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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 27, at 10:30 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 Margot Sanger-Katz of The New York Times. 

Margot Sanger-Katz: Hello, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello! 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi. 

Rovner: Later in this episode, we’ll have my interview with Dean Rosen about his time working for Kansas Republican Sen. Nancy Landon Kassebaum, who died last week at the age of 94, and how she represented a type of lawmaker we don’t see that much anymore. But first, this week’s news. So we’re taking the next week off for a needed break for our entire team, which makes this the last podcast of the technical summer. And I thought I’d do something just a little bit different. I’m going to break the discussion up into what I’m calling “The Themes of the Summer” 鈥� things we’ve talked about nearly every week. I hope it gives some of you the realization that I get from putting this together every week, that we’re looking less at a long list of separate events and items and more at pieces of a much larger picture that we don’t often see. 

So, theme No. 1 this week is declining health coverage. When Republicans passed their big budget bill last summer, they thought they were being clever by backdating most of the Medicaid cuts so they wouldn’t happen before the 2026 midterms. Well, the problem for them is that states and health systems are already making their own cuts in anticipation of those federal cuts to come, and people are already starting to feel them. This week’s evidence is from a Stat News piece called “,” and it includes ways that access is shrinking overall, particularly in heavily rural states like Maine and Louisiana, as the number of people without insurance goes up and the money from the government goes down. Is it really possible that Republicans didn’t see this coming? Or did they really believe they could take a trillion dollars out of the nation’s healthcare system and not have people notice? 

Sanger-Katz: I think that many of them were not paying very close attention. I think it may be accurate to say that they were indifferent to this possibility and are, in fact, surprised now to see the way that it is working out. I just, you know, for context, this bill that made these very large cuts to Medicaid and some smaller cuts to Obamacare funding was part of this huge package that included, you know, major tax cuts and tax reforms that were a big priority for Republicans, changes to energy policy, changes to other social welfare programs, changes to education policy, and, you know, they called it the One Big Beautiful Bill. And I think the bigness of it is easy to forget, in retrospect. But I think for a lot of lawmakers, they were really focused on the parts of the bill that they really cared about. For many of them, it was the tax part of the package. And the president and their leadership repeatedly told them not to worry about the Medicaid changes, characterized them as not being cuts. And I think, you know, a good, responsible lawmaker ought to do some diligence about that. But I think that many of them maybe took their eye off of the healthcare parts of the bill, were focused more on these other parts of the bill, and now are really starting to see what is happening in their home states as these policies are starting to roll out. 

Roubein: And I also think it’s true that, like, some of the full impacts, as I think Daniel Payne pointed out in his Stat piece, won’t be felt for years to come, particularly as the Medicaid work requirements do kick in next year. So once there are more concrete human faces and examples, that tends to come to more the forefront and, like, you know, the political mind. So yes, those changes a lot of them are not fully going into effect till after the midterms. 

Rovner: I do think that one thing that lawmakers really didn’t appreciate was how much this might impact not just people who would be losing coverage, but people who would be losing access. I mean, people who still have coverage, but, you know, if a hospital can’t keep its door open, or a clinic can’t keep its door open, or a doctor can’t, you know, keep the practice going, that’s going to impact people with insurance as well as people who are losing their insurance. I mean, that’s, I think, that’s part of why this piece went to explore some of these more rural places, where people are going to feel this first. Shefali, I see you nodding. 

Luthra: Yeah, one thing I’ve been thinking about a lot is you do hear Republicans, especially someone like [Maine Sen.] Susan Collins, really trying to tout the rural health fund that was part of this, right, and that was meant to, at least rhetorically, offset these massive healthcare cuts. Obviously, you look at math, you look at numbers, and one doesn’t really undo the other. But 鈥�  

Rovner: Yeah, the rural health fund is, what, $150 billion of $1 trillion 鈥� ? 

Sanger-Katz: $50 billion, I think. 

Rovner: Or, oh, it was even less. 

Luthra: And so, yeah. I mean, I think what maybe people didn’t fully appreciate is that voters are less compelled, perhaps, by [lawmakers] saying I voted for this funding, and more compelled by what they see happening around them, which is these massive cuts resulting in major changes to what is often the biggest employer, what is often the only source of healthcare for miles, something that is very intimate, very much of the community. And that’s why this is just such a potent issue, especially in a lot of these really close Senate races now. 

Roubein: I mean, we’ve seen in the past how rural healthcare can impact politics. With Medicaid expansion, Republicans were really, really, really against it, and then you saw some begin to change their mind 鈥� North Carolina being a notable example, and just all of the ballot measures in red states 鈥� Oklahoma, for instance. 

Rovner: Idaho. 

Sanger-Katz: I think it’s worth just pointing out how much is still to come. I think a lot of what we’re seeing right now is hospitals and other healthcare organizations that were kind of in a difficult financial situation going into this change in policy. They’re looking around, they’re already in the red, and they see they’re not going to get more money in the future; they’re going to get less money. And so I think a lot of them are accelerating changes that they were hoping to stave off. But the real cuts in almost all cases have not come yet. So, you know, the work requirements, as Rachel noted, are going to reduce the number of people who are covered by Medicaid. So that means that a lot of these healthcare organizations are going to have to absorb uncompensated care that was previously paid for. But then, further down the road, there are actually much larger cuts that are coming to state Medicaid budgets that are done in these kind of complicated, a little bit obscure, formulaic ways. But there are these reductions on how much the state can directly pay hospitals for care. There are reductions in how much states can raise through Medicaid taxes that then get transferred back. And there, I think, have been very valid criticisms of these funding mechanisms for Medicaid. They are this kind of Rube Goldberg complicated ways of financing the program, but they’ve been around for decades, and these healthcare organizations and these state budgets have really been built on the foundation of these funding streams. And so, as that money starts to go away, I think, then we may see even larger impacts because, again, the things that are happening now are healthcare organizations looking down the road and thinking, Ooh, it’s going to get messy. Maybe I should start adjusting now. But down the road, it will start getting messy for them, and I think there are going to be potentially some much harder choices for some of these organizations. 

Rovner: Well, continuing along that theme, , we talked earlier this summer about a new rule from the Centers for Medicare & Medicaid Services to enforce the administration’s ban on the use of the Medicaid or CHIP [Children’s Health Insurance] Program to pay for gender-affirming care for minors. But it seems that the mechanism CMS is using could open the door to denying coverage for other drugs too, or at least some uses of other drugs. Now, this isn’t in the Stat story, but, Shefali, when I read it, I wondered if one goal here is to cut back on the use of drugs like misoprostol, which is used for a lot of things, but also for medication abortion. 

Luthra: That’s a really good question, and I think one that we still don’t really know. And obviously, a lot of states’ Medicaid doesn’t cover abortion to begin with. That really only happens in states that have actively made an effort. But, I mean, misoprostol is not only used for abortion; it is used for miscarriage management. And I think it’s just something really important for us to keep in mind what happens when you see these sorts of approaches to just, like, carving out individual forms of healthcare. And obviously, it’s very interesting as well because drugs used for gender-affirming care are also used for other things. RFK [Robert F. Kennedy] Jr. really loves hormone therapy for many people, just not trans people. And so I think there’s just a lot of questions that we don’t really have answers to about just how sweeping the implications of something like this could be. 

Rovner: Yeah, we will see as it goes. Well, it’s not just Medicaid. that CMS is clawing back billions of dollars in Affordable Care Act premium subsidies from insurers who have allegedly phantom enrollees, people with zero premium plans who don’t file claims. And while that is a known problem, a lot of those people might be actual enrollees who just haven’t needed their insurance yet, as in young, healthy folks who have health insurance just in case, or because their parents told them that they should, and, by the way, they could get a plan with a zero premium. And stripping these people from the rolls is likely to boost premiums overall by making risk pools sicker, in general. I feel like this administration might not be familiar with the bizarre and sometimes illogical way the health insurance market works? 

Sanger-Katz: I think there’s a delicate balance going on here, where if there are people who are enrolled in these plans who are fake, are not real people, do not know that they have insurance, never plan to use their insurance, you know, that is a waste of federal dollars to subsidize those premiums and just give that money to insurance companies. But I don’t think that there’s very strong evidence that there are a lot of these people. And I also think that the mere fact that someone has not used their health insurance yet, in a year, is not by itself evidence that they are a fake person or that their enrollment is fraudulent. As you said, Julie, there are a lot of reasons why people in this market may not have used their insurance. You know, a lot of the people who have become newly enrolled are relatively young and healthy. That is good for the risk pool, but it may mean they don’t have a lot of healthcare needs. There’s also, just because of the nature of the individual market, you know, one expert pointed out to me, there’s just a lot of churn. You know, someone loses their job, they sign up for a plan, then they get a different plan, or, you know, people who are in this market may only be in this market for a short period of time, and that may also explain why there’s a higher share of them who don’t make any claims, because they haven’t sort of gotten through the whole year, they haven’t had a healthcare need yet. So I think deciding to just disenroll people on this basis does risk disenrolling people who are legitimately insured, who are not phantoms, and who are not committing any kind of fraud. To the degree that there is fraudulent enrollment, and I think there’s evidence that there’s some of it, there are, you know, I think that is a valid concern, and I think the federal government is certainly within its rights to try to address that and make sure that these federal tax subsidies are being appropriately spent. 

Rovner: Yeah, I think “delicate balance” is exactly the right word. I mean, that’s, you know, with the work requirements too. I mean, the idea is to make sure that people are doing things. But if you make the administrative requirements so burdensome, then you’re going to throw off people who are legitimately enrolled. 

Moving on to the next theme of the summer: the resurgence of measles, and the continuing fight over vaccine policy. Until this week, the Trump administration had boasted that while measles cases have been rising pretty precipitously 鈥� they’re at the highest level in more than three decades 鈥� the U.S. was actually doing better than most other countries with outbreaks, and besides, no one had died of measles yet this year. Well, that worked until Tuesday, when the Pennsylvania Department of Health announced two measles-related deaths in Lancaster County 鈥� although we have few details other than that both people were unvaccinated and one was an infant. The announcement touched off a rather nasty war of words between Pennsylvania governor (and possible 2028 presidential candidate) Democrat Josh Shapiro and HHS Secretary Robert F. Kennedy Jr., who said that the state was not cooperating with federal health officials, and maybe the people didn’t actually die of measles after all. This isn’t really going to get more people vaccinated, I would suggest 鈥� this just sort of fighting back and forth, right? 

Luthra: It’s a good question. It certainly doesn’t help. I think one thing I was thinking about this morning, and this is not measles-specific, but there’s a really great New Yorker piece from this week looking at the actual vaccine data over the past year and a half, and obviously people are affected by public rhetoric, but the declines in vaccination are not as big as one might have feared when RFK Jr. was initially nominated and really made a point of highlighting anti-vaccine beliefs. And so obviously, like, this is, the fact that people are dying is very bad. The fact that they’re sowing confusion 鈥� 

Rovner: The fact that people are getting measles is very bad! 

Luthra: Yes, it’s very, very bad. It’s not, none of it is good. But that was actually really striking to me that amidst all of this, like, really terrible news, there is a bright spot, which is that things could be a lot worse. That is something that I hadn’t thought about. 

Roubein: I mean, if, I think 鈥� I’ve been thinking about this today, like, if you kind of step back from the really high-level view, I think Americans who are watching this are confused. They are not sure who to trust. There are, you know, Republicans are saying one thing, Kennedy allies are saying one thing, the Department of Health [and Human Services] and Gov. Shapiro, Democrats are saying another thing. You’re seeing a, you know, a war of words between, like, Republican and Democratic county commissioners on this, you know, just from a public health messaging standpoint. 

Rovner: Yeah, it has not been a great job of communication all the way around. I think there, I mean, there are even, you know, public health defenders who are saying, Why don’t we know more about these two deaths yet? There’s been not a lot of information, and that has, of course, as we saw, you know, during covid, the more noninformation you have, the more people try to fill in their own information, whether it’s true or not.  

Well, even before the Pennsylvania news, we had a somewhat excruciating pair of appearances on CBS’ Sunday show Face the Nation this week. First, CMS Administrator Dr. [Mehmet] Oz needed three separate tries to be able to say that, no, President [Donald] Trump was incorrect when he said in his Oval Office vaccine event that the measles, mumps, rubella combination shot was lethal. Spoiler: It is not. Then Florida Republican congressman Byron Donalds, who’s now the Republican candidate for governor, said the measles outbreak there has been caused by illegal immigration rather than residents not getting their children vaccinated. What happened to the idea we heard last winter that being anti-vax wasn’t good politics? I think this speaks to what you were just saying, Shefali. You know, I think in January and February we thought that Republicans were going to sort of leave this alone and focus on other things. 

Sanger-Katz: Well, I think one thing that we’ve learned recently is that while a lot of the president’s advisers and political staff, I think, were concerned that an anti-vaccine message was damaging, what we’ve seen is that the president himself sincerely has anti-vaccine views and has been saying them out in public. And so I think it does put other Republican political figures in a difficult bind, and certainly puts folks like Dr. Oz, who work in the administration, in a difficult place. Whatever his genuine views are, whatever his political advisers and his public health advisers are telling him, he works for President Trump, and President Trump has made it pretty clear what he thinks. And so I think that’s why we are now seeing this kind of new round of muddled messaging around vaccines, when I do think for a little while there was kind of a pullback on the most overt anti-vaccine rhetoric, and, you know, we saw RFK talking less about it, for example, in public. Now, I think we’re in a little bit of a new phase, where the president is leading the way back. 

Roubein: Yeah, I mean, I think that’s exactly right, and I mean, Trump has, you know, privately questioned why his administration had yet to release new vaccine recommendations, , with Lena [H. Sun] and my colleague Dan [Diamond]. And that’s, you know, some of what, a lot of what drove the executive order that we saw from just a few weeks ago to reduce the childhood vaccine schedule. Trump says he wants to break up the MMR shot. That’s not something that is currently available, but, you know, he has driven that by pushing some of his advisers. 

Rovner: Yeah, absolutely. Well, meanwhile, demonstrating just how expensive it is to track, trace, and quarantine people after a confirmed case of measles. One Denver outbreak that ended up being just 10 cases still cost state and local agencies nearly a half a million dollars, almost 7,000 hours of work from 189 staff members, not to mention 91 people being quarantined and 500 days of school being missed. We may call public health invisible when it works, but it is certainly not cheap. 

Roubein: Yeah, I mean we don’t talk about the economics of it very often. I mean, public health officials always say that they are underfunded, but just, in general, the talk of the economics here is generally not a huge part of the conversation. 

Sanger-Katz: And measles is just such a difficult disease to contain because it is so contagious. It is one of the most contagious infectious diseases out there. And so that means that any person who has measles just has the potential to spread it to so many people. And I think that really strains these traditional public health approaches of trying to track, trace, and quarantine because you have to find so many contacts. 

Rovner: Yeah, just a reminder, I mean, measles can linger in the air after the infected person has left for, I think it’s like, two hours. So it’s, you know, anybody who’s been in a place where somebody with measles has been is potentially at risk if they’re not vaccinated. 

Sanger-Katz: I mean, we remember how hard this was with covid. Of course, in the early days, no one was vaccinated, so there were more people who were susceptible to covid. But measles is substantially more contagious even than covid. 

Rovner: Yeah. Well, as yet, as the debate continues to rage over vaccines, the evidence continues to pile up that vaccines are actually, on balance, a very good thing. Just this week, we have two more studies. of 4 million teens and young adults that found that those who received that controversial mRNA-based covid vaccine were less likely than those who just got covid to develop myocarditis or other heart problems. That was something that people were worried about with young people getting this vaccine. appears to confirm that the shingles vaccine, Shingrix, appears to not only have a protective effect against dementia, something we reported earlier this year, but also against cardiovascular disease. How do we get to a place where vaccines have become controversial again? I assume, I mean, I want to go back, Margot, to what you were saying that it does seem that President Trump himself has anti-vax views that I think we didn’t appreciate until this year. I mean, I think most of us thought that this was all being driven by RFK Jr., who’d obviously made a career of being anti-vax. But when he backed off, we saw the president basically fill right in, and that’s kind of where we are? 

Sanger-Katz: And I also think this is a reminder to us, both of these studies and others that have come out recently, that, you know, vaccines have some risks. They do. But infectious disease can be really dangerous for people, and it can have lingering and downstream effects that are not obvious. It’s not just that you get sick in the moment that you get sick, but having that disease affects your body in ways that may show up much later. And I think some of these longer-term studies that are following people 鈥� you know, not just in the weeks and months after they get a vaccine, but what happens years later to their heart or to other major organ systems 鈥攔eally shows that preventing people from getting serious illness is good for their long-term health. 

Rovner: Yeah. 

Roubein: And I mean, Secretary Kennedy, just to go back to last year, he did drive changes. He fired CDC’s [the Centers for Disease Control and Prevention’s] vaccine advisers, who had made changes to vaccines. The health department did release a new childhood, slimmed-down childhood immunization schedule earlier this year. A lot of those changes, though, have been on hold from a federal judge. 

Rovner: Yeah, he also fired the head of the CDC, who refused to rubber-stamp his vaccine changes. So, he was busy before he got sort of unbusy with this. All right, we are going to take a quick break. We will be right back. 

OK, our next theme of the summer are the continued cutbacks by the Trump administration to federal health programs, including some of those that have been specifically funded by Congress. First up is a story from 吃瓜不打烊 this week about how, at the same time President Trump can’t stop talking about the increasing rates of autism and what a problem it is, the administration is scaling back enforcement of civil rights protections for people with autism, research into the education needs of people with all sorts of disabilities, and even data collection efforts. So, on the one hand, the president keeps pressuring RFK Jr. to find a definite cause of autism, but at the same time, this administration is doing less to help those who are already diagnosed? 

Luthra: I think what I find really interesting every time we talk about this is the really, really long tail of funding cuts, because this is something on, like, a broad macro scale that began at the beginning of this administration, right? Just massive funding cuts and freezes across the board and have continued. And because of the way grant-making works, because of the way research works, we keep seeing the consequences. We keep getting more people reporting, “Oh, my funding didn’t come,” or “This was held up,” or “This project I was working on no longer can.” And what I think is also really interesting is we see how slow the ability to respond is because of the long tail of funding cuts. I mean, courts take a long time, finding new funding when you suddenly lose yours actually is very difficult. And this is something that we’re just going to keep coming back to. We are going to be seeing the consequences of these funding cuts for months and years, as we’ve been talking, but also for much longer as the consequences in terms of research, of cures developed or not developed, becomes even more clear. 

Rovner: Yeah, although sometimes I think it’s going to be hard to connect the dots to get from, you know, from you cut this so this didn’t happen. It’s almost going to be like proving a negative at some point. 

Well, another big theme this summer has been drug prices, particularly prices for those expensive GLP-1 weight loss drugs. As part of the administration’s push to make those drugs less expensive for the end users, CMS offered states the option to participate in its direct negotiations with the drug manufacturers if they would offer them through their Medicaid programs. Only, , so far only one state has taken up the offer, and more states are actually cutting back on their GLP-1 coverage through Medicaid that they have been offering because it’s been such a financial strain on their programs. Several state officials told Politico that they worry about the long-term financial sustainability of the program. I know it’s also a worry for the Medicare GLP-1 program, which is basically at this point a year-and-a-half-long pilot for drugs that, as far as we know, need to be taken indefinitely. Is it fair to say that the president has not really been able to keep his promise to make these drugs cheaper and much more widely available, or that if he has, people may end up getting them yanked out from underneath of them? 

Sanger-Katz: I think it’s complicated. I think it’s hard to know how much credit the president should get. But I will say that the prices for these drugs 鈥� the kind of cash-pay prices, that he was able to negotiate allegedly, and that he was able to announce certainly a few months ago 鈥� were substantially lower than what individuals and insurers, including some public insurers, were paying for those drugs. So we are now seeing a kind of cash price for the main anti-obesity drugs that is much more affordable than it had been in the past. I think some of that was driven by market pressures and would have happened regardless of the president’s intervention. But I think certainly his pushing these companies, his threatening of these companies, his cajoling of these companies probably maybe did induce them to sort of do it at the same time, to do it faster, and to do it more prominently. 

Rovner: Well, some of it already had happened, before he got in. The self-pay cost had already gone down because so many insurers had stopped covering it. 

Sanger-Katz: It had gone down, but it then went down again.  

Rovner: It did. 

Sanger-Katz: The prices that are available now that the president announced are lower than what we had seen in the past, and they are a major discount even compared to the previously lowered prices that had been public. So I think that is a real thing. Whether or not those prices were meaningfully lower than the price that the Medicaid programs in states were already paying is a little bit of an unanswered question. But my understanding from talking to some Medicaid officials is that Medicaid was already getting very similar prices, even before the president announced these discounts. And that’s because Medicaid has, by law, gets the best price for drugs. They get discounts that are not available to other purchasers. And Medicaid budgets are quite tight. You know, as we were just discussing, all of these state Medicaid programs are facing very substantial cuts that are coming down as the rollout of the big tax-and-spending bill is implemented. And the states that went early and did cover GLP-1 drugs for obesity, I think that they saw that interest and uptake really exceeded their expectations. There were a lot of people in the Medicaid population who stood to benefit from these drugs, and that when so many of them enrolled at once and started taking these drugs at once, it did create, I think, an unanticipated budget strain. So I think states are in a difficult position. This pilot is offering them this cash price for their Medicaid programs, and I think a lot of them are looking at that, and they’re saying, “Well, this is, like, a good price. It’s not that much better than what we could have gotten before, and we weren’t doing it before because we didn’t think that we could afford it.” And so I think those circumstances really haven’t changed. It will be interesting to see what happens over time. It does seem like there is huge potential public health benefit for Medicaid populations if these programs can find a way to cover these drugs. You know, the evidence about the health benefits of these drugs for people who have obesity are just really tremendous, and we’re seeing them over numerous, different health conditions and body systems. And, you know, in my own reporting on North Carolina’s Medicaid program, which was one of the early ones to cover these drugs, you know, I just talked to a lot of people who were really excited about having this opportunity to take this drug. People who had really struggled with their weight and related illnesses, and, you know, were glad that the state was offering it to them. And now, you know, North Carolina has had, is one of the states that’s had to roll back. 

Rovner: Yep. All right. Well, finally, this week, a word about Dolly Parton, possibly the only person in America who was pretty literally loved by everyone. The country and pop music superstar and actress who was known for her genuine kindness and generosity was, in fact, also an important healthcare philanthropist. A lot of people probably remember she gave a million dollars to Vanderbilt University in 2020 to help develop the aforementioned mRNA-based covid vaccine. What people might not remember is that she also used her own money to fund pediatric infectious disease research, underwrite a women’s healthcare center in the East Tennessee county where she was raised, and help train pediatric health professionals. There are celebrities who lend their name and their time and sometimes their money to causes to help burnish their personal PR, and then there are those who clearly do it because they want to give back. I think it’s fair to say that Dolly Parton was one of the latter, and I think she’s going to really be remembered for a lot of the work that she did on bringing healthcare to more people, right? 

Luthra: Yeah, yeah. It’s very sad. 

Rovner: It is. And healthcare owes her a debt. All right, that is this week’s news. Now we’ll play my interview with Dean Rosen, and we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast Dean Rosen. Dean is a partner at Mehlman Consulting, where he landed after a long career on both sides of Capitol Hill, during which he helped shape some of the most important health legislation of the 1990s and early 2000s, including President George W. Bush’s HIV/AIDS program, PEPFAR; the Medicare prescription drug law; and the 1997 Balanced Budget Act. But before all those things, Dean was the top health aide to Sen. Nancy Landon Kassebaum, the Kansas Republican who passed away last week at the age of 94. After Republicans took over Congress in the wave election of 1994, Kassebaum chaired the then-Senate Labor and Human Resources Committee, now the HELP [Health, Education, Labor, and Pensions] Committee, and stewarded the surprisingly difficult path to law of what was originally a very bipartisan bill, the Health Insurance Portability and Accountability Act of 1996, or HIPAA. Dean Rosen, welcome. 

Dean Rosen: Thanks, Julie. I’m honored to be here, and I’m a longtime fan of What the Health? 鈥� so this is a real great opportunity. Excited to be with you. 

Rovner: Great. So, HIPAA, which was known at the time as Kassebaum-Kennedy for its bipartisan Senate sponsors 鈥� your boss and the late Edward M. Kennedy, a Democrat of Massachusetts 鈥� is today mostly known for its medical records confidentiality provisions. But that’s not how it started out, right? It was really an effort to do something bipartisan in the wake of the failed Bill Clinton very partisan health plan. Talk about how it kind of came to be. 

Rosen: Yeah, that’s exactly right. It sort of started in the Senate and then moved to the House and then moved to a traditional conference committee, which we don’t seem to do very much of, either, anymore these days. But when it started off, it really did start, as you said, as a health insurance portability bill, and just a really, in some ways, minimalist solutions-oriented legislative proposal that was designed to try to get at what was really, I think, the core concern, or one of the core concerns, at the time, which was people’s ability to get and maintain health insurance if they had preexisting conditions.  

And really what happened was the Clinton plan had kind of imploded spectacularly, as you know, despite the fact that there were huge Democratic majorities in the House and the Senate 鈥� not filibuster-proof, but close in the Senate 鈥� and the Democrats just couldn’t 鈥� get it done. And they couldn’t get any Republican support. They couldn’t get enough Democratic support. And then in the 1994 election, something unexpected happened. I guess polling was a little less sophisticated at the time, but you had the “Republican Revolution” led by [who] was to be Speaker [Newt] Gingrich in the House, and you had the Senate 鈥� which had changed hands before, but the House, which had not changed hands and had been in Democratic control for 40 years 鈥� switch, and Republicans were ascendant. Bill Clinton was still president. I think probably some of the fact that there was such a gain of seats had something to do with the failure of health reform. And Republicans were getting ready to move a very aggressive deregulatory agenda. And Ted Kennedy, who was a liberal lion of the Senate, who you know was a champion of universal coverage and other liberal causes, moved from the majority side of the dais and having the gavel at the Senate Labor Committee, now the HELP Committee, to the minority side. And Sen. Kassebaum, who had hired me just a few months before that, all of a sudden became the first woman to chair a major committee in the Senate, a standing committee in the Senate. And really, what started it, was that Sen. Kennedy and his team came over and met with us, and somewhat surprisingly, said, “Hey, I know I’m for universal coverage, but I’m willing to do something that’s much more modest,” and shared with Sen. Kassebaum and me and the team a chart that they had put together showing where, not had there been disagreement, but where actually there had been agreement among the major plans, ranging from the most liberal, the Clinton plan, to some of the most conservative plans. And the heart of that, Julie, was health insurance portability, preexisting condition protections at access, and that was the bill that started off in the Senate, and that’s the one that gained traction and passed until we got to the House. 

Rovner: So, Sen. Kassebaum was one of those legislators who actually believed in passing laws, even if it meant compromising 鈥� so you only achieved a few of your goals at a time. Why are there so few people like that on either side anymore? 

Rosen: Yeah, well, you know, I think I would say also about HIPAA that it 鈥� she was an incrementalist. I think she was one of the reasons 鈥� she was considered a moderate Republican in the day, and I think now even more moderate. But she was at her heart a conservative in the sense of she believed that the best legislating was done sort of inch by inch, step by step, as opposed to in one bill. And you sort of saw that proof come to be when the Clinton plan failed, because it tried to really do everything in the healthcare system; it was huge. I think to your question: Today, it’s harder because there’s just less overlap, and the incentives are such that, you know, as one current member of Congress, very senior, told me a couple years ago, if you’re a Republican, you’re looking over your right shoulder. If you’re a Democrat, you’re looking over your left shoulder. And I think that the venerable, you know, Cook Political Report says that in this election, there are only truly 18 toss-up seats in the House out of 435. And so, what it means is that, you know, 5% of the country is going to decide who controls the House ultimately, and the incentives are not to put together bipartisan bills, big or small, healthcare or not healthcare. But the incentive is, frankly, to play to your base, particularly in a midterm election. Now, that’s not always the case. You do have examples of bipartisanship, but I think it’s harder because of those incentives, which we’ve seen become more and more true as politics has changed, and, frankly, as the country’s changed. 

Rovner: You wrote a really lovely tribute to the senator about going to the White House for the signing of HIPAA by Bill Clinton, which I think just showed sort of the generosity of spirit of Sen. Kassebaum. Tell us about it? 

Rosen: Yeah, so, you know, after Nancy passed away, there’s a group of us who’ve been keeping up through chat over the years, and her family, actually granddaughter and stepdaughter, had informed us all before they informed the press over the weekend that she had passed away. And I suddenly was sitting there over the weekend and realizing, Julie, that it had been 鈥� she had died 30 years to the day since HIPAA was signed by Bill Clinton. And, you know, to your point of bipartisanship, that bill passed the House with only two dissenting votes and the Senate unanimously. So not only was it bipartisan, but it passed unanimously. 

So we went over to the White House 鈥� to kind of tell a little bit of the story 鈥� I’d never been to the White House before. This was, like, my first job on Capitol Hill. I was much younger then, and 鈥� obviously 鈥� and the senator made sure I was on the invitation list. And this was, you know, Sen. Kassebaum was not really known as a legislator who was someone who passed, you know, tons of major bills. This was really, if you read all the obituaries, the health insurance portability law is one of the two bills they mention 鈥� the other one being a general aviation bill, and her work internationally, which was significant around apartheid. But they mention this health insurance bill as her signature achievement. So we go to the White House. It’s a hot August day, and as I said, I realized that she died 30 years to the day after this bill was signed. And I was reflecting on the fact of something that I never really shared publicly before, that at the signing ceremony, it’s traditional 鈥� as you know, you’ve probably been to many, many, many of these 鈥� that the presidents will sign these bills, they’ll use multiple pens, as Bill Clinton did, and he handed one of the pens to Sen. Kennedy, and he handed another one to Sen. Kassebaum 鈥� we’re standing over each of his shoulders. And we’re walking out of the Rose Garden, and Sen. Kassebaum came over to me, and it was just the two of us, and she said, “Here, I want you to have the pen. You wrote the bill.” And, you know, I guess as a staff person you do, but I didn’t think of it that way. I thought of the fact that she was giving away to me really one of the most tangible symbols of her signature bill, and I said, “I can’t take this. This is your bill. This is one of your crowning achievements. You worked so hard to get this done.” And she insisted that I keep it.  

And as I said in the piece that I wrote, you know, it struck me that that was just essential Nancy Kassebaum, that not only in the legislation could she find ways to work with Ted Kennedy, who, she said, in subsequent interviews, coming from Kansas 鈥� and folks will appreciate this with Wicked being out 鈥� that I think a lot of Kansans thought that Ted Kennedy was the Wicked Witch of the East. But working with Ted Kennedy to get something passed into law, and then coming over to me with no ceremony, with no one around, with no political advantage, and just saying, “Here, I’d like to give you credit, as opposed to taking credit for myself,” I think said a lot about her character, and I shared that story with her family, and they gave me permission to share it publicly. I think it just goes to her character and who she was, which, as I said, I think is, much more important than the legislative achievement, was just the kind of person that it takes to get things like that done in Washington today, and, frankly, in Washington then. 

Rovner: Any chance we’re going to get back to seeing those kinds of legislators on Capitol Hill? We’re both in this for the long run. 

Rosen: Yeah, you know, I have to say, you know, I prefer to be somebody, Julie, who looks forward. I mean, you know, you can look back and wring your hands and be pessimistic. But, you know, I came to Washington as a [Ronald] Reagan Republican, and Reagan always said that he felt like American optimism was the heart of the country, and that our best days were ahead. And I really do feel optimistic about the country. We’ve survived a lot over the last 250 years, and you’ve got examples of bipartisan legislation. You’ve got, you know, Dr. [John] Joyce and [Rep. Greg] Murphy, and [Rep. Kim] Schrier, a bipartisan bill in the House that takes on the difficult and expensive issue of Medicare physician reform. You’ve got a bill by Sen. [Chuck] Grassley and [Catherine] Cortez Masto and others in the Senate that got introduced a couple weeks ago on fraud and abuse at a time when that issue could be really political. 

So to me, I do see people of goodwill in both parties who want to get things done. I think we’ve got to recognize, as we talked about a moment ago, that the broader incentives in our country and in our political environment and in our institutions are pulling people apart. And I think it is going to take people of goodwill to find things to do where they can compromise without losing their principles and find ways to make progress. And I do see hopeful signs of that. You know, I’m not sure we’re going to get back to the day where there’s tremendous overlap and a huge number of moderates in either party, but I think it makes it even more important that people of goodwill who come to Washington as citizen legislators and want to solve things find ways to do that. And in this divided government, where we’ve seen 12 change elections of the last 14 and extremely narrow historic margins, it’s going to take both sides to get things done. 

Rovner: We will keep watching, Dean Rosen. Thank you so much. 

Rosen: Thanks, Julie. Thanks for having me. 

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

Roubein: My extra credit is from The New York Times. The headline is “,” by Noah Daly and Andrew Jacobs. And the story is about how Americans are traveling abroad, often to Latin America, for psychedelics, a form of medical tourism, and the authors write that this could carry substantial risks. There’s no official tally of injuries, deaths, or adverse events at the overseas psychedelic clinics. But The New York Times interviewed more than two dozen patients and researchers, who cited just a litany of troubling episodes. Basically, the field of psychedelics is in its infancy, so researchers have found this sort of patchwork of standards and rules. And, just for context, here in the United States, the FDA hasn’t approved a psychedelic as of yet, but the idea has really gained traction in recent years for mental health conditions, but particularly, this spring, when President Trump signed an executive order that was aimed at accelerating research into the drugs and also fast-tracking federal reviews of psychedelic medicines. But advocates for these drugs do have concerns about adverse events at overseas clinics because they don’t want it to, you know, kind of spark a backlash that could hamper this trajectory. The Times did speak to a practitioner who said that his prescribing practices were informed by a patient’s self-reported medical history. But I thought this was a really interesting look at what’s happening overbroad given there’s been so much chatter about psychedelics in the United States. 

Rovner: Something else to worry about. Margot. 

Sanger-Katz: I wanted to recommend an article in Stat from Anil Oza. Headline is “.” And this story outlines that a number of people who had submitted comments on a rule about science funding suddenly found their comments removed from the public record. And it appears that the reason is because they were making reference to Russell Vought, the OMB [Office of Management and Budget] head, who, you know, was behind this rule. He has a child with cystic fibrosis who has benefited from a [National Institutes of Health] NIH-funded drug, and I think a lot of them were making reference to that as part of a personal plea for him not to implement this policy. But it’s a little bit puzzling why OMB removed them, on what basis. They haven’t been transparent about it, and there have been basically no explanations. And I think, you know, Secretary Kennedy, during his confirmation hearings, talked about radical transparency in the HHS process and policymaking. And I think this is one of many examples where that really hasn’t happened. There has been a reluctance, I think, by HHS to go through notice-and-comment rulemaking in situations where it is not necessary. There has been a reluctance sometimes to answer questions from the public, from reporters, and I do think that the kind of deletion without explanation of these comments is part of that broader pattern. There is obviously this personal sensitivity here that is part of it, and there may be some valid reason why this public official’s child should not be in the federal record. But it would be nice if someone would explain. 

Rovner: Yeah, and also props not just to Stat, but to the people who actually have been tracking these comments and noticed that they were taken down. Shefali. 

Luthra: All right. My story is from LJ Dawson. It is a collaboration between 吃瓜不打烊 and The Washington Post. The headline is “.” This story combines many of my interests, like European vacations, Greece, and fertility treatment. And I think it’s a really, really, like, interesting and useful look into just how expensive this can be for Americans, especially if insurance doesn’t cover it, and the lengths to which people go to become pregnant. And the family that the story follows, they live in Florida. They could only get pregnant through IVF [in vitro fertilization]. They were quoted close to $40,000 for a round, and they were like, This is nowhere near what we can afford. They realized it was much cheaper to travel to Greece, to literally go on vacation in Greece and get IVF done there. And this is a thing that people genuinely do. Like, I know many people who have looked into the costs of IVF in different European countries, including Scandinavian ones. And I think it’s just a really helpful, dramatic look at what happens when people really, really would benefit from a medical treatment for achieving their fertility goals, their reproductive goals, etc., but it is simply not affordable. And I think this is also interesting because there has been so much chatter about making IVF more affordable, but, in fact, it is more expensive than ever and more in demand than ever because people are having children later, more likely to need fertility treatment, and we don’t really have a good solution yet in sight. 

Rovner: No, except that our system is way too expensive. Well, you may have noticed that in my themes of the summer, I left out the unusual spate of foodborne illnesses. Well, fear not. My extra credit this week is also from The Washington Post. It’s by Tamar Haspel. It’s called “.” And it makes a pretty good case that lettuce and its leafy green cousins are not only the foods most likely to result in foodborne illness, but it’s also not got much to offer nutritionally. It doesn’t store very well, and the land that we use to cultivate it could be better used for, well, better food. I have to say, I stopped buying lettuce a long time ago, mostly because it doesn’t keep very well, and I live by myself. And while I do eat plenty of salad, it’s mostly cucumbers, peppers, and tomatoes. Now, you guys all do you, but I can just say that I haven’t contracted cyclospora this summer. 

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

Luthra: I’m on Bluesky . 

Rovner: Margot. 

Sanger-Katz: I am all the places , and on Signal at sangerkatz.01. 

Rovner: Rachel. 

Roubein: Several places: on X, ; Bluesky, ; ; Signal; etc. 

Rovner: As I mentioned at the top, we’re taking next week off. You should too, if you can. It’s going to be a busy fall. We will be back in your feed on Sept. 10. Until then, be healthy. 

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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 13, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my “Bill of the Month” interview with Paula Andalo. But first, this week’s news. We’ll start this week with vaccine policy 鈥� more specifically, vaccine policy being made from the Oval Office. On Monday, President [Donald] Trump, surrounded by HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr., and other health officials, signed an executive order calling for “gold-standard” childhood vaccine recommendations. The order calls for the current federal childhood vaccine schedule to be divided into three parts: one with a shorter list of shots recommended for all children, another list for high-risk populations, and a final list of vaccines to be given as a result of “shared decision-making” between doctors and parents. The president also wants to separate the combination measles, mumps, and rubella vaccine into three separate shots, which don’t actually exist in the U.S. at the moment. That would necessitate more visits for parents and more individual sticks for kids. While the order itself has no force of law, it does direct each executive department and agency to “take [any] appropriate steps to advance them, to the fullest extent allowable by law.” So, what’s the immediate impact of this? Besides a whole lot of confusion, because when RFK Jr. tried to do essentially this, back last year, it was blocked by a federal judge. 

Edney: Yeah, I think confusion is the main impact of this right now. You know, this comes in the news every so often because President Trump has not wanted to let this go, even though we kind of thought he was 鈥� or at least RFK Jr. was 鈥� directed to let it go because of the midterms and how that was looking. But this is something that President Trump has really had on his agenda and not let go. And I think that there is not really a possibility for an immediate impact, say, with breaking up the shots. Like it doesn’t, like you said, it doesn’t exist here. Merck, which is a company that makes these MMR shots, said that could take up to 10 years. It’s not just a simple thing for them to do. So, in the meantime, you have some parents who are wondering, Well, is this bad? Like, what should I be doing? How 鈥� you know. So I think confusion is the No. 1 impact here. 

Rovner: Yeah, I want to break this down into sort of what it means for health and what it means for policy and what it means for politics. So, in terms of health, the U.S. is already in the midst of its worst measles outbreak since 1991, and we’re seeing more cases of other vaccine-preventable diseases, including whooping cough and even tetanus. And pediatricians are already slammed. How are they ever going to make room for all these extra appointments and parent discussions of these vaccines that used to be sort of generally recommended and now are going to have to be the subject of individual discussions? Anna, you’re the mom on the panel. 

Edney: Yeah, I was thinking that from the parents’ side, but yes, from the pediatricians’ side as well. I mean, they’re already overwhelmed. They already have a huge list of patients trying to get in for many things. And from the parents’ side and the child’s side, this is, like you had mentioned, more sticks. 鈥� The children will have to be given more shots in this case, and a lot of times that can mean missed shots because going once kind of gets everything done. We all like to have a one-stop shop versus having to go to a bunch of different times. And so, besides the confusion, [it] could decrease vaccine adherence because people just might miss those shots. You know, they’re going into the first year of childhood, so many parents, even in the first couple weeks or months, are back at work and are having to carve out time for this. So it could, you know, it could really overwhelm the physician, the pediatricians’ offices, with these conversations, and you know, kind of just lead to actually less protection for children. 

Rovner: And hence, I’d say, the increase in vaccine-preventable diseases that we’re actually seeing. Go ahead, Maya. 

Goldman: I was just going to say there are also all these other logistical concerns 鈥� like we mentioned, these shots don’t even exist yet in the U.S. So that’s, you know, step one. But then you need more storage at the pediatrician’s office for a shot that’s three separate shots instead of one combination. You need more people working at the office to accommodate all the extra appointments that are already in a shortage of pediatricians in a lot of places in the country, and healthcare support workers. And so it’s just this huge cascade of side effects. 

Edney: Yeah, and I think we should add to that: When President Trump talked about this from the Oval Office, he linked wanting to separate these shots to the rise in autism, and there is evidence that’s showing that that is an issue, and that the shots should be separated for that reason. 

Rovner: And just last week, we had another large-scale study that showed no increase in autism due to childhood vaccines. I want to talk about policy, too. There’s one particularly ominous phrase in the EO [executive order] that says that states, who set the rules on which vaccines are required for school attendance, are “advised to review” the recommendations and “consider updating relevant laws and regulations that define the scope of immunization requirements.” On a brief call with reporters on Monday, one administration official suggested that newly sworn-in Attorney General Todd Blanche could go after states that don’t provide enough exceptions to their immunization policies with violating federal religious freedom laws. Is this really good policy or good politics? I mean, most states 鈥� I did go back and look 鈥� most states have exceptions, have medical exceptions; obviously, if a kid can’t take a shot, a kid can’t take the shot. Most of them also have religious exceptions. But it’s not clear how broad this administration wants those exceptions to be, and what it might do about states that don’t allow exceptions. I would note that one of the few states that has almost no exceptions is West Virginia, which is a very red state. 

Raman: I think this is really the area to watch on this. I mean, a lot of the other pieces of this executive order are broader, and I think a little bit more, you know, messaging to the political base based on some of these logistical issues that we’ve outlined. But this is a direct action to three different agencies, you know, to look at these exemptions. And this is already something that they’ve been investigating 鈥� there are already some lawsuits about some of these exceptions in the five states that don’t have, as you know, the same exemptions as other states. So I think here is really the area to look, especially with Blanche now confirmed, and just keeping an eye on some of the existing cases that are already there challenging some of these exceptions. Because this is really where we could see movement, or, just even on the state level, for them passing additional laws. You know, that was something mentioned in the presser too, that they were going to encourage states to do this. So I think state level is somewhere to really look, especially 鈥� vaccine requirements come down to schools, and those are on a state-by-state level done by [the Department of] Education, not HHS. So that’s where I would be watching. 

Rovner: Yeah, there’s more to come, I suspect, here. Before we leave this, though, I want to talk a little bit about the politics. I mean, Anna, you mentioned this. There were polls that showed that going after vaccines was not very popular with Democrats or Republicans, and that Secretary Kennedy was told earlier this year to focus on other things instead. Why is Trump bringing this up two months before the midterms? I mean, who 鈥� what politics is this aimed at? I guess is my question, because I certainly don’t know. 

Edney: From the reporting that I’ve read, and you know, , and Politico. This is just something that Trump himself believes and does not want to let go. He’s talked to the HHS secretary about it time and time again, saying, you know, basically needling him to get on it, even though others have told him not to do that. And so it seems like something that the president really wanted to happen. And just given this discussion we just had, I think it’s pretty evident that most of it is kind of a “We let him do his thing.” He got to talk about it in the Oval Office, and, like, hopefully he’ll shut up about it now, and nothing will actually happen. I think that that is a possibility. 

Rovner: We’ll see if nothing actually happens. But one more thing before we leave the vaccine wars topic, a story from last week that caught my eye: Texas Attorney General Ken Paxton, who is also Texas Republican Senate candidate Ken Paxton, announced in his AG role that he has opened an investigation into the American Academy of Pediatrics. That’s the group that’s led the charge to preserve the immunization schedule, according to, you know, science. Paxton, in a press release, says his office is looking into “concerns that the organization may be promoting and recommending childhood vaccines for financial gain.” Now, given that most pediatricians lose money on giving vaccines, that feels like a bit of a stretch. Or am I missing something here? 

Goldman: Yeah, I think, what I interpreted from that announcement was, you know, he’s concerned about the organization of AAP, which has some big funders in the pharmaceutical companies. So maybe he’s claiming that the organization is worried they’re going to lose that funding, as opposed to individual pediatricians making money off vaccines. But I think it’s really from AAP’s perspective: damned if you do, damned if you don’t, right? This is something that they have done the science on, looked into, and that’s what their basis is. Be very interesting to see if this actually goes to court and if there’s, you know, a legal argument to be made here. I think this is, like, something that is just starting to unfold. 

Raman: What struck me was it’s similar to what we’ve seen in other areas as well. It’s the same kind of rationale we’ve had going after some of the transgender medical professional groups. You know, saying that they’ve made various recommendations about gender-affirming care for financial gain, and questioning some of those decisions. So in that way it’s not unique, especially since Texas has kind of led the charge on some of those. But I do think it’s interesting that we’re going after some of the same organizations for this again and again. 

Rovner: Yeah, I’m wondering sort of the political benefit for Paxton of going after the American Academy of Pediatrics, but we shall see. All right, speaking of politics, the Centers for Disease Control and Prevention got a new director this week 鈥� at least according to its website; I have not seen that she’s actually been sworn in 鈥� a year after its old director was ousted for refusing to rubber-stamp Secretary Kennedy’s handpicked vaccine advisers’ recommendations. Erica Schwartz, a former deputy surgeon general, told the Senate HELP [Health, Education, Labor, and Pensions] Committee during her confirmation hearings that she supports the vaccine schedule and would “never betray the science.” She’s about to get tested on that, isn’t she? 

Raman: I think it was a really interesting choice they didn’t swear her in before they held that event and bring her out there. You know, we did have [Jay] Bhattacharya as the acting official, but they could have easily brought her in there to speak on that, and they didn’t. I think that was a conscious decision. 

Goldman: I was just going to say they waited until she got confirmed. 

Rovner: I would say she got confirmed last week, and the event was on Monday, so they could have sworn her in in time for the event. 

Goldman: Right, they did the event after they confirmed her, but before they swore her in. 

Rovner: Right. 

Goldman: To shore up support in the Senate. 

Rovner: Fair point. Yes, rather than rub it in [Sen. Bill] Cassidy’s face right before he voted to confirm her; that is an excellent point in terms of the timing. Well, meanwhile, things at the CDC are still apparently not great. It’s been almost exactly a year, not just since the last director was ousted, but since a gunman literally shot up the building, killing a security officer because the gunman’s father said he believed that the covid vaccine had made him suicidal. Secretary Kennedy went to visit the CDC campus in Atlanta for a memorial for the officer last week and held a fireside chat with CDC staff, who were, shall we say, not very impressed with his fireside manner. Among other things, according to a transcript of the meeting, he repeated that scientists are not trustworthy. All this comes at a time when CDC is fighting an Ebola outbreak in Africa, several foodborne outbreaks here in the U.S., and the aforementioned spike in vaccine-preventable diseases. It’s not a great time for the CDC, is it? 

Goldman: It’s really not. And there’s a this week by an anonymous CDC staffer that sort of outlines all of the different things that, you know, I’ve even forgotten the CDC has gone through in the last year 鈥� thinking about Ebola and funding cuts and just, this person said, that they can still see damage from the bullet holes when they’re sitting in their office it hasn’t been fixed. And you really have to feel for these workers that are trying to do their best but not being given the resources or support to do it. 

Rovner: Yeah, and I will say, you know, after decades of covering the CDC, the people who work for CDC are, you know, among the most mission-driven people in healthcare. I mean, they toil in sort of the, you know, most difficult parts of the healthcare system and are, like, constantly fighting uphill battles and not getting a lot of support, I would suggest, from the current administration. Well, meanwhile, the never-ending Medicaid news keeps on coming. This week, the Trump administration issued final rules banning certain gender-affirming care for minors. Now, this is separate from its rules for hospitals, right, Sandhya? You wrote about this, yes? 

Raman: Yeah. So the rule this time is related to Medicaid for under 18, and for states that also fund the CHIP [Children’s Health Insurance Program], under 19 they would also have to comply with this rule. And kind of what struck me was that we, you know, just on this podcast, I think, maybe a month or so ago there was this, you know, is the administration going to pull this back or not? And there had been reporting saying that they were, and then HHS said, Yes, we are still going ahead with this rule. So indeed, they did. I think this is part of the broader framework, like you said, of different things related to them wanting to emphasize biological sex in their various rulemaking. 

Goldman: Yeah, I think an important distinction about this particular policy is that it strips federal funding, federal Medicaid funding, from states to cover gender-affirming care for minors. So states can still use their own state dollars if they choose to. Private insurance can still cover this, no problem. This is not a ban on gender-affirming care, but it will certainly make things more difficult for children on Medicaid who need this care, want this care. And, especially as states are facing so many other cost pressures, it’s going to be hard to come up with money to patch this hole if they want to do that. 

Rovner: And, to be clear, we’re not talking about surgery here. I mean, we’re talking about all kinds of care, including counseling, right? 

Goldman: Counseling actually is not included in this one. 

Rovner: Oh, OK. 

Goldman: They can still use federal Medicaid funding to cover counseling. 

Rovner: But not other forms of nonsurgical gender-affirming care. 

Goldman: Yes, hormone therapy, puberty blockers, exactly, which are recommended for kids with gender dysphoria by most major medical associations. 

Rovner: Including the aforementioned American Academy of Pediatrics. All right, next in the Medicaid realm: those work requirements that begin next January. We’ve talked at some length about how the federal government is going to give people an extra year to self-attest that they are too sick to work before they have to get proof from a medical professional. But points out that some states aren’t taking that option. Eight Republican-dominated states, including Arkansas, Idaho, Ohio, and Indiana, are declining that grace period and making their work rules even stricter than the administration is otherwise requiring. What’s the likely impact of this? That in January they’re going to have to start proving immediately that they’re either too sick to work or they could lose their Medicaid. 

Edney: Well, I think the, usually, at least the point of doing a rollout, I guess, is giving states time to figure it all out and giving people time to understand what they need to do. So those states are choosing not to do that. So it seems like this could create a lot more chaos than even was anticipated in the first place, and maybe potentially a lot more people coming off the rolls than when maybe they shouldn’t have been, just because of paperwork errors or misunderstandings and things like that. 

Rovner: And much like pediatricians who are worried about having to break up vaccine appointments into multiple appointments, doctors are kind of freaked out about having to see all these patients so they can, you know, write them notes to excuse them from the work requirements, which is another burden that I don’t know that Congress really fully accepted when it was deciding, and the administration was deciding, how to implement these work rules. 

Edney: You know, that’s not something they normally do assess, whether someone can go back to work. So I’m sure they would probably prefer not to be doing that, but if they, you know, without the time and the ability to figure this out, it could be even tougher, and people will be trying to rush to get in there to get this done. 

Rovner: Well, I guess we’ll be watching these as “the early states,” when this all begins. All right, we’re going to take a quick break. We’ll be right back. 

So, the vaccine executive order from the president very much overshadowed what I think HHS Secretary Kennedy had hoped would be the big HHS story this week: the unveiling of proposed new standards for food additives that have been deemed “generally recognized as safe,” or GRAS. The rules, which have been a long time coming, as in several administrations long, wouldn’t so much make it harder for companies to use food additives like thickeners and stabilizers that are often seen in highly processed foods, but it would require companies to tell the FDA how it’s using those substances. And it stops well short of what former Republican FDA commissioner David Kessler had been urging in a citizen petition, that he filed more than a year ago, that would have made companies actually prove that those products are safe before they can put them in the food supply. Why are these rules so timid? Isn’t, you know, making the food supply safer Kennedy’s, one of his biggest MAHA [Make America Healthy Again] goals? 

Edney: It seemed to me that the way the FDA put it was that they needed Congress basically to step in to boost their ability maybe to do more. Sometimes that’s an excuse not to do more. Sometimes it really is true that they could really open themselves up to challenges from Big Food and court challenges that they don’t want to fight. And so they do the thing that they think they’re able to, and then tell Congress, you know, we need you to go the rest of the way. 

Rovner: Interesting, because they don’t seem to be afraid of court challenges or, you know, stepping on Congress’ toes on lots of other things. I mean, is this really just emblematic of the power of Big Food? I mean, we’ve already seen, you know, Kennedy be sort of squashed by the power of Big Pesticide. 

Edney: Yeah, I think that that’s absolutely the case 鈥� that Big Food, you know, they put their lobbying to work, and they talked about how this could stop them from being able to innovate and being able to get newer things into our food, and that basically we should trust them 鈥� what they’re putting in there is safe. And so that has had some sway. Particularly, there have been a lot of industries that have been able to go to the White House and make those cases and kind of water down things that RFK or, like you said, former FDA commissioner [Marty] Makary had said they were going to do. 

Goldman: I’ve also seen some statements from, quote-unquote, “Big Food” lobbying groups arguing that this is an affordability issue. You know, if they have to comply with all these extra rules and regulations and pre-market reviews, that could tank the president’s affordability agenda, is something that I saw. 

Rovner: I would say we’re all still waiting for the new definition of highly processed food, so we will see what that ends up. On another subject regulated by HHS, Secretary Kennedy also announced major action to start the process of decertifying the organ procurement organization that coordinates organ transplants for the region that includes Kentucky and parts of Indiana, Ohio, and West Virginia. OPOs are the go-betweens between medical professionals who care for patients who become organ donors and those who care for the transplant recipients. There’s been a lot of attention to some pretty big failings in the organ transplant network over the past couple of years. This case cites instances where potential donors were not yet dead. That’s a big problem. But you have to wonder if the public is going to wonder whether dramatic action like this is warranted because the OPO really is deficient, or whether it’s political, since we’ve seen this administration going after some states and some organizations for what they say is fraud that looks like it might more be about electoral politics. 

Raman: I think this is a little different. With this organization, Network for Hope, we’ve had a lot of action over the past year or so on this organization in general. We had congressional hearings about it. We had letters from lawmakers with concerns about this, and it’s not the first time that they’ve moved to decertify. You know, there was a division of University of Miami Health System that they decertified last year. Again, documented problems about this, and even if you listen to some of the statements from Democratic lawmakers, they are not against this. I think that, you know, it’s a recognized problem across political lines, which is a little different than some of the issues where fraud is being, you know, viewed more through one lens than another. 

Rovner: There is a point at which HHS is supposed to regulate organizations. I mean 鈥� when they find evidence of an organization not doing what it’s supposed to, they’re supposed to take action. That’s kind of how the government works. Sorry. 

Edney: You know, The New York Times has done a lot of great reporting on the organ procurement system and showing many, many flaws. But I think for this one, specifically, when I read about what made HHS look into it, it is shocking and a little scary. So I do understand. You know, what happened was there was a man who overdosed and he wasn’t quite dead, but they were starting the procurement process, and he was waking up. And it just seemed like they kept going on this a little too far. He survived; they didn’t get any organs out of him. But if you sign that form that says you’re an organ donor, it’s not something you want to think about: If something happens to you and you’re not quite dead, that they might decide to go ahead. And then HHS did find that this had happened on many occasions. So I think that it seems like something that the government should have stepped in on. 

Rovner: Yeah, there were some pretty serious deficiencies here. All right, well that is this week’s news, or at least as much as we could get to. Now we’ll play my “Bill of the Month” interview with Paula Andalo, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague Paula Andalo, who reported and wrote the latest 吃瓜不打烊 “Bill of the Month.” Hi, Paula. 

Paula Andalo: Hi. How are you? 

Rovner: So this month’s patient is kind of a success story, right? Someone with a nonemergency condition and no health insurance who was nonetheless able to shop around for the best price? Tell us who he is, where he lives, and what kind of care he needed. 

Andalo: Yeah, his name is Ronmel Rangel, and he’s from Venezuela. He moved to the U.S. in 2019 to live with one of [his] daughters that live[s] in Portland, Maine, and he has been living there since. 

Rovner: And then he got sick and needed 鈥�  

Andalo: So it was interesting because 25 years ago he had an inguinal hernia and he had surgery in Venezuela. And at the end of last year, he began to feel a pain on the other side of the body. Again, it was a hernia, so he needed surgery. 

Rovner: So he’d been through this before. 

Andalo: Yeah, yeah, in a different health system. So he doesn’t have insurance, although he’s a green-card holder, so he can have insurance. But when he moved here 鈥� now he’s 64, so it was six, seven years ago 鈥� and he was looking around, you know, the Obamacare and all the stuff. But he realized that for his age, the prices were crazy. He’s a pretty healthy person, so he decided to not have insurance. Instead, he began to see a doctor in a concierge medicine. You know these kind of practices that charge as little as $70 per month to unlimited visits and some small procedures like stitches or 鈥�  

Rovner: But not hernia repair. 

Andalo: Not hernia. So at that moment he needed surgery. 

Rovner: Right. So he did the medical tourism thing, looking both here in the U.S. and in some other countries, where he had family that he could stay with. And, a bit surprisingly to me, at least, he found the best price here in the U.S.? 

Andalo: Yeah, it was like a miracle. Yeah, he looked in Oklahoma, but it was far away. Also, he has a daughter living in Santiago, in Chile, and he looked there, and it was very expensive, adding also the cost of traveling to Chile. So, he finally found his place in Maryland. In Rockville, Maryland, in a place called Affordable Surgery Center. He had his procedure in April. 

Rovner: And how much did he end up paying 鈥� I guess both for the travel and for the hernia repair? 

Andalo: Well, the first estimate that he had was in his state in a big health system, and at that moment the estimate was $23,000 for a laparoscopic procedure. In this center in Maryland, the total cost, including anesthesia, was $2,900. 

Rovner: Wow. 

Andalo: So, adding the cost of tickets for him and his wife and one night of hotel, etc., it was less than $5,000. 

Rovner: Wow. So that’s a whole lot less, even than he could have gotten at home in Maine. 

Andalo: Yeah, exactly. 

Rovner: So what’s the takeaway here, other than that medical tourism doesn’t have to mean a trip to another country to find the most cost-effective care? 

Andalo: Well, the takeaway is that you can shop around, especially if you have an elective procedure, so you have time. Because if you have an emergency, you don’t have time. But with these kinds of procedures that are pretty common, and there are different options to do it, you can shop around and look for the best place. He had the help of his family doctor 鈥� that was very helpful, you know, helping him with lists of places. But he has had time to shop around, to look for prices, and to take care of his hernia. 

Rovner: And I guess it’s important to remember that the most expensive isn’t always the best, but the cheapest also isn’t always the best. 

Andalo: Exactly. So one advice is, the expert says, that you need to look at the reviews of the place and do your homework to realize that if it’s a good place. Although the research says that sometimes higher prices doesn’t mean better care, but in these kinds of procedures, you can pay much less if you shop around. 

Rovner: Well, nice to have a happy ending for a change. Paula Andalo, thank you so much. 

Andalo: Thank you. 

Rovner: OK, we’re back. Now 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 go first this week? 

Goldman: Sure. My extra credit this week is an article titled “.” This one is in The New York Times by Mark Arsenault. I am a University of Michigan alum, just like Julie, and so this one caught my eye. But it’s also very interesting to hear what, you know, universities are taking student mental health seriously to the point where they’re making big policy changes or, at least in this case, piloting policy changes to try to get at the root of the problem. I have my own skepticism that this is, you know, the root of the problem. Academic pressures are certainly a big stressor for students adjusting to college, and so maybe this could help. But I think that this is a multifaceted problem, and I’m interested to see how they’re going to measure the success of this. But this isn’t the first university to have done it. There are a couple others: MIT, Brown. The University of Michigan is a massive school with a lot more students, though, so I think it’ll be interesting to see if other schools of that ilk follow suit. 

Rovner: I would just point out that I went to the University of Michigan in the 1970s, and even then we could take classes pass/fail if we wanted to. It’s not really all that new. But yes, I’ve seen a lot of rolled eyes this week about this story. Anna, why don’t you go next? 

Edney: Mine is from CBS News by Julia Ingram: “.” I thought it was a smart thing to look at, that this farm had not been inspected since 2019. And not just that, but that the FDA has been really lagging on all of their foreign food safety inspections, not even meeting 10% of the goal that Congress had set for them about a decade ago. And I thought that was just a great way to get into this story and talk about inspections and how the FDA is struggling. They’ve struggled for a while to meet these kinds of mandates, but showing how it’s now gotten even worse since there have been lots of cuts within the agency. 

Rovner: Yep, that we’ve been talking about, and these are the result of those cuts. Sandhya. 

Raman: My pick this week comes from NOTUS, and it’s from Margaret Manto, and it’s called “.” I am from West Virginia, so was a reason why I was really intrigued by reading this story. But it’s really good. It looks at the work of a pediatrician in the small town of Summersville, and West Virginia has some of the highest childhood vaccine rates in the U.S. And the county where Summersville is has some really high rates compared to some of the more populous counties that are around it. This is a county that voted three times for President Trump. And just looking a lot at the changing climate regarding, you know, vaccination and attitudes there, and, you know, rural health more broadly. 

Rovner: It’s a really good story. Well, my extra credit this week is from the journal Health Affairs by my soon-to-be boss here at KFF, Mollyann Brodie. It’s a to one of her, and my, health policy heroes, Bob Blendon, the Harvard health policy professor who passed away earlier this summer. Molly was lucky enough to have studied under Bob, which I never got to do. But I still feel like one of his students, as he was always so generous with his time and so very quotable, and contributed so much to my personal understanding of the intersection of health policy and politics, which I try to share with all of you every week. We miss Bob already. May his memory be a blessing, and may he live on in those that he taught. 

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 now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥� as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , or on Bluesky . Where are you guys hanging these days? Maya? 

Goldman: I’m mostly hanging out on under my name. 

Rovner: Anna? 

Edney: , , @annaedney. 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

Rovner: We’ll 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: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 6, 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: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Rovner: And my 吃瓜不打烊 colleague Amanda Seitz. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have excerpts of my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim, who’s proposing universal coverage starting with all American children. But first, the freight train of health news continues. 

We’re going to start this week in Michigan with that very closely watched Senate primary to fill the seat being vacated by the retiring Democrat Gary Peters. We’ve known for months the Republican candidate will be former congressman Mike Rogers, who narrowly lost to Sen. Elissa Slotkin two years ago. And now we know he will face Abdul El-Sayed, an MD epidemiologist and former public health director of Detroit. El-Sayed, who ran on a platform emphasizing “Medicare for All” and has even written a book about it, narrowly defeated four-term Democratic congresswoman Haley Stevens, who had a gigantic cash advantage, mostly provided by supporters of Israel. Now, the fight over Israel in Gaza is for some other podcast to get into, but I do think that this underscores the increasing popularity of Medicare for All in the base of the Democratic Party. What does El-Sayed’s primary win tell us? And can someone from the more progressive wing of the Democratic Party win in a very purple state like Michigan? 

Ollstein: Well, I also want to point out, like, this isn’t an outlier. It was really notable to me that during the Maine rushed, redo primary they just had for the Democratic Senate candidate to take on Susan Collins, everyone in that race was endorsing Medicare for All and calling for it. And Maine is also a very purple state with an older electorate, and, you know, not raging progressive. And so I think it is notable that this isn’t just in the big blue cities anymore. This is a growing drumbeat within the party, and, you know, of course it comes as we’re seeing a lot of people lose their health insurance, which we’re going to talk about. We’re seeing costs go way up, and so there’s just this wellspring of frustration that I think is fueling some of this. 

Seitz: Oh, I was just going to say I would caution, though, how big of a win this is for progressive Democrats. You know, they’ve won the battle, and I’ll say it has built quite a strong coalition. But this was a really narrow primary win, and that is not the situation you want to be in when you have two diametrically opposed candidates from the same party running in a primary in a very purple state headed into the midterm elections. 

Rovner: Yeah, well, let us talk a little bit more about Medicare for All because it’s a trendy moniker for something that’s not really all that specific. Some people think it’s just shorthand for “everyone gets government-provided health insurance.” Some think it’s actually socialized medicine. And some think it’s literally just an extension of today’s Medicare program, which is itself a very public-private hybrid. My friend Jonathan Cohn over at The Bulwark, who happens to live in Michigan, has a  that I will link to about how consideration of Medicare for All looks different in 2026 than it did in 2016 or even in 2009, when they were doing the Affordable Care Act. Where do you guys think we are on Medicare for All? I would remind that what was in the 2020 campaign, every candidate, every Democratic running except for Joe Biden said they were for Medicare for All, and yet Joe Biden is the one that came out of the primaries. 

Kenen: I think Kamala Harris was for “Medicare for All Who Wanted It.” She had some strange hybrid of it, but that is part of our past. I mean, Medicare for All is something you hear about from the Democratic Party, a segment of the Democratic Party, in pretty much every election with more or less intensity. And more so [with] Bernie Sanders running against Hillary [Clinton], it was a much more pronounced debate. In Michigan, I don’t think this is the defining issue. I mean, I think that global politics in the Middle East, and given the demographics of Michigan, and what the race is focused on, and points of contention are, it’s pretty easy to talk about wanting everybody to be covered, and it’s a lot harder to get there, as we all know, because we’ve been talking about it for decades. So I think you’ll hear about it from Democrats 鈥� I’m not sure in Michigan and elsewhere, but I’m not sure how specific a plan or a definition it is, sort of this holy grail that nobody knows quite what it looks like. 

Ollstein: But that also makes sense. I mean, it’s not really in their interest to put out detailed policy plans that people can pick apart at this phase of things. And so it makes sense that we’re in the grand, sweeping, dreams phase of things, and not in the 鈥� 

Rovner: We’re in the slogan phase. 

Ollstein: Exactly, exactly right. Because, you know, as soon as Democrats put out an actual bill, a draft bill, then the vultures will descend and point out all the downsides, and that doesn’t help them heading into, you know, a major midterm election. So we imagine that work is going on behind the scenes, because they want to have something ready to go if and when they have control in Congress. But what exactly that is, we don’t know. 

Kenen: But I also think there’s pressure for the Democrats to be 鈥� in the best-case scenario, if you had a united Democratic Party where they all wanted Medicare for All and they all agreed on what that meant, you don’t press a button and get there. It would be some kind of incremental phase, and it’s not going to be, like, OK, today we have this and tomorrow we have Medicare for All. So I think, in the short term, less controversial and maybe more urgent is affordability and access right this minute. We are going to talk about the coverage decline and affordability and just access on a day-to-day 鈥� even if you are able to afford your care and even if you have pretty good insurance, getting into a doctor when you need to has become really frustrating. Even if you’re sick and already know that doctor. So even if you’re a pretty health-savvy consumer, the way all of us are, we see this in our friends and family, and we understand the system 鈥� sort of, like “the system” in quotes. So I mean, I think there’s the Medicare for All, you know, Democratic dream, and it 鈥� I don’t mean it’s not sincere; I mean, that’s what many people want 鈥� but I also think you’re going to see a lot more nuts and bolts: What has happened in the last two years, and how do we fix it? 

Rovner: I’m interested in the fact that Republicans who are already sort of ginning up their talking points against the, you know, wave of progressive candidates like El-Sayed, although he’s not as progressive as, you know, the [Zohran] Mamdanis and, you know, some of the other avowed socialists. They’re talking about socialism and communism, and they’re talking about all kinds of things. They don’t seem to be talking about healthcare, which suggests to me that Republicans are kind of aware that things are not going well, and that, Joanne, as you point out, I mean, you know, it used to be let’s see if we can fix the health system without messing up the people who are happy. There are fewer and fewer people who are happy right now with how the health system is falling apart. 

Kenen: Including the doctors, right?  

Rovner: Right. Oh, absolutely. 

Kenen: Nobody’s happy. 

Rovner: Well, well, let us move on to all of the ways in which the healthcare system is falling apart. Item one is a new Gallup-West Health poll that found nearly a quarter of workers surveyed said they were staying in a current job that they otherwise wanted to leave only to retain their health insurance. That was up 8 percentage points since the last time they’d asked in 2021. Now “job lock,” as this is called, is something that HIPAA was supposed to address back in 1996. The “P” in HIPAA stands for Portability. It was the Health Insurance Portability [and Accountability] Act. How is this still a thing 30 years later, that people feel stuck because they can’t change health insurance? 

Ollstein: This was also a big driving force behind the argument for Obamacare. The argument was: We’re going to free up all these people by creating this individual market, we’re going to unleash American ingenuity, and we’re going to have entrepreneurs and people starting their own businesses and experimenting and trying things that they wouldn’t feel able to do because they’re so afraid of 鈥�  

Rovner: Shark Tank for All! 

Ollstein: 鈥� losing their health insurance. And so I think the way the Trump administration has targeted some key pieces of Obamacare, you know, they obviously, as we know, failed to get rid of the whole thing, but they are chipping away at the subsidies, which has caused a lot of people to drop their coverage; they’re going after the Medicaid expansion piece of Obamacare, and so I think that’s driving some of this return to, you know, clinging to the job you have in order to maintain your health insurance. Although, going back to the point that nobody’s happy, employer health insurance, while it may be better than a lot of the other options, is, you know, people aren’t thrilled either. The costs are still quite high for both employers and employees. 

Rovner: And employers are looking for ways to cut back. Go ahead, Joanne. 

Kenen: I was also wondering, as I read those numbers about job lock 鈥� and we should also remember, even though it wasn’t in that particular story, there’s also something called “marriage lock,” where people stay in marriages they don’t really want to be in because they wouldn’t have, they fear they wouldn’t have coverage. But one thing I just sort of wondered about is I wonder how many people realize that they might, in fact, qualify for the Affordable Care Act. I think people are still confused about the ACA, as well as they’re confused about a whole laundry list of things that we could spend a year talking about. People aren’t always paying attention, so some of the people who are afraid that if they change jobs or think they have to stay in their job think that Obamacare is for somebody else. So I don’t know. 

Rovner: They wrongly think they’re in job lock. 

Kenen: Right, right. So, but it still affects the behavior. If you feel that way 鈥� you’re anxious and insecure and unhappy 鈥� then you’re anxious, insecure, and unhappy. Whether you are aware of there’s an alternative or not, it doesn’t affect how you feel now, which is, you know, grumpy. That’s not the right word, but you know what I mean. 

Rovner: I know what you mean. 

Seitz: Yeah, well, and I think that that’s what I found fascinating, too, is like when we look back at 2022, there was a lot of head-scratching as to how Democrats performed so well in the midterm elections. But you look back at that time, and people 鈥攊t was the peak of the Great Resignation 鈥� people were leaving their jobs. They were able to get big raises for the first time in a while. Unemployment was extremely low, so you had, like, an electorate that was pretty happy and didn’t have that anxiety. And now you’re staring down a situation where people are afraid to leave their jobs. They’re afraid to lose their health insurance, and the social safety net is deteriorating at the behest of the Trump administration. And I think that’s not a very good situation to have a lot of Americans in, as you head to a midterm election. 

Rovner: Well, item two: Several outlets, , reported last week that hospital systems are seeing what the Times’ Reed Abelson described as, quote, an “unexpectedly sharp rise in uninsured patients and the costs associated with treating them.” We are starting to hear this in earnings reports from for-profit chains and anecdotally from nonprofits. Now, this was something that we saw coming. People can no longer afford their ACA plans and drop them, or as they can no longer afford the premiums without the expanded subsidies and had to buy down to less-generous plans with larger deductibles, which they then can’t cover when they end up in the hospital. This would suggest the Trump administration’s claim that the drop in ACA coverage is all due to fraudulently enrolled people with zero claims might not actually be the case. 

Seitz: I question how much, like, the Trump administration realizes they’re playing with fire here. And I think in part because during the first Trump administration, you saw a few hundred thousand people disenroll from the ACA. They kind of let it to languish, but there was also a lot of question about the ACA marketplaces’ ability to survive. This time around is so much different. You’re talking about millions of people losing coverage within the first year. The Trump administration came in; they had record enrollment in the program. So these are real losses. These are real hospitals, and these are going to be real headlines of real people experiencing these real misfortunes. And you’re going to have either taxpayers eating the cost of the care through emergency Medicaid, or you’re going to have people winding up with really big medical bills that they can’t pay. And again, those are going to be real stories. And the Trump administration is going to find that they can’t just continue to yell fraud to cover all that up. 

Ollstein: Yeah, to Amanda’s point, I think this message could definitely backfire politically. Nobody likes to be told that they are a fraudster or don’t exist when they are losing their health insurance. And this is hitting red-state hospitals just as much as blue states, if not more. And so, I think going into the midterm election, sticking by this line and not admitting who is being harmed is definitely risky. 

Rovner: Yeah, it’s worth pointing out that, I mean, it does hit red states harder because the red states that didn’t expand Medicaid ended up with bigger enrollment in the ACA when they expanded the subsidies 鈥� 

Seitz: Florida’s the biggest. 

Rovner: 鈥� and so those people are now losing coverage. Yeah, Florida, Georgia, Texas. Those are the places where the hospitals are going to see it first when people are showing up who can’t pay their bills. 

Kenen: And those are the states that already have a lot of rural hospital closures. There are rural hospital closures and hospital closures across the country, but the rate of closures is much more acute in the states that did not expand Medicaid. So now you’re going to have more hospitals in jeopardy. It is not a healthy situation. 

Rovner: Well, related to this, we have the impending cuts to Medicaid. A federal judge appointed by Bill Clinton declined to block the Medicaid work rules from taking effect as scheduled Jan. 1. This was in a lawsuit filed by Democrat-led states. But there could still be some delay, right? I know doctor groups are completely freaked out by having to potentially write notes for tens of thousands of patients who may or may not be too medically frail to work. There’s still a lot of sort of panic, if you will, in the states about what’s going to happen to people if they can’t meet these work requirements. 

Ollstein: Yeah, and I want to make sure people know that the judge [who] ruled in this case, he said you shouldn’t take this ruling to mean that I think the states are wrong in challenging this policy. They could very well prevail eventually and strike it down. He just said, basically, this isn’t ripe. You don’t have enough evidence right now of harm to the states because the policy hasn’t officially started yet. Although it has in a couple states that weren’t part of the lawsuit, which we can get into. But this particular piece of the story is not over. Also, people should know that what was being challenged in court was not the entirety of the work requirements; it was just the piece requiring sick people on Medicaid to prove that they are too sick to work, prove beyond just having a diagnosis of cancer or an autoimmune disease or something. Just the diagnosis is not enough; they have to have some kind of proof. It’s not totally clear what kind of proof will count. And, to your point, they’re worried that it’s going to end up being individual doctors’ notes, which will completely overwhelm the system. Doctors don’t have the capacity to see all these people to document this and provide care. 

Rovner: And doctors don’t have the training to determine, you know, who’s disabled and who isn’t. That’s why we have these, you know, special masters for disability programs. Your average doctor is not really in a position to say, “Well, so-and-so can work this month but not next month.” Really, I mean, doctor groups really are legitimately worried about that this is going to fall to them. 

Kenen: And also, like, an awful lot of the people on Medicaid who would be affected 鈥� this is the Medicaid expansion population. It’s not all of Medicaid. But a lot of this population has chronic disease. And chronic disease is often sort of on and off, right? You’re doing OK for a while. You can work, and then kaboom, you have an exacerbation. You have a setback. You have an episode. Whatever your disease is, there are different things that happen, and then you can’t work. And doctors don’t know 鈥� I mean, mental illness is clearly one of the things where people could be stable for a long time and then crash and then recover and stabilize again. Cancer, you can be doing fine, on chemo for a certain amount of time, and then your body just says, you know, I’ve had enough chemicals pumped into it. Or you have 鈥� every chronic disease is pretty much 鈥� every one I can think of is an up-and-down, on-and-off 鈥� like how bad do you feel or how good you feel at any given time. And they certainly don’t have 鈥� then you’re out of compliance. You know, well, you’re healthy enough to work. Why aren’t you working? You know, bye-bye healthcare. So it’s really a complicated mess. The only little thing that may buy the states some time, in addition to whatever happens in the court, is for the first year and only the first year, people will be allowed to self-attest, meaning I’m just going up and saying I’m, you know, here’s my diagnosis, and I’m too sick to work. That is not likely to be extended. It’s unclear how that will play. I’ve written about it in somewhat detail about one state. I’m not exactly sure how it’ll run out in all 50, but it is part of the current rule that, this controversial rule that was dropped on June 1, that made this all sort of more complicated and more difficult. That self-attestation would be available on Jan. 1 for a limited period of time. 

Ollstein: But not in every state. So CMS [the Centers for Medicare & Medicaid Services], the federal government, said states can accept self-attestation. Several states are saying no thanks. We’re going to start requiring proof right away. No self-attestation allowed. So this is yet another sort of natural experiment where we’re going to see, you know, the differences between these states with these different policies, and how many people lose coverage as a result. 

Kenen: But it’s going to be way more than we thought at the beginning. I mean, the difference in this medical frailty rule versus what CMS was telling states until a few weeks ago versus, kaboom, on June 1, it is a much more cumbersome process. I mean, nobody thinks the old estimates of coverage loss are accurate anymore. I mean, there’s always a lot of guesswork in that, right? None of us know exactly how many people will lose coverage, but it looks like a lot more than we thought. 

Rovner: So we already have one of these natural experiments going on in Nebraska, which volunteered to implement its work rules first. The state is now getting ready to disenroll the first Medicaid patients who have failed to meet the requirements. Clearly, some of those people are still eligible, including a pregnant woman reported on by Nebraska Public Media who showed up for an appointment and was denied coverage because apparently the state missed the fact that she was pregnant and therefore eligible. I imagine we’re expecting more of this, right, Alice? We’ve seen this movie before? 

Ollstein: Yes, so we’re getting a sneak preview in Nebraska of what could happen in the rest of the states that expanded Medicaid come Jan. 1. A couple other states are also starting early, although they have different rules about when the penalties kick in and when the enforcement kicks in. But yes, you know we’re seeing a lot of confusion, people losing coverage who are technically eligible for coverage, and basically everything that providers and community groups and patient advocates predicted would happen. 

Kenen: And we know from Georgia, which does have work requirements already, they’re not a full-expansion state. They have their own version of a partial expansion, but it’s still, the law still applies to them. And they’ve had a lot of people losing coverage who probably are still eligible. We know from Arkansas’ experiment in, I believe was 2018, tons of people 鈥� I think it was 17,000 or 18,000 鈥� who lost coverage, and most of them actually qualify. In fairness, the technology since 2018 and 2027 鈥� and learning from Arkansas’ mistakes. 鈥� I think it’s important to be aware of how flawed and problematic Arkansas was. I don’t think it necessarily means that everything will be exactly that bad because, you know, there’s more broadband access in rural America, etc. We don’t have to go into all that. But it’s not a great precedent in terms of smooth rollouts. 

Seitz: And we also know it from the Medicaid unwind during the pandemic, too. We saw these errors and the initial estimates of how many people would be removed from coverage after the federal government said, OK, you can’t allow continuous enrollment anymore. They blew past those initial estimates. So, to your point, Joanne, earlier about how we are going to see much greater disenrollment than was initially predicted.  

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

We are back, turning to abortion. Alice, you were part of a  about U.S. Attorney General nominee Todd Blanche and something he promised to anti-abortion groups. Tell us what he said. 

Ollstein: Yes, so this was on a private call that the White House Faith Office did with what they said were thousands of faith leaders around the country. And they, you know, said over and over on this call, this is private, this is off the record, this is not for the news, and then they posted it on YouTube for some reason and on some other places online. Explain that. Anyways, it’s been taken down since our story published, but we have the audio saved. So Blanche was basically promising that not only would he take action to restrict mail delivery of abortion pills and curbing abortion access in other ways, if confirmed, he sort of went beyond that and said that policies are already in the works. There’s already discussions going on between the White House, DOJ [Department of Justice], FDA, all of these different agencies sort of pledged to stop the ability of patients in red states to order abortion pills online and get them delivered by mail, which is, you know, a key line of access that patients have turned to in this post-Roe era of bans. It was not clear from the audio that we obtained how he plans to go about doing that. I also imagine if, you know, the FDA does come out and change its policy, that his remarks could be used to challenge that and say, you know, this was not based on science. This was based on ideology and religious opposition to abortion, which is not what the FDA is supposed to base its drug access policies on. So this was really fascinating, particularly because it did not really jive with what he said publicly in his confirmation hearing, where he sort of hemmed and hawed and said, “Oh, I can’t speak to that because there’s ongoing litigation,” and sort of made 鈥� yes, this was more specific promise of action than we’ve heard from him publicly. 

Rovner: And just to be clear, I think I have this right: Even if the FDA doesn’t change its policy, the DOJ could decide We’re going to enforce the Comstock Act 鈥� that 1873 law that bans the mailing of abortion drugs. And that would sort of leave FDA out of the entire equation, right? I mean, in theory, he could do that. 

Ollstein: Yes, and a lot of anti-abortion activists are very frustrated that the administration has not done that yet. They could have done that a year ago, theoretically put out a new OLC memo. Of course 鈥� 

Rovner: OLC, the Office of Legal Counsel. 

Ollstein: Yeah, which the Biden administration used to say that the Comstock Act cannot be used for cracking down on mail delivery of abortion pills. Of course, even if that happened 鈥� and there’s no sign that that’s necessarily imminent or something the administration would want to do ahead of the midterms potentially 鈥� but, you know, I think it’s notable to ask: How would they enforce that? This is private mail going to people’s private homes 鈥� short of mass surveillance and looking at everyone’s mail. I mean, logistically and constitutionally, it raises a lot of questions. 

Rovner: It does. Well, and now Sen. Susan Collins has cited it as one of the reasons that she’s going to vote against Blanche’s confirmation. Although I will quickly add that once Susan Collins announces she’s voting against something controversial, that usually means Republicans already have the votes they need and can let her go. 鈥� I see nodding. Do we think that’s the case here? 

Kenen: She’s always in tight races. For the past 30 years, she’s won. But you know, Maine is really obviously in play this year. None of us have a good enough crystal ball to know how this plays out. But the issue for her, in many ways, is just her [Supreme Court Justice Brett] Kavanaugh confirmation vote. So anything she does seen as further eroding abortion could really tip the election for her. So I’m not positive that this goes through. I think it’s likely, but [Sen. Bill] Cassidy, I don’t believe, has said what he’s going to do. [Sen. Lisa] Murkowski hasn’t said 鈥� if someone has more recent information, please update me. But my understanding 鈥�  

Rovner: As of this morning, Cassidy and Murkowski are still holdouts. 

Kenen: Right. And I’m not 100%, even though [Sen. John] Cornyn and [Sen. Thom] Tillis got him out of committee, they’re watching. They’re seeing, you know, what’s going on. Abortion is not the issue for them, but the weaponization, you know, what did he really mean by, you know, does his memo really stop it? What else are they going to do? I don’t think this is a done deal, as opposed to getting closer to being a done deal. But there’s no question that Collins had to vote against this. 

Rovner: We will see. All right. Well, over at the Department of Health and Human Services, things continue to be messy, which is also the description of an interview that Secretary Robert F. Kennedy Jr. gave to CNN’s Dana Bash on Sunday. Here’s how my colleague . I don’t think I can improve on this. “This morning, HHS Secretary Robert F. Kennedy Jr. sat down with Dana Bash on CNN’s State of the Union, and for 20 minutes it went about the way you’d expect. Both of them raised their voices, each accused the other of attacking them. He told her she’d committed press malpractice and that scaring people was the job of CNN. She told him he was causing inaccurate information to circulate. By 9:20 a.m. they were calling each other parrots.” By the way, this week saw publication of yet another large-scale study, 2.5 million children large, that found no association between autism and the measles, mumps, and rubella vaccine. But it raises the broader question: Does giving the secretary a mainstream platform like this actually make the media complicit in spreading the misinformation that he likes to spew? 

Ollstein: Things like this are such a Rorschach test because you had everyone on the left describing it as a crash out and, you know, a meltdown and something that made the secretary look really terrible, and you had people on the right who support him sharing it widely and saying, “Oh, he really gave it to the evil mainstream media.” And so, in terms of, you know, value to the public, I’m not sure. 

Seitz: I think you’re totally right, Alice. But what was really revealing is we have a health secretary who could not articulate what his plan is for any sort of outbreak, as there are multiple infectious disease outbreaks exploding throughout the country. And the one thing that he said he would do repeatedly was he would listen to doctors. Well, doctors on the front line of emergency rooms are saying, We are overwhelmed with measles. We are overwhelmed with infectious disease. Please, promote vaccines more. Please get your children vaccinated. So I think that was really just revealing. And again, it’s really troubling to see because everyone’s going to walk away from that conversation viewing it one way or the other, and not agreeing on anything, it seems. 

Rovner: Yeah, I will say, I mean, I watched it live. It was hard to watch. I don’t think it covered anybody with any kind of glory. Well, earlier this morning, speaking of breaking news, Kentucky Sen. Rand Paul’s Homeland Security and Governmental Affairs Committee voted to hold former NIH [National Institutes of Health] institute director and White House science adviser Anthony Fauci in contempt of Congress for pleading the Fifth, rather than answering their questions at a hearing last week. As former Trump surgeon general Jerome Adams quipped on X: “Your healthcare costs are exploding and the entire U.S. financing system is collapsing in real time鈥� Meanwhile Congress is spending more energy debating whether to lock up an 85-year-old over his private journal entries about Barbra Streisand. Priorities.” At the same time, Politico is reporting that a top candidate for Fauci’s old job, running the National Institute of Allergy and Infectious Diseases, is a pharma executive who co-authored a book arguing that covid came from a lab leak and that fact was covered up by U.S. scientists. Steven Quay, who’s the nominee, has no training in infectious disease and was not selected for an interview by NIH staff for the NIAID job, but was instead handpicked by RFK Jr. Institute directors, I would hasten to add, are not usually political positions, unlike the director of NIH as a whole. So, what does this all suggest? 

Kenen: More of the same and worse. The Fauci situation is mind-boggling, even to people whose minds are now frequently boggles. Right? It’s 鈥� I think it’s safe to guess that he regrets writing certain things down on a government computer. And now they’ve got his phone. Sen. Johnson has his phone 鈥� or a copy of what his phone is. So I don’t know what’s going to come out about that, and how it will be interpreted. Remember that the measures that people are so angry about, several years later, were actually done during the Trump administration. They were not implemented by Biden. The national rules set at the, you know, the “six weeks to stop the spread” 鈥� that was Trump. Later regulations about opening restaurants and so forth, and other businesses and schools, and schools being the most contentious 鈥� churches are also contentious 鈥� that was done at the state level. Anthony Fauci did not go around the country locking churches. So public health made mistakes. But what people are forgetting about is that public health made mistakes dealing with a completely unprecedented and extremely complicated disease, which we still don’t understand all the sequel, all the stuff that people are still dealing with post-covid, right? And under emergency circumstances, in a politically volatile environment. And what we’re also forgetting is mistakes were made on the other side too. People were spreading quote-unquote “facts” that harmed people, that killed people. 鈥� I don’t mean they went out and murdered people, but things that led to unnecessary and avoidable deaths. So the whole debate, I mean, you can tell I’m 鈥� I’ll stop. Tony Fauci was not single-handedly making every decision, and the people trying to make public health decisions in a difficult environment were doing their best to save lives. And 鈥� it doesn’t matter what he said about Barbra Streisand. 

Rovner: And I would just add that it is Congress’ job to do things like examine the mistakes that were made and how things could have been done better, how communication could have been better. And I feel like, you know, Congress is just is so busy finding a scapegoat that it is not doing what could be a really useful exercise in an after-action report. Because there will be another pandemic, and, you know as we’ve said, we are having smaller-scale public health emergencies even as we speak, and nobody is dealing with it well. 

All right, moving on. Finally, this week, the House has decamped for its August recess, but the Senate is still here on Capitol Hill, trying to get a pretty ambitious list of things passed before it leaves at the end of the week, starting with a continuing resolution to keep the government open when the new fiscal year begins Oct. 1. The House passed a CR to run until after the midterms before it left in July. The Senate’s CR is similar with one big change that we have actually discussed lately. It would block, at least temporarily, a controversial rule from the Office of Management and Budget that would further politicize the grant-making process by allowing political appointees to decide whether individual grants conform to the president’s agenda. Can this get back through the House, assuming the Senate passes it when the House comes back in September? Or is this going to come down to the wire and we’re going to have a fight over it as we approach Oct. 1? 

Kenen: Well, the other question that some researchers, you know, when I when I talk to some people about, well, they 鈥� and remember they’re not killing this rule; they’re halting its implementation. 

Rovner: They’re delaying it, right? 

Kenen: Right. You know, one of the scientists’ first response was, “Yeah, well, just because Congress passes a law doesn’t mean the administration will respect it.” There are other ways to politicize, and I mean, they’ve been cutting funding and stopping grants and virtually shutting down agencies. Science has already been hurt. So whatever happens in the House, which, and I think Julie is right, I don’t think they just come back and say, “OK, we’re going to just agree.” I think there’ll be some kind of fight 鈥� how it fits into other trade-offs between the House and the Senate. And there are things other than health that we don’t pay as much attention to that are also out there, including a couple of wars. So yes, there’ll be some fighting about it. No, we don’t know how it turns out. But at the end of the day, if the administration really wants to further politicize an already politicized grant-making process, they will probably find a way of doing so. 

Rovner: Well, speaking of which, the administration has figured out other ways to effectively gut programs. Case in point: Head Start, which is a bipartisanly popular preschool education, nutrition, and healthcare program for low-income kids, just this morning, HHS is dropping new rules that would basically eliminate many of the required standards for Head Start programs, including things like teacher-to-student ratios. This administration is nothing if not creative, because this is not 鈥� you know, last year they were delaying the money going out for Head Start. Now they’re just going to say, Well, we’re just going to take away the rules, and you can sort of take this money and do whatever you want. Amanda, you’re nodding. 

Seitz: Yeah. Well, I found this really striking because I was with Secretary Kennedy a few months ago at a Head Start in Toledo, [Ohio], where he talked about the importance of the program, that it was inspired by his uncle, and he he said he really stood up against the White House to make sure 鈥� it was still funded last year, and he demanded that. And the other thing that really struck me about that visit is the Head Start’s owner had flown in from New York in this tailored suit to take photos with Kennedy and greet him personally. And I was a little confused why this person from New York is owning this Head Start. And it turns out a lot of private equity firms have been buying up daycares across the country, and this was the case for this Head Start. So, you know, pulling back the regulations of Head Start around class sizes 鈥� that seems like it would benefit more the private equity firms than the teachers and the children in the classrooms. 

Rovner: Fancy that! All right. Well, finally, finally, one of the things the Senate has managed to do this week is confirm Erica Schwartz as the director of the Centers for Disease Control and Prevention. That agency has been operating without a Senate-confirmed head since the departure of Susan Monarez last August, just weeks after she had been confirmed over differences with Secretary RFK Jr. over vaccine policy. How confident are we that Dr. Schwartz, who is a retired rear admiral in the U.S. Public Health Service Commissioned Corps and a self-proclaimed vaccine supporter, will last longer than her predecessor? 

Seitz: I think that is a huge question. I mean, we’re now on our third CDC nominee of this administration, second confirmed candidate, and we know that Secretary Kennedy and Susan Monarez never really got along. It was not, she was not his first choice. That has been made very clear with Schwartz as well, when he said that he was not even consulted really about the pick. So I think the big question is: Can these two work together, and how quickly will that potentially deteriorate? 

Rovner: Yeah, well, the clock is about to start. I guess as soon as she is sworn in. 鈥� She was just confirmed on Wednesday, so I don’t think she’s been sworn in yet. Alice, you want to add something? 

Ollstein: Yeah, I did think it was interesting, though. On Capitol Hill, you heard from some senators that, you know, they did have concerns about her ability to stand up to RFK and advocate for evidence-based medicine science, you know, particularly on the vaccine front. But because there hasn’t been a leader at this crucial agency for a year now, they wanted to vote to confirm her just for some stability and some leadership. I mean, look, we’ve got diarrhea lettuce, we’ve got salmonella eggs, we’ve got measles. We’ve got a lot of problems, and it’s never a great time to not have a leader of the CDC, but right now is really not a good time to not have a leader of the CDC. 

Rovner: Yeah, I think that’s what Tim Kaine of Virginia, a Democrat, said. I think he was the only Democrat that voted for her. More important to have somebody at the CDC leading it. 

All right, that is this week’s news, or as much of this week’s news as we could get to. Now we’ll play my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim. Then we’ll come back with our extra credits. 

I am pleased to welcome New Jersey Democratic Sen. Andy Kim to “How Would You Fix It?” Sen. Kim’s a member of the Senate Health, Education, Labor, and Pensions Committee, and just introduced legislation to guarantee health coverage to every child up to age 26. Sen. Kim, welcome. 

Andy Kim: Yeah, thanks for having me. It’s a pleasure. 

Rovner: As I hope this series is highlighting, it appears the country is moving, albeit kind of slowly, towards another major debate over healthcare coverage and cost. What made you decide to step into these very choppy political waters? 

Kim: Well, first of all, I’ll say it is because of healthcare that I ran for Congress to start with. So, you know, eight years ago or so, when I first started running, it was because I had a little baby boy who had some real health issues right there as he was born, and I was one of those very scared, anxious parents trying to figure out what kind of care could my kid get. Meanwhile, we saw a debate in Congress where the Republican-led Congress in 2017 was trying to gut the Affordable Care Act. So that was why I actually got engaged in politics, [because] my congressman was leading that charge on trying to cut preexisting condition protections.  

The other aspect of this is right now things are just moving in the wrong direction. We have upwards of, you know, 1.75 million to 2 million more kids losing Medicaid over the last year and a half. We see the numbers already atrocious. You know, 4.4 million children in this country without health insurance, 23 million kids that are underinsured, which means they have coverage that doesn’t cover their full needs. I’m appalled by that. I’ll be honest with you. Like, you know, we’re the richest, most powerful country in the world. I’m here at the Capitol, where we’re right now having these debates about, you know, a $1.5 trillion defense budget and other things that, you know, just are pushing forward. Yet we are just for some reason just OK with, or at least just allowing this type of void when it comes to our healthcare. I just find it to be 鈥� I mean, just appalling and a real dereliction of our duty that we have not found a way to be able to ensure that every child is able to go see a doctor when they need to without breaking the bank. So I think, for me, this has just been years in the making, and right now I wanted to introduce this because I can’t just be talking about what I’m against. I have to be talking about what I’m for. What is the vision for this country? Not just to reverse things that I think are wrong from what this administration has done, but I owe it to my constituents and to the American people to lay out a vision forward for us to try to think through where we go from here. 

Rovner: So, how would this bill work? 

Kim: First of all, the bill is called MediKids. So, as you said, it would be a guarantee of healthcare from birth to 26. I think one of the more novel parts of this that is different from what we see right now is that there’s an automatic enrollment upon birth into MediKids, which is a foundation built upon Medicaid. So the idea right now is we’re seeing so many kids and families losing Medicaid or potentially losing Medicaid in part because of just the onerous paperwork, the bureaucracy, the different types of things that are meant right now, just the twice-annual requirements to be able to recertify. That’s what’s standing in the way here and preventing so much of the progress that we need. So I wanted to really tackle that and be able to make sure that people can be able to get the care that they need.  

And another part of it is that I chose to put the platform upon Medicaid because Medicaid, in many ways, was designed for kids. You know, when it comes to the early and periodic screenings and diagnostics and treatment, that whole system is, as I’ve looked at it, really the most comprehensive system for kids. What healthcare experts have really shared with me over the years, as I taught talk them, is we can’t just think of kids as little adults. But instead, like, having a system that is designed for kids, that is designed to be able to have the screenings at the appropriate times and age intervals, to be able to have that requirement, to be able to treat any and all problems that are determined, and to think about this as comprehensively 鈥� not just like healthcare here, dental and vision, but to think about it across all of it. All of that is necessary for kids because their bodies are developing, their brains are developing well into their 20s, which is why, again, I pushed meta kids out into the 20s. It’s like you want to make sure that all of these kids are able to get the care that they need, and that you don’t see the kind of withdrawal of or restriction of care that could have real consequences down the road. So that’s really what we were trying to do. 

Rovner: So, as you well know, Democrats have been fighting for decades now over whether to try for a really comprehensive overhaul of the nation’s healthcare system or something more incremental. Obviously, the Affordable Care Act was something more incremental, but also fairly comprehensive. Is that how you envision this? Where do you fall on the “Let’s pull it up and start over from scratch,” and the “Let’s try to fix it one step at a time” debate? 

Kim: Well, yeah. Well, look, I want to be bold, and I want something that can really push forward. Because look, I’ll be honest: The American people want something bold. Like, the problems that we are facing are enormous. No one is happy with the status quo, so we need to have that change. But I was also thinking through how to design something that I think will have enormous impact upon healthcare, but doing it in a way that is implementable. You know, so with MediKids, I’m not creating some new bureaucracy. I’m not creating some new agency or new department. I am taking something that is already, frankly, covering a large percentage of children in this country already, and I’m trying to make it available for everybody through that automatic enrollment, and taking something that is proven to be able to have that comprehensive approach and use that as a foundation. I really tried to design this in a way that is implementable. As I’ve been in Congress now for eight years, I see the types of bills that can get through parliamentarians and get through into passage, and I’ve really tried to design something that hits that sweet spot while still fundamentally reshaping how healthcare in this country will be attained by people. And I really do think that it will have a sizable impact tremendously. Not just in terms of providing that care for kids, but everyone knows healthier kids means healthier adults, which means a healthier workforce, which means a stronger economy, which means lower healthcare costs. The knock-on effects are so strong. So many of the challenges that we see amongst adults when it comes to chronic illnesses and other challenges are often things that have been exacerbated because of the lateness of diagnosis or the lack of treatment early on. So those are the things that we’re really trying to think through when it comes to this approach. 

Rovner: Back in 1994, when the Bill Clinton plan went down, the first big health reform that I covered, there was an effort, mostly spearheaded by Sen. Tom Harkin of Iowa, that they called “Kids First.” They said, well, let’s just cover kids. It still took three years, a lot of fighting, and sort of they luckily found a tobacco tax to help pay for it. But it was bipartisan. Do you have any thoughts that Republicans are going to maybe have some renewed interest in increasing healthcare coverage? 

Kim: Well, what I will say is, first of all, if ever there was an issue that should be bipartisan or, frankly, nonpartisan, it should be about our kids, right? And that’s why I wanted to focus on this too. I think it’s the strongest argument that we have in our country when it comes to guaranteed healthcare. I get it, eyes wide open, I was on the Senate floor last year when I saw my colleagues vote to cut Medicaid at such a dangerous level, so I have my eyes wide open. But what I will say is, I’ve gone around the Senate over the last period of time, like the last two weeks since I’ve introduced, is that it is sparking that conversation. And whether or not my colleagues on the other side of the aisle or both sides of the aisle agree with all the different principles and proposals that I have in MediKids, it is creating this dialogue and this debate about healthcare for our kids. And that’s what I want. Yeah, that’s what I want us to be able to do. And you’re right. Like, we’ve seen bipartisan support in the past for CHIP [the Children’s Health Insurance Program], for healthcare for kids in different ways, and I just saw that going in the wrong direction last year, which is why I wanted to release this now to try to move it back into the fold. I saw a real deprioritization of concerns raised by parents of kids with disabilities that were worried about how these Medicaid cuts would affect them. It’s not good enough for them to just get, like, a wink and a “trust us” type of message. We really need to make sure that we just never have parents with that type of anxiety about whether or not they’re going to lose care for their child. So, well, we’ll see going forward. But at least my early conversations with my colleagues from both sides of the aisle, certainly around the overarching principles of care for kids, is promising. And I’m hopeful to be able to make some gains as we move forward in both the Senate, as well as in the House, as we start to push forward on that debate there too. 

Rovner: Well, we’re all about keeping the conversation going forward. Sen. Andy Kim, thank you so much. 

Kim: Yeah, thanks so much for having me. 

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

Kenen: OK. This is a story that’s up online in The New York Times, and I believe it’ll be in the Sunday Magazine this weekend. It’s by Dr. Helen Ouyang, whose name I don’t know how to pronounce, so I’m just going to apologize for not knowing how to pronounce it. The story is “.” For me, it’s not great because I was working on the same story, talking to some of the same people, and you know that’s not going to happen now. But something like she used the number 4 million, and it’s probably closer to 6 million, kids, between roughly the ages of like 10 and 18 or 19, are in fact the major caregiver for a sick parent or grandparent, and they are trying to juggle some kind of attendance at school and then doing medically complicated things, plus the psychological burden and not being able to be a normal teen. And these are largely poor kids. They are disproportionately Black and Hispanic kids. We do not have a system for helping them. The answer is not let them be caregivers because no one would be a caregiver. The person would have no care. The question is, really, how do we support them? Make it easier. Make sure they’re connected to whatever community resources or state resources or health resources that are available. Make sure they’re maxing out on that. But it’s a really disturbing and very moving story what these kids go through, because even those of us who are adults who’ve taken care of grandparents or parents, it’s really hard. And if you’re 15 or 10, it’s even harder. 

Rovner: Yeah, and taking care of siblings too in a lot of cases. Amanda. 

Seitz: My pick this week is “,” by Katherine Long of The Wall Street Journal. This is a story about a surrogate who agreed to carry what ended up being triplets for a father overseas in China. What I just found really remarkable about the reporting is that it takes this really horrible case 鈥� these children have essentially been left in the U.S. with the surrogate mother because the father from China hadn’t been able to come over due to visa issues. And, but it takes this really complicated story and looks at just the overall perils of the surrogacy industry that has exploded while being completely unregulated, and how all of these cases are largely playing out in courts and being complicated by the immigration policies of the Trump administration. So it was just a really fascinating read. 

Rovner: Other things that policymakers could be doing with their time. Alice. 

Ollstein: My pick is from NOTUS. It is called “.” So we talked about the vote to hold Fauci in contempt, but this is a look at what inadvertently, I guess, happened as a result of Rand Paul, who, let’s remember, is a doctor himself as well as a senator, releasing a huge tranche of private documents from Fauci and not redacting people’s personal medical information about their diagnoses. And this article talks about how that happened and how little recourse the people involved have about their information being exposed, and how this is a pattern with the administration of failing to redact people’s sensitive information when they do these big document dumps. 

Rovner: Oops. Yeah. Well, my extra credit this week is also about the Fauci affair. It’s from our podcast pal Sheryl Gay Stolberg at The New York Times, and it’s called “.” And wouldn’t you just know it, but it turns out that HHS Secretary RFK Jr. and one of his sons, and Kentucky Republican Sen. Rand Paul, have all published books accusing Tony Fauci of various crimes and misdeeds, and that after last week’s hearing, sales of those books jumped. Wrote Sheryl, “Ethics experts say that Mr. Kennedy, his son and Mr. Paul did not cross any legal or ethical lines, but several said the secretary and the senator did cross a threshold for hypocrisy by using their platforms to sell books about Dr. Fauci while accusing the scientist of profiting from his own public service.” I will let you all draw your own conclusions. 

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 now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥� 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 mostly on  and on  . 

Rovner: Amanda. 

Seitz: And I am still tweeting from X on . 

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