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

Julie Rovner: Hello, from �Թϲ����� and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for �Թϲ�����. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 22, 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: Liz Essley White of The Wall Street Journal. 

Liz Essley Whyte: Hi. 

Rovner: And my �Թϲ����� colleague Amanda Seitz. 

Amanda Seitz: Hey, thanks for having me. 

Rovner: Later in this episode, we’ll have my interview with Alice here, whose brand-new book, Side Effects: How Abortion Bans Impact Everyone’s Health, comes out officially next week. But first, this week’s news. 

Let’s start with Medicaid. Election Day is less than two weeks away, and, despite the fact that Republicans tried to backload the Medicaid cuts in their 2025 budget bill so that most of them wouldn’t start until next year, Democrats appear to be making some headway using them as a campaign issue already this year. . Start us off. 

Ollstein: Yeah. So the cuts are hitting people already. People are already feeling them, and that’s for a few different reasons. One, some states have decided to pull the trigger early on work requirements, and even those that are waiting until the congressionally set January deadline, they’re already receiving notices, and so they’re freaked out about their coverage. Also, even though the cuts are not taking effect, states have to make their budgets in advance to prepare for them. Hospitals need to make their budgets in advance to prepare for them. And so you’re already seeing cutbacks in other areas — in services, in programs — and so people are feeling that. And the impact is happening way outside Medicaid as well: People on private insurance, whether they get it on the individual market or through their job, are seeing really big increases in costs. And Democrats are capitalizing on that and are connecting what the pain people are feeling to Republicans’ basically one major piece of legislation that they passed over their two years in power, which is the quote-unquote “One Big Beautiful Bill” that had all these healthcare provisions tucked into it. And so I found that in basically every single Senate debate that I’ve been watching in these battleground states, there was almost identical exchanges, where Democrats attacked about the Medicaid cuts, Republicans responded by pointing to the rural health funding in the bill and saying, You know, I fought for that, and I guess you hate rural health because you criticize this bill. Then Democrats responded, OK, the rural health funding is great, but it’s just a fraction of what states are losing on other federal health funding. And so this is just playing out again and again and again — in Michigan and Maine and Alaska and all of these states that have these close races. 

Rovner: Yeah, and we’ll talk about this more next week. But the KFF annual employer survey is out just this morning, and it shows not only, I mean, what we already knew, which is that premiums are going up, but it also shows that employers are starting to pass along the cost of those increased premiums to their employees. So it kind of balloons the idea that people are really feeling the increases in healthcare costs. 

Seitz: Yeah, I think the issue is less about the Medicaid cuts themselves and more about that idea that healthcare costs are rising at every level, and no one has offered a solution to really fix that. If you recall, President [Donald] Trump said that he had “concepts of a plan” to fix the ACA [Affordable Care Act]. Well, instead, all we got were cuts to Medicaid, higher ACA premiums, higher premiums for private insurance. So I think that people see there’s kind of no real road map being offered here to get out of this situation of continuously rising costs and access to care becoming increasingly more difficult. But I think the hard part now for Democrats, in particular, becomes OK, what is your plan? And they have not offered a clear, unified vision for what they will do. We’re still kind of waiting to see what that might be. So if they do succeed in taking back control of Congress, for example, that’s going to be a real challenge for them to quickly come up with a plan so they’re not in the same position two years from now. 

Rovner: Right. I mean, at some point they’re going to have to fight about what it is they want to do. But right now, they could just point to what the Republicans have done. Well, meanwhile, the Trump administration this week is doubling down on its healthcare fraud fight, announcing it will freeze another $1.2 billion in federal Medicaid funding to California. That’s on top of the $2.2 billion already withheld this year, mostly about home care programs. The administration says the program’s rapid growth signals something fraudulent, although it hasn’t provided evidence. California says it’s just responding to growing demand, and that, by the way, providing home care is actually cheaper than paying for institutional care that patients might otherwise need. How’s the whole fraud thing playing with voters? Is there any traction, and does it make, I wonder, an impact that they seem to be mostly going after blue states — first Minnesota, California, apparently now New York? 

Ollstein: I see this as sort of under the umbrella of “things that have long been popular in theory becoming less popular once people see the impact in real life.” And so I think that has also been true of the concept of Medicaid work requirements. When people were polled about it before, in theory, people are, like, “Yeah, you should have to work, etc.” And now, when they’re seeing people losing their insurance who are working or have a legitimate health issue, that popularity is crashing. And I think the same is true of these fraud crackdowns, where they are popular when polled on, you know, the general concept of them. But these cuts are hitting a lot of real patients, and, like you noted, it has the appearance of being very politicized because it’s mainly been targeting California, Minnesota — states run by Democratic governors, and not just any Democratic governors, but those that have clashed with the administration very openly. 

Rovner: Yeah, I think the other thing is when you get into the details of some of this, you know, they say when they’re talking about fraud, you know, Oh well, these are people who are carrying groceries and doing things that family members should be doing for free. But in a lot of these cases, when you’re paying a family member for care, they’re doing things like changing IV lines and helping people go to the bathroom. It’s not just running errands. This is, in many cases, real medical care that family members are providing in lieu of going to other jobs. And it’s basically, as I said, keeping people out of institutions, which, in the long run, is a lot cheaper to pay somebody to care for their own loved one than it is to put them in a nursing home. I just, I feel like this is sort of being missed in this whole fight. 

Seitz: I also think that it’s really hard for this to resonate when, frankly, people aren’t seeing any result from this fraud push. Their taxes aren’t necessarily going down as a result of these busts. The federal deficit is continuing to skyrocket in this administration, as we talked about: Healthcare costs are rising. So it’s like, as Alice was saying, it’s a really good talking point, especially for conservatives who oppose big government. But I don’t know that it’s going to move the needle if voters aren’t seeing any change in their daily life. 

Rovner: Yeah, that’s a good point. 

Whyte: I do think Republicans think it’s worth spending time on because we’re seeing near-daily announcements about some kind of fraud crackdown from CMS [Centers for Medicare & Medicaid Services] or DOJ [Department of Justice] or Vice President [JD] Vance’s task force. I mean, it’s a deluge of these announcements, including the one yesterday about New York’s adult daycare program, which Dr. [Mehmet] Oz called “a plague to the state.” 

Rovner: Yeah, they are definitely playing it up. It seems to be their major campaign issue. … This is all goes with the whole “drain the swamp” thing. Well, in a preview of what we can expect if Democrats retake the majorities in the House and/or Senate, three top senators on the Senate Finance Committee that oversees Medicare and Medicaid are calling for the administration to impose more standards on the private contractors who run most state Medicaid eligibility computer systems. The systems — say possible incoming Finance chair Ron Wyden of Oregon, along with Elizabeth Warren of Massachusetts and Raphael Warnock of Georgia — have already demonstrated that they don’t always accurately reflect who is and isn’t eligible for Medicaid, and that the coming implementation of the work requirements in January could mean that millions of people could be bounced off their health insurance wrongly. I would think this would be something to watch pretty closely come January. I think no matter who is in charge of Congress, this is, I know, a big concern. You know, the administration keeps saying, “Oh, we’ve got these computer systems, and they’re going to do all of this in the background, and everything’s going to be fine.” And you know, I know, Alice, I keep asking you to reiterate this, but the last time we tried this in 2018 with the work requirements, things were not so fine with the eligibility systems.  

Ollstein: That’s right. So the states that had a sort of pilot version of this before it became mandatory for everyone found that the work requirements did not increase employment. It did not cause more people to get off the couch and work, and, you know, which is sort of how it’s been framed in the public discourse. Instead, it led to a lot of people who should have been eligible — either because they were working or they had a legitimate claim on one of the exceptions: caregiving, going to school, having a medical condition, etc. — they lost their insurance because they were unable to navigate the bureaucracy, not because they were not actually eligible. And so that is what is predicted to happen again on a much bigger scale now. 

Rovner: Well, this is definitely one to watch, and I would think that even if Republicans keep the Senate, they’re going to have to keep a wary eye on this because if things go sideways, they will say that is not what they intended. Meanwhile, over at the White House, President Trump, with first lady Melania Trump at his side, signed an executive order on Monday establishing a White House Women’s Health Task Force and a, quote, “new” Women’s Health Division at the National Institutes of Health. Except the NIH has had an Office of Women’s Health since 1990. I covered its creation, which came after a gigantic bipartisan effort by women members in the House and in the Senate. The office was codified in legislation that was passed in 1993, and women’s health offices intended to address disparities in research and treatment into women’s health ailments were further expanded in the Affordable Care Act in 2010. Does President Trump really think that insisting something is his idea will automatically get people to believe him? Are people believing him that this has never existed before, and that he thought of it, or I guess that Melania thought of it? 

Seitz: Well, I think we can look back to November of 2023, when Jill Biden rolled out a similar measure, and I don’t know that it had any impact on how people felt about the election. I thought the timing of this was also really interesting because the administration has sort of lost its MAHA Mom momentum, and that effort also fizzled out. I mean, you had, at one point, you had all these high-level people in the administration meeting for these MAHA Mom meetings, and then you had “The MAHA Report.” But, like, we didn’t really see a lot of outcome from that. We didn’t see anything happen from that. So I think it will be interesting to see if this task force tries to veer into that direction at all, if it touches on some of the things that we’ve seen, you know, the MAHA crowd focus on — for example, like increasing the fertility rate, educating people on how to get pregnant, menopause research, weaning off of antidepressants, like that’s been the focus. So I’m very curious to watch how much it goes in that direction. 

Rovner: It also goes directly against the whole DEI thing because, you know, diversity, equity, and inclusion includes minorities, but it’s also included women over the years. I’m still sort of shaking my head at the whole thing because it’s just sort of the polar opposite of a lot of what this administration has been working towards for its first two years. Or is it just me? 

Whyte: When I talked to sources about this, it was clear it was a Melania-driven initiative, and even health officials weren’t really sure what it was going to accomplish. I mean, this was while it was being developed, so maybe they have a clearer picture now. But it didn’t seem like they thought it would be substantively impactful. 

Rovner: Also, there’s no money attached to it. 

Ollstein: I was just gonna say that. I think that’s really the biggest tell here. There’s no new funding. In fact, many programs that focus on women’s health have been cut significantly by this administration. Grants have been canceled, etc. Some grants focused on women’s health have been canceled because they’ve been labeled DEI, as you noted, and there’s also no deadline for any kind of delivery from this initiative. And so I kind of think of it in a similar category as the fertility announcements, which talked a big game and didn’t have a lot of new funding or meaningful programs behind it. 

Rovner: Or policy, for that matter. It’s just sort of statements of intent. Well, the president also this week “discovered,” air quotes, the idea of rewarding whistleblowers who help uncover fraud in federal programs, announcing something called the Fraud Whistleblower Incentive Program to crowdsource tips on federal program fraud. This is also something that is not new. The Federal False Claims Act actually dates back to 1863, during the Civil War, and, in fact, Republican Sen. Charles Grassley of Iowa has spent much of his career pushing for expansions to make it easier for whistleblowers to receive compensation for uncovering fraud. Now, this sounds great, and it does go hand in hand with the administration’s focus on fraud, but again, are voters actually going to believe that he’s the first person to think of this? 

Whyte: I don’t know if voters will believe that, but what I would more wonder is whether any of that is breaking through at all. I mean, the voters …  

Rovner: Yeah, are they even going to hear it? 

Whyte: Yeah, polls show affordability is at the top of voters’ minds. Fox News had a poll recently that said corruption was at the top of voters’ minds. They have bigger fish to fry, I think, when they’re going to the polls than whistleblower payments, regardless of whether it’s a good policy idea or not. 

Rovner: I did see a social media post that people have been flooding this new fraud whistleblower line with tips about corruption in the administration, which was not the intent, I don’t think. We’ll see how that plays out. All right. Next: news about the Affordable Care Act. You might remember that last month the administration announced it was dropping three-quarters of a million enrollees from ACA plans, saying that their enrollments were likely fraudulent and that they were likely not even real people. Now, according to my �Թϲ����� colleague Julie Appleby, they’re adding a, quote, “small number” back. Apparently, those are people who turned out not to be made-up ghosts after all, but actual enrollees whose applications might have lacked required information and who haven’t filed a claim. Now, it is not clear how many people are being added back. The Washington Post editorial page suggests that it’s only 51 people so far. But isn’t it possible that there are way more of those people who just don’t yet know they’ve lost their coverage because they’re healthy and they haven’t tried to use it? After all, the people who got cut off are people who, by definition, haven’t filed any claims. 

Seitz: Julie, you and I have talked about this, like, in the newsroom — just, you know, I didn’t even go to my primary care doctor until like a week or two ago, so that’s totally possible. I think what I find most interesting, though, about this is that there’s clearly a problem, right, with the broker system. 

Rovner: Absolutely. 

Seitz: And both sides of the aisle have raised concerns about insurance brokers. And in normal times, this would be kind of one of those issues that you might see some legislation on. But it seems they’re not really working toward any sort of thing around that, and it’s a missed opportunity, frankly, for folks to come together and look into regulating this industry a little tighter. 

Rovner: Yes, and another hat tip to Julie Appleby, who helped break some of the stories about the broker fraud. Indeed, they’re, you know, one of the problems when they created these zero-premium plans is that they actually gave brokers an incentive to switch people without their knowing it, or to sign up fake people so that they could get the commissions. It is a problem. Everybody acknowledges it’s a problem. But pulling off people who didn’t have their entire Social Security number, or, you know, they haven’t filed a claim. Not all those people are going to be fraudulent, and I’m just wondering if, yeah, if it’s only a couple of 100 people, there probably won’t be a backlash. But if there’s many thousands of these people who eventually discover that they are not covered and that they thought they were, there could be a backlash. I see nods. All right. Well, they’re talking, apparently, the administration is looking at another half a million enrollees with the intention of perhaps cutting them off. So we will see how this one plays out. All right. We’re going to take a quick break. We will be right back. 

Turning to news out of the Department of Health and Human Services, two new studies out this week suggest that Secretary Robert F. Kennedy Jr.’s policy change to stop recommending a birth dose of the hepatitis B vaccine could dramatically increase cases of the chronic disease that can cause liver cancer and other lifelong health problems. One study in the journal Annals of Internal Medicine modeled what could happen if the policy is changed from recommended to what’s called shared decision-making [and] found it could result in half of all children entering adulthood susceptible to the highly contagious virus, and a more than 80% increase in cases. The other study that was presented at an infectious disease meeting by Kaiser Permanente researchers found that most young children who were exposed to the virus were exposed by someone other than their mothers. That suggests that even if a mom is tested and tests negative, that doesn’t necessarily protect the baby. I don’t expect that these studies are going to change any minds, though, among the sort of anti-vaccine activists and the, I guess what we could call, the vaccine-skeptical and vaccine doubters, right? 

Ollstein: I do think it’s notable that specifically on these vaccine studies and policy considerations seems to really have hit a nerve with the administration because they are going all out on attacking the individual reporters, accusing them of having sources who are making up information, etc. And so that sort of shows that at least they are, you know, worried about this maybe hitting home for folks. 

Rovner: Maybe a little sensitive? 

Seitz: And Julie, I think that, too, I mean, it will help down the road, right? Because this is what we have heard from public health researchers or anyone who’s really worked in public health, doctors, is this exact concern: that this is how this would play out, reducing the recommendations. And … 

Rovner: Not to mention Senate HELP [Health, Education, Labor, and Pensions] Committee Chairman Bill Cassidy. 

Seitz: Yes, that was on my list as well — the liver doctor who warned that this is exactly what will happen. So it gives us, one, a road map to what our future will look like, and helps public health researchers prepare in that sense. And then also, it gives a lot of fodder down the road for We knew that this was going to happen, and here is, we predicted it would happen, and no one listened. So it really puts a lot of culpability in the administration’s hands. 

Rovner: Well, in related vaccine news, that the board that oversees the hospital on the NIH campus here in Bethesda, Maryland, delivered a public rebuke of the secretary over his establishment of a new office to study vaccine injuries and accused the secretary of undermining trust in science. Now, this board is made up of people outside the government, so I imagine it’s easier for them to criticize the secretary without fearing for their jobs. But still, I can’t imagine they won’t be rather quickly replaced?  

Seitz: That was exactly my first thought: Is how quickly is Kennedy going to try and replace this board? And we know that the White House has been forcing Jay Bhattacharya into some very uncomfortable positions over the last couple weeks, and some very uncomfortable conversations with folks. So, you know, this is yet another one that he’s probably going to be tasked with tackling, I would guess.  

Rovner: I have to say, I live up the street from the NIH Clinical Center — I pass it multiple times week — I had no idea there was an independent board that oversees literally the running of the hospital and for safety and efficiency services. I mean, this is the large hospital on the NIH campus where people who are in clinical trials can be cared for. I mean, lots of people are in clinical trials in other places in the country, but there are some people who end up coming to NIH, and the Clinical Center is where they end up if they need to be hospitalized. So, I mean, it is a rather substantial-sized facility. I was just, I was surprised to see them, of all people, standing up and saying this is not necessarily a great thing to do. We will watch how that one plays out too.  

Well, finally this week the administration has delayed a policy change that was to take place today that would have made it harder for people to order cheaper drugs from licensed pharmacies in Canada and other countries that have, you know, price controls. While it’s always been technically illegal to buy drugs through the mail from other countries, U.S. officials have long looked the other way at small amounts that are imported for personal use. According to a study from 2020, more than 2 million Americans purchase their medications from other countries. Now, the administration isn’t canceling the policy change that’s going to make it basically impossible for people to get their drugs this way — it’s just pushing it back 90 days, so safely beyond Election Day. Still, it’s kind of hard to square this with the administration’s claims that drug prices are coming down, unless they say that drug prices are coming down enough that you don’t have to buy your medicine from Canada anymore, that it won’t be cheaper? 

Whyte: I think there’s enough people doing this that it just seems like it would actually be a bad move politically ahead of the midterms. You know, people are reliant on these cheaper drugs, and to have that pathway cut off, I imagine, would cause a kerfuffle. But, so it wasn’t surprising to see this delay. I was kind of surprised they were going to do it in the first place. 

Rovner: It’s funny. It’s been on the podcast rundown every week for, like, the last three weeks. I keep putting it off because it’s getting closer. And then, of course, last week at almost the very last minute, the administration announced, “Never mind, we’re not going to do this right now.” But yeah, also, I mean, all through August and September, people were starting to get these letters that said, “Hey, you know …” — when they were getting their drugs, it’s like: “You know, after Oct. 22, we’re not going to be able to do this anymore.” So now it’s going to be after January-something. I mean, I’ll be interested to see if they actually go through with this because I think you’re right, Liz. There are a lot of people who — and I’ve seen other estimates that it’s as many as 4 million people who are getting their drugs this way. And it is not a way to make friends and influence people, shall we say? Particularly when lowering drug prices is one of your administration’s big, you know, achievements, according to what the president keeps saying at all of these rallies. 

All right, that is this week’s news. Now we’ll play my interview with Alice about her book, and then we’ll come back and do our extra credits. 

I am pleased to welcome to the interview portion of the podcast my friend, colleague, and podcast panelist Alice Miranda Ollstein, whose brand-new book, Side Effects: How Abortion Bans Impact Everyone’s Health, comes out next week. Alice, thanks for being here. 

Ollstein: Thank you, Julie. 

Rovner: So, as our regular podcast listeners know well, you’ve been covering the impact of the Supreme Court’s overturn of Roe v. Wade since it happened. What made you want to take some extra time and write a book about it? 

Ollstein: Yeah, so over the course of my reporting for Politico, I was traveling all around the country, and readers of Politico know that the focus is politics. So it was a lot about the political impact of the Dobbs ruling and state abortion bans and how people were reacting to them, the ballot initiatives, the candidates, etc. But as I was doing that reporting, I kept hearing over and over from patients, from doctors, from medical researchers, from all kinds of people who are involved in the healthcare system in some way bringing up these impacts that they were seeing that I just thought were not getting enough attention. These were impacts not only on care for pregnant people but healthcare for everyone — for men, for people living in blue states, for people living in red states, for old people, for young people — and this just kept coming up over and over. And I really wanted to write this book to sort of capture that bigger picture and capture that even though these laws were tailored to really go after abortion, they were having these broader impacts across the healthcare system. And it’s just very, very hard to separate. 

Rovner: What’s the most unexpected consequence or far-flung consequence that you found after nearly half the states banned abortion? 

Ollstein: Two things: one, the impact on healthcare for people with chronic conditions, pregnant or not, and then the other is the impact on medical research. How medical research, both on abortion, on pregnancy, on contraception, and on completely unrelated areas of healthcare were compromised. Some medical studies were delayed, some were made more burdensome and expensive, and some were scuttled altogether as a result of post-Dobbs restrictions. And that just kept cropping up in really interesting. In surprising ways. So, back to the care for people with chronic conditions, what happened after Dobbs is that in lots of different places — in states with bans, in states with abortion protections — patients who depend on certain medications to manage their chronic illnesses, drugs like methotrexate, which is sometimes used to terminate an ectopic pregnancy, and lots of different kinds of drugs — neurological drugs, drugs for autoimmune conditions that have the potential to cause a birth defect if you take them while pregnant. So doctors, pharmacists, insurers became a lot more scared of dispensing these drugs to patients with chronic conditions, even though they had completely valid diagnoses of lupus, Crohn’s, all kinds of conditions where they depend on these medications. 

Rovner: Yeah, rheumatoid arthritis is a big one, right? 

Ollstein: Mm-hmm. Absolutely. And so I just kept hearing about patients who, in some cases, had been taking these drugs for years and years and years, and really depended on them just to get through the day, honestly, and not experience, like, a flare-up of inflammation or other symptoms. And suddenly they were being, you know, grilled on what are you using this for? They experienced days of delays, and some of them were unable to get the medication altogether, and it really had an impact on their health. And so there were some lawsuits related to this, there were some advocacy campaigns related to this, the Biden administration took action on it, and the Trump administration rolled back those actions. And so I just really wanted to shine a light on how this was hitting people who aren’t even physically capable of being pregnant. In some of these medication-denial stories, I found, you know, it was happening to prepubescent children. In one of the circumstances, it happened to someone who had had a hysterectomy. So there’s no way an abortion could happen even accidentally. And you know, it happened to a lot of people who were taking contraception or who were just too chronically ill to sustain a pregnancy. And it still had this, you know, big impact because of the fear and confusion throughout the medical system. 

Rovner: And what about the research part? 

Ollstein: Yeah, absolutely. So that took a lot of different forms. So one category was research on abortion drugs specifically, to look into potential other uses for them. There are a lot of promising studies going on, some in the U.S. and a lot in other countries that don’t have the same restrictions about other uses of the drug mifepristone for cancer, for uterine fibroids, for all kinds of things. Some of those studies are still moving forward, but there were all kinds of delays and hurdles because they were taking place in a state with a ban, and the researchers had trouble even obtaining the medication. Even, in one circumstance I write about in detail, on a study that is only testing the medication on older male veterans of Operation Desert Storm. And still the researcher had a lot of trouble obtaining the drug, obtaining permission to do the study, obtaining funding, etc., and faced years of delays. And so these veterans that could really benefit from this medication, according to her research, still can’t get it. 

Rovner: I would say, people who are clearly not going to be using it to terminate a pregnancy. 

Ollstein: Exactly, these are older men. So those studies are still moving forward, but face years and years of delays. Other studies, including a study out of Indiana testing whether mifepristone could help people with breast cancer, especially people who were getting preventive mastectomies because they had the gene that put them at high risk, they were testing whether maybe taking mifepristone could help them avoid having to do that major surgery. That study was canceled altogether because the researcher was so concerned about losing access to mifepristone in the middle of the study and of, you know, facing potential legal consequences because she was based in a state with a ban that she just abandoned it altogether. In addition to the impact on studies on mifepristone, there’s all kinds of impacts that I found happening in the research space. It’s become harder to study abortion, even though we sort of need those studies more than ever because we want to know what are the medical and sociological and all kinds of impacts of these bans? You know, the government and the healthcare system can’t help people if they don’t know what’s happening. But those studies that depend on interviewing patients who are considering abortion to determine what factors push someone one way or another, those have become much harder because there is a fear among researchers that they could be charged under these so-called aiding and abetting laws in certain states. They don’t know if it could be considered aiding and abetting if they even talk to a study participant about what they’re thinking, and if that study participant goes on to get an abortion, you know, could they be charged? They’re not sure, and so those studies have become much harder to do. And I also found impacts on clinical trials that have nothing to do with abortion, nothing even to do with pregnancy. But there is a concern that representation of women of reproductive age in these clinical trials — which is already quite bad, women of reproductive age are really underrepresented in medical research, and only were included at all more recently. You know, we just don’t know if all kinds of drugs even work on women because they were only tested on men. And researchers are concerned now that we’re going to backslide on the little progress we have made on that front because they’re saying, look, how can a woman feel comfortable participating in a clinical trial of a new drug if, you know, that new drug could cause birth defects? She becomes accidentally pregnant during the course of the study, and she’s not able to get a termination based on what state she’s in. How can she feel comfortable participating at all? Meanwhile, bioethicists and experts told me that if research is only limited to states that allow abortion, that could completely skew the data because people have different health status, and those, you know, it’s important to study people in many geographic areas of the country in order to get good data, and now that’s under threat. 

Rovner: Lots of things that I think people didn’t anticipate. Another trend you highlight is the increased activism of the medical community itself. I always used to say that the American Medical Association was allergic to abortion, in that it never wanted to address the issue because it had members on both sides of a very hot topic and it didn’t want to anger any of its constituency. That’s changed, too, in the wake of the overturn of Roe, hasn’t it? 

Ollstein: Absolutely. So both these big national organizations, like the AMA, but also state-level organizations that also used to really try to steer clear of abortion because, you know, they didn’t want to alienate any of their members or their members’ patients. And it was just seen as this, you know, sort of political third rail. But as a result of seeing the impacts of these restrictions on their members’ ability to practice medicine, the organizations have decided to take a stronger stand. They’re writing amicus briefs. They’re passing resolutions. They’re lobbying their state and federal legislators.  

Rovner: Some of them are running for office.  

Ollstein: Exactly. So, I think combined with the institutions really changing their behavior, individual doctors are really changing their behavior. And, like you said, they’re running for office. They’re out on the campaign trail campaigning for the candidates they feel, you know, will uphold abortion access and keep the government from meddling in medicine in other ways. They are, you know, participating in lawsuits. You know, getting active in all kinds of ways we’ve never seen before. You know what I also found was that abortion providers, as a group, have been politically active and very vocal for a long time. You know, a lot of times they felt like they had to be. But what’s really new post-Dobbs is that physicians of lots of different specialties, including many that don’t have anything to do with abortion or pregnancy, have really come off the sidelines, and some of them told me that they were motivated to do so because they did see how this was impacting their work. It was, you know, for instance, going back to the chronic illness thing, you know, I talked to rheumatologists and oncologists who felt like they couldn’t have the conversations with patients freely that they used to be able to have. They couldn’t prescribe certain medications that they wanted to prescribe. But some told me that, Hey, I haven’t really felt the impacts of this at all personally, but I feel motivated to do something because I’m concerned that if the government can and feels emboldened to interfere in medicine in this way, like, what else could they do? What could they do next? And so they wanted to get involved in ballot initiative campaigns and other things to sort of draw that line in the sand. 

Rovner: Alice, lots of really interesting stuff. I think everybody should read the book. Congrats again, and thanks for joining us, as always. 

Ollstein: Thank you so much. 

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. Liz, why don’t you go first this week? 

Whyte: Sure. My extra credit is a Stat story by Tara Bannow [“”]. It’s a great investigation into the middlemen who are now in charge of doing the arbitration for the No Surprises Act, so it starts out with this amazing anecdote of this company that was thinking about getting acquired. I mean, it was really struggling financially, and now three years later has a 70% profit margin. Its revenue has grown thirteenfold. It’s just rolling in the dough, and it’s not alone. I mean, there’s all these middlemen now that are just raking in money from being arbitrators here in a way that is, really, you can’t object to it. I mean, she had a great quote from someone representing employers who referred to them as “mini gods.” And they’re siding with doctors in over 80% of cases. So the insurers and employers are really bent out of shape about this, and they’re also awarding huge sums of money. So she gave the example of a common spine surgery, typically costs $1,400 in-network, and now fetches $34,000 in arbitration at the median, with some providers getting over $100,000. So doctors are loving this, obviously. But there’s a number of lawmakers on the Hill who are looking at this and saying, “Ooh, we have a real problem here. This is not what we were going for.” And now there’s some possible solutions on the table for fixing it. 

Rovner: Yes. I think, of the things that I think that Congress is actually going to tackle at some point in the not-too-distant future, this is, like, pretty high on the list because this was not what they intended when they did the No Surprises Act. Alice. 

Ollstein: My piece is an op-ed in Stat by one of the whistleblowers from Theranos who helped expose Elizabeth Holmes as a fraudster, and the piece is called “.” This is his take on the movie. I hesitate to call it a documentary because it’s more of an art piece. But he’s pointing out that if you just watched the movie and you didn’t know anything else about the background of this case, you would not get an accurate picture of what happened. He notes that she shows pieces of a machine, and it’s not the machine she says it is. He notes that, you know, while this movie sort of poses the question: Did she intentionally lie, or is she just sort of this misunderstood, you know, neurodivergent genius who didn’t communicate things in the way other people did? And he notes that hard evidence came out in trial that she knew she was lying about certain things and very aggressively moved to cover it up and punish the people who tried to expose it. So I think it’s just a good supplement if people do end up watching that movie, which, according to my group chats, many, many people are fascinated and eager to see.  

Rovner: For the record, I am not. But as I said on social media, I’m not interested in hearing your takes on the movie unless you have read the book . And I will link to it in our show notes just in case people are more interested.  

Ollstein: And this whistleblower who wrote this op-ed was one of the sources for Bad Blood. 

Rovner: Yes, it was. Named. Tyler Shultz, so … 

Ollstein: Yes. 

Rovner: Amanda. 

Seitz: My extra credit this week is “,” by Andrew [Jacobs] for The New York Times. This piece looked at how companies are racing to develop new ketamine products to treat depression or substance use disorders in an effort that, as one person described, is feeling “unethical and cash-grabby,” which I just loved that quote. This ketamine arms race of sorts is being promoted, prompted in part by Secretary Kennedy’s embrace of psychedelics, but also the success of a ketamine-like drug developed by Johnson &  Johnson, which is this nasal spray that the FDA recently approved to be used for stand-alone treatment for depression. 

Rovner: It’s quite the eye-opening story. All right, my extra credit this week is from Rachel Cohen Booth at Vox. It’s called “.” It’s about Colorado, which is one of three states that have used the Affordable Care Act’s waiver authority to create a so-called public option health plan — that’s the unicorn that Democrats have talked about for most of this century. Today, roughly half of Colorado’s marketplace customers are now in so-called Colorado option plans, which are state-designed but privately run, and they’re saving roughly $100 per month in premiums for mid-tier coverage, which isn’t a ton of money, but it also isn’t nothing. It hasn’t been smooth sailing, but I think more and more people are now looking at what Colorado and Washington and now Nevada are doing, and it is well worth a read. 

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

Seitz: I’m on X . 

Rovner: Alice? 

Ollstein: On X and on Bluesky . 

Rovner: Liz. 

Whyte: I am on X and on Bluesky, . Just Google it; it’s too long to say. 

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