Open enrollment for 2026 Affordable Care Act insurance plans starts in most states Nov. 1, with no resolution in Congress about whether to continue more generous premium tax credits expanded under President Joe Biden or let them expire at the end of this year. It is unclear whether the backlash from millions of enrollees seeing skyrocketing premiums will move Democrats or Republicans to back away from entrenched positions that are keeping most of the federal government shut down.

Meanwhile, the Trump administration — having done away earlier this year with a Biden-era regulation that prevented medical debt from being included on consumers’ credit reports — is now telling states they cannot pass their own laws to bar the practice.

This week’s panelists are Julie Rovner of KFF Health News, Paige Winfield Cunningham of The Washington Post, Maya Goldman of Axios, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Tens of millions of Americans are bracing to lose government food aid on Nov. 1, after the Trump administration opted not to continue funding the Supplemental Nutrition Assistance Program during the shutdown. President Donald Trump and senior officials have made no secret of efforts to penalize government programs they see as Democratic priorities, to exert political pressure as the stalemate continues on Capitol Hill.
• People beginning to shop for next year’s plans on the ACA marketplaces are experiencing sticker shock due to the expiration of more generous premium tax credits that were expanded during the covid pandemic. The federal government will also take a particular hit as it covers growing costs for lower-income customers who will continue to receive assistance regardless of a deal in Congress.
• In state news, after killing a Biden-era rule to block medical debt from credit reports, the Trump administration is working to prevent states from passing their own protections. In Florida, doctors who support vaccine efforts are being muffled, and the state’s surgeon general says he did not model the outcomes of ending childhood vaccination mandates before pursuing the policy — a risky proposition as public health experts caution that recent measles outbreaks are a canary in the coal mine for vaccine-preventable illnesses.
• And in Texas, the state’s attorney general, who is also running for the U.S. Senate as a Republican, is suing the maker of Tylenol, claiming the company tried to dodge liability for the medication’s unproven ties to autism. The lawsuit is the latest problem for Tylenol, with recent allegations undermining confidence in the common painkiller, the only one recommended for pregnant women to reduce potentially dangerous fevers and relieve pain.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: KFF Health News’ “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage,” by Bernard J. Wolfson.

Alice Miranda Ollstein: ProPublica’s “Citing Trump Order on ‘Biological Truth,’ VA Makes It Harder for Male Veterans With Breast Cancer To Get Coverage,” by Eric Umansky.

Paige Winfield Cunningham: The Washington Post’s “Study Finds mRNA Coronavirus Vaccines Prolonged Life of Cancer Patients,” by Mark Johnson.

Maya Goldman: KFF Health News’ “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown, New England Public Media.

Also mentioned in this week’s podcast:

• The Washington Post’s “Average Obamacare Premiums Are Set To Rise 30 Percent, Documents Show,” by Paige Winfield Cunningham
• KFF Health News’ “Doctors Muffled as Florida Moves To End Decades of Childhood Vaccination Mandates,” by Arthur Allen.
• CBS News’ “The Quiet Collapse of America’s Reproductive Health Safety Net,” by Céline Gounder.

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

Julie Rovner: Hello, from KFF Health News and, starting this week, from WAMU public radio in Washington, D.C., and welcome to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 30, at 10 a.m. As always, news happens fast, and things might’ve 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: Maya Goldman of Axios News. 

Maya Goldman: Good to be here. 

Rovner: And we welcome back to the podcast one of our original panelists, Paige Winfield Cunningham of The Washington Post. So great to see you again. 

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

Rovner: Before we dive in, we have a little of our own news to announce. Starting this week, we’re partnering with WAMU, Washington D.C.’s public radio station, to distribute the podcast. That means you can also now find us on the NPR app. And welcome to all you new listeners. OK, onto the news. We are now 30 days into the federal government shutdown, and there is still no discernible end in sight. And this Saturday is not only the start of open enrollment in most states for the Affordable Care Act health plans, which we’ll talk more about in a minute. It’s also the day an estimated 42 million Americans will lose access to food stamps after the Trump administration decided to stop funding the SNAP [Supplemental Nutrition Assistance] program. That’s something the administration did keep funding during the last Trump shutdown in 2019, and, according to budget experts, could continue to do now. So what’s behind this? As I think I pointed out last week, not such a great look to deprive people of food aid right before Thanksgiving. 

Ollstein: So I think this follows the pattern we’ve seen throughout the shutdown, which is just a lot of picking and choosing of what gets funded and what doesn’t. The angle of this I’ve covered is that out of all of the uniformed forces of the government, the Trump administration dug around and found money to keep paying the armed members, but not the public health officers, who are also part of the uniformed branches of the country. And yeah, you’re seeing this in the SNAP space as well. President Trump and his officials have openly threatened to go after what they see as Democrat programs. So it’s just interesting what they consider in that category. But you’re seeing a lot of choices being made to exert maximum political pressure and force various sides of this fight to cave, but we’re not seeing that yet either. 

Rovner: Yeah, they are. I mean, it seems this is also backwards because it’s usually the Republicans who are shutting down the government, the Democrats who are trying to pressure them to reopen it. And now, of course, we’re seeing the opposite because the Democrats want the Republicans to do something about the Affordable Care Act subsidies, and the Republicans are going after previously what had been kind of sacrosanct bipartisan programs like food stamps and the WIC [the Special Supplemental Nutrition Program for Women, Infants, and Children] program, for pregnant and breastfeeding moms and babies. And now, apparently, they’re going to stop funding for Head Start, the preschool program for low-income families with kids. On the one hand, you’re right, they are programs that are very cherished by Democrats, but I feel like this whole shutdown is now sort of going after the most vulnerable people in America. 

Goldman: It’s also been interesting because [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] has tried to use SNAP as a vehicle for his Make America Healthy Again agenda, right? Trying to get states to limit the sugary drinks that their SNAP programs offer. And he’s, like, really touted that as part of the agenda. And now there does not seem to be any interest from HHS in speaking out about that. 

Rovner: Well, of course, and SNAP isn’t an HHS program. 

Goldman: Exactly. Exactly. 

Rovner: It’s a program in the Department of Agriculture, which is even more confusing, but you’re absolutely right. I mean, it’s odd that some of the things that he’s been pointing to are things that this administration is kind of trying to lay at the Democrats’ feet, as in, You want this program, reopen the government. So as I mentioned, Saturday is the start of Obamacare open enrollment in most of the states. And, Paige, you got a sneak peek at the premiums for plans in the 30 states that use the federal marketplace, which is now open for what we call window-shopping before open enrollment officially begins. What did you find? 

Winfield Cunningham: Yeah. So I got some documents at the end of last week showing that the average premium for the second-lowest-cost silver plan — which, of course, is what, we know … that’s what the subsidies are pegged to — is going up 30%, which is the second-highest premium increase. The highest we saw was 2017 to 2018. But this is a really, really significant increase. And of course, CMS [the Centers for Medicare & Medicaid Services] didn’t include that number in the document that it finally released this week. So the documents I saw had some sort of numbers like that, which were all stripped out of the official documents. But all of this is just so interesting because I was thinking about, back to 2017-2018, and the politics of this are so flipped right now because basically it was the Democrats then who didn’t want to talk about premium increases and the Republicans who were yelling about it. 

So it’s funny how that has changed. But I guess on the politics of this, it seemed for a while like Democrats were thinking maybe the Nov. 1 start of open enrollment would provide this out for them to pass the spending bill because they could say, like, OK, we tried. Now open enrollment has started, or the premiums are kind of baked, so we can’t really do anything to change it now. But I don’t think we’re going to have anything this week. It seems like both sides are pretty dug in still. I mean, I guess the other thing I would say on these costs, it’s really highlighting a weakness that we’ve known for a long time in the Affordable Care Act, which is that, like, yes, it made health insurance affordable for a lot of people, but there’s always been this smaller number of people that are above 400% federal poverty that have had no shield from insurance costs. They have the last four years, and now they’re not going to have one anymore. And it’s funny because Democrats are talking about this, but that’s sort of a problem they hadn’t wanted to acknowledge for a long time in the early years of the Affordable Care Act. And as you guys all know, there’s not going to be any political will for bipartisan work to create affordable options for these folks unless the subsidies get extended, which, of course, that doesn’t seem very likely at the moment from how things stand. 

Rovner: Yeah. Going back to what the Republicans sort of announced, their talking points, is that, well, first the premium increases aren’t that big and that the expiring extra subsidies aren’t that big a piece of it, both of which are actually kind of true. But, of course, that’s not where the sticker shock is coming from. The sticker shock is coming from the expiration of those tax credits that’s going to …  

So people who had been shielded from these very high premiums are no longer going to be shielded from them. And that’s why, if you look at social media, you see all these screenshots now of insurance that costs $3,000 a month for people who were paying $150 a month, which is obviously not affordable. Why is it so difficult to explain the difference? I’ve been working on different ways to explain it for the last three weeks. 

Goldman: I was trying to figure this out last night, when I was writing something for my newsletter today. And I think one of the really confusing parts about this is that, like Paige said, like Paige scooped, premiums are going up a certain amount, and that’s not actually what people are seeing. That’s not what almost anyone is going to actually face. Either you’re getting that huge sticker shock because you’re losing your subsidies that you had this year or you’re continuing to have subsidies, they’re not quite the same, but you’re still not going to pay a 30% increase. And so I think that that’s really confusing for me even, and hard to explain. 

Winfield Cunningham: I think one way to think about this is like the party that is going to bear the brunt of the premium costs to a large degree is the government because for people that are before 400% federal poverty, they are basically guaranteed under the Affordable Care Act that they’re not going to have to pay more for premiums over a certain percentage of their income. And so this just means, like, the subsidies are getting really expensive for the federal government, which goes back to the issue of kind of like why Democrats didn’t extend these enhanced premiums indefinitely — because it’s just expensive to do it. This is the government subsidizing private health insurance. And then it’s also significant again for those people over 400% poverty who had had a cap on what they would pay. I think it was 9.5% of their income under the enhanced … and now they have no cap. 

Rovner: I think 8.5% of their income, actually, under the enhanced premiums. 

Winfield Cunningham: Under the enhanced. OK. 

Rovner: It’s going to go back to 10%. 

Winfield Cunningham: Yeah. Yeah. But there’s no cap if you’re like over, over 400%. 

Rovner: 400%. 

Winfield Cunningham: Right. Yeah. Yeah. 

Rovner: That’s right. 

Winfield Cunningham: Yeah. But that’s why people are confused. And the other thing is, like, the administration is correct, that the vast majority of people in the marketplaces will continue to get subsidies. And we are basically going back to what the situation was before covid, but it’s that smaller number of people that are at the higher income levels. But the other thought I had was, of course, the health care industry and Democrats are talking a lot about this and spreading these huge premium increases far and wide and making sure everybody hears about them, but it’s like a relatively small number of people, if you think about it. 

And I think it’s only like a couple million people in the marketplaces who are at that higher income levels. And I wonder if that factors into Republicans’ calculations here, where they’re looking at how many voters are actually seeing these massive premium increases, having to pay for all of them. And in the whole scheme of the U.S. population, it’s not like a ton of people. So I just wonder if that’s one reason they’re sort of, like, seem to be increasingly dug in on this and very reticent to extend these subsidies. 

Rovner: Although I would point out that when the Affordable Care Act started, it was only a small number of people who lost their insurance, and that became a gigantic political issue. 

Winfield Cunningham: This is very true. 

Rovner: So it’s the people who get hurt who sometimes yell the loudest, although you’re right. I mean, at that point, the Democrats stayed the course and eventually, as Nancy Pelosi said, people came to like it. So it could work out the same way. It does help explain why everybody’s still dug in. Maya, you wanted to say something. 

Goldman: I was just going to say, I think it’ll be interesting to see, if subsidies aren’t extended, how this affects premiums next year for people and for the federal government, because if a couple million people drop out of the ACA marketplace because it’s too expensive, and those people tend to be healthier, then the remaining pool of people is sicker, and then that’s the death spiral, right? So … 

Rovner: Yeah. Although it is … 

Goldman: Obviously, that’s a lot of what ifs, but … 

Rovner: … only the death spiral that goes back to prior to covid, which — it was kind of stable at 12 million. I’m sort of amused by seeing Republicans complaining about subsidizing insurance companies. It’s like, but this was the Republicans’ idea in the first place, going back to the very origin of the ACA. 

Ollstein: And we should not forget that there is a group of people who are going to be losing all of their subsidies, not just the enhanced subsidies. And that’s legal immigrants, and that’s hundreds of thousands of people. So, like Maya said, that will probably mean a lot of younger, healthier people dropping coverage altogether, which will make the remaining pool of people more expensive to insure. So these things have ripple effects, things that impact one part of the population inevitably impact other parts of the population. And again, these are legal tax-paying immigrants with papers — will be subject to the full force of the premium increases because they won’t have any subsidies. 

Rovner: Yes, our health system at work. All right, we’re going to take a quick break. We will be right back with more health news.  

Moving on, the federal government is technically shut down, but the Trump administration is still making policy. You might remember last summer, a federal judge blocked a Biden administration rule that prevented medical debt from appearing on people’s credit reports. The Trump administration chose not to appeal that ruling, thus killing the rule. Now the administration is going a step further — this week, putting out guidance that tries to stop states from passing their own laws to prevent medical debt from ruining people’s credit, and often their ability to rent, or buy a house, or purchase a car, or even sometimes get a job. According to the acting head of the federal Consumer Financial Protection [Bureau], Russell Vought — yes, that same Russell Vought who’s also cutting federal programs as head of the Office of Management and Budget — states don’t have the authority to restrict medical debt from appearing on credit reports, only the federal government does, which of course he has already shown he doesn’t want to do. Who does this help? I’m not sure I see what the point is of saying we’re not going to do it and states, you can’t do it either. Part of this, I know, is Russell Vought has made no secret of the fact that he would like to undo as much of the federal government as he can. In this case, is he doing the bidding of, I guess it’s the people who extend credit, who, I guess, want this information, want to know whether people have medical debt, think that that’s going to impact whether or not they can pay back their loans, or is this just Russell Vought being Russell Vought? 

Goldman: I guess, in theory, maybe it goes back to the idea that if you have consequences for medical debt, then people will pay their bills, and maybe that would help the health systems in the long run. But I also think that — I don’t know what health systems have said about this particular move, to be honest — but I think there’s an interest in making medical debt less difficult for people to bear in the whole health system. So I’m not sure how popular that is. 

Rovner: Yeah. Yes. Another one of those things that’s sort of like, we’re going to hurt the public to thwart the Democrats, which kind of seems to be an ongoing theme here. Well, as we tape this morning, the Senate health committee was supposed to be holding a hearing on the nomination of RFK Jr. MAHA ally Casey Means to be U.S. surgeon general. Casey Means was going to testify via video conference because she is pregnant, but, apparently, she has gone into labor, so that hearing is not happening. We will pick up on it when that gets rescheduled. Perhaps she will appear with her infant. 

Back at HHS, a U.S. district judge this week indefinitely barred the Trump administration from laying off federal workers during the shutdown, but at the Centers for Disease Control and Prevention, it appears the damage is already done. The New York Times’ global health reporter, Apoorva Mandavilli, reports that the agency appears to have had its workforce reduced by a third and that the entire leadership now consists of political appointees loyal to HHS secretary Kennedy, who has not hidden his disdain for the agency and the fact that he wants to see it dissolved and its activities assigned elsewhere around the department. What would that mean in practice if there, in effect, was no more CDC? 

Winfield Cunningham: Hopefully we don’t have another pandemic. There’s just a lot of stuff the CDC does. And it’s been really confusing to follow these layoffs because in this last round, I remember trying to figure out with my colleague Lena Sun how many people were sent notices and then hundreds were sort of, those were rescinded and they were brought back. But yeah, I mean, I think we’re going to see the effects of this over the next couple of years. When I’ve asked the administration broadly about the reductions to HHS, what they say is that the agency overall has grown quite a lot in its headcount through the pandemic, which is true. I think they got up to like 90,000 or so. And then, according to our best estimates, maybe they’re back around 80,000, although I’m not entirely sure if that’s accurate. Again, it’s really been hard to track this. 

Rovner: Yeah. I’ve seen numbers as low as 60,000. 

Winfield Cunningham: It may be lower. Yeah. Yeah. So I think actually the 80,000, that may have been the headcount before the pandemic. Anyway, all that to say, it did grow during the pandemic, and that’s kind of the argument that they’re making, is that they’re just bringing it back to pre-pandemic levels. 

Rovner: But CDC, I mean, it really does look like they want to just sort of devolve everything that CDC does to the states, right? I mean, that we’re just not going to have as much of a federal public health presence as we’ve had over these past 50, 60 years. 

Winfield Cunningham: For sure. They’ve definitely targeted CDC. I mean, they mostly left CMS alone and FDA because, statutorily, I think it’s easier for them to shrink CDC, but it definitely is going to have massive effects over the next couple of years, especially as we see future pandemics. 

Ollstein: And the whole argument about returning to pre-covid, that doesn’t fit with what they’re actually cutting. I mean, they’re gutting offices that have been around for decades — focused on smoking, focused on maternal health, all these different things. And so this is not just rolling back increases from the past few years. This is going deeper than that. 

Winfield Cunningham: Well, yeah, it’s not like they’re just cutting the roles that were added since the pandemic. 

Ollstein: Exactly. 

Rovner: It’s not a last-in, first-out kind of thing. Well, as I said, since it looks like public health is now mostly going to be devolved to the states, let’s check in on some state doings. In Florida, where state Surgeon General Joseph Ladapo last month announced a plan to end school vaccination mandates. My KFF Health News colleague Arthur Allen has a story about how health officials, including university professors and county health officials, who actually do believe in vaccinating children, are effectively being muzzled, told they cannot speak to reporters without the approval of their supervisors, who are likely to say no. Seeing the rising number of unvaccinated children in a state like Florida, where so many tourists come and go, raising the likelihood of spreading vaccine preventable diseases, this all seems kind of risky, yes? 

Goldman: Yes. That was a fantastic article from your colleague, and there was a really illuminating line, which I think had been reported before, but a reporter asked the surgeon general if he had done any disease modeling before making the decision. And he said, Absolutely not, because this to him was a personal choice issue and not a public health issue. And I think that just goes to show that we have no idea what is going to happen as a result of this public health decision and it could have massive ripple effects. 

Rovner: But what we are already seeing are the rise of vaccine-preventable diseases around the country. I mean, measles, first in Texas, now in South Carolina; whooping cough in Louisiana; I’m sure I am missing some, but we are already seeing the consequences of this dwindling herd immunity, if you will. Alice, you’re nodding your head. 

Ollstein: Yeah. And I’ve heard from experts that measles is really sort of the canary in the coal mine here because it’s so infectious. It spreads so easily. You can have an infected person cough in a room and leave the room, and then a while later, someone else comes in the room and they can catch it. Not all of these vaccine-preventable illnesses are like that. So the fact that we’re seeing these measles outbreaks is an indication that other things are probably spreading as well. We’re just not seeing it yet, which is pretty scary. 

Rovner: And of course, one of the things that the CDC does is collect all of that data, so we’re probably not seeing it for that reason, too. Well, meanwhile, in Texas, Attorney General and Republican Senate candidate Ken Paxton is suing the makers of Tylenol. He’s claiming that Johnson & Johnson spun off its consumer products division — that includes not just Tylenol, but also things like Band-Aids and Baby Shampoo — to shield it from liability from Tylenol’s causing of autism, something that has not been scientifically demonstrated by the way — even Secretary Kennedy admits that has not been scientifically demonstrated. My recollection, though, is that Johnson & Johnson was trying to shield itself from liability when it spun off its consumer products division, but not because of Tylenol, rather from cancer claims related to talc in its eponymous Baby Powder. So what’s Paxton trying to do here beyond demonstrate his fealty to President Trump and Robert F. Kennedy Jr.? 

Ollstein: I was interested to see some GOP senators distancing themselves from the Texas lawsuit and saying like, Look, there is no proof of this connection and this harm. Let’s not go crazy. But as I’ve reported, it’s just very hard to get good information out to people because there just isn’t enough data on the safety of various drugs, because testing drugs on pregnant women was always hard and it’s gotten even harder in recent years. And so, based on the data we have, this is a correlation, not causation. But it would be easier to allay people’s fears if we had more robust and better data. 

Rovner: Yeah. Does a lawsuit like this, though, sort of spread the … give credence to this idea that — I see you nodding, Maya — that there is something to be worried about using Tylenol when pregnant? Which is freaking out the medical community because Tylenol is pretty much the only drug that currently is recommended for pregnant women to deal with fever and pain. 

Goldman: Yeah. I think some of my colleagues have reported on the concern of another death spiral here, right? Where people get concerned, perhaps without basis, of taking Tylenol or any other drugs, vaccines even, because there are lawsuits and then the makers of these drugs say it’s not worth it for us to make these anymore. And then they don’t make them. And then it’s like a bad cascade of events. And so it’s obviously too soon to see if that’s what’s happening here, but it’s certainly something to watch. 

Rovner: But as we’ve pointed out earlier, not treating, particularly, fever can also cause problems. So … 

Ollstein: Right. Basically all of the alternatives are more dangerous. Not taking anything to treat pain and fever in pregnancy can be dangerous and can lead to birth effects. And taking other painkillers and fever reducers are known to have dangerous side effects. Tylenol was the safest option known to science. And now that that’s being questioned in the court of public opinion, people are worried about these ramifications. 

Winfield Cunningham: I think about the effect on moms who have kids with autism who are now thinking back to their pregnancies and thinking, Oh my gosh, how much Tylenol did I take? I know I took, I had pregnancies that I took plenty of Tylenol during. My nephew has autism, and I was talking to my sister about this, and she was like, “I took Tylenol.” And what they’re doing is, I guess, other reflection I have on it is, in general, there’s just less research on most things than we need. And there are some studies showing a correlation, which as we all know is not causation. And what it looks like the administration did was they took those tiny little nuggets of suggestions and have blown them up into this overly confident declaration of Tylenol and pregnancy and probably unnecessarily causing many women to blame themselves or think, Should I have done something differently during my pregnancy? when they were really just doing what their doctor recommended they do. 

Ollstein: I’m surprised that we haven’t seen legal action from Tylenol yet. I imagine we might at some point, especially if there is some kind of government action around this, like a label change. I think we will see some sort of legal action from the company because this is absolutely going to impact their bottom line. 

Rovner: Yeah. All right. Well, finally this week, more news on the reproductive health front. California announced it would help fund Planned Parenthood clinics so they can continue providing basic health services, as well as reproductive health services, after Congress made the organization ineligible for Medicaid funds for a year and the big budget bill passed last summer. California’s the fourth state to pitch in joining fellow blue states Washington, Colorado, and New Mexico. Meanwhile, family planning clinics in Maine are closing today due to that loss of Medicaid funding. And at the same time, the Health and Human Services Office of Population Affairs, which oversees the federal family planning program, Title X, is down apparently from a staff of 40 to 50 to a single employee, according to my colleague Céline Gounder. Is contraception going to become the next health care service that’s only available in blue states, Alice? 

Ollstein: So Title X has been in conservatives’ crosshairs for a long time. There have been attempts on Capitol Hill to defund it. There have been various policies of various administrations to make lots of changes to it. Some of those changes have really limited who gets care. And so it’s been a political football for a while. Of course, Title X doesn’t just do contraception. It’s one of the major things they do, providing subsidized and sometimes even free contraception to millions of low-income people around the country. But they also provide STI testing, even some infertility counseling and other things, cancer screenings. And so this is really hitting people at the same time as the anticipated Medicaid cuts, and at the same time Planned Parenthood clinics are closing because they got defunded. And so it’s just one on top of another in the reproductive health space. Each one alone would be really impactful, but taken all together, yeah, there’s a lot of concern about people losing access to these services. 

Winfield Cunningham: I think the politics of this are more interesting to me than the practical effect. I mean, under the ACA, birth control has to be covered, right? by marketplace plans. Generally speaking, if people have insurance, they do have coverage for a range of birth control. But the Title X program is interesting because it seems to like overlap between the MAHA priorities and the social conservatives. Of course, as Alice said, this has long been a target of social conservatives. I think in Project 2025 called for any Title X, I believe. And then there’s this current in the MAHA movement that’s kind of like anti-hormonal birth control and there’s also these kinds of streams of pronatalist people, of have more babies, don’t take birth control. So that’s kind of interesting to me because there’s this larger narrative I think in HHS right now of the RFK MAHA people versus the traditional conservative, anti-abortion people. So that’s just like one program where I see overlap between the two. 

Rovner: One of my favorite pieces of congressional trivia is that Title X has not been reauthorized since 1984, which, by the way, is before I started covering this. But I’ve been doing this 39 years and I have never covered a successful reauthorization of the Title X program. So it’s obviously been in crosshairs for a very, very long time. Maya, did you want to add something? 

Goldman: I was just going to say to Paige’s point, telling women that they can’t take any painkillers during pregnancy is not a good way to raise the birth rate. 

Rovner: Yes. That’s also a fair point. Well, meanwhile, red states are trying to expand the role of crisis pregnancy centers, which provide mostly nonmedical services and try to convince those with unplanned pregnancies not to have abortions. In Wyoming, state lawmakers are pushing a bill that would prohibit the state or any of the localities from regulating those centers “based on the center’s stance against abortion.” This comes after a similar proposal became law in Montana, the efforts being pushed by the anti-abortion group Alliance Defending Freedom. Is the idea here to have crisis pregnancy centers replace these Title X clinics and Planned Parenthoods? 

Ollstein: I think there are a lot of people that would like to see that, but, as you said, they do not provide the same services, so it would not be a one-to-one replacement. Already, there are way more crisis pregnancy centers around the country than there are Planned Parenthood clinics, for example, but that doesn’t mean that everyone has access to all the services they want. 

Rovner: And many of these crisis pregnancy centers don’t have any medical personnel, right? I mean, some of them do, but … 

Ollstein: It’s really a range. I mean, some have a medical director on staff, or maybe there’s one medical person who oversees several clinics, some do not. Some offer ultrasounds, some don’t, some just give pamphlets and diapers and donated items. It’s just really a range around the country. And states have also been grappling with how much to, on the conservative side, support and fund such centers. And on the other side, states like California have really gone to battle over regulating what they tell patients, what they’re required to tell patients, what they can’t tell patients. And that’s gotten into the courts and they’ve fought over whether that violates their speech rights. And so it’s a real ongoing fight. 

Rovner: Yes, I’m sure this will continue. All right, that is the news for this week. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it; we’ll put the links in our show notes on your phone or other mobile device. Maya, why don’t you go first this week? 

Goldman: Sure. So this story is from KFF Health News and New England Public Media. It’s called “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown. And I think this stood out to me because I was just in Vegas last week for health, but this, I think, is a really interesting issue to explore through a public health lens, the issue of sports betting and betting addiction. And there are states that are trying to do a lot of work around this and just organizations. And then of course the gaming companies themselves have their own pushback on that, and I think this story just lays it out really well and it’s an important issue that gets very overlooked. 

Rovner: Yeah, it is a public health issue, an interesting one. Alice? 

Ollstein: I chose a story from ProPublica by reporter, Eric Umansky, and it’s called “Citing Trump Order on ‘Biological Truth,’ VA Makes It Harder for Male Veterans With Breast Cancer To Get Coverage.” So this is one of many examples that you could give of policies intended to target transgender folks having spillover effects and impacting cisgender folks, too. In this instance, it’s now harder for male veterans to qualify to get treatment for breast cancer. Men can get breast cancer. Let’s just say that. Men can and do get breast cancer, and it can be harder to detect and very lethal, and obviously very expensive to treat if you don’t have coverage. And so this story has a lot of sad quotes from folks who are losing their coverage, especially because they likely acquired cancer by being exposed during their service to various toxic substances. And so I think, yeah. 

Rovner: Yeah. A combination of a lot of different factors in that story. 

Ollstein: Definitely. 

Rovner: Paige? 

Winfield Cunningham: Yeah. So my story is by, actually, my colleague Mark Johnson. I sit next to him at The [Washington] Post, and the headline is “Study Finds mRNA Coronavirus Vaccines Prolonged Life of Cancer Patients.” I was really struck by this story because it talks about how patients with advanced lung cancer, they were given the covid vaccines and it somehow had the effect of supercharging their immune systems. And, actually, their median survival rates went up by 17 months compared with those that weren’t given the vaccines. And, of course, this administration has really gone after the covid vaccines and the mRNA research, in particular, and canceled $500 million in funding for mRNA research. And all of the ACIP’s [Advisory Committee on Immunization Practices’] moves on vaccines have gotten so much attention. But I think the thing that also is going to be perhaps even more impactful is pulling back on this really promising research, because it has sort of become politicized because the covid vaccines have become politicized. And it seems a shame that we’re pulling back on this really promising research. So I thought that was a really interesting story by my colleague. 

Rovner: Yes. Yet another theme from 2025. My extra credit this week is from my KFF Health News colleague Bernard J. Wolfson, and it’s called “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage.” And it’s a good reminder about something we did talk about earlier this year when the Republican budget bill passed. It limits federal grad school loans to $50,000 per year at a time when the median tuition for a year in medical school is more than $80,000. The idea here is to push medical schools to lower their tuition, but in the short run, it’s more likely to push lower-income students either out of medicine altogether or to require them to take out private loans with more stringent repayment terms, which could in turn push them into pursuing more lucrative medical specialties rather than the primary care slots that are already so difficult to fill. It’s yet another example of how everybody agrees on a problem: Medical education is way too expensive in this country. But nobody knows quite how to fix it.  

OK. That is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder, “What the Health?” is now available on WAMU platforms, the NPR app, and wherever else you get your podcasts, as well as, of course, kffhealthnews.org. If you already follow the show, nothing will change. The podcast will show up in your feed as usual. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me at X, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Maya? 

Goldman: I am on X as @mayagoldman_ and I’m also on LinkedIn, just under my name. 

Rovner: Alice? 

Ollstein: @alicemiranda on Bluesky and @AliceOllstein on X.  

Rovner: Paige? 

Winfield Cunningham: I am still @pw_cunningham on X. 

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

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This story can be republished for free (details).

Democrats and Republicans are both facing potential political consequences in their continuing standoff over federal government funding. Republicans are likely to face a voter backlash if they refuse to agree to Democrats’ demands that they renew additional tax credits for Affordable Care Act marketplace plans, since the majority of those facing premium hikes live in GOP-dominated states. For their part, Democrats are worried that Republicans will violate the terms of any potential spending deal.

At the same time, the Trump administration is using the shutdown to try to lay off thousands of federal workers, including those performing key public health roles at the Centers for Disease Control and Prevention.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• As the federal government shutdown drags on, there has been little progress toward a deal on government spending — or on the expiring ACA marketplace subsidies Democrats are fighting to renew. Potential subsidy compromises could, for instance, implement a minimal premium in place of $0 premiums, to reduce enrollment fraud, as Republicans want.
• A federal judge halted the Trump administration’s latest layoffs of federal workers amid questions about the layoffs’ legality. The administration in particular dealt a heavy blow this round to the CDC, an agency that has been battered by staff reductions, policy shifts, and even violence.
• New reporting shows the Trump administration explored the feasibility of tracing abortion pill residue in wastewater, following up on an anti-abortion claim that the drugs may be contaminating the water supply. Yet advocates could have an ulterior motive: developing the ability to trace use of the pill to further crack down on abortions.
• And President Donald Trump unveiled a deal with a second drugmaker, AstraZeneca, that allows the company to avoid tariffs in exchange for building a new U.S. facility. But as with the first deal, it’s unclear how much money the agreement will save patients.

Also this week, Rovner interviews health insurance analyst Louise Norris of Medicareresources.org about the Medicare open enrollment period, which began Oct. 15.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: Politico’s “RFK Jr.’s Got Advice for Pregnant Women. There’s Limited Data To Support It,” by Alice Miranda Ollstein.

Anna Edney: The New York Times’ “The Drug That Took Away More Than Her Appetite,” by Maia Szalavitz.

Joanne Kenen: Mother Jones’ “From Medicine to Mysticism: The Radicalization of Florida’s Top Doc,” by Kiera Butler and Julianne McShane.

Lauren Weber: KFF Health News’ “Senators Press Deloitte, Other Contractors on Errors in Medicaid Eligibility Systems,” by Rachana Pradhan and Samantha Liss.

Also mentioned in this week’s podcast:

• The Washington Post’s “She Left the Medical Mainstream and Rose To Be RFK Jr.’s Surgeon General Pick,” by Lauren Weber and Rachel Roubein.
• The Bulwark’s “There’s Something Weirdly Familiar About This New GOP Argument,” by Jonathan Cohn.
• Politico’s “4 GOP Ideas for an Obamacare Subsidies Compromise,” by Benjamin Guggenheim.
• The New York Times’ “The E.P.A. Followed Up on an Unusual Request About Abortion Pills,” by Caroline Kitchener and Coral Davenport.
• Bloomberg News’ “WHO Warns Against Three India-Made Cough Syrups After Child Deaths,” by Satviki Sanjay.

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

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 16, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi. 

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

Joanne Kenen: Hey, everybody. 

Rovner: Later in this episode we’ll play my interview with health insurance expert Louise Norris, who will explain some of the changes coming with this year’s open enrollment for Medicare, which began Wednesday. But first, this week’s news. 

So, today is Day 16 of the government shutdown, and there is still no discernible end in sight. This week Republicans shifted their main talking point against Democrats. They were arguing that Democrats are trying to restore eligibility for Medicaid to illegal immigrants. Now it’s become a general takedown of the Affordable Care Act and arguing that in urging continuing the expanded tax credits for ACA premiums, Democrats want to throw good money after bad, because the ACA has made health care more expensive. 

First off, it has not. There’s lots of evidence that the ACA has actually held down health spending increases, although other factors have pushed it up. But more to the point, do Republicans still not get that the expiration of these additional tax credits are going to hurt their voters more than it’s going to hurt Democratic voters? I see arched eyebrows. 

Edney: It doesn’t seem like they get that yet, but I’m not in those strategy rooms, so a little tough to say what their line will be with this game of chicken. They basically are allowing firings of federal workers to continue to go forward in a way that they hope maybe will turn the tide and attention. It doesn’t seem to be working. So I don’t know if they’re having these conversations quite yet, but I know that the notices are starting to go out to some people in some states about these increases, and so it really might depend on what that backlash is from people who are going to see much higher costs for their health care. 

Rovner: Yeah, apparently open enrollment began in Idaho on Wednesday. I didn’t realize that they started early, and so there’s just that one little state where people are actually able to see what these premium increases look like, assuming that they do not continue these extra subsidies. I’m wondering sort of about the Republican strategy of, We couldn’t get any traction with the illegal immigrants, so we’re just going to move to “The ACA is terrible.” Joanne. 

Kenen: Well, I mean, we talked about this a couple of weeks ago. And Julie linked to the story, and I wrote about the politics of this. And one of the issues is [President Donald] Trump is a master of deflection. Are these people going to think it’s really Republican policy? Or are they going to think it’s greedy insurers, leftovers of the flaws of Obamacare itself, it’s Biden’s fault? And also concentration, I mean where the voters are in these states. Are there enough of them who actually are going to turn out to make a difference? They’re not going to flip Texas, right? 

Are there enough of them in swing states or closer-margin states to make any difference? Are there enough in a single congressional district to make any difference? I mean part of it, I think they’re just sort of banking on that they won’t get the blame, that it’s really easy for us to get mad at our insurers. And I think that’s part of what they’re hoping, that they can just say: Blame them. Blame the structure of Obamacare. Because it’s not our fault. So, whether that works as a selling tactic remains to be seen. If they thought it was a huge political risk, they wouldn’t do it. 

Rovner: True. Lauren. 

Weber: I’ve been fascinated to see [Rep.] Marjorie Taylor-Green come out and say, Wow, these are some expensive premiums. And her in general, her seeming split from some parts of the Republican Party, is fascinating to watch for many reasons. But it’s just a lot of money that these people could be staring down. I mean, there was an analyst quoted in some coverage that was, like, people will have to decide between groceries and rent. I mean, if you are paying over a thousand dollars more a month, for some of these folks, I mean, that is a significant amount of cash. So, I do feel like people vote with their pocketbooks more than they vote with anything else. But to Joanne’s point, I mean, will they attribute the blame? I’m not sure. 

Rovner: So, Politico was reporting on some possible options for a deal on those subsidies, which lawmakers are apparently talking about quietly behind closed doors, since actual negotiations are not yet happening. Two of those possibilities seem like real potential common ground. Minimum premiums — so, people who are now not paying any premiums, and the argument from some Republicans is that that’s pushing fraud, because some people, if they’re not paying premiums, don’t even know that they’re enrolled, and that the brokers are making money, which my colleague Julie Appleby has written about ad nauseum. So that seems like a possible place for compromise, to have a minimum $5-a-month premium so people would know that they have insurance. And maximum incomes for the subsidies. I know that people are floating, like, $200,000 a year or something like that. 

Then there are two possibilities that at least strike me as less likely. One of them is grandfathering the subsidies, so only people who are getting them now could continue to get them, which would be problematic at a time when the economy seems to be shedding jobs, and changing the abortion language, which I don’t even want to start with. So, I’m seeing the first two as a real possibility. The second two, not so much. I’m wondering what you guys think. 

Kenen: I mean, I’ve talked to some Republicans who claim that the current structure of the subsidies would enable families who are making $600,000, which all of us would agree is a fair amount of money. When I was told that, I went on a whole bunch of different calculators and pretended I was making $600,000. And could I actually get the subsidies? And I kept being laughed at by these calculators. I think there are probably some cases where this has happened. It’s a complicated formula where 8% of — we don’t have to get into the technicality. There may be— 

Rovner: But it is a percent of your income. You only get a subsidy if it’s more than — yeah. 

Kenen: And you’d have to have a premium that’s, like, an extraordinarily rich premium. I mean, it has to be in a really, really, really, really high number. Can this exist under current law? Several reputable Republicans have told me yes. Or conservatives — they’re not all necessarily Republicans. Conservative on this issue, at least — have said yes. I mean, if that’s the kind of thing that you want, to set an income cap, that was probably what was intended. I would take that out of the nonstarter and into the starter pile. I don’t think that’s enough, but I think that’s a reasonable discussion for both sides to have. I don’t think the intention was to subsidize people who were really not lower-middle, middle class. 

Rovner: The people who got the big tax cuts. 

Kenen: Right. They’re getting other tax cuts. I thought that was an interesting piece with some interesting options, but I’m also hearing escalating rhetoric, back to 2014 kind of rhetoric, back to repeal kind of rhetoric, that everything that you hate about the health care system is the fault of Obamacare, nothing in Obamacare works. We’ve got a really — they’re not saying “repeal,” but they’re saying reform it, and I’m hearing more and more of that. It’s just in the air now. So, and Jon Cohn had a really good piece in The Bulwark about some of the background of this. I think it could mean that this becomes a more intense tug-of-war that does not bode well for a quick resolution of the shutdown. 

I don’t think we necessarily get into a yearlong repeal fight, even if you call it reform. But I think that these demands and this rhetoric about, Well, high-risk pools worked. Well, no, they didn’t. That, This is why your insurance costs have gone up. No, there’s a whole bunch of incentives and structures and bad stuff in our health care system. It is, Obamacare fixed certain problems. Those of us, we all have employer insurance, I believe, and all of us face cost increases and frustrations and hitting our head against brick walls and delays. And things are not perfect by any means, but it’s not because of these subsidies in Obamacare. 

Rovner: And it’s not because of Obamacare. [Barack] Obama himself this week was on a podcast and said it was intended as a start, not as the be-all, end-all. I was surprised. I mean, I think one of the reasons that Republicans, I mean, this is now in their talking points about, We’re going to go after Obamacare. And [Rep.] Mike Johnson, the speaker, had kind of a rant on Monday, I mean, which sort of opened this up. And I think some of the Republicans were also talking about it on the Sunday shows. But I can’t imagine that Republicans don’t remember that the last time they had this big fight against Obamacare, Obamacare won. That was in 2017, and if anything, it’s even more popular now because there’s twice as many people on it, which was kind of the way I set up my first question. 

Kenen: Right. But the dynamic of a year’s worth of repeal votes while other things are actually functioning in government versus a fight about this when Trump holds a lot of the cards in a shutdown — it’s comparable but not the same. 

Rovner: Anna? 

Edney: Well, and I also have to wonder if an actual extended replace, or reform, whatever we’re going to call it, fight is what they want, or if this is a strategy to help blame the increases in premiums that are coming on Obamacare in general directed towards the Democrats, right?. I mean, you can see how that line could be drawn. And so if they just keep bashing Obamacare, it’s Obamacare’s fault that Obamacare’s premiums got higher, not because they didn’t vote on extending the subsidies. 

Kenen: And we’re also talking about Obamacare again. We had been talking about the Affordable Care Act. It had gone from Obamacare, which is politically toxic, to Affordable Care Act, which was sort of a subtle acknowledgment that it had bipartisan popularity among people getting benefits. And now we’re back to Obamacare, which sort of tells me, yes, we’re back into some of this endless loop of political fights about Obamacare. 

Rovner: Yeah. 

Kenen: And trying to get the Guinness Book of World Records for repeal votes on a single piece of legislation. 

Rovner: Well, meanwhile — and I said this last week and I think the week before — that even if there is a deal on the tax credits, the bigger problem for Democrats right now is that if they make a deal on spending levels for fiscal 2026, which is what this fight is actually over, the administration can simply undo it, and Congress can ratify that undoing with a simple majority of just Republican votes. This week, even Republican [Sen.] Lisa Murkowski wondered aloud why Democrats would do a deal like that. So, I’m still wondering how they get out of that box, even if they were to get some kind of a compromise on the ACA subsidies. I certainly don’t know how Democrats get out of that box. I think the Republicans don’t know how they get out of that box. 

Kenen: They don’t realize they’re both in the box. That’s one of the problems. This is a large box. 

Rovner: It’s Schrödinger’s shutdown. We will have to see how that plays itself out. In the meantime, I’m not holding my breath. Well, moving on, despite laws against it, as Anna already mentioned, the Trump administration began firing federal workers last week, and the cuts hit particularly hard at the Department of Health and Human Services and agencies like the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration. The cuts appeared both sweeping and devastating, at least at first, including the entire staff of the CDC’s news journal and lead public health source of information, the Morbidity and Mortality Weekly Report. Though by the end of the weekend, many of the firings had been rescinded. It’s not clear whether that really was a coding mistake, as was the official explanation, or an effort to continue to put federal workers, quote, air quotes here, “in trauma” as OMB [Office of Management and Budget] Director Russell Vought famously promised before he took office for the second time. Whichever, it’s not really the way to get the best work out of your workforce, right? Telling you: You’re fired. No, you’re not. Maybe you are? Go ahead, Lauren. 

Weber: I would like to go back to the story I wrote in April when a bunch of fired health workers were told to contact an employee who had died. I don’t think, based on the coding error or some of these past things, it does not seem like these layoffs are being done in any sort of organized way. It doesn’t seem like they have up-to-date records. It seems like, also, are these layoffs even legal, based on some of the litigation that’s been filed? I think there’s going to be a lot that has to shake out there. But, I mean, to be quite honest, it is very striking to see a bunch of CDC employees continue to get laid off after, again, this is an agency that got shot at with hundreds of bullets. Police officer— 

Rovner: Yeah, literally shot at. 

Weber: Literally shot at with hundreds of bullets, and a police officer died responding to that, due to a shooter who had been radicalized in part, it seems, from his father’s account, by information that was wrong about the covid vaccine. So, to see more of those employees get laid off, I mean, you just have to wonder who’s going to want to work at these places. Morale is just completely, as we understand it, terrible. But yeah, I also question if that was a coding error or what exactly was happening there, because there were a lot of priorities of folks that were seemingly let go that are allegedly Make America Healthy Again priorities, but that’s also been true for many months of policymaking, so— 

Rovner: Yeah, there’s a lot of right hand not seemingly knowing what left hand is doing in all of this, which may be the goal. I mean, I think you put your finger on it. It’s like, who would want to work at these places after what’s being done? And I think that’s the whole idea of the Russell Vought strategy of, Let’s shrink the federal government to a point where it’s so small that you can just sort of put it in a box and put it under the bed. That’s essentially where we are. Well, Lauren, as you mentioned, Wednesday afternoon, a federal district court judge ordered the administration to pause the firings. But will they actually obey that? And do we even know what offices have been most affected at this point? 

I mean, we heard a lot of things like the entire Office of Population Affairs at HHS, which runs Title X, has apparently been reduced to one person. The people who do a lot of the statistics and survey work at CDC. All these people sort of appear to have been laid off, but we’re not quite sure, and we’re not quite sure what’s going to happen from here. 

Kenen: I’m not sure if they know they’ve been laid off and rehired, because if you were laid off, you lost your access to your work email, and then if you get an email in your work email saying, Oops, you’re hired. I mean, I guess people sort of may just see if they have access again, but I’m not really sure how the actual notification of this somewhat chaotic layoff, no-layoff thing is. 

Rovner: It has been chaotic. I think that’s a good word to describe all of this. Well, one reason it was relatively easy for the administration to go after the CDC is that it doesn’t have a leader — or even a nominated leader — at the moment, after the firing of Susan Monarez in August, less than a month after her Senate confirmation vote. Another high HHS position that remains vacant is that of surgeon general, although that office at least has a nominee, Casey Means. She’s the sister of RFK [Robert F. Kennedy] Jr. top aide and MAHA associate Calley Means and more than a little bit controversial. Lauren, you did a deep dive this week into the prospective surgeon general. What’d you find? 

Weber: Yeah, my colleague Rachel Roubein and I did a deep dive into her background. And she’s, look, she’s a fascinating example, really, of MAHA today. And you could argue she really wrote the manifesto to MAHA with her book “Good Energy” that she authored with her brother, Calley Means. But basically she’s a very accomplished person in the sense that she went to Stanford undergrad; she graduated from Stanford med school; she had a very prestigious residency in ear, nose, and throat surgery; and then she resigned. She left and decided she wanted to take a different path and has become a bestselling author, a health products entrepreneur, and has also worked, as her financial disclosures have revealed, to promote a variety of products in some of her work. Financial disclosures revealed that she had received over half a million dollars over basically the last year and a half promoting a variety of different supplements, teas, elixirs, diagnostic products, and so on. 

And several of the medical and scientific experts I spoke to said that they worried that she spoke in too absolute of terms about health, and they were really concerned that as someone who would be the surgeon general that she would use that bully pulpit and speak in terms not necessarily grounded in evidence. They pointed to some of her remarks about how cancer and Alzheimer’s and fertility was within one’s power to prevent and reverse, and they felt like that language went a step too far. And looking at her history, they are concerned about what that could mean for the health of the nation if she is directing it. 

Rovner: She doesn’t even have a confirmation hearing scheduled yet, does she? Well, the Senate’s in so they could. 

Weber: She is pregnant, so I think that is playing into the timing of some of her stuff. But yes, she does not have it scheduled. Her forms seemingly were pretty delayed. And then obviously there’s other things going on. I mean, I think the CDC firing also sucked a lot of health air out of the room of what people want to deal with and spend their political capital on, I suspect. But yes, we shall see. 

Kenen: Yeah, she has to go before the [Senate] HELP [Health, Education, Labor, and Pensions] Committee, which is, Sen. [Bill] Cassidy is the chair. He is not a happy camper at the moment, from his public statements, and we do not know what the private conversations he is having at this point in time. 

Rovner: And of course, that committee will also have to pass on the new CDC nominee when there is one. 

Kenen: Yes. And the last CDC hearing, which all of us watched, I think he’s clearly concerned and displeased by lots of things going on at the federal health agencies. So, none of us are in those rooms, but they’re probably interesting conversations. 

Rovner: As I like to say, we will watch that space. Well, turning to reproductive health, The New York Times has a story this week about something that we’ve talked about before on the podcast, arguments by anti-abortion activists that abortion pill residue in wastewater might be contaminating the nation’s waterways. Notwithstanding that there is no evidence of that, the Environmental Protection [Agency], acting on a request from anti-abortion lawmakers in Congress, ordered scientists to see if they could develop methods to detect the drug in wastewater. Now, the groups that originally pushed this say they were concerned about pollution. But if such a detection method is successfully developed, abortion rights supporters worry that it could be used to trace users in particular buildings in order to enforce abortion bans. This is basically another step in this sort of, Let’s try and shut down abortion nationwide. Is it not? And Anna I see you nodding. 

Edney: Well, I mean that was my feeling when I read this really good piece that you’re talking about. And it’s a little bit lower down in the piece when they do start talking about using this to target maybe buildings or places where someone might have used an abortion drug. And I kind of was like, Yes, this is what I assumed they were trying to do, as I read this. And the reason for that is not just because I feel like there’s always a vindictive motive or something, but it’s because there are lots of drugs that are in our wastewater, and people are taking far larger amounts daily of many more things that is all going into our wastewater. So, particularly, why you would want to track that one, which is not used by millions of people for a chronic condition on a daily basis, it seems like there would be an ulterior motive. 

Rovner: And has not been shown to do any harm, even if it is showing up in trace amounts in the wastewater. Although presumably that’s what the EPA scientists were also tasked with trying to figure out. 

Kenen: I mean, it’s really hard to get rid of a drug you no longer take. I mean, pharmacies don’t want to take it back. In my neighborhood, there is a pharmacy at a supermarket that does have a take-back, which is great, but it’s always broken. If you have any drug that you want to get rid of responsibly and not have it end up — Anna’s right, I mean, there’s just a lot of stuff in our water. It’s really hard to do. And this is not the only drug that is an issue with. 

Rovner: Although if you Google it, there are a lot of places where you can actually take back drugs. 

Kenen: It’s hard. It’s limited hours, limited access, and the machines are often— 

Rovner: Yeah. Yeah. 

Kenen: I’ve been trying for a couple of them for a few months, actually. 

Rovner: You do have to actually take some steps actively to do it. Well, turning to drugs, and drug prices, there was so much other news, you might’ve missed this, but President Trump last Friday afternoon announced a deal with a second drug company to bring back manufacturing, in order to avoid tariffs. This deals with AstraZeneca, which promised to build a plant in Virginia. But Anna, is there any promise to actually bring down prices for consumers in any of this? 

Edney: Minimally, possibly. It’s a lot like the Pfizer deal, and we saw that focus largely on Medicaid, that already has extremely steep discounts that are required by law. And so how much they’d actually be slashing to offer the “most favored nations” pricing that Trump wants to the Medicaid program, it seems like that probably isn’t a huge leap, and certainly we saw that Wall Street didn’t react with any hair on fire. They’re not worried about the bottom lines of these companies when these deals come out, and they’re avoiding tariffs for three years. So, kind of net positive, seemingly. We don’t have all the details of the deal— 

Rovner: Like with the Pfizer deal where we never got all the details. 

Edney: Yeah, exactly. So, there’s some stuff that we still don’t know, but Medicaid is the main focus. Then they’ll offer, again, some of their drugs on TrumpRx. So, maybe if your insurance doesn’t cover something, or if you don’t have insurance, and you want to get a drug, that might be helpful. But most people I think are going to opt to pay their lower copay than the cost of a drug that is discounted but still full price. 

Rovner: Well, in case you’re looking for a reason why it might be a good thing to reshore some drug manufacturing, the World Health Organization this week warned of potentially poisonous cough syrup made in India. According to one of your Bloomberg colleagues, Anna, 22 children have died in the central Indian state of Madhya Pradesh — I hope I’m pronouncing that close to right. And this is far from the first time poisonous substances have been found in medications made in India, right? You’ve done a lot of reporting on this. 

Edney: Yeah, for sure, and these are really tragic stories that now seem to keep, particularly with these kind of cough medicines, keep popping up. And thankfully the FDA did put out a message saying these cough medicines in this round were not sold in the U.S., but there have been times where India has imported some of these. There were children in the Gambia that died last time — this was a few years ago. Because what’s happening is some of the drugmakers in India are supposed to be purchasing a solvent. It’s propylene glycol. Well, that solvent, that helps the medicine kind of all mix together. It can be a lot cheaper if you buy something that looks like it but is actually deadly, diethylene glycol. And so that’s what some of these companies are doing, is saving money and substituting a deadly ingredient. And so we see that this is a problem a lot of times with some of the drugmakers, and it’s happened, unfortunately, particularly in India, where the cost-cutting, the corner-cutting has actually affected people’s lives, and in this case, tragically, children. 

Rovner: Yeah. There is reason to kind of want to keep drug manufacturing where the FDA can keep an eye on it, which I know you will continue to report on. 

Edney: For sure. 

Rovner: Because that has been your specialty, I know, of late. 

Edney: Yes. 

Rovner: All right, that is this week’s news. Now we will play my Medicare open enrollment interview with Louise Norris, and then we’ll come back with our extra credits. 

I am so pleased to welcome to the podcast Louise Norris. She’s a health policy analyst at Medicareresources.org and at Healthinsurance.org and the author of some of the most helpful guides to health insurance out there — and the person who keeps track of all the changes for health reporters like me. Louise, so happy to welcome you to “What the Health?” 

Louise Norris: Thank you so much, Julie. It’s a pleasure to be here. 

Rovner: So, we’ve talked a lot these past few months about how the Affordable Care Act and its potentially skyrocketing premiums for 2026 is about to happen, but we haven’t talked as much about some of the changes to Medicare, for which open enrollment began this week. Now, most years it’s probably OK for Medicare recipients just to let whatever coverage they have kind of roll over. But that’s not the case this year, right? 

Norris: Well, I feel like it’s never the best idea to just let your coverage roll over, because there’s always plan-specific changes that people just really need to pay attention to. And even though averages might be fairly steady in terms of premiums and benefits, that doesn’t mean your plan will have a steady premium or benefits. And for 2026, we’re seeing in the Medicare Advantage and Part D —stand-alone Part D — drug plans, there are fewer plans available on average and actually a slight average decrease in premiums. But I feel like if people see that as the headline, they might be sort of lulled into complacency, of like, Oh, I just don’t need to look, when in reality there’s quite a bit of variation from one plan to another. So, although the average stand-alone Part D plan premium is actually decreasing slightly, some plans are increasing their premiums by as much as $50 a month. So, you need to really pay attention to the notice you got from your plan about what’s happening for 2026 and then comparison-shop. Comparison-shop is always in your best interest every year. 

Rovner: Right, because, I mean, people don’t realize that maybe your doctor’s been dropped from your Medicare Advantage plan or your drug has been dropped from your Part D plan. So, I mean, even if your premium doesn’t change that much, your coverage might be changing a lot, right? 

Norris: Exactly. And you don’t want to find that out when you go to the pharmacy in January to fill your prescription and then you’re locked into your Part D plan for all of 2026. It’s definitely better to know all those details at this right now during open enrollment. 

Rovner: Now there are some coverage changes that people are starting to feel from really a couple of years ago, yes? 

Norris: There are. So, there’s some basic changes like, for example, the maximum out-of-pocket cost on Part D plans, which just went into effect in 2025 under the Inflation Reduction Act, it was a $2,000 cap on out-of-pocket costs for Part D. That is indexed for inflation. So for 2026 it goes up to $2,100. So not a huge change but definitely a change people should know about. And you do still have the option to work with your plan to spread that out in equal payments across all 12 months of the year instead of having to meet it right at the beginning of the year, if you take an expensive medication. There’s this change in the maximum Part D deductible, just like there is every year. This year it’s, for 2025, it’s $590 is the maximum deductible. It’ll be $615 next year. That doesn’t mean your plan will have a $615 deductible, but it might. 

But there are also plan-specific changes that vary from one plan to another. So, for example, your Medicare Advantage plan might be adding or subtracting supplemental benefits. They might be changing the amount of your deductible or changing the amount of your inpatient hospital copay. There’s all sorts of changes that aren’t necessarily broadly applicable but that apply to your plan. And then, like you were saying, whether or not your doctor and hospital are still in the network, whether your prescription drug is still covered and covered at the same level, plans can move prescription drugs from one tier to another. So, those are all the sorts of things you really need to pay attention to now so that you can comparison-shop and see if something else might be a better option. 

Rovner: And we are seeing plans starting to sort of drop out. I mean, I know at one point there was concern that there were too many plans for people to choose from, that it was, just, it was too confusing. But now are we running the risk of having too few plans in some places? 

Norris: Well, I think the concern about too many plans is definitely valid. For a while, there were — it could definitely be overwhelming for people shopping for coverage. For both Medicare Advantage and Part D, we do have, overall, an average of a reduction in how many plans are available for next year. There are a few states where the average beneficiary will actually see more options for Medicare Advantage, but that’s rare. But the average beneficiary will have access to more Medicare Advantage plans than they did before 2022, for example. It’s just been in the last few years that it has decreased, but it still hasn’t decreased below the level that it was in 2022. So it’s still a lot. I believe it’s an average of 32 plans. And then in the Part D, for people who buy stand-alone Part D coverage, everybody has between eight and 12 plans to pick from. 

So, if your plan is ending, you obviously need to shop for new coverage. If you’re on a Medicare Advantage plan and you don’t shop for new coverage, you’ll just be automatically moved to original Medicare on Jan. 1. If you’re on a Medicare Advantage plan that’s ending, because your carrier is exiting the market or pulling out of your area and your plan can’t be renewed, you can pick any other Medicare Advantage plan that’s available in your area. But you also can do, you can switch to original Medicare, and you’ll have guaranteed issue access to Medigap, which is not normally the case. During this open enrollment period, people have guaranteed issue access to Medicare Advantage and Part D but not Medigap. So, for other folks whose Medicare Advantage plan is continuing, obviously they have the option to switch to original Medicare. But depending on how long they’ve been on their Advantage plan and what state they’re in, they do not have guaranteed issue access to Medigap. So, that is an important thing for folks to know if their plan is actually ending, is that they can make that choice if they want to. 

Rovner: We’ve seen a lot of increases in health care costs overall, and I guess that’s true for Medicare, too. I mean, why should people who aren’t on Medicare care about what happens to Medicare and what happens to the Medicare market? 

Norris: First of all, hopefully all of us will eventually be on Medicare. Almost everyone by the time they’re 65 is on Medicare. But even if you’re a long ways away from that, it is important to know how much the whole Medicare sphere, in terms of the insurance companies and the regulations, how that sort of trickles down to the rest of the commercial insurance sector. Drug price negotiation, for example, that will have a trickle-down effect into what the insurance companies in the rest of the commercial market pay for drugs. When regulations come out for Medicare, they oftentimes, the insurance companies follow suit in the private market, or states will follow suit in terms of how they regulate the private market. So, it certainly does matter for everyone, even if it’s not a direct effect. 

Rovner: So even if you’re not 65 or helping somebody who’s over 65. 

Norris: Exactly, yes, and that’s the other thing is a lot of folks who are younger are helping a parent or a grandparent navigate this, and so it really does affect most people. 

Rovner: Yeah, it is one of the autumn tasks for many people. 

Norris: Absolutely. 

Rovner: Helping Mom and Dad or Grandma and Grandpa navigate their Medicare coverage for the following year. 

Norris: And I do think, like you were saying earlier, as far as just letting it ride, obviously if you comparison-shop and you’re happy with your coverage and you’ve determined that it is still the best option, then, yes, you do not need to do anything. You just, assuming it’s still available for renewal, you just let it renew. But oftentimes I think people don’t comparison-shop, simply because the process seems overwhelming and they just figure, I’ll just keep what I have. And of course, if you’re in that situation, you might be one of the people who’s on a Part D plan that’s increasing by $50 a month next year, or you might find out in January that your doctor’s no longer in-network with your Advantage plan. 

So if you get those notices from your plan and something doesn’t make sense or you’re confused, it’s much better to reach out to someone who can help you, whether it’s a family member or friend, asking them for help, or call 1-800-MEDICARE. Call the Medicare SHIP in your state. Every state has a State Health Insurance Assistance Program that’s staffed with people who can answer your questions. Contact a Medicare broker in your area. Just asking questions and finding out the answers is a much better approach than just assuming things will work out if you just let your plan renew. 

Rovner: I’ll put a link to your site also. 

Norris: Yeah, Medicareresources.org. We do have an open enrollment guide where we list all of the changes that are happening for 2026, the broad changes, and we’ll continue to update that. For example, we don’t yet have the Medicare Part B premiums for 2026, so as those numbers come out, we’ll update that guide with everything people need to know. 

Rovner: Louise Norris, thank you so much. 

Norris: Absolutely. Thank you so much for having me, Julie. 

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

Kenen: The piece I have this week is from Mother Jones, and it’s about Florida Surgeon General Dr. Joseph Ladapo. And the headline is “From Medicine to Mysticism: The Radicalization of Florida’s Top Doc,” by Kiera Butler and Julianne McShane. It’s a phenomenal read. He has stellar credentials — Harvard, Stanford. He was an academic medicine MPH [master of public health]. He’s public health and medicine. He had this stellar traditional career. He was widely respected. And now he is this leading voice. He’s trying to get rid of the vaccine mandates, childhood vaccine mandates, to the whole state of Florida. He has questioned all sorts of established public health practices. He is out there. And we’ve sort of all wondered: How do people get to this point? 

And this story talks about his wife and her mysticism, and their guru healer, who walks on their thighs to the point that it’s painful. And they emerge from this foot-walking thigh-walking thing, and his mystical experiences with this whole different take on the human experience and the role of health. I cannot begin to capture it. And here it is. It is a long, detailed, and fascinating read on his wife, who he met on an airplane, and her beliefs in, we bring certain things on ourselves because of who we are and who are the ancestors that we carry. She sees auras and visions, and this is their current belief system. And it is not compatible with what most of us think of as science-based public health. Really good read. Really, really good read. 

Rovner: Definitely MAHA to the max. Anna. 

Edney: Mine was a guest essay in The New York Times, “The Drug That Took Away More Than Her Appetite,” [by Maia Szalavitz]. And I thought it was a really great look at how some of these obesity medications, the GLP-1s like Ozempic and others, can be used to treat addiction. And so it follows this woman who was addicted to different kinds of drugs at different times. And she lost her children and all sorts of horrible things and had tried over and over again to stop using, and then has been in this program that uses a version of these GLP-1s at a lower level — they don’t necessarily want you also losing weight — but to treat addiction, and just how it’s kind of been the only thing that’s worked for her. It stops the cravings, kind of as you think it might do for people with obesity as well. 

I thought we don’t see this as much, and the companies that make these drugs aren’t extremely focused on this. So I thought the article did a good job of saying why this could be really important, and looking at the fact that right now it requires federal funding of research to keep the promise alive, and hope that at some point some pharmaceutical company will be more willing to pick it up. 

Rovner: Right now, there’s a lot more money to be made in the obesity side of this. But yeah, it’s a really interesting story. Lauren. 

Weber: I actually highlighted work from Rachana Pradhan and Samantha Liss from KFF Health News. The article’s titled “Senators Press Deloitte, Other Contractors on Errors in Medicaid Eligibility Systems.” It’s impact from their great reporting, which I think we talked about on this podcast earlier in the year, about how — talk about waste, fraud, and abuse — that there’s some questionable issues with how Deloitte manages Medicaid systems and how money’s being wasted through them. And the senators, it looks like, read KFF Health News’ reporting and have sent some letters about it. So, great work by the team over there, and eye-opening for sure to see, on some of the dollars, Medicaid, that are not going to patients. 

Rovner: Journalism impact. My extra credit this week is a really thoughtful story from our fellow podcast panelist Alice Miranda Olstein at Politico. It’s called “RFK Jr.’s Got Advice for Pregnant Women. There’s Limited Data to Support It.” It’s about a topic that I have been covering for more than three decades — the difficulties of including women, particularly women of childbearing age, in clinical trials of drugs. As Alice outlined so well, the problem isn’t just ethical — an unborn fetus obviously can’t give informed consent to be part of an experiment — but it’s also a question of liability. Drugmakers are afraid of getting sued for bad pregnancy outcomes, and with good reason. That’s why it’s so hard to know what is and isn’t safe to take during pregnancy and what might cause birth defects or miscarriages. And despite the secretary’s promise to, quote, “do the science,” it is not that easy. It’s a really, really good read. 

OK, that is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me still on X, @jrovner, or on Bluesky, @julierovner. Where are you folks these days? Joanne? 

Kenen: I’m either on Bluesky, @joannekenen, or on LinkedIn. 

Rovner: Anna? 

Edney: Bluesky or X, @annaedney. 

Rovner: Lauren. 

Weber: I’m on X or Bluesky, @LaurenWeberHP. 

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

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This story can be republished for free (details).

It’s not yet clear how the federal government shutdown will end, but Democrats are continuing to draw attention to the issue they are promoting — the coming expiration of additional subsidies for Affordable Care Act insurance plans. Some Republicans are now going public with their worries about the huge cost increases many of their constituents face.

Meanwhile, the Food and Drug Administration quietly approved a second generic version of the abortion pill mifepristone, much to the dismay of anti-abortion groups — even as FDA officials are investigating new claims about potential safety risks posed by the drug.

This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• As the shutdown dragged on, Rep. Marjorie Taylor Greene — a Georgia Republican known for her vocal opposition to Democratic policies, including the ACA — spoke out this week in favor of renewing the federal subsidies. She noted that her adult children expect to see their health premiums double if the subsidies expire, a problem looming for many Americans on marketplace plans.
• Federal officials recently warned that WIC — the supplemental nutrition program that helps many American families purchase staple foods — has nearly exhausted its funding. The Trump administration has said it will use the proceeds from tariffs to keep the program operating, yet it’s unclear whether it has the authority to do that, as well as whether the tariffs themselves are legal.
• Meanwhile, the Supreme Court heard a case challenging Colorado’s conversion therapy ban, and based on the tone of arguments, it seems likely the ban will be struck down. And the vaccine schedule is changing — though that change also jump-starts needed shipments for the Vaccines for Children Program.

Also this week, Rovner interviews Sarah Grusin of the National Health Law Program about the GOP’s misleading claims that Democrats shut down the government in pursuit of free health care for immigrants in the country illegally.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Washington Post’s “How Some Veterans Exploit $193 Billion VA Program, Due to Lax Controls,” by Craig Whitlock, Lisa Rein, and Caitlin Gilbert.

Tami Luhby: The Washington Post’s “Trump Plan Would Limit Disability Benefits for Older Americans,” by Meryl Kornfield and Lisa Rein.

Sarah Karlin-Smith: The New York Times’ “It’s Just a Virus, the E.R. Told Him. Days Later, He Was Dead,” by Lisa Miller.

Alice Miranda Ollstein: The 19th’s “Ice Fears Put Pregnant Immigrants and Their Babies at Risk,” by Mel Leonor Barclay and Shefali Luthra.  

Also mentioned in this week’s podcast:

• The Hill’s “Greene Doubles Down on Remarks About Affordable Care Act Subsidies,” by Tara Suter.The Washington Post’s “Six Surgeons General: It’s Our Duty To Warn the Nation About RFK Jr.,” by Jerome Adams, Richard Carmona, Joycelyn Elders, Vivek Murthy, Antonia Novello, and David Satcher.
• Politico’s “Animal Welfare Is Now Part of RFK Jr.’s MAHA Agenda,” by Erin Schumaker.
• The Washington Post’s “How Big Agriculture Got Its Way in the Latest MAHA Report,” by Amudalat Ajasa and Rachel Roubein.
• Politico’s “Health Agencies Lose ‘the Backbone Folks Who Can Keep Things Running’ to Indian Health Deployments,” by Alice Miranda Ollstein and Maya Kaufman.

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

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 9, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, everybody. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: And Tami Luhby of CNN. 

Tami Luhby: Hello. 

Rovner: Later in this episode we’ll play my interview with Sarah Grusin of the National Health Law Center. She’ll help untangle the claims that Republicans are making that Democrats want to give free health care to undocumented immigrants. Spoiler, they don’t. But first, this week’s news. 

So, today is Day 9 of the government shutdown, and so far there’s still no discernible end in sight. While last week it seemed like some Democrats might be getting cold feet, at least in the Senate, about keeping government workers either at home or at work and not getting paid, this week it’s looking like some Republicans are getting cold feet about the coming lapse in additional Obamacare subsidies that will subject lots of Republican voters to huge premium increases come January. Any evidence either side is actually giving in? Or are we still in a state of pretty complete standoff here? 

Ollstein: I was up on the Hill this week, and it seemed like pretty complete standoff. There were some testy in-person exchanges, which is not as usual, just outright raised voices, arguments between lawmakers just in the hallways in full view of the press, about this ongoing shutdown and about the stakes for health care. And Republicans are saying, Oh, we want to address the health care issue and prevent the subsidy hikes, but you have to open the government first and then we’ll do it. Democrats are basically saying: We’re not idiots. We need to use the leverage we have, and the leverage we have is the shutdown. I mean, there were some notable moments here. I mean, one, there’s just been polling coming out showing that the public is blaming Republicans more than Democrats, and so I think that’s strengthening Democrats’ spine a little to hang on a little longer. I mean, people are not only blaming Republicans because Republicans are in control of the House, Senate, and White House but also because Democrats are staking their claim on these, wanting to prevent people’s plans from becoming much more expensive, which is a popular stance. 

Rovner: And plus people are used to blaming Republicans for shutdowns. I really think a big —I do — I seriously think a big part of it is, If the government is shut down, it must be the Republicans who shut it down— 

Ollstein: Right. 

Rovner: —because they’re the ones that don’t like government. 

Ollstein: Right, right. And this comes amid a bigger public souring on our political leaders. But one thing that really caught people’s attention this week was Marjorie Taylor Greene, the very conservative congresswoman from Georgia, coming out and saying, Look, I’m no fan of Obamacare, but my kids’ plans are about to get way more expensive, and Republicans have no, no idea what to do. 

Rovner: Yeah. I would say, I think it’s safe to say I did not have Marjorie Taylor Greene— 

Ollstein: Nope. 

Rovner: —on my bingo card as the Republican who was going to come out in favor of saving the extra subsidies. 

Luhby: Right, although the interesting thing is she noted that her kids, their premiums would double, so it’s really hitting home for her, and she’s bringing that to the attention of the Congress. 

Rovner: Yeah, and we should note that, I mean, she is emblematic. She’s got kids who are in their late 20s, who have just aged out of her congressional health insurance, so they’re buying their own coverage. She lives in Georgia, which is one of the states where Obamacare enrollment went up dramatically after the enhanced subsidies. She is like the poster child for what the lapse of these increased subsidies will do, which I find kind of amusing. And she’s been doubling down, saying: I don’t like Obamacare. I wasn’t here when it passed. I think it’s dumb. I think all these other things. But I also don’t think it’s fair to take it out on my kids and my constituents. Which is kind of what I’m wondering: Is this the beginning of the cave for the Republicans? Or is she just going to go her own way, as she sometimes does? 

Ollstein: Exactly. I mean, she often goes her own way. She is more willing than most on the GOP side to buck the party line. And so, I mean, she is influential. She has a huge platform. And so you could see strange bedfellows where some of the more moderate Republicans sort of join with her on this. It’s hard to see where it’s going right now, but it was a very interesting development this week. 

Rovner: Yeah, for a week in which nothing much happened, there’s sure been a lot to follow. Well, the shutdown is actually starting to pinch, which you would know if you were trying to fly in or out of an airport that’s missing some of its air traffic controllers. On the health side, not much is happening yet, except there’s a curious new twist with the Women, Infants, and Children feeding program, known as WIC, which was about to run out of money. Tami, what is happening there? 

Luhby: Right. So, it’s a program that serves almost 7 million people, mainly pregnant women, new mothers, infants, toddlers, young children. And it’s long had bipartisan support. It’s a 50-year-old program. And just to explain what it does, it provides funding for families to get vouchers to get basics like milk, eggs, bread, fresh fruit and vegetables, peanut butter, cereal. And it was — the National WIC Association had said that it only had enough funding maybe for a week or two, so the clock was ticking down. I spoke to a couple of moms last week, who were very concerned about what they were going to do. One mom told me she’s already conserving the milk her kids drink to try to stretch it out more. And this week, the Trump administration said that it was going to use tariff money to keep the program operating. 

So, people have been very happy about that, but at least one budget expert I spoke to questioned whether the administration actually has the authority to do that. He said it’s not that the administration doesn’t have the money to pay for it. It’s that Congress hasn’t told them what they can do with the money. So, it’s a little unclear how the administration will be able to take these tariff funds and use it to fund the WIC benefits, but that’s what they said they’re going to do. 

Rovner: Yeah, that was creative. It’s not unusual. I think you can reprogram money during a shutdown. But again, there’s a question about whether these tariffs are even legal. That’s something the Supreme Court’s going to decide later this year. So, it is interesting to say the least. Well, meanwhile, some of the other places that health cuts are showing up actually have nothing to do with the lapse in appropriations. Most Medicare telehealth authority ended with the end of the fiscal year, leaving rural and homebound patients hanging in many cases. And even though Republicans set up their budget bill this summer to delay most of the Medicaid cuts until after the midterms, a lot of states who were trying to close budget holes are cutting Medicaid now. This is likely to put even more pressure on Republicans, right? 

Luhby: They knew it was going to happen. I mean, I’m not sure how much more pressure or how much new information they’ve received. I mean, for the first six months of the year, states, advocates, hospitals, everyone was saying that if the One Big Beautiful Bill goes into effect it’s going to be a big problem. So, we’re starting to see the early effects. 

Rovner: Yeah, I would say that the Democrats aren’t really shutting down the government over health care, although they do care a lot about these subsidies. The Democrats are really shutting down the government over wanting promises that the Trump administration will stop basically second-guessing and violating what Congress is passing in terms of funding bills. But this is turning into a pretty big health debate, which kind of surprises me. I think it may surprise some of the Democrats. I mean, the Democrats wanted to use health care because it’s one of the few issues where they have an advantage over the Republicans politically, but this seems to be kind of building on itself to a level of health system debate that I haven’t seen I don’t think since 2017. 

Luhby: And I know you’re going to get into this later in the podcast, but I mean the Republicans are trying to take back some ownership over this by saying, Well, what the Democrats really want to do is provide free health care to, as they term it, illegal aliens. So, they are trying to use one of their few leverage points in the health care debate to take back the conversation. But there’s been a lot of blowback on that, as you will discuss. 

Rovner: We will see how this all goes. Well, moving on. This is the week with the first Monday of October in it, which means the Supreme Court is back in session, and they’re diving right back into the culture wars. On Tuesday, the justices took up a case challenging Colorado’s law outlawing so-called conversion therapy intended to help LGBTQ+ people turn straight. The plaintiff in the case is a Christian counselor who says the law violates her free speech rights. If the court strikes down the Colorado law, which those who watch the argument suggest seems likely, it could lead to the striking down of similar laws in about half of the states. Now, these laws are based on decades of research showing that attempts to change people’s sexual orientation are often more harmful than beneficial. Is this yet another example of the justices playing doctor? It would hardly be the first time. 

Ollstein: It was interesting. In the oral arguments, there was a lot of justices questioning the medical consensus. And I think we see this in several areas now, where they’re sort of like, Well, the eggheads got it wrong on X other thing, so we should be skeptical on Y thing, sort of an attitude which is extremely common in laypeople circles on the right. But it’s very interesting to see the Supreme Court, who is this elite specialized authority, questioning other elite specialized authorities, basically. 

Rovner: Yeah, going back to, I think Hobby Lobby [Burwell v. Hobby Lobby Stores] was the first time where I think that the justices said: We don’t believe you medical experts who have all filed in this case. We’re going to make our own decision. And it looks kind of like they’re planning on going the same way this time. 

Well, while we are on the subject of culture wars, last week, the Food and Drug Administration tried unsuccessfully to avoid one. It quietly — so quietly I don’t think there was even a press release —approved a generic copy of the abortion pill mifepristone. Now, this isn’t the first generic. There’s another one already on the market, and it’s actually part of the overall series of lawsuits over states trying to ban medication abortion. But I found out about this new pill, as I imagine you probably did, Alice, from a press release from outraged anti-abortion groups, followed by outraged press releases from outraged anti-abortion members of Congress. What happened here? And actually, Sarah, you can probably explain this better. How did this pill get approved at the same time when the FDA says it’s reexamining the approval of the original abortion pill? 

Karlin-Smith: Right. And the way that the FDA and some of the HHS [Department of Health and Human Services] leadership that says they are committed to reexamining the abortion pill and the way it is prescribed and used have sort of justified it, they’re saying that under current law, when you approve a generic, basically generics just need to essentially show they’re what’s known as bioequivalent to the brand version, and that’s really the only parameters the FDA has in terms of whether they can approve or deny the drug. If it’s essentially the same product, they have to approve it. But they’re sort of saying at the same time to people who are concerned about the use of abortion medicine and abortions in this country: But wait, wait. Hold up. We have to do this, but we’re still committed to and looking at the science around the drug, how the drug is — the safety programs around how the drug is prescribed. So, I think that while obviously people in the anti-abortion community are upset about this, the message that the political leadership at HHS is trying to send is, We are still looking at potentially making changes that could decrease access to this drug. 

Rovner: Alice, one of my colleagues said, after this, Well, why did they decide that they had to follow the law this time? There have been plenty of cases where they have decided they don’t have to follow the law. Does this signal something about the — I know that [Health and Human Services Secretary Robert F.] Kennedy [Jr.] is not an anti-abortion advocate through most of his life. I don’t think Marty Makary, the head of FDA, has either. Are they trying to have it both ways here? 

Ollstein: So, on the one hand, I wouldn’t read too much into it. Like Sarah said, there’s a very standard process for this. As long as the new generic can prove it’s the same as the old generic, it’s sort of a rubber-stamp, normal thing. And I think it’s notable that they tried to keep it so quiet, whereas maybe another administration would’ve said, Hey, look, new generic for you. But yeah, I would not take it as a sign either way. But I think it’s interesting that the anti-abortion movement is so frustrated. And they really feel sort of sidelined right now, not just with this decision. They’re very skeptical of the review that HHS announced about the abortion pills. They’re worried it’s going to come to nothing, or they’re already sort of trying to prebut what they anticipate it’s going to be, saying: Oh, just slapping a new warning label on the pills is not enough. We need to restrict them. 

And so they’re already signaling that they’re not going to be satisfied with anything less than new restrictions and bans on the drugs. So, I mean I think it’s interesting in that sense. I also think social conservatives have been disappointed. The administration talked a big game about IVF [in vitro fertilization] on the campaign trail, and now we’re not really seeing anything on that front. And of course there are divisions within the right about that. But I think there is some skepticism and disillusionment from the anti-abortion movement about what this administration has done so far. 

Rovner: We’ll get to more “MAHA” [“Make America Healthy Again”] news in a minute, but first I want to talk about the little bit of vaccine news that we have. Last week I said that neither the acting head of the CDC [Centers for Disease Control and Prevention] nor HHS Secretary Robert F. Kennedy Jr. had yet approved the changes to the vaccine schedule recommended by the advisory committee on vaccine practices last month. Well, it turns out that acting CDC Director Jim O’Neill had in fact approved the changes, but the CDC didn’t bother to tell us that until Monday. Sarah, remind us what these changes are that the ACIP [Advisory Committee on Immunization Practices] made and how this is going to impact the availability of the vaccines that the schedule’s being changed for. 

Karlin-Smith: So, the CDC and ACIP have basically changed from a universal covid vaccine recommendation, saying everybody 6 months and older should be getting at least one covid shot a year, to now they’re saying you should basically consult with your doctor and do what’s known as shared decision-making. So, have a conversation with, well, a doctor or some other provider and make a decision as to whether the shot at this time is appropriate for you. And when the ACIP voted on it, they sort of emphasized that their recommendation was people 65 and older or with certain health conditions are where they believe the shot is most appropriate, which kind of aligns with how FDA has adjusted their approval for it. The impact of CDC fully signing off on this is now that there were a number of states that it made it very hard for you to get a shot at the pharmacist, or without getting a prescription, without CDC and ACIP acting. 

Also, there’s the Vaccines for Children Program, which provides free vaccines to about half the children in this country, children on Medicaid who are under- and uninsured, and without the CDC signoff, the ACIP recommendations for covid vaccines, that program wasn’t activated. So, a number of children will now have access to shots that couldn’t have. 

Luhby: I was just going to say, one other issue is that insurers have said, because it’s — one thing is getting the vaccine. There’s also a question of whether insurance will pay for it. When I went to get my vaccine last month, initially CVS said, Oh, sure, no problem. And then when I got there, they said, I’m sorry, your insurance won’t pay for it, and they took it off. And then I protested a bit and they said, Oh, well, actually your insurance will pay for it, and it’ll be covered. So I got it. I specifically did this, of course, before the ACIP meeting, but— 

Rovner: Yes, I did that too. 

Luhby: Yes. But insurers have come out and said that they will cover it at least through the end of next year, so people should be able to get insurance coverage for it for now. There’s a question of what will happen going forward, and there also is a bit of a concern that there is a little uncertainty whether some insurers will interpret the shared medical decision-making as not a requirement for a vaccine at no charge under the ACA [Affordable Care Act] regulations. But so far it does seem that people will be able to get it at no cost for now. 

Rovner: I was saying does that shared medical decision-making apply to pharmacists? It’s only in some states, right? 

Karlin-Smith: No, you can do — shared decision-making can occur at a pharmacy and with a pharmacist. You don’t need to go to your medical doctor. And I honestly think, in practice, most providers are not going to make a big deal about it. If you make an appointment, they’re not going to force you into a long conversation. But I think what Tami flagged is important because technically the ACA coverage requirements for zero-cost coverage does apply, but I think with other vaccines in the past there has been confusion or just more people needing to actually fight to ensure they actually get the coverage that is technically in law. 

Rovner: More to come. Well, there’s other news out of HHS. Alice, you were part of an interesting story this week about how RFK Jr.’s following through on his vow to send more people to staff the Indian Health Service is having an impact elsewhere in the department. What has he done, and what impact is it having? 

Ollstein: Yes, Kennedy has touted his commitment to Native American populations and their health and has had a lot of meetings with tribal leaders and really raised hopes. And these Indian Health Service centers have been just really underfunded and understaffed for so long. They desperately need help. But based on our reporting, the help they’re getting is causing harm elsewhere. They’re not hiring more people. They’re just shuffling people around. And they’re shuffling pretty important people out of state and federal agencies and local health departments, where people are depending on them to run very key programs. HHS did not disclose who all these people are or where they’re being sent, but based on our reporting, we uncovered a few examples, including a pretty senior person at SAMHSA [the Substance Abuse and Mental Health Services Administration] and a very important person at the New York City health department. And so, we just kept hearing that what is really needed here is a permanent staffing-up, not a shuffling around. 

There were also some folks we talked to who were wondering if this was yet another tactic to try to get people to quit, to say, Oh, we’re sending you to Arizona or Montana or these sort of remote rural areas for four months, over the holidays, with just a couple weeks’ notice. But according to our reporting, no one has resigned so far. They’re all carrying out this assignment. But yeah, it could really feel the pinch, and they’re really feeling the pinch more than ever because during a government shutdown, these Commissioned Corps officers are some of the only people protected from being furloughed or laid off. And so, while tens of thousands of their colleagues are on furlough, they’re really running the show. So, they really can’t afford to lose a bunch of them at this time. 

Rovner: Yeah, it was a really interesting story. Meanwhile, there’s more reporting about the MAHA movement. The Washington Post has an excellent story about the seemingly successful lobbying effort by the pesticide industry to keep their products out of the line of fire in the recent MAHA report. And I’ve seen a bunch of stories in the past few weeks on the efforts to improve the lot of lab animals or get rid of animal testing in general, replacing it with cell cultures or other modalities. When did lab animal welfare become part of the MAHA movement? I did see that Laura Loomer is part of this, the oft-mentioned right-wing person who whispers in the ear of the president. It seems striking to me that a president who clearly is not an animal lover in the way previous presidents have been — I believe the Trumps have no pets — is suddenly, I am seeing stories out of HHS where they really are doing things to try to minimize the use of lab animals or get rid of them altogether. 

It struck me. Obviously it has its following. It is significant, and it is bipartisan. It’s often been Republicans who’ve led it. I’ve just — this is the first time I’ve seen sort of this much activity actually at HHS in all the years I’ve been covering HHS. I’m wondering, is this sort of another way that [President Donald] Trump is gathering together small groups of people who feel very strongly about something to sort of draw into his base, like he did with MAHA in general? 

Ollstein: Well, I think, like you know, Trump is no animal lover himself, and famously he uses like a dog as one of his favorite insults. So, I don’t think this is necessarily coming from the top, but it’s certainly part of this MAHA coalition he put together. And it predated this administration, because I kept seeing conservative groups in part of their crusade against [Anthony] Fauci bringing up animal testing issues. And so, this isn’t brand-new. It’s sort of been bubbling up. But yeah, I think Sarah knows more than I do about this. 

Karlin-Smith: I was going to say, I think they’ve also been able to tap into scientific literacy — or illiteracy — issues or lack thereof here, because, again, there is this bipartisan element of it. Because who isn’t going to think, like, Aw, who wants to be experimenting — right? — and giving animals terrible diseases or experimental drugs and all this stuff? And FDA and NIH [the National Institutes of Health] and so forth are now under a lot of pressure to switch away from requirements related to animal research and do things in cell-based and model-based. I think the technicalities around that in terms of where the technology actually is, in terms of people talk about organ-on-the chip technology and really being able to test it, is maybe not quite where it needs to be to move away from using some of these animals. 

I don’t think anybody in an ideal world wants to have to use animals for so many experiments. Unfortunately, I think it’s been the best tool, sometimes, we have, that ethicists have had. But I think, again, like I said, it’s hard to kind of explain all that science and technology. And what are the other options if you don’t use animals? And it’s very easy to just get the reaction of, You’re treating animals terribly and cruelly. 

Rovner: Hey, I used to write fundraising appeals over lab animals, so I know how to do this. But yes, it’s kind of sad that I did this in the early 1980s and it’s now 40 years later and we’re still working on developing alternatives to animal models. But I could go on, but I will not. 

But before we leave HHS, I want to call attention to a pretty remarkable op-ed co-authored by six former U.S. surgeons general — three Republicans and three Democrats — who together are saying, quote, “The actions of Health and Human Services Secretary Robert F. Kennedy Jr. are endangering the health of the nation,” actions that they say pose a, quote, “profound, immediate and unprecedented threat.” Over on Earth 2, this would’ve been enormous news, but in the world of Trump 2.0, where just about everything is unprecedented, it hasn’t gotten much more than a nod. Does all this criticism just kind of make Kennedy stronger among the people who support him? 

Ollstein: I think that there is a hardcore group of people who are going to support Kennedy no matter what. They’re the die-hards. But I think just like with Trump, where that’s also the case, there’s a bunch of people who supported them recently who were not hardcore, long-term devotees, and they are more flexible. And so as new information comes in and as they see what they’re doing in power, what they’re not doing, that support can erode. And so you have seen polling showing Kennedy’s popularity slipping, as well as just the Trump administration overall, people having a more negative view. And so it’s interesting to see which issues break through and which don’t. So, whether it’s animal welfare or vaccines or Native American health or, I mean, just pick your issue. 

Abortion — obviously there’s anger coming at Kennedy from both sides of that. It’ll be really fascinating to see which issue, if anything, is the downfall. I mean it’s kind of fascinating because there was a lot of Cabinet turnover in Trump’s first administration, famously with HHS, too, but other agencies as well. And so I know we’re just coming up on three-quarters through Year 1, but it’ll be interesting to see who stays and who gets booted. 

Rovner: Yeah. And whether. I mean I do — it does seem in some cases that the more criticism somebody gets, the more supporters, and also the more President Trump, kind of dig in, so — until they don’t. So, I guess we will — go ahead. 

Karlin-Smith: I was going to say, Kennedy’s core supporters seem like they are not pushing him to moderate at all. They are not. They’re pushing him the other way. They’ve been more frustrated not just in the abortion debate but with vaccines, with food— 

Rovner: Yeah 

Karlin-Smith: —with other things that he’s made some progress, but it’s been a lot smaller than I think they want. He’s still allowing mRNA vaccines on the market. Yes, some people are frustrated that he’s restricting covid vaccines, but for them he’s basically practically left the status quo when he’s promised to get rid of it. So, the momentum from his supporters is actually pushing him farther towards his MAHA agenda than towards what these surgeon generals were arguing for. 

Rovner: Yeah. That’s true. All right, well that is this week’s news, now we’ll play my interview with Sarah Grusin of the National Health Law Program, and then we will come back and do our extra credits. 

I am pleased to welcome to the podcast Sarah Grusin, a senior attorney with the National Health Law Program. Sarah is a civil rights lawyer and an expert in the exact fight that’s going on now in Congress, so I have asked here to help us break it all down. Sarah, welcome. 

Sarah Grusin: Hello. Thanks for having me. 

Rovner: So, we’ve now been subjected to more than a week of finger-pointing, with Republicans insisting that Democrats, in the words of House Speaker Mike Johnson, quote, want to “reinstate free health care for illegal aliens paid by American taxpayers.” Democrats, meanwhile, say that is flatly not true. So let’s start at the beginning. What kind of government-funded health care has been available to legal immigrants and to those who are undocumented, at least until this summer? 

Grusin: Well, for undocumented immigrants, the answer is easy. They are not eligible for any sort of comprehensive federally funded coverage. The answer for lawfully present immigrants is more complicated. So I’ll take that one program by program. So, start first with the Affordable Care Act premium subsidies. Those are only available to lawfully present individuals. They’re not available to undocumented immigrants. And that’s been true since the ACA was first passed, and it hasn’t changed. In fact, undocumented individuals are not even eligible to enroll in marketplace plans, even if they pay full cost. So this whole fight over extending the enhanced ACA subsidies has nothing to do with coverage for undocumented immigrants. But like I said, the Affordable Care Act subsidies are generally available to lawfully present immigrants, with a big asterisk for DACA recipients, or Deferred Action for Childhood Arrivals. They are not in fact eligible for those subsidies. 

Rovner: But they were for a while, right? 

Grusin: They were for a few months this year. So they weren’t for a long time, the Biden administration tried to fix it, then the Trump administration undid that, and so they are now, again, without access to the marketplace subsidies. Medicaid and CHIP [Children’s Health Insurance Program] eligibility is more complicated. The main thing to understand though is that Medicaid and CHIP is available to a smaller group of lawfully present immigrants than the ACA subsidies. So, Medicaid has only been available to a narrow group of what the statute calls qualified immigrants. So these are LPRs [lawfully permanent residents] or people colloquially known as green card holders — Cuban-Haitian entrants, refugees, asylees, and certain other humanitarian statuses, like people with protection under the Convention Against Torture, victims of trafficking, survivors of domestic violence and battery. But just having a qualified immigration status is not enough to necessarily guarantee Medicaid eligibility. Many qualified immigrants, most notably LPRs, are subject to a five-year waiting period, meaning that they have to have that status for five years before they can be eligible. 

So a lot a lot of people who live here lawfully, who live here permanently, who have robust, complete lives here, people on student visas, people here with work visas, asylum applicants, and even LPRs who are being sponsored by a family member, aren’t eligible for Medicaid in a lot of situations. I will say there are some options that states have to expand Medicaid with federal funding for other immigrants beyond these sort of narrow set of qualified statuses, but that’s limited to children and coverage for pregnancy. There are no equivalent options for non-pregnant adults. And then, each state has to elect whether to take up those options. And so there are dozens of states that have taken it up for either children or pregnancy or both, but that leads to a lot of variation across the country in terms of who’s available for those services. But bottom line, lawfully present immigrants are generally eligible for the ACA subsidies, and some but not all lawfully present immigrants are eligible for Medicaid and CHIP. Undocumented individuals are not eligible for either. 

Rovner: But there is this emergency Medicaid, right? 

Grusin: There is this thing called emergency Medicaid. And so, emergency Medicaid, I want to explain what it is. It covers people who would otherwise be eligible for Medicaid if it weren’t for their immigration status. So, they still have to meet the income requirements. They still have to fall, in a non-expansion state, into one of the covered population groups, so child, parent, person with a disability. And then in addition, the coverage is extremely limited, so it is only coverage necessary to treat an emergency medical condition. But if somebody gets into a car accident and goes to the emergency room, emergency Medicaid could cover their hospital bill if they can otherwise establish their Medicaid eligibility. It also does cover labor and delivery services, but just labor and delivery, not prenatal care. So, and that reimbursement that the hospital gets is a combination of state and federal funds. 

Rovner: How did the “big, beautiful” Republican budget Bill change that? It sort of contracted some of it, right? 

Grusin: Well, so it didn’t change the eligibility, who’s eligible for emergency Medicaid, and it didn’t change what services are covered under emergency Medicaid. All it did was reduce — like I said, the reimbursement was federal and state money — all it did was reduce the federal amount of money that’s going to pay for these services. So that means that the states are just going to have to pick up the bill. Really all it’s doing is shifting the cost to the states. And I had one other point about emergency Medicaid, which is, to be clear, it does cover individuals who don’t have status, but it also is the only source of coverage available for all of those lawfully present folks who aren’t eligible for full-scope Medicaid. So I often hear people talking about emergency Medicaid as though it only covers undocumented individuals, and I just want to be clear that that’s not true. 

There are a lot of people who are lawfully present, including LPRs, who haven’t met that five-year waiting period, for whom emergency Medicaid is in fact their only option. So, we talk about emergency Medicaid when we’re talking about people who don’t have status because that’s the only thing available to them, but it’s also the only thing available to a whole group of lawfully present folks, too. 

Rovner: And the budget bill also contracted who’s eligible, of the lawfully present people, who can get some of these programs, right? 

Grusin: Dramatically. It dramatically reduced it. So, following the implementation of those changes in both Medicaid and the Affordable Care Act subsidies, the only groups that will be eligible for coverage are LPRs, still with the same five-year waiting period, migrants under the Compact of Free Association, or COFA migrants, and Cuban and Haitian entrants. So this means that one of the primary effects that this bill has is ending eligibility for people with humanitarian statuses. So refugees, people granted asylum for fear of persecution in their home country, people with protection under the Convention Against Torture, survivors of trafficking, survivors of domestic violence, these are the people who the Republican bills stripped of their health coverage. And really, there are not going to be any other options left for most of those lawfully present immigrants to get meaningful coverage once those changes go into effect, unless they happen to live in a state that is providing exclusively state-funded services, but there’s not that many of those. 

Rovner: What’s the practical impact of this going to be? 

Grusin: I mean we all know what the consequence of taking away people’s health care coverage is. It’s more suffering. It means people will have no viable option to receive necessary care. It means more deaths. It means more disease. It means more enduring pain due to chronic conditions. There are refugees, other folks who are currently living in nursing homes, they’re going to be evicted. There are people who won’t be able to afford their insulin. There are people who are going to have to skip prenatal appointments. The other thing is we know that the effects and the loss of coverage will extend well beyond the people who are explicitly losing coverage. After PRWORA [the Personal Responsibility and Work Opportunity Reconciliation Act] was passed, there were a lot of families, whether due to confusion or fear or both, chose not to enroll household members who were still eligible, including citizen children in mixed-status households. 

And we live in a country where 1 in 4 kids lives with an immigrant parent, and so we know that this effect is going to be enormous. And then, of course, there’s also the economic effects as well, right? Increased costs for states. Increased costs for hospitals due to uncompensated care. More people having to leave the workforce due to untreated medical conditions. I mean, the tolls are going to be enormous. 

Rovner: And just to back up a little bit, PRWORA being the 1996 welfare bill, where they last had a huge fight about coverage for immigrants in general. And I covered that one, too, because I’m old. 

Grusin: That’s great. Yeah. PRWORA, the worst acronym that anyone’s ever come up with. 

Rovner: Bottom line, it’s not really fair to say that if the Republicans were to reverse the Medicaid cuts, which of course is what the Democrats are asking for, it would not, quote-unquote, “reinstate” coverage for illegal immigrants. You’re shaking your head. 

Grusin: No. No. They didn’t have it before. They don’t. They wouldn’t have it after. What it would do is reinstate coverage for humanitarian lawfully present immigrants. 

Rovner: Excellent. I hope that as this goes on, we can come back and ask you to revisit it. Sarah Grusin, thank you very much. 

Grusin: Thank you. 

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

Ollstein: Yeah, I have a piece by friend of the pod Shefali Luthra of The 19th. [“Ice Fears Put Pregnant Immigrants and Their Babies at Risk,” by Mel Leonor Barclay and Luthra.] It is a fascinating and sad story about how the current ramped-up immigration enforcement is making a lot of immigrant women who are pregnant afraid of going to seek prenatal care, and that’s already having repercussions. It’s so important to have prenatal visits. That’s where you diagnose things early, whether it’s a syphilis infection that you can catch in time, or it could be hypertension or high blood pressure or low blood pressure or something. And when you don’t catch those things early, they can become really dangerous later on, both for mothers and babies. And so she talked to people around the country who are already seeing the repercussions of this, and people are just afraid to drive to these appointments. And so it’s a downstream effect that’s important to keep in mind. 

Rovner: And of course, that was why in previous administrations immigration officers were not allowed at health care facilities, so as to not deter people from getting health care. Sarah, why don’t you go next? 

Karlin-Smith: I took a look at a New York Times piece: “It’s Just a Virus, the E.R. Told Him. Days Later, He Was Dead” [by Lisa Miller]. And it’s a really tragic story about a young college student who went to the ER twice with an illness and was both times sent home sort of just to recover at home, and he did die. And what I find really interesting is the piece highlights the broader public health policy questions about how our overstrapped emergency rooms are equipped to handle the wide range of patients that come into them, given how much the system is put on them, and how do we set up a system, given the complexity of the people they see and the amount of space and time they have to see them, that can really dig into these unique situations. 

Because it seems like there were some maybe unique flags about this particular person’s blood work and so forth that were missed potentially, but it’s not like a clear-cut case, it seems like from reading it, these doctors really missed something clear and obvious and did harm, but points out a bunch of broader systematic things that set everybody up to potentially fail here. 

Rovner: Yeah, I was interested in the interactions with the electronic medical record that’s supposed to help them catch these things. But because it ends up giving doctors so many alarms that aren’t really accurate, that when it does give one that’s accurate, that gets ignored, which seems to be one of the many things that happened kind of tragically in this case. Tami. 

Luhby: Well, my story is by Meryl Kornfield and Lisa Rein of The Washington Post, titled “Trump Plan Would Limit Disability Benefits for Older Americans.” It’s a scoop for The Post, which has done fantastic reporting over the years on Social Security disability, and they found out that the Trump administration is preparing a plan that would make it harder for older Americans to qualify for Social Security disability payments and could result in hundreds of thousands of people losing their benefits. The story explains that the Social Security Administration considers age, work experience, and education when evaluating disability claims. Older applicants, those typically over 50, have a better chance of qualifying, because aid is treated as a limitation in being able to adapt to a new job that one with disabilities might be able to do. 

But the administration is considering eliminating age as a factor or raising the threshold to 60. So it’s already pretty well known that disability benefits are very tough to qualify for. The process can take years. And this change would make it even harder for folks to get the disability benefits. So it’s something I’m sure The Washington Post will continue following closely, and as will I and many others who are interested in this issue. 

Rovner: So, my extra credit this week is kind of the flip side of Tami’s. It’s also from The Washington Post, and it’s called “How Some Veterans Exploit $193 Billion VA Program, Due to Lax Controls,” by Craig Whitlock, Lisa Rein, and Caitlin Gilbert. It’s a reminder that every government program, no matter how well meaning, is subject to fraud, and it’s kind of our job as journalists to point that out when we find it, so it can be fixed. You really should read the whole thing, but here’s the nut graph: “About 556,000 veterans receive disability benefits for eczema, 332,000 for hemorrhoids, 110,000 for benign skin growths, 81,000 for acne and 74,000 for varicose veins, the most recently available figures from VA [Department of Veterans Affairs] show. Individual payouts for such mundane conditions vary, but collectively they cost billions of dollars a year.” The VA has already called this an attack on veterans programs, but it’s really an effort to point out how these programs could be saved for the people for whom they’re actually intended. So, good journalism from The Washington Post on sort of both sides of this issue. 

OK, that is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you could subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. 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, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Alice. 

Ollstein: Mostly on Bluesky, @alicemiranda. Still on X, @AliceOllstein. 

Rovner: Sarah? 

Karlin-Smith: Also mostly on Bluesky and LinkedIn, @sarahkarlin-smith. 

Rovner: Tami. 

Luhby: I’m at cnn.com. 

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

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Just days after his firing of the brand-new director of the Centers for Disease Control and Prevention, a defiant Robert F. Kennedy Jr., the U.S. secretary of health and human services, defended that action and others before a sometimes skeptical Senate Finance Committee. Criticism of Kennedy’s increasingly anti-vaccine actions came not just from Democrats on the panel but from some Republicans who are also medical doctors.

Meanwhile, members of Congress have only a few weeks left to complete work on spending bills or risk a government shutdown, and time is also running out to head off the large increases in premiums for Affordable Care Act health plans likely to occur with additional Biden-era government subsidies set to expire.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of Pink Sheet, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• The FDA approved this year’s covid booster for people older than 65 and for younger people with serious illnesses. Previously, it had been recommended more broadly. All eyes will now turn to the CDC’s Advisory Committee on Immunization Practices, which is scheduled to meet Sept. 18. Usually this panel would endorse these recommendations and perhaps offer more guidance on the booster’s use for specific populations. But it is not clear whether it will do so — or whether it might even impose more limitations.
• Kennedy’s firing of CDC Director Susan Monarez and the subsequent resignation of multiple senior scientists is raising questions about the agency’s future. Many staffers who were already on the fence about staying now are increasingly likely to leave. Many of these career scientists associate Kennedy’s history of harsh criticisms of public health workers with the recent CDC shooting in Atlanta. But since the shooting, Kennedy seems to have doubled down on his position.
• At the hearing before the Senate Finance Committee, even those Republicans who were critical of Kennedy were careful not to criticize President Donald Trump. There’s some speculation that this duality is meant to drive a wedge between Kennedy and the White House, and to communicate that the HHS secretary could be politically damaging.
• With vaccine policy in flux, red and blue states alike seem to be doing their own thing. Some, like California, Oregon, and Washington — which formed what they’re calling the West Coast Health Alliance — appear to be taking steps to protect access to vaccines. Red states could move in the other direction. For instance, this week, Florida Surgeon General Joseph Ladapo announced an effort to undo all statewide vaccine mandates, including those that require certain vaccines for children to attend school. If more states follow suit, it could lead to a geographic patchwork in which vaccine availability and requirements vary widely.
• This month is lawmakers’ last chance to reup the federal ACA tax subsidies. If Congress doesn’t act to extend them, an estimated 24 million people — many of whom live in GOP-controlled states like Georgia and Florida — will see significant increases in their health insurance premium costs. There’s some talk that Congress could opt for a short-term or limited extension that would postpone the pocketbook impact until after the midterm elections. But insurers are already factoring in the uncertainty as they set rates for the upcoming plan year.
• The Centers for Medicare & Medicaid Services announced a Medicare pilot program beginning next year that will use artificial intelligence to grant prior authorization decisions for certain procedures. There is irony here. United Healthcare and other private plans have already gotten into a lot of trouble for doing this, with AI systems often denying needed care.

Also this week, Rovner interviews KFF Health News’s Tony Leys, who discusses his “Bill of the Month” report about a woman’s unfortunate interaction with a bat — and her even more unfortunate interaction with the bill for her rabies prevention treatment.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: ProPublica’s “Gutted: How Deeply Trump Has Cut Federal Health Agencies,” by Brandon Roberts, Annie Waldman, and Pratheek Rebala.

Jessie Hellmann: KFF Health News’ “When Hospitals and Insurers Fight, Patients Get Caught in the Middle,” by Bram Sable-Smith.

Sarah Karlin-Smith: NPR’s “Leniency on Lice in Schools Meets Reality,” by Blake Farmer.

Alice Miranda Ollstein: Vox’s “Exclusive: RFK Jr. and the White House Buried a Major Study on Alcohol and Cancer. Here’s What It Shows,” by Dylan Scott.

Also mentioned in this week’s podcast:

• The Washington Post’s “Florida Moves To End All School Vaccine Mandates, First in Nation To Do So,” by David Ovalle and Lori Rozsa.
• The 19th’s “Texas Passes Bill Banning Abortion Pills From Being Mailed to the State,” by Shefali Luthra.
• The New York Times’ “Medicare Will Require Prior Approval for Certain Procedures,” by Reed Abelson and Teddy Rosenbluth.

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

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Friday, Sept. 5, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sarah Karlin-Smith of the Pink Sheet. 

Sarah Karlin-Smith: Hi, everybody. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: And Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Hi there. 

Rovner: Later in this episode, we’ll have my interview with my KFF Health News colleague Tony Leys, who reported and wrote the August “Bill of the Month” about a patient’s unfortunate run-in with a bat and an even more unfortunate run-in with the bill for rabies prophylaxis. But first, this week’s news.  

Well, it is safe to say that there has been quite a bit of health news since we last met in mid-August. Health and Human Services Secretary Robert F. Kennedy Jr. testified before the Senate Finance Committee yesterday, which we will talk about in a moment. But first, I want to catch us up on what you might’ve missed. Our story starts, kind of, with the FDA’s [Food and Drug Administration’s] approval of this year’s covid boosters, which are only being licensed for those over age 65 and those who are younger but have at least one condition that puts them at high risk of serious illness if they contract the virus. That leaves out lots of people that many doctors think ought to be boosted, like pregnant women and children. Sarah, what’s supposed to happen after the FDA acts? The next step happens at CDC [the Centers for Disease Control and Prevention], right? 

Karlin-Smith: Correct. So right now the CDC’s Advisory Committee on Immunization Practices is scheduled to meet Sept. 17 to 18, 18 to 19, but about two weeks from now. And they would typically vote on sort of endorsing use of these vaccines and, again, have like sort of a second chance to weigh in on which populations they would be used for. And that’s often important for triggering insurance coverage without copays. And also many states rely on the CDC recommendations for various state laws that say, again, who can get the vaccine or whether you can get it via a pharmacist or only at a doctor’s office, do you need a prescription, and things like that. So the CDC and FDA, I would say, in general is a little bit behind this year. I could think a lot of people have been trying to go out and get these new shots even though those steps haven’t happened yet. 

Rovner: That’s right. I mean, it is early. Even if there was nothing else going on, there is that little bit of a lag between when FDA acts and when the CDC acts, right? 

Karlin-Smith: Yeah, there usually is. I think in the past they’ve tried to have both FDA approval and the CDC act so that the vaccines could start rolling out more like late summer, early September. So they’re definitely behind, and there’s been a number of reports of covid kind of slowly rising as the summer winds down and school gets back in session. 

Rovner: Yeah, so there’s a lot of other things going on. Well, in the meantime, nothing that was supposed to happen has happened yet, and we still don’t know all the details, but it certainly appears that Susan Monarez, who was just confirmed by the Senate to lead the CDC a month ago, was fired after she refused to override her scientific advisers and approve the new restrictions on covid vaccine availability, even before the ACIP met. In turn, four top CDC leaders resigned as well, going public to warn that the agency is being politicized by the secretary. How much of a mess is the CDC in right now? And how long is it going to take to put the pieces back together? 

Karlin-Smith: I think they’re in a pretty bad place, because not only did they lose their director really quickly, but after she resigned, about I think it was eight or nine senior CDC leaders resigned last week as well. And so, really critical people to various parts of the operation that you don’t just replace very easily. And Kennedy has slotted in Jim O’Neill as the temporary director of the CDC and kind of indicated he wants to remake the agency. And I think there are questions as to how that remaking shapes both its priorities and how it handles public health throughout the U.S. 

Rovner: And of course, morale at CDC is awesome, in part because, as we discussed the last time we met, a gunman came and shot up the place, killing a policeman and leaving the staff pretty upset. And that gunman, who then took his own life, was later found to have had some discontent with vaccines. So things are just really bright and cheery there in Atlanta at the CDC. Alice, I see you nodding. 

Ollstein: These things kind of snowball, you know? I think there are likely to be a lot of staff who were already on the fence about staying and decided to stay because they trusted these pretty senior leaders with a lot of decades of expertise and institutional knowledge. And that was sort of the thread they were hanging on as well, at least: I’m with these people. And now that they’ve left, I think that could trigger a bigger exodus on top of the exodus that was already underway. 

Rovner: And it’s important to say — even though we say it, I think, every time — that these are career scientists who’ve worked for Democrats and Republicans over the years. These are not generally political people. They’re not political appointees. And they basically do their jobs. And until fairly recently, public health wasn’t this partisan, so it wasn’t that hard to be a career public health official just working for public health. That’s just not the case anymore, is it? 

Karlin-Smith: I think there’s been a lot of insult to injury added with what happened with the shooting at the CDC, because there is a sense that the kind of rhetoric that Kennedy in particular has used over the years, even before he came into HHS [the Department of Health and Human Services], on sort of his movement has sort of amplified the criticism of public health workers and put them in this situation where they’re dangerous. And Kennedy, instead of really acknowledging that and maybe apologizing or giving any sense that he was going to shift in a different direction, has actually really kind of doubled down on it. And even in some of the pieces he’s written recently about how he wants to reform the CDC, he kind of keeps criticizing the rank-and-file employees and so forth. So there’s a lot of tension between the political leadership and the career staff, I think, at this moment. 

Ollstein: And in normal times, most of the American public would not even know the names of these people. They’re not public figures. They’re just very behind-the-scenes scientists doing their work. And now their personal photos are being combed through and shared to attack them because they’ve criticized the administration. They’re getting threats. It’s just this whole level, like you said, of politicization that we haven’t seen before. 

Rovner: Well, so, in kind of a coincidence, Kennedy had already agreed to appear on Thursday before the Senate Finance Committee, which by the way doesn’t have jurisdiction over the CDC or the rest of the public health service. But no matter — a Senate hearing is a Senate hearing. And let’s just say it didn’t go that well for the secretary. Democrats were kind of withering in their criticism of Kennedy’s eight-month tenure so far. Here’s Colorado Sen. Michael Bennet. 

Sen. Michael Bennet: This is the last thing, by the way, our parents need when their kids are going back to school, is to have the kind of confusion and expense and scarcity that you’re creating as a result of your ideology. 

Rovner: Republicans weren’t that impressed, either, particularly the Republicans on the committee who are also doctors. [Sen.] Bill Cassidy, a doctor who’s on Finance but is also the chairman of the Health, Education, Labor, and Pensions Committee and is facing a primary challenge in Louisiana, seemed to tread pretty carefully. More surprising, at least to me, was Dr. Sen. John Barrasso of Wyoming, who’s also in the Senate leadership. 

Sen. John Barrasso: So over the last 50 years, vaccines are estimated to have saved 154 million lives worldwide. I support vaccines. I’m a doctor. Vaccines work. 

Rovner: I was super impressed that even the Republicans who criticized RFK were careful not to criticize President [Donald] Trump. In fact, there were several suggestions — this was clearly a talking point — that Trump should be given a Nobel Prize for his work overseeing Operation Warp Speed, just so the senators could kind of bifurcate their complaints. What impact, if any, is this hearing going to have on RFK’s future as secretary? 

Ollstein: Well, I think there was an attempt to, I think, what you just mentioned. That like dual criticism with praise of Trump was meant to drive a wedge and to get Trump to question RFK’s leadership. That does not seem to have worked so far. We don’t know what’s going to happen in the future, but I think it’s an attempt to get the message to Trump that RFK’s reputation and actions could be damaging to the administration overall. And there was some reporting that polling showing that most people do support vaccines was circulated amongst Republican members before the hearing. And so, I think it’s trying to, yeah, get the message that this is both damaging in a public health sense but also potentially damaging in a political sense as well. 

But so far, the reporting is that Trump is standing by RFK, that he liked how combative he was. And so I don’t know where those attempts to drive a wedge will go in the future, but like you said, it was notable that if folks like Barrasso, [Sen. Thom] Tillis, who’s not running for reelection, was also more vocally critical, and a couple others, not a lot. We’re not seeing a great dam breaking yet. But I think there’s more cracks than there used to be on the GOP side. 

Rovner: I did notice that Trump, he had a very strange Truth Social post earlier in the week that basically said that CDC is a mess and it has to be fixed. Kind of just Trump being the omniscient observer. And then, apparently at a dinner with tech titans after the hearing, he said that he had not watched the hearing but that he heard that Kennedy did well, which is not exactly what I would call a ringing endorsement. I feel like Trump is giving himself some runway to go either way depending on sort of how things continue to shake out. I see nodding. 

Karlin-Smith: Yeah. I saw a lot of people reposting that clip on social media last night who are frustrated with Kennedy and using it to try and ramp up their banks and say: Keep calling. Keep pressuring. This shows we have an opening. I think it’s really always hard to read the tea leaves with Trump and his language and words. He’s a harder person to interpret. But I also thought it was really interesting that in some ways Cassidy and some of the other Republicans were throwing RFK a bone and saying: This is your president. This was his greatest achievement. Can you support it? 

And RFK couldn’t even really twist himself into doing that. He sort of tried to, but he could never square it with the bulk of his remarks at the hearing, which were incredibly critical. MRNA vaccines and vaccines in general — he defended the massive cuts in this area for research. He defended people who have really said very untrue things about the harm caused by these vaccines. So in some ways I felt like Cassidy was trying to give him one more chance or something, and RFK couldn’t even take it when it was couched as this Trump achievement. 

Rovner: I can’t help but wonder if this is playing to Trump’s advantage because it’s distracting from Trump’s other problems, that perhaps Trump likes that there’s so much attention on this because it takes attention away from other things. 

Ollstein: Yeah. Although I do find the eagerness of Democratic members of Congress and other folks to wave away certain things as a distraction as a little bit questionable. This is all part of the agenda of the administration, and dismantling government bureaucracy is clearly a core, core part of the administration’s agenda, and so— 

Rovner: And flooding the zone. 

Ollstein: Exactly. Well, it might also serve as a distraction. I think that it should be considered a serious part of what they actually want to do as well. 

Rovner: So there were a couple of things that we learned about RFK Jr. from his confirmation hearings back in the winter. One is that he’s not at all deferential to elected officials, even calling them liars, which is pretty unheard of. And that he doesn’t really know how his department works. And it appears that eight months later, neither of those things have changed. How does he get away with being so rude? I mean, I’ve just never seen a Cabinet official who’s been so undeferential to the people who basically put him in office. Is it just me? 

Karlin-Smith: I think it’s part of the times where politics is really trumping behavior or policy, right? Even though there were a few Republicans that we’ve talked about who have kind of started to get frustrated with RFK and his vaccine policies. You saw at the beginning of the hearing, Chairman [Mike] Crapo was asked by the ranking Democrat, Sen. [Ron] Wyden, to basically swear Kennedy in because Wyden has felt like Kennedy has lied to the committee before. And Crapo just basically brushed that away and dismissed it. And I think, so, in many ways a lot of the Republicans on the committee endorsed Kennedy’s behavior kind of, maybe not overtly but indirectly, and that’s sort of been how they’ve been operating. It’s more of a political theater thing, and they’re OK with sort of this disrespect, of its sort of political fight that somebody on their side is taking up. 

Ollstein: I also think Congress’ unwillingness so far to actually sanction or take action in any way about anything RFK has done seems to have emboldened him. I think the fact that he has broken all these promises he made to Cassidy and other senators and there have been basically no consequences for him so far feeds into that. He kind of has a What are you going to do? attitude that was very evident in the hearing. 

Rovner: Yeah, I think that’s fair. Well, there were, as always, parochial question from senators about home state issues, but one topic I don’t think I expected to see come up as many times as it did was the future of the abortion pill, mifepristone, which is about to celebrate the 25th anniversary of its original approval by the FDA. Alice, what are you hearing about whether FDA is going to rein the drug back in, which is what a lot of these anti-abortion Republicans really want to see happen? 

Ollstein: Yeah, so I think there was nothing new in the hearing this week. What he said was what he’s been saying, that they’re looking into it, that they’re evaluating. He made no specific commitments. He gave no specific timelines. He said basically enough to keep the anti-abortion people thinking that they’re cooking up some restrictions but not explicitly promising that, either. And so I think we’re just where we were before. They continue to reference data put forward by an anti-abortion think tank that was not peer-reviewed and claiming that it is this solid scientific evidence, which it is not, about the risks posed by the pills, which many actual, credible, peer-reviewed studies have found to be very safe. And so we just don’t know what’s going to happen. I think any nationwide restrictions, which is what they’re mulling at the federal level, which would impact states where abortion is legally protected, that would be a potentially politically damaging move. And so it’s understandable why they might not want to pull that trigger right now. So, right. 

Rovner: And Trump has said, I mean, Trump has indicated that he does not really want to wade into this. 

Ollstein: Correct. But again, he’s also very good about not making hard promises in either direction and sort of keeping his options open, which is what they’re doing. The anti-abortion activists, this is not their only iron in the fire. This is just one of many strategies they have going on. They also have multiple pending lawsuits and court cases that are attempting to accomplish the same thing. They’re pursuing new policies at the state level, which we’ll probably talk about, Texas and others. 

Rovner: Next. 

Ollstein: And so yes, this pressure on FDA and HHS to use regulation to restrict the pills is only one of many ongoing efforts. 

Rovner: Well, you have anticipated my next question, which is that while we are on the subject of the abortion pill, Texas, because it is always Texas, has a new bill on its way to the governor for a signature to try to outlaw telemedicine prescribing of the abortion pill. What exactly would this Texas law do? And would it work? Because, obviously, this has been the biggest loophole about stopping abortion in these states that have banned abortion, is that people are still able to get these pills from other states via telemedicine. 

Ollstein: Yeah. So in one sense, nothing’s changed. Abortion was already illegal in Texas, whether you use a pill or have a procedure. And so this is just layered on top of that. The groups who backed this explicitly said the attempt is to have a chilling effect. What they’re hoping is that no lawsuits are even needed, because this just scares people away from ordering pills and scares groups in other states away from sending pills. One concern that I saw raised is that the law criminalizes simply the shipping of the pills. Somebody doesn’t even have to take them for a crime to have been committed. 

And so that’s raising concerns that anti-abortion activists will do kind of sting operations, sort of entrapment-y things where they order the pills solely in the interest of bringing a lawsuit. Because there is a cash bounty that you can get for filing a lawsuit — there’s an incentive. So that’s a concern. And then just the general concern of a chilling effect and people who are using less safe means than these pills to terminate their pregnancies out of fear, which studies have shown is already on the rise, people injuring themselves taking herbs and other substances, chemicals. So that’s a concern as well. 

Rovner: We’ll continue to watch this, but back to vaccine policy. With the status of federal vaccine recommendations in limbo, states appear to be going their own way. Blue states California, Washington, and Oregon are banding together in a consortium to make official recommendations in the absence of federal policy, and several blue-state governors are acting unilaterally to make sure covid vaccines, at least, remain available to most people. At the same time, some red states are going the other way, with Florida Surgeon General Joseph Ladapo, who we have talked about before, now vowing to get rid of all vaccine requirements for schoolchildren. Sarah, that would be a really big deal, right? 

Karlin-Smith: Right. I think the big fear then is that the school requirements is kind of what gets us to close to, in many cases, universal vaccine uptake in the country, because everybody needs their kids to be in school. Unless you’re homeschooled, you really must follow these vaccine requirements. And it not only hurts the kids who don’t end up getting vaccinated individually, but it can really hurt the idea of herd immunity and the protection we need for these diseases to disappear in the community. So there’s— 

Rovner: And protection for people who can’t be immunized for some reason. 

Karlin-Smith: Right. Who either can’t be immunized or don’t have an adequate response to the immunization because they’re going through cancer treatment or they have some other medical reason that their body is immunocompromised. 

Rovner: So, I mean, is this going to end up like abortion, where it’s availability absolutely depends on where you live? 

Karlin-Smith: I think that’s hard to say. I think that a policy like what Florida is trying to implement could very quickly and easily go wrong, I think, and be reversed, as we’ve seen, like what’s happening in Texas now, with measles outbreaks. You know you only need just very small fractions of decreases in vaccination to create huge public health crises in places. And so I think it would be more sort of visible, in a way, to some of these states and their populations, the potential harm that could be caused, than maybe it is to them the abortion harm. But we definitely are seeing some sense of, right, the Democratic-controlled states trying to implement policies that help people get better access to vaccines, even when the federal government is trying to maybe harm that, and red states not caring as much. 

So there is going to be some more of a patchwork. And I feel like, in talking to just sort of people outside of the health policy space, there is a lot of confusion about: Where can I get my covid vaccine? Am I going to have to pay? Do I qualify? Especially being in D.C., which has less generous, I guess, pharmacy laws, because of this. So people are confused. If I go to Maryland, which is really close, does that matter even though I live in D.C.? And it’s just all these things we kind of know end up leading to less people getting vaccinated. Because even if they want to do it, the hurdles end up driving people away. 

Rovner: Yeah, I think something you’d said earlier about the fact that we’re seeing kind of a covid spike, so people are anxious to get covid vaccines, I think, a little bit earlier than normal. It’s usually kind of a fall thing and it’s only the beginning of September, but I think there’s just this combination, this confluence of events that has a lot of people very excited about this right now. 

Karlin-Smith: Yeah, I think it does. And covid has been, I think there’s been lots of hope in the public health world that covid would become a little bit like the flu, where we could predict a little bit more when it would really peak and get everybody vaccinated around the same time as they’re getting flu vaccines. Just again, because we know when we make it easier on people to get vaccinated, if you could just one-and-done it, it would be good. Unfortunately, covid has tended to also still have summer peaks, and this year again it’s kind of a late summer peak. And a lot of people, including seniors, are still recommended really actually to get two vaccines a year. So many people are kind of coming due for that second update right now. 

Rovner: Well, we’ll keep watching that space. Moving on, as we kind of pointed out already, Congress is back in town, with just a couple weeks to go before the start of fiscal 2026 on Oct. 1. This was the year Congress was really, truly going to get all of its spending bills passed in time for the start of the new year. How’s that going, Jessie? 

Hellmann: It’s going great. I’m just kidding. There’s a lot of friction on the Hill right now. The White House budget chief is talking about doing more clawbacks of foreign aid, which is frustrating both Democrats and Republicans. It’s about $5 billion, and we’re seeing Democrats kind of start to put their neck out there a little more than they did earlier in the year when they were also kind of making noise about government funding. And they’re now saying that Republicans are going to have to go this alone and they’re not going to support partisan spending bills. So it’s kind of difficult to see where we go from here. And then— 

Rovner: Are we looking at a shutdown on Oct. 1? I mean, that’s what happens if the spending bills aren’t done. 

Hellmann: It’s hard to say. There might be a short-term spending bill, but anything longer-term than that, it seems really difficult at this point. And there are just massive differences between the health bills that the House came out with and the Senate came out with. I mean, there’s differences in all the other appropriations bills, too, but I was just going to focus on health. 

Rovner: Yes, please. 

Hellmann: The Senate bill would allow an increase for HHS, and the House bill would cut it pretty significantly. So it’s kind of hard to see how they could do anything more substantive when there’s so much light between the two. 

Rovner: Yeah. I mean, on the one hand, we have both the Senate and the House subcommittee that’s marked up the Labor HHS [Labor, Health and Human Services, Education, and Related Agencies] appropriation on record as not supporting at least the very deep cuts to the National Institutes of Health that were proposed by President Trump. But on the other hand, as you mentioned, we still have the administration, primarily budget office chief Russell Vought, making the case that the administration doesn’t have to spend money that Congress appropriates. And from all we can tell, at least as of now, there’s a lot of money that won’t be spent as of the end of the fiscal year, despite the fact that that is illegal. It’s known as a pocket rescission, a term I think we’re about to hear a lot more about. Alice, you referred to this earlier: Is Congress just going to quietly ignore the fact that the administration is usurping their power? 

Ollstein: I think that in many areas of politics, there is a faction that wants to play hardball and really use whatever leverage is possible and there’s a faction that wants to play nice and try to get what they can get by negotiation. And I think both parties always fear being blamed for shutdowns, and so that drives a lot of it. But I think there’s mounting frustration with Democratic leadership about not playing hardball enough. I mean, the jokes I hear are Democrats like to bring a spreadsheet to a gunfight, just seen as being unwilling, in the face of what many see as lawlessness, being unwilling to really put a check on that using the levers they have, including this federal spending. But I think we’ve seen that there are risks no matter what they do, and so I think people make reasonable points about the pros and cons of various strategies. 

Rovner: Well, we know that [Sen.] Susan Collins, who’s now the chair of the Senate Appropriations Committee, is very, very concerned — because Susan Collins is always very, very concerned. But she’s the one whose power is basically being thwarted at this point. People have gotten a lot of gray hair waiting for Susan Collins to stand up and be combative, but one would think if there was ever a time for her to do it, this would be it. Jessie, are we seeing, I was going to say, any indication that the appropriators are going to say, Hey, this is our job and our constitutional responsibility, and you’re supposed to do what we say when it comes to money? 

Hellmann: They are saying these things. I feel like we are seeing more Senate Republicans, at least, express discomfort with what the Trump administration is doing, saying things like: This is Congress’ job. We have the power of the purse. And then they are passing some of these spending bills through committee. But what else are they supposed to do? Unless Susan Collins wants to get on Fox News and start screaming about government funding, which I don’t really see happening and I don’t know if it would be effective, you kind of just wonder: What other options do they have at this point? 

Rovner: Yeah. Well, we’ll sort of see how this plays out over the next few weeks. Meanwhile, it’s not just the spending bills that Congress is facing deadlines for. This month is basically the last chance to re-up those, quote, “expanded subsidies” for Affordable Care Act plans before the sticker shock hits 24 million people in the face. Not only are premiums going up by an average of 18% from this year to next — that’s for a lot of reasons: increasing costs of health care, tariffs, drug prices — but eliminating those additional subsidies, or actually letting them expire, will cause some people to have to pay double or triple what they pay now. And it’s going to hit folks in red states like Georgia and Florida and Texas even harder because more folks there are on the Affordable Care Act plans, because those states didn’t expand Medicaid. Do Republicans not understand what’s about to happen to them? 

Hellmann: I think they understand, but they keep acting like there’s no urgency to the situation. They keep saying: We still have time. We have till the end of the year. Which I guess is technically true, but we’re already seeing insurers proposing these giant rate hikes. And it’s not easy to just go back and make changes to some of this. I guess the idea is— 

Rovner: So they really don’t have until the end of the year, though. Because people are going to get, they’re going to see the next year’s premiums that they have to start signing up in November. So, I mean, they basically have this month. 

Ollstein: If there’s uncertainty, they’re going to price very conservatively, aka high. They don’t want to be left holding the bag. And so, yeah, you and Jessie are exactly right that there isn’t time. These decisions are being made now. Even if they pass something to kick the can until after the midterms, I think some damage will already have been done. 

Rovner: Yeah. Jessie, I cut you off, though. I mean, the idea is that sort of their one chance to maybe do this before people actually start to get these bills, or at least see what they’re going to have to pay, would be wrapped into this end-of-fiscal-year continuing resolution. And maybe they can kick the appropriations down the road until November or December, but they can’t really kick the question of the subsidies down the road until November or December. 

Hellmann: Yeah. I think something would have to happen really quickly. We’re seeing some politically vulnerable Republicans, in the House, specifically, say that they want at least a year-long extension. It’s just a really difficult issue. We know, obviously, the Freedom Caucus is already making threats about it. They hate the ACA, maybe more than anything. It’s going to be really interesting how this turns out. I’ve also heard that maybe there might be a paired-back version of an extension that they could do, maybe messing with some of the income parameters. But I don’t know if that kind of compromise would be enough unless Republicans work with Democrats, which as we already said is complicated for other reasons. So it’s just a mess right now. 

Rovner: I love September on Capitol Hill. All right, finally this week Medicare has announced it will launch a pilot program next January to test the use of artificial intelligence to perform prior authorization for Medicare fee-for-service patients in six states. The program is aimed at just a handful of services right now that are considered to be often wasteful and of dubious value to patients. So, honestly, what could possibly go wrong here? This is a serious question. I mean, isn’t using AI to do prior authorization what got a lot of these private health plans in trouble over the last year? 

Karlin-Smith: Yeah, they did. UnitedHealthcare I think is sort of infamous for that. There was a lot of irony when they first announced this concept of doing a little more prior auth, essentially, in Medicare. It came right after they made another announcement where they were trying to say, We’re actually going to crack down on prior authorization for a health plan. So there’s a bit of, and I think they were trying to not have the, in this second announcement, not have the words “prior auth,” so that they kind of could get wins on both levels. Because I think they know that prior authorization is generally not popular with health consumers. People see it as kind of a barrier to care that their doctor has said they need and is largely stopped because of cost reasons. And then I think once you add in this idea that artificial intelligence is doing it, not a human being, I think people have less trust that it’s being done in the proper way and really that they’re stopping inappropriate care. 

Rovner: Well, to paraphrase RFK Jr. at the Senate Finance hearing, who said many times, both things can be true, even if they are contradictory. All right, that is this week’s news, or at least as much as we have time for. Now we’ll play my “Bill of the Month” interview with Tony Leys, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast KFF Health News’ Tony Leys, who reported and wrote the latest KFF Health News “Bill of the Month.” Tony, welcome back. 

Tony Leys: Glad to be here. Thanks, Julie. 

Rovner: So this month’s patient got a literal mouthful when she went to photograph the night sky in Arizona. Who is she and what happened? 

Leys: While Erica Kahn was taking photos at Glen Canyon last summer, a bat flew up, landed on her, and jammed itself between her camera and her face. Kahn screamed, as anyone would, and the bat went into her mouth. It only was in there for a few seconds, and she didn’t feel a bite. But she feared it could have infected her with a rabies virus, which bats frequently carry. 

Rovner: Yeah, not a great thing. So as with any run-in with a bat, Erica wisely reported to the nearest emergency room for preventive rabies treatment, which we know from previous “Bills of the Month” can total many thousands of dollars. How much did her treatment cost? 

Leys: Nearly $21,000, mostly for a series of vaccinations and other treatments, over the course of two weeks, aimed at preventing the deadly virus from gaining a foothold. 

Rovner: Yikes. 

Leys: Yikes, indeed. 

Rovner: Now, the problem here wasn’t so much that she was charged as what her insurance status was. What was her health insurance status? 

Leys: Well, Kahn had been laid off from her job as a biomedical engineer in Massachusetts, and she had turned down the COBRA [Consolidated Omnibus Budget Reconciliation Act] plan, which would’ve allowed her to stay on her employer’s insurance plan. The plan would’ve cost her about $650 a month, which seemed too much for her. And she was a young, healthy adult who was confident that she would quickly find a new job with health insurance. She also thought that if she became ill in the meantime, she could buy a private plan that would cover preexisting health conditions. 

Rovner: Yeah. That was the big problem, right? 

Leys: Right. 

Rovner: So what did she do? And then what happened? 

Leys: So before she went to the hospital for rabies prevention treatment, she signed up for a policy she found online. The policy, which she thought was full-fledged health insurance, apparently wasn’t. But she says the company selling it told her it would cover treatment of a life-threatening emergency, which this sure seemed to be. But the company later declined to cover any of the bills, citing a 30-day waiting period for coverage. 

Rovner: Yeah. Now, I mean, you can’t generally buy any kind of insurance after an insurable event happens. You can’t buy fire insurance the day after a fire or car insurance the day after an accident. Health insurance is no different. Although in her case, she could have actually resumed her previous coverage through COBRA, right? How would that have worked? 

Leys: So after you lose coverage from an employer, you generally have 60 days to decide whether to sign up for COBRA coverage, which would be retroactive to the day your old policy lapsed. Khan was within that period when the bat went in her mouth. So she could have retroactively bought COBRA coverage, but she didn’t know about that option. 

Rovner: Yeah. A lot of people, they initially lose their job or they leave their job and they don’t take COBRA, because it’s really expensive, as a rule — because it’s employer insurance and employer insurance is usually pretty generous — and they think they don’t need it. But this is one of those cases where she actually probably could have gotten it covered, right? 

Leys: Right, right. And in fairness, I’d never heard about that 60-day thing, either, and I’ve covered this, so— 

Rovner: I had, but I was there when COBRA was started. So what’s the takeaway here about people who don’t have insurance or think they can buy it at the last minute? 

Leys: Well, two things. One is you should have health insurance. 

Rovner: Because you never know when a bat’s going to fly in your mouth. 

Leys: And that a bat in the mouth does not count as a preexisting condition. 

Rovner: True. 

Leys: We know that now. 

Rovner: And what happened with this bill? 

Leys: She is still trying to get it worked out. 

Rovner: And presumably she’s going to be paying it off for some time to come. 

Leys: That’s what it sounds like. Yep. 

Rovner: But she won’t get rabies. 

Leys: Nope. 

Rovner: So happy ending of a sort. Tony Leys, thank you so much. 

Leys: Thank you for having me. Appreciate it. 

Rovner: OK, we’re back. And now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. Sarah, you were the first to come up with your extra credit this week. Why don’t you tell us about it? 

Karlin-Smith: I picked a piece that ran in NPR from KFF’s Blake Farmer, “Leniency on Lice in Schools Meets Reality,” because it’s about the one-year anniversary of my family getting lice from school. And I actually was exposed to this new reality, which is since I was in school, and it’s, I guess, a broader national policy that they no longer kick kids out of school once you see lice and make it kind of difficult before you can go back to school. And I guess the public health rationale is generally that lice is actually, while it’s quite itchy, it’s not really harmful. So trying to think about the best way to cause the least harm, letting kids stay in school while you treat the infection is seen as most appropriate now. 

But there’s been, as a story goes into, some pushback from parents who feel that then it’s just getting them in these cycles where they’re constantly getting lice and having to deal with it. And dealing with getting the shampoos and stuff for lice can be kind of costly. So I thought it was a slightly lighter health care story for people to think about in these times. 

Rovner: Yeah. Risks and benefits. Classic case of risks and benefits. Alice. 

Ollstein: Well, this is definitely more on the risks than the benefits side of things, but I have a very good piece from Vox. It’s an exclusive. It’s called “RFK Jr. and the White House Buried a Major Study on Alcohol and Cancer.” And so they talked to these scientists who were commissioned to compile all of the data about the risk of drinking alcohol to having cancer. And it was compiling high-quality data that was already out there. And it really shows that no amount of drinking is totally safe. Even a very small, moderate amount of drinking includes a cancer risk, and that goes up the more you drink. 

And now, according to this report, the administration is not going to publish this. The authors turned it in in March, and they’ve just been sitting on it and they said they have no plans to publish it. And this is coming as the alcohol industry does a lot of lobbying to try to prevent stuff like this from being put out in the public consciousness. I just found this really fascinating. Already the younger generations are drinking a lot less. And so there does seem to be a growing awareness of the health risks of even moderate drinking. But I think that anything that keeps people from seeing this information is worrying, although this report did say that they are planning on publishing it in a peer-reviewed medical journal, which they were always planning anyways. But not having the federal government’s backing is a big deal. 

Rovner: It’s not exactly “radical transparency” is what they’ve been talking about. Jessie. 

Ollstein: And it’s not exactly “MAHA” [“Make America Healthy Again”]. They’re talking MAHA. They’re talking about lifestyle stuff. They’re talking about what you eat, but apparently not about what you drink. 

Rovner: Jessie. 

Hellmann: My story is from KFF Health News, from Bram Sable-Smith. It’s called “When Hospitals and Insurers Fight, Patients Get Caught in the Middle.” It is about what happens when providers and insurers have contract disputes. The one example in this story is in Missouri, and it kind of focuses on this family that’s caught in the middle of a dispute between the University of Missouri Health Care system and Anthem. And it means patients don’t get care. There’s not a lot of protections for them. There are provisions that were in the No Surprises Act kind of intended to ensure there was some continuity of care in these situations. But at least for this couple, they weren’t really able to access those protections. So unclear if those are working as intended. 

I just thought it was really interesting because it’s not a new problem, but it’s definitely something that we are hearing more and more. It just happened in the D.C .area a few weeks ago. It just happened in New York. And it kind of raises questions about: What are policymakers going to do about this? They complain about rising health care costs, but they don’t often do very much. They complain about competition and consolidation, and this is one of the effects of that. People lose access to care. So I thought this was a really interesting story. 

Rovner: Yeah. These are all the policy issues that policymakers are not working on but could be. My extra credit this week is from ProPublica. It’s called “Gutted: How Deeply Trump Has Cut Federal Health Agencies,” by Brandon Roberts, Annie Waldman, Pratheek Rebala, and Sam Green. And it’s a deep data dive that found that more than 20,500 workers, or about 18% of the Health and Human Services Department workforce, have left or been pushed out in the first month of Trump 2.0. That includes more than a thousand regulators and safety inspectors and 3,000 scientists and public health specialists. The agency, in its official response to the story, said, quote, “Yes, we’ve made cuts — to bloated bureaucracies that were long overdue for accountability.” I guess we will have to see if America gets healthier. In the meantime, it’s good to have some data on where we were and now where we are at HHS. 

OK, that’s this week’s show. Thanks to our fill-in editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. As always, you can email us your comments or questions at whatthehealth@kff.org, or you can find me on X, @jrovner, or on Bluesky, @julierovner. Where are you guys hanging out these days? Sarah. 

Karlin-Smith: Kind of everywhere. At Bluesky, X, LinkedIn — @SarahKarlin or @sarahkarlin-smith. 

Rovner: Alice. 

Ollstein: Mostly on Bluesky, @alicemiranda, and still on X, @AliceOllstein. 

Rovner: Jessie. 

Hellmann: I am on X, @jessiehellman. I’m also on LinkedIn. 

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

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And they worry there’s more to come, including a national abortion ban.

“You take away our freedoms, we’ll take away your seats,” said Jodi Hicks, CEO of Planned Parenthood Affiliates of California, during Gov. Gavin Newsom’s pitch to adopt Democratic-leaning maps to offset President Donald Trump’s attempt to bolster GOP seats in Texas.

“We can’t sit idly by while the Trump administration, while their backers in Congress, pursue every avenue to strip blue states of their autonomy.”

California legislators this week are debating the new congressional maps, drawn by Newsom allies, which would temporarily replace those drawn by the state’s independent redistricting commission. If they’re approved, voters would have the final say in a November special election.

The mobilization comes as Planned Parenthood, one of the nation’s leading reproductive rights groups, tries to prevent further political and funding losses. Since the Supreme Court overturned Roe v. Wade in 2022, conservative states, including Texas, have implemented laws banning abortion almost entirely. And Republicans passed Trump’s tax-and-spending bill with massive cuts to Medicaid, which keeps safety net providers like Planned Parenthood afloat.

The Trump administration also recently barred the organization and its affiliates from receiving reimbursement for nonabortion services such as cancer screenings and birth control, though a federal judge has temporarily paused enforcement pending a legal challenge.

John Seago, president of Texas Right to Life, said the anti-abortion group is not taking a position on either state’s redistricting proposals. But, he said, Democrats’ rhetoric about protecting democracy rings hollow when blue states like California pass “shield laws” that protect patients seeking abortions and their health care providers from facing consequences and make it more difficult for states like Texas to enforce their laws.

Hicks, whose group represents about 1 in 5 Planned Parenthood clinics nationwide, promised to “go all in” on Newsom’s ballot measure. She declined to say how much money the organization would spend on the campaign.

She added that she wouldn’t be surprised to see more health care groups — many of which opposed the recent Medicaid cuts — jump into electoral politics following the passage of Trump’s signature law. “Health care organizations that, maybe, don’t get involved in those particular races are looking at things differently,” she said.

So far, health industry support has been limited to abortion rights advocates. Reproductive Freedom for All, the national abortion rights group formerly known as NARAL, also lauded Newsom for “holding Republicans accountable for trying to steal votes.”

Planned Parenthood Texas Votes, the advocacy arm of the state’s affiliates, has urged supporters to testify at special session meetings and held a webinar to “stop the redistricting power grab.” And the national Planned Parenthood Action Fund encouraged leaders in Democratic states to use “all tools in their power to push back, level the national playing field, and stop the slide into authoritarianism.”

Hicks and her group are no strangers to big political fights — even against Newsom. Last year, she and other health leaders led a $56 million campaign to pass a revised state health care tax in November over the governor’s concerns.

Newsom, who is trying to build a national profile ahead of a potential 2028 presidential bid, said the effort would “neutralize” Republican gerrymandering in Texas to pad their party’s fragile five-seat advantage in the U.S. House. The party in the White House has generally lost congressional seats in the midterm elections, and political analysts say the trend appears likely to continue in 2026.

Newsom also called on lawmakers in other Democratic states to follow suit if GOP states move ahead with redistricting plans. Leaders in Florida, Illinois, Indiana, Missouri, New York, and Ohio have suggested they could explore similar actions, creating a potential cascade that political experts have said could sow chaos in next year’s midterm elections and set a dangerous precedent.

California Republican Party chair Corrin Rankin, whose party stands to lose five of the nine House seats it currently holds, called Newsom’s proposal a “calculated power grab that dismantles the very safeguards voters put in place” when they passed congressional redistricting reform in 2010.

Democratic leaders have cast the move as necessary to combat an existential threat to democracy. And they have criticized Republicans for trying to make an end run around voter anger toward their policies, particularly around health care. Nearly half of adults think the Republican-passed tax-and-spending law will hurt them, according to a July survey by KFF. More than half believe abortion should be legal, at least under some circumstances, per a Gallup poll in May.

The Republican-passed megabill is projected to slash Medicaid, the federal health care program that covers low-income Americans, by nearly $1 trillion over 10 years. And the Trump administration has cut funding to the Centers for Disease Control and Prevention and the National Institutes of Health, including clawing back medical and scientific research funds from universities.

“They know that voters will hold them accountable for the cuts they rammed through Congress that will strip health care away from millions of people,” said Democratic state lawmaker Sabrina Cervantes, chair of the Senate Elections and Constitutional Amendments Committee. “Because they know they cannot win fair elections, they are changing the rules in the middle of the game.”

Republican incumbents who could be redistricted into oblivion are crying foul.

“Mid-Decade redistricting is wrong, no matter where it’s being done,” Rep. Doug LaMalfa wrote on the social platform X. Last week, the seven-term Republican endured a hostile town hall in his rural Northern California district, defending his vote for the new law by saying it “doesn’t cut a single dollar from people who qualify” for Medi-Cal, the state’s Medicaid program.

If approved by voters, proponents said, California’s 52 new House districts would also bolster vulnerable congressional Democrats and be in effect for the 2026, 2028, and 2030 elections. The map would not go into effect unless another state approved its own gerrymandering effort. After the 2030 census, the state commission would regain control of the process.

Paul Mitchell, a redistricting expert who helped draft the Democrats’ map, said his team used the commission’s district boundaries as a starting point and, for more than half the districts, moved fewer than 10% of voters.

“This is not a Twitter hack job,” said Mitchell, a Democrat who is married to Hicks and has long supported the independent commission’s work. “I want to get back to nonpartisan redistricting, but right now we’re in a crisis.”

National polls show voters oppose partisan redistricting. And California voters still overwhelmingly support the state’s independent redistricting system, said veteran GOP strategist Rob Stutzman, who added that passing such complicated ballot language in an off-year election would be no easy feat.

“You’re asking voters to make an unprincipled decision. You’re asking them to rig an election because allegedly Texas is rigging an election,” Stutzman said. “‘No’ votes are so much easier when it’s confusing, and this is extremely confusing.”

Dave Wasserman, senior editor and elections analyst for the Cook Political Report, said Texas and California have the potential to set off a “redistricting apocalypse” that will have major implications in the fight to control Congress.

“If Democrats fail to pass a ballot initiative to offset Texas, then Republicans would go from having a very narrow chance to hold the House to, perhaps, an even chance,” he said. But, he added, public opinion on health care cuts remains the biggest obstacle in the party’s path.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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With abortion now restricted or illegal in 22 states, jurisdictions like Maryland have become a destination for patients from as close as neighboring West Virginia to as far as Texas.

With a staff of six, the Baltimore Abortion Fund helps patients who need to travel pay for bus or plane tickets, lodging in Maryland, and sometimes meals. The fund spends about a million dollars a year on that support. Calls to its confidential helpline have increased by 50%-60% every year since Roe v. Wade was overturned, said Lynn McCann-Yeh, the fund’s co-director.

The fund disburses aid as people call in. Often, the weekly allotment is depleted after just one or two days.

“Sometimes that means that our helpline is closing within 24 to 48 hours at the start of the week, because there’s just too much demand for the amount of resources that we have,” McCann-Yeh said. “There are many, many more dozens of callers each week that are just getting a voicemail message saying that we’ve run out of support.”

To help, the Maryland Legislature turned to a pot of money established under the 2010 Affordable Care Act. Under the law, states could decide to require insurance plans sold on the ACA “marketplaces” to cover abortion. The plans were required to charge a minimum fee of $1 a month on every plan bought through the marketplace.

That money was then put into an account that would help pay when insured patients received abortion care.

The state accounts were necessary because of the federal Hyde Amendment, which restricts the U.S. government from paying for abortions, except in cases involving rape, incest, or severe medical risk to the patient.

Because the federal government partially subsidizes insurance plans sold through the ACA marketplaces, commercial insurers had to use their money to pay the monthly fee for each policyholder.

“Insurers have quietly complied with the ACA special rules resulting in these segregated accounts that have millions of dollars in them intended for abortion coverage,” said Cat Duffy, a policy analyst for the National Health Law Program.

Over time, the accumulated fees in such accounts have outstripped the withdrawals for abortion care for women on those insurance plans. Maryland’s account has grown to $25 million and takes in about $3 million each year.

Maryland passed a new law that allows the state health department to tap those funds and allocate up to $2.5 million a year in grants to organizations operating in Maryland that offer abortion assistance. Those groups can use the money for traveling patients, low-income patients in Maryland, or people without insurance.

“We know that we will be able to use those funds wisely and to make sure that we’re not turning away any patient due to their inability to pay,” said Ramsie Monk, the director of development at the Women’s Health Center of Maryland on the border with West Virginia.

Without assistance from abortion funds, many of the patients would not be able to pay for their care, says Diane Horvath, an OB-GYN at Partners in Abortion Care, in College Park, Maryland. Unlike some other health centers, which offer abortion only up to 16 weeks of pregnancy, Partners in Abortion Care can provide an abortion later in pregnancy. Those procedures are more complicated and more expensive.

More than 90% of the patients at Partners in Abortion Care receive financial assistance through various abortion funds.

“I would say a typical patient that we see probably every week is somebody who’s already got at least one child, they’re working a job that doesn’t offer substantial leave for medical care, it may not offer health insurance, or the insurance it offers doesn’t cover abortion, particularly when they’re coming from out of state and they’re struggling and living paycheck to paycheck,” Horvath said.

The new law passed this spring and took effect July 1. The first tranche of money is set to be transferred from the ACA fund to the state health department by the fall.

Since the Supreme Court overturned Roe in 2022, states where abortion remains legal, like Maryland, have seen an increase in abortion procedures, including for patients who can’t get a legal abortion in their home state. Many need financial assistance for the procedure or to cover travel costs from other states, lodging, and related expenses while they recover.

That financial aid is often provided by local and regional abortion funds, such as the nonprofit Baltimore Abortion Fund.

As more patients travel to Maryland, and some abortion funds exhaust their resources, clinics that provide abortions in Maryland are feeling financial pressure to serve traveling patients, as well as uninsured and low-income Marylanders seeking care.

Clinicians in Maryland performed about 39,000 abortions last year, a 28% increase from 2020, according to the Guttmacher Institute, a nonprofit focused on sexual health research.

Maryland’s move to tap the ACA fund represents an innovative solution for states that have opened their doors to out-of-state patients but are grappling with the logistics and costs of the increased clinical demand in a post-Roe landscape.

“This bill is super important for Maryland; we’re making sure our clinics stay open,” said Maryland state Del. Lesley Lopez, a Democrat who sponsored the bill. “Maryland has been a leader on a lot of reproductive bills for the past 30 years, and so in that way, this bill fits into that legacy. It’s also nationally significant, because there’s 25 or 26 other states that can take this model and run with it. We’re looking for California, Illinois, New York, those bigger states that are sitting on potentially hundreds of millions of dollars to take what we’ve done here in Maryland and implement it there.”

Anti-abortion groups in Maryland opposed the bill, saying that the new law will force some insurance consumers to pay for procedures they may disagree with.

“This bill uses insurance premiums from insured women to abort the children of uninsured women,” Laura Bogley, executive director of Maryland Right to Life, told the state legislature on March 6.

“Many of those uninsured women are non-Maryland residents who are trafficked into the state for late-term abortions that are restricted by other states.”

The bill’s supporters deny that traveling patients are being trafficked when they are traveling of their own volition in search of health care.

This article is from a partnership with WYPR and NPR.