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

Julie Rovner: Hello, from 51ÊÓƵ Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 51ÊÓƵ 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, Aug. 20, 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: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have another “How Would You Fix It?” interview, from his car, with businessman and entrepreneur Mark Cuban, who’s now devoting most of his professional attention to the mess that is U.S. healthcare. But first, this week’s news. So, we finally have a nominee to lead the Food and Drug Administration, which has been without a Senate-confirmed commissioner since Marty Makary resigned in May — officially, over a dispute about flavored vapes. The winner of the search is Heidi Overton, a 37-year-old physician and former protégé of Makary’s from Johns Hopkins, who currently oversees the health portfolio at the White House Domestic Policy Council. What do we know about Dr. Overton, and what are her prospects for confirmation? We’ve already seen HELP [Health, Education, Labor, and Pensions] Committee Chairman Bill Cassidy say on social media that he has “concerns” about her, but he’s voted for nominees about whom he’s had concerns as recently as — checks notes — earlier this month. 

Kenen: I mean, Cassidy’s saying he has concerns is not indicative of where this ends up. At the end of the day, President [Donald] Trump has gotten most of his choices through a Senate that often begins hesitant to recalcitrant and usually gives him what he wants. So … sometimes it doesn’t. I mean, it’s not 100%. So, Cassidy is in a different position politically since he’s about to leave the Senate, and partly because President Trump. So we just don’t know where Cassidy is. But it’s not a great start. But it doesn’t mean … it’s the end. 

Rovner: What do we know about Heidi Overton, though? Everything I’ve read about her, she’s either pro-MAHA [Make America Healthy Again] or the MAHA people don’t like her, or she’s, you know, of Marty Makary or not of Marty McCarry. 

Ollstein: Yeah. So my colleagues and I wrote about this yesterday, and a lot of the leading MAHA activists view her as having been a roadblock in the White House to their efforts around pesticides, around vaccines, and other things, and so they are up in arms about the pick. They are, you know, saying she’s … part of the swamp and not part of, you know, the movement that they want to see sweep aside some of these government practices. And I think that her time in the White House and her previous work for the America First Policy Institute could really come back to haunt her. She wrote a lot of papers and op-eds with some controversial takes and policy positions, and I think everybody is sort of scrambling to go over that. People are also talking about her lack of managerial experience. You know, managing a huge agency with a huge staff, and you know, obviously, we have seen recent examples of people who lack that experience being appointed. So that’s also not a deal-breaker necessarily. But all of these things could add up to be problematic for her in the confirmation process. And then what I focused on was her anti-abortion record, which, you know, both could help and hurt her depending on whose votes we’re talking about. 

Rovner: That’s right. I mean, we saw [Sen.] Patty Murray, senior member of the HELP Committee, come out and, you know, and say, Not somebody that I could ever vote for. And also, I mean, she was at the signing of the vaccine executive order that the president had. So that puts her — whether, whatever she says in her confirmation hearings — that sort of puts her with the “Let’s change the vaccine schedule” group. I mean, she seems to fit in nowhere. I guess that’s sort of my question here. 

Luthra: That’s what’s so interesting about her is that there are these sorts of different interests and constituencies that have concerns about her, but sometimes they feel as if they could be contradictory. You obviously have, I mean, Patty Murray — I don’t know if she was ever going to vote for whoever Trump picked — but then you have Susan Collins in a very difficult reelection race, where abortion is a concern. You now have these concerns about vaccines. You have people saying maybe she’s not MAHA enough. And I mean, I think to Joanne’s point, Trump has gotten most people he has wanted. However, this does feel like this could get very complicated, just given how many people may be bringing different criticism from different vantages that could ultimately add up. 

Kenen: I’m not sure we’ve ever seen anything on the Senate floor where she’s going to be called anti-abortion and pro-pesticide. If it gets to the floor, I mean, it’s a weird one. But at the end of the day, you know, does it go through? You know, if you made me bet, my bet would be yes, but I wouldn’t want to bet a whole lot of money. 

Rovner: Well … we’re going to talk about reproductive health later in the podcast, but I do want to talk about abortion right now in the context of this nomination because, Alice, as you point out, Overton is known to be a fairly strident abortion opponent, and if she is confirmed, she’ll take over the study of the safety of the abortion pill mifepristone, which, as we have mentioned many, many, many times, the administration has sort of backbenched, if you will. Given that the new attorney general, Todd Blanche, has raised the specter of invoking the 1873 Comstock Act to bar the mailing of abortion pills, or anything else used for abortions, what is the outlook for medication abortion if Overton actually becomes the FDA commissioner? 

Ollstein: Well, it’s hard to say because we’ve really seen decision-making centralized in the White House, and so often it doesn’t matter what the Cabinet secretaries want to do. It’s about what the White House wants. And the White House, I think, has made it pretty clear that this is not a top, you know, restricting abortion is not a top priority for them. They are certainly sensitive to the politics of it, and so there is speculation that, you know, there’s a delay until after the midterms for anything meaningful on this front, so as not to risk the kind of backlash we saw in 2022 after the fall of Roe v. Wade. But I think it’s also pretty clear that this is just not a top priority for the White House. That doesn’t mean they won’t allow some of these, you know, former activists to do what they want to do — so Blanche, and now Overton potentially. But I think it’s not really a given either way. 

Rovner: Yeah. All right. Well, meanwhile, in administration news that we’ve talked about before but is still relevant, we’re just over a month from the end of the fiscal year, and grant money is still being held up at the National Institutes of Health, according to our podcast pal Paige [Winfield] Cunningham at NOTUS. Despite pressure from Congress, the agency is still delaying funds for already-approved grants while it conducts searches for keywords that could signal that the grant does not adhere to the administration’s political priorities. And it’s not just keywords. Reading from : “In multiple flagged grants, officials expressed concerns that they weren’t worth funding because their only practical use might be to support the writing of new laws.” Now, this is going on against the backdrop of a proposal from the Office of Management and Budget that would officially insert political approval into grant funding. That’s something the Senate has voted to at least temporarily block, but the House hasn’t weighed in on it yet. This could not only have huge implications for federally funded research going forward, but you could argue it’s having implications now. We’re seeing researchers, you know, taking opportunities overseas because they don’t know what their, you know, grant funding continuation is going to look like, and students not going to graduate school or not pursuing research careers. I mean, this is … even some of these sort of small things are having these bigger potential ripples as they go outward, right? 

Kenen: Colleagues who are grant-funded, NIH-funded, or other government-funded. I mean, they try to track the ever-changing rules. First of all, it’s very murky. It is changing. They keep adding things. Basically, they don’t want — not just the banned words — they don’t want research that can be bad, that can be used for policy …  

Rovner: For things they disagree with, for policies they disagree with. 

Kenen: They don’t say it … right. Guidance doesn’t come out and say “policy that you know we don’t like.” It just says “policy.” But it’s really vast and confusing. It’s not new. What Paige wrote about is an update. I mean, this is still happening. It’s been happening since the beginning of the Trump administration. NIH is the biggie. There are some smaller agencies, like Agency for Healthcare Quality and Research [sic], AHRQ, right? 

Rovner: Research and Quality. 

Kenen: Agency for Healthcare Research and Quality. That’s pretty much defunct now. But those grants, the money stopped going out the door many months ago. So …  

Rovner: And the National Science Foundation. I mean, NIH is sort of the biggest of them. Yeah. 

Kenen: It has to have the word “science.” … NIH is the biggie, right? I mean, and it’s also the bench science, the science that the drug industry … people don’t understand, they say, Let the drug industry do it. They can’t do this kind of basic bench research. They take this research and develop drugs, but the fundamental cellular level is NIH, or NIH-funded. And it’s really, I mean, clinical trials have been stopped in the middle — really promising research that is not partisan. … Disease doesn’t care. It’s cliché, and it’s also true. It just stopped, and work has been lost. But people haven’t done things that are several years in. … The deadline, also, for fiscal year spending is, if it’s not out the door, which is Sept 30, anything that’s out that door is, like, that’s done. It’s it. Bye-bye. The money isn’t gonna, unless it would go through a whole new process next year, which is unlikely in these grants, that’s the end of that. 

Rovner: Yeah, and that’s, I mean, my point in wanting to bring this up again — and you’re right, it is sort of an update of what we’ve seen — is that every time one of these top administration officials comes to Congress, they say, You’re supposed to be spending the money that we have appropriated, and they say, Oh yeah, not a problem. We’re going to spend the money that you’ve appropriated. And yet we keep seeing these stories that they are not spending money that Congress has appropriated. 

Kenen: Yeah, and historically NIH has been reasonably bipartisan. There have been years when there have been fights. There’s obviously stem cells and sort of certain issues have been, you know, very hot potato. But the basic enterprise of U.S. science, health science, has been largely bipartisan. Again, not every appropriation season, not every bill. But if you look at the overall arc, it’s bipartisan. 

Rovner: It was Republicans who doubled NIH funding in the 1990s — who led it.  

Kenen: [Arlen] Specter. 

Rovner: It was Newt Gingrich, actually. I mean. 

Kenen: Yeah, Gingrich, too, was very into health tech and things like that before his time. I mean, the War on Cancer was federal, right? That was [President Richard] Nixon. So, but we’re now in a …  

Rovner: Different place. 

Kenen: Yeah, frozen. 

Rovner: Yeah. Meanwhile, Mike Stobbe at the AP is at the Centers for Disease Control and Prevention — again, where money’s been appropriated, but there is literally nobody at home. At the agency’s Office on Smoking and Health, and offices on Alzheimer’s disease, epilepsy, and sickle cell data collection, funds are allocated, but all the staffers have either been laid off or are still on administrative leave. So they’re being paid, but they are banned from working. This is yet another immediate challenge for new CDC Director Erica Schwartz, who had her first meeting with CDC staff yesterday. What do we expect her to take on first? 

Luthra: I don’t envy her. It, frankly, seems very difficult to figure out what your priorities are or should be, if you perhaps don’t have staff. It does seem like, from the reporting, perhaps a priority that she has outlined might be morale. And we know that morale has been very low in a lot of government agencies and the executive — especially places like the CDC, where you have a lot of career people who are mission-oriented, really believe in doing things for public health, and have seen that really attacked. And so I don’t know if that is enough to actually translate into things that are supposed to happen actually happening. But that seems like probably a place where it makes sense to start, right?, is just to help people feel confident that they actually will be able to do the work that they signed up to do. 

Rovner: Yeah, and you know, as you say, CDC is perhaps the most mission-oriented of all the HHS agencies. And because they’re in Atlanta, and you know not in the Washington area the way most of the rest of HHS is, they do often feel cut off. So she does have … she has a lot on her plate. And speaking of the CDC, the agency put out a rather cryptic press release this week on vaccine uptake among kindergartners entering school, noting that “CDC continues to encourage parents to discuss vaccination options with their doctors.” Meanwhile, the data linked to in the press release shows a small increase in parents opting out of having their children vaccinated nationwide. But that masks a much larger increase in some states. In Idaho, for example, just 75% of kindergartners entering school have had the MMR [measles, mumps, and rubella] vaccine. That’s obviously well below the 95% needed to provide herd immunity for measles. As my friend Jonathan Cohn put it in his piece for The Bulwark. “The scientific term for that is yikes.” Yikes indeed. 

Kenen: And it’s even within states … and some rural counties … there’s a lot of variation. The trend … for a number of years now has been dropping vaccine rates. Period. So I mean, whether CDC wants to engage in this as their first issue, they’re going to be asked about it. … They track it … can’t avoid it, because they have to approve and recommend, and, you know, insurance coverage, all sorts of things are imminent. So decisions have to be made. … Back to school’s already started in some parts of the country. 

Rovner: And so … I would say new CDC Director Schwartz was rather pointedly not in the room when the president signed the executive order on vaccines, even though now-FDA nominee Heidi Overton was. 

Kenen: She cannot put her head in the sand on this one. She’s going to have to … 

Rovner: “She” Schwartz?  

Kenen: Yeah. So she’s she says, I mean, what we know so far is she’s been quite, you know, she went to the CDC, and the reports are that she came out and said, you know, I’m going to stick to the science, and the science supports vaccines.  

Ollstein: I thought what was really interesting about the recent reports is that, you know, the executive order the Trump administration signed doesn’t actually change anything legally, but it’s designed to put pressure on states to change their recommendations. And it’s been fascinating to me to see that even the reddest states really aren’t going for it yet. But that doesn’t mean that everything’s fine and everyone’s getting vaccinated. What we are seeing is, you know, individual parents making these moves away from vaccination. And so even without the state officially changing its requirements, the environment is just shifting, and using the bully pulpit in this way is changing people’s behavior — building on trends that were already happening: distrust and misinformation, and all of that. And so … even a small, small decline in the vaccination rate can have huge negative effects. I mean, the difference between having 97% vaccination vs. 91% — it may not seem like a big deal, but that’s the difference between herd immunity and people really being vulnerable. 

Rovner: And lots and lots more cases of measles, as we are seeing already this year. I mean, it’s, you know, talk about things that were completely predictable. Well, meanwhile, as my 51ÊÓƵ Health News colleagues Amanda Seitz and Stephanie Armour point out this week, all of this public pronouncing by the president and other health officials about the supposed dangers of vaccines comes as HHS Secretary RFK Jr. blows past deadline after deadline to uncover the promised cause of the rising cases of autism. The story notes that the secretary “has looking for root causes in a research effort that’s offered no public status updates and few details about who, or even which agency, is leading the effort.” We do know that one of the people working on the project is Reyn Archer — he’s a noted vaccine critic, son of a former House Ways and Means Committee chairman, and was head of the Title X Family Planning Program during the George H.W. Bush administration in the early 1990s — even as he was publicly opposing legalized birth control, which of course is what the Title X program does. He later served as Texas’ state health commissioner under then-Gov. George W. Bush, although he was eventually fired for making racist remarks to a subordinate. I had not heard his name since, until now. But he’s going to uncover the root causes of autism, am I right? That’s the plan? 

Kenen: More power to him. I mean, autism. It’s not like there’s no research, and the conclusion is that it’s multi-causal. That there’s not one cause. That’s the current state of the science, which can always evolve. But the current belief is there’s probably a genetic component, but it’s a mix of factors that we don’t fully understand. But vaccines is not one of them. 

Rovner: Or at least so every study, every big study, we have seen continues to say. Well, moving on, lots of news about healthcare prices this week, which remain a pressing issue for both Republican and Democratic voters as the midterms draw near. One interesting story this week noted that prescription drug prices fell year over year by more than 3% — that’s the largest drop since the early 1960s — but it’s not entirely clear why. The Trump administration, of course, says it was their efforts, particularly to bring down the price of those popular but very expensive GLP-1 weight loss drugs. Analysts say it’s more likely the result of the Biden-era Medicare drug price negotiations, which involved more widely used medications. Whichever, I imagine if you’re not seeing your prices drop at the pharmacy, and those drops may well be absorbed by insurers and middlemen and all the people we talk about, will this good news even have much of an impact when people go to the polls? 

Luthra: I can’t imagine it necessarily would be that meaningful because overall the macro trends remain pretty bad. Health insurance is still getting very expensive. Employers are really struggling — those that offer it — they are largely passing more costs to consumers. And so people are getting to have to pay more for healthcare, even if their drug prices may be decreasing in the aggregate. And so it’s just hard to really suggest that this good news could really outweigh those other factors, especially when you think about the broader sort of angst that exists around costs and costs continuing to go up. 

Rovner: Yeah, well, in wonky news that could actually have a larger impact on what people pay for medical care, the Trump administration is actually going after some deep-pocketed healthcare providers. Stat News reports, in separate stories, first that the — that’s the parent of UnitedHealthcare, the insurer, and Optum, the services and tech arm — for allegedly underpaying taxes by funneling money through a foreign subsidiary. And second, the for potential antitrust violations. State attorneys general are also looking at Epic’s alleged anticompetitive practices. Cracking down on some of the monopolistic practices of the largest payers in the healthcare system actually could end up saving the system money, right? I mean, this was … something that we saw a fair bit of during the Biden administration, particularly from the Federal Trade Commission, and not so much of during the Trump administration, which has seemed to have been more favorable, if you will, to big companies. 

Luthra: I guess there’s still that question about providers, and obviously bringing down prices and addressing consolidation in payers, amongst things like electronic health record companies, can be effective, but we probably also would want to see meaningful movement in terms of provider consolidation as well, and that just seems potentially like a bigger hill to climb. 

Rovner: But this is a start. One would say, particularly this administration, going after United, which is sort of the the biggest … United’s power threatens the federal government’s bargaining power at this point. I was interested to see, you know, this story, if nothing else, made public, because obviously somebody leaked it. We will see how these all shake out. Well, finally, Costco, home of the cheap rotisserie chicken and the $1.50 hot dog and soda, is entering the Medicare market, . According to the Journal, Costco will partner with the nonprofit SCAN Group to offer Medicare Advantage plans in two states and a Medicare supplement, Medigap, plan in a third state. Could this eventually make a dent in the private Medicare market? Costco already does big business selling discount prescription drugs, eyeglasses, and hearing aids. I get my dog’s flea and tick medication at Costco. It costs half of what it does at my vet’s office. One presumes this could be, you know, a leader. We’ve not seen this before, right? 

Kenen: The head of SCAN, which is a pretty reputable insurance company … 

Rovner: Nonprofit insurance company. 

Kenen: Nonprofit insurance, and I should say I know … personally the current CEO, president, whatever his post is. I mean, but you know, I’ve written a lot about aging over the years, and it’s basically considered … one of the higher-quality, more reliable elderly-focused health plans. And he has something interesting to write when he announced it or wrote about on LinkedIn about how he personally, like, is a big Costco guy. But he talked about trust, which we’re all talking all the time about how there’s a lack of trust in healthcare. There’s a lot of trust in Costco, and he talked about how branding, SCAN, and Costco, you know … obviously it’s a business decision he made, but he’s also, like, this big Costco guy and who worries — I know him through conferences on trust, actually, that’s where I met him — and he’s thinking, OK, Costco, in addition to, like, giving you way too much of whatever it is you thought you needed, it can also fix the trust crisis in America. Right? 

Rovner: Hey! 

Kenen: And they’re efficient, right? I mean, I don’t know if all four of us are Costco people, but the, you know … 

Rovner: I am. 

Kenen: I saw her. I ran into her buying her veterinarian [unintelligible, through laughter] … I was in the photo section. … It is a trusted brand, and it’s an interesting — and they have national reach in there, you know. 

Rovner: And you will hear in my conversation with Mark Cuban that trust is a really big deal in healthcare right now. I mean, we obviously talk about this every week. I mean, I’m, obviously this is a very small step, but I’m really interested in where it turns out. 

Kenen: It’s a smart business move, and it’s a talker, too. Like, people are gonna see this headline and pay attention to it because it’s, like, just a thing. 

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

So, a good bit of reproductive health news this week. Glad to have both Alice and Shefali here. We will start in Idaho, where a federal district court judge ruled that the state’s abortion ban cannot be used to prosecute doctors who perform abortions to protect the pregnant person’s health, not just her life. Of course, abortion opponents vehemently oppose health exceptions, as they’re called, because they say health includes mental health, and that becomes a loophole so big that it basically eviscerates the ban. The state’s attorney general, former congressman Raúl Labrador, said he would appeal and was confident the decision would be overturned. I would imagine that he’s probably right. Is the Supreme Court eventually going to have to spell this out? I wouldn’t be that surprised if they wanted to. 

Ollstein: I think this gets into some of the same EMTALA [Emergency Medical Treatment and Active Labor Act] territory, where we have seen the Supreme Court sort of back away from in recent years. But again, we just keep circling around and around the same question, which is, when is an abortion OK for a medical emergency purpose? How close to dying does a woman have to get before a doctor can perform an abortion? And we’ve seen again and again in Idaho that doctors are scared and confused, and even when they think that they should have the right to perform the procedure, you know, they’re still putting women on these dangerous life flights to other states in order to get care, leading to hours and hours of delays and potential complications. And so, you know, this court case and this court ruling was sort of aimed at clarifying that and giving doctors the confidence to be able to intervene when they feel it’s medically necessary. But now we’re seeing the state challenge that, and we’re just going around and around. And, you know, there have been similar cases in other states, just a whole mix of rulings, one way or the other, and that just creates more of a patchwork where, you know, some somebody’s ability to get care varies completely between states — and even within states, between hospitals, based on how much you know institutional backing doctors feel like they have. You know, will their hospital’s lawyers go to the mat for them or not? Do they work in a private practice vs. a big hospital system? All of these things come into play, 

Rovner: And, of course, we’ve also seen doctors, particularly in Idaho, leaving the state because they’re afraid that they can’t practice. I mean, they can’t adequately care for their patients. Shefali, I see you nodding. 

Luthra: Yeah, and what’s interesting about this case, other than the fact that Idaho will actually have an abortion ballot measure this November, is that we do have a federal judge here saying, in particular contexts, I see a right to an abortion. And I was talking to some abortion legal scholars about this, and they made the point that, in a way, this runs afoul of the Dobbs decision, because you do have a federal judge saying people are actually entitled to abortions, and that is a right that they have, even if it is much narrower than what Roe v. Wade guaranteed. And obviously, this is going to be appealed. This is going to continue to be litigated. We may not see immediate change for people’s ability to get healthcare in Idaho or other places with very strict bans, but it does underscore how unsettled these legal questions remain — how there remains a lot of debate over whether Dobbs was actually a correct interpretation of constitutional law. And I think it really takes us back to the argument we heard from some of the conservative majority that this would now settle every question about abortion. Obviously, it has not. Obviously, many more questions will continue to be argued and litigated in the courts. 

Rovner: Yeah. Well, meanwhile, in other breaking news, a federal judge here in Washington blocked the Trump administration’s changes to the teen pregnancy prevention program that funds classes on contraception and abstinence, among other things. But they’re still not necessarily getting the money appropriated by Congress, right, Alice? 

Ollstein: So a judge in D.C. is blocking the administration from using its very strict new guidance going forward when it doles out money for the program, but it’s not ordering the administration to give back the money that was already cut earlier this summer from all of these grantees around the country. And, by the way, the money was cut both from grantees like Planned Parenthood, where you would say, “Oh, well, that sort of makes sense that the administration would go after their money.” But they’re also cutting funding from, you know, faith-based programs, abstinence-only programs in very red states, and prompting a fair amount of backlash that I’ve been covering. You know, places like Texas and South Carolina and West Virginia have also lost funding. And, of course, all the programs in those states had to abide by state restrictions around what can be taught. And so they were already following these very conservative guidelines. But that’s not conservative enough for the administration, which put out this guidance saying, you know, while abstinence-only was an option before, now it is basically mandatory. And so that guidance is on hold, but, again, the judge said that he didn’t know if he had the authority to order them to give back the money, or if some other jurisdiction could handle that. And so, this is just a preliminary injunction, which means there’s going to be months and months of litigation going forward. 

Rovner: Finally, this week, a story from the “Who Could Ever Have Imagined This?” files: A California couple hired a surrogate in Alaska to carry their pregnancy. After the fetus was diagnosed with a life-threatening heart condition, the couple exercised their option in the surrogacy contract to terminate the pregnancy. But the surrogate refused to have an abortion, and she traveled to Texas, where abortion is illegal, and gave birth to a baby boy last week. News reports say the baby, who is now in the custody of the couple who are biologically his parents, had the first of several surgeries needed to treat the heart condition. But this is a genuinely wrenching situation. Who gets to decide what here and under which state’s laws? Bioethicist Arthur Caplan told Houston Public Media that there are so many ethical issues here, he could spend an entire semester’s course teaching it. 

Luthra: And I think what is important about this case as well is, I mean, it’s obviously just like so, so, so sad, and this poor family is just having to deal with something really heartbreaking that no one should have to navigate under the national spotlight in Texas. It is really energizing conservatives who want to ban surrogacy, and we have already heard from lawmakers in the state legislature say they will be looking at surrogacy specifically when they convene next year. I have talked to anti-abortion activists in the state who are very hopeful that this case will give them new impetus to ban, at the very least, commercial surrogacy. They would love to ban all forms of surrogacy. And it is seen by a lot of anti-abortion folks who oppose fertility treatment, including IVF [in vitro fertilization], as something maybe easier to target. And I think it’s politically really complicated, because Americans don’t know as many people who get pregnant through surrogacy as they do people who might use IVF. But when I was talking to, again, legal experts about this, one point they made is that if surrogacy restrictions do take off in a meaningful way, often, the intellectual framework and arguments being made are ultimately the ones that would be used for IVF restrictions as well. And so, there is a possibility of a real slippery slope and more of that opening the door to fertility treatment restrictions that could affect a lot of people. 

Kenen: I think there’s a lot of public misunderstanding about what a gestational carrier is. When surrogacy became, not common, but sort of emerged in the public eye, there were a couple of really high-profile court cases. This was in the late ’80s. The “Baby M” was the most famous. And these were situations, at that point, where the woman carrying the child, it was her egg. So in the Baby M case, it was a couple that couldn’t have children. She was-— I don’t even know if that was — that wasn’t probably IVF. That was probably some other kind of artificial insemination. But the woman who decided she didn’t want to give up the baby after carrying it — it was, in fact, her biological child — and the practice became not to let, to separate the surrogate carrier from the egg donor. It’s not 100%. It’s not that it never happens, particularly if there’s family situations where maybe an aunt carries, etc. In this case, we’re really, based on public record, because I did a little reading on it this morning, it’s not clear, of the “biological parents,” it’s his baby. It’s not 100% clear on the public record that it’s actually her egg, the wife’s egg. But it is not the carrier’s egg. The woman suing to keep the child, saying she wants to have the baby, it is not her, it was not her egg. State law varies. Most states say that the surrogate in this kind of situation does not have maternal rights; that it’s the couple that hired her. Texas is, I believe, more blurry. There are a few states that it is more ambiguous, and also remember that this is a really tight, unusually and unexpectedly tight Senate race in Texas, where a very anti-abortion state, obviously, and also in this case the couple says they didn’t even ask for the abortion, but that’s he-said-she-said-they-said, we don’t know. I don’t know, at least, right? But abortion is a huge political driver in Texas; it’s a close race. [Ken] Paxton, who is the state attorney general, who is taking the side of the surrogate mother, is also the Senate candidate. You know, this is, you know, we’re 2½ months out, whatever, from the election. Three, I guess, closer to three still. But it’s very political in a state that probably has more politics around abortion than probably any other state. 

Rovner: Just what we needed: another thorny issue to throw into this mix. All right, that is this week’s news, or at least as much of it as we could get to. Now we will play my in-the-car interview with Mark Cuban, and then we’ll come back and do our extra credits. 

I am so pleased to welcome businessman and entrepreneur Mark Cuban to “How Would You Fix It?” Mark is probably best known to most people as a former shark on the TV show Shark Tank and the former [co-]owner of the Dallas Mavericks NBA team. But he’s also the co-founder of the Mark Cuban Cost Plus Drugs company, which sells generic medications directly to consumers at transparent prices and big discounts. More recently, he’s been talking about even bigger reforms to the healthcare system, which is why I’m so excited to have him here. Mark Cuban, thank you so much for joining us. 

Mark Cuban: Thanks for having me. 

Rovner: I’m curious: Your background’s been mostly in tech and in sports. How did you come to make healthcare such a priority? 

Cuban: I got a cold email from my now co-founder, Dr. Alex Oshmyansky, and he wanted to build a compounding pharmacy that made sterile injectables that are on the FDA short-supply list — which it’s crazy that there is a short-supply list for generic injectables. So that was great, but it wasn’t big enough. And as I looked into it, it was right around the time that “pharma bro” [Martin Shkreli] was going to jail, and I was like, “How can this dude jack up the price of a generic medication to the detriment of so many people?” And then it became obvious that nobody knew what a medication costs, nobody knew why it cost what it costs, and nobody understood why everybody paid a different price for the same medication. That list led to us launching costplusdrugs.com in January of 2022, and it’s just been growing like a weed ever since. 

Rovner: For decades now, the big debate in health policy has been whether the system should be more run by the government or more run by the private sector. Is that even the right way to focus on this anymore? Now everything is sort of hybrid and a mess. 

Cuban: Yeah, no, it’s not, because if the government doesn’t have data, and the government can’t trust the vendors that they’re working with, it doesn’t matter that it’s the government doing all the negotiating. And you see that in other countries. For instance, we get emails from countries around the world — from Canada, England — asking to buy generics from us ’cause our prices for generics, particularly specialty generics, are less expensive than what they sell for in countries that have single-payer or universal care. And so, while I’m not opposed to single-payer or universal healthcare at all, and kind of the analogy I use is: If healthcare costs $1 per person per year — yeah, great, taxpayers would pay that. But it would be a set $1 and it’d be obviously inexpensive. But when you don’t know all the costs, when there’s no transparency, it’s impossible to determine if it’s a better solution or not. 

Rovner: Are there segments of the healthcare industry that would work better if the private sector ran them, and better if the government ran them? I’m thinking, you know, hospitals, doctors, drugs.  

Cuban: I don’t think it’s like that at all. I think it depends on how much transparency there is. The fundamental issue is transparency and trust. If you don’t know … like, there are a lot of hospitals, and you know this better than anybody, that don’t know their costs. And if you just hire the same people and just say, “Look, we’re going to pay Medicare pricing to Mayo Clinic, and Mayo Clinic doesn’t know all their costs,” or “We’re going to take an urban hospital and continue to pay them Medicare and Medicaid because that’s most of their business,” and they don’t know their cost, they just know their cash balance, it doesn’t matter who runs it. 

Rovner: So, what do you fix first? 

Cuban: Transparency. You have to be able to publish contracts so that any contract that’s signed with a federal agency, the federal government, a state agency, a city, not only are the terms of the contract published, but the prices are published, so that Tricare would be required to publish their prices. By seeing the actual contract, you can see where the city-state agency is getting ripped off. Because right now there’s confidentiality requirements, and the companies, like the big insurance conglomerates, they say, you know, we can’t do this. We can’t show this, it’s proprietary information, which is nonsense. You’ve got hundreds of thousands of companies. You’ve got hundreds of agencies and states and cities that negotiate the same contracts. So lots of people know, but they do it to make it more complicated. And so, as a result, nobody knows how the deals are structured. And if you don’t know how the deals are structured, it’s impossible to negotiate better ones. And if they’ll sue you for discussing it with their peers, then nobody … it’s like Fight Club. The No. 1 rule [of] Fight Club is you can’t talk about Fight Club. The No. 1 rule of healthcare contracts is you can’t talk about healthcare contracts. 

Rovner: Yeah, and we’ve, you know, Congress has passed laws. The president has pushed a lot of these transparency rules, and basically, the health industry has said, “Yep, sorry, we can’t do it,” or “We’re going to do it in such a way that you can’t find it out anyway.” 

Cuban: Correct. 

Rovner: “We’re going to send you reams and reams and reams of data, and you can go digging if you would like.” 

Cuban: Correct. And so you take that to the next step. The big healthcare companies — first of all, they’re vertically integrated. They have hundreds, if not thousands, of subsidiaries. People don’t even know what the subsidiaries are when they do business with them, right? And so, when that happens, there’s just no way for any of the states, cities, federal government to enforce the laws. The big healthcare companies have more lawyers, move faster, are better able to find loopholes than the government and the agencies that enforce it are able to enforce it. And so, what ends up happening. You see all these fines. This PBM, this insurance company, whatever got fined for A, B, or C, and then they just go right back to doing business with them. So when I talk to governors, one of the first things I say in terms of reform is A) publish the contracts, and B) if you are doing business with a vertically integrated healthcare company, and they are fined by any federal agency or any state government, they get one mulligan. If they are fined a second time, they can’t do business with you for five years. That will act as the enforcement mechanism to keep them in line. And then the third thing that I always push is that anybody is able to go out and make a cash purchase, whether it’s medical or pharmacy, as long as it’s less expensive than their out-of-pocket, and have it by law count towards their deductible and max out-of-pocket. When you do that, you give them the opportunity to shop. When something is shoppable — not everything is — but you give them the opportunity to shop, and that helps force down prices. 

Rovner: So, I’ve been doing this since the 1980s, and it’s always been the Democrats beating up on the big insurance companies, and the Republicans basically defending them. Now that Republicans are beating up on the big insurance companies, are we kind of inevitably going towards a government-run single-payer? 

Cuban: No. Like, if you look up, if you look at the Break Up Big Medicine bill that was introduced by Josh Hawley, a Republican, and Elizabeth Warren, to me that’s the first step. So the good news: It was introduced on a bipartisan basis. Because if you break up these big, huge conglomerates, everything changes. The price of everything drops like a rock. But the problem is, nobody else, no senators have supported it, and nobody in the House has introduced a comparable bill. Everybody just chickened out. And so that’s the first step. Put aside the economics. Put aside that we don’t know the cost. Put aside that we have no transparency. All those things are important, but making sure we have health care for everybody is more important. That’s the difference. I think that also should be an American dream. As an entrepreneur, I’m a big fan of the American dream. But being able to be healthy and not be afraid that you can’t afford what you need or your family needs, that’s wrong in our American dream. And you know, when we talk about healthcare as a right, doctors freak out because they presume that they’re going to be paid Medicare rates, and they lose control of their life, right? And they talk about opting out and not doing it, you know. And so you need to get all these stakeholders accounted for. And until you start to do that and put together a plan that people will accept, we’re not going to ever be in a position to take care of people like so many of us hope to do. 

Rovner: And yet that would require both parties to basically lay down their arms.  

 

Cuban: Yes, which I think is possible. I think it’s doable because the No. 1 thing that, in every poll, people are concerned about healthcare costs. It’s not the quality of healthcare. Nobody really complains about the quality. Our doctors are great. Our systems are great. It’s the economic side. And who defines the economic side? Those humongous healthcare conglomerates. And what’s the best way to get to a point where we have transparency at the contract level, you know, flexibility and understanding, etc., all the things I mentioned? You break up those huge conglomerates that have thousands of subsidiaries that do $150-plus billion in intercompany transfers, that game the medical loss ratio. I mean, all these things happen because those big companies have more control over the economics of our healthcare system than the government does. 

Rovner: Well, I hope we actually get to that point, and I hope you’re around to help with some of these stakeholder conversations. 

Cuban: Oh, hopefully I’m not going anywhere. 

Rovner: Thank you so much. 

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. Shefali, you picked first. Why don’t you go first this week? 

Luthra: Sure. My story is from The 19th by my colleague Barbara Rodriguez. The headline is “.” And I love this whole genre of story. The GLP-1 market is exploding because these drugs can be so expensive to get from your healthcare provider. You see advertisements everywhere, all over social media, people promising to sell you a GLP-1. And as Barbara’s story gets into, often they are not actually GLP-1s. It is something fake. It is not actually going to help you lose weight, but it is going to take your money. And I just think that this is such an exploding market. So much has changed that we can’t read enough about how the, just the growth of options, or not legitimate options, is affecting people, and I’m really glad she did this story. 

Rovner: Yeah, it was a really good story. Alice. 

Ollstein: I have a story from The Texas Observer by Mary Tuma, and it’s called “.” So this is taking a deep dive on the situation in Texas, but the article does a good job of pointing out that this is a trend across several states that implemented abortion bans, where there was, you know, efforts to pause or revamp, or obscure, or change in some way the groups in every, that exist in every state that study maternal deaths. And there is just a suspicion that this is an attempt to hide from the public the impact of the abortion ban on maternal mortality. You have a lot of experts quoted in this piece. You have the family members who have lost their wives and mothers to pregnancy-related deaths, and so this is just an ongoing fight. And, you know, doctors say we really need this data and this analysis to know how to better provide care in the future. It’s not just a political football; it’s actual medical knowledge that we need to build. 

Rovner: Yeah, I think ProPublica did this for Georgia, I think, last year, so yet another in these series. Joanne. 

Kenen: There’s a story in Politico by Owen Dahlkamp: “.” This is not unique to health law, but given how complicated health law is and how much health law Congress deals with in any given year, it’s quite relevant to health law. So staffers are using AI to actually draft legislation, not just to research something. And I mean, it’s hard to get away from AI now. It’s, like, even pops up on people’s phones, right? But drafting legislation is very precise and complicated, and AI is apparently not very good at it. So the House counsel, which is the Office of Legal Counsel, which actually has to make sure the legislative language is correct and doesn’t accidentally reveal the wrong thing, they’re having a hard time. Although they have now created their own tool to try to correct the AI slop, but they’re getting overwhelmed. There’s, you know, we’ve all seen stories, we’ve all gotten pitches about, you know, so-and-so introduced a law. What the general public doesn’t understand is introducing a law, you know, it’s good for a press release — introducing a bill, excuse me. Introducing a bill does not mean a whole hell of a lot, except that you’re satisfying some constituent or constituent group, right? But congresspeople and senators like to say they introduce this and they introduce that and they introduce the other thing. So the number of bills being introduced was already rising spectacularly, and now with the slop, there’s like the slopth degree of it. So it’s messy. 

Rovner: It is messy, and it does, I mean, it sort of prevents the real work of actually drafting legislation that’s going to become law from getting done. 

Kenen: There’s going to be something, like, really bad that comes out that somebody in the poor OLC office doesn’t catch, and it’s going to repeal, like, you know, the flag. 

Rovner: Yeah. We will see. All right my extra credit this week is from Mother Jones by Sophie Hurwitz. It’s called “.” And you may have heard that ICE [Immigration and Customs Enforcement] is spending $20 million to buy these gloves, which administer an electric shock at the touch of a button on the wrist for their officers. What makes them better than a Taser or other non-[lethal] device? Well, one Missouri police officer whose force uses them said the gloves “allow their wearer to inflict pain without leaving the sort of marks that could look bad to witnesses or leave an officer vulnerable to lawsuits.” In other words, they make it easier for people to inflict pain on others, whether warranted or not, without likely recourse. How very 2026. 

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

Ollstein: on Bluesky and on X. 

Rovner: Shefali. 

Luthra: on Bluesky. 

Rovner: Joanne. 

Kenen: Mostly on and on . 

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 51ÊÓƵ Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 51ÊÓƵ 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, Aug. 6, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my 51ÊÓƵ Health News colleague Amanda Seitz. 

Amanda Seitz: Hi, great to be here. 

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

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

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

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

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

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

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

Rovner: We’re in the slogan phase. 

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

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

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

Kenen: Including the doctors, right?  

Rovner: Right. Oh, absolutely. 

Kenen: Nobody’s happy. 

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

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

Rovner: Shark Tank for All! 

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

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

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

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

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

Rovner: I know what you mean. 

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

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

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

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

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

Seitz: Florida’s the biggest. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: OLC, the Office of Legal Counsel. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: They’re delaying it, right? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: So, how would this bill work? 

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

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

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

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

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

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

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

Kim: Yeah, thanks so much for having me. 

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

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

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

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

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

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

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

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

Ollstein: On Bluesky , and on X . 

Rovner: Joanne. 

Kenen: I’m mostly on  and on  . 

Rovner: Amanda. 

Seitz: And I am still tweeting from X on . 

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