• Click here to hear Boden on “Central Valley Daily”
• Read Boden’s “House Cats With Bird Flu Could Pose a Risk to Public Health”

KFF Health News South Carolina correspondent Lauren Sausser juxtaposed the increasing trendiness of rural health care and the lack of Medicaid expansion in the South on America’s Heroes Group on Feb. 12.

• Click here to watch Sausser on America’s Heroes Group
• Read Sausser’s “Across the South, Rural Health Care Has Become ‘Trendy.’ Medicaid Expansion Has Not.”

KFF Health News contributor Rebecca Grapevine, of Healthbeat, discussed the barriers to lifesaving HIV drugs in Georgia on America’s Heroes Group on Feb. 12.

• Click here to watch Grapevine on America’s Heroes Group
• Read “Biden Rule Cleared Hurdles to Lifesaving HIV Drug, but in Georgia Barriers Remain”

KFF Health News Southern correspondent Sam Whitehead discussed childhood vaccination rates on WUGA’s “The Georgia Health Report” on Feb. 7.

• Click here to hear Whitehead on “The Georgia Health Report”
• Read Whitehead’s “Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” co-reported with Daniel Chang

KFF Health News public health local editor and correspondent Amy Maxmen discussed the U.S.’ pulling out of the World Health Organization on America’s Heroes Group on Feb. 5.

• Click here to watch Maxmen on America’s Heroes Group
• Read Maxmen’s “What a US Exit From the WHO Means for Global Health”

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.

USE OUR CONTENT

This story can be republished for free (details).

She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, say doctors and public health experts.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Feb. 12 press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, President Donald Trump announced the U.S. would withdraw from the WHO.

A critical analysis of the seasonal flu selected for distribution through the CDC’s Health Alert Network has stalled, according to people close to the CDC. They asked not to be identified because of fears of retaliation. The network, abbreviated as HAN, is the CDC’s main method of sharing urgent public health information with health officials, doctors, and, sometimes, the public.

A chart from that analysis, reviewed by KFF Health News, suggests that flu may be at a record high. About 7.7% of patients who visited clinics and hospitals without being admitted had flu-like symptoms in early February, a ratio higher than in four other flu seasons depicted in the graph. That includes 2003-04, when an atypical strain of flu fueled a particularly treacherous season that killed at least 153 children.

Without a complete analysis, however, it’s unclear whether this tidal wave of sickness foreshadows a spike in hospitalizations and deaths that hospitals, pharmacies, and schools must prepare for. Specifically, other data could relay how many of the flu-like illnesses are caused by flu viruses — or which flu strain is infecting people. A deeper report might also reveal whether the flu is more severe or contagious than usual.

“I need to know if we are dealing with a more virulent strain or a coinfection with another virus that is making my patients sicker, and what to look for so that I know if my patients are in danger,” Stokes said. “Delays in data create dangerous situations on the front line.”

Although the CDC’s flu dashboard shows a surge of influenza, it doesn’t include all data needed to interpret the situation. Nor does it offer the tailored advice found in HAN alerts that tells health care workers how to protect patients and the public. In 2023, for example, a report urged clinics to test patients with respiratory symptoms rather than assume cases are the flu, since other viruses were causing similar issues that year.

“This is incredibly disturbing,” said Rachel Hardeman, a member of the Advisory Committee to the Director of the CDC. On Feb. 10, Hardeman and other committee members wrote to acting CDC Director Susan Monarez asking the agency to explain missing data, delayed studies, and potentially severe staff cuts. “The CDC is vital to our nation’s security,” the letter said.

Several studies have also been delayed or remain missing from the CDC’s preeminent scientific publication, the Morbidity and Mortality Weekly Report. Anne Schuchat, a former principal deputy director at the CDC, said she would be concerned if there was political oversight of scientific material: “Suppressing information is potentially confusing, possibly dangerous, and it can backfire.”

CDC spokesperson Melissa Dibble declined to comment on delayed or missing analyses. “It is not unexpected to see flu activity elevated and increasing at this time of the year,” she said.

A draft of one unpublished study, reviewed by KFF Health News, that has been withheld from the MMWR for three weeks describes how a milk hauler and a dairy worker in Michigan may have spread bird flu to their pet cats. The indoor cats became severely sick and died. Although the workers weren’t tested, the study says that one of them had irritated eyes before the cat fell ill — a common bird flu symptom. That person told researchers that the pet “would roll in their work clothes.”

After one cat became sick, the investigation reports, an adolescent in the household developed a cough. But the report says this young person tested negative for the flu, and positive for a cold-causing virus.

Corresponding CDC documents summarizing the cat study and another as-yet unpublished bird flu analysis said the reports were scheduled to be published Jan. 23. These were reviewed by KFF Health News. The briefing on cats advises dairy farmworkers to “remove clothing and footwear, and rinse off any animal biproduct residue before entering the household to protect others in the household, including potentially indoor-only cats.”

The second summary refers to “the most comprehensive” analysis of bird flu virus detected in wastewater in the United States.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, said delays of bird flu reports are upsetting because they’re needed to inform the public about a worsening situation with many unknown elements. Citing “insufficient data” and “high uncertainty,” the United Kingdom raised its assessment of the risk posed by the U.S. outbreak on dairies.

“Missing and delayed data causes uncertainty,” Nuzzo said. “It also potentially makes us react in ways that are counterproductive.”

Another bird flu study slated for January publication showed up in the MMWR on Feb. 13, three weeks after it was expected. It revealed that three cattle veterinarians had been unknowingly infected last year, based on the discovery of antibodies against the bird flu virus in their blood. One of the veterinarians worked in Georgia and South Carolina, states that haven’t reported outbreaks on dairy farms.

The study provides further evidence that the United States is not adequately detecting cases in cows and people. Nuzzo said it also highlights how data can supply reassuring news. Only three of 150 cattle veterinarians had signs of prior infections, suggesting that the virus doesn’t easily spread from the animals into people. More than 40 dairy workers have been infected, but they generally have had more sustained contact with sick cattle and their virus-laden milk than veterinarians.

Instead, recently released reports have been about wildfires in California and Hawaii.

“Interesting but not urgent,” Nuzzo said, considering the acute fire emergencies have ended. The bird flu outbreak, she said, is an ongoing “urgent health threat for which we need up-to-the-minute information to know how to protect people.”

“The American public is at greater risk when we don’t have information on a timely basis,” Schuchat said.

This week, a federal judge ordered the CDC and other health agencies to “restore” datasets and websites that the organization Doctors for America had identified in a lawsuit as having been altered. Further, the judge ordered the agencies to “identify any other resources that DFA members rely on to provide medical care” and restore them by Feb. 14.

In their letter, CDC advisory committee members requested an investigation into missing data and delayed reports. Hardeman, an adviser who is a health policy expert at the University of Minnesota, said the group didn’t know why data and scientific findings were being withheld or removed. Still, she added, “I hold accountable the acting director of the CDC, the head of HHS, and the White House.”

Hardeman said the Trump administration has the power to disband the advisory committee. She said the group expects that to happen but proceeded with its demands regardless.

“We want to safeguard the rigor of the work at the CDC because we care deeply about public health,” she said. “We aren’t here to be silent.”

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.

USE OUR CONTENT

This story can be republished for free (details).

The day after Trump’s inauguration, South Carolina GOP Gov. Henry McMaster asked federal officials to approve a work requirement plan. Ohio Republican Gov. Mike DeWine plans to soon follow suit. Republicans in Congress are eyeing Medicaid work requirements as they seek to slash billions from the federal budget.

But, just as a second Trump administration reignites interest in work requirements, Georgia is proposing to scale back key parts of the nation’s only active program. And Arkansas announced an effort to revive — with fundamental changes — a program that ended after a legal judgment in 2019.

The Georgia and Arkansas proposals, from the only two states to have implemented Medicaid work requirements, reveal the disconnect between rhetoric behind such programs and the realities of running them, said consumer advocates and health policy researchers.

“They recognize that what they did the first time didn’t work,” said Ben Sommers, a Harvard professor and a former health official in the Biden and Obama administrations. “It should be a signal to federal policymakers: Don’t point to Georgia and Arkansas and say, ‘Let’s do that.’”

More than a dozen states had Medicaid work requirement programs approved during Trump’s first administration.

After an expensive and bumpy rollout, Georgia in January posted a draft renewal plan for its Georgia Pathways to Coverage program. The plan removes the requirement to document work every month and to pay premiums. Those key elements — which supporters have argued promote employment and personal responsibility — were never implemented, the state said.

Enrollees would still have to meet the work requirement when they first apply and when they renew each year. The draft plan also expands the group of people who can opt out of work reporting to include parents of children under age 6. A public comment period on the plan is open through Feb. 20.

Arkansas’ latest request to federal officials doesn’t require enrollees to report their work hours. Instead, it proposes checking whether people are working, caregiving, or fulfilling other qualifying activities by using data, which could include income, job history, educational status, whether a child lives at home, and other criteria, said Gavin Lesnick, a spokesperson for the state’s Medicaid agency.

People deemed “not on track towards meeting their personal health and economic goals” won’t be disenrolled but can participate in a “success coaching” program to maintain coverage, according to the state’s proposal. A public comment period on Arkansas’ program runs through March 3.

‘Fundamentally Flawed’

More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to KFF. Still, several states are quickly moving to restart Medicaid work requirements.

Besides the three states of Arkansas, Ohio, and South Carolina, Iowa and South Dakota are considering similar proposals. Lawmakers in Montana are weighing them as they debate renewing the state’s Medicaid expansion.

This week, House Republicans floated a budget proposal to cut $880 billion from the Energy and Commerce Committee, which oversees Medicaid, the state-federal health insurance program for people with low incomes or disabilities. Before the release of that plan, Speaker Mike Johnson said Republicans were discussing changes to Medicaid that include imposing work requirements.

Supporters of such requirements say Medicaid should be reserved for people who are working.

Right now, it “disincentivizes many low-income families from earning additional income” because they would lose health coverage if they make too much money, said South Carolina Gov. McMaster in his January letter to federal officials. He has argued that a work-reporting requirement is “fiscally responsible” and “will incentivize employment.”

There is no evidence showing such programs improve economic outcomes for people; the requirements don’t help people find jobs, but not having health insurance can keep them from working, health policy researchers say.

The goal of Ohio’s plan is to focus “resources and efforts on those who are engaged with their health choices and independence,” said the state. The plan doesn’t require most individuals to regularly “report activities, fill out forms, or take any action” beyond what is generally required for Medicaid enrollment. Ohio estimates that more than 61,000 people, or 8% of enrollees subject to its measure, would lose Medicaid eligibility in the first year.

Consumer advocates, health policy analysts, and researchers said the scaling back seen in recent work requirement proposals speaks to the challenges of mandating them for public benefits — and could serve as a cautionary tale for Republicans in Washington, D.C., and across the country. The programs can eliminate people from the Medicaid rolls or suppress enrollment, while adding costly layers of bureaucracy, they said.

“As a matter of health policy, work-reporting requirements in Medicaid are fundamentally flawed,” said Leo Cuello, a researcher at the Georgetown Center for Children and Families.

Lessons Learned?

Arkansas got its initial program off the ground in 2018 before a federal judge said it was illegal. Unlike Georgia, the state had already expanded Medicaid. That work-reporting requirement led to more than 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working.

In his ruling that ended the program, Judge James Boasberg said its approval was “arbitrary and capricious” because it failed to address a core goal of Medicaid: “the provision of medical coverage to the needy.”

Arkansas’ latest proposal tries to address a potential legal challenge by suspending, rather than terminating, health coverage through the end of the calendar year for people who don’t meet requirements.

“We have worked to design this amendment taking into account lessons learned from previous work requirements,” said Arkansas Medicaid Director Janet Mann at a press conference in late January announcing the new proposal.

But the requirements are “subjective,” and the difference between suspension and termination isn’t meaningful, said Camille Richoux, health policy director of Arkansas Advocates for Children and Families.

“The impact is the same: You can’t go to the doctor,” she said. “You can’t get your prescriptions filled.”

In Georgia, the Pathways program, launched in 2023, has offered coverage to a small portion of those who would qualify for Medicaid if the state had fully expanded it to all low-income adults, as 40 others have done. With the proposed changes, the state estimates enrollment in Pathways would grow to as many as 30,000 people in the final year of the pilot. The state currently estimates at least 246,000 would become eligible for Medicaid under a full expansion.

About 6,500 people were enrolled in Pathways as of late January, said Grant Thomas, the state’s deputy Medicaid commissioner, in a legislative hearing. According to state officials, the program has cost more than $57 million in state and federal funds through December, with most of that money going toward program administration, not benefits.

“Pathways is doing what it is designed to do: increase access to affordable health care coverage while lowering the uninsured rate across Georgia,” said Russel Carlson, who oversees the state’s Medicaid program as commissioner of the Department of Community Health. The changes to Pathways are an attempt to “improve the member experience” while finding ways “to make government more efficient and accessible,” he added.

Pathways requires that enrollees regularly submit documentation to prove they are working, but the program doesn’t include meaningful measures to help people find work, critics said. People who could be eligible for Pathways have said the whole process is time-consuming due to lengthy questionnaires, a glitchy system for uploading documents, and confusing technical language on the website, according to those working with potential enrollees.

“There’s stuff that sounds good on paper, but when you go to implement it in real life, it’s costly and burdensome,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute.

So far, Pathways has cost state and federal taxpayers nearly $9,000 per enrollee, largely back-end costs to run the program. States that have expanded Medicaid spent about $6,500 per enrollee in that group in 2021, according to KFF researchers.

Georgia GOP Gov. Brian Kemp has said he’s committed to his signature health program, but some Republican state lawmakers have shown an openness to consider full expansion.

A group of Democratic senators cited KFF Health News’ reporting last year when they asked the federal government’s top watchdog to investigate Pathways spending.

Even with the proposed changes, some people, including those who work in the informal or gig economy, may not have official records and may be locked out of health coverage, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. People caring for older children or aging relatives, older adults who struggle to find work, and those with medical conditions that prevent them from working still wouldn’t qualify for health coverage, she said.

“The Pathways program just doesn’t reflect the reality of how people are working,” Colbert said. “Pathways is a program that has clearly been developed by people who have had salaried jobs with predictable incomes.”

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.

USE OUR CONTENT

This story can be republished for free (details).

Congress has mostly stood by as the Trump administration — spurred by Elon Musk and his Department of Government Efficiency, named and created by President Donald Trump  — takes a chainsaw to a broad array of government programs. But now the courts are stepping in to slow or stop some efforts that critics claim are illegal, unconstitutional, or both.

Funding freezes and contract cancellations are already having a chilling effect on health programs, such as biomedical research grants for the National Institutes of Health, humanitarian and health aid provided overseas by the U.S. Agency for International Development, and federal funding owed to community health centers and other domestic agencies.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Shefali Luthra of The 19th, and Maya Goldman of Axios.

Panelists

Among the takeaways from this week’s episode:

• Universities are reconsidering hiring and other forward-looking actions after the Trump administration imposed an abrupt, immediate cap on indirect costs, which help cover overhead and related expenses that aren’t included in federal research grants. A slowdown at research institutions could undermine the prospects for innovation generally — and the nation’s economy specifically, as the United States relies quite a bit on those jobs and the developments they produce.
• The Trump administration’s decision to apply the cap on indirect costs to not only future but also current federal grants specifically violates the terms of spending legislation passed by Congress. Meanwhile, the health impacts of the sudden shuttering of USAID are becoming clear, including concerns about how unprepared the nation could be for a health threat that emerges abroad.
• Congress still hasn’t approved a full funding package for this year, and Republicans don’t seem to be in a hurry to do more than extend the current extension — and pass a budget resolution to fund Trump’s priorities and defund his chosen targets.
• The House GOP budget resolution package released this week includes a call for $880 billion in spending cuts that is expected to hit Medicaid hard. House Republican leaders say they’re weighing imposing work requirements, but only a small percentage of Medicaid beneficiaries would be subject to that change, as most would be exempt due to disability or other reasons — or are already working. Cuts to Medicaid could have cascading consequences, including for the national problem of maternal mortality.

Also this week, Rovner interviews Mark McClellan — director of the Duke-Margolis Institute for Health Policy who led the FDA and the Centers for Medicare & Medicaid Services during the George W. Bush administration — about the impact of cutting funding to research universities. And Rovner reads the winner of the annual KFF Health News’ “health policy valentines” contest.

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

Julie Rovner: Axios’ “Nonprofit Hospital Draws Backlash for Super Bowl Ad,” by Maya Goldman. 

Shefali Luthra: Politico’s “‘Americans Can and Will Die From This’: USAID Worker Details Dangers, Chaos,” by Jonathan Martin. 

Maya Goldman: KFF Health News’ “Doctor Wanted: Small Town in Florida Offers Big Perks To Attract a Physician,” by Daniel Chang.

Jessie Hellmann: NPR’s “Trump’s Ban on Gender-Affirming Care for Young People Puts Hospitals in a Bind,” by Selena Simmons-Duffin. 

Also mentioned in this week’s podcast:

• Reuters’ “USAID Families Have Their Lives Upended by Trump Move To Shut Agency,” by Jonathan Landay and Humeyra Pamuk.
• Newsweek’s “First USAID Death as Freeze Sees Oxygen Supplies Cut Off for Refugee,” by Theo Burman.

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Feb. 13, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Hi. 

Rovner: And we welcome to the podcast our first of two new panelists you’ll be hearing in the coming weeks, Maya Goldman of Axios news. 

Maya Goldman: Hi, great to be here. 

Rovner: Later in this episode we’ll have my interview with doctor and economist Mark McClellan, former commissioner of the Food and Drug Administration and administrator of the Centers for Medicare & Medicaid Services under President George W. Bush — though not at the same time. Mark now heads a research institute at Duke University, and he will try to explain what’s happening with NIH [National Institutes of Health] grants. We also have the winner of our annual KFF Health News Health Policy Valentine Contest, but first this week’s health news. 

So by the time you hear this, Robert F. Kennedy Jr. is almost certain to have been confirmed by the Senate as the next secretary of health and human services. But even before he gets sworn in, as we have been chronicling these past few weeks, things are changing fast and furious over at HHS [the Department of Health and Human Services], and, increasingly, courts are trying to stop or at least slow some of those changes. 

The thread running through all of these, which we will talk about, is growing doubt about whether this administration will comply with those court orders or touch off a constitutional crisis. So I admit I had to make myself a chart to keep track of all of these lawsuits challenging all of the actions the administration has taken just in its first three weeks. We’ll start with what’s going on — or not — at the National Institutes of Health, where last Friday night the agency announced that, henceforth, indirect costs as part of agency grants would be capped at 15%, including for current grants. We’ll have more on this and what it might mean in my chat with Mark McClellan later in this episode. But suffice it to say that I am old enough to remember when NIH was an untouchable jewel for both Republicans and Democrats. What the heck happened here? 

Hellmann: I think Elon Musk, in his crusade to find government waste, decided to hone in on NIH next. And this has been something that the conservative think tanks have been talking about for a little bit, that they think some of these universities are just ripping off the government with these indirect costs on NIH grants. Some of the universities get up to 60% or higher on their NIH grants to cover administrative costs, staffing, stuff like that. But it’s just become a target. [President Donald] Trump also tried to do something similar in 2017, but Congress said, No, we do not want to do that, and actually put a rider in appropriations bills to stop it. And that was kind of the end of it. But it seems like the strategy in this version of the Trump administration is to do something anyway and then take it through the courts. 

Rovner: Don’t skip over that too fast. There’s actual language in the spending bill that says you can’t do this. 

Hellmann: Yeah, there just doesn’t seem to be a lot of concern about this, even from people who have historically supported NIH, and Republicans are just kind of going along with what Elon Musk has been saying about, This is wasteful. We think 15% is fair. So it’s definitely been a big shift. 

Goldman: There have been some Republicans that have spoken out, though. I think Sen. Katie Britt from Alabama was one of the first voices to — I don’t know if you could necessarily say she spoke out against it so strongly, but she said, I value the research that the universities in my state do, and I’m talking to RFK Jr. I think, well, it’s not the same kind of response that we might’ve seen seven, eight years ago. There is a little bit of pushback, which is I think different than some other health changes that we’ve seen. 

Rovner: I did notice that [Sen.] Susan Collins had a strongly worded statement in which she buried the news that she was going to vote for RFK Jr., too, as HHS secretary but also saying that Jackson Labs, big biomedical research facility in Maine, thinks this is really important. I have sort of a broader question. This usually comes up in the context of Medicare. We talk about whether or not the federal government is a good or a bad business partner. Because if they keep changing the rules, you don’t want to rely on their word if it can change. I mean it’s one thing to say, Yes, going forward we’re going to cap indirect costs of 15% and you can decide whether to take it or leave it, but they’re doing this for current grant. They’re just saying: OK, that’s it. We’re not going to pay you this money that we gave you a grant and agreed to pay you for five years. One would think that could have longer-term consequences even if this is eventually reversed. And as I just said, there is language in the spending bill that says they can’t do this. 

Luthra: The other thing that I think is worth noting is that there is this sort of uncertainty that it has created at a lot of universities, similar to what we’re seeing in basically any institution that’s been touched by some sort of very sudden funding freeze or funding cut. A lot of universities really rely on these funds, and they don’t know whether they will come back, whether they’ll be losing tens of millions of dollars each year. And they’re trying to plan their budgets, and that means in some cases I’ve heard about universities canceling existing hiring cycles because they don’t think they can necessarily afford to pay for employees that two weeks ago they thought they’d be able to. And what we have seen in other institutions, which we’ll talk about later in the podcast, is coming up here in academia as well, and this will just have vast ripple effects throughout our country and our economy, given what a big role universities play. 

Rovner: And also, in the young scientist pipeline, that’s always been a concern that, who’s going to be the next generation. If graduate students and even undergraduate students see all of this uncertainty and people being suddenly laid off, are they going to think, Well, maybe I should go learn coding or do something else? Maya, you’re nodding. 

Goldman: Yeah, I talked to somebody yesterday who said she’s hearing from students that she mentors — she’s a professor — she’s hearing from students that she mentors that they’re, like, Maybe I should just go to the private sector and make some money. Which I think is actually maybe one of the underlying goals of DOGE [the Department of Government Efficiency] and Elon Musk, to get people to go to the private sector. 

Rovner: Although as we discover, and we will talk more about this, the private sector gets a lot of money from the federal government. 

Goldman: Absolutely. 

Rovner: That’s been kind of the Republican mantra for many generations, of Let’s partner more with the private sectors. Therefore, there’s a lot of partnerships between the public and private sectors. 

Hellmann: It’s also interesting because there’s been a lot of distrust from RFK Jr. about health research done in the private sector by pharmaceutical companies. So if you’re not doing this research or funding it through NIH and you don’t trust pharmaceutical companies to do it, either, then where does that leave you? 

Rovner: Well, moving on to the broader funding freeze that the Office of Management and Budget tried to impose, then tried to rescind, but apparently didn’t in many cases. A U.S. district judge ordered the administration to resume payments, and when officials didn’t, another judge in a second lawsuit ordered the resumption in much angrier terms and led Elon Musk and Vice President JD Vance, the latter of whom is a graduate of Yale Law School, to question whether judges even have the authority to tell the executive branch what it can and can’t do. I have not been to law school, but, I don’t know, I’ve been doing this for a long time, and my perception has always been that’s courts’ jobs, to tell the executive branch and Congress what it can and can’t do. Is it not? 

Luthra: It is, and any of us who has taken civics or American history could tell you that. But I do think it’s worth noting that this actually isn’t a new talking point for, in particular, the vice president, who frequently references Andrew Jackson, the president who famously said: “The courts have made their order. Let’s see them enforce it.” And to what you alluded to earlier, Julie, that is the question about whether we find ourselves hurtling toward some kind of very serious constitutional, if not crisis, then very serious concern about whether the separation of equal powers remains tantamount. 

Rovner: I think you can call it a constitutional crisis. I mean we’re not there yet— 

Luthra: Yes, but we could be hurtling toward one. 

Rovner: Yes. I think that’s very, very fair. 

Luthra: Excellent. 

Rovner: Well, also among the early Trump actions getting shot down by federal judges are the removal of various webpages and datasets at HHS, including a two-week delay of the release of the CDC’s [Centers for Disease Control and Prevention’s] Morbidity and Mortality Weekly Report, with a couple of key studies of bird flu, which by the way continues to spread from birds to cows to people in a growing number of states, most lately Nevada. In a case filed by the liberal groups Doctors for America and Public Citizen, a judge has given HHS until this Friday to restore the websites to the state they were in before they were taken down. I checked this morning, and the CDC website still says it’s being, quote, “modified” to comply with the president’s executive orders. Is this another of those judicial orders the administration considers optional to obey? 

Goldman: I am very curious to see that. I think it’s also hard to wrap my head around exactly what was taken down and changed, because there’s just so much information on the CDC’s website, on federal health websites. So I think it’ll be really hard to know unless you’re looking on a case-by-case basis to see if something has been restored or changed. 

Rovner: I did see, I think this was in The Washington Post, a researcher who said she had a paper on using mobile vans to distribute fruit and vegetables and healthier foods in remote areas and it was taken down because it had the word “diverse” populations in it. I can’t remember whether it was back up or not. But I mean, yes, the president gets to say, We’re not going to do DEI [diversity, equality, and inclusion] again, but this is like the NIH grant. It’s one thing to say we’re not going to do this going forward, and it’s another thing to say everybody who’s ever said this is now fired, which basically they’re saying in a lot of departments. 

Luthra: And that words have very vast meanings. You mentioned diverse populations. “Biodiversity,” a scientific term that may not be used in a lot of these papers anymore, just sort of creates a real chilling effect and makes it in some cases impossible to do accurate science. 

Rovner: Yes. And if you missed it in last week’s episode, I read out part of the list of the words that can no longer be used in federally funded research. Well, outside of HHS, but still inside of health care, the fight continues over the fate of the U.S. Agency for International Development, which Elon Musk has all but obliterated. This may be an example of court relief coming too late. We’re getting stories of rotting food in warehouses with no one to deliver it, a 71-year-old refugee from Myanmar dying because the hospital that had been providing her oxygen in Thailand closed suddenly, and pregnant USAID workers suddenly finding themselves ordered to change continents while in their third trimester of pregnancy. Is there a point to this? There’s so far been no real evidence of fraud in the program. It’s only spending that the new administration doesn’t agree with. 

Luthra: I think we could go even further than spending they don’t agree with. It’s hard to see that they’ve even reviewed it. A lot of the reporting coming out shows that people who work at USAID haven’t gotten any questions from the administration about, What work are you doing? There’s been process initiated to review all the grants that they have frozen, which suggests that maybe they won’t actually do that. This seems very arbitrary, very broad, and to your point, Julie, the health implications will be and are very immediate and very sweeping and risk setting Americans, but also people across the globe, back in terms of health progress by I don’t even know how much. 

Rovner: One presumes that USAID is a target because Americans in general don’t like foreign aid. This is foreign aid. Most people haven’t heard of it. It’s an easy target, if you will, and they can sort of, like, If we can do this with USAID, then we can go on and do it with things that might be a little more politically sensitive. Is that a fair interpretation? Maya, you’re nodding. 

Goldman: Yeah. I mean I think so, but it’s also a matter of national security in a lot of ways, and foreign aid, at least global health foreign aid, is a pretty small fraction of the federal budget. But I’ve been talking to some virologists who are really worried that the collapse of U.S. involvement in global health efforts, there’s going to be viruses that mutate and then come back to the U.S., and who knows if we’ll have the public health infrastructure in our country to fight them anymore. But it’s also just a good investment to fight these viruses, prevent these viruses abroad before they even get to the U.S. 

Rovner: Yeah, it’s better to control Ebola in Africa before somebody with it gets on an airplane. 

Goldman: Exactly, yeah. And there’s also the question that we’ve been talking about on my team of the collapse of U.S. soft power in some ways. You’re leaving a vacuum for another country like China, perhaps, to come in and exert influence in other countries. And I think that you could also see that in biomedical research if NIH funding continues to be cut. 

Rovner: So moving over to Capitol Hill, we’ll talk about efforts to launch the fiscal 2026 budget process and legislate President Trump’s agenda in a moment. But first, our weekly reminder that Congress hasn’t yet finished the fiscal 2025 spending bills, even though the fiscal year began last Oct. 1. And the temporary funding that Congress passed in December runs out March 14. So the new Congress must be about to get that all tied up in a bow, right? 

Hellmann: Yeah, it doesn’t seem to be a lot of urgency about that right now. House Republicans are now pushing for a full-year CR [continuing resolution]. Some Democrats are talking about potentially using a potential shutdown as leverage as they fight back against some of these unilateral spending cuts by Elon Musk. But yeah, most of the focus right now seems to be on the budget reconciliation package that Donald Trump wants to extend his tax cuts and do border spending and things like that. And the government doesn’t shut down for a month, which is a million years in Congress time. So— 

Rovner: It’s like the opposite of dog years. But still, when you say a, quote-unquote, “full-year CR,” that’s really a seven-month CR. That’s really just, Let’s continue what we’ve been doing and move on to fight the next battle. 

Hellmann: Yeah. 

Rovner: Which of course they could have done in December, but they didn’t want to, because I think they were going to come in and do exciting things for the rest of fiscal 2025. But Congress being Congress, they’re going to kick the can down the road. And while we’re on news from Congress, as I mentioned at the top, RFK Jr. will become the next health and human services secretary any minute, if it hasn’t already happened. They are literally voting as we tape this morning. This was a huge controversy — until it wasn’t. What happened to Republicans who were so worried about his anti-vax and potentially pro-abortion-rights views? It just all kind of melted away? 

Luthra: I think what happened is what’s happened with every Cabinet nominee with the exception of Matt Gaetz, which is that the resistance from Senate Republicans is simply not there anymore. I’ve been pretty surprised personally to see some of the lawmakers who are typically considered more moderate, the Susan Collinses of the world, Lisa Murkowskis, who in Trump 1 would vote against some of these types of picks but appear to have changed their perspective this time around. There was so much attention on [Sen.] Bill Cassidy during last week’s hearings, and he made a very public conversation about whether RFK Jr.’s views on vaccines would be deeply detrimental. 

And then he came back and said, I have gotten real reassurances that everything will be fine. And all of these lawmakers are citing these private conversations they’ve had and these commitments that they say they received, and at the same time you have Democrats like [Sen.] Patty Murray saying they have never had more disturbing conversations with a nominee than they had with this particular one. And it just really shows how stark the contrast is. You have the Republican Party largely saying yes to everything Donald Trump is proposing, and Democrats may be critical in cases like this one, but without really the power to stop it. 

Rovner: As we pointed out on the podcast, Kennedy showed an almost alarming lack of knowledge about the programs that he’s going to be overseeing as secretary. I mean, not just didn’t know but apparently just didn’t bother to do the basic homework that one would assume that a Cabinet nominee would do before coming before the Senate. Perhaps he knew that it didn’t matter, that Republicans are going to basically fall in line for whoever Trump wants, because that seems to be what’s going on right now. 

Hellmann: Yeah, he was asked about Medicare and Medicaid in his first hearing and didn’t have a very good answer, and then was asked about it in his second hearing and I think somehow gave a worse answer. So it’s like he didn’t go home and do any studying on it. And maybe he has since. 

Rovner: Yeah, we will see. 

Hellmann: Hopefully. 

Rovner: All right. Well, now onto next year’s budget. It’s not hard to see why President Trump is trying to do so much using his executive power, because the Republican Congress is so far looking unlikely to do anything approaching the president’s, quote, “big, beautiful bill” anytime soon. Just a reminder that in 2017 the Republican Congress just barely got its big tax bill over the finish line before Christmas, so it took them an entire year back then. Jessie, I know you’re following this, or trying to. First, why are the House and the Senate seemingly on different tracks? If they’re going to plunge ahead with the president’s agenda, shouldn’t they be trying to do the same thing at the same time? 

Hellmann: I think Trump just wants to let both sides go at it and see who gets it done fastest and who comes up with the best outcome, kind of like pitting them against each other a little bit. But I think Senate Republicans have a lot of doubt about how quickly the House can get this done. There’s been a lot of pushback on the House side from members of the Freedom Caucus, the really conservative members who would like to see deeper spending cuts. And I think House leadership knows that that’s going to necessitate some cuts that are going to be really unpopular for some moderate Republicans in competitive districts. So I think the Senate sees a sense of urgency. Ross Vought, the OMB director, was on the Hill today basically saying they’re running out of money to do some of these immigration things that they want to do, and [Sen.] Lindsey Graham is saying: We need to be more urgent about this. We need to get this done quickly. So I think that that’s why they’re trying to move. 

Rovner: Just to be clear: The Senate is trying to do a smaller bill first with a single budget resolution, and then they’ll do the tax bill later, and the House is trying to do all of it together. Is that basically where we are in the 15-second wrap-up? 

Hellmann: Yes. 

Rovner: Well, President Trump rather famously on the campaign trail said he would not cut Social Security or Medicare benefits, and just two weeks ago he said he wouldn’t cut Medicaid, either, except for fraud and abuse. How on Earth is either chamber going to pay for $4 trillion in tax cuts without cutting Medicare, Medicaid, or Social Security? 

Goldman: I think it’s important to note that Trump said that he’s going to love and cherish Medicaid and only make changes in fraud, waste, and abuse categories. But what does that mean? We don’t really know. There are a lot of ways that that could be interpreted. So I definitely don’t think that Medicaid and, possibly, I haven’t heard chatter about Medicare, but if you apply the same logic, possibly Medicare and Social Security as well are on the table. 

Rovner: Yeah. And Medicaid, I know that certainly everybody seems to be getting all excited about Medicaid work requirements. They seem to have forgotten what we learned before, which is that most people on Medicaid already work, and if they don’t, it’s because they can’t. They’re either disabled themselves, caring for someone who’s disabled, or for other legitimate reasons cannot work. And that when you do work requirements, generally what we discovered in Arkansas is that you knock eligible people off the rolls, not because they’re not working but because they’ve not been able to properly report that they are working. So we saw lots of people who were eligible and working who were still cut — which maybe that’s the idea of how you cut Medicaid and call it waste, fraud, and abuse? 

Goldman: Definitely possible. 

Rovner: Shefali, what’s the impact of a really big cut to Medicaid, besides the fact that it would save a lot of money? 

Luthra: I think it’s something that we don’t talk about enough, because Medicaid is such a tremendous payer for so many people’s health insurance. We’ve seen really meaningful efforts to expand Medicaid’s reach in the past. Even just a few years, I’m thinking about its role in covering pregnancy, in particular. About half of all pregnancies are paid for through Medicaid. A lot of people qualify for the program specifically when they become pregnant, because the income threshold is different. And we’ve seen a lot of states extend eligibility so that you can hold on to your Medicaid for six months postpartum, the period when you’re most vulnerable, in an effort to reduce pregnancy-related mortality. And obviously insurance is not the sole silver bullet toward improving health, but it makes a very big difference. And so when we talk about cuts toward Medicaid, we talk about cuts toward very vulnerable people. We also do talk about backtracking in an effort to undo one of our most significant reproductive health problems, which is that we really trail other wealthy nations when it comes to maternal mortality, and jeopardizing Medicaid means that we could continue to do that. 

Rovner: An administration that pushes not just the pro-life position, but the pro-family position and the pro-natal, the Let’s have more children position, that seems to be something that gets lost, I think, in a lot of this fiscal discussion of, Let’s cut Medicaid to save money so we can have tax cuts. But obviously we will be talking more about this, because this is just the very beginning of it. 

All right. That is the news this week, or at least as much as we have time for. Now we will play my interview with Mark McClellan, and then we will come back and do our extra credits. 

I am so pleased to welcome to the podcast health economist and doctor Mark McClellan, who is the only person to have led both the Food and Drug Administration and the Centers for Medicare & Medicaid Services, both in the George W. Bush administration. Mark now leads the Duke-Margolis Institute for Health [Policy], which conducts interdisciplinary health policy research across Duke University and its affiliated health care system. Mark, welcome to “What the Health?” 

Mark McClellan: Julie, great to be with you. That was a mouthful and nice to be talking about. There’s so much to discuss on these kinds of topics right now. 

Rovner: I know. You’re really in the right place. So I listened to a podcast that you taped all the way back in January talking about some of the policy changes you were expecting in a second Trump administration. Is it safe to say that what’s happening now over at HHS is not what you were expecting? 

McClellan: Well, maybe it’s a matter of degree and timing, but I think the Trump Version 2 here is, they said themselves, it’s different than Version 1. There are some common themes — tax cuts, deregulation — and some new themes, though, as well — “Make America Healthy Again,” bigger emphasis on finding ways to prevent chronic disease and reduce disease burden than deal frankly with a big frustration of Americans. The first Trump administration was more about repealing the ACA [Affordable Care Act]. This is a different approach here. And also the president promised not to cut Medicare benefits. But then, Julie, I think you’re referring to the third part, which may be the DOGE part, which is a more aggressive approach. As President Trump said, “I’ve learned a lot” over the last eight years. I think he and the people who are advising him have come away from that thinking they can be more aggressive if they want to get more changes done in the direction that they feel like they were elected to pursue. 

Rovner: Well, my main reason in asking you to join us today was to explain this big fight going on at the National Institutes of Health, one of the few major agencies at HHS that you have not led, at least not yet. I assume that many of the researchers you work with have NIH grants, right? 

McClellan: Yeah. So at Duke University, very heavily dependent on federal function, a big federal grant support for its research functions, lots of programs, from gene therapies to cutting-edge AI. All of the efforts to translate that from basic science to impacts on making Americans healthier depends on the NIH. 

Rovner: So how’s the grant process supposed to work? I live near NIH, and I think most people think, Oh, it all goes on there. It’s like the vast majority of it does not go on there. 

McClellan: No, the vast majority is grants that go out to academic institutions and other researchers. And that goes back to the post-World War II era when the United States was trying to figure out what kind of biomedical science policy would work best. And the decision then was we’re not going to have just government institutes run and executed under direct government oversight. We’re going to do this as a public-private partnership with the federal government providing a lot of support, especially for the basic research, what us economists call a public good. Something that benefits everybody is therefore kind of harder for an individual company to support by itself. We’re going to support private academic institutions, nonprofits, sometimes state-affiliated, and we’re going to do that through the grants themselves and also for the infrastructure that’s needed to sustain that research base and grow it out and strengthen it over time. 

Rovner: And that’s what these indirect costs are, right? 

McClellan: Yeah, the indirect costs also date back to the early days, and over time, just like everything else that where federal funding is involved, you’ve got to be careful about how to do it. So in order to do research, you not only need cutting-edge technology and equipment, the funding for the researchers who are the best trained in the world and have the most promising ideas out there, but also funding for increasingly advanced and sophisticated medical equipment, gene sequencers, advanced microscopes. 

And not only the equipment themselves, but maintaining all of this. I work with a lot of these labs and researchers in them. They are also having to spend a lot of resources and time and effort making sure that they’re handling data and samples securely and appropriately, that they’re maintaining all this equipment and the buildings and the other infrastructure supports that they need. And also making sure they’re documenting and complying with all the requirements for what you can and can’t do with federal grant money. That’s where all the overhead goes, and there’ve been, over years, a lot of agreements worked out that have a whole process for figuring out what’s an appropriate cost and what’s not that factors into the resulting overhead rates that academic institutions get for their grants. 

Rovner: So the Trump administration says that, Why should the federal government be paying these indirect costs, particularly to big institutions like Duke that have big endowments? Why can’t Duke just use its endowment to pay for these indirect costs? 

McClellan: Well, Duke does have an endowment, but most of the organizations that are conducting research don’t have an endowment that would cover the kinds of costs that we’re talking about here. We’re talking about, like, biosecure materials, sensitive patient information, very complex equipment put together at scale for major research projects. And that’s something that historically has been part of what governments do best, just like paying for the development of the good research ideas to see if they really pan out and can be advanced to be used effectively in humans. Also, the supports for those increasingly complex research projects that are needed. And the private foundations, Julie, that pay for some additional projects and things, they’re really operating off of this base publicly supported infrastructure that’s had tremendous contributions — you look at the data — tremendous contributions in terms of value for money for the research spending, including the overhead spending that goes into it. 

I should say that that’s not to say that we’ve got all this right. These programs get established and you need to keep looking at them. So do we really need as many NIH institutes as we have today? We’ve learned that a lot of underlying biological processes work across different diseases, not only different types of cancer, but say, as we’ve seen with some of the obesity drugs, obesity and cardiometabolic diseases also have implications for heart and kidney disease, maybe even cancer. Are we doing enough big moonshots on these, kind of understanding fundamental biologic processes? Are we set up to do that? And are these really the most efficient ways to set overhead to support modern technology and research where AI and cloud-based data infrastructure are a much more important part? So it’s important to keep looking at these questions, but they are important issues to deal with if you want to have effective research infrastructure. 

Rovner: What happens, though? At the moment, this is on hold. Judges ordered it stopped. I believe NIH had said they will go back to issuing grants. But if this were to happen — I mean, you’re an economist, also — this would have an enormous economic effect, and in addition to the impact that it would have just on— 

McClellan: Yeah. And I’ll leave it to the universities and the research advocates who have made a very clear case about — these are billions of dollars in funding, collectively. It would have a big impact on the biomedical research infrastructure. And I think, Julie, that’s why you’ve seen two things have happened since this proposal went out. The first was the proposals faced judicial restrictions, temporary restraining orders, both on the ground. This was a very broad decision that might not be consistent with the congressional requirements to spend money on these research priorities. But second, what they call in government regulatory speak an arbitrary and capricious government decision, one that wasn’t tied to a look at. And the NIH does have the authority to set and adjust rates, but it has a well-established set of processes for figuring out what is an appropriate rate. It can update those processes, but it has to go through the effort, essentially what the temporary restraining orders on these cases have put in place. So those are not moving forward right now. 

The other thing that’s happened has been a lot of these research advocates and others, patient groups, affected cancer patients, etc., have talked to their members of Congress, and you’ve seen a bipartisan swell of concern about this. This is not a new thing under the sun. The Trump administration in 2018 actually proposed in its legislative budget proposals to limit overhead costs. The response to that in Congress was not only continuing the NIH budget where it was, but restricting reductions in overhead rates without a due-process approach. So we’re seeing some of the same thing playing out here. 

Rovner: Last question. This is really for you. You’ve worked as a high-level HHS official in a Republican administration. What advice would you give those who are about to walk into the jobs that you once had? 

McClellan: Well, I would advise them to, and I hope would advise the administration, to help those people get there soon. So these kinds of policy approaches, some further proposals for NIH and, for that matter, FDA and CDC reforms, are on the books, but we don’t have confirmed leaders in any of those agencies right now, and also some very thin staff. Julie, often in addition to the Senate-confirmed leader of the organization, there’ll be some other senior leaders who can carry out the administration’s policy agenda, but also have a lot of experience with the agency or with the organizations that the agency is dealing with. 

And the NIH, the FDA are pretty thin on those people right now. I’d contrast that with CMS, where my other successor, Dr. [Mehmet] Oz, is not there yet. He hasn’t been confirmed, but he has a whole team of seasoned political appointees and actually some really good career appointees who have come back who are trying to implement policies effectively there. That’s what I’d really encourage, getting a team on board so we can look at these issues, find ways to do research more efficiently and effectively. Those are the kinds of goals that I think a lot of people would share. 

Rovner: Well, we will all be watching. Mark McClellan, thank you so much. 

McClellan: Great to talk with you. 

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

Hellmann: My story is from NPR. It’s called “Trump’s ban on gender-affirming care for young people puts hospitals in a bind.” It’s about an executive order basically ordering hospitals not to provide gender-affirming care if they want to continue receiving Medicare and Medicaid funding and other kinds of federal funding. Obviously, Medicare and Medicaid are huge revenue sources for hospitals, and so they really feel like they have no other option but to comply with his executive order. And the story looks at the impact that that has. Hospitals have been canceling appointments that people have already made to receive this care. And then on the other hand, you have states telling hospitals that they can’t stop providing this care if they’ve been doing it already. And it just really shows how there’s no playbook for this and hospitals and patients are left in a really tenuous position. 

Rovner: Shefali. 

Luthra: My piece is from Politico, by Jonathan Martin. The headline is “‘Americans Can and Will Die from This’: USAID Worker Details Dangers, Chaos.” And it’s a really great Q&A that he’s done with a longtime USAID worker whose name he withholds for privacy concerns. And they talk about how this employee feels and how he’s processed the past several days of USAID being virtually abandoned by the federal government. What I love about this is how frank the conversation is and how I think it does a really important job of putting a very human face on the kind of people that we have heard really criticized by Elon Musk and by Donald Trump, described as fraudsters and disloyal and criminals. 

And what we see in this piece is that the people who work for USAID and work in this industry, they could be making more money elsewhere, but they are risking their lives and often facing threats of kidnapping, of violence in their work because they think it means something and they really care about doing this work. I just hope that more people read pieces like this to understand who exactly is being hurt, workers and also the people whom they help, the lives they save every day, when we talk about the decimation of USAID that we are currently experiencing. 

Rovner: Yeah, it’s quite a moving piece. Maya. 

Goldman: My extra credit is a story published by KFF Health News on CBS’ website called “Doctor Wanted: Small town in Florida offers big perks to attract a physician.” And I think it’s important for a couple reasons. One, it’s a good reminder that while there is so much chaos happening in Washington, there are other issues that have been going on since long before the election, like health care worker shortages and primary care shortages that are still really important to pay attention to. But I also love that this takes a really big issue, provider shortages in rural areas, and humanizes it, like Shefali said, and shows a really poignant example. There’s this small town. They had one doctor for many years, and that doctor retired. And now, what do you do? It’s just, I think, a good look at that problem. 

Rovner: It is. Right, my extra credit is actually by Maya, and it’s called “Nonprofit hospital draws backlash for Super Bowl ad.” So between those ads for movies and Dunkin’ Donuts and new cars and beer was one for NYU Langone Health, a giant academic medical center in New York City. It’s not the first hospital ad to air during the Super Bowl, and it’s not even NYU’s first. But a supposedly nonprofit system dropping a cool $8 million while the long knives are out for health spending, as we’ve been discussing for the last half an hour, is maybe not the best look. I don’t know. I personally prefer the Budweiser Clydesdales. 

OK, so before we go, as promised, I am honored to announce the winner of this year’s KFF Health News Health Policy Valentine Contest. It’s from Sally Nix of North Carolina, and it goes like this. “Roses are red, our system is flawed. Surprise bills and denials leave us all feeling odd. They promise us care, yet profits come first, leaving patients to suffer and wallets to burst. But know that voices stand by your side, doctors and advocates who won’t let this slide. Love should mean coverage that’s honest and kind, not loopholes and jargon designed to blind. This Valentine’s Day, let’s champion care, and demand a system that’s honest and fair.” 

Congratulations, Sally. I hope the rest of you also have a very happy Valentine’s Day. OK, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Thanks as always, to our producer and editor, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me occasionally at X, @jrovner, and increasingly at Bluesky, @julierovner. Where are you guys hanging on social media these days? Maya? 

Goldman: I’m on Twitter [X] and Bluesky, @Maya_Goldman_, I believe. And been a little more active on LinkedIn recently, so find me there. 

Rovner: I’m hearing that a lot. Shefali, where are you? 

Luthra: I am on Bluesky, at @shefali.bsky.social, and that’s about it. 

Rovner: Jessie? 

Hellmann: I am at X and Bluesky, @jessiehellmann. 

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

Credits

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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.

USE OUR CONTENT

This story can be republished for free (details).

And indeed, abortion opponents held their breath when, during Trump’s first few days in office, his piles of executive orders did not include any on abortion. 

But he has more than made up for it since, having gone further in his first two weeks in office to restrict abortion than any president since Roe v. Wade was decided in 1973. 

As was widely expected, Trump has reinstated the “Mexico City Policy,” an order issued by every GOP president since it was adopted by former President Ronald Reagan in 1984. It bars funding to international aid organizations that “perform or actively promote” abortion. 

He also issued a similar-sounding order seeking to end “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs. It in fact goes further to restrict abortion than previous presidents in the modern era. 

Trump’s order, and a memo from the Department of Health and Human Services following up on it, says that the basis for this policy is the Hyde Amendment, which was named for the late GOP congressman and anti-abortion crusader Henry Hyde. That measure has barred federal funding of most abortions since Congress first passed it in the late 1970s. 

In its current iteration (it has changed several times over the years), the Hyde Amendment says that no HHS funding “shall be expended for health benefits coverage that includes coverage of abortion.” 

But Hyde bars only payment. Unlike the Mexico City Policy, it says nothing about “promoting” abortion. 

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that grantee providers give patients with unintended pregnancies “nondirective” counseling about all their options, including abortion, and be referred for abortions if they request it. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term. 

With Roe now in the rearview mirror, the Trump administration could take even more dramatic action to restrict abortion at the federal level, including by canceling FDA approval of the abortion pill mifepristone. His anti-abortion backers are expecting he will. So are those who support abortion rights. 

“We said they were coming for us,” said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. “And they are.” 

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.

USE OUR CONTENT

This story can be republished for free (details).

Confusion continues to reign at the Department of Health and Human Services, where policies seem to be changing at a breakneck pace even before a new secretary or other senior officials are confirmed by the Senate. Some federal grantees report payments are still paused, outside communications are still canceled, and many workers are being threatened with layoffs if they don’t accept a buyout offer that some observers call legally dubious.

 Meanwhile, that new HHS secretary may soon arrive, given the Senate Finance Committee approved Robert F. Kennedy Jr.’s nomination this week on a party-line vote — including an “aye” vote from Sen. Bill Cassidy (R-La.), a doctor who had strongly condemned Kennedy’s anti-vaccine activism.

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

Panelists

Among the takeaways from this week’s episode:

• In Washington, the Trump administration’s federal funding freeze, buyout offers to scores of federal workers, and disabling of federal agency websites have left more questions than answers. A tangle of legal issues and lack of communication have only served to sow confusion around the nation and globe for health providers, researchers, and foreign aid groups — to name a few.
• As the Trump administration runs through many of the disruptive policy changes prescribed last year in the Heritage Foundation’s presidential transition playbook, Project 2025, some people are asking: Where are the Democrats? Lawmakers have taken up mostly individual efforts to question and protest the administration’s changes, but, thus far, Democrats are still pulling together a unified approach in Washington to counter the Trump administration’s break-it-to-change-it approach.
• Faced with threats to crucial federal funding, some in the health industry are falling in line with President Donald Trump’s executive orders even as they’re challenged in the courts. Notably, some hospitals have stopped providing treatment to transgender minors in Democratic-run states such as New York.
• Meanwhile, a doctor in New York is facing a criminal indictment over providing the abortion pill to a Louisiana patient. The doctor is protected by a state shield law, and the indictment escalates the interstate fight over abortion access. And a Trump order barring federal funding from being used to pay for or “promote” abortions is not only rolling back Biden-era efforts to protect abortion rights, but also going further than any modern president to restrict abortion — after Trump repeatedly said on the campaign trail that abortion policy would be left to the states.

Also this week, Rovner interviews KFF Health News’ Julie Appleby, who reported the latest “Bill of the Month” feature about a young woman, a grandfathered health plan, and a $14,000 IUD. If you have an outrageous or baffling medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: The New York Times’ “How R.F.K. Jr. and ‘Medical Freedom’ Rose to Power,” on “The Daily” podcast.  

Lauren Weber: CNN’s “Human Brain Samples Contain an Entire Spoon’s Worth of Nanoplastics, Study Says,” by Sandee LaMotte.  

Alice Miranda Ollstein: The Washington Post’s “Did RFK Jr. or Michelle Obama Say It About Food? Take Our Quiz,” by Lauren Weber. 

Also mentioned in this week’s podcast:

• KFF Health News’ “Trump’s Already Gone Back on His Promise To Leave Abortion to States,” by Julie Rovner.
• STAT’s “Removal of DEI Content From a Microbiology Group’s Website Shows Reach of Trump Executive Orders,” by Usha Lee McFarling.

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Feb. 6, at 10 a.m. As always, news happens fast and things might well have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: And Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Later in this episode, we’ll have my interview with my KFF Health News colleague Julie Appleby, who reported and wrote the latest “Bill of the Month” about a young woman, a grandfathered health plan, and a $14,000 IUD. It is a wild one. But first, this week’s health news. 

Now, I know a million things have happened since the Trump administration tried to freeze domestic spending and was ordered to stop by a federal judge. That happened, checks notes, last week. But I want to start there because it turns out that was far from the end of the story at the Department of Health and Human Services, and things are still far from normal. First of all, even though the funding freeze is, quote-unquote, “over,” there are still lots of reports of agencies that still can’t get paid, including Head Start programs, community health centers, and lots of nonprofits that provide domestic social services. 

We’ll get to the international stuff separately in a moment. This is potentially leaving not just people high and dry for services but staff unable to get paid, rent unable to get paid. Just to be clear, this is not supposed to be happening, right? 

Ollstein: There’s just so much confusion right now, and there is not across-the-board clarity that people can follow. And so some people are getting their funding, but they’re getting it late. Some people are not getting it at all. People are being told conflicting things. 

There are also a lot of health care providers around the country are also receiving confusing guidance about how to comply with various executive orders related to, quote-unquote, “DEI and gender.” And so they’re not clear if any program that serves lots of different people, including trans people, needs to be suspended or if anything related to serving particular, underserved minority groups needs to be suspended. There’s just so much confusion that we’re hearing, and a lot of folks are scrambling to draw down whatever funding they can now, because they don’t know what’s going to happen in the future. 

Rovner: And of course, adding to this is today is the deadline for federal workers to say whether they want to accept this strange offer allegedly from the Office of Personnel Management, which is not supposed to be sending out government-wide emails telling people that if they reply to the email with “resign,” they can have eight months of pay, even though the government is only funded at the moment through March 14. 

So, of course, all of these federal workers are getting all kinds of conflicting information about what they should do for their own situation, much less what they should do for the people they’re supposed to be serving in their jobs. 

Weber: Yeah. I think it’s important to look no further than what Elon Musk did to Twitter. He stripped it down to bare bones, and I think a lot of federal workers looking at that historical example potentially see the writing on the wall that their jobs may or may not exist. 

So they’re looking at this offer but with trepidation because, as you pointed out, how can they possibly pay the full eight months? How would that work? Is this legally possible? There’s just so much confusion swirling around, no one really has a sense of what’s up from down in terms of how this could go forward. 

Rovner: And we need to make it clear. When Elon Musk bought Twitter, he bought a company, he bought a private company. It was basically his to do with as he pleased. If he wanted to offer people buyouts — which, by the way, I think a lot of them didn’t get promised severance — he could. And if he wanted to fire people, he could. 

This is the federal government. Hundreds of thousands of civilian workers are supposed to have civil service protections. We’re not talking about political appointees. Most left on their own the day [Donald] Trump took over. These are people who were supposed to be there throughout changes in administration. 

People are just seeming to accept this at face value, that Elon Musk and his group of 19-to-25-year-olds can basically come in and fire the entire federal government at will. That’s not legal. 

Ollstein: And I’m also seeing a lot of federal worker unions telling people: Don’t fall for this. Don’t accept this “buyout.” Hold the line. They’re challenging this in court. And so again, what you both said, it’s not clear that they can fulfill this promise of funding through the fall, but it’s also not clear if any of this is legal. 

And so you have these unions and organizations pleading with federal workers not to fall for it and not to take the resignation offer. But you also have a lot of people saying, Well, if the choice is accept this or wait and just be laid off with nothing, then I’m going to accept this. And then so a lot of people are worried about their own livelihoods and thinking this is sort of a lifeboat. 

Rovner: Well, meanwhile, it’s not just funding. At the same time, webpages around the Department of Health and Human Services, mostly from the Centers for Disease Control and Prevention, the FDA [Food and Drug Administration] and the NIH [National Institutes of Health] have been disappeared. Some have been reappeared. A banner atop the main page for the CDC website says it’s, quote, “being modified to comply with President Trump’s Executive Orders.” 

And while the freeze on outside meetings and travel and grant review at NIH has been loosened, it is still ongoing. Oh, and we haven’t had a Morbidity and Mortality Weekly Report from the CDC in two weeks now. News flash: There’s an Ebola outbreak in Uganda and a herd of cattle in Nevada with a different strain of bird flu than the one that’s been going around. 

What are you guys hearing about what’s happening in these departments with their outside communications? They’re not really allowed to talk to the public yet, right? 

Weber: I think it’s just widespread confusion. It depends on the agency. It depends on your interpretation of the guidance, what you’re able to say, what you need to modify, what’s being taken down. I think, overall, a lot of folks that are on the inside are doing their best to comply and maintain their jobs, and also deal with the restrictions that seem to come and go. 

Ollstein: And I will say, like we were talking about the funding issue, the communications issue has completely been spotty, and enforcement is all over the place. For instance, yesterday we did get a report out from CDC on maternal mortality data, which we can talk about if we want. But people were not sure whether that would be released or not amid all of this, because other reports have been held up. And so it’s just all seeming from the outside to be very ad hoc right now, and there’s not, like, blanket policies that people can depend on. 

Rovner: So, Alice, you referred to this earlier, but one of those executive orders that agencies are supposed to be bringing their programs and funding in line with is aimed at eliminating any vestiges of what’s known as diversity, equity, inclusion, and accessibility in the federal government and in grant programs. 

Over at the National Science Foundation, apparently projects are suspect if they include keywords including “disability,” “female,” “historically,” “socioeconomic,” or “women,” also “minority,” “institutional,” or “excluded.” Basically, if your grant has any of those words in it, it is marked for potential cancellation. And it’s not just in government. Stat this week is reporting that the American Society for Microbiology, which is not a government agency, although it does receive some federal funding, has removed all the DEI content from its website. 

And the impact may be having unintended effects also. Eliminating all DEI jobs in federal agencies also includes people like sign language interpreters for the deaf and others who provide accommodations for workers with disabilities, which is required under — remember those? — federal laws like the Americans With Disabilities Act. Has anybody asked the White House about this or even HHS? We’re seeing reports of things happening that one assumes were not intended by these executive orders. 

Weber: There’s just so much, there’s such a flooding the zone of this, I think a lot of the federal agencies are also waiting till their new heads get into place. I think there’s a little bit of a waiting game going on here. Obviously, we saw that Robert F. Kennedy Jr.’s confirmation hearing’s advanced. 

Assumedly, sometime next week, he will likely be confirmed. I think you will see more clarification potentially. I think that’s, well, potentially, after you have some of these heads of agencies, whether that’s HHS, CDC, FDA, come into place. I think some of this was a stop, hold the line, kind of get situated. 

But the reality is, as I pointed out, Kennedy is not currently HHS head, and so there’s still a lot of waiting time. And in the meantime, there’s a lot of confusion over what the communications are. What’s allowed? What’s not allowed? What’s complying? What’s not complying? 

You saw some of that clarified when Pete Hegseth took over at DOD [the Department of Defense]. I think that some of the health agencies have just a little bit more of a waiting game, because their folks aren’t going to be confirmed for a period of time here. 

Rovner: Right. There are no Senate-confirmed agency heads at HHS yet. 

Ollstein: And I will just point out that it is a bit ironic that a big part of Kennedy’s message, as he’s sought confirmation, is being pro-data, pro-science, wanting more transparency on both. And he is saying that at a time when things are being stripped offline, decades-old databases are going down, communication is halted. And so that’s an interesting tension, and I haven’t seen members of Congress really press him on that. 

Rovner: Oh, you were anticipating my next question, which is: Where are the Democrats? 

Ollstein: There are a variety of tactics and approaches, from trying to hold press conferences and trying to enter certain federal agencies and being turned away. There are folks who are pressuring individual nominees. You’ve had Democrats pressure Kennedy to change his ethics agreement, so that he isn’t directly profiting from these anti-vax lawsuits that he was going to maintain a financial stake in. Although now it has been transferred to his son, which Sen. Elizabeth Warren and others argue is still a huge conflict of interest and doesn’t really fix the problem. There is not a unified response and message. Individual members of Congress seem to all be doing what they think is best in this moment. 

Weber: Yeah. 

Rovner: Let me ask— 

Weber: Oh, go ahead. 

Rovner: No, let me ask the question in a slightly different way. A lot of what’s happening right now was all written out in Project 2025 for those of us who read it. They are literally following the guidebook. Why weren’t the Democrats ready for any of this? They just seem frozen in place. Lauren? 

Weber: I was just going to say, Steve Bannon has publicly said, many members of the Trump administration going in have said the plan is to flood the zone. So it is a good question, Julie. If you are the opposing party, why would you not have a better plan for that? But I would just say that the Dems have seemed to be in disarray since Kamala Harris lost. They’ve been pointing a lot of fingers. I think now, one would think they would get together with some sort of unity, but they’ve yet to kind of coalesce. They’ve all been doing their own individualistic fighting back. 

We’ll continue to see how this plays out. I think flooding the zone is an effective tactic in the sense of there’s so much to respond to that they seem to not be able to get together to work on that. But we’ll have to see how this unfolds. 

Rovner: They have sent lots of sternly worded letters, as far as I can tell, that’s been — and press conferences that are scheduled like a day and a half when something happens. And then 14 other things happen between the time they schedule the press conference and the time they have it. Because that’s the strategy right now, as you say, is to flood the zone. 

Before we leave this, separately from the DEI stuff are executive orders aimed at transgender people. A judge has already blocked an effort to transfer three transgender women federal inmates to men’s facilities and to cut off their access to hormone therapy. But meanwhile, demonstrating that these orders go further than many might’ve anticipated, and I think one of you actually already mentioned this: Hospitals around the country are already cutting off treatment, including reversible treatments to transgender minors, for fear of losing all of their federal funding. 

Now, I know a lot of families moved from states with restrictive policies to states with less restrictive ones over the past couple of years. This is like what they want to do on abortion — right? — is just cut off access nationwide. 

Ollstein: I think that there are a lot of parallels with abortion in this space. I think, one, you see impacts on blue-state residents who thought they would be, quote-unquote, “safe” from these policies being effected. You’re seeing hospitals in California, you’re seeing hospitals in New York, you’re seeing hospitals in other states with their own state protections suspending services out of confusion and fear of losing federal funding, etc. I think, in both contexts, we’ve really seen over the last few years especially just how fundamentally risk-averse and cautious the health care world is. 

And when there is a gray area, they tend to lean more towards overcompliance than undercompliance. I think you’re seeing that both in the abortion space and in the trans care space right now. 

Weber: I just wanted to add, at the end of the day, hospitals are businesses. If the threat is half of your revenue from Medicaid and Medicare is cut off, they’re going to comply. That’s just a massive amount of money for a lot of these hospitals that they’d potentially be putting at risk. Not to mention the research grants that may or may not also be affected. So I think the stories that we’ve already seen trickle out, obviously, of the hospitals you mentioned in California and New York, some in D.C. and Virginia and in our backyard, is going to become very much the norm until this is sorted out more. 

Rovner: Yeah. I think what a lot of people were not expecting, Congress is basically nowhere to be seen. All of this is happening because of these executive orders, which on the one hand, yes, can reach the federal government itself. But I think people didn’t anticipate how far beyond they are reaching, basically anybody who gets federal money, which is almost everybody. The reach of this kind of executive power is, I think it’s fair to say, unprecedented. 

As someone already mentioned, Robert F. Kennedy Jr. is likely to soon become the secretary of health and human services, although he is not there yet. The Senate Finance Committee approved his nomination on a party-line vote on Tuesday. The yes votes included one from doctor and Health, Education, Labor, and Pensions Committee chairman Bill Cassidy, who serves on the Finance Committee also. Cassidy was considered the key swing vote, having sharply criticized Kennedy’s anti-vaccine advocacy. 

But Cassidy explained on the Senate floor after the Finance Committee vote that Kennedy has promised to work closely with him and not to do anything to deter Americans from getting vaccines. We have a cut of tape. 

Sen. Bill Cassidy: We need a leader at HHS who will guide President Trump’s agenda to make America healthy again. Based on Mr. Kennedy’s assurances on vaccines and his platform to positively influence Americans’ health, it is my consideration that he will get this done. 

Rovner: So what are we to make of Cassidy’s confidence that all will go well here for supporters of childhood and other vaccines? 

Weber: Is that confidence, or is that him saying he struck a deal, and these are the terms of the deal, and we’ll see how that deal turns out? Georges C. Benjamin’s told me, from the American Public Health Association, he said, Do you think that Kennedy’s going to call Cassidy every time he makes a controversial decision? And I think it’s a good question asked by the doctor over, that runs the American Public Health Association. I think at the end of the day it seems— 

Rovner: That’s what Cassidy said, though. He said that Kennedy would consult with him on all of these decisions. 

Weber: That is, I understand that’s what he said. I’m curious to see if that’s actually how that happens. Cassidy sang quite a different tune than he did in his questioning the second day of the hearings, where he said, I just really — I have a hard time believing that a 71-year-old man’s going to change his stripes. But it seemed by the time the vote came around this week that he felt that way, despite RFK Jr. really [not] giving him any sort of assurances that his position had changed on his numerous instances of falsely claiming that vaccines are linked to autism. 

Ollstein: I completely agree. And there were almost points in the hearing where Cassidy seemed to be begging Kennedy to give him something to work with, to give him some shred of a sign that he had really changed his views, and he did not get that. But clearly he was convinced by whatever assurances he got. We know because Cassidy said so, that he’s been bombarded, his office has been bombarded by phone calls. 

We know that [Vice President] JD Vance and other administration officials had been putting the screws on him in the lead-up to the vote. We’ve seen in the wake of his decision to vote for Kennedy, the public health world being really outraged and feeling that he chose his role as a politician over his role as a medical doctor. It’s also worth noting that he is up for reelection soon, would likely face a primary from the right, and so that is seen as playing into this, too. Yeah, I’ve just seen a lot of the health world really upset. I’ve seen people referring to this as “the Louisiana Purchase.” 

Rovner: I had not seen that. 

Ollstein: Feeling that he was bought off, not necessarily with money but with these pledges and promises. 

Rovner: And also, I believe he also already has a primary opponent. He’s up in the next round of elections. 

Ollstein: But we don’t know if he’s running. We don’t know if Cassidy is running for reelection, but if he does run, he will have a primary challenger. Yes. 

Rovner: Yes, that’s fair. All right. Well, leaving HHS for a moment, I want to remind our listeners that foreign policy is also health policy, which brings us to the U.S. Agency for International Development. Despite the fact that this is a congressionally created agency with an appropriated budget, Elon Musk’s “DOGE” [Department of Government Efficiency] is basically disassembling it. 

And as of the end of this week, nearly all employees will have been placed on administrative leave and those overseas being ordered home. Among the programs run by USAID is PEPFAR [the President’s Emergency Plan for AIDS Relief], the HIV/AIDS program created by President George W. Bush that’s credited with saving tens of millions of lives in Africa and other developing nations. 

Secretary of State Marco Rubio has said he’d grant exceptions for some ongoing humanitarian assistance, but the status of PEPFAR remains unclear. What, if anything, are you all hearing about all of the global health activities that had been going on? 

Ollstein: It’s hard to operate as reporters, and we are hearing from sources that it is hard for them to operate these programs, because what they’re hearing announced from the administration is not the reality they’re experiencing on the ground. And so they’re losing trust in the official announcements and guidance that they’re getting, because the frozen funds were supposed to be unfrozen, but the funds are not flowing. So there is a real fear that there is going to be a lot of tangible human suffering associated with this, millions of people losing access to the programs that keep them alive and prevent transmission. And as we know, when it comes to a transmissible disease like this, even a small pause could mean more spread and more problems down the line, even if things are restored. 

Rovner: Yeah. Lauren, are you following this at all? 

Weber: The level of confusion, I think, is amplified when you have folks in far-flung corners of the world who are dealing with life-and-death situations and have no one to reach out to. We’re talking about people that work at refugee camps. We’re talking about people that deliver nutritional aid in various countries on the brink of famine. We’re talking about folks that are now emailing people back at USAID who don’t have emails anymore. 

The scale of this is somewhat mind-boggling to those who are covering it, and as Alice said, the lack of clarity around it is pretty clear. And at the end of the day, Elon Musk has gone as far as to call the program, I believe it was, “evil”? I’ll have to check the language, but the vilification of a program that has been credited with quite a lot of impact in such a short period of time has been very complete. 

Rovner: Well, we talked about this a little bit on the domestic side. It’s not just these government workers. It’s the people who are on the ground, the contractors doing the job. And interestingly, the largest contractor for USAID is Catholic Charities, which is now faced with having to stop work and lay people off. So, again, did President Trump really think that he should be going after Catholic Charities? We’re going to find out, because that’s in fact what’s happening. 

It’s not just foreign policy. Trade policy is also health policy. Last week, President Trump announced new tariffs on goods from Mexico, Canada, and China. The big story for most of the media was the 30-day pause on the Mexican and Canadian tariffs. But the tariffs on China took effect as scheduled, and those could drive up the cost of drugs, particularly generic drugs, and many drug ingredients, which are increasingly made overseas, as well as other medical devices. I thought we were trying to reduce our reliance on China during covid, particularly for medical supplies. What happened with that? 

Weber: Well, what happened with that is it’s very expensive to build manufacturing facilities for products that don’t make people a lot of money. So no, there was not much done to really alleviate that. That was a boom-bust cycle of pandemic funding that we’re far beyond the bust. We’ve busted the bust here. So if these tariffs stay in place, many drug experts say, you could expect generic drugs to go up in the coming months. Contracts are in place that minimize probably the pocketbook hit right now, but in the coming months, that very well could change. 

Rovner: Well, meanwhile, it’s not on the front burner, but the future of abortion is still way up in the air. The big news last week came from Louisiana, where a grand jury in Baton Rouge indicted a doctor from New York for legally prescribing an abortion pill online to a Louisiana teenager. The teen’s mother is also charged with a felony. Now, the New York doctor is specifically protected by her state’s shield law, or she is supposed to be. Alice, this is the beginning of the big fight we’ve been expecting for a while, right? 

Ollstein: Well, it’s really a continuation of the big fight. We’ve seen cross-border fights. It’s an escalation, for sure. We already saw Texas bring civil charges against this very same New York doctor. And so this is a criminal charge, which is again an escalation but not a completely new attempt. And I think we’ve all been pointing out all along that, quote-unquote, “sending abortion back to the states” is not possible, because we live in an interconnected country. People travel, medications travel, and these laws are in direct conflict with one another. It’s interesting, because conservatives argue that New York providers are being allowed to meddle in and undermine the anti-abortion laws of red states, while progressives say that it’s the red states that are attempting to reach across their borders and criminalize behavior that’s legal in the place that it’s being practiced. 

It’s legal for the New York doctor sitting at her desk in New York to prescribe these medications, and they are attempting to criminalize that behavior. So this was sort of inevitable, and it will be fascinating to see how courts treat it. Of course, we have still ongoing, the same mifepristone lawsuit that now three states are leading in Texas. And so you have three other— 

Rovner: Three states that don’t include Texas. 

Ollstein: Correct. Three other GOP-led states claiming standing in a Texas court in Amarillo against mifepristone availability all over the United States. So we shall see what happens to that, but some of these cases will certainly be back on their way to the Supreme Court sooner or later. 

Rovner: Well, it’s not just in the state. I have my own column out about this week, which I will shamelessly link to in the show notes. But abortion restrictions are tightening here in Washington on the federal level as well, despite President Trump’s claim on the campaign trail that he would leave the issue to the states. This week, newly approved defense secretary Pete Hegseth, as expected, rolled back the policy instituted by President [Joe] Biden allowing members of the military time off and travel allowances to obtain abortions for themselves or a family member if they’re stationed in a banned state. 

Alice, this administration got off to a kind of slow start on abortion. We actually talked about it amongst ourselves. How are the president’s anti-abortion backers feeling about it now? 

Ollstein: They’re feeling quite good, and they’re feeling good about Kennedy, as well. He said a lot of things in his confirmation hearing that they wanted to hear, which we can walk through if we want. But I would say what’s been interesting is a lot of the stuff they’re doing, they’re doing a bit under the radar. 

So that defense policy, that didn’t get a big, splashy announcement. That was sort of quietly put out there. And like you said before, they did not do the big, splashy Day 1 executive orders that past conservative administrations have done. But Trump ran on trying to please both sides, and a lot of people who support abortion rights did vote for Trump. 

But it’s been clear, even if he’s not doing everything anti-abortion people want, he is only doing things that they want. He is not doing things that the other side wants. So he sort of ran on pleasing both sides, but it’s pretty clear which side he’s chosen. 

Rovner: Yeah, and we will. Obviously, once Kennedy gets set up at HHS, then we will talk about what’s going to go on there, because, obviously, there are many, many more shoes to fall on this particular subject. All right. Well, that’s as much news as we have time for this week. Now we will play my “Bill of the Month” interview with Julie Appleby, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my KFF Health News colleague Julie Appleby, who reported and wrote the latest KFF Health News “Bill of the Month.” Julie, thanks for joining us. 

Julie Appleby: Thanks for having me. 

Rovner: So tell us about this month’s patient, who she is, and what kind of medical care she got. 

Appleby: This month’s patient is Callie Anderson. She’s 25, she lives in Scranton, Pennsylvania, and she went to the doctor and wanted to get off the birth control pill. So they discussed it and decided that an IUD [intrauterine device] would be right for her. So she got an appointment a couple months later and got an IUD. 

Rovner: This feels like a slam dunk, right? She has health insurance. FDA-approved contraception, including long-acting contraception like IUDs, are supposed to be covered with no patient copay under the Affordable Care Act. But that’s not what happened here. How much was the bill she got? 

Appleby: Her bill was $14,658. 

Rovner: That sounds like a lot for an IUD, even if you didn’t have insurance. Is that a lot? 

Appleby: Yes, it is a lot. The Geisinger Health System charges in this case were multiple times what the average looks like it is. For example, I spoke with Planned Parenthood, and they say it can vary depending on the type of IUD and where you live and things like that. But in general, $500 to $1,500 for an insertion is what they’re seeing. And I also looked at FAIR Health, which tracks claims, and they say, for an uninsured person, it can range from about $1,100 to $4,300, depending on where you get it. 

Rovner: So this was really an astronomically high amount. 

Appleby: That’s what one of the folks I spoke with described it, yes. 

Rovner: And why wasn’t it covered with no copay like the ACA required? 

Appleby: Very good question. There’s a type of coverage that doesn’t require plans to follow the Affordable Care Act, and these are called “grandfathered” plans. And they’re called “grandfathered” because they were in existence before March 23, 2010, which was when President Barack Obama signed the Affordable Care Act, and they’ve remained sort of substantially the same since then. So they don’t have to follow all the rules of the Affordable Care Act. And Callie Anderson’s plan — which she got through her dad because she’s 25 and she’s still on his plan, and he’s a retired police officer in Pennsylvania — that plan is grandfathered. 

Rovner: So retired police officers in Pennsylvania didn’t have coverage for FDA-approved contraception before the Affordable Care Act? 

Appleby: Yes, because it’s a grandfathered plan. And interestingly, KFF, which does an employer survey, found that about 14% of all covered workers in 2020 were on grandfathered plans. So they’re a little unusual but not that unusual. 

Rovner: Yeah. That feels like a lot to have a plan that really hasn’t substantially changed in 15 years. 

Appleby: That does seem like a lot. 

Rovner: So what’s the takeaway here for patients in this situation? 

Appleby: Experts always say it’s always best to read your benefit booklet or call your insurer before you undergo some kind of nonemergency medical procedure, just to check: Is it covered? And ask to speak with a representative. Call your insurance plan, find out how much you might owe out-of-pocket for the procedure. 

And sometimes you have to get really specific with birth control, because while birth control is covered, you might have to specify exactly what type you want. Because some insurers only cover certain brands or certain types, so it’s always best to double-check that. But that puts a lot of onus on the patient. And in this case, Callie did ask that she get prior authorization through her health system, and she thought that had been done, but it had not. 

Rovner: And what is happening with her bill? 

Appleby: What’s happening with her bill is she was offered a discount. And then she got a discount off the discount if she agreed to pay the entire amount in full, in one payment. So she ended up paying $5,236 for her IUD. 

Rovner: Still a lot. 

Appleby: Yes, still a lot of money. 

Rovner: Alas, we have plenty more Bills of the Month that we can still do. Julie Appleby, thank you so much. 

Appleby: Thank you. 

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 put the links in our show notes on your phone or other mobile device. Lauren, why don’t you go first this week? 

Weber: I pitched an article in CNN [“Human brain samples contain an entire spoon’s worth of nanoplastics, study says”] that talked about how we have a lot more plastic that is apparently residing in the cracks and crevices of our brains. Now, it’s microplastics. They’re very, very small, much smaller even than a strand of your hair. But their health impact is not known. 

And there was also some findings, not correlated, but potentially that there was more plastic, or there appeared to be more plastic, in some of the brains that were examined of folks that had dementia or Alzheimer’s. It’s unclear whether or not that’s because those brains change in size, shape, and leave reservoirs more for plastic to hide in. But as we all talk about microplastics and their health impacts, it is alarming to see that they appear to be showing up more in people’s brains. 

Rovner: I hope this is something that RFK is worried about, too. Alice. 

Ollstein: So I chose Lauren’s story [“Did RFK Jr. or Michelle Obama say it about food? Take our quiz”] at The Washington Post that is a quiz to show how much the things that RFK Jr. has been saying about the nation’s food system — you know, they sound pretty familiar. And they sound pretty familiar because they sound a hell of a lot like things Michelle Obama said when she was promoting her healthy food campaigns. 

And so it’s a quiz of: Who said it, RFK Jr. or Michelle Obama? And I will say, I got most of them right. But my strategy was that I focused on the style of speaking rather than the content, because the content is very similar but the style of speaking is not. So that’s my tip for all you out there, but it does show that— 

Rovner: Oh, cheater. 

Ollstein: —that conservatives who were outraged when Michelle Obama said these things — they thought it was a nanny state and big government telling you what to do and it’s our American right to eat french fries and all that — are now embracing this MAHA [“Make America Healthy Again”] movement that’s making very similar points. 

Rovner: Well, I took the quiz and I got most of them wrong. 

Weber: Well, Julie, that was the point. That was the point, though. 

Rovner: Yeah, exactly. All right. My extra credit this week is another podcast, the Jan. 30 episode of The New York Times’ “The Daily.” It’s called “How R.F.K. Jr. and ‘Medical Freedom’ Rose to Power.” And it’s an interview with longtime health policy and politics reporter Sheryl Gay Stolberg, who has coincidentally been working on a book on the political history of public health. In the podcast, she shares just enough of what she’s learned to make me really look forward to reading the book. But in the meantime, it’s a great half hour of how we got to where we are now in our distrust of public health. 

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

Weber: You know what? I did finally get a Bluesky account, so I am now on both X and Bluesky, @laurenweberhp, because I just can’t let the “hp” for “health policy” go. 

Rovner: There you go. Alice. 

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

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

Credits

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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.

USE OUR CONTENT

This story can be republished for free (details).

Years ago, Wilkins was dating a man newly diagnosed with HIV and went to get tested, she said, but was not offered PrEP.

Since then, Wilkins said, doctors either have told her she doesn’t need the drug or were reluctant to prescribe it. Her insurance through work would not cover a long-acting injectable form that tends to have better results than the original pill form. Getting to appointments across Atlanta for the pills was a challenge. She is now enrolled in a drug trial for a promising PrEP injection but worries about future access and cost.

Preexposure prophylaxis, known as PrEP, reduces the risk of new HIV infections through sex by 99% and among injectable drug users by at least 74%, according to the Centers for Disease Control and Prevention.

Among states, Georgia has the highest rate of new HIV infections, but residents — especially women and Black patients like Wilkins — are often not getting PrEP, data shows.

A rule enacted by the Biden administration that took effect for many Affordable Care Act plans on Jan. 1 should make it easier for people like Wilkins to get long-acting PrEP injectable drugs.

A new Trump administration adds an X factor to this and other federal health programs. On Jan. 27, the White House announced a federal funding freeze, which sent shudders through health agencies and nonprofits. By Jan. 29, it had reversed the order.

Federal initiatives like the Ryan White HIV/AIDS Program and HIV prevention funding seemed to be affected — and “blocking access to PrEP would have deadly consequences,” said Wayne Turner, a senior attorney at the National Health Law Program.

Georgia has big racial and gender discrepancies in PrEP uptake, said Patrick Sullivan, who is an epidemiology professor at Emory University and leads AIDSVu and PrEPVu, which track HIV data and access to the drug — work that is backed by Gilead Sciences, a PrEP drug manufacturer.

Public health experts use what’s called a “PrEP-to-need ratio” to measure how many people at risk of HIV are getting the drug. A higher number is better. In Georgia for 2023, the statewide ratio was 6, while it was nearly 167 in Vermont, according to PrEPVu.

While the ratio for white people in Georgia was roughly 22, it was about 3 for Black people and just over 3 for Hispanic people. And while it was 7 for men, it was just over 2 for women.

“Black people generally are underserved by PrEP, and women are underserved by PrEP relative to men,” Sullivan said.

Increasing PrEP uptake would help the state cut its new HIV diagnoses, said Dylan Baker, associate medical director at Grady Health’s HIV Prevention Program.

Georgia’s rate of new HIV diagnoses was 27 per 100,000 in 2022, according to the most recent available data. That’s second only to Washington, D.C., and more than double the national rate of 13 per 100,000. That amounts to about 2,500 new cases diagnosed in Georgia in a year.

Globally about 3.5 million people used PrEP in 2023, up from 200,000 in 2017 but short of the United Nations’ 2025 target of 21.2 million people, according to a 2024 report by the United Nations Program on HIV/AIDS.

PrEP users in Atlanta report many challenges in getting the drug, including cost, medical providers who don’t prescribe it, stigma, a lack of inclusive marketing, and transportation. Wilkins said she has run up against all of those.

“Here I am telling you that I’m here to get tested because I have come into contact with someone who was living with HIV, and we had a sexual relationship, and you’re not even mentioning PrEP to me,” Wilkins said. “That was a disservice.”

Insurers Now Required To Cover PrEP

Cost has long been a barrier. The Biden administration last fall issued guidance requiring most insurers to cover the full cost of all forms of PrEP, without prior authorization, along with certain lab work and other services. This includes pills as well as Apretude, an injection given every two months.

That means insured PrEP users should not face out-of-pocket costs, said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, which lobbied for the rule.

It applies to those on the federal marketplace plans and most large private health plans. A similar rule exists for Medicare and Medicare Advantage plans.

Schmid said he does not think the Trump administration will repeal the rule, but he is concerned the U.S. Supreme Court could end coverage for preventive services, including PrEP, when it issues a decision in Braidwood Management v. Becerra, anticipated this summer.

The rule will not help the uninsured. In Georgia, which did not expand Medicaid under the ACA, about 1 million adults under age 65 are uninsured.

“The cost is also a struggle, especially given different people are part of the gig economy, a lot of folks don’t always have access to health insurance,” said Maximillian Boykin, an Atlanta PrEP user.

Expanding Medicaid would help. States that have done so, Sullivan said, “have higher levels of PrEP uptake.”

Winning the PrEP Lottery

Since getting on PrEP in 2019, Wilkins has encountered two doctors who did not want to prescribe it.

One female OB-GYN told her “‘Girl, at our age, we should know better.’” Wilkins said she “fired” that doctor, telling her that such comments are stigmatizing.

When Wilkins moved, she looked for a nearby primary care provider so she would not have to pay for transportation to get PrEP.

But the doctor she found, Wilkins said, told her to find an infectious disease specialist for PrEP.

“‘You’re not treating an infectious disease,’ I say. ‘This is preventive care,’” Wilkins recalled.

Wilkins’ fortunes turned when she was selected to join a study for a twice-yearly injectable form of PrEP.

Lenacapavir, already approved for HIV treatment, showed promising results for HIV prevention in two earlier Gilead trials. Wilkins is part of a trial in Atlanta including about 250 cisgender women nationally who have sex with men.

It’s much better than a daily pill or even a shot once every two months, Wilkins said.

She hopes to stay on the drug, but the U.S. list price for lenacapavir as an HIV treatment averages about $40,000 a year.

Gilead last year announced it signed royalty-free licensing agreements with six manufacturers to make generic lenacapavir for 120 primarily low- and lower-middle-income countries.

It’s not clear where it falls with the Biden rule. “We believe it should be covered,” Schmid said, “but want the federal government to state that clearly.”

For many patients, challenges remain. Most people are willing to travel about 30 minutes for routine health care, Sullivan said, but in cities like Atlanta, those relying on public transportation may face longer commutes to PrEP providers. Some who need PrEP have unstable housing without firm mailing addresses.

Privacy is another concern. “Everybody should be able to find a place that's comfortable,” Sullivan said. “More of that can go on in primary health care.”

Others agree that public health messaging around PrEP services should target more diverse audiences. Dázon Dixon Diallo is the founder of SisterLove, an HIV, sexual, and reproductive health organization focused on Black women in the Southeast.

“You’re not going to get to us by giving us a 3-second cameo in a commercial about PrEP,” she said. “There’s no story in there for me, right?”

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

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.

USE OUR CONTENT

This story can be republished for free (details).

Their concerns mounted after Trump named Robert F. Kennedy Jr., a longtime supporter of abortion rights, to lead the Department of Health and Human Services — and then as he signed a slew of Day 1 executive orders that said nothing about abortion.

As it turns out, they had nothing to worry about. In its first two weeks, the Trump administration went further to restrict abortion than any president since the original Roe decision in 1973.

Hours after Trump and Vice President JD Vance spoke to abortion opponents gathered in Washington for the annual March for Life, the president issued a memorandum reinstating what’s known as the Mexico City Policy, which bars funding to international aid organizations that “perform or actively promote” abortion — an action taken by every modern Republican president.

But Trump also did something new, signing an executive order ending “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs — effectively ordering government agencies to halt funding to programs that can be construed to “promote” abortion, such as family planning counseling.

Dorothy Fink, the acting secretary of Health and Human Services, followed up with a memo early last week ordering the department to “reevaluate all programs, regulations, and guidance to ensure Federal taxpayer dollars are not being used to pay for or promote elective abortion, consistent with the Hyde Amendment.”

The emphasis on the word “promote” is mine, because that’s not what the Hyde Amendment says. It is true that the amendment — which has been included in every HHS spending bill since the 1970s — prohibits the use of federal dollars to pay for abortions except in cases of rape or incest or to save the mother’s life.

But it bars only payment. As the current HHS appropriation says, none of the funding “shall be expended for health benefits coverage that includes coverage of abortion.”

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that patients with unintended pregnancies be given “nondirective” counseling about all their options, including abortion. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term.

So, what is the upshot of Trump’s order?

For one thing, it directly overturned two of Biden’s executive orders. One was intended to strengthen medical privacy protections for people seeking abortion care and enforce a 1994 law criminalizing harassment of people attempting to enter clinics that provide abortions. The other sought to ensure women with pregnancy complications have access to emergency abortions in hospitals that accept Medicare even in states with abortion bans. The latter policy is making its way through federal court.

Trump’s order is also leading government agencies to reverse other key Biden administration policies implemented after the fall of Roe v. Wade. They include a 2022 Department of Defense policy explicitly allowing service members and their dependents to travel out of states with abortion bans to access the procedure and providing travel allowances for those trips. (The Pentagon officially followed through on that change on Jan. 30, just a few days after Defense Secretary Pete Hegseth took over the job: Service members are no longer allowed leave or travel allowances for such trips.) The order is also likely to reverse a policy allowing the Department of Veterans Affairs to provide abortions in some cases, as well as to provide abortion counseling.

But it could also have more wide-ranging effects.

“This executive order could affect other major policies related to access to reproductive health care,” former Biden administration official Katie Keith wrote in the policy journal Health Affairs. These include protections for medication abortion, emergency medical care for women experiencing pregnancy complications, and even in vitro fertilization.

“These and similar changes would, if and when adopted, make it even more challenging for women and their families to access reproductive health care, especially in the more than 20 states with abortion bans,” she wrote.

Anti-abortion groups praised the new administration — not just for the executive orders, but also for pardoning activists convicted of violating a law that protects physical access to abortion clinics.

“One after another, President Trump’s great pro-life victories are being restored and this is just the beginning,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.

Abortion rights groups, meanwhile, were not surprised by the actions or even their timing, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. The association represents grantees of Title X, which has been a longtime target of abortion opponents.

“We said we didn’t think it would be a Day 1 thing,” Coleman said in an interview. “But we said they were coming for us, and they are.”

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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.

USE OUR CONTENT

This story can be republished for free (details).

• Click here to watch Allen on CBS News Chicago
• Read Allen’s “What RFK Jr. Might Face in His Nomination Hearings This Week”

KFF Health News editor-at-large for public health Céline Gounder discussed why the CIA has “low confidence” in its assessment of the origins of the covid-19 virus on CBS News 24/7 on Jan. 27.

• Click here to watch Gounder on CBS News 24/7

KFF Health News senior correspondent Noam N. Levey discussed the Consumer Financial Protection Bureau’s final rule to remove medical debt from consumer credit reports on PBS’ “PBS News Weekend” on Jan. 25.

• Click here to watch Levey on “PBS News Weekend”
• Read the KFF Health News series “Diagnosis: Debt”

KFF Health News contributor Sue O’Connell discussed Montana’s mental health facilities on Billings’ KTVQ on Jan. 24.

• Click here to watch O’Connell on KTVQ
• Read O’Connell’s “Montana Eyes $30M Revamp of Mental Health, Developmental Disability Facilities,” co-reported with Mike Dennison

KFF Health News senior correspondent Renuka Rayasam discussed bird flu in Georgia on WUGA’s “The Georgia Health Report” on Jan. 24.

• Click here to hear Rayasam on “The Georgia Health Report”
• Read Amy Maxmen’s “How America Lost Control of the Bird Flu, Setting the Stage for Another Pandemic”

KFF Health News chief Washington correspondent Julie Rovner discussed the nomination of Robert F. Kennedy Jr. for secretary of Health and Human Services on CBS News on Jan. 22.

• Click here to watch Rovner on CBS News

KFF Health News correspondent Molly Castle Work discussed mental health specialists’ role in the Los Angeles wildfire response on America’s Heroes Group on Jan. 22.

• Click here to hear Work on America’s Heroes Group
• Read Work’s “Amid Wildfire Trauma, L.A. County Dispatches Mental Health Workers to Evacuees”

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.

USE OUR CONTENT

This story can be republished for free (details).

Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump nominated to lead the nation’s top health agency, did little to win over his critics at two Senate confirmation hearings this week. 

Democrats argued he’s not qualified for the job. And by botching answers to basic questions about health policy, Kennedy supplied some evidence. 

It’s uncertain whether Kennedy will get enough votes in the Senate to be confirmed as the secretary of Health and Human Services. Every Democrat and independent is expected to vote against him, meaning he can afford to lose only three GOP votes. 

Sen. Bill Cassidy (R-La.), a physician who sits on the Finance Committee and chairs the Senate Health, Education, Labor and Pensions Committee, known as HELP, is seen as the crucial vote. 

He made a point of highlighting the successes of vaccination and questioned whether Kennedy, as HHS secretary, would champion the lifesaving medicines he has spent years attacking. 

Kennedy, 71, appeared before Finance on Wednesday, backed by dozens of supporters wearing “Make America Healthy Again” shirts and hats. Advocates also cheered him on at Thursday’s hearing of Cassidy’s HELP Committee. 

Over 3½ hours at Finance, Kennedy confused Medicare and Medicaid, the two largest government health insurance programs, which together cover more than a third of Americans but operate very differently. He also mistakenly said that Medicaid is funded solely by the federal government. In fact, nearly a third of costs are paid by the states. 

Kennedy, as recently as last year a supporter of abortion rights, said he agreed with Trump that “every abortion is a tragedy.” 

Kennedy also said he didn’t think HHS had “a law enforcement branch.” The agency can issue fines and penalties against health providers who break the law. 

He didn’t do much better Thursday at HELP, where he couldn’t correctly answer a question from Sen. Maggie Hassan (D-N.H.) about how Medicare works. 

Kennedy got kid-glove treatment from most Republicans on both Senate panels, with several seeking (and receiving) assurances that he would prioritize rural health care or leave alone federal policies that affect farmworkers. 

But Cassidy was an exception. At the Finance hearing, he unsuccessfully pressed Kennedy to say how he would improve care for people enrolled in Medicare and Medicaid, often called dual eligibles, for whom the government has struggled to coordinate care and control costs. 

Opening the HELP hearing, Cassidy made clear to Kennedy that he supports vaccines and that he expects the U.S. health secretary to support them as well, yet he couldn’t persuade the nominee to disavow debunked conspiracies that childhood vaccines cause autism. 

The Finance Committee plans a vote next week; HELP does not vote on HHS nominees. 

At the close of Thursday’s hearing, Cassidy said he would take the weekend to consider his vote. “Will you continue what you have been, or will you overturn a new leaf at age 70?” Cassidy 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.

USE OUR CONTENT

This story can be republished for free (details).