President Donald Trump this week nominated a former deputy surgeon general who has expressed support for vaccines to lead the Centers for Disease Control and Prevention. Considered a more traditional fit for the job, Erica Schwartz would be the agency’s fourth leader in roughly a year, should she be confirmed by the Senate. 

And Health and Human Services Secretary Robert F. Kennedy Jr. appeared on Capitol Hill this week in the first of several hearings discussing Trump’s budget request for the department. But the topics up for discussion deviated quite a bit from the subject of federal funding, with lawmakers raising issues of Medicaid fraud, measles outbreaks, the hepatitis B vaccine, peptides, unaccompanied minors, and much, much more. 

This week’s panelists are Mary Agnes Carey of KFF Health News, Anna Edney of Bloomberg News, Emmarie Huetteman of KFF Health News, and Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine.

Panelists

Among the takeaways from this week’s episode:

• Trump on Thursday named four officials to the CDC’s leadership team. Schwartz, whom he picked as director, is a physician and Navy officer who served as a deputy surgeon general during Trump’s first term. She has voiced support for vaccines and played a key role in the covid-19 pandemic response.
• RFK Jr. testified before three committees of the House of Representatives this week on the president’s budget request for HHS. While the hearings touched on a wide variety of topics, notable moments included a slight softening of Kennedy’s stance on the measles vaccine, including the acknowledgment that being immunized is safer than having measles — although he also stood by the decision to remove the recommendation for the newborn dose of the hepatitis B vaccine.
• New studies on the use of acetaminophen during pregnancy and the effects of water fluoridation on cognitive function refute Trump administration claims. And a White House meeting that brought together Trump, Kennedy, and other leaders of the Make America Healthy Again movement aimed to soothe concerns among supporters — yet there’s reason to believe the overture won’t completely mend fences between the Trump administration and the MAHA constituency ahead of the midterm elections.

Also this week, KFF Health News’ Julie Rovner interviews Michelle Canero, an immigration attorney, about how the Trump administration’s policies affect the medical workforce.

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

 Mary Agnes Carey: Politico’s “‘A Crisis in the Making’: Nebraska Races To Impose Work Requirements on Medicaid,” by Alice Miranda Ollstein.

Joanne Kenen: The New York Times’ “He Warned About the Dangers of A.I. If Only His Father Had Listened,” by Teddy Rosenbluth.

Anna Edney: Bloomberg’s “Hormone Drugs Make $6.3 Billion Comeback After FDA Nixes Safety Warnings,” by Anna Edney.

Emmarie Huetteman: KFF Health News’ “Your New Therapist: Chatty, Leaky, and Hardly Human,” by Darius Tahir.

Also mentioned in this week’s podcast:

• JAMA Pediatrics’ “Acetaminophen Exposure During Pregnancy and the Risk of Autism in Offspring,” by Kira Philipsen Prahm, Pingnan Chen, Line Rode, et al.
• Proceedings of the National Academy of Sciences’ “Municipal Water Fluoridation, Adolescent IQ, and Cognition Across the Life Course: Evidence From the Wisconsin Longitudinal Study,” by John Robert Warren, Gina Rumore, Kamil Sicinski, and Michal Engelman.
• KFF Health News’ “Pennsylvania Town Faces Fallout From Trump’s Environmental Rule Rollback,” by Stephanie Armour and Maia Rosenfeld.
• The New York Times’ “In Private Meeting, Trump Soothes Disenchanted MAHA Leaders,” by Sheryl Gay Stolberg.
• Wakely Consulting Group’s “Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market,” by Michelle Anderson, Chia Yi Chin, and Michael Cohen.

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Speed, efficiency, and lower costs. Those are the traits artificial intelligence supporters celebrate. But the same qualities worry physicians who fear the technology could lead to insurance denials with humans left out of the loop.

With scant federal regulation, states are left to shape the rules on AI in health care. For residents in the Washington, D.C., metropolitan area, a divide is playing out on opposite sides of the Potomac River. Maryland and Virginia have taken very different approaches to regulating AI in health insurance.

KFF Health News correspondent Lauren Sausser joined WAMU’s Health Hub on April 15 to explain why where you live may determine how much of a role AI plays in your coverage.

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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It’s not unusual for the rancher to wake up early to tend to livestock, but at 5:45 a.m. this day his cattle wouldn’t come first. For the past 3½ years, three days a week, Pieper has made an early-morning commute to get dialysis at the nearest hospital.

Pieper lives outside Hay Springs, which has 599 residents, according to a sign at the edge of town. He makes sure not to forget his chocolate-brown cowboy hat before starting up his pickup truck for the half-hour drive to Chadron.

That February morning was one of his last dialysis sessions there before the hospital shuttered the service at the end of March.

“I guess I’ll just bloat up and die in a month,” Pieper remembered thinking when he learned the center was closing, eliminating the only option near his home.

He needs dialysis to survive after cancer treatment damaged his kidneys.

Pieper and 16 other patients relied on Chadron Hospital for the life-sustaining therapy that filters waste and fluid from their blood — a job their failing kidneys could no longer do. Treatment lasts about four hours.

The closure is just one example of the long decline of health care services in rural America, where people have higher rates of many chronic conditions but less access to care than elsewhere.

The Trump administration promised to address this problem, when it launched the $50 billion federal Rural Health Transformation Program in September. It may not be enough to stop the trend.

“[President Donald] Trump says he is going to help the rural health care,” Pieper said. Dialysis “is one thing that we really need here.”

Some patients have moved to live closer to care, including several nursing home residents. Their new facilities may be farther from their families.

Others are making long drives to dialysis centers. Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region of western Nebraska. The hour-and-a-half drive will triple his time on the road to more than nine hours each week.

Jim Wright and his wife reduced their drive time — but are spending more money — by renting a small home near Rapid City, South Dakota, and living there on weekdays so he can get dialysis. Wright said he understands that rural hospitals face financial challenges.

“But we’re talking about something that’s lifesaving. It’s not a matter of, ‘Oh, I would like to be there’” getting treatment, he said. “It’s a case that if you don’t, you die.”

An Influx of Money That’s Out of Reach

Jon Reiners, CEO of the independent, nonprofit Chadron Hospital, wrestled with the decision to end dialysis services. He and several patients said that the closure was announced as Nebraska officials celebrated the $219 million the state will receive in first-year funding from the Rural Health Transformation Program.

But the five-year program is aimed at exploring new, creative ways to improve rural health, not to help existing services stay afloat. States can use only up to 15% of their funding to pay providers for patient care.

At least 11 states — Nebraska is not among them — have mentioned using funding for rural dialysis programs, according to a KFF Health News review of applications. Their ideas include starting a mobile dialysis unit and helping people get treatment at home or in long-term care facilities.

Reiners said Chadron Hospital lost $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs.

The facility is a critical access hospital, a designation that allows certain small, mostly rural hospitals to get increased reimbursement rates for their Medicare patients. While most of the affected patients were on Medicare, the critical access program doesn’t cover outpatient dialysis, Reiners said.

Reiners said the hospital worked for more than a year to find solutions, such as reaching out to four private companies to potentially take over the center. But he said they all passed after realizing they would lose money.

Nephrologist Mark Unruh said the dialysis closure in Chadron reflects a wider trend of staffing and funding challenges.

“You do end up in situations where you have people who are displaced like this, and it’s just sad,” said Unruh, chair of the Internal Medicine Department at the University of New Mexico.

People in rural America face significant disparities in kidney health and treatment, according to a study published in 2024 in the American Journal of Nephrology. They’re more likely to develop end-stage kidney disease and face higher mortality rates after diagnosis, according to data from the National Institutes of Health.

The best way to address this is to focus on prevention, Unruh said. He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure.

Another idea, Unruh said, is boosting the rate of kidney transplantation for rural patients. He’s part of a study looking at whether it’s helpful to “fast-track” tests patients need to get approved for a transplant by scheduling all of them over a couple of days to limit travel time.

Unruh said the U.S. health system also needs to recruit more staff who can train patients and their caregivers to administer dialysis at home.

Exploring the Option of Home Dialysis

Rural dialysis patients are more likely than urban ones to get home dialysis, according to data from the National Institutes of Health. In 2023, the rate was nearly 18% for rural patients and about 14% for urban ones.

One type of home dialysis requires surgery to get a catheter placed in the abdomen and up to 15 days of training. The other kind requires up to eight weeks of training. The nearest facility to Chadron that offers training for the first option is in Scottsbluff. The nearest that offers training for the latter kind is three hours away in Cheyenne, Wyoming.

Pieper said doctors told him he’s not a candidate for home dialysis or a transplant. The Panhandle has a nonprofit, rural transit system, but its schedule won’t work for Pieper. He said that leaves him with no choice but to get treatment in Scottsbluff, a 200-mile round trip.

It takes Linda Simonson even longer — more than four hours round trip — to drive her husband, Alan, from their ranch to his treatment in Scottsbluff.

Linda sat in the waiting room with a yellow legal pad during one of Alan’s final treatments in Chadron. The paper was scrawled with phone numbers of politicians to call and driving distances to dialysis centers in the region. She said facilities closer to their ranch either don’t have room for new patients or lack good spots along the route to take a driving break in bad weather.

“It’s just unreal,” she said.

She said even if Alan took a bus, she’d have to ride along to support him during the trip and his treatment.

Jim and Carol Wright, the couple staying near Rapid City on weekdays, said they can’t afford to rent a second home forever. Their weekly commute is already taking a physical and emotional toll. They said they’ll eventually have to move to a bigger city, giving up the house they love in the scenic Nebraska National Forest.

Carol said she feels for the dialysis staffers in Chadron, who are wonderful.

“It just doesn’t seem right to sacrifice one unit that’s so vital,” she said while standing next to a pile of moving boxes stacked inside their rental.

The Wrights wrote letters to politicians and hospital leaders to share their concerns and ideas for keeping the unit open, including using the federal rural health funding.

Simonson said she spoke with aides for the governor and her state representatives but none of the leaders called her back.

“It feels like they don’t know that we exist at this end of the state,” she said.

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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Zach Dyer reads the week’s news: Rising health costs have some middle-aged adults skipping the doctor until Medicare will pick up the tab. Plus, there’s little evidence that immigrants without legal status are using Medicaid, despite White House claims.

April 2

Arielle Zionts reads the week’s news: Scientists say staff losses at the National Institutes of Health could lead to fewer medical breakthroughs. Plus, doctors worry they’ll see more kids with potentially deadly complications from measles, as cases surge.

March 26

Jackie Fortiér reads the week’s news: Consumers know which party they blame after Congress failed to extend enhanced Obamacare subsidies. Plus, updated standards say seniors should aim for even lower blood pressure readings.

March 19

Sam Whitehead reads the week’s news: Amid federal spending cuts and suspicion of fluoride, tooth problems are sending more kids to the ER. Plus, patients look to health savings accounts to deal with rising medical costs.

March 12

Katheryn Houghton reads the week’s news: Looming Medicaid cuts could mean states stop covering dental care for adults, and a growing number of U.S. nurses are moving to Canada.

March 5

Zach Dyer reads the week’s news: The Trump administration is calling for sharp restrictions on direct-to-consumer drug ads, and for some people facing skyrocketing health insurance costs, becoming eligible for Medicare because of a new diagnosis is a terrible irony.

Feb. 26

Sam Whitehead reads the week’s news: Some places are bringing back house calls to try to fight maternal and infant mortality, and almost all Americans benefit from health care subsidies in different forms.

Feb. 19

Arielle Zionts reads the week’s news: Some health systems are using AI tools to help patients get primary care, and the Trump administration’s new data-sharing rules make going to the hospital more dangerous for people without legal status.

Feb. 12

Jackie Fortiér reads the week’s news: Moves by the Trump administration have slowed cancer research, and more of America’s doctors are working into their golden years.

Feb. 5

Katheryn Houghton reads the week’s news: American farmers are being hit hard by the end of extra Obamacare subsidies, and hospitals are starting their own Medicare Advantage plans.

Jan. 29

Zach Dyer reads this week’s news: An expensive new gene therapy that can potentially cure people with sickle cell disease will be covered by Medicaid, but only when it works for patients. Plus, community health centers are preparing to help care for millions more uninsured people.

Jan. 22

Arielle Zionts reads the week’s news: Some states are cutting public funding for a type of autism therapy, and older adults are more likely than younger ones to stop taking GLP-1 drugs such as Ozempic. 

Jan. 15

Jackie Fortiér reads the week’s news: Parents are confused by an overhaul of U.S. childhood immunization guidelines, and while people 65 and older make up the fastest-growing homeless population in the country, traditional homeless shelters often can’t accommodate them.

Jan. 8

Zach Dyer reads the week’s news: Instead of extending extra Affordable Care Act subsidies that would keep monthly premiums more affordable, some Republicans are pushing health savings accounts. Plus, people seeking cheaper health insurance options outside the ACA marketplaces may find some, but they come with downsides. 

Jan. 1

Katheryn Houghton reads the week’s news: AI voices can help patients who have had their voice boxes removed sound like themselves again, and many state-run psychiatric hospitals don’t have enough beds to treat patients unless they’ve been charged with a crime.

The KFF Health News Minute is available every Thursday on CBS News Radio.

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An elementary school teacher chose a low-price health insurance plan but soon realized she wasn’t clear about what it would mean for her family’s finances.

“Once I got the insurance card, I compared our old plan to our new plan, and that’s when I really got worried, because I didn’t really understand what a deductible was. It got me thinking, how do I use this insurance?”

— Madison Burgess, 31, of San Diego

When enhanced federal subsidies expired at the end of 2025, a lot of people buying their own health insurance on the state and federal exchanges saw their expected monthly rates jump. To keep costs down, many switched to a high-deductible health plan. These plans offer lower monthly payments, but in exchange patients can face steep out-of-pocket costs when they need care.

The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006.

Madison Burgess, a teacher in San Diego, gets health insurance through her teaching job. But when she investigated adding her husband to her plan, it was just too expensive, so she started shopping on the exchange for a cheaper option for him.

The longer she scrolled through the plan options, the more overwhelming it felt. Insurance jargon made it hard to tell what her family would owe if her husband got sick.

“I didn’t know what a deductible was, so I just went with what was cheap, and now I have regret,” she said.

In exchange for that lower monthly premium payment, her husband’s coverage won’t kick in for most care until they’ve paid $5,800 in medical bills. Burgess didn’t know that the deductible must be met before insurance picks up part of the tab.

Deductible:

The amount you as the patient have to pay before insurance picks up part of the tab

Premium:

The monthly bill for your policy, paid to the insurance company

How do you prepare for thousands of dollars in upfront costs? One option is a health savings account, or HSA, which lets you save pretax money and is now available to people enrolled in lower-tier state and federal exchange plans, including bronze and catastrophic coverage. These plans generally have the lowest premiums on the exchange but the highest out-of-pocket costs when you need care.

Burgess had chosen a bronze plan and didn’t know HSAs were an option.

“I’ve never thought about having to put money away for a deductible,” she said.

Burgess and others are often more worried about socking away money for unexpected car and house repairs or vet bills.

If, like Burgess, you chose cheaper health coverage for this year only to discover you’re on the hook for meeting a high deductible, these tips can help you prepare.

1. You might qualify for an HSA and not know it.

If you’re enrolled in a bronze or catastrophic plan, you qualify to open a health savings account. Think of it as a medical piggy bank with tax perks. You put in pretax money, which lowers your taxable income. The money grows tax-free, and when you spend it on qualified medical expenses, those transactions are also tax-free. That’s what people call a “triple tax advantage.”

These accounts build a cushion for future health costs, such as doctor visits, prescriptions, and even products like over-the-counter medicine, tampons, and sunscreen.

The money typically can’t be used for monthly premiums, but the account is yours to use for qualified medical expenses for yourself, your spouse, or your dependents anytime in the future. The money in the account is yours, even if you change jobs or health plans.

An HSA is not the same as a flexible spending account, or FSA. FSAs are tax-advantaged too but are offered only through employers. The money expires annually and you lose any remaining money when you leave that job.

2. HSA-curious? Here’s how to open one.

You open a health savings account through a bank or other financial institution. The institution will issue you a debit card so you can make purchases from the HSA.

You can open an HSA at any point during the year as long as you’re covered by an eligible plan. You can choose where to open the account, but be sure to check for any fees financial institutions charge and shop around.

If you get insurance through your job, your employer may require you to use a specific IRS-approved company.

Many people decide they can’t afford to contribute to an HSA. For some households, the desire to set aside money for medical expenses competes with the need to pay rent and buy groceries.

But there’s a detail that can make it feel more manageable. Contributions don’t have to be large. Just a few dollars a month can get you started.

There is, however, a limit. The IRS sets an annual cap on how much you’re allowed to contribute to an HSA. In 2026, an individual is limited to $4,400, or $8,750 for a family plan. Under that ceiling, the amount is up to you.

3. Preventive services should be covered at no cost to you.

All plans sold on marketplaces must cover certain preventive services at no cost to the patient as long as the care is provided in-network. Those services include routine immunizations and cancer screenings.

Beyond preventive care, understanding what different services cost can help you decide which type of medical appointment works best for your health needs and your wallet. For example, some plans charge less for a telehealth visit than to see your primary care doctor in person.

Check out your summary of benefits for more details.

4. Seek care early in the year.

Most deductibles reset on Jan. 1. Scheduling appointments or surgeries early in the year can be strategic if you discover a condition that requires ongoing care. If you can afford it, meeting your deductible sooner can make the rest of the year significantly cheaper, said Caitlin Donovan, a senior director at the Patient Advocate Foundation.

5. Consider paying cash instead of spending down your deductible.

Some hospitals, clinics, or other providers offer cheaper prices if you pay cash. You have the right to an itemized estimate and explanation of how much a health service would cost if you paid out-of-pocket. Ask for the estimate before you get care. Then, compare that price with what your insurance company tells you it would cost if you used your insurance. If you decide to go with a cash payment, you’ll need to pay while you’re still at the doctor’s office, before charges get submitted to your insurance company.

Paying cash may save you money, but the amount you pay generally won’t count toward your deductible or out-of-pocket maximum.

“If you don’t think you’re ever going to hit your deductible — you’re that young invincible, and your deductible is $10,000 — negotiate the cash price,” Donovan said.

6. On an ACA plan? Update your income and use an HSA to avoid a tax surprise.

If you’re on an ACA plan and you’re eligible for subsidies, be aware: If your earnings change and you don’t update your marketplace application, you could owe thousands of dollars at tax time. The fix is simple. Report raises, new jobs, or side gigs as they happen. If your income goes up, stashing money in an HSA can help because the money you put in the account doesn’t count toward your taxable income.

As soon as you report an increase in your income, that could mean higher premiums (if you no longer qualify for the same subsidy), but experts say it’s better to pay now than owe a big bill that you have to pay all at once.

“One of the biggest problems I see is someone is newly unemployed and they sign up for coverage, they say that they’re not making any money, and then eventually they get a job and don’t report it, and then they have this huge tax bill at the end,” Donovan said.

She advises updating your marketplace profile as soon as your income changes, which could newly qualify you for Medicaid or a plan that contributes more toward your medical bills.

Taylor Cook contributed to this report.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and KFF Health News.

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Even the Trump administration is testing AI’s usefulness in managing the prior authorization process for the Medicare program, as well as seeking to override AI regulation by states.

But class action lawsuits have accused insurers of using AI to wrongfully withhold treatment. And new research from Stanford University outlines the risks of training AI on a current system rife with wrongful denials.

“There is a world in which using AI could make that worse, or at least replicate a bad human system, because the data that it would be training on is from that bad human system,” said Michelle Mello, a co-author of the study.

Although, Mello said, the research team found “real positives alongside the risks.”

In this video produced by KFF Health News’ Hannah Norman, Darius Tahir, a correspondent covering health technology, explains.

You can read Tahir’s recent coverage of AI’s use by health insurers below:

• “Red and Blue States Alike Want To Limit AI in Insurance. Trump Wants To Limit the States,” by Darius Tahir and Lauren Sausser.
• “AI Will Soon Have a Say in Approving or Denying Medicare Treatments,” by Lauren Sausser and Darius Tahir.

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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At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.

Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.

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

Panelists

Among the takeaways from this week’s episode:

• The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
• It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
• Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
• Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.

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

Julie Rovner: The Atlantic’s “HHS Officials’ Year in Purgatory Is Ending,” by Katherine J. Wu.

Maya Goldman: KFF Health News’ “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records,” by Amanda Seitz and Maia Rosenfeld.

Lauren Weber: CNN’s “These Common Drug Tests Lead to Tens of Thousands of Wrongful Arrests a Year, Experts Say. One State Is Fighting Back,” by Holly Yan.

Alice Miranda Ollstein: Politico’s “A Slowdown in US Visa Processing Is Wreaking Havoc on Foreign Doctors’ Lives,” by Simon J. Levien.

Also mentioned in this week’s podcast:

• JAMA Internal Medicine’s “Accuracy of Self-Selection for Medication Abortion Using a Prototype Drug Facts Label,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
• KFF Health News’ “Immigrant Seniors Lose Medicare Coverage Despite Paying for It,” by Vanessa G. Sánchez, El Tímpano.
• The New York Times’ “Idaho Cut Services for People With Schizophrenia. Then the Deaths Began,” by Ellen Barry.
• Stateline’s “Medicaid Cuts Could Add Pressure to Already-Stressed Psychiatric Units,” by Nada Hassanein.
• The Washington Post’s “CDC Delays Publishing Report Showing Covid Vaccine Benefits,” by Lena H. Sun.

[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 WAMU Public Radio in Washington, D.C. 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 covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

Rovner: And my fellow Michigan Wolverine this national championship week, Maya Goldman of Axios. Go, Blue! 

Maya Goldman: Go, Blue. 

Rovner: No interview this week, but plenty of news. So let’s get right to it. We’re going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill mifepristone. Wait, what? Please explain, Alice, how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit. 

Ollstein: Yeah. So this has been building for a while, and it is not the only lawsuit of its kind out there. There are several. A bunch of different state attorneys general, who are very conservative and anti-abortion, have been suing the FDA in an attempt to either completely get rid of the availability of the abortion pill mifepristone or reimpose previous restrictions on it. So right now, at least according to federal rules, not according to every state’s rules, you can get it via telehealth. You can get it delivered by mail. You can pick it up at a retail pharmacy. You don’t have to get it in person handed to you from a doctor like you used to. So these lawsuits are attempting to bring back those restrictions or get the kind of national ban that a lot of groups want. And so you have other ones pending: Florida, Texas, Missouri, you have a bunch of ones. So this is the Louisiana version. And the Trump administration, it’s important to note, they are not defending the FDA or the abortion pill on the merits. They are saying, we don’t want this lawsuit and this court to force us to do something. We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. But they’re asking courts to give them the time and space to complete that process and saying, you know, This is our power we should have in the executive branch. And so, in this case, the judge, in ruling for the Trump administration, basically just hit pause. This doesn’t get rid of the case. It just puts a stay on it for now, and that’s important. In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here. So this doesn’t mean that abortion pills are going to be available forever. This doesn’t mean nothing’s going to happen, and they’re going to be banned. This just means, you know, we’re kicking the can down the road.  

Rovner: I was saying, just to be clear. I mean, we know that this FDA quote-unquote “study” — whether it is or isn’t going on — is part of, kind of, a delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms. So they’re trying to sort of run the clock out here. Is that not sort of the interpretation that’s going on right now?  

Ollstein: That’s what people on both sides assume is going on. It’s really been fascinating how everyone is being kept in the dark about what’s happening inside the FDA — and if this review is even happening, if it’s real, if it’s in good faith, what is it based on? And so it’s become this sort of Rorschach test, where people on the left are saying, you know, They’re laying the groundwork to do a national ban. This is just political cover. They just want to wait until after the midterms, and then they’re going to go for it. And people on the right are saying, you know, The administration is cowardly, and they aren’t really doing anything, and they’re just trying to get us to shut up and be patient. We don’t know if either of those interpretations or neither of them are true.  

Rovner: Lauren, you want to add something? 

Weber: I just think it’s pretty clear this is also just on a [Health and Human Services Secretary Robert F.] Kennedy [Jr.] priority. I mean, let’s go back. The man … comes from one of the top Democratic political families originally. You know, there’s obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously, he’s on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other hot issues that, [if] I had to guess, I don’t think that they’re trying to rock the boat on this one. … I think, some background context too, to some of what’s going on.  

Rovner: We’ll get to some of those hotter issues. But, meanwhile, the Journal of the American Medical Association [Internal Medicine] has a study out this week suggesting that medication abortion is so safe that it could be provided over the counter — that’s without any consultation with a medical professional, either in person or online. This doesn’t feel like it’s going to happen anytime soon, though, right? While we’re still debating the existence of medication abortion in general. 

Ollstein: That’s right. I mean, there are a lot of people who can’t get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter, whereas in the United States, the most common way to have a medication abortion is with a two-pill combination, mifepristone and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is effective and it is largely safe. It’s slightly less safe than using both pills together. And so I think there’s a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could. But because of bans and restrictions, they can’t. And so people are turning to these activist groups. 

Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception — which is not the abortion pill — made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?  

Weber: Yeah, I just wanted to say I find it really interesting. Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter. But there are a lot of things that are considered potentially more dangerous that you can order up in a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate. So I think the differences of access of this compared to other less studied, potentially more unsafe medication is quite striking. 

Goldman: Part of [President Donald] Trump’s “Great Healthcare Plan” is making more medications available over the counter. So this is certainly something that they have said they want to do, in general. This is a political nightmare, though, to do that for abortion. 

Ollstein: Yeah, and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes. And you’ve seen that, and that comes up in lawsuits and political arguments about this. And I think, you know, people can point to this as another example. 

Rovner: So last week, we talked about the federal family planning program Title X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some big changes to the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s. 

Ollstein: Well, the changes have sort of been announced. They’ve more been teased. What we are still waiting for is an actual rule, like we saw in the first Trump administration, that would impose conditions on the program. And so what we saw recently, it was part of a wonky document called a “Notice of Funding Opportunity,” or NOFO, for those in the D.C. lingo. And basically it was signaling that when groups reapply — they just got this year’s money, but when they reapply for next year’s money — it sets up sort of new priorities and a new focus for the entire program. And what was really striking to me is, you know, this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of people who depend on this program, and the word “contraception” did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote, “family formation.” So this is really striking to me. I think we saw some signs that something like this was coming. You know, about a year ago, there was some Title X money approved to focus on helping people struggling with infertility. But that was sort of just a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program. So I think when the actual rule to this effect drops, and we don’t know when that will be — will they wait till after the midterms to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then. But I think right now, this is just sort of a sign of where they want to go in the future. And it’s important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out to all of the clinics that got it before, including Planned Parenthood clinics. The anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future, right now. 

Rovner: Just to remind people that the ban on Planned Parenthood funding from last year was for Medicaid, not for the Title X program. 

Ollstein: Right.  

Rovner: And that’s why Planned Parenthood got money. 

Ollstein: Yes, and Planned Parenthood is not allowed to use any Medicaid or Title X money for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be cut off. So they were very pissed that this money went out to Planned Parenthood. And so very quickly after, the administration put out this document, saying, Look, we are taking things in another direction, and it is not the direction of Planned Parenthood. 

Rovner: Lauren, you want to add something? 

Weber: Oh, I just wanted to say Alice has really been owning the beat on all the Title X coverage, so … 

Rovner: Absolutely.  

Weber: … glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.  

Goldman: Yeah, great coverage. 

Rovner: Yes. Very happy to have you for this. Turning to the budget, which is normally the major activity for Congress in the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about $15 billion, but those cuts are far less deep than those proposed last year. And, as we have noted, Congress didn’t actually cut the HHS budget last year by much at all. And many programs, like the National Institutes of Health, actually got small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to Health and Human Services programs aren’t actually popular with the public or with Congress, for that matter, going into a midterm election? 

Weber: I think it’s that last little piece you mentioned there, Julie. I think it’s the “going into the midterm election.” I think you hit the nail on the head there. Cuts are also not good economically for many Republicans. You know, we saw Katie Britt be one of the — the Alabama Republican senator — be one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year. So I think what you’re hinting at, and what we’re getting at, is that it’s not politically popular, it can be economically problematic, on top of the scientific advances that are not found. So I suspect you are right on that. 

Ollstein: The administration knows that this is “hopes and dreams” and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like Title X, because at the same time they put out this guidance from HHS about the future of Title X, moving away from contraception, in the president’s budget he proposed completely getting rid of Title X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that doesn’t exist? 

Goldman: I think, also, this is the second budget that they’re putting out in this administration, right? So now they are just a little more used to what’s going on, and they have more of their feet under them. 

Weber: As a preview for listeners, too, I’m sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget. So I am sure that we will hear a lot more on this front in the weeks to come. 

Rovner: Yeah, I would say that’s one thing that the budget process does, is when the president finally puts out a budget, the Cabinet secretaries travel to all of the various committees on Capitol Hill to, quote, “defend the president’s budget,” which is sometimes or, I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week — that was supposed to be private, but ended up being live-streamed — said, and I quote, “It’s not possible for us to take care of day care, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote, “military protection.” Did I just hear a thousand Democratic campaign ads bloom? 

Goldman: I think this is a prime example of when you should take Trump seriously, but not literally. I don’t think that there’s any world, at least in the foreseeable future, where the federal government isn’t funding Medicare. But, you know, you certainly have to watch at the margins. It’s like, it’s not a secret that this is something that they’re interested in cutting back spending on. It’s super politically difficult to do that, and they know that, and that’s part of why, which I’m sure we’ll talk about in a little bit, they bumped up the payment rate for 2027 to Medicare Advantage plans.  

Rovner: Which we will get to. 

Goldman: Yeah, so I mean, it’s certainly an eye-opening statement, and you should remember it. But I don’t think that we’re in immediate jeopardy here. 

Rovner: This is the president who ran in 2024, you know, saying that he was going to protect Medicare and Medicaid. I mean, it’s been, you know, against some of the recommendations of his own administration. I was just sort of shocked to see these words come out of his mouth. Lauren, you wanted to say something?  

Weber: I mean, it’s not that surprising, though. I mean, look at what the One Big Beautiful Bill [Act] did to Medicaid. He’s already pushed through massive Medicaid cuts, which are essentially being offloaded to the states. So, I mean, I think this ideology has already borne out and will continue to bear out, and obviously it’s happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.  

Rovner: Well, meanwhile, Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’s Big Beautiful Bill, except this time it’s essentially just to fund the military and ICE [Immigration and Customs Enforcement] and border control, because Democrats won’t vote for those things, at least they won’t vote for additional military spending. What are the prospects for that to actually happen? And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as some have suggested? 

Goldman: You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of blowback from politicos, from advocates, from, you know, kind of across the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health care as an offset. But I would say that Republicans are pretty good at rhetoric, right? That’s one of the things that they’re known for right now, and there’s always a way to spin it. 

Rovner: Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I didn’t think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have. 

Goldman: And I think that is something that you do in between election years. That’s not something you do in an election year. 

Rovner: That’s true, yes … you do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but … 

Ollstein: And I think it’s important to remember that the reason Republicans are in this bind and that they feel like they have to keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement. And so they feel pressured to put all their effort and political capital towards that, and don’t want to mess that up by adding a bunch of other health care things that could cause fights and lose them votes.  

Goldman: The money has got to come from somewhere. 

Rovner: And health care is where all the money is. Speaking of Medicare and Medicaid, where most of the money is, there is news on those fronts, too. Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember, we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically? Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year. That’s compared to the less than 1% increase in the proposed rule. That’s a difference of about $13 billion. The final rule also eliminated many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage? Are their lobbyists really that good? 

Goldman: Their lobbyists are pretty good. This was a year where there were — I think CMS [the Centers for Medicare & Medicaid Services] said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think it’s also not that surprising. Historically, the final rate announcement for Medicare Advantage is almost always a little higher than the proposed because they incorporate additional data from the end of the previous year that wasn’t available when first rate is proposed, the initial rate is proposed. But certainly they backed away from a big change to risk adjustment, or, like, the way to adjust payment based on how sick a plan’s enrollees are. You get more pay …  

Rovner: Because that’s where the overbilling was happening, that we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severe illness, and using that to get additional payments. 

Goldman: Right. And they did move forward with a plan to prevent diagnoses that are not linked to information that’s in a patient’s medical chart from being used for risk adjustment. But a lot of plans had said, like, Yeah, this is, that’s the right thing to do, and it’s not going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said, We’re still really focused on trying to right-size this program. That’s still a priority for us as an administration, but we also want to safeguard it. And so I think insurers are not off the hook entirely. There’s still going to be a lot of scrutiny, but their lobbyists are pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare. 

Rovner: And we have seen this before, that when Congress cuts “overfunding” for Medicare Advantage, the plans, seeing that they can’t make its big profits, drop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So, in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.  

Well, apparently, one group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid. But we at KFF Health News have a story this week about legal immigrants who’ve paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is apparently the first time an entire category of beneficiaries are having their Medicare taken away. I’m surprised there hasn’t been more attention to this, or if it’s just too much all happening at once. 

Ollstein: I mean, there’s a lot happening at once, and even just in the space of immigrants’ access to health care, there is so much happening at once. And so this is obviously having a huge impact on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with a thousand other things, Medicaid cuts, you know, these federal changes, work requirements, are grappling with this as well. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I mean, I thought it was, there was a striking quote in the story from Michael Cannon, who basically said, The reason this isn’t resonating is because this won’t upset the Republican base. And I think that’s a striking quote to be considered. 

Rovner: Michael Cannon, libertarian health policy expert, just kind of an observer to this one. But yeah, I think that’s true. I mean, or at least the perception is that these are not Republican voters, although, you know, as we’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters. So we will see how this all plays out.  

Well, at the same time that this is all going on, the folks over at the newsletter “Healthcare Dive” are reporting that the Centers for Medicare & Medicaid Services are trying to embark on all these new initiatives on fraud, and work requirements, and artificial intelligence with a diminished workforce. While CMS lost far fewer workers in the DOGE [Department of Government Efficiency] cuts last year than many other of the HHS agencies — it was in the hundreds rather than the thousands — CMS has long been understaffed, given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and Medicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDA Commissioner Marty Makary said he wants to hire more workers to replace the 3,000 who were RIF’ed or took early retirement there at the FDA. And CMS does have lots of job openings being advertised. But it’s hard to see how replacing trained and experienced workers with untrained, inexperienced ones are going to improve efficiency, right? 

Goldman: Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. I don’t, I think that is a dynamic that far predates this administration, but … 

Rovner: Oh, absolutely. 

Goldman: But it’s certainly interesting. And … CMS has very ambitious plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this CMS, they are generally like, pretty support- … like, they say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable. 

Rovner: And as we have mentioned many times, you know, Dr. [Mehmet] Oz, the head of CMS, is very serious about his job and doing a lot of really interesting things. It’s just, it’s hard, you know, in the federal government, if you don’t have the resources that you want to … if you don’t have the resources to match your ambitions. Let’s put it that way.  

Well, meanwhile, on the Medicaid front, we’re already seeing states cutting back, and some of the results of those cutbacks. Stateline has a piece on how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people and also tend to lose money. And The New York Times has a heartbreaking story of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed funding the program, but obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations wouldn’t see their services cut. But that’s not how this is playing out, right?  

Weber: I just think the story by Ellen Barry, who you should always read on mental health issues in The New York Times, “Idaho Cut Services for People With Schizophrenia, Then the Deaths Began,” is such an illustrative example of unintended consequences from these cuts. And the reason that they’re being reversed — by Republican legislators, no less — in Idaho, is because it’s more expensive to have cut the money from it than it is efficient. I mean, what they found was, is that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations, that this avoided. And I think it’s a real canary in the coal mine situation, because we’re only starting to see these states cut these things off. And this was a pretty immediate multiple-death consequence. And I think we’re going to see a lot of stories like this, of a variety of programs that we all don’t even have any idea that exist in the safety net across the country that are being chipped away at.  

Rovner: Well, turning to other news from the Department of Health and Human Services, we’re getting some more competition here at What the Health? Health secretary Kennedy has announced he’ll be unveiling his own podcast, called The Secretary Kennedy Podcast, next week. He promises to, according to the trailer posted online on Wednesday, quote, “name the names of the forces that obstruct the paths to public health.” OK then, we look forward to listening.  

Meanwhile, in actual secretarial work, the secretary this week also unveiled changes to the charter of the Advisory Committee on [Immunization] Practices after a federal judge last month invalidated both the replacement members that he’d appointed last year and the changes made to the federally recommended vaccine schedule. So what’s going to happen here now? Will this get around the judge’s ruling by watering down the expertise that members of this advisory committee are supposed to have in vaccines? And why hasn’t the administration appealed the judge’s ruling yet? 

Goldman: You know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the secretary and HHS says, OK, you don’t like it that way? We’ll do it this way, and then they’ll do it another way, and advocates will sue, and we’ll see how this plays out going forward in the courts. I think this is not the end of the story. Even though the judge’s decision was a big win for vaccine advocates, it’s just we’re in the midpoint, if that. 

Rovner: And Lauren, speaking of vaccines, your colleague Lena H. Sun has quite the scoop on HHS and vaccine policy. 

Weber: Yeah, Lena Sun is always delivering. She found out that the acting director of the CDC [Centers for Disease Control and Prevention] at the time delayed publication of a report showing that the covid-19 vaccine[s] cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting, that some of his underlings are not necessarily touting the benefits of vaccine, so to speak. And I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaser was very leaning into the Kennedy that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public, and so on. And then the press team had these statements of, like, Kennedy will investigate the affordability of health costs and food and nutrition. And I think this dichotomy of who Kennedy is and who the White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast. So I think we will all be listening to hear how that goes. 

Rovner: Yeah, we keep hearing about how the secretary is being, you know, sort of put on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite at odds with him having his own podcast. Alice, do you want to …? 

Weber: I guess, it depends on who’s editing the podcast and who they have on. I’m just very … you could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see guests on it. 

Ollstein: I mean, it’s also worth noting that this is an administration of podcasters. I mean, you have Kash Patel, you have so many of these folks who have a history of podcasting, clearly have a passion for it, just can’t let it go while working a full-time, high-pressure government job.  

Rovner: We shall see. Meanwhile, HHS, together with the Environmental Protection Agency, is waging war on microplastics, those nearly too impossible to detect bits of plastic that are getting into our lungs and stomachs and body tissues through air and water and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we don’t have enough information to regulate them yet. I would think this would be one of those things that pleases both MAHA [Make America Healthy Again] and the science community, right? Or is it just, as one MAHA supporter called it, theater? 

Goldman: I think this is a great example of the, you know, part of the reason why MAHA is so interesting to such a wide swath of people. Like, there’s a lot of legitimate concern, not that other concerns aren’t necessarily legitimate, but there’s a lot of concern over, from the scientific community, over microplastics. I’m honestly surprised that we’re this far into the administration with this announcement. I would have thought that this is something they would have done sooner, but they obviously had other priorities as well. 

Rovner: Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr. Oz are declaring war on junk food in hospitals. Again, this seems like a popular and fairly harmless crusade; hospitals shouldn’t be serving their patients ultraprocessed food. Except, almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who, because of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health care is as simple as it seems, right?  

Weber: I think what’s also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I just am curious to see how fast that gets implemented. And it’s a very valid — a lot of people complain about hospital food. It’s a very valid thing to push for better food. But I also question, as I understand it, this seems more like a carrot than a stick when it comes to the regulation they put out. 

Rovner: As it were. 

Weber: As it were. And so I’m curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves — the Northwell [Health] example in New York is a good example — to really improve their hospital food. And frankly, it’s a money maker. If your food’s better, people come to your hospital, especially in an urban area where there is hospital competition. So you know, like most MAHA topics, there’s a lot of interesting points in there, and then there’s a lot of what’s the reality and what’ actually going to happen. And so I’ very curious to see how this continues to play. 

Rovner: I did a big story, like, 10 years ago on a hospital chain that had its own gardens, that literally grew its own healthy food. So this is not completely new but, again, interesting. 

All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: I have a piece from my co-worker Simon [J.] Levien, and it is called “A Slowdown in US Visa Processing Is Wreaking Havoc on Foreign Doctors’ Lives.” This is about thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and, in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. And so they’re sort of in this scary limbo, and that’s putting these hospitals and clinics that they work in in a really tough bind. And so they’re hammering the Trump administration to give them answers about what their fate is. You know, they’re not trying to deport them yet, but they’re not allowing them to continue working either.  

Rovner: For an administration that’s been pushing really hard to improve rural health care, this does not seem to be a way to improve rural health care. Maya. 

Goldman: My extra credit this week is called “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.” It’s a great KFF Health News scoop from Amanda Seitz and Maia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence, doing these small regulatory announcements that could have big impact. Basically, the Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get very detailed medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And, obviously, there is a strong concern that that could be used against them.  

Rovner: Yeah … this was quite a scoop. Really, really interesting story. Lauren. 

Weber: Mine was a pretty alarming story by Holly Yan at CNN: “These Common Drug Tests Lead to Tens of Thousands of Wrongful Arrests a Year, Experts Say. One State Is Fighting Back.” And basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth or ecstasy, and horrible legal and other consequences of this kind of misdiagnosis in the field. And the reason these drug tests are often done is because they’re cheaper. There’s a more expensive, more accurate version, but these are cheaper. They’re done in the field. But the potential side effects and horrible, wrongly accused effects are quite large, and so Colorado has passed this law to try and move away from this. And it’s curious to see if other states will follow suit. 

Rovner: Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from The Atlantic by Katherine [J.] Wu, and it’s called “HHS Officials’ Year in Purgatory Is Ending.” And it’s about how some of the very top career officials from the NIH [National Institutes of Health], the CDC, and other agencies have, after having been put on leave more than a year ago, finally been reassigned to far-flung outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now, if these officials’ skills matched those needed by the Indian Health Service, this all might make some sense. But what the IHS most needs are active clinicians: doctors and nurses and social workers and lab technicians. And those who are now being reassigned are largely managers, including — and here I’m reading from the story, quote — “the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer.” The Native populations who are ostensibly being helped here aren’t very happy about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American who’s now running for governor in New Mexico, called the reassignment proposals, quote, “shameful” and “disrespectful.” Also, and this is my addition, not a very efficient use of human capital. 

OK, that’s this week’s show. Thanks this week to our fill-in editor, Mary-Ellen Deily, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X @jrovner, or on Bluesky @julierovner. Where do you guys hang these days? Maya. 

Goldman: I am on LinkedIn under my first and last name, Maya Goldman, and on X at @mayagoldman_. 

Rovner: Alice. 

Ollstein: I’m on Bluesky @alicemiranda and on X @AliceOllstein. 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both X and Bluesky. 

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

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Family physician Eric Boose has been using an artificial intelligence tool to get back to what he calls “old-fashioned medicine” — talking with patients face-to-face, without having to type into a computer at the same time. 

“I can really just sit there and engage and just focus on them and listen,” said Boose, who practices at Cleveland Clinic. 

Roughly two years ago, he started using an AI notetaker app during patient visits. The tool listens while he talks with patients and then automatically generates a visit summary based on the conversation. The summary is usually ready within seconds after the appointment ends. 

“It’s taking care of all that tedious work of charting and taking notes during the visit,” he said. “It’s just freeing up a lot more time to get that done, and I can get home to my family earlier.” 

Nearly a third of physician practices are using AI scribes and others are working to add the tool, in an effort to cut down on administrative work. 

If your practitioner suggests using an AI scribe at your next appointment, here are three things to keep in mind:

1. Clinicians should ask for your permission. 

At the start of an appointment, your doctor might ask something like, “Are you OK if I use an AI scribe to help me take notes during this appointment?” A common practice is to accept verbal, not written, consent from patients before turning the tool on. However, the legal requirements for getting permission to record a patient conversation vary by state. 

Boose said you can ask to pause the AI scribe at any point, especially to discuss something sensitive. And if you decline altogether, your practitioner will likely return to taking manual notes on a computer. 

2. AI scribes make mistakes too, so check their work. 

Like other AI tools, medical scribes can “hallucinate,” or spontaneously add errors into a record. AI scribes can also omit important information or miss context clues within a conversation. 

Clinicians are supposed to review and edit the AI-generated visit summaries before adding them to a patient’s record. As a patient, it’s a good practice to carefully review your visit summary and contact your health provider if you notice errors. 

3. Yes, the AI company could use your data, with limitations. 

Companies and health systems that offer AI scribe tools have access to medical data and are subject to federal standards about how they use and store patient data, under the Health Insurance Portability and Accountability Act, more commonly known as HIPAA. 

They may use data from your appointment to help improve their software without informing you, said Darius Tahir, who reports on health technology for KFF Health News. “ If information is ‘de-identified,’ which can mean stripping it of identifiers [and] making sure it’s not personally traceable back to people, then it is more free to be used in more ways,” he said. “There are way fewer regulatory requirements.” 

If you want to know how your data is being used, ask either your practitioner or medical system for more information. But you might not get a clear answer, Tahir said. 

People and Policy 

The U.S. health care system will likely continue to integrate AI technology into patient care. The Trump administration strongly supports the development and use of AI, especially in health care. In early 2025, President Donald Trump issued an executive order reducing existing regulations on AI to help the U.S. “retain global leadership of artificial intelligence.” In December, the U.S. Department of Health and Human Services released an AI strategy stating that the department supports “integrating AI to modernize care and public health infrastructure to improve health at the individual and population levels.” 

Emily Siner at Nashville Public Radio contributed to this report. 

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and KFF Health News.

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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Big swings in federal vaccine policy are creating confusion for some parents and clinicians. A federal judge recently struck down Health and Human Services Secretary Robert F. Kennedy Jr.’s new, shortened list of recommended vaccines for all kids. But with the Trump administration likely to appeal, the situation is in flux. Meanwhile, cases of vaccine-preventable illnesses such as measles, mumps, and whooping cough continue to accumulate nationwide and in the Washington, D.C., area.

Julie Rovner, KFF Health News chief Washington correspondent and host of the podcast What The Health?, appeared on WAMU’s “Health Hub” on April 1 to break down what’s changed, what hasn’t, and what’s still unclear.

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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This story can be republished for free (details).

Recent polling finds that health costs are a top worry for much of the American public, while Republicans in Congress are considering still more cuts to federal health spending on programs such as Medicaid and the Affordable Care Act.

Meanwhile, the Supreme Court ruled that Colorado cannot ban mental health professionals from using “conversion therapy” to treat LGBTQ+ minors, a decision that’s likely to affect other states with similar laws.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Sandhya Raman of Bloomberg Law.

Panelists

Among the takeaways from this week’s episode:

• Republicans reportedly are weighing still more cuts to federal health spending. With the war in Iran draining military coffers, GOP leaders in Congress are eying a drop in health funding — a decision that could exacerbate problems following the passage of legislation expected to lead to major reductions in Medicaid spending, as well as the expiration of enhanced ACA premium subsidies that were not renewed by lawmakers last year. And President Donald Trump’s budget could include another sizable reduction in funding to the National Institutes of Health.
• The Supreme Court this week struck down a Colorado law prohibiting licensed professionals from practicing a form of therapy that tries to change the sexual orientation or gender identity of LGBTQ+ minors. States have long had the power to regulate medical care, with the goal of restricting treatments that can be harmful. Also, the Idaho Legislature passed a bill requiring teachers and doctors to out transgender minors to their parents.
• Meanwhile, the Department of Health and Human Services is studying whether to make private Medicare Advantage plans the default option for seniors enrolling in Medicare, a change that would seem to conflict with the Trump administration’s scrutiny of overpayments to the private insurance plans. And a tech nonprofit’s lawsuit seeks to reveal more about the administration’s pilot program testing the use of artificial intelligence in prior authorization in Medicare.

Also this week, Rovner interviews KFF Health News’ Elisabeth Rosenthal, who wrote the last two KFF Health News “Bill of the Month” stories. If you have a medical bill that’s outrageous, infuriating, or just inscrutable, you can submit it to us here.

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

Julie Rovner: New York Magazine’s “The Dog Owners Taking Their Injured Corgis and Doodles to Tijuana: Mexico Is to Pet MRIs What Turkey Has Become for Hair Transplants,” by Helaine Olen.  

Jessie Hellmann: The Texas Tribune’s “‘Don’t Take Me to the Hospital’: Undocumented Immigrants in Texas Are Delaying Medical Care,” by Colleen DeGuzman, Stephen Simpson, Terri Langford, and Dan Keemahill. 

Sandhya Raman: Science’s “Supporters Push To Revive Moribund Agency Studying Patient Care,” by Jocelyn Kaiser.  

Alice Miranda Ollstein: The New York Times’ “Cuban Patients Are Dying Because of U.S. Blockade, Doctors Say,” by Ed Augustin and Jack Nicas.  

Also mentioned in this week’s podcast:

• KFF Health News’ “States Pay Deloitte, Others Millions To Comply With Trump Law To Cut Medicaid Rolls,” by Samantha Liss and Rachana Pradhan.
• KFF Health News’ “Trump’s Hunt for Undocumented Medicaid Enrollees Yields Few Violators,” by Phil Galewitz.
• The Colorado Sun’s “Why Children’s Hospital Colorado Has Not Resumed Gender-Affirming Care Despite a Favorable Court Ruling,” by John Ingold.
• Politico’s “Poll: The Battle for MAHA That Could Sway the Midterms,” by Alice Miranda Ollstein, Erin Doherty, Marcia Brown, and Carmen Paun.
• The New York Times Magazine’s “Why Some Teenage Girls Are Trading Medicine for MAHA,” by Coralie Kraft.
• NOTUS’ “To Sue or To Woo? The Medical Establishment Is Divided on MAHA,” by Margaret Manto.
• The Dallas Morning News’ “A Texas Pregnancy Center Told Her Everything Was Fine. Three Days Later, She Aas in the ER,” by Emily Brindley.

[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 WAMU Public Radio in Washington, D.C. 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 covering Washington. We’re taping this week on Thursday, April 2, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my interview with KFF Health News’ Elisabeth Rosenthal, who reported and wrote the last two KFF Health News “Bills of the Month.” One is about a patient who got caught in the crossfire over prices between insurers and drug companies. The other is about a woman who, and this is not an April Fools’ joke, got her insurance canceled for failing to pay a bill for 1 cent. But first, this week’s news. 

So Congress is on spring break, but when they come back, health policy will be waiting. A new Gallup poll out this week found 61% of those surveyed said they worry about the availability and affordability of health care, quote, “a great deal.” That was 10 percentage points more than the economy, inflation, and the federal budget deficit, and it topped a list of 15 domestic concerns. And while we are still waiting for final enrollment numbers for Affordable Care Act plans, we do know that the share of people paying more than $500 a month for their coverage doubled from last year to 2026. Yet Axios this week is reporting that Republicans are considering still more cuts to the Affordable Care Act to potentially pay for a $200 billion war supplemental. What exactly are they thinking? And it’s looking more like Republicans are going to try for another budget reconciliation bill this spring. Isn’t that, right, Jessie? 

Hellmann: House Budget chair Jodey Arrington has kind of been pushing this idea really hard of going after what he says is fraud in mandatory programs like Medicare and Medicaid. He’s also talked about funding cost-sharing reductions, which is an idea that slipped out of the last reconciliation bill, and it’s a wonky kind of idea … 

Rovner: But I think the best way to explain it is that it will raise premiums for many people. That’s how I’ve just been doing it.  

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

Hellmann: It would reduce spending for the federal government but wouldn’t really help people who buy insurance on the marketplace. He hasn’t been very specific. He’s also talked about, like, site-neutral policies in Medicare, but it’s hard to see how all of this could make a serious dent in a $200 billion Iran supplemental. There’s also a new development. I think President [Donald] Trump threw a wrench in things yesterday when he said he wanted the reconciliation bill to focus on border spending and immigration spending to cover a three-year period, and now Senate Majority Leader John Thune is saying that there’s probably not room for much else in the bill. So, unclear what the path forward is for all of that. 

Rovner: Yeah, and of course, that was part of the deal to free up the Department of Homeland Security’s budget in the appropriation. It’s all one sort of big, tied-up mess at this point. Alice, I see you’re nodding. 

Ollstein: Yeah. I mean, what often happens with these reconciliation bills is it starts out with a tight focus and everyone’s unified, and then, because it can often be the only legislative train leaving the station, everybody gets desperate to get their pet issue on board, and then the more and more things get piled onto it, then they start losing votes, and people start disagreeing more. And so I think even though this is still in the ideas phase, you’re already seeing some signs of that happening. And when it comes to health care, it can be particularly fraught. And of course, you have lawmakers, especially in the House, with wildly different needs. Some of them need to fend off a primary from the right, and so they want to be as conservative as possible. Some are fighting to hang on in swing districts, and so they want to be more moderate. And these things are in conflict. And so these proposals to cut health spending, even more than the massive amount that was cut last year, are already, you know, raising some red flags among some moderate Republican members. And it’s very possible the whole thing falls apart. 

Rovner: Well, along those lines, we’re supposed to get the president’s budget on Friday, which is only two months late. It was due in February. And while I haven’t seen much on it, Jessie, your colleagues at Roll Call are reporting that the budget will seek a 20% cut to the National Institutes of Health. That’s only half the cut that the administration proposed last year. But given that Congress actually boosted the agency’s budget slightly this year, that feels kind of unlikely. 

Hellmann: Yeah, I don’t think that the appropriators are likely to go along with this. They have really strong advocates, and Sen. Susan Collins, who’s chair of the Senate Appropriations Committee. And, like you said, they rejected cuts last year. Kind of surprised. Twenty percent is not as deep as the Trump administration went last year. I was actually kind of surprised it wasn’t a bigger proposed cut. But either way, I don’t think Congress is going to go along with that.  

Rovner: Meanwhile, I saw a late headline that FDA is looking to hire back people after DOGE [Department of Government Efficiency] cut thousands of people last year. Sandhya, HHS [Department of Health and Human Services] is just in this sort of personnel churn at this point, isn’t it? 

Raman: Yeah, I think that HHS is kind of getting bit in the foot from, you know, we’ve had so many of these layoffs, and we’ve also had a lot of people just flee the various agencies over the past year because of some of this instability and all of these changes. And as we’re getting closer and closer to, you know, deadlines of things that they need to get done, they’re realizing that they do need more personnel to get some of those things done, as we’ve been passing deadlines. So I don’t think it’s something that’s unique to just FDA. But I think the way to solve this — it’s not an overnight thing for the federal government to staff up. It’s a longer process, but it’s really showing in a lot of areas right now. 

Rovner: Yeah, I would say this is not like TSA [Transportation Security Administration], where you can, you know, hire new people and train them up in a couple of months. These are … many of them scientists who’ve got years and years of training and experience at doing some of these jobs that, you know, the federal government is ordered to do by legislation. 

Raman: Yeah, those statutes are things that, you know, if they don’t meet those deadlines, those are things that are going to be challenged, and just further tie things up in litigation. And we already see so many of those right now that are making things more complicated.  

Rovner: Well, in news that is not from Congress or the administration, the Supreme Court this week said Colorado could not ban licensed mental health professionals from using so-called conversion therapy aimed at LGBTQ individuals, at least not on minors. What’s the practical impact here? It goes well beyond Colorado, I would think. 

Ollstein: Interesting, because a lot of people think of this as regulating health care, restricting providers from providing health care that is not helpful and maybe actively harmful to the health of the patients. 

Rovner: And that’s … I would say that’s been a state … 

Ollstein: Power. 

Rovner: … power. For generations.  

Ollstein: Absolutely. Right, I mean, you don’t want people selling sketchy snake oil pills on the street, etc. So many people view this as akin to that. But it has morphed in the hands of conservative courts into a free speech issue, and that, you know, these laws are restricting the speech of mental health workers who are against people transitioning. And so, yes, it definitely has national implications. And of course, we are in a national wave right now of both state and federal entities, you know, moving in the direction of rolling back trans rights in the health care space and beyond. 

Rovner: Yeah. In related news, regarding Colorado and minors and gender, The Colorado Sun reports that Children’s Hospital Colorado has not yet resumed providing gender-affirming care for transgender youth. That’s despite a federal judge in Oregon having struck down an HHS declaration that would have punished hospitals for providing such services. Apparently, the hospital in Colorado is concerned that the judge’s ruling doesn’t provide it with enough legal cover for them to resume that care. I’m wondering, is this the administration’s strategy here to get organizations to do what they want, even if they might lack the legal authority to do it? Just by making them worry that they might come after them? 

Raman: I think the chilling effect is definitely a big part of this broader issue. I mean, we’ve seen it in other issues in the past, but just that if there is this worry that it’s a) going to stop on the provider side, new folks taking part in providing care, and also just it’s going to make patients, even if there are opportunities, even less likely to want to go because of the fears there. I mean, it goes broader than that. We’ve had FTC [Federal Trade Commission] complaints, where they have gone and investigated different places that provide gender-affirming care or endorse it. So I think it’s broader than this, and really part of that chilling effect.  

Rovner: And Alice, as you were saying, I mean, the subject of transgender rights, or lack thereof, remains a political hot topic. The Idaho Legislature this week passed a bill that now goes to the governor that would require teachers and doctors to out transgender minors to their parents. Parents could sue teachers, doctors, and child care providers who, quote, “facilitate the social transformation of the minor student.” That includes using pronouns or titles that don’t align with their sex at birth. I don’t know about teachers, but that definitely seems to violate patient privacy when it comes to doctors, right? 

Ollstein: There’s definitely patient privacy issues there. I also think, you know, it’s interesting that this kind of nonmedical transitioning is now coming under attack. Because, you know, you would think that there would be some support for letting a kid, you know, go by a different name for a few weeks, test it out, see how it feels. Maybe it’s a phase, then they discover that they don’t want to actually pursue taking medications and going through a medical transition. But this is sort of shutting down that avenue as well. You can’t even change your appearance, change how you present in the world, at a time when kids are really trying to figure out who they are. So I think the broad acceptance of hostility to medical transitioning for youth is now spilling over into this kind of social transitioning, and I wonder if we’re going to see more of that in the future. 

Rovner: Yeah, I feel like we started with minors shouldn’t have surgery. They shouldn’t do anything that’s not easily reversible. And now we’ve gotten down to, in the Idaho law, there’s actually mention of nicknames. You can’t … a kid can’t change his or her nickname. It feels like we’ve sort of reduced this way, way, way down. 

Ollstein: And I think we’ve seen these laws, laws related to bathrooms. We’ve seen these have negative impacts on people who are not trans at all, people who just are a tomboy or not looking like people’s stereotypes of what different genders may look like. And so there’s a lot of policing of people who are not trans in any way. You know, there’s media reports of people being confronted by law enforcement for going into a bathroom that does align with their biological sex. And so it’s important to keep in mind that these laws have an effect that’s much broader than just the very small percentage of people who do consider themselves trans. 

Rovner: Yeah, it’s kind of the opposite of not being woke. All right, we’re going to take a quick break. We will be right back.  

So while we’ve had lots of news out of the Department of Health and Human Services the past few weeks, it’s been mostly public health-related. But there’s a lot going on in the Medicare and Medicaid programs too. Item A: Stat News is reporting that HHS is studying whether to make the private Medicare Advantage program the default for seniors when they qualify for Medicare. Right now, you get the traditional fee-for-service plan that allows you to go to any doctor or hospital that accepts Medicare, which is most of them. You have to affirmatively opt into Medicare Advantage, which often provides extra benefits but also much narrower networks. What would it mean to make Medicare Advantage the default, that people would go into private plans instead of the government plan, unless they affirmatively opted for the traditional fee-for-service? 

Hellmann: Someone’s experience with … can vary greatly between being on traditional Medicare and Medicare Advantage. If you’re in Medicare Advantage, you could be exposed to narrow networks. You can only see certain doctors that are covered by your plan. You can be exposed to higher cost sharing. A lot of people are kind of fine with their plans until they have a medical issue and need to go to the hospital or they need skilled nursing care. So making this the default could definitely be a challenge for some people, especially people that have complex health needs. Some people on the early side of their Medicare eligibility are fine with Medicare Advantage, and then they get older and they’re not fine with it anymore. So it’s interesting that the administration would kind of float this idea because they’ve been critical of Medicare Advantage. 

Rovner: Thank you. That’s exactly what I was thinking. 

Hellmann: Yeah, they’ve talked about the federal government pays these plans too much, and it’s not for better quality in a lot of cases, and they’ve talked about reforms in that area. So I was a little surprised to see that. 

Rovner: Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know, sort of redid the program in 2003. And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because we’re overpaying them. And now the Republicans seem to have joined a lot of their — at least some Republicans — seem to have joined a lot of the Democrats in saying, Yes, we’re overpaying them. We’re paying them too much. And you know, they talk about the big, powerful insurance companies, and yet they’re now floating this idea to make Medicare Advantage the default. So pick a side, guys. 

All right, well, in other Medicare news, the Electronic Frontier Foundation is suing Medicare officials to learn more about the pilot program that’s using artificial intelligence to oversee prior authorization requests in the traditional Medicare fee-for-service program. The idea here is to cut down on, quote, “low-value services,” things that doctors might be prescribing that aren’t either particularly necessary or shown to actually work. But the fear, of course, is that needed care for patients will be delayed or denied, which is what we’ve seen with prior authorization in Medicare Advantage. This is the perennial push-pull of our health care system, right? If you do everything that doctors say, it’s going to be too expensive, and if you second-guess them, it’s going to be, you know, it might turn out to be too constraining. 

Hellmann: Well, I was just going to say this is another issue that was kind of a little surprising to me, because there’s been so much criticism of the use of prior authorization and Medicare Advantage. And CMS [Centers for Medicare & Medicaid Services] looked at that and said, Oh, what if we did it in traditional Medicare? Like it was never going to go over well politically, and I think there are even some Republican members of Congress who are not in support of this, but they haven’t really made a huge stink about it. Yeah, this wasn’t something I really expected to see. 

Rovner: Yeah, we’ll see how this one plays out too. Well, meanwhile, regarding Medicaid, two really good stories this week from my KFF Health News colleagues Phil Galewitz, Rachana Pradhan, and Samantha Liss. Phil’s story found that efforts in multiple states to find enrollees who were not eligible for the program due to their immigration status turned up very few violators. While Samantha and Rachana detailed the hundreds of millions of dollars states and the federal government are spending to set up computer programs to track Medicaid’s new work requirement, despite the fact that we already know that most people on Medicaid either already work or they are exempt from the requirements under the new law. Is it just me, or are we spending lots of time and effort on both of these policies that are going to have not a very big return?  

Ollstein: Well, that’s what we’ve seen in the few states that have gone ahead and attempted this before, that it costs a lot, and you insure fewer people. And that’s not because those people got great jobs with great health care. You insure fewer people, and the level of employment does not meaningfully change. 

Rovner: I would say you insure fewer people who may well still be eligible. They just get caught in the bureaucratic red tape of all of this. 

Ollstein: Exactly. These tech systems that are being set up are challenging to navigate, if people even have a means to do it, if they even have a smartphone or a computer or access to Wi-Fi. There are not that many physical offices they can go to to work it out if they need to. And some of those are very far from where they live. And so you see some of these tech vendors, you know, are set to make off very well out of this system, and people who need the care not so much. And then, of course, you know, it’s not just the patients who will feel the impact. You have these hospitals around the country that are on the brink of closure. And if they have people who used to be insured — they used to be able to bill and get reimbursed for their services, suddenly they’re uninsured — and they’re coming in for emergency care that they can’t pay for, that the hospital has to throw out-of-pocket for, that puts the strain that some of these facilities can barely cope with. And so you’re seeing a lot of state hospital associations sounding the alarm as well. 

Raman: I would also say the timing is interesting. You know, we spent so much time and energy last year going through the reconciliation process to tighten these areas, to get in the work requirements, to reduce immigrant eligibility for Medicaid. And then, you know, as they’re gearing up to possibly do this again, to defer their crackdown on health care as part of that, instead of it saving money — that it’s not having as much of an effect and costing so much, in the case of the work requirements, where we’re not expected to see the return of it. 

Rovner: Yeah, that may be, although I guess the return is that people will not have insurance anymore, and so the federal government, the states, won’t be spending money for their medical care. They’ll be spending money on other things. All right, of course, there’s more news from HHS than just Medicare and Medicaid this week. We also have a lot of news about the Make America Healthy Again movement, which is a sentence that 2023 me would definitely not recognize. Alice, you have a cool story this week about a new poll that finds the MAHA vote isn’t necessarily locked in with Republicans. Tell us about it. 

Ollstein: Yeah, that’s right. So Politico did our own polling on this, because we hadn’t really seen good data out there on who identifies as MAHA and what do they even believe about the different parties and about different issues. And so we found that, OK, yes, most people associate MAHA with the Republican Party — most, but not all. But a lot of voters who identify as MAHA, and a lot of voters who voted for Trump in 2024 don’t think that the Trump administration has done a good job making America healthy again. And they rank the Democratic Party above the Republican Party on a lot of their top priority issues, like standing up to influence from the food industry and the pharmaceutical industry. They rank Democrats as caring more about health. So, you know, we found this very fascinating, and it supports what we’ve been hearing anecdotally, where Democratic candidates, a handful of them, and Democratic electoral groups, are really seeing a lot of opportunity to go after MAHA voters and win them over for this November. And you know, we should remember that even if you don’t see a big swing of people voting for Democrats, even if MAHA voters are disillusioned and stay home, that alone could decide races. You know, midterms are decided by very narrow margins. 

Rovner: Well, two other really interesting MAHA takes this week. One is from NOTUS. It’s about the tension in and among medical groups, about how to deal with HHS Secretary [Robert F.] Kennedy [Jr.] and the MAHA movement. The American Medical Association seems to be trying to play nice, at least on things it agrees with the secretary about, lest it risk things like its giant contract to supply the CPT billing codes to Medicare. On the other hand, the American Academy of Pediatrics and the American College of Physicians have been more confrontational to the point of going to court. The other story, from The New York Times Magazine, profiles teen girl influencers pushing MAHA. One thing I noticed is that all of the teens in the story seem to suffer from physical problems that are not well understood by the mainstream medical community, and so they turned online to seek advice instead, which is understandable in each individual case. But then they turn around and try to influence others. And you can see how easily misinformation can spread. It makes me not so much wonder — it makes me see how, oh, this is how this stuff sort of gets out there, because you see so much … and Alice, this goes back to what you were saying about MAHA is not a movement that’s allied with one particular political party. It’s more of sort of a mindset that doesn’t trust expertise. 

Ollstein: I think it spans people who identify as Democrats, identify as Republicans. And, you know, we’re not really interested in politics until the rise of Robert F Kennedy Jr., and so I think it does show a lot of malleability. And there is a fight for this, for this cohort right now, on the airwaves, on the internet, etc.  

Rovner: And, as The New York Times pointed out, you know, we’ve thought of this as being sort of a young men cohort. It’s now also a young woman cohort, too. So there’s lots of people out there to go and get, for these people who are pursuing votes.  

Well, turning to reproductive health, we have a couple of follow-ups to things we covered earlier. The big one is Title X, the federal family planning program, whose grants were set to end as of April 1. Sandhya, it looks like the federal government is going to fund the program after all? 

Raman: Yeah, the family planning grantees in this space have been on edge for so long, you know, waiting to see would they finally just issue the grant applications. And then it was such a short timeline for them to get them done. And then everyone that I talked to in the lead-up was expecting some sort of delay, just because it was such a short timeframe before they were set to run out of money. And so I think that they were all pleasantly surprised that HHS was able to turn things around when they confirmed that the money is going to go out the day before the deadline. It does take a couple of days to go through the process and get that done. But I think the new worry now is also that in the statements that the White House and HHS have made is just that they are still at work on getting Title X rulemaking out so that a lot of these groups would be ineligible if they also provide abortions. Or we also don’t know what will be in the rule — if it will be broader than what was under the last Trump administration, if it encompasses other restrictions. So a little bit of both there.  

Rovner: Yeah. And I also was gonna say, I mean, we know that anti-abortion groups are unhappy with the administration, so this would be one place where they could presumably throw them a bone, yes? 

Ollstein: So people on both sides have been a little mystified why we haven’t seen a new Title X rule yet. They were expecting that near the beginning of last year, especially if the administration was just planning to reimpose his 2019 version, that would be pretty straightforward and simple. And yet, here we are, more than a year into the administration, and we haven’t really seen this yet. The administration did confirm to me — we put this in our newsletter — that a new rule is coming. And they said it will align with pro-life values. And the White House’s comments to some conservative media outlets were very explicit that this will be the last time Planned Parenthood can get funding. Now I wonder if that statement will come back to bite them in court, because the rule previously was very careful not to name Planned Parenthood or name any specific organization. It just imposed criteria that applied to a lot of Planned Parenthood facilities, and in order to make them ineligible for Title X funding. And so I wonder if that will help Planned Parenthood sue later on. But we’ll put a pin in that and come back to it. But we have confirmed that some sort of new rule is coming, but we don’t know when, and we don’t know what it would entail. There’s a lot of speculation that this could go way beyond an attempt to kick Planned Parenthood out. There’s speculation it could involve restrictions on particular forms of birth control. There’s speculation that it could entail restrictions on gender-affirming care. There’s speculation that it could involve rules around parental consent, stricter parental consent requirements, which are currently something that’s not part of Title X. And so we just don’t know, you know, in order to mollify the anti-abortion groups that are upset, they are saying, Don’t worry, new rule is coming. But again, we don’t know when, and we don’t know what’s going to be in it. 

Rovner: Well, we’ll be here when it happens. Another topic we’ve talked about at some length is crisis pregnancy centers, which are anti-abortion organizations that sometimes offer some medical services. This week, we learned about a Texas woman who was told after an ultrasound at a crisis pregnancy center that she had a normal pregnancy, and three days later, ended up in emergency surgery because the pregnancy was not normal, but rather ectopic — in other words, implanted in her fallopian tube rather than her uterus, which could have been fatal if not caught. This is not the first such case, but it again raises this question of whether these centers should be treated as medical facilities, which we’ve talked about many states do.  

Raman: And I think a lot of the rationale that people have for trying to do some of these mandatory ultrasounds, you know, encouraging people to go to this is because the talking point is that you don’t know if you have an ectopic pregnancy, you don’t have another complication, so you should go here to instead of just taking a medication abortion. So … we’re coming full circle here, where this is also not helping the case, if you’re not finding the full information there. So I think that was an interesting point to me …  

Rovner: Yeah, it’s going on both sides basically. It is fraught, and we will continue to cover it. 

All right, that is this week’s news. Now we’ll play my interview with Elisabeth Rosenthal at KFF Health News, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast KFF Health News’ Elisabeth Rosenthal, who reported and wrote the last two “Bills of the Month.” Libby, thanks for coming back. 

Elisabeth Rosenthal: Thanks for having me.  

Rovner: So let’s start with our drug copay card patient. Before we get into the particulars, what’s a drug copay card? 

Rosenthal: Well, copay cards, or copayment programs, are things that the drug companies give patients. You know, when it says you could pay as little as $0, where they pay your copayment, which is usually pretty big — when you see a copay card, it means the price is big, and they’ll bill your insurance for the rest. So for patients, it sounds like a good deal, and it is a good deal when they work. 

Rovner: So tell us about this patient, and what drug did he need that cost so much that he required a copay card? 

Rosenthal: Well, the funny thing is — his name is Jayant Mishra, and he has a psoriatic arthritis. And the doctor told him, you know, there’s this drug called Otezla that would really help you. And he was, he was a little cautious, because he knew it could be expensive, so he did wait a few months, and his symptoms, his joint pain, in particular, got worse. He was like, OK, I’ll start it. So he started it the first month, and it worked really well.  

Rovner: “It” the drug, or “it” the copay card, or both? 

Rosenthal: Both seemed to work very well. So the copay card covered his copay of over $5,000 and he was like, Oh, this is great. And then what happened was, the next month, he tried to fill it, and it was like, Wait, the copay card didn’t work! And really what happens is copay cards, they are often limited in time and in the amount of money that’s on them. So depending on how much the copay is, they can run out, basically expire. You used all the money, and you have a drug that you’ve used that is working really well for you, and then suddenly you’re hit with a big bill. So they kind of get people addicted to drugs, which they then can’t afford.  

Rovner: And what happened in this case was the insurance company charged more than expected, right? 

Rosenthal: Well, Otezla, you know, there’s so many things about this, and many “Bill of the Month” stories that, you know, are eye-rollers. Otezla — there are biosimilars that were approved by the FDA in … 2021? … which everyone’s talking about, faster approval of biosimilars. Well, this was approved, but the drugmaker filed multiple suits and patent infringement, and so in the U.S., it won’t be on the market, the biosimilar, until 2028, so that’s a problem too. 

Rovner: So if you want this drug, it’s going to be expensive. 

Rosenthal: It’s going to be expensive. And the other problem is copay cards. Insurers used to say, OK, that will count towards your deductible, right? So you didn’t really feel it, right? Because you got a $5,000 copay card, and you had a $5,000 deductible if you had a high-deductible plan. And everything was good. Now, insurers kind of said, Whoa, we’re not sure we like these things. So yeah, you can use them, but it won’t count towards your deductibles. So they’re not nearly as useful as they might have been in the past. But patients are really stuck, because these are really expensive drugs that most people couldn’t afford without copay cards. 

Rovner: So what eventually happened to this patient, and how can other people avoid falling into the copay card trap? 

Rosenthal: So basically, because he had used up the amount on the copay card, which was $9,400 for the year, by the second month, he tried for the third month to kind of ration his drugs to take half as much, and his symptoms came back. And then the lucky thing for him was then it was January, right, copay cards are usually done for the year. So he got a new copay card for another $9,400 and he was good for January, and he paid with his health savings account for the first month’s copay, with the copay card the second month, with the copay card and his health savings account. And when this went to press, he wasn’t sure how he was going to pay for the rest of the year. And for him, it’s not a huge problem, because he has a very well-funded health savings account, which few of us do, but he was really up in the air for the rest of the year when we wrote about this. 

Rovner: So sort of moral of this story, be careful if you want to take an expensive drug, and the theory that when the drugmaker promises, Oh, you can have this for as little as $0 copay. 

Rosenthal: Well, I think it’s you have to understand what a particular card does. You have to understand what’s the limit on how much is on the copay card. You have to understand how many months it’s good for. You have to understand, from your insurer’s point of view, if that will count as your deductible or not. And then, man, you know, you’re kind of on your own, right? Sometimes your copay card will work great for you, and at other times it will work for a shorter amount of time. And you got to figure out what to do. I think the third, bigger lesson is getting biosimilars, which are these very expensive drugs approved, is not really the big problem in our country. The problem is the patent thickets that surround so many of these drugs that prevent them from getting to the patients who need them.  

Rovner: In other words, you can make a copy of this drug, but you might not be able to get it onto the market.  

Rosenthal: Right. You can make a copy this drug — it [a generic] was approved in 2021 — but that won’t help patients until 2028, which is really terrible. You know, it’s available in other countries, but not here. 

Rovner: So moving on, our March patient had insurance through the Affordable Care Act exchange and was benefiting from one of those zero-premium plans until she got caught in a literally Kafkaesque mess over a 1-cent bill that turned into a 5-cent bill. Who is she and what happened here? 

Rosenthal: Yeah, her name in this wonderful, terrible story is Lorena Alvarado Hill. And what happened here is she was on one of these $0 insurance plans through the Obamacare exchanges with that great subsidy, the Biden-era subsidy, and she and her mother were on the same plan, and her mother went on to Medicare, turned 65. So Lorena didn’t need the family coverage and told the insurer that. And the insurance, of course, automatically recalculates your subsidy, and her premium went from being zero to 1 cent. Now, no human would make that, you know, would say, Oh, that makes sense. And to Lorena, it didn’t really make sense either. She was like, I’m not sure how to pay 1 cent, like, will it work on my credit card? And some of the bills said, you know, you understand that this could impact the continuation of your insurance, but, you know, she was like, 1 cent, I don’t think so. And then she kept going to doctors, and the insurance still worked, and then at some point, four months later, she got a letter in November saying, Oh, your insurance was canceled in July, and you owe money for all these bills. 

Rovner: And what happened with this case? 

Rosenthal: Well, you know, like many of our “Bill of the Month” patients, I celebrate them for being real fighters, because her bill, since her premium was 1 cent a month, went from 1 cent to 2 cents to 3 cents to 4 cents to 5 cents, when they sent her the note saying your insurance has been canceled for the last four months. And what turns out, which is really interesting, is this is a known glitch in the way the subsidies were calculated, were administered. There’s a recalculation of subsidies every time there’s a life event, a kid goes off the plan, you change jobs, get married, you get divorced. So the recalculation happens automatically. And the Biden administration, understanding that this glitch could exist, they gave the insurers the option not to cancel insurance if the amount owed was less than $10. And there were apparently 180,000 people caught in this situation where their insurance could have been canceled for under $10 of a recalculated premium. The Trump administration revoked that rule because their feeling was, you owe something, you pay something. So it’s part of their “stamp out fraud and abuse,” and this was, in their view, abuse of a system when people didn’t pay what they owed.  

Rovner: One cent. 

Rosenthal: One cent, right. So what happened with her is, you know, a good bill-paying citizen sending her daughter to college with loans. She wrote her insurers, she wrote to the state, she wrote to everyone. And as a last resort, of course, someone said, Well, there’s this thing called Bill of the Month you could write to. So when we looked into this, at first HealthFirst, which was her insurer in Florida, said, Oh, she’s not insured through us. And I was like, Yeah, because you canceled her insurance. And then I gave them her insurance number, and they said, Well, yes, according to law, we did the right thing. She didn’t pay, so it was canceled. Somehow, through all of this, word got back to the hospital and the insurer, and they worked together, and her bills were suddenly zero on her portal. So that’s the good news for Lorena Alvarado Hill. It doesn’t really help all those other people whose insurance may have been canceled for premiums that were under $10. 

Rovner: So, basically, if you get a bill for 5 cents, you should pay it. 

Rosenthal: Yeah, you know, it was funny when this story went up, many people were sympathetic, but other commenters said, Well, she should have just paid $1 because you can pay that. And maybe there was a way to pay 1 cent. And I’m kind of with her, like, if I got a bill for 1 cent, life is busy. This is a woman who is a teacher’s aide and works on weekends at a store to help pay for her daughter’s college. Life is busy. You just can’t sweat over 1-cent bills and spend a lot of time figuring out how to pay them. And I guess the lesson is, what’s the worst that can happen in a very dysfunctional system where so much is automated now? The worst that can happen is always really bad. Your insurance could be canceled. 

Rovner: So basically, stay on top of it, I guess, is the message for both of these stories this month. Elisabeth Rosenthal, thank you so much. 

Rosenthal: Thanks, Julie, for having me. 

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

Hellmann: My story is from The Texas Tribune, from a group of reporters who I can’t name individually. There’s too many of them. But it is about how undocumented immigrants are avoiding medical care in Texas after the governor issued an executive order a few years ago requiring that hospitals check patients’ citizenship. So the story found that hospital visits by undocumented people dropped by about a third, and the story also got into how this is bleeding into other types of health care at other facilities, free vaccine clinics are not being attended as widely anymore. People aren’t attending their preventive care appointments, like cancer screenings or prenatal care checkups. Some of these other health facilities are required to check citizenship status, but it’s definitely a chilling effect over the broader health care landscape in Texas. 

Rovner: Yeah. There have been a lot of good stories about that. Sandhya. 

Raman: My extra credit is from Science, and it’s by Jocelyn Kaiser, and the story is “Supporters Push To Revive Moribund Agency Studying Patient Care.” In her story, she talks about how last year, you know, the administration cut a lot of staff at the Agency for Healthcare Research and Quality. They’ve canceled all of the open grants, but Congress still appropriated $345 million for the agency this year, and so supporters kind of want to revive what should be going on at the agency, which hasn’t been issuing any of the grants since the start of the fiscal year, and just kind of make progress on some of the things that this agency does do, like running the U.S. Preventive Services Task Force, which has been, you know, something that has been talked about this year. So thought it was an interesting piece.  

Rovner: Yeah, I’m old enough to remember when AHRQ was bipartisan. Alice. 

Ollstein: So a very harrowing story in The New York Times titled “Cuban Patients Are Dying Because of U.S. Blockade, Doctors Say.” And I will say, since this piece ran, we have seen that an oil shipment from Russia is going through to the island, but I don’t think that will be sufficient to completely wipe away all of the upsetting conditions that this piece really gets into, what is happening as a result of the ramped-up U.S. embargo and blockade of the island. People can’t get food, they can’t get medicine, they can’t get electricity, and that is having a devastating effect on health care. The Cuban health care system has been really miraculous over the years, just the pride of the government. It has meant, prior to this blockade, that their life expectancy was better than ours, and a lot of their outcomes were better. And so this has been really devastating. There’s, you know, harrowing scenes of people on ventilators having to be hand-pumped when the electricity cuts out, babies in incubators, you know, losing power. You know, people having to skip medications, etc. And so this is really shining a light on a foreign policy situation that this administration is behind. 

Rovner: Yeah, that’s really been an under-covered story, too, I think, you know, right off our shores. My extra credit this week is one I simply could not resist. It’s from New York Magazine, and it’s called “The Dog Owners Taking Their Injured Corgis and Doodles to Tijuana: Mexico Is to Pet MRIs What Turkey Has Become for Hair Transplants,” by Helaine Olen. And as the headline rather vividly points out, we are witnessing the rise of pet medical tourism, along with human medical tourism, which has been a thing for a couple of decades now. It seems that veterinary medicine is getting nearly as expensive as human medicine, and that one way to find cheaper care is to cross the border, which is obviously easier if you live near the border. I’m not sure how much cheaper veterinary care is in Canada, but as the owner of two corgis, I may have to do some investigating of my own.  

OK, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us 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 hanging these days? Sandhya. 

Raman: On X and on Bluesky @SandhyaWrites. 

Rovner: Alice. 

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

Rovner: Jessie. 

Hellmann: I’m on LinkedIn under Jessie Hellmann and on X @jessiehellmann. 

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

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