[Editor’s note: This transcript was generated using transcription software. 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 16, 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 Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everyone. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have the latest in our “How Would You Fix It?” series, this week with Elizabeth Mitchell of the Purchaser Business Group on Health, which represents employers and institutional buyers of health insurance and health services. But first, this week’s news. 

So, Congress is back from its July Fourth break with lots of changes, but still not a ton of forward progress on its legislative agenda. Sen. Mitch McConnell, who was hospitalized in June for what his office now says was a fall followed by a case of pneumonia, is still out. And close [President Donald] Trump ally South Carolina Republican Sen. Lindsey Graham died suddenly over the weekend. He’s already been replaced temporarily by his sister, Darline Graham Nordone, who presumably will be a reliable vote for Trump priorities, but probably not the dealmaker and mover-and-shaker her brother had been. In the House, members approved a surprisingly divisive bill to make daylight saving time permanent. But there doesn’t look to be a very clear legislative path for things like, oh, the annual spending bills that need to be done by Sept. 30? And yet another party-line Republican budget bill that might or might not be partly paid for by another push on healthcare fraud. What are you folks hearing about the major things that Congress has to do before the end of the fiscal year?  

Ollstein: Well, the thing that amused me the most that I saw was that leadership in the House, who are facing the same struggles over and over, herding the cats and getting enough Republicans to stay in line to pass even these party-line, you know, slim-majority bills, they’re trying the same tactic they tried with the last reconciliation bill, which is Hey, I know you’re disappointed that all of the things you wanted in this bill are not included, but don’t worry; there’ll be another one after it, so just vote for this one. And so they said that when they were working on “Reconciliation 2.0,” they said, Don’t worry; all the things you want, including Planned Parenthood’s Medicaid funding, that’ll be in 3.0. And now that we have 3.0, and it’s not included, and a bunch of other things they want are not included, they’re saying, Don’t worry; we’ll put it in 4.0. Now, there’s a lot of skepticism that even 3.0 can get done, so 4.0 seems like a wild fantasy at this point. 

Rovner: Yeah, I saw the reference to “Reconciliation 4.0,” and it’s important to remember that there’s only a limited number of budget reconciliation bills you can do. Each budget resolution gives you two or three, I guess, if you include â€¦ you can do a separate one to increase the debt ceiling. But generally, each budget resolution gives you a chance to do a tax reconciliation bill and a spending reconciliation bill. And when they neglect to do the budget resolutions, sometimes they can have a year where they’ll do two budget resolutions for two different fiscal years. But really, that just leaves them four. And I think, I’m not sure there’s a budget resolution that can come for a Reconciliation 4.0. But I guess we’re gonna see. I mean, basically, this really is all about: There’s a segment of the Republicans, particularly in the House, but I think also in the Senate, that want to permanently defund Planned Parenthood from Medicaid, which the Senate parliamentarian has said they can’t do on a permanent basis, and that just sort of continues to string this out, right? 

Ollstein: Right, and there are Republicans in the House that don’t want to take a vote on that in an election year. They worry it could hurt them politically, and then you have the more conservative wing of the party that is very upset that Planned Parenthood recently got its Medicaid funding back, because that law from last year was allowed to expire. So you just have a lot of angst and finger-pointing and upset Republican-on-Republican arguments going on this week, you know. Not to mention, there’s only, I think, seven weeks that they’re in session before the midterms. After the midterms, you could start to have attendance problems, and so people are very, very skeptical that 3.0, but especially some sort of 4.0, could happen. 

Rovner: Yeah, well, so the legislative agenda is kind of stalled. But there were confirmation hearings this week for the administration’s nominees for a couple of top Health and Human Services posts: head of the Centers for Disease Control and Prevention and assistant secretary for preparedness and response. Anything newsworthy from the nominees, Erica Schwartz or Sean Kaufman? Sandhya, you were at this hearing, yes? 

Raman: Yeah. I think this was really interesting to me because, up until yesterday, we had a lot of people kind of pleased with the nomination of Erica Schwartz as, you know, a more kind of mainstream, like, career type health official to be the head of the CDC, and you know even Democrats were pretty pleased with this. And, you know, we even had people that were more MAHA [Make America Healthy Again]-aligned, you know, being more skeptical that she would speak to some of their concerns that they’ve had. And what we had at the hearing was her kind of shifting gears, you know, deflecting on a lot of questions, being asked about various things, being asked about cuts to mRNA research, and saying, Oh, you know, I’m not familiar with that. Saying that she wasn’t familiar with some of the changes related to food safety, while we’re in the cyclosporiasis situation that we are right now. And even issues like the CDC Office [on] Smoking and Health, which she said, you know, smoking prevention was like one of her top priorities when she was working pre-government, and, you know, saying she wasn’t familiar with that office being eliminated. So that was interesting. And even you had the [Health, Education, Labor and Pensions Committee] chairman, Sen. Bill Cassidy, saying, you know, it seems like you’re a little overprepared for this and not answering. But I think the main takeaway was just vaccines. We had so many questions about vaccines from Cassidy, but just throughout the members of the [HELP] committee, trying to kind of garner where they were on it. And again, it was kind of, you know, walking that line to kind of appeal to the widest selection of people as possible. And I don’t think that that was what necessarily everyone was expecting there. For the ASPR [assistant secretary for preparedness and response] nominee, Sean Kaufman, there had been reporting earlier in the week about some of his old LinkedIn posts suggesting some of his comments about, you know, pediatric vaccination and things, and him being a little bit more skeptical. But he came out pretty strongly in favor, saying, I think, vaccines are safe and effective. But I think that there’s still some questions there when you talk to both of the nominees about, you know, whether or not they’d be willing to buck the secretary or the president if push comes to shove on some of these issues. And I think that was what really raised some eyebrows by some of the members on the committee. 

Rovner: I would say Cassidy got pretty exercised about some of the vaccine stuff. Do we know whether that’s going to make him not want to vote for some of these nominees? I mean, that’s pretty much up to him whether these things move forward. And you know, he has since said, after voting for Kennedy, that he was he was … I don’t think he said that it was a mistake, but he said that Kennedy has not kept the commitments that he made to Cassidy and the committee. So, you know, Cassidy â€¦ who’s a lame duck, has at least another chance to exercise some power here. Is he gonna? 

Raman: He did do some fiery exchanges with both of them on some of the vaccine-related issues, but at no point, I mean, did he come down as strong as that. I mean, at some point, he was saying to Schwartz, the CDC nominee, that, you know, I came in here ready to support you. Like, I want assurances on some of these things. But he didn’t, you know, indicate that he was gonna draw the line there. I mean, I guess we’ll see. I think one thing that did stand out was that he said that his conversations with her, you know, one-on-one, physician-to-physician, before the hearing were a bit different from what he was hearing in the hearing. So it depends, you know, are there more conversations? Does something sway? But it seems like it’s still, you know, heading towards, you know, getting across the finish line. 

Rovner: And to be clear, Erica Schwartz is, you know, she’s a doctor and an epidemiologist, and, you know, ran healthcare, I think, for the Coast Guard. I mean, she’s got a lot of government experience as well. 

Raman: She’s a former deputy surgeon general. She’s, yes, absolutely. 

Rovner: Yeah. Yeah. I mean, she clearly, clearly, on paper, she is more than qualified for this job. It’s just whether Cassidy is angry enough to actually, you know, put his power where his mouth has been. 

Well, there was some health-related news out of the hearing for Todd Blanche, the acting attorney general nominated to take the job permanently. Under questioning from several anti-abortion Republican senators, Blanche rather specifically promised to examine something called the Comstock Act, an anti-vice law from the late 1800s, to potentially outlaw the mailing of abortion pills, regardless of what the FDA says. Alice, what would that mean? 

Ollstein: So, I think it’s important to emphasize that Blanche only promised to review this. He didn’t promise to make any specific changes. I saw a lot of anti-abortion activists getting, I think, a little overly excited about what he said. You know, they could review it and take no action. I think it’s also important to remember that Trump specifically promised on the campaign trail not to use the Comstock Act to go after abortion pill providers. You already have activists on the other side, pro-abortion rights activists, characterizing that as the kind of national ban, federal ban that Trump also promised not to enact. You know he specifically has this, you know, “leave it to the states” stance, and you could argue he’s already broken that in some ways. But this would be a much bigger way. So, a lot of different ways the government could cut off access to abortion pills by mail came up in the hearing. The Comstock Act is one of them. I think what abortion rights activists find troubling about the Comstock Act, in particular, is that it could be used to cut off access to both mifepristone and misoprostol, whereas the strategies that the anti-abortion movement is using that are focused on the FDA are pretty much only focused on just one of those two drugs that have to be used together for abortions. So, if the FDA were to act to restrict mifepristone, people could still have abortions just using misoprostol. But if they tried to use the Comstock Act, they could cut off access to both, which could also impede people’s access to those drugs for nonabortion purposes, which they are used for. 

Rovner: Misoprostol has a lot of other uses. I mean, mifepristone is primarily an abortion drug that’s also used for miscarriage. But misoprostol is an anti-ulcer drug that’s used for a whole lot of different indications that have nothing to do with reproductive health. 

Ollstein: And that’s a big part of why the Biden administration put out this memo from the DOJ [Department of Justice] saying that they don’t think the Comstock Act should be used to prosecute doctors who prescribe abortion pills and mail them because you can’t know if the person is ordering them for a legal or illegal purpose. And, you know, obviously people quibble with that in various ways, but that is the sort of underlying rationale, and that precedent is still in place, and that’s what these senators were trying to push Blanche to change, if confirmed. 

Rovner: And yeah, I say, and clearly all of this depends on whether or not Blanche gets confirmed as attorney general, which is still up in the air, mostly for other reasons. But â€¦ 

Ollstein: Yeah, absolutely, people are upset with him for the handling of the [Jeffrey] Epstein files and all kinds of stuff. And just one GOP senator on the committee could block him from going forward. So it’s not all about this, but this is definitely in the mix. 

Rovner: Yes, I think so. Well, moving on, as we’ve noted, the big cuts to Medicaid from the 2025 Republican budget bill mostly don’t start until next January. But states whose fiscal years started this July 1 are already making changes in order to be ready. Several states are already trimming back Medicaid benefits that are optional for states, including many community-based long-term care services. This is despite Republican assurances last year that traditional populations of moms and kids, seniors, and those with disabilities wouldn’t be impacted by the cuts. Stat has a  out of Maryland about cuts to a family caregiver program that may leave a family with the choice of either going bankrupt or putting their disabled child into an institution. It’s hard to see how this isn’t going to be a big campaign issue, right? I mean, this, you know, there were all of these claims that, you know, we’re really only going after the able-bodied Medicaid recipients. That’s not what states are doing.  

Raman: I mean, we’ve already seen it becoming a campaign issue. I mean, even before this was passed into law, we saw Democrats really, like, going in on this far before the midterms, you know, emphasizing this over and over and over again. And I see, you know, they’re going to continue doing that, especially when costs are such a big issue for voters this year. And if you lose Medicaid, then that is another added cost for you if you have a health issue of any kind. But I think what’s even more interesting is how this has been really played back on the Republican side. They’re not talking about this as much as they did a few months ago. Even, you know, we passed the anniversary of the law earlier this month, and there wasn’t a big push on this like there has been on other issues. They’ve really shifted into talking more about â€¦ as for in the healthcare bubble, we’re talking about fraud, fraud, fraud, not any of the things that were in the “Big Beautiful Bill.” 

Rovner: Yeah, things that they hoped people would see as an advantage are not so much right now. Well, another tack that states seem to be taking is not to cut Medicaid for recipients, but rather to get someone else to help pay the bill. And they’re targeting large employers of low-wage workers who have Medicaid. New Jersey is planning to charge those larger employers a fee. Other states are looking at ways to do something similar. But there’s not just pushback from business groups, who obviously don’t want to pay a fee for their workers who are eligible for and get Medicaid. Some advocates for low-income people say that it will make it harder for workers who get Medicaid to stay employed if their employers will be penalized. I know this was, you know, this came up many years ago â€” I think just after the beginning of the Affordable Care Act, when there was concern that a lot of big employers were actually going to dump their workers onto Medicaid. Many of them in the end did not. But it’s hard to see how this is really going to catch on. I grant states creativity for, like, OK, we’re not allowed to ask healthcare providers to help pay our Medicaid bills anymore. So now we’re going to ask big employers to help pay our Medicaid bills. 

Edney: Well, I think it’s an interesting â€¦ it’s probably a tough calculation for the people, you know, that are actually making this decision. The person who’s deciding, you know, do I take this employer insurance or Medicaid? And then you do want to push employers to offer plans that are affordable and that are comprehensive. That’s what they’re supposed to do, especially these big employers. But there can be kind of a lot of calculation that goes into this: maybe the size of the household, who else in the household might be working. So you know, I can see why it might feel like it’s not just on the company, but maybe some of the employees who are making these decisions could end up suffering. 

Rovner: Yeah, as I say, kind of points for creativity, but not clear that this is actually going to catch on because there are clearly going to be problems with it. States are going to have to keep looking to figure out how to continue to pay their â€¦ share of the Medicaid bills. As Sandhya already mentioned, some of you may have noticed the U.S. is having an outbreak of something called cyclosporiosis, which is an infection caused by a parasite that causes, let’s just say, major gastrointestinal upset. Screening for the parasite, which, by the way cannot easily be washed off of infected produce or other food products, used to be part of a list of parasites whose reporting was mandatory to the CDC’s Foodborne Diseases Active Surveillance Network, known as FoodNet. But it was made optional last year, and, as of now, we still don’t know what foodstuff is spreading this parasite â€” although suspicion’s being cast on lettuce or some other leafy green vegetable. Is this yet another “I told you so” about cuts to public health? And is anybody really gonna care, other than the thousands of people who are really sick right now? 

Edney: Yeah, I think that, absolutely, this is another “I told you so” in the sense that, like, you can’t just decide what bacteria you’re going to track if, you know, it pops up and you can’t really control that. And I think that a lot of people already care, you know â€” I think you’ve seen a lot of decisions being made, at least that’s what social media has indicated. I have not seen, like, shopping numbers, but people seem to be concerned. â€¦ They don’t want to buy lettuce, raspberries, cilantro, things that have been implicated in these outbreaks before. And so, with states not reporting to FoodNet, it’s harder to track in real time. So it’s taking longer to narrow down what food is responsible for this, what, who the producer is. So people are left wondering and left just cutting, you know, entire fresh fruits and vegetables out of their diet at this point. They’re really worried. 

Rovner: It kind of cuts against the whole “eat healthier.” 

Edney: Exactly. 

Rovner: Like when the healthiest things might cause all kinds of problems. 

Edney: Yeah, I mean, you know, if all you feel comfortable eating is packaged goods and microwaving all your food to make sure it’s safe, I think it is a problem. And there are people I think who do feel that way, especially in states, you know, in the Midwest that have a lot higher numbers of these cases. 

Rovner: I would say the federal government keeps saying, “Oh, we get cyclospora outbreaks every year,” and we do. But this is much, much higher than it has been in many years. Sorry, Alice, you wanted to say something. 

Ollstein: Well, I mean, it’s the classic situation of, you know, when public health is working well, it’s completely invisible, and so it’s easy to take it for granted. And you can say, well, there hasn’t been a serious outbreak in this many years. What’s the point of this expensive monitoring and prevention program? And turns out, this is why. It’s a very thankless sector because when it’s working well, you don’t get any kudos. You don’t get any awards for not having an outbreak of diarrhea parasite. But everybody gets upset when there is an outbreak of diarrhea parasite. 

Rovner: And screwworm, which we also have after we canceled some of the watchouts for it. All right, we’re going to take a quick break. We will be right back.  

OK, we are back. So in news from what I’m calling the “Department of Updates,” a couple of weeks ago we talked about Health and Human Services Secretary Robert F. Kennedy Jr. calling up libertarian candidates in Iowa in an effort to get them to drop out of House races in order to prevent them from siphoning votes from Republicans. Well, now Oregon Democratic Sen. Ron Wyden is officially asking the U.S. Office of Special Counsel for an investigation into whether that violated the Hatch Act, which generally prohibits federal employees from participating in political activities. Of all the, quote, “scandals” attributed to RFK Jr. since he’s been in office, where does this one rank? 

Edney: That’s a really good question. I’m not sure a lot of people might understand the gravity of it, but a person in appointed position is not really supposed to be weighing in and putting their thumb on elections and influencing those outcomes. I mean, that’s the law. And so it is a Democrat asking for this investigation, which the consequences might be less heavy, I guess, you never really know. I mean, I think it does, kind of the whole situation. Secretary Kennedy’s trying to influence these does kind of show you how worried they are, how worried he is, that he might have to go up before Congress should Democrats win the House and answer a lot of questions under subpoena. 

Rovner: Yeah, and of course that’s exactly what he said to the libertarian candidates when he was trying to get them drop out is, like, if the Democrats take over the House, I’m going to spend all of my time, you know, on Capitol Hill rather than working to, you know, make America healthy again. That was his argument.  

All right. Well, another topic we have spoken about before is the proposed rule from the Office of Management and Budget to give political appointees far more power over which scientific and medical grants get funded. The comment period for the rule closed this week with nearly half a million comments filed. That’s a whole lot, by the way. And our friends at Stat, with help from researchers at the University of North Carolina,  that have been posted so far, and found them overwhelmingly in opposition to the rules, with concern about politicization of science dominating the reasons. I still feel like this is an under-covered story. We’re talking about the fate of more than a trillion dollars in federal funding each year, and a huge change in the way this money is allocated and spent. I mean, you know, already we’ve seen the administration trying to hold back some of this money and getting pushback from Congress, but this would basically codify, if you will, the ability of political appointees to say, We’re not going to give you money unless we agree with it. Essentially. 

Raman: I mean, I think even from the get-go of this comment period, there has been that groundswell of people submitting comments. You know, even a few days in, we were hitting numbers that we would usually maybe not see even throughout the whole comment period for other proposed rules. And so much of that in, like you said, the scientific community has been this. But grants extend to so many departments in the federal government and cover so many different things, and I think it’s kind of hard to quantify just how sweeping something like this would be. Even, you know, looking at a few different pieces, just because the types of grants are so different. â€¦ So many grants are multiyear, and might go from one administration to another, and then be implemented. And if politicization of approving or rubber-stamping continuing grants is there, that would create a lot of up and down in terms of Will these things continue? So I will not be surprised if as we get a little further along there is more litigation filed with people trying to stop this. It’s just we’re at this stage now where proposed rule time is not really where you would you would get that. There needs to be a little further in the process. But yeah, I think this is something that a lot of people are really keeping an eye on. But it is something that’s harder, I think, to communicate out to folks that maybe don’t realize that they are using grant money for something that is available in their community.  

Rovner: We need a Schoolhouse Rock! for peer review and grant-making. Maybe I’ll have to do a video with the dog. Yes, my next video with the dog. 

Ollstein: Just quickly, I will say that the abortion rights community is very anxious about this. They worry that it will lead to any sort of research remotely tied to reproductive health will be cut unless it’s, you know, explicitly pro-abstinence, pro-fertility. But again, like we talk about with so many things, when you implement these changes, it cuts both ways, and a Democratic administration in the future could wield this in ways that conservatives don’t like. And so â€¦ 

Rovner: I think what freaks out the science and medical community is just the lack of continuity. It’s that if it’s going to change back and forth, I mean, one of the things that research really depends on is that research takes as long as it takes, and that often stretches way across Democratic and Republican administrations. That’s kind of the idea of not having this be in charge of political appointees. So I think that’s a lot of â€” I mean, I have obviously have not read half a million comments, but many of the comments I’ve seen have suggested that there’s concern about the going back and forth that would be as damaging as anything else. 

All right. Well, speaking of updates,  that the Department of Health and Human Services is backing away from a new regulation proposed with much fanfare last December that threatened to withhold Medicare and Medicaid funding from hospitals that offered transgender care to minors. Some 30,000 comments on that rule were filed, including those from major medical groups urging that the rule be rejected as an unwarranted interference in medical care. The administration actually pushed back against the NPR story, saying the rule hasn’t been officially pulled, which does appear to be the case. But it seems that officials are kind of trying to have it both ways by leaving the possibility that it could be revived hanging over hospitals’ heads. Is this kind of a clever way to put pressure on hospitals to do what the administration wants without actually having it litigated about whether the administration has the legal authority to do this in the first place? 

Edney: Yeah, I think that’s a good point, that are they sort of leaving it in place without ever fully implementing it? Because states are supposed to be able to regulate this, not have the federal government tell them what to do. And certainly, you know, the hospitals could have their say in it. So they could have been facing a lot of litigation, and I think not pulling it doesn’t mean that it’s not gone. It’s just, you know, according to the story, they clearly decided not to go forward with it. But leaving it in place does kind of, for the hospitals that already moved on this, and we did see some that got nervous. Then, you know, they might be the ones who kind of keep everything in place, just because they’re not sure. 

Rovner: Yeah, I mean they’re making the point that they’re not moving forward on it now. But that doesn’t mean that they’re never moving forward on it, which seems to be a theme from this administration on a whole lot of things. It’s like: We’re not going to do this now, but we still could do it later.  

Well, finally this week, there’s always plenty of news on reproductive health. Alice, I feel like I’m being transported back to, like, 2014 or even 2018, but it looks like the Trump administration is going to try again to  as required by the Affordable Care Act. Why are we debating this again now? 

Ollstein: So this is the case that won’t die ever. Apparently. This is about a workaround in the Affordable Care Act that was created so that religious employers who really object to contraception for, you know, deeply held faith reasons, there’s a workaround so they don’t have to pay for the insurance that covers contraception for their employees. But their employees can still access that contraception coverage if they want it. But certain groups have kept suing over this again and again over the years. It went all the way up to the Supreme Court, and then it came back, and now it’s bouncing around in the lower courts because they say that even participating in that workaround is a violation of their beliefs. Now, on a sort of parallel track … 

Rovner: They are facilitating â€¦ right, obviously, they are facilitating. They’re “complicit.” That’s the word they’re using; they are complicit in allowing people to get contraception, which they don’t believe in. 

Ollstein: Correct, and â€¦  

Rovner: “They” not the people who are getting it, “they” the people who are complicit in getting it. 

Ollstein: The bosses, yes. 

Rovner: Right. The bosses. 

Ollstein: So, sort of on a parallel track, the Trump administration tried to vastly expand the number of companies, the kind of companies that could say we don’t want to provide contraception for our employees, so that now it doesn’t have to be because of a religious belief. It could just be because of an ideological belief. And also now this could be, you know, a big for-profit, publicly traded company, not just a small religious group. Folks have been fighting this, and so here we are back in court again. This is, you know, an ongoing struggle. Of course, you know it’s important to remember that the question of whether or not working folks can access contraception has much higher stakes now that abortion is illegal in much of the country. 

Rovner: We will see. Well, and while abortion doesn’t seem to be as big a political issue in 2026 as it was in 2022, we are seeing ballot measures in several key states, as well as abortion being centered in places like the Maine Senate race, where ostensibly pro-choice Republican Sen. Susan Collins’ vote to confirm Supreme Court Justice Brett Kavanaugh is being hung around her neck, even though she doesn’t have an actual Democratic opponent yet, after Graham Platner dropped out. How is abortion shaping up as a political issue this year? Alice, you’re, I assume, following this. Sandhya, so are you, right? 

Ollstein: It’s interesting. I have a story coming on this in the next day or so. The Democrats who are jockeying for the chance to take on Collins and all of the outside groups supporting them and rushing through this process, they’re very anxious about the ability to make the case that Susan Collins has, as they say, betrayed, you know, her promises to protect abortion rights by confirming not only the Supreme Court justices who helped overturn Roe v. Wade, but a lot of lower court judges who have voted for abortion restrictions in a lot of states. And so they want to be able to put that front and center in their campaign against him. And so they’re really anxious about the records of the Democrats running, because they don’t want to muddy that message at all, and to have Susan Collins have the opportunity to say, Actually, these people have a worse record than me on this issue. And so there’s a lot of hand-wringing on that front. And it’s just tough because some of the Democrats running have a mixed record on this. They used to oppose abortion, and then in more recent years have, you know, passed very strong legislation supporting it. And then you have a lot of candidates who have no record at all on this. They have no voting record. Some of them have never held office before, or this issue just has not been something they’ve had a chance to work on. And so, it is tough for voters to compare someone who has a mixed record but made real accomplishments for abortion rights versus people with no record at all. 

Rovner: So, abortion is going to be an issue, but maybe not sort of â€¦ like with the attorney general, “in the mix” — is that a fair way to put it? 

Ollstein: Oh, absolutely! And no matter what, it’s going to be a huge part of the campaign against Susan Collins. You’re already seeing groups start to air ads about it. 

Rovner: All right. Well, that is this week’s news. Now we’ll play excerpts from my “How Would You Fix It?” interview with Elizabeth Mitchell. You can . And then we will come back and do our extra credits. 

I am pleased to welcome Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, to “How Would You Fix It?” PBGH represents large employers and other institutional buyers of healthcare from both the public and private sectors. Elizabeth Mitchell, thanks for joining us. 

Elizabeth Mitchell: So glad to be here. A lot to fix. 

Rovner: Yeah, a lot to fix. So I want to start by having you talk a little bit about employers’ role in the U.S. healthcare system â€” how it started, and why it persists. 

Mitchell: Yeah, well, I think we know it was an accident of history, right? They weren’t looking to get into the healthcare business, but when, you know, they were looking for alternatives to wages, when there were limits on what they could offer, and they started with what was a pretty inexpensive offering, helping pay for hospital care. And that has now grown to be the second-largest line item in their budgets after payroll. So it has taken on a life of its own. Employers cover over 160 million Americans, so they are a major player in healthcare in the U.S., for better or worse. But they are committed to achieving just a better system because they’re paying for it and because their employees need it. 

Rovner: What’s unique about large employers, particularly the large employers that you represent â€” the ones that not only pay for their workers’ health benefits but also design and manage them in most cases? 

Mitchell: Yeah, it’s a great question. I work with large and jumbo self-insured employers and public purchasers like CalPERS. 

Rovner: CalPERS, for those who don’t know, is the California pension system. 

Mitchell: Yeah, they are the second-largest purchaser after Medicare, I believe. So not small. And honestly, the major difference for large employers is the leverage, right? They have the ability to negotiate arrangements that small employers just don’t have. You know, there is somewhat of a myth that the health plans are responsive to large employers. That is sadly not often the case. As large employers have sought to exercise that leverage, the system has consolidated in response, so the health insurers have consolidated, the health systems have consolidated. So there’s been this arms race of consolidation, meaning that even the largest employers in the world are smaller and don’t have the leverage many times. So they’re looking at how can they align or aggregate even across large employers to really drive the changes they’re looking for? 

Rovner: Well, the premise of this entire project is that we’re heading towards another major national debate over health because just about every stakeholder is unhappy with the status quo. I assume that’s at least as true for large employers now as it was in the early 2000s, when the ground was being laid for the Affordable Care Act. Do you agree with that? And just how dissatisfied are your members with the current functioning of the healthcare system? 

Mitchell: I do not know any employers that are happy with the current system. I will say that that dissatisfaction is growing exponentially every year of double-digit price increases and lack of access and just administrative complexity. We are seeing readiness for wholesale changes that I’ve never seen before. So there is very high frustration, but I also see that as a big opportunity. 

Rovner: So how would your members fix the system? What are some of those policy changes that they would like to see? 

Mitchell: So there is no simple answer. I know that goes without saying, but there’s a collection of changes that we are prioritizing based on evidence. So one of them is primary care, really robust primary care â€” and not the kind that is just set up as a feeder into the health system â€” is a top priority for our members. Another really is more on the purchasing side, right? There is so much administrative waste in the system. And some of our members now are turning to AI just to look at their contracts and realize that they are paying these absurd fees they never agreed to. And then finally, transparency. It is absolutely essential. There are immediate savings opportunities just by looking at the data and realizing you can get the exact same quality or better-quality service across the street for a fraction of the price. And that has immediate savings for out-of-pocket costs as well. So, using transparent information to find the best partners, banning anticompetitive practices, and investing in primary care and high-quality specialty care. Those are my top few. 

Rovner: There are voices both on the left and now on the right who would like to get rid of the basically employer-based system that we have â€” you know, “Medicare for All” â€” and would anticipate, would take that away, you know, basically would have the government, if not providing them, at least paying for all healthcare services. Now we’re seeing Republicans talking about, you know, big bad insurance companies, and we should just give people money, and they should buy their own care. Where are large employers on that, sort of? I assume they would like to keep some semblance of the system that we have now in a reformed system, or am I wrong? Are they ready to give it up and let everybody fight it out for who provides healthcare? 

Mitchell: Well, I represent a subset of jumbo employers who are very progressive, very innovative, and very invested in fixing the system. That said, I don’t think anybody would say it’s working right now. We have a very real affordability crisis. And I would say jumbo self-insured employers are some of the best-positioned actors to do something about that. They have the opposite incentives. They want lower cost and better quality. So if they are empowered and enabled, in some cases through policy change, to be more effective purchasers, I do think that that is a viable strategy still. Because even if you just gave everyone cash, you still have a price problem. It just becomes the problem of the patient instead of the purchaser, because prices are the issue here, and consolidated, unresponsive providers and plans. There is a tendency, and it’s not totally unjustified, of blaming the customer. But there are some aspects of our system that need to change. Whether the government’s paying for it, individuals are paying for it, or employers are paying for it. So it’s a matter of how do we get at that? If it was Medicare for All, they set prices. Maybe that will work. I think the opponents of that historically have been hospitals and health insurers, not employers. But employers are committed to playing a very active role in achieving affordable, high-value care. 

Rovner: Well, that was sort of my question: Are employers ready to say: We just, we would like to wash our hands of this and let somebody else do it? Or would they prefer to stay involved? Or I guess I’m sure it depends on the details.  

Mitchell: It depends. I mean, again, we don’t work very much with small and midsized employers, but â€¦ 

Rovner: I’ll talk to them separately. 

Mitchell: Yeah, it wouldn’t surprise me if they wanted to wash their hands of it, because they have so little leverage. I think that there are large employers who remain committed to this. But depending on the policy environment that we are in in the next three to five years, who knows? I do think that if employer-sponsored insurance doesn’t demonstrate real affordability in the next few years, you know, I think it’s an open question. 

Rovner: So we seem as a society to be growing further apart rather than closer together on a lot of policy issues â€” not just healthcare, but education, climate, immigration. How do we get back to a place where people who disagree can work together to address something that everybody agrees is a problem, like the state of our healthcare system? I realize that’s sort of beyond your pay grade, but unless people think about it, we’re not going to get there. 

Mitchell: No, I think it’s a really, really important question. I don’t necessarily have the answer. But, I mean, I think it’s also finding where we have agreement, right? Everyone, well, all the people I work with, think we are paying too much for healthcare, so we’ve got to have a clear goal of affordability. And employers alone can’t fix that, right? So how do they partner with clinicians and providers and communities and governments to actually achieve that? I think if you focus on those sort of pragmatic shared goals, I mean, it may lower the temperature a bit. Healthcare is also so complex. Everybody sees different sides of the elephant, and they, so they have very strong views. They’re not wrong. It’s just not the whole system. So really, taking a systems approach, understanding the existing practices and incentives and behaviors. I think level-setting on why we are where we are is also really important. And I do not believe it is well understood. I talk to Congress a lot, and staff, and agencies, and administration, and, you know, there is a pretty deep understanding of Medicaid and Medicare, but not the commercial market. So really understanding the actual barriers, I think, would go a long way to sort of, you know, at least some initial consensus. 

Rovner: So more education, basically. 

Mitchell: Education and alignment on large goals, even if we have some differences on, you know, how we get there, and respecting that there are going to be different strategies, you know. I’m in Maine right now, and rural Maine may need a whole different approach to paying for rural behavioral health than you would have needed in San Francisco. So let’s be open to multiple approaches to the same problems. 

Rovner: Looking forward to the debate. Elizabeth Mitchell, thank you so much. 

Mitchell: Thank you. 

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

Edney: Sure. This is a story that I wrote. It’s “.” During covid, obviously, a lot of personal protective equipment we had issues getting it. There were shortages, and so the government decided to spend almost a billion dollars on these handful of companies that they were going to try to boost medical glove-making here. And those are like the nitrile exam gloves you see in every hospital, every doctor’s office. And we were not fully making them here. The main ingredient, particularly the most important piece, we weren’t making here. Well, fast-forward six years, we are still not making it here. So none of those companies that the government funded are making medical gloves. And so, essentially, we’re at the point where there are full entire factories built with huge reactors and things to try to make this main ingredient because it’s a petroleum product. But they aren’t able to finish the project; they aren’t plugged in and ready to go. And the U.S. government has decided they’re not going to fund that anymore. These went from Trump 1 to Biden to Trump 2, and Trump 2 has said we’re letting this go. We’re not going to do it, and this factory will probably end up being sold for parts. Others have shut down, and we’re getting our medical gloves still mostly from Malaysia. Kind of the reason I wanted to write this now is because it’s just when the government decided to abandon this project, but also because of the war with Iran has raised the cost of petroleum products, which is the main, you know, nitrile butadiene rubber. And so the cost of that has gone way up, and so we’re kind of in this cycle where we still can’t get it, but it’s still being affected by outside forces. 

Rovner: Well, thank you for doing the accountability journalism on this. It was. I really, really liked this story.  

Ollstein: Thank you. 

Rovner: Sandhya. 

Raman: So my extra credit this week is from my colleagues Nyah [Phengsitthy] and Skye [Witley] at Bloomberg Law, and it’s called “.” So they spent a few months looking at the, you know, hundreds of different supplements and different packaged foods that have been, like, trying to gain momentum in this space because of the popularity of GLP-1 medications and just, you know, there has been really limited federal oversight of claims of these, you know, the supplements and the foods. It’s causing â€¦ 

Rovner: I would say, and to be clear, these aren’t people trying to make GLP-1s. These are people making supplements that are to appeal to people who are on GLP-1s, saying, you know, if you want it because you’re not eating as much, here’s a way you could get the nutrition that you need. 

Raman: Yes, absolutely. So you know, it might say like GLP-1-friendly, or, you know, it might be on, you know, a snack food you buy, or, you know, just a supplement that’s unregulated at a drugstore. And just a lot of the confusion there. There’s not a lot of research on some of these things. There’s, you know, a lot of litigation brewing in different places related to this, and there’s not, you know, a standard federal definition of what something like “GLP-1-friendly” even means. So they have a great deep dive into this. So you should take a read.  

Rovner: Yeah, at some point, Congress is going to have to take another look at the whole supplement regulation thing. But I thought this was really fascinating because it’s just a whole new sort of category of supplements that has popped up in the wake of the GLP-1 popularity. Alice. 

Ollstein: I have a story from my co-workers Amanda Chu and Robert King [“”], and it’s about how the federal government’s attempt to crack down on what they claim as widespread Medicaid fraud in Minnesota, in particular, is having all of these damaging spillover effects and has cut off Medicaid payments to a bunch of providers: mental health, eldercare, all kinds of things â€” folks that are not suspected of committing fraud at all. The state is pausing payments to a wide range of providers while they try to implement these new anti-fraud measures, and so it just is a good look at the danger of using kind of a sledgehammer to go after a more narrow problem. 

Rovner: Yep â€¦ I think we’re going to see that more and more as sort of these Medicaid sort of crackdowns and the fraud crackdowns continue. My extra credit this week is from Mississippi Today. It’s called “.” It’s by Sophia Paffenroth and our own podcast pal Joanne Kenen. And it’s about something I’ve been talking about a lot this entire very hot summer, which is the impact that heat and the lack of air conditioning has on health. We know excessive heat takes a special toll on the elderly and those with respiratory issues, but it’s also super dangerous for pregnant people and the very youngest among us. And while Mississippi has been taking some novel steps to address that, a lack of attention by medical professionals and a lack of research, along with budget cuts, have been making that task much harder. It’s a topic I’m sure we will all continue to watch. 

Okay, that is this week’s show. OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from 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 about these days? Sandhya? 

Raman: On  and on  @SandhyaWrites. 

Rovner: Anna. 

Edney:  and  @annaedney. 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

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

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

Julie Rovner: Julie, 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 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 videoconference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: And Anna Edney of Bloomberg News. 

Anna Edney: Hello. 

Rovner: Later in this episode, we’ll have my interview with Michael Cannon of the libertarian Cato Institute and Liz Fowler of the Johns Hopkins Bloomberg School of Public Health. Michael and Liz, who are on opposite sides of most things in the health debate, are jointly promoting the idea of eliminating, or at least scaling back, the employer health insurance tax exclusion that underpins much of the U.S. healthcare system but also drives up health spending. But first, this week’s news. 

Let’s start this week on Capitol Hill, where Democrats in the Senate say they plan to use the Congressional Review Act to force a vote to disapprove the Trump administration’s Affordable Care Act payment rule that was finalized in May. For those who haven’t been paying close attention, this is the rule for next year’s plans. It includes things like allowing non-network plans that could open policyholders to unlimited out-of-pocket spending, or else possibly no available providers of care in their area, as well as new catastrophic policies with lower premiums but deductibles well into the five figures. 

The CRA is a handy tool for Congress. It allows the minority to force a vote on the floor and only requires a simple majority of both houses to pass. Few rules are actually canceled using this procedure, but it does allow members of Congress to highlight an issue, in this case playing into Democrats’ desire to keep one of their best midterm electoral issues, healthcare, front and center. So, will this succeed at getting attention, even if it ultimately doesn’t cancel the rule? Or is there just too much else going on right now? I have to say, I haven’t seen a lot of coverage of this other than from my colleague Julie Appleby. Bless her heart for bringing this story to everybody’s attention. 

Stolberg: I think that by November this will resonate. We’re in a situation now where costs are rising, gas costs are going up, and they may go down if this Iran deal goes through, but healthcare and the cost of care is always an issue for Americans. It’s long been an issue that Democrats have led on. I actually find it interesting. What [President Donald] Trump is trying to do really kind of undercuts the very premise of Obamacare, which was to offer kind of a baseline level of care, to require that plans gave people a baseline level of care. You know, come November, it’s going to be just after the enrollment period of October, and I think Democrats are going to be talking about this. And then, it might not resonate or break through now, but they will point back to this vote in this moment. 

Edney: Yeah. I was going to say that I do think it’s possible by then. I think you were right to say that right now it’s hard for things to break through, but by the midterms we may see, as a direct result of this, people losing coverage. And I think that coverage losses â€” or deciding not to have coverage any longer, because it’s too expensive. So, I do think that coverage losses, whether it’s in the ACA marketplace or Medicaid, are going to be a big campaign issue. And if Democrats can point to this vote as a direct line to We support you having your coverage and Republicans don’t, that could be something that breaks through to those potentially millions of people who no longer have care. 

Rovner: Yeah, last week I described this as the drip, drip, drip of declining coverage, which is that we sort of keep seeing these things bit by bit. Rather than sort of one dramatic, Oh my goodness, I can’t afford my coverage and I’m going to drop it, we’re seeing people scrambling to try and keep coverage, or to buy down to have less expensive plans with bigger deductibles. And then, once they start to seek care, they’ll realize they can’t handle those deductibles. So it’s happening in pieces rather than all at once. 

Well, speaking of that Affordable Care Act rule, props to the eagle-eyed Reed Abelson, your colleague at The New York Times, Sheryl, for spotting a little-noticed piece of the rule that allows insurers to offer loans to patients who can’t immediately come up with those multi-thousand-dollar deductibles should they need medical care. Now, this is not a new idea. Overall, veterinarians have long offered payment plans to pet owners, as have health practitioners, whose services are often not covered by insurance, like cosmetic surgeons. But for necessary medical care, it seems like loading patients with still more medical debt seems like a less-than-popular solution to high healthcare costs. Or is that just me? Lauren. 

Weber: I mean,  was a blockbuster, and also just horrifying. And what kind of dystopian future are we all in? Instead of paying your premiums, you’re also paying your payment plan to the same people. It’s already been said enough that there’s some concern that health insurance plans are gobbling up so many parts of the healthcare market. You wonder what happens when they also become essentially your mortgage broker. And so I think the story deserves a lot more attention, because I think a lot of Americans would be quite terrified if they realized that is potentially the future. 

Edney: And it seems like the point should be to make coverage more affordable, not to find new ways for you to pay the same really high amounts. 

Stolberg: I just was going to say I thought it was interesting that Reed pointed out that roughly a third of Americans have some kind of medical debt, and she linked to an analysis, a  in HealthAffairs, about medical debt and collections being very common and large. 

Rovner: Yeah, I’m just noting the irony of Republicans deciding to come out against Big Insurance, and yet this â€” talk about own goals, going against exactly what you’re saying. Let’s make Big Insurance less popular by having people owe money on a payment plan, have a credit card to pay their insurance company back for things that their insurance company basically isn’t covering anymore. Yes, presumably with interest, so Big Insurance will make even more money. 

Well, moving on, it’s been a busy week on the reproductive health front. In Texas, the state’s Republican platform includes a plank calling for women who have abortions to be held criminally liable for murder after another Texas anti-abortion group fought unsuccessfully to have it removed. , the attorney general’s office is sending cease-and-desist letters to out-of-state organizations that offer abortion pills via telehealth. The letters say the companies, including some well-known ones like Plan C and Cambridge Reproductive Health Consultants, must stop all advertising, sale, and delivery of pills to Alabama residents or face potential legal action, including fines of $2,000 per violation. On the other hand, one former abortion provider in the state pointed out that the letters themselves act as an advertisement for the various services that otherwise people might not know anybody about, or where they are. Is this just performative? Or do we think there are going to be real efforts to reach distributors outside states with abortion bans, despite shield laws in the states where those distributors are actually located. 

Weber: It’s probably a mix of both, right? I think that some of it is for press coverage. I did find the former abortion provider saying this is a giant billboard for all these products to be somewhat quite the comment to be made. But it’s true. If you live in Alabama and you went to this woman who is an abortion advocate, she could not tell you where to look these things up online, and now there’s a plethora of media coverage and attorney general’s letters that lead you right to the source. 

Rovner: With their addresses. 

Weber: With their addresses. With their web addresses. And so— 

Rovner: That’s right. 

Weber: It’s an interesting move on all counts. I think it’s just a one and another. I think I don’t think we’re going to just see this from Alabama. 

Stolberg: Yeah, I was going to say this is part of a broader assault by the anti-abortion movement on abortion medication, and in particular mifepristone. And my colleague Pam Belluck and I  about this lawsuit that was brought by the state of Louisiana, which instead of targeting the manufacturers of the pill, they want courts to bar a policy allowing abortion providers to provide or prescribe mifepristone and send it through the mail. This was the policy of the Biden administration’s FDA [Food and Drug Administration]. The Trump administration has said, We’re studying this issue. That study seems to be going on a very long time. Some people suggest it will go on past the midterms, so— 

Rovner: That seems to be the strategy. 

Stolberg: Right. But nonetheless, now that Roe [v. Wade] is gone and states regulate abortion, we are seeing this kind of clash between states about what can happen from one state to another, and I think this is part of that. 

Rovner: Yeah, and as we’ve pointed out multiple times in multiple ways, anti-abortion groups are furious that the administration has not rolled back this ability to send these pills through the mail, because that is why I think we’re seeing less backlash to some of these bans than we would have otherwise, because a lot of these bans are fairly easily evadable by going, having a telehealth appointment with a doctor in another state and getting the pills in the mail. And there’s very little that the ban states, as we’ve discovered, can do to stop it. So they’re sort of trying everything, including these cease-and-desist letters. But this is clearly a fight that’s going to go on unless and until the administration steps in or the courts step in. And we’re, I guess, at this point waiting on both. 

Meanwhile, the Huffington Post has a truly  about women who get positive home pregnancy tests, arrange to travel or take time off from their jobs to get an abortion, only to discover once they get to the clinic that they weren’t actually pregnant at all. It seems most of the false positives are coming from the same brand, Clearblue. And it’s not that the tests are wrong as much as they appear to be too sensitive, likely picking up pregnancies that either end themselves before they’re fully established or picking up the hormone that the tests detect from sources other than an active pregnancy. The most chilling part of the story is at the very end, with one doctor wondering how many women are doing telehealth abortions with pills who were never actually pregnant to begin with. It seems that do-it-yourself healthcare maybe isn’t as foolproof as we’ve made it out to be? 

Weber: I think the story, just â€” first off, everyone should read it, because it’s an incredible deep dive. She managed to uncover multiple complaints that physicians who provide abortion had made to the FDA, which appear to have been undealt with, and it speaks to the tragedy of some of these people that take time out of their day, raise money, travel across state borders to potentially try to end their pregnancy, and realize they don’t have a pregnancy at all, and the emotional trauma of that. But more than anything it speaks to the fact that as abortion rules have become more restrictive, you need to know if you are pregnant earlier than ever, so that’s why a lot of these people are taking these pregnancy tests. And the fact that this is so sensitive, the article does posit that it could be picking up pregnancies that are called chemical pregnancies, which don’t end up becoming actual pregnancies. But the point is that usually if you wanted to go check that, you would go to a doctor and they would check your blood levels and see if they were rising. But a lot of women are afraid to do that in this current environment. And so I feel like it’s a big story of unintended consequences and horror that has unfolded as some of these pregnancy tests are not accurate. 

Rovner: Yeah, and in some cases there are multiple cases. Go ahead, Sheryl. 

Stolberg: Lauren’s words, “unintended consequences,” were just what I was about to say. This is part of a whole panoply of things that were not foreseen by anyone, really, when Roe was overturned. A couple years ago I went to Idaho  how OB-GYNs, especially those who dealt with complicated pregnancies, were fleeing the state because of the restrictive abortion rules. And that was leading family practice doctors, like one I featured, without help in caring for patients with complicated pregnancies. And that, too, is sort of an unintended consequence. And when we were talking before about the abortion pill being sent across state lines, yes, you can evade the bans that way, but it still leaves women without medical care, without follow-up care should something go awry. So a lot of things happened, have flowed from the Dobbs [v. Jackson Women’s Health Organization] case that we didn’t think about at the beginning. 

Rovner: Yeah, one of the things that I’ve written about is it’s not just OB-GYNs who are leaving states or not going to states in the first place, choosing not to do residencies there. 

Stolberg: Right. 

Rovner: But it’s other doctors who are not going to some of the states with bans, because doctors who finish their medical school and residencies tend to be of reproductive age. And they are women, or if they are men and have spouses and want to start families, they’re worried about being in states that don’t have enough doctors if there’s a difficult pregnancy. We’re talking about people who want to get pregnant being a little bit concerned about going to states with abortion bans, because so many of the doctors who would deal with difficult pregnancies have left. So it’s just, it spins out and out and out and out. 

Well, finally, in something from the Trump administration that will please anti-abortion forces, a new grant announcement for a George W. Bush-era program promoting the adoption of frozen embryos left over from IVF [in vitro fertilization] refers to them as, quote, “children who already exist and are in need of a family.” Is this formal announcement the quiet beginning of this administration’s effort to establish fetal personhood in federal law? Or is it just another way to pacify pro-lifers who are still angry over the other administration policies we were just talking about that they don’t like so much? 

Stolberg: Huh. That’s interesting. 

Rovner: Sheryl, you probably remember the “snowflake babies” from the Bush administration. 

Stolberg: OK, I’m actually the person who  on the front page of The New York Times, and then suddenly snowflake babies and their parents were appearing at the White House and on Capitol Hill, it was a group called— 

Rovner: Remind younger people who these snowflake babies are. 

Stolberg: So, there was a group called â€” this was at a time when we were talking about excess embryos left over from in vitro fertilization and what should happen with them, and— 

Rovner: And whether they should be allowed to be used for stem cell research. 

Stolberg: Right. That’s exactly right. And whether they should be allowed to be used for stem cell research. And there was a group called Nightlight Christian Adoptions. They’re a Christian adoption agency, and they had come up with another way, they said, in which infertile couples were literally adopting embryos that were left over from other people’s pregnancy effort attempts. And this was a solution for deeply religious people who did believe that life begins with the embryo and did not want to destroy their embryos and also did not want to have to pay in perpetuity for them to be housed in a lab somewhere. And they called them snowflake babies. And so this is something that George Bush talked about and became enshrined in, I guess, his administration. And, I don’t know. I guess Trump is looking back 20-some-odd years or so, reviving the past. 

Rovner: Well, there has been, there â€” it’s a program that has continued. 

Stolberg: Right. 

Rovner: And there were some adopted embryos even during the Biden administration. But I guess the question that sort of comes up now is, by describing them as already children— 

Stolberg: Yeah. Are they laying the groundwork for this? 

Rovner: â€”are they setting â€” yes, are they laying the legal groundwork? Lauren, you wanted to add something. 

Stolberg: Maybe. 

Weber: I was just curious. Does this lay the legal groundwork that any leftover embryo would then qualify for this program? What if you didn’t want your leftover embryo to go through this? I’m curious. The regulation seems a little unclear. 

Stolberg: I think parents retain the right. Parents retain the right to, they are in essence the property â€” I don’t like to use that word, but â€” 

Rovner: I think legally, though, that’s what they are. 

Stolberg: And legally, embryos created by an infertile couple belong to that couple. And in fact we’ve seen, and my colleague Caroline Kitchener  a lawsuit between a husband and wife who divorced and the woman wanted to implant the embryo and the man did not. And the question was, who quote-unquote “owned” the embryo. But I think that personhood question is really interesting, Julie, and maybe it does establish, in a way, a government recognition of embryos as people that is unprecedented. 

Rovner: Yeah, that’s certainly the concern, that it’s sort of taking it one step further. All right, we’re going to take a quick break. We will be right back. 

We are back. And speaking of issues the administration is trying to tiptoe around, let’s turn to vaccine policy. Last month, the Journal of Toxicology and Environmental Health announced it was retracting a 2010 study that linked the hepatitis B vaccine to an increased risk of autism, because, and I’m quoting here, “due to fundamental methodological flaws the study’s conclusions are unsound.” That was one of the studies cited by Secretary Robert F. Kennedy Jr.’s handpicked advisory committee to change the recommendations for the birth dose of the hep B vaccine. Separately, the journal Toxicology Reports retracted a 2021 study that claimed a link between vaccines and sudden infant death syndrome, also citing methodological errors â€” which is typical, by the way, for why studies are retracted. Yet that retraction led Secretary Kennedy to write a letter to the journal demanding to know why and giving the journal’s editor a deadline of June 26 to respond. What is Secretary Kennedy trying to accomplish here? And will it work or is it just coming off as bullying? 

Edney: I think certainly it’s coming off a little bit as bullying in the sense that this was a decision that the journal made about something that â€” clearly this happens, because it happened with this other study. I think that in Secretary Kennedy â€” and Sheryl, you’ve written about this, and others â€” he does still have a vaccine agenda, whether he’s allowed, or an anti-vaccine agenda, whether he’s allowed to talk— 

Rovner: We’ll get to that in a moment. 

Edney: â€”or not. So I think when he makes these requests, he’s kind of trying to sow doubt into what these other doubts the journal is bringing out. 

Rovner: Lauren, you want to say something. 

Weber: Yeah, I just, I think in general, this is a pattern of actions by Kennedy that several experts have described to me as somewhat hypocritical. He’s attempting to bully a medical journal. He had a big thing about all information should be free during covid, no one should be silenced. And here he is using his platform to potentially change things on that front. And then he also recently issued a quarantine order for someone with hantavirus to stay in Nebraska, which flies in the face of a lot of his “medical freedom” rhetoric during covid. And so I think some of these moves are really interesting because they seem to strike at a contradiction in a lot of the rhetoric he espoused before coming into office. And even on top of the vaccine of it all, I just, I think that’s important context to consider. 

Rovner: And Sheryl, we spent some time last week talking about  about the secretary. But anything you would like to add, please do. 

Stolberg: Yes. I think this is not at all out of character for the secretary. The secretary has long believed that the established medical journals are censoring what he views as legitimate research, i.e. research into the alleged harms of vaccines. And even before he became secretary, when he was running for president, he laid out a very clear agenda in which he said he was going to use government science to lay the groundwork for research that could be used in court against pharmaceutical makers, vaccine makers, and he was also going to take on the medical journals. And in the aftermath of covid, what we saw was also this sort of alternative ecosystem of medical journals growing up, published by these covid contrarian doctors, the Independent Medical Alliance, and other groups. So it wasn’t surprising to me at all that Kennedy went on the offensive against a journal that retracted a study, because he and his allies have long complained that these journals are censoring them. When journals find fault with research that Kennedy likes or supports his views, he doesn’t want to hear about that. 

Rovner: Well, separately, or perhaps not so separately, the Justice Department, on Kennedy’s behalf, is asking for an expedited appeal of a lower-court ruling that found his changes to the childhood vaccine schedule to be, quote, “arbitrary and capricious” and his handpicked vaccine advisory committee members unqualified for their posts. The administration is arguing that because the ACIP [Advisory Committee on Immunization Practices] is currently frozen, the administration can’t act on new vaccines for this fall, including for things like flu, RSV [respiratory syncytial virus], and covid. The , meanwhile, which brought the lawsuit that got the changes stayed, argues that Kennedy can reconstitute ACIP anytime he wants, as long as he follows the federal advisory committee rules and appoints members with vaccine expertise. How might this standoff get resolved? Or does this standoff need to be resolved? There are arguments the FDA has already approved a vaccine for this fall. Insurers have already said they’re going to cover it. So is this, speaking of things that are performative, also performative? 

Stolberg: That’s â€” I think we’re in uncharted territory, Julie. In the past, the CDC’s [Centers for Disease Control and Prevention’s] vaccine advisory committee has met well in advance of every upcoming fall, the flu season, to discuss vaccines to protect the American public and kind of issue their recommendations, which guide what insurers cover. And as a result of this lawsuit, we’re in a place where kind of everything is going on without that central pillar that backs up these decisions. So insurance companies are saying, Yeah, we’ll cover, and the FDA is saying, Yeah, we’ll approve, but there are no experts, outside experts, really thinking through what the right policy is. So, I suppose— 

Rovner: Technically there’s not even an acting director of the CDC, right? Because it went on too long? 

Stolberg: That’s right. 

Rovner: Or is that — so Jay Bhattacharya— 

Stolberg: Well, Jay Bhattacharya is functioning as the acting director but technically he is not the acting director. He is acting in the capacity of director or something like that? 

Rovner: I believe that is the phrase. 

Weber: Who needs senior leadership? 

Rovner: Yeah. It’s all very weird, so— 

Weber: They’re all gone. 

Stolberg: I think it’s a question of, can the government function without this? Yes. Is the government doing the best work for the American people without this system in place? You know, probably not. 

Rovner: Well, meanwhile, more quietly, since the White House ordered Kennedy to back off his more public anti-vaccine efforts, it appears that things are still happening, just a bit more out of public view. Both  and now  are reporting new efforts to study possible ill effects of vaccines at the CDC, the NIH [National institutes of Health], and elsewhere in the department. Quoting from the Washington Post story, by Lena Sun and our podcast panelist Rachel Roubein: “Kennedy’s allies are embedding his agenda in institutions that decide what gets studied, who does vaccine research and how these findings are translated into policy. This could keep the Trump administration’s questioning of vaccines’ safety alive for years to come,” close quote. Could these changes have an even longer-term impact than some of RFK Jr.’s sort of splashier actions that we were just talking about, that could be more easily overturned by an incoming administration? 

Weber: I think absolutely, Julie. I think at the end of the day, too, some of what my colleagues Rachel and Lena found was that they are exploring adding new members to ACIP, that they’re also exploring adding a new Office of Science in the CDC. What does that mean? If is that an Office of Science that Kennedy agrees with? Or is that an Office of Science? These are the questions one has to ask. And then, what kind of long-term ramifications are there for that? Many public health experts say that this continued back-and-forth on vaccines just leaves a lot of people confused and will likely contribute to lower vaccination rates, which could contribute to the continuous rise of preventable, vaccine-preventable, disease. And so there’s a lot of concern that some of this groundwork that’s being laid to underpin some of Kennedy’s long-held beliefs could have a very, very long tail. 

Rovner: Yeah, and of course we’re already seeing cases, not just measles spreading but whooping cough and the kinds of diseases that are preventable with vaccines that people are now not getting for their kids. 

Well, finally this week, two amazing stories related to HHS but not of HHS. One is from The New York Times’ Christina Jewett and Kenneth Vogel, and it’s a  into how lobbying has helped keep the potentially dangerous supplement kratom, if not on pharmacy shelves everywhere, then at least in gas stations and convenience stores around the country. This story has lots of twists and turns over several presidential administrations, but it does seem that Trump 2.0 has been welcoming, shall we say, to the kratom industry, which has in turn given lots of campaign contributions to the administration and its allies. Anna, I see you nodding. 

Edney: Yeah, I loved the story. I thought it was really well done. And, like you said, lots of twists and turns. And there was a really great quote, and I’m not looking at it, but it was along the lines of this being kind of a coin-operated policymaking administration. So, like, you’re â€” if you give enough money. That’s why we’re seeing it’s not your typical, like, Big Pharma putting a lot of lobbying in, right? It’s kratom, it’s flavored vapes, things that kind of you might have considered on the fringes bubbling up to hit. Even the president’s talking about them, and at press conferences that are completely unrelated. So I think that it was a great look at how this industry really kind of got into the administration, and in their view, in the industry view, it’s like, Listen, we’re just paying to be at the table, and we’ve never really been at the table before. But pretty much anyone who can bend the presidency, or someone in his administration, seems to be able to make these inroads that we haven’t seen before, when the product is not proven safe and has been shown to harm people and cause, lead to death. 

Rovner: Yeah. Sheryl, you wanted to add something. 

Stolberg: Yeah. So I was going to say, I lived through this story by my colleagues Ken Vogel and Christina Jewett, and props to them. We’ve been talking about this for a while. I noticed a while back, when  the MAHA [Make America Health Again] movement and Trump, that this company called Botanic Tonics had kind of donated like a million dollars to the MAHA PAC: And I thought: “What is this? Why are these people donating a million dollars to this PAC? Who are they? What is kratom?” And it turned out that my colleague Ken Vogel and also Christina Jewett were kind of already onto this. And the thing that they found to me that was so amazing is that not only this company and the promoters of kratom, which is kind of like an addictive gas station drug â€” it supposedly boosts energy â€” not only were they cultivating Kennedy, but also Markwayne Mullin, who now leads the Homeland Security Department but formerly was a senator, had an investment worth as much as a million dollars in this company, the company of Botanic Tonics. The company’s founder was an energy executive in Mullin’s home state. He’s this odd guy who I think had some sort of brush with the law and changed his name, and it was just this kind of crazy story of influence, like Anna said, kind of, or maybe you said, Julie, on the fringes but coming to the fore. 

Rovner: Yeah, and the original sin here, I think, and someday we’ll go into a deep dive on this, was the 1994 fight in Congress about dietary supplements and— 

Stolberg: The DSHEA [the Dietary Supplement and Health Education Act]. Yes. 

Rover: Right. 

Stolberg: And I’ve thought a lot about this. That has created kind of the, what critics call, the wellness industrial complex, which allows these companies to sell things that are supplements as food, which means they are not regulated as stringently as drugs, can only be regulated after they come to market. And a lot of shady stuff is sold as a result. 

Rovner: Yeah, as I say, it goes back a lot of administrations. All right. Well, finally this week, my other story, and this is my extra credit this week. It’s the second blockbuster in the last three weeks for my ºÚÁϳԹÏÍø News colleague Darius Tahir about President Trump’s stock trading. The previous one was about the prescription drug industry. This one is about tobacco. It seems that the teetotaling commander in chief is fine with other legal vices, that he holds more than $1.6 million in stock in tobacco giant Philip Morris, as well as positions in Altria and other tobacco companies. The tobacco industry has been good to him, too, giving millions to Trump-affiliated super PACs. And what has the administration given back? Quoting from the story: “It’s FDA piloted a fast-track program to approve nicotine pouches. It unveiled a program to allow vapes on the market more rapidly, despite resistance from career civil servants and leadership, culminating this year in guidance waving through flavored electronic cigarettes. It cut public health employees focusing on anti-tobacco policy. And it broadened enforcement against illicit e-cigarette, competitors to the big industry players with a financial relationship to Trump,” close quote. This is a big difference from the first Trump administration when it comes to tobacco, isn’t it? My recollection is that they were not quite this welcoming to tobacco from 2017 to 2020. Anna, I see you nodding. 

Edney: Yeah. 

Rovner: You did some work on this. 

Edney: Yeah, well, this was when, the first Trump administration was when Scott Gottlieb was the FDA commissioner, and he was quite anti-tobacco. And we went through this whole scare about kids getting some strange lung disease from vaping. And there were a lot more restrictions that â€” and less approvals, or clearances, whatever you want to call the tobacco side of FDA. So, I think it’s been a complete turnaround, where this time around the Trump White House would prefer to run roughshod over the FDA and get what they want for the tobacco industry, because they’re getting a lot of money from them. 

Rovner: Yeah, and props to Darius for connecting all of the dots. Lauren, you want to add something? 

Weber: Yeah. Let’s go back to  about Trump meeting over cheeseburgers with the tobacco guys at the White House. I think Darius’ piece lays out the money that maybe is hanging out there. But props to Darius for having two of these quite good stories looking at these conflicts of interest. 

Stolberg: Yes, during the Trump administration, the first Trump administration, Alex Azar, his health secretary, pressed Trump to take some sort of action restricting vaping, and Trump got really mad at Azar about it, and he complained privately and yelled at Azar, saying to him, You’re costing me votes, because the MAGA crowd likes vaping. This was recounted in a book. I’m pretty sure it was Phil Rucker and Carol Leonnig’s book, the two Washington Post reporters. So, Trump was, maybe he wasn’t this aggressive in supporting the tobacco industry, but then there’s this added component to it, which is that he thinks MAGA [the Make America Great Again movement] likes vaping. And he was yelling at Azar, saying: You’re costing me votes. You’re going to cost me this election. I’m sorry I ever did this. 

Rovner: Oh, we will see how this one plays out. All right, that’s this week’s news. Now, we’ll play my interview with Michael Cannon and Liz Fowler, and then we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast two people who have taught me a lot over my years covering health policy. And full disclosure, I consider both of them friends. Liz Fowler is a distinguished scholar at the Johns Hopkins School of Public Health. During the Biden administration, she ran the Center for Medicare and Medicaid Innovation, an agency created by the Affordable Care Act, which she helped write as the chief health counsel on the Senate Finance Committee and implement as a senior official in the Obama administration. Michael Cannon is the director of health policy studies at the Cato Institute, a libertarian think tank here in Washington, D.C., and has spent most of the past 16 years trying to get the Affordable Care Act repealed after vehemently and almost successfully blocking its passage. Yet this unlikely pair is on a new mission, pointing out why the first step in the next round of health reform should be to get rid of something called the employer health insurance tax exclusion, which we will explain in a minute. Liz and Michael, welcome. Thanks for doing this. 

Liz Fowler: Thanks for having us. 

Michael Cannon: Thanks for having me. 

Rovner: So for most people this would be a hard question, but you guys have been on the circuit, so one of you give me the 30-second explanation of what the employer tax exclusion is and why it exists in the first place. 

Cannon: So when Congress passed the income tax in 1913, there was no such thing as health insurance, really. So they gave no thought to the question of if an employer provides health insurance to its employees, should that be subject to the tax. The Treasury bureaucrats, when someone presented that idea, said: This is really hard. We don’t know. We’ll just say we’ll exclude that from the tax base, so we won’t tax compensation in the form of employee health insurance. That was in the 1920s. In the 1940s â€” so that gave employer health insurance a boost. In the 1940s there were wage and price controls that gave it a further boost, because employer health insurance was exempt from those wage controls, so it gave employers a way to compete. But it’s really that tax exclusion that is responsible for the fact that more than half of U.S. residents have health insurance through an employer, because it works like this: If your employer gives you a dollar of cash, you have to pay federal income and payroll taxes on that, and you’re left with, on average, at the margin, 66 cents. The federal government takes a third of it. But if the employer gives you that same dollar as health insurance, then you get a dollar’s worth of health insurance. So you can see how this sort of distorts the prices, the after-tax prices that people face, when they’re choosing between more cash wages and spending that money on other things versus spending money on health insurance, employer-sponsored health insurance. And so people more often buy employer-sponsored health insurance, they demand more of it than they would otherwise, and this also lets employers end up controlling about, for the average family with employer coverage, $20,000 of the worker’s earnings. And all of these effects end up increasing spending on employer-sponsored insurance and increasing prices for health insurance, and the fact that it’s encouraging a form of insurance that disappears when you change jobs means it’s creating gaps in health insurance coverage. So, for decades, economists have said: Hey, this is a real problem. We need to solve this. And I would argue that it is really the reason that Congress wanted to enact the Affordable Care Act in the first place, to fill some of the gaps that this exclusion created. 

Rovner: So, Liz, originally this was considered a good idea. It’s like, Oh, we’re encouraging the creation of a new fringe benefit for workers: health insurance. When did it outlive its usefulness? 

Fowler: That’s a great question. I think our workforce is very different. Employment is very different than it was back in the 1940s and ’50s, when my parents or grandparents had the same job for decades and they all got health insurance through their workplace. That has eroded over time. I don’t know exactly, Michael probably knows exactly, what the trajectory has been. We’re now down to about 50% of employees receiving healthcare through their workplace. But people are employed in different ways than they used to. I’ve had several jobs throughout the course of my career. People don’t stay in the same job for decades anymore. And people piece together work in ways that they didn’t. Maybe they have more than one job. Maybe they have a part-time job over here and a part-time job over there. This tying health coverage to employment, I think, has become, is starting to become, anachronistic. And I think for me, in particular, watching the debate over HR1 [congressional Republicans’ One Big Beautiful Bill Act] and trying to tie Medicaid coverage to employment or community engagement brought up this whole question of: Why do we tie health benefits to work in 2026? 

And so that’s part of why I wanted to revisit this policy question, which we tried to tackle in the Affordable Care Act and didn’t get very far. And the sort of the distorted version that we included in the law, the “Cadillac tax,” was repealed with a bipartisan â€” what, almost unanimous â€” vote. So I think it’s time to sort of ask these questions again. It’s a very expensive part of the tax code. It’s one of the largest if not the largest tax expenditure in the U.S. tax code, to â€” what â€” close to upwards of $300 billion a year that this benefit provides to a group of workers who are more likely to get health coverage and more likely to get generous health coverage, and at the higher end of the income scale more likely to see a larger benefit. So all of these questions, I think, are ripe for revisiting. 

Rovner: So one of my most vivid memories from covering the Affordable Care Act was a roundtable hearing that the Senate Finance Committee had with all of these economists from across the spectrum talking about how to pay for the Affordable Care Act. And I remember â€” I actually went and looked this back up â€” one of the senators asked what would be the best way to pay for it And one by one by one, these witnesses, eminent health economists from literally every part of the political spectrum, says you need to do something about the employer tax exclusion, literally every one. And obviously, as you said, Liz, they tried. There was sort of the beginnings of this that we called the Cadillac tax, and it was ultimately repealed. Why is this so hard if it, as you guys point out, it doesn’t make very much sense anymore? 

Cannon: Well, it creates a lot of benefits for a lot of very powerful groups. It benefits the health industry because the government is effectively penalizing workers for every dollar of their earnings that they don’t spend on health insurance and medical care. It benefits large employers because they can spread the administrative costs of providing health insurance over a larger number of workers, which means they can take the savings and offer higher salaries than their smaller competitors do, which gives them an advantage in the labor market. So between those two groups right there, you have a very powerful coalition that has blocked, defanged, repealed every effort to try to limit or reform the exclusion, and there have been a lot. Presidents [Ronald] Reagan, [Bill] Clinton, Bush the younger, [Barack] Obama. Presidential candidate John McCain famously tried to reform the tax exclusion, and Barack Obama really, I would say, demagogued that that proposal. I didn’t favor that proposal either, but McCain’s policy director says he still has nightmares about the attack ads that Obama ran. And it’s because of the fear those â€” it’s not just that people have a financial interest in preserving this huge tax break for employer-sponsored insurance. It’s the fear that those special interest groups are able to demagogue, to play upon that people with employer-sponsored health insurance who have expensive medical conditions will lose their coverage and be left with nothing. 

Now I am not a fan of the Affordable Care Act, or what I now call Obamacare. We’ve discussed this. Liz and I do not see eye to eye on that one. I would repeal it tomorrow if I could. But if it is in place, then it actually helps with that problem. It helps with this fear that people would, if we reform the tax exclusion for employer-sponsored health insurance, that people will lose their coverage. There’s a lot of evidence to suggest that employer coverage will stick around for the vast majority of workers, but for those for whom it does not, the Obamacare exchanges are there as a sort of safety net, so that should make the politics a little bit easier. 

Rovner: So, obviously, the Cadillac tax didn’t work. What would be a step that would, that possibly could happen, that we could take to start to move away from this? 

Fowler: Well, one of the things that we initially tried to do in the Senate Finance Committee, in an early version of the Affordable Care Act, was to cap the exclusion. So you can say above the 80th percentile, or the 85th percentile, or something lower â€” below that will still exclude it from income. But if you get very generous coverage, very expensive coverage, we’ll start to— 

Rovner: Like Cadillac-type coverage? 

Fowler: Well, but the difference is we’ll include that as income for the worker. I think that’s where we ran into problems and political challenges. I think there was some reluctance to tax individuals, and Oh, that looks like a new tax increase. So the Cadillac tax was, OK, let’s instead put that tax on employers and insurers instead of the workers, and that became very unpopular with, as you can imagine, the employers and the insurers. So it makes sense why it’s been a tortured history and it’s been hard to get done. I think one of the reasons, and Michael talked about this, why it was a little bit scary to go down this road in the past, because you didn’t know where people would get their health coverage if you tried to change the employer structure we have now. But now there is a place. There are marketplaces. And the bigger that risk pool, and the more people are part of it, I think the more affordable and the more stable it becomes over the long run. 

Additionally, I’m not sure employers want to stay in this business. I think it’s becoming very unsustainable to continue to provide very costly insurance that, where the cost is rising at quite a rapid pace, certainly higher than wages, and is eating more and more of a household’s income over time. And so I think if we really lift up the hood and start looking at the potential impacts, the opportunities, the options, the policy options on the table, and have an honest debate about what this could look like, I think there would be more openness perhaps now than there was back in 2010. 

Rovner: Well, thank you both for kicking this off. Michael Cannon. Liz Fowler. This was great. 

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

Edney: Sure. Mine is in Politico Magazine. One of the co-authors is our podcast colleague Alice Miranda Olstein. It’s “.” And I thought it was a really smart look at something Trump had said, again talking about things he did in his first administration, that we could end the HIV epidemic in the U.S. by 2030 and put policies in place to try to get there. And Alice and her colleague talked to a lot of top former administration people to look at what happened, and it seems to be not one single lightning bolt but sort of that there were all these other policies around Trump 2.0 that â€”DOGE [the Department of Government Efficiency] and other things that cut a lot of this type of funding â€” that created this situation we’re in now, where no one, except maybe Trump himself, thinks we’re going to meet that 2030 goal. 

Rovner: Yeah, a lot of differences between Trump 1.0 and Trump 2.0, as we’ve been discussing. Sheryl. 

Stolberg: So my extra credit is “Tennessee Pharmacies Sell Potent Ivermectin, Led by Anti-Vaccine Doctor Who’s Taken ‘Bucketloads.’” And this appears in ºÚÁϳԹÏÍø News. It’s by Brett Kelman and Rachana Pradhan. And what I love about this story is it talks about how ivermectin, this drug that actually is a Nobel Prize-winning, generally safe drug approved for treating parasitic diseases in humans, has become kind of this ideological touchstone in our society. And it started during the covid pandemic. And now we’re seeing where people on the right and other influencers were pushing it as a treatment for covid without evidence that it worked, and in fact despite FDA warnings that taking too much of it could cause harm. And now it’s sold over the counter in Tennessee, and Marjorie Taylor Greene was promoting it as a treatment for hantavirus, and— 

Rovner: Which it’s not. 

Stolberg: Which it’s not. Exactly. And it’s just sort of taken on this life in our culture, and I guess I just feel like this story sort of reflects something about this cultural moment and how we are addressing medicine and healthcare as a society, 

Rovner: Indeed. Lauren. 

Weber: So I chose a story titled “,” by Benjamin Mazer in The Atlantic. And it posits this basically interesting thesis, which is that a lot of these chatbots that people use, and even doctors use, are not really regulated by the FDA, and so you kind of are interacting with AI in any sort of healthcare setting, whether you know it or like it or not, and whether those tools are up to snuff or not. And the ending of the article is really the most alarming, because it basically is like: Is this like Uber and Lyft, where Uber and Lyft just disrupted the market so much that we all had to get on board without regulating it more, and that that’s what could happen to hospitals? And I think it’s a really interesting and fascinating question of: What is the role of government regulation when it comes to these AI tools being used in a hospital setting? And are they anywhere near equipped to catch up with what’s going on right now? 

Rovner: Yeah, it’s a really thoughtful piece. All right. That is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is 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 questions or comments. We’re at whatthehealth@kff.org, or you can find me still on X, , and on Bluesky, . Sheryl, where are you on social media these days? 

Stolberg: I am @SherylNYT  and . 

Rovner: Anna. 

Edney: @annaedney  and . 

Rovner: Lauren. 

Weber: @LaurenWeberHP â€” the HP is for “health policy” —  and . 

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

[Editor’s note: This transcript was generated using 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 28, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Later in this episode, we’ll have my interview about the ongoing Ebola outbreak with Céline Gounder, ºÚÁϳԹÏÍø News’ public health editor-at-large and, conveniently for us, an infectious disease specialist. But first, this week’s news. I want to start this week with more of a trend than actual news, and that is the continued decline in health insurance coverage in the U.S.  on the number of children falling off the Medicaid rolls. It’s down about 1.75 million from the beginning of Trump 2.0 through this past January. Now, I thought we were told that none of the Medicaid cuts that Congress made last year would affect the core Medicaid constituencies: pregnant women, children, seniors, and people with disabilities. What’s happening here? 

Goldman: So, the law does exempt kids and parents of young kids from the eligibility and enrollment changes, work requirements, more frequent eligibility checks. That doesn’t mean that there aren’t going to be spillover effects, and we’re seeing that already, Absolutely, even though most of these provisions haven’t gone into effect. And there are a couple of reasons for that, including chilling effects from immigration enforcement and people who are in mixed-status households maybe not feeling comfortable enrolling their children in public benefits, even though their children would qualify, or also just confusion around who’s eligible for what. Often kids are eligible for Medicaid and Children’s Health Insurance Program â€” its sister program, CHIP â€” at a much higher income level than their parents, and that’s not communicated well to parents very often. And so one theory â€¦ is that this year, when a lot of parents maybe saw how much their ACA [Affordable Care Act] premiums were going up and decided that they couldn’t afford health coverage anymore, they were just pulling their whole family out of health insurance, even though their kids might still actually be eligible for Medicaid. And â€¦ there are a lot of other trends percolating in this, but I think it’s concerning to see this, these figures, even before this has really started. 

Rovner: Yeah, it’s funny, when you’re applying for health insurance, they’ve set it up so that you get funneled to the right place for which you’re eligible. But when you’re dropping your health insurance, there’s no funnel to say, hey, your kids might still be eligible for this, even though you’re no longer going to be getting Affordable Care Act insurance. 

Goldman: Exactly, and navigators for ACA coverage have also â€” funding for those programs have been cut, and so that’s harder, even harder for that process to actually work. 

Rovner: Yeah, I’ve also noticed in the states that are starting things like their work requirements early, there was kind of a shocking anecdote  â€” one of the states that’s starting early â€” who’s blind, has multiple health problems, and a chemotherapy port, who was told that she might be required to work under these rules and was seeing about getting her port taken out when finally another person told her, No, you’re exempt. So, I mean â€¦ in some of the states that are speeding this up, there’s a lack of knowledge among the state workers, which I think was one of the big concerns about people who are going to be dropped off the rolls, not because they’re no longer eligible, but because of mistakes. 

Weber: We also know that, in general, Medicaid enrollment is a tricky process. Typically, there’s paper forms that may get lost in the mail. Parents may not get the forms for their kids. This was very eloquently actually described on The Pitt â€” which, shoutout for getting this part of health policy correct. Although I’m still irritated about their Medicare-Medicaid mix-up in one of the other episodes, but we’ll get over it. 

Rovner: Yeah, me too. There were two of those. 

Weber: Yes, but very eloquently show[ed] how a mom who had moved and missed some Medicaid paperwork was now really in a hole financially. And so, as Maya has reported out, you know, more of these children falling off the rolls really could lead to some dire consequences for the families to which they belong. 

Goldman: Yeah, and I think one important thing to mention is that a lot of these kids that are uninsured are still eligible, and when they go to the hospital, the hospital can help them enroll in retroactive Medicaid coverage, but they’re not getting their yearly checkup, or maybe, like in The Pitt, they miss their asthma medication, and so now they’re in the hospital, and costs are just going up for the whole health system. 

Rovner: Well, along those same lines, we have another story in our ºÚÁϳԹÏÍø News series called “Priced Out” about how people who can no longer afford comprehensive coverage are patching together other forms of insurance, or in some cases not even actual insurance, that leaves them on the hook for thousands of dollars if they end up needing actual medical care, which kind of raises the perennial question with our health system: Is it better to have bad insurance and not know it, or to have no insurance, so at least you know that you’re not prepared if something happens. 

Weber: I thought what was so striking in that story was it led off with a retired teacher who said, I recognize I am gambling. I mean, that’s what she said, she’s very clear. But to her, I think her cost had risen something like $900-something a month, and the other plans that she cobbled together were $300 a month, and so to her the short-term risk was worth it. But as we all know, hospital stays can run you several thousand dollars and, you know, you can get hit by a car. You may be a very healthy person, but something bad can happen, and you are left with large, large medical debt. And I think it seemed like the folks interviewed in the story were at least clear that these plans were less favorable, but I do think there is also this submarket where a lot of folks think that the health ministry plan that they’re in is going to save them in case of an issue. And we have found over and over again, and KFF, in particular, has found over and over again in reporting, that’s just not the case. And so this whole question of Is a bad plan better than no plan? I don’t know, but it’s striking to see people say I’m willing to take the gamble, because this is just what these increases in premiums have meant for me. 

Luthra: I just think what’s so interesting about these, these health shares, in particular, is when I’ve talked to people who’ve used them or considered them, they know these are not insurance, but I don’t think they always fully understand just how restrictive they are, and how often medical needs will be dismissed as lifestyle choices. I mean, obviously, often contraception is not covered, but something related to drug or alcohol use might not be covered, because that’s immoral, right? Let’s say the ministry says, “Oh, well, this accident you got into, maybe that’s because of alcohol use.” That’s a huge expense that you just might not have realized wouldn’t be covered at all. And the other thing that I was just so struck by is very often childbirth isn’t covered. Or you have to be enrolled for a very long time before childbirth is covered, which health insurance is required to cover childbirth. It is very, very expensive. It’s fascinating, also, because a lot of these [sharing ministries] are so religiously aligned and ostensibly pro-family, etc. And yet this, in particular, is just something where people will opt for this instead because it looks more affordable than insurance. But very often you end up paying a not-zero amount of money, and ultimately getting basically nothing for very expensive, even bankrupting medical needs. 

Rovner: Or you’re gambling, you know, maybe, maybe you’ll get reimbursed, and maybe you won’t. Although these days people feel that way about their health insurance. Maya, you want to say something? 

Goldman: I think a lot of young people also take for granted that health insurance will cover preexisting conditions. If you’ve come up, you know, post-ACA, and certainly I do. I’m 28, and that’s, like, something that never even crossed my mind that I would need to consider, and that really struck me in this article. A lot of these alternative plans are not bound to those requirements. 

Rovner: Well, Shefali, I wanted to ask you in particular about  about how abortion rights supporters are trying to adapt reproductive health to fit under the bigger affordability umbrella that seems to be the theme of this year’s midterm campaigns â€” that things like whether or not to get pregnant or whether to get unpregnant, that those are all wrapped up in all sorts of financial issues, as you just mentioned. Is this a natural fit, or do you think they’re kind of forcing it here? 

Luthra: I think it really depends on how you talk about it, and the context of where you are. And after the mifepristone case was before the Supreme Court, I spent a lot of time looking at different Senate campaigns and examining how they’re talking about it. And one example is Jon Ossoff in Georgia actually has a really interesting example where he talks about access to abortion and healthcare as part of this larger argument around the state of reproductive healthcare, talking about hospital closures, talking about Medicaid cuts, and putting all of this together as this broader policy ecosystem that is making your healthcare harder to come by and ultimately threatening your life. I think that’s very interesting. It could work. It makes sense logically to me. The other one that does come to mind â€” and this is not abortion, but it’s related â€” is in Maine, Graham Platner talking about IVF [in vitro fertilization] in the lens of affordability, saying, Oh, I couldn’t afford it in America. I traveled to Norway to try and get fertility treatments. Those are fascinating approaches, and a lot of people who work in abortion rights advocacy will say this has long been an economic argument, and many of them will look at polling and put it out that says when you frame this as an economic story, voters really, really do appreciate it and resonate with it. I think sort of the question is whether we actually see these candidates â€” and it’s not lost on me the two who I mentioned are both men â€” actually talk about the word “abortion” specifically, rather than saying “reproductive healthcare” more broadly. And you know those are very different, and they just register with voters differently when you single out something as specific as abortion versus whether you don’t. 

Rovner: And Graham Platner, for those who don’t know, is going to be the Democratic candidate running against Susan Collins in Maine. Jon Ossoff is the incumbent Democrat in Georgia, which always feels weird to say. There haven’t been a lot of Democratic senators from Georgia, but right now there’s two. 

So, moving on, the Trump administration says the declines in health insurance coverage are fine because they’re more about fraud and kicking people off of public health insurance rolls who aren’t actually eligible or â€” in the case of Affordable Care Act broker fraud â€” who don’t even know they’re covered. But a lot of the tools in last year’s big budget bill are pretty blunt, and they’re going to impact both those who maybe shouldn’t be there and those the administration says it wants to keep serving. This week’s example is a newly proposed rule to implement that law’s cap on something called state-directed payments, which is, in fact, a key way many states help ensure adequate funding for hospitals, nursing homes, and other healthcare providers. Now, this isn’t fraud, but it is what analysts like to call creative funding, and Congress has every right to limit it. But that’s not to say that it won’t have an impact on healthcare at the delivery level, right? It’s not just going to impact people that the administration says don’t deserve to be covered. 

Goldman: Yeah, this came up when I was talking to children’s hospitals for the story on children’s coverage that I wrote this week. They’re saying, you know, this is going to affect all kids that we can care for. This is going to mean less money into our funds, and, you know, a lot of people argue that hospitals have enough money, but hospitals will say, “No, we don’t, not to take care of all the people that we need to take care of.” And this is going to be less money. And then it’s not just kids who are on Medicaid who are struggling, it’s all kids. And I think another interesting thing about this proposed rule is that it’s significantly more federal savings than was estimated originally. I think CBO, Congressional Budget Office, originally estimated that the state-directed payments provision would save about $150 billion, and this rule would save about $510 billion in federal funding. So hospitals are concerned. 

Rovner: Yes, this is always the issue. Are we overpaying hospitals? But when you take money out of it, what does that mean for the health system writ large? Which I imagine is going to continue to be a theme as we go forward. Well, the Trump administration is also going very high-profile in its health fraud-fighting effort. The president has put Vice President JD Vance in charge. Earlier this month, he announced that the administration will be withholding $1.3 billion in federal Medicaid funding from California, because, said the vice president, the state has not taken fraud very seriously. This is the second Democrat-led state the administration is taking the nearly unprecedented step of withholding funding from in advance, after Minnesota. California has responded that one reason the state’s home health bill has gone up is that it has raised wages for home healthcare workers, and it has expanded eligibility. It’s not because of fraud. Again, while there obviously is fraud â€” not just in Medicaid, but in all health programs, public and private, because there is so much money there â€” these blunt tools, I think, will probably punish more than just those who are defrauding the program. Right? 

Weber: I mean, absolutely. At the end of the day â€¦ look, it’s no coincidence that California is a blue state that seems to be getting targeted with that amount of cash. But let’s be very honest, there is a lot of fraud. I mean, all of us here have written stories about healthcare fraud. There is a lot of fraud to root out. So, to be very clear, I don’t think anyone should be upset about actual fraud being targeted. But there’s also a question of: What are the numbers? [Centers for Medicare & Medicaid Administrator Mehmet] Oz has gotten the numbers wrong before. The AP [Associated Press] had a great story on that a couple weeks ago. Show us the fraud, like, I want to see the actual fraud that we’re talking about. And, in addition, this reminds me of how the administration continuously says that they’re investing the most money in rural healthcare when they have this $50 billion rural healthcare fund. Well, the Medicaid cuts that [President Donald] Trump led is going to cut like triple that almost out of rural areas. So is this a talking point? Show us the money. I need to better understand what’s behind it. 

Rovner: Yeah, so far they’re doing well with a lot of very high-profile news events. We’ll see how much fraud they are actually able to ferret out. All right, we’re going to take a quick break, we will be right back. 

Let’s talk about Ebola. As you will hear later in this episode from our in-house expert, Dr. Céline Gounder, this is not likely to become the next covid or even a pandemic. But this administration, having hollowed out the Centers for Disease Control and Prevention and obliterated the U.S. Agency for International Development, is addressing this outbreak with many fewer arrows in its quiver. Lauren,  about someone close to this outbreak. Tell us about it. 

Weber: Yes, I was able to speak with an American missionary physician who was exposed to Ebola and actually evacuated to Prague and is sitting in basically like a bubble room waiting to see if he tests positive for Ebola. And what traumatizes him, as he was telling me, was that he’s sitting there, there’s all these people with endless gloves that are tending to him, he’s been evacuated, and stretchers with all this plastic and all these measures, and his colleagues that he worked alongside in the Congo are â€” you know, one died while we are in the middle of an interview, he learned of their death. And, in addition, they’re filling the hospitals themselves, that they say they don’t have enough gloves, they don’t have enough PPE [personal protective equipment]. There’s no vaccine to fight this current form of Ebola, and they’re in an environment in which people are very mistrustful. Ebola looks like malaria until it’s Ebola. And so you could send a family member into the hospital thinking it’s malaria, which is common in this part of the world, and then suddenly be told your relative has Ebola and died. A lot of people don’t believe it, and it’s leading to violence. And the usual public health measures and efforts by the international community to get in there are somewhat hampered. And Part Two, by the fact that this outbreak is happening in a really insecure region, where there’s roving militias and other violence. And there’s just a lot of concern that they caught this late, this could continue to explode, and case counts could really go up. But it was very humanizing to speak with this American missionary who obviously really put himself on the line to help these folks and is heartbroken to kind of be watching from afar as this continues to go poorly. 

Rovner: Well, meanwhile, the U.S. is banning foreign nationals who’ve been in any of these countries from entering the U.S. and also U.S. green-card holders who’ve been in countries where the virus is spreading. Not only that, but they’re not allowing exposed U.S. citizens to return, even though the U.S. has multiple facilities to care for exactly these types of patients. We have seen this before, just in the last 15 years. What happened to the medical freedom that this administration has been touting so much? 

Weber: It’s a real plot twist. I mean, these are the folks that said that they were the contrarians that oppose quarantine and mask mandates, and they are strictly having the hantavirus folks in Nebraska. They’re signing off on travel bans that go further than other administrations, and not allowing Americans back in and sending them to Kenya if they’re exposed. My colleague Lena Sun and I had a report a week ago about how the White House didn’t want exposed Americans back in the U.S., but the Kenya step is another step in that direction. Is really could have huge ramifications for the response as a whole, because it will likely limit the number of people that want to go. If you know that you’re not going to be able to be sent back, we saw, I think, yesterday the State Department union was like, look, our foreign service officers were sent here under the impression that they would be able to come back. I mean, this is somewhat completely uncharted territories in the vein of how they’re handling this. So we’ll see. 

Goldman: I’m very curious to see what the MAGA [Make America Great Again] base and the MAHA [Make America Healthy Again] base that were so anti-mask mandates and things like that during covid, like, what are they going to say? Are they going to say anything? Is it partially our responsibility as the media to point out this contradiction? 

Rovner: Yeah, and obviously there’s also so much else happening right now. It’s interesting that the hantavirus, which turned out to not be such a big deal, got so much play, and yet this, which could be a much bigger deal, is getting so much less attention. 

Weber: Do we think there’s maybe a reason for that? Let’s all be honest. The hantavirus cruise was a lot of wealthy, some Americans on a cruise sailing around Argentina and Antarctica. And then this outbreak is happening in Africa, and I think there’s less interest from the general public, as they feel like hantavirus is novel, whereas Ebola, they’ve heard about it before, so a depressing reality of some of that. 

Rovner: Yes, and also, you know, Americans and Europeans versus Africans. 

Weber: Yes, yes, exactly. 

Rovner: All right, moving on. I want to catch up on some drug price news, because there’s been a lot over the past few weeks. The Supreme Court earlier this month declined to hear a case challenging the Medicare drug price negotiation system that was implemented under the Biden administration, which ironically will probably redound to the credit of the Trump administration, even though it nominally opposed the Biden program. Also, earlier this month, the president announced a big expansion of his TrumpRx website, adding links to websites selling lower-cost generic drugs, including the site run by Mark Cuban, Cost Plus Drugs. But the most provocative drug price story I have seen this month came from my colleague Darius Tahir, noting that Trump himself was buying stock in drug companies just as he was negotiating with those companies to help bring drugs, particularly those GLP-1 medications that he likes to call “the fat drugs,” to more people. Now this isn’t technically illegal, although there are lots of efforts on Capitol Hill to outlaw individual stock trading by members. But I can’t help think if any other government official in any other administration ever did this, they would be out of a job instantly, if only for the appearance of the conflict of interest. This is just â€” Lauren, as you were saying â€” one in this whole long list of things that keeps happening, but every time I look at it, I’m like, he was doing what?! 

Weber: Julie, when I saw Darius’ story, I was blown away. First off, I feel like this should have been front-page news on every outlet. But secondly, it was a lot of money, it was like over $600,000. And now I understand they say that Trump himself, they don’t know whether he directed this or not. And in fairness, Trump’s not the only one. I mean, we’ve seen plenty of members of Congress that have done also questionable stock trades. But it is a very conflict-of-interest-looking-like thing, considering that CMS recently expanded massive access to these drugs. And so I do think conflicts of interest like this, especially in HHS [Department of Health and Human Services], which has constantly decried conflicts of interest, despite having many of them, are very important to highlight. And so, thank you to Darius for surfacing this. 

Rovner: Yes, we will never not have enough to do here as health reporters. Well, finally, this week I want to . President Trump this week had his third, quote, “annual” physical in the past 13 months â€” math does not math there â€” after which he said he checked out perfectly. But he is about to turn 80. He’s been caught on camera dozing off at public events in the Oval Office and has gone on hours-long social media rants in the wee hours of the night/morning. Now, much of this hasn’t been treated as news, because well, it’s pretty much par for the course for Trump, just more so. And therein lies the question: When does his increasingly aberrant behavior and obvious health issues, like visibly bruised hands and swollen ankles, become a public right-to-know issue? And is there a double standard for Trump compared to former President [Joe] Biden, when he began to show obvious signs of aging, and it was all over the news all of the time? I see raised eyebrows. 

Luthra: No, it’s such a good question. On the one hand, there was obviously a lot more scrutiny on Joe Biden’s age than there appears to be on Donald Trump’s. But part of it, I think, is that a lot of what you just highlighted, Julie, is out in the open. Everyone has seen the president dozing off on camera, whereas under the last administration, there were things that were not public that then became public, and that was obviously very important. That said, there’s certainly a level of focus on this issue that perhaps is lacking. Maybe it would be useful or newsworthy to put some more attention, even something that we already know, highlighting why it is important, putting together the fact that having this many physicals at this point in the presidency is actually more than normal. What could that mean, contextualizing it with everything we have seen publicly about the president’s sleep patterns, risk factors as you age, bruising, etc. But I think this kind of thing is complicated in terms of how you cover it appropriately and fairly, also just because you don’t want to assume things that you don’t have the evidence for. 

Rovner: And, in fair, I mean, Trump has not been transparent about his health, going back to when he was a candidate in 2016. He’s the only major presidential candidate, you know, he put out that, this famous letter from his personal doctor saying, you know, he’s the healthiest man I’ve ever seen. That’s pretty much what we get, having covered presidential health for a lot of administrations. We have much, much less information about Trump than we have had about previous presidents, which has been a continuing policy concern among doctors. I mean, this is not to single out Trump, who just happens to be president right now and turning 80. But this is, you know, an issue that goes back obviously to, you know, Dwight Eisenhower, to Woodrow Wilson, when he had a stroke, and they kept it a secret. Presidential health is a policy issue. 

Goldman: Yeah, I think that’s an important caveat, or note, I guess. Presidential health is not always as transparent as it claims to be, even going back, as you said. And so it’s not totally out of the ordinary that Trump wouldn’t be transparent about his health, even though, maybe ethically â€¦ presidents in general should be. 

Rovner: Obviously something else we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with Céline Gounder. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague, Dr. Céline Gounder, ºÚÁϳԹÏÍø News’ editor-at-large for public health, a CBS News medical correspondent, and an internist, epidemiologist, and infectious disease doctor. I can’t think of anyone I trust more to explain what’s going on with Ebola than Céline. So, thank you very much for doing this. 

Céline Gounder: Oh, it’s my pleasure to be here, Julie. 

Rovner: So, when everybody was covering the hantavirus outbreak on that cruise ship a few weeks ago, experts like you were saying it was a cause for concern, but not likely to become a serious problem. All of those same experts seem much more concerned about this latest Ebola outbreak in Central Africa. How is this different from what we were just talking about with hantavirus, and how is it different from previous Ebola outbreaks? This is not the first one. 

Gounder: Yeah, so to give you a sense of perspective, when I first heard the reports of a viral respiratory illness out of Wuhan in very late 2019, early 2020, I was terrified by what I was hearing. When I heard the reports of the hantavirus outbreak on the cruise ship, I was concerned for the other people on the cruise ship. I was not worried about a larger outbreak, and I would be very surprised, especially at this point, if we see any further cases. With respect to this Ebola outbreak, I am very concerned about a very large, huge, regional epidemic, where we may have some sporadic spread to other countries outside of the region. I am not worried about a pandemic. So, this is one difference: An epidemic is usually within a certain region. Pandemic is when it goes worldwide. So, I think this is going to be an epidemic in Central, possibly also East, Africa, but not going beyond that. 

Rovner: So, how is this different from â€¦ you worked in one of the past Ebola outbreaks. This one people seem to think is more serious than the last couple that we’ve seen. 

Gounder: Yeah, so I worked in Guinea during the 2014-2016 Ebola epidemic. I was there for two months. You have some of the same risk factors for a large epidemic, so you have urban areas affected, you have cross-border spread. There you had the epidemic start in Guinea, then move to Liberia, then Sierra Leone, then back to Guinea, and then you also had migrant workers that would go back and forth. And so you have those same, exact risk factors with this current outbreak, and then, secondly, you have large refugee populations in South Sudan. And so both of those issues also further complicate movement, both in and out of the area. Healthcare workers trying to get in to address issues. Healthcare workers being safe doing this kind of work, and also getting supplies, in particular, PPE â€” personal protective equipment â€” as well as tests into the area to help respond. 

Rovner: What about the U.S. pullback in foreign aid? We’ve obviously, you know, seen sort of the demise of USAID and a hollowing out of the CDC here. I imagine that’s impacting how we’re responding to this. 

Gounder: Yeah, so starting with USAID. So, USAID funded the people on the ground that would do the contact tracing, who might help set up Ebola triage, as well as treatment units. And that funding is gone. In fact, over the last week, I’ve been talking to some of the Congolese doctors who used to have jobs funded by USAID. And, in addition, USAID really supported the supply chain infrastructure for the area. So now you’ve seen a collapse of their ability to get personal protective equipment. There are shortages of this, which is also contributing to healthcare workers getting infected right now. And then also pharmaceutical supply chain. So, you know, even the most basic of medications is a challenge to get into the area. With respect to CDC, there have been tremendous layoffs related to the DOGE [Department of Government Efficiency] cuts from last year. We had the CDC shooting last August, and morale at the agency is â€¦ it’s horrible, it’s horrible. And just in the last day or so, Dr. [Jay] Bhattacharya, who’s the NIH [National Institutes of Health] director, and also, I guess he’s calling himself something else, because he can’t technically be acting CDC director anymore. But … 

Rovner: He’s nominally in charge of CDC, without being the acting director. 

Gounder: Right, exactly, whatever that means. But he has asked for CDC staff to volunteer to go over to Kenya, and staff a quarantine and, sounds like, treatment unit for any American healthcare workers who might get sick or be exposed while responding to the Ebola outbreak. And based on what we’re hearing, it sounds like they do not want anyone with Ebola coming back into the U.S., including the very people they’re asking right now to volunteer to go to this unit in Kenya. So I think that is also going to further complicate the response. You know, like, if you volunteer for the Marines, you enlist, and you get sent overseas, and you have an injury, you expect to be repatriated as quickly as is possible for treatment here in the United States, right? That is not the case. These are people who are similarly putting their lives on the line, who are responding to that call for help, and we are not seeing similar respect for that sacrifice. 

Rovner: And yet, I mean, the U.S. is set up to take care of people with seriously contagious diseases, right? 

Gounder: Oh, yeah, we have over a dozen units that were specifically created for this very purpose. Several of them have hands-on expertise, experience with this. So, in particular, Emory [University School of Medicine] in Atlanta, [NYC Health + Hospitals/] Bellevue in New York City, where I am, as well as University of Nebraska Medical Center. All three of those have experience with Ebola, not just having done preparations. And it’s really confounding why you would not want to make use of that. When somebody gets Ebola, particularly if you’re talking about an American, you know, who has put themselves in harm’s way â€” there are some real questions about fairness and equity of access to certain levels of care â€” but American aid workers, the expectation is that they would get the full-court press. And that might include being on a ventilator, that might include needing dialysis, for example, and to do those things when somebody has Ebola, and you need to do that in biosafety Level 4 conditions, I have a hard time seeing how they’re going to be able to put that together in Kenya on such short notice. 

Rovner: So we learned a lot of lessons from covid, not all of them good, obviously. You have a , which I will post a link to, about the psychology of pushback. Can you talk about that briefly? Because I think that has a lot to do with how the U.S. is responding to this. 

Gounder: Yeah, and I think a lot of people may actually identify with their own experiences during covid. You had a lot of people who didn’t want to wear a mask. In fact, we saw masks being burned, right? People not wanting to get vaccinated. And what happens is, when you have somebody who, for whatever reason, people don’t trust telling them to do something, they feel like they’ve been backed into a corner and they lash out. And so you tell them to do something, very often they want to do the exact opposite. And I saw this exact same thing when I was in Guinea over 10 years ago now. It was related to the presidential elections at the time, and it was a way of expressing dissent towards the current, at that time current, president and ruling party. And so, you know, for Ebola, the measures are pretty basic, particularly at that time: It really came down to contact tracing, testing, safe burials. And people would refuse to do some of those really basic things, and it was their way, what we called in Guinea and French, La réticence c’est la résistance, so reticence and resistance. And you saw that whole spectrum manifest there, and I think we’re seeing the same thing all over again, predictably so, in the DRC [the Democratic Republic of Congo] right now. 

Rovner: So, what could this administration be doing better, or be doing that they’re not doing that could maybe help us tamp this down, I mean, before it gets out of hand? 

Gounder: Well, I am concerned it’s already out of hand. They’re only following up on one out of every five contacts, so that means four out of every five contacts could be seeding new chains of transmission. So I think this is going to get a lot worse before things start to turn around. In fact, I would predict this is going to be a year or two to control. I mean, based on prior experiences with the 2018-2019 outbreak in the same area, as well as the 2014-2016 outbreak in West Africa. This has the potential to be even worse. What could the U.S. be doing? Well, we are currently adopting a very isolationist stance with respect to our public health policy. The dismantling of USAID is a big part of that, but it’s not the only thing. And I think what is happening now, frankly, gives me flashbacks to the 2014 Ebola news and midterm elections, and the way in which Ebola was politicized at that time. At that time, President Trump was not president; he wasn’t even a candidate yet, but he spoke very loudly about having travel bans. He called for President [Barack] Obama to resign because he allowed, in fact, facilitated the transport of infected Americans back to the U.S. for treatment. And so he’s on the record as having said he never wanted anybody with Ebola in this country. And I think the current policy that you’re seeing is consistent with that. We’re headed into midterm elections again. We’re seeing travel bans being instituted for real this time, not just talked about. And one of the other concerns around travel bans at that time, and again now, was what would it mean for healthcare workers and other aid workers, their willingness to volunteer to respond? And I remember Craig Spencer, a very good friend of mine, he was hospitalized at Bellevue with Ebola, and it was right around that time as well, Kaci Hickox, a nurse who had responded, she came back to Newark Airport. Chris Christie, as I recall â€¦ 

Rovner: Then the governor of New Jersey. 

Gounder: Yeah, right, governor of New Jersey, Chris Christie, at that time mandated that she be quarantined. So she did not have symptoms, but that she be quarantined due to her work on, I think, it was the tarmac at Newark Airport with a Porta Potty and a tent, something along those lines. And I had a lot of friends at that time who pulled out of volunteering â€” between Craig getting sick and Kaci and the mandated quarantine really under inhuman[e] and humiliating conditions. And I think this time it’s going to be even worse because not only are you having to face potentially getting sick, but you may not get to come home. And it’s really unclear at what stage, if you get sick, would you be allowed home. Do you have to wait until you recover? And what if you die? What happens then? Does your body get repatriated? Does your family, right, get to receive the body? That’s a big deal for a lot of families to have that closure. So I know, even among my friends who, like me, are Ebola veterans, there’s a lot of hesitance about stepping up again. 

Rovner: Well, I hope we can call on you as this continues, alas. Thank you so much. 

Gounder: Oh, of course, Julie. 

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

Goldman: My extra credit this week is a story in The Texas Tribune by Terri Langford and Colleen DeGuzman titled “.” And you know, I think it’s obviously a very important political story in the fight over transgender rights, and specifically rights for transgender kids, and the medical practice around gender-affirming care. But one of the things that’s especially interesting to me about this settlement is that there’s not really demand for detransition services, at least at the level of having a dedicated clinic at a children’s hospital for them. And so this is basically a children’s hospital is going to put resources towards creating something that, or presumably put resources towards creating something that may not be used. And as hospitals are talking about how stressed they are for dollars, and just in general overextended, you know, I think this is a very interesting use of resources. 

Rovner: That’s one way to put it. Lauren. 

Weber: I have the New York Times investigation by Sarah Kliff and Margot Sanger-Katz â€” which, you know, as soon as you see those two names, you have to read it â€” titled “.” And it’s a great look and also builds upon, you know, some great reporting by The Wall Street Journal, I’ll have to shout them out as well in this area. But it details how, amid this focus on autism clinic fraud how â€¦ what that looks like on the ground. And it’s pretty terrible on the ground. A lot of these autism treatment clinics, the science is questionable on whether it really works. They’re encouraging people to send their kids there instead of to school. â€¦ There’s this horrific anecdote in the lede about how a child is woken up from a nap that can only last almost seven minutes, so they can bill more. I mean, it’s pretty gut-wrenching and gets at the clear issue in a lot of healthcare, which is that a lot of this is done to maximize profit and not necessarily for the patient. So it’s very well done. 

Rovner: Yeah, it is really scary. Shefali. 

Luthra: Mine is in the New York Times opinion section by Dr. Sejal Hathi. The headline is “.” She herself is a new mom, in addition to running the Oregon Health Authority, and she writes about how our postpartum care system is terrible. We do not care about new moms. We only care about infant checkups. We have very little medical care for people when they are postpartum, and that is not good, because pregnancy is really hard. You can have complications. Most pregnancy-related deaths happen after giving birth, not during. Most of them are preventable, and yet we don’t treat this as something that could be addressed, even though it very well could be, because in other countries they actually do make an effort to care about new moms. I love that she wrote about this from a personal and professional standpoint. I think it’s great, and I hope that it inspires some states to think about ways to improve postpartum health. 

Rovner: Yeah, that story made me so angry. Well, my extra credit this week is also about reproductive health. It’s from ProPublica by Pulitzer Prize-winning reporter Kavitha Surana. It’s called “.” And it’s about yet another case of a mom pregnant with her second child, a college-educated healthcare worker, whose membranes ruptured early, putting her at high risk of sepsis, but who couldn’t get the pregnancy terminated at the hospital where she worked, because the doomed fetus still had a heartbeat. This was a well-connected family. The patient’s father is a doctor. She was in the same sorority at the same college as Arkansas Gov. Sarah Huckabee Sanders, and she enlisted one of the top reproductive health lawyers in the country to plead her case with hospital officials. I won’t spoil the end for you, because you really should read the entire piece, but it underscores yet again that abortion bans can endanger people who don’t think they will ever want or need an abortion. 

All right, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from 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 , and on Bluesky . Where are you guys hanging these days? Maya. 

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

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Lauren. 

Weber: Still on  and  under @LaurenWeberHP. As I like to say, the HP is for health policy. 

Rovner: We’ll 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. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 21, 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 Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with Miranda Yaver, a health policy professor at the University of Pittsburgh and author of a cool new book all about insurance denials. But first, this week’s news. 

So, the biggest health policy news in Washington this week is the primary defeat of Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy, who finished third in a three-way Republican primary in Louisiana Saturday â€” not just to congresswoman Julia Letlow, the candidate endorsed by President [Donald] Trump, but to state treasurer and former representative John Fleming, who, like Cassidy, is also a medical doctor. Fleming and Letlow will now advance to a runoff next month to see who will make the general election ballot in November and likely advance to the Senate from very red Louisiana. 

Meanwhile, though, Cassidy still has the rest of this year at the helm of the HELP Committee, where he is still in charge of filling Trump administration vacancies for surgeon general, Food and Drug Administration commissioner, and director of the Centers for Disease Control and Prevention. And, just judging from the last few days, Cassidy appears to feel liberated from his former fealty to President Trump. He switched sides and voted with Democrats to limit Trump’s war powers. He questioned the legality of a $1.8 billion fund to pay people who claimed they were victims of unfair federal prosecutions, and he defended his vote to convict Trump in the impeachment trial after Jan. 6, which is what got him in hot water with the president in the first place. What does this portend for what might happen at the HELP Committee going forward the rest of this year? 

Stolberg: Well, I think we see Cassidy, as you said, “liberated,” unfettered. You know, Cassidy agonized over whether or not to confirm Bobby Kennedy. I recently reread his testimony, and at the end, he delivered this soliloquy, and he said, Man, you know, I don’t know, can a 71-year-old man, you know, change his tune after all this time? He said, I’m 71; Kennedy’s 71, and he wondered if Kennedy could, you know, really do the things that he promised Cassidy he would do. And in the end, Kennedy did not, and Cassidy was kind of humiliated in Washington. He may have been defeated by forces in Louisiana other than what he did in Washington, but at least here in Washington, Cassidy, you know, still has his perch. He was never comfortable with Bobby Kennedy. There’s nothing holding him back now. When I asked him before his primary, I said, Will we see a vote on Casey Means? She was still the nominee then, and he said, We’ll talk about that later. And I have a feeling that Cassidy will talk about a few things later. 

Rovner: I feel like two things happen when senators are, you know, become lame ducks like this, is they can either go rogue and do everything they always wanted to do and say everything they always wanted to say â€” which we’re kind of seeing with Sen. Thom Tillis from North Carolina â€” or they can actually hunker down because they’re worried about what they might do when their term is over, and they want to get a job, and they want to be able to lobby their former colleagues. Do we have a feel for which way Cassidy is going? 

Stolberg: Cassidy already gave us a feel. In 2021, he voted to convict Trump on a charge of incitement of insurrection. He said at the time I voted to convict Trump because he’s guilty. Now it is true that Trump is still in office now; Cassidy probably never expected him to come back, but I don’t know. Cassidy tried containing or constraining himself, and it didn’t work out. He lost, so no, why not let it rip now? 

Kenen: I was always sort of struck that once he cast that impeachment vote, which was a really defining vote, even, as Sheryl just pointed out, not expecting Trump to â€” I mean, [Sen. Mitch] McConnell didn’t expect him to, a lot of people didn’t expect him to â€” come back after that. But he had done it, and he can’t erase it once Trump did come back. So once you have that, sort of, you know, what for Trump is a mark of Cain on your forehead, then why â€¦ like, we saw it was so visible, you could see Cassidy wrestling with the Kennedy nomination, you could see it. It was so visible, it was like [unintelligible] â€¦ 

Stolberg: It was like Hamlet. 

Kenen: And then vote against his conscience, probably, none of us are in his head or his heart, but you know it was not a vote he was completely comfortable with. And it wasn’t going to save him. Like, at that point, the politically smarter thing might have just gone, OK, I’m going to be an independent-minded guy, and if I lose, I’m going to lose if I do this, and take a gamble on doing that. I don’t think anyone expected him to come out ahead in this primary, although maybe he did. I never understood the Kennedy vote. I never â€¦ 

Rovner: I understood the Kennedy vote. What I never understood was what happened afterwards, when Kennedy did not keep all the promises that he made to Cassidy, that he would come and testify that he wasn’t going to change the vaccine schedule, all the things that he then did. And Cassidy sort of â€” you could see that he was disapproving of it, but he never really did anything about it. I think that was the part that surprised me much more than the actual vote. 

Ollstein: Cassidy also, throughout the course of his campaign, really tried to align himself with Trump and sort of tried to argue that, you know, forget about the impeachment vote a few years ago, you know, more recently we align on X policy and Y policy, and we both believe in border security, and we both believe in stopping fentanyl, and X, Y, and Z. And so, honestly, the entire primary was just about Trump. All three candidates tried to argue that they were the most aligned with Trump. Obviously, that was easiest for Letlow, who was endorsed by Trump, but all three tried to argue that they were carrying the MAGA [Make America Great Again] banner, including Cassidy, despite that impeachment vote, which was, I think, interesting. The RFK vote did not come up quite as much. It was really overshadowed by Trump. 

Stolberg: But you know what’s interesting? Cassidy did grow a little more vocal along the way. When I asked him in the early days how he thought Kennedy was responding to the measles outbreak, he said, Oh, it was, you know, OK. Like, he encouraged people to get vaccinated. And I said, No, he didn’t. He said â€¦ vaccination was a personal choice. And Cassidy said, Well, it’s the gestalt of the thing. And then he slowly, you know, did speak out more. But what I found very striking was the way Kennedy spoke out against Cassidy right after Trump withdrew the Casey Means nomination. And he accused Cassidy of doing the bidding of, you know, the pharmaceutical industry and of forces that would thwart MAHA [Make America Healthy Again], which really tells you that the relationship was and is broken. 

Rovner: Well, to push the segue a little bit, one of the things that Cassidy has, the freed Cassidy, has done this week, as I mentioned, is criticized that $1.8 billion potential fund out there for people to collect who say that they’ve been unfairly taken to court and possibly convicted by the federal government. Alice, it looks like that could include people who broke into and blocked patients from abortion clinics. That would be something that Cassidy would presumably like, because he’s so anti-abortion. But is that really true? 

Ollstein: Yes. So the text of this settlement that was released, it was extremely broad. Really, it’s saying that anyone who feels they’ve been victimized by any administration, past or present, can apply for money from this fund. There really aren’t a lot of guardrails on it, but it did give a few specific examples of people who could apply for this money. And one of those examples was people convicted under the FACE Act, the Freedom of Access to Clinic Entrances Act, which is a law, since the 1990s, that is aimed at protecting abortion clinics but also anti-abortion crisis pregnancy centers and houses of worship. And it has these additional federal penalties. And so these are folks who the Trump administration pardoned last year, people who are serving felony sentences in many cases for breaking into abortion clinics, blocking the entrances of it, of them. And so , who have been documenting a rise in threats to clinics over the last couple years, since the pardons that came in 2025, at the beginning of Trump’s second term. And now they’re worried that this potential payout to these folks could serve as an increased incentive for that kind of behavior. 

Rovner: Yeah. Well, we will see if Sen. Cassidy, and maybe Sen. Tillis, and maybe some others who’ve expressed some doubts about this fund, manage to block it. Whatever happens for the rest of this year, though, come 2027, there will be a new chairman at the Senate Health, Education, Labor, and Pensions Committee. If the Republicans maintain control of the Senate, it’s likely to be one of the two other doctors currently on the committee, Roger Marshall of Kansas or Rand Paul of Kentucky. What could we expect from either of them? They have very different outlooks. 

Ollstein: Yeah, Roger Marshall is a big cheerleader of RFK Jr. and the MAHA movement. He is the head of a MAHA caucus in Congress, and so it would be a complete reversal of the criticisms we have been getting from Cassidy of the administration’s actions on that front â€” so, really, replacing one of the HHS secretary’s biggest critics with one of its biggest cheerleaders. 

Stolberg: I think Rand Paul wants to keep [his chairmanship of the ] Homeland Security [and Governmental Affairs Committee], I really do. Because I’m pretty sure he could have been â€” could he have been chairman this time around? 

Rovner: I think he, I think â€” no, Joanne is shaking her head no. 

Kenen: I might be wrong, but I think not. 

Rovner: But he definitely â€¦ could be chairman, I think, if he wanted it. I think he’s senior to Marshall. 

Stolberg: But I do think he wants to keep Homeland Security. But I think if we saw a Rand Paul chairmanship, we would see a lot of going after the NIH [National Institutes of Health] and investigating [Anthony] Fauci. Rand Paul has repeatedly said he thinks Fauci should be in prison. And â€¦ I think he’s kind of like a dog with a bone there. I don’t think he’s going to let that go. 

Rovner: No, he’s sort of the biggest iconoclast, I think, on that committee. 

Kenen: But there’s also two quite moderate, among the most moderate, Republicans on that committee, which [is] Susan Collins, who obviously has a tough race, and we’re not sure if she’ll be there next year, and Lisa Murkowski. Both of them have other committee assignments on Approps [Appropriations], they’re not being talked about so much in the in the mix for succeeding Cassidy. But it’s an odd committee. It’s always been an interesting committee for years to watch because of the mix of who wants to be on it and what they can do. But the speculation right now is Marshall. 

Stolberg: And if they lose, Bernie Sanders will be the chair, and we’re going to hear a lot about drug prices. 

Rovner: Yes, I think that’s fair. Well, meanwhile, this year, there are still more vacancies happening at a Department of Health and Human Services that never seems to get settled, in the wake of the departure of FDA Commissioner Marty Makary last week. Was it really just last week? Also out is Tracy Beth Høeg, who was running FDA’s drug center and was a vaccine critic and a favorite of the MAHA movement. But, meanwhile, the acting FDA chief, Kyle Diamantes, did some “kiss and make up” with anti-abortion activists who helped lead to Makary’s ouster. Alice, did this work? 

Ollstein: Depends what you mean by “work.” So we reported this a couple weeks ago, and it was really notable that he spent his first couple days in power making personal phone calls to several anti-abortion groups, trying to reassure them that he is on their side, that he has been personally anti-abortion for a while. He was trying to calm a storm that had been brewing when court records came to light showing that he had, as a private attorney a decade ago, represented Planned Parenthood in a legal case in Florida. 

Rovner: It was a real estate case. It had nothing to do with abortion. 

Ollstein: Sort of. It sort of had to do with abortion. It was about what is a surgery, and can a building at this site, you know, be approved for surgery, and is abortion a surgery or just a procedure? So it sort of had to do with abortion. But obviously defending Planned Parenthood in any capacity is verboten in the anti-abortion community, and so that was seen as sort of a black mark on his record that he was rushing to reassure these groups that he did that against his will, that he tried to leave the case, etc. I will say that blitz of outreach did not completely alleviate concerns. We heard from both anti-abortion folks on Capitol Hill and in the advocacy community that they remain concerned. But since he is rumored to not be in the running to be the leader of the agency on a more long-term basis, I think that those concerns are sort of just simmering for now. 

Kenen: Didn’t he represent Planned Parenthood for three full years? 

Ollstein: His name â€¦  

Kenen: I mean, the case might not have been active, but his name was on there for three â€¦  

Ollstein: Right. His name was on the documents. 

Kenen: It’s hard to talk about three years and say, Well, I withdrew because I’m morally opposed to abortion. You know, if his name was on there for a week, it would be a more easier case to make, but three years is a lot of days. 

Ollstein: Yeah, and that’s what some folks told us. They said they still have questions, basically, that it’s not clear when he asked to be removed from the case, what his involvement was, etc. And so, yes, people do remain concerned. But because he seems to not be in consideration to be the FDA leader more permanently, then it’s sort of a moot point. 

Rovner: But the immediate concern is this purported study of the safety of mifepristone, which was one of the things that the anti-abortion movement said Makary was sitting on and not doing. Sheryl, I see you nodding â€” you guys had some reporting [on] this. What the heck is the status of this study? 

Stolberg: So this is what we reported this week, my colleague Christina Jewett and I. First of all, this study hasn’t even started. 

Rovner: Surprise! 

Stolberg: The basic issue here: There’s a court case going on. The FDA left intact a Biden policy that broadened access to mifepristone, an abortion pill. The state of Louisiana is suing, saying that that policy undermines its ability to enforce its abortion restrictions, which are some of the strictest in the nation, no exceptions for rape or incest. So the FDA has been saying, We will study this issue, we’re studying it, and when we have a determination about the safety of mifepristone, we will reconsider this policy. And they’ve been saying this for months, since last fall. But the fact of the matter is, as we reported, this study has not even begun. And the reason it hasn’t begun, at least according to our sources, is not that Marty Makary was sitting on it. Makary is actually anti-abortion. It is because the FDA wanted to use this database, called the Sentinel Initiative, which is [a] vast database of medical records and insurance billing claims, but they needed an updated version, and it’s been caught up in the bureaucracy by the higher-ups at the somewhat dysfunctional headquarters of the Department of Health and Human Services. So, absent having this database, our sources said the FDA couldn’t begin the study. 

Now, it is true that the delay conveniently coincides with pushing this study past the midterm elections. And Trump and his White House, and Republicans more generally, really want this issue of abortion to go away by the time of the midterms, because they saw what happened in 2022 right after Dobbs. In those midterms, nobody thought abortion was going to be an issue in 2022. Then Dobbs came along, and it really benefited Democrats, and they regained control of the Senate, and they only lost a few seats in the House, where they were supposed to, you know, get slaughtered. So Trump does not want a repeat of that, and they just want this whole thing to go away. 

Rovner: We will keep watching that space. So it’s not just the FDA where the Department of Health and Human Services is seeing changes. Secretary Kennedy has now fired the two leaders of the U.S. Preventive Services Task Force, which is in charge of determining what preventive services are covered by health insurance. The deadline to nominate new members is this Saturday. It’s unclear as of this morning what will happen. But this is an important group that’s now headless and looks likely to remain that way for some time. And this is not Kennedy’s first strike at the USPSTF. He canceled the panel’s last several meetings and appears to be looking to sideline it completely? I mean, this could create havoc in a lot of other places â€¦ there’s 150 million Americans who are in plans that are covered basically by USPSTF recommendations. 

Kenen: Right, I mean, we should make clear that, in addition to saying, certifying this is a good thing to do for preventive care, it’s also â€¦ creates what certain health plans have to cover legally. 

Rovner: Right, under the Affordable Care Act. 

Stolberg: Such as mammograms, right? 

Kenen: Right, so it’s not just like a recommendation, it’s whether people really do have coverage to follow through on these recommendations. So it’s incredibly important. It hasn’t been, like, compared to a lot of things that are always controversial, and they flip back and forth in different administrations, and they come and go. There’s been controversy sometimes about a specific recommendation changing or causing confusion, but sort of â€¦ there hasn’t been an existential crisis before about it, at least that I remember. 

Rovner: Right. What age should mammograms start, I think, has been the biggest controversy. 

Kenen: That one, yeah, there’s like, and prostate cancer. There are things that like that, which there’s scientific debate, and things change, and â€¦ but that’s different. Like, the fact that this agency that most Americans don’t know exists, but benefit from, it has never been a hot potato, the way you know various other alphabet soup things that people may not be familiar with, but have constantly been, you know, in Congress, you know, AARP, for instance, or â€¦ but this one has just sort of been, Oh yeah, you know, it’s how I get my shots free. 

Rovner: Do we know why Kennedy has had knives out for this? Is it because of the vaccine recommendations? 

Kenen: Probably a factor, but also he does have a lot of control over this agency, and it does shape what he regards as preventive care. I mean, some things are not controversial, some things we would all agree are preventive care, and there’s some things that, you know, we’ve said before that there are things that he’s, he believes â€¦ certain things that there’s broad consensus about. But I think that the whole shift in how he thinks about health and the health industry, or the health industrial complex, as he might call it, and maybe has called it. This is one of the sort of obscure to normal people, but it’s one of the battlegrounds for what is preventive care? Who pays for it, and who gets access? So, I think it’s potentially â€¦ recommending coverage of some unproven supplements, or something like that. 

Stolberg: Right. That’s exactly what I was gonna say. I … 

Kenen: Peptides. 

Stolberg: Kennedy is fixated on prevention, right? He’s always saying that America has a sick care system, not a healthcare system. We need to focus on prevention. It’s kind of curious to me, then, why he is decimating the CDC, which has the word “prevention” in its name. But I do wonder if he wants to reshape this committee in a way that will cover other things that he sees as prevention â€” like supplements, like wearables, like peptides, or all of these other things that are unproven, but that are part of what public health people would call the wellness industrial complex. You know, he rails against the medical industrial complex, but public health people complain about the wellness industry. That’s the only thing that I can think about as to why he might have done this, but I confess I don’t have direct insight into his thinking about this, and just talking about it kind of makes me want to know more. 

Rovner: Well, we will keep watching this space. 

Stolberg: So stay tuned. Maybe Alice knows. 

Rovner: Alice, you have â€¦ you would like to add something? 

Ollstein: Yeah, so we got some foreshadowing that this was coming more than a year ago, because this issue was before the Supreme Court, and the administration surprised some people by technically defending the Affordable Care Act. But, in its argument in defense of this panel, said that it is legal and its folks were legally appointed because they really stressed that the HHS secretary has the power to fire and replace these people or ignore their recommendations or override them. And so the fact that they wanted to make it clear to the court that they had the power to do this â€” and, lo and behold, now they’re doing it â€” should surprise no one. But, like Sheryl said, exactly why they want to do it and what they plan to do next, we still don’t know. 

Rovner: Well, there could still be even more big personnel changes to come. Department of Health and Human Services last Friday announced that it is moving hundreds of senior career staff to a new civil service classification that strips them of many protections and makes it easier to fire them. This is a new version of the so-called Schedule F that the president floated at the end of his first term, and then was included in Project 2025. Now, if this really happens, and apparently it still requires a separate executive order from the president, it would give Kennedy power to oust even more career HHS workers than have already either been pushed out or forced to retire, or, you know, whatever. I mean, really remake the department in his image, right? 

Stolberg: I’m hearing from a lot of HHS employees who are really worried about this. They’re worried that it’s a de facto system of expanding political appointees â€” that, basically, once you serve at will, you’re not really a career servant anymore, you’re serving the whims of your boss, maybe the NIH director or the CDC director, or whomever. And there’s a lot of fear that this will diminish independence at these agencies, especially in the scientific agencies: the NIH, the FDA, and the CDC. 

Rovner: And also just, I mean, discourage people from speaking out, many of them, as scientists, to talk about what the evidence shows, not what a political appointee might desire. 

All right, we’re going to take a quick break. We will be right back. 

OK, we are back. Moving on to public health, the hantavirus outbreak from that cruise ship was apparently just our warm-up. Now we have an outbreak of Ebola in Africa that seems to have all those public health experts who said not to worry about hantavirus, now they’re really worried about Ebola. What’s different about this Ebola outbreak? We’ve had them before, and it’s never really affected us here. 

Stolberg: It’s a novel strain, and, Joanne, you should talk in a minute, but what I think is different, frankly, is that the Trump administration has really injured the public health infrastructure around the world to prevent and track and respond to infectious disease outbreaks. So we’ve withdrawn from the World Health Organization, we’ve dismantled USAID [the United States Agency for International Development], which I noticed was founded in 1961 under President John F. Kennedy, in part to combat the spread of disease. And funding is withering, and people in [the Democratic Republic of] Congo, public health people in Congo, are saying, like, this outbreak got out of hand before they even knew it was happening. And the question is, did all of these cuts hinder our response? 

Rovner: Yeah, which, I mean, if we’d had people on the ground, we probably would have known about it sooner. 

Kenen: Yeah, I agree with everything Sheryl said. The other thing is, I mean, this is one of the poorest countries in the world, and yet they’ve had a bunch of Ebola outbreaks, and they’re actually pretty good at handling them, for a low-resource country. This is much worse for where it broke out. There’s conflict in parts of the country. There’s refugee camps, where sanitation and people are very close. And it’s just a worst-case scenario. And because it is the rare strain, the standard, most commonly used tests don’t pick it up. So it’s not like they didn’t notice something bad was going on, but when they tested, the locally available tests came out negative, because it was not the most common Zaire strain they were most used to seeing, and that were best at fighting. So this is already spread undetected. It wasn’t like they thought, Oh, this couldn’t be Ebola, and then it had already spread before they knew it, not just in that country, but in, at least, to Uganda. And the real bad thing is the vaccine doesn’t work, as far as they know. And most of the treatments that have been developed for Ebola, which is not an easily treatable or curable disease, even with the advances that have been made, they don’t work for this one, or at least they’re not believed to work very well. Every time I look it up, the number’s gone up by like another 100. I think there’s 600 confirmed cases now, something in that range. And by tomorrow, as the disease spreads and as they detect more, we’re looking at a really terrible scenario of late detection and a hard-to-treat, really lethal version of this disease that’s already in a geopolitical bad place for a bad disease. 

Rovner: And possible spread. 

Kenen: Yes, and plus, as Sheryl said, you know, the global public health infrastructure â€” combination of the cutting of â€¦ the wood chipping of AID, plus the U.S.’s intent of leaving WHO, and we’re a big source of funding â€” and it’s just really a diminished capacity. 

Rovner: We will clearly have more on this next week. Moving on to news about the Affordable Care Act, my colleagues here at KFF have a  out projecting that marketplace enrollment could fall by 5 million by the end of the year. And that even those who have managed to hang on to coverage have much higher deductibles, with the average of nearly $4,000 before their insurance kicks in for most things. That’s up $1,000 from the year before, and the biggest increase in the history of the program. And in its final rule for 2027, the Trump administration is proposing even more big changes to the ACA, including making it easier for people to sign up for those so-called catastrophic plans with even bigger deductibles, and to sign up for something called non-network plans, which, as far as I can tell, basically say we, the insurance company, will pay a set fee for services, and if you can’t find a healthcare provider to accept that fee, that’s too bad for you. Am I misreading this? Is that how these plans seem to work? 

Kenen: Your guess is as good as mine, Julie. We haven’t seen this before, and we don’t know â€¦ like many things this administration proposes, and we don’t always know exactly what they mean at the beginning, and then when it becomes â€¦ presumably it will become somewhat clearer. But I’d never heard of this before. 

Stolberg: I would just say this is â€¦ not what Congress intended when it passed the ACA, and Obama signed it into law in 2010. 

Rovner: I think that is definitely fair. I will say, when the ACA passed, I spent a lot of time reading it, and all the places that it gave, quote-unquote, “secretarial discretion,” I thought to myself, The secretary isn’t always going to be somebody who supports this. I think this is a good example of it, that the secretary of HHS has a lot of discretion to do stuff like this, and they seem to be doing it. And you know, unlike some of the other things that they’re doing, this does not seem to be against the rules. â€¦ It seems fairly clear that they can. Alice, did you want to add something? 

Ollstein: Yeah, I mean, I think it just helps us to keep in mind that, you know, while there’s always a lot of attention on the numbers of uninsured and the recent numbers of people dropping their insurance because they can’t afford it anymore, there’s a whole other category of people who are newly becoming underinsured, who are moving from comprehensive plans that’ll be there for them when they need them, when they get sick, when they have facing a major health crisis, and plans that are very skimpy and won’t really cover what they need, or they’ll be facing such a huge deductible that they can’t afford to pay that either, and so I think it helps us keep a broader scope in terms of assessing, you know, the health of the marketplace. The uninsured numbers aren’t the only thing to pay attention to. 

Rovner: Yeah, and I think it’s important that â€¦ the KFF analysis said that the numbers of people losing insurance were smaller than had originally been predicted, because so many people moved from affordable deductible plans to basically unaffordable deductible plans. So they still have insurance, sort of in name, even if most people don’t have $10,000 hanging around that they can use to pay their deductible if something happens. 

Kenen: The first Trump administration, obviously, you know, he got elected on “repeal and replace,” which was a failure. Spent a lot of political capital and didn’t repeal â€¦ or certainly didn’t replace it. But from the very beginning, from like the very, very beginning, they were always trying to undermine the ACA, and in a variety of ways. And uninsurance â€” those numbers did rise after the first few years of the ACA. There was a steady increase in coverage and in comprehensive coverage. It deteriorated in the Trump administration the first time around, but what we’re seeing this time is much, much larger projections of lost coverage. And that’s not even counting â€” that’s just in the ACA. That doesn’t count what’s going to happen with Medicaid and the private insurance market in general, and whatever they’re going to do with discussions about changes in Medicare. People aren’t going to lose Medicare completely, but there could be â€” no one’s talking about repealing Medicare, but there are a lot of levers to change how people get care. So this is a pretty aggressive approach without using the politically difficult traumatic memories of repeal and replace. 

Rovner: Yeah, we’re just gonna go in and change it a lot. 

Stolberg: I was gonna say it suggests that we need to start tracking people who have catastrophic plans, because to call them insured is really not the case. And you know, this really plays out in people’s lives. I actually know someone who fell and injured both legs, and the doctors wanted to do MRIs on each, and this person said, “No, I can only afford one.” And you know, you think about the choices that people are forced to make. 

Rovner: And that they’re not forced to make in any other industrialized country. I think that’s sort of the thing that people miss. It’s like we are the only country where you can fall down the stairs and go broke. You will get care, we â€¦ have EMTALA [the Emergency Medical Treatment and Active Labor Act], we have other laws. You will be taken to a medical facility, and care will be delivered, and then you will be broke. I mean, that’s kind of where we are in the United States right now. 

Kenen: But we should also point out a version of catastrophic plans, or bronze plans, has existed. It’s always been options for people who truly want that option, right? For some individuals, that might be the best choice, and the original version of ACA had it. But it’s being changed because the end of the enhanced subsidies and other factors, the other options are less affordable for many people. There’s a lot of nudges in capital letters pushing people into these flimsier plans. So it’s been around for a while in various forms. Some people want them. But they’re looming now as like a big part of coverage, as opposed to an option that some people might want to choose. 

Rovner: And originally catastrophic plans were supposed to be accompanied by medical savings accounts â€” they were originally called, now they’re called health savings accounts. The idea is that you would, you, the consumer, would be given some money, so that you would be able to pay for these things before you got to your deductible, and that’s kind of going away. I mean, rich people now have health savings accounts because they’re a good tax shelter. But most people with high-deductible plans don’t. They’re just expected to be able to come up with this money on their own. That was not even the original conservative idea: Give people more control over their money. This is simply, We’re going to give you cheaper insurance by saying that we’re not going to pay for the first however many thousands dollars’ worth of care that you need. 

Kenen: We’re going to give you great cheap insurance as long as you don’t get sick or injured. 

Rovner: Exactly. All right. Well, that is this week’s news. Now we will play my interview with Miranda Yaver. Then we will come back and do our extra credits.  

I am pleased to welcome to the podcast Miranda Yaver, who I have followed for some years now. She’s an assistant professor of health policy and management at the University of Pittsburgh, and the author of a timely new book called Coverage Denied: How Health Insurers Drive Inequality in the United States. Miranda Yaver, welcome to What the Health? 

Miranda Yaver: Thanks so much for having me. I appreciate it. 

Rovner: So, you came to health policy less because of initial academic interest than because of need, right? How did you end up here [rolling] in the muck with us other health policy nerds? 

Yaver: Yeah, we’d been really interested in health policy, and I’d been writing on the ACA repeal efforts, but my work had been pretty separate. And then I ran into some health issues, and the great American experience is running into health issues often means running into insurance issues. And I just kept sort of stepping back and realizing I have so much privilege in terms of health literacy, job flexibility. If I’m struggling, what do other people who don’t have the education and the stamina to be able to do it, how did they navigate healthcare access? And so I just really wanted to take this opportunity to bring my social science skills to this health policy space that felt rather understudied. 

Rovner: So, there are a lot of things that are wrong with our healthcare system. How did you come to focus on insurance company denials, and what does that tell us about the greater dysfunction of the U.S. healthcare system? 

Yaver: Yeah, so one of the things that I was really struck by as I was experiencing denials of my own, was that KFF had done such great work to catalog the number of claim denials and the infrequency of appeals. But no one had really gotten under the hood to get a feel for who these people are, and how does this reshape lives? And so people can get denied in a couple of different ways, it can be prior to treatment â€” or, which is to say prior authorization, or required health insurer preapproval â€” or it can happen on the other end. And those are going to have very different experiences for the patient, where prior authorization may mean that healthcare is going to be out of reach for a while in a country where healthcare is exceedingly expensive. Whereas with claim denials, where we will have received the care, but then we’re dealing with the financial repercussions of the insurer not picking up at least part of the tab. And so thinking about this through the lens of burden and equity felt like a really important story here. So I really look at this insurance complexity through this lens of administrative burden, because these are these really big bureaucracies that we often have to navigate when we’re not having our best day. 

Rovner: I mean, it’s not just education, often it’s just time. I mean, one of the things that insurers love to do is make you sit on hold forever. If you have not a desk job, basically you can’t do that. 

Yaver: Yeah, absolutely. I’m fortunate â€” in academia, I work a lot, but it is sufficiently flexible that I can be on hold between 2 and 4 on a Tuesday and make up my work later, and that isn’t something that everyone can do. And so Annie Lowrey has this great piece in The Atlantic called “The Time Tax,” which I cite in this book. And it really is laborious, and it becomes easy once you’ve started to navigate this oneself to realize why so many appeals are ultimately abandoned by patients. 

Rovner: So, in many cases, insurers deny coverage because healthcare providers have incentives to provide too much care, often care that’s not necessary, or maybe more expensive than necessary, in order to pad their own pocketbooks, or serve their own private equity owners, or whatever. Doesn’t some of the blame for this problem fall on providers? 

Yaver: Yeah, these tools didn’t originate without any underlying purpose. So we see prior authorization come up amid concerns about greater healthcare spending, health inflation, but also overutilization â€” overtesting and overtreatment. And so my book doesn’t so much aim to dispel that argument so much as raise the question of: Do we address this with a hammer or a scalpel? And essentially thinking about, yes, there is overutilization, and there’s a really great book called Unhealthy Politics that also really dives into what accounts for this. Some of it is financial incentive, some of it is just practices get really entrenched, and we don’t update our beliefs very quickly, based on, you know, a latest study, potentially, and a lot of other factors. And so there is this overutilization. There’s some question about exactly how much there is. And then, you know, medical malpractice raises defensive medicine concerns on top of all of that. And so there are a lot of reasons why we have overutilization, but then there’s this question that I raise, which is essentially: Is the answer to this utilization to impose broad-based barriers to care and administrative burdens that are borne by both patients as well as their physicians, as opposed to going after the overprescribers? 

Rovner: So what surprised you most in researching and writing this book? 

Yaver: So I was really initially coming at this book from the patient perspective. So I did a survey, I did interviews, and I wasn’t actually thinking about the physician side quite as much when I was writing this. And I realized I was wrong, that even though we do have these challenges of overprescribing prior auth works to mitigate, I also really got a better appreciation of the immense staffing support and broader burdens that this causes for physicians, which I’ve also argued elsewhere can contribute to inequities among physicians’ experience of this. Because Black and Hispanic physicians are more likely to work in smaller solo practices, where we can’t have all that staffing support. And mental health providers are more likely to operate in small and solo practices, where it’s just harder to shift that burden to administrative support. And so I really enjoyed getting to dive into that side of things. And then, you know, I was just really felt grateful that so many patients just trusted me with their stories. And some of them were infuriating, some were heartbreaking, and some really just highlighted that there’s also administrative error that can be costly to both patients and their physicians. 

Rovner: So is there a way to address this without tearing the entire system down and rebuilding it all at once, which I know we’re probably moving towards at some point. 

Yaver: So one of the ways that I argue that this can be addressed â€¦ is through a shift to an audit-based model. So if overprescribing is an issue, and it is an issue to some extent, why not target those who are prescribing outliers? And then maybe do random audits of everyone else with the idea that prior authorization could potentially be a penalty for overprescribing â€” a watchful eye when someone seems to be ordering a tremendous number of lower lumbar spine MRIs, which is a sign of overprescribing. And then for people who seem to be doing appropriate prescribing, allow them to have the greater professional autonomy in doing so. And so I think that this would bring prior authorization closer to its original purpose of an appropriate guardrail, whereas right now I think a lot of the pain and frustration that my book works to illuminate is that it has just seeped into every corner of healthcare delivery, even areas where there isn’t evidence of abuse. I mean, PrEP can have prior authorization â€” we’re not taking that for fun. Insulin is a huge source of frustration to get covered. 

Rovner: One would think that doctors are not prescribing insulin for profit. 

Yaver: No, exactly. And especially in a country where insulin is so expensive, this is not something that people are taking for a rainy day. So I think that that is a real illustration of how prior auth has evolved. And I think that then, when I was really diving into insulin in the book, I kept wondering, like, if you don’t give someone a continuous glucose monitor, aren’t they going to get sicker and costlier to treat? And I think that the surprising factor that I hadn’t really appreciated until writing this was the fact that people changing insurance companies can often reshape the incentives to cover these things. 

Rovner: Well, dare I say it, this sounds like something that Congress would actually have to address. 

Yaver: Yeah, I mean that’s one of the challenging things is that this big gnarly law called ERISA [the Employee Retirement Income Security Act of 1974] — which I’m now writing a book about, because I have some masochistic tendencies, it turns out â€” really limits what states can do with respect to the majority of employer-sponsored health insurance. And so in so many areas of health policy, we’re pretty accustomed to saying, OK, well, D.C. is really gridlocked, but at least California and Massachusetts â€” and take your pick of other states â€” can move the needle. And ERISA, preempting state policymaking that relates to so much of health insurance, really limits that. And so this really is an area where national reform is needed, but, of course, politics is pretty fraught right now, to say the least. 

Rovner: We will come back when maybe politics is a little bit less fraught. But Miranda Yaver, thank you. Thank you for contributing to the knowledge base here, and thanks for coming on. 

Yaver: Thanks so much. It’s been a real pleasure. 

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

Ollstein: Yes, so I have a very grim story that is part of Stat’s ongoing series on alcohol and its many healthcare consequences. And this latest installment is by Isabella Cueto [“”], and it is about drinking during pregnancy, which is unfortunately, despite decades of public health efforts to stop it, is still fairly prevalent and really damaging. It has lots of physical and neurological impacts on developing fetuses. It got worse during the pandemic, and there is a lot of misinformation. And so, to be clear, this article stresses that the medical evidence is that no amount of drinking in pregnancy is considered safe. And that comes as people are getting mixed messages, even from doctors, about whether that’s the case. So, definitely something I recommend reading. 

Rovner: Yeah, the whole series is really good. Joanne. 

Kenen: This is a story from The Associated Press by Tiffany Stanley: “.” It was interesting because this is â€” he’s a reproductive endocrinologist working on IVF [in vitro fertilization], and he’s anti-abortion, deeply religious, and has been wrestling, you know, with the destruction of the excess embryos, or the perpetual storage of them. But he also believed, you know, he found value in helping couples have babies, and his â€” I don’t want to use the word “compromised” in any kind of negative way, I mean â€” his solution for him was to start a sort of a Christian-guided IVF practice, where they’re basically using fewer embryos. Now that makes some of the religious couples more comfortable. It can raise the cost, because IVF is not 100% certain by any means, so if you have fewer embryos, you might have to go through even more cycles. It also made me think, and I’m not an expert on this, and one of you might know, I mean, there is such things as egg freezing now. The technology is not fabulous yet. It is better than it was a few years ago. I mean, I’m sort of wondering, do we get â€” IVF technology is much better. Success rates are better. There are fewer multiple births. There’s â€¦ they were able to bring the embryos out to six or seven days after fertilization. It’s very different than it was 20 or 30 years ago. But if you got to the point where egg freezing was really viable and that they really worked well, it would eliminate this whole issue of the stored embryos. But I just thought it was interesting in that this was a man with two competing sets of values, right? He was against the destruction of embryos, and he was for the creation of embryos, and as a doctor, he had the power to address both in a way that probably some Christians would still find ethically problematic, but it does give religious couples some new choices too. 

Rovner: Yeah, it was a really interesting story. Sheryl, you also have a reproductive health story. Oh, go ahead. 

Stolberg: I do, but I just want to say about Joanne’s story, that is so interesting to me because 25 years ago, when George W. Bush was considering stem cells, I wrote about an adoption agency, a Nightlight Christian Adoptions that â€¦ 

Rovner: Snowflake babies! 

Stolberg: â€¦ had these quote-unquote “snowflake babies,” right. And they were adopting out frozen embryos with the argument was that, see, we don’t have to destroy these embryos for stem cells, we can adopt them out to religious couples. 

Kenen: That’s mentioned in this story too, that is â€¦ but it’s never â€¦ I wrote about them too, and Julie did, but it’s never really caught on on a super â€” and we all know people have gone through IVF, and even people who aren’t deeply religious, or the whole thing of those leftover frozen embryos does bother people. And the science is changing, and â€¦ you don’t need as many embryos as you might have, or they freeze better, you could have one IVF cycle, and two kids. But I just thought it was a thoughtful article about an interesting phenomenon. 

Rovner: It was. OK, Sheryl, your extra credit. 

Stolberg: My extra credit is ºÚÁϳԹÏÍø News by Jazmin Orozco Rodriguez. It’s called “Religious Anti-Abortion Center Finds Opportunity in Town Without OB-GYNs.” And the story is set in Idaho, where crisis pregnancy centers are flourishing, as they are across the country in the wake of Dobbs. And one reason I really like this was because, in 2023, I traveled to Idaho and I , and maternity care was suffering as a result. And this story really shows what’s happening three years on, which is that local hospitals are shuttering their maternity wards and their labor and delivery units. And in towns with very limited maternity care, these crisis pregnancy centers, often run by religious organizations, are basically the replacement. But in this particular case, this center that they focused on was not medically licensed, not required to meet regulatory standards for medical facilities, and has an agenda that discourages pregnant women from terminating their pregnancies. And there have been a lot of investigations of these kind of centers saying that they mislead patients by drawing them in with offers that, you know, you’ll get free pregnancy care, etc., etc. And so this is really kind of the upshot of Dobbs and how it’s playing out and in small towns and rural places across America. 

Rovner: Yeah, it is. All right, my extra credit this week is from The Wall Street Journal. It’s called “” It’s by Josh Dawsey, C. Ryan Barber, and Liz Essley Whyte, who, by the way, will be joining our podcast panel soon. It’s quite the eye-opener to follow on our tobacco discussion of the past few weeks about how yet another source of nicotine, in addition to cigarettes and vapes, nicotine pouches have become hugely popular in Trump administration circles as a way to get that nicotine buzz without inhaling stuff into your lungs. Now, these are not harmless products. Nicotine is addictive, and scientific evidence on the pouch’s safety is relatively thin, although they’ve been growing rapidly in popularity, particularly among young men, pushed by some of the biggest tobacco companies. It’s yet another piece of the puzzle of why this administration, which purports to be so health-conscious, seems to have kind of a blind spot when it comes to tobacco-related substances. 

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

Ollstein:  on Bluesky and  on X. 

Rovner: Joanne. 

Kenen: I’m Joanne Kenen on  and I’m on . 

Rovner: Sheryl. 

Stolberg: And I’m at @SherylNYT on  and also on . That’s Sheryl with an S. 

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