[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, 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 51视频 Health News 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 51视频 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-51视频 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 51视频 Health News 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 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, Sept. 17, 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 Tami Luhby of CNN. 

Tami Luhby: Howdy. 

Rovner: Later in this episode, we’ll have my interview with Sabrina Corlette, one of the authors of a new paper from the Georgetown University Center on Health Insurance Reforms, about some possible shorter-term fixes for what ails our dysfunctional healthcare system. But first, this week’s news. 

So I try not to talk too much here about artificial intelligence, partly because we at 51视频 already have a separate podcast devoted to AI and its implications for the business of health, and partly because I am one of the many, many Americans who doesn’t really understand it. But I feel like we really can’t avoid it this week, with AI leaders all but pleading with Congress for regulation, lest they accidentally, or not, create something that could literally kill all us humans. And while I don’t think any of us has the expertise to comment on whether some future AI might actually be justified in trying to rid the planet of humanity, given what we humans have done to the planet, I’m more interested in reports about humans currently using AI to do things like manipulate viruses to create, you know, a pandemic 鈥� but maybe even a more deadly one than the one that we just had. Anthropic, which touts itself as the most ethical and responsible of the big AI companies, said it has already . I feel like maybe this is something members of Congress might want to address in the near-term future? 

Edney: Definitely, I think that, like, the timing for this, given what’s going on in the larger AI world with these warnings that we’re seeing, was certainly very ominous for creating that potential worst pandemic that you’re talking about. And it does seem like it could be part of that discussion and what Congress may want to do; it could be sort of its own thing. It’s unclear how that’s going to be handled, especially, I think, we all are aware of the timing as well, with the midterms coming up and Congress not getting a lot done. And this is a really complicated subject, I think 鈥� the kind of issues with this report coming out was these could be just regular research queries. You know, it’s really unclear if this was nefarious. If it is, that’s really bad, and if it wasn’t, let’s not get worked up about something that isn’t there yet. But it does show that there’s the potential for that to happen. So 鈥t’s good to think about it early. 

Rovner: And of course, the House, we should mention, has up and left until after the election. So they couldn’t do anything even if they wanted to. Alice, you wanted to add something? 

Ollstein: Yeah. So I was up on Capitol Hill yesterday, and there did not seem to be a groundswell of interest in rapid action and keeping the members in session to deal with this. I mean, when it comes, you know, to technology, especially, often federal policy is decades behind, you know, where the technology is going and moves so much slower. And I don’t know, even if there was the political will to stay in session and do something, if they would even know what to do or be able to come up with something quickly. This is something that could take years. Meanwhile, the technology itself is just leaping ahead in leaps and bounds, and so I am not optimistic about a robust response from Congress, given their record recently, and given what I witnessed on the Hill. Even though there is bipartisan interest in doing something, but what that something is, there is no agreement. 

Luhby: There’s a legitimate concern of how/what China is doing with AI, and even if we control what’s happening within our borders, we can’t control what’s happening with the development in the world. So that is an overarching problem that Congress can’t solve. 

Rovner: Right. 

Ollstein: I also often hear, you know, Oh, we should really pare back AI on everything except healthcare because it has so much promise in the healthcare space. But there’s also a lot of risk in the healthcare space. I mean, you were mentioning the development of potential viruses and bioweapons, but even beyond that, there’s already reports of AI being used to deny people’s claims, to entrench human biases in decision-making. You know, there’s a lot of risk in the healthcare space, too. It’s not all sunshine and rainbows and the risk is only in other areas. 

Rovner: Well, you are actually anticipating my next question, which is: Meanwhile, from the “AI might not actually kill us, but it’s going to make a lot of people rich” file, my former colleague Christina Jewett, now at The New York Times, has a about how medical AI entrepreneurs are exercising perhaps undue influence at the Department of Health and Human Services, and, according to the story, worrying some officials that AI adoption in medicine is coming faster than the evidence that it’s safe and effective 鈥� never mind money-saving. Again, as you were saying, Alice, I can’t imagine technology in medicine running ahead of attempts to regulate it. That’s only happened basically every time for the last 50 years. 

Edney: I think the attempts to regulate it are 鈥� the issue is who’s going to do the regulating. The FDA seems sort of split right now, where you have the traditional medical devices director, and this is Christina’s reporting, as you mentioned, Julie, someone 鈥� more in the commissioner’s office who is a tech-connected person wanting to wrest the AI part of regulation from the medical device center, where it normally sits. So I think that that question, too, is still being figured out. 

Rovner: And there’s even the, you know, what is AI? Is it a medical device? What kind of evidence would one need to approve it? Who would approve it? I mean, there’s definitely a lot more to come here. All right. Well 鈥� 

Luhby: Looking at healthcare’s role in the economy, it’s a major source of jobs right now and in the future, but it may not be, depending on what happens with AI. I was just actually at a doctor’s appointment at a major New York City medical center, and the doctor was speaking to, you know, a human assistant in the room, which I was 鈥� and I said to her, “Thank you so much for actually, you know, using humans.” And she sort of said, “Well, we’ll see how long that lasts,” indicating that her medical center may be really pushing doctors to use more AI scribes. And I was thinking, Wow, that’s going to cost a lot of people their jobs. 

Rovner: Although I just went to the doctor, and he was starting to use an AI scribe. He said he was just trying it out. So we will see how this all moves on. All right. 

Well, back to the pocketbook issues that seem to be driving voter anger this fall, even more than AI and data centers, President [Donald] Trump, the day after he floated the idea of sending all U.S. adults a $5,000 check if they return Republicans to power after the midterms, separately is proposing to send a $500 check before the elections to about a million unsubsidized enrollees in the Affordable Care Act plans. Unlike the $5,000, which would pretty clearly have to be approved by Congress 鈥� spoiler: probably won’t happen; it would be really expensive 鈥� the $500 ACA checks at least seem plausible. They represent unspent user fees the federal government has already collected. Two questions about this: One, is it really legal? And, if it is, and the administration does it, will it make up for the huge increases that most unsubsidized ACA enrollees saw in 2026 after the Biden-era extra subsidies expired? A lot of people saw increases that were a lot more than $500 just this year. 

Luhby: I mean, I think it’s questionable as to whether it’s legal and also whether it’s fair, because you’re also talking about giving this money only to be unsubsidized. And you can argue that, yes, the people who got subsidies already got, you know, a federal gift. But there are a lot of questions about these checks. But as far as whether they will make up for the massive increase in premium payments that a lot of folks have paid 鈥� especially for the people who didn’t receive subsidies, which, who are generally the people who make more than, you know, 400% of poverty, or 鈥� even a higher percentage, because the changes in the subsidy structure 鈥� those people are probably among the most 鈥� the ones who had the highest increases in premiums between ’25 and ’26. And there’s another round of double-digit premium increases on the way in 2027, or for 2027. So Cynthia Cox, one of our favorite experts at 51视频, questioned whether $500 would even cover one month of a premium increase, much less one year. But, you know, as we know, healthcare costs are on the top of voters’ minds, and the Trump administration feels like it has to do something to say that it is helping to lower them ahead of the midterm elections. 

Rovner: Yeah, and this would be, I guess, something that they, in theory, could do. Well, moving on, it may be time to revisit one of the few bipartisan pieces of consumer health legislation of the past decade: the No Surprises Act. That law has successfully spared millions of patients from ending up in the middle of payment disputes between health insurers and medical providers. What it hasn’t done such a good job at, though, is settling those disputes in a cost-effective way. Instead, to quote from the Georgetown study that’s the subject of this week’s podcast interview with Sabrina Corlette, “the dispute resolution process created by the law has cost the health system an estimated $22 billion in just four years.” As a result of that, groups from across the ideological spectrum, from the liberal Families USA to the conservative Paragon Institute, as well as Republicans and Democrats on some key committees in Congress, are that something needs to change. Now this arbitration process that’s gotten so out of whack was the very last thing settled and almost scuttled this law on the launchpad. Is there a suitable alternative available, or will the magnitude of how badly this arbitration process is skewing in favor of providers who are getting enormous payouts going to force some sort of compromise? 

Edney: It seems like there needs to be a compromise. I was a little surprised that that’s being acknowledged. I think when this was first being talked about and coming to light, it seemed like the lawmakers were like, “Well, the law is working for patients,” and, like, “Well, you know, it’ll be OK.” But as you know, those numbers are coming in, that’s 鈥� billions of dollars. That’s a huge amount. And, you know, there are options. I think a lot of it was talked about and not agreed upon. But maybe benchmarking these to what Medicare pays or something along those lines when there’s a dispute could be more palatable, given, you know, what’s going on now that they’ve seen the results of what ended up being put into law. 

Rovner: Of course, that was, I mean, that was the hope when they were doing this is that they would set some sort of upward bound of, you know, yes 鈥� 

Edney: Right. 

Rovner: And sure, if you’re trying to lowball the provider, we’re going to make sure the provider gets at least something, you know, that’s reasonable if they’re not in-network. Except what’s happening is, with these arbitrations, these providers are getting things that are way more than anticipated, and that’s turning back into these premium increases that we were just talking about. I mean, it’s all sort of one big circle here. 

Luhby: Right, and that’s one thing that, you know, as Politico reported this morning, that’s one thing that employers and insurers want to make sure that people know, and that congresspeople know, is that these increases, these, you know, these payouts that they have to provide for the doctors are going to increase premiums. And you know, as we just discussed, healthcare is on the top of voters’ minds. Already, you know, various consulting groups have said that employer coverage, which is the most prevalent type of coverage, the premiums again are going to increase by a lot for 2027. And, you know, again the employers and insurers are pointing fingers at this arbitration, you know, provision and what doctors are doing and how they’re manipulating it as one of the drivers of these increased healthcare costs and premiums. 

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

Moving to immigration, this week nearly half the states filed suit in federal court to block the Trump administration’s new, quote, “public charge rule.” That’s what gives immigration officials more leeway to block people from entering the country who they think could eventually qualify for government aid. Tami, you wrote about this. What are the states arguing, and what are they asking for? 

Luhby: Well, the main concern here 鈥� they want the rule to be blocked, but it looks like it’s supposed to go into effect tomorrow. And at this point, we know that the judge 鈥� there are two lawsuits: there’s states and cities 鈥� and the judge 鈥� it shouldn’t be probably the same judge, but we don’t know for sure yet. And the judge who has been assigned to the state lawsuit is not holding an initial hearing until, I think, it’s Oct. 9, or it’s early October, so it does look like the new rules will go into effect on Friday. But basically, what the concern is is that this is going to end up causing a lot of immigrants, particularly their families, particularly their U.S. citizen children, who may be eligible for benefits like Medicaid, like CHIP [Children’s Health Insurance Program], like housing vouchers, food stamps, school meals, WIC [Special Supplemental Nutrition Program for Women, Infants, and Children]. There’s, you know, a huge number of safety net programs that these immigrants and their families may choose to drop out of or not enroll in, and this is going to cause, obviously, you know, major concerns for hunger, for health, and housing. And the cities and states are arguing that they’re going to be harmed because they’re going to have to pick up the tabs. And, you know, these people will still need to, you know, obviously have healthcare and housing and food when it comes to it, so they’re concerned about their public costs as well as their local economies. 

Rovner: Yeah, and I mean that’s a really important point, which is that this is not just about people coming into the country. This is about people who are already here. Alice, I know you’ve done some reporting on the whole public charge issue, and we’ve got a really good 51视频 Health News story that I will link to this week that’s called “A Generation of Kids Suffer as Trump Destabilizes Immigrant Families.” This is really reaching much beyond 鈥� you know, they originally, he said we’re just going to deport the worst of the worst 鈥� but this is reaching much, much further into immigrant communities here legally in the United States, right? 

Ollstein: Yeah, and I think there are just a lot of downstream consequences of this that we saw the first time they did this in the first Trump administration, and that, you know, folks are predicting will happen again that impacts everyone in the community. So for one, immigrants tend to be younger than the general population, and so removing them from these, you know, insurance systems could raise other people’s premiums 鈥� you know, the people who remain, because the costs will be higher. It’ll be an older, sicker population sharing those costs. Also, you are seeing that when these rules go into effect, people who remain eligible for the insurance programs, just out of confusion or fear, don’t enroll, and so it impacts even the people it doesn’t officially apply to, through a chilling effect, which, again, you know, leads to those same higher premiums and worse risk pool. But also, you have, you know, you mentioned risks of infectious diseases; if you deter people from getting preventive care, from getting vaccines, from getting checkups, that puts the whole community at risk. 

Rovner: Yeah. 

Luhby: And even DHS [Department of Homeland Security] itself acknowledges that there’s going to be a chilling effect. They estimated that 950,000 people may opt to leave or not enroll in 鈥� they examined six public benefit programs: Medicaid, food stamps, CHIP, federal assistance 鈥� and I think nearly a million people who, you know, are eligible for these safety net programs who may not participate. 

Rovner: Well, I guess that is one way to cut the budget. 

Turning to reproductive health, Alice, there’s movement on that story you’ve been following about testing wastewater [drinking water] for remnants of abortion pills. Now, what’s the latest? 

Ollstein: Yeah, so this was a story my colleagues and I broke recently that the EPA [Environmental Protection Agency] itself is now going to do some testing on this front. Of course, they’re not testing just for abortion pills; they’re testing for a bunch of different pharmaceutical medications. But putting abortion pills on that bigger list is, you know, something that anti-abortion groups have been clamoring for years and are . Of course, they’re still pushing for a separate process where EPA would require utilities around the country to monitor for certain drugs, including abortion pills. And so they’re still pushing on that front. But they consider this a step towards, you know, potential restrictions. Now, it’s important to know that the test the EPA is using only will show if any amount is detectable in the water; it will not determine the concentration. And so even if they say, “OK, we found traces of this,” it doesn’t mean it has any impact on plants, animals, humans. It does not mean that. So whatever they come up with, it’s important for people to keep that in mind. Environmental experts we talked to stress that this is sort of a bad-faith push. There is no evidence that there’s any actual environmental harm here. Pharmaceutical contamination of water is a real thing, but there are medications that are way more of a threat in their minds than this one. 

Rovner: Yeah, but this is what they’ve been pushing as yet another way to try to go after abortion pills. Well, meanwhile, while the FDA continues to restudy the safety of mifepristone, at the urging of anti-abortion groups, in California, the attorney general is wrapping up a lawsuit against two anti-abortion nonprofits for their proffering of that purport to stop a medical abortion partway through. Unlike mifepristone, which has been studied in many clinical trials in the U.S. and internationally, there is no evidence that giving the hormone progesterone can save a pregnancy partway through a medical abortion. Alice, how big an impact could this case have, and when do we expect to hear from the judge? 

Ollstein: So this could really set a precedent. There are a lot of legal battles around the country. There’s another one the New York attorney general is in the middle of that is similar to this one. But it’s getting into this interesting space between protecting patients versus free speech and what clinics, even, you know, less-regulated crisis pregnancy centers, like the ones that are at issue in this case, what they can tell people and whether states are able to regulate that in the name of protecting patients from potential harm. Like you said, this hormone regimen, where after you take mifepristone, which is an anti-progesterone, you know, they’re saying, Oh, if you change your mind and you don’t want to have an abortion after all, you can take a high dose of progesterone to counteract the effects and save the pregnancy. Again, this has been very little studied, and the studies that have happened are methodologically weak. They don’t have control groups. They don’t have random sampling. They’re very, very small numbers. Whereas, like you said, the medical studies of mifepristone itself have been covered millions over the years, and so there’s just a lot more evidence of the safety record. And so, this could be really interesting coming out of California, in terms of these clinics, which have really become a major front in the anti-abortion movement’s larger battle. These centers are very prevalent around the country and have only grown in number since Roe v. Wade was overturned, and so they’re really seen as sort of the forefront of spreading the anti-abortion movement’s message. 

Rovner: Well, speaking of lawsuits that might set a precedent, the family of Tierra Walker, a 37-year-old pregnant woman who died in Texas of multiple complications after being repeatedly denied an abortion, has filed a malpractice suit against her doctors and is also suing Texas Attorney General and Republican Senate candidate Ken Paxton. Paxton, you may remember, personally threatened individual legal action against doctors who performed abortions, even on women whose medical conditions apparently qualified for exceptions to the state’s ban. What does it mean that they’re actually going after Paxton personally 鈥� or, I guess, in his role as attorney general in this case? 

Ollstein: Yeah, they’re going after state officials, and they’re going after the hospital, the doctors. There’s a lot of different charges in this one case. There’s medical malpractice charges. There’s [Americans with Disabilities Act] ADA-like discrimination, refusing-of-care charges. There’s the constitutional charges about the law itself. And so this is really sort of getting into new territory. It’s something I covered in my book, that doctors largely have reported that when they’re operating under abortion bans, they’re more afraid of providing what, even what they consider a medically necessary abortion. They’re more afraid of the legal consequences of providing it than the legal consequences of not providing it. And this is an attempt, and there have been some others to try to change that calculus. So I know there’s an ongoing case in Georgia as well, a medical malpractice case. But it’s sort of attempting to make doctors also afraid of the legal consequences of not providing what could be a lifesaving abortion, and we’ll see what the outcome is in this instance. 

Rovner: And we’ll talk more about this, and we’ll talk more about your book in the coming weeks as we get ready for its launch. Well, finally, this week the House may be gone, but the Senate is still here, and two Senate committees held confirmation hearings this week for Chris Klomp, the Medicare official who’s been nominated to be deputy HHS secretary, as well as a hearing for Nicole Saphier, the radiologist and former Fox News contributor, who is the latest nominee for U.S. surgeon general. At both the Finance Committee, which will vote on Clomp, and the health committee, which will vote on Saphier, there were lots of questions about the administration’s position on vaccines. This comes as Pennsylvania announces its third and fourth measles-related death this summer, and as HHS Secretary RFK Jr. [Robert F. Kennedy Jr.] gives a keynote address here in Washington today at his former nonprofit, the anti-vax group Children’s Health Defense. Interestingly, both Klomp, who is not a doctor, and Saphier, who is a doctor, sort of, kind of endorsed the measles vaccine, but neither appeared enthusiastic enough to satisfy HELP [Health, Education, Labor & Pensions] Committee Chair Bill Cassidy, who’s also on the Finance Committee, of their sincerity. Cassidy delivered some of his strongest critiques yet of the damage the administration is doing by promoting vaccine hesitance. Yet I wonder if Cassidy would plan to vote against either of these nominees, or if any Republicans plan to vote against either of these nominees. 

Edney: I think that’s a great question. And Cassidy clearly has not done that in situations where the stakes 鈥� you know, it seemed like, you know, he had more reason almost, I mean, there was more, at least, like, outwardly publicly, you know, conflicting with his stance, and he didn’t do it. So he is leaving Congress, so that could change things for him. But I’m not sure that I would expect some sort of vote that really spoke out against Trump at this point. 

Rovner: He voted to confirm the new CDC [Centers for Disease Control and Prevention] director, about whom he had basically the same questions. 

Edney: Yeah, “Boy Who Cried Wolf,” I think is what that was. 

Rovner: All right. Well, that is this week’s news. Now we’ll play my interview with Sabrina Corlette, and then we’ll come back with our extra credits. 

I am pleased to welcome to the podcast Sabrina Corlette. Sabrina is a research professor, founder, and co-director of Georgetown University’s Center on Health Insurance Reforms. She’s also the co-author of a brand-new paper called “A Three-Part Strategy for Better Health Insurance” that includes a series of policy changes Congress could make in the short term that could help patients better navigate our messed-up healthcare system. Sabrina Corlette, thanks for joining us. 

Sabrina Corlette: Oh, it is such a delight, Julie. Thank you for having me. 

Rovner: So, I think a lot of us have been predicting that rising costs, lowering access, and increasing confusion is frustrating patients to the point that the nation is likely headed for another major healthcare debate, probably after the next presidential election. But this paper focuses on smaller changes that could be made in the nearer future. What made you decide to look at that? 

Corlette: Well, I’ll be honest, Julie, one inspiration was the 51视频 [Health News] “Bill of the Month” series. You know, I follow that series, and I just saw story after story about patients encountering just the craziest billing situations, coverage challenges, and it just struck me 鈥� particularly in this last year, where we had this big debate over Medicaid and the Affordable Care Act marketplaces, and a number of groups and lawmakers were defending a status quo that, quite frankly, nobody was happy with 鈥� and so I got together with some of my colleagues, you know, what are some concrete things that would have a tangible impact on people’s experience with their health insurance that can be done quickly, would not require a lot of money 鈥� because as you know, Julie, all too well, anytime you want to improve coverage, immediately employers and others say, “Well, this is just going to raise premiums.” So we wanted to come up with something that could immediately improve coverage without raising costs, and learn from some state actions that, you know, are quite frankly happening on a bipartisan basis. So, things that felt achievable. 

Rovner: Right. So, your first part is looking at immediate ways to reduce healthcare costs. What are some of those proposals? 

Corlette: Yeah. Sort of a marquee proposal in here is to bring down deductibles. Deductibles have risen 43% over the last decade or so, and they’re just [an] insurmountable cost barrier for so many American families. So that’s No. 1. But as you know, Julie, if you were to try to lower deductibles across the board, it’s like pushing on a balloon, right? Immediately, premiums are going to go up. So the second part of that proposal is to reduce spending on excessive hospital prices that are, you know, many, many multiples of the Medicare rates. And we’ve seen real progress on that at the state level, with states as diverse as Indiana and Vermont starting to rein in most hospital prices. 

Rovner: And we’ve seen both Democrats and Republicans pointing their fingers at hospitals. We’ve talked about that a lot on the podcast 鈥� that hospitals are clearly one of the big drivers right now. That seems to be getting through to policymakers, if not to patients. 

Corlette: That’s right. Yep. 

Rovner: That’s the cost part. Next is reducing unnecessary complexity, which I know is something that everybody would appreciate. What are a couple of the things that we could do there? 

Corlette: Yeah, I mean the main thing that we looked at there was the prolific use of what’s called prior authorization, which is, like, before you can get a healthcare good or service, you have to run it by your health plan and get their advance approval. And that’s just, you know, it used to be that that was really used for certain experimental or very, very high-cost types of services, and now it’s just endemic. And so we propose a number of reforms to 鈥� not eliminate that practice because, you know, you do need some checks on the system 鈥� but to really try to streamline it and reduce the burden for not only patients but physicians as well. 

Rovner: So last is protecting patients from corporate abuses 鈥� again, something that seems to have some bipartisan backing and that people get really furious about? 

Corlette: Yeah, and here the list is pretty long, but I’ll just [home] in on one element, which is reining in some of the more egregious financial practices of private equity, which has really entered the healthcare space in a big way in the last decade or so. And so trying to limit some of the transactions that they engage in that sort of strip assets from a healthcare provider to line the pockets of the investors and really drain away the infrastructure of the, say, the hospital or health system, so that it’s not able to provide as high-quality care. 

Rovner: Things like buying the hospital and then selling the real estate out from underneath, so the hospital now has to pay rent. 

Corlette: Exactly. 

Rovner: And you want to fix the dispute resolution system from something that Congress already tried to fix on a bipartisan basis, which is stopping surprise bills, right? 

Corlette: Oh my gosh, yeah. I mean, you know, that’s one of those issues, again, I think could be very bipartisan. And it’s not every provider in the system, but largely private equity-backed physician group practices really taking advantage of the dispute resolution process under the No Surprises Act to the tune of $22 billion in costs. All that is being passed on in the form of higher premiums for employers and policyholders. So, yeah, we propose some significant reforms to that process. 

Rovner: So, all of these things together are what we health policy types like to refer to as low-hanging fruit, in that it would be less controversial, say, than “Medicare for All.” But we’ve seen that even incremental changes like these that have bipartisan support can be really hard to push through. How optimistic are you that this Congress and this administration, both of which have said they want to do stuff about healthcare and healthcare costs, might be able to actually get any of this stuff done? 

Corlette: Well, I think you and I both, Julie, have been doing this work for long enough. It’s true, nothing is easy. But I will also say that if you look at the polling, Americans now rank healthcare costs higher than groceries and housing as their No. 1 cost concern. I, quite frankly, think that if you’re a politician and you’re not listening to that data and thinking about ways you can reduce costs for people, then you’re committing political malpractice. 

Rovner: We will see if any of this gets picked up. But thank you for doing the paper, Sabrina Corlette, and thank you for joining us. 

Corlette: Thank you for having me. 

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

Edney: Sure. This is a story from a few of my colleagues: “.” And they took a look at some recently released data about prior authorizations and denials, and, essentially, you know, seeing how often people are able to overturn those when they try. Not a lot of people know that they can try to appeal that. And so I really encourage everybody to take a look at it. Check out where your insurer is. I think that that was interesting for me because, you know, they did it by insurer, so you can see what their stance is and how often they’re denying things. 

Rovner: Yeah, and that reminder that we always have with the “Bill of the Month.” It’s, like, don’t pay the first bill, and if you get a bill, don’t be afraid to appeal it. Tami. 

Luhby: My extra credit is a Washington Post story titled “,” by Erica Sloan. The story stood out to me, personally, because I was actually diagnosed with low ferritin 14 years ago, but it took time for the doctor to figure out why I was feeling so tired. So I, actually, I had blood tests, and then I actually went to a sleep doctor because I was figuring, Well, I must not be, you know, sleeping well at night. Maybe I have sleep apnea. But he actually asked to see the blood tests, and he was the one who pointed out my low ferritin levels. So, for those who don’t know, ferritin is a protein that stores iron in the body. And the story cautioned people 鈥� the ferritin face, I think, is what got, you know, is trying to get people into the story because apparently this is a thing, although I had not heard of it before this. 

Rovner: A thing on social media. 

Luhby: Yeah, a thing on social media, and I don’t think I actually ever had ferritin face. I asked my husband. But the story cautioned people from trying to diagnose themselves with iron deficiency based on social media and influencers. But the attention, they said, is raising awareness about iron deficiency, which is really important and which is the, you know, the step before anemia. So I thought the story was important because it highlights how common iron deficiency is 鈥� nearly one-third of U.S. adults are affected 鈥� but how, I was surprised, it’s not part of regular screenings. And the article goes on to explain how to test for iron deficiency, which is to check your ferritin level, and how to treat it, which is to eat more iron-rich food, like spinach, beans, red meat, fortified cereals 鈥� or, if your iron levels are very low, to take iron supplements, which I also personally know are not the most fun because they can cause GI [gastrointestinal] issues. So, and if you’re curious about what ferritin face is, which I was, is apparently it falls under the, you know, “looking tired” umbrella: a dull complexion, dry skin, cracked lips, under-eye circles. But, you know, I think those are symptoms of many things other than iron deficiencies. 

Rovner: And yet still news you can use. Alice. 

Luhby: Yes. 

Ollstein: I have a story from 51视频 [Health News]. It is by Ashley Mizuo, and it’s called “Indigenous Groups Are Exempt From Medicaid Work Rules, but Native Hawaiians Aren’t.” And it examines how, you know, lacking official federal recognition of your tribal status is making Indigenous Hawaiians, who are facing a lot of the same challenges as other Native groups in the mainland U.S., are not exempt from these new Medicaid work requirements that are starting on Jan. 1. And that could be a big barrier to care, and they already have a lot of barriers to care, including sometimes needing to travel from one island to another in order to access services. And so this could really prevent a lot of people who have a lot of health challenges from getting care they need. And so it, you know, looking at a sort of niche overlooked consequence of these new rules. 

Rovner: My extra credit is also about an overlooked consequence. It’s a local story from KJZZ Phoenix public radio called “,” by Camryn Sanchez. And in a situation reminiscent of people in Arkansas losing their Medicaid back in 2018 because the state couldn’t stand up a system allowing them to report their work hours, it seems Arizona can’t figure out how to keep eligible SNAP [Supplemental Nutrition Assistance Program] beneficiaries on that program. Turns out that the state agency that runs the program reported that nearly 9 in 10 interviews with applicants were abandoned, dropped, or otherwise incomplete. The agency itself said it dropped more than 3 million calls due to call-center error or lack of call-center capacity. As a result of that, 53.7% of Arizonans attempting to recertify their food benefits were denied for failing to complete the interview. It is just a really wow story, and, you know, the point that, really, it is incumbent on the states to make these things available. That’s part of why they are supposed to be there. 

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 find me on X , or on Bluesky . Where are you guys hanging out on social media these days? Anna? 

Edney: on X or . Also on . 

Rovner: Alice? 

Ollstein: on Bluesky and on X. 

Rovner: Tami. 

Luhby: I’m just at these days. 

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