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

Julie Rovner: Hello, from 51视频 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 51视频 Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 30, 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 Rachel Cohrs Zhang of Bloomberg News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: Liz Essley Whyte of The Wall Street Journal. 

Liz Essley Whyte: Hello. 

Rovner: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

Rovner: No interview this week, but more than enough news, so we’ll get right to it. I want to start with a story that I feel like is getting a little bit buried because it broke last Friday.  on a federal court filing in which the Trump administration admitted that it canceled $7.5 billion in clean-energy grants solely because they were located in states represented by Democrats that voted for Kamala Harris in 2024. In other words, the actions were purely political. Now, this is before the administration finalizes proposed rules that would give political appointees still more power over how grant funding is distributed. I heard one pundit say on cable news that in any other administration, this sort of information would lead to an immediate impeachment inquiry. But these days, it’s just another day that ends in “y.” Is the lack of public outcry about this because everyone already assumes that everything this administration does is political? Or is this considered just too inside baseball for most voters?  

Whyte: Well, I was gonna say I think this has long been people’s suspicions about why certain grants are cut in the way that they are, or some of these Medicare/Medicaid investigations are the way that they are. And so I think maybe the lack of outcry was just people shrugging their shoulders and saying, I mean, yeah, we guessed that, you know. I don’t know. 

Cohrs Zhang: It was really chaotic too, and hard to keep track of all these different things for people whose job it is to do so. So I feel like the fact that this is protracted for so long, we’re like, which DOGE [Department of Government Efficiency] cuts were those? And I think it is important, certainly, and I’m glad there’s been coverage of it, just for the record, and just kind of for history purposes and just understanding the limits of that kind of change to government at that speed. But yeah, I think it is just hard to break through in this news cycle, and it was very chaotic and confusing for everyone.  

Luthra: One thing I have been thinking about, though, is when you think about these states where grants were canceled, there are a lot of people who live there who did, in fact, vote for Donald Trump. And depending on the size of the state, you probably have members of Congress who are actually in Republican districts. And that, I think, is really interesting. And I just wonder if eventually there is some sort of conversation. Those are probably in some cases members who might be a little bit more on the defensive in other ways, just given the political environment we are in. And is this an issue that Democrats can talk about and highlight and sort of bring to voters and say, you know, your representative is not here defending your interests because of these broader sort of punitive measures being taken by the White House. I think that’s an interesting thing that we don’t know the answer to yet. 

Rovner: I know I keep saying this, but I can’t believe that Republicans on the [Senate] Appropriations Committee aren’t being louder about this. This is the one power that they have. It’s why you get on the Appropriations Committee, is you get to steer money to your state or your district. That is the great perquisite of being in Congress, and the administration is basically taking it away. And they’re just letting them. I mean, Susan Collins told Politico, quote, “I obviously think that’s wrong.” But she doesn’t seem willing to do anything about this. I mean, she’s the chairman of the Senate Appropriations Committee! 

Cohrs Zhang: I think we’re, like, testing the checks-and-balances system to its fullest extent. This administration. They can only pick so many fights, you know. 

Whyte: Yeah, Susan Collins, especially, this whole administration has had to choose about when to say something and when to push behind closed doors, push publicly. I mean, there’s been lots of stuff that she hasn’t liked. 

Rovner: Yeah, for sure. Well, this is not the only case where the government has admitted to canceling grants for political reasons. In a case brought by researchers from the University of California, the administration confirmed it canceled some grants because  like “diversity,” “gender,” and “vaccine hesitancy” to cut off funding. The plaintiffs in that case argue that it’s a First Amendment violation. Again, we’ve known for some time that this has been happening. Are the courts just too slow to be able to deal with it, Rachel? That’s kind of what you were intimating. This has been dragging out, sort of bit by bit by bit. 

Cohrs Zhang: Yeah, I think it’s hard. And I 鈥� just like with these grants dragging out too, it has impact for the people who are supposed to be receiving this funding and how their cycles work and hiring and just all the 鈥� that grant process. But I think it’s hard to make that connection, back to the individual voter. And I think that’s just a tough hill to climb in terms of public communications. So I think, yeah, we’re seeing these similar themes play out. 

Luthra: And one thing that I think is really relevant that I keep coming back to is we did see a test run of this with the USAID [United States Agency for International Development] cuts at the beginning of the administration. Those happened very quickly. The courts took a very, very long time, and by the time there was any kind of real momentum in any direction, it was too late. People did not have money, firms had downsized, people had left their jobs, left the industry altogether. And, at the time, that seemed to me like a really striking test. If this is able to happen here, and it shows that things just continue, why not happen in other areas as well, where you have these grants being put out there that have maybe ideological tension with where the administration wants to be going? 

Rovner: So I wanted to talk about some specific impacts on health policy, notably AHRQ, the Agency for Healthcare Quality and Research, which, like USAID, the administration has all but eliminated, despite the fact that it was appropriated nearly $350 million for this year in a bill signed by President Trump. AHRQ, which is down to a fraction of its original staff and hasn’t funded any grants in more than a year, is actually a completely bipartisan creation from the 1990s. It was established to study healthcare quality and access issues, many of which go neatly hand in hand with the “Make America Healthy Again” agenda. Earlier this month, the administration stopped funding more than 100 grants, and an HHS [Department of Health and Human Services] spokeswoman told my 51视频 Health News colleague Arthur Allen only that the agency plans to establish a new, quote, “framework,” which I thought was the job of Congress. Again, too small to attract much notice? 

Luthra: Probably. I mean, voters don’t know what AHRQ is. Like, we know about it because of our jobs, but this is not something people wake up and think about or talk to their neighbors about. It just feels very divorced from a lot of people’s realities. Even though, to your point, the consequences are far-reaching. They are long-term, and, also, the significance in terms of, as Rachel pointed out, separation of powers, checks and balances are also very striking.  

Rovner: I mean, AHRQ studies things like patient safety. I’m old enough to remember when the, you know, the big Institute of Medicine [now National Academy of Science] report came out that said how many people were injured by medical errors. It was a huge, huge issue. I mean, for years. And that’s basically what AHRQ does, and that’s what this administration says that they care about. They care about gold-standard science. They care about fraud. They care about making the health system safer. And yet, you know, AHRQ is just, well, we don’t know what it is, so we’re going to make it go away, basically. 

Whyte: Obviously, the HHS has not been as clear on this as you might hope and expect for the “most transparent administration in history.” But it is clear that, like, Kennedy is looking for pots of money to do the things that he wants to do. And it seems like this is one of the pots they’ve landed on as something that can be shifted around. 

Rovner: Yeah, so it does. Well, one cut that is likely to be noticed is the administration’s decision to end the temporary subsidy for Medicare Part D that prevented the addition of an out-of-pocket cap on how much enrollees have to spend each year on prescription drugs from spiking those monthly premiums. This will almost certainly raise premiums for many, if not most, of the 25 million seniors who have stand-alone Part D drug plans. And they will see those increases right before Election Day, because Medicare open enrollment starts Oct. 15. And, by the way, seniors vote in disproportionate numbers in midterm elections. If I was a political adviser for this administration, I don’t think I would have advised doing this. Am I missing something here? 

Cohrs Zhang: I think you are seeing there’s an interesting shift happening in terms of the power of the fiscal conservative wing of the administration. And I think we’ll continue to see that play out. I will say it’s unclear, like, how much premiums would have increased anyway without this subsidy program ending, given that the premium increases are capped by statute, in the Inflation Reduction Act through 2029. So, I mean, there is a chance that they might have gone up 6% anyway. We’re maxing out that increase. But the messaging certainly was not stellar for them. And I think we saw some cleanup efforts on that, for them trying to say that, you know, most seniors will see, you know, no increase or an increase of less than $10 a month. 

Rovner: Or they’ll have, I think Dr. [Mehmet] Oz said, they’ll still have an option for a cheaper plan. Of course, that cheaper plan might not cover all their drugs, but 鈥� 

Cohrs Zhang: Yes. So I think that’s just like a 鈥� this is one, I think, data point in this larger theme I’m thinking about. And how do we see 鈥� as we move past the midterm elections and affordability may not be top of mind if there’s no electoral accountability for it 鈥� how does that change what we’re seeing out of these agencies? 

Rovner: I’m just old enough to remember when, you know, you don’t raise costs for Medicare beneficiaries right before a midterm election, which is what this will do. Well, it isn’t all cuts. The administration this week finally released the $600 million that Congress had appropriated for the global Vaccine Initiative, Gavi. That was money for last year and this year. The funding had been blocked by HHS Secretary Robert F. Kennedy Jr. even though it goes through the State Department, not the Department of Health and Human Services. Kennedy had been concerned that Gavi was paying for vaccines containing the preservative thimerosal, which has been accused, and cleared, of causing autism. Do we know what finally sprung this money loose? 

Cohrs Zhang: I think there was a deadline of Sept. 30, and the funding would have expired. And we did see kind of an exchange with Secretary of State Marco Rubio and Susan Collins, where he said, “You know, I’m going to take ownership of this, and we’re going to get it done.” And so I think there was a push by administration officials to get this funding pried loose. And I think there are questions about whether Gavi was kind of heading this way already with some of these vaccines. I think they were starting the transition, but I think there 鈥� we’ll see how the implementation works on it. But I think there might be an argument that maybe this transition might have happened maybe faster 鈥� or to a broader degree. 

Rovner: The transition away from using thimerosal. 

Cohrs Zhang: Yes, the states 鈥� there’s one hexavalent vaccine where countries could already apply to transition to a different 51视频tion without thimerosal starting in 2023. So, but maybe an option would be broader. Just there’s kind of a lot up in the air as to actually how this gets operationalized in the timeline. 

Rovner: Yeah, I was thinking, though, this might have been one of the cases where Congress complaining, both publicly and privately, did actually have some impact. But also, I know a lot of it was Marco Rubio stepping in and saying, “Hey, this is a State Department thing.” And finally, you know, I say a year and eight months later, the money gets distributed. All right, we’re going to take a quick break. We will be right back.  

Well, speaking of things that may or may not be good politics, Republican Sen. Rand Paul of Kentucky called former NIH [National Institutes of Health] and White House science official Tony Fauci before his Homeland Security Committee Wednesday to rake him over the coals again over his handling of the covid pandemic. Fauci, who received a preemptive pardon from President Joe Biden as Biden was walking out of the Oval Office door in 2025, did not take the bait. He pleaded the Fifth, lest anything he said be used for a new prosecution for lying to Congress. Meanwhile, Paul says he’ll try to find Fauci in contempt of Congress, which, by the way, would take 60 votes, which feels a little unlikely. Separately, several red-state attorneys general say they now want to investigate Fauci since his pardon doesn’t cover state prosecutions. First, prosecute him for what? And is relitigating covid origins and lockdowns really good politics for Republicans? I’m sure it riles up the base, but it’s hard to see them running on this as their health agenda. 

Whyte: So Rand Paul actually said on TV last night that he just thinks his committee needs to do the contempt of Congress vote, and then they can refer it to the DOJ [Department of Justice]. So they may not need 60 votes. So that will be interesting. Meanwhile, [Sen.] Ron Johnson [R-Wis.] has also threatened to subpoena Fauci. And the Florida attorney general is opening an investigation. And Alabama Sen. Tommy Tuberville says if he becomes governor, he’s going to try to figure out a way to prosecute Fauci in Alabama. So there’s definitely a lot of focus on Dr. Fauci. 

Rovner: I repeat, though, prosecute him for what? 

Whyte: Well, you know, before the hearing, Rand Paul was saying, Yeah, his preemptive pardon covers stuff in the past, but if he lies again at this hearing, then we will, you know, go after him or whatever. 

Rovner: Right, and that’s why he didn’t, that’s why he pleaded the Fifth.  

Whyte: Right, which is why it was viewed as an 鈥� entrapment situation that he should probably steer clear of, and why he would not even answer, like, what is the color of the carpet. 

Rovner: And what color his tie was, or was it Sen. [Josh] Hawley’s tie? 

Whyte: Yeah, and what day of the week it was, yeah. Whether it’s good politics for Republicans, I think we’ll have to see. There’s an Ohio candidate that they’ve tried to get for being, you know, covid czar or whatever, and that really hasn’t gone anywhere in Ohio. She’s polling OK. So I think that’s a good question on whether voters still care about this or not. I think obviously a lot of them do, but, like, the suburban women who are, you know, the famous swing voters, what do they think about Dr. Fauci? Will be interesting to see. 

Rovner: Yeah, I mean, I guess just for watching the questioning, it seemed that they’re trying to, you know, that we know that Democrats have more enthusiasm going into this midterm than Republicans. And it looked like the Republicans were trying to, you know, reactivate the angry covid base, if you will, to get them to come out and vote. It’s just hard to know how many people are angry enough to come out, you know, six years later.  

All right. Well, speaking of buzzy stories, Liz, you  about how Trump might be pushing RFK Jr. on childhood vaccine policy rather than what we all assumed was the other way around. So tell us about it. 

Whyte: Yeah, this is a bit of a counterintuitive news development for two reasons. One, because everybody thinks RFK Jr. is the big vaccine skeptic in the administration. And two, because the White House had, you know, is widely reported that they were telling HHS to “ix-nay on the accines-vay” ahead of the midterms 鈥� like, just dial it down a little bit because of polling they had from the winter that showed while food and ag [agricultural] stuff was really popular, the other MAHA stuff, vaccine skepticism, was not, and they kind of wanted to tone it down. But the president does what he wants. He does not always listen to the polling. And he has been telling Kennedy since at least May, why aren’t you doing more to probe the connection, in his mind, between vaccines and autism? And this took Kennedy aback, actually, at a golf course lunch in May. He was surprised because he was still under the impression they were supposed to be dialing back. And President Trump told him, “You have the yips,” which I just think is such a funny word. 

Rovner: It’s a golf term. 

Whyte: Yes, it’s a golf term. And that has continued to be, actually, a point of tension between the two men, with the president venting his frustration to Kennedy at a mid-June Oval Office meeting. And part of the reason we’re seeing some of this increased action, even if it’s not, you know, really talked about much, but appeals to the federal appeals court to speed up the decision for the key vaccine advisory panel of the CDC [Centers for Disease Control and Prevention], and then also there was that EO [executive order] in May that Trump put out on the childhood vaccine schedule, and just kind of general scrambling behind the scenes to figure out, like, what they can deliver for the president, who is, I’m told, a results guy and wants to see results and thinks, you know, it’s been a year and a half, and why aren’t there results? So, we’ll see where that leads. 

Rovner: Well, meanwhile, if this puts Kennedy in hot water with the president,  what the newest, who the newest likely candidate is should RFK Jr. leave his post, either voluntarily or not so voluntarily. Tell us about your story. 

Cohrs Zhang: So I have been working on this story for a very long time. But I think we’ve seen kind of this surprise in Washington that Dr. Oz, who’s leading Medicare and Medicaid, has actually like navigated the Trump administration with great skill, and I think we were finally able to capture the scope of that, him translating that skill into personal relationships with the president, with the secretary, and getting himself a seat at the table on far more policy issues than a CMS [Centers for Medicare & Medicaid Services] administrator would normally get. And I think we saw, those of us who remember the first Trump administration, how ugly things got between HHS and CMS 鈥� was like very adversarial, like a really bad time in there, very toxic. But I think we’ve seen him take a more, like, cooperative approach. He wields his influence, is more explaining things. He is a medical doctor, his training, unlike the secretary. And I think there is just, like, a general trust and, like, personal friendship between the two of them that has translated into this interesting dynamic, where Dr. Oz kind of serves as a go-between on some of these issues between the White House and the secretary and gets everybody kind of to the place where they need to go. And he’s just a good communicator and has built a lot of trust and parlayed that into getting himself a seat at the table. 

Rovner: Yeah, and Liz 鈥� your story about Kennedy and Trump also suggested that Oz’s favor is rising, shall we say? 

Whyte: Yeah, the White House staff love Oz because they know they can send him to the Hill. They can put him on TV. Like, he’s going to do a great job. Rachel had this too. You know, the president calling and texting Oz and saying, you know, what about this issue? and it has nothing to do with CMS. He’s, you know, being called upon to do other stuff that is not in his portfolio. So yeah, every lobbyist is just, like, watching their clock and seeing when Oz takes over. I don’t know that it’s that straightforward. I think the president and secretary have a very warm friendship, and it took a lot for Kristi Noem to get let go, and I don’t think we’re anywhere near that. So we’ll have to see if the mood changes after the midterms. But it doesn’t seem to me that anything would be imminent. 

Rovner: I would add that I know Oz is the one person practically in the entire administration, not just at HHS, who actually does well when he goes to the Hill. Who, you know, is respectful and sort of understands how administration officials are supposed to conduct themselves when they are in front of the people who theoretically are responsible for them having their jobs.  

Whyte: Yeah, you’ll find the Democrat staffers are like, Oh, we actually like Oz, which is funny, I think.  

Rovner: He’s a good politician! What can I say? Rachel, do you want to add something? 

Cohrs Zhang: I will say, though, he did play a role in selling all these Medicaid cuts that are going to be coming down the pike. 

Rovner: He did. 

Cohrs Zhang: And so I think he is going to be the face of this when they actually go to implement it.  

Rovner: He will. 

Cohrs Zhang: So yeah, we’ll see how that goes.  

Rovner: We’ll see how that goes.  

Cohrs Zhang: What time frame they’ll be doing that in. But yeah, certainly. Yeah, it’s interesting. 

Whyte: They’ve kind of given up selling that, too. You know, it’s not something they’re being like, Oh, look at all the great stuff we did with Medicaid in the One Big Beautiful Bill. It’s very much pivoted to fraud.  

Rovner: Yeah, but when it starts, when it takes effect next year, I think there’s going to be, there will be lots of questions to answer. Shefali, do you want to add something before we move on? 

Luthra: The only thing that really just I keep thinking about is the long history of this relationship between Dr. Oz and the president, and, in particular, when during the 2016 campaign he was the one to talk about the president’s testosterone levels on TV and how they were excellent. And I just think it’s really special that we’ve come full circle in this way. 

Rovner: Yes, yes, it is, and we have. All right, moving on. One thing that Secretary RFK Jr. said this week that’s pretty clearly not true is that the department has the cyclospora parasite outbreak, quote, “under control.” A former deputy commissioner of food at the FDA under both the first Trump administration and President Biden told Politico this week that, quote, “it is starting to approach a catastrophic level in terms of how mismanaged it’s been on multiple fronts.” Rachel, you’re keeping an eye on this. What is the latest? What do we know about cyclospora and where it’s coming from? And are the recalls that are in existence enough to stop it? 

Cohrs Zhang: I don’t think they’re stopping it, by any means, especially with an incubation period of two weeks. I think we are continuing to see more cases reported, and I think, like you mentioned, there’s, I think, fingers pointing in all directions. Our team and others have done reporting on just how Taylor Farms has handled themselves behind the scenes. The public spat between Taylor Farms and the FDA was not something you usually see in an outbreak of this kind. It’s just worth probably pointing out that the FDA did DOGE much of its communications staff that has experience with this sort of outbreak. We have, you know, officials shifting around, and there’s some key vacancies at the FDA as well in a lot of these leadership positions. So I think there’s been complaints, certainly, at, like, the report you mentioned about the federal response, but also about the company and their speed and their clarity and communication, and whether that’s truly serving the public interest or not. And I think there are, if I’m not mistaken, some ongoing investigations into other potential causes. But we are seeing a lot of these cases tied back to lettuce from a specific part of Mexico. So I think they have gotten the word out now, but just the confusion and the back-and-forth. And I think former FDA commissioner Scott Gottlieb got on CNBC and said he would have expected more communication from the FDA on this issue. But it’s kind of a tough one when it’s a voluntary recall, and there’s a company, and they’ve used some restrictions, you know, and what they’re supposed to be talking about publicly. But I think there has just been so much consumer confusion, and that’s not in anyone’s interest. 

Rovner: And as we said, this is not a simple thing to track. It’s not like E. coli; you can’t really find it. Liz, you and your colleagues reported, though, on, you know, Taylor Farms going straight to the White House to try and sort of go over the heads of the FDA on this. 

Whyte: Yeah, Bloomberg and The Wall Street Journal had stories with different pieces of this, and it was, you know, in our story, you could see that they were trying to distance themselves from the outbreak before they got named publicly, which is kind of this new wild West of lobbying that we’re in, where it makes a lot of sense for companies to go straight to the White House and skip over dealing with career officials. And what was interesting was that the way all that played out with the communications is Taylor was able to say, FDA apologized to us, made this like really confusing statement. And the FDA, maybe because it didn’t have the comms folks with experience, like Rachel was talking about, at the FDA with, you know, various layers of people who have done this before, you know, it took them till the next day to say: By the way, our epidemiology on this is really good. It’s definitely still Taylor Farms. We just, like, had that one false positive. It was crazy to me how, like, twisted and turned that got. 

Rovner: It was not well handled from a public communications standpoint, shall we say? All right. Well, one thing that we know that RFK Jr. thinks highly of are peptides; those are the amino acids that wellness influencers say can build muscle, heal injuries, and burn fat, among other things. Last week, an FDA advisory committee voted, over the objections of FDA’s own scientists 鈥� who say evidence on the benefits of peptides is either skimpy or nonexistent 鈥� to nonetheless make it easier for compounding pharmacies to make and sell products containing several different specific peptides. Now, this is not just a scientific disagreement. Several members of this advisory panel are actual sellers of this product, right? 

Whyte: Yeah, the panel was a bunch of members who either worked for companies that sell peptides or had a clinic that offers them. And the HHS said these people went through a conflict process. It doesn’t seem like it could have been as rigorous as the previous conflict processes that were in place. I haven’t seen a ton of reporting on that. But, you know, predictably they greenlighted most of the peptides that they looked at over and against the strong recommendations from FDA staff scientists who said we don’t have evidence that these are safe. Like, this is kind of unprecedented. The argument in favor was, well, you know, we do something similar with supplements. You know, Secretary Kennedy has said people should be free to try these out, and you know he wants to end the war on peptides. And meanwhile, scientists with a traditional background in looking at risk and benefits are saying the risks are there, the benefits are not proven, and this almost creates a different paradigm for how we’re looking at medical interventions now. 

Rovner: Yeah, and I think we’ve seen this across the FDA and across HHS. I mean, this is basically what they’re, you know, calling gold-standard science. That there’s a lot of people 鈥� go ahead, Rachel. 

Cohrs Zhang: I was just gonna say, and I’m 鈥� I think, looking forward, this creates a split decision, right, between the FDA scientists and the ag comm, and that’s gonna put the FDA in a tough position as to who what they’re going to choose because former commissioner Marty Makary loved to say he was siding with the career scientists, and now we have this forum to hear what they actually think, like, presented to the public. So I think that’s going to be a tough decision ahead, and that’ll tell us how things are working inside. 

Rovner: And of course, we only have an acting commissioner of FDA right now, so 鈥�  

Cohrs Zhang: Yes, with instructions to not make news. 

Rovner: Finally, this week, news on reproductive health 鈥� because there is always news on reproductive health. Shefali, we had a decision in one of the court cases challenging how the FDA regulates the abortion pill mifepristone, but it’s not the case that we’ve all been watching, right? 

Luthra: No, this was the Virginia case. And what it reminds us is that there’s actually a million different mifepristone cases because you have people looking for more restrictions on mifepristone, and you also have people looking for fewer restrictions on mifepristone. And a lot of the folks who provide the drug, the doctors and manufacturers, have argued that, in fact, there are more restrictions than are actually appropriate. That this is actually much safer, and it does not need to be so hard to get because, for all of the concerns from conservatives and abortion opponents, it actually is very difficult to prescribe and make mifepristone available without going through a lot of hoops of certification. And so we see, right, in some cases, like here, an effort to try and loosen those restrictions a bit and say this could be more available, especially, I mean, people when they have miscarriages, it is actually very hard to get mifepristone, even though it actually would be very beneficial for management. But I think what this does, practically, is again not much changes for now because we have so much going through so many courts in different ways. Realistically, I mean, access to the drug stays as what it is: available in some places, not available in others. And the big case that we’re all waiting for, the Louisiana one, that could possibly bring restrictions in, that very briefly did bring restrictions in mifepristone earlier this year 鈥� we’ll probably see more on that closer to the election. And that could be very interesting because, as we’ve talked about so many times, this is not really an issue the White House or a lot of Republicans, frankly, would like to be in the news, because they know that restrictions on abortion just remain so unpopular and continue to be for a long time. 

Rovner: And this is almost certainly heading for the Supreme Court, right? We now have a court, you know, a lower court saying that the Biden administration’s restrictions were too tight, and one assumes that coming out of Louisiana, we will have a decision that says that they’re not tight enough. 

Luthra: I would be stunned if the Supreme Court did not hear a mifepristone case in the coming few years. It just seems like we’ve been building in this direction for a very long time. You’re totally right. The split circuit looming makes that more likely. And I mean, realistically, if I supported abortion rights, if I wanted to make this pill more available, as the folks arguing against the Biden restrictions are, I don’t know that I would be thrilled about this being something before the Supreme Court because this is known to be a more conservative court. A lot of members who think abortion should be far less available than it is 鈥� this is the same court that overturned Roe v. Wade. And so I think there’s a real possibility that as we see more and more abortion decisions make their way to the Supreme Court, the restrictions we have become even more so, and where we are now becomes a baseline for making this even more difficult for people to obtain. 

Rovner: We will have to see. Meanwhile, our podcast pal Alice [Miranda] Ollstein has a co-bylined story at Politico this week about how anti-abortion groups are pulling out all the stops to try to show that the increased use of . Now they have a study, commissioned by the group Students for Life, claiming that mifepristone is showing up in, quote, “significant levels” in waterways in Austin, Texas; Blacksburg, Virginia; and Carbondale, Illinois 鈥� all major college towns, not coincidentally. And while the science behind this remains questionable, the politics don’t, right? 

Luthra: Right. And this is a strategy they’ve been working on for quite some time, putting bills in state legislatures, talking to anyone who will listen about this, and saying, If we care about the environment, the left cares about the environment,why don’t we care about what they say is this mifepristone pollution in the water that they say is caused by medication abortions? And they want to use this argument as a different prong on the way to stop people from having mifepristone made available, of making medication abortions harder to obtain. We haven’t really seen this really yield fruit yet. However, this is part of, again, a longer-term strategy to lay groundwork. And studies like this, they create an intellectual groundwork as well. We saw that with the telehealth studies, the mifepristone safety and efficacy studies 鈥� and I perhaps should do “studies” in air quotes because a lot of mainstream researchers call these not very good science. But if you create a large-enough body to point to, then ultimately you can have people in positions of power say, “Well, we’ve looked at the evidence from all sides, and we see these real concerns, and we’re going to use them to inform policy.” I don’t know that that will happen anytime soon, but it’s certainly a goal that they’re building toward. 

Rovner: They’re talking points, basically. 

Luthra: Absolutely. 

Rovner: All right. Well, that is this week’s news. 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? 

Cohrs Zhang: Mine is from 51视频 Health News. The headline is “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. I think this is one installment, and that this broader arc of coverage that they have really owned 鈥� it’s so diffuse. There’s like states, and there’s providers, and there’s government officials involved, but I think it really illuminates kind of like where is the Trump administration looking for data? I think this is something that started during the DOGE era, where you had DOGE employees trying to get data from different government agencies. But you’re seeing it as, I think, we’ve talked about previously, like, there’s a desire for studies and, you know, things to move faster. Like, where are we looking for data? I think this whole arc of coverage has been really valuable in illuminating: Where are they looking. Is this precedented? Kind of how could these datasets be used? What are the patient potential issues? Are there privacy issues? Can this data be protected? That I think are going to be really important as we kind of look into the rest of this administration, because we’re only a year and a half in. Like, we got a ways to go. 

Rovner: And, oh I mean we say over many, many, many years it’s always been Republicans who have been, you know, very much into the federal government shouldn’t have its hands in people’s personal data, and yet here we have an administration that’s trying to get personal data from every single possible place. 

Cohrs Zhang: Right, it’s fascinating. And this just makes it so concrete. And I think it’s great accountability work, and they’ve clearly developed great sourcing on this. 

Rovner: Yeah. Liz. 

Whyte: Mine is a  by two doctors who are concerned about the burgeoning pediatric public health emergency, as they call it, about e-bikes and e-scooters. And I’ve been wondering about this for a long time because I see kids doing two, three kids on these scooters going so fast with no helmets. It’s always boggling my mind, but it’s apparently gotten really bad. They looked at data from 2020 to 2021 and saw an increase in injuries, up 71% in just one year 鈥� kid injuries with e-scooters and e-bikes. So that was 8,545 of those injuries in 2021. And the doctors discuss how, you know, these injury patterns that these kids get 鈥� I mean, they’re going up to like 28 mph 鈥� look very similar to when a child gets hit by a car. And that’s, it’s just real sad. So TBD on whether anybody does any kind of age-appropriate access standards or something like that that can help dial back these injuries. And then I guess I’m cheating Julie, but a shoutout to  recently, about how peptide med spa clinics have less regulation at the state level than your local restaurant or hair salon. She contacted all 50 states, and I thought it was just a really good supplement to the peptide news that we saw recently. 

Rovner: It was, and 鈥� forgive me for not mentioning it, and we will link to that one too. But I’m so glad you did the e-bike thing because if you hadn’t done that, I was going to, because the number of kids just in my neighborhood, little kids on motorized vehicles, it’s like: Shouldn’t they have to have driver’s licenses to do this? Anyway. Shefali. 

Luthra: My piece is by Aaron Carroll. It is an op-ed in The Washington Post. The headline is: “.” And what he talks about, I think, is just so smart. It’s about how it actually would be great if we had better and more research on SSRIs. However, the point he makes is that the government is actually not really approaching this from that kind of vantage. And instead the idea is to try and just cut back access to SSRIs, rather than learn more about them, learn how to make them work better, if they are as effective as they want them to be. And the point that he gets at the end as well is that while it is really good and worthwhile to investigate and study how well SSRIs work, one thing that we are actually getting into, which is really problematic, is stigmatizing use of them. And he talks about why that’s actually not good, and that is not actually helpful when it comes to thinking about how to make treatment for depression better and better and better. And I love this framing because we should try and make medications better for people. We should always be looking at treatments we have and saying, yes, they work. But what if we made them work better and better? What if we had fewer side effects? What if we made them more effective? That would be awesome. And I really love that he is putting those questions out there in a way that is smart and productive and forward-looking. 

Rovner: And not partisan. This has never been partisan. This is just so 鈥�  it’s all so unprecedented. All right. My extra credit this week is from The Arkansas Times. It’s called “,” by Byron Tate. And it’s about exactly what the headline says. Since Congress gave states the option to extend Medicaid coverage to postpartum women for a full year after they give birth, 49 states have exercised that option 鈥� all but Arkansas, where that coverage still ends after 60 days. And Arkansas has one of the nation’s highest maternal mortality rates. So who’s against it? Apparently, the governor, Republican Sarah Huckabee Sanders, herself a mom. She says these women should be transitioning to other coverage, except apparently most of them are not. According to one study, 94% of those losing postpartum Medicaid are becoming uninsured instead. 

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 , and on Bluesky . Where are you folks hanging on socials these days? Rachel? 

Cohrs Zhang: I’m on X  and also on . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Liz. 

Whyte: I am on X  鈥� with a “Y,” W-H-Y-T-E 鈥� and . You can Google me. 

Rovner: I’m sure people can find you. All right, 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 51视频 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 51视频 Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 16, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everyone. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edney: Exactly. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ollstein: Correct, and 鈥�  

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

Ollstein: The bosses, yes. 

Rovner: Right. The bosses. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: I’ll talk to them separately. 

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

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

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

Rovner: So more education, basically. 

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

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

Mitchell: Thank you. 

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

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

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

Ollstein: Thank you. 

Rovner: Sandhya. 

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

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

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

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

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

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

Okay, that is this week’s show. OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 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? Sandhya? 

Raman: On  and on  @SandhyaWrites. 

Rovner: Anna. 

Edney:  and  @annaedney. 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

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