leaders of the FBI were reassigned to child sex trafficking crimes or faraway distant lands in the hopes of getting them to resign. So, I think we are seeing that play out at HHS, but it certainly is a tactic they’ve used in other federal agencies to, quote-unquote, “drain the swamp.” 

Rovner: Right. And in the first Trump administration, they did move some offices out of Washington to the middle of the country, if you will, and most people obviously didn’t go. And now there’s a lot of expertise that, again, that we lost. I think that really can’t be overstated, is how much expertise is being pushed out the door right now, in terms of things that, as I said, this administration says that it wants to do or get accomplished. Meanwhile, Secretary Kennedy has been invited — or should I say summoned — to come testify next week before the Senate health committee at the behest of Republican Chairman Bill Cassidy, Democratic ranking member Bernie Sanders. So far Congress has mostly just been kind of sitting back and watching all of this happen. Is there any indication that that’s about to change? 

Karlin-Smith: I think Democrats are pushing a little bit harder, but I’m not sure they have enough power or have enough, again, momentum yet to actually do what they can with their power. I’m interested to see how Cassidy handles this hearing going forward because his statement the day of the big reduction in force seemed to suggest that the media was maybe unfairly reporting on it and that Kennedy may have another side to the story to share to justify it. And it didn’t sound like somebody that was necessarily going to go particularly hard at RFK. It seemed like somebody who wanted to give him a chance to justify his moves. But we’ll see what happens. I think Cassidy has been, despite RFK walking back a lot of his promises he made to Cassidy around vaccines and so forth, Cassidy has not been that willing to go hard on him so far. 

Rovner: Yeah, the other thing we’ve seen is that most of the big health groups that you would expect to be out on the front lines, hair on fire, have actually been keeping their heads down through most of these huge changes. But that seems to be maybe changing a little bit, too. This is a pretty dramatic change to get not a huge response from. I’ve seen way lesser changes get way bigger responses. 

Cohrs Zhang: Yeah, I think I spend a lot of time thinking about what is going to be the last straw for some of these organizations. And I think we saw some more effective organizing from the, like, medical device industry when actual medical device reviewers were laid off, and I think they went public pretty quickly, and those people were rehired. But I think it’s important to remember that some of these larger trade organizations in these companies are looking at a broader picture here. And there are all these different pieces of the puzzle. And certainly I think we’ve seen some trade groups that represent, like, pharmaceutical companies criticize some of the cutbacks at HHS, but also for now they were spared in a tariff announcement this week. 

And so I think they are trying to walk this tightrope where they have to figure out how to get the wins that they think they need and take losses in other place, and hope it kind of all evens out for them. So, I think they’re in a tough situation, and I think there’s much more concern behind the scenes than we’re seeing spill out into the public. But I think at some point maybe the line will be crossed, and I just don’t think we’ve seen that quite yet. 

Karlin-Smith: Yeah, I think the dam is definitely starting to break a bit, though. I was shocked — I guess, what day was it, Tuesday, when all this happened? — when finally late in the day, pharma sent a statement, and it was more scathing than you might even expect. And I think it was the first time they’ve actually responded to anything I’ve asked them to respond to that the administration does. And they said that it’s going to raise crucial questions about the FDA’s ability to fulfill its role. And so I think that is a big sign because, as Rachel mentioned, the medical device community was willing to stick their neck out there when they felt they were really harmed. Smaller trade associations have been starting to push back, but the silence has really been notable, and notable I think by people outside who were hoping that these powerful industries that have sort of more connections to the Republican Party would use that leverage, and they sort of felt abandoned by them. So, I think that is a significant crack to follow. 

Rovner: I feel like everybody’s waiting for somebody else to stand up and see if they get their head chopped off. I agree. I mean, I’m hearing, quietly, I’m hearing the concern, too, but publicly not so much. Well, moving to Capitol Hill, Congress is in this week. Well, they were in. We’ll get to the House in a minute. But first in the Senate, New Jersey’s Cory Booker set a new record for holding the floor, which is saying something for a place where being long-winded is basically a prerequisite. Twenty-five hours and five minutes, besting by almost an hour the 1957 filibuster against the Civil Rights Act by Strom Thurmond of South Carolina. Much of what Booker talked about during his more than a day on the Senate floor was health care. Is this still the issue that Democrats are hoping to ride to their political return? 

Weber: I was going to say, if the massive Medicaid cuts that are forecast come through, I do think that will be the midterm political return of Democrats. I think the writing is on the wall politically for Republicans if those do go through, which is why I think you’re seeing a lot of Republican leaders start to say: Oh, no. No, no, no. We don’t want some of these Medicaid cuts like this. But to be determined how that actually plays out. 

Rovner: Rachel. 

Cohrs Zhang: I was just going to say that Democrats are just trying to figure out something that will break through to people. They’re just trying to throw spaghetti at the wall and see if there’s some strategy they can find to get through to people. And I think this, just given the viewership of Sen. Booker’s speech, seemed to break through in a way and felt like even though Democrats do have really limited levers of power in Washington right now, that at least somebody was doing something, you know. And that’s kind of the takeaway that I had from that speech. 

But I will say I think Congressman Jake Auchincloss appeared after White House adviser Calley Means criticized the scientific establishment and HHS and was defending these cuts, and Congressman Auchincloss, I think, did have a more forceful tone in pushing back and just arguing for the scientific advances that have happened and had some really camera-ready little tidbits about the new administration being run by like conspiracy theorists and podcast bros. And I think they’re trying to figure out how to push back and how to get through to people and what approaches are going to work. And I think that was just a new tactic that we saw break through. 

Rovner: Well, if the Democrats did want to make a statement about Medicaid, they could make a stand against President Trump’s nominee to head the Medicaid program, as well as Medicare and the ACA [Affordable Care Act], Dr. Mehmet Oz. That vote is scheduled in the Senate for today after we finish taping. But we’re not really seeing that much pushback. Are we, Lauren? 

Weber: Not so far. I guess we’ll see. We’re taping before this happens. But Mehmet Oz really waltzed through his confirmation hearing process. It’s rare that you see someone who will lead such a massive agency on health care mention the multiple Daytime Emmys he’s won, but I think that helped in his charming of legislators. His daytime bona fides were on high display. He was able to dodge multiple questions about what he would do about cuts to Medicaid, and even Democratic senators were inviting him to come to church. I would be surprised if we see some sort of big stand today. 

Rovner: He was super well prepped, which we said — we did a special after the hearing — which is of all of the Trump nominees, I think he was the best prepped of anybody I’ve seen. He was ready with tidbits from every single member of the committee. But I will say that, going back years, and as I said, you know, 40 years, this is a position that one party or the other has frequently blocked, not for reasons that the nominee was not qualified but because they wanted to make a point about something that was going on at the agency. And it kind of surprises me that we haven’t seen that sort of thing. There were years where we did not have a Senate-approved head of Medicare and Medicaid. Sarah, as you pointed out, there were years when we didn’t have a Senate-approved head of the FDA for the same reason. Had nothing to do with the nominee. Had everything to do with the party that was out of power trying to use that as leverage to make a point. And we’re just not even seeing the Democrats try that. 

Weber: I guess we’ll see this afternoon. You could be forecasting what’s going to happen, Julie. But I think on top of him being well prepped, Oz does have a history in health care, is a very accomplished surgeon. But what is fascinating to me is that he’s coming back to the Senate after a 2014 grilling by the Senate on his pushing of supplements and other things for, quote, “fat blasting” and, quote, “weight loss” products. And it’s just the turnaround of daytime TV star to failed Senate candidate to potential administrator for CMS, which runs hundreds of millions Americans’ health insurance, potentially at a very consequential period in which there are massive cuts to them, is really going to be something. 

Rovner: Yes. Yet another eye-opening thing out of this administration. Well, over in the House, things are a little more confusing. On Tuesday, the usually unified Republicans rejected a rule, normally a party-line , because Speaker Mike Johnson was using it to avoid a vote on a bill that would allow new parents to vote by proxy, basically granting them parental leave. I did not have this fight on my bingo card for this year. It’s actually less a partisan fight than one between younger — read, childbearing age — members of Congress and older ones from both parties. I’m kind of surprised that this of all things is what stopped the House from doing business this week. 

Cohrs Zhang: Yeah, I think that it is an interesting contrast here because House Republicans have had this very pro-family rhetoric in the campaign, but they also have been so against remote work in any fashion, and members of Congress travel really far. There’s a time in pregnancy when you can no longer fly on a plane. And so I think given Republicans’ really, really slim majority in the House, it puts them in kind of a pickle where they need these votes to keep the majority, but it kind of sits at the intersection of all these different forces at play. So, I think, yeah, just a really weird political pickle that House Republicans have found themselves in this week. 

Rovner: Yeah, and of course this was a member of the House Freedom Caucus, a Republican member of the House Freedom Caucus, who was pushing this, who got a majority of the House to sign her discharge petition, which is supposed to bring this bill to the floor. So, we will see how that one plays out. Obviously, with everything else that’s going on, it’s not the biggest story, but it sure is interesting. 

Well, the big non-health news of the week are the tariffs that President Trump announced in the Rose Garden Wednesday afternoon. There is a health care angle to this story. The tariffs reportedly include at least some drugs and drug ingredients that are manufactured overseas. This, again, feels like it’s going to do exactly the opposite of what the president says he wants to do in terms of reducing drug prices, right? 

Weber: I mean, yes, yes. That would seem to be exactly how that is likely to go. Even look at drugs we get from Canada. They’re going to have tariffs on them. I think we have to wait and see exactly what happens. Trump has had a history of proposing these and then taking them back. Obviously these are much more sweeping than the ones we’ve seen so far. So, I think it, the jury is out on how exactly this will play out over the next couple weeks. 

Rovner: Right. And I said there’s also the exception process, right? 

Karlin-Smith: So, yeah, there’s been I think a lot of confusion and lack of clarity around exactly what happened yesterday here. It seems like the drug industry did get some key exemptions, but people are trying to kind of clarify some of those, including, like: Do you just apply to finished product? Do ingredients that they need lower down in the supply chain get impacted? So, I think it seems like pharma at least got some amount of a win here and got some of the typical exemptions for medicines, but people are not confident in all of that and how it’s going to play out. And I’ve seen sort of mixed reactions from analysts in the space. But yeah, it’s just like other parts of the economy that people have talked about with tariffs. It’s not entirely clear how the average American consumer would actually benefit from these tariffs versus having to just pay more money for goods. 

Rovner: We are apparently going to tariff penguins from islands off the coast of Australia. That much we seem clear on this morning. Turning to abortion, this week, as we mentioned last week, the Supreme Court heard a case out of South Carolina testing whether a state can kick Planned Parenthood not just out of the federal Family Planning Program, Title X, but whether Planned Parenthood can be disallowed from providing Medicaid services as well. Now, Planned Parenthood gets way more money from Medicaid than it does from Title X, and neither program allows the use of federal funds to pay for abortion. I will say that again: Neither program allows the use of federal funds to pay for abortion. Interestingly, it seems the high court might actually be leaning towards Planned Parenthood in this case, not because the conservative justices have any sympathy towards Planned Parenthood but because the court has fairly recently made it clear that the provision of Medicaid law that says patients can choose any qualified provider actually means what it says: The patient can choose any qualified provider. 

At the same time, though, the Trump administration this week declined to distribute a big swath of that Title X funding. And you have to wonder whether, even if Planned Parenthood wins this South Carolina case, what’s going to be left of either Title X or the Medicaid program. Possibly a Pyrrhic victory coming here? It seems that this administration is just whacking things, and even if the court ultimately says you can’t kick them out, there’s going to be nothing for them to stay in. 

Karlin-Smith: Well, the any-willing-provider debate struck me as sort of most interesting here because that type of clause seems to be something you typically see conservatives want to put into a government health program. They don’t feel comfortable kind of restricting people and choices in that way around who they see. So that was one of the elements of this case. The other thing that I think is being watched is this argument that the state is making around, like, how you enforce disagreements, I guess, around how the Medicaid program is being operated. And that seems like it could have a lot of long-lasting impacts as well if people, depending on if the court weighs in on that and so forth, just what rights people have to contest problematic decisions made in state Medicaid programs. 

Rovner: Yeah, for the first hour of the debate, the word “abortion” wasn’t mentioned. The word “Planned Parenthood” wasn’t mentioned. This was really about whether patients actually have a right to sue over not being able to get the kind of care that they want, which has been a long-standing fight in Medicaid, back to, I think, pretty much the beginning of Medicaid. So, we’ll see how this one comes out. Well, turning to the states and another case we have talked about, Texas wants to prosecute a New York doctor who was acting legally under New York law from prescribing abortion pills via telemedicine to a Texas patient. The latest is that the court clerk in Ulster County, New York, has refused to file a judgment for the $100,000 fine that Texas says the New York doctor owes. 

At the other end of the spectrum, in Georgia, meanwhile, lawmakers held a hearing on a bill that would — and I’m quoting from a Georgia state news service here — “ban abortions in Georgia from the moment of fertilization and codify it as a felony homicide crime unless a pregnant woman was threatened with violence to have the procedure.” Now, under this bill, both the woman and the doctor could be charged with murder. This bill is unlikely to be enacted this year, but I feel like the Overton window on this continues to move towards maybe punishing women with poor pregnancy outcomes. 

Karlin-Smith: Well, and punishing women who have trouble getting pregnant, as some of the opponents of this bill are arguing. It’s not clear whether it will really be possible to do IVF procedures if the bill was enacted how it was written. And even it seems like some of the reason why some pretty anti-abortion groups are concerned about this law, because they feel uncomfortable that it’s penalizing or going after the woman rather than other people involved in the abortion system. 

Rovner: I feel like we’ve been creeping this direction for a while, though. Obviously, this bill’s probably not going to move this cycle, but it got a hearing. We’ve seen a lot of things like this introduced. We’ve rarely seen it progress to the hearing stage. Another thing that bears watching. So, last week in the segment that I’m now calling “MAHA [Make America Healthy Again] in the States,” we talked about West Virginia banning food dyes and additives. Well, hold my beer — um, make that water, says Utah. Utah has now become the first state to ban fluoride in public water systems, something takes effect next month. Lauren, I feel like states are rushing to match RFK Jr. Is that what we’re seeing? 

Weber: There is some interest at the state level, but I also think it speaks to RFK’s limitations. I think everybody always thinks the game is always in D.C., but there’s a lot the states can do. And so I think it’ll be fascinating to kind of see how this continues to play out. 

Rovner: Yeah, well, we will keep watching it. All right, that is this week’s health news. Now we will play my interview with KFF Health News’ Julie Appleby. Then we will come back and do our extra credits. 

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

Julie Appleby: Thanks for having me. 

Rovner: So, this month’s patient is yet another with a gigantic colonoscopy bill, but there’s a twist with this one. Tell us who he is and, important for this story, what kind of health insurance he has. 

Appleby: Yes, absolutely. His name is Tim Winard, and he lives in Addison, Illinois. He bought his own health insurance after he left his management job to launch his own business. So he shopped around a little bit. This is the first time he’s bought insurance. And he chose a short-term policy, which is good for six months in his state. And the first six months went pretty well. And he was still working on starting his business, so he signed up for another short-term policy with a different insurer. And this one cost about $500 a month. 

Rovner: So, remind us again. What is short-term health insurance? And how is it different from most employer and Affordable Care Act coverage? 

Appleby: Right. These types of policies have been sold for years. They’re generally intended for people who are, like, between jobs or maybe just getting out of school. They’re a temporary bridge to more comprehensive insurance, and as such they are not considered Affordable Care Act-qualified plans. So they don’t have to meet the rules that are set under the Affordable Care Act. So, for example, they might look like comprehensive major medical policies, but they all have sort of significant caveats. And some of these might surprise people who are accustomed to work-based or ACA plans. So, for example, like in Tim Winard’s plan, some set specific dollar caps on certain types of medical care, and sometimes those are, like, per day or per visit or something like that, and they can be sometimes far below what it actually costs. 

And all of them — this is a key difference with ACA plans — all of these types of short-term plans screen applicants for health conditions, and they can reject people because of health problems or exclude those conditions from coverage. Many also do not cover drugs or maternity care. So people really have to read their policies carefully to see what they cover and what they don’t cover. 

Rovner: So this is sort of like pre-ACA. It’s cheap because it doesn’t cover that much. 

Appleby: Exactly. That’s why they can offer them lower premiums. Now, again, some people with a subsidized ACA plan, these are not necessarily cheaper, but for others these are less expensive. 

Rovner: So back to our patient this month. He does what we always advise and calls his insurance company before he goes for this, because it is obviously scheduled care, not an emergency. What did they tell him? 

Appleby: Well, I think he only asked where he could go. He was concerned that he would go to a facility that was in-network, and they told him he could pretty much go anywhere. He did not ask about cost in that phone call. 

Rovner: Yeah, so he gets his colonoscopy. Everything turns out OK medically. And then, as we say, the bill comes. How big was it? 

Appleby: He was left owing $7,226 after his plan paid about $817 towards the bill. They got a little bit of a discount for being insured, but then he was still left owing more than $7,000. 

Rovner: And what was the explanation for him owing that much? Just a reminder that this should have been fully covered if he’d had an ACA plan, right? 

Appleby: That’s correct. Under the ACA, screening colonoscopies and other types of cancer screenings are covered without a copay for the patient. But he didn’t have an ACA plan here. So, what was the explanation? Well, this time he did email his insurance company, which is Companion Life Insurance of Columbia, South Carolina, and they wrote him back, and they told him his policy classified the procedure and all of its costs, including the anesthesia, under his policy’s outpatient surgery facility benefit. What is that? you might ask. Well, in his policy, that benefit caps insurance payments within that facility to a maximum of a thousand dollars per day. So, the most they were going to pay towards this was a thousand dollars, because they classified the whole thing as an outpatient procedure with that cap. And this surprised Winard because he thought the cancer screening was covered and he would only owe 20% of the bill, not almost the entire thing, basically. 

Rovner: So how did this eventually work out? 

Appleby: Well, we reached out and tried to reach Companion Life, and we also talked to Scott Wood, who works as a program manager and is a co-founder of a marketing company that markets Companion Life and other insurance plans. And he thought there was some room for interpretation in the billing and in the policy language. So he asked Companion Life to take another look. And shortly after that, Winard said he was contacted by his insurer, and a representative told him that upon reconsideration the bill had been adjusted. And he wasn’t really given a reason why that happened, but as it turns out his new bill showed he owed only $770. 

Rovner: Which is, I assume, about what he expected when he went into this, right? 

Appleby: That’s, yes, correct. He didn’t think he was going to have to pay as much as it was initially billed at. 

Rovner: So, what’s the takeaway here other than to come to us if you have a bill that you can’t deal with? 

Appleby: Right. Well, I think experts say to be very cautious and read the plans very carefully if you’re shopping for a short-term plan. And realize they have some of these limits and they may not cover everything. They may not cover preexisting conditions. And this could become more widespread in the coming years as — short-term plans have been somewhat of a political football. So, out of concern that people would choose them over more comprehensive coverage, President Barack Obama’s administration limited them to terms of three months. Those rules were lifted during the first Trump administration, and he allowed the plans to again be sold as 364-day policies, just one day short of a year, and then you could try to get another one. Or in some cases the insurer could opt to renew them. 

And then Joe Biden came in, and President Biden called them “junk insurance,” and he restricted the policies to four months. So, it’s been bouncing back and forth, back and forth. Everybody really expects the Trump administration to do what it did the last time and make them available for longer periods. So I think if we’re going to hear more about short-term plans. They may become more common. And again, it’s just a matter of trying to understand what you’re buying, and why they might be less expensive in your mind than an ACA plan, but they might not turn out to be. 

Rovner: And you can always ask for an estimate, right? 

Appleby: And always ask for an estimate. That’s a given. Experts always say, before any kind of scheduled procedure, call your insurer, call the provider, ask for an estimate on how much this might cost you out-of-pocket. 

Rovner: Good. And if all else fails, then you can write to us. 

Appleby: There you go. 

Rovner: Julie Appleby, thank you very much. 

Appleby: Thanks for having me. 

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 put the links in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week? 

Cohrs Zhang: All right. My extra credit is a piece in The Wall Street Journal, and the headline is “FDA Punts on Major COVID-19 Vaccine Decision After Ouster of Top Official,” by Liz Essley White. It’s a great story, and I think, as we talked about earlier, I’m thinking about: What are the breaking points for companies, for industries, as they look at how the HHS is changing? And I think one of those metrics is if the FDA starts missing deadlines to approve products. I think this one is a little bit of a special case because it is a covid-19 vaccine, which is, like, the most highly politicized medical product right now. But I think there could be other cases, and I think industry is watching this so closely to see if some of these changes at FDA really do bleed into approvals, whether the approval process will be politicized, whether they’re going to start missing deadlines. And given just the amount of financial support that industry provides to fund routine activities, I think this was kind of a really good marker in this process as we learn what the impacts are. 

Rovner: Yeah, agree. Lauren. 

Weber: I read “Miscarriage and Motherhood” by Ashley Parker, now at The Atlantic. And I’ve got to be honest — if you read it, be in a place where you can cry. It’s an incredibly moving piece about tragedies of miscarriage, and frankly about women’s health care, and how little support and understanding there is in general about what surrounds that entire field. And some of the fascinating parts in it is when Ashley details going in for a D&C [dilation and curettage] and being told that is an abortion. And it’s kind of an interesting interplay between how what words mean, what people understand what words mean, and what exactly parenthood entails in modern America today. 

Rovner: And how extremely common miscarriage is. I think people just don’t realize, because it’s something that’s just not talked about very much. It’s a really beautiful story. Sarah. 

Karlin-Smith: I looked at an MSNBC piece [“Florida Considers Easing Child Labor Laws After Pushing Out Immigrants”] by Ja’han Jones, about Florida considering easing their child labor laws after pushing out immigrants. And, yeah, the state is considering bills that would allow very young teenagers to work overnight, to maybe work at the kinds of jobs that would normally be seen as too unsafe for such young people. And, yeah, it just seems like an interesting sort of consequence of pushing out immigrant workers. But also it comes after some really moving reports over the past few years, too, about just how dangerous some of this work is, and how even under current law that is supposed to prevent this, particularly immigrants and the most vulnerable workers have ended up with young people in this job, and they’ve really — these types of jobs — and they’ve been harmed by it. 

Rovner: Who could have possibly seen this coming? Sorry. My extra credit this week is from Stat, and it’s called “Uber for Nursing is Here — and It’s Not Good for Patients or Nurses,” by Katie J. Wells and Funda Ustek Spilda. And it’s yet another case of something that sounds really good, using an app to help nurses who want to find extra work and set their own schedules get it, and helping facilities that need extra help find workers. But like so many of these things, it’s not as rosy as it appears unless you’re the one that’s collecting the fees from the app. Workers are basically all temps. They may not be familiar with the facilities they’ve been assigned to, much less the patients, which doesn’t always result in optimal care. And they bid against each other for who will do the job for the lowest rate, creating a race to the bottom for wages. It’s another one of those quote-unquote “advances” that’s a lot less than meets the eye. 

All right, that is this week’s show. 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. Special thanks as always to our producer, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner, and at Bluesky, @julierovner. Where are you guys these days? Rachel, you’re still on LinkedIn, right? 

Cohrs Zhang: Still on LinkedIn. Still on X. I do have a Bluesky account, too. But any and all the places. 

Rovner: Excellent. Sarah. 

Karlin-Smith: Yeah, I’m at Bluesky, some X, some LinkedIn, @SarahKarlin or @sarahkarlin-smith. 

Rovner: Lauren. 

Weber: I’m still on X, and I am on Bluesky, @LaurenWeberHP. And as a member of — a congressional staffer asked me: Does the “HP” really stand for “health policy”? And yes, it does. So, still there. 

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

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This story can be republished for free (details).

Layoff notices began arriving early Tuesday for thousands of employees of the sprawling Department of Health and Human Services and its subsidiary agencies, with as many 10,000 workers potentially expected to be hit by the cuts, including some of the country’s top health officials.

The range of job losses across institutes and offices reflected the breadth of what HHS does and the role it plays in the U.S., in both the obvious ways and less appreciated ones. The cuts and reorganizations affected people who help approve new medicines, track emerging pathogens, and uncover the secrets held in our DNA. But they also reached those developing safer tobacco policies, trying to reduce injuries, and protecting people who rely on Medicare and Medicaid — as well as the staff who made the agencies operate day to day and aimed to communicate health updates, new recommendations, and policy shifts to the public. 

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The Host

Julie Rovner
KFF Health News

@jrovner

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.

Two months into the new administration, federal workers and contractors remain off-balance as the Trump administration ramps up its efforts to cancel jobs and programs — even as federal judges declare many of those efforts illegal and/or unconstitutional.

As it eliminates programs deemed duplicative or unnecessary, however, President Donald Trump’s Department of Government Efficiency is also cutting programs and workers aligned with Health and Human Services Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” agenda.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of the Pink Sheet, and Rachel Roubein of The Washington Post.

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Jessie Hellmann
CQ Roll Call

@jessiehellmann

Read Jessie's stories.

Sarah Karlin-Smith
Pink Sheet

@SarahKarlin

Read Sarah's stories.

Rachel Roubein
The Washington Post

@rachel_roubein

Read Rachel's stories.

Among the takeaways from this week’s episode:

• Kennedy’s comments this week about allowing bird flu to spread unchecked through farms provided another example of the new secretary of health and human services making claims that lack scientific support and could instead undermine public health.
• The Trump administration is experiencing more pushback from the federal courts over its efforts to reduce and dismantle federal agencies, and federal workers who have been rehired under court orders report returning to uncertainty and instability within government agencies.
• The second Trump administration is signaling it plans to dismantle HIV prevention programs in the United States, including efforts that the first Trump administration started. A Texas midwife is accused of performing illegal abortions. And a Trump appointee resigns after being targeted by a Republican senator.

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

Julie Rovner: The Washington Post’s “The Free-Living Bureaucrat,” by Michael Lewis.

Rachel Roubein: The Washington Post’s “Her Research Grant Mentioned ‘Hesitancy.’ Now Her Funding Is Gone.” by Carolyn Y. Johnson.

Sarah Karlin-Smith: KFF Health News’ “Scientists Say NIH Officials Told Them To Scrub mRNA References on Grants,” by Arthur Allen.

Jessie Hellmann: Stat’s “NIH Cancels Funding for a Landmark Diabetes Study at a Time of Focus on Chronic Disease,” by Elaine Chen.

Also mentioned in this week’s podcast:

• The Wall Street Journal’s “Trump Administration Weighing Major Cuts to Funding for Domestic HIV Prevention,” by Liz Essley White, Dominique Mosbergen, and Jonathan D. Rockoff.
• The Washington Post’s “Disabled Americans Fear Losing Protections if States’ Lawsuit Succeeds,” by Amanda Morris.

click to open the transcript

Transcript: Federal Health Work in Flux

[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, March 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 videoconference by Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi. 

Rovner: Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, everybody. 

Rovner: And Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Hello. 

Rovner: No interview today, but, as usual, way more news than we can get to, so let us jump right in. In case you missed it, there’s a bonus podcast episode in your feed. After last week’s Senate Finance Committee confirmation hearing for Dr. Mehmet Oz to head the Centers for Medicare & Medicaid Services, my KFF Health News colleagues Stephanie Armour and Rachana Pradhan and I summarized the hearing and caught up on all the HHS [Department of Health and Human Services] nomination actions. It will be the episode in your feed right before this one. 

So even without Senate-confirmed heads at — checks notes — all of the major agencies at HHS, the department does continue to make news. First, Robert F. Kennedy Jr., the new HHS secretary, speaks. Last week it was measles. This week it was bird flu, which he says should be allowed to spread unchecked in chicken flocks to see which birds are resistant or immune. This feels kind of like what some people recommended during covid. Sarah, is there any science to suggest this might be a good idea? 

Karlin-Smith: No, it seems like the science actually suggests the opposite, because doctors and veterinary specialists are saying basically every time you let the infection continue to infect birds, you’re giving the virus more and more chances to mutate, which can lead to more problems down the road. The other thing is they were talking about the way we raise animals, and for food these days, there isn’t going to be a lot of genetic variation for the chickens, so it’s not like you’re going to be able to find a huge subset of them that are going to survive bird flu. 

And then the other thing I thought is really interesting is just it doesn’t seem economically to make the most sense either as well, both for the individual farmers but then for U.S. industry as a whole, because it seems like other countries will be particularly unhappy with us and even maybe put prohibitions on trading with us or those products due to the spread of bird flu. 

Rovner: Yeah, it was eyebrow-raising, let us say. Well, HHS this week also announced its first big policy effort, called Operation Stork Speed. It will press infant formula makers for more complete lists of ingredients, increase testing for heavy metals in formula, make it easier to import formula from other countries, and order more research into the health outcomes of feeding infant formula. This feels like maybe one of those things that’s not totally controversial, except for the part that the FDA [Food and Drug Administration] workers who have been monitoring the infant formula shortage were part of the big DOGE [Department of Government Efficiency] layoffs. 

Roubein: I talked to some experts about this idea, and, like you said, they thought it kind of sounded good, but they basically needed more details. Like, what does it mean? Who’s going to review these ingredients? To your point, some people did say that the agency would need to staff up, and there was a neonatologist who is heading up infant formula that was hired after the 2022 shortage who was part of the probationary worker terminations. However, when the FDA rescinded the terminations of some workers, so, that doctor has been hired back. So I think that’s worth noting. 

Rovner: Yes. This is also, I guess, where we get to note that Calley Means, one of RFK Jr.’s, I guess, brain trusts in the MAHA movement, has been hired as, I guess, in an Elon Musk-like position in the White House as an adviser. But this is certainly an area where he would expect to weigh in. 

Hellmann: Yeah, I saw he’s really excited about this on Twitter, or X. There’s just been concerns in the MAHA movement, “Make America Healthy Again,” about the ingredients that are in baby formula. And the only thing is I saw that he also retweeted somebody who said that “breast is best,” and I’m just hoping that we’re not going back down that road again, because I feel like public health did a lot of work in pushing the message that formula and breast milk is good for the child, and so that’s just another angle that I’ve been thinking about on this. 

Rovner: Yes, I think this is one of those things that everybody agrees we should look at and has the potential to get really controversial at some point. While we are on the subject of the federal workforce and layoffs, federal judges and DOGE continue to play cat-and-mouse, with lots of real people’s lives and careers at stake. Various judges have ordered the reinstatement, as you mentioned, Rachel, of probationary and other workers. Although in many cases workers have been reinstated to an administrative leave status, meaning they get put back on the payroll and they get their benefits back, but they still can’t do their jobs. At least one judge has said that does not satisfy his order, and this is all changing so fast it’s basically impossible to keep up. But is it fair to say that it’s not a very stable time to be a federal worker? 

Karlin-Smith: That’s probably the nicest possible way to put it. When you talk to federal workers, everybody seems stressed and just unsure of their status. And if they do have a job, it’s often from their perspective tougher to do their job lately, and then they’re just not sure how stable it is. And many people are considering what options they have outside the federal government at this point. 

Rovner: So for those lucky federal workers who do still have jobs, the Trump administration has also ordered everyone back to offices, even if those offices aren’t equipped to accommodate them. FDA headquarters here in Maryland’s kind of been the poster child for this this week. 

Karlin-Smith: Yeah, FDA is an interesting one because well before covid normalized working from home and transitioned a lot of people to working from home, FDA’s headquarters couldn’t accommodate a lot of the new growth in the agency over the years, like the tobacco part of the FDA. So it was typical that people at least worked part of their workweek at home, and FDA really found once covid gave them additional work-from-home flexibilities, they were able to recruit staff they really, really needed with specialized degrees and training who don’t live near here, and it actually turned out to be quite a benefit from them. 

And now they’re saying everybody needs to be in an office five days a week, and you have people basically cramped into conference rooms. There’s not enough parking. People are trying to review technical scientific data, and you kind of can’t hear yourself think. Or you’re a lawyer — I heard of a situation where people are basically being told, Well, if you need to do a private phone call because of the confidentiality around what you’re doing, go take the call in your car. So I think in addition to all of the concerns people have around the stability of their jobs, there’s now this element of, on a personal level, I think for many of them it’s just made their lives more challenging. And then they just feel like they’re not actually able to do, have the same level of efficiency at their work as they normally would. 

Rovner: And for those who don’t know, the FDA campus is on a former military installation in the Maryland suburbs. It’s not really near any public transportation. So you pretty much have to drive to get there. And I think that the parking lots are not that big, because, as you pointed out, Sarah, the workforce is now bigger than the headquarters was created to accommodate it. And we’re seeing this across the government. This week it happened to be FDA. You have to ask the question: Is this really just an effort to make the government not work, to make federal workers, if they can’t fire them, to make them quit? 

Hellmann: I definitely think that’s part of the underlying goal. If you see some of the stuff that Elon Musk says about the federal workforce, it’s very dismissive. He doesn’t seem to have a lot of respect for the civil servants. And they’ve been running into a lot of pushback from federal judges over many lawsuits targeting these terminations. And so I think just making conditions as frustrating as possible for some of these workers until they quit is definitely part of the strategy. 

Roubein: And I think this is overlaid with the additional buyout offers, the additional early retirement offers. There’s also the reduction-in-force plans that federal workers have been unnerved about, bracing for future layoffs. So it’s very clear that they want to shrink the size of the federal workforce. 

Rovner: Yeah, we’ve seen a lot of these people, I’ve seen interviews with them, who are being reinstated, but they’re still worried that now they’re going to be RIF-ed. They’re back on the payroll, they’re off the payroll. I mean there’s nothing — this does not feel like a very efficient way to run the federal government. 

Karlin-Smith: Right. I think that’s what a lot of people are talking about is, again, going back to offices, for many of these people, is not leading to productivity. I talked to one person who said: I’m just leaving my laptop at the office now. I’m not going to take it home and do the extra hours of work that they might’ve normally gotten from me. And that includes losing time to commute. FDA is paying for parking-garage spaces in downtown Silver Spring [Maryland] near the Metro so that they can then shuttle people to the FDA headquarters. I’ve taken buses from that Metro to FDA headquarters. In traffic, that’s a 30-minute drive. They’re spending money on things that, again, I think are not going to in the long run create any government efficiency. 

And in fact, I’ve been talking to people who are worried it’s going to do the opposite, that drug review, device review, medical product review times and things like that are going to slow. We talked about food safety. I think The New York Times had a really good story this week about concerns about losing the people. We need to make sure that baby formula is actually safe. So there’s a lot of contradictions in the messaging of what they’re trying to accomplish and how the actions actually are playing out. 

Rovner: Well, and finally, I’m going to lay one more layer on this. There’s the question of whether you can even put the toothpaste back in the tube if you wanted to. After weeks of back-and-forth, the federal judge ruled on Tuesday that the dissolution of USAID [the U.S. Agency for International Development] was illegal and probably unconstitutional, and ordered email and computer access restored for the remaining workers while blocking further cuts. But with nearly everybody fired, called back from overseas, and contracts canceled, USAID couldn’t possibly come close to doing what it did before DOGE basically took it apart, right?. 

Karlin-Smith: You hear stories of if someone already takes a new job, they’re lucky enough to find a new job, why are they going to come back? Again, even if you’re brought back, my expectation is a lot of people who have been brought back are probably looking for new jobs regardless because you don’t have that stability. And I think the USAID thing is interesting, too, because again, you have people that were working in all corners of the world and you have partnerships with other countries and contractors that have to be able to trust you moving forward. And the question is, do those countries and those organizations want to continue working with the U.S. if they can’t have that sort of trust? And as people said, the U.S. government was known as, they could pay contractors less because they always paid you. And when you take that away, that creates a lot of problems for negotiating deals to work with them moving forward. 

Rovner: And I think that’s true for federal workers, too. There’s always been the idea that you probably could earn more in the private sector than you can working for the federal government, but it’s always been a pretty stable job. And I think right now it’s anything but, so comes the question of: Are we deterring people from wanting to work for the federal government? Eventually one would assume there’s still going to be a federal government to work for, and there may not be anybody who wants to do it. 

Roubein: Yeah, you saw various hiring authorities given to try and recruit scientists and other researchers who make a lot, lot more in the public health sector, and some of those were a part of the probationary workforce because they had been hired recently under those authorities. 

Rovner: Yeah, and now this is all sort of coming apart. Well, meanwhile, the cuts are continuing even faster than federal judges can rule against them. Last week, the administration said it would reduce the number of HHS regional offices from 10 to four. Considering these are where the department’s major fraud-fighting efforts take place, that doesn’t seem a very effective way of going after fraud and abuse in programs like Medicare and Medicaid. Those regional offices are also where lots of beneficiary protections come from, like inspections of nursing homes and Head Start facilities. How does this serve RFK Jr.’s Make America Healthy Again agenda? 

Karlin-Smith: I think it’s not clear that it does, right? You’re talking about, again, the Department of Government Efficiency has focused on efficiency, cost savings, and Medicare and Medicaid does a pretty good job of fighting fraud and making HHS OIG [Office of Inspector General], all those organizations, they collect a lot of money back. So when you lose people— 

Rovner: And of course the inspector general has also been laid off in all of this. 

Karlin-Smith: Right. It’s not clear to me, I think one of the things with that whole reorganization of their chief counsel is people are suggesting, again, this is sort of a power move of HHS wanting to get a little bit more control of the legal operations at the lower agencies, whether it’s NIH [the National Institutes of Health] or FDA and so forth. But, right, it’s reducing head count without really thinking about what people’s roles actually were and what you lose when you let them go. 

Rovner: Well, the Trump administration is also continuing to cut grants and contracts that seem like they’d be the kind of things that directly relate to Make America Healthy Again. Jessie, you’ve chosen one of those as your extra credit this week. Tell us about it. 

Hellmann: Yeah. So my story is from Stat [“NIH Cancels Funding for a Landmark Diabetes Study at a Time of Focus on Chronic Disease”], and it’s about a nationwide study that tracks patients with prediabetes and diabetes. And it was housed at Columbia University, which as we know has been the subject of some criticism from the Trump administration. They had lost about $400 million in grants because the administration didn’t like Columbia’s response to some of the protests that were on campus last year. But that has an effect on some research that really doesn’t have much to do with that, including a study that looked at diabetes over a really long period of time. 

So it was able to over decades result in 200 publications about prediabetes and diabetes, and led to some of the knowledge that we have now about the interventions for that. And the latest stage was going to focus on dementia and cognitive impairment, since some of the people that they’ve been following for years are now in their older ages. And now they have to put a stop to that. They don’t even have funding to analyze blood samples that they’ve done and the brain scans that they’ve collected. So it’s just another example of how what’s being done at the administration level is contradicting some of the goals that they say that they have. 

Rovner: Yeah, and it’s important to remember that Columbia’s funding is being cut not because they deemed this particular project to be not helpful but because they are, as you said, angry at Columbia for not cracking down more on pro-Palestinian protesters after Oct. 7. 

Well, meanwhile, people are bracing for still more cuts. The Wall Street Journal is reporting the administration plans to cut domestic AIDS-HIV programming on top of the cuts to the international PEPFAR [President’s Emergency Plan for AIDS Relief] program that was hammered as part of the USAID cancellation. Is fighting AIDS and HIV just way too George W. Bush for this administration? 

Hellmann: It’s interesting because President [Donald] Trump unveiled the Ending the HIV Epidemic initiative in his first term, and the goal was to end the epidemic in the United States. And so if they were talking about reducing some of that funding, or I know there were reports that maybe they would move the funding from CDC [the Centers for Disease Control and Prevention] to HRSA [the Health Resources and Services Administration], it’s very unclear at this point. Then it raises questions about whether it would undermine that effort. And there’s already actions that the Trump administration has done to undermine the initiative, like the attacks on trans people. They’ve canceled grants to researchers studying HIV. They have done a whole host of things. They canceled funding to HIV services organizations because they have “trans” in their programming or on their websites. So it’s already caused a lot of anxiety in this community. And yeah, it’s just a total turnaround from the first administration. 

Rovner: I know the Whitman-Walker clinic here in Washington, which has long been one of the premier AIDS-HIV clinics, had just huge layoffs. This is already happening, and as you point out, this was something that President Trump in his first term vowed to end AIDS-HIV in the U.S. So this is not one would think how one would go about that. 

Well, it’s not just the administration that’s working to constrict rights and services. A group of 17 states, led by Texas, of course, are suing to have Biden-era regulations concerning discrimination against trans people struck down, except as part of that suit, the states are asking that the entirety of Section 504 of the Rehabilitation Act be declared unconstitutional. Now, you may never have heard of Section 504, but it is a very big deal. It was the forerunner of the Americans With Disabilities Act, and it prevents discrimination on the basis of disability in all federally funded activities. It is literally a lifeline for millions of disabled people that enables them to live in the community rather than in institutions. Are we looking at an actual attempt to roll back basically all civil rights as part of this war on “woke” and DEI [diversity, equity, and inclusion] and trans people? 

Hellmann: The story is interesting, because it seems like some of the attorneys general are saying, That’s not our intent. But if you look at the court filings, it definitely seems like it is. And yeah, like you said, this is something that would just have a tremendous impact. And Medicaid coverage of home- and community-based services is one of those things that states are constantly struggling to pay for. You’re just continuing to see more and more people need these services. Some states have waiting lists, so— 

Rovner: I think most states have waiting lists. 

Hellmann: Yeah. It’s something, you have to really question what the intent is here. Even if people are saying, This isn’t our intent, it’s pretty black-and-white on paper in the court records, so— 

Rovner: Yeah, just to be clear, this was a Biden administration regulation, updating the rules for Section 504, that included reference to trans people. But in the process of trying to get that struck down, the court filings do, as you say, call for the entirety of Section 504 to be declared unconstitutional. This is obviously one of those court cases that’s still before the district court, so it’s a long way to go. But the entire disability community, certainly it has their attention. 

Well, we haven’t had any big abortion news the past couple of weeks, but that is changing. In Texas, a midwife and her associate have become the first people arrested under the state’s 2022 abortion ban. The details of the case are still pretty fuzzy, but if convicted, the midwife who reportedly worked as an OB-GYN doctor in her native Peru and served a mostly Spanish-speaking clientele, could be sentenced to up to 20 years in prison. So, obviously, be watching that one. Meanwhile, here in Washington, Hilary Perkins, a career lawyer chosen by FDA commissioner nominee Marty Makary to serve as the agency’s general counsel, resigned less than two days into her new position after complaints from Missouri Sen. Josh Hawley that she defended the Biden administration’s position on the abortion pill mifepristone. 

Now, Hilary Perkins is no liberal trying to hide out in the bureaucracy. She’s a self-described pro-life Christian conservative hired in the first Trump administration, but she was apparently forced out for the high crime of doing her job as a career lawyer. Is this administration really going to try to evict anyone who ever supported a Biden position? Will that leave anybody left? 

Roubein: I think what’s notable is Sen. Josh Hawley here, who expressed concerns and I had heard expressed concerns to the White House, and the post on X from the FDA came an hour before the hearing. There were concerns that he was not going to make it out of committee and— 

Rovner: Before the Marty Makary hearing. 

Roubein: Yes, sorry, before the vote in the HELP [Health, Education, Labor and Pensions] Committee on Marty Makary. And Hawley said because of that, he would vote to support him. What was interesting is two Democrats actually ended up supporting him, so he could have passed without Hawley’s vote. But I think in general it poses a test for Marty Makary when he’s an FDA commissioner, and how and whether he’s going to get his people in and how he’ll respond to different pressure points in Congress and with HHS and with the White House. 

Rovner: And of course, Hawley’s not a disinterested bystander here, right? 

Karlin-Smith: So his wife was one of the key attorneys in the recent big Supreme Court case that was pushed down to the lower courts for a lack of standing, but she was trying to essentially get tighter controls on the abortion pill mifepristone. But it seems like almost maybe Hawley jumped too soon before doing all of his research or fully understanding the role of people at Justice. Because even before this whole controversy erupted, I had talked to people the day before about this and asked them, “Should we read into this, her being involved in this?” And everybody I talked to, including, I think, a lot of people that have different views than Perkins does on the case, that they were saying she was in a role as a career attorney. You do what your boss, what the administration, wants. 

If you really, really had a big moral problem with that, you can quit your job. But it’s perfectly normal for an attorney in that kind of position to defend a client’s interest and then have another client and maybe have to defend them wrongly. So it seems like if they had just maybe even picked up the phone and had a conversation with her, the whole crisis could have been averted. And she was on CNN yesterday trying to plead her case and, again, emphasize her positions because perhaps she’s worried about her future career prospects, I guess, over this debacle. 

Rovner: Yeah, now she’s going to be blackballed by both sides for having done her job, basically. Anyway, all right, well, one big Biden initiative that looks like it will continue is the Medicare Drug Price Negotiation program. And we think we know this because CMS announced last week that the makers of all of the 15 drugs selected for the second round of negotiations have agreed to, well, negotiate. Sarah, this is news, right? Because we were wondering whether this was really going to go forward. 

Karlin-Smith: Yeah, they’ve made some other signals since taking over that they were going to keep going with this, including last week at his confirmation hearing, Dr. Oz, for CMS, also indicated he seemed like he would uphold that law and they were looking for ways to lower drug costs. So I think what people are going to be watching for is whether they yield around the edges in terms of tweaks the industry wants to the law, or is there something about the prices they actually negotiate that signal they’re not really trying to get them as low as they can go? But this seems to be one populist issue for Trump that he wants to keep leaning into and keep the same consistency, I think, from his first administration, where he always took a pretty hard line on the drug industry and drug pricing. 

Rovner: And I know Ozempic is on that list of 15 drugs, but the administration hasn’t said yet. I assume that’s Ozempic for its original purpose in treating diabetes. This administration hasn’t said yet whether they’ll continue the Biden declaration that these drugs could be available for people for weight loss, right? 

Karlin-Smith: Correct. And I think that’s going to be more complicated because that’s so costly. So negotiating the price of drugs saves money. So yes, basically because Ozempic and Wegovy are the same drug, that price should be available regardless of the indication. But I’m more skeptical that they continue that policy, because of the cost and also just because, again, HHS Secretary Robert F. Kennedy seems to be particularly skeptical of the drugs, or at least using that as a first line of defense, widespread use, reliance on that. He tends to, in general, I think, support other ways of medical, I guess, treatment or health treatments before turning to pharmaceuticals. 

Rovner: Eating better and exercising. 

Karlin-Smith: Correct, right. So I think that’s going to be a hard sell for them because it’s just so costly. 

Rovner: We will see. All right, that is as much news as we have time for this week. Now, it is 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, you’ve done yours already this week. Rachel, why don’t you go next? 

Roubein: My extra credit, the headline is “Her Research Grant Mentioned ‘Hesitancy.’ Now Her Funding Is Gone.” In The Washington Post by my colleague Carolyn Y. Johnson. And I thought the story was particularly interesting because it really dove into the personal level. You hear about all these cuts from a high level, but you don’t always really know what it means and how it came about. So the backstory is the National Institutes of Health terminated dozens of research grants that focused on why some people are hesitant to accept vaccines. 

And Carolyn profiled one researcher, Nisha Acharya, but there was a twist, and the twist was she doesn’t actually study how to combat vaccine hesitancy or ways to increase vaccine uptake. Instead, she studies how well the shingles vaccine works to prevent the infection, with a focus on whether the shot also prevents the virus from affecting people’s eyes. But in the summary of her project, she had used the word “hesitancy” once and used the word “uptake” once. And so this highlights the sweeping approach to halting some of these vaccine hesitancy research grants. 

Rovner: Yeah that was like the DOD [Department of Defense] getting rid of the picture of the Enola Gay, the plane that dropped the atomic bomb, because it had the word “Gay” in it. This is the downside, I guess, of using AI for these sorts of things. Sarah. 

Karlin-Smith: I took a look at a KFF story by Arthur Allen, “Scientists Say NIH Officials Told Them to Scrub mRNA References on Grants,” and it’s about NIH officials urging people to remove any reference to mRNA vaccine technology from their grants. And the story indicates it’s not yet clear if that is going to translate to defunding of such research, but the implications are quite vast. I think most people probably remember the mRNA vaccine technology is really what helped many of us survive the covid pandemic and is credited with saving millions of lives, but the technology promise seems vast even beyond infectious diseases, and there’s a lot of hope for it in cancer. 

And so this has a lot of people worried. It’s not particularly surprising, I guess, because again, the anti-vaccine movement, which Kennedy has been a leader of, has been particularly skeptical of the mRNA technology. But it is problematic, I think, for research. And we spent a lot of time on this call talking about the decimation of the federal workforce that may happen here, and I think this story and some of the other things we talked about today also show how we may just decimate our entire scientific research infrastructure and workforce in the U.S. outside of just the federal government, because so much of it is funded by NIH, and the decisions they’re making are going to make it impossible for a lot of scientists to do their job. 

Rovner: Yeah, we’re also seeing scientists going to other countries, but that’s for another time. Well, my extra credit this week, probably along the same lines, also from The Washington Post. It’s part of a series called “Who Is Government?” This particular piece [“The Free-Living Bureaucrat”] is by bestselling author Michael Lewis, and it’s a sprawling — and I mean sprawling — story of how a mid-level FDA employee who wanted to help find new treatments for rare diseases ended up not only figuring out a cure for a child who was dying of a rare brain amoeba but managed to obtain the drug for the family in time to save her. It’s a really good piece, and it’s a really excellent series that tells the stories of mostly faceless bureaucrats who actually are working to try to make the country a better place. 

OK, that’s this week’s show. 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. Thanks as always to our producer, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner, and at Bluesky, @julierovner. Where are you guys these days? Sarah? 

Karlin-Smith: A little bit everywhere. X, Bluesky, LinkedIn — @SarahKarlin or @sarahkarlin-smith. 

Rovner: Jessie. 

Hellmann: I’m @jessiehellmann on X and Bluesky, and I’m also on LinkedIn more these days. 

Rovner: Great. Rachel. 

Roubein: @rachelroubein at Bluesky, @rachel_roubein on X, and also on LinkedIn. 

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

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Julie Rovner
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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.

As abortion and other reproductive issues gain more prominence in the looming election, some Republicans are trying to moderate their anti-abortion positions, particularly in states where access to the procedure remains politically popular. 

Meanwhile, open enrollment is underway for Medicare, even as some health plans are challenging in court the federal government’s decision to reduce their quality ratings — with millions of dollars at stake. 

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, Sarah Karlin-Smith of the Pink Sheet, and Victoria Knight of Axios.

Panelists

Rachel Cohrs Zhang
Stat News

@rachelcohrs

Read Rachel's stories.

Sarah Karlin-Smith
Pink Sheet

@SarahKarlin

Read Sarah's stories.

Victoria Knight
Axios

@victoriaregisk

Read Victoria's stories.

Among the takeaways from this week’s episode:

• With polls showing more voters citing abortion as a top voting issue, some candidates with long track records opposing abortion rights are working to moderate their positions.
• Many older Americans will spend less on prescription drugs next year due to a new out-of-pocket pricing cap, among other changes in store as provisions of the 2022 Inflation Reduction Act take effect. But some are realizing the limits on those benefits, as deeper problems persist in drug pricing, insurance coverage, and access.
• The FDA is reconsidering a weight-loss drug decision that caused confusion for patients and compounding pharmacies. Compounded drugs are intended for individual issues, like needing a different dosage — and while the process can be used to augment mass manufacturing during times of drug shortages, it is not well suited to address access and pricing issues.
• In abortion news, a comprehensive study shows abortions have increased since the overturn of Roe v. Wade, even among women in states with strict restrictions — and those states are seeing higher infant mortality rates, according to separate research. And an effort is underway to revive in a Texas court the challenge to mifepristone’s FDA approval. The last challenge failed because the Supreme Court found the plaintiffs lacked standing.

Also this week, Rovner interviews Tricia Neuman, senior vice president of KFF and executive director of its Program on Medicare Policy, about Medicare open enrollment and the changes to the program for 2025. 

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

Julie Rovner: NBC News’ “Crisis Pregnancy Center’s Forms Give Rare Insight Into Anti-Abortion Practices,” by Abigail Brooks.  

Sarah Karlin-Smith: Vanity Fair’s “Inside the Bungled Bird Flu Response, Where Profits Collide With Public Health,” by Katherine Eban. 

Rachel Cohrs Zhang: The Atlantic’s “The Perverse Consequences of Tuition-Free Medical School,” by Rose Horowitch.  

Victoria Knight: NPR’s “Why Catholic Bishops Are Donating Less To Oppose Abortion Rights Measures This Year,” by Rosemary Westwood and Jack Jenkins.

Also mentioned on this week’s podcast:

• The New York Times’ “Abortions Have Increased, Even for Women in States With Rigid Bans, Study Says,” by Claire Cain Miller and Margot Sanger-Katz.
• CNN’s “Infants Died at Higher Rates After Abortion Bans in the US, Research Shows,” by Deidre McPhillips.

click to open the transcript

Transcript: Less Than Two Weeks To Go

[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, Oct. 24, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this, so here we go. 

Today we are joined via video conference by Rachel Cohrs Zhang of Stat News. 

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Victoria Knight of Axios. 

Victoria Knight: Hello, everyone. 

Rovner: And Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, everybody. 

Rovner: Later in this episode we’ll have my interview with my friend and KFF colleague Tricia Neuman about Medicare open enrollment and what to expect in Medicare in the coming year. 

But first, this week’s news. We will start on the campaign trail since Election Day is now less than two weeks away. Let that sink in. Abortion is, at least according to many polls, on the upswing as a voting issue and, probably not coincidentally, abortion-adjacent issues, like contraception, are also getting more attention. But while it’s clear that Democrats are still pretty much the party of abortion rights and Republicans are pretty much the party representing anti-abortion activists, we’re seeing some Republican candidates working pretty hard to muddy the waters. Yes? 

Knight: Yeah, it’s been interesting this election cycle. We have seen some Republicans saying that they are pro-choice. And this is at a time when, finally, on the Democratic side in Congress, there really are not many anti-abortion Democrats left. We have in the House congressman Henry Cuellar [of Texas] is really the only one left. [Pennsylvania] Sen. Bob Casey, we’ve kind of seen him swing over time to be more in the camp of pro-choice, pro-abortion rights and so … 

Rovner: … which was really, in Casey’s case, really interesting, because his father, who was the governor of Pennsylvania, was sort of the original anti-abortion Democrat back in the early 1990s. 

Knight: Yeah. I’m interested to see if this works in — we’re seeing, particularly in some more moderate, swinging House seats, that Republicans are trying to message in this way that they’re more moderate on abortion, saying they’re more pro-choice. I’m interested to see if this actually works. And then we have perhaps this caucus within the House, if that works, that are more moderate. I mean, you already see in the current makeup of the House, there are some House Republicans, particularly the New York Republicans, that were really careful in this 118th Congress when they were having to vote on certain bills that would restrict, for example, access to mifepristone. That was kind of a rider in the FDA appropriations bill, and they didn’t want to vote for it, and they helped cause chaos on the House floor for that bill, particularly, because they didn’t want to pass it because they knew that would look bad on their record and they were having to run for the House again. So, will this messaging work for the kind of new people that are running this cycle? I’m not sure, but we’ll see. 

Rovner: I was kind of surprised to see Liz Cheney this week (who was out campaigning with Vice President [Kamala] Harris), who’s strongly anti-abortion, has been her entire career, actually pipe up on her own — and she’s not running for anything; she’s basically a person without a party at the moment — but say that even though she’s anti-abortion, she is not in favor of some of the things that are happening with some of these abortion bans, like women having miscarriages not being able to get immediate medical [care]. I was fascinated to see somebody who, with as strong anti-abortion credentials as she has, speak out about these things that one would assume even people who are anti-abortion would not be against. We do see the anti-abortion group saying making abortion illegal doesn’t make it illegal to treat ectopic pregnancies and miscarriage care, even though it gets all muddled when you’re actually on the ground doing it and you’re a doctor facing potential jail time. 

Knight: Well, and I think the thing is, people are seeing the realities of the abortion bans a couple of years in. I think that’s really the consequences. … When these first happened two years ago, people can say all these kind of things, but now that they’ve been in place for a couple years and women have died, we’re hearing these stories from news outlets of how that happens and it’s often women that want the babies. It’s like people are having to moderate their stances somewhat, I think. 

Rovner: It’s — there’s nuance. … Politics is not great with nuance, but we’re seeing nuance. 

Well, one abortion-adjacent story that jumped out at me this week is happening in Florida, where it seems that the office of Florida Gov. Ron DeSantis himself was behind legal threats to TV stations running ads in favor of the ballot measure that would enshrine abortion rights in the state’s constitution. According to the Tampa Bay Times, “Florida Department of Health general counsel John Wilson said he was given prewritten letters from one of DeSantis’ lawyers … Oct. 3 and told to send them under his own name, he wrote in a sworn affidavit.” Wilson subsequently resigned rather than send out more letters. In between, a judge warned the state to cease and desist with the threat, saying, and I quote, “It’s the First Amendment, stupid.” I have honestly never seen anything quite like this, although I would also point out I’ve never seen anything quite like Florida’s surgeon general recommending against people getting vaccines. What the heck is going on in Florida? 

Cohrs Zhang: I think we’ve seen state officials in Florida try to enact their will and challenge public health recommendations. Certainly, we saw that happen during the covid-19 pandemic. They were trying to put out their own guidelines on vaccination, and so I don’t think it’s a particular surprise. I think it is just uglier than usual now that we get the full backstory on how these letters came to be. And court cases take a long time, and I think that’ll extend to beyond the next couple of weeks. But it’s an interesting publicity stunt for what it is, and yeah I … 

Rovner: I wouldn’t want to be one of the TV stations threatening to have its license canceled, although the head of the FCC, I think, got involved too and said, “Um, this is not how this works.” 

Cohrs Zhang: Yeah, I think so. I don’t expect that the court would find that political ads you don’t like are illegal, so, yeah. 

Rovner: Yeah, I don’t think the governor can tell you to pull political ads that they don’t like. Pretty sure that’s not how these things work. 

Well, meanwhile, given the very real possibility that Donald Trump will return to the White House, the D.C. rumor mill is already spinning out names of those who could fill Cabinet and other senior health posts. What are you guys hearing? And is RFK Jr. really going to end up in some big health policymaking job? 

Knight: That’s funny that you say that because I was just having a talk with my editors about the names that we’re hearing. I have heard, and I am sure Rachel and Sarah have names on their mind as well, but someone said this to me, I think it’s funny: A very 2004 pick would be Bobby Jindal. He’s at the America First Policy Institute, which has a lot of former Trump administration people there, and it’s kind of seen this swing, I think recently, now that Project 2025 is kind of like no one wants to touch Project 2025 anymore. It seems like more people are, like, OK, AFPI is the place to pick people from if there’s a new Trump administration. And there’s been some stories this week about the chief of staff potentially coming from AFPI. So, people have been telling me Bobby Jindal, but I think he seems to have some solid grounding in that. You probably are more familiar with him, Julie, than I am, but … 

Rovner: Oh, yes. I’ve known him since 2004. I’ve known him since before 2004. He was actually … he was brought to Washington by Democratic Sen. John Breaux to staff a Medicare commission back in, I think it was the very late 1990s. He served in Congress, he was the governor of Louisiana, and he served in HHS [the Department of Health and Human Services] in the George W. Bush administration. So he’s got lots of experience, and he’s coincidentally all over Twitter this week with a paid ad, trashing Kamala Harris’ support for “Medicare for All,” which, of course, she hasn’t supported since 2019. But yeah, suddenly Bobby Jindal, who we hadn’t seen in a while, is kind of everywhere. He was one of the bright young lights about, what, eight years ago? 

Knight: Right, right. 

Rovner: But I guess before Trump, he was one of the bright young Republican lights. So yeah, I keep hearing his name too. 

Cohrs Zhang: I don’t know … 

Rovner: Go ahead, Rachel. 

Cohrs Zhang: I was just going to say that I don’t think there are a lot of people that we’ve been talking to who are worried about RFK himself getting appointed to one of these posts, but I think there has been a lot of buzz about some of his allies, like Calley and Casey Means. I know my colleague Isa Cueto did a great — just, profile of kind of who they are and kind of how their rise has just been so meteoric, and I think we’re also seeing some allies. So people who rose in the conservative movement over skepticism, over vaccine mandates, and just like the whole public health establishment have really gotten a new platform. And so I think people are a little nervous, as we’ve reported, both health care industry leaders who are worried about anti-pharmaceutical industry sentiment, anti-science sentiment, and even establishment Republican leaders and officials who served in prior Trump administrations that the picks could be more extreme than a Bobby Jindal establishment-Republican type and that this could be taking a turn. 

Rovner: Sarah, what are you hearing with FDA? 

Karlin-Smith: I mean, it’s a little less clear, I think, who might end up in FDA, but the sentiment has been probably a more typical Trump pick than maybe we got last time. FDA was sort of insulated in some ways, I think, from some of the drama, if you will, of the Trump administration last time. Scott Gottlieb was able to run FDA with pretty hands-off from other parts of the administration, and I think he ran FDA more like you would expect a traditional Republican to run FDA, not necessarily a Trump Republican. And I think people are recognizing that FDA will be a lot more vulnerable this time around that we’re probably not going to get another kind of Scott Gottlieb to save FDA if Trump is president. There’s certainly more concerns about how that impacts staff turnover as well, among civil service folks. 

Rovner: Yeah, we will see. 

All right, well, moving on. Open enrollment for Medicare began last week and continues until Dec. 7. That’s when people on Medicare can join or change their private prescription drug and/or Medicare Advantage plans. We explore this in more detail in my interview later in this episode with KFF’s Tricia Neuman. We know that most people with Medicare and most people with private insurance, where they can change plans during an open enrollment season, don’t actually bother to do anything. But this year there really are a lot of changes coming in Medicare, particularly on the prescription drug side. Why is it extra important this year that people take a look at their coverage? 

Karlin-Smith: So, some of the big changes with the IRA [Inflation Reduction Act] that kick in this year for Medicare and the prescription side, like the $2,000 out-of-pocket cap. Your plan actually has to cover that. One thing, I was at a conference this week and they’re saying that drug has to be, actually be on your plan for you to reap those savings of hitting that cap, which seems obvious, but … 

Rovner: Oh, I don’t know. I think people don’t quite realize that. It’s like they think that there’s a $2,000 cap no matter what, and it’s important. It’s, like, if your drug is not one of the drugs that’s covered by your plan, does not count. 

Karlin-Smith: Right, and so it’s looking for all of those things to make sure all the pieces of your plan actually fit together with your medical needs. There’s been, I think, a reduction, in some degree, into the amount of particularly Part D stand-alone plans for people who elect to use traditional Medicare for their other health benefits. So you may just want to look a little bit more closely at what the options are, what the premiums are, because some of these changes to Part D have impacted premiums a bit, though the federal government has stepped in to try to alleviate that. 

But I think this is seen as an adjustment year for the plans because one of the ideas behind the IRA is to put both health insurance companies as well as the pharmaceutical companies more on the hook, in some ways, for the cost of drugs. The old way Part D plans worked, the government ended up bearing a lot of the costs of the drugs to a point where it didn’t give a lot of incentives for both the drug companies to want to lower the prices, for the insurance companies to push for that. So I think it may take a little bit of time for them to figure out now how to adjust the benefits and the premiums and so forth, given this new dynamic. So people just may want to pay a little bit more close attention for premium aspects and others as well to the plans they’re picking. 

Rovner: And if you’re helping someone on Medicare, which I know many people are, it’s good to do a little extra homework this year. 

Well, another story that caught my eye is a survey of independent drugstores that suggests many of them won’t stock the very expensive drugs that Medicare negotiations are making less expensive, because they would actually lose money dispensing them. Sarah, is this an unexpected glitch, and can it be fixed, or is this just the price of bringing down drug prices? 

Karlin-Smith: I would say not entirely unexpected. These independent pharmacies have warned CMS [the Centers for Medicare & Medicaid Services] and tried to push in guidance so that when they’re dispensing a drug, basically, they will be entitled to get quicker rebates from the drug companies so that they can make stocking these drugs more reasonable for them. And these pharmacies, I think in particular, have been raising alarm bells outside of Medicare drug price negotiations for a while now, that they’re being placed in these difficult positions where they have to buy drugs at whatever the wholesale acquisition cost is. And then there’s all of this insurance back-end stuff going on, and they sometimes get reimbursed by the plans and so forth for less than they’ve actually bought the drugs. 

So it’s not just a Medicare drug price negotiation issue here. Some of it is, again, about the time that the pharmaceutical companies have to rebate the costs and they ask Medicare for a bit of leeway. And others, it’s just this broader way our system works, where they’re buying wholesale. You have a patient come to the counter that pays their small portion of it, their plan pays, whatever, and everybody has to sort of, right at the end … and these pharmacies are saying, “We can’t afford to do that.” I do think, politically, if this becomes a problem, if patients can’t get the negotiated prices/drugs at the pharmacies they’re used to, this could be politically problematic for the IRA moving forward. Even though, again, I’m not entirely sure. It’s illuminating a broader problem in the system that I think existed without it. 

Rovner: Right, it’s all a big mess, and it’s underlining it. 

Karlin-Smith: Right, but that doesn’t mean that politics won’t come into play and blame drug price negotiation. And certainly, anytime an opposing party hates something — we know Democrats are really into this, Republicans aren’t, and I’m sure they will try and blame it on the IRA as much as possible. And we’ll see if CMS maybe realizes that they had a little more leverage to try and make this a little bit easier and fixes it for the next round. 

Rovner: Yeah. Before we leave Medicare, I want to talk briefly about Medicare Advantage. This Medicare Advantage market is so valuable to insurers and so competitive that we now have at least two lawsuits charging that Medicare wrongly lowered the number of quality stars some plans received. Now, this feels like a restaurant suing Yelp for lowering its rating from four stars to three, but in Medicare Advantage, this is a really big deal, right, when they lose a star? 

Cohrs Zhang: Right, I think if the Yelp rating was worth $70 million, or whatever that figure is, then yeah, maybe they would sue. So I think we certainly — I think it’s a measure that is so important to insurers, to regulators, but that individual people might not understand. And there were some really interesting details from that lawsuit about the potential that there was one call-center call that tipped the balance into a quality measure and that there might’ve been some technical difficulties, and it does just cast these larger questions that I think I’ll be interested to see what documents come out during these lawsuits. And just questioning how useful these metrics really are, if that really was the case. 

Rovner: Yeah, I found it, I also was taken aback. It’s like, really, one call to a customer service center didn’t happen properly, and so the whole plan loses a star? That seemed a little bit dramatic, but yes, like you, I’ll be interested to see. There’s a lot of pressure on Medicare Advantage from every conceivable angle, but we are now in litigation over it. 

Well, while we are on the subject of private health companies suing the federal government, the compounding pharmacies who have been legally selling unapproved copies of the very popular and very expensive diabetes/obesity drugs Mounjaro and Zepbound have apparently successfully gotten the FDA to reverse its earlier finding, based on the pharmaceutical manufacturers’ say-so, that those drugs are no longer in shortage. That’s a decision that would’ve made it illegal for the compounders to continue to make and sell those drugs. At the same time, Novo Nordisk, maker of the very popular and very expensive diabetes/obesity drugs Ozempic and Wegovy, are trying to get the FDA to stop compounders from copying their drugs, which are still in shortage. Can somebody please explain what’s going on here? 

Karlin-Smith: So, basically, compounding is where pharmacists can sometimes make drugs in a more customized fashion because a person maybe can’t swallow a pill or needs a slightly different dose or a different inactive ingredient, but there’s not … 

Rovner: And they add flavoring for kids too, right? 

Karlin-Smith: Right. 

Rovner: Isn’t that a big compounding thing? 

Karlin-Smith: But it’s not supposed to be something that takes the place of mass-manufactured drugs. But one of the times when it kind of can — and FDA, after some big safety incidents in 2013, developed a sort of scheme where there can be some degree mass compounding, but there’s a little bit more safety oversight from their end. 

And one of the cases where you can do more compounding is when a drug is in shortage. But once FDA flipped the switch and said, “Oh, OK, actually, these drugs are no longer in shortage,” that makes it illegal. So these companies sued. My understanding from talking to legal experts is it’s not necessarily clear that FDA is entirely reversing course and agreeing that drugs aren’t in shortage. They’re agreeing to re-look at their decision, which may mean they are going to bolster their case so when they get back into court, they have a much clearer documentation of why the drugs are actually out of shortage. But in the meantime, we have probably at least another four weeks or so where everybody can compound these products. 

At the same time, I think Novo Nordisk and, actually, Eli Lilly before them had also submitted a similar citizen petition to FDA trying to basically get these drugs from being on lists where you really could not compound them at all. And there’s clearly a lot of money at stake here. These are probably some of the most well-known drugs right now with huge markets in the U.S., but they’re also really expensive and they haven’t been picked up and covered by a lot of insurance plans, particularly when you’re talking about the weight loss element. I think for Type 2 diabetes, there’s pretty good coverage. And the thing here that’s really so significant is this is probably one of the first times in the U.S. where we’ve seen this mass-market compounding for a drug kind of at the beginning-ish of its exclusivity, at least when you’re talking about weight loss — again, not diabetes. And it’s not like a niche thing. So many people are using it,  through compounding. And again, it’s really like … 

Rovner: The advertising is everywhere on social media. 

Karlin-Smith: Right, I mean, that just surprised me, I think, at first to begin with, how open these companies were about it being available via compounding pharmacies. And so I think FDA is in a really tricky position, particularly if they can clearly document it’s not a shortage situation anymore, because there still probably is going to be a lot of demand because of the cheaper prices coming from compounders, because of health insurance coverage issues. But, again, the compounding system is not meant to address those sorts of price and access issues. Right? It’s supposed to be for very particular situations where people really can’t use the exact manufactured drug, in most cases. And so maybe this tension will force us to address the other issues of price and insurance coverage, but it’s an awkward position for FDA to be in. 

And again, because, I think, it’s just also important just to go backtrack and remember, you know, FDA facilitates an important role of inspecting the manufacturing facilities, ensuring every lot is being manufactured to a consistent quality, approving the drug to begin with. So there’s certainly this delicate dance of you want people to be able to get drugs they need and you also don’t want this kerfuffle to undermine the entire drug-approval system we have that ensures that when you get a drug, a prescription drug, you know it’s a certain quality. 

Rovner: And it is what it says it is. 

Karlin-Smith: Right. 

Rovner: Yes. All right, well, turning back to abortion. A new study out this week suggests that not only has the number of abortions not gone down since the Supreme Court overturned Roe v. Wade, it actually might’ve gone up. Now there are lots of caveats with these numbers and, clearly, one big reason is the loosening of restrictions on obtaining abortion medication by mail. We also have a separate study this week that found infant mortality in states with abortion bans are rising, perhaps due to less available medical care in some of those states, as well as more fetuses with deadly anomalies being carried to term. But I have to wonder what these numbers will prompt from the anti-abortion side. Are they going to double down on efforts to impose some sort of nationwide restrictions or bans if Republicans regain control of the White House and Congress? And how are they going to address the rising infant mortality numbers? Victoria, are you hearing anything from the anti-abortion side? I’ve heard kind of not a lot. I’ve been surprised at how much I have not heard. 

Knight: Yeah, I mean I think this has been an interesting election for them because I think Trump has said different things throughout this election cycle on his stance on abortion and being — taking credit for appointing the Supreme Court justices who overturned Roe, but then at the same time being, like, it’s a states issue. And I’ve seen some reporting on that a lot of these groups are frustrated with Trump, but they kind of are sticking with him for the moment because they’re, like, this is the guy we have. 

So I think that perhaps they will put more pressure, depending on what the makeup of Congress is, and I think it’s important to remember it really depends on the majorities, this upcoming Congress, what will that look like? So if there is a Republican sweep, how many senators will be there? How many Republican senators? Also in the House, it may not be a huge majority either. And as we talked about earlier in this episode, there are some Republicans that are trying to walk the line more and be more moderate on abortion. And will they want to vote for a national abortion ban? That seems doubtful to me. And, for now, the filibuster is still in place in the Senate, so you still need 60 votes to pass anything. So, I think that they’re being quiet for now, but I think, depending on what Congress looks like, they could up their ante later. 

Cohrs Zhang: Again, I think Congress just has no appetite really to talk about these things, and I don’t expect that to change, especially, like you said, with narrow majorities. And I just think that the cost-benefit, maybe we’re going to see new leadership in the Senate Republican party too, and I think a lot of that could shape how much appetite they have to pick a fight on this. So yeah, just a lot of unknowns at this point. 

Rovner: And, as we’ve discussed before, if Trump is elected, he can do a lot from the executive branch that wouldn’t require Congress, and I completely agree with Rachel: I think Congress does not have a whole lot of appetite for this. 

Knight: Right. 

Rovner: Possibly on either side. 

Knight: And I think one more thing also interesting to point out is that the current House speaker, Mike Johnson, is very anti-abortion. Throughout his congressional career and even his career as a state lawmaker, he’s always been very anti-abortion, but he’s been in power now over a year, at least a year, and he has done, really, nothing on this. And he has a slim majority, but also I think you see that, yeah, as Rachel said, there’s just not an appetite for it, so … 

Rovner: He doesn’t have the votes. 

Knight: Yeah, exactly. He doesn’t have the votes, but he’s staunchly anti-abortion, has done really nothing, so. 

Rovner: Well, Sarah, you have a story on the revived lawsuit challenging the FDA over its rules for the abortion pill mifepristone. This is my chance to say I told you so, when the Supreme Court ruled that the original plaintiffs in this case did not have standing to sue. We said at the time: not over. Not over, right? 

Karlin-Smith: Yeah, three states are trying to revive that case in the court in Texas, where it originated. And it’s not particularly a surprise, like you said, the Supreme Court didn’t totally throw out the case. They said, “You guys don’t have standing,” that the doctors’ group that filed suit there. One of the interesting things now, given the timing, is as this case moves forward and if Trump wins the election, it’s not really clear to me whether his FDA and his Justice Department and so forth would actually want to defend this case or whether they would just, again, use the powers they have and push FDA to go back to the older restrictions around mifepristone’s availability. And basically make it … 

Rovner: We’re no longer talking about pulling it from the market right now? We’re just talking about the changes that were made in 2016 that makes it more easily available? 

Karlin-Smith: Right, so they sort of … 

Rovner: Is that a fair way to put it? 

Karlin-Smith: That’s like one change, which by the time we got to the Supreme Court, we were largely arguing about this as well, but they had initially started to just — by trying to get it off the market entirely. But now we’re basically arguing about changes that have made it easier to take later in pregnancy, so up to 10 weeks, and just made it easier to access. So you can now get it via telehealth and via mail and so forth, which has been really important given some of the state-specific bans on abortion. And it’s why abortion pills have become a really much more popular method for abortion. So a lot of legal experts don’t actually think these three states have standing either, or have jurisdiction, certainly in this court. However, I think they also acknowledge there’s a good chance this case proceeds and proceeds very similarly to how it did before, if for no other reason than the judges involved in the past have been willing to let these states be heard in their courtroom. 

Rovner: Yeah, it is in the 5th Circuit land of mostly Republican anti-abortion judges. 

Karlin-Smith: Right. So there’s a good chance, again, barring this sort of scenario where Trump administration comes in and just says, “We’re not going to defend this. We’re going to revert to the old restrictions anyway.” But under a Democratic administration, they could end up back all the way at the Supreme Court having to defend mifepristone’s newer availability as well. 

And the other thing that there’s been a number of mifepristone cases around the country, but there’s one that’s very similar in the 9th Circuit, where judges have basically ruled that the entire, what’s known as a REMS [risk evaluation and mitigation strategy], these restrictions related to mifepristone should actually be removed altogether. And they, actually, in some ways, want to make it more easily accessible. So whenever you have a circuits … but you also know that the Supreme Court is likely to take things up against. So yeah, I think the big thing is if people thought that last June’s Supreme Court ruling was kind of like Eh, it’s over, mifepristone is here to stay, that was just sort of the first round of many fights in access and availability of that in the courts. 

Rovner: Could a Trump administration just say, “The FDA should never have approved this drug,” and pull it from the market? Or does somebody have to file a petition for that to happen? 

Karlin-Smith: Ooh, that’s a good, tough question. I mean, there are very formal processes that go around withdrawing a drug. I think it would be challenging because at least the generic companies that manufacture the drug still want to be manufacturing it at this point. And I would imagine there would be quite a process FDA would have to go through, particularly to try and declare it no longer safe and effective to be marketed. And you, again, to raise strange history, I think if you looked at all the documents in science, because you have FDA scientists who over the years have declared it’s safe and effective and said, “Actually, as we’ve got more use with this, we realize you can actually give it to more women at different parts of pregnancy, and it’s safer than we thought. We don’t need to monitor a woman at a doctor’s office while she takes it.” So I think it would be challenging. I certainly wouldn’t put it past them trying this. 

But it does get to, I think, what’s been worrying about this mifepristone case to begin with for just people outside of the abortion space, but who follow FDA and the drug industry, which is this lack of certainty you start to lose when politicians come in and start trying to undermine the scientific drug-approval process and using politics instead, and their whims, to shift what is available or not available, because, obviously, it undermines FDA’s authority. 

And for the drug industry, I mean, a big thing they dislike is certainty, right? You’re investing millions, maybe even billions, of dollars to bring a drug to market. You want some confidence that if it’s successful and FDA says yes, it’s going to stay there unless some new, real, true safety event happens, which it does occasionally happen, but for the most part, you don’t want a new president to come into office or a new member of the Congress to flip and all of a sudden you have a drug that they’ve decided to challenge. So it’s an abortion case that’s always had these broader undertones of just confidence and trust and certainty around our scientific agencies in the U.S. 

Rovner: Yet another space we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with KFF’s Tricia Neuman, and then we’ll come back and do our extra credits. 

I am so pleased to welcome to the podcast Tricia Newman, who’s KFF’s senior vice president and executive director of KFF’s Program on Medicare Policy, and senior adviser to the president, and the person I always turn to first when I have a question about Medicare and have done so for more than three decades. Tricia, welcome back to “What the Health?” 

Tricia Neuman: Hi, Julie. Thanks for having me back. 

Rovner: So, as anybody who watches over-the-air or cable TV knows, it’s Medicare open enrollment right now until Dec. 7. What should people in Medicare or people helping people in Medicare know about changes coming for 2025? 

Neuman: This is the time for people to really compare coverage options. What we’ve seen in our own research is that most people don’t compare options during the open enrollment period, but plans change, people’s needs change, and this is a great moment. People have between now until Dec. 7, as you said. The important thing to do is figure out what is actually most important to either yourself or the person you’re helping. 

Some people really need certain drugs covered by their plan, and so that might be the go-to question. Other people care very much about being able to see certain doctors or hospitals. So, for them, it’s a question of do they want to be in traditional Medicare, where they can see virtually any doctor and go to any hospital? Or if they want to be in a Medicare Advantage plan for a variety of reasons, the question is, are the doctors that they care most about covered by their plan? 

Rovner: There are big changes coming next year both for prescription drugs and for Medicare Advantage, right? 

Neuman: Absolutely. I mean, Medicare Advantage plans also cover prescription drugs, and what the big thing people need to know there is there’s a new out-of-pocket limit that’s coming. There’s not really much you have to do in order to get; it’s a Medicare benefit. So that’s really a huge change and it really is a change that helps people who take very expensive medications. I mean, I can tell you how helpful it would be to some family members of mine. I have a family member who is taking a drug, she had a Part D plan, and it was costing her $13,000 a year for this particular drug for her cancer treatment. With the new $2,000 out-of-pocket cap, her costs would drop from $13,000 to $2,000. Keep in mind that half of all people on Medicare live on an income of $36,000 or less, so this is a big deal. And not everybody is going to need this benefit in any given year, but over time, you never know. And so it’s a big change that will be helpful to people who take expensive medications. 

Rovner: Over the spring and summer, it looked like, because of this $2,000 cap, Part D plans were going to raise their premiums dramatically. That mostly didn’t happen. Why not? 

Neuman: The administration, the government put in place what they call a demonstration or a model, and essentially what it did is it limited premium increases. So no Part D plan will have a premium increase greater than $35 between 2024 and 2025. 

Rovner: … of $35 a month. 

Neuman: … of $35-a-month increase. Now that said, some will increase by $35, some will decrease. There are going to be changes, and that’s an important thing for people to keep an eye on as they consider their drug coverage for next year. 

Rovner: There are Republicans in Congress who say that what the administration did was sort of unfairly politically tinkering with Medicare, but this isn’t the first time this kind of thing has been put into place, right? 

Neuman: That’s absolutely true. I mean, I would agree that there was some concern that people in Medicare would see big increases in their drug premiums, and that was part of the concern that motivated the administration. But that was also a concern that motivated prior administrations. In fact, right after the drug benefit went into effect, and that was under the Bush administration, there were similar demonstrations that took effect. And at the time, nobody really complained because the main issue was protecting people from higher premiums. 

Rovner: But now everything is more political. 

Well, regular listeners to the podcast know that Medicare Advantage has become not just more popular among beneficiaries, but also much more controversial. Some companies are even using artificial intelligence to deny benefits and micromanaging doctors and other health care providers. Has the cost-benefit analysis for Medicare Advantage shifted over the past few years? 

Neuman: I think the focus on Medicare Advantage has changed. The way people are thinking about it is changing. Medicare Advantage is quite popular among people because plans, for a variety of reasons related to their payments, are able to offer extra benefits, and they are appealing. I mean, dental, vision, hearing. Now, the latest thing is “flex cards,” which is just kind of offering money for people to sign up for a plan. So it’s really appealing, particularly for people with fixed incomes. But the medical community has sort of surfaced and started raising concerns about what these prior authorizations and other cost-management tools mean for them and for their patients. 

So hospitals, for example, have expressed concerns about delayed payments. Doctors are now talking about prior authorization hassles. We recently did a study that documented 46 million prior-authorization requests, close to 2 million requests per enrollee. That’s a hassle for doctors. It also can delay or lead to no care for beneficiaries when it’s been prescribed by their doctor. It could, of course, limit inappropriate care, not necessary care, but I think the medical community now sees that Medicare Advantage is a big part of their patient profile and has some concerns. 

We’ve also been reading stories about some medical groups that are saying that we’re not going to take any more Medicare Advantage patients. So I think there’s a little bit more of an eye toward, gee, this has gotten really big. We know it’s really popular, but it might require a closer look. 

Rovner: Speaking of which, I mean, Medicare hasn’t really been a big campaign issue in 2024 when maybe it should have been. It doesn’t seem that safe to leave a program of its size and importance on autopilot, which is kind of what former President Trump is promising. What do we know about what Vice President Harris would do for Medicare if she were elected and what former President Trump would do if he was elected? 

Neuman: We actually know very little about what former President Trump would do. 

Rovner: He says he wouldn’t touch it. 

Neuman: He said he wouldn’t touch it. He said he’s concerned about drug costs, but we’re not really sure what more he would do there. He was for a proposal called Most Favored Nation, but he’s now withdrawn support for that. So it’s hard to know whether he would implement anything new or scale back what has already become the law of the land. For example, it’s not clear what he would do about government negotiations and whether or not there would be sufficient pressure in his caucus to scale back that pretty popular proposal that was included in the Inflation Reduction Act. 

Vice President Harris has talked about strengthening Medicare and improving the solvency, mostly through revenues on higher-income people. So that is one major proposal she has with regard to solvency. She has recently put out a proposal that would add a home care benefit to Medicare. This responds to a huge issue that you and I have talked about, that a lot of families across the country have talked about where people are really struggling to care for a family member. Family members are dropping out of the workforce in order to care for somebody because they cannot afford to get help at home. Medicare really does not currently provide a home care benefit except under limited circumstances. So this is recognizing a huge issue for families that are, it’s an economic issue if people, mostly women, have to step out of the workforce. It’s also an issue if you just cannot afford or you’re paying huge amounts for people to come into your home to help a parent, grandparent, spouse who’s unable to care for themselves. So that’s a big initiative on her part that would be funded primarily out of expanding Medicare’s ability to negotiate drugs. 

Rovner: So neither candidate is talking about solvency issues with Medicare, though, and that’s a long-term issue that somebody’s going to need to address, right? 

Neuman: Yes, that is absolutely true. It is an issue that is not going away. We have more and more people aging onto Medicare and the people who are on Medicare are getting older. And as people grow older, they tend to be more expensive. So this is not an imminent concern, but it is an issue that policymakers will have to deal with one way or the other in the years to come. 

Rovner: Well, we will keep talking about it. Tricia Neuman, thank you so much. 

Neuman: And thank you for having me, Julie. 

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

Knight: Sure. My extra credit is a story on NPR, it’s called “Why Catholic Bishops Are Donating Less To Oppose Abortion Rights Measures This Year.” It was on Weekend Edition, and it is by Rosemary Westwood and Jack Jenkins, basically detailing that in the past, the Catholic Church and bishops have been really big in the anti-abortion movement and that has also translated to donating a lot of money to anti-abortion campaigns. But this year, they’re kind of seeing almost a historic low in how little they’re donating to anti-abortion campaigns. And they didn’t really have a clear answer of what the reason for that was, except that maybe they’re just acknowledging the reality of the situation. When you look at particularly the ballot measures in states and how popular those have been — we’ve seen since 2022 that the ballot measures, even in more conservative-leaning states, that protect abortion access, and those vary depending on the state, what they look like, they’ve been really, really popular. And they really have been really overwhelmingly approved, even if there’s Republicans running on the same ballot with them and that people are voting for. People still really support abortion rights mostly. 

So that seems to be the reason — they didn’t really have a clear reason, but it was an interesting marker in the trend of just kind of following where abortion rights are going, as well as where the Catholic Church is moving as well. It seems to be becoming somewhat more progressive over time. 

Rovner: I was fascinated by this story, which I just heard on the radio as I was driving, because the Catholic Church is the originator of the right-to-life movement in the United States. And for a long time, it was almost exclusively the Catholic Church that was pushing this, and now it seems to have moved sort of into other places. So this is sort of the exclamation point on that, that it’s broadened and changed, but it’s no longer being driven as much by the Catholic Church as it used to be. Rachel, why don’t you go next? 

Cohrs Zhang: Sure. So my piece is in The Atlantic, and the headline is “The Perverse Consequences of Tuition-Free Medical School,” by Rose Horowitch. And I just love this story because it’s a look back on this policy that seemed like a good idea at the time, where these really wealthy benefactors are donating to elite, often elite medical schools to make tuition free. And the whole idea was that more doctors will go into primary care if they don’t have debt, and it might open medical school to a more diverse cohort of students. And the opposite has almost happened, where they’re not seeing any more doctors going into primary care and their student body has actually gotten more wealthy than it was before. So I mean, it’s just a great check-in, because I feel like so often we’re just looking forward with the news that we don’t take a moment to question whether some of these policies or stories that we’ve covered, how they’ve worked out a couple of years later. So, I thought it was a great look back. 

Rovner: Yes, in health care, so many things go in, we try things with so much promise, and sometimes they don’t work. So it’s good to notice when they don’t work. Sarah? 

Karlin-Smith: I took a look at a Vanity Fair piece by Katherine Eban: “Inside the Bungled Bird Flu Response, Where Profits Collide With Public Health.” And it’s a fascinating deep dive to the challenges the U.S. has faced in containing what is, right now at least, mostly just an epidemic in animals, but certainly has public health folks worried about the potential for a human spillover pandemic, if not properly contained. And it’s just a really great story that shows you all of the tensions, and how it has a lot of these flashbacks to early days of covid, where you had different parts of the government with different responsibilities, not quite working together well, and not quite knowing how to play together well. Because you have the USDA in this case, which in many ways has the economics of farmers and the dairy industry in mind more than perhaps broader health concerns. You have FDA, which regulates milk; CDC, which comes in and does the human health; and then you have states, which don’t necessarily always have to answer to everything the federal government would like them to be doing here. 

And the biggest, I think, crisis we face now is just we don’t have a lot of data. We don’t have enough information to truly know the scope of this outbreak. And without knowing that, I think you risk something bad happening before we are on top of it. And that’s really what people are really concerned about now, particularly with seasonal flu season coming up, is if you mix this virus and a human being with seasonal flu or even in an animal, you could develop an even more dangerous virus. So, it’s a warning to everybody in the public health space that this is something we need to be paying attention to because, obviously, the best thing to do is contain it and tamp it out and not have to deal with a much larger human pandemic. 

Rovner: Yes, that would be nice. Something else to keep us awake at night. 

My story this week is from NBC News, it’s called “Crisis Pregnancy Center’s Forms Give Rare Insight Into Anti-Abortion Practices,” by Abigail Brooks. She got a hold of the intake forms of a pregnancy center in Idaho, which included not just the typical medical questions, but also questions about religious and financial status. And one asking, “What decision would the father like you to make, regarding the outcome of your pregnancy?” The answers, which are not protected by HIPAA, because crisis pregnancy centers are not technically medical providers, allow the staff to score whether a patient is “abortion-vulnerable,” which would lead them to try to talk her out of ending the pregnancy. 

It also includes a story of one patient who was strung along so long waiting for test results from this crisis pregnancy center that she ended up needing a second-trimester abortion. It’s quite the look at what goes on behind the scenes at some of these centers, and I strongly recommend it. 

OK, that’s all the time we have today. 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. Special thanks, as always, to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, I’m @jrovner. Sarah, where are you hanging these days? 

Karlin-Smith: A little bit on X, a little bit on Bluesky, at @SarahKarlin or @sarahkarlin-smith. 

Rovner: Rachel? 

Cohrs Zhang: I’m on X @rachelcohrs and also spending some time on LinkedIn, so feel free to follow me there. 

Rovner: Great. Victoria? 

Knight: I am @victoriaregisk still on X. I am trying to post more on LinkedIn, too. 

Rovner: OK, well, we will be back in your feed next week. Until then, be healthy. 

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