[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 ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C., and welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 18, 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 Tami Luhby of CNN. 

Tami Luhby: Hello. 

Rovner: Alice Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

Rovner: And I am pleased to welcome to the podcast panel Lizzy Lawrence of Stat News. Lizzy, so glad you’ll be joining us. 

Lizzy Lawrence: Thanks so much for having me. I’m excited. 

Rovner: Later in this episode, we’ll have my interview with Tony Leys, who reported and wrote the latest ºÚÁϳԹÏÍø News “Bill of the Month” about yet another very expensive ambulance ride. But first, this week’s news. 

Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of the additional ACA [Affordable Care Act] subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House, along party lines, passed a bill that Republicans are calling the “Lower Healthcare Premiums for All [Americans] Act,” which actually doesn’t, but we’ll get to that in a moment. Notably, not part of that bill was any extension of the enhanced tax credits that now are going to expire at the end of this year, thus doubling or, in some cases, tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue the additional subsidies with some changes, but in the end, he didn’t. 

So, four of those Republicans, from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed on to a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell us what’s in that bill that just passed the House. 

Luhby: Well, there are four main measures in it, but none of them, as you say â€¦ they will lower potentially some premiums for certain people, but they’re really a bit of a laundry list of Republican favorite provisions. 

So, one of the main ones is association health plans. They would allow more small businesses â€” and, importantly, the self-employed â€” to band together across industries. This could lower health insurance premiums for some people, but these plans also don’t have to adhere to all of the ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure. 

There are some PBM, pharmacy benefit manager, reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have … the experts I spoke to said it’s really just tinkering around at the edges and may not be that consequential. 

Rovner: And it’s not even as robust a PBM bill as Republicans and Democrats had agreed to last year â€¦ 

Luhby: Exactly. 

Rovner: â€¦ that Elon Musk got struck at the last minute because the bill was too long. 

Luhby: Exactly, it’s a narrower transparency. There are narrower transparency provisions. It would also, importantly, refund the cost-sharing provisions. And remember, there are two types of subsidies in the Affordable Care Act. There are the premium subsidies, which is what everyone is talking about, the enhanced premium subsidies. But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, their out-of-pocket expenses. 

President [Donald] Trump, during his first term, in an effort to weaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them. So what the insurers did was they increased the premiums of the “silver” plans in order to make up some of the difference, but those silver plans, remember, are tied to â€¦ the cost of those silver plans are what determines the premium subsidies that people get. So, basically, by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will, in turn, lower the premium subsidies that the government has to pay and save the government money. 

The people in silver plans probably won’t be affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy “gold” plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy “bronze” plans for really cheap. So basically, this provision will end, will reduce the premium assistance that people get, and it’ll effectively raise premium payments for people in a lot of plans, which will make it more difficult for them. 

Rovner: Which was a wonderful explanation, by the way, of something that’s super complicated. 

Luhby: Thank you. 

Rovner: But I’ve been trying to say it basically moves money around. It takes money that had been … it lowers how much the federal government will have to pay, while at the same time loading that back onto consumers. 

Luhby: Right. 

Rovner: So, hence my original statement that the “Lower Premiums for All” Act doesn’t lower premiums for all. So, this is â€¦ 

Luhby: No, there’ll be a lot of people in gold and bronze and “platinum” plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care. 

And then there’s a fourth provision that’s not as consequential: It’s called choice plans. It’s to help employers give … it’s to make it easier for employers to give money to people to buy coverage on the exchanges. 

Rovner: Yeah, which I think nobody disagrees with. But Alice, there’s another even catch to the cost-sharing reductions, which is that it’s only for states that ban abortion or that don’t ban abortion. Now I forget, which is it? 

Ollstein: So, it’s, yeah. So the great compromise of the Affordable Care Act was that it’s up to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s 50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provision sought to penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets. 

And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday, it’s nowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way as an impediment, including in the Senate as well. 

Rovner: Yeah. So, what are the prospects for these additional subsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies â€” in January, after they’ve expired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here? Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds? 

Ollstein: Well, Democrats and advocacy groups are trying to ramp up that pressure. We’ve been covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this. They’re highlighting the stories of individual, sympathetic-character folks who are having their premiums go way up. 

So, there were press conferences just this week I saw with retirees and people who are on Social Security Disability and small-business owners and single parents, and it’s not hard to find these stories; this is happening to tens of millions of people. And so, I think this is going to be a major, major political message going into next year. Whether it’s enough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree on some kind of an extension, that remains to be seen. And we really haven’t, despite the defection of a small handful this week in joining the Democrats on an extension â€” which was really notable and a sign that Speaker Johnson is not keeping his caucus in array. But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise. It can go either way. 

Rovner: I saw a lot of people yesterday saying that, Well, even if the House were to pass the clean three-year extension of the enhanced subsidies â€” which is what’s in the Democrats’ bill â€” the Senate just voted on it last week and voted it down, so it wouldn’t have any chance. To which my response was, “Hey, Epstein files.” When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you; you wanted to say something. 

Luhby: No, I was just going to say that yes, things can certainly change and there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all been writing stories about the cancer survivors or cancer patients who may have to drop their coverage in the middle of their treatment because they can’t afford the new premiums, or all of these stories. So, none of this is new, but we’ll see. There’s obviously â€¦ what is somewhat new is the administration’s message on increasing affordability, and this is a huge affordability issue. So, maybe that will spur some change in votes or change in mindset. 

Rovner: Well, definitely a January story too. 

Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official â€” after being blessed by the acting director of the agency, who is neither a doctor nor a public health professional â€” the U.S. government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991. 

And merging two stories from this week, there’s also news about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will “harm children, their families, and the medical professionals who care for them.” And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesday terminated seven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, and identifying autism early. According to The Washington Post, which , an HHS spokesman said the grants were canceled because they “no longer align with the Department’s mission or priorities.” 

First, this is not normal. Second, however, it’s HHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy, you’re nodding. 

Lawrence: Absolutely. Yeah, I think this has become very commonplace in this administration. And also interestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea, West Africa, to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so, we’re seeing an active removal of funds from the American Academy of Pediatricians [Pediatrics], and then giving funds now to research. And this is a research group actually that RFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will be really interesting to see if this is a trend that continues, if they’re kind of … we already know that HHS, the CDC’s vaccine panel, there’s been discussions about making our vaccine schedule closer to Denmark’s. Now there’s this money being given to Danish researchers who align with the way that they think about vaccines is similar to Kennedy and to another official at FDA, called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So, yeah. 

Rovner: And who is Danish, I believe. 

Lawrence: Yes, her husband is Danish, and so she lived in Denmark for many years. 

Rovner: I saw some scientists complain about that study in Guinea-Bissau, because they say it’s actually unethical to use a placebo to study the hepatitis B vaccine because we know that it works. So if you’re giving a placebo to children, you’re basically exposing them to hepatitis B.  

Lawrence: Right. 

Ollstein: Yeah. I saw that too. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people of colonial experiments in medicine that were really unethical and subjected people to more risks than would be allowed here. And like you said, basically knowingly withholding something that is safe and effective and giving someone a placebo instead. 

Another issue I saw raised was that it is not a double-blind study; it is a single-blind study. And so, that allows for potential biases there as well. 

Lawrence: Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027. 

Rovner: Oops. 

Lawrence: So, that’s a crazy … yeah, you have babies born before that year who are not given this dose, and then after … so yeah, it raises all kinds of ethical concerns, and it’s just remarkable that the government would just pull away and offer this money to them. 

Rovner: HHS in 2025. Specifically on the covid vaccine, there were two stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated against covid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at , editor Jeremy Faust, who’s both a doctor and a health researcher, says that FDA vaccine chief Vinay Prasad overstated his case when he said the agency has found at least 10 children who’ve died as a result of receiving the covid vaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. This isn’t great evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest. 

Lawrence: Right, right. Yeah, the memo that Vinay Prasad sent, which was immediately leaked, was remarkable in that it included no data backing up his claims. And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues. I think sometimes it’s hard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately, and it’s a really severe claim to say that this has killed 10 children. And so, that discussion needs to be shared transparently and allow for experts to really weigh in. 

Rovner: Yeah. Well, another issue that’s going to bleed over into January. All right, we’re going to take a quick break. We will be right back. 

So in other administration health news, it appears, at least , that the on-again, off-again cuts to medical personnel at the Department of Veterans Affairs are on again. The Post is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel. That’s on top of a cut of 30,000 people earlier in 2025. Altogether, it’s about a 10% cut in total. Apparently, most of the positions are currently unfilled, but that doesn’t mean that they’re unneeded, particularly after Congress dramatically expanded the number of veterans eligible for health benefits by passing the PACT Act during the Biden administration. That’s the bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’ ability to get timely care from the VA? Nothing good, I imagine. 

Luhby: Well, I’ve been speaking over the past year or two to a VA medical staffer, who wishes to remain anonymous for obvious reasons. And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’ shift. And they’ve asked if the boss is going to be replaced because they obviously can’t do two people’s jobs well, and they’ve been told that the boss will not be replaced. 

There’s also, on top of all of this, there’s a hiring freeze and there’s restrictions in hiring. So, it’s been very difficult for agencies, including the VA, including the medical personnel, to get new people. And again, the person I’ve spoken to said that the veterans are not getting the care, as good care as they were last year because this person just can’t do two people’s jobs. And it’s on the medical side, but the source also said that it’s throughout the hospital with the support staff and even the custodial staff. I mean, just â€¦ there’s a lot of unfilled positions that are affecting overall care.  

Rovner: I feel like a big irony here is that during the first Trump administration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, here he’s basically undoing everything that he did for veterans during the first administration. 

All right. Well, meanwhile,  that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994 â€” I still have scars from that fight â€” following a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval, as long as customers were informed that they were not intended to “diagnose, treat, cure, or prevent any disease,” a phrase that I’m sure you’ve heard many times in commercials. Of course, diet supplements are practically an article of faith for followers of the “Make America Healthy Again” movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the “aggressive suppression” of vitamins and dietary supplements. Lizzy, you’re nodding. 

Lawrence: Yeah, this is super interesting because this was one of the first things a year ago, when RFK was announced as the HHS secretary, when people were speculating on what some of his priorities would be, deregulating supplements was a big one. And so, I think this will be a really interesting space to watch and see. And it’s emblematic, too, of the uneven view of products regulated by the FDA, where there are some products where there’s â€¦ that RFK and other leaders at the FDA are super “pro” and well, we don’t actually need as much evidence here. And then others, like vaccines or SSRIs [selective serotonin reuptake inhibitors], where it seems that they want to really raise evidence standards, which is not how the FDA is supposed to work. It’s supposed to be dispassionately, with no bias, reviewing medical products. 

Rovner: And I would point out, in case I wasn’t clear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something. 

Ollstein: Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and, like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, if you’re taking a prescription drug, it’s been tested a lot more than if you’re taking a supplement. 

Rovner: Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists, Joanne Kenen and Paige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act. I think I noted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress: flatter them and take their parochial concerns seriously. That’s something that his boss, RFK Jr., has most certainly not mastered as of yet. And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year? 

Luhby: Well, one thing that’s interesting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, because it’s obviously something that he had promoted on his shows. It’s something that the Biden administration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And he said basically, “You guys have to step up,” and so, it’ll be interesting to see going forward what additional measures they take. But yeah, he’s certainly not bending over to the insurers. 

Rovner: Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing, that somebody had briefed him well. Apparently, according, I think , he’s been talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list. 

Luhby: Well, and one thing to also point out that was , particularly, is that what we’ve been hearing at other agencies â€” the CDC, and across the Trump administration â€” that a lot of the political appointees are really at odds with the staff. They’re not communicating with the staff; there were concerns about that after the CDC shooting over the summer. And one thing that, obviously, Dr. Oz is very personable, he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paige detailed about how he really is interacting a lot with the staff. And I’m sure that’s obviously helping morale and helping the mission at CMS. Also, of course, it’s an agency that RFK has not focused on. 

Rovner: I say, what a shock, treating career staff with some respect, like they know what they’re doing. 

All right. Well, finally, we end this year on reproductive health, pretty much the same way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability, even across state lines, of medication abortion. Alice, you’ve got quite the story this week about an unusual way to go after the pill. Tell us about it. 

Ollstein: Yeah. So this is a trend I’ve been covering for the last few years, and it’s anti-abortion groups trying to use various environmental laws to achieve the ban on the pills that they want to achieve. And so, there’s been some various iterations of this over the years. The latest one is that groups are jumping on a EPA [Environmental Protection Agency] public comment process that’s going to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country. So this is a big deal. It costs a lot to track these chemicals. There can only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list. 

Rovner: This is wastewater, right? Not drinking water? 

Ollstein: No, this is drinking water. 

Rovner: Oh, it is drinking water. 

Ollstein: There are other efforts to use wastewater laws to restrict abortion pills, yes. So we talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we have  talking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list. 

So, just to zoom out a little bit, while this particular campaign tactic, whatever you want to call it, may not succeed, I think it’s part of a bigger project to sow doubt in the public’s mind about the safety of mifepristone in various ways. We’ve been seeing this all year, and for several years. But I think that this kind of gross-out factor of there’s abortions in the water! Even without scientific evidence of that, I think it contributes to the public perception. And KFF had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, if not quite yet at federal agencies. 

Rovner: Another one we will be watching. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Tony Leys, and then we’ll come back and do our very special year-end extra credits. 

I am pleased to welcome back to the podcast ºÚÁϳԹÏÍø News’ Tony Leys, who reported and wrote the latest ºÚÁϳԹÏÍø News “Bill of the Month.” Tony, welcome back. 

Tony Leys: Thanks for having me, Julie. 

Rovner: So, this month’s patient had a very expensive ambulance ride, alas, a story we’ve heard as part of this series several times. Tell us who he is and what prompted the need for an ambulance. 

Leys: He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called [staphylococcal] scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER, where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton, about 40 miles away. They put in an IV and then put him in the ambulance. His mom went with and said the driver didn’t go particularly fast or use the siren, but did get them there in about 40 minutes. 

Rovner: But it still was an ambulance ride. So, how big was the bill? 

Leys: $9,250. 

Rovner: Whoa. Now, this family doesn’t have insurance, which we’ll talk about in a minute. So, it wasn’t an in- or out-of-network thing. Was this unreasonably high compared to other ground ambulance rides of this type? 

Leys: It’s really hard to say because the charges can be all over the place, is what national experts told me. But if Darragh had been on Medicaid, the ambulance company would’ve been paid about $610, instead of $9,200. 

Rovner: Whoa. So, what eventually happened with the bill? 

Leys: The company agreed to reduce it about 40% to $5,600 if the family would pay it in one lump sum. They did, they wound up putting it on a credit card, a no-interest credit card, so they could pay it off overtime. 

Rovner: Now, as we mentioned, this family doesn’t have insurance, but they belong to something called a health sharing ministry. What is that? 

Leys: Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would cover maybe about three-quarters of what they owed, so â€¦ 

Rovner: Have they heard about that yet? 

Leys: I have not heard. 

Rovner: OK. So, what’s the takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, you shouldn’t just bundle them into your car instead, right? 

Leys: I sure wouldn’t. Yeah, no. I mean, at that point, she felt like she had no choice. I mean, she did say if she would’ve just driven straight to the children’s hospital instead of stopping at the local hospital, they would’ve gotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So, that’s in retrospect what she wishes she would’ve done. But if they’d had insurance, the insurer would’ve presumably negotiated a lower rate, and they wouldn’t have had to do the negotiation themselves. 

Rovner: So, they are paying this off, basically? 

Leys: Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice. 

Rovner: All right. Tony Leys, thank you very much. 

Leys: Thanks for having me, Julie. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s usually where we each recognize a story we read this week we think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different. I’ve asked each of our panelists to take a minute or two to talk about what they see, not necessarily as the biggest single health story of the year, but the most important theme that we’ll remember 2025 for. Tami, why don’t you start us off? 

Luhby: OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill [Act], which Congress passed over the summer. The legislation enacts historic cuts to [the] nation’s safety net, with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than $900 billion from Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come from Congress adding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do … well, the Trump administration allowed certain states to do that. It really only took effect in Arkansas, and about 18,000 people lost coverage within months from the work requirements, many of whom, the advocates say, many people are working, they’re going to get caught up in red tape. They’re either working or they’re eligible for exemptions, but they’ll get caught up in red tape. 

So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or [dependent] children under age 14 would have to work, volunteer, or attend school or job training programs at least 80 hours a month to remain eligible, unless they qualify for another exemption, such as being medically frail or having substance abuse disorder. The package also limits immigrants’ eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source for states and which will have ripple effects across hospitals and across states in general. 

Now, what’s important to note is, most of these provisions haven’t taken effect yet. Most of them actually take effect after the midterm elections next year. So, they’ll be rolling out in coming years and the full impact is yet to come. 

Rovner: Alice. 

Ollstein: So, I have chosen the resurgence of infectious diseases that we are seeing right now. I think measles is really the canary in the coal mine. Because it’s so infectious, that’s what’s showing up first, but it’s not going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so, I think that a lot of different policies and trends are feeding into this. And I think we have the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies that we’re seeing. And then just cuts to public health and public health staff, cuts to surveillance, so it’s just harder to know where the outbreaks are happening and how bad they are. It’s hard to get reliable data on that. And so I think, yes, we’re seeing measles first, but now we are starting to see whooping cough, we’re starting to see some other things, and it’s really troubling, and it could have a political impact too. 

I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say, “This is the consequence of Republican health policies, and this is why you should vote for me.” So, I would be keeping an eye on that in the coming year. 

Rovner: Lizzy. 

Lawrence: So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, but there’s been the politicization of science in every agency. And this is something that used to be pretty taboo, right? I keep thinking these days about the [Barack] Obama HHS secretary, Kathleen Sebelius, and the legal and political repercussions she faced when she vetoed an FDA decision to make Plan B over-the-counter. And those days seem very far away, because now we’re seeing at the FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices. 

At the FDA and CDC, you’re seeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or even really no or debunked evidence. 

You’re seeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries. You’re seeing NIH [the National Institutes of Health] pull funding from research studies that go against Trump administration ideology. So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world. 

And then I’d say that has a trickle-down effect to the way that everyday people think about science, and it calls everything into question and makes … People look to politicians and to the heads of public health agencies to tell them the truth. I mean, maybe not politicians, but it seems that doctors and medical experts’ voices are increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So, I think this is a very important topic and one that I’ll keep watching closely in the next year. 

Rovner: Yep. So my topic builds on Lizzy’s. It’s how this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and health care workforce well into the future. The administration has frozen or terminated literally billions of dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest. 

And as we’ve talked about so many times before in this year’s podcast, the administration also seems intent on basically choking off the future health care workforce. The big budget bill includes caps on how much medical students can borrow in federal loans. That’s an effort to get medical schools to lower their tuition, but most observers think that’s unlikely to happen. The Education Department has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a “profession,” thus also limiting how much they can borrow. And a new $100,000 visa fee is going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers are literally the only ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in 2026. 

OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me on X , or on Bluesky . Where are you guys hanging these days, Alice? 

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Tami. 

Luhby: You could find me at . 

Rovner: Lizzy. 

Lawrence: You can find me at , on LinkedIn at , on X , and on  â€” and I forget my username, but I’m somewhere there. 

Rovner: Don’t worry about it. OK, we will be back in your feed in January. Until then, be healthy. 

[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 ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 11, 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 Anna Edney of Bloomberg News. 

Anna Edney: Hi, Julie. 

Rovner: Maya Goldman of Axios News. 

Goldman: Great to be here. 

Rovner: And I’m pleased to welcome to the podcast panel my friend and longtime health reporting colleague, Sheryl Gay Stolberg of The New York Times. Sheryl, so glad to have you join us. 

Stolberg: I’m so glad to be here, Julie. 

Rovner: So, later in this episode, we’ll have my interview with Linda Blumberg of Georgetown University. Linda has spent years analyzing Republican proposals to fix health care and has some interesting observations to share. But first, this week’s news. 

We will start again with the continuing saga of the expiring enhanced tax credits for the Affordable Care Act. Starting Jan. 1, millions of people who get their insurance from the Obamacare marketplaces will face huge increases in what they have to pay in premiums. Some will find those increases so big they’ll have no choice but to drop their insurance altogether. And next Monday, Dec. 15, is the deadline for people to sign up for coverage that starts in January. So, the Senate is set to vote today on two different options. The first, backed by all the chamber’s Democrats, calls for a straight, three-year extension of the enhanced payments that were first implemented in 2021. Those extra payments made insurance so much more affordable that enrollment basically doubled from about 12 million people in the marketplaces to about 24 million. That bill, though, is unlikely to achieve the 60-vote majority it would need to advance. The Senate is also scheduled to consider a Republican alternative, sponsored by Finance Committee Chairman Mike Crapo of Idaho and Health Committee Chair Bill Cassidy of Louisiana. It wouldn’t extend the enhanced tax credits at all. Instead, it would provide either $1,000 or $1,500 for a tax-preferred health savings account that individuals could use for routine health expenses to be coupled with a high-deductible insurance policy. “High-deductible” meaning many thousands of dollars. It’s not expected to achieve 60 votes either. So, assuming both of these plans fail to muster the needed 60 votes, where does that leave us? 

Edney: I think that leaves us looking for what the next turn of the key will be. I mean, will they be able to come to some agreement on extending the tax credits â€” likely â€” or the subsidies â€” likely after. Like you said, enrollment has been underway, and people are enrolling even though they don’t really know what the fate of these will be. So, it’ll be interesting to see how the marketplace reacts given what happens. But I don’t think there’s a really clear idea yet, except that everyone thinks that something might start moving once these votes are dispensed with. 

Stolberg: I think what happens is that a lot of Americans are going to lose their health insurance. We know that the number of Americans insured on the Obamacare exchange is more than double after the enactment of these extended tax credits in 2021. I think there were 11 million; now there are 24 million. And people, as you said in the outset, have to decide now. And maybe they’ll sign up now. But if they lose these credits, I think that a lot of folks are going to suddenly find themselves without insurance coverage. And I think politically for Republicans, that is going to be a big problem going into next year’s midterms. They know this, and that’s why they’re scrambling to come up with some kind of alternative that does not have Obamacare in its name. But we also know that the alternatives that they’re proposing won’t go very far in terms of offsetting out-of-pocket costs for people who are struggling to pay for health care. 

Rovner: Things are starting to bubble up in the House, too. I mean, we’ve seen this. … We knew we were going to have this Senate vote, which is everybody protected by everyone to be a show vote, but now Republicans in the House are getting skittish as well. 

Goldman: Yeah, absolutely. And we’ve seen a couple different proposals in the House. So, there are some moderates that are Republican moderates that are proposing a straight, two-year extension. I think, like Anna said, we’ll see what happens after the Senate votes today, if that brings people to the table or not. I think one thing that struck me this week is The Associated Press reported that  are actually slightly ahead of where they were at this time last year. But of course, that doesn’t mean that that’s going to result in more overall enrollment. There is still a lot that needs to be ironed out there. One thing that I’m wondering is: Is health coverage just something that people are biting the bullet on at this point? And they’re like, Well, I know it’s really expensive, but I still need to have health insurance. And is that going to … even if people do drop off, we’re so far away, politically speaking, from the November elections, that, is that actually going to resonate still? I don’t know. 

Rovner: Yeah. I mean, one of the things that … I saw that AP story, too, that enrollment is actually higher than it was last year at this time. But you have to worry if there’s going to be what they call the death spiral, where only the people who need insurance the most sign up. You have to wonder whether these are the people who would sign up no matter what. And it’s the healthier people for whom it’s a bigger question mark â€” whether they actually need the health insurance at this much higher price â€” who are probably waiting right now. If you’re sick, you’re probably going to sign up no matter what. So, in some ways, I wondered if that was more of a warning signal than anything else. 

Goldman: That’s a great point. 

Stolberg: I think the death spiral is a real concern, especially with the plan that Cassidy and Crapo are putting forward. It would drive people into either catastrophic plans or “bronze” plans, which are lower costs, but high-deductible. And the people who are going to get into those plans are healthy people. That is going to deprive the risk pools for sick people of the healthy. And we know what happens when the risk pools become imbalanced like that. Then insurance costs really skyrocket for the people who need it most. 

Rovner: Yeah. Now, even if Republicans do decide they want to sue for peace, if you will, there are a lot of other obstacles to a bipartisan deal. We’ve talked about abortion. But it looks like there are other things that Republicans want to do that Democrats are not going to want to accept. 

Stolberg: Such as ending support for IVF [in vitro fertilization] coverage like they did in the defense bill this week? 

Rovner: Yeah, which we’ll get to in a little while. 

Stolberg: OK. 

Rovner: Yeah. I mean, I could see a bipartisan deal. I’m just dubious partly â€” and we’ve said this, I think, every week for the last five or six weeks â€” that Republicans won’t vote for an extension without permanent abortion restrictions, and Democrats won’t vote for an extension with permanent abortion restrictions. But I know that some of these Republican bills also would deprive legal immigrants. There are anti-fraud provisions, some of which might be supported by Democrats, some of which might be seen as so onerous that they would prevent legitimate people from legitimately signing up. Does anybody actually see a bipartisan deal happening? I guess how scared do Republicans have to get before they’re willing to do something that the Democrats would agree to? 

Stolberg: I don’t see a bipartisan bill happening in time. I mean, Cassidy said at this hearing last week, literally pleading with his colleagues saying, We can talk about grand plans, Bernie [Sanders, I-Vermont] can talk about “Medicare for All,” and we can talk about this, but we got to do something in three weeks. Well, now it’s two weeks, and they’re not going to come to some compromise, especially not one involving abortion or undocumented immigrants by Christmas. It’s not going to happen. 

Rovner: Yeah. Congress loves to give itself deadlines and then not meet them. 

Goldman: Absolutely. And I think we have Republicans with their grand plans, and you can’t implement a full HSA [health savings account] expansion in the time that they’ve allotted. That’s just not practicable. 

Rovner: Yeah. I think this is a war of talking points at this point. All right. Well, the ACA may be this week’s news, but I don’t want to miss out on the vaccine news from late last week after we taped. As predicted, HHS Secretary RFK Jr.’s [Health and Human Services Secretary Robert F. Kennedy Jr.] handpicked CDC [Centers for Disease Control and Prevention] advisory committee on vaccine practices voted to roll back the universal recommendation for a first dose of the hepatitis B vaccine for infants, right after birth. Instead, the panel recommended making the vaccine the subject of “individual-based decision-making.” What’s the difference between that and actually recommending the vaccine? Is this a really big change? Anna, Sheryl, you guys have been watching this closely. 

Edney: Yeah, I think that it’s a big change in the sense that it can be pretty confusing for parents. And it injects this idea of the vaccine possibly being harmful â€” although that’s not something that’s seen in the data â€” and also that maybe it’s just not that big of a deal, which is the problem of the success of the vaccine is the vaccine works. Hepatitis B cases in newborns go down, and people think, Oh, well, we don’t really have to worry about this anymore. But that’s just not the case. Obviously, as we’ve seen with other diseases of late, these things can come back. 

And so I think it’s not going to change at the moment, at least, necessarily insurance coverage for having the vaccine, but it does leave open this door that, Well, maybe you should talk to your doctor, see if it’s really the best thing. And there’s just a lot coming at you as a new parent or a parent with a new child on the way, and a lot of medical advice to wade through, and things like that. So, this adds an extra piece to that for which a lot of the medical societies and doctors, Sen. Cassidy included, have said, This isn’t something that we’ve had a big question mark on. It’s been actually really, really helpful in the health of children. 

Rovner: Yeah. Hepatitis B cases in children and teens have gone down 99%. 

Stolberg: That’s right, since 1991. I was going to say, I think this is a really big deal. And it’s a really big deal for a couple of reasons. One, it’s not science-based. There’s no evidence that delaying the vaccine makes it any safer for children. Two, it’s a really big deal because of the debate that Kennedy and his allies have created around what was once not given any thought. And it’s also a big deal because, as doctors will tell you, in theory, one could argue, as Kennedy and his group do, that this is a disease that’s transmitted sexually, or it’s transmitted through intravenous drug use. And for infants, the real risk is mother-to-child transmission. Well, first of all, that’s not entirely true. The virus can last and live on household items like scissors, or tables, or whatever. We know that newborns are the ones that are most at risk. 

And we also know that the best time to capture or vaccinate a newborn is when they’re there in the hospital, and they have access to medical professionals who can administer the vaccine. And unlike countries like Denmark, which follow up their babies, our babies don’t get that kind of follow-up. And so the likelihood is that kids will not get vaccinated when they’re older. Parents will forget about it, and they will have missed that critical opportunity to be protected against an infection that can cause chronic liver disease and death. 

Goldman: Yeah. And there was a lot of discussion during the meeting on, Oh, well, we need to do a better job of screening the mothers for hepatitis B, and you should still get the newborn vaccine if you test positive, et cetera, et cetera. But that’s not ACIP’s [Advisory Committee on Immunization Practices] job to say that we should be screening mothers, so they don’t have any authority there to enforce that. And a CDC staff member said, We’re working on that. But, like Sheryl said, we don’t have the same kind of system that they have in other countries, where you can get those follow-up appointments, and get women in for prenatal care that they need. And so I agree, it’s going to be a huge, huge issue. 

Rovner: Yeah. Well, speaking of those other countries, later on Friday after the meeting, in news that some might have missed, President [Donald] Trump issued an executive order basically telling RFK Jr. that he can do anything he wants with the childhood vaccine schedule because he should compare it to our “peer nations.” Sheryl, you had a big story last week about . What are they? 

Stolberg: Well, what I reported with my colleague Christina Jewett is that Kennedy has been on this two-decade crusade to really upend American vaccine policy. Ultimately, he would like to end all mandates for childhood vaccination. That’s not within his purview. That’s in the purview of the states. But he wants to revisit the entire childhood vaccine schedule. And you can see in what he has done by installing his allies, some of whom presented at this ACIP meeting last week, he’s put them in key places. People like Mark Blaxill, who is a parent of a child with autism, who was a founder of a group called Safe Minds, which was an advocacy group. Mark Blaxill now works for the CDC. He’s a smart, Harvard-educated businessman, not a doctor, but he presented on hepatitis B. We saw Aaron Siri, Kennedy’s lawyer, presenting on the childhood vaccine schedule. 

This is a committee that is supposed to be comprised of medical experts â€” people who are physicians who’ve administered care. And what we are seeing is Kennedy installing these people and others, sprinkling them throughout the department, or bringing them in, to carry out his vision. And he was very clear about that vision in an interview with me. I mean, he firmly believes, as he said â€” he was careful â€” he said that autism has gone up over these past decades, and it’s the same time as the childhood vaccines have become … we’ve had more widespread use of vaccines. We’ve also had more widespread drinking of pumpkin spice lattes, as Kennedy’s critics note, but Kennedy has said vaccines must be a potential culprit. I thought that was very interesting that he put that word in â€” potential. It was a wiggle word. But frankly, what he thinks is that vaccines are responsible, and he has said as much in other interviews. 

Rovner: And yet, while this is going on at this very high level, we’re now having a huge and growing measles outbreak in South Carolina, in addition to the one that we’ve already had in Texas. This is really having an impact on parents’ willingness to have their children vaccinated. I mean, that, I think at this point, cannot be denied just by the evidence. 

Edney: Yeah. Fewer parents are getting their kids vaccinated for school. They’re getting more waivers and things like that, too. So, we do see that this is definitely giving parents who maybe had concerns, or have felt some kinship with the MAHA [Make America Healthy Again] movement as it’s grown, the ability to do what they feel is right, less so following the science. 

Stolberg: Peter Hotez, who is at Baylor University, told me that he was not surprised when there was a measles outbreak in Texas, and in particular in that part of West Texas, because vaccination rates in that corner of the state had been dropping precipitously in the years prior to the outbreak. And he said he could see it coming. 

Goldman: I think it’s also, it’s not just people that are very in line with the MAHA movement at this point. I think if you’re not paying as close of attention as we are, the messages that you’re seeing are, Vaccines are bad. We need to look into vaccines. I don’t know, should I get a vaccine? Should I give my children vaccines? And I think that’s really taking hold. 

Rovner: Another story that we’re going to follow into 2026. All right, we’re going to take a quick break. We will be right back.  

Turning to reproductive health, the last big bill Congress is trying to finish before leaving for the year is the National Defense Authorization [Act]. And for the second year in a row, House Speaker Mike Johnson has ordered the removal of a provision passed by both the House and the Senate that would provide military personnel the same fertility coverage that other federal employees and members of Congress get. Right now, fertility treatments like IVF are only covered for those in the military who have service-related injuries or illnesses. I thought this was a priority for President Trump. At least he keeps saying that it is. 

Stolberg: I think this is daylight between Trump and Mike Johnson, clearly. 

Rovner: I have to say, I was surprised. Since when can the speaker just take something out of a bill that was passed by both the House and the Senate? 

Stolberg: Also, not to mention that members of Congress have this coverage. 

Rovner: That’s right, which they only got fairly recently. I’m surprised that there’s, I would say, less pushback. There obviously is pushback. There are people who are really furious about this, but in the manner of how things work in Congress, this is literally the second time he’s done it. And his spokespeople admit that he did it. And he says, Well, I only want this if it’s done ethically. And a reminder, he’s from Louisiana, which is the state that has current restrictions on the destruction of excess embryos from IVF that’s made IVF difficult to obtain in that state. It’s one person exerting his will over the rest of the Congress. 

Stolberg: Yeah. I think that’s the most interesting thing about it is the daylight between Johnson and Trump and also Kennedy on this issue. Because while Trump and Kennedy profess to be anti-abortion, it’s not really a top-of-mind issue for either one of them. But it is for Johnson. And I guess I can’t imagine Trump vetoing the defense bill, so I guess this is going to go through. 

Rovner: Yeah, without it. Again. Well, speaking of who it’s a priority for, much [to] the frustration and anger of the anti-abortion movement, a new report finds that the percentage of medication abortions using telehealth continues to grow, including those from states with shield laws that protect prescribers to states that have abortion bans, to patients in those states that have abortion bans, which underlines a story from your colleagues at Bloomberg, Anna, suggesting that FDA commissioner Marty Makary is  of the abortion pill that was promised to anti-abortion lawmakers, that he’s apparently slow walking that until perhaps after the midterms. 

I hasten to add that HHS spokesman Andrew Nixon denies the studies being deliberately delayed. But just the story has angered anti-abortion forces so much [that] they’re now calling for Makary’s firing. And Missouri Republican Sen. Josh Hawley, who’s been at the forefront of the fight against the abortion pill, and I believe the person who got the promise for this study, has called the allegations unacceptable and is demanding answers by this Monday. Combined with what’s going on with the carousel of center directors at the FDA, how much longer can Makary last under this continuing onslaught? 

Edney: Yeah, what I was thinking of when you were talking about this story is this is just one in a tiny slice of all the things that seem to be coming at Makary and going wrong, and calling into question his ability to manage the FDA. I think specifically â€” you were just mentioning this with abortion, Sheryl â€” that it’s not top of mind for Trump or RFK. So, I’m not sure that this is the thing that does him in unless Sen. Hawley or something breaks on that end. Maybe there are some senators who will be upset enough as more, or if, more details come out. 

I think that definitely Makary appears to be fighting for his job. I think there have been some great stories in The Washington Post and The Wall Street Journal talking about these discussions at the White House every few weeks, where should we keep doing this? Do we need to think of maybe putting someone different in leadership? He’s still there. And so, it seems that RFK is backing him pretty publicly. Obviously, that can change at a moment’s notice. So, something to keep a really close eye on. 

Goldman: Something that we’ve been talking about on my team related to that is that it’s going to be really hard to get anyone else approved through the Senate for any of these positions. And they can install an acting director, but there are limits to how long that can last. And so I think that that is maybe partially helping with some job security for a lot of these people at these high levels. 

Stolberg: I think it would be very hard to get someone else installed given the broken promises that Kennedy has made to Cassidy. They’re going to be very wary. And also, Makary is in the arc, or the spectrum, of people who could fill that job. He’s actually kind of moderate, if you will. And I talked to someone close to Kennedy who said that Kennedy still has confidence in him. So, his ouster, I think, would require the White House bigfooting Kennedy. And I’m not sure that that would happen. 

Rovner: And they have, as we’ve noticed, other things to deal with right now. Finally this week, remember that $50 billion Congress included for rural health in last summer’s big budget bill to offset the nearly $1 trillion in cuts to Medicaid? Well, now the Trump administration is effectively telling states that if they want to claim a share of that money, they need to make changes that align with other  â€” things like barring people from using food stamps for junk food, or legalizing short-term insurance plans that many states worry could destabilize the individual insurance market. Now, I wouldn’t call this outright coercion, but I remember that the Supreme Court basically did just that when they ruled that the ACA’s Medicaid expansion had to be voluntary. Is this really going to fly, that the Trump administration could say, You can’t have this money unless you do other things that we want you to do? 

Goldman: If I’m remembering correctly, all states that have all right to applications will get a baseline of money, and states can get more money for certain things that they apply for. And so I think that maybe that makes this a little different. But I think states will be very upset if they don’t get the money that they want, that they are asking for. And it’ll be interesting to see if there is legal action on the back end, too. 

Rovner: Yeah. I mean, clearly this $50 billion for rural health is not enough to even begin to make up for the cuts that are coming to Medicaid. So, we’re talking about small amounts of money. It’s just, I don’t remember seeing conditions that were quite this blatant. And you’re right, Maya, it’s not all of the money, but it is some segment of the money. But for them to just literally come out and say, We’re going to give you money if you do what we want. I would think at some point Congress gets to say, Hey, not what we had in mind. 

Stolberg: But Congress won’t say it. Not this Congress. 

Rovner: Yeah, not this Congress. So maybe a future Congress. All right. Well, that is this week’s news. Now, we will play my interview with Linda Blumberg of Georgetown University, and then we will come back and do our extra credits.  

I am pleased to welcome to the podcast Linda Blumberg. Linda is a research professor at Georgetown University and an institute fellow in the Health Policy Division of the Urban Institute, and one of my go-to people whenever I have a really complicated question about health policy. Linda, welcome to What the Health? 

Linda Blumberg: Thanks so much for having me here. 

Rovner: So, to the unpracticed eye, it looks like Republicans in the House and Senate are just now coming up with all these new and different health plans. But, in fact, most of them are variations on what Republicans have been pushing, not just for years, but for decades in some cases. Is there anything really new, or is this just a long list of golden oldies? 

Blumberg: I think this is basically a list of things that have been brought out before. Now, they have to present them and talk about them in the context of the Affordable Care Act, which they didn’t have to do many years ago. They’re working around in terms of what they’re impacting on the Affordable Care Act, and how these other pieces would fit in with what they want to do there. But they’re essentially the same things they’ve been talking about for a long time. 

Rovner: So, you’ve been analyzing these plans for years now. And while they may look different on the surface, you say they all have one thing in common: that they work to segment rather than pool risk. Can you explain that in layman’s terms? 

Blumberg: Sure. When I talk about segmenting health care risk, what I’m talking about is policies, or strategies that place more of the financial responsibility of paying for medical care on the people who need that care when they need it, or on those who are most likely to need medical care. That is the opposite of pooling risk more broadly, which actually takes health care costs and spreads them to a greater extent across people, both healthy and sick. 

Rovner: So basically, protecting sick people, which is the idea of health insurance in general, right? 

Blumberg: Well, from my perspective, yes. The situation is because there is â€” what we in economics call â€” a very skewed distribution of health care spending, that means that in any particular year, at any particular moment in time, most people are pretty healthy and don’t use much medical care, and the great bulk of health care spending falls on a small percentage of the population. And so, when you’re only looking in the short term, when you’re not looking broadly across time, or across somebody’s life, then people who, when you segment health care risk, you can create savings for people when they’re super healthy. The problem is that it increases the cost even more when they are not healthy, and none of us are healthy forever. 

Rovner: And just to be clear, the percentage of people who use the majority of health care is really, really tiny, isn’t it? 

Blumberg: Yeah. So, for example, there is a rule of thumb that around the top 5% of health care spenders account for basically half of all health care spending, and the bottom half of spenders account for less than 3% of health care spending. But that is at a particular moment in time, again. And I think the problem is when we think about health care spending as Who’s going to win? Who’s going to lose? in terms of money, right now, at a particular moment in time. Instead of thinking about what happens to us over the course of our lifetime, which is, then, when we spread the costs much more broadly, we’re more protected. We have access to adequate affordable health care under broad-based pooling of health care risk. When we segment it, we’re really making people much more vulnerable to not being able to get the care they need when they need it. 

Rovner: And how do things like health savings accounts, and giving consumers more power to go out and negotiate on their own, how do those actually segment risk? 

Blumberg: So, the more you take the dollars that are being spent on health care and remove it from the health insurance pool â€” the amount of money that is going to pay for claims through health insurance,  whether it’s public or private insurance â€” the more you take it out of the insurance pool and you put it on the individuals, the more we’re separating the risks and putting heavier costs on people when they need care. So, a health savings account gives us some cash, or allows us to put some cash into an account to use when we’re needing care. But it also comes with health insurance plans that are much higher deductibles and much larger out-of-pocket costs. 

And so what we see in practice is that the people who have these accounts, they tend to not … First of all, they tend to be much wealthier people because they’re tax advantages for wealthy people, not for people who are [of] much more modest means. And when they go to get care, there’s usually not that much money in the account to help them pay for these much larger deductibles and out-of-pocket costs. And so they’re paying for a lot more when they need the care. The insurance kicks in at a much higher level of spend. And so the financial burden, even though they’ve paid lower premiums when they need the care, the financial hit is on the individual. 

Rovner: So why shouldn’t we put higher-risk people in a different pool? Since, as you point out, most people are healthy most of the time. That would reduce costs for more people than it would raise costs for. Right? 

Blumberg: Well, it would, at a particular moment in time, but the problem is we don’t stay healthy all of the time. And so, I’m not born with a stamp on my head that says, You’re going to be a low spender, and so you’re going to be better off over here. All I need is a broken leg. All I need is somebody in my family to develop diabetes. God forbid, a kid gets hit by a car, or develops a brain tumor. Stuff happens from out of the blue. And then, if that’s the case, if I’m in a situation that could really make it so that I can’t access, or my loved ones can’t access, the care that they need when they need it. And by the way, as we age, everybody tends to use more and more care. 

So, you can save money at a moment of time by segmenting risk in these ways, but if you do it, you’re putting so many people at risk for not being able to get adequate care when they need it. And because of that skewed distribution of health care spending, it’s a situation where what you save when you’re healthy from segmenting risk is really pretty small compared to the extra amount you have to spend for pooling risk. Because if you take these dollars, and you spread them over everybody, then the increment that you have to spend in order to make sure you’re protected, and everybody else is protected when they need medical care, is not that big. 

Rovner: Is there some ideological reason why Republicans seem to be coalescing around these risk-segmentation ideas? 

Blumberg: I’m not a psychologist, so the motivation escapes me. Because I do think people are better off over the course of their lifetimes when we spread risk broadly. I think part of the issue is the other philosophical difference between conservatives and more progressive policymakers is the idea of income distribution. And the truth of the matter is that really wealthy people, if they get sick and have a high-deductible plan, or they have a much more narrow set of benefits that are being offered to them, they have wealth that can take them a long way to get to buy medical care. They can pay for the broken limb. They can pay for various different medications. 

If they have a very serious illness, or injury that’s longer lasting, they may not â€” even wealthy people â€” may not be able to cover the costs, or it may really have a big impact on them. But by and large, wealthy people are able to insulate themselves to some degree, even with very pared-down coverage. Whereas somebody who’s middle-income, who’s lower-income, who’s not super wealthy, is not going to be able to access that care. So, if your focus is on protecting the assets of those with a lot of wealth, this is a positive in that regard. 

Rovner: So how does this ongoing debate about these enhanced premium subsidies play into this whole thing? 

Blumberg: When we’re talking about the enhanced premium tax credits, which seem to be, by the end of this week, will be going by the wayside, those are actually pooling mechanisms, too. And I think it’s important for people to understand that financial assistance for lower- and middle-income people, one of the great things that it does â€” as a secondary effect of just giving those people insurance coverage â€” is it brings a lot more healthier people into the pool. People who are healthy, young, who wouldn’t have been able to afford health insurance coverage before, and so would have remained uninsured and did before these credits were in place. It brings them into the pool. It lowers the average medical expenses of people insured. And by pooling risk in that way, it actually lowers the premium. Because as the average cost of the individuals enrolled goes down, the premiums go down, too. 

And so one of the things besides these other strategies, which would tend to segment risk further, as we talked about, the strategy that they are denying â€” which is continuing these enhanced subsidies â€” is also going to further segment risk because it’s going to push healthier people out of the pool that can’t afford it anymore. Same with, by the way, the people who are immigrants but are residing here legally, who are no longer going to be able to access assistance to buy coverage in the marketplaces as they have been for the last number of years, they also tend to be people who use less medical care on average. And so those immigrants being in our insurance pools are actually helping to subsidize American citizens who are less healthy. And so by saying, Listen, we’re not going to let you in. We’re not going to give you subsidies to make it affordable for you to come in. We’re actually pushing the average cost of the health insurance coverage upward for no good reason, honestly. 

Rovner: Linda Blumberg, thanks very much. 

Blumberg: My pleasure. Good to see you. 

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

Edney: Yeah, thank you. I had a story just published today. It’s in Bloomberg: “.” And I took a deep look at this issue of preterm infant formula. So, for preemies that are born really early, there’s this big debate right now on whether formula is harming them, or whether it’s something else that’s causing one a day, essentially, to die from this awful disease, necrotizing enterocolitis. And so Abbott is struggling because they don’t make a lot of money off of this formula, but they’re being sued for billions and billions of dollars. So they really want Congress, any agency, the White House, whoever, to intervene in some way. 

They’re throwing everything at the wall to see what can stick. And I’ll just say one tidbit that I found that was really interesting. There’s a lot of debate. There was an NIH [National Institutes of Health] report on this disease recently that moved in Abbott’s favor a little bit. I did learn through my reporting that the report was ghostwritten by a company that does a lot of work with Abbott, and lists them as a client. So that’s an interesting conflict of interest there, maybe a hook to get you guys to go read it. Thanks. 

Rovner: Oops. I’m definitely going to go read it. Maya, why don’t you go next? 

Goldman: Yeah, I’m excited to read that, Anna. 

Edney: Thank you. 

Goldman: My extra credit this week is from ProPublica. It’s by Aliyya Swaby and it’s called “” There are a lot of details in the story, but I think the headline tells you the gist of it. But what stuck out to me about this is I think in health journalism and health policy, we often talk about the safety net as if it’s magic and going to catch everyone, or at least I find myself slipping into that mindset sometimes. And I think it’s really important to look into how people on the ground are actually experiencing these services. And it’s also a reminder, unfortunately, that there are bad actors everywhere. 

Rovner: Alas. Sheryl. 

Stolberg: So, my extra credit this week is actually more of a science policy story than a health policy story, but it is a fascinating yarn. It’s titled “.” It’s in The New York Times by my colleague Katie J.M. Baker. And this is the story of two Chinese virologists who were married, and the woman came to believe that covid was a bioweapon created in a lab, and that the Chinese government had purposefully grown this virus and released it to set off the pandemic. And this doctor fell under the sway of people like Steve Bannon, Trump’s ally, and an exiled Chinese billionaire who had reason to want to blame the Chinese government, and who brought her to the United States, placed her in a series of safe houses once she arrived, and arranged for her to meet some of Trump’s top advisers. 

And she has now gone underground, and her husband actually moved to the United States to try to find her. And she’s basically in hiding. She’s cut off contact with her family. And it’s heartbreaking, and poignant, and also, from my perspective, revelatory about just the politics that have come to define our debates around science and health in the wake of the pandemic. 

Rovner: Yeah, it is quite the story. All right. My extra credit this week is from The Washington Post. It’s called  by David Ovalle. And we’ve talked about this issue before. These fees were mainly aimed at tech companies, who are the biggest users of the H1B visa program, but this new $100,000 fee is already preventing particularly rural practitioners from bringing medical professionals to places in the United States that Americans just don’t want to practice. This story centers on an overworked kidney disease practice in North Carolina that’s still waiting on a U.S.-trained doctor that it hired months ago, who is stuck in India. We’ve already talked about how the Medicaid cuts are going to hit rural areas particularly hard. This fee to bring in international medical professionals sounds like it’s making that even worse.  

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcast, 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 still on X  or on Bluesky . Where are you folks hanging these days, Maya? 

Goldman: I am on X  and on LinkedIn under my name. 

Rovner: Anna? 

Edney:  or  @AnnaEdney,and LinkedIn as well. 

Rovner: Sheryl. 

Stolberg: And I’m on  and  @sherylnyt, and LinkedIn under my own name. 

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

[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 ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C., and welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 18, 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 Tami Luhby of CNN. 

Tami Luhby: Hello. 

Rovner: Alice Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

Rovner: And I am pleased to welcome to the podcast panel Lizzy Lawrence of Stat News. Lizzy, so glad you’ll be joining us. 

Lizzy Lawrence: Thanks so much for having me. I’m excited. 

Rovner: Later in this episode, we’ll have my interview with Tony Leys, who reported and wrote the latest ºÚÁϳԹÏÍø News “Bill of the Month” about yet another very expensive ambulance ride. But first, this week’s news. 

Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of the additional ACA [Affordable Care Act] subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House, along party lines, passed a bill that Republicans are calling the “Lower Healthcare Premiums for All [Americans] Act,” which actually doesn’t, but we’ll get to that in a moment. Notably, not part of that bill was any extension of the enhanced tax credits that now are going to expire at the end of this year, thus doubling or, in some cases, tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue the additional subsidies with some changes, but in the end, he didn’t. 

So, four of those Republicans, from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed on to a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell us what’s in that bill that just passed the House. 

Luhby: Well, there are four main measures in it, but none of them, as you say â€¦ they will lower potentially some premiums for certain people, but they’re really a bit of a laundry list of Republican favorite provisions. 

So, one of the main ones is association health plans. They would allow more small businesses â€” and, importantly, the self-employed â€” to band together across industries. This could lower health insurance premiums for some people, but these plans also don’t have to adhere to all of the ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure. 

There are some PBM, pharmacy benefit manager, reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have … the experts I spoke to said it’s really just tinkering around at the edges and may not be that consequential. 

Rovner: And it’s not even as robust a PBM bill as Republicans and Democrats had agreed to last year â€¦ 

Luhby: Exactly. 

Rovner: â€¦ that Elon Musk got struck at the last minute because the bill was too long. 

Luhby: Exactly, it’s a narrower transparency. There are narrower transparency provisions. It would also, importantly, refund the cost-sharing provisions. And remember, there are two types of subsidies in the Affordable Care Act. There are the premium subsidies, which is what everyone is talking about, the enhanced premium subsidies. But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, their out-of-pocket expenses. 

President [Donald] Trump, during his first term, in an effort to weaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them. So what the insurers did was they increased the premiums of the “silver” plans in order to make up some of the difference, but those silver plans, remember, are tied to â€¦ the cost of those silver plans are what determines the premium subsidies that people get. So, basically, by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will, in turn, lower the premium subsidies that the government has to pay and save the government money. 

The people in silver plans probably won’t be affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy “gold” plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy “bronze” plans for really cheap. So basically, this provision will end, will reduce the premium assistance that people get, and it’ll effectively raise premium payments for people in a lot of plans, which will make it more difficult for them. 

Rovner: Which was a wonderful explanation, by the way, of something that’s super complicated. 

Luhby: Thank you. 

Rovner: But I’ve been trying to say it basically moves money around. It takes money that had been … it lowers how much the federal government will have to pay, while at the same time loading that back onto consumers. 

Luhby: Right. 

Rovner: So, hence my original statement that the “Lower Premiums for All” Act doesn’t lower premiums for all. So, this is â€¦ 

Luhby: No, there’ll be a lot of people in gold and bronze and “platinum” plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care. 

And then there’s a fourth provision that’s not as consequential: It’s called choice plans. It’s to help employers give … it’s to make it easier for employers to give money to people to buy coverage on the exchanges. 

Rovner: Yeah, which I think nobody disagrees with. But Alice, there’s another even catch to the cost-sharing reductions, which is that it’s only for states that ban abortion or that don’t ban abortion. Now I forget, which is it? 

Ollstein: So, it’s, yeah. So the great compromise of the Affordable Care Act was that it’s up to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s 50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provision sought to penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets. 

And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday, it’s nowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way as an impediment, including in the Senate as well. 

Rovner: Yeah. So, what are the prospects for these additional subsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies â€” in January, after they’ve expired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here? Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds? 

Ollstein: Well, Democrats and advocacy groups are trying to ramp up that pressure. We’ve been covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this. They’re highlighting the stories of individual, sympathetic-character folks who are having their premiums go way up. 

So, there were press conferences just this week I saw with retirees and people who are on Social Security Disability and small-business owners and single parents, and it’s not hard to find these stories; this is happening to tens of millions of people. And so, I think this is going to be a major, major political message going into next year. Whether it’s enough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree on some kind of an extension, that remains to be seen. And we really haven’t, despite the defection of a small handful this week in joining the Democrats on an extension â€” which was really notable and a sign that Speaker Johnson is not keeping his caucus in array. But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise. It can go either way. 

Rovner: I saw a lot of people yesterday saying that, Well, even if the House were to pass the clean three-year extension of the enhanced subsidies â€” which is what’s in the Democrats’ bill â€” the Senate just voted on it last week and voted it down, so it wouldn’t have any chance. To which my response was, “Hey, Epstein files.” When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you; you wanted to say something. 

Luhby: No, I was just going to say that yes, things can certainly change and there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all been writing stories about the cancer survivors or cancer patients who may have to drop their coverage in the middle of their treatment because they can’t afford the new premiums, or all of these stories. So, none of this is new, but we’ll see. There’s obviously â€¦ what is somewhat new is the administration’s message on increasing affordability, and this is a huge affordability issue. So, maybe that will spur some change in votes or change in mindset. 

Rovner: Well, definitely a January story too. 

Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official â€” after being blessed by the acting director of the agency, who is neither a doctor nor a public health professional â€” the U.S. government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991. 

And merging two stories from this week, there’s also news about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will “harm children, their families, and the medical professionals who care for them.” And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesday terminated seven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, and identifying autism early. According to The Washington Post, which , an HHS spokesman said the grants were canceled because they “no longer align with the Department’s mission or priorities.” 

First, this is not normal. Second, however, it’s HHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy, you’re nodding. 

Lawrence: Absolutely. Yeah, I think this has become very commonplace in this administration. And also interestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea, West Africa, to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so, we’re seeing an active removal of funds from the American Academy of Pediatricians [Pediatrics], and then giving funds now to research. And this is a research group actually that RFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will be really interesting to see if this is a trend that continues, if they’re kind of … we already know that HHS, the CDC’s vaccine panel, there’s been discussions about making our vaccine schedule closer to Denmark’s. Now there’s this money being given to Danish researchers who align with the way that they think about vaccines is similar to Kennedy and to another official at FDA, called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So, yeah. 

Rovner: And who is Danish, I believe. 

Lawrence: Yes, her husband is Danish, and so she lived in Denmark for many years. 

Rovner: I saw some scientists complain about that study in Guinea-Bissau, because they say it’s actually unethical to use a placebo to study the hepatitis B vaccine because we know that it works. So if you’re giving a placebo to children, you’re basically exposing them to hepatitis B.  

Lawrence: Right. 

Ollstein: Yeah. I saw that too. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people of colonial experiments in medicine that were really unethical and subjected people to more risks than would be allowed here. And like you said, basically knowingly withholding something that is safe and effective and giving someone a placebo instead. 

Another issue I saw raised was that it is not a double-blind study; it is a single-blind study. And so, that allows for potential biases there as well. 

Lawrence: Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027. 

Rovner: Oops. 

Lawrence: So, that’s a crazy … yeah, you have babies born before that year who are not given this dose, and then after … so yeah, it raises all kinds of ethical concerns, and it’s just remarkable that the government would just pull away and offer this money to them. 

Rovner: HHS in 2025. Specifically on the covid vaccine, there were two stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated against covid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at , editor Jeremy Faust, who’s both a doctor and a health researcher, says that FDA vaccine chief Vinay Prasad overstated his case when he said the agency has found at least 10 children who’ve died as a result of receiving the covid vaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. This isn’t great evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest. 

Lawrence: Right, right. Yeah, the memo that Vinay Prasad sent, which was immediately leaked, was remarkable in that it included no data backing up his claims. And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues. I think sometimes it’s hard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately, and it’s a really severe claim to say that this has killed 10 children. And so, that discussion needs to be shared transparently and allow for experts to really weigh in. 

Rovner: Yeah. Well, another issue that’s going to bleed over into January. All right, we’re going to take a quick break. We will be right back. 

So in other administration health news, it appears, at least , that the on-again, off-again cuts to medical personnel at the Department of Veterans Affairs are on again. The Post is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel. That’s on top of a cut of 30,000 people earlier in 2025. Altogether, it’s about a 10% cut in total. Apparently, most of the positions are currently unfilled, but that doesn’t mean that they’re unneeded, particularly after Congress dramatically expanded the number of veterans eligible for health benefits by passing the PACT Act during the Biden administration. That’s the bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’ ability to get timely care from the VA? Nothing good, I imagine. 

Luhby: Well, I’ve been speaking over the past year or two to a VA medical staffer, who wishes to remain anonymous for obvious reasons. And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’ shift. And they’ve asked if the boss is going to be replaced because they obviously can’t do two people’s jobs well, and they’ve been told that the boss will not be replaced. 

There’s also, on top of all of this, there’s a hiring freeze and there’s restrictions in hiring. So, it’s been very difficult for agencies, including the VA, including the medical personnel, to get new people. And again, the person I’ve spoken to said that the veterans are not getting the care, as good care as they were last year because this person just can’t do two people’s jobs. And it’s on the medical side, but the source also said that it’s throughout the hospital with the support staff and even the custodial staff. I mean, just â€¦ there’s a lot of unfilled positions that are affecting overall care.  

Rovner: I feel like a big irony here is that during the first Trump administration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, here he’s basically undoing everything that he did for veterans during the first administration. 

All right. Well, meanwhile,  that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994 â€” I still have scars from that fight â€” following a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval, as long as customers were informed that they were not intended to “diagnose, treat, cure, or prevent any disease,” a phrase that I’m sure you’ve heard many times in commercials. Of course, diet supplements are practically an article of faith for followers of the “Make America Healthy Again” movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the “aggressive suppression” of vitamins and dietary supplements. Lizzy, you’re nodding. 

Lawrence: Yeah, this is super interesting because this was one of the first things a year ago, when RFK was announced as the HHS secretary, when people were speculating on what some of his priorities would be, deregulating supplements was a big one. And so, I think this will be a really interesting space to watch and see. And it’s emblematic, too, of the uneven view of products regulated by the FDA, where there are some products where there’s â€¦ that RFK and other leaders at the FDA are super “pro” and well, we don’t actually need as much evidence here. And then others, like vaccines or SSRIs [selective serotonin reuptake inhibitors], where it seems that they want to really raise evidence standards, which is not how the FDA is supposed to work. It’s supposed to be dispassionately, with no bias, reviewing medical products. 

Rovner: And I would point out, in case I wasn’t clear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something. 

Ollstein: Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and, like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, if you’re taking a prescription drug, it’s been tested a lot more than if you’re taking a supplement. 

Rovner: Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists, Joanne Kenen and Paige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act. I think I noted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress: flatter them and take their parochial concerns seriously. That’s something that his boss, RFK Jr., has most certainly not mastered as of yet. And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year? 

Luhby: Well, one thing that’s interesting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, because it’s obviously something that he had promoted on his shows. It’s something that the Biden administration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And he said basically, “You guys have to step up,” and so, it’ll be interesting to see going forward what additional measures they take. But yeah, he’s certainly not bending over to the insurers. 

Rovner: Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing, that somebody had briefed him well. Apparently, according, I think , he’s been talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list. 

Luhby: Well, and one thing to also point out that was , particularly, is that what we’ve been hearing at other agencies â€” the CDC, and across the Trump administration â€” that a lot of the political appointees are really at odds with the staff. They’re not communicating with the staff; there were concerns about that after the CDC shooting over the summer. And one thing that, obviously, Dr. Oz is very personable, he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paige detailed about how he really is interacting a lot with the staff. And I’m sure that’s obviously helping morale and helping the mission at CMS. Also, of course, it’s an agency that RFK has not focused on. 

Rovner: I say, what a shock, treating career staff with some respect, like they know what they’re doing. 

All right. Well, finally, we end this year on reproductive health, pretty much the same way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability, even across state lines, of medication abortion. Alice, you’ve got quite the story this week about an unusual way to go after the pill. Tell us about it. 

Ollstein: Yeah. So this is a trend I’ve been covering for the last few years, and it’s anti-abortion groups trying to use various environmental laws to achieve the ban on the pills that they want to achieve. And so, there’s been some various iterations of this over the years. The latest one is that groups are jumping on a EPA [Environmental Protection Agency] public comment process that’s going to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country. So this is a big deal. It costs a lot to track these chemicals. There can only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list. 

Rovner: This is wastewater, right? Not drinking water? 

Ollstein: No, this is drinking water. 

Rovner: Oh, it is drinking water. 

Ollstein: There are other efforts to use wastewater laws to restrict abortion pills, yes. So we talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we have  talking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list. 

So, just to zoom out a little bit, while this particular campaign tactic, whatever you want to call it, may not succeed, I think it’s part of a bigger project to sow doubt in the public’s mind about the safety of mifepristone in various ways. We’ve been seeing this all year, and for several years. But I think that this kind of gross-out factor of there’s abortions in the water! Even without scientific evidence of that, I think it contributes to the public perception. And KFF had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, if not quite yet at federal agencies. 

Rovner: Another one we will be watching. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Tony Leys, and then we’ll come back and do our very special year-end extra credits. 

I am pleased to welcome back to the podcast ºÚÁϳԹÏÍø News’ Tony Leys, who reported and wrote the latest ºÚÁϳԹÏÍø News “Bill of the Month.” Tony, welcome back. 

Tony Leys: Thanks for having me, Julie. 

Rovner: So, this month’s patient had a very expensive ambulance ride, alas, a story we’ve heard as part of this series several times. Tell us who he is and what prompted the need for an ambulance. 

Leys: He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called [staphylococcal] scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER, where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton, about 40 miles away. They put in an IV and then put him in the ambulance. His mom went with and said the driver didn’t go particularly fast or use the siren, but did get them there in about 40 minutes. 

Rovner: But it still was an ambulance ride. So, how big was the bill? 

Leys: $9,250. 

Rovner: Whoa. Now, this family doesn’t have insurance, which we’ll talk about in a minute. So, it wasn’t an in- or out-of-network thing. Was this unreasonably high compared to other ground ambulance rides of this type? 

Leys: It’s really hard to say because the charges can be all over the place, is what national experts told me. But if Darragh had been on Medicaid, the ambulance company would’ve been paid about $610, instead of $9,200. 

Rovner: Whoa. So, what eventually happened with the bill? 

Leys: The company agreed to reduce it about 40% to $5,600 if the family would pay it in one lump sum. They did, they wound up putting it on a credit card, a no-interest credit card, so they could pay it off overtime. 

Rovner: Now, as we mentioned, this family doesn’t have insurance, but they belong to something called a health sharing ministry. What is that? 

Leys: Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would cover maybe about three-quarters of what they owed, so â€¦ 

Rovner: Have they heard about that yet? 

Leys: I have not heard. 

Rovner: OK. So, what’s the takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, you shouldn’t just bundle them into your car instead, right? 

Leys: I sure wouldn’t. Yeah, no. I mean, at that point, she felt like she had no choice. I mean, she did say if she would’ve just driven straight to the children’s hospital instead of stopping at the local hospital, they would’ve gotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So, that’s in retrospect what she wishes she would’ve done. But if they’d had insurance, the insurer would’ve presumably negotiated a lower rate, and they wouldn’t have had to do the negotiation themselves. 

Rovner: So, they are paying this off, basically? 

Leys: Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice. 

Rovner: All right. Tony Leys, thank you very much. 

Leys: Thanks for having me, Julie. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s usually where we each recognize a story we read this week we think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different. I’ve asked each of our panelists to take a minute or two to talk about what they see, not necessarily as the biggest single health story of the year, but the most important theme that we’ll remember 2025 for. Tami, why don’t you start us off? 

Luhby: OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill [Act], which Congress passed over the summer. The legislation enacts historic cuts to [the] nation’s safety net, with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than $900 billion from Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come from Congress adding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do … well, the Trump administration allowed certain states to do that. It really only took effect in Arkansas, and about 18,000 people lost coverage within months from the work requirements, many of whom, the advocates say, many people are working, they’re going to get caught up in red tape. They’re either working or they’re eligible for exemptions, but they’ll get caught up in red tape. 

So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or [dependent] children under age 14 would have to work, volunteer, or attend school or job training programs at least 80 hours a month to remain eligible, unless they qualify for another exemption, such as being medically frail or having substance abuse disorder. The package also limits immigrants’ eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source for states and which will have ripple effects across hospitals and across states in general. 

Now, what’s important to note is, most of these provisions haven’t taken effect yet. Most of them actually take effect after the midterm elections next year. So, they’ll be rolling out in coming years and the full impact is yet to come. 

Rovner: Alice. 

Ollstein: So, I have chosen the resurgence of infectious diseases that we are seeing right now. I think measles is really the canary in the coal mine. Because it’s so infectious, that’s what’s showing up first, but it’s not going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so, I think that a lot of different policies and trends are feeding into this. And I think we have the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies that we’re seeing. And then just cuts to public health and public health staff, cuts to surveillance, so it’s just harder to know where the outbreaks are happening and how bad they are. It’s hard to get reliable data on that. And so I think, yes, we’re seeing measles first, but now we are starting to see whooping cough, we’re starting to see some other things, and it’s really troubling, and it could have a political impact too. 

I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say, “This is the consequence of Republican health policies, and this is why you should vote for me.” So, I would be keeping an eye on that in the coming year. 

Rovner: Lizzy. 

Lawrence: So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, but there’s been the politicization of science in every agency. And this is something that used to be pretty taboo, right? I keep thinking these days about the [Barack] Obama HHS secretary, Kathleen Sebelius, and the legal and political repercussions she faced when she vetoed an FDA decision to make Plan B over-the-counter. And those days seem very far away, because now we’re seeing at the FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices. 

At the FDA and CDC, you’re seeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or even really no or debunked evidence. 

You’re seeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries. You’re seeing NIH [the National Institutes of Health] pull funding from research studies that go against Trump administration ideology. So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world. 

And then I’d say that has a trickle-down effect to the way that everyday people think about science, and it calls everything into question and makes … People look to politicians and to the heads of public health agencies to tell them the truth. I mean, maybe not politicians, but it seems that doctors and medical experts’ voices are increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So, I think this is a very important topic and one that I’ll keep watching closely in the next year. 

Rovner: Yep. So my topic builds on Lizzy’s. It’s how this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and health care workforce well into the future. The administration has frozen or terminated literally billions of dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest. 

And as we’ve talked about so many times before in this year’s podcast, the administration also seems intent on basically choking off the future health care workforce. The big budget bill includes caps on how much medical students can borrow in federal loans. That’s an effort to get medical schools to lower their tuition, but most observers think that’s unlikely to happen. The Education Department has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a “profession,” thus also limiting how much they can borrow. And a new $100,000 visa fee is going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers are literally the only ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in 2026. 

OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me on X , or on Bluesky . Where are you guys hanging these days, Alice? 

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Tami. 

Luhby: You could find me at . 

Rovner: Lizzy. 

Lawrence: You can find me at , on LinkedIn at , on X , and on  â€” and I forget my username, but I’m somewhere there. 

Rovner: Don’t worry about it. OK, we will be back in your feed in January. Until then, be healthy. 

[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 ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 11, 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 Anna Edney of Bloomberg News. 

Anna Edney: Hi, Julie. 

Rovner: Maya Goldman of Axios News. 

Goldman: Great to be here. 

Rovner: And I’m pleased to welcome to the podcast panel my friend and longtime health reporting colleague, Sheryl Gay Stolberg of The New York Times. Sheryl, so glad to have you join us. 

Stolberg: I’m so glad to be here, Julie. 

Rovner: So, later in this episode, we’ll have my interview with Linda Blumberg of Georgetown University. Linda has spent years analyzing Republican proposals to fix health care and has some interesting observations to share. But first, this week’s news. 

We will start again with the continuing saga of the expiring enhanced tax credits for the Affordable Care Act. Starting Jan. 1, millions of people who get their insurance from the Obamacare marketplaces will face huge increases in what they have to pay in premiums. Some will find those increases so big they’ll have no choice but to drop their insurance altogether. And next Monday, Dec. 15, is the deadline for people to sign up for coverage that starts in January. So, the Senate is set to vote today on two different options. The first, backed by all the chamber’s Democrats, calls for a straight, three-year extension of the enhanced payments that were first implemented in 2021. Those extra payments made insurance so much more affordable that enrollment basically doubled from about 12 million people in the marketplaces to about 24 million. That bill, though, is unlikely to achieve the 60-vote majority it would need to advance. The Senate is also scheduled to consider a Republican alternative, sponsored by Finance Committee Chairman Mike Crapo of Idaho and Health Committee Chair Bill Cassidy of Louisiana. It wouldn’t extend the enhanced tax credits at all. Instead, it would provide either $1,000 or $1,500 for a tax-preferred health savings account that individuals could use for routine health expenses to be coupled with a high-deductible insurance policy. “High-deductible” meaning many thousands of dollars. It’s not expected to achieve 60 votes either. So, assuming both of these plans fail to muster the needed 60 votes, where does that leave us? 

Edney: I think that leaves us looking for what the next turn of the key will be. I mean, will they be able to come to some agreement on extending the tax credits â€” likely â€” or the subsidies â€” likely after. Like you said, enrollment has been underway, and people are enrolling even though they don’t really know what the fate of these will be. So, it’ll be interesting to see how the marketplace reacts given what happens. But I don’t think there’s a really clear idea yet, except that everyone thinks that something might start moving once these votes are dispensed with. 

Stolberg: I think what happens is that a lot of Americans are going to lose their health insurance. We know that the number of Americans insured on the Obamacare exchange is more than double after the enactment of these extended tax credits in 2021. I think there were 11 million; now there are 24 million. And people, as you said in the outset, have to decide now. And maybe they’ll sign up now. But if they lose these credits, I think that a lot of folks are going to suddenly find themselves without insurance coverage. And I think politically for Republicans, that is going to be a big problem going into next year’s midterms. They know this, and that’s why they’re scrambling to come up with some kind of alternative that does not have Obamacare in its name. But we also know that the alternatives that they’re proposing won’t go very far in terms of offsetting out-of-pocket costs for people who are struggling to pay for health care. 

Rovner: Things are starting to bubble up in the House, too. I mean, we’ve seen this. … We knew we were going to have this Senate vote, which is everybody protected by everyone to be a show vote, but now Republicans in the House are getting skittish as well. 

Goldman: Yeah, absolutely. And we’ve seen a couple different proposals in the House. So, there are some moderates that are Republican moderates that are proposing a straight, two-year extension. I think, like Anna said, we’ll see what happens after the Senate votes today, if that brings people to the table or not. I think one thing that struck me this week is The Associated Press reported that  are actually slightly ahead of where they were at this time last year. But of course, that doesn’t mean that that’s going to result in more overall enrollment. There is still a lot that needs to be ironed out there. One thing that I’m wondering is: Is health coverage just something that people are biting the bullet on at this point? And they’re like, Well, I know it’s really expensive, but I still need to have health insurance. And is that going to … even if people do drop off, we’re so far away, politically speaking, from the November elections, that, is that actually going to resonate still? I don’t know. 

Rovner: Yeah. I mean, one of the things that … I saw that AP story, too, that enrollment is actually higher than it was last year at this time. But you have to worry if there’s going to be what they call the death spiral, where only the people who need insurance the most sign up. You have to wonder whether these are the people who would sign up no matter what. And it’s the healthier people for whom it’s a bigger question mark â€” whether they actually need the health insurance at this much higher price â€” who are probably waiting right now. If you’re sick, you’re probably going to sign up no matter what. So, in some ways, I wondered if that was more of a warning signal than anything else. 

Goldman: That’s a great point. 

Stolberg: I think the death spiral is a real concern, especially with the plan that Cassidy and Crapo are putting forward. It would drive people into either catastrophic plans or “bronze” plans, which are lower costs, but high-deductible. And the people who are going to get into those plans are healthy people. That is going to deprive the risk pools for sick people of the healthy. And we know what happens when the risk pools become imbalanced like that. Then insurance costs really skyrocket for the people who need it most. 

Rovner: Yeah. Now, even if Republicans do decide they want to sue for peace, if you will, there are a lot of other obstacles to a bipartisan deal. We’ve talked about abortion. But it looks like there are other things that Republicans want to do that Democrats are not going to want to accept. 

Stolberg: Such as ending support for IVF [in vitro fertilization] coverage like they did in the defense bill this week? 

Rovner: Yeah, which we’ll get to in a little while. 

Stolberg: OK. 

Rovner: Yeah. I mean, I could see a bipartisan deal. I’m just dubious partly â€” and we’ve said this, I think, every week for the last five or six weeks â€” that Republicans won’t vote for an extension without permanent abortion restrictions, and Democrats won’t vote for an extension with permanent abortion restrictions. But I know that some of these Republican bills also would deprive legal immigrants. There are anti-fraud provisions, some of which might be supported by Democrats, some of which might be seen as so onerous that they would prevent legitimate people from legitimately signing up. Does anybody actually see a bipartisan deal happening? I guess how scared do Republicans have to get before they’re willing to do something that the Democrats would agree to? 

Stolberg: I don’t see a bipartisan bill happening in time. I mean, Cassidy said at this hearing last week, literally pleading with his colleagues saying, We can talk about grand plans, Bernie [Sanders, I-Vermont] can talk about “Medicare for All,” and we can talk about this, but we got to do something in three weeks. Well, now it’s two weeks, and they’re not going to come to some compromise, especially not one involving abortion or undocumented immigrants by Christmas. It’s not going to happen. 

Rovner: Yeah. Congress loves to give itself deadlines and then not meet them. 

Goldman: Absolutely. And I think we have Republicans with their grand plans, and you can’t implement a full HSA [health savings account] expansion in the time that they’ve allotted. That’s just not practicable. 

Rovner: Yeah. I think this is a war of talking points at this point. All right. Well, the ACA may be this week’s news, but I don’t want to miss out on the vaccine news from late last week after we taped. As predicted, HHS Secretary RFK Jr.’s [Health and Human Services Secretary Robert F. Kennedy Jr.] handpicked CDC [Centers for Disease Control and Prevention] advisory committee on vaccine practices voted to roll back the universal recommendation for a first dose of the hepatitis B vaccine for infants, right after birth. Instead, the panel recommended making the vaccine the subject of “individual-based decision-making.” What’s the difference between that and actually recommending the vaccine? Is this a really big change? Anna, Sheryl, you guys have been watching this closely. 

Edney: Yeah, I think that it’s a big change in the sense that it can be pretty confusing for parents. And it injects this idea of the vaccine possibly being harmful â€” although that’s not something that’s seen in the data â€” and also that maybe it’s just not that big of a deal, which is the problem of the success of the vaccine is the vaccine works. Hepatitis B cases in newborns go down, and people think, Oh, well, we don’t really have to worry about this anymore. But that’s just not the case. Obviously, as we’ve seen with other diseases of late, these things can come back. 

And so I think it’s not going to change at the moment, at least, necessarily insurance coverage for having the vaccine, but it does leave open this door that, Well, maybe you should talk to your doctor, see if it’s really the best thing. And there’s just a lot coming at you as a new parent or a parent with a new child on the way, and a lot of medical advice to wade through, and things like that. So, this adds an extra piece to that for which a lot of the medical societies and doctors, Sen. Cassidy included, have said, This isn’t something that we’ve had a big question mark on. It’s been actually really, really helpful in the health of children. 

Rovner: Yeah. Hepatitis B cases in children and teens have gone down 99%. 

Stolberg: That’s right, since 1991. I was going to say, I think this is a really big deal. And it’s a really big deal for a couple of reasons. One, it’s not science-based. There’s no evidence that delaying the vaccine makes it any safer for children. Two, it’s a really big deal because of the debate that Kennedy and his allies have created around what was once not given any thought. And it’s also a big deal because, as doctors will tell you, in theory, one could argue, as Kennedy and his group do, that this is a disease that’s transmitted sexually, or it’s transmitted through intravenous drug use. And for infants, the real risk is mother-to-child transmission. Well, first of all, that’s not entirely true. The virus can last and live on household items like scissors, or tables, or whatever. We know that newborns are the ones that are most at risk. 

And we also know that the best time to capture or vaccinate a newborn is when they’re there in the hospital, and they have access to medical professionals who can administer the vaccine. And unlike countries like Denmark, which follow up their babies, our babies don’t get that kind of follow-up. And so the likelihood is that kids will not get vaccinated when they’re older. Parents will forget about it, and they will have missed that critical opportunity to be protected against an infection that can cause chronic liver disease and death. 

Goldman: Yeah. And there was a lot of discussion during the meeting on, Oh, well, we need to do a better job of screening the mothers for hepatitis B, and you should still get the newborn vaccine if you test positive, et cetera, et cetera. But that’s not ACIP’s [Advisory Committee on Immunization Practices] job to say that we should be screening mothers, so they don’t have any authority there to enforce that. And a CDC staff member said, We’re working on that. But, like Sheryl said, we don’t have the same kind of system that they have in other countries, where you can get those follow-up appointments, and get women in for prenatal care that they need. And so I agree, it’s going to be a huge, huge issue. 

Rovner: Yeah. Well, speaking of those other countries, later on Friday after the meeting, in news that some might have missed, President [Donald] Trump issued an executive order basically telling RFK Jr. that he can do anything he wants with the childhood vaccine schedule because he should compare it to our “peer nations.” Sheryl, you had a big story last week about . What are they? 

Stolberg: Well, what I reported with my colleague Christina Jewett is that Kennedy has been on this two-decade crusade to really upend American vaccine policy. Ultimately, he would like to end all mandates for childhood vaccination. That’s not within his purview. That’s in the purview of the states. But he wants to revisit the entire childhood vaccine schedule. And you can see in what he has done by installing his allies, some of whom presented at this ACIP meeting last week, he’s put them in key places. People like Mark Blaxill, who is a parent of a child with autism, who was a founder of a group called Safe Minds, which was an advocacy group. Mark Blaxill now works for the CDC. He’s a smart, Harvard-educated businessman, not a doctor, but he presented on hepatitis B. We saw Aaron Siri, Kennedy’s lawyer, presenting on the childhood vaccine schedule. 

This is a committee that is supposed to be comprised of medical experts â€” people who are physicians who’ve administered care. And what we are seeing is Kennedy installing these people and others, sprinkling them throughout the department, or bringing them in, to carry out his vision. And he was very clear about that vision in an interview with me. I mean, he firmly believes, as he said â€” he was careful â€” he said that autism has gone up over these past decades, and it’s the same time as the childhood vaccines have become … we’ve had more widespread use of vaccines. We’ve also had more widespread drinking of pumpkin spice lattes, as Kennedy’s critics note, but Kennedy has said vaccines must be a potential culprit. I thought that was very interesting that he put that word in â€” potential. It was a wiggle word. But frankly, what he thinks is that vaccines are responsible, and he has said as much in other interviews. 

Rovner: And yet, while this is going on at this very high level, we’re now having a huge and growing measles outbreak in South Carolina, in addition to the one that we’ve already had in Texas. This is really having an impact on parents’ willingness to have their children vaccinated. I mean, that, I think at this point, cannot be denied just by the evidence. 

Edney: Yeah. Fewer parents are getting their kids vaccinated for school. They’re getting more waivers and things like that, too. So, we do see that this is definitely giving parents who maybe had concerns, or have felt some kinship with the MAHA [Make America Healthy Again] movement as it’s grown, the ability to do what they feel is right, less so following the science. 

Stolberg: Peter Hotez, who is at Baylor University, told me that he was not surprised when there was a measles outbreak in Texas, and in particular in that part of West Texas, because vaccination rates in that corner of the state had been dropping precipitously in the years prior to the outbreak. And he said he could see it coming. 

Goldman: I think it’s also, it’s not just people that are very in line with the MAHA movement at this point. I think if you’re not paying as close of attention as we are, the messages that you’re seeing are, Vaccines are bad. We need to look into vaccines. I don’t know, should I get a vaccine? Should I give my children vaccines? And I think that’s really taking hold. 

Rovner: Another story that we’re going to follow into 2026. All right, we’re going to take a quick break. We will be right back.  

Turning to reproductive health, the last big bill Congress is trying to finish before leaving for the year is the National Defense Authorization [Act]. And for the second year in a row, House Speaker Mike Johnson has ordered the removal of a provision passed by both the House and the Senate that would provide military personnel the same fertility coverage that other federal employees and members of Congress get. Right now, fertility treatments like IVF are only covered for those in the military who have service-related injuries or illnesses. I thought this was a priority for President Trump. At least he keeps saying that it is. 

Stolberg: I think this is daylight between Trump and Mike Johnson, clearly. 

Rovner: I have to say, I was surprised. Since when can the speaker just take something out of a bill that was passed by both the House and the Senate? 

Stolberg: Also, not to mention that members of Congress have this coverage. 

Rovner: That’s right, which they only got fairly recently. I’m surprised that there’s, I would say, less pushback. There obviously is pushback. There are people who are really furious about this, but in the manner of how things work in Congress, this is literally the second time he’s done it. And his spokespeople admit that he did it. And he says, Well, I only want this if it’s done ethically. And a reminder, he’s from Louisiana, which is the state that has current restrictions on the destruction of excess embryos from IVF that’s made IVF difficult to obtain in that state. It’s one person exerting his will over the rest of the Congress. 

Stolberg: Yeah. I think that’s the most interesting thing about it is the daylight between Johnson and Trump and also Kennedy on this issue. Because while Trump and Kennedy profess to be anti-abortion, it’s not really a top-of-mind issue for either one of them. But it is for Johnson. And I guess I can’t imagine Trump vetoing the defense bill, so I guess this is going to go through. 

Rovner: Yeah, without it. Again. Well, speaking of who it’s a priority for, much [to] the frustration and anger of the anti-abortion movement, a new report finds that the percentage of medication abortions using telehealth continues to grow, including those from states with shield laws that protect prescribers to states that have abortion bans, to patients in those states that have abortion bans, which underlines a story from your colleagues at Bloomberg, Anna, suggesting that FDA commissioner Marty Makary is  of the abortion pill that was promised to anti-abortion lawmakers, that he’s apparently slow walking that until perhaps after the midterms. 

I hasten to add that HHS spokesman Andrew Nixon denies the studies being deliberately delayed. But just the story has angered anti-abortion forces so much [that] they’re now calling for Makary’s firing. And Missouri Republican Sen. Josh Hawley, who’s been at the forefront of the fight against the abortion pill, and I believe the person who got the promise for this study, has called the allegations unacceptable and is demanding answers by this Monday. Combined with what’s going on with the carousel of center directors at the FDA, how much longer can Makary last under this continuing onslaught? 

Edney: Yeah, what I was thinking of when you were talking about this story is this is just one in a tiny slice of all the things that seem to be coming at Makary and going wrong, and calling into question his ability to manage the FDA. I think specifically â€” you were just mentioning this with abortion, Sheryl â€” that it’s not top of mind for Trump or RFK. So, I’m not sure that this is the thing that does him in unless Sen. Hawley or something breaks on that end. Maybe there are some senators who will be upset enough as more, or if, more details come out. 

I think that definitely Makary appears to be fighting for his job. I think there have been some great stories in The Washington Post and The Wall Street Journal talking about these discussions at the White House every few weeks, where should we keep doing this? Do we need to think of maybe putting someone different in leadership? He’s still there. And so, it seems that RFK is backing him pretty publicly. Obviously, that can change at a moment’s notice. So, something to keep a really close eye on. 

Goldman: Something that we’ve been talking about on my team related to that is that it’s going to be really hard to get anyone else approved through the Senate for any of these positions. And they can install an acting director, but there are limits to how long that can last. And so I think that that is maybe partially helping with some job security for a lot of these people at these high levels. 

Stolberg: I think it would be very hard to get someone else installed given the broken promises that Kennedy has made to Cassidy. They’re going to be very wary. And also, Makary is in the arc, or the spectrum, of people who could fill that job. He’s actually kind of moderate, if you will. And I talked to someone close to Kennedy who said that Kennedy still has confidence in him. So, his ouster, I think, would require the White House bigfooting Kennedy. And I’m not sure that that would happen. 

Rovner: And they have, as we’ve noticed, other things to deal with right now. Finally this week, remember that $50 billion Congress included for rural health in last summer’s big budget bill to offset the nearly $1 trillion in cuts to Medicaid? Well, now the Trump administration is effectively telling states that if they want to claim a share of that money, they need to make changes that align with other  â€” things like barring people from using food stamps for junk food, or legalizing short-term insurance plans that many states worry could destabilize the individual insurance market. Now, I wouldn’t call this outright coercion, but I remember that the Supreme Court basically did just that when they ruled that the ACA’s Medicaid expansion had to be voluntary. Is this really going to fly, that the Trump administration could say, You can’t have this money unless you do other things that we want you to do? 

Goldman: If I’m remembering correctly, all states that have all right to applications will get a baseline of money, and states can get more money for certain things that they apply for. And so I think that maybe that makes this a little different. But I think states will be very upset if they don’t get the money that they want, that they are asking for. And it’ll be interesting to see if there is legal action on the back end, too. 

Rovner: Yeah. I mean, clearly this $50 billion for rural health is not enough to even begin to make up for the cuts that are coming to Medicaid. So, we’re talking about small amounts of money. It’s just, I don’t remember seeing conditions that were quite this blatant. And you’re right, Maya, it’s not all of the money, but it is some segment of the money. But for them to just literally come out and say, We’re going to give you money if you do what we want. I would think at some point Congress gets to say, Hey, not what we had in mind. 

Stolberg: But Congress won’t say it. Not this Congress. 

Rovner: Yeah, not this Congress. So maybe a future Congress. All right. Well, that is this week’s news. Now, we will play my interview with Linda Blumberg of Georgetown University, and then we will come back and do our extra credits.  

I am pleased to welcome to the podcast Linda Blumberg. Linda is a research professor at Georgetown University and an institute fellow in the Health Policy Division of the Urban Institute, and one of my go-to people whenever I have a really complicated question about health policy. Linda, welcome to What the Health? 

Linda Blumberg: Thanks so much for having me here. 

Rovner: So, to the unpracticed eye, it looks like Republicans in the House and Senate are just now coming up with all these new and different health plans. But, in fact, most of them are variations on what Republicans have been pushing, not just for years, but for decades in some cases. Is there anything really new, or is this just a long list of golden oldies? 

Blumberg: I think this is basically a list of things that have been brought out before. Now, they have to present them and talk about them in the context of the Affordable Care Act, which they didn’t have to do many years ago. They’re working around in terms of what they’re impacting on the Affordable Care Act, and how these other pieces would fit in with what they want to do there. But they’re essentially the same things they’ve been talking about for a long time. 

Rovner: So, you’ve been analyzing these plans for years now. And while they may look different on the surface, you say they all have one thing in common: that they work to segment rather than pool risk. Can you explain that in layman’s terms? 

Blumberg: Sure. When I talk about segmenting health care risk, what I’m talking about is policies, or strategies that place more of the financial responsibility of paying for medical care on the people who need that care when they need it, or on those who are most likely to need medical care. That is the opposite of pooling risk more broadly, which actually takes health care costs and spreads them to a greater extent across people, both healthy and sick. 

Rovner: So basically, protecting sick people, which is the idea of health insurance in general, right? 

Blumberg: Well, from my perspective, yes. The situation is because there is â€” what we in economics call â€” a very skewed distribution of health care spending, that means that in any particular year, at any particular moment in time, most people are pretty healthy and don’t use much medical care, and the great bulk of health care spending falls on a small percentage of the population. And so, when you’re only looking in the short term, when you’re not looking broadly across time, or across somebody’s life, then people who, when you segment health care risk, you can create savings for people when they’re super healthy. The problem is that it increases the cost even more when they are not healthy, and none of us are healthy forever. 

Rovner: And just to be clear, the percentage of people who use the majority of health care is really, really tiny, isn’t it? 

Blumberg: Yeah. So, for example, there is a rule of thumb that around the top 5% of health care spenders account for basically half of all health care spending, and the bottom half of spenders account for less than 3% of health care spending. But that is at a particular moment in time, again. And I think the problem is when we think about health care spending as Who’s going to win? Who’s going to lose? in terms of money, right now, at a particular moment in time. Instead of thinking about what happens to us over the course of our lifetime, which is, then, when we spread the costs much more broadly, we’re more protected. We have access to adequate affordable health care under broad-based pooling of health care risk. When we segment it, we’re really making people much more vulnerable to not being able to get the care they need when they need it. 

Rovner: And how do things like health savings accounts, and giving consumers more power to go out and negotiate on their own, how do those actually segment risk? 

Blumberg: So, the more you take the dollars that are being spent on health care and remove it from the health insurance pool â€” the amount of money that is going to pay for claims through health insurance,  whether it’s public or private insurance â€” the more you take it out of the insurance pool and you put it on the individuals, the more we’re separating the risks and putting heavier costs on people when they need care. So, a health savings account gives us some cash, or allows us to put some cash into an account to use when we’re needing care. But it also comes with health insurance plans that are much higher deductibles and much larger out-of-pocket costs. 

And so what we see in practice is that the people who have these accounts, they tend to not … First of all, they tend to be much wealthier people because they’re tax advantages for wealthy people, not for people who are [of] much more modest means. And when they go to get care, there’s usually not that much money in the account to help them pay for these much larger deductibles and out-of-pocket costs. And so they’re paying for a lot more when they need the care. The insurance kicks in at a much higher level of spend. And so the financial burden, even though they’ve paid lower premiums when they need the care, the financial hit is on the individual. 

Rovner: So why shouldn’t we put higher-risk people in a different pool? Since, as you point out, most people are healthy most of the time. That would reduce costs for more people than it would raise costs for. Right? 

Blumberg: Well, it would, at a particular moment in time, but the problem is we don’t stay healthy all of the time. And so, I’m not born with a stamp on my head that says, You’re going to be a low spender, and so you’re going to be better off over here. All I need is a broken leg. All I need is somebody in my family to develop diabetes. God forbid, a kid gets hit by a car, or develops a brain tumor. Stuff happens from out of the blue. And then, if that’s the case, if I’m in a situation that could really make it so that I can’t access, or my loved ones can’t access, the care that they need when they need it. And by the way, as we age, everybody tends to use more and more care. 

So, you can save money at a moment of time by segmenting risk in these ways, but if you do it, you’re putting so many people at risk for not being able to get adequate care when they need it. And because of that skewed distribution of health care spending, it’s a situation where what you save when you’re healthy from segmenting risk is really pretty small compared to the extra amount you have to spend for pooling risk. Because if you take these dollars, and you spread them over everybody, then the increment that you have to spend in order to make sure you’re protected, and everybody else is protected when they need medical care, is not that big. 

Rovner: Is there some ideological reason why Republicans seem to be coalescing around these risk-segmentation ideas? 

Blumberg: I’m not a psychologist, so the motivation escapes me. Because I do think people are better off over the course of their lifetimes when we spread risk broadly. I think part of the issue is the other philosophical difference between conservatives and more progressive policymakers is the idea of income distribution. And the truth of the matter is that really wealthy people, if they get sick and have a high-deductible plan, or they have a much more narrow set of benefits that are being offered to them, they have wealth that can take them a long way to get to buy medical care. They can pay for the broken limb. They can pay for various different medications. 

If they have a very serious illness, or injury that’s longer lasting, they may not â€” even wealthy people â€” may not be able to cover the costs, or it may really have a big impact on them. But by and large, wealthy people are able to insulate themselves to some degree, even with very pared-down coverage. Whereas somebody who’s middle-income, who’s lower-income, who’s not super wealthy, is not going to be able to access that care. So, if your focus is on protecting the assets of those with a lot of wealth, this is a positive in that regard. 

Rovner: So how does this ongoing debate about these enhanced premium subsidies play into this whole thing? 

Blumberg: When we’re talking about the enhanced premium tax credits, which seem to be, by the end of this week, will be going by the wayside, those are actually pooling mechanisms, too. And I think it’s important for people to understand that financial assistance for lower- and middle-income people, one of the great things that it does â€” as a secondary effect of just giving those people insurance coverage â€” is it brings a lot more healthier people into the pool. People who are healthy, young, who wouldn’t have been able to afford health insurance coverage before, and so would have remained uninsured and did before these credits were in place. It brings them into the pool. It lowers the average medical expenses of people insured. And by pooling risk in that way, it actually lowers the premium. Because as the average cost of the individuals enrolled goes down, the premiums go down, too. 

And so one of the things besides these other strategies, which would tend to segment risk further, as we talked about, the strategy that they are denying â€” which is continuing these enhanced subsidies â€” is also going to further segment risk because it’s going to push healthier people out of the pool that can’t afford it anymore. Same with, by the way, the people who are immigrants but are residing here legally, who are no longer going to be able to access assistance to buy coverage in the marketplaces as they have been for the last number of years, they also tend to be people who use less medical care on average. And so those immigrants being in our insurance pools are actually helping to subsidize American citizens who are less healthy. And so by saying, Listen, we’re not going to let you in. We’re not going to give you subsidies to make it affordable for you to come in. We’re actually pushing the average cost of the health insurance coverage upward for no good reason, honestly. 

Rovner: Linda Blumberg, thanks very much. 

Blumberg: My pleasure. Good to see you. 

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

Edney: Yeah, thank you. I had a story just published today. It’s in Bloomberg: “.” And I took a deep look at this issue of preterm infant formula. So, for preemies that are born really early, there’s this big debate right now on whether formula is harming them, or whether it’s something else that’s causing one a day, essentially, to die from this awful disease, necrotizing enterocolitis. And so Abbott is struggling because they don’t make a lot of money off of this formula, but they’re being sued for billions and billions of dollars. So they really want Congress, any agency, the White House, whoever, to intervene in some way. 

They’re throwing everything at the wall to see what can stick. And I’ll just say one tidbit that I found that was really interesting. There’s a lot of debate. There was an NIH [National Institutes of Health] report on this disease recently that moved in Abbott’s favor a little bit. I did learn through my reporting that the report was ghostwritten by a company that does a lot of work with Abbott, and lists them as a client. So that’s an interesting conflict of interest there, maybe a hook to get you guys to go read it. Thanks. 

Rovner: Oops. I’m definitely going to go read it. Maya, why don’t you go next? 

Goldman: Yeah, I’m excited to read that, Anna. 

Edney: Thank you. 

Goldman: My extra credit this week is from ProPublica. It’s by Aliyya Swaby and it’s called “” There are a lot of details in the story, but I think the headline tells you the gist of it. But what stuck out to me about this is I think in health journalism and health policy, we often talk about the safety net as if it’s magic and going to catch everyone, or at least I find myself slipping into that mindset sometimes. And I think it’s really important to look into how people on the ground are actually experiencing these services. And it’s also a reminder, unfortunately, that there are bad actors everywhere. 

Rovner: Alas. Sheryl. 

Stolberg: So, my extra credit this week is actually more of a science policy story than a health policy story, but it is a fascinating yarn. It’s titled “.” It’s in The New York Times by my colleague Katie J.M. Baker. And this is the story of two Chinese virologists who were married, and the woman came to believe that covid was a bioweapon created in a lab, and that the Chinese government had purposefully grown this virus and released it to set off the pandemic. And this doctor fell under the sway of people like Steve Bannon, Trump’s ally, and an exiled Chinese billionaire who had reason to want to blame the Chinese government, and who brought her to the United States, placed her in a series of safe houses once she arrived, and arranged for her to meet some of Trump’s top advisers. 

And she has now gone underground, and her husband actually moved to the United States to try to find her. And she’s basically in hiding. She’s cut off contact with her family. And it’s heartbreaking, and poignant, and also, from my perspective, revelatory about just the politics that have come to define our debates around science and health in the wake of the pandemic. 

Rovner: Yeah, it is quite the story. All right. My extra credit this week is from The Washington Post. It’s called  by David Ovalle. And we’ve talked about this issue before. These fees were mainly aimed at tech companies, who are the biggest users of the H1B visa program, but this new $100,000 fee is already preventing particularly rural practitioners from bringing medical professionals to places in the United States that Americans just don’t want to practice. This story centers on an overworked kidney disease practice in North Carolina that’s still waiting on a U.S.-trained doctor that it hired months ago, who is stuck in India. We’ve already talked about how the Medicaid cuts are going to hit rural areas particularly hard. This fee to bring in international medical professionals sounds like it’s making that even worse.  

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcast, 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 still on X  or on Bluesky . Where are you folks hanging these days, Maya? 

Goldman: I am on X  and on LinkedIn under my name. 

Rovner: Anna? 

Edney:  or  @AnnaEdney,and LinkedIn as well. 

Rovner: Sheryl. 

Stolberg: And I’m on  and  @sherylnyt, and LinkedIn under my own name. 

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