A from the Office of Personnel Management could dramatically change which personally identifiable medical information the agency obtains, giving it the power to see prescriptions employees had filled or what treatment they sought from doctors. The regulation would require 65 insurance companies that cover more than 8 million Americans — including federal workers, retired members of Congress, mail carriers, and their immediate family members — to provide monthly reports to OPM with identifiable health data on their members.

The proposal is prompting unease from insurers as well as health policy and legal experts, who are concerned about the legality of OPM acquiring such a sweeping database of sensitive health information, and the agency’s ability to safeguard it.

OPM could use the data to analyze costs and improve the system, said Sharona Hoffman, a health law ethicist at Case Western Reserve University in Ohio.

“But,” she said, “they are going to get very, very detailed and granular data about everything that happens. The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically.”

OPM spokespeople did not respond to repeated requests for comment. The agency’s notice asks insurers that offer Federal Employees Health Benefits or Postal Service Health Benefits plans to furnish “service use and cost data,” including “medical claims, pharmacy claims, encounter data, and provider data.” It says the data will “ensure they provide competitive, quality, and affordable plans.”

The notice, posted and sent to insurers in December, does not instruct them to redact identifying information — a burdensome process that they would need federal guidance to complete.

Instead, it states that insurers are legally permitted to disclose “protected health information” to OPM. Several experts in health policy and law consulted by ���ϳԹ��� News said they interpreted the request to mean the Trump administration was seeking identifiable data.

The ask comes a year into a Republican administration that has been defined by haphazard mass layoffs and firings of thousands of federal workers, who say they were in acts of or for the . Under President Donald Trump, the government has also routinely tested the legal bounds of sharing sensitive and personally identifiable tax or health information across government agencies in its efforts to carry out mass immigration arrests or pursue identify fraud.

“You can anticipate a scenario where this information on 8 million Americans is now in the hands of OPM and there’s a real concern of how they use it,” said Michael Martinez, senior counsel at Democracy Forward, an advocacy organization that filed a public comment opposing OPM’s proposal in February. Martinez previously worked at OPM.

“They’ve given no information about how they would treat that information once they have it,” he said.

Among Martinez’s concerns is how the administration might use information about employees who have sought abortions — 41 states have some type of abortion ban — or transgender treatment, medical care that the Trump administration has tried to curb.

The American Federation of Government Employees, the largest union representing federal workers, did not respond to requests for comment.

Martinez and others who reviewed the notice for ���ϳԹ��� News said the proposal was so vague that they were uncertain, exactly, what medical records OPM wants to access.

At the very least, they said, the proposal would allow the agency to access the medical and pharmaceutical claims of patients with their identifying information, such as names and birth dates. Claims data also includes diagnoses, treatments, visit length, and provider information.

OPM’s request to view “encounter data” could allow the agency to look at “anything and everything,” Hoffman noted.

That could include detailed medical records, such as a doctor’s notes or after-visit summaries.

Jonathan Foley, who worked at OPM advising on the Federal Employees Health Benefits program during the Obama and Biden administrations, said he doubts the agency has the capability to ingest such minutiae.

The agency, however, could easily begin collection of personally identifiable medical and pharmaceutical claims information from insurers, he said.

Foley said he sees a benefit to OPM having broader access to de-identified claims data. In recent years, OPM has ramped up its analysis of claims data, which has allowed it to examine prescription drug costs and encourage plans to offer federal workers cheaper alternatives. He’s worried, though, that the Trump administration’s proposal goes too far, because it appears to seek identifiable data.

“It’s kind of shocking to think of them having protected health information without having strict guardrails,” he said.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent.

Those entities can disclose such information without consent only in specific scenarios, with a justification that it is deemed “reasonable” or “necessary.” Even then, HIPAA mandates that they provide only the minimum amount of information required.

OPM argues in its notice that it is entitled to the information from insurers “for oversight activities.”

But several people who reviewed the notice questioned whether OPM’s explanation for requesting the information is sufficient.

“The language in it seems quite broad and encompasses potentially a lot of information and data and is sort of light on justification,” said Jodi Daniel, a digital health strategist who helped develop the legal framework for HIPAA privacy rules over two decades ago.

Several major insurers that offer federal employee health plans — including the Blue Cross Blue Shield Association, Kaiser Permanente, and UnitedHealthcare — declined to comment on their plans to comply with the notice or offer insight on where plans to implement the data sharing stood.

Only one insurer individually weighed in with a public comment on OPM’s plan. In March, CVS Health executive Melissa Schulman urged the federal agency to reconsider its proposal.

“OPM’s request raises substantial HIPAA compliance issues,” Schulman wrote, arguing that federal law allows the agency to examine records but not to collect data. Insurers would be breaking the law by providing personal health information for OPM’s “vague and broad general purposes,” she added.

Schulman, who did not respond to additional questions from ���ϳԹ��� News, also raised concerns about a lack of data privacy protections. She noted that insurers could be liable for security breaches or other situations “where consumer health information is inappropriately shared and outside of our control.”

In 2015, OPM announced the personal records of roughly 22 million Americans had been in a data breach that has been blamed on the Chinese government.

The Association of Federal Health Organizations, which represents CVS Health and dozens of other federal health plan carriers, also weighed in with a 122-page comment opposing the notice. In it, AFHO Chair Kari Parsons emphasized that insurance carriers are bound by HIPAA to safeguard personal health information.

Federal law requires carriers “to furnish ‘reasonable reports’ OPM determines to be necessary,” Parsons wrote, “not to furnish the individual claims data of every individual.”

This isn’t the first time OPM has requested detailed data from insurers. In the AFHO comment, Parsons noted OPM had made a similar proposal in 2010, prompting HIPAA concerns. She described how, after several years of negotiations with AFHO, they discussed — but OPM never finalized — an agreement in 2019 for carriers to share de-identified data with OPM.

But since then, Parsons wrote, OPM has collected such detailed information on enrollees and their families that, with OPM’s new request, the agency may be able to trace even de-identified records to individuals.

OPM has not provided any update since closing comments in March. The agency would need to publish a final decision before anything officially changes.

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Still, 69% of those enrolled last year signed up again this year, often for less generous coverage. About 9% said they had to forgo insurance, according to the survey by KFF, a health information nonprofit that includes ���ϳԹ��� News.

The KFF poll revisited the people who responded to of Affordable Care Act enrollees during open enrollment for ACA plans.

Steve Davis, a 64-year-old retired car salesman in Rogersville, Tennessee, who participated in both polls, said he was looking at an annual premium of about $14,000 to renew his ACA coverage this year. He didn’t qualify for enough of a tax credit to defray the cost, he said, after Congress gridlocked on an extension of more-generous subsidies put in place under President Joe Biden.

But things worked out for Davis. He landed a job at a convenience store that came with insurance, with his share costing about $100 more a month than the $300 he paid for an ACA plan last year, before the enhanced tax credits expired.

“As it happened, the Lord provided and my insurance kicked in through my employer,” he told ���ϳԹ��� News.

In the November survey, many respondents were not sure what they would do for their health insurance in the coming year.

Some were waiting to see whether Congress would extend the enhanced premium subsidies, which had helped many people get lower-cost — or even zero-cost — health premiums.

Congress’ inaction left some consumers in a bind.

Now, the new poll found, affordability issues are hitting home as the midterm election approaches. And that might play a role in competitive districts, creating headwinds for Republicans.

Midterm Signals

Across all respondents who were registered to vote, the poll found more than half place “a lot” of blame for rising costs on Republicans in Congress (54%), with a similar share putting the same level of blame on President Donald Trump (53%). A smaller group placed a lot of the blame on congressional Democrats (34%). Among independents, a group expected to be a key factor in many districts, the percentages putting a lot of the blame on the GOP (56%) and Trump (58%) were higher.

Among Republicans, 60% placed a lot of the blame on Democrats in Congress.

“Those who have marketplace coverage, who remained on it, they’re really struggling with health care costs,” said Lunna Lopes, senior survey manager for KFF.

While more than half (55%) of returning ACA enrollees said they will have to pare back on other household expenses to cover health care costs, about 17% said they might not be able to continue paying insurance premiums throughout the year.

Overall, 80% of those who reenrolled for 2026 said their premiums, deductibles, or other costs are higher this year than last, with 51% saying they are “a lot higher.”

About three-quarters of ACA enrollees in the survey who were registered voters said the cost of health care will have an impact on their decision to vote — and on which party’s candidate they support.

Democrats were more than twice as likely as Republicans to say those costs will have a major impact on their decision.

“Democrats seem particularly more energized by health care costs than their Republican counterparts,” Lopes said.

Enrollment Tally Down

Data released Jan. 28 by federal officials showed that about 23 million people enrolled in Obamacare plans across the federal healthcare.gov marketplace and those run by states, about 1.2 million fewer than in 2025.

But it isn’t yet known how many are paying their monthly premiums on time, and many analysts expect overall enrollment numbers to fall as that data becomes available in the coming months.

For most people, having to pay more for premiums this year was mainly due to the expiration of the enhanced tax cuts, pollsters noted. Because the subsidies that remain are less generous, households have to pay more of their income toward coverage. Congressional inaction also meant the restoration of an income cap for subsidies at four times the poverty level, or $62,600 for an individual, sticking people like Davis with higher bills.

Not everyone saw increases.

Matthew Rutledge, a 32-year-old substitute teacher in Apple Valley, California, who participated in both KFF polls, said he qualified as low-income and his subsidies fully offset his monthly premium payment, just as they did last year. He does have copayments when he sees a doctor or accesses other medical care, but he told ���ϳԹ��� News that “as long as the premium doesn’t go up, I’m fine with it.”

Rising premiums are fueled by a variety of factors, including hospital costs, doctors’ services, and the prices of drugs.

To lower premiums, insurers offer plans with higher deductibles or copayments. In the ACA, plans with lower premiums but higher deductibles are called “catastrophic” or “bronze” plans. “Silver” plans generally balance premiums and out-of-pocket spending, while the highest-premium plans with lower deductibles are “gold” or “platinum.”

About 28% of those who stayed in the ACA marketplaces switched plans, the pollsters noted.

One 56-year-old Texas man told pollsters that his family’s income exceeded the cap for subsidies, so they switched down from a gold plan to a bronze. “Even doing that, our premiums are three times what they were in 2025, with lower plan features and a higher deductible,” he said, according to a KFF poll news release.

For some, reenrolling was not a viable option.

In addition to the 9% who said they are now uninsured, about 5% said they switched to some type of non-ACA coverage.

Some people, like Davis, landed job-based coverage, while others found they qualified for Medicaid, the joint state-federal program for low-income residents.

Such churn in and out of ACA coverage is not unusual, Lopes noted. “People get a job. They get married. They age into Medicare,” the program for older or disabled people, she said.

The poll highlighted that many people dropping coverage were younger, between 18 and 29. About 14% of people in that range now say they are uninsured.��

That’s not surprising, given that younger people tend to use health coverage less. ACA insurers said one reason they raised premiums this year was because they expected more young or healthy people to drop out, leaving them with a higher share of older, more costly enrollees. Among those 50 or older, the poll found that only 7% are now uninsured.

GOP critics of the now-expired enhanced subsidies say they were always meant to be temporary. Extending them would have cost about $350 billion from 2026 to 2035, .

But not extending them means more people will become uninsured. The CBO said the extension would have meant 3.8 million more people having insurance coverage in 2035.

KFF pollsters, in February and early March, surveyed 1,117 U.S. adults, more than 80% of the ACA enrollees originally polled in November, online and by telephone. The margin of error is plus or minus four percentage points for the full sample.

Are you struggling to afford your health insurance? Have you decided to forgo coverage?��Click here��to contact ���ϳԹ��� News and share your story.

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Raven’s case reveals a little-known gap in the U.S. donation system: There is no clear, nationally binding way to opt out — or to ensure a later “no” overrides an earlier “yes” in a different state.

This gap, along with a range of other issues related to the organ procurement system, has become a point of bipartisan congressional concern. Late last year, the House Ways and Means subcommittee on oversight examining what members described as shortcomings, including alleged consent failures.

The panel’s scrutiny of organ procurement organizations, or OPOs, and their consent practices is a first step toward a more meaningful accountability plan that could help maintain trust across the system, according to some committee staff members.

The trust in our organ procurement and transplant system “has been eroded,” said Rep. Terri Sewell of Alabama, the panel’s senior Democrat, calling for stronger transparency and oversight to rebuild public confidence.

“Respect for autonomy — our ability to make our own decisions (self-determination) — allows for both ‘yes’ and ‘no’ decisions and for changing one’s mind,” Margaret McLean, a bioethicist at Santa Clara University, said in an email.

“Medical decision-making is not well served in a context of ambiguity,” she said.

And if a donor revokes consent, she added, “revocation by that person should carry the same ethical and procedural weight as the initial authorization, perhaps more.”

Raven Kinser Changed Her Mind

Raven was 25 when she died. Her parents, Jeff and Jaime Kinser, were at home in Michigan when they received the phone call that shattered their world. They drove through the night to the Newport News hospital, where they learned Raven’s disposition had been referred to LifeNet Health, the region’s federally designated OPO. LifeNet a failing OPO by the Centers for Medicare & Medicaid Services, meaning it doesn’t meet the government’s standards for how well it finds donors and recovers usable organs for transplant compared with other organizations.

Under federal law, hospitals are required to refer deaths and imminent deaths to OPOs, which take responsibility for donation-related decisions and discussions.

OPOs occupy a hybrid position in the health care system, as private nonprofit entities that hold exclusive, federally authorized contracts to recover organs within defined regions. They are regulated by CMS and overseen by the Health Resources and Services Administration, but that oversight occurs primarily through certification standards, performance metrics, and periodic audits rather than routine public disclosure requirements. With donor registries largely managed at the state level and no unified federal reporting requirement for removals, comprehensive national data on revocations is elusive.

OPOs are meant to separate bedside care from organ procurement decisions — to help prevent conflicts of interest and preserve the trust that decisions about life-sustaining treatment are made solely in the dying patient’s interest. But the , leaving families unsure who is in control if and when conflicts arise.

The Kinsers, for instance, felt their daughter would not have wanted to go through the donation process, but, at the time, had no evidence. Jaime remembers telling her husband that Raven would have been mad at them for letting it happen. In an effort to stop it, Jaime inquired about whether she would be asked to sign a consent form. But a LifeNet staff member told her that wasn’t an option because donation was Raven’s “living will,” Jaime said. Meanwhile, Raven’s parents said, her personal effects, including her Virginia driver’s license, which bore no donor designation, had not yet been turned over to the family, leaving them no meaningful way to challenge LifeNet’s determination in real time.

Jaime struggled with this outcome, even mentioning in Raven’s obituary that she was an organ donor. “How would you try to make peace with something that you felt was so wrong but had no proof?” Jaime said.

Two months passed before the Kinsers gained possession of the license, which, as they had expected, showed that Raven had not opted to be an organ donor.

According to the Kinsers, LifeNet staff told them that Raven’s status as a registered donor was established by her designation on her older Michigan license.

An emailed statement attributed to Douglas Wilson, LifeNet executive vice president, said the OPO follows federal law on organ donation, the , and queries applicable state donor registries, relying on time stamps and governing law to determine the , legally valid expression of intent. Under that framework, a prior donor authorization remains enforceable unless a valid revocation is recorded in the regional OPO’s donor registry.

Because of privacy laws, Wilson said, LifeNet could not comment on the specifics of any individual case.

Raven Kinser’s choice not to be a donor when she applied for a Virginia license in July 2024 was not reflected in the registry LifeNet consulted, according to her parents, who said that is what the organization told them. According to Lara Malbon, executive director of Donate Life Virginia, which manages the state’s organ donor registry, if someone changes their donor status while completing a Virginia driver’s license or ID transaction, “that information is sent to our registry, and the registry is updated daily to reflect those changes.” Malbon also said Virginia’s registry includes only people who have “affirmatively said ‘yes’ to becoming an organ, eye, and tissue donor, and it retains records solely for those who have made that decision.”

The Kinsers said they were never told why Raven’s Virginia DMV record was insufficient, or how an older yes from Michigan could outweigh a newer no in Virginia.

In December, the Kinsers filed a complaint with the Health Resources and Services Administration, urging federal regulators to investigate LifeNet’s actions and require OPOs to provide families with documented proof of the donor’s current status at the time of referral. They also called for OPOs, which operate as federally designated regional monopolies but are structured as private nonprofits, to be made subject to public records laws.

When Opting Out Doesn’t Stick

Such confusion is not unique to the Kinser family. It is a consequence of the organ donation consent process in the United States.

“I have also wondered that: why there’s not just one” registry for organ donation, Jaime said. If you go to get a firearm, you have one federal registry, she said.

Here’s how the system works: Americans typically register their organ donation intentions when they apply for driver’s licenses through state DMVs, and that decision remains governed largely by state law. That has led to 50 different sets of rules and very little federal regulation of what has become an in the U.S.

In some states, a donor checkbox is a binding legal document. In other states, the same choice may have different rules about when it takes effect, what it covers, and how it can be revoked.

Those differences can be big. State rules determine whether a person’s “gift” is limited to transplantation or also includes research and education. They determine whether the donation authorization includes tissue. And they can determine what counts as a valid revocation and when it is legally recognized.

Because of the system’s fragmentation, though, signals can cross when someone changes their mind, like Raven; it’s not always reflected from one state system to another.

Under state versions of the Uniform Anatomical Gift Act, a donor’s most recent legally valid expression of intent is meant to control.

“Personal autonomy is paramount to everything,” said Adam Schiavi, a neurointensivist who studies end-of-life decision-making. “If I say I want to be a donor, or if I say I don’t want to be a donor, that has to take precedence over everything else.”

But states differ in how revocation must be recorded and which registry is considered authoritative if someone has lived in more than one state. Those inconsistencies can create uncertainty when records conflict across jurisdictions.

“It has to be the most recent expression, not the most recent yes,” Schiavi said.

In Michigan, a change to someone’s donor status is reflected immediately in the secretary of state’s system, but only affirmative “yes” registrations appear in the registry. Removal information remains in internal motor vehicle records. In Virginia, the state registry includes only those who have affirmatively said “yes,” retaining records solely of donors, creating potential gaps if someone believes a DMV change alone is sufficient.

Elsewhere, processes and volumes differ sharply. New Mexico updates driver records in real time but does not transmit status changes to its donor registry. Instead, donor services receive restricted search access. The state logged nearly 15,000 removals in late 2021 and almost 30,000 in 2022. Florida, which maintains formal removal records through weekly DMV data files, reported 356,161 removals in 2020, more than 1.5 million in 2023, and over 1.2 million in 2025. Kentucky processed 847,371 donor registrations from 2020 to 2025, but only 16,043 icon removals, with registry withdrawal handled separately. In 2025, more than 570,000 Texans opted into the registry, while over 31,000 individuals requested removal.

According to a federal official who asked not to be identified for fear of professional repercussions, OPOs have been highly effective at lobbying states to broaden the definition of consent and authorization — shaping how those terms are applied, whether those statuses must be renewed, and how easy or difficult it is for someone to opt out.

In subsequent correspondence with federal officials, the Kinsers have urged reforms to prevent OPOs from relying on older registry entries when a more recent state DMV record exists, and they have called for criminal penalties in cases in which consent is knowingly misrepresented. Federal regulators have not indicated whether such proposals are under consideration.

Congress Takes a Closer Look

Ethicists have long cautioned that consent must be more than a checkbox and must remain grounded in respect for the donor-patient. In an October on organ transplantation, the American College of Physicians emphasized that clinicians’ primary duty is to the patient in their care, and that maintaining trust requires transparency and safeguards to prevent conflicts of interest from blurring that “bright line.”

Advocates say those steps leave unresolved the core problem raised by the Kinser family: the lack of a clear, legally binding way for people to say “no” and for that decision to follow them across state lines.

The said it “supports strengthening donor registries and enhancing registry interoperability to ensure that an individual’s documented donation decision is honored.” But OPOs have also argued that current policies protect donation as a legally enforceable gift and prevent families from overriding a loved one’s “yes” in the midst of grief. They argue that stronger, more durable consent helps reduce missed donations and saves lives.

Congress and federal regulators are considering changes to the nation’s organ donation system, including how consent is recorded and what should happen when a donor changes their mind.

Sen. Ron Wyden (D-Ore.) last year to create new federal standards for patient safety, transparency, and oversight of organ transplants, including a formal authorization for hospital or OPO staff to pause harvesting if there is any “clinical sign of life.”

HHS press secretary Emily Hilliard said the agency is “committed to holding organ procurement organizations accountable” and to “restoring integrity and transparency” to organ donation policy, calling reforms essential to informed consent and protecting donor rights. CMS issued related March 11, but it does not address the problems highlighted by the Kinsers’ case.

Critics of the organ transplant system say it is difficult for families to obtain documentation or independently verify how consent determinations were made in disputed cases.

HRSA has launched a sweeping modernization of the Organ Procurement and Transplantation Network, the national system that oversees organ allocation and transplant policy. Federal officials have described the overhaul as the most significant restructuring of the transplant system in decades, aimed at breaking up a long-standing contractor monopoly, strengthening patient safety oversight, and replacing aging technology infrastructure.

Central to that effort is modernizing the OPTN’s data systems: improving interoperability, audit trails, and transparency in how decisions are documented and reviewed. A more modern federal data architecture could make it easier to trace which registry was queried, what time stamp controlled, and how a consent determination was reached in disputed donations that span multiple states. But the modernization effort would not change the underlying state-by-state legal framework for donor authorization and what counts as a valid “no.”

Meanwhile, Donate Life America, a national nonprofit that supports state donor registries, also runs the , a central database that allows people to sign up as organ donors directly. Unlike many DMV systems, the national registry lets people log in at any time to view, update, or remove their registration and print proof of their decision. The group is also starting a project to let participating states send registrations directly into the national system, creating one place to track donor sign-ups and removals across state lines.

Each of the proposals comes with trade-offs, and both advocates and OPOs have raised concerns about how they would work in practice.

“Just doing a dump truck dump of information is not going to do much unless you really apply it through checking and auditing,” said Arthur Caplan, a professor of bioethics at New York University’s Grossman School of Medicine. “It could be like the IRS. They don’t have to audit everybody. Just do a spot audit once in a while.”

The Kinsers aren’t opposed to organ donation itself. They celebrated Raven’s donation in her obituary, and in their complaint to federal regulators, they wrote, “We are NOT anti-organ donation, and we will never take away the gift of life our oldest daughter gave to others. However, that was not LifeNet’s choice to make.”

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Engineered quartz countertops have surged in popularity in the home renovation market, with industry analysts estimating the global engineered stone market at . It’s continuing to expand as quartz surfaces replace natural stone in kitchens in the United States and worldwide.

When González was working, the dust that rose from his saw didn’t look extraordinary. It settled on his clothes, in his hair, across the shop floor. In a small countertop fabrication shop, he cut marble and granite before shifting to engineered stone after the 2008-09 recession, when demand for cheaper quartz countertops surged.

But the crystalline silica released while the engineered stone was cut and polished also settled into his lungs, scarring them beyond repair. What began as breathlessness hardened into silicosis, an irreversible disease that stiffens the lungs until even ordinary movement becomes effort.

A lung transplant was his path forward. The procedure can extend survival, but it redraws the boundaries of a life: anti-rejection drugs every day, constant monitoring, vulnerability to infection, the knowledge that breathing depends on the fragile acceptance of another person’s donated organ.

González, who was diagnosed with silicosis in 2023, is not alone in dealing with a disease that once was associated with miners at the end of long careers. It’s now prevalent among the much younger, often Hispanic men who work in this industry, physicians and public health officials say.

In the United States, cases are appearing in countertop fabrication shops from California to Texas, Florida, and the Northeast. Because silicosis is not a nationally reportable disease and surveillance varies by state, no comprehensive national count exists. But clinicians who treat occupational lung disease say the number of workers — often men in their 30s and 40s — diagnosed after cutting engineered stone has risen sharply over the past decade.

As of , California had identified 519 confirmed cases of engineered-stone-associated silicosis and 29 deaths since 2019. The median age at diagnosis is 46; at death, 49.

Doctors don’t debate whether working with engineered stone can scar lungs.

Manufacturers argue, though, that proper ventilation, wet cutting, and respirators can make fabrication safe. Workers, physicians, and plaintiffs’ attorneys counter that a material composed almost entirely of crystalline silica may be impossible to handle safely at scale.

“This is comparable to the tobacco industry saying cigarettes are safe,” said epidemiologist David Michaels, an assistant labor secretary under President Barack Obama who led the Occupational Safety and Health Administration.

More than 370 lawsuits have been filed by workers who say engineered stone manufacturers failed to warn employees about the risks or sold a product that cannot be fabricated safely. At the same time, members of Congress are that would largely shield manufacturers from liability in those cases, turning a workplace health crisis into a national debate over regulation, responsibility, and the limits of civil litigation.

Gustavo Reyes, 36, is part of that debate. Like González, he spent the early years of his career cutting marble and granite before shifting to engineered stone, a quartz-based material that can contain up to 95% silica and generates far more hazardous dust when cut.

In the shop, he said, cutting was done with water to control the dust. But finishing work — sanding and shaping — generated heavy dust. He said he wore disposable respirator masks or a reusable elastomeric respirator with filters. A door was kept open. Fans ran overhead.

When he was diagnosed in 2021, he did not know what silicosis meant. The doctor told him that there was no medication and that he had three to five years to live. He received a lung transplant in 2023.

Asked who he believes is responsible, Reyes answered: “The industries who created the artificial stone, the product.” Manufacturers dispute that characterization. Major companies say engineered stone can be fabricated safely when employers follow OSHA dust controls, including wet cutting, ventilation, and respirator use.

An Old Disease, Reengineered

Silicosis is not new. It was synonymous with mining disasters and sandblasting, most notoriously in the , when hundreds of workers drilling through silica-rich rock in West Virginia in the early 1930s developed acute silicosis after months of unprotected exposure to dust. In 1938, advised that the disease could be prevented if dust controls were conscientiously applied.

What is new is the industry in which it has resurfaced.

Engineered stone, often marketed as “quartz,” is typically composed of crushed quartz bound with resins and pigments. Unlike marble, which contains little crystalline silica, engineered slabs contain very high levels of the substance.

Cutting changes the material.

“When you grind it, when you cut it, you’re pulverizing it,” said Robert Blink, an occupational and environmental medicine specialist who treats patients with advanced silicosis in Chicago and is a member of the Western Occupational and Environmental Medical Association. “You’re weaponizing the silica.”

Power tools fracture the surface into respirable particles small enough to lodge deep in the lungs. Repeated exposure triggers inflammation and fibrosis. Once scarring begins, it doesn’t reverse.

What Happens When You Look for It

In California, physicians say the pattern emerged gradually.

Robert Harrison, an occupational medicine physician at the University of California-San Francisco, helped identify the of engineered stone silicosis cases in California in 2019 after several workers from the same countertop fabrication shop died or were diagnosed with the disease. He described the crisis as “the largest outbreak of silicosis in decades.” What initially appeared as isolated cases of unexplained lung scarring in young men resolved into a recognizable occupational epidemic once work histories were examined.

Jane Fazio, a pulmonologist at UCLA, recalls seeing advanced fibrosis in otherwise healthy workers. “They have families. They were working full-time,” she said. Some experienced respiratory failure within a few years.

When doctors compared work histories, the pattern became unmistakable: Many of the men had worked in small shops cutting and polishing engineered stone countertops.

Sheiphali Gandhi, an occupational and environmental pulmonologist at UCSF, warned that the true burden remains uncertain. “We’re missing cases,” she said. “There’s no national surveillance system for this.”

California designated silicosis a reportable disease . Since 2019, statewide surveillance has identified hundreds of cases linked to engineered stone. The numbers probably underestimate the toll, though makes the illness visible.

Outside California, there is no comparable tracking.

Early Warnings

California was not the first place this happened.

The earliest modern alarm came from Israel. Caesarstone, a company founded on a kibbutz in the late 1980s, helped popularize quartz countertops globally.

Israeli physicians began in young countertop workers as early as 1997.

“We had never seen this before,” said Mordechai Kramer, a retired pulmonologist who previously worked at Rabin Medical Center in Israel. “In classic silicosis, you expect long exposure, decades. Here, it was much shorter.”

Several patients required lung transplantation.

Despite the warning signs, the market continued to expand.

Australia confronted the same pattern in the late 2010s.

Rather than wait for sporadic diagnoses, Australian regulators launched systematic CT-based screening of artificial-stone workers. Disease prevalence was far higher than anticipated.

Ryan Hoy, a respiratory physician and occupational health researcher at Australia’s Monash University, described severe disease in workers with relatively short exposures.

Authorities examined whether wet cutting, ventilation, and respirators could reduce exposure sufficiently. They ultimately concluded that even with controls, fabrication of high-silica engineered stone posed unacceptable risk.

In 2024, Australia prohibited the manufacture, supply, and installation of engineered stone containing high levels of crystalline silica. Manufacturers pivoted toward lower- and zero-silica formulations.

In the United States: Who’s To Blame?

Fabrication in the U.S. continues under OSHA’s silica standard, which relies on exposure limits, wet cutting, ventilation, and respiratory protection. Manufacturers argue that compliance works and that the problem lies with shops that fail to follow the rules.

OSHA first adopted silica limits based on research from mining, quarrying, and foundry work. Although the agency updated the rule , it regulates crystalline silica broadly and does not distinguish between natural stone and high-silica engineered quartz.

The regulatory debate has now spilled into Congress. , introduced in September by Rep. Tom McClintock (R-Calif.), would largely shield manufacturers and distributors of engineered stone from civil lawsuits arising from the manufacture or sale of their products. McClintock’s office did not respond to a request for comment.

The bill was the subject of a January .

Supporters of the measure argue that manufacturers should not be held liable for injuries caused by employers who fail to follow OSHA standards. Opponents warn that removing litigation pressure would eliminate one of the few mechanisms capable of driving product reform if the material itself cannot be safely handled.

Michaels, the former OSHA official, sees the stakes as historical. “Litigation drives change,” he said, pointing to past battles over asbestos and tobacco.

Plaintiffs’ attorneys argue that compliance with the OSHA silica standard does not eliminate risk.

“It’s not a few bad actors,” said Raphael Metzger, a product liability attorney who has filed roughly 200 silicosis-related injury cases and a class action seeking medical monitoring. He said the issue is the product’s composition, not isolated regulatory noncompliance.

James Nevin, a tort attorney representing workers in silicosis cases, framed the congressional debate as a fight over accountability. “When it comes to causation, there’s no question,” he said, arguing that the wave of cases explains why manufacturers are now seeking what he calls “a manufacturer bailout.”

In mid-2025, Caesarstone US introduced its first products containing less than 1% silica. In response to questions, Irene Williams, a spokesperson for Caesarstone, said, “The company is not responding as these are matters of pending litigation.”

The U.S. engineered stone market is dominated by a handful of large brands — including Caesarstone, Spain-based Cosentino, and U.S.-based Cambria — while the volume of slabs imported from Asian manufacturers is growing.

Cosentino, too, is moving to low-silica products: “One third of the portfolio, including most new collections, contain less than 10% of crystalline silica,” said Kamela Kettles, a Cosentino spokesperson. “Cosentino will not be providing additional commentary at this time,” she said.

Commenting on behalf of Cambria, Mark Duffy, a communications consultant for the company, wrote, “Reckless employers are criminally violating the law, exposing workers to deadly working conditions.” He added that engineering and administrative controls, when properly used, are effective in reducing exposures below OSHA limits and said Cambria maintains exposures below the OSHA Action Level in its own facilities.

While Caesarstone and Cosentino are headquartered overseas, Cambria is based in Minnesota. Its chief executive, Marty Davis, has been a major Republican political donor, to President Donald Trump’s election campaigns as well as to other Republican candidates and political action committees, according to federal campaign finance records. Davis has also contributed to the campaign of Rep. Brad Finstad (R-Minn.), a co-sponsor of the legislation. Finstad’s office did not respond to a request for comment.

Nevin, the attorney, said the bill would give manufacturers “free rein” from civil liability.

He also questions whether regulatory enforcement alone can address the problem. Even before the Trump administration’s funding and staffing cuts, “you had a better chance of being struck by lightning than being visited by OSHA,” he said, arguing that inspections are too infrequent to prevent disease in an industry composed largely of small shops.

Breathing on Borrowed Time

For González, the debate arrives after the fact. The dust he inhaled has already reshaped his life.

And Reyes’ transplanted lungs may last years, but not decades. The median survival time for transplanted lungs is about eight years, UCSF’s Gandhi said.

Reyes said he hopes people shopping for countertops understand that buying artificial stone “will harm the worker. The one who cuts it, the one who manufactures it.”

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Bill Cassidy offered jabs to thousands of inmates at Louisiana’s maximum-security prison in the early 2000s. A decade before that, he set up vaccine clinics in middle schools, a model as a success.

“He got that whole generation immunized in East Baton Rouge,” said Holley Galland, a retired doctor who worked with Cassidy vaccinating schoolchildren.

About the same time, a lawyer and environmental activist with a famous last name was starting to build the loyal anti-vaccine coalition that, two decades later, would move President Donald Trump to nominate him as the nation’s top health official.��

Today, a year after now-Sen. Cassidy warily cast the vote that ensured Robert F. Kennedy Jr.’s ascension to that role, the Louisiana Republican’s life’s work — in medicine and in politics — is unraveling.��

Newborn hepatitis B vaccination rates in the U.S. had plunged to 73% as of August, down 10 percentage points since a February 2023 high, published in JAMA last month. In December, the Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices — remade by Kennedy — voted to revoke a two-decade-old recommendation that all newborns get the shot.

The next month, Trump endorsed U.S. Rep. Julia Letlow, a Cassidy challenger in what’s shaping up to be a competitive Republican Senate primary. Letlow’s foray into politics began in 2021 when she took the seat won by her husband, left vacant after he died from covid.

���ϳԹ��� News made multiple requests for comment from Cassidy over three months. His staff declined to make him available for an interview or provide comment. Letlow’s campaign did not respond to requests for comment.

Rise of the Skeptics

As the May primary nears, some Louisiana doctors are worried they’ve begun a long trek down a dark road when it comes to vaccine-preventable diseases.

Last year, on the day Kennedy was sworn in a thousand miles away in Washington, Louisiana’s health department stopped promoting vaccines, halting its clinics and advertising. Its communications about an ongoing whooping cough outbreak in the state have nearly ceased. It took months for the state to announce last year that two infants had died from the illness. A Louisiana child’s death from the flu was confirmed this January, and a couple of cases of measles were reported last year.

Spokespeople for the Louisiana Department of Health did not respond to questions.

“It’s so hard to see children get sick from illnesses that they should have never gotten in the first place,” said Mikki Bouquet, a pediatrician in Baton Rouge. “You want to just scream into the void of this community over how they failed this child.”

As anti-vaccine forces have taken hold of the state and federal health departments, Cassidy has lamented the consequences.

“Families are getting sick and people are dying from vaccine-preventable deaths, and that tragedy needs to stop,” he last fall.

But while it is Cassidy’s duty as chairman of the Senate’s Health, Education, Labor, and Pensions Committee to conduct oversight of the health department, Kennedy has appeared before the committee just once since he was confirmed.

The secretary speaks at a “regular clip” with Cassidy, said Department of Health and Human Services spokesperson Andrew Nixon.

Kennedy’s department has elevated Louisiana vaccine skeptics. The state surgeon general who terminated Louisiana’s vaccine campaign, Ralph Abraham, was named deputy director of the CDC. (He left the role in February.) And Kennedy handpicked Evelyn Griffin, a Baton Rouge OB-GYN who later replaced Abraham as the state surgeon general, for an appointment to ACIP. Griffin the covid vaccine had dangerous side effects for young patients.

Research has shown that serious side effects from the vaccinations are rare and that the shots saved millions of lives during the pandemic.

Cassidy “has really not had an outspoken chorus of policy supporters” when it comes to inoculating people, said Michael Henderson, a professor of political communication at Louisiana State University. “There’s not a lot of political stakes in doing that in Louisiana if you’re a Republican.”

Louisiana Gov. Jeff Landry reprimanded Cassidy after the senator called for the state’s health department to ease access to covid shots.

“Why don’t you just leave a prescription for the dangerous Covid shot at your district office and anyone can swing by and get one!” the Republican in September.

On ‘Eggshells’ in the Exam Room

On a sunny February afternoon, as Carnival floats were readied to parade the streets of New Orleans, pediatrician Katie Brown approached a basement apartment on a well-child visit. Cowboy boot pendants dangled from her ears, and a pack of diapers were clutched tightly in her arms.

The patient, a toddler who waved at the sight of visitors, was up to date on her immunizations. But when Brown suggested a covid vaccine, the girl’s mother quickly declined, noting she had never gotten the shot either.

Many of Brown’s young patients — seen through Nest Health, which offers in-home visits covered by Louisiana’s Medicaid program — are current with their vaccines. Brown said home visits make parents more comfortable immunizing their children, but she’s still spending more time these days explaining what they’re getting in those shots.

“After covid vaccines, that’s when some people just decided, ‘I don’t know if I trust vaccines, period,’” she said.

Across the state, vaccination rates have declined since the pandemic, falling short of the levels scientists say are required to achieve herd immunity for some deadly diseases, including measles. About have had the recommended two doses of the measles, mumps, and rubella vaccine.

The New Orleans Health Department has tried to step up with a $100,000 immunization campaign of its own, with clinics and billboards, during this year’s flu season, said Jennifer Avegno, the department’s director.

But the state’s absence is felt. Other parishes across Louisiana have not taken similar action, leaving doctors largely on their own to promote immunizations.

“I’ll say that with certainty,” Avegno said. “It’s been a blow to not have a statewide coordination.”

A day after Brown’s home visit, a mother in Baton Rouge shook her head when Bouquet offered a flu shot for her 10-year-old daughter in an exam room.

In the waiting room, parents could thumb through a handmade book that offers scientific facts to counter fears about vaccines. A laminated guide placed in each exam room explained the benefits of each recommended immunization.

Bouquet said she’s experimenting with ways to educate parents about vaccines without seeming overbearing. She still hasn’t figured out a surefire formula. Some parents now shut down any vaccine talk, and she worries others skip scheduling appointments to avoid the topic entirely.

“We’re having to walk on eggshells a bit to determine how to get that trust back,” Bouquet said. “And maybe these discussions can come up in future visits.”

Pro-Vax, Pro-Anti-Vaxxer

Children’s Health Defense, the nonprofit that Kennedy helmed, worked to erode vaccine trust during the pandemic — falsely claiming, for instance, that covid shots cause organ damage and that polio vaccines were at fault for a rise in the disease. The organization also sued the federal government over the mRNA-based covid shots, hoping to get their emergency authorizations from the Food and Drug Administration revoked.

When Kennedy came before Cassidy’s committee in January 2025 as Trump’s nominee for health secretary, the senator-doctor saw risks if the prominent anti-vaccine lawyer was confirmed.

Cassidy described a time years ago when he loaded an 18-year-old onto a helicopter to get an emergency liver transplant. The young woman had acute hepatitis B, an incurable disease that is spread primarily through blood or bodily fluids and can lead to liver failure.

It was “the worst day of my medical career,” he said, addressing Kennedy at the witness table in front of him. “Because I thought, $50 of vaccines could have prevented this all.”

Cassidy started in politics in 2006 as a state senator, winning election to the U.S. House two years later. When he first ran for the U.S. Senate, in 2014, he charmed Louisiana voters with campaign ads showing him , talking about his work with Hurricane Katrina evacuees and patients at Baton Rouge’s public hospital.

But some Republicans soured on Cassidy after he voted to convict Trump on an article of impeachment charging him with inciting the Jan. 6, 2021, insurrection at the U.S. Capitol.

The impeachment vote has hampered Cassidy’s reelection bid this year in a state where Trump captured 60% of the vote in 2024.

“Cassidy has things that are associated with his name: the impeachment vote in 2021,” Henderson said.

Cassidy’s loyalty to Trump was tested again with Kennedy’s nomination. Cassidy said he endorsed Kennedy after extracting pledges that he wouldn’t tinker with the nation’s vaccination program.

But since taking office, Kennedy has largely ignored those promises, and Cassidy hasn’t publicly rebuked him.

Former Texas congressman Michael Burgess served for years with Cassidy in the House, where they were founding members of the GOP Doctors Caucus, started in 2009. He said Cassidy’s discomfort with some of Kennedy’s actions is palpable.

“You could hear some of the pain in Sen. Cassidy’s voice when he was addressing that the secretary wanted to drop the birth dose of hepatitis B,” Burgess said. “You got cases to nearly zero on hepatitis B. It was painful to him to think about taking this away from the population.”

Retired Baton Rouge nurse practitioner Elizabeth Britton has switched her party affiliation so she can vote in the closed Republican primary for Cassidy, with whom she vaccinated inmates decades ago.

She doesn’t quite understand the “mess” in Washington that resulted in the senator voting to confirm a vaccine critic.

Watching Kennedy and others promulgate doubts about shots she once administered has made her “profoundly sad” and “angry,” she said, but most of all worried.

“It puts a pit in my stomach, because I know the consequences of people not getting the vaccine,” she said.

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The midterm elections are months away, yet changes at the Department of Health and Human Services suggest the Trump administration is focusing on how to win on health care, which remains a top concern for voters. Facing growing concern about the administration’s actions on vaccines in particular, the Food and Drug Administration this week reversed course and said it would review a new mRNA-based flu vaccine after all.

And some top HHS officials are changing seats as the Senate prepares for the long-delayed confirmation hearing of President Donald Trump’s nominee for surgeon general, Casey Means.

This week’s panelists are Mary Agnes Carey of ���ϳԹ��� News, Tami Luhby of CNN, Shefali Luthra of The 19th, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• After a week of bad press, the FDA announced it would review Moderna’s application for a new flu vaccine. Yet the agency’s original refusal fits a pattern of agency decision-making based on individual officials’ views rather than set guidelines — and reinforces a precedent that’s problematic for drug development.
• Those caught up in the latest HHS leadership shake-up include Jim O’Neill, who, as acting director of the Centers for Disease Control and Prevention, signed off on changes to the childhood vaccine schedule. His removal from that role comes as the White House is showing more interest in controlling health care messaging ahead of the midterms — and as polling shows Americans are increasingly concerned about federal vaccine policy.
• Senators will hear from Means next week as they consider her nomination as surgeon general. Means, a key figure in the “Make America Healthy Again” movement, is expected to be asked about her medical credentials and past, problematic claims about medicine.
• And while early numbers show that Affordable Care Act marketplace enrollment has not dipped as much as feared, Americans are still absorbing the rising cost of health care this year. The collapse of congressional efforts to reach a deal on renewing enhanced premium subsidies could be an issue for voters come November.

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

Mary Agnes Carey: Politico’s “,” by Robert King and Simon J. Levien.��

Lauren Weber: NiemanLab’s “,” by Laura Hazard Owen.��

Tami Luhby: The City’s “,” by Claudia Irizarry Aponte and Ben Fractenberg.��

Shefali Luthra: NPR’s “,” by Jasmine Garsd.��

Also mentioned in this week’s episode:

• Politico’s “,” by Lauren Gardner and Tim Röhn.
• The Washington Post’s “,” by Rachel Roubein, Lena H. Sun, and Lauren Weber.
• CNN’s “,” by Meg Tirrell.
• The Washington Post’s “,” by Lauren Weber and Rachel Roubein.
• KFF’s “,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.
• CNN’s “,” by Adam Cancryn.
• Health Affairs’ “,” by Katie Keith.
• Health Affairs’ “,” by Katie Keith and Matthew Fiedler.
• Health Affairs’ “,” by Katie Keith.

[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.]��

Mary Agnes Carey:��Hello from��KFF��Health News and WAMU Public Radio��in Washington, D.C. Welcome to��What the��Health?��I’m��Mary Agnes Carey, managing editor of�����ϳԹ��� News, sitting in for your host, Julie Rovner.��I’m��joined by some of the best and smartest health reporters covering Washington.��We’re��taping this week on Thursday, Feb.��19, 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’re��joined via video conference by Lauren Weber of The Washington Post.��

Lauren Weber:��Hello,��hello.��

Carey:��Tami��Luhby of��CNN.��

Tami Luhby:��Glad to be here.��

Carey:��And Shefali��Luthra��of��The��19th.��

Shefali��Luthra:��Hello.��

Carey:��Let’s��start today with the Food and Drug Administration. The FDA has now agreed to��review��Moderna’s application for a new flu vaccine, reversing the agency’s decision from just a week ago to reject the application because it said the company’s research design was flawed. What happened?��

Weber:��I think we��got to take a step back, and we got to think about this in the lens of the midterms, because, of course, we got to talk about��the midterms on this��podcast.��

Carey:��Of course.��

Weber:��But what��we’ve��seen, really, since the beginning of January, after��[Health and Human Services Secretary] Robert F.��Kennedy��[Jr.]��overhauled the vaccine schedule under Jim O’Neill, is a lot of changes. And part of that, I think, is due to a big poll that came out by a Republican pollster, the Fabrizio poll, that��indicated��that some of the vaccine changes were making voters nervous.��Basically, it��told the president, and it told Republicans,��that��maybe you��shouldn’t��mess with the vaccine schedule as much. And ever since that poll has��kind of reached��the ether,��you’ve��seen a lot more tamping down of conversation about vaccines.��So��you’ve��seen Kennedy stay a lot more on��message��about food. And then you saw what happened this past week with the��Moderna flu reversal. So what ended up happening is the FDA came out and said they were not going to review the��Moderna flu vaccine, which was an mRNA vaccine, which, as we all remember, was the vaccine technology that became quite famous during the covid pandemic that��[President Donald]��Trump really championed in his first term.��So��the FDA came out and was like,��You��know what,��we’re��not going to review this��—��which was a huge issue. It caused massive shock waves through the vaccine industry. A lot of vaccine and pharma insiders��said this could really��dampen their ability to develop future vaccines, because they felt like this action was made without enough explanation.��And after a week of��pretty much��bad headlines and bad press, the decision was reversed.��And Lauren Gardner from Politico had a��, along with a colleague��[Tim��Röhn], where she pointed out that this reversal happened after a meeting with the FDA head in the White House,��where Trump expressed some concern over the handling of vaccines. So I think this reversal that you’re seeing fits into the broader picture of the unpopularity of Kennedy’s push around vaccines, and I expect that, considering their hesitancy, along with a really contentious midterms race, we may see more pushback to whether or not Kennedy is able to continue on his push against vaccines.��

Carey:��So,��what are the implications for drug and vaccine manufacturers in the months ahead?��How will this��impact��them? Does it provide stability and reassurance that if you spend billions of dollars on drug development,��you’re��not going to be stopped by federal agencies?��

Weber:��I think��the reversal��maybe does, but,��I mean, certainly��they’re��still spooked. I mean, the reality is that��it’s��a little unclear. Obviously, there was a pressure campaign to reverse this, and it has been reversed.��But the current makeup of the FDA, with��Vinay Prasad,��has led many to be unclear on what will and will not get approved.��Under this HHS administration,��there’s��been a big push for placebo-controlled trials and so on, and��somewhat a��shifting of expectations. And I think that while the reversal will settle feelings a bit, you also��…��this is on a backdrop of hundreds of millions of dollars being canceled in mRNA vaccine contracts.��So��I think��there’s��a lot of unease, and��there’s��a lot of fear that this could continue to��[dampen]��vaccine development.��

Luthra:��I think,��to add to what Lauren’s saying, it’s just pretty hard to imagine that after the past year and change that anything could really feel predictable if you are in the business of developing biopharmaceuticals in any form.��It’s��just so��much��has changed, and so much really seems to depend on the whims of where the politics are and where the different players are and��who’s��carrying influence.��It’s��just hard��to really think about how you would want to invest��—��right?��—��a lot of money in developing these products,��where you may or may not have success. But one other thing that I am just so struck by in this whole episode is there is a lot of tension in��different parts��of the health policy��community groups around how the FDA is approaching different policies.��And one area I’ve been thinking about a lot is where the FDA has been on abortion is a source of real frustration for a lot of abortion opponents, and seeing this episode play out if the White House did get involved, I think it raises a really interesting question for people who oppose abortion and want the FDA to take a harder look at it.��Are they going to expect similar movement from the��president, similar intervention,��or conversations from the White House?��And if they don’t get that, how does��that affect, again,��just another issue that feels really salient as we head into a midterm election that gets closer and closer.��

Carey:��And��I think you��know, this is a sign of what health care might mean and play in the fall election, so��we’ll��keep our eye on that. Lauren, you just��mentioned recently��some changes at the Department of Health and Human Services.��We’re��going to shift from the FDA to HHS, where��there’s��been a shake-up in top leadership.��Jim O’Neill, who had served as the HHS deputy secretary and as acting director for the Centers for Disease Control and Prevention, is leaving those positions. Other agency changes include Chris Klomp, who oversees Medicare, being named��chief counselor at HHS, where he will oversee agency operations.��And National Institutes of Health. Director Dr.��Jay��Bhattacharya will also serve as acting director of the CDC.��Clearly, there��is a lot going on here. Why are these changes happening now?��

Weber:��So��our understanding��from��reporting��is that the White House wanted to shake things up before the midterms. I mean, if you know��—��kind of what I alluded to in my last comments is, you know, Jim O’Neill was the person who signed off on the childhood vaccine schedule. I mean, his name was plastered all over that in January, and now��he’s��been shipped off to be head of the National Science Foundation, but certainly not as high profile of an HHS deputy role or CDC acting director. From our understanding,��that’s��because the White House wants a bit tighter control over messaging and overall��thrust��of HHS heading into the midterms.��And I think��it’s��noticeable��— you mentioned Chris Klomp,��I mean,��let’s��note where he came from. He came from��CMS. You know,��you’re��seeing a fair amount of folks from CMS,��from��“Oz Land,”��come into HHS and exert seemingly, it��looks like,��more power, based on the White House’s judgment, along with Kennedy. Kennedy is said to have also signed off on these changes.��But it remains to be seen��how this will��impact��HHS focus going forward.��

Carey:��So��while��we’re��talking about HHS,��let’s��look at��Secretary Robert F.��Kennedy Jr.’s first year in office. There’s so much we could talk about:��the firing of members of the Advisory Committee on Immunization Practices, also known as ACIP,��and the addition of several members who oppose some vaccines;��major changes in the childhood vaccine schedule, changes that the American Academy of Pediatrics has called��“dangerous and unnecessary”;��pullbacks of federal funding for vaccination programs at local departments that were later reversed by a federal judge;��the firing of Senate-confirmed CDC director Susan��Monarez, who had only served��in��that position for less than a month;��new dietary guidelines aimed at getting��ultra-processed foods out of our diets, but adding red meat and whole milk��—��foods that many nutritionists have steered people away from. This is an open question for the panel:��What do you make of Kennedy’s tenure so far?��

Luhby:��I mean,��he’s��certainly been changing the agency in��ways that we somewhat��expected��and, you know, other ways that we��didn’t. I will let the others speak to some of the��vaccine and others. But one thing��that’s��also notable is the makeup of the agency.��They’ve��laid off or prompted many people to quit or retire. You know, there’s major staffing changes there as well, and��there’s��a large brain drain, which has concerned a lot of people.��

Weber:��Yeah,��I’ll��chime in and say, I mean, I think public health officials have been horrified by his first year in office. There is a growing fear that,��obviously,��his many vaccine changes could have long-term consequences for vaccine��[uptake]��and an increase in vaccine hesitancy.��There’s��been a lot of concern among public health officials and experts that Congress really has not stepped in to stop any of this.��That said,��there are currently��…��there’s a lawsuit the AAP has brought against these changes, which could have an outcome in the coming days that may or may not impact whether or not they’re going forward.��You mentioned how he reconstituted ACIP, the��federal��advisory��committee on vaccination.��You know, what’s really interesting is, right now, we’re unclear if that ACIP meeting is still happening at the end of February.��And again, it��goes��back to my point of vaccines seem to be,��after this polling, not where Republicans want to be talking. And��so��a lot of Kennedy’s primary concern, even though he talked a lot about food in his first year in office,����of his social media, and he talked way more about food than he talked about vaccines. But his focus,��and ultimately, what��he was able to upend a lot of,��was vaccine infrastructure. And I think this year we will��see.��More of the impacts of that, and also whether or not he’s allowed to make some of these changes, if there is enough backlash, or if there is enough pushback, or if there is enough political detriment that pushes back on what he has done.����

Luthra:��And I think��a really important��thing for us to think about, that Lauren just alluded to, is a lot of the consequences of this first year are things we will be seeing play out for many years to come. There has been this��dramatic upending of the vaccine infrastructure. We have seen medical groups try and step in and try and offer independent forms of authority and��expertise��to give people useful medical information. But��that’s��a very big��role��to fill��in the context of this tremendous brain drain. And I think what we are waiting to see is, how does that translate to decision-making on the individual level and on the aggregate level?��Do people feel like they can trust the information��they’re��given? Do they get the vaccines they would have gotten in the past for their families, for their children? Is it easier? Is it harder?��Does��those difficulties matter in the end?��And��that’s��the kind of impact and consequence that we can talk about now, but that��we’ll��only really understand in years to come when we look at whether and how population health outcomes shift.��

Carey:��Sure.��And��so��we’re��talking about, you know, Lauren and the full panel��has��made this clear, talking about some of the shifts in the messaging out of HHS as we head into the fall elections.��Lauren, if I heard you correctly, you were saying on Secretary Kennedy’s social media feeds, he had talked a lot more about food than vaccines,��but yet, the vaccine message seems to have resonated more.��So,��as you look towards the fall elections, right?��We’re��talking about��affordability,��in a moment��we’re��going to be talking about the Affordable Care Act.��We’ve��read a lot��…��and folks have talked on this podcast about drug prices. Are the steps enough that are happening here on the messaging? Is it enough to��focus��the message, and is it going to land with voters, or will they be looking at it in��a different way?��

Weber:��And will he stay on message?��

Carey:��Exactly.��

Weber:��I’ve��watched,��I’ve��watched hundreds of hours of Kennedy speaking, and the man,��when let rip��—��I mean, recently he said in a podcast, he talked about snorting��cocaine��off a toilet seat. I mean, that was something that came up in a long-form conversation. Obviously,��there’s��more context around it.��But he is known for��speaking off the cuff. And so, I think it remains to be seen if, if they are able to see how that messaging��—��in order to talk about drug prices, talk about affordability��—��if that continues to play for the midterms, and if it doesn’t, what the consequences of that may be. I think��it’s��important��too��…��I mean, last night, Trump issued an executive order that is aimed at encouraging the domestic production of glyphosate, which is a really widely used weed killer that has been key in a bunch of health lawsuits around��Roundup and other pesticides, is a real shot against,��across the bow for the MAHA��[“Make America Healthy Again”]��crowd, and it puts Kennedy in a tough position. I mean, he’s issued a statement saying he supports the president, but I mean, this is a man who’s advocated against glyphosate and pesticides for years and years and years, and it’s really divided the MAHA movement that,��you know��…��many folks who said they joined MAHA,��many��MAHA��moms, pesticides are a huge issue, and this could fracture this movement,��you know,��that��, just as they’re starting to try to get on message.��

Luhby:��One thing also that my colleague, I wanted to talk about, my colleague Meg Tirrell did a��fantastic piece last week��about Kennedy’s first year, and��it’s��headlined��“.”��So I think that that’s one thing that also we have to look at is that Trump had said that there would be historic reforms to health and public health, and that, you know, it would bring back people’s trust and confidence in the American health��care systems after covid��— and you know, after what he criticized the Biden administration for.��But��also��it shows that actually,��if you look at��recent polling from��KFF, it shows that trust in government health agencies has plummeted over the last year. So��that’s��going to be something that they also��will��have to contend with, both in the midterms and going forward.��

Carey:��We’ll��keep our eye on those issues now and in the months ahead. And right now,��we’re��taking a quick break.��We’ll��be right back.��

All right,��we’re��back and returning to the upcoming confirmation hearing for Dr.��Casey Means.��She’s��President Trump’s nominee to be��surgeon��general.��The Senate Health, Education, Labor��&��Pensions, or HELP,��Committee, as it is known, will consider that nomination next Wednesday, Feb.��25.��You might remember that��Means’��confirmation hearing was scheduled for late October, but it was delayed when she went into labor.��She was expected then to face tough questions about her medical credentials and her stance on vaccines, among other areas. Means is known as a wellness influencer, an entrepreneur, an author,��and a critic of the current medical system, which she says is more focused on managing disease than addressing its��root causes. If confirmed as��surgeon��general, she would oversee the more than 6,000 members of the U.S.��Public Health Service, which includes physicians, nurses,��and scientists working at various federal agencies. What do you expect from the hearing,��and what should people look for?��

Weber:��So��I did a����last fall. And what we learned,��in��really digging into reading her book, going through her newsletters, going through her public comments, is that this is someone who left the medical establishment. She left her residency near the end of��it, and��has really promoted and become central in��MAHA��world due to her book,��Good��Energy, which, you know, some folks in politics referred to as the��bible of��MAHA.��So��if��confirmed, I think she could play a rather��large role��in shepherding the MAHA movement. But I think��she’ll��face a lot of questions from folks about her medical license and practicing medicine.��So��Casey��Means currently has a medical license in Oregon that she voluntarily placed in��inactive status, which, according to the Oregon State Medical Board, means she cannot practice medicine in the state as of the beginning of 2024.��Additionally, she has received over half a million dollars in partnerships from various wellness products and diagnostic companies, you know, some of which in her disclosure forms talked about elixirs and supplements and so on. And I expect��that��will get a lot of scrutiny from senators as well. And I will just note,��too, I think it’s important to look at a passage from her book that a lot of public health experts that we spoke to were a bit concerned about, because she wrote in her book that��“the ability to prevent and reverse”��a variety of ailments, including infertility and Alzheimer’s,��“is under your control and simpler than you think.”��And statements like that really��worried��a fair amount of the public health experts I spoke to. [They]��said she would have this��bully��pulpit to speak about health, but��they’re��concerned that she��doesn’t��underpin it with enough scientific reasoning. And��so��we’ll��see if those issues and,��also obviously having to answer for Kennedy and the HHS shake-ups and Kennedy and vaccines��—��I’m��sure a lot of that will come up as well. It should��…��I expect it to be a hearing with a fair��amount��of fireworks.��

Carey:��Do you think the fact that��…��they’ve��scheduled this hearing means that they have the votes for confirmation? Or is it simply a sign that the administration just wants to get moving on this, or shift a bit from some of the hotter issues that have happened recently?��

Weber:��I mean, this is a long time for the American public to not have a surgeon general.��So��I mean,��I think they��were hoping to get this��moving, to get her in the position.��As I said, she could be��a very strong��voice for��MAHA,��considering her book underpins a lot of the MAHA movement. I think,��in general, Republicans do have the votes to confirm her, but it just depends on how much they are agitated by her medical credentials and some of her past comments. I think we could see some fireworks, but, you know, we saw fireworks��in��the Kennedy hearing, and he got approved. So, you know,��I think it��remains to be seen what happens next week.��

Carey:��Sure. Well, thanks for that.��Let’s��move on to the Affordable Care Act,��or the ACA.��More Americans than expected enrolled in ACA health plans for this year, even though the enhanced premium subsidies expired Jan.��1. But��it’s��unclear if these folks are going to keep their coverage as their health care costs increase. Federal data released late last month showed a��year-over-year��drop of about 1.2 million enrollments across the federal and state��marketplaces. But these aren’t the final numbers, right?��

Luhby:��No.��What’s��going to happen is people have time��now,��they still��have to��pay their premiums. The numbers that were being released were the number of people who signed up for plans.��So��what experts expect is that,��over time, people who receive their bills may not pay them.��A��lot of people,��remember, get automatically enrolled, so they may not be even aware of how much their premiums are going to increase until they actually get their bill.��So��they may not pay the bills, or they may try to pay the bills for��a short time��and find that��they’re��just too high. Remember that the premiums,��on average, premium payments were expected to increase by 114% according to��KFF. So that just may be unmanageable. The experts��I’ve��spoken to expect that we should get better numbers around April or so to see what the numbers of actual enrollees are.��Because people,��actually, if they don’t pay their premiums, can stay in the plants for three months, and then they get washed out.��So��we’re��expecting to see if, hopefully,��CMS will release it, but��we’re��hoping to see better numbers in April.��

Carey:��Shefali, I know you closely follow abortion. How much has the abortion and the Hyde Amendment played in all these discussions about Congress trying to find,��if they really want to find,��a resolution to this subsidy issue?��

Luthra:��It’s��so interesting. A lot of anti-abortion activists have been quite firm. They say that there cannot be any permission that ACA-subsidized plans cover abortion if the subsidies are renewed.��That, of course, would go��against laws in some states that require those claims to cover abortion using state funds, not using federal funds, because of the Hyde Amendment.��The president��relatively recently, even though it feels like a lifetime, said,��Oh, we should be flexible on this abortion restriction that anti-abortion activists want. They were, of course, furious with him and said,��We��can’t��compromise on this.��This is��very important��to our base.��And they view it as the federal government making��abortion��more available. And��so��I think��it’s��still an open question as to whether this will��ultimately be��a factor.��It’s,��to your point, not really clear that lawmakers are anywhere close to coming to a deal on the subsidies.��They very well may not,��right?��They still��have to��figure out funding for��DHS��[Department of Homeland��Security].��They have many other things that��are keeping��them quite occupied.��But this is absolutely something that abortion opponents will remain very firm on. And I mean, they��haven’t��had the victories they really would have hoped for in this administration so far, and I think��it’d��be��very difficult��for them to take another loss.��

Carey:��So,��Lauren,��what’s��going on with the discussions on Capitol Hill about potentially extending the enhanced ACA subsidies?��We’re��hearing reports from negotiators that the deal might be dead. How would that impact voters in November?��

Weber:��I think people should be interested in getting a solution, because I think��—��talk about hitting voters’��pocketbooks and actual consequences. I mean, this seems like this is a thing��that’s��only going to continue to pick up speed. I was fascinated��…��I know you want to talk more about that great��Politico piece that dives into the��ticktock of how this all happened. But��…����

Carey:��Yes,��great story.��

Weber:��I think, in general, the ACA��subsidies fall into a trap of most of the contentious two-party system that we’re in right now, where different issues that are issues that we can’t touch end up blowing up problems that affect��everyday��Americans in their day-to-day, and then no action gets made, and then we end up closer to the midterms,��where people actually may or may not want to do something.��So��I’m��not sure that people��don’t��want to do something.��I’m��just not sure that��there’s��enough consensus around what that would be, and in the meantime, actual people are feeling the pain.��So��we’ll��see how that continues to play out.����

Carey:��Sure.��

Luthra:��I��just��wanna��say, just to add one more point to what Lauren mentioned about political pressure and backlash.��The����shows that health��care costs are voters’��No. 1��affordability concern. And we know there was that��brief moment��when the��president said,��We��should be the affordability party,��not��Zohran Mamdani��and the Democrats. And��so��I think that’s really interesting, right? Are they able to stick to that? Are they able to address this policy that voters are saying is such a high priority for them, because it is so visceral, right? You know what��you’re��paying, and you know that your bills are higher than last��year.��And if they can’t, is that the kind of thing that actually does shape how voters react in November, especially given so many other��cost-of-living��concerns many of them have.��

Luhby:��Right, well, one of����about how the Trump administration’s messaging,��or what��they’re��suggesting that the GOP message for the midterms is lower drug prices, which is something that they have been��very active��on.��So��they��don’t��want to discuss the exchanges, and��we’ll��talk a little bit about the new rule that��they’ve��just proposed.��But yeah, I think the administration is going to focus on health care.��They’re aware of the concerns of health care, and their message is going to be��“most favored nation,”��TrumpRx,��and the other efforts that they’ve made to lower drug prices, which is something,��of course, Trump was also very focused on in his first term as well, but to less effect.��

Carey:��Speaking of that rule, Tami, can you tell us more about that?��

Luhby:��Sure.��Well, CMS wants to make sweeping changes for ACA plans for 2027.��It issued a proposed rule last week that would give more consumers access to catastrophic policies. Now these are policies that have��very high��deductibles and��out-of-pocket costs,��generally offer��skimpier benefits, but,��importantly��for the administration, have lower premiums. The proposed rule would also repeal a requirement that exchanges offer standardized plans, which are designed to make it easier for people to compare options. It would ease network adequacy rules and require, as we were just talking about, require more income verifications to get subsidies and crack down on brokers and agents who,��we’ve just discussed about, you know, have been��…��some of whom have been complicit in fraud. The goal is to lower the ACA premiums and give people more choice,��according to CMS. Premiums, of course, have been a big issue, as we discussed��…��because of the increase in monthly��payments due to the��expiration��of the subsidies. But notably, the agency itself says that up to��2 million people��could lose ACA coverage because of this proposed rule.��It’s��a sweeping,��577-page rule, I think?��And if you want to get more information, I highly recommend you read Georgetown’s Katie Keith’s��, which was published in Health Affairs.��

Carey:��All right, well,��we’ll��have to keep our eye on that rule and all the comments that I��am��sure will come in.��

Luhby:��Many comments.��

Carey:��Many.��I’m��also intrigued about some of the GOP talking points on potential fraud in the program. For example, the House Judiciary Committee has subpoenaed eight health insurers,��asking for information on their subsidized ACA enrollees and potential��subsidy-related��fraud. It has been a Republican talking point that��it’s��their��perception, for many Republicans, that there is a lot of fraud in the program that needs to be investigated. Is there any merit to the claim, and will this discussion of fraud shift away from this��really critical��affordability issue that��we’re��all talking about?��

Luhby:��Well, we know that there has been fraud in the program, particularly after the enhanced subsidies went into effect. I mean, even the Biden��administration released reports and information about brokers and agents that were��basically switching��people into different plans, switching them into low-cost plans,��enrolling them��in order to��get the commissions.��And��it’s��one��that��actually played��also into the argument on Capitol Hill about extending the subsidies,��whereas��the Republicans were very forceful about not having zero-premium subsidies, because they felt that this helped contribute to the fraud.��So��you know,��that’s��not an issue anymore, because the subsidies were not renewed, but both CMS and Congress are still focused on this idea of fraud with the subsidies.��

Carey:��All right, well,��we’ll��keep watching that now��and in the months��ahead.����

So��that’s��the news for this week. And before we��get to��our extra credits, we need to correct the name of the winner of our��Health��Policy Valentines contest. The winner is Andrew Carleen of Massachusetts, and thanks again to everyone who entered.����

All right, now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize a story that we read this week and think you should read,��too.��Don’t��worry if you miss it.��We’ll��post the links in our show notes. Lauren, why don’t you start us off this week?��

Weber:��Yeah, I have two pieces, a piece from��NiemanLab:��“.”��And then I also have one from my��publication��at��The Washington Post.��It’s��from Scott Nover.��The Atlantic’s��essay about measles was��gut-wrenching.��And some readers feel deceived. And for a little bit of background for anyone who��didn’t��read it, Elizabeth wrote a very striking, beautifully written piece in The Atlantic from the perspective of a mom who lost her child to measles after a fatal complication that can happen for measles. But the way it was written, a lot of people did not realize it was fiction, or creative nonfiction,��or creative��fiction to some degree.��And��so��it was written from the perspective like it was��Bruenig’s��story, but at the very end of the piece, and it turns out this was attached later,��after��publication, was an editor’s note saying this piece is based on interviews.��I��gotta��say, as,��when I initially��read it, as a savvy consumer, I initially was like,��Is��this her story?��until I got to the��editor’s��note at the end.��The��NiemanLab��reporting says that that��editor’s��note wasn’t actually even on the piece when it started.��I think this��is a fascinating question,��in general. I think that in an era where vaccine misinformation is rampant and the truth is important, it seems like having a pretty clear��editor’s��note at the top of this piece is essential.��But��that’s��just my two cents on that, and I thought both the discussion and the online discussion about it was really fascinating this week.��

Carey:��That’s��fascinating. Indeed. Tami,��what’s��your extra credit?��

Luhby:��My extra credit is titled��“,”��by��Claudia Irizarry Aponte and Ben��Fractenberg��in��The��City, an online publication covering New York.��We’ve��been having a major nurses’��strike in New York City. It’s, you know, notable��in��the size and number of hospitals and length of the strike, which has been going on already for over a month.��It’s��affected several large hospitals��—��Mount Sinai,��Montefiore,��and��NewYork-Presbyterian��—��with nurses demanding stronger��nurse-to-patient��staffing ratios, which, you know, has been a long-standing issue at many hospitals. Now, the interesting development is that the city uncovered a rift between��NewYork-Presbyterian’s��nurses��union and their leadership.��So��what happened is the nurses at Montefiore and Mount Sinai have recently approved their contracts��and are back to work, but the��NewYork-Presbyterian nurses did not approve their contract because the language differed on the staffing-ratio enforcement and did not guarantee job security for existing nurses. And what actually apparently happened is that the��union’s��executive committee rejected the contract, but the union leaders still forced the vote on it, which was,��actually,��ended��up voting down. So now the nurses have demanded a formal disciplinary investigation into the union��leaders for��forcing this vote. So more than 1,500 nurses��at��NewYork-Presbyterian signed the petition,��and more than 50 nurses delivered it to the New York State Nurses Association headquarters. One nurse told��The��City they are overriding our voices. The union president urged members not to rush to judgment. Now, the��NewYork-Presbyterian nurses remain on strike, which has lasted already for more than a month, and it’s going to be interesting to watch how this develops, especially because you have, obviously, the contentious negotiations between the hospital and the��nurses��union, but now you also have this revolt, and, you know, issues within the��nurses��union itself.��

Carey:��Wow, that is also an amazing story. Shefali?��

Luthra:��Sure. My piece is from NPR. It is��by��Jasmine Garsd. The headline is��“.”��And the story looks at something that we know from research happens, but on the ground in Minneapolis, of people concerned about��ICE��[Immigration and Customs Enforcement]��and immigration presence at medical centers, delaying important health��care that can be treatment for chronic ailments, it can also be treatment for acute conditions. And what I like about this story is that it highlights that this is something that is going to have consequences, even now with this surge of DHS law enforcement in Minnesota winding down.��The consequences of��missed��health��care can last for��a very long��time. And something I have heard often when just talking to immigrants and medical providers in the Minneapolis metropolitan area is exactly this fear that they��actually don’t��know what the coming weeks and months are going to bring.��They don’t know when they will feel safe getting health care again, when it will feel as if the consequences of this really concentrated federal blitz will be ameliorated in any way.��And I love that this story��takes that longer view and highlights that we are going to be navigating the medical effects of something so seismic and frankly��pretty unprecedented��for quite some time. And I encourage people��to read it.��

Carey:��Thank you for that. My extra credit is from Politico by Robert King and Simon��J. Levien, called��“.”��The piece is an inside look at why and how Congress��failed to��take action��on extending the enhanced Affordable Care Act subsidies, which led to the longest government shutdown��in U.S.��history and higher ACA premiums for millions of Americans.��

OK, that’s this week’s show.��As always,��thanks to our editor, Emmarie��Huetteman, and our producer and engineer,��Francis Ying.��A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts��—��as well as, of course,��kffhealthnews.org.��Also, as always, you can email us with your comments or questions.��We’re��at��whatthehealth@kff.org,��or you can find me on��X��.��Lauren, where can people find you these days?��

Weber:��On����and on��:��@LaurenWeberHP.��The��HP stands for��health��policy.��

Carey:��All right.��Shefali.��

Luthra:��On��Bluesky:����

Carey:��And Tami.��

Luhby:��You can find me��at��.��

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

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This story can be republished for free (details).

The Department of Health and Human Services is funded for the rest of the fiscal year. But lawmakers remain concerned about whether the Trump administration will spend the money as directed.

Meanwhile, negotiations over extending expanded subsidies for Affordable Care Act plans have broken down in the Senate, mostly over a perennial issue — abortion. The subsidies’ expiration at the end of 2025 has left millions of Americans unable to afford their health insurance premiums.

This week’s panelists are Julie Rovner of ���ϳԹ��� News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Sandhya Raman of CQ Roll Call.

Panelists

Among the takeaways from this week’s episode:

• President Donald Trump signed government spending legislation that provides for HHS, as well as a separate measure that addresses pharmacy benefit managers and some Medicare programs. Meanwhile, Trump has yet to put out his own budget — traditionally a president’s wish list of priorities. On the health side, that is likely to include familiar “Make America Healthy Again” ideas, such as funding for a new agency, proposed last year, that would be known as the Administration for a Healthy America.
• In Congress, negotiations over renewing more-generous ACA premium tax credits have collapsed. While lawmakers are likely to continue hearing from constituents about the high cost of health care, now Senate negotiators are signaling that the chances of renewing the expired tax credits are low.
• A new study in JAMA finds that cancer patients covered by high-deductible health plans had lower rates of survival. The research suggests that high out-of-pocket costs discourage preventive and necessary care — and it comes as little surprise in an environment where many Americans cannot afford unexpected bills for a few hundred dollars, let alone four- or five-figure deductibles.
• And a new interview reveals a very different mandate for Health and Human Services Secretary Robert F. Kennedy Jr.’s remade vaccine advisory panel: to scrutinize the risks of immunizations, rather than balance their risks and benefits. The interview with the panel’s chair, published by Politico, quoted him saying Americans should view them “more as a safety committee,” adding, “Efficacy will be secondary.” The notion that the panel will no longer balance a vaccine’s potentially health- and lifesaving effects against its possible side effects flies against decades of government best practices.

Also this week, Rovner interviews ���ϳԹ��� News’ Renuka Rayasam about a new reporting project, “Priced Out,” which explores the increasing unaffordability of insurance and health care. If you have a story 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: Politico’s “,” by Arek Sarkissian.

Sandhya Raman: The Washington Post’s “,” by David Ovalle.

Anna Edney: The Atlanta Journal-Constitution and Associated Press’ “,” by Dylan Jackson, Jason Dearan, and Justin Price.

Joanne Kenen: Inside Climate News’ “,” by Johnny Sturgeon.

Also mentioned in this week’s episode:

• Politico’s “,” by Sophie Gardner.
• ���ϳԹ��� News and WBUR’s “NIH Grant Disruptions Slow Down Breast Cancer Research,” by Martha Bebinger.
• Stat’s “” by Lizzy Lawrence.
• Stat’s “,” by Jonathan Wosen.
• JAMA Network Open’s “,” by Justin M. Barnes, Arjun Gupta, Meera Ragavan, Patricia Mae Santos, September Wallingford, and Fumiko Chino.

[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 from ���ϳԹ��� News and WAMU radio in Washington, D.C. Welcome to��What the Health?��I’m��Julie Rovner, chief Washington correspondent for ���ϳԹ��� News, and��I’m��joined by some of the best and smartest health reporters in Washington.��We’re��taping this week on Thursday, Feb. 5, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.��

Today, we are joined via video conference by Sandhya Raman of CQ Roll Call.��

Sandhya Raman:��Good morning.��

Rovner:��Anna Edney at Bloomberg News.��

Anna Edney:��Hi, everybody.��

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

Kenen:��Hi, everybody.��

Rovner:��Later in this episode,��we’ll��have my interview with Renuka Rayasam about our new ���ϳԹ��� News project “Priced Out.” If you have a story��you’d��like to share with us about your inability to afford your health insurance or your health care, I will post a link in our show notes. But first, this week’s news.��

So after a two-week detour,��during which funding for the Department of Homeland Security was separated out for a separate resolution, which is still TBD, President��[Donald]��Trump on Tuesday signed into law the rest of an omnibus spending bill that includes funding for the remainder of the fiscal year for the Department of Health and Human Services, as well as a separate health package that includes, among other things, new rules for pharmacy benefit managers and an extension of temporary Medicare programs, expanding payment for telehealth and so-called hospital at-home care. Sandhya, you succinctly summarized��all of��this the last time you were on,��when we thought this was about to become law. But��I think it��bears repeating that the spending part of this bill includes very few of the cuts to health programs President Trump asked for in his budget proposal last year. How confident are we that this money is��actually going��to get��spent��the way Congress is ordering?��

Raman:��I think that’s��kind of difficult��to say. I think one clue we can look at is in the lead-up to this.��We did have some of the different grants rescinded and then reinstated in a short amount of time��—��related to mental health��and in��public health and a few other areas like that��—��in order to��get this across the finish line. I��don’t��know what guarantees we have that if��it’s��not this,��it’s��something else. But I think they do seem a little bit more confident that they got a little bit more��language in��there this time to prevent that. But I think��we’ll��also see, as we get into fiscal 2027 spending and what the White House ends up proposing there.��

Rovner:��Yeah, I heard an interview with Sen.��Tammy Baldwin, who’s the ranking Democrat on the subcommittee that handles HHS, saying that, you know, unlike last year, when it was just a continuing resolution, this year they��actually put��in language that says,��You��will spend this this way. But of course,��they’ve��had language��that’s��supposed to spend certain��things��a��certain way, which they have thus far ignored, right?��

Raman:��Yeah, and I think��it’s��something that comes up in��all of��the hearings they have on this that, you know, appropriators��love to say Congress has the power of the purse. You know, this is what they are there to do, is to��dole out��who gets what. And��so��it’s��an affront to them to say, you know,��you’ve��spent all this time deciding how��much��should go to various things, and then it��doesn’t��actually��end��up��that way.��So��we’ll��see how that plays out.��

Rovner:��As you mentioned,��it’s��worth noting that the��president’s budget for fiscal 2027,��which starts in just eight months, is already technically late. It was due this past Monday. Any idea when��we’ll��see a budget from the administration? What might be in it? I know it usually comes after the��president’s State of the Union, but that speech is usually at the end of January, and this year the State of the Union��isn’t��until the end of February.��

Raman:��So,��I will say that��almost always��the White House budget comes after the date that��it’s��supposed to,��in statute. But we are, I think, expecting at this point either��very late��this month or pushing into next month, in terms of when we get it.��I think in terms of what would be in there, a lot of what we can look��to��is��similar to��what we saw in last year’s request;��since the White House budget request is a wish list��—��it’s the things the White House wants, not necessarily the things they will get.��So��I think we can look for a lot of the same proposed cuts as before, because some of those were even proposed in the first Trump administration. I think we can also probably look for a lot��of,��you know, MAHA-oriented things��proposed in��there that��didn’t��get across the finish line��— the new agency, Administration for a Healthy America, and just kind of flushing that out.��And��I think those��are the��big things��I’d��look for as we get closer to that.��

Rovner:��Well, turning to the Affordable Care Act��—��remember the Affordable Care Act and those expired subsidies that are driving up costs for millions of Americans?��Remember the frantic negotiations in the Senate to��come up with��a compromise after the House passed a��Democratic-led effort��to extend those enhanced subsidies for three more years?��Well, apparently, negotiations��on a deal have collapsed, and it’s,��apparently��—��as��we’ve��said many times��—��over the��often insurmountable��issue of abortion. Is this really it for the ACA negotiations, or could this issue come back later this winter, even spring, as��more and more��people end up dropping their coverage because they��can’t��afford the new premiums?��

Edney:��I think��that’s��the key��point,��is we��don’t��have those numbers. We��don’t��have��a great sense��of what��that’s��going to look like.��So��I think that when lawmakers start��getting��those phone calls, that could revive things. I think certainly with the ACA,��as it relates to the Hyde Amendment��—��which it is kind of a��“never say never,”��like, it often kills these deals, but then��suddenly something can kind of appear so��…��so,��yeah, I think you’re right.��

Rovner:��Yeah, the Hyde Amendment, just for those who��don’t��remember, is what��basically bans��federal funding for abortion through the��Labor-HHS spending bill. But anti-abortion forces want to put it in permanent law, rather than having it renewed every year through the spending bill process. And��that’s��a hang-up that almost blocked the ACA from becoming law in the first place, because even Democrats disagreed over it.��

Edney:��Exactly,��yeah, and it comes up every single time. You know, there’s��…��just no solution, no��good solution.��

Raman:��I feel like this is��maybe the��last straw at this point, based on the conversations from the Hill this week. I mean, there was a little hope earlier in the week when we talked to Sen.��Tim Kaine��[D-Va.], and he said, you know,��we’ll��see in the next couple��days��or��so,��we’re��still talking. They met this week.��They’re��planning to meet more this week and talk about it, and then I think in the last day or so, it just��…��I think both sides��were��kind of admitting��that it was done��… because of this issue, [and] there are a couple of other things that are sticking points, and even things that they��hadn’t��gotten to really ironing out.��But��they’d��said it was��kind of moot��at this point, if they��couldn’t��get over Hyde and some of the stuff related to health savings accounts, so.��…��There are some people that are still hopeful that said��that maybe, but��I really��don’t��see how they continue without the people that are most focused on this in the Senate,��like really dialing into it.��

Rovner:��Yeah, they seem to be sort of consumed right now��with��figuring out what to do about the��Department��of��Homeland��Security in general, and��ICE [Immigration and Customs Enforcement]��in particular.��And��I’m��glad you mentioned health savings accounts, because obviously��that’s��been a big Republican push,��to give more money directly to people, rather than to insurance companies. Well, it turns out����in the��Journal��of��the American Medical Association��[Network]��this week that found that cancer patients who have those��high-deductible��health��plans, which get combined with the health savings accounts, those patients had lower rates of survival compared to those with more comprehensive insurance coverage. Quoting from the study,��“These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.”��That’s��not going to help Republicans in their efforts to make patients more financially responsible for their care,��I��wouldn’t��think.��

Edney:��Yeah, I think a lot of these things that a cancer patient��can’t��afford��—��I mean, this��isn’t��a $40 copay;��often��it’s��hundreds of��thousands��of��dollars,��they’re��considering selling property, selling a house, whatever.��So��it’s��not��…��something that people are shopping around for, becoming more fiscally responsible, trying to find, like, a cheaper��option��to do this. This is something that,��clearly, if they could do it, they would.��And you know, instead, as this study showed,��they’re more at risk of dying because they can’t get these treatments.��

Kenen:��I think that just in general, you know,��that these high-deductible plans people treat them as for an emergency, for a catastrophic expense, which means people are delaying��—��uninsured people and poorly insured people��—��often delay preventive care and screening. And therefore, if you catch��a cancer, and I��don’t��know the stage of diagnosis��—��I read part of the study;��I��didn’t��read the entire thing. I��don’t��know the stage of diagnosis.��But if your cancer is caught later because you��didn’t��do preventive screening, some of which are free now, and some of which are not, or some of which are just caught by, you know, when��you’re��going in for something else, whatever.��Later-stage cancer diagnosis��is��a��worse cancer diagnosis.��So��the disincentives for preventive care, the disincentives for going in earlier, because you��don’t��want a big bill for something that you are��hoping��is nothing, is part of the overall picture.��

Rovner:��Yeah, and I mean, it also bears saying that, you know, when��we were��first arguing about health savings accounts��and��high-deductible��health��plans,��high-deductible��health��plans had��deductibles of,��like,��$500 or $1,000.��Now, high deductibles are five figures.��They’re��$10,000 and up. And that’s��way more��than just��inflation over the last 20 years.��We know that��generally people��don’t��even have $400 set aside for an emergency.��So��the��idea that they can meet a $10,000 deductible so their insurance can kick in is��kind of fanciful, I think, for most people.��

All right. Well, meanwhile, there is lots more news on the vaccine front. In an����this week, the new chair of the CDC’s��[Centers for Disease Control and Prevention]��Advisory Committee on Immunization Practices, Kirk��Milhoan, said that the panel should be viewed, quote,��“more as a safety committee.”��“Efficacy,”��he said,��“will be secondary.”��Basically, he’s��saying the panel, whose actual charge is to weigh benefits versus risks of various immunizations, is going to put its finger on the scale to emphasize the risks. Am I reading that right, Anna?��

Edney:��Yeah,��that’s��what,��that’s��how I read��his��conversation with��Politico. …��They’re��really charged now to look at the risks��of these, which is interesting, because, to put it mildly, because I think��it’s��kind of a��warped way of thinking about��vaccines, generally.��…��There are some risks��…��but we are potentially stopping how many hundreds,��thousands��of deaths from polio or something like that.��So��seems like it could get worked into focusing on those risks versus the lives that are saved by it. It��seems to be��the direction that this administration certainly wants��to go.��

Rovner:��And that’s, I mean, the point of having��… an��expert outside committee is for them to��actually do��that weighing of benefit versus risk, at least that was my assumption.��It’s��what��I’ve��always been told in the almost 40 years��I’ve��been doing this.��

Edney:��Right,��and whether it should be a required vaccine versus something you��…��deciding to get or something like that. Conversation can help with those kinds��of decisions. But this is something��—��a vaccine doesn’t come to market if the FDA is looking at these risks when they consider it in the clinical trials, and that side of it is vetted by the people who are able to have access to a lot of that information. I don’t know that the panel is going to see��[it]��in the same way, because if you’re looking at the adverse-event database that is kept on vaccines, anyone can send in a side effect to that, or, you know, say that something happened after they had a vaccine. And it can be tough to read that and��actually get��helpful information from that if��we’re��looking at the post-market vaccine side effects coming in.��

Rovner:��We will continue to watch this space. And it turns out that the changes to vaccine policy extend beyond the United States,��too. Reuters broke the story this week that the U.S.��is threatening to stop giving money to the global vaccine group Gavi, unless it promises to phase out the use of vaccines that still��contain��the preservative thimerosal, which has long since been cleared of accusations about causing autism. Gavi��provides vaccines to children in the poorest parts of the world, and to stretch its funding, it often relies on less expensive, multidose vaccine vials, which use preservatives to prevent contamination.��Apparently, this��threat applies to the $300 million the U.S.��is already withholding from Gavi��that was approved by Congress and to any future funding. So now the U.S.��is exporting its effort to scale back childhood immunizations around the world,��too?��

Edney:��Yeah.��It was surprising to see something like that,��kind of a��demand like that put on Gavi. I guess, in a way,��it’s��surprising that the administration is still funding Gavi,��maybe at��all.��So��you know, I guess,��maybe not as shocking��that��they asked for certain stipulations to be met. But as you mentioned, it is a way to stretch the vaccines to get them to people and countries who otherwise might not have any access to them.��So��there’s��been concern, as you said, that has been debunked about thimerosal, and so��we’re��not using them that much in vaccines in the U.S., but��it’s��kind of pushing��a first-world problem on other countries.��

Kenen:��One��really helpful��way of thinking about the risk of this preservative is��it’s��been, as Anna just said,��it’s��been phased out, not entirely, but mostly in the United States.��But in the years��…��like,��most children are not getting it in their shots. And it has to do with storage of��large quantities��versus individual vials. We��don’t��have to go into details there.��It’s��just not,��there’s��not much of it anymore, and the autism rate has continued to go up while��the��thimerosal��use went down. So that’s��…��even if��you’re��not a biostatistician, a statistician, it should tell you something,��you know. …��If that was the cause, we wouldn’t be seeing more cases.��The rise��of��autism is a complicated thing. We��don’t��have time to discuss��all the��theories and measurements and how we do it right here, but��it’s��easy to understand:��One went up,��and one went down. It��didn’t��cause it.��

Rovner:��Well, finally, on the vaccine front, this week,��here’s��what happens when fewer people get immunized. Two detainees at one of the Department of Homeland Security’s family detention centers in Texas have now tested positive for measles, which, as we have discussed at some length,��is��among the most contagious diseases in the known world. Measles��has��also been found at another detention facility in Arizona.��Now,��in the first Trump administration, I remember complaints about children who were being held in detention, having been separated from their parents, being vaccinated without their parents’��permission.��But which is worse?��Getting vaccinated without parents’��permission, or getting a potentially deadly vaccine-preventable disease?��

Edney:��Yeah,��that’s��certainly, certainly, I think, an easy answer. But you know��…��these detention centers,��it’s��so scary because everyone is just packed in there. Everything��we’ve��heard is how crowded they are, and��the��people��not even being��able to lay down.��So��you do have to wonder whether��they’re��starting to think differently about just letting it rage through there, or��what’s��going to happen. I mean, we��don’t��know yet if quarantine has worked, or anything along those lines.��

Raman:��And I think that goes��hand��in hand a little bit with what��we’ve��talked about in the past, about, you know, it already being harder to get care for the folks in these facilities, and providers not being able to do that. And if��you’re��not able to stop something that is so contagious and spreading,��it’s��just going to��exacerbate��the whole situation.��

Rovner:��Yeah, we have��talked at some length about health care for people who are in these detention camps, and how it��appears to be significantly��lacking. All right,��we’re��going to take a quick break. We will be right back.��

Back on Capitol Hill,��National Institutes of Health Director Jay Bhattacharya appeared before the Senate��HELP��[Health, Education, Labor & Pensions]��Committee on Tuesday and tried to make the case that the agency’s work hasn’t been disrupted by the on-again, off-again funding and grant cuts made��during the course of��2025.��He pointed out that eventually NIH did spend��all of��the money that was��appropriated��to it, but boy, a lot of it came in the last couple of weeks of the fiscal year. Also, as��we’ve��discussed at some length, there are plenty of stories out there that show that, in fact, funding disruptions��have��hurt science, including two new ones this week.��Stat��News has a����who are having trouble finding positions in labs��—��even those students who have their own funding via scholarships or fellowships��—��because the labs��don’t��know how to plan for what��they’re��going to have in terms of money. And here at�����ϳԹ��� News, we have a��story about a Harvard breast cancer lab��that’s lost seven of its 18 lab employees after getting its grant frozen and eventually unfrozen, but too late to apply for it to be renewed. Bhattacharya made a big deal of, you know,��the NIH,��it’s��like,��OK, we spent all your money. But turning this spigot off and then on again, and then off and then on again,��doesn’t��feel like a particularly efficient way to spend it.��

Kenen:��No, it��hurt.��It’s��really well��documented.��There are labs��all across��the country that were hurt, and that meant science that didn’t happen, or didn’t happen as fast and as well as it could have and should have happened.��So��…��to say on-again, off-again��biomedical science funding is fine and dandy.��It’s��not fine or dandy.��

Rovner:��And there were patients whose care was disrupted.��

Kenen:��And people in��clinical trials who were taking��a risk,��and inconvenience as well as risk,��to be part of a clinical trial. I mean, this was��more true��of some of the stuff in Africa, when��the��USAID��[United States Agency for International Development]��money went away, but some��really extreme��examples there.��But people whose care was interrupted, and people who had volunteered in clinical trials whose care��has��been��interrupted.��

Rovner:��Yeah, and people, I mean, for whom these clinical trials were their last chance for, you know, for life or death. I mean, we did see stories from��all across��the country about clinical trials that got,��just stopped in their tracks, and you��can’t��really restart those, because now��you’ve��interrupted the care.��So��the science��from them is not going to be as valuable.��I mean, you basically��have to��start over.��

Kenen:��You could��restart��but not where you left off.��You��have��to��start again.��

Rovner:��Right,��exactly.��You��have to��start again, which is also not��a great use��of money.��

Well, meanwhile, over at the FDA, there are still apparently some��pretty loud��complaints over the agency’s new,��quote,��“priority voucher”��program, which promises expedited approvals for drugs that, quote,��“align with national priorities,”��which can��apparently be��political as well as medical.��Our podcast panelist Lizzy��Lawrence, over at��Stat,����from an employee��town��hall at FDA, as well as members of Congress who are continuing to express concerns about the potential, if not actual, politicization of the drug review process with this program. Anna, what are you hearing?��

Edney:��Yeah, I��think that��that is still the concern.��That��town hall did not��fix anything in the sense that there’s��—��it’s��a completely new paradigm for how they are choosing drugs and pushing them to the front of the line.��The FDA has��never before��really been supposed to or has considered price or anything beyond��Is��this drug going to be beneficial?��They would give things priority review, if it��was something that was��for lifesaving treatments, or something that just, you know, had,��was a huge advance,��never existed before. But now��they’re��saying,��If��you align with the��national��views, and��nobody really knows exactly what that means.��It��seems to be��that, you know, maybe if you made a deal with Trump to bring down drug prices, you might get some of these. Or if it’s, you know, if��you’ve��promised to build more manufacturing in the U.S., you might get this. Or if��it’s��a drug that they just like, then you might get it. I think��there’s��still just a lot of concern about the legality of this. So even among some drugmakers, there are��ones obviously��who want this. There are about, I think, 15 right now who have this voucher to get to the front of the line to be,��have a superfast review. But there is concern from some that, if��another administration comes in, is this even valid? You know, if we get approval, do we even,��does��it even count if they want to, like, take it, if somebody wants to take it off the market, just given the process?��So��there’s��… you know, people have quit at the FDA over��it,��very high-profile people, and��it’s��interesting that��it’s��still going,��that Marty Makary, the��commissioner,��is still trying to sell it. And��[he]��even told staff, you know, according to the reporting from Lizzy, that he was doing it because it was really their idea.��So.��

Rovner:��Meaning the staff’s idea.��

Edney:��Yeah,��that’s��one way to sell it.��

Rovner:��I saw that part. I feel like this is a theme throughout the department, which is that, you know, we’ve had for decades in Republican administrations,��and��Democratic administrations, science sort of shielded from the political leadership of these agencies, of the FDA and the NIH and the CDC, that the science��…��that you can lay over the politics.��It’s��like, here are our priorities, but��the science��is��the science. And I feel like��we’ve��had now��politics entering every single one of these what are supposed to be scientific agencies, right?��

Edney:��Yeah, that’s��absolutely true.��There’s��more political appointees.��I think this��was brought up when Bhattacharya was before Congress,��as well.��At NIH,��there’s��more political appointees, just people with an idea in mind of what might be more important than something else, rather than following where��the science��is going��at the moment. And in the case of FDA,��before it was not about trying to go as fast as possible. And��it’s��not just that there’s politics injected, but��it’s��that��we’re��cutting out the regular reviewers with��the scientific��knowledge because they would like to go faster.��That’s��part of the appeal, I guess, of the voucher.��

Rovner:��Yeah, well,��we’ll��see how that plays out. All right,��that’s��the news for this week. Now we will play my interview with�����ϳԹ��� News’ Renuka Rayasam, and then we will come back and do our extra credits.��

I am pleased to welcome back to the podcast my�����ϳԹ��� News colleague Renuka Rayasam, who is spearheading our newest series, called “Priced Out.”��I will, of course, post links to the first stories in our show notes. Renuka, welcome back to��What��the��Health?��

Renuka Rayasam:��Thanks for having me, Julie.��

Rovner:��Tell us about this project and what the goal is��in pursuing��it.��

Rayasam:��So actually, we��started thinking about this a year ago, my colleague Sam Whitehead and��I.��And we looked at what was happening both with health care��costs generally, but��also with what Congress was likely to do or not do. And we realized��we’re��going to start to see uninsurance rates climb back up after years and years of falling. And so��that’s��what was the impetus for this project. And then, of course, by the end of the year, Congress��didn’t��extend enhanced subsidies for ACA premiums. People started to feel and see their ACA premiums jump because of that and because of other things that have led to an increase in health care costs.��And overall, obviously, people are feeling the pinch in their budgets, and health care is no��exception. And this was born out of watching all those trends come together. And then people started writing to us and saying things like:��I have insurance, but my deductible is a quarter of my take-home income. You��know:��I’m��a lawyer. I have my own business, but I��can’t��afford for��my family��to be on insurance this year. I��can’t��afford my medication. I��can’t��afford��going��to the doctor.��And��so��I think that��was��really how��this series came together, was hearing those stories about people who,��whether��they’re��insured or not, and often not, were just really facing these��high costs��of health��care.��

Rovner:��Yeah, as you say, this is not just the binary:��Do you have��insurance��or do you not have insurance? A lot of this is about people who have health insurance and still��can’t��afford to access care.��That’s��a big part of this, isn’t it?��

Rayasam:��Yeah, absolutely. I mean,��so��interesting talking to this guy, Noah��Hulsman.��He’s��in Louisville, Kentucky. He owns a skateboard shop there. Youngish guy, 37 and he was saying, you know, he had a��“gold”��plan last year that he bought through the exchange, and now he has a��“bronze”��plan, and he’s paying the same amount per month for his premium, but he’s,��like, you know,��if something were to actually go wrong, I can’t afford my deductible, like,��I can’t��pay the bills I need��for my shop and meet my deductible.��And his shoulders hurt, and he’s,��like,��I��can’t��afford to get it looked at because of the copays and all the��out-of-pocket��costs that come along with that. And I think, you know, in this administration and in this Congress, this GOP-led Congress, a lot of talk of things like short-term health plans and lowering premium costs, but these are a lot of plans that come with high costs��if you actually try to go and use��the health��care. And��that’s��the sticker shock that people are going to face when they start to��actually try��to��go and get��health care when they have an issue that they need to get taken care of.��

Rovner:��So��one of the first stories in this series includes some actionable information, as we call it, for folks who are looking for alternate ways to afford the care that they need if��they’ve��had to drop or scale back their insurance. What are some of those ways?��

Rayasam:��Sure.��So��I’ll put this caveat out there:��Every single person I spoke with in putting these tips together said, even if you have a high deductible, even if the��out-of-pocket��costs are��really high, you should have health insurance because that is the best protection against big bills. If something��really catastrophic��were to��happen,��it’s��better than nothing.��It’ll��keep you from going bankrupt. So��that’s��a caveat��out there. But if, after all of that, you still cannot find a plan, you can still,��can’t find a plan that you can afford��—��which is a lot of people, that’s, you know, it’s not a negligible number of people in this country. A few things you can do:��Talk to your doctor.��I think a lot of people are��really nervous��about talking to their doctor about money and costs, but, you know, I think if a doctor knows this patient is paying out-of-pocket, they might have a cheaper cash-pay option.��They might be able to adjust care to try things that are��maybe less��expensive, you know,��maybe get��the same quality of care, but try different things that might be a little cheaper. If your doctor is not budging, then go to a place that does specialize in treating patients without insurance. So federally qualified health clinics, community health clinics, a��lot of doctors will advertise cash pay. I’m seeing that��more and more,��actually, a lot of doctors��saying,��Hey, we do cash-pay options.��When you get a prescription from your doctor,��don’t��just head to the local pharmacy.��Comparison-shop.��It’s��a lot easier to shop for drugs than doctors. A lot of drugmakers have coupons and drug discounts and other ways you can get those��products for��cheaper. And a lot of big-box retailers��—��like Walmart, Costco��—��will offer generic options for your prescription for��really affordable��prices,��and so��…��be sure that��you’re��shopping around and that��you’re��being a smart consumer and looking at different avenues and ways to get care. You know, one last thing��I’ll��mention is something people��don’t��think about a lot, which is their local county health center. They have a lot of services,��disease��testing��and screenings, and,��in a lot of cases, even mental health or substance abuse care.��So��contact your local county, see��what’s��out there, and look around. There are ways to get care��if you��don’t��have insurance.��It’s��harder.��It’s��going to take more time, but there are options��out there.��

Rovner:��Can you give us a preview of some of the upcoming stories in the series?��

Rayasam:��That’s��a��good question.��So��we’re��starting to get people who are writing to us and talking about their concerns and,��like I said, these are people who could no longer afford their insurance premiums, people who’ve had to scale back on the coverage they’ve gotten and are dealing with that. And��so��we’re��going to sift through those responses and start to��write��more stories about the things that people are facing and the consequences of that. You know, one of the women I talked to for this first story was talking about how she started rationing her rheumatoid arthritis medication when she found out that she��wasn’t��going to be able to afford her ACA plan.��So��we’re, you know, going to dive deeper into issues like that. And,��you know, what are the health risks if you��have to��ration��your medication? What are the problems there?��What are ways that people can get into��troubles?��Things like medical credit cards.��I think people might be tempted to turn to a medical credit card, but I think��there’s��a lot of ways that can make the problem of cost of care worse, you know, if that interest starts compounding.��And��so��I think we’re going to��look into��all the ways that the cost of care��[is] affecting��people��—��their physical health, their financial health, and just their overall well-being.��It’s��incredibly stressful, and it can really affect so many parts of your life to not have access to affordable care.��

Rovner:��Well, it’s��a really important��series.��Renuka��Rayasam,��I’m��looking forward to reading the rest of it.��

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

Raman:��All right.��So��I picked a story from The Washington Post by David��Ovalle,��and��it’s��called��“[].”��And his story looks at some of the impacts after the Florida AIDS Drug Assistance Program, which is funded through federal money;��it’s��helped a lot of people with HIV who��weren’t��able to��afford antiretroviral drugs, be able to afford that. And��what’s��happened in Florida is that the state officials have lowered the income��thresholds to get those benefits, saying that there are financial difficulties.��And just��kind of looking��at, you know, some of the cases, and how��that’s��affecting people over there.��

Rovner:��Yeah,��good story.��Joanne.��

Kenen:��This is from��Inside Climate News by Johnny Sturgeon, and��it’s��called��“.”��And I had never heard of this before.��There’s��something called shipbreaking. And shipbreaking is exactly what it sounds like. You take a great big ship, like a big transport, you know, freighter transport ship��—��we’re��not talking about,��like,��little rubber things in a bathtub.��And they are full of heavy metals, radioactive materials,��and all sorts of toxic waste. And the way you get them out when��you’re��done with them is you ram them into the beach as��hard and fast��as you can.��It’s��shipbreaking!��So��this is in��poor areas, in areas that already have, you know, pollution:��India, Pakistan,��and Bangladesh are not known for having the cleanest air and water in the world, and poor people live near there. And it’s huge,��it’s��a really interesting��story about something that you would have thought,��like,��somebody was��making up��on a comedy show.��But it’s happening, and it’s harming people,��and it’s harming��the planet.��

Rovner:��Yeah, I never thought about what happens to a ship when��you’re��done with it.��

Kenen:��I thought��there would be some way of, like, I think in our country, we have some way of taking them apart safely. But no.��I mean, and this is a global thing. I mean��…��it’s��not just ships from the region.��…��This is happening��to hundreds of ships a year.��

Rovner:��Anna.��

Edney:��Following in the theme of Joanne’s article, mine is��“.”��This was��a really interesting��collaboration with al.com,��The Atlanta Journal-Constitution,��The Associated Press, and a few others.��I won’t name all of them, but it’s a look at��…��there’s a town in Georgia that is the carpet capital of the U.S., and is how they use Scotchgard on all the carpets, and how that has forever chemicals in it, and has, over the years, just polluted the water there, and people are getting sick. You know, someone’s goats all died.��It’s��a really inside��look at how the local government, the industries, have all collaborated to get to this point. And you know, just as something was potentially being done about PFAS��under the Biden administration, the Trump administration has rolled a lot of that back, so��I think it��makes that particularly relevant now.��

Rovner:��Yeah, it does.��All right,��well, I also have a story from Florida.��My extra��credit’s��from Politico.��It’s��called��“.”��It’s��by��Arek Sarkissian, and��it’s��from the��“Who could possibly have seen this coming, except everyone?”��file. It turns out that although FDA specifically gave Florida permission to begin importing cheaper drugs from Canada��—��more than two years ago, Florida was the first state to��actually get��permission to do this.��And although the state has spent an estimated $82 million in state taxpayer funds to contract with��a logistics��company and open a warehouse for the drugs,��it seems that none��have been imported yet. Why? Well, because Canada��apparently wasn’t��kidding when it said its government had no interest in selling drugs to Balkan states so that they could��basically import��Canada’s price controls. But fear not. The DeSantis administration says��it’s��still trying to get the program up and running, and it has until May of this year to do that,��under the permission that was granted by the FDA. I will be watching that space but not holding my breath.��

OK, that is this week’s show.��As always, thanks to our editor, Emmarie��Huetteman,��and our producer-engineer, Francis Ying.��A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts —��as well as, of course, kffhealthnews.org.��Also, as always, you can email us your comments or questions.��We’re��at��whatthehealth@kff.org,��or you can��find me on��X��, or on Bluesky��. Where are��you guys��hanging these days? Sandhya?��

Raman:��I’m��on����and on����@SandhyaWrites.��

Rovner:��Joanne.��

Kenen:��I’m��on����and����.��

Rovner:��Anna.��

Edney:����and��X��.��

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

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Por segundo año, el demócrata pidió a los legisladores estatales que eliminen la cobertura para un sector de los inmigrantes ante los recortes federales al gasto en Medicaid y un déficit presupuestario de aproximadamente .

Muchos analistas advierten que, si estalla la burbuja de la inteligencia artificial, .

Newsom propuso que el estado no intervenga cuando, a partir de octubre, el gobierno federal deje de brindar cobertura médica a unos 200.000 residentes legales, entre ellos .

Legisladores progresistas y activistas afirmaron que esos recortes representan un alejamiento de la promesa de Newsom de garantizar “”. Por otro lado, los republicanos siguen criticándolo porque utiliza fondos públicos para cubrir a personas que no son ciudadanas.

Según el Departamento de Finanzas, la propuesta más reciente de Newsom permitiría un ahorro estimado de $786 millones en este año fiscal y de $1.100 millones anuales en los años siguientes, dentro de un presupuesto proyectado de $349.000 millones.

La senadora estatal Caroline Menjivar, una de las dos demócratas que el año pasado votaron en contra de los recortes de Newsom, dijo que le preocupa que las ambiciones políticas del gobernador estén pesando más que lo que es mejor para los californianos.

“Está pendiente de lo que van a opinar Arkansas o Tennessee, cuando lo que piensa California es algo completamente diferente”, se quejó Menjivar, quien contó que sus críticas anteriores le costaron de un subcomité clave del presupuesto. “Esa es mi perspectiva sobre lo que está ocurriendo aquí”, agregó.

Mientras tanto, el senador estatal republicano Tony Strickland criticó a Newsom por restar importancia del estado que, según funcionarios estatales, podría crecer hasta los $27.000 millones el próximo año. Además, lo acusó de seguir ofreciendo cobertura a residentes de California que viven en el país sin autorización. “Lo único que quiere es relanzarse políticamente, proyectar una nueva imagen”, dijo Strickland.

Es una cuerda floja política que se irá tensando aún más a medida que disminuya el apoyo federal y sigan aumentando los gastos en atención médica, afirmó Guian McKee, codirector del Proyecto de Políticas de Salud de la Escuela de Asuntos Públicos Miller de la Universidad de Virginia.

“Newsom tiene que hacer malabares con tres o cuatro temas delicados al mismo tiempo”, opinó ��McKee. Si decide postularse, agregó: “las prioridades de los votantes demócratas en las primarias —que en gran medida reflejan estados progresistas como California— son muy distintas a las del electorado en general, que está mucho más dividido”.

En Estados Unidos, las opiniones sobre si el gobierno debería ofrecer cobertura médica a personas sin papeles están muy divididas.

En una realizada el año pasado, una pequeña mayoría —54%— se opuso a una disposición que establecía sanciones a los estados que utilizaban sus propios recursos para brindar atención médica a inmigrantes. Había grandes diferencias según la afiliación política. Finalmente, esa disposición no fue incluida en la versión final del proyecto de ley aprobado por el Congreso y promulgado por el presidente Donald Trump.

Incluso en California, la idea de ofrecer atención médica perdió apoyo a causa de los problemas presupuestarios.

En , el 41% de los adultos expresó estar de acuerdo con ofrecer cobertura médica a inmigrantes sin papeles, una caída significativa con respecto en 2023.

el vicepresidente JD Vance, y legisladores republicanos han acusado en repetidas ocasiones a California y a otros estados demócratas de usar fondos públicos para dar atención médica a inmigrantes, un tema que enardece a la base del Partido Republicano.

Mehmet Oz, administrador de los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés), de “” para recibir más fondos federales, liberando recursos estatales para su programa de Medicaid, conocido como Medi-Cal, que ha inscrito a cerca de 1,6 millones de inmigrantes en situación irregular.

“Si usted es un contribuyente en Texas o Florida, sus impuestos podrían haberse usado para financiar la atención médica de inmigrantes ilegales en California”, dijo en octubre.

Funcionarios de California negaron esas acusaciones y afirmaron que solo se utilizan fondos estatales para dar servicios de salud general a personas indocumentadas, ya que la ley prohíbe usar fondos federales.

Newsom ha convertido esto en un “”, ya que ampliar la cobertura a inmigrantes, según su administración, mantiene a las y ayuda a evitar costosas visitas a salas de emergencia que muchas veces se terminan pagando con dinero público.

“Ninguna administración ha hecho más que ésta para ampliar la cobertura total de Medicaid para nuestras comunidades diversas, con y sin estatus migratorio”, dijo Newsom a periodistas en enero. “Hay quienes han construido toda su carrera política criticando mi postura”.

Newsom advirtió sobre el “carnaval de caos” del gobierno federal al aprobar la ley One Big Beautiful Bill Act de Trump. Esa ley, sostuvo, pone a 1,8 millones de californianos en riesgo de perder su cobertura médica debido a la implementación de requisitos laborales, otras reglas de elegibilidad y nuevos límites al financiamiento federal para los estados.

Según la Oficina de Presupuesto del Congreso, desde ahora y hasta 2034, a nivel nacional, 10 millones de beneficiarios podrían perder su cobertura.

han señalado que un número mayor de personas sin seguro —en especial aquellas que están relativamente sanas— podría concentrar la cobertura en , lo que potencialmente elevaría los costos de las primas y los costos hospitalarios en general.

Organizaciones que trabajan con los inmigrantes señalan que es especialmente cruel dejar sin atención médica a quienes pudieron haber huido de situaciones de violencia o sobrevivido a la trata o a situaciones de abuso.

Las normas federales actuales exigen que los programas estatales de Medicaid cubran a “no ciudadanos calificados”, incluidos solicitantes de asilo y refugiados, explicó Tanya Broder, del National Immigration Law Center. Pero la One Big Beautiful Bill Act, impulsada por los republicanos, puso fin a esa cobertura, lo que afectaría a legales en todo el país.

Como muchos gobernadores estatales aún no han presentado sus propuestas de presupuesto, no está claro cómo piensan cubrir los recortes al financiamiento, dijo Broder.

Por ejemplo, funcionarios de Colorado estiman que unos 7.000 inmigrantes legales podrían perder cobertura por los cambios en la ley. En el estado de Washington, las autoridades calculan que , solicitantes de asilo y otros inmigrantes con autorización legal se quedarán sin cobertura de Medicaid.

Ambos estados, al igual que California, ampliaron la cobertura completa a todos los residentes elegibles por ingresos, sin importar su situación migratoria. Ahora, sus funcionarios electos están en la incómoda posición de tener que explicar por qué algunos inmigrantes legales podrían perder su cobertura médica mientras que otros sin estatus legal podrían conservarla.

El año pasado, el aumento de los costos en atención médica y los recortes presupuestarios llevaron a los gobernadores demócratas de —JB Pritzker y Tim Walz, dos potenciales aspirantes a la presidencia— a suspender o cancelar la cobertura para inmigrantes sin papeles.

También en 2025, legisladores de California votaron por la eliminación de la cobertura dental y congelaron nuevas inscripciones para personas sin documentos. A partir del próximo año también se cobrará una prima mensual a quienes mantengan su cobertura.

Aun así, se estima que el estado gastará $13.800 millones de su fondo general en atención médica para inmigrantes no cubiertos por el gobierno federal, según H.D. Palmer, vocero del Departamento de Finanzas.

En enero, en una conferencia de prensa en San Francisco, Newsom defendió estas medidas y dijo que eran necesarias por “prudencia fiscal”. Evitó responder preguntas sobre la cobertura para solicitantes de asilo y refugiados, y minimizó la importancia de su propuesta, al decir que podría revisarla cuando tuviera la oportunidad de actualizar el presupuesto en mayo.

Kiran Savage-Sangwan, directora ejecutiva de la California Pan-Ethnic Health Network, señaló que el estado aprobó una ley en la década de 1990 que le exige cubrir con Medi-Cal cuando los fondos federales de Medicaid no están disponibles. Esto incluye a personas con residencia permanente que aún no cumplen con el período de espera de cinco años para inscribirse en Medicaid.

Savage-Sangwan calificó la propuesta del gobernador como “arbitraria y cruel” y criticó su decisión de priorizar los depósitos del fondo de emergencia para tiempos difíciles en vez de mantener la cobertura. Agregó que culpar al gobierno federal era engañoso.

También consideró que es un gran retroceso respecto de lo que ella esperaba que California pudiera lograr el primer día de Newsom en el cargo, hace siete años, cuando el gobernador declaró su apoyo a un sistema de salud con financiamiento público integral y propuso ampliar los subsidios para pagar el seguro médico para la clase media.

“Tenía esperanza y celebramos los avances que impulsó el gobernador”, afirmó Savage-Sangwan. “Por eso estoy aún más decepcionada”.

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For a second year, the Democrat has asked state lawmakers to roll back coverage for some immigrants in the face of federal Medicaid spending cuts and a roughly that if the artificial intelligence bubble bursts. Newsom has proposed that the state not step in when, starting in October, the federal government stops providing health coverage to an estimated 200,000 legal residents — comprising .

Progressive legislators and activists said the cost-saving measures are a departure from Newsom’s , while Republicans continue to skewer Newsom for using public funds to cover any noncitizens.

Newsom’s latest move would save an estimated $786 million this fiscal year and $1.1 billion annually in future years in a proposed budget of $349 billion, according to the Department of Finance.

State Sen. Caroline Menjivar, one of two Senate Democrats who voted against Newsom’s immigrant health cuts last year, said she worried the governor’s political ambition could be getting in the way of doing what’s best for Californians.

“You’re clouded by what Arkansas is going to think, or Tennessee is going to think, when what California thinks is something completely different,” said Menjivar, who said previous criticism got her from a key budget subcommittee. “That’s my perspective on what’s happening here.”

Meanwhile, Republican state Sen. Tony Strickland criticized Newsom for glossing over the state’s , which state officials say could balloon to $27 billion the following year. And he slammed Newsom for continuing to cover California residents in the U.S. without authorization. “He just wants to reinvent himself,” Strickland said.

It’s a political tightrope that will continue to grow thinner as federal support shrinks amid ever-rising health care expenses, said Guian McKee, a co-chair of the Health Care Policy Project at the University of Virginia’s Miller Center of Public Affairs.

“It’s not just threading one needle but threading three or four of them right in a row,” McKee said. Should Newsom run, McKee added, the priorities of Democratic primary voters — who largely mirror blue states like California — look very different from those in a far more divided general electorate.

Americans are deeply divided on whether the government should provide health coverage to immigrants without legal status. In a last year, a slim majority — 54% — were against a provision that would have penalized states that use their own funds to pay for immigrant health care, with wide variation by party. The provision was left out of the final version of the bill passed by Congress and signed by President Donald Trump.

Even in California, support for the idea has waned amid ongoing budget problems. In a by the Public Policy Institute of California, 41% of adults in the state said they supported providing health coverage to immigrants who lack legal status, a sharp drop from the 55% .

, Vice President JD Vance, , and congressional Republicans have repeatedly accused California and other Democratic states of using taxpayer funds on immigrant health care, a red-meat issue for their GOP base. Centers for Medicare & Medicaid Services Administrator Mehmet Oz has of “” to receive more federal funds, freeing up state coffers for its Medicaid program, known as Medi-Cal, which has enrolled roughly 1.6 million immigrants without legal status.

“If you are a taxpayer in Texas or Florida, your tax dollars could’ve been used to fund the care of illegal immigrants in California,” he said in October.

California state officials have denied the charges, noting that only state funds are used to pay for general health services for those without legal status because the law prohibits using federal funds. Instead, Newsom has made it a “” that California has opened up coverage to immigrants, which his administration has noted and helps them avoid costly emergency room care often covered at taxpayer expense.

“No administration has done more to expand full coverage under Medicaid than this administration for our diverse communities, documented and undocumented,” Newsom told reporters in January. “People have built careers out of criticizing my advocacy.”

Newsom warns the federal government’s “carnival of chaos” passed Trump’s One Big Beautiful Bill Act, which he said puts 1.8 million Californians at risk of losing their health coverage with the implementation of work requirements, other eligibility rules, and limits to federal funding to states.

Nationally, 10 million people could lose coverage by 2034, according to the Congressional Budget Office. higher numbers of uninsured patients — particularly those who are relatively healthy — could concentrate coverage among sicker patients, potentially increasing premium costs and hospital prices overall.

Immigrant advocates say it’s especially callous to leave residents who may have fled violence or survived trafficking or abuse without access to health care. Federal rules currently require state Medicaid programs to cover “qualified noncitizens” including asylees and refugees, according to Tanya Broder of the National Immigration Law Center. But the Republican tax-and-spending law ends the coverage, affecting legal immigrants nationwide.

With many state governors yet to release budget proposals, it’s unclear how they might handle the funding gaps, Broder said.

For instance, Colorado state officials estimate roughly 7,000 legal immigrants could lose coverage due to the law’s changes. And Washington state officials refugees, asylees, and other lawfully present immigrants will lose Medicaid.

Both states, like California, expanded full coverage to all income-eligible residents regardless of immigration status. Their elected officials are now in the awkward position of explaining why some legal immigrants may lose their health care coverage while those without legal status could keep theirs.

Last year, spiraling health care costs and state budget constraints prompted the Democratic governors of , potential presidential contenders JB Pritzker and Tim Walz, to pause or end coverage of immigrants without legal status.

California lawmakers last year voted to eliminate dental coverage and freeze new enrollment for immigrants without legal status and, starting next year, will charge monthly premiums to those who remain. Even so, the state is slated to spend $13.8 billion from its general fund on immigrants not covered by the federal government, according to Department of Finance spokesperson H.D. Palmer.

At a press conference in San Francisco in January, Newsom defended those moves, saying they were necessary for “fiscal prudence.” He sidestepped questions about coverage for asylees and refugees and downplayed the significance of his proposal, saying he could revise it when he gets a chance to update his budget in May.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, pointed out that California passed a law in the 1990s requiring the state to cover when federal Medicaid dollars won’t. This includes green-card holders who haven’t yet met the five-year waiting period for enrolling in Medicaid.

Calling the governor’s proposal “arbitrary and cruel,” Savage-Sangwan criticized his choice to prioritize rainy day fund deposits over maintaining coverage and said blaming the federal government was misleading.

It’s also a major departure from what she had hoped California could achieve on Newsom’s first day in office seven years ago, when he declared his support for single-payer health care and proposed extending health insurance subsidies to middle-class Californians.

“I absolutely did have hope, and we celebrated advances that the governor led,” Savage-Sangwan said. “Which makes me all the more disappointed.”

���ϳԹ��� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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The actions of federal Immigration and Customs Enforcement agents are having ramifications far beyond immigration. Medical groups say that ICE agents in health facilities in Minneapolis and other cities are imperiling patient care, while in Washington, the backlash from a second fatal shooting by agents in Minnesota has stalled action on an eleventh-hour suite of spending bills.

Meanwhile, anti-abortion groups remain unhappy with the Trump administration over what they see as its reluctance to scale back the availability of the abortion pill mifepristone.

This week’s panelists are Julie Rovner of ���ϳԹ��� News, Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• Concerns intensified this week over President Donald Trump’s immigration sweep after federal agents killed a second citizen in the midst of the crackdown in Minneapolis. Democrats in Congress are blocking approval of government spending as they call for renegotiating Department of Homeland Security funding, potentially forcing a partial government shutdown this weekend. In Minnesota and elsewhere, there are reports of patients postponing medical care and doctors pushing back on the presence of federal agents in hospitals.
• After the Department of Health and Human Services cut off some federal funding to Minnesota over allegations of Medicaid fraud, other Democratic-led states in particular are fearing HHS could do the same to them. Typically the federal government conducts investigations and imposes sanctions in response to concerns of fraud; it’s unusual that HHS has opted to halt some funding instead.
• Abortion opponents last week held their annual March for Life in Washington. The Trump administration marked the occasion by reinstating and expanding policies imposed during the president’s first term, including a ban on fetal tissue research and what’s known as the Mexico City Policy. Still, the administration has not made notable progress on a key goal of the anti-abortion movement: barring access to medication abortion.
• Meanwhile, senators are still trying to sort out a bipartisan compromise to restart the enhanced Affordable Care Act premium subsidies that expired last year. And insurance company executives appeared before House lawmakers last week to answer questions about affordability as the Trump administration announced a plan to keep reimbursement rates nearly flat next year for private Medicare Advantage plans.

And ���ϳԹ��� News’ annual Health Policy Valentine contest is open. You can enter the contest here.

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

Julie Rovner: Science’s “,” by Monica Hersher and Jeffrey Mervis.

Maya Goldman: NBC News’ “,” by Berkeley Lovelace Jr.

Alice Miranda Ollstein: The New York Times’ “,” by Kenneth P. Vogel and Christina Jewett.

Rachel Roubein: Stat’s “,” by O. Rose Broderick.

Also mentioned in this week’s episode:

• Axios’ “,” by Maya Goldman.
• Annals of Internal Medicine’s “,” by Jeremy W. Jacobs, Garrett S. Booth, Noel T. Brewer, and Janet Freilich.
• Politico’s “,” by Alice Miranda Ollstein.
• The Washington Post’s “,” by Lena H. Sun and Rachel Roubein.
• The Georgetown University Center for Children and Families’ “,” by Andy Schneider.
• KFF’s “,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.

[Clarification: This article was revised at 12:30 p.m. ET on Jan. 30, 2026, to clarify that the agents involved in the Trump administration’s immigration crackdown represent not only the U.S. Immigration and Customs Enforcement agency but also the broader Department of Homeland Security.]

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

Julie Rovner:��Hello from��KFF��Health��News and WAMU��public radio��in Washington, D.C. Welcome to��What the��Health?��I’m��Julie Rovner,��chief Washington correspondent for�����ϳԹ�����News, and��I’m��joined by��some of��the best and smartest health reporters in Washington.��We’re��taping this week on Thursday, Jan.��29,��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:��Maya Goldman of Axios��News.��

Maya Goldman:��Hi.��

Rovner:��And Rachel��Roubein��of��The Washington Post.��

Rachel��Roubein:��Hi,��everyone.��

Rovner:��No interview��this iced-in��week here in Washington,��but��still��lots of��news. So last week at this time, Congress was busy patting itself on the back for��being poised��to pass all 12 annual appropriation bills before their Jan.��30 deadline, including the two biggest ones, those funding the Departments of Defense and Health and Human Services.��Still, as��I believe I��said at the time, it’s not done until it’s done,��and,��well, it’s not done.��What happened, of course, is that after the House passed the remaining six spending bills and left for a week’s recess,��on Saturday,��federal��[Border Patrol]��officers shot and killed a VA��[Department of Veterans Affairs]��ICU nurse, Alex Pretti,��on the streets of Minneapolis, where he was participating in an��ICE��[Immigration and Customs Enforcement]��protest. That second killing of a civilian in three weeks��turned Senate Democrats,��who were supposed to approve the spending package this week,��unanimously against the spending bill for the Department of Homeland Security, which includes��ICE��and which��is included��within the appropriations package passed by the House last week. But��it’s��not as easy as splitting off the��Homeland��Security bill and passing the other five. If the Senate changes anything about the package, it��has to��go back to the��House, which, as I mentioned,��isn’t��even in town this week. So where are we?��And how likely is it that��we’re��going to look at a partial government shutdown��come��Saturday?��

Ollstein:��So��it’s��really a mess right now. You have��some��in both parties who are calling for passing the rest of the bills and pulling out the��Homeland��Security funding to keep negotiating.��Some��people are saying they should do a very short-term CR��[continuing resolution]��—��a week, a couple��weeks��—��in order to��give Congress more time to negotiate these reforms and restrictions that Democrats are demanding. But then you have House��Republicans who are saying,��Oh, if��we’re��opening this all back up again, we have��some��demands,��too, and we want more of this and more of that and XYZ. And��so��they’re��saying,��We’re��gonna��defund all sanctuary cities.��So, like you said, once you open this back up, it��opens up��a whole��can of worms. That said,��the Democrats’��base is really saying��don’t��give one penny more to this agency that they see as completely running amok and violating life and civil liberties. And��so��we’re��really at��kind of an��impasse right now.��

Rovner:��This is a classic��never-count-your-chickens in Congress. Maya, you want to add something.��

Goldman:��Yeah, I was going to��say,��it seems like the health��care package is collateral damage here, right?��There’s��a lot of��agreement, bipartisan agreement, that these changes that��they’re��trying to make, PBM��[pharmacy benefit manager]��changes, things like that,��should��be passed. But then, like you said, Julie,��it’s��never over till��it’s��over, and more time between getting a bill negotiated and��actually passing��it just gives interest groups more time to get things changed. So that will be interesting to see.��

Rovner:��And just a reminder for those who aren’t following this as closely as we are, there is this health package that’s riding along in this spending-bill package that includes the PBM reform and extensions for things like home health care and telehealth and other things that are not technically spending-bill issues but that need to be renewed periodically by Congress. So��that’s��also sitting out there waiting to see what the Senate decides to do and then what the House decides to do,��depending on what the Senate decides to do.��

Roubein:��And the last government shutdown,��in the fall,��was��based on health care. But as you mentioned, the fight was over Affordable Care Act subsidies, which is not part of this package that Julie mentioned.��

Rovner:��That’s��right. So that will continue. But I want to talk about��ICE. We have tiptoed into the immigration debate as it��impacts��health��care in recent months, but now��it’s��really front and center, and��I’m��talking about more than just the fight over ICE��tactics in Minnesota and blocking the spending bill for the entire Department of Health and Human Services. Maya,����about how��ICE��presence��in hospitals and other health��care facilities is having an impact on patient care. Tell us what you found.��

Goldman:��Yeah,��a lot of��physicians and nurses in Minneapolis, Twin Cities,��and also��across the country are saying that this is approaching, or has already��become,��a public health crisis. And the problem is twofold. It’s,��Part��1, patients��aren’t��coming to get the care that they need, because��they’re��worried about leaving their homes. And one doctor during a press conference said she��even has patients who��don’t��want to take telehealth appointments,��because��they’re��afraid of getting on the phone or getting on the computer,��because��they’re��worried��they’re��being surveilled. So��that’s��a huge problem. And then��some��doctors are also saying that��ICE��presence in and around hospitals is making it harder for them to do their jobs of providing care, because there are reports of agents being aggressive and sort of being in places where they are not supposed to be, or are��physically impeding care.��So��two sides of the coin.��

Rovner:��Yeah,��a reminder that��ICE��was��largely forbidden��from��operating��in, quote,��“sensitive”��areas like schools and churches and health facilities,��in both Republican and Democratic administrations, until��[President Donald��Trump]��changed it last January.��We’ve��heard��a lot��since then about��ICE��being in��all of��these sensitive locations, right?��

Goldman:��Yeah,��yeah. And I think��it’s��important to��note��the Department of Homeland Security, when I reached out to them, said that they are not conducting enforcement operations in hospitals, even though they��are now allowed��to. If they take a patient��who’s��in custody��to��the hospital, they are in the hospital. They can get a warrant to come into the hospital. They can be in public spaces like parking lots and waiting rooms, waiting for people.��

Rovner:��And as��we’re��hearing,��that’s��exactly what��they’ve��been doing.��

Goldman:��Exactly.��

Rovner:��Even though��they’re��not, quote-unquote,��“conducting enforcement operations”��there.��Doesn’t��mean��they’re��not there. So even the American Medical Association, not exactly a left-wing group, issued a statement expressing concern about��ICE��activity in and around hospital emergency rooms, which it called a,��quote,��“tactic��fueling fear among patients and hospital staff alike.”��Are we starting to turn a corner here? I feel like this is,��maybe it��was a combination of what happened last week,��coincided with the big snowstorm in half the country and people were stuck inside watching TV. I do feel like there’s way more awareness than there was even two or three weeks ago of this stuff.��

Ollstein:��I think it��remains to��be seen��whether there is��a meaningful policy and��practice��change or just a sort of symbolic or rhetorical change.��There’s��a different tone��being struck.��There’s��sort of backpedaling��on��the immediate reaction from government officials we heard,��which was to blame the people who��were killed��for their own killings. There are calls for investigations coming from both sides of the aisle. There are calls for��some��top officials’��resignations. But again,��we’re��hearing from people on the ground that things have not actually shifted in the enforcement behavior of these agents. And��so��I think it��really remains to��be seen��what happens in Congress in terms of passing policies. There’s discussion of putting limitations in the spending bill on what��ICE��can do. But again, there is a lot of concern that I’ve heard from the advocacy community that they’re going to set up some government official��—��whether it’s��[Homeland Security Secretary]��Kristi Noem��or��[Trump deputy chief of staff]��Stephen Miller or,��already we’ve seen��[Border Patrol official��Gregory]��Bovino��—��to be a fall guy��and then nothing will actually change substantially beyond that. And��so��there’s continued anxiety around that.��

Rovner:��Yeah, and��just a reminder that even if the spending bill��doesn’t,��for the Department of Homeland Security,��didn’t��pass and they��didn’t��even��do��a continuing resolution,��ICE��has��I believe��it’s��$75 billion��from the budget bill that passed last year.��So��they have��a big chunk��of money to keep��operating��regardless.��Talk about collateral damage��—��it would be��all of��these other agencies that would have to sort of stop operating if there is��some kind of a��shutdown.��

Well, meanwhile,��it’s��not just��ICE��that’s��going after the state of Minnesota. The Centers for Medicare��&��Medicaid Services earlier this month cut off a chunk of the state’s Medicaid funding��going forward.��They’re��charging that the state is, quote,��“operating its program in substantial noncompliance”��with rules to detect waste, fraud,��and abuse. This is not how this is supposed to work. CMS can sanction states for their anti-fraud efforts being lacking, but��there’s��supposed to be��a lot of��due process first, with��lots of��hearings and��appeals and fact-finding and all kinds of��mumbo jumbo that we do go through before people��actually get��sanctioned.��That’s��apparently not��what’s��happening here. Although the��ICE��headlines are overshadowing the other punitive measures the��federal government is taking toward Minnesota,��I’m��kind of surprised��this aspect of the story��isn’t��getting more attention. Might it when other governors realize that this could happen to them,��too, even if they��didn’t��happen to be on the ballot against Trump in the last election, like Minnesota Gov. [Tim]��Walz��was?��

Goldman:��Yeah, I was talking to somebody in the Medicaid space from a different blue state who was��saying this feels like a turning point, something that they��are scared��of��happening��in their state as well.��And,��yeah,��I think there��are��a lot of��things that we need to see how they’ll play out, but this is��definitely raising��eyebrows.��

Rovner:��Yeah, and I will post in the show notes����by Andy Schneider��—��who’s at Georgetown University and��who��wrote, when he worked on the Hill, wrote a lot of the Medicaid statute��—��explaining how this is all supposed to work and quite how different this is. But I would expect to be hearing more about this in the coming days and weeks, particularly if the administration��doesn’t��back off, because��it’s��a lot of��money and,��as we know, Medicaid is a huge, huge piece of every single��state’s��budget.��

Well, meanwhile, on the abortion front, last week was the annual March for Life, marking the anniversary of the now overturned Supreme Court decision��Roe v.��Wade, and it’s fair to say that the anti-abortion movement is not happy with the Trump administration’s actions so far on the issue. Let’s start with what the administration did do to prove its devotion to the anti-abortion cause, To mark the movement’s big day in D.C., the Department of Health and Human Services reinstated its first-Trump-term ban on the use of fetal tissue in biomedical research, which President��[Joe]��Biden had reversed, and it expanded pretty dramatically the so-called Mexico��City��Policy that bans��U.S.��funding for international groups that, quote,��“perform”��or��“promote”��abortion. Now things like��DEI [diversity, equality, and inclusion]��and gender-affirming care��are included,��too. Alice and Rachel,��you guys��cover this. What should we know about these two new policies? It��doesn’t��seem like��much,��because they had both been in effect before, but��it’s��pretty big.��

Ollstein:��So��the fetal tissue ban is also,��research, is also an expansion of the first-term version, just like the Mexico City Policy. It goes further than before. And��so��the��new version��bans not only in-house government research but also government funding of research at outside institutions that use fetal tissue that��was donated��from abortions,��and that has��been used��in��all kinds of��really important��medical research,��development��of��vaccines,��etc.��And��so��there is��a lot of��concern about that. They also imposed new restrictions on accepting new stem cell lines.��There are��lots of��existing stem cell lines that they just keep propagating��over and over��from a long time ago, but��they’re��pausing��accepting new ones while,��they say,��they’re��exploring��alternatives that they find more ethical. All of this has really rattled the research community.��

And as for the Mexico City Policy, the expansion there is far beyond the issue of abortion.��It’s��banning funding going to groups that promote what they consider��DEI��and what they consider��gender ideology. And��so��this is groups that serve��the trans community in other countries and have programs for specific marginalized groups. So again,��a lot of��concern in��the��public health world��because��in order to��tackle big public health problems, you often need to direct resources to the communities most at risk, and often that is the trans community, that is racial minorities. And��so��there’s��a fear of this really impeding the delivery of services in a way that will��impact��the broader population.��

Rovner:��All right, so now to what the administration��didn’t��do that makes the anti-abortion movement so unhappy��—��anything further to restrict the abortion pill mifepristone. In fact, as expected, the Justice Department filed its brief in a closely watched lawsuit out of Louisiana this week, urging the court to pause the suit while the FDA��[Food and Drug Administration]��finishes its study of mifepristone, a study that abortion opponents say is the FDA purposely using to drag its feet on any action.��So��what the heck��is going on here? Rachel, you start.��

Roubein:��Yeah,��basically the��Department of Justice����in this lawsuit in Louisiana, and��basically their��justification was that:��The Food and Drug Administration is reviewing mifepristone. We need time to do that.��So that was��basically��what��their��ask��was, was,��like:��Put this on pause. We will do this review��that, as you said, anti-abortion advocates have been upset and said that it has been moving too slowly.��

Ollstein:��So I really saw the��legal��brief was kind of a Rorschach test that people could see different things and signs in it, because you had the pro-abortion-rights community looking at them saying:��Look, they’re saying that the FDA didn’t properly review this in the past, and that’s why they’re doing this rigorous review now.��That’s��a sign that��they’re��going to impose restrictions.��Also, the anti-abortion side looked at��it��and they were upset, one,��that the Justice Department is arguing that the FDA allowing telemedicine��doesn’t��harm the states, and the��states believe that it does, and so��they’re��saying:��You��can’t��prove harm. You��don’t��have��standing��to bring this case.��I think really the common theme in this filing and in��some��other��ones��last year��related to these state abortion lawsuits is that the Trump administration is defending federal power and federal decision-making, and that can cut both ways. And��so��they’re��saying,��Leave it to us. And the anti-abortion groups are saying:��We��don’t��trust you. We��don’t��want to leave it��to��you. We want to let these state lawsuits move forward.��

Just to very quickly go back,��the Trump administration did one other thing around the��March for��Life as a bone to the anti-abortion community,��throwing them a bone, and that is they are attempting to claw back��tens��of millions of dollars in covid loans that went to Planned Parenthood affiliates.��A lot of��these loans��were already forgiven��by the Biden administration, but they are trying anyways to claim there was fraud going on and to get their money back. This boils down to��sort of wonky��arguments of whether the specific state Planned Parenthood chapters��are considered��enough part of��national Planned Parenthood that they��can’t��claim to be a small business. This is going to��be a legal fight. Planned Parenthood��maintains��they did absolutely nothing wrong. The state affiliates are separate from the national group, but—��

Rovner:��Which they��are, by the way.��

Ollstein:��They are. They are. And courts have found that they��are��in the past. However, the anti-abortion movement was��very��excited��about this. They see it as the first step towards declaring all��Planned��Parenthoods ineligible for any government funding,��something��they’re��calling debarment, which��they’ve��been pushing for��for��a while. So��that’s��one other thing to keep an eye on.��

Rovner:��And a reminder,��many,��many��Planned��Parenthoods��don’t��and never have offered abortion.��Well��we��won’t��get as far into the weeds as we could here, but if you press me, I will.��All right,��we’re��going to take a quick break. We will be right back.��

So over at the Department of Health and Human Services, we have yet another mysterious case of stopping funding and then almost��immediately��restarting it. Earlier this month, the Substance Abuse and Mental Health Services Administration cut off��nearly��$2 billion��worth of grants to drug abuse and mental health providers, only to reverse that decision a day later. Now,��nearly��the��same thing has��basically happened��with about��$5 billion��worth of grants from the Centers for Disease Control and Prevention to all 50 state health departments for things like community outreach, emergency preparedness,��and disease outbreaks. According to The Washington Post, which broke��, notices to states were sent out Friday and barely 12 hours later, an HHS official told the��Post the funding pause,��quote,��“had been lifted.”��Still, it��apparently took��several��more days for states to be able to access their funding portals. You��can’t��help but think that at least��some of��this is an actual effort to destabilize the nation’s public health infrastructure, right?��They��can’t��be that sort of disorganized that��they’re��going to cut off funding and put it back.��There��has to��be a reason here.��Rachel,��you’re��smiling.��

Roubein:��My colleague Lena��Sun��and I were hearing about this on Saturday, ahead of the��big storm. State officials were trying to kind of figure out��what’s��going on.��With the mental health grants, you saw��a very kind��of concerted push from the advocacy community, from Republicans and Democrats on the Hill,��to push for,��that was a termination of those grants,��to��be rescinded, and they were within about a day. This happened��sort of over��the weekend, and it happened very quickly. So, I��can’t��say what the result of��sort of the��change was,��because the notices��were dated��Friday, but state officials��didn’t��really start getting them��till��on��Saturday. And then��we’d��heard sort of midday Saturday that the temporary pause��was lifted. But��it��definitely threw,��sort of,��state and local health departments that we were talking about into sort of a state of confusion trying to figure out sort of what they needed to do��and��by when.��

Rovner:��Yeah, and we have seen this repeatedly from this administration.��These are sort of two dramatic cases just this month, but the stopping and starting of grant funding is making it impossible to do any planning and figure out what you can do when.��It’s��just, it feels like just a matter of,��Let’s��make it as hard as possible for these people to do their jobs.��

Goldman:��Yeah, and—��

Rovner:��By��“these,”��yeah,��I’d��say by��“these people”��I mean the grant recipients, not the people who are overseeing the money.��

Goldman:��I��can’t��claim to know exactly��what’s��going on behind the scenes, but I think,��what do you expect to happen when you gut��all of��the administrative functions of these agencies, which is what HHS did earlier this year?��And of course,��some of��those people have come back, but��there’s��a lot of��instability in HHS’��rank-and-file workforce itself, and so that naturally will trickle down to their grantees.��

Rovner:��Right, and particularly at the CDC. Well, adding to that,��elsewhere at the CDC,��some��key databases, mostly concerning vaccines, are not��being updated.��That’s��according to����in this week’s Annals of Internal Medicine��medical��journal. The study found what the authors called��“unexplained pauses”��in��nearly half��of the 82 databases they studied that��are normally updated��monthly.��Eighty-seven percent��of those databases were on vaccination-related topics. Now,��this could be political. It could also be due, as Maya was just saying,��to the��budget and personnel cuts at CDC that��we’ve��talked about so much over the past year. But it does seem that��we’re��continuing to fly ever more blind on things like disease surveillance, right?��

Goldman:��Yeah, and then when you couple that with the state and local public health divisions are the ones who would be the backstop there, but if their funding is in question��now, that is even more concerning for public health surveillance.��

Rovner:��Yeah, and of course, we are in the middle of big measles outbreaks in South Carolina and Texas and trying to watch that closely, but��it’s��hard to do if you only have��sort of state-by-state��backups to look at.��

All right.��Well, before we go, we need to talk about the Affordable Care Act. Remember the Affordable Care Act?��Before it��was subsumed��by all the other headlines?��Apparently, the��Senate is still working on a bipartisan compromise that could restart lapsed subsidies that have spiked health insurance premiums for millions of Americans. And��apparently things��aren’t��going all that well. And to add to it,��here’s��the headline on the press release for��,��hot off the presses just this morning��—��quote,��“.”��On the other hand, the poll did find that Republicans still trust Republicans more. And while the ACA��remains��pretty popular��overall, it is less popular with Republicans than it was before last fall’s campaign by Republicans to blame��all of��the health care system’s ills on the 2010 health law. So where does that leave us?��We’re��with��—��this is the end of January. People who have been��sort of reenrolled��in the ACA are starting to get these huge premium notices that they may or may not be able to pay. Has Congress just��kind of moved��onto the next crisis?��

Ollstein:��So��some��people in Congress are still trying to resolve this crisis, even as new crises pile up. The bipartisan talks are still going on, but there is just not��a lot of��optimism here. There is not really��agreement��on��lots of��aspects of extending the subsidies, and all of this is really discussing, at most,��sort of a��one-year extension. And��so��they would just have to have this whole fight all over again. But yes, I would say things are looking��more bleak��on that front than even��a few��weeks ago.��I��don’t��know what my fellow panelists think.��

Rovner:��And��any anybody��have��optimism for getting these subsidies extended?��I’m��not seeing anybody raising their��hand. Well,��we will continue, obviously, to watch this space.��

All right. Lastly, health insurers are starting to get the same heartburn as the pharmaceutical industry.��Last week,��in back-to-back hearings at the House Energy and Commerce and Ways and Means committees, the heads of five of the biggest health insurers got��pretty much��filleted��by��members of both parties. Then this week, the Trump administration��kind of shocked��the markets by offering a much-smaller-than-expected increase for private Medicare Advantage plans. Those have been the darlings of Republicans for a couple of decades��now. Maybe Republicans do really mean it when they say they want to stop giving so much taxpayer money to health insurers?��

Goldman:��I was a little bit struck by how surprised everybody was at��this, because��I think��[CMS Administrator]��Dr.��Mehmet��Oz has been hinting that he’s much more amenable to cracking down on reported improper behavior among Medicare Advantage plans than people anticipated the next Trump administration would be.��And��there’s��really this groundswell in the House of Representatives as well among Republicans to sort of rein in improper spending��in��Medicare Advantage.��

Rovner:��Sen.��Bill Cassidy has been pretty—��

Goldman:��Yes.��

Rovner:��—outspoken on it, which surprised��a lot of��people. Now��his,��the committee that��he’s��the��chairman��of��doesn’t��have��jurisdiction��over this, but he is also a member of the��Finance��Committee,��which does have��jurisdiction��over this.��

Goldman:��Exactly. Exactly. And��so��to me it��wasn’t��that surprising,��I have to say.��But��it sent��shock��waves through the markets?��Obviously, insurers are saying that if this��is��finalized��as proposed,��they’re��going to have to cut benefits for seniors even��more,��they’re��going to have to raise premiums and things like that. And of course this could be a bad political move,��potentially,��for Republicans. But��I think—��

Rovner:��Because there are��lots of��Republican voters who are in Medicare Advantage plans—��

Goldman:��Absolutely.��

Rovner:��—and��don’t��want to��see their benefits cut.��

Goldman:��Absolutely,��and Medicare Advantage insurers have been saying this��over and over again.��The Biden administration was also��pretty conservative��on Medicare Advantage.��I guess maybe��“conservative”��is a funny word choice, but—��

Rovner:��Light-handed.��

Goldman:��Yes.��

Rovner:��Were light-handed.��

Goldman:��Yes,��I think, and��insurers were��largely able��to weather that. Of course, there are��some��changes that��they’re��making this year.��We’re��seeing��some��market realignment.��So��it, another year of that, who knows what would happen.��But��I think it��still remains��to��be seen��how impactful this will��actually be��for beneficiaries.��

Rovner:��Yeah, well, another constituency to��get riled��up in the run-up to the midterms. All right, that is this week’s news. Now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize the story we read this��week��we think that you should read,��too.��Don’t��worry if you miss it.��We’ll��post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?��

Ollstein:��Yeah.��So��I have this fascinating investigation from��The New York Times. The headline is��“.”��So��this is a story about these nursing home industry groups making massive donations to Trump’s super PAC and,��after that, gaining��a lot of��access to him and using that access to lobby for the scrapping of a rule that required minimum staffing in��nursing homes. And that rule was already not really��being enforced, but now they are getting rid of it formally. And so I think the story does a good job of saying,��Look, we can’t prove exactly that they got rid of this rule because of the donations, but it is part of a pattern where people who have given a lot of money to the��president’s various groups have gotten just an incredible amount of access to him and other top officials.��And the story also stresses��why we should care about all of this.��There’s just been a lot of horrific data coming out of nursing homes of problems caused by understaffing,��patients��experiencing preventable injuries, infections and other health problems that go unnoticed until it’s too late or it gets way more serious, and even facilities using, basically drugging patients to keep them��easy to control and complacent,��because there just isn’t enough staff to attend to them.��People who have dementia and other things��need��a lot of��care and can get��upset and disoriented.��And instead of taking care of them,��they’re��putting��them��on heavy��psychotropic drugs. And��so��it’s a��really sad��and serious situation, and this article shows��some��potential pay to play.��

Rovner:��Yeah, I tend to be, in general, skeptical of administrations doing things that we thought they were going to do��anyway��and someone else happened to give them money.��But this draws a pretty clear line.��They did do what they were going to do anyway, which was going to��sort of not��really enforce these regulations.��Anyway��it’s��really��good story.��Should��read it. Maya.��

Goldman:��My��extra credit this week is��“,”on NBC News by Berkeley Lovelace Jr. And��it’s��one of those stories that, wow, I wish I had written this. It’s a really great explanation of one of the sort of lesser-talked-about side effects of losing enhanced ACA subsidies, which is that people are going into plans that are��—��they’re still opting to be in insurance, but they’re taking plans that are lower premiums but much higher deductibles, which means that their coverage is less valuable. And they might still have to pay��a lot of��money out-of-pocket for most services, and then they might not seek those services, which��sort of negates��the purpose of having health insurance and its effect on public health. And this story shows that Kentucky, Idaho, Massachusetts, New York, Virginia, Rhode Island, California are all seeing decreases in��“silver”��plan enrollment, which is��sort of that��lower-deductible, higher-premium tier, and increases in��“bronze”��enrollment, which is super-high-deductible.��So��huge thing to watch.��

Rovner:��Really,��really good��explanation.��Rachel.��

Roubein:��My extra credit is by��Stat��News. The headline is��“,”��by O.��Rose Broderick. And the story lays out how the Department of Health and Human Services yesterday, on Wednesday, announced the appointment of new members to a federal committee that will advise Secretary��[Robert��F.]��Kennedy��[Jr.]��on autism.��Broderick��reports that��many��of the new members of the committee, which��is called��the��Interagency Autism Coordinating Committee, have publicly expressed or belonged to groups that have publicly expressed a belief in the debunked claim that vaccines can cause autism. Stat had����earlier this week that the members of the committee had met in secret and that some members of the kind of broader autism community were worried about the panel.��And just kind of for sort of the big-picture point of view, Kennedy, last year, pledged to find the causes of autism. And during his tenure as HHS��secretary,��he’s��challenged years of public health messaging on vaccines, such as instructing the CDC to contradict the long-settled scientific conclusion that vaccines do not cause autism. Kennedy, in a press release��yesterday, called the researchers��“the most qualified experts��—��leaders with decades of experience studying, researching,��and treating autism.”��

Rovner:��Yet another piece of this.��There’s��a lot��of��advisory committees at HHS, and there are��many��of them worth keeping a close eye on. All right, my extra credit this week is from��Science��magazine,��by Monica��Hersher��and Jeffrey Mervis.��It’s��called��“,”��and it puts��some actual numbers to the science brain drain that��we’ve��been talking about. The authors looked at 14 agencies across the federal government, including the NIH��[National Institutes of Health],��FDA,��and CDC at HHS. They noted that those 10,000-plus experts represented only 3% of the more than 300,000 federal workers��who’ve��left employment since Trump took office, but they��represent��14% of the total number of��Ph.D.s��in science, technology, engineering, math,��and health fields. Most��quit��or retired after taking buyouts rather than��being fired, according to the data. But as the authors noted, quote,��“these departing��Ph.D.s��took with them a wealth of subject matter expertise and knowledge about how these agencies operate.”��Certainly��a win for the Trump administration, which wants to remake the federal government’s approach to science. For the rest of us, we will have to wait and see.��

OK, that’s this week’s show.��Before we go, a reminder that our annual��KFF��Health��Policy Valentine contest is open. We want to see your clever, heartfelt,��or hilarious tributes to the policies that shape health care.��Submit your poem, whether conventional, free-form, or��haiku, by noon Eastern on Wednesday, Feb.��4. The winning poem will receive a custom comic illustration in the��Morning��Briefing��on Feb.��13.��I will post a link to��the formal announcement��in our show notes.��

As always, thanks to our editor,��Emmarie Huetteman,��and our producer-engineer,��Francis Ying.��A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts, as well as, of course,��kffhealthnews.org.��Also, as always, you can email��us��your comments��or questions.��We’re��at��whatthehealth@kff.org,��or you can still find me on��X,��,��or on��Bluesky,��. Where are you folks these days?��Maya?��

Goldman:��You can find me on����under my name or on��X,��.��

Rovner:��Alice.��

Ollstein:��Still on��X,��,��and on��Bluesky,��.��

Rovner:��Rachel.��

Roubein:����under my name.��Bluesky,��.��X,��.��

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

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