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The Host

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

The Trump administration this week missed a deadline to nominate a new director for the Centers for Disease Control and Prevention. Without a nominee, current acting Director Jay Bhattacharya — who is also the director of the National Institutes of Health — has to give up that title, leaving no one at the helm of the nation’s primary public health agency.Ìý

Meanwhile, a week after one federal judge blocked changes to the childhood vaccine schedule made by the Department of Health and Human Services, another blocked a proposed ban on gender-affirming care for minors.Ìý

This week’s panelists are Julie Rovner of ºÚÁϳԹÏÍø News, Rachel Cohrs Zhang of Bloomberg News, Lizzy Lawrence of Stat, and Shefali Luthra of The 19th.

Panelists

Rachel Cohrs Zhang Bloomberg News Lizzy Lawrence Stat Shefali Luthra The 19th

Among the takeaways from this week’s episode:

• A federal judge ruled against the Trump administration’s declaration intended to limit trans care for minors, though the ruling’s practical effects will depend on whether hospitals resume such care. And a key member of the remade federal vaccine advisory panel resigned as the panel’s activities — and even membership — remain in legal limbo.
• Two senior administration health posts remain unfilled, after President Donald Trump missed a deadline to fill the top job at the Centers for Disease Control and Prevention — and the Senate made little progress on confirming his nominee for surgeon general.
• The percentage of international graduates from foreign medical schools who match into U.S. residency positions has dropped to a five-year low. That’s notable given immigrants represent a quarter of physicians, many of them in critical but lower-paid specialties such as primary care — particularly in rural areas. Meanwhile, new surveys show that more than a quarter of labs funded by the National Institutes of Health have laid off workers and that federal research funding cuts have had a disproportionate effect on women and early-career scientists.
• And new data shows the number of abortions in the United States stayed relatively stable last year, for the second straight year — largely due to telehealth access to abortion care. And a vocal opponent of abortion in the Senate, with his eyes on a presidential run, introduced legislation to effectively rescind federal approval for the abortion pill mifepristone.

Also this week, Rovner interviews Georgetown Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.

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 “,” by John Wilkerson.Ìý

Shefali Luthra: NPR’s “,” by Tara Haelle.Ìý

Lizzy Lawrence: The Atlantic’s “,” by Nicholas Florko.Ìý

Rachel Cohrs Zhang: The Boston Globe’s “,” by Tal Kopan.Ìý

Also mentioned in this week’s podcast:

• Stat’s “,’” by Jonathan Wosen.
• ºÚÁϳԹÏÍø News’ “Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare,” by Sam Whitehead.
• Guttmacher’s “,” by Isaac Maddow-Zimet and Kimya Forouzan.
• United for Medical Research’s “.”

click to open the transcript Transcript: A Headless CDC

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

Julie Rovner:ÌýHello,Ìýfrom ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C. Welcome toÌýWhat the Health?ÌýI’mÌýJulie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, andÌýI’mÌýjoined by some of the best and smartest reportersÌýcoveringÌýWashington.ÌýWe’reÌýtaping this week on Thursday,ÌýMarch 26,Ìýat 10Ìýa.m.ÌýAs always, news happens fast, and things might have changed by the time you hear this. So,Ìýhere we go.Ìý

Today,Ìýwe are joined via video conference by RachelÌýCohrs ZhangÌýof Bloomberg News.Ìý

Rachel Cohrs Zhang:ÌýHi,Ìýeverybody.Ìý

Rovner:ÌýShefali LuthraÌýofÌýTheÌý19th.Ìý

Shefali Luthra:ÌýHello.Ìý

Rovner:ÌýAnd Lizzy Lawrence of Stat News.Ìý

Lizzy Lawrence:ÌýHello.Ìý

Rovner:ÌýLater in this episodeÌýwe’llÌýhave my interview with Katie Keith of Georgetown University about the state of the Affordable Care Act as it turns 16Ìý—Ìýold enough to drive in most states. But first,Ìýthis week’s news.Ìý

So,Ìýit has been another busy week at the Department of Health and Human Services. Last week, a federal judge in Massachusetts blocked the department’s vaccine policy,Ìýruling it had violated federal administrative proceduresÌýregardingÌýadvisory committees. This week, a federal judge in Portland, Oregon,Ìýruled the department alsoÌýdidn’tÌýfollow the required process to block federal reimbursement for transgender-related medical treatment. The case was brought by 21ÌýDemocratic-led states. Where does this leave the hot-button issue of care for transgender teens? Shefali,Ìýyou’veÌýbeen following this.Ìý

Luthra:ÌýI mean, I think it’s still really up in the air.ÌýA lot of this depends on how hospitals now respondÌý—Ìýwhether they feel confident in the court’s decision,Ìýhaving stayingÌýpower enough to actually resume offering services.ÌýBecause a lot of them stopped.ÌýAnd so that’s something we’re still waiting to actually see how this plays out in practice.ÌýObviously,Ìýit’sÌývery symbolic, very legally meaningful, but whether this will translate into changes in practical health care access, I think, isÌýan open question still.Ìý

Rovner:ÌýYeah, we willÌýdefinitely haveÌýto see howÌýthis one playsÌýoutÌý— and,Ìýobviously,Ìýif and whenÌýthe administrationÌýappealsÌýit. Well, speaking of that vaccine ruling from last weekÌý—Ìýwhich,Ìýapparently,ÌýtheÌýadministration has not yet appealed, but is going toÌý—Ìýone of the most contentious members of that very contentious Advisory Committee on Immunization Practices has resigned. Dr.ÌýRobert Malone, a physician andÌýbiochemist, said heÌýdidn’tÌýwant to be part of theÌý“drama,”Ìýair quotes.ÌýBut he caused a lot ofÌýthe drama, didn’t he?Ìý

Cohrs Zhang:ÌýHe has beenÌýpretty outspoken, andÌýI think heÌýisn’tÌýlike a Washington person necessarilyÌý—Ìýisn’tÌýsomebodyÌýwho’sÌýused to,Ìýlike,Ìýbeing on a public stage and having your social media posts appear in large publications.ÌýSoÌýI thinkÌýit’sÌýquestionable, like, whether he had a position to resign from.ÌýI think his nominationÌýwas stayed,Ìýtoo.ÌýBut I think it isÌý…Ìýthe back-and-forth,ÌýI think,Ìýthere is a good point that this limbo can be frustrating for people when meetingsÌýare canceledÌýatÌýthe last minute, and people have travel plans,Ìýand it doesÌý…Ìýjust changes the calculus for kind of making it worth it to serve on one of these advisory committees.Ìý

Rovner:ÌýAnd I’m not sure whether we mentioned it last week, but the judge’s ruling not only said that the people were incorrectly appointed to ACIP, but it also stayed any meetings of the advisory committee until there is further court action, until basically, the case is done or it’s overruled by a higher court. SoÌý…Ìývaccine policyÌýdefinitely isÌýin limbo.ÌýÌý

Well, meanwhile, yesterday was the deadline for the administration to nominate someone to head the Centers for Disease Control and Prevention since SusanÌýMonarezÌýwas abruptly dismissed, letÌýgo, resigned, whatever, late last summer. Now that that deadline has passed, it means that actingÌýDirector Jay Bhattacharya, who had added that title to his day job as head of the National Institutes of Health,Ìýcan no longerÌýremainÌýactingÌýdirector of CDC.ÌýApparently, thoughÌýhe’sÌýgoing toÌýsort of remainÌýin charge, according to HHS spokespeople, with some authorities reverting toÌý[Health and Human Services]ÌýSecretaryÌý[Robert F.]ÌýKennedyÌý[Jr.].ÌýWhat’sÌýtaking so long to find a CDC director?ÌýÌý

To quote D.C.Ìýcardiologist and frequent cable TV health policy commentatorÌý,Ìý“The problem here is thatÌýthere’sÌýno candidateÌýwho’sÌýqualified, MAHA acceptable, and Senate confirmable. Those job requirements are mutually exclusive.”ÌýThat feels kind of accurate to me.ÌýIs that actuallyÌýtheÌýproblem?ÌýRachel, I see you smiling.Ìý

Cohrs Zhang:ÌýYeah.ÌýI think it is tough to find somebody who checks all of those boxes.ÌýAnd though it has beenÌý210 daysÌýsince the clockÌýhas started, I would just point out that there has been a significant leadership shake-up at HHS, like among the people who are kind of running this search, and they came in, you know, not that long ago.ÌýIt’sÌýonly been, you know,ÌýaÌýmonth and a half or so.ÌýSoÌýI think there certainly have been someÌýnew facesÌýin the room who might have different opinions.ÌýButÌýI think itÌýisn’tÌýa good look for them to miss this deadline when they have this much notice. But I thinkÌýthere’sÌýalso, like,Ìýlegal experts thatÌýI’veÌýspoken withÌýdon’tÌýthink thatÌýthere’sÌýgoing to be a hugeÌýday-to-dayÌýimpact on the operations of the CDC. ItÌýkind of remindsÌýme of that office where there’s,Ìýlike,ÌýanÌý“assistantÌýtoÌýtheÌýregionalÌýmanager vibe”Ìýgoing on, where, like,ÌýDr.ÌýBhattacharya is now acting in the capacity of CDC director, even though heÌýisn’tÌýactingÌýCDC directorÌýanymore. So,ÌýI think IÌýdon’tÌýknow thatÌýit’llÌýhave a hugeÌýday-to-dayÌýimpact, but it isÌýkind of hangingÌýover HHS at this point, as they are already struggling with theÌýsurgeonÌýgeneral nomination,Ìýto get that through the Senate.ÌýSoÌýit just creates this backlog of nominations.Ìý

Rovner:ÌýI’veÌýassumedÌýthey’veÌýfloated some names, let us say, one of which is Ernie Fletcher, the former governor of Kentucky, also a former member of the House Energy and Commerce health subcommittee, withÌýsome certainly medical chops, if not public health chops.ÌýI thinkÌýtheÌýhead of the health department in Mississippi. There was one other whoÌýI’veÌýforgotten, who it is among the names that have been floatedÌý…Ìý

Cohrs Zhang:ÌýJoseph Marine.ÌýHe’sÌýa cardiologist at Johns Hopkins, who hasÌý—Ìýis kind of like in the kind of Vinay Prasad world of critics of the FDA and,Ìýlike,ÌýCDC’s covidÌýbooster strategy.Ìý

Rovner:ÌýAnd yet, apparently, none of them could pass, I guess, all three tests. Do we think it might still be one of them? Or do we think there are other names that are yetÌýto come?Ìý

Cohrs Zhang:ÌýOur understanding is that there are other candidates whose names have not become public, and I think there’s also a possibility they don’t choose any of these candidates and just drag it on for a while because,Ìýat this point, like, I don’t know what the rush is,Ìýnow that the deadline is passed.Ìý

Lawrence:ÌýYeah, is there another deadline to miss?Ìý

Cohrs Zhang:ÌýIÌýdon’tÌýthink so.Ìý

Lawrence:ÌýI think thisÌýwas the only one.Ìý

Cohrs Zhang:ÌýThis was the big one that they now have.ÌýIt’sÌývacant, but it was vacant before as well. Like, I think, earlier in theÌýadministration, whenÌýSusanÌýMonarezÌýwas nominated.Ìý

Rovner:ÌýBut she, wellÌý…Ìýthat’sÌýright, she was theÌý“acting,”Ìýand then once she was nominated, sheÌýcouldn’tÌýbe the acting anymore.Ìý

Cohrs Zhang:ÌýYeah.Ìý

Rovner:ÌýSoÌýI guessÌýitÌýwas vacant while she was being considered.Ìý

Cohrs Zhang:ÌýIt was.ÌýSoÌýit’sÌýnot an unprecedented situation, even in this administration.ÌýIt’sÌýjust not a goodÌýlook, I guess. And I think there is value in having a leader that can interface with the White House and with different leaders, and just having a direction for the agency, especially because it’s in Atlanta, it’s a little bit more removed from the everyday goings-on at HHS in general.ÌýSoÌýI think there’s definitely a desire for some stability over there.Ìý

Rovner:ÌýAnd we have measles spreading in lots more states.ÌýI mean, every time IÌý…Ìýopen up my news feeds, it’s like, oh, now we have measles, you know, in Utah, I think,Ìýin Montana.ÌýWashtenaw County, Michigan,Ìýhad its first measles case recently.ÌýSoÌýthis is something that the CDC should be on top of, and yet there is no one on top of the CDC. Well, Rachel, you already alluded to this, but it is also apparently hard to find a surgeon general who’s both acceptable to MAHAÌýand Senate confirmable, which is my way of saying that the CaseyÌýMeans nomination still appears to lack the votes to move out of the Senate, Health, Education, LaborÌý&ÌýPensions Committee. Do we have any latestÌýupdateÌýon that?Ìý

Cohrs Zhang:ÌýI think the latest update, I mean, my colleagues at Bloomberg Government justÌýkind of hadÌýan update this week thatÌýthey’reÌýstill not toÌý“yes” —Ìýlike,Ìýthere are some key senators that stillÌýhaven’tÌýannounced their positions publicly.ÌýSoÌýI think a lot of the same things thatÌýwe’veÌýbeen hearingÌý…ÌýlikeÌýSens.ÌýSusan Collins andÌýLisa Murkowski and Bill Cassidy obviously have notÌýstatedÌýtheir positions publicly on the nomination.ÌýSen.ÌýThom Tillis, who youÌýknowÌýis kind of in a lame-duck scenario and doesn’t really have anything to lose, has, you know, said he’s not really made a decision.ÌýSoÌýI think they’re kind of in this weird limbo where they, like, don’t have the votes to advance her, but they also have not made a decision to pull the nomination at this time. So either, I think,Ìýthey have to push harder on some of these senators, and I think senators see this as a leverage point that I don’t know that a lot ofÌý—Ìýthat all of the complaints are about Dr.ÌýMeans specifically, but anytime that there is frustration with the wider department, then this is an opportunity for senators to have their voice heard, toÌý…Ìýpotentially extract some concessions. AndÌýsoÌýthere’sÌýa question right now, are they going to change course again for this position, or are they going to, you know, sit down at the bargainingÌýtableÌýand really cut some deals to advance her nomination? I justÌýdon’tÌýthink we know the answer to that yet.Ìý

Rovner:ÌýYeah,Ìýit’sÌýworth reminding that,Ìýfrequently,Ìýnominations get held up for reasons that are totally disconnected from the person involved. We wentÌý—ÌýI should go back and look this upÌý— we went, like, four years in two different administrations without a confirmed head of the Centers for MedicareÌý&ÌýMedicaidÌýServices because members of Congress were angry about other things, not because of any of the people who had actually been nominated to fill that position. But in this case, it does seem to be, I think,Ìýboth CaseyÌýMeans and,Ìýyou know, her connection toÌýMAHA,Ìýand the fact that among those who haven’t declared their positions yet,Ìýit’s the chairman of the committee, Bill Cassidy, who’s in this very tight primary to keep his seat.ÌýSoÌýwe will keepÌýon that one.ÌýÌý

Also, meanwhile, HHS continues to push itsÌýMake AmericaÌýHealthyÌýAgain priority. Secretary Kennedy hinted on the Joe Rogan podcast last month that the FDA will soon take unspecified action to make customized peptides easier to obtain from compounding pharmacies. TheseÌýmini-proteinsÌýare part of a biohacking trend that many MAHAÌýadherents say canÌýbenefitÌýhealth,Ìýdespite their not having been shown to be safe and effective in the normal FDA approval process. The FDAÌýhasÌýalsoÌýformallyÌýpulledÌýa proposed rule that would have banned teens from using tanning beds. We know that theÌýsecretary is a fan of tanning salons, even though thatÌýhasÌýbeen shown to cause potential health problems,Ìýlike skin cancer. Lizzy,Ìýis Kennedy just going to push as much MAHAÌýas he can until the courts or the White House stops him?Ìý

Lawrence:ÌýI guess so. I mean, we do have this new structure at HHSÌýnow that’s trying toÌý—ÌýclearlyÌý…Ìýthere are warring factions with the MAHA agenda and the White House really trying to focus more on affordability and less onÌý…Ìývaccine scrutiny and the medical freedom movement that is really popular among Kennedy’s supporters.Ìý…ÌýI’mÌývery curious aboutÌýwhat’sÌýgoing to happen with peptides, becauseÌýit’sÌýa sign of Kennedy’s regulatory philosophy, whereÌýthere’sÌýsome products that are good and some that are bad.ÌýIt’sÌývery atypical, of course, forÌý…Ìý

Rovner:ÌýAnd that he getsÌýto decideÌýrather than the scientists, because heÌýdoesn’tÌýtrust the scientists.Ìý

Lawrence:ÌýRight. Right.ÌýBut there has been, I mean, the FDA has kind of been pretty severe on GLP-1ÌýcompoundersÌýHimsÌý&ÌýHers, so it’ll be interesting to see, you know, how much Kennedy is able to exert his will here, and how much FDA regulators will be able to push back and make their voices heard.Ìý

Rovner:ÌýMy favorite piece of FDAÌýtriviaÌýthis week is that FDA is posting the jobs that are about to be vacant at the vaccine center, and one of the things that it actually says in the job description is that you don’t have to be immunized. IÌýdon’tÌýknow ifÌýthat’sÌýa signal or what.Ìý

Lawrence:ÌýYeah,ÌýI think itÌýsaid no telework, which Vinay Prasad famously was teleworking from San Francisco. So,Ìýyeah, IÌýdon’tÌýknow.ÌýButÌýthisÌýwas,ÌýI think itÌýwas for his deputy, althoughÌýI’mÌýsure, I mean, they do need a CBERÌý[Center for Biologics Evaluation and Research]Ìýdirector as well.Ìý

Rovner:ÌýYeah,Ìýthere’sÌýa lot of openings right now at HHS.ÌýAll right,Ìýwe’reÌýgonnaÌýtake a quick break. We will be right back.Ìý

SoÌýMonday was the 16th anniversary of the signing of the Affordable Care Act, which we will hear more about in my interview with Katie Keith.ÌýBut I wanted to highlight aÌýstory by myÌýKFFÌýHealthÌýNews colleague Sam WhiteheadÌýabout older Americans nearing Medicare eligibility putting off preventive and other care until they qualify for federal coverage that will let them afford it. For those who listened to my interview last week with Drew Altman, this hearkens back to one of the big problems with our health system. There are so many quote-unquoteÌý“savings”Ìýthat areÌýactually justÌýcost-shifting, and often that cost-shifting raises costs overall. In this case, because those older people can no longer afford their insurance or their deductibles,Ìýthey put off care until it becomes more expensive to treat. At that point,ÌýbecauseÌýthey’reÌýon Medicare, theÌýfederal taxpayer will foot a billÌýthat’sÌýeven bigger than the bill that would have been paid by the insurance company.ÌýSoÌýthe savings taxpayers gained by Congress cutting back the Affordable Care Act subsidies are lost on the Medicare end. Is this cost-shifting the inevitable outcome of addressing everything in our health care system except the actual prices of medical care?Ìý

Cohrs Zhang:ÌýI thinkÌýit’sÌýjust another example of how people’s behavior responds to these weird incentives. And I thinkÌýwe’reÌýseeing this problem, certainly among early retirees,ÌýexacerbatedÌýby theÌýexpirationÌýof the Affordable Care Act subsidies thatÌýwe’veÌýtalked about very often on this podcast, because it affects these higher earners, and it can dramatically increase costs for coverage. AndÌýI think peopleÌýjust hope that they can hold on. But again, theseÌýstatutory deadlines that lawmakers make up sometimes,Ìýnot with a lot of forethought or rationalÌýreasoning,Ìýthey have consequences.ÌýAnd obviously, the Medicare program continues to pay beyond age 65 as well.ÌýAnd I thinkÌýit’sÌýjust another symptom of what the administration talks about when they talk about emphasizing, you know, preventative care and addressing chronic conditionsÌý—Ìýlike,Ìýthat is a real problem. And,Ìýyeah, I thinkÌýwe’reÌýgoing to see these problems in this population continue to get worse as more people forgo care, as it becomes more expensive on the individual markets.Ìý

Luthra:ÌýI think youÌýalso make a good point, though, Julie, because the increase in costs and cost sharing is not limited to people with marketplace plans, right? Also, people with employer-sponsored health care are seeing their out-of-pocket costsÌýgo up. Employers are seeing what they pay for insuranceÌýgoÌýup as well. And there absolutely is something to be said aboutÌýit’sÌýbeen 16 years since the Affordable Care ActÌýpassed,ÌýweÌýhaven’tÌýreally had meaningful intervention on the key source of health care prices, right? Hospitals, providers, physicians. And it does seem, just thinking about where the public is and the politics are, that there is possiblyÌýappetiteÌýaround this. You see a lot of talk about affordability, but a lot ofÌýthis feels, at least as an observer,Ìývery focusedÌýon insurance, which makes sense. Insurance isÌýa very easyÌývillain to cast.ÌýBut I think you’ve raised aÌýreally good point:Ìýthat addressing these really potent burdens on individuals and eventually on the public just requires somethingÌýmore systemic and more serious if we actually want to yield better outcomes.Ìý

Rovner:ÌýYeah, there’s just, there’s so much passing the hat that, you know,ÌýI don’t want to do this,ÌýsoÌýyouÌýhave to do this.ÌýYou know, inevitably, people need health care.ÌýSomebody has to pay for it.ÌýAnd I think that’sÌýsort of theÌýbottom line that nobody really seems to want to address.Ìý

Well, the other theme of 2026 that I feel like I keep repeating is what funding cutbacks and other changes are doing to the future of the nation’s biomedical and medical workforces. Last week was Match Day.ÌýThat’sÌýwhen graduating medical school seniors find out if and where they will do their residency training. One big headline from this year’s match is that the percentage of non-U.S.Ìýcitizen graduates of foreign medical schools matching to a U.S.Ìýresidency position fell to a five-year low of 56.4%.ÌýThat compares to a 93.5% matching rate for U.S.Ìýcitizen graduates of U.S.Ìýmedical schools. Why does that matter? Well, a quarter of the U.S.Ìýphysician workforce are immigrants, and they are disproportionately represented, both in lower-paid primary care specialties, particularly in rural areas, both of whichÌýU.S.Ìýdoctors tend to find less desirable. This would seem to be the result of a combination of new fees for visas for foreign professionals thatÌýwe’veÌýtalked about, a general reduction in visa approvals,Ìýand some peopleÌýlikely notÌýwanting to even come to the U.S.Ìýto practice. But that rural health fund that Republicans say will revitalize rural health careÌýdoesn’tÌýseem likeÌýit’sÌýreally going to work without an adequate number of doctors and nurses, I would humbly suggest.Ìý

Lawrence:ÌýYeah, absolutely. I mean,Ìýit’sÌýpatients that suffer, right? I mean, you need the people doing the work. AndÌýsoÌýI think that the impacts will start being felt sooner rather than later. That is something that hopefully people will start to feel the pain from.Ìý

Rovner:ÌýI feel like when people think about the immigrant workforce, they think about lower-skilled, lower-paid jobs that immigrants do, and they don’t think about the fact that some of the most highly skilled, highly paid jobs that we have, like being doctors, are actually filled by immigrants, and that if we cut that back, we’re just going to exacerbate shortages that we already know we have.Ìý

Luthra:ÌýAnd training doctors takes, famously,Ìýa very longÌýtime. AndÌýsoÌýif you are disincentivizing people from coming here to practice, cutting off this key source of supply,Ìýit’sÌýnot as if you canÌýimmediatelyÌýgo out and say,ÌýHere,Ìýlet’sÌýfind some new people and make them doctors. It will take years to make that tenable, make that attractive,Ìýand make that a reality. And it just seems,Ìýto Lizzy’s point,Ìýthat even in the scenario where that was possibleÌý—Ìýwhich I would be somewhat doubtful;Ìýmedicine is a hard and difficult career;Ìýit’s not like you can make someone want to do that overnightÌý—Ìýpatients will absolutely see the consequences. IÌýdon’tÌýknow ifÌýit’sÌýenough to change how people think about immigration policy and ways in which we recruit and engage with immigrant workers, butÌýit’sÌýabsolutely something that should be part of our discussion.Ìý

Rovner:ÌýYeah, and I thinkÌýit’sÌýbeen left out.ÌýWell,Ìýmeanwhile,Ìýover at the National Institutes of Health, aÌý,ÌýLizzy,Ìýfound that more than a quarter have laid off laboratory workers. More thanÌý2ÌýinÌý5Ìýhave canceled research,Ìýand two-thirds have counseled students to consider careers outside of academic research. A separate study published this week found that women and early-career scientists have been disproportionately affected by the NIH cuts, even though most of the money goes to men and to later-career scientists. As I keep saying,ÌýthisÌýisn’tÌýjust about theÌýfuture of science. Biomedical research is aÌýhuge piece of the U.S.Ìýeconomy. Earlier this month, the groupÌýUnited forÌýMedicalÌýResearchÌý,ÌýfindingÌýthat every dollar invested produced $2.57 for the economy. Concerned members of Congress from both parties last week at an appropriations hearing got NIH Director Jay Bhattacharya to again promise to push all the money that they appropriated out the door.ÌýButÌýit’sÌýnot clear whetherÌýit’sÌýgoing to continue to compromise the future workforce. I feel like, you know, we talk about all these missing people and nomination stuff, butÌýwe’reÌýnot really talking a lot aboutÌýwhat’sÌýgoing on at the National Institutes of Health, which is a, you know, almostÌý$50 billion-a-year enterprise.Ìý

Lawrence:ÌýRight.ÌýIn some labs, the damage has already been done. YouÌýknow, even if Dr.ÌýBhattacharyaÌý[follows through],Ìýtry spending all the money that has been appropriated. There are youngÌýresearchers that have been shut out and people that have had to choose alternative career paths. AndÌýI think thisÌýis one of those thingsÌýthat’sÌýdifficult politically or, you know, inÌýthe publicÌýconsciousness, because it is hard to see the immediate impactsÌýit’sÌýmeasured. And I think my colleague Jonathan wroteÌý[that]ÌýbreakthroughsÌýareÌýnotÌýdiscoveredÌýthings, you know.ÌýSoÌýit’sÌýhard to know whatÌýis being missed.ÌýBut the immediate impact of the workforce andÌýnot missing this whole generation of scientists that has decided to go to another country or go to do something else, those impacts will be felt for years to come.Ìý

Rovner:ÌýYeah, this is another one where youÌýcan’tÌýjust turn the spigot back on and have itÌýimmediatelyÌýrefill.ÌýÌý

Finally, this week, there is alwaysÌýreproductiveÌýhealthÌýnews. This week,Ìýwe got the Alan Guttmacher Institute’sÌýÌýfor the year 2025,Ìýwhich both sides of the debate consider the most accurate, and it found that for the second year in a row, the number of abortions in the U.S.Ìýremained relatively stable, despite the fact that it’s outlawed or seriously restricted in nearly half the states.ÌýOf course, that’s because of the use of telehealth, which abortion opponents are furiously trying to get stopped, either by the FDA itself or by Congress.ÌýLast week, anti-abortion Sen.ÌýJosh Hawley of Missouri introduced legislation that wouldÌýbasically rescindÌýapproval for the abortion pill mifepristone. But that legislation isÌýapparently givingÌýsome Republicans in the Senate heartburn, as they reallyÌýdon’tÌýwant to engage this issue before the midterms.ÌýAnd,Ìýapparently,ÌýtheÌýTrump administrationÌýdoesn’tÌýeither, given what we know about the FDA saying thatÌýthey’reÌýstill studying this.ÌýOn the other hand, RepublicansÌýcan’tÌýafford to lose the backing of the anti-abortion activists either.ÌýThey put lots of time, effort,Ìýand money into turning out votes, particularly in times like midterms. How big a controversy is this becoming, Shefali?Ìý

Luthra:ÌýThis is a huge controversy, andÌýit’sÌýso interesting to watch this play out. When I saw Sen.ÌýHawley’s bill, I mean, that stood out to me as positioning for 2028.ÌýHe clearly wants to be a favorite among the anti-abortionÌýmovementÌýheading into a future presidential primary. But at the same time, this is teasing outÌýreally potentÌýand powerful dynamics among the anti-abortion movement and Republican lawmakers,Ìýexactly what you said. Republican lawmakers know this is not popular. They do not want to talk about abortion, an issue at which they are at a huge disadvantageÌýwithÌýthe public. Susan B AnthonyÌýList and other such organizations are trying to make the argument that if they are taken for granted,Ìýas they feel as if they are, that will result in an enthusiasm gap.ÌýRight? People will not turn out. They will not go door-knocking,ÌýtheyÌýwon’tÌýdeploy their tremendous resources to get victories in a lot of these contested,Ìýparticularly Senate and House,Ìýraces. And obviously, theÌýpresident cares a lot about the midterms.ÌýHe’sÌývery concernedÌýabout what happensÌýwhenÌýDemocrats take control of Congress. But I think what Republicans are wagering, andÌýit’sÌýa fair thought, is that where would anti-abortion activists go? Are they going to go to Democrats,ÌýwhoÌýlargely supportÌýabortion rights? And a lot of them seem confident that they would rather risk some people staying home and,Ìýoverall, not alienating a very large sector of the American public that does not support restrictions on abortion nationwide, especially those that many are concerned are not in keeping with the actual science.Ìý

Rovner:ÌýYeah, I think the White House, as you said, would like to make this not front and center, let’sÌýput it that way,Ìýfor the midterms. ButÌýyeah, and just to be clear, I mean, Sen.ÌýHawley introduced this bill. ItÌýcan’tÌýpass.ÌýThere’sÌýno way it gets 60 votes in the Senate.ÌýI’dÌýbe surprised if it could get 50 votes in the Senate.ÌýSoÌýhe’sÌýobviously doing this just to turn up the heat on his colleagues, many of whom are notÌývery happyÌýabout that.Ìý

Luthra:ÌýAnd anti-abortion activists are already thinking about 2028.ÌýThey are, in fact, talking to people like Sen.ÌýHawley, like theÌýviceÌýpresident, like Marco Rubio, trying to figure out who willÌýactually beÌýtheir champion in a post-Trump landscape. And so far, whatÌýI’mÌýhearing,Ìýis that they areÌývery optimisticÌýthat anyone else could be better for them than theÌýpresidentÌýis because they are just so dissatisfied with how littleÌýthey’veÌýgotten.Ìý

Rovner:ÌýAlthough they did get the overturn ofÌýRoe v.ÌýWade.Ìý

Luthra:ÌýThat’sÌýtrue.Ìý

Rovner:ÌýBut you know, it goes back toÌýsort of myÌýoriginal thought for this week, which is that the number of abortionsÌýisn’tÌýgoing down because of theÌýrelatively easyÌýavailability of abortion pills by mail. Well, speaking of which, in aÌýsomewhat relatedÌýstory, a woman in Georgia has been charged with murder for taking abortion pills later in pregnancy thanÌýit’sÌýbeen approved for, and delivering a live fetus whoÌýsubsequentlyÌýdied. But the judge in the case has already suggested the prosecutors have a giant hill to climb to convict her and set her bail at $1.ÌýAre we going to see our first murder trial of a woman for inducing her own abortion?ÌýWe’veÌýbeenÌýsort of flirtingÌýwith this possibility for a while.Ìý

Luthra:ÌýIt seems possible.ÌýI think it’s a really good question, and this moment certainly feels like a possible Rubicon, because going after people who get abortions is just so toxic for the anti-abortion movement.ÌýThey have promised they would not go after people who are pregnant, who get abortions.ÌýAnd this is exactly what they are doing. AndÌýI think whatÌýreally stands out to me about this case is so much of it depends on individual prosecutors and individual judges. You haveÌýthe law enforcement officials who decided to make this a case, andÌýthey’reÌýactually using, not the abortion law, even though the language in the case,Ìýright,Ìýreally resonates, reflects with the law in Georgia’sÌýsix-week ban. Excuse me, with theÌýlanguageÌýin Georgia’sÌýsix-week ban. But then you have a judge who says this is very suspect. And what feels so significant is that your rights and your protection under abortion laws depend not only on what state you live in, but who happens to be the local prosecutor, the local cop, the local judge, and that’s just a level of micro-precision that I think a lot of Americans would be very surprised to realize they live under.Ìý

Rovner:ÌýYeah, absolutely. We should point out that the woman has been charged but not yet indicted, because many, many people are watching this case very, very carefully.ÌýAnd weÌýwillÌýtoo.Ìý

All right, that is this week’s news. NowÌýI’llÌýplay my interview with Katie Keith of Georgetown University Law Center, and thenÌýwe’llÌýcome back with our extra credits.Ìý

I am pleased to welcome back to the podcast Katie Keith. Katie is the founding director of the Center for Health Policy and theÌýLaw at the Georgetown University Law Center and a contributing editor at Health Affairs, where she keeps all of us up to date on the latest health policy, legal happenings. Katie, thanks for joining us again.ÌýIt’sÌýbeen a minute.Ìý

Katie Keith:ÌýYeah.ÌýThanks for having me,ÌýJulie,Ìýand happy ACA anniversary.Ìý

Rovner:ÌýSoÌýyou are myÌýgo-to for all things Affordable Care Act, which is why I wanted you this week in particular,Ìýwhen the health law turned 16. How would you describe the state of the ACA today?Ìý

Keith:ÌýYeah,Ìýit’sÌýa great question. So,Ìýthe ACAÌýremainsÌýa hugely important source of coverage for millions of people who do not have access to job-based coverage. I am thinking ofÌýfarmers,ÌýandÌýself-employed people,Ìýand small-business owners.ÌýAnd you know, in 2025,Ìýmore thanÌý24 million peopleÌýrelied on the marketplaces all across the country for this coverage.ÌýSoÌýitÌýremainsÌýa hugelyÌýimportant placeÌýwhere people get their health insurance. And we are already starting to see real erosionÌýinÌýthe gains made under the Biden administrationÌýas a result of, I think, three primary changes that were made in 2025.ÌýSoÌýthe first would be Congress’Ìýfailure to extend the enhanced premium tax credits, which you have covered a ton,ÌýJulieÌýand the team,Ìýas havingÌýa huge impactÌýthere. The second is the changes from theÌýOneÌýBigÌýBeautiful BillÌýAct. And then the third is some of the administrative changes made by the Trump administration thatÌýwe’reÌýalready seeing.ÌýSoÌýweÌýdon’tÌýyet have full data to understand the impact of all three of thoseÌýthings yet.ÌýWe’reÌýstill waiting.ÌýBut the preliminary data shows that already enrollmentsÌýdownÌýby more than a million people.ÌýI’mÌýexpecting that to drop further. There was someÌýKFFÌýsurvey data out last week that aboutÌý1Ìýin 10 people are going uninsured from the marketplace already, and that’s not even, doesn’t even account for all the people who are paying more but getting less, which their survey data shows is about, you know,Ìý3Ìýin 10 folks.ÌýSoÌýyou know what makes all of this really,Ìýreally tough, as you and I have discussed before, is, I think,Ìý2025, was really a peak year. We saw peak enrollment at the ACA. We saw peak popularity of the law, which has been more popular than not ever since 2017,Ìýwhen Republicans in Congress tried to repeal it the first time.ÌýAndÌý…Ìýbut now it feels like we’re sort of on this precipice for 2026,Ìýwatching what’s going to happen with the data into this really important source of coverage for so many people.Ìý

Rovner:ÌýAndÌý…Ìýthere’sÌýbeen so much news that I thinkÌýit’sÌýbeen hard for people to absorb. You know, in 2017,Ìýwhen Republicans tried to repeal the Affordable Care Act, they saidÌýthat,ÌýWe’reÌýtrying to repeal the Affordable Care Act. Well,ÌýtheÌý2025 you know,Ìý“Big,ÌýBeautifulÌýBill,”ÌýtheyÌýdidn’tÌýcall it a repeal, but it hadÌýpretty much theÌýsame impact, right?Ìý

Keith:ÌýIt hadÌýa quiteÌýsignificant impact. And I think a lot,Ìýlike,Ìýyou know, there was so much coverage about how Democrats in Congress and the White House learned,Ìýin doing the Affordable Care Act, learned from the failed effort of the Clinton health reform in theÌý’90s. I think similarly here you saw Republicans in Congress, in the White House, learn from the failed effort in 2017 to be successful here. AndÌýsoÌýyou’re exactly right. You did not hear any talk ofÌý“repeal and replace,”Ìýby any stretch of the imagination. I think in 2017 Republicans were judged harshlyÌý—Ìýand appropriately so, in my opinionÌý—Ìýby theÌý“replace”ÌýportionÌýof what,Ìýyou know, what they were going to do, and it justÌýwasn’tÌýthere. AndÌýsoÌýyou did not see that kind of framing this time around. Instead, it really is an attempt to do death byÌýa thousandÌýpaper cuts and impose administrative burdens and a real focus onÌýkind of whoÌý—Ìýyou can’t see me, but air quotes,Ìýyou knowÌý—ÌýwhoÌý“deserves”Ìýcoverage and a focus on immigrant populations. SoÌý…Ìýthose changes,Ìýwhen you layer all of them onÌý—Ìýchanges to Medicaid coverage, Medicaid financing, paperwork burdens, all across all these different programsÌý—Ìýyou know, theÌýOneÌýBigÌýBeautiful BillÌýAct,Ìýit really does erect new barriers that fundamentally change how Medicaid and the Affordable Care Act will work for people. AndÌýsoÌýit’sÌýnot repealed. I think those programs will still be there, but they will look very different than how they have and,Ìýyou know, the CBOÌý[Congressional Budget Office]Ìýat the time, the coverage losses almostÌý…Ìýthey look quite close to, you know, the skinny repeal that we all remember in the middle of the morningÌý—Ìýearly,Ìýlike,Ìýlate night,ÌýSen.ÌýJohn McCain with his thumbs down.ÌýThe coverage losses were almost the same,Ìýand you’ve gotÌýtheÌýCBO now saying,Ìýestimating about 35 million uninsured people by 2028,Ìýwhich,Ìýyou know,Ìýis notÌý…Ìýit’s justÌýerasing, I think, not all, but a lot of the gains we’ve made over the past 15, now 16,Ìýyears under the Affordable Care Act.Ìý

Rovner:ÌýAnd now the TrumpÌýadministration is proposing still more changes to the law, right?Ìý

Keith:ÌýYep,Ìýthat’sÌýright.ÌýThey’reÌýcontinuing, I think, a lot of the same.ÌýThere’sÌýseveral changes that, you know, go back to the first Trump administration thatÌýthey’reÌýtrying to reimpose. Others are sort ofÌýnew ideas.ÌýI’mÌýthinking some of the same ideas are some of the paperwork burdens. So really, in some cases, buildingÌýoff ofÌýwhat has been pushed in Congress.ÌýWhat’sÌýmaybe newÌýthis time around for 2027 thatÌýthey’reÌýpushing is a significant expansion of catastrophic plans. So huge, huge, high-deductible plans that,Ìýyou know,ÌýreallyÌýdon’tÌýcover much until you hitÌýtensÌýofÌýthousandsÌýof dollars in out-of-pocket costs. You get your preventive services and three primary care visits, butÌýthat’sÌýit.ÌýYou’reÌýon the hook for anything else you might need until you hit theseÌýreally catastrophicÌýcosts.ÌýThey’reÌýpunting toÌýthe states on core things like network adequacy. You know, again, some ofÌýit’sÌýsort of new. Some ofÌýit’sÌýa throwback to the first Trump administration, so not as surprising. And then on the legislative front, IÌýdon’tÌýknow what the prospects are, but you do continue to see PresidentÌý[Donald]ÌýTrump call for, you know,ÌýhealthÌýsavingsÌýaccount expansions. We think, I think, you know, the idea is to send people money to buy coverage, rather than send the money to the insurers, which I think folks have interpreted as health savings accounts.ÌýThere’sÌýa continued focus on funding cost-sharing reductions, but that issue continues to be snarled by abortion restrictions across the country. SoÌýthat’sÌýsomething that continues to be discussed, but IÌýdon’tÌýknow if it will ever happen. And you know anything else that’sÌýkind of underÌýthe so-calledÌýGreatÌýHealthcareÌýPlan that the White House has put out.Ìý

Rovner:ÌýYou mentioned that 2025 was the peak not just of enrollment but of popularity.ÌýAnd we have seen in poll after poll that the changes that the Trump administrationÌýandÌýCongressÌýisÌýmaking are not popular with the public, includingÌýthe vast majority ofÌýindependents and many, many Republicans as well. Is there any chance that Congress and President Trump might relent on some of these changes between now and the midterms?ÌýWe did see a bunch of Republicans, you know, break with the rest of the party to try to extend the, you know, the enhanced premiums. Do you see any signs thatÌýthey’reÌýweakeningÌýorÌýareÌýwe off onto other things entirelyÌýright now?Ìý

Keith:ÌýIt’sÌýa great question.ÌýI think youÌýprobably needÌýa different analyst to ask thatÌýquestion to. IÌýdon’tÌýthink my crystal ball covers those types of predictions. But to your point, Julie, I thought that if there would have been time for a compromise andÌýsort of aÌýpath forward, it would have been around the enhanced premium tax credits. And it was remarkable, you know, given what the history of this law has beenÌýandÌýthe politicsÌýsurrounding it, to see 17 Republicans join all Democrats in the House to vote for a clean three-year extension of the premium tax credits. But no, I think especially thinking about where those enhanced tax credits have had the most benefit, it is states like Georgia, Florida, Texas, and I thought thatÌýmaybe would,Ìýcould have moved the needle if there was a needle to be moved.ÌýSoÌýI,Ìýit seems likeÌýthere’sÌýmuch more focus on prescription drugs and other issues, but anything can happen.ÌýSoÌýI guessÌýwe’llÌýallÌýstay tuned.Ìý

Rovner:ÌýWell,Ìýwe’llÌýdo this again for the 17th anniversary. Katie Keith, thank you so much.Ìý

Keith:ÌýThanks,ÌýJulie.Ìý

Rovner:ÌýOK,Ìýwe’reÌýback.ÌýIt’sÌýtime for ourÌýextra-creditÌýsegment.ÌýThat’sÌýwhere we each recognizeÌýaÌýstory we read thisÌýweekÌýwe think you should read too.ÌýDon’tÌýworry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lizzy, why don’t you start us off this week?Ìý

Lawrence:ÌýSure.ÌýSoÌýmy extra credit is byÌýNickÌý[Nicholas]ÌýFlorko, formerÌýStat-ian,ÌýinÌýThe Atlantic,Ìý“”ÌýIÌýimmediatelyÌýread thisÌýpiece, becauseÌýthis is somethingÌýthat’sÌýbeen driving meÌýkind of crazy. Just seeingÌý—ÌýifÌýyou’veÌýmissed itÌý—Ìýthere have beenÌý…ÌýHHS has been posting AI-generated videos of Secretary Kennedy wrestling a Twinkie,Ìýwearing waterproof jeans,Ìýall ofÌýthese things. And this has been, this is not unique to HHSÌý—Ìý[the]ÌýWhite House in general has really embraced AI slop as a genre, and IÌýcan’tÌýlook away. AndÌýsoÌýI thoughtÌýNick didÌýa good jobÌýjust acknowledging how crazy this is, and then also what goesÌýunsaid in these videos.ÌýI think IÌýpersonally am just very curious if this resonates with people, or ifÌýit’sÌýkind of disconcertingÌýfor the average AmericanÌýseeing these videos like,ÌýOh, my government isÌýmakingÌýAI slop.ÌýLike I,Ìýyou know, social media strategy is so important, soÌýmaybe forÌýsomeÌýpeople areÌýreallyÌýlikingÌýthis. ButÌýyeah,ÌýI’mÌýjustÌýkind of curiousÌýabout public sentiment.Ìý

Rovner:ÌýI know I would say, you know, the National Park Service and the Consumer Product Safety Commission have beenÌýsort of famousÌýfor their very cutesy social media posts, butÌýnot quite toÌýthis extent. I mean,Ìýit’sÌýone thing to be cheeky and funny. This isÌýsort of beyondÌýcheeky and funny.ÌýI agree with you. I have no idea how this is going over the public, but they keep doing it.ÌýIt’s a really good story.ÌýRachel.Ìý

Cohrs Zhang:ÌýMine is a story in The Boston Globe, and the headline isÌý“”ÌýbyÌýTal Kopan.ÌýAnd this was a really good profile of Tony Lyons, who is Robert F.ÌýKennedy Jr.’s book publisher, and he’s kind of had the role of institutionalizing all the political energy behind RFK Jr.Ìýand trying to make this into a more enduring political force.ÌýSoÌýI think heÌýis, like, mostly a behind-the-scenes guy, not really like a D.C.Ìýfixture, more of like a New York book publishing figure.ÌýBut I think his efforts and what they’re using, all the money they’re raising for, I think,Ìýis a really important thing to watch in the midterms, and like, whether they can actually leverage this beyond a Trump administration, or beyond however long Secretary Kennedy will be in his position.ÌýSoÌýI think itÌýwas just a good overview ofÌýall the tentacles of institutional MAHAÌýthat are trying to, you know, find their footing here, potentially for the long term.ÌýÌý

Rovner:ÌýI hadÌýnever heard of him, so I was glad to read this story.ÌýShefali.Ìý

Luthra:ÌýMy story is from NPR. It is byÌýTaraÌýHaelle. The headline isÌý“.”ÌýStory says exactly what it promises, that if you have an infant, babiesÌýunderÌý6Ìýmonths, then getting a covid vaccine while you are pregnant willÌýactually protectÌýyour baby, which is great because there is no vaccine for infants that young. I love this because it’s a good reminder of something that we were starting to see, and now it just really underscores that this is true, and in the midst of so much conversation around vaccines and safety and effectiveness, it’s a reminder that really, really good research can show us that it is a very good idea to take this vaccine, especially if youÌýare pregnant.Ìý

Rovner:ÌýMore fodder for the argument, I guess. AllÌýright,Ìýmy extra credit this week is a clever story fromÌýStat’s John Wilkerson calledÌý“.”ÌýAnd,Ìýspoiler,Ìýthat loophole is thatÌýone wayÌýcompanies can avoid running afoul of their promise not to charge other countries less for their products than they chargeÌýU.S.Ìýpatients is for them to simply delay launching those drugs in those other countries that have price controls.ÌýAlready, most drugs are launched in the U.S.Ìýfirst, andÌýapparently someÌýof the companies that have done deals with the administration limited their promises to three years,Ìýanyway. That way they can chargeÌýU.S.Ìýconsumers however much they think the market will bear before they take their smaller profits overseas. Like I said,Ìýclever.ÌýMaybe that’sÌýwhy so many companies were ready to do those deals.Ìý

All right, that is this week’s show.ÌýAs always, thanks to our editor,ÌýEmmarieÌýHuetteman;Ìýour producer-engineer, Francis Ying;Ìýand our interview producer,ÌýTaylor Cook.ÌýAÌýreminder:ÌýWhat theÌýHealth?Ìýis now available on WAMU platforms, the NPR app,Ìýand wherever you get your podcasts, as well as,Ìýof course,Ìýkffhealthnews.org. Also, as always, you can emailÌýusÌýyour comments or questions.ÌýWe’reÌýatÌýwhatthehealth@kff.org.ÌýOr you can still find me onÌýXÌýÌýorÌýon BlueskyÌý. Where are you folks hanging these days?ÌýShefali?Ìý

Luthra:ÌýI am onÌýBlueskyÌý.Ìý

Rovner:ÌýRachel.Ìý

Cohrs Zhang:ÌýOnÌýXÌý, orÌý.Ìý

Rovner:ÌýLizzy.Ìý

Lawrence:ÌýI’mÌýonÌýXÌýÌýandÌýÌýandÌý.Ìý

Rovner:ÌýWe will be back in your feedÌýnext week.ÌýUntil then, be healthy.Ìý

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