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

Mary Agnes Carey: Hello from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of 吃瓜不打烊, filling in for Julie Rovner this week. As always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 15, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we’re joined via videoconference by Paige Winfield Cunningham of The Washington Sun. 

Paige Winfield Cunningham: Hi, Mary Agnes. Great to be with you. 

Carey: Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Good morning. 

Carey: And Joanne Kenan of the Johns Hopkins School of Public Health. 

Joanne Kenen: Hi, everyone. 

Carey: Later in this episode, we’ll have Julie’s interview with Dan Weissmann, host of our sister podcast An Arm and a Leg, about the new and even more confusing Medicare landscape as the 2026 open enrollment begins. But first, this week’s news. 

Yesterday, the Centers for Medicare & Medicaid Services announced it had identified 189,000 people receiving Affordable Care Act plan subsidies who were also enrolled in a second government health program or are dead. CMS officials said that eliminating that duplication would save taxpayers approximately $1.5 billion over the next year. Wednesday’s announcement follows the administration’s move last month to remove 760,000 people from ACA coverage, citing alleged fraud. The cost of healthcare is a top issue for voters in the upcoming midterm elections, and the Trump administration keeps highlighting its efforts to combat waste, fraud, and abuse. How do these two announcements help Republicans in the midterms, especially as early voting is beginning in some states? 

Cunningham: Well, I was at the press conference yesterday where they announced this, and it’s kind of interesting that they’re trying to fit this announcement into their larger effort to combat fraud, because officials actually said yesterday that this doesn’t necessarily reflect fraud. So what they were announcing yesterday is basically they were looking for people who had often moved from one state to another and then didn’t cancel their ACA plan or Medicaid coverage, and so now they’re enrolled in both. And so this is more of an issue of just kind of cleaning up the rolls, making sure that people are only on one plan instead of two. And so I thought they did a pretty good job of explaining yesterday what they were doing there. 

But it was interesting because, as you note, they have this larger anti-fraud effort. It seems like every time I’m tuning in to what [CMS Administrator Mehmet] Oz is doing, he’s talking about fraud. And they’ve partnered with DOJ [the Justice Department] and other agencies to go after fraud in all manner of areas. And I would say, some of the stuff they’re doing on Medicaid is quite unprecedented, right? They’ve deferred huge sums from California and Minnesota. They’re alleging massive fraud. The states say that they’ve provided no evidence of fraud. So there’s a lot of questions there. But I will say on the ACA efforts, when I talk to career staff inside CMS, they say, You know, we did need to do a lot of cleaning up of the rolls in ACA. And there has been an ongoing issue of agent broker fraud, and there are incentives for agents to enroll people without using Social Security numbers because they get commissions every time they do. So I think that’s a real and important effort. 

But I do think it’s interesting they’re trying to kind of roll it all together in this big anti-fraud messaging ahead of the midterms. And I think especially [Vice President] JD Vance, for example, talking about this in starkly political terms, like he will go out there and say blatantly Republicans want to get rid of fraud and Democrats want fraud, which is a ridiculous thing to say because you talk to anybody in the, you talk to any state, red or blue, and they say obviously we don’t want fraud. It’s more of a question of how many resources you put toward trying to get rid of fraud. I don’t have a great sense of how much this is resonating with the public, but they certainly have been kind of tying it to this message of: These are taxpayer dollars that are being misused, and we’re going to right all of these wrongs. 

Kenen: There’s a couple of issues. The crooked brokers is a problem, has been around for a while, and Democratic and Republican administrations have announced they’re cracking down and so forth. And we also know there’s provider fraud, right? Every few years there’s a spectacular bust of some home health agency somewhere, Florida, Brooklyn, wherever 鈥� it’s in red states and blue. But the way it’s talked about, it’s often made to sound like it’s the recipients rather than the brokers or the providers. I’m not saying there’s no individual in the entire United States who hasn’t committed some kind of fraud. Obviously, we have crooks among us, but the healthcare fraud is largely not the recipients. But by talking about it, they make it sound like the recipients are bad guys. Not always. I’ve seen CMS releases that have been very precise that this is brokers or something. They’ve been accurate. But the tone, the way they talk about people on Medicaid, the way they talk about work requirements, the way they talk about the ACA, it’s like lazy, fraudulent people who don’t deserve things. So that’s sort of the political thing. The fact that there’s healthcare fraud 鈥� there’s always been healthcare fraud, unfortunately, because I don’t know anybody who’s actually in favor of it except the people committing fraud. 

Winfield Cunningham: Yeah, I think on the ACA, it is true. We’re coming off of the pandemic, where a lot of these anti-fraud efforts, particularly on ACA, were paused, and obviously people were allowed to stay on Medicaid longer, so that was a thing. And they keep referencing, they keep trying to blame, the Biden administration for the rolls of the ACA and Medicaid kind of expanding. But you’re right, Joanne. On the Medicaid piece, every state has a fraud control unit that has been operating for a long time, and sometimes when they try to kind of trumpet their efforts, they’re also rolling in a lot of previous efforts to combat fraud that happened under previous administrations. 

Carey: But from the election viewpoint, how does this square with a voter? Right? If you are struggling to afford your healthcare premium, or if you were one of those folks that got that enhanced ACA subsidy that’s now gone, or you’re paying more for your drugs at the pharmacy counter, does that really comfort you that the Trump administration is focusing on waste, fraud, and abuse,-a problem that’s been with us, as we are all noting here, for a while? 

Winfield Cunningham: I do think people respond to tangible things. Which I think the administration has that sense, which is why you saw them announce that they’re sending these $500 checks to it’s like around a million ACA enrollees, and the checks are mostly going to, well, they’re all going to states that rely on healthcare.gov. And most of the states that have really competitive Senate races this year, are voters in those states, are getting those checks. So I don’t know. I don’t ever have a very good political sense, so I can’t say. But maybe if somebody gets a $500 check in the mail, they maybe are feeling better about the administration. But it’s definitely a patch on the existing problem of just marketplace plans being too expensive if you’re not heavily subsidized. 

Kenen: If you lost your health subsidies and you’re now either uninsured or paying a lot in the private market for a plan that might not be very good, I don’t see that health $500 check is going to make you feel whole. It’s like you lost something worth thousands and they’re giving you hundreds. And I’m not sure if this $500 is taxable or not. I don’t know if anyone, if any of you know that I’d be interested. 

Carey: Oh, I do not know that. 

Kenen: I don’t know, but it’s not that much money. I don’t think that the people who are mad about the expired subsidies are going to suddenly decide they don’t matter because they got 500 bucks, right? And in fact, if you go on what Mary Agnes said, this is more in the, the red states are more reliant on 鈥� fewer of them are running their own exchanges. I don’t think the $500 check is going to make a big difference in terms of how people vote. I don’t think most people who’ve lost insurance could be, if you were going to vote against the Republicans because of that, I don’t think 500 bucks changes it. 

The other fraud conversation is the president himself, who’s constantly saying that there’s fraudulent elections, that the Democrats cheat, and so on and so forth. That the media lies. So there’s a separate fraud conversation. I think that the healthcare conversation about fraud may reinforce that a little bit, but I don’t know that we know that people make a connection to the political stolen-election dialogue and the healthcare fraud dialogue. I think that they are sort of creating an impression that there are a lot of people who are getting federally subsidized healthcare who don’t deserve it. But I think that translates into support for entitlements, or what used to be entitlements, or now sort of modified entitlements for some. But I don’t know if it really changes your view of your political affiliation and how you’re going to vote. 

Winfield Cunningham: Well, and if you think about just the numbers, I remember talking to ACA enrollees at the end of last year who were going to lose all of their subsidies. You’re talking about your cost going from a $500-a-month premium to $1,500 a month or $2,000 a month. I talked to a lot of people that were looking at that. So $500 is just a patch. Maybe it helps fill in the gap for one month, but you have 11 other months you have to cover these higher premiums. 

Carey: Let’s shift to what happens after the elections. Congress comes back for a lame-duck session on Nov. 9, and with the midterm campaigns behind them, lawmakers might be willing to tackle politically sensitive issues that both parties prefer to defer until after the elections. But depending on who wins and by what margin, and if, it’s predicted, Democrats take at least one chamber, compromise may not be high on the agenda. Must-pass legislation includes funding the government beyond Dec. 11, when the current continuing resolution expires. Healthcare items could certainly hitch a ride on that measure. Lawmakers from key healthcare committees have floated fixes to the No Surprises Act. That’s legislation that protects consumers from high out-of-pocket costs if they seek emergency care from a provider that’s not in their current insurance network. The law’s arbitration system has come under fire on several fronts 鈥� more claims than expected, and some payouts for physicians that insurers have said are sky high and refuse to pay. Rep. Frank Pallone of New Jersey 鈥� he’s the top Democrat on the House Energy and Commerce Committee 鈥� has proposed eliminating arbitration and instead paying doctors at median in-network rates. Rep. Greg Murphy, a North Carolina Republican who is a physician and sits on the House Ways and Means Committee, he expects that panel to have legislation on the issue. And outgoing Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy, a Louisiana Republican, has said that he hopes to introduce legislation as well. Does all this attention to the No Surprises Act mean we’re going to see movement on this? If so, what might that legislation look like? 

Raman: I think it goes back to what you said before, which is really the midterms are going to shape so much of this, Depending on that outcome, if Republicans keep control of both chambers, the air in the room, I think, is really going to push towards getting appropriations done, or done quicker, so they can move on to new things next year, whereas if Democrats get one or more chamber, they’re going to want to push it so that they can have more buy-in doing it next year. And I think so much of that, what would get done regardless, is going to ride on that. There hasn’t been a huge appetite in general to get a lot of these little healthcare things done. And when we did the No Surprises Act before, it took a while. This was multiple years of fine-tuning, trying to get things done. And so rolling, I think, something out really quickly was going to be hard, especially when we have limited time in an election year to move that forward. 

Kenen: I think another thing to look at will be [Sen.] Susan Collins [of Maine], not so much on No Surprises but obviously on appropriations, whether she wins or loses, either way. If she wins, she’s insulated for six years. She’s sort of free to be more independent. She’s a moderate Republican who speaks a lot, again, of her disagreement with [President Donald] Trump but hasn’t been the pivotal vote in all that many situations. The issue that really is relevant to our listeners is she has been a leader in fighting for the NIH [National Institutes of Health] and also against the administration’s efforts to have political appointees oversee, decide, what we’re spending our scientific grants on. She’s fought it on, successfully, twice at least, but those have been short-term achievements. Can she get something more permanent in whatever goes through Approps in lame-duck? 

If she loses, she has nothing to lose. She can be as independent as she wants. If she wins, she’s empowered. So that whole issue of funding is going to be very interesting to watch. I think something is going to happen in the foreseeable future on surprise bills. It was bipartisan. People like it 鈥� not everybody, but generally consumers like it. Problems have arisen as often things happen. People have figured out how to find the loopholes, game the system. I think something will get fixed. Whether it gets fixed in December, I’m not sure. It may well go into next year. Things don’t happen all that fast in Congress. You could do a quick deal and get it off the table for everybody, because there’s a certain amount of agreement on the approach, or it could simmer the way everything in Congress tends to simmer. But I’m sort of really watching what happens to Collins, whether she’s got another month in the Senate or whether she’s got six more years in the Senate. 

Carey: Well, she’s been, to your point, Joanne, Collins has been working with [Sen.] Patty Murray [of Washington], who’s the ranking Democrat on Approps, to push back against exactly what you’re talking about, those efforts at the White House to have more political involvement in medical grantmaking. Other senators have also expressed concerns, and maybe they’ll join these efforts. But what could happen in lame duck, if anything, on these Medicare extenders? The stuff we hear about every year, things on price transparency, or for Medicare extenders, community health centers, lab services, hospital and physician payments? Would that be kind of an easy thing, easier than trying to fix the No Surprises Act or to come up with comprehensive legislation pushing back on the grantmaking interference from the White House? Any thoughts on that? 

Kenen: Extenders are by definition extending something, more or less, that already exists. So it’s not certain. Things get complicated, But a lot of the extenders, they get tied up and delayed as part of a pawn in other fights. But the end of the day, they usually eventually go through. Sandhya and Paige are both on the Hill more than I am, so they can tell me if that’s no longer the case, but they’re not鈥� 

Winfield Cunningham: I don’t go to the Hill, Joanne. Everything’s happening at the agency. I don’t go to the Hill. 

Kenen: Right. So extenders are on the Hill, right? So by definition, they get extended. 

Carey: That’s exactly right, yeah. 

Kenen: They’re sort of on an assembly line. People make speeches. People hold them up because they want something else. They’re bargaining chips. They’re lower-profile. They get pushed aside, blah blah blah blah blah. Congress has endless ways of postponing and delaying and arguing. They’re very good at all that. But at the end of the day, extenders eventually get extended. Whereas there are interest groups lined up around something, the providers vs. the insurance industry over how you’re going to address surprise bills. Clearly, there were unintended consequences. The legislation was popular and bipartisan, but we can see it needs to be tightened up. I think you would find bipartisan agreement on tightening it up. You might not see Republicans rushing to embrace a Democratic solution before Thanksgiving or whatever. But I think they’re different animals. They’re different animals. 

Raman: Exactly that, the kicking the can down the line for extenders, it’s the same conversation every year. I think the other issue with surprise billing is that half of these conversations that we have are just, even if they agree on the policy, them trying to figure out offsets and just what happens there. And that becomes contentious at times, just trying to hammer all of that out, find something bipartisan, even when the underlying policy is something that folks agree on wanting to get done. So, just with the limited time, I think it’ll take a little bit longer than just the next couple months. 

Carey: Well, we’ll all be keeping an eye on that. So now we’re going to take a quick break, and we’ll be right back. 

Let’s shift from Capitol Hill to the Department of Health and Human Services, where Secretary Robert F. Kennedy Jr. has opened a new National Institutes of Health clinic that focuses on patients experiencing health problems following vaccination. HHS has also proposed reimbursing physicians for reporting suspected vaccine-related injuries and urges better electronic health records tracking of these events. Sandhya, I know that , and can you tell us a bit, start off our conversation here, on why the agency and the secretary took these steps? Don’t doctors already report these issues? 

Raman: Yes, this is something that is reported. The secretary and others feel that it is vastly underreported, that there need to be other levers in place to make sure that it’s reported to the extent that they’re seeing. And so, this event that they unveiled this all last week was kind of interesting in that it was not something the press was invited to. They didn’t do a big announcement when it happened on Monday. It took several days, and then they put out some pieces related to this happening. They did a ribbon-cutting for this vaccine injury clinic. The clinic is not open yet. This is just kind of the start of this process. But the reimbursement piece is interesting. 

So it stems from a proposed rule, an annual Medicare physician payment rule that came out earlier this year, should be expected to be finalized in November. And under the language that we have right now, it would reimburse physicians and other providers, physicians’ assistants, nurse practitioners, etc., for tending to more severe vaccine-adverse reactions, so maybe not something like mild swelling of the arm or something that’s more common. They would create a new code under the Medicare system for that to allow providers to bill for diagnosing that and reporting it to the vaccine adverse effects system. And there have been some concerns from some of the medical professional groups 鈥� we have the Infectious Diseases Society of America, the American Academy of Neurology, American Nurses Association 鈥� that kind of have some concerns that this could incentivize certain folks to report more on this, that the system already adequately covers you as a provider reporting these systems and counseling someone for what happens here, and that if it were a really severe reaction, they would use some other kind of billing code because there’d be multiple visits, that kind of thing. So, I guess the next step to watch would be whether or not this gets finalized as is next month, to be put in place next year. But that’s what we’re watching on the reimbursement piece. 

Kenen: One of the issues with defenders of vaccines, nobody says there’s never a side effect or an injury. Nobody who’s on the pro-vax side says nothing ever goes wrong. They do say that most of the side effects are mild, like Sandhya just said, a sore arm or something like that. But they also acknowledge there are rare cases in which something does go wrong. So the current reporting system is anybody could write anything. Some of it is suspected to be made up by people who oppose vaccines to exaggerate the problems. And then there’s also a problem of what causes something, right? A biostatistician would say causation vs. correlation, right? We don’t have to go there. Basically, if I have a vaccine on Monday and I get sick on Tuesday, it doesn’t mean the vaccine made me sick, right? So that gets confused, and it’s very, unless the science is done really, really, really well, it’s going to prove what people want it to prove. So the number of people who file a complaint that they’ve been injured is quite high. The number of people who have actually been injured is quite small. It’s not zero, but much smaller than the anti-vaccination movement says. So sorting: Who’s doing the science? What does the science look like? What kind of peer review is the science going to have? How transparent are they going to be? What are we going to learn from it? Is it predestined? Is it designed to prove that vaccines cause autism, even though we know it doesn’t? There’s just a whole lot of questions about this endeavor. 

Winfield Cunningham: But I think this underscores how Kennedy just brings in a fundamentally different set of assumptions about this than any other health secretary we’ve ever had, which is most medical experts say these supposed injuries are overreported, right? Because as you say, Joanne, people report things and they don’t really know if it’s actually related to a vaccine. But Kennedy has been saying for years that these events are underreported, and he has close allies. I know Aaron Siri is one who’s been pushing him to try to reform the reporting system, so it’s part of this bucket of things he’s trying to kind of do around HHS to change almost the government’s posture toward rare vaccine events. 

Carey: And that’s this week’s news. Now we’ll play Julie Rovner’s interview with Dan Weissmann of An Arm and a Leg podcast, and then we’ll come back and do our extra credits. 

Julie Rovner: I am pleased to welcome back to the podcast Dan Weissmann, host of our sister podcast about why health costs so much, An Arm and a Leg. Welcome back, Dan. 

Dan Weissmann: Julie, thanks so much for having me. 

Rovner: So this week is the start of open enrollment for the 70 million Americans on Medicare. That’s when people can change their private Medicare Advantage plans if they want to, or their private Medicare drug plans, or go back to one or the other. And you guys have just dropped this great episode about how this year is, well, kind of different. Tell us what people on Medicare can expect. Why is Medicare open enrollment so different from, say, your employer’s open enrollment period? And what’s new this year? 

Weissmann: Oh my gosh. OK, let’s start with the big question: Why is 鈥� how is Medicare open enrollment different from your employer’s? And basically 鈥� taking a deep breath 鈥� Medicare is super complicated. You’ve already mentioned a couple of things. The big distinction with Medicare is that you make a big choice, usually when you turn 65, between what we think of as traditional Medicare run by the U.S. government and Medicare Advantage, which is administered by private insurance companies. Generally, you go one way or the other when you turn 65. If you’re in traditional Medicare, things don’t change a whole lot from year to year. You probably have a supplemental plan to cover things that government Medicare doesn’t cover. You might hop from one to the other, but they’re basically different versions of the same thing. 

Medicare Advantage is this whole other world where, wherever you live, there’s a bunch of different carriers usually offering different plans, and then you sort through them. In that way, it’s a little like your employer’s open enrollment, except there’s nobody like your HR person telling you, These are your choices. You’re kind of on your own to figure it out. And what’s different this year is a really big deal. We’re seeing continuation of a trend that started last year, where for many of the people 鈥� you mentioned, 70 million people are on Medicare. The numbers we’re seeing this year are about 3.8 million 鈥� so that’s almost 5% of those folks 鈥� are getting letters from the plan they’ve got now, which maybe they’d want to stick with, saying: Yeah, actually, this plan will not be available next year. You’ve got to find something else. That’s a pretty big change. 

Rovner: So, Medicare Advantage has always been this sort of interesting swap for people. You can, in exchange for getting extra benefits that Medicare doesn’t cover, things like dental and vision and hearing coverage, you have to stay in your Medicare Advantage plan’s network, so you can’t go to any hospital or any doctor like you can mostly with traditional Medicare. The thing about Medicare Advantage, though, is that you can’t go to anybody outside your network. So sometimes people want to go back or they want to change. And what a lot of people don’t seem to know is that while you can change every year from one Medicare Advantage plan to another, if you go back to traditional Medicare, with no limits generally on the networks, you might not be able to buy a supplemental plan that helps you with those thousands of dollars in out-of-pocket costs that regular Medicare exposes you to, and premiums and deductibles and copays. How big a shock was this to the people that you talked to? 

Weissmann: Well, for this story, I think, just to take a step back for a minute, when people choose Medicare Advantage instead of traditional Medicare, they’re often looking at a couple things, and one is those extra benefits that you mentioned. And the other is, yeah, traditional Medicare has big limits. Specifically, in addition to vision and teeth and ears, it only covers 80% of the bulk of regular medical care, things that you’re not going into inpatient care for, like seeing your doctor, physical therapy, getting an infusion, even outpatient surgery. All that you’re on the hook for 20% of, which, if anybody’s seen a medical bill recently, can be a whole heck of a lot more than you could pay on your own. So you would need this supplemental policy to protect you from that. And they’re expensive. They’re not cheap. The average, and it varies depending on the kind of plan you pick and where you live, but, like 200 bucks a month, which is a lot for a lot of people. And you’re also already paying about 200 bucks a month to the government for Medicare, which is also a surprise to a lot of people turning 65.  

So those things make Medicare Advantage seem really, really advantageous, because often those plans also tell you, We’ll take care of a lot of, or even all of, that $200 you’d be paying to the government. So for a lot of people whose incomes are kind of limited after they, say, retire, they’re like, I’m going into this. But then people run into the problems with Medicare Advantage, which is everything we’re familiar with from dealing with private insurance companies in our regular life. They can deny you care. They can tell you you can only see their doctors, and they may not have a lot of doctors, and they may be far away, and they may not be very good, depending whatever you see. So people might want to switch back, but it’s a no-back-seat situation in most states, where you can’t buy one of those supplemental policies for love or money because they might say, You have preexisting conditions, and we don’t have to take you. 

Rovner: Right. They only have to take you once when you first go on Medicare. 

Weissmann: When you go into Medicare for the first time, they have to take you. In a few states, they have what’s called guaranteed issue, and they have to take you anytime. But generally, for most of us, yeah, they don’t have to. And it’s a kind of pre-Obamacare world where they’re like: You have preexisting conditions. No, we’re not going to sell you anything. So that’s a big shock to a lot of people. It was a big shock for me when I first started learning about Medicare. I was like: Really? That’s the deal? So, OK, you can switch from one Medicare Advantage plan to another. You could go back to traditional Medicare. You may not have that option. But what we’re seeing this year happened last year. It happened on a slightly smaller scale. But very significant this year, we think it’s about 3.8 million people getting notes their Medicare Advantage plan is ending. 

Last year was 3 million, which was a big shocker, and so my colleague Emily Pisacreta talked to a lot of people 鈥� people who are in that situation and people who are helping people in that situation, community workers, health insurance brokers, all the rest. And one thing that she learned was that in that case, at least in Minnesota, having your Medicare Advantage plan end gave you a little bit of a get-out-of-jail-free card. You could go back to traditional Medicare and buy a supplement, and they couldn’t turn you down. However, what people told us was, for the most part, people didn’t feel like they really had the financial option to go back to traditional Medicare, because those supplements were so expensive for them. And as our colleague Julie Appleby has been chronicling, they’re getting much more expensive year over year. 

So that was a surprise to us. It was kind of a big 鈥� the big reveal was like: Oh, man, wait. This is bad. Your traditional 鈥攜our Medicare Advantage plan could go away, and sometimes in a few cases there were no Medicare Advantage plans available to people in certain counties. But even in the places where there were, again, the people who were in the business of helping people find new plans said: Look, the plans that remained in Medicare Advantage were not as good. They cost you more out-of-pocket. They covered less. The benefits weren’t as good. All those things were true, and yet people chose them because the alternative, the monthly out-of-pocket spend just to maintain that supplement and pay the 200 bucks to the feds, was more than they felt like they could afford. So they were stuck. And this seems, to us it seems like a big problem for Medicare. Because if we’re in a situation where Medicare Advantage retreats in a way, and it’s less available, and what’s there is less good 鈥攗m, that’s not good, especially if the majority of people in this situation can’t afford anything else. They’re stuck with whatever remains. 

Rovner: And let’s play a little excerpt of what you found in Minnesota. 

Emily Pisacreta: Meanwhile, Kelli Jo Greiner and her colleagues at the state’s Medicare hotline were scrambling, too. 

Kelli Jo Greiner: We had wait times of two hours. Nobody wants to wait for even 10 minutes, let alone two hours. 

Pisacreta: She and her team had to improvise. 

Greiner: We have staff that don’t usually do Medicare counseling. They help with long-term care and other areas, and we even put those folks on the phones to help. 

Pisacreta: And she wrangled a weekly spot on Fox 9 in the Twin Cities to answer big questions. 

Amy Hockert: Medicare Monday is what we’re calling it. A lot of changes coming in 2026. Kelli Jo, thanks for joining us. 

Greiner: Well, thank you. I’m glad to be here again. 

Hockert: All right. Well, let’s roll 鈥� 

Pisacreta: Kelli Jo told viewers the most important thing is to be proactive. If you don’t do anything, the system will put you into traditional Medicare, but without a Medigap plan. Oh, and by the way, she told them, your drug plan will probably disappear, too, unless you sign up for a new one. 

Rovner: So, what do you do if you get a letter telling you that your plan is ending? Or if you just plain need help? There is actually 鈥� this is the one bright spot 鈥� there is a lot of help available. Right? 

Weissmann: There is help available. Yeah. The best thing you can do is go to Google and Google the word “SHIP” and “Medicare” and the name of your state. SHIP is a kind of federally backed program. There’s one in every state. And it’s an acronym, but the words it stands for are slightly different from state to state, so just use “SHIP” and “Medicare” and, in my case, “Illinois,” and you will get a link to essentially a program where you 鈥� there’s a hotline you can call. There’s people there who 鈥� some of them are volunteers, some of them are staff 鈥� and their whole job in life is to walk you through your options for what kind of Medicare you could get. And they’ll know everything about what Medicare Advantage plans are available to you, what supplements cost for you, and they’ll talk through with you your options. I should say, one of the things we found when we talked to people in Minnesota was that those hotlines were jammed last year. But, so try it and do it and don’t give up.  

The other thing is you can look for a health insurance broker, but there’s a caveat there, too 鈥� a couple of them. One of them is 鈥� some brokers are great. We talked to somebody who did all of this, and didn’t get paid, but helped all of her clients and dozens more people find plans that could work for them. And the reason she, I’m saying she did this for free is because this is another piece of the puzzle in things that are changing. Big carriers like United and Humana are telling brokers they’re no longer going to pay commissions on sales of Medicare Advantage plans. So this is going to make it harder. The woman we talked to said, yeah, she was getting calls from people who couldn’t reach their own brokers because their brokers were no longer doing any of this. They just got out of the business. That’s really tough. And when you, if you can find a broker, you want to ask them things like, Do you sell every plan that’s available in my marketplace? Because you want to make sure that they’re doing the best they can for you. It is really tough. It is really tough. But those are things you can do. 

Rovner: And do it early, because Medicare open enrollment only goes until Dec. 7. So don’t wait until Dec. 6 to make that call. 

Weissmann: Yes, and so a couple of other pieces of advice that we got. One, if you’re in a Medicare Advantage plan, watch the mail like a hawk. By Oct. 1, you’re supposed to get a notice if this is happening to you, about whether your plan is available or there any changes to it. Don’t miss that, because the period to do something about it is limited. And here’s what’s going, and just, you should know what’s going to happen if you don’t do anything in this situation, which is you would end up being automatically enrolled in traditional Medicare. But you wouldn’t have a supplement, because you’re not signing up for it in this. You’re not doing anything about it. And in Medicare Advantage plans, drug coverage is generally bundled with the plan that you have, which means your drug coverage is ending, too. You have to sign up for a new one. So that would be bad to end up Jan. 1 not having a drug plan and being on the hook for 20% of anything that happens when you go to the doctors. Do anything you can to avoid it. 

And, honestly, go to the local library, call your city council member, call representatives of local government and state government, and ask them for help. They may be aware of resources besides SHIP that can be helpful to you. Emily talked to the folks from a senior federation that covers seven counties north of the Twin Cities. It’s an unusual group, and they were super dedicated. That exact kind of group doesn’t exist everywhere, but if you called your state rep or your city council person, they could tell you, Hey, here’s somebody who helps people. This is a really tough situation for so many people. It’s worse than last year. There’s more people getting these letters than did last year, and more brokers are being told that they’re not going to be paid a commission than last year. So start hunting ASAP for any help you can get. 

Rovner: Dan Weissmann, thanks so much for doing this. What a great service. 

Weissmann: Thanks so much for having me. 

Carey: We’re back, and it’s time for the extra credit segment. That’s where we each recognize a story we read this week and we think you should read it, too. Don’t worry if you miss it. We’ll 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 actually rather than a traditional print story. Margaret Brennan (Face the Nation) did with this CTO, the chief technology officer of Palantir, Shyam Sankar. Much of it was about all the things we’re hearing about, the debates about the future of AI and the existential threats and its effects of altruism, things that are not relevant to us focusing on health. But there was one real zinger that came out, which is that Sankar told Margaret Brennan that people in the AI world are beginning to smoke cigarettes just to prove how confident they are that AI is going to cure lung cancer quickly. As he said, these engineers or software developers, they’re basically saying, as he said, I’m showing you that my chips are all in. and Margaret Brennan said what I would have said, as her comment was: “What? That makes no sense.” But there you have it. 

Carey: Wow, that is supreme confidence. All right, Sandhya. 

Raman: So I picked 鈥� my piece is from Stat. It’s called “,” by her colleague Andrew Joseph. And it’s a really sweet tribute to Helen, who passed away this week from cancer. She’s been a long-standing, very influential reporter on the infectious disease beat. Had really early insights into covid. She covered the 2003 SARS outbreak. And she’s well known and respected throughout folks following healthcare, and even internationally. The WHO [World Health Organization] put out a statement about her passing. And she will be sorely missed. 

Carey: No, it’s a beautiful tribute, and thank you for flagging that. Everyone should read that. Paige. 

Winfield Cunningham: Yeah, mine is a KFF Health news story [“AI, Tech Leaders Are Lobbying Trump Health Officials in a Government-Run Chat Room”] by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. And I was really struck by the story. It was just fantastic reporting. And they gained access to thousands of Slack messages and meeting transcripts and video recordings that kind of shed light on how the administration has given tech companies a direct line to government officials as they’re basically lobbying the government to allow them to bill Medicare for their AI health apps. And instead of doing this through public meetings that anyone can view, it was kind of done behind closed doors through these closed Slack channels. So I thought it was just a really insightful look into kind of that conversation between the administration and the kind of wellness AI tech industry. 

Carey: I agree. It was an amazing piece. My extra credit is from my colleague Amy Maxman, titled “People Say These Peptides Hurt Them. Their Stories Are Muffled in MAHA’s Push for Medical Freedom.” Amy examines how the lack of data in clinical trials leaves consumers in the dark about peptide safety, their efficacy, and their dangers. Experimental peptides are often sold at longevity, wellness, and so-called performance medicine clinics, even though they haven’t been proven safe and effective in clinical trials. If you’re thinking about using peptides, I’d read this first. 

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

Winfield Cunningham: I’m on X, . 

Carey: Sandhya. 

Raman: I’m and , @SandhyaWrites. 

Carey: Joanne. 

Kenen: I’m mostly and on , @joannekenen. 

Carey: 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, Oct. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: And we welcome back to the podcast Paige Winfield Cunningham, now of the brand-new Washington Sun. 

Paige Winfield Cunningham: Hi, Julie. It’s great to be back. 

Rovner: Later in this episode, we’ll have my interview with Michelle Andrews, who reported and wrote the latest 吃瓜不打烊 “Bill of the Month,” about a patient who got a bill from a hospital emergency room, although she never actually received any treatment there. But first, this week’s news. 

So Election Day is less than a month away, and a finds that healthcare is voters’ top cost concern going into the midterms, and cost concerns are the top voting issue. When asked about their biggest financial concern, health costs topped things like food, utilities, and rent, and tied with the cost of gas. My big boss, Drew Altman, , theorizes that’s not just because individual health costs have spiked of late, but because health costs are so unpredictable and potentially catastrophic. So, is it fair to call these midterms a healthcare election? 

Winfield Cunningham: When is it not a healthcare election? 

Rovner: That may be. 

Winfield Cunningham: I don’t know. I guess I feel it’s not new that Democrats have the advantage on healthcare. Like, they pretty much always have the advantage on healthcare in polls. But what’s sort of interesting to me is that this administration has really tried to score some political wins here and kind of flip the script. I don’t think they’re necessarily being successful, but President [Donald] Trump is going about this in a very President Trump kind of way, right? They passed the [One] Big Beautiful Bill [Act], which was unpopular, and they’re not talking about that at all. But instead, you see Trump trying to, you know, send ACA [Affordable Care Act] checks to ACA customers and checks to Medicare customers. 

Rovner: Yes, we’ll get to that in a second, yes. 

Winfield Cunningham: And then, you know, they’re talking about their deals with drug companies. We know President Trump loves to cut deals. I think in his own way they’re trying to be, like, Hey, we’re good at healthcare, and, like, we are worried about costs, etc. And we’re doing something. But, of course, much of this is a one-time kind of fix, and not even a fix. That’s probably being too generous. But a one-time check that people are getting. So yeah, I don’t think Republicans are being successful in 鈥� presenting themselves as the party people can trust on healthcare per se. 

Ollstein: To Paige’s point, I think the sudden rush to mail out checks to a bunch of people who’ve been impacted by Republican healthcare policies is a sign that they’re sweating the impact of those Republican healthcare policies. I don’t think that it is coming from a place of confidence. It is coming from a sweatier place, I believe. And it’s almost an acknowledgment that those folks need that money because their costs are so much higher, and that’s having a political impact. And I also think, you know, you’re seeing Republicans having to spend a lot of money campaigning in states that were previously considered safe red states. And some of those states have been particularly hard hit by rising health costs and a lot of people losing their insurance. I did a reporting trip to Ohio a little bit ago, and I saw so much evidence of that, and I know it’s happening in other states as well. 

Edney: I also think that everything that Paige and Alice just mentioned are really important, and, you know, these efforts to send out checks and talk about this in certain ways is it’s trying to fill this gap that the Trump administration sort of started by saying, Oh, we’re bringing down drug prices by 鈥� I don’t know, whatever mathematical impossibility that they said they brought them down in. And that’s not actually what people are seeing in their pocketbooks. So it’s at front of mind for them because I think maybe there was some expectation that something might happen, but that’s not what they’re seeing in their bills. 

Rovner: So another interesting finding from the poll is that support for that amorphous phrase “Medicare for All” is at its highest point in at least a decade. And while, as usual, support drops dramatically when people are told that it could mean higher taxes or longer wait times for care, support didn’t drop as much as usual when people were told Medicare for All could mean eliminating private insurance companies. It was, of course, the threat of losing your own coverage that doomed the Clinton healthcare plan and that almost sunk Obamacare on the launch pad. Are Americans finally ready for a big change, or do they just think they are until they see the specifics? 

Ollstein: Well, the question has sort of always been, like: How bad does it need to get before people are open to a radical alternative? And I think, really, until now, people have been happy enough 鈥� I won’t say happy; I’ll say happy enough 鈥� with a partially private, partially public, partially regulated, not partially unregulated healthcare system. Enough people were happy enough to keep these proposals at bay, and now you have so many people who can’t afford insurance, who can’t afford care even if they have insurance. There was some new studies out this week about the number of people with private insurance, what’s considered the good stuff, who still have tons of medical debt and are having to put off payments, you know, on other things and cut back in other areas of life to afford their healthcare. That is changing people’s minds and making people more open. Now, we know that what public sentiment is does not always translate into what Congress is willing to vote for. So I won’t say that it is going to be any kind of foregone conclusion, even if Democrats take back the majorities in Congress, but there’s definitely a shift going on. 

Winfield Cunningham: I was just gonna say to Alice’s point, just the fact that Congress just can’t do anything on healthcare, and you even had quite a lot of Republicans that wanted to extend the subsidies. Like, this is really an area that should have been ripe for bipartisan work, right? I mean, this is like the government subsidizing private plans, something, an idea in theory that Republicans should like and have supported in other ways. 

Rovner: It was a Republican idea! 

Winfield Cunningham: Yeah, exactly. And then also, when I’ve talked to Democrats about, like, what’s your biggest regret about the ACA, or what’s the thing that you wish you had done differently? Many have said to me: The cliff, the subsidy cliff, was not well done. You shouldn’t have a situation where people are going from subsidies to zero subsidies, and they’re still kind of like mid-income people. So this should have been an area that was ripe for bipartisan work last year. And we all saw what happened. It fell apart. So, I mean, even at this point, Congress is just so dysfunctional. They can’t even, they can’t even agree to fix pieces of a law, which now people kind of generally like. So that’s where we’re at. 

Rovner: Well, it’s funny. I would say one of the big ironies I’ve noticed is that, you know, you’ve got a lot of sort of more progressive Democrats this year running on Medicare for All, and Republicans, you know, that are saying: This is communism. This is socialism. We can’t have this. On the other hand, for the first time I can remember, Republicans are coming out very loudly about greedy insurance companies, which, even more ironically, isn’t really the biggest problem. It’s not what’s driving up healthcare costs. You know, the cost of care is what’s driving up healthcare costs. It’s not excessive insurer profits. But I wonder if the Republicans’ beating up on big insurance is like feeding this desire for Medicare for All 鈥� ironically. I mean, Republicans are terrified about ending up there, and yet I feel like they’re inadvertently pushing us that way. 

Edney: Well, I think they’re also hitting on the zeitgeist of the day. Like, they’re sending this message out because it’s one that’s being well received, and that people are very upset. You know, there was unfortunately the murder of the UnitedHealth[care] CEO Brian Thompson, and I think that that has, like, not abated in the sense that people are really angry, and that any politician who wants to talk about the big, bad insurance companies has free rein to do so. 

Winfield Cunningham: Yeah, I think it’s really easy to get people really riled up about their insurance companies, even though, as you say, Julie, they are not collecting the biggest profits in the healthcare system. But your interaction with the insurer is not personal. You know, you just see this number that you have to pay them every month, and then you see copays you have to pay. Whereas you’re having a personal interaction typically when you’re at the hospital with the doctors and the nurses that are caring for you, and you’re going to see your physician. So there’s much blame to be spread around here in terms of healthcare costs going up, and, like, many villains in this industry. Maybe not. Maybe villains isn’t the right word, but many actors in this industry. But I think it is really easy to get people upset about insurers, in particular. 

Rovner: Yeah, I mean, some of it is that we’ve just invented things that are really cool, like GLP-1 drugs that happen to be really expensive. So that’s not necessarily a villain, but it is definitely one of the things that is driving up, at least at the moment, healthcare costs. 

Well, we need to move on. One of the things that’s pushed healthcare to the top of the concern list, as we’ve mentioned, oh, pretty much every week since the spring, is that while Republicans tried to time the Medicaid and other health spending cuts in their 2025 budget bill to , that message didn’t get to the hospitals, clinics, and state and local governments that are already making cuts in anticipation of lower federal funding to come. Plus, as we’ve said, millions of people saw their Affordable Care Act premiums skyrocket when Republicans declined to continue the expanded premium subsidies. Alice, you managed to see how a lot of this was playing out on the ground on the reporting trip you already referred to. What else did you find out there? 

Ollstein: Yeah, like you said, the effort to put off the more controversial cuts until after the election does not mean that this election will not be about those cuts. Those cuts are coming up in every debate, in every Democratic town hall and speech, and they’re in a lot of ads. And Democrats really see this as one of Republicans’ biggest liabilities going into the election, and they’re really trying to press their advantage there. And polling indicates that it may be working. And, like you said, even though those cuts, a lot of them, aren’t going to hit until 2027, states have to make their budgets now, and so they’re making these deep cuts to services in anticipation of losing all that Medicaid money. Hospitals need to make their budgets now. They are cutting services. They’re closing labor and delivery wards. They’re closing down entire facilities because they see the writing on the wall. And so I thought it was fascinating because I dug up an article my colleagues wrote last year when the bill was being debated and passed, and Democrats were worried that the delayed implementation would make it impossible for them to attack Republicans about it. And, lo and behold, that was not the case. 

Rovner: Yeah. Well, and even though the Medicaid work requirements included in that 2025 bill aren’t required to start until next January, several states have now either started early or started the process of notifying people that their Medicaid coverage will soon be contingent on their proving that they’re working. And 鈥� this is my shocked face 鈥� people are very confused. I will also post a link to a story from Montana Public Radio about how the rollout there has been, well, pun intended, kind of rocky. I thought AI [artificial intelligence] was going to make this process all smooth compared to the last time. That apparently is not the case. 

Edney: Definitely not. I mean, the article you’re referring to about Montana, I mean, it sounded very confusing. Something that you would think AI could sort of clear up is just getting the dates right when you need to be getting paperwork and stuff in, but even that wasn’t the case. 

Ollstein: And adding fuel on the fire here is that the federal administration has gone beyond what Congress ordered in terms of the harshness of the implementation of these work requirements. Even beyond that, certain states are implementing the work requirements in a harsher way than the federal government is requiring, and they are allowed to do that. And so, some are offering exemptions for certain populations, and some are saying no thanks to that. Some are saying, OK, for the first year you get kind of a grace period if you have a serious illness. We’ll just take your word for it if you testify that you have an illness that prevents you from working, and we won’t require, you know, a doctor note or other proof, just for the first year, and then after that you have to prove. But some states are saying: no one-year grace period. You need your proof now, or we’re kicking you off your insurance. And so I think all of those different layers of harsh enforcement are really hitting a lot of people, and we pretty much only have hard data out of Nebraska so far because they were so early in their implementation, way out in front of any other state. And there, we’ve seen hundreds and hundreds of people lose their insurance, and most of them was for, you know, procedural reasons, not because they were ineligible. And so I think that is a sort of canary in the coal mine of what we could see in other states once implementation becomes mandatory everywhere. 

Rovner: And wait until all these people have to go to their doctor, sort of hat in hand, saying you have to write me a note, or I’m going to lose my insurance. 

Winfield Cunningham: I just tend to think, and I haven’t followed this story quite as closely over the last couple of months, but I tend to think 鈥� that a lot of it is going to have to do with the nuts and bolts of what verification looks like, and each state is going to do that differently. And if you believe Dr. [Mehmet] Oz when he talks about this, he makes it sound as though it’s going to be this easy process where people have an app, and they can go into the app, and maybe they have to submit one document one time, but then they can go in and check a box or whatever. But in reality, maybe it’ll look like that in some states. Maybe it won’t look like that in some states. Yeah, if someone just has to go into an app and check something, fine. If someone’s having to log onto a website and get a document from their employer or their educational institution and submit this in a really tedious way, then I do think you’re going to see a lot of people dropping off. So I’m really curious to see what those nuts and bolts look like. 

Rovner: Yeah, I am too. We will clearly see more of this. 

All right, turning to vaccines, because there is always vaccine news. The measles case count in Pennsylvania has now topped 1,000, making it officially the biggest outbreak in 35 years. And some of the complications that doctors are seeing are among people who did not have underlying health conditions, which has been troubling. Even more troubling is a , now at the University of Minnesota’s Center for Infectious Disease Research and Policy. She reminds us that measles causes something called immune amnesia by basically erasing the body’s immunity to other germs, making those who have had measles more susceptible to other infections. So everyone who’s getting measles now is going to be more at risk in the future. And against that backdrop comes a , The New York Times’ Christina Jewett, about Texas Attorney General and Republican Senate candidate Ken Paxton, who is investigating pediatricians in the state for what he claims are potential violations of the state’s deceptive trade practices law. Paxton’s office is demanding reams of paperwork from busy pediatric practices, trying to prove that they are pushing unnecessary vaccines in exchange for financial incentives provided by vaccine makers. Given how little profit is made on vaccines at every level of the distribution chain 鈥� so little that many vaccine makers have threatened to get out of the business altogether 鈥� this feels like a weird investigation. Do we know what’s behind it? 

Edney: I don’t think that we know for sure by any means, and there’s not even a ton of information on exactly what he’s investigating, but it does seem to fit with things that President Trump has gone after, that Secretary [Robert F.] Kennedy [Jr.] has talked about in the sense that Big Pharma is making money off of these things, pediatricians are being paid off, and we’ve heard this many times from them. You know, that’s a way they’ve tried to go after vaccines, and I think that Ken Paxton would like some backup from the president for other endeavors that he has in life, and so he was looking for some backup. And maybe that’s one of the reasons for this is, you know, to kind of look more aligned with the administration. 

Rovner: Yeah, he may not dress well, but at least he’s pursuing the president’s policies. 

Winfield Cunningham: I don’t have any inside information about it, but it does feel like a play to look quite aligned with an administration that is increasingly not shy about looking vaccine-skeptical. I mean, Trump has been very out there in recent months, signing the executive order, you know, talking about how, I guess, he says for his five kids their shots were spaced out. He has, you know, personal concerns about this. And then the other thing is it seems like this is attractive to Paxton’s base. You know, I mean, there are plenty of MAHA [Make Americans Healthy Again] moms in Texas who have, you know, left traditional pediatrician practices and gone more like the functional health route, where they go to these doctors who are willing to let them space or skip vaccines, so this seems like maybe a good political move for him. I’m not sure. 

Rovner: And I will just say before we leave this: There are lots of places where there’s clearly industry influence over prescribing practices and types of procedures. But I think the one place it’s fair to say that there is not a lot of profit being made is in vaccines. Vaccines are hanging on by a thread. I’ve been doing this for 40 years. I mean, I was there when they passed the Vaccine Injury Compensation Act, and it’s because all of the vaccine makers were threatening to stop making vaccines. It’s just not a place where there is lots of profit. 

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

Turning to reproductive news, yesterday was the date that the FDA had to report to a federal court in Louisiana how that safety study of the abortion pill mifepristone is going. Alice, what did they say? 

Ollstein: Of course, they waited until, like, 9 p.m. on the deadline, which was very helpful to all of us reporters who were refreshing PACER [Public Access to Court Electronic Records] all day long. But we finally got it. It was not a very fulsome update, I would say. It was just a few pages long. And the main news is that they said we’re going to finish gathering all the data we need by December, but we’re not going to release a report. We’re going to need until March to crunch the numbers and draft our report on whether we deem mifepristone to be safe and effective. Now, I also think it was notable in there that they’re sort of separately studying the drugs’ safety and efficacy and the safety of the telehealth rules around it from 2023 that the Biden administration imposed. And they noted 鈥� and I thought this would, you know, maybe additionally piss off the anti-abortion groups who were already pissed off by the punt until March 鈥� they said that they will be examining the 2023 rule changes in light of both court challenges, saying that the current rules are too loose, and court rulings saying the current rules are too strict and access to 鈥�  

Rovner: Which we rarely talk about! 

Ollstein: Yes, but two different federal courts have ruled that the remaining restrictions on abortion pills are too strict and not justified, and that it would be safe without them. And so you have the FDA acknowledging these competing forces and pressures on it from the courts and from activist groups and from states. And so it really seems like they’re trying to walk this careful line to not piss off anyone, but they’re ending up pissing off everyone. And what I found really notable about the reaction to this filing was you have the pro-abortion rights forces saying, basically, you know, Wake up, sheeple, they’re waiting until right after the midterms and then they’re going to ban everything! And the anti-abortion groups don’t seem to think that’s the case; they do not seem confident that that is what is going to happen. They are blasting the administration not only for not doing more, to date, to impose restrictions on the drugs, but they do not seem to have confidence in this review process at all. So obviously, we don’t know what will happen. They shared very little detail about who’s in charge of this study, exactly what data are they incorporating? So it continues to be somewhat of a black box. 

Rovner: So, what does this all mean for the potential confirmation of Heidi Overton, the White House health policy aide who’s been nominated to head the FDA and had her confirmation hearing, at which she politely declined to answer most of the lawmakers’ questions, and the Senate left town without acting on said nomination? 

Winfield Cunningham: Well, I believe [Sen. Bill] Cassidy has not said yet how he’s going to vote on Overton. I imagine 鈥�  

Rovner: Cassidy, the chairman of the relevant committee. 

Winfield Cunningham: The outgoing Sen. Cassidy. Heidi was asked very pointedly, I think, by Sen. [Patty] Murray, “Do you believe this is safe and effective?” She gave a very carefully 鈥� you could tell her answers were very, very carefully rehearsed. I’m not sure what’s going to happen there, but I was going to say, as I think about after the election and kind of how all of this unfolds, I really have no idea. I think you could kind of argue it both ways. There are a lot of anti-abortion allies in key places at the Domestic Policy Council in certain offices within HHS. In some ways, this administration looks like a bit of a traditionally Republican administration. A lot of folks in there, when I talk to pro-lifers, they are, like, “We really have allies here.” But on the other hand, I think Trump’s kind of done with this. The White House still says he’s the most pro-life president. This is the pro-life president, they say. But he’s made it very clear that he doesn’t really want federal policymaking here. And then RFK Jr., he’s, like, Catholic, but I don’t think this is a top issue for him as well. So I’m genuinely curious. I do not know how they’re going to handle this. 

Rovner: I did not have on my bingo card Trump going with the anti-vaxxers but throwing the anti-abortion forces under the bus. Which, hey, everything’s a surprise. 

Ollstein: And to that point, you know, Cassidy is very anti-abortion, and so if he votes against Overton, it will not be because of her anti-abortion views. It will be because of vaccines or something else. You know, her general leadership abilities or whatnot, whatever else he’s concerned about. It’s not going to be about abortion. But you have some other people on that panel who could be concerned about her views on abortion that could affect her confirmation going forward. And I think it’s notable that that too is getting punted until after the election, so as not to provide any fodder or controversy for the members who are having to run. But I also think that there’s always another election coming up, and so, yes, they don’t want to rile people up right before the midterms with some sort of big sweeping anti-abortion action. But as soon as this election’s over, they’re going to be thinking about 2028 and not wanting to rock the boat there. And so I think these sort of political pressures are only going to continue. And we have seen in Congress and in the executive branch sort of an effort to tell the anti-abortion forces that are getting more and more and more frustrated: Just wait. Just be patient. You know, we’re going to get to you. We’re going to get to your priorities eventually. And it keeps not happening. So you’ve seen that on the defund Planned Parenthood front. They keep saying, Oh, it’s going to be in the next reconciliation bill. It’s going to be in the next one, the next one, the next one. 2.0, 3.0, 4.0, and it keeps not happening. And so you could see that again on this front as well. But, also, you know, whether as a result of a court ruling or just the FDA on its own, something could happen that really restricts drugs both in states with abortion bans and in states where they’re legally protected. This would affect the whole country. 

Rovner: All right. And sure enough, not only do we have outbreaks here in the U.S. of measles and other vaccine-preventable illnesses, there’s now a scary case out of Russia of a lab worker who died of a so-far-unidentified strain of pneumonia. Oh, and the patient worked at a lab in Siberia studying plague. Russian officials said that they have the situation under control, but I feel like we’ve heard that before somewhere? Um, I don’t know about you guys. I’m kind of watching this one with a wary eye. 

Edney: Yeah, I think that that is the right way to be when we have these very secretive countries, China with covid, and now Russia with the plague. Where these things start doesn’t lead to a lot of information getting out there, so filling the holes is very difficult. It sounds like the U.S. government doesn’t really even know a whole lot, and we’ve had assurances from Russia that everything is under control. But where’s the proof? I guess. It hasn’t really manifested. So I think watching it closely is right. No need to panic. There’s been no verified reports of anyone else dying at that lab, but, you know, certainly something not to turn away from. 

Rovner: Finally this week, we’ve talked in the past about how doctors no longer want to be associated with helping carry out the death penalty by lethal injection. Well, in Tennessee, we saw yet another botched execution with the patient surviving not one, but two injections intended to end her life. Fifty-year-old Christa Pike, who was on death row for her part in the torture and murder of a classmate when she was 18, was awake and talking as of Wednesday after being unconscious for several days. And it’s not clear what will happen to her now. In the meantime, though, Tennessee’s governor has put a moratorium on executions in the state for the rest of the year and ordered an independent review of what happened. This was the second time this year the state has failed to successfully carry out an execution. I will link to a story from Nashville Public Radio’s Catherine Sweeney, who is an official media witness for both unsuccessful executions. I will warn you: It’s really vivid. It also raises the question of whether lethal injection, which was supposed to be a more “humane,” air quotes, alternative to hanging or an electric chair, really is. Particularly given that many doctors and now many drug companies won’t participate on ethical grounds, and states are turning to some pretty questionable and, as we’ve seen, not always successful protocols, are we sort of getting to the end of this? Anna, I see you nodding. 

Edney: Yeah, I think that these botched executions and the most recent one have given a lot for the anti-capital-punishment groups to work with and to make their case about torture and that this isn’t something humane that we should be doing in the United States; we’re one of the few developed countries that does do that. And you brought up the point about medications and how a lot of the pharmaceutical companies don’t even want to give them to the corrections facilities anymore. And the problem is then those facilities need to find the drugs somewhere. They’re maybe going to less reputable places, or keeping them, the ones they do find, on hand for too long past their expiration date. And so it’s clearly not working out, when maybe if you had the perfect protocol and the drug just off the line of a very respectable company, things might work. But that’s not what’s been happening. 

Rovner: Yeah, I think we’re going to watch that space. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Michelle Andrews. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast Michelle Andrews, who reported and wrote the latest 吃瓜不打烊 “Bill of the Month.” Hi, Michelle. It’s been a minute. 

Michelle Andrews: Hi, Julie. It’s great to be here. 

Rovner: So this month’s patient was sent to the emergency room by an urgent care doctor for a particularly severe migraine attack. Tell us who she is, where she’s from, how she ended up at the hospital. 

Andrews: Sure. Her name is Autumn Daniels, and she lives in Champaign, Illinois, and she has a history of severe migraines back to when she was a kid, like a 10-year-old. And so she gets them regularly, more regularly now. And she had had this migraine for seven days, and finally, the urgent care doc said, “If you still are having trouble tomorrow, you need to go to the emergency room.” Because they’d given her some, you know, a shot to help relieve the symptoms, and it hadn’t worked. So she ended up at the emergency room, with her sister, and waited a long time for care. 

Rovner: So once she got there, she got triaged, right 鈥� checked by a nurse to see how serious her ailment was compared to others waiting to be seen. Then what happened? 

Andrews: Sure, I just want to say a word about triage because the hospital kind of makes a big deal of that. It’s just checking her temperature, her pulse, and her blood pressure, and asking her, “Do you often get migraines?” So they did this little bit of “care,” in quotes, and then they sent her back out to the waiting room, and she waited, with her sister. And she waited, for four hours, and nothing happened. 

Rovner: So she leaves and goes to another ER where she does get seen and treated, but then she gets a bill from the first ER, too. How much was it, and what did they say it was for? 

Andrews: The bill was for $410, and they said it was for an emergency room Level 1 visit, and they also stuck a procedural code on it that said that it had been an evaluation and management visit, meaning that some medical care had been provided by a healthcare provider. 

Rovner: Which was questionable, right? 

Andrews: Absolutely questionable. 

Rovner: So, is this a new thing? Hospitals billing for patients who don’t get beyond the initial triage? 

Andrews: Well, it’s new for this hospital, which I thought was interesting. Their policy changed, starting in March, I believe it was, where they said, oh, you know: If you come into our hospital, even if you don’t get treated by a provider, we can still bill you because we’re using up our staff time and we have to keep our facility running. And so that’s the justification that they use. Let me just say, I don’t know that other hospitals do it, but I don’t think it’s that rare, from what I understand. 

Rovner: And her insurance company was not buying this, right? 

Andrews: Exactly. They covered her second ER visit, and that was fine, where she got treated. But this whole, you know, You came to the hospital and you left without getting treatment. Sorry, we’re not going to cover that. 

Rovner: Because technically they said she left against medical advice, right? 

Andrews: Exactly, and of course she didn’t actually receive advice. But I did ask some experts in billing about this, and they said, Well, from the insurer’s perspective, what that often means is that, you know, she didn’t get care at the facility by a provider, and so she’s leaving against their advice, basically. 

Rovner: So, what’s the takeaway here? Is there a way to prevent something like this from happening? 

Andrews: I think there is no way to easily prevent it, but you can certainly ask when you arrive at the hospital, at the ER desk, with your throbbing headache, you can say, “Oh, what happens if I wait and I don’t get care?” You can check with your insurance company and ask them. You know, you would do that perhaps if you were someone who often ended up at the ER, but it’s not something most of us are going to think about. And then let me just say, you can, of course, appeal, and you should appeal if you’re not getting the answers or you’re getting billed in a way that you shouldn’t be billed. 

Rovner: Yeah, I love the kicker of your story: If you don’t appeal, the answer is always no. 

Andrews: Always no. Yes, exactly. 

Rovner: But still, I mean, another list of things that you need to do when you’re in an emergency health situation. Awesome. 

Andrews: I know, I know, and I think there was some conversation about well, you know, you signed these papers, and she’s like, Of course I signed the papers. I can’t be held responsible for the papers. I couldn’t 鈥� I could barely see. I was vomiting every 10 minutes. 

Rovner: Anyway, thank you for following this. And yet another thing to beware of when you go to the emergency room. Michelle Andrews, thanks for doing this. 

Andrews: Thanks, Julie. 

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

Ollstein: Yeah, I have a story from my colleague Carmen Paun. It’s called “,” and it is how that approach to foreign policy and foreign aid is playing out in the healthcare space, where the CDC [Centers for Disease Control and Prevention] is now closing offices it had in a bunch of other countries that were supporting local health systems there and also helping to monitor for outbreaks of infectious diseases. Nothing bad ever came from overseas, as we know! And so there’s a lot of worry about this. There is a lot of prediction over both the cuts that have come to HIV prevention and a bunch of other things, increased risk of outbreaks, but also just an inability to have early detection going forward. And there’s going to be some big appropriations fights about this that she previews in the story. 

Rovner: Good story. Paige. 

Winfield Cunningham: Yeah, mine is a New York Times story by Reed Abelson and Teddy Rosenbluth called “.” And I thought this was a really, really interesting story. It’s basically talking about how hospitals are running their coding through AI tools, and the AI is basically picking up more complicated conditions and then adding secondary conditions to basically maximize the number of things that they can bill the insurers for. And I had heard rumblings about this, and I remember actually talking to my sister last year, and she was telling me how they haul in the nurses and actually put them through training sessions of how to code for maximal return. And so it’s easy to see how if you’re now just starting to run this stuff through AI, they’re finding ways to just, you know, upcode as much as possible. So something to really watch amid this larger conversation about healthcare costs ballooning. 

Rovner: Indeed. Anna. 

Edney: Mine is from Annie Waldman at ProPublica: “.” Obviously, it’s an awful story about this baby who was given raw milk and contracted a terrible case of E. coli, and she’s going to have lifelong problems from this. It’s not just some simple thing. But I think the really important point that a lot of coverage before I haven’t seen as much of is that this was in California. The state really couldn’t do a whole lot. This farmer had sold potentially contaminated raw milk, and that’s not supposed to be something, even contaminated or not, that is sold. But there really wasn’t a lot that the state could do. When they even went to collect samples, they couldn’t enter the farm. They had to tell her they were coming back tomorrow to collect samples to test the milk. So, I mean, you can imagine all the things you could do to make sure the milk is clean by then. So I think it was an interesting look at why maybe this is proliferating right now. The FDA certainly isn’t doing a whole lot, given the secretary’s support for raw milk, and then it seems to be like the states’ hands are tied as well. 

Rovner: Yeah, it was a really good story. Well, my extra credit this week is an amazing read from Sarah Zhang at The Atlantic. It’s called “,” and it’s about a rare but tragic medical mystery involving mostly young men who fail to wake up normally from anesthesia, even for minor procedures. I won’t spoil the solution to the mystery, but it’s really a testament to smart and persistent moms for figuring out what happened and why, and working to prevent it from happening to more people in the future. You really need to read it. 

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 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 and on Bluesky . Where are you guys hanging about these days? Alice? 

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Anna. 

Edney: All the places . 

Rovner: Paige. 

Winfield Cunningham: And I’m mostly on X . 

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

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

Julie Rovner: 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, Oct. 1, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Rachel Roubein of The Washington Post. 

Rachel Roubein: Hey, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And my 吃瓜不打烊 colleague Rachana Pradhan. 

Rachana Pradhan: Hi, Julie. 

Rovner: Later in this episode, we’ll have my interview with Dr. Aaron Carroll of AcademyHealth about the undoing of the federal Agency for Healthcare Research and Quality, AHRQ, where most of the staff has been laid off or retired, and hundreds of grants have been canceled midcycle. But first, this week’s news. 

So we haven’t talked about the Make America Healthy Again movement in a while. It was a big week for MAHA here in Washington, D.C., with a gigantic summit at what used to be the Trump [International] Hotel, down the street from the White House. But it was hardly the event you’d expect if you still think of MAHA as moms who want their kids to have access to healthier food grown with fewer pesticides. Rather, this event featured representatives from health companies with business before the federal government, paying sponsorships of up to $300,000 each to sit on panels with officials from said government to talk about everything from the use of psychedelic drugs to fraud-fighting to wearables and AI [artificial intelligence]. The panel featuring Medicare and Medicaid chief Dr. [Mehmet] Oz was somewhat bizarrely moderated by comedian Russell Brand, who’s awaiting trial on sexual misconduct charges back in England. What was this event supposed to accomplish? 

Roubein: I think you kind of hit the nail on the head in terms of just thinking about the MAHA movement and sort of where it’s going next, because you had some people, more sort of MAHA activists, who were upset that it didn’t talk about some of the core issues of the MAHA base, like vaccines, like pesticides. There have been some influential MAHA activists who’ve been upset at the administration and disillusioned that it hasn’t done more to crack down on pesticide use, etc., have been upset at the Trump administration, and have been saying just weeks before the midterm elections that Republicans may lose some of these votes, and some so-called MAHA moms might sit out the elections. And I don’t think this summit did anything to persuade them to go and vote Republican in the midterms. 

Rovner: Yeah, it did seem, it seemed a great get-together if you wanted to sort of commune with the people who regulate your products, on a public stage. But both the president and Health and Human Services Secretary Robert F. Kennedy Jr. have felt free of late to talk about vaccines, although obviously not at this summit. But it seems that the issue that had united most of MAHA that we were just talking about, pesticides and ultraprocessed food, have been back-burnered by the White House. Rachel, you wrote a . What happened to the food agenda? 

Roubein: Pretty notably, one of the big potential parts of the food agenda is this petition that was filed by David Kessler. He’s the former head of the FDA [Food and Drug Administration] under both Republican and Democratic administrations. And his petition, essentially 鈥� I talked to food safety experts about it 鈥� could have launched a process that could have forced the industry to reformulate some ultraprocessed foods eventually. So that could have been a big deal. The status of it: It was filed August 2025, and Kennedy earlier this year had done a response to it, where he wanted to have food companies produce any detailed safety studies showing that certain ingredients common in ultraprocessed foods are generally safe. And what I had heard from talking to people is that that potential push had been slow-walked at the White House. I obtained a March draft of the letter that Kennedy sent to the White House for review. Now, HHS pushed back on the assertion that it was slow-walked, but this isn’t the first time that administration officials had wanted to and planned to announce something. They had been working on a definition of ultraprocessed foods that they wanted to release back in August, and that was delayed at the last minute, them just putting out more information about this draft definition. 

Rovner: I feel like there’s this tension between the MAHA movement, which started as a grassroots movement to crack down on corporate power, and the White House is sort of wanting to deregulate everything. Those two things seem to be kind of at loggerheads, and it looks for now like the corporations are winning. We saw this with the pesticides earlier in the year, with glyphosate, that the agricultural community fought back and said, You can’t make us stop using it, because we need it to produce food. And now it seems that the food producers are saying: You have a deregulatory agenda. Why are you talking about regulating us more? Is that, am I reading this right that the corporate power is winning, at least so far? 

Pradhan: It’s still a Republican administration, right? Regardless of Secretary Kennedy’s sort of mandate and passions, he’s still working with and for people who do not like to use government to restrict or regulate or ban things. Even, if you think about, we’ve come a long way since this point. But when former first lady Michelle Obama tried to put healthier foods in schools, she was roundly criticized for embodying a nanny state and all these things. And now, the political winds have shifted. But I still think to go up against the party’s kind of traditional views on regulating business and corporate interests, it’s a swamp. What are you going to do? They’re not going to want to regulate a lot. And like you said, Julie, there are ample actions to date that show that there isn’t necessarily a desire to impose more regulations. It’s also an election year. They may not want to antagonize corporate interests when you’re trying to not see huge losses, especially in potentially the House and maybe even the Senate. 

Rovner: Yeah, they have enough people who are mad at them. They don’t want to add to it. 

Pradhan: Exactly. 

Rovner: Well, of course, with every political split comes a new political opportunity. In Michigan, Democratic Senate nominee Abdul El-Sayed, who’s a prominent supporter of “Medicare for All,” is now trying to grab back some of those Democrats who gravitated to MAHA by unveiling something he’s calling the “Building a Healthier America” agenda, focusing on fewer pesticides, cleaner water, and healthier food. Rachel, you . Might it work? Might Democrats be able to sort of reclaim some of these people who drifted to the Republicans along with RFK Jr.? 

Roubein: I think it’s something that particularly some progressive Democrats are looking to, and they might look to do if they win back the House. In the Farm Bill, you saw Republicans and 鈥� some Republicans 鈥� and Democrats push back against giving pesticide makers immunity liability shields. But I think it remains an open question. And I think it also depends on the different groups, in terms of MAHA. Tony Lyons at MAHA Action has said that they want there to be an alliance with Republicans. But you also see this with Rep. Alexandria Ocasio-Cortez trying to court some MAHA activists her way. So I think it’s an open question in terms of how this movement unfolds and whether there are any deviations towards the left. But it is a hard sell in some ways. Vaccines are a big part of a lot of people in the MAHA base. And when I asked El-Sayed about this, he said they’re, like, We’re going to agree to disagree on vaccines. 

Rovner: Yeah, he’s trained as a doctor and he does believe in vaccines. And he was the head of public health at the city of Detroit. He’s definitely not with the anti-vaccine types. But it’s important to remember that the original anti-vax movement was a combination of people from the far right and from the far left. So there have always been a lot of Democrats in the anti-vax movement, and this has been a group that’s been kind of up for grabs. And we will, I guess we’ll see how it will all shake out. 

Roubein: And some of the things on food Sen. Bernie Sanders has said for a long time, too. So there has always sort of been some of that intersection on certain issues. 

Rovner: Yeah. Well, originally RFK Jr. was running as a Democrat before he took up with the Trump team. All right. Moving on. Today is Oct. 1, the start of the fiscal year. Happy FY 2027, everyone. The Trump administration marked the day a little early, informing Congress last Friday that it was declining to spend more than $800 billion, in what’s called a pocket rescission. That’s when an administration declines to spend money appropriated by Congress so close to the end of the fiscal year that it basically can’t be spent at all and Congress doesn’t have time to disapprove it. The majority of this funding is from HHS, largely for programs to help noncitizens and for what the administration calls, quote, “overfunded and unaligned” HHS research programs. That includes many related to minority health. Congressional spending leaders, including Senate Appropriations Chair Susan Collins of Maine, complained that pocket rescissions are illegal under a law called the Impoundment Control Act, and the Government Accountability Office issued an opinion this week backing that claim up. But, as we know, this administration likes to dare courts to stop it from doing things that just about everybody else acknowledges is illegal. And I guess that’s where we are here? 

Luthra: No, I was just thinking, right? It’s October. Everything that happens now, we also think about in the context of an election, and I think a dynamic that we have talked about a lot is this effort by the administration to just sort of do what it would like to do with funding, even when many people might say that is not how the laws and separation of powers are supposed to work. And I think something really interesting for us to consider is whether those dynamics do, in fact, change in the new year. Given what Rachana mentioned earlier, there is a very good chance that Democrats control both chambers of Congress, not just one. And [does] that possibility of conflict with another branch in Washington change what behavior we see from the White House? I think that’s a really interesting question and something that we should be thinking about as the election gets closer, and then again depending on what the results end up being. 

Rovner: Yeah, one of the really weedy issues here is who gets to sue the administration to say that, Hey, you’re not allowed to not spend money that we’ve appropriated. It was important that they came out and said that this was illegal, because the GAO, under the law, has standing to sue. But they don’t have a confirmed leader at this point, and Susan Collins was asked about this and said they may be a little bit wary to kind of get out in front of Congress. But I think it’s probably fair to say that if Democrats take back the House and Senate, that they would be more likely to want to either 鈥� I think that the Congress itself can sue the administration, can go to court and say, Hey, you can’t do this, which obviously the Republican Congress hasn’t wanted to do. But a Democratic Congress might. 

Pradhan: What 鈥� has GAO ever been known to sue? 

Rovner: That’s a good question. I can’t remember. We’ve had fights about rescissions before. 

Pradhan: Yeah. 

Rovner: But it’s 鈥� Russell Vought, the head of the White House Office of Management and Budget, says publicly that he thinks that the Impoundment Control Act is unconstitutional and therefore they don’t have to obey it. That’s clearly something for a court to determine. That’s clearly something for the Supreme Court to determine. We haven’t gotten there yet, but most of the time, I think, we’ve had lower courts that have warned the administration: Um, hey, there’s this law that says you can’t do that. You have to spend money the way Congress says you should spend money. The last time we had a pocket rescission, I looked it up, was last year when this administration did the same thing. That was the USAID [U.S. Agency for International Development] money. So before that, I’m not sure when. I may go back and have a look. Shefali, to your point, that was my next question anyway. It’s like, I would think that the one thing that is likely to change if the Democrats take Congress 鈥� obviously, we have two more years of the Trump administration 鈥� but I would think they would be a lot more zealous in guarding their spending power than this Congress has been. 

Luthra: One would imagine. It seems hard to abdicate the power that one might want. That’s how separation of powers, in theory, is supposed to work. 

Rovner: And it is kind of written into the Constitution. 

Pradhan: I do wonder, though, if they think that, if they wouldn’t get a good, friendly decision from a court 鈥� 

Rovner: The Supreme Court. Yeah. 

Pradhan: Yeah. That could be far more damaging in the long term, right? 

Rovner: Yes. There is the concern that the Supreme Court would agree with Russell Vought that the Impoundment Control Act 鈥� 

Pradhan: Right. 

Rovner: 鈥� is unconstitutional. That is a risk that they would run. 

Pradhan: Right. 

Rovner: Well, that will happen. We will see what happens with that. All right. So, obviously these latest cuts aren’t the only ones to HHS that have been made since [President Donald] Trump returned to office in 2025. We will talk more about what’s happened at the Agency for Healthcare Research and Quality in this week’s interview, but I want to talk a little bit right now about the Centers for Disease Control and Prevention, whose workforce we now know is down by almost a third, according to . Quote: “The changes have hindered the C.D.C.’s ability to respond to outbreaks as measles spreads at home and Ebola abroad,” while, quote, “entire divisions have been shuttered, including teams that worked on smoking, sexual violence, child abuse and falls among older adults.” Separately, but not really separately, the CDC’s advisory committee on vaccine practices has ground to a halt after a judge struck down Kennedy’s replacement members as unqualified. Medical societies have stepped in with their own vaccine recommendations for this fall, but the official CDC guidance is already out of date because there’s no ACIP [Advisory Committee on Immunization Practices] to make recommendations. This is all going to come home to roost the next time we have a bad flu season, I imagine. 

Pradhan: Yeah, I think that the Times, the New York Times, story, what I thought was really, kind of what they led with, was that even though last year you had these widespread firings across HHS and different agencies, including the CDC 鈥� the CDC at that time we know lost about 1 in 5 workers 鈥� but really the true scale of the losses is much higher. It’s about 30% fewer employees. But the CDC has really had a rough go of it. I think it probably was the 鈥� it was the poster child for everything that went wrong during the pandemic, in Republicans’ view. And so they’ve been very keen on dismantling a lot of that agency, more so than the FDA and more so than the NIH [National Institutes of Health], for example, even though they’ve also seen a lot of staff reductions. But CDC, I think, has been so crippled for so long, both because of the staff reductions and just the awful morale at the agency because of everything that the current political leadership has done since. Yeah. 

Rovner: I would say, and the politicization of its leadership, things that were long run by career scientists in Democratic and Republican administrations that are now being run by political appointees, who are rather pointedly not scientists 鈥� 

Pradhan: Yeah. 

Rovner: 鈥� running this very scientifically driven agency. And of course we’ve had a fifth measles death in Pennsylvania now, that apparently the CDC is still not acknowledging the measles deaths in Pennsylvania. So there are still a lot of questions. The CDC does have, unlike several of the other HHS agencies, does have a Senate-confirmed leader. But so far, we haven’t heard very much from her. I guess we are all still sort of waiting to see what happens, but in the meantime, I can just imagine if we have a bad flu season or some other respiratory ailment that could have been prevented if CDC had been up to date with its vaccine recommendations, things could get rather loud and nasty later this winter. 

Roubein: Some of the vaccine recommendations, some of this is very much tied into the lawsuit, just like the high-level ACIP not putting more vaccine recommendations out. And this part has had somewhat of a snowball effect, like the Vaccines for Children Program, giving out free vaccines to uninsured, underinsured kids, that was held up for about a month. That is now going through, but they had to kind of work through: What are the recommendations going to be? And they ended up going with prior recommendations because there is not an ACIP to meet. So some of this has been tied up in legal limbo. And yeah, on the measles deaths, CDC is now acknowledging two out of the five that Pennsylvania has reported. 

Rovner: There we go. We’re finally hearing something. All right, we’re going to take a quick break. We will be right back. 

Turning to reproductive health, the Hyde Amendment 鈥� that’s the annual appropriations rider that bars federal funding for abortion in most cases 鈥� turns 50 this week, which, as one abortion rights group pointed out, means that the ban itself has now been in effect longer than Roe v. Wade was in force. Shefali, what’s been the impact of the Hyde Amendment on the ground? What does it actually mean for people who are seeking reproductive care? 

Luthra: It’s a bit more complicated than I think people might initially realize. The Hyde Amendment prohibits the use of federal funds to pay for abortion 鈥� functionally, Medicaid. And so Medicaid programs are jointly funded by state governments and federal governments. If you are in a state where the state government does not want to put money into paying for Medicaid coverage of abortion, your abortion will not be covered, especially if you are low-income. Most people who get abortions are people who cannot afford another child. They are parents already. They are largely people who are low-income and rely on something like Medicaid. However, there are states, the Californias, etc., of the world, that have made a point of putting state funds into their Medicaid programs. So in some states, you can get Medicaid to cover your abortion. That’s really helpful. It makes this procedure much more affordable. It can cost hundreds of dollars, sometimes a lot more, depending on where you are in your pregnancy, to get an abortion. But, of course, the fact that this has existed for so long has absolutely made it harder for people, often those who are most financially vulnerable, to get abortions. What you often hear from those patients, though, when I speak to them, is, like, This is something I really can’t afford right now, but I will pay for it anyway because I really can’t afford another child. I think the Hyde Amendment is really striking in that it makes this thing much harder to get. But for a lot of people, it doesn’t necessarily stop them from getting it, because it is just so important to them. 

Rovner: It’s ironic that something that has to, literally Congress has to pass every year 鈥� it is a rider on a spending bill. Democrats have tried various ways to get rid of it, always failed. Even when we had a Congress that supported abortion rights, they could not get this out. It is just sort of part of the landscape now, isn’t it? 

Luthra: And part of it is, I think, demonstrative of one of the more effective anti-abortion lines a lot of Republicans have. Abortion public opinion is very complicated. And people support abortion rights in the abstract, but when you get into more specifics, their views become more complicated. And one framing a lot of the GOP has really found success with is saying, We don’t support taxpayer funding of abortion. And that really works because people will hear that and they say: Oh, well, that sounds very extreme. I support this for other people, but, like, my tax dollars, they can’t fund that. And that is the line that has been used to keep Medicaid from paying for abortions, to keep the Hyde Amendment intact, and to keep other federal programs as well from making this more available. And I think it’s perhaps more politically complicated than first blush at abortion polling data might suggest to undo something like this, 

Rovner: I absolutely agree. Well, still, anti-abortion forces remain intent on cutting off the main remaining source of access to abortion, the abortion pill mifepristone. This week, the attorneys general of Louisiana, Alabama, and Arkansas filed suit in federal district court 鈥� not at the Supreme Court, which the group’s press release says 鈥� to strike down the shield laws in New York, Massachusetts, and California. Those are the laws that enable doctors in those states to provide telehealth appointments to people in ban states seeking to terminate their pregnancies. Shefali, there’s already a lawsuit on mifepristone making its way through the courts, and it’s from Louisiana. How is this one different? 

Luthra: This one is different because it specifically goes after shield laws and it challenges their constitutionality. That is a different argument. It is more sweeping. It could be the thing that finally gets the Supreme Court to weigh in on this issue. Right? It’s a very, very big legal question, something that constitutional scholars have believed, since the enactment of shield laws will ultimately be settled by the Supreme Court. However, I think it’s really important for us to take this suit with context. As you mentioned, there are so many cases making their way through the courts right now around how people get abortions, the provision of mifepristone, shield laws, etc., etc. We don’t know which one will end up at the Supreme Court. We don’t know how courts will rule. This is just one more quiver in the bow that abortion opponents are trying to use to stop this telehealth model that has found quite a bit of success. We will see which one lands. It very well could be this one, but, at this point, we just don’t know. 

Rovner: Yeah, and I should point out that the other Louisiana case is about FDA and its approval of mifepristone to be prescribed via telehealth. So, and of course, we’re also waiting for the administration to do, to finish its FDA safety review, which we expect to see sometime after the election. Speaking of which, abortion is not quite the high-profile electoral issue this year that it was in 2024, but there’s still several abortion-related ballot initiatives to be voted on this year. Shefali, any that you’re watching particularly closely? Or any of the others of you? 

Luthra: I am personally very interested in the Idaho measure and the Missouri one. I spent a bit of time in both of those states learning about what’s happening there over the past month. I think it’s really fascinating. In Missouri, it’s a very strange case. Two years ago, voters amended their constitution and said, We will protect abortion rights. Abortion is now legal in Missouri, a state run by very, very anti-abortion lawmakers. Those same lawmakers were horrified by this finding, and so they have put forth a new ballot measure that would overturn the 2024 result, and it would amend the state constitution to ban abortion. And if that passes, Missouri’s constitution would be the only state constitution to explicitly ban abortion. That’s a really big deal. If this passes, it could set an example to other states where voters have said, We support abortion rights and lawmakers have felt very frustrated by that. Polling right now is a very even split. There is a lot of money. We will see what happens. But I think this is a really interesting case for us to be following. 

Rovner: And it’s super confusing because they just voted on this. 

Luthra: It’s so confusing. And it’s called Amendment 3. If you look at two years ago, the abortion rights measure was also called Amendment 3, and so you might be like: Well, I just voted on Amendment 3. I voted for it. I should vote for it again. And in fact, that would be the opposite. And I’ve spoken to people 鈥� 

Pradhan: That’s very confusing. That’s very confusing. How are people supposed to keep up with all this? I can barely keep up with it. 

Luthra: How are they supposed to keep up with all of it? That’s such a good question. 

Pradhan: It’s a lot. 

Luthra: But no, and I’ve spoken to people who work in politics in the area, and they had no idea this was even on the ballot. And I was like, That’s also really striking that abortion has faded from a lot of the political consciousness. But actually there’s this measure that could have really sweeping consequences and really inspire similar action in other states. And the Idaho measure, I think, also very interesting. That would actually not amend the constitution. It would just pass a law that would overturn Idaho’s very, very strict abortion ban, which has sparked all these headlines 鈥� women being airlifted to Utah for medical emergencies, doctors leaving, labor and delivery wards shutting down because the law is so strict there. It’s really an open question, but there is some polling that suggests that this could pass. They have gotten a lot of support from Democrats, but also independents, also Republicans. A lot of people in Idaho who were never really politically engaged very deeply are, because this abortion ban has been so sweeping, affected so many of them so personally. If it passes, the legislature could vote to overturn it, and we’ve seen that happen in states around the country. But I think we don’t know, A) if it will pass and, B) if it did how lawmakers might react. There’s a real chance 鈥� right? 鈥� that they are just so surprised that this happens that maybe you do reconsider the politics of instituting an abortion ban when voters rejected one. But absolutely worth following and seeing what happens in this case, for political reasons but also because a lot of people’s lives could be really, really fundamentally changed as a result of it. 

Roubein: Missouri sounds like such an interesting test case, because I remember back in 2022, after the Supreme Court decision, abortion rights groups were really grasping for a strategy, so they were throwing a bunch of different things at the wall, lawsuits, and then they tried the ballot measures, and it just seemed to work and take off steam. So that’s pretty interesting. 

Rovner: Yeah, and of course, as you pointed out, Missouri has some of the most strident anti-abortion lawmakers in Congress. Josh Hawley, the senator whose wife is one of the lawyers for the anti-abortion, for the main anti-abortion legal group. So Missouri is one of those states that’s got all of the poles represented, and we will have to see how that all comes out. 

Pradhan: Can I make one last addendum on the abortion thing, which is because I’m a Virginia resident? Actually, I was talking to my husband the other day. I said, “Oh, this is how you know that Democrats are in charge,” or we have a relatively new Democratic governor. So now there’s a proposed constitutional amendment on the ballot to amend the state constitution to codify abortion being legal until 28 weeks, so basically through the first two trimesters. Which, you know, Virginia is interesting. I’m biased because I live here, but it’s, of course, trended blue with many prior elections, like leading up to now. But parts of the state are very, very conservative. 

Rovner: Yeah, Virginia is still the South in a lot of ways. 

Pradhan: Yeah. Oh, yeah. And it doesn’t take you long to figure that out once you leave the D.C. area, and there’s a lot of religious-based opposition to abortion. So I’m not sure how it’ll do, whether people will support it or not. 

Rovner: I’m curious whether 鈥� if we really are looking at a blue wave, and we certainly see a lot of Democrats in unlikely states who seem to have at least a chance of getting elected because of the frustration, mostly with the economy 鈥� whether that will bring along some of these other issues in a way that it might not have. Because, as we say all the time, midterms are about turnout, and it looks like the motivated voters this time are bluer than redder. But I guess that’s another thing that we will have to wait and see. 

All right, that is this week’s news. Now we’ll play my interview with Aaron Carroll of AcademyHealth, and then we will come back and do our extra credits.  

I am pleased to welcome back to the podcast Dr. Aaron Carroll, president and CEO of AcademyHealth, which supports the health services research community. Aaron Carroll, thank you so much for being here. 

Aaron Carroll: Always a pleasure. 

Rovner: So I’ve asked you here to talk about the Trump administration’s effective dismantling of the Agency for Healthcare Quality and Research, which even many of our very nerdy listeners might not have heard of. But first, tell us what health services research is and how it differs from the biomedical research that most people are more familiar with. 

Carroll: I think everybody really gets what we might call discovery research, which is about learning new things at a cellular, molecular, you know, body level 鈥� the creation of drugs, the creation of new procedures. You know, everybody sort of understands why we need to do that. But that’s only part of the problem. The bigger problem is how do we actually get that to where people are? So health services research focuses on: How do we improve the access, the quality, and the cost of a healthcare system? Another way I like to think about it is that everything that people hate about healthcare is what health services research focuses on. It costs too much? Yeah, that’s health services research. You can’t get in to see the clinician you want? Wait times are too long? That’s health services research. You feel like you’re not getting the quality that you should, or you’re worried that you know chronic diseases on 鈥�? That’s health services research. We spend very little time and very little money, unfortunately, on that type of research. But it’s just as important as discovery research, and I think that one of the reasons why we continue to be so dissatisfied with the healthcare system is because we’re not committed to studying and improving those things in the same way we are discovery. 

Rovner: So how does AHRQ facilitate that, or how has AHRQ facilitated that? 

Carroll: Sure. So, I mean, some of it is by creating and maintaining some of the big databases that people use to study the healthcare system, things like MEPS or other related databases. 

Rovner: MEPS is the Medical Expenditures 鈥� 

Carroll: Medical Expenditure Panel Survey. Yes, but I think the bigger way is that they give out independent investigator grants the same way that the NIH does. It just focuses more on health services research, and sometimes they have, you know, different areas that they choose to focus on, depending on the administration, because every administration should get to set priorities or, you know, decide what they think are most important. But they usually give out lots of grants, and I’ve had some over my career, that allow you to do all kinds of research to try to examine how you might improve the way that people receive care or pay for care or get care. 

Rovner: And some of that research has actually created improvements in the healthcare system, is that fair to say?  

Carroll: Absolutely. Yeah, I mean, the reason that, like, we landed on, say, $35 for insulin is because of health services research. It’s because of research that was done that found that that was sort of the inflection point. That when out-of-pocket costs got above that amount, people stopped taking their insulin as they should. And I understand the need for some copays 鈥� and obviously, we have a healthcare system. 鈥� But it’s, like, finding that kind of stuff out is health services research. And, you know, even some of the grants that were canceled this year would make sense to any, everyday Americans. Like, how do we improve the way that hospitals use antibiotics so we get less resistance, or how do we improve care using telehealth so that kids can get better asthma care or autism diagnoses? These are not discoveries in the sense of new medications, but they are things that we need to learn how to do to make the healthcare system work for everyone. 

Rovner: So I actually covered the creation of not just AHRQ, but of its predecessor agency, the Agency for Health Care Policy and Research, way back in 1989, when I was a baby healthcare reporter. It was not just a bipartisan agency. Its creation was spearheaded by Republicans who wanted to know, basically, which medical interventions worked and whether the U.S. was getting its money’s worth on medical procedures. The reinvention of the agency 10 years later was led by Sen. Bill Frist, a Republican former transplant surgeon who later served as the Senate’s majority leader. So, how did the Trump administration come to view this agency as so “woke” that it basically needed to be disassembled? 

Carroll: I don’t know. And again, if you don’t like the research priorities, it is perfectly reasonable for an administration to say, Let’s change them. And if they decided they wanted to focus on cost, OK. If they decided they wanted to focus on access, OK. There’s so many different ways to do this, but what they’ve done instead is apparently cancel a ton of grants that were already ongoing 鈥� and I’d be happy to talk about more specifics about that 鈥� but also they just are not spending the money. In fiscal year 2025, there was a significant amount of money that wasn’t spent. Many believe that’s an illegal impoundment, and there’s a case working its way through the courts right now, led by the Society for General Internal Medicine and Public Citizen, and they actually folded in some of the cancellation grants. But in fiscal year 2026, almost no money has been given out for new grants. Today, as we’re taping this, it is the last day of the fiscal year. I have no idea how possibly they’re going to spend the $345 million that was appropriated in 2026. A lot of that is not going to go out the door. In answer to that, they have said that 97% is being on track to be spent. I don’t know how that’s possible. And it’s very, very likely, again, we’re going to see a ton of money unspent, and I imagine lawsuits and more yelling will follow. 

Rovner: So, Congress appropriated this money. The president signed the appropriations bill. What can Congress do, and why isn’t Congress doing something? 

Carroll: So I ask those same questions every day. I don’t understand how Congress is not out of its mind. I mean, this is not something, again, from the “woke” Biden administration. This is this Congress, this House, this Senate passed a budget in a bipartisan manner, that was then signed by the president of the United States 鈥� this president 鈥� into law. The money’s been appropriated. 鈥� In fact, there was specific language in the budget that required HHS to staff up to make sure that they could spend this money. They have not staffed up. They have not spent the money. I don’t know how Congress is not losing their minds. It is an absolute ignoring the law. It is absolutely ignoring Congress’ will. I know there’s a GAO investigation. I know questions have been asked, and I don’t think answers have been given. It makes no sense whatsoever. I don’t know, again, why Congress isn’t screaming and yelling and taking action. Now, what action should they take? Hearings, oversight, make sure that all of this happens. Haul people in to session and find out why are they not following the law, and force the executive branch, as the legislative branch should do, as an equal part of our government, to follow the law. 

Rovner: And it’s not just the grants. I mean, most of the staff has now been basically terminated. 

Carroll: Yeah. Well, that’s what I mean. And there are now minimum staffing requirements in the law, and those are not being followed. I mean, depending upon whose estimates you believe, somewhere between 75% and 90% of AHRQ staff have either been let go or have left the organization. We can’t get exact numbers because they won’t release them. But there aren’t enough people even to process or put the money out the door. Even if they decided today we’ve got to get all the money, it’s not possible. There just aren’t people there to fill out the forms, check the budgets, do all the due diligence, administer the grants, oversee it. There’s no one there, and it’s an absolute abdication of their responsibility to enact the budget and the law as Congress has appropriated and put forth. 

Rovner: Last question: What would it mean 鈥� I mean, what would the loss, basically, of what AHRQ has been doing for these last 26 years mean 鈥� to the healthcare system and how it runs? 

Carroll: I mean, we spend $40-some billion a year on the NIH 鈥� I think about $47 billion. AHRQ, again, is $345 million. So we have been massively underspending on sort of what I would call “delivery” research on how the healthcare system works. And it’s one of the reasons why Americans are getting angrier and angrier every year because they’re, like, Why won’t things get better? Well, we’re not funding it enough. We’re not doing enough. And then, what little we were doing, they canceled in July and refused to spend now. So, what’ll happen? We will remain just as angry, if not angrier, about how much we’re paying for healthcare. We will remain just as angry, if not angrier, about how we can’t get what we need, and we’ll remain just as angry, if not angrier, about the fact that we can spend all this money that we do, $5 trillion-plus, and still feel like we’re not getting the quality, and continue to complain about how unhealthy we all are. AHRQ is the solution to a lot of these problems, and, for some reason, we just won’t use it. 

Rovner: Aaron Carroll, we will stay on top of this. We will revisit it. I promise. 

Carroll: I’m glad to hear that. 

Rovner: Thank you. 

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

Roubein: My extra credit is headlined “” It was in Stat by Elaine Chen. I thought it was a really fascinating story because we’ve all seen the cultural shift toward GLP-1s, and we’ve all heard the drugs praised as a way to address obesity as a medical issue. But Elaine reports that the drugs are now being increasingly marketed as a way to look and feel better. I thought there were some notable examples. The story explored how Novo Nordisk, which is one of the drugs’ makers, has particularly leaned into the shift. For instance, the company had advertisements this summer with slogans that include “live lighter” and “a summer glow-up.” And instead of labeling the drug as a drug for weight management, it sometimes is referring to it as a weight loss drug. And Elaine talked to some doctors and patient advocates that think the drug’s being talked about more as a retail product, run against the industry’s sort of initial goals of trying to convince the greater public that obesity is a disease and that the drug should be covered by insurance. For Novo Nordisk’s part, a spokeswoman told Elaine that how people expect to access and experience care has changed in recent years, and the company recognizes that healthcare needs to become more responsive, relevant, and easier to fit into everyday life. 

Rovner: I would just note, and it’s a very good story, that if the drugmakers lowered the price of the drugs, it would be easier to get it covered by insurance. But that’s just an aside. Shefali. 

Luthra: My story is from The Atlantic by Caitlin Dickerson. The headline is “.” It’s a great story. It is about when parents are deported without their children, what happens to those children? This is the kind of reporting that is really hard to do because you have to spend time with children who have lost their parents. But I think it’s really important, especially as we see this uptick in detaining and deporting, in particular, people with children. I’ve spoken to a lot of mothers who have been deported when they had children here, and the consequences will last probably people’s whole lives. There are health consequences, especially when you have young children. There is PTSD, and I think Caitlin Dickerson has done some of the best reporting on immigration in the past decade, maybe longer. And this is absolutely an essential addition to that canon. 

Rovner: It is indeed. Rachana. 

Pradhan: My story is a trifecta from my colleagues Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett, who wrote a story about, as of today, hundreds of thousands likely of immigrants who are lawfully present in the United States but who have low incomes are now no longer eligible for Medicaid. This is part of President Trump’s signature One Big Beautiful Bill Act, which will enact greater coverage reductions next year, starting in 2027. But this group of people is now no longer eligible for Medicaid. It includes refugees, some people who have been granted asylum, and also, you know, victims of domestic violence and/or human trafficking. So the story gets into how we have our beloved Congressional Budget Office here in Washington that sort of estimates the impacts of tons of legislation. And they estimated previously that about 100,000 immigrants would be uninsured by 2034 because of this provision. But based on figures that my three colleagues got from state governments or state Medicaid agencies, the figure is likely to be higher of the numbers of immigrants with legal status who are going to now not be able to receive Medicaid. So yeah. So it’s a great read, and I know Julie will put the link in the podcast and in the comments. 

Rovner: I will indeed. Yes, there’s the continuing, you know, “immigration is a health issue, too” theme that we have this week. All right, my extra credit is actually an update to an extra credit from last month. Like last month’s story, it’s from The New York Times, and it’s called “,” by Madaleine Rubin. And it seems that my alma mater 鈥� also, full disclosure, the alma mater of my editor and several of our panelists 鈥� has rethought the idea of letting incoming freshmen complete their first semester without letter grades to ease them into college life. According to a statement from interim university president Domenico Grasso, there was concern that students would be, quote, “unfairly portrayed as coddled or unprepared for the demands of a rigorous Michigan education.” Yeah, I would add that a lot of the backlash came from my fellow alums, and that even though I attended Michigan well back in the 20th century, even in the olden days, we had the option to take classes pass/fail if we wanted to. Although I would note that under the original proposal here, the students wouldn’t have failed, but they would either have gotten a pass or a “no credit.” Good job rethinking this, guys, and Go Blue. 

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 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 about these days? Shefali. 

Luthra: I guess I’m on Bluesky , but you can also email me. 

Rovner: There you go. Rachana. 

Pradhan: @rachanadpradhan, both on and on , and you can always email me at RachanaP@kff.org. 

Rovner: Rachel. 

Roubein: Yes. X: ; Bluesky: ; and Signal is always good too: RachelRoubein.28. 

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

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

Julie Rovner: 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, Sept. 24, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Tami Luhby of CNN. 

Tami Luhby: Hello. 

Rovner: 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 Sarah Jane Tribble. 

Sarah Jane Tribble: Good to be here. 

Rovner: No interview this week, but plenty of news. So let’s dive right in. We’re less than six weeks away from the midterm elections, and healthcare, particularly its rising cost, is shaping up as a top issue for voters. Sarah, I want to start with you this week because you’re part of a new polling project that KFF is doing with the AP, looking at rural voters. What did our new poll find about rural voters and their views on healthcare? 

Tribble: Yeah. Well, the big headline is that 48% of rural voters believe the economy is worse off now, and that leads into healthcare because their key pain points are, not surprisingly, gas, groceries, and healthcare. Those all rank right up above 60% of those who are polled. They polled about 2,200 roughly rural Americans across the U.S. in August, mid-August. So this is a very fresh poll, only focused on rural Americans, which, as we know, is a key voting bloc for [President Donald] Trump and the Republican Party. 

Rovner: So 鈥� the rural voters tend to be more heavily Republican, right? 

Tribble: Yeah, they tend to skew Republican. Yep. 

Rovner: But there are fewer of them. So, but they’re a key voting bloc. 鈥� What did they find in terms of, you know, their continued support for President Trump and Republicans in general? 

Tribble: Yeah. So, you know, it was an interesting survey in the nuance. And what I love about this, and I’ve been covering rural America for four or five years now, exclusively, and there is a lot of nuance in rural America. It’s not a monolith, right? There’s lots of different people. So, while 48% of rural voters believe the economy is worse off now, about half also still approve of Trump’s job performance. And so what we’re finding is the Republicans 鈥� I talked to one expert, Tim Slack at the Louisiana State University. He’s a sociology professor. He’s written some books. What he said was he expects Republicans to sit this one out. And we talked to an array of Republicans, and that’s sort of what we heard. And you’ll have to read our story, but that’s pretty much what’s in there. 

Rovner: I will link to the story. But that’s really important because I mean one of the things we know about midterms, it’s not just who supports who and who opposes who, but who actually shows up to vote, right? 

Tribble: Right. Yeah. And what was really interesting for me, personally 鈥� and it’s, like, one of my colleagues and I were talking, and he was like, “You have a front-row seat to the elections,” because, you know, rural Americans, they too tend to come out to vote. They skew older, and they tend to be voters, right? But when I talked to the Democrats, they were certainly going to the polls. They definitely knew who they were voting for. But the Republicans I talked to, for the most part, were very sort of like, Well, I’ll definitely vote for this Republican, but maybe not my Senate seat, because I’m not happy with them. So it was a really interesting sort of pause that they would give. 

Rovner: So yeah, it’s an early indication, as we say. Well, healthcare is also playing a role in several high-profile Senate races. Michigan, of course, is a top one, pitting Democrat Abdul El-Sayed, a longtime backer of “Medicare for All,” against Republican Mike Rogers, a former House member who is touting price transparency as his health platform. But health is also showing up in Iowa, where Republican Rep. Ashley Hinson says she’ll fight Big Insurance, while Democrat Josh Turek says he’ll fight Big Pharma. And in Ohio, where Democratic former senator and Affordable Care Act sponsor Sherrod Brown is pushing to rein in insurance company denials, while Republican opponent Jon Husted is both vowing to overhaul the Affordable Care Act and restore the expanded subsidies that expired last year, at least temporarily. So it looks like , but in many different pieces. Am I sort of reading this right? 

Kenen: I think, rather than being a healthcare election in great big capital letters 鈥� which we’ve all lived through a number of those, both in the primaries and in the generals 鈥� I think it’s falling under this larger affordability issue. Like, I think that it now has a whole bunch of dollar signs instead of vowels. And I think healthcare is a big concern for people. We hear about it every day, but it’s part of this longer, Oh my God, life is just too, too, too expensive. And then there’s also this big 鈥� distrust of big things, including Big Pharma, Big Insurance, big everything. Right? At the same time, this is a really fast-moving political environment. Well, we all know that since, you know, by the end of the day, it feels like 20 years. And the issue, which started out as the data center issues; it’s now a larger existential fear of AI, and what is going to be done about it, and who is afraid. So this is a really shifting election. Like, what is going to motivate people? And what happens is even more un- 鈥� I mean, elections are unpredictable by definition, and this is going to be 鈥� like, if it was right today, the Democrats would be extremely happy. But who knows how many news cycles we go through between today and tomorrow? So yes, it’s a healthcare election, but we’re not calling it a healthcare election. 

Rovner: I was more thinking that it’s 鈥� 

Kenen: I mean, existential, getting wiped out is a health issue! 

Rovner: I was more thinking, though, that neither party actually has a health platform. I’m sort of struck by how Democrats and Republicans are all talking about health, but they’re all talking about different pieces of it, because we know that within each party there are differences in what they want to do about healthcare. 

Luhby: Right, and I think that’s one of the main issues. I mean, the Democrats are talking about how they want to extend the expired Affordable Care Act premium subsidies, which caused a lot of premiums to go up for many millions of people, but they also want to reverse the Medicaid cuts and the [One] Big Beautiful Bill. But then you also have the other side, where they’re talking about Medicare for All among the progressives, so they’re sort of split within themselves, and they don’t have exactly a unified message. And the Republicans are on the ropes this year on healthcare, as they have been in other elections. And this year, you know, they don’t want to highlight all of the cuts that they’ve made. So they’re highlighting, you know, their efforts to fight fraud. We saw [Vice President JD] Vance’s announcement earlier this week, and they’re touting, many of them are touting the Rural Health Transformation Fund, the $50 billion fund that was in the Big Beautiful Bill, without saying that the Medicaid cuts are going to affect rural America far more than the transformation fund will help them. 

Tribble: Yeah, one of the interesting findings in the research study 鈥� so, this Rural Health Transformation Program is something I’ve been following pretty closely 鈥� and one of the interesting findings in it for rural America is they pretty much hadn’t heard of it. 

Rovner: So for all of that effort! 

Luhby: Yeah, that’s surprising because so many of the candidates in that, you know, area are touting it on the trail. 

Tribble: Yeah, well, and at the same time, though, they also pretty much hadn’t heard of Medicaid changes either. Even people I talked to who had kids enrolled in Medicaid said they were pretty much unaware 鈥� maybe some cuts were coming. I did talk to a former hospital worker who said, “Yeah, it’s going to hurt a lot of people.” But she was a Democrat. Most of the people I talked to were unaware of Medicaid, and they also were unaware of the Rural Health Transformation Program and its impact. So I don’t know where that leaves the Republicans, but their messaging just isn’t getting out there on at least the RHT. 

Rovner: Well, to pick up on what Tami 鈥� oh, Joanne, go ahead. 

Kenen: I think people are just very overwhelmed, like, I don’t think 鈥� it’s really hard to know, like, people have these gut feelings and these sort of ideological identities, but everybody’s so overwhelmed by everything right now. I even wonder with the polls, like, who even answers their cellphone for it? We already made the shift from landline to cellphones, right? I mean, everybody is just swamped, and some people have just tuned out, and some people just can’t absorb everything that’s out there. So I don’t think voters are that well informed about the facts. I think a lot of people vote on guts and, you know, sort of gut feelings, and I think that’s always been true to a certain extent. But 鈥� you can’t poll on whether people are paying attention to polls. 

Luhby: One thing that an expert told me a couple of years ago that I thought was really, you know, insightful was the fact that people see their gas prices every time they fill up or every time they pass the gas station. They see the increase in grocery prices every time they go to, you know, buy food or go to a restaurant or so. But they only see their healthcare increases when they need care, or maybe once a month for the premium. So, you know, I think you were right, Joanne, when you said that the healthcare is now sort of lumped into a larger issue of affordability. But the affordability crisis that people are really seeing daily or weekly are gas and groceries, not necessarily healthcare. 

Tribble: In my interviews, what I noticed was people 鈥� I would like call people, and they were 鈥� one guy was at the gas station who was filling up his truck, right? A grandmother talked about how much her groceries were and how her gas and grocery bill every week was $200, which was just a lot for just her, right, in Iowa. And so it’s very salient to them and very tangible, like you said, Tami, that those costs are right in front of them. And, frankly, it should not be overlooked that for a lot of people, they don’t pay attention to diesel prices, but diesel prices have a huge impact on people in rural America, especially, not only because they’re using it for their trucks and the farming equipment, but they just use it more. So these affordability issues, these pocketbook issues and concerns, the messaging on that is not positive for either party right now. 

Kenen: And you don’t have to message. You just have to pull out your wallet, right? I mean, all of us can afford our groceries, but I’m aware. I mean, when you go into the store, you see. I mean, I think even people who are not pressed are shopping differently, and thinking differently. So, I mean, I think people aren’t necessarily paying attention to the messaging, but they are paying attention to the lived experience, which, as Tami said, you see on every gas station every time you drive by. Even if you’re in an EV [electric vehicle], you’re aware of it. 

Rovner: So, also, as Tami said, the administration seems to be pushing its fraud agenda as its big health issue. As you mentioned, Vice President JD Vance had a press conference Tuesday to announce that the administration is canceling the ACA [Affordable Care Act] policies of more than three-quarters of a million people, who the administration suspects are fraudulently enrolled in the program. Now, one of their indications is that these enrollees haven’t filed a claim. But I did a little digging, and, according to our Peterson-KFF Health [System] Tracker, it’s not at all unusual for people not to file a claim. First of all, most people are healthy most of the time. The bottom half of the population only accounts for 3% of healthcare spending. By comparison, the top 5% account for 50% of healthcare spending. Also, those with the cheapest plans tend to have the biggest deductibles, and now the average Affordable Care Act deductible is nearly $4,000. So even if you do have a medical expense, you’re likely not to bother to file a claim that you know isn’t going to be covered. So I know fraud is one of the really big Republican answers to rising healthcare costs this year, but is it really good politics to announce you’re taking away people’s health insurance, like, the month before people go to the polls? 

Luhby: Well, I mean, again, they’re saying that they’re actually not taking away health insurance. If you listen to the press conference, both Vice President Vance and CMS [Centers for Medicare & Medicaid Services] Administrator Mehmet Oz said that a lot of these people are phantom enrollees. That this is all just fraud. That brokers and agents, you know, seeking higher commissions, signed up people who don’t necessarily exist. And they argued that other people may not have known that they had ACA insurance, or they may not be eligible, so therefore they don’t qualify. Now, I’m not necessarily justifying that, but that’s what they’re arguing. They’re not saying they’re ripping it away from, you know, people who, you know, should be on the plans. And then, you know, they are taking some measures against fraud. They’re suspending brokers and agents who are suspected of fraud. They’re going to be more strict with the guidelines. But interestingly, they’re also putting a moratorium on new brokers and agents, which could make it harder for people to sign up in coming months. You know, as you said, Julie, open enrollment. Well, you had said it’s right before the election. It’s also right before open enrollment starts on Nov. 1. So, you know, I think there are probably a lot of brokers and agents, and, of course, the government navigators out there to help people. But, you know, it’s possible that some people may not be able to be helped as quickly because there is now this moratorium. But the discussion of the nonmedical claims, which Dr. Oz also really focused on, is coming from Paragon [Health Institute], which is run by Brian Blase, who was, you know, is a conservative health policy leader and was involved in the first Trump administration, and he’s definitely very involved in this administration as well. 

Rovner: And I actually saw some pushback about that, you know, how they are counting people who don’t file a claim. I saw some pushback from the insurance industry that said, you know, they’re double-counting some of these. If you’ve changed plans, if you, you know, even if you were only in a plan for a month and you didn’t file a claim, they’re looking at that as you having been enrolled in that plan all year. So yes, there definitely is some fraud. We’ve known this since my colleague Julie Appleby helped uncover what was going on back in, I think, 2023, definitely in 2024. The Biden administration addressed this; the Trump administration has also already addressed this. But it seems unlikely that they’re going to revoke, you know, 750,000 policies and all of those are going to be phantom enrollees, or people who didn’t know they had coverage. There’s going to be some number of those people who have insurance and assume they have insurance, or who assumed they had insurance and may go to use their insurance and find they no longer have it. 

Luhby: Right, and that is, I mean, people have definitely been concerned that some, you know, legitimate enrollees will be caught up on this. And you know that was a question that actually came up in the press conference, and they said, “Well, you know, we worked really hard. We sent FedEx letters. We tried to contact them. We knocked on doors. We went to their houses.” You know, I don’t know if they or the insurers actually did that, but yeah, there are people who are concerned that just giving people 30 days to respond and prove they’re real may not be enough. 

Kenen: On the politics level, there’s the two fighting messages, which is, you know, We’re getting rid of the crooks and the fraudsters, right? And then there’s the, more on the Democratic side, They’re taking, they’re ripping health insurance out of people’s hands. And the truth is, there’s, you know, Julie, you all just said, you know, there is fraud out there, and we all know that, and none of us are, I mean, we don’t want to be endorsing fraud. But there’s a policy reason, too. Some of these people who are supposedly not making claims are healthy. You know, like, they just didn’t get sick this year. Doesn’t mean they won’t get sick next year or be in a car accident, or what else? But right now, it’s good for insurance risk pools, it’s good for the ACA, to have healthy people in it. So the idea that we’re going to look for people who don’t have health claims and kick out the healthiest ones is just going to raise costs for the sick ones. It’s what they call the death spiral, right, or the insurance death spiral. So 鈥�  

Rovner: And it already is raising costs. We know that. 

Kenen: Right. Right. So, I mean, there’s something like, on a policy basis, yes, go for the fraud. Make sure it’s really fraud. Stop talking about the individual 鈥� although the CMS press release was balanced, it was really, it did not talk about crooked recipients. It really did talk 鈥� I went back and read it, because politicians talk about it differently. But the CMS press release was about brokers and fraud on the business side. It wasn’t blaming the individuals. But people hear “fraud,” and, you know, get away from that. Figure out where the fraud is and where the need is and what the smart economic policy 鈥� knowing what we know about insurance 鈥� is, and don’t do things that are going to raise costs as you scream “fraud.” 

Tribble: I guess the question I had actually was, you know, I did not cover this announcement, and, Tami, it sounds like maybe you did, but did they say they were cutting subsidies, or are they canceling the arrangements with the individuals? Like, are they working with the insurance companies, or are they just canceling? I don’t quite understand the actual practical implication of it, basically, what’s happening. 

Luhby: That’s also one thing that’s not 100% clear. 

Rovner: Yeah, I went back and watched, and yeah, it was all a little bit vague. So, we will see how this plays out. But I guarantee there are going to be people who are not fraudulent who are going to get caught up in this, because there always are. All right. 

Kenen: And there’s some people who don’t exist. I mean, there probably really are some phantoms. 

Rovner: And absolutely, I mean, I’m sure there are a lot of phantoms. I don’t doubt that. 

Tribble: And before you leave the topic, Julie, I think it bears pointing out that all of this is happening, this announcement comes just as people are looking at that open enrollment and looking at their premiums and deductibles and copays going up on the marketplace as well. So it’s just an onslaught against these ACA plans at this point. 

Rovner: That’s right. And one of the things we know is that it’s not the greedy insurance companies, as some politicians are saying. Healthcare costs are going up, and therefore premiums across the board in the ACA, in Medicare, in employer health insurance, premiums are going up everywhere. We’re seeing that this year.  

All right, moving on. Over the summer, we talked about a regulation from the White House Office of Management and Budget that would impose a layer of political oversight over the grant process, pretty much across the government. Congress has blocked that regulation, at least until December. But late last week, The Washington Post reported that the administration was preparing an executive order to create a political oversight committee just for grants from the National Institutes of Health, basically trying to ensure that all biomedical research funding advances the president’s priorities. It appears, as of Wednesday, the administration is backing off on that, after Senate Appropriations Committee Chair Susan Collins of Maine, who’s battling to keep her seat and with it the possible Republican majority in the entire Senate, she complained publicly about this. But what would it mean if the administration actually follows through with such an overt politicization of the scientific grant process? 

Tribble: I mean the power to veto the awards that the National Institutes of Health gives, the huge research portfolio that they have, and use politics to veto that, I mean, it’s just a really interesting battle going on because [NIH Director Jay] Bhattacharya, he, you know, he has long been an advocate of some of these policies that, or these research programs, that are focused on minority populations. So it’s interesting to watch play out. It’ll be interesting to see what the next step is for the administration. 

Rovner: Yeah, I mean, according to several news sources, I think this was , there was a big fight in the Oval Office last week with Jay Bhattacharya, the head of NIH, a former researcher who’s received NIH grants, and Russell Vought, the head of the Office of Management and Budget, who’s behind this effort to put a political layer of approval on top of the grant-making process. And, according to the stories, Vought won. Although now 鈥� after Susan Collins wrote a strongly worded letter, that I actually snidely said, “Well, this isn’t going to have much impact.” Clearly, it did. So I was wrong. And again, as I point out, Collins is also is embattled right now and needs to keep her seat. And it would behoove the administration for Collins to keep her seat and keep the Republican majority. But, you know, there seems to be a lot of pushing and pulling in this administration about, you know, how much they want to try and basically take away Congress’ ability to determine how this money gets spent. It’s $47 billion for NIH every year, and Congress has long, you know, bipartisanly, maintained that they get to determine how that money is spent, not the administration. They say, You’re going to spend it this way. The administration’s job is to do that. 

Kenen: The other thing is this fight, you know, which Collins has won for now, this panel overseeing your final review of grants, is not the politicization of science. The politicization of science started on Jan. 20 of 2025. NIH grants have been cut. We’ve all seen the wars. You know, like, “wars” is not too strong a word between the administration and leading research universities. The funding that’s been cut. Those are very NIH-funded institutions 鈥� Harvard being the one that’s sort of most in the headlines consistently, but it’s not just Harvard. There’s a list of banned words that if, you know, “diversity” and things like that, that you can’t get funded for. So there’s all sorts of politicization of science that has already occurred, that has been, is occurring every single day. This would have taken it to another level. Collins, for now, has won, and she has some 鈥� there’s a few other voices speaking up. I noticed that Sen. [Dave] McCormick, from 鈥� I believe 鈥� I’m saying his name right, Julie, correct me. I’m going to say that again. If it’s wrong, tell me later. I believe Sen. McCormick of Pennsylvania, a Republican of Pennsylvania, has and some statements saying, you know, science is important. Science cures. Science also is great for our economy. Science is a driver of 鈥� the ROI [return of investment] on NIH is high. So the politicization isn’t starting. 鈥� This was an attempt to escalate it, and we’ll see where it goes. I mean, Collins has been pretty consistent on this. She did get the temporary blockage of related proposals 鈥� 

Rovner: The regulation, yeah. 

Kenen: Yeah. So this has been a consistent issue for her, and, you know, I think she’s been successful so far. 

Rovner: Well, I think, and I’m so glad that you said that. You know, this all, the politicization of science started when this administration, you know, took office because I think that’s been one of the undercovered stories, really, of last year and this year, about how the nation’s entire biomedical research establishment is struggling under not just the cuts and the delays imposed by the administration, but the uncertainty and their inability to plan. The Harvard Crimson has two interesting stories this week related to this. In one, the Harvard School of Public Health is considering approaching some major health corporations, including UnitedHealthcare and CVS/Aetna, to help make up for the federal funding cuts that they’ve seen. Just two days later, the Crimson reported that three current and former Harvard researchers, one each from the medical school, the School of Public Health, and the Kennedy School of Government, are all leaving Harvard to go to Canadian universities. We’ve talked about a potential brain drain before, as European universities kind of upped their recruiting of American scientists. Are we actually seeing this exodus start? I mean, biomedical research, as you pointed out, Joanne, you know, the return on investment for biomedical research in this country has been huge. This is an enormous and bipartisan engine of economic development in this country, and people are sort of not paying attention as it’s kind of crumbling. 

Kenen: It’s not just scientists either. I mean, first of all, it’s not just Harvard. There are academics from across the country. I do not have the numbers. I can’t cite you an 鈥� accurate number. But scientists, researchers, and the social sciences and humanities too. I mean, there are academics, not just the international ones, who have to go home for some of the students, but the American academics in science and non-science have left the country in numbers that are worth paying attention to. Although it’s not like they’ve all gotten into, like, you know Noah’s Ark. 鈥� But the other thing is it’s not just future science. They have cut large numbers of clinical trials that were already underway, which means that we’ve lost the investment we already made, and that people, you know, who’ve been given their time and volunteered for these trials also don’t get, they got cut off from them. So, I mean, I just 鈥� it’s not a left-right thing. I just don’t understand the common sense of stopping a cancer trial midway or stopping an Alzheimer’s trial or anything else midway and throwing out the money and the knowledge, because these are not partisan. Republicans and Democrats agree that cancer is bad, you know, like Republicans and Democrats, and I dare say independents, don’t want to get Alzheimer’s or see their loved ones get Alzheimer’s. I’ve just never totally understood why this has been seen by top officials in the Trump administration as a good thing. 

 

Tribble: I mean, I think we need to go back to what you said, Joanne, which is January 2025. There were two executive orders on “woke” things, right? Diversity, inclusion, and all that. And I have not been focused on these particular grants, but I’ve been writing about the Digital Equity Act from a broadband standpoint that affects, you know, tons of rural Americans and their ability to do telehealth, for example, and things like that. And that act has been under fire from President Trump, and they have been using those executive orders as a way to sort of attack not only science and research and the things that we watch here with the federal agencies, but across the board in the administration. If it’s considered a “woke” mandate, they’ve gone after it. So I think we do have to go back to that and look at those executive orders and say that’s the game plan. Right? And so I just wanted to note that. I do think these grants have been undercovered. I think this research has been undercovered. But I also think across the board with this administration, those executive orders have had a large impact. 

Rovner: Yeah, you know, we talk about how executive orders don’t have the power of law. Although, I will say, in this administration, executive orders have had a lot of power to actually do things, as we’ve pointed out, sometimes maybe not legally. You know, sometimes we’ve had courts step in to stop them. But this administration has always been: Do it first and ask permission later. All right, we’re going to take a quick break. We’ll be right back. 

So I am old enough to remember when we were told that Republican pollsters told the White House to stop talking about 鈥� and stop HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. from talking about 鈥� vaccines, because anti-vax sentiment wasn’t popular with voters. Well, that advice didn’t seem to age well. Last week, we had RFK Jr. giving the keynote at a conference of the group Children’s Health Defense. That’s the anti-vax organization he helped found. In his hourlong-plus speech, Kennedy told the group that it has a “strong and steadfast friend” in Donald Trump, among other things, and promised new studies into the effects of electromagnetic fields and contrails, the water vapor clouds emitted by jets. Meanwhile, Trump himself doubled down on his earlier vaccine comments 鈥� this time, urging the drugmakers divide regular doses of vaccines into five separate doses. It’s not clear which vaccines he was talking about. In an effort to reduce autism, this, despite the fact that vaccine doses are carefully tested already, and there is no evidence that any vaccine or combination of vaccines has anything to do with causing autism. Do they care more about the anti-vaccine base and maybe getting them out to vote, or do they just not care that much about the majority of voters who believe that vaccines are, on balance, you know, a good thing? 

Tribble: I mean, I think that they are out campaigning, right? Like they are worried about the midterms, and they have sent Kennedy out to rural areas, in particular, which is why I know about this, to campaign on this. He’s been in Iowa trying to draw that MAHA crowd. So the anti-vax movement is part of the Make America Healthy Again movement, and it’s true that more people tend to believe that they can favor Make America Healthy Again 鈥� they tend to be folks who are also in the Make America Great Again camp, too, and have that identity. So if they can gin up the base, then I think they’re going to try to do that before November. 

Rovner: Yeah, back to what we were talking about at the beginning. It’s all a matter of who turns out. 

Kenen: The health part of, not MAGA, but MAHA is not all anti-vax, right? And some surveys have shown that many of them do vaccinate their children. And they’re concerned about pesticides. They’re concerned about ultraprocessed foods. They’re concerned about other things that, you know, many people would actually agree on, although they may identify more with the MAHA movement. So even within MAHA 鈥� they don’t all agree with Kennedy on vaccines. But I mean, I agree with Sarah. The timing of this and the intensity of this, as people are dying from measles, which Kennedy says they’re not 鈥� I think they see that in certain counties or areas of the country, the rejuvenation of the anti-vax conversation and orders and so forth is probably a voter intensity issue for them. Trump has never called for no vaccines. Trump has never said polio vaccine was a fake. I mean, he hasn’t gone anywhere near. He’s really in that, sort of, we have to change how we vaccinate, rather than we don’t want any vaccinations. He’s the changing the dose, smaller, you know. And of course, he exaggerates it. You know, those of us who have kids, they’ve never had a syringe the size of a vat. We don’t put vats of chemicals into our children. 鈥� I mean, how would they fit? I mean, very small babies. You know, you can put the baby in a vat, but you can’t put a vat in a baby. I mean, I agree that the timing is very political, and, you know, there were rumors a few months ago 鈥� not even a few months ago 鈥� there were rumors a few weeks ago that Kennedy would be out after the elections, and that, you know, Oz might go in. Now, interestingly, Oz has gone on TV and said the measles vaccine is good. Your child, you know, there’s measles out there. Get your kid vaccinated. But he’s not as loud as Kennedy. 

Rovner: Or as visible. Well, meanwhile, as we are taping today, the president’s nominee to lead the Food and Drug Administration, White House health policy aide Heidi Overton, is appearing before the Senate HELP [Health, Education, Pensions, and Labor] Committee for her confirmation hearing. It’s only just starting, so we will pick up on what happened there next week.  

Next up are drug prices. President Trump last Friday held yet another event at which he bragged about lowering drug prices. But I keep wondering: Has he really? Yes, drug prices are down a bit 鈥� not the 80% or 90% that Trump likes to say. It’s more like 3%. And analysts say at least some of that is due to the Medicare negotiations that were put in place under President [Joe] Biden, but are just now taking effect. So it’s not at all clear how much is due to the deals the president says he’s striking with these drug companies. Public Citizen actually got hold of some of the documents, and the agreements are pretty vague. I guess the big question is whether the public will believe the president when he says he’s lowered drug prices or whether they’ll believe what they see when they go to the pharmacy counter. Back to, again, back to what we were saying earlier. You know, it’s hard to talk about gas prices going down when every time you get in your car and drive, you see them on a big sign. I mean, I guess drug prices might be a little bit easier because not everybody takes drugs. But I’m wondering whether the people who do are believing him when he says this. 

Luhby: Right, and this has been, you know, one of his mantras in the first administration as well as now. And I fact-checked both his comments on that drug prices have been down this year and that we have the lowest prices in the world now, which is another thing that he loves to say. He loves to say that he’s strong-armed Germany and France and other European countries to lower their drug prices, which 鈥�  

Rovner: No, to raise their drug prices. 

Luhby: I’m sorry, to raise their drug prices, right? That we’re benefiting because now other countries are paying more and, you know, shouldering more of the burden. And, you know, the international experts that I’ve spoken to say there’s no evidence of that. So no, generally 鈥� you mentioned that the drug prices are down a little bit, 3% That’s from the CPI [Consumer Price Index], from the inflation index. But, you know, most experts don’t use that. People I spoke to said that that’s a very faulty measure. It shows the total cost at the pharmacy, but that’s also what insurers pay. So, you know, whether people are paying less, it’s hard to say. And as we know 鈥� what people pay at the pharmacy counter depends on their insurance. I mean, yes, there’s deductible issues and all of that, and copay issues, but, you know, that’s a yearlong contract typically, and it depends. And even today, in fact, showing that on TrumpRx 鈥� they looked at, I think, 32 drugs, and only about half of them actually did have lower prices than, you know, another comparable country. So it’s very murky. We did get some details from the Pfizer and Eli Lilly disclosures that Public Citizen got, but it’s also very heavily redacted. And [The] Washington Post, that , said that they omit key financial terms, the negotiated prices for drugs, and other provisions, making it difficult to independently assess the agreement’s values to taxpayers or the companies. You know, and I’m sure also to patients. So, you know, it’s unclear. 

Rovner: And another thing we know is that people who follow the stock prices of these companies have suggested that it’s not going to hurt the companies very much, which suggests that it’s not going to lower the prices very much. I mean, you can’t 鈥� again, we don’t know a lot of specifics, but that’s certainly an indicator that the companies don’t think that they’re going to have to lower their prices enough to hurt their profitability. Let’s put it that way. 

Luhby: Right. Some companies have mentioned some headwinds from U.S. pricing and MFN [most-favored-nation], but it’s not been a huge issue for them. 

Rovner: Yeah. 

Luhby: And from the beginning, I mean, you would think that when Pfizer started this out in September, oh, you know, if this was really a huge issue for Pfizer, their stock price would have plummeted, and, you know, that’s not the case. 

Rovner: It has not. Finally, this week, an update on that very sad and strange surrogacy case in California and Alaska and Texas. That’s where a surrogate, who was carrying a baby for a couple, wanted to keep the baby who was born with severe cardiac birth defects. That was after she, the surrogate, refused a request from the couple to terminate the pregnancy after the heart defect was detected in utero. This week, Supreme Court Justice Elena Kagan refused to overturn a lower-court decision allowing the baby to remain in the custody of his biological parents. This may or may not be the last word in this particular case, but I’m sure this is an issue that eventually will get heard by the high court. And good luck to the justices sorting it all out. You know, one of the difficulties that we have seen with some of these cases, with, you know, who really are parents? Is it the people who provide the genetic material or the people who carry the fetus determine what are we going to do when we have artificial wombs? And I think we’re going to go on. And Joanne, did you want to add something? 

Kenen: Yeah, most of these are state laws. Most of these surrogate cases are basically a state law, and maybe we’ll see that change. But I also think it’s important to point out that this child, the baby, was born. It does, in fact, have a heart defect, and the biological parents who got the custody, according to the court, are taking care of the baby 鈥� I forgot whether it’s a he or she 鈥� in the hospital.  

Rovner: It’s a he. 

Kenen: It’s a he, in the hospital getting the heart care. I don’t think the prognosis is great, but they are doing everything you can to make the baby as healthy and comfortable 鈥� from the press reports, I’m not in that hospital room. But this is a family that did not want to have a child with this really serious heart defect born. That is a fact. They wanted the abortion. They didn’t succeed. The courts prevented them from getting the abortion. The woman, the carrier, the gestational carrier, won that. But it is important to note that this couple is doing what I think all of us would, you know, agree: The child is getting medical care. 

Rovner: Yes. They have a baby, and they’re doing everything they can to keep him alive and get him well. 

Kenen: Other decisions get made down the road, and it’ll be their decision, you know. Hopefully, it’ll have as good an outcome as possible. It’s obviously not easy for anyone who has 鈥� I have never had a seriously ill child, but I have had friends who have. It’s unfortunate that the extra legal battle gets imposed on top of what’s, obviously, this is a family that, this is a couple who really wanted kids. You know, surrogacy is not cheap or easy or emotionally, you know, it’s difficult. And this is not a happy story for anybody. 

Rovner: It is not. All right. Well, that is this week’s news. Now it is 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. Tami, why don’t you go first this week? 

Luhby: OK. Well, my extra credit is an exclusive Wall Street Journal story titled “,” by Liz Essley Whyte. And, you know, we were talking about where the grant money goes. Well, some of it apparently is going for RFK security. So she noted in the story that the cost of the health secretary’s security jumped from about $10 million in the last fiscal year to $17 million this year. And what she said was striking was that HHS told Congress earlier this year that it was moving about $12 million from its Office of Minority Health to help cover the increased security costs. Now, Liz spoke to some internal unnamed sources, who told her that the secretary’s office had discretionary funds that it could have used instead, but it took the $12 million from the minority health fund to deal with across-the-board budget cuts. Now, I didn’t actually realize that this Office of Minority Health was created by President Ronald Reagan after a landmark report found that Black infants in the U.S. were more likely to die than white babies, and you know, among other disparities. And this, the office actually funds grants and efforts to close these gaps. Its budget, its annual budget, is about $74 million. So the other thing that the story noted, as we were discussing, a little different than NIH, but it said that HHS notified 16 nonprofits and universities in August that grants from the Office of Minority Health had been canceled. They were telling the nonprofits that the cancellations were due to limited funding and new priorities, and those new priorities include the root causes of infertility and reproductive health conditions, including low sperm count and erectile dysfunction. So that’s the story. I will say that an HHS spokeswoman told The Wall Street Journal: Secretary Kennedy faces much more serious, a different security environment, and that his protection reflects the threats he faces, his extensive travel, and the security required for him to safely carry out his duties nationwide. 

Rovner: OK. Joanne. 

Kenen: My friend, colleague, and co-author, Josh Sharfstein at [Johns] Hopkins, flagged this story for me, and he might have used as many exclamation points as I usually use in my email to him. It’s a Slate story. It’s quite a story. A Slate story by Molly Olmstead, and the headline is just called “” This is a long, involved story where each paragraph gets darker and more mind-boggling than the prior paragraph. The medbeds, in case any of you don’t know, are these fictitious things that Trump tweeted about 鈥� or maybe it was, I think, it was Truth Social 鈥� about a year ago, and then deleted it the next day. There’s never been an explanation. Medbeds do not exist, but they are believed, by people who think they exist, to cure all illnesses and make us all whole, healthy, probably happy 鈥� 

Rovner: And long lives!  

Kenen: 鈥� etc. Right. It’s 鈥� as the author, she calls it 鈥� a dark fantasy that we will be pain-free, that we will have forbidden knowledge, etc., etc. 鈥� Molly Olmstead decided to trace where did this come from. And her first thought was like QAnon, and then, so there’s a section about QAnon, and then .. she goes back. It wasn’t QAnon. Then she goes through New Age. She went to a yurt in Sedona, and she learned about subatomic tachyon, I’m not pronouncing it, particles, and it turns out it wasn’t even New Age. Without being a spoiler, it actually goes back to some people with rather ahead-of-their-time crazy beliefs in the 1960s! So just go read it. 

Rovner: Yeah, it’s quite the read. Sarah. 

Tribble: First, I just want to say, you know, reporters like the ones you’re mentioning are just amazing. Like, the work they’re doing and that digging into the agency spending and following those trails, and that’s why I picked this other one, John Wilkerson at Stat. My extra credit is “.” Now, the reason I really like this story is John knows Medicare. He knows MedPAC [the Medicare Payment Advisory Commission]. If you’ve ever sat in that room watching MedPAC discuss things, and then you talk to the experts 鈥� find out that Medicare Advantage was supposed to save Medicare money, but never has. Right? I say go read this story. It’s a very interesting analysis, basically, of how it could help insurers, but may not actually decrease Medicare Advantage payments at all anyway. So it’s just another ball down that road, but it’s definitely worth following. And kudos to John for writing it in a way that’s a fun read. 

Rovner: My story is also from a colleague who likes to dig for things. It’s from my 吃瓜不打烊 colleague and cubicle mate, David Hilzenrath. It’s called “The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren’t Done.” It’s one of those stories that has been done before but needs to be repeated every so often: that when the FDA approves something with the requirement for postmarket follow-up, that follow-up often does not happen. The FDA has, for generations, tried to walk the fine line between getting promising treatments into the hands of patients as fast as possible while still ensuring that they are safe and effective. An analysis of FDA data found that nearly 600 postmarket studies that were supposed to have [been] done have been delayed, often by years. Which means not just that some products on the market may be causing problems, but even if they’re not, they might not actually be working, which wastes money and keeps patients sick. So, hats off to my colleagues who did this analysis, too. 

All right, that is this week’s show. Thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 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. You can still find me on X , or on Bluesky . Where do you folks hang around these days on the socials? Sarah? 

Tribble: I’m mostly on LinkedIn, actually. So look for me on LinkedIn: . 

Rovner: Joanne. 

Kenen: I’m more on LinkedIn than anywhere else, too: JoanneKenen on . I’m a little bit on , and I still haven’t fixed my Twitter authenticator. 

Rovner: Tami. 

Luhby: You can find me at . 

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, Sept. 10, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

Joanne Kenen: Hi, everybody. 

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

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have my interview with Lauren Sausser, who reported and wrote the latest 吃瓜不打烊 “Bill of the Month.” It’s about a breast cancer screening that’s not necessarily considered covered preventive care. But first, this week’s news. 

So, welcome to the sprint to the midterms. As we have talked about all year, affordability 鈥� or, to be more specific, unaffordability 鈥� is the topic that seems to be most on voters’ minds this fall. And healthcare is at or near the top of that list of things that voters are finding increasingly unaffordable. So the news from the past few weeks that healthcare costs are likely to go up even more next year, not only pushing up premiums but in many cases prompting employers to cut back on coverage, is probably not going to make consumers any happier. These are some of the steepest increases in healthcare costs that we’ve seen since the early 2000s 鈥攖hat’s when frustration prompted the debate that became the Affordable Care Act. What’s driving these increases, and what is it likely to lead to? 

Kenen: There’s multiple causes, right? We’re in an era 鈥� we’ve had high inflation overall. We 鈥� have had the number of insured people drop, which means there’s more uninsured, uncompensated care, which means the rest of us who do have insurance end up paying for it. Some people would argue that the consolidation 鈥� in fact, many people would argue 鈥� that the consolidation in the healthcare sector has added to costs. Private equity has been part of that consolidation, and their business model is, you know, there’s still research 鈥�  

Rovner: Their business model is to take money out of healthcare, basically. 

Kenen: And you know, I mean, some people would say that, you know, it’s not just profit; it’s also greed. That’s not true across the healthcare system. That’s not true about everybody. But I think you could see it. 

Rovner: It’s certainly a good place to make money these days. 

Seitz: I think, as far as what’s to come, too, Julie, we got a very significant signal this morning of how nervous the White House is about all of this. Axios is reporting that [President Donald] Trump wants to send $500 checks to a million enrollees across 30 states just ahead of the Nov. 3 midterm elections. So it just shows the timing here could not be worse. And that is kind of always the case when it comes to the election and open enrollment. But with those big increases we’re expecting, it’s only going to get worse in the coming weeks because people haven’t actually begun to preview those health insurance costs, what they’ll look like for next year. It’s not 鈥� it’s typically available around October for most employers and for the Medicare and ACA marketplace. So those prices are going to be landing in people’s inboxes and mailboxes right as they’re making choices about who they’re going to vote for, and it’s just not very good timing for this administration. 

Rovner: Darn that fall! Well, one of the things we’ve seen is it’s not just prices; employers are also dropping popular but expensive benefits like GLP-1 coverage or coverage for infertility treatment. Could that eventually drive prices down because providers of those benefits will have no choice if nobody has insurance for their products or services? Or are they just going to become unaffordable for all but the very rich in our K-shaped economy? 

Seitz: I think that’s certainly a concern, and again, going back to 鈥� this is just such a visible example of the affordability issue that people are talking about. People are paying more, and they’re getting less. And that is a frustration across our economy, but healthcare is such a blatant example of that happening. And there are questions: Will care be out of reach for people? I mean, we’re seeing that happen, obviously, in certain markets. In rural marketplaces, for example, it’s now, you know, in some places a luxury to have a doctor nearby that you can go to. So I certainly think that’s a concern. 

Kenen: I mean, it’s partly the way we’ve always measured prevention. It’s not that prevention doesn’t save money over the long haul. You know, there’s a lot of 鈥�. there’s dispute among the economists. There’s a lot of data that prevention in the long haul is a good investment, but that prevention isn’t, like, if I’m a health plan, I have no necessarily, you know, economic interest in making sure that you’re healthy in 20 years. You’re my client. You’re my customer now. Maybe next year. Maybe the year after that. So what’s good for the overall health system and the public’s health, and arguably the economy in the long term 鈥� it’s bad short term when, you know, an insurer, a company that decides not to cover GLP-1s. Although I sort of wonder if we’re going to get to the point where it’s just put in the water supply as more and more things are discovered about it. I’m being a little facetious, but only a little. 鈥� It’s a smart short-term sticker-price move. It’s not necessarily a wise move in the long run, and it’s going to get people mad because people who are, you know, who have struggled with weight, who’ve done the right things, and who still have trouble losing weight, or who have diabetes. I mean, I’m not sure if they’re dropping it for diabetes or they’re dropping it for obesity. I don’t know enough about it. 

Rovner: I think they’re mostly dropping it 鈥� yeah, I don’t think they can get away with dropping it for diabetes 鈥� I think they’re dropping it for weight loss. 

Kenen: Right. But I mean, as it becomes more restricted, but it’s turning out not to just be weight loss. I mean, it’s like people who get on it for weight loss are finding out that their livers get healthier. You know, there’s increasing research and causative signs about addiction. There’s, you know, it’s a really interesting drug, which we don’t totally understand. But it’s expensive, and that’s what, you know, people 鈥� the American healthcare system, or even the American business sector, isn’t always really thinking about the long term, particularly when the sticker shock is so big right now. 

Rovner: So another level of frustration 鈥� and something that we didn’t see the last time rising health costs were a top-tier political issue 鈥� is this whole trend of , or sometimes not-so-elective procedures, because so many patients now have multi-thousand-dollar deductibles, which we didn’t see the last time healthcare costs were spiking. That means many more patients could be blocked from getting needed care in the first place or, best-case scenario, fighting for months after that prepayment turned out to be too much. Ask me how I know about that latter part. I can’t help but think this is just going to increase the anger for voters. 

Raman: I mean, I really think so. We even, you know, last year I feel like there was so much outcry from folks when we were trying to see if Congress was going to extend the enhanced tax subsidies for the ACA. And, you know, all this talk about people maybe picking lower-tier plans because that is what they could afford. And I think we could see similar things now, where even if someone is still getting employer-sponsored insurance, maybe picking lower coverage than they want, not getting covered for as many things as they want. And, you know, feeding in with the prepayments, just so much more top of mind how much cost is going to be an issue in healthcare for folks. 

Rovner: Yeah, it’s one thing to have skin in the game. I say it’s another thing to have, you know, a limb in the game. Sorry, go ahead, Amanda. 

Seitz: Yeah, and I also think it will bring, that approach could backfire a little because it will bring a little bit more scrutiny to what providers are charging. A lot of times people get the bill after insurance has picked up a lot of the costs. Now you’re inviting them to look at it, you know, in advance and ask some questions that they might not have before afterwards. 

Rovner: Yeah. So what, if anything, are lawmakers proposing to do? Republicans seem to have retreated into the “let’s root out fraud” mode. President Trump is promising to send checks. Democrats seem to be proposing a lot of what I call “more of the same,” including rolling back the Republican cuts to the Affordable Care Act and Medicaid, and expanding Medicare benefits to things it doesn’t now cover, like dental and vision care. I feel like none of these things are really kind of meeting the moment of the intensity of the frustration. 

Seitz: I think it’s difficult to meet the moment in some ways because everyone knows that they won’t agree on anything. So, you know, it’s this sort of piecemealed approach of maybe what will stick, like trying to throw things at the wall and see what will stick. 

Kenen: There could be, like, a real bipartisan accord if, like, Trump agreed to put the $500 check into the mail-in ballot. [Hearty laughter] 

Rovner: Maybe you’re on to something, Joanne. 

Kenen: Probably not. Hypothetical. I think the one thing that, I mean, there’s a little bit of confounding is that people are upset about all prices, not just healthcare. There’s sort of an outrage, and not everybody is sick, and not everybody is, you know, facing a $10,000 prepayment. So it’s, I mean, I think people are aware and angry and angrier about healthcare, but it’s just sort of an affordability crisis, which healthcare is a component. And in some ways, it makes it easier for Congress to just sort of shout about it right now, before the elections. They’re really good at that, right? I mean, they’re all experts in shouting. 

Rovner: They’ve had lots of practice. 

Kenen: Yes, and, you know, I don’t really see 鈥� there’s going to be a fight on the left about single-payer, “Medicare for All,” but 鈥� I don’t think we yet know, outside of a couple of states, how 鈥� I haven’t really seen a unifying Democratic narrative on healthcare. You know, I see a fight about single-payer, but I don’t really see where they’re going. And 鈥� are they going to agree that the fight should be against the Republicans or against each other? That’s always a Democratic problem. Whereas the Republicans, I also don’t, you know, they tend to be, you know, more market-based, and they’re talking fraud, fraud, fraud, fraud, fraud. And, you know, there was just recently a big fraud bust on a Medicaid provider, not Medicaid beneficiaries. The way they talk about it, that can get confused. We all know there’s fraud. 鈥� Fraud is not the major driver of the healthcare costs in this country. But none of us would ever say there’s no fraud. There is. And we would all rather see less money spent on fraudsters and more money spent on making people healthy. But I think the Republicans right now are just going to keep shouting fraud. 

Rovner: Moving on, another trend we didn’t see as much in the early 2000s, when health prices were last spiking, was healthcare providers suing their patients over their unpaid bills. Our former podcast pal Sarah Kliff over at The New York Times has a really eye-popping story this week about how Kansas Republican Sen. Roger Marshall, who was an OB-GYN before being elected to Congress, and the headline tells you most of what you need to know: “ 鈥� a senator, I would add, who has voted to repeal both the Affordable Care Act and to cut Medicaid. I want to call this a scandal, but is it really? He’s not accused of doing anything illegal. His lawyers went after people who owed him money. Why has this story raised so very many eyebrows? 

Kenen: It’s an amazing story. You know, not only was he, and his response to these people 鈥� he wasn’t just, like, chasing them. They were arrested, and he was charging them 18% interest, and these people were, you know, most of them that we read about in that story were poor. So 鈥�  

Rovner: And some of them owed, like, $100! 

Kenen: Right. And it’s unclear whether they even knew they had court dates. And his response was just like, you know, a political one for the ages, which is 鈥� I think it was his spokesman, not him, saying, you know, he didn’t jail them, he didn’t issue the subpoenas and the warrants or whatever it was; the court did. But he brought the case, so it just doesn’t 鈥� is it going to, like, affect his eventual reelection? No, but is it just sort of, say, something’s really broken here? Yeah. 

Rovner: Yeah, and I mean, these weren’t people having tummy tucks. These were people who were delivering babies, in some cases, really difficult deliveries. 

Kenen: In one case, they had lost the babies. 

Rovner: That’s right. 

Kenen: Twins, I think it was twins. Yeah. 

Rovner: I think it was. Sandhya, sorry. 

Raman: There were two things that kind of, you know, caught my eye with this. A) is that, you know, doctors do have discretion in how they go after this issue. I mean, even if one is allowed to go after folks for this, they don’t have to. There are other options. But two, you know, I think one of the reasons this really resonates is that right now with Sen. Bill Cassidy, you know, losing his primary, not going to be in the Senate next year, Sen. Roger Marshall is probably one of the top contenders to lead the HELP [Health, Education, Labor, and Pensions] Committee, if Republicans maintain control of the Senate. So he’s going to have a lot of power over health policy and setting the agenda for what that committee does. And, you know, when so much of the conversation has been, like we talked about before, you know, affordability and things like that, I think that that has, you know, really struck a chord with some folks as well. 

Seitz: I also think that, you know, I did see some people saying, Listen, he is entitled. He did this work. He is entitled to get paid for it. And certainly, people might sympathize with that. But in this particular case, Sen. Marshall has leaned in to this idea that he was this upstanding community doctor who helped deliver babies of poor women on Medicaid. So when you’re a U.S. senator and you’re using that sort of imagery, but people have a completely opposite experience, it is fair game for them to speak out about that. 

Kenen: No, I mean it’s also, it’s true. Not all OBs take Medicaid. It’s a good thing that he took Medicaid. But in that bio, he left out that he was also, what, the co-owner of a hospital making millions of dollars. So, like, going after some 鈥� putting somebody in jail for two days over, you know, an obstetrics bill is probably something he’s going to have to discuss at home. 

Rovner: Well, while we are on the “Eyebrow-Raising Story” beat, The Wall Street Journal last week had a 鈥� he of the hoodies and shorts 鈥� apparently not being all that interested in “senatoring” these days. Among the anecdotes in the story, all of which were provided by former staffers, is one where he declined to meet with the folks from the Children’s Hospital of Philadelphia, which is not just one of the top children’s hospitals in the country, it’s one of the top hospitals in the country. They wanted to talk about Medicaid cuts. He reportedly said he wasn’t worried about Medicaid cuts, and they were just looking for an excuse to visit Washington. In more than 40 years of covering healthcare in Congress, I cannot remember an elected official dissing a major hospital in their own district. Have any of you ever seen 鈥�?  

Kenen: Particularly a children’s hospital! 

Rovner: And yes, particularly a children’s hospital. I mean, this is just so out of the ordinary. It’s hard for me to express. 

Kenen: Yeah, but that’s his middle name now: “out of the ordinary.” 

Seitz: It also just shows, like, you know, there’s so much when you talk to voters, they talk about how their elected officials don’t really care about them. And that was so on display in this article. 

Rovner: And, I mean, is there something different about hospitals these days? I guess that’s sort of what, the other thing that made it jump out to me. I mean, hospitals are sort of increasingly the bad guys in raising 鈥� costs. It used to be 鈥� the Republicans are all going after the big, greedy insurance companies. We’ve seen studies recently that said it’s not the insurance companies who are making more money these days; it’s the hospitals that are making more money these days, and premiums are going up because hospitals are charging so much. I’m just wondering if hospitals are kind of losing their luster a little bit on Capitol Hill. 

Seitz: I think so, and I think part of that is the consolidation, right? You have, no longer do you have, in all cases, community hospitals that really run 鈥� where you have, like, this great relationship with your local doctor and everyone knows who’s providing their healthcare. it’s become more corporate, and I think that makes it an easier target for sure. 

Rovner: Well, finally, on the “Scandalous Story” beat this week, while we were gone, The Guardian and The Associated Press that contradict testimony that HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. gave to Congress when he denied that his 2019 trip to Samoa was related to vaccines. A letter he wrote to the Samoan prime minister before he went specifically said he wanted to study what happened with the MMR vaccine in the island nation, where two children died after receiving an improperly mixed version of the vaccine, and later a measles outbreak, after vaccinations declined, sickened thousands and killed 83 more people. In response to this story, Sen. Ron Wyden, who’s the ranking member of the Senate Finance Committee, has called for a criminal investigation into whether Kennedy lied to Congress. Of course, it seems unlikely that the current Justice Department would take up such a case. But if Democrats do take back the Senate, could they use this to try to oust the secretary? 

Raman: I think they could use it to bring him in. I mean, he wasn’t under oath when making these remarks about this during the hearing. But I think, I mean, that’s the main pull for Democrats in this presidency is if they do gain control of one or more chambers to be able to do more oversight on the things that they’re not getting answers to through other means. So I mean, we could see that 鈥� 

Rovner: I believe it is still a crime to lie to Congress, even if you’re not under oath. Just throwing that out there. 

Raman: I mean, I don’t know what they can do with this other than hold oversight, because I don’t see the DOJ or other enforcement kind of going after this. 

Rovner: Yeah. I guess I’m just wondering, I mean, of all the things that we know that Secretary Kennedy has not been completely truthful about, is this the one that they’re going to sort of want to run into the ground? 

Seitz: I totally agree. It might not. You know, there’s a lot of maybe half-truths that have been given at this point, and it’ll be interesting to see which ones the Democrats do go after, even if they do get power, which is very up in the air right now. 

Rovner: Right. 

Kenen: And there are rumors that Kennedy is 鈥� I mean, these rumors always happen at this time of year before an election 鈥� there’s, you know, rumors that he’ll be out anyway, but, you know, who knows? Because right now, you know, Trump seems to be embracing him again. There was some distance. Now there’s, you know, these things go up and down, and it’s not unique to Republicans. There are always rumors about Cabinet secretaries changing after the midterm, but this is sort of one of the ones that is circulating in D.C. that there could be a change. 

Rovner: No, we will see. All right. Speaking of HHS, Politico did a deep dive into what’s happened with personnel and has found that the number of political appointees in the agency has reached the highest level since the Clinton administration 鈥� even while career staffing has dropped by more than 20% 鈥� and that HHS actually now has the most non-Senate-confirmed political appointees in the federal government. That includes several departments that are far larger, like Defense. In some parts of HHS, even though hiring has resumed, those quitting still outnumber those coming in. And at the same time, agencies are failing to carry out policies and spend money appropriated by Congress. At some point, is Congress going to notice this and try to do something about it? I feel like I ask this question every single week. 

Seitz: I mean, this was such smart reporting because I think all of us have, at some point, been, like, you know, where’s this anti-vaccine ally of Kennedy’s? Why is he in this agency? So we’ve all noticed, like, this just influx of advisers 鈥� usually is how they label them. But in many ways, this wasn’t surprising. I mean, the CDC [Centers for Disease Control and Prevention], FDA, NIH [National Institutes of Health], the career staffers have really been cut out of the decision-making on so many things, whether it be autism research, tobacco, vaccines, the MAHA Report that relied more on AI than any actual in-house expertise. So, you know, RFK has been very vocal on how much he does not trust the people working in these agencies. So, like I said, in many ways it’s not surprising, but it is certainly 鈥� shocking to see those sort of numbers. 

Rovner: Yeah, I found the numbers really 鈥� I mean, anecdotally, and we’ve been talking about this for months. I mean, you know, this agency or that agency where everybody has left, or 鈥� I forgot, there’s still, you know, thousands of people who are being paid and are on administrative leave and not working. I mean, particularly at the CDC, there’s entire offices of people, of career people, that are simply out in limbo while these, you know, political appointees are doing all the policymaking.  

Well, one thing that Congress has appeared to notice is an interagency agreement in which HHS would let the Department of Defense tap into billions of dollars appropriated to the NIH for the DOD to use to study military biodefense programs. The agreement was . It’s quite an eye-popping story. I will link to it. Democratic Rep. Rosa DeLauro of Connecticut and Sen. Patty Murray of Washington, the ranking Democrats on the House and Senate Appropriations committees, are both furious. But it remains unclear what they can or will do. Is there anything they can do about this? I mean, it appears to be something that, you know, HHS has done with DOD, and it seems to be kind of a fait accompli. 

Raman: I mean, this whole situation has been kind of unusual. You know, we had the Democrats last week, you know, speaking out about how they’re very worried about this. We had the White House and the Republican leader of the House Appropriations Committee, you know, pushing back and saying that no money is changing hands and that it’s a partnership. And I think there’s still a lot of missing pieces that we’re still trying to figure out. I think a lot of groups have been trying to say, you know, are certain programs going to be cut to fund this, or there other things that are, you know, going to get de-emphasized, or is this just like a regular partnership? Because they do, you know, these two do work a lot on various biodefense issues over the years. That’s not unusual. I think one clue we might be able to look at is next week the Appropriations Committee is looking at the law that governs these interagency agreements, and so while it doesn’t explicitly say this agreement, I think that could come up a lot, and maybe, you know, pull out some leads in terms of what maybe is happening more here, and, you know, is money changing hands? Is it not? But that’s what I would kind of look to next. 

Rovner: Yeah, I do feel like Congress has sort of thrown up its hands about, Hey, we have the power of the purse, not you, administration. All right, we’re going to take a quick break. We’ll be right back. 

So, abortion is kind of receding as a leading issue for voters this fall, obviously in favor of affordability. But there’s some still pretty epic fights raging, particularly over the abortion pill mifepristone and whether it should remain available via telehealth. That’s a change made by the Food and Drug Administration during the Biden administration during the pandemic that was later made permanent. On Wednesday, a federal appeals court in New Orleans heard oral arguments in a case brought by Louisiana, charging that the FDA policy undermines its state’s ban and should be rolled back. Meanwhile, states where abortion remains legal argue that banning telehealth prescribing would violate their ability to make abortion available, which is what the Supreme Court’s Dobbs decision said they should be able to do. Sandhya, you listened to the arguments; they were pretty arcane. What is this case going to turn on? 

Raman: So it was interesting, but I will agree with you that there was a lot of arcane legalese here. So, Louisiana, during their arguments, was asking the court to, you know, pause what the FDA has done, but also to pause that their own decision because the Supreme Court right now has put a pause on letting any of the regulation change while the litigation plays out. So a pause of a pause. And so there was a little bit of talk of, you know, what can we do here as a court and, you know, the authorities there. I thought what was, you know, pretty interesting was that, you know, the FDA didn’t really say a lot in responses to the judges. They basically just said that Louisiana didn’t have standing. They didn’t answer a lot of the questions asked of them. You could tell the judges were kind of frustrated about that. And, you know, I think a little bit is understandable. You know, we’re in this position where the FDA is defending an abortion policy put in place by the former Democratic administration. They’re in an unusual spot. We still have the, you know, review of mifepristone happening at FDA that could, you know, decide something on the safety. We don’t know yet, depending on what it is that they’re going to look for. But I think it’ll be interesting to see what they say, just because it seemed like the judges were frustrated with many responses from different people. But whatever outcome we get here will definitely be appealed by whoever to the Supreme Court. I mean, we’ve seen that with other cases; it’s almost, you know, guaranteed here. 

Rovner: And of course, we’re still waiting for that FDA study that they’ve been promising that we expect, I guess, after the midterms, conveniently, because the administration didn’t want to further inflame both sides before the midterms. 

Well, along these same lines, while we were on break, Senate HELP Committee Chairman Bill Cassidy, who’s a strong abortion opponent from Louisiana, released the result of an investigation by Republicans on his committee that criticized the FDA’s handling of mifepristone regulation. Will this investigation and report have any ongoing impact 鈥� given that this is also being played out in the courts, maybe in confirmation hearings for Heidi Overton, the current White House health aide who’s been nominated to head the FDA? 

Raman: I think it’ll definitely come up in her confirmation hearings. I’m not sure how much this specific report is going to play a huge difference, because, I mean, we’ve had over the last several months a lot of different Republicans going and asking FDA for specific things to speed up this review, to do it in the first place, to do specific things, and it doesn’t seem like that has moved the needle and changed much. You know, they’ve kind of stuck to whatever it is that they had in mind on that. So, I mean, it could be something that they cite, but I don’t know that it’s going to have a drastic effect when they already have that underway. 

Rovner: I’m interested. We’re seeing a whole bunch of hearings for Senate confirmations for HHS officials, but not yet for Heidi Overton, who’s been working in the White House as a health official. Amanda, do you expect that we’re going to see anything about her before the election, or maybe they’re going to try to hold it over? 

Seitz: Yeah, I heard some chatter that there might be a possibility, but then of course we got the notice for the deputy secretary and for the surgeon general, and not her yet. So we will see. I, you know, I think obviously the hearings next week will be far less controversial people, and I think that’s, you know, key right now. 

Rovner: Yeah, I should say that Chris Klomp, who’s 鈥� at CMS now, but who’s basically been acting as deputy secretary and has been nominated to be deputy secretary. I don’t think anybody expects there to be a whole lot of controversy associated with that one. 

Seitz: Though I will say it’ll be interesting to see. I mean, certainly he’s going to get questions about vaccines, and I’m very curious to see how he responds to that, as well as the surgeon general. You know, those are not normally questions that these folks are fielding, but they’re going to have to answer them, and it’s going to be really, like, telling how they walk that line. 

Kenen: Klomp is one of the probably least controversial people at HHS. People think, people in both parties and in the private sector and the health sector think he’s very competent, and that, you know, apparently he’s a 鈥� I don’t know him personally 鈥� but he’s apparently, you know, someone one can talk to. So I don’t think this is a fireworks-y thing, other than the mandatory, you know, both parties always want to score some points, and they will be point-scoring. But you know, he’s 鈥� I think there are a lot of Democrats who are actually pretty glad he’s there. 

Rovner: Yeah, I’ve met him. He’s very smooth, and I mean that in a good way. I don’t mean that in a slick way. I mean he’s just, he’s one of these people who clearly is good at his job. 

Well, meanwhile, still on reproductive health, our friends at ProPublica are reporting, using federal health statistics, that the , those that implant outside the uterus, has doubled since 2020 compared with the six years before. Some of that was likely due to the pandemic, when healthcare was harder to access. But the rate has continued to grow, and it’s grown much faster in states that have implemented abortion bans. Other ProPublica reporting has shown how women with pregnancy complications, like ectopic pregnancies, have had trouble getting care in states with bans. I guess at some level this shouldn’t be that surprising, but it still kind of jumped out at me. 

Seitz: It’s such important work because it’s been so hard to measure the impact of these bans. You know, we heard anecdotally over and over again from doctors how difficult it was to treat patients in these states. We obviously heard the horrific stories of women being turned away or dying in some cases. But a lot of people have sort of dismissed that and said, “Oh, you know, this was a bad doctor, or someone who wasn’t following the law or wasn’t reading it close enough, or a bad hospital attorney.” This gives us such a clear picture of how drastically the overturning of Roe v. Wade has been in raw numbers that you really can’t refute, and I thought that was very important. 

Kenen: This is the one, not the one thing, but this is one thing that there’s no debate about: An embryo cannot develop outside the womb. It cannot. It cannot. It can’t. I mean, it’s 鈥� it got lost, basically. I mean, I think I’ve mentioned before. 鈥� I have had an ectopic pregnancy. I’ve had a heterotopic pregnancy. And it’s nothing 鈥� you know, in my case, it was very much a planned, wanted baby, and it was very upsetting for me. But I was, I got treatment. But, you know, for people to mess around with this who don’t understand it, I mean, there was one lawmaker, and I forgot who it was, and I also forgot whether it was state or federal, who said, “Why can’t they just move it where it belongs?” You know, you can’t. I mean, trust me, I would have chosen that. 鈥� This is, like, it’s not abortion. This is just a medical problem that no baby is going to come out of an ectopic pregnancy, and a woman can die. So the fact that this is, like, still being 鈥� that women are dying is, like, if you’re pro-life, you’re supposed to care about life. And, you know, partly because of some misunderstandings, and partly because there’s some politics, and partly just because of some 鈥� you don’t know you have one. I mean, I didn’t know I had an ectopic pregnancy. And it just shouldn’t 鈥� women should not die in 2026 in the United States of America or anywhere else. This is not an abortion. 

Rovner: Even the anti-abortion movement makes the semantic case that treating ectopic pregnancies is 鈥� they don’t consider treating ectopic pregnancies an abortion. 

All right. Well, finally, this week, an update on the political fight over the measles outbreak in Pennsylvania, which has pitted HHS Secretary RFK Jr. against the state’s Democratic governor and possible presidential candidate, Josh Shapiro. The Lancaster County coroner has now reported to the CDC that the two measles-related deaths in the state in August were both infants, both from Amish families, but only one died “from” measles. (She puts in air quotes.) The other died “with” measles. I feel like we’re already back to covid. Does this actually make a difference? 

Kenen: It depends. Like, I thought, one of the best summaries of this case, and it was actually some of the facts that have come out in the public 鈥� Paul Offit had a very 鈥� from Children’s Hospital, speaking of Children’s Hospital 鈥� 

Rovner: Children’s Hospital of Philadelphia, yes. 

Kenen: 鈥� and one of the leading vaccine researchers in the country, and someone who’s very good at explaining things. He had, like, a 10-paragraph 鈥� I think it was in MedPage, the other day 鈥� it was a little bit. 鈥� We’ve learned more about these cases since then, so I don’t know that he’s updated that. But the, you know, the basic idea was that in this “with measles,” in this particular case, might actually have been, like, without the measles, the baby might not have died, or the child might not have died. 

Rovner: This was a baby who died from a ruptured spleen. 

Kenen: And that the spleen could have been damaged because of the measles. And he didn’t say it’s definite. He said a number of tests needed to be performed to be sure one way or the other, and to the best of what had come out publicly before that, those tests had not 鈥� we didn’t know if those tests had been performed. So yes, it is possible that this was, the baby died because of the spleen damage, but that the spleen could have been because of the measles, and apparently we’re not really sure of it. But yeah, it matters because it’s part of the mix. You know, a baby died, a child died, a baby died, and getting in a fight about “with” doesn’t 鈥� it’s a risk factor. Period. 

Rovner: Well, one small silver lining: The Pennsylvania Department of Health says it has seen a surge in measles vaccines being given, nearly twice as many this August as is typical. Is that how this is going to go? People won’t get vaccinated until they see cases of the things they could have already been vaccinated to prevent? 

Seitz: It depends on who they trust, right? I mean, I think that is the unfortunate thing about this entire 鈥� I mean, there are so many unfortunate things about this entire case, and the first being that two babies are dead. But the other unfortunate thing is that people are now thoroughly confused, and it’s hard to discern, really, what happened. Even as a reporter who’s following this. Imagine being just, you know, a parent trying to decide what to do with your kid. So I think you’ll see some people that do go: OK, I don’t want to take this risk. I think you’ll see some that double down and go: You know, I’m not sure that the government’s being honest with me. And the nation’s health secretary also suggested that the Pennsylvania state government’s not being honest with me. So, unfortunately, I think we’re going to see all kinds of reactions to all of this. 

Rovner: And which government is not being honest with me 鈥� the federal government, or the state government, or the local government? Because now we’ve got the local coroner involved in this. So it’s, yeah, it is truly 鈥� I feel like this is a real microcosm of what’s going on with vaccines around the country. 

Kenen: In some ways it’s, what some people in public health would say, the best possible scenario is that people do wake up to the fact. Now we haven’t had a lot of measles for many years. We have now had more measles, and people are learning about the danger of measles, and maybe that will change behavior and reverse some of the anti-vaccination movement. On the other hand, you also have people saying that, not just in this case, but that it wasn’t measles that killed so-and-so. You know that there have been cases where someone died, but no, it wasn’t measles. You know, it was bad care. It was lack of vitamin A. It was, you know, malpractice. It was bad luck. It was something else, right? So you have sort of 鈥� you hear in public health is, like, Oh the tragedy is it’s going to take measles deaths for people to rediscover the importance of vaccine, and we may be seeing a little of that. But the other, the simultaneous narrative is, you know, it’s not measles that’s killing you; you don’t need the vaccine, that’s worse. So there’s 鈥� two narratives. Right now we see the, you know, the pro-vaccine may be inching up, but I don’t think we know yet where we’re going to be in a few more months. The, you know, there’s a lot of measles out there. 

Rovner: Yeah, clearly more of this to come. All right, that’s this week’s news, or at least as much as we have time for. Now we will play my “Bill of the Month” interview with Lauren Sausser. Then we will come back with our extra credits. 

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

Lauren Sausser: Hi. 

Rovner: So this month’s patient was doing what just about every medical expert recommends: getting preventive screenings for breast cancer. Tell us who she is, what kind of medical care she got, and why she needed something extra. 

Sausser: OK. So, the patient this month, her name is Stephanie Halver. She lives in Washington state, and her primary care physician recommended that she get a breast MRI in addition to her annual mammogram because of her age, partly. Stephanie is over 40. She has dense breast tissue, and she also has a family history of breast cancer. Her mother and her aunt were both diagnosed in the past. 

Rovner: So she was at high risk, and her doctor recommended this MRI in addition to the regular mammogram, and her insurance company preapproved it. So, how was there a fight over the bill, and how big was the bill? 

Sausser: So, this actually took me a minute to figure this out. So, Stephanie had gotten a preapproval letter from her insurer before she went to schedule the MRI. But then, several months later, she got a bill, a significant bill for over $1,000, and she didn’t understand why this was not covered in the same way that her annual mammogram was covered. And to figure that out, we have to go back to the Affordable Care Act, which says that insurers have to cover some screenings, some cancer screenings, at zero cost to patients. Mammograms are in that list. Colonoscopies are in that list. Breast MRIs are not in that list. So the question is, who comes up with this list? It’s a group that you probably have heard of before, called the U.S. Preventive [Services] Task Force, which looks at all the available scientific evidence and uses a really rigorous process to figure out which screenings are best suited for the entire population. So, anyway, at this point in time, the U.S. Preventive [Services] Task Force 鈥� which, I should say, is not an active group of scientists since Kennedy disbanded the group essentially last year. 

Rovner: Yes, and we talk about this on the podcast all the time. 

Sausser: OK, so you all are up to speed about that. But as the current guidelines are written, breast MRIs 鈥� the group does not, has not found enough evidence that they’re necessary for a large group of people. Now, interestingly, I recently spoke to the former head of the task force, and he concedes that that does not mean that breast MRIs are not the right choice for some people. There’s this tension between, you know, what’s good for a population and what’s good for individual patients. In this case, Stephanie Halver’s primary care doctor appropriately recommended a breast MRI, but because breast MRIs are not included in the task force recommendations, her insurer does not have to cover that at zero cost. Now, as you mentioned, she had that preapproval letter, so why did she get the bill? Well, in this case, Stephanie had a really high deductible. It was over $5,000. That’s not super high anymore, but it was high. So in this case, the cost of the MRI was just applied toward her deductible. So she got a bill for it. If it had happened later in the calendar year and she’d met her deductible at that point, she might not have gotten a bill, or maybe wouldn’t have gotten a bill that was for essentially the full amount of the MRI. 

Rovner: So it was covered. It just wasn’t covered as a no-out-of-pocket-cost preventive service? 

Sausser: Exactly, exactly. 

Rovner: Now 鈥� we’ll add one more level of complication to this. I know in your research you discovered that some states are actually requiring breast MRIs to be covered in certain situations, and Washington is one of those states. So why wasn’t it covered for her? 

Sausser: So yeah, this added another level of complexity because when Stephanie was researching, you know, why, how did this bill happen? I live in Washington state. There’s a state law in Washington state that requires insurers to cover this procedure 鈥� or this test, I should say. Those state laws don’t regulate the type of insurance that she has. So a lot of people, like Stephanie, like you and me, get their health insurance through their employer. Those employer-sponsored plans are regulated federally through the Department of Labor, and so state laws generally don’t touch that type of insurance. Now, if Stephanie had had a federal marketplace plan or some other type of insurance, it’s possible that that state law would have applied. But in her case, because she had insurance through her job, that state law didn’t benefit her. 

Rovner: This is why we needed the Affordable Care Act in the first place because state laws don’t cover many 鈥� all of those employer plans that are federally regulated, which is most employer plans, although it’s not all. 

Sausser: Right, and it’s really, it’s confusing for people. 鈥� Insurance regulation is so piecemeal, and these self- 鈥攖hey’re also called these self-insured plans. If you work for a very large employer, chances are the plan is self-insured, and that means, at a very basic level, that the employer, not the insurance company, is actually the one that decides which benefits will be paid for and how they will be paid for, and, in this case, Stephanie did check with her HR [human resources] department, which confirmed that breast MRIs are not covered in the same way that mammograms are covered. 

Rovner: So, what’s the takeaway here? If you’re a patient and you find yourself in a similar situation, and your doctor recommends this care, I mean, is there a way to, like, save some money? 

Sausser: There is. One thing that you can do is shop around for the best price. So you’re going to pay more for a breast MRI probably through a hospital than you are through sort of a freestanding imaging center. The other thing that you might consider doing is, if you have a very high deductible 鈥� let’s say, you know, $10,000 or $20,000 鈥� you might consider paying cash because you’re probably going to be quoted a lower cash price than if the provider bills the MRI through your insurance. The other thing is that you could consider scheduling this after you’ve met your deductible. So let’s say that Stephanie had decided to wait till the end of her plan’s calendar year, and she had met her deductible at that point. She probably wouldn’t have had to pay very much for this MRI. There are also advocacy groups that can help patients who are struggling to pay the bill, find a lower-cost alternative. There are programs through Medicaid that help patients get screened. The takeaway, to answer your question, is don’t ignore your doctor’s recommendation. If you need a breast MRI, there are probably ways to lower your cost if you know going into it that you may be on the hook for all or part of the bill. 

Rovner: Well, as always, it’s buyer beware in the healthcare marketplace. Lauren Sausser, thank you very much. 

Sausser: Of course. Thanks 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’ll post the links in our show notes on your phone or other mobile device. Sandhya, why don’t you go first this week? 

Raman: So my extra credit this week is called “.” It’s from my colleagues at Bloomberg Government, Erin Durkin and Claire Hebert. So something some folks might not know is that Medicaid is a significant funding source for special-needs services in K through 12 public schools. And so they took a look at Indiana, which has, you know, been aggressively cutting Medicaid enrollment, seeing some of the biggest drops in child health insurance compared to other states, and just looking at some of the effects there, you know, in part by the tax law that Republicans passed last year, and just Indiana laws that also made similar changes. So it’s a good deep dive into this. 

Rovner: It is. Joanne. 

Kenen: This is a story from ProPublica in collaboration with the Oregon paper, The Oregonian, I believe it was: “.” It’s by Audrey Dutton. It’s about Idaho, which is, there’s a community that’s been there for, like, 100 years that did not believe in medical intervention. They believe that if a baby is dying, then that’s, you know, what God wanted. It is not 鈥� there’s an astonishing, a disturbing number of cases. They are under Iowa state, excuse me, Idaho state law. They are not prosecuted. They are under state law. They are allowed to let their children die. And there are some voices in that story about the police who have to go and how disturbing it is for them, and that ProPublic also had a retired pediatrician review the medical records. Many, many of these are avoidable deaths 鈥� something that would have responded to antibiotics. Something that would have, you know, simple, not terribly invasive surgery. There was a quote from a midwife that really stuck with me, talking about watching a child die, and she said, “It’s not pretty. They don’t just close their eyes.” It’s a very, very powerful story. 

Rovner: Amanda. 

Seitz: Yeah, I have two extra credits this week, but they both touch on the same topic. The first is “,” by Daniel Payne at Stat News. This story looks at how, ahead of all these Medicaid cuts, rural hospitals are sort of clinging on for dear life by getting the backing of a larger hospital system. They’re often out of town, and, actually, one of the hospitals my own mom works at, so that was kind of cool. But the article does a great job of raising the balance here 鈥� that while this approach is saving hospitals from closing, it changes the care that people are getting, and it could make it more expensive. And then my second article is by our 吃瓜不打烊 colleagues Noam [N.] Levy and Hannah Norman. They published an article: A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back.” That looks at how this hospital in a small town of Troy, New York, was instructed to close its birthing center by the multibillion-dollar health system that’s out of town that it’s owned by. And there was this sort of herculean, bipartisan pushback over the proposed closure that stretched from, like, the local city to the state. Both of these articles just do a really great job, I thought, of showing the local impact of hospital consolidation and corporatization of those systems. 

Rovner: Well, my extra credit this week is from NBC News. It’s part of its “Disabled and Denied” series called “,” by Mike Hixenbaugh. And it’s about a new AI program being used in Nebraska. I guess we’re all looking at different states this week. And this program is being used in other states, too, to help determine how much Medicaid funding should be allocated to those living with disabilities 鈥� which sounds fine until he discovered that the algorithm basically penalizes families who’ve managed to care for their disabled loved ones at home. Because they’ve never been institutionalized, they’re suddenly deemed more able than they actually are, and funding that’s been allowing them to live is being cut dramatically. In one case, parents in their 70s caring for a pair of severely disabled sons in their 40s are facing a loss of more than $200,000 in Medicaid funding. That’s jeopardizing their ability to continue to keep their sons at home. The entire story is pretty wrenching. I really can’t recommend it strongly enough. 

OK, 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 these days , or on Bluesky . Where are you guys hanging on the socials, as they say? Amanda. 

Seitz: I am also on X . 

Rovner: Joanne? 

Kenen: I’m mostly on and . 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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