In South Dakota, too, official records show zero abortions that year.

And in Idaho, home to abortion battles that have recently made their way to the U.S. Supreme Court, the official number of recorded abortions was just five.

In nearly a dozen states with total or near-total abortion bans, government officials claimed that zero or very few abortions occurred in 2023, the first full year after the Supreme Court eliminated federal abortion rights.

Those statistics, the most recent available and published in government records, have been celebrated by anti-abortion activists. Medical professionals say such accounts are not only untrue but fundamentally dishonest.

“To say there are no abortions going on in South Dakota is ludicrous,” said Amy Kelley, an OB-GYN in Sioux Falls, South Dakota, citing female patients who have come to her hospital after taking abortion pills or to have medical procedures meant to prevent death or end nonviable pregnancies. “I can think of five off the top of my head that I dealt with,” she said, “and I have 15 partners.”

For some data scientists, these statistics also suggest a troubling trend: the potential politicization of vital statistics.

“It’s so clinically dishonest,” said Ushma Upadhyay, a public health scientist at the University of California-San Francisco, who co-chairs WeCount, an academic research effort that has kept a tally of the number of abortions nationwide since April 2022.

The zeroing out is statistically unlikely, Upadhyay said, and also runs counter to the reality that pregnancy “comes with many risks and in many cases emergency abortion care will be needed.”

“We know they are sometimes necessary to save the pregnant person’s life,” she said, “so I do hope there are abortions occurring in South Dakota.”

State officials reported a sharp decline in the official number of abortions after the Supreme Court overturned Roe v. Wade in June 2022.

• Arkansas reported zero abortions in 2023, compared with 1,621 in 2022.
• Texas reported 60 in 2023, after reporting 50,783 abortions in the state in 2021.
• Idaho reported five in 2023 compared with 1,553 in 2021.
• South Dakota, which had severely restricted abortions years ahead of the Dobbs ruling, reported zero in 2023 compared with 192 abortions in 2021.

Anti-abortion politicians and activists have cited these statistics to bolster their claims that their decades-long crusade to end abortion is a success.

“Undoubtedly, many Arkansas pregnant mothers were spared from the lifelong regrets and physical complications abortion can cause and babies are alive today in Arkansas,” Rose Mimms, executive director of Arkansas Right to Life, said in a press statement. “That’s a win-win for them and our state.”

A spokesperson for the Arkansas Department of Health, Ashley Whitlow, said in an email that the department “is not able to track abortions that take place out of the state or outside of a healthcare facility.” State officials, she said, collect data from “in-state providers and facilities for the Induced Abortion data reports as required by Arkansas law.”

WeCount’s tallies of observed telehealth abortions do not appear in the official state numbers. For instance, from April to June 2024 it counted an average of 240 telehealth abortions a month in Arkansas.

Groups that oppose abortion rights acknowledge that state surveillance reports do not tell the full story of abortion care occurring in their states. Mimms, of Arkansas Right to Life, said she would not expect abortions to be reported in the state, since the procedure is illegal except to prevent a patient’s death.

“Women are still seeking out abortions in Arkansas, whether it’s illegally or going out of state for illegal abortion,” Mimms told KFF Health News. “We’re not naive.”

The South Dakota Department of Health “compiles information it receives from health care organizations around the state and reports it accordingly,” Tia Kafka, its marketing and outreach director, said in an email responding to questions about the statistics. Kafka declined to comment on specific questions about abortions being performed in the state or characterizations that South Dakota’s report is flawed.

Kim Floren, who serves as director of the Justice Empowerment Network, which provides funds and practical support to help South Dakota patients receive abortion care, expressed disbelief in the state’s official figures.

“In 2023, we served over 500 patients,” she said. “Most of them were from South Dakota.”

“For better or worse, government data is the official record,” said Ishan Mehta, director for media and democracy at Common Cause, the nonpartisan public interest group. “You are not just reporting data. You are feeding into an ecosystem that is going to have much larger ramifications.”

When there is a mismatch in the data reported by state governments and credible researchers, including WeCount and the Guttmacher Institute, a reproductive health research group that supports abortion rights, state researchers need to dig deeper, Mehta said.

“This is going to create a historical record for archivists and researchers and people who are going to look at the decades-long trend and try to understand how big public policy changes affected maternal health care,” Mehta said. And now, the recordkeepers “don’t seem to be fully thinking through the ramifications of their actions.”

A Culture of Fear

Abortion rights supporters agree that there has been a steep drop in the number of abortions in every state that enacted laws criminalizing abortion. In states with total bans, 63 clinics have stopped providing abortions. And doctors and medical providers face criminal charges for providing or assisting in abortion care in at least a dozen states.

Practitioners find themselves working in a culture of confusion and fear, which could contribute to a hesitancy to report abortions — despite some state efforts to make clear when abortion is allowed.

For instance, South Dakota Department of Health Secretary Melissa Magstadt released a video to clarify when an abortion is legal under the state’s strict ban.

The procedure is legal in South Dakota only when a pregnant woman is facing death. Magstadt said doctors should use “reasonable medical judgment” and “document their thought process.”

Any doctor convicted of performing an unlawful abortion faces up to two years in prison.

In the place of reliable statistics, academic researchers at WeCount use symbols like dashes to indicate they can’t accurately capture the reality on the ground.

“We try to make an effort to make clear that it’s not zero. That’s the approach these departments of health should take,” said WeCount’s Upadhyay, adding that health departments “should acknowledge that abortions are happening in their states but they can’t count them because they have created a culture of fear, a fear of lawsuits, having licenses revoked.”

“Maybe that’s what they should say,” she said, “instead of putting a zero in their reports.”

Mixed Mandates for Abortion Data

For decades, dozens of states have required abortion providers to collect detailed demographic information on the women who have abortions, including race, age, city, and county — and, in some cases, marital status and the reason for ending the pregnancy.

Researchers who compile data on abortion say there can be sound public health reasons for monitoring the statistics surrounding medical care, namely to evaluate the impact of policy changes. That has become particularly important in the wake of the Supreme Court’s 2022 Dobbs decision, which ended the federal right to an abortion and opened the door to laws in Republican-led states restricting and sometimes outlawing abortion care.

Isaac Maddow-Zimet, a Guttmacher data scientist, said data collection has been used by abortion opponents to overburden clinics with paperwork and force patients to answer intrusive questions. “It’s part of a pretty long history of those tools being used to stigmatize abortion,” he said.

In South Dakota, clinic staff members were required to report the weight of the contents of the uterus, including the woman’s blood, a requirement that had no medical purpose and had the effect of exaggerating the weight of pregnancy tissue, said Floren, who worked at a clinic that provided abortion care before the state’s ban.

“If it was a procedural abortion, you had to weigh everything that came out and write that down on the report,” Floren said.

The Centers for Disease Control and Prevention does not mandate abortion reporting, and some Democratic-led states, including California, do not require clinics or health care providers to collect data. Each year, the CDC requests abortion data from the central health agencies for every state, the District of Columbia, and New York City, and these states and jurisdictions voluntarily report aggregated data for inclusion in the CDC’s annual “Abortion Surveillance” report.

In states that mandate public abortion tracking, hospitals, clinics, and physicians report the number of abortions to state health departments in what are typically called “induced termination of pregnancy” reports, or ITOPs.

Before Dobbs, such reports recorded procedural and medication abortions. But following the elimination of federal abortion rights, clinics shuttered in states with criminal abortion bans. More patients began accessing abortion medication through online organizations, including Aid Access, that do not fall under mandatory state reporting laws.

At least six states have enacted what are called “shield laws” to protect providers who send pills to patients in states with abortion bans. That includes New York, where Linda Prine, a family physician employed by Aid Access, prescribes and sends abortion pills to patients across the country.

Asked about states reporting zero or very few abortions in 2023, Prine said she was certain those statistics were wrong. Texas, for example, reported 50,783 abortions in the state in 2021. Now the state reports on average five a month. WeCount reported an average of 2,800 telehealth abortions a month in Texas from April to June 2024.

“In 2023, Aid Access absolutely mailed pills to all three states in question — South Dakota, Arkansas, and Texas,” Prine said.

Texas Attorney General Ken Paxton filed a lawsuit in January against a New York-based physician, Maggie Carpenter, co-founder of the Abortion Coalition for Telemedicine, for prescribing abortion pills to a Texas patient in violation of Texas’ near-total abortion ban. It’s the first legal challenge to New York’s shield law and threatens to derail access to medication abortion.

Still, some state officials in states with abortion bans have sought to choke off the supply of medication that induces abortion. In May, Arkansas Attorney General Tim Griffin wrote cease and desist letters to Aid Access in the Netherlands and Choices Women’s Medical Center in New York City, stating that “abortion pills may not legally be shipped to Arkansas” and accusing the medical organizations of potentially “false, deceptive, and unconscionable trade practices” that carry up to $10,000 per violation.

Good-government groups like Common Cause say that the dangers of officials relying on misleading statistics are myriad, including a disintegration of public trust as well as ill-informed legislation.

These concerns have been heightened by misinformation surrounding health care, including an entrenched and vocal anti-vaccine movement and the objections of some conservative politicians to mandates related to covid-19, including masks, physical distancing, and school and business closures.

“If the state is not going to put in a little more than the bare minimum to just find out if their data is accurate or not,” Mehta said, “we are in a very dangerous place.”

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).

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).

With supermajorities in both houses, Democrats in the California Legislature passed — and Democratic Gov. Gavin Newsom signed — laws taking effect this year that will erase medical debt from credit reports, allow public health officials to inspect immigrant detention centers, and require health insurance companies to cover fertility services such as in vitro fertilization.

Still, industry experts say it was a relatively quiet year for health policy in the Golden State, with more attention on a divisive presidential election and with several state legislators seeking to avoid controversial issues as they ran for Congress in competitive swing districts.

Newsom shot down some of legislators’ most ambitious health care policies, including proposals that would have regulated pharmaceutical industry middlemen and given the state more power to stop private equity deals in health care.

Health policy experts say advocates and legislators are now focused on how to defend progressive California policies such as sweeping abortion access in the state and health coverage for immigrants living in the U.S. without authorization.

“I think everyone’s just thinking about how we’re going to enter 2025,” said Rachel Linn Gish, a spokesperson with the consumer health advocacy group Health Access California. “We’re figuring out what is vulnerable, what we are exposed to on the federal side, and what do budget changes mean for our work. That’s kind of putting a cloud over everything.”

Here are some of the biggest new health care laws Californians should know about:

Medical debt

California becomes the eighth state in which medical debt will no longer affect patients’ credit reports or credit scores. SB 1061 bars health care providers and debt collectors from reporting unpaid medical bills to credit bureaus, a practice that supporters of the law say penalizes people for seeking critical care and can make it harder for patients to get a job, buy a car, or secure a mortgage.

Critics including the California Association of Collectors called the measure from Sen. Monique Limón (D-Santa Barbara) a “tremendous overreach” and successfully lobbied for amendments that limited the scope of the bill, including an exemption for any medical debt incurred on credit cards.

The Biden administration has finalized federal rules that would stop unpaid medical bills from affecting patients’ credit scores, but the fate of those changes remains unclear as Trump takes office.

Psychiatric hospital stays for violent offenders

Violent offenders with severe mental illness can now be held longer after a judge orders them released from a state mental hospital.

State officials and local law enforcement will now have 30 days to coordinate housing, medication, and behavioral health treatment for those parolees, giving them far more time than the five-day deadline previously in effect.

The bill drew overwhelming bipartisan support after a high-profile case in San Francisco in which a 61-year-old man was charged in the repeated stabbing of a bakery employee just days after his release from a state mental hospital. The bill’s author, Assembly member Matt Haney (D-San Francisco), called the previous five-day timeline “dangerously short.”

Cosmetics and ‘forever chemicals’

California was the first state to ban PFAS chemicals, also known as “forever chemicals,” in all cosmetics sold and manufactured within its borders. The synthetic compounds, found in everyday products including rain jackets, food packaging, lipstick, and shaving cream, have been linked to cancer, birth defects, and diminished immune function and have been increasingly detected in drinking water.

Industry representatives have argued that use of PFAS — perfluoroalkyl and polyfluoroalkyl substances — is critical in some products and that some can be safely used at certain levels.

Immigration detention facilities

After covid-19 outbreaks, contaminated water, and moldy food became the subjects of detainee complaints and lawsuits, state legislators gave local county health officials the authority to enter and inspect privately run immigrant detention centers. SB 1132, from Sen. María Elena Durazo (D-Los Angeles), gives public health officials the ability to evaluate whether privately run facilities are complying with state and local public health regulations regarding proper ventilation, basic mental and physical health care, and food safety.

Although the federal government regulates immigration, six federal detention centers in California are operated by the GEO Group. One of the country’s largest private prison contractors, GEO has faced a litany of complaints related to health and safety. Unlike public prisons and jails, which are inspected annually, these facilities would be inspected only as deemed necessary.

The contractor filed suit in October to stop implementation of the law, saying it unconstitutionally oversteps the federal government’s authority to regulate immigration detention centers. A hearing in the case is set for March 3, said Bethany Lesser, a spokesperson for California Attorney General Rob Bonta. The law took effect Jan. 1.

Doctors vs. insurance companies using AI

As major insurance companies increasingly use artificial intelligence as a tool to analyze patient claims and authorize some treatment, trade groups representing doctors are concerned that AI algorithms are driving an increase in denials for necessary care. Legislators unanimously agreed.

SB 1120 states that decisions about whether a treatment is medically necessary can be made only by licensed, qualified physicians or other health care providers who review a patient’s medical history and other records.

Sick leave and protected time off

Two new laws expand the circumstances under which California workers may use sick days and other leave. SB 1105 entitles farmworkers who work outdoors to take paid sick leave to avoid heat, smoke, or flooding when local or state officials declare an emergency.

AB 2499 expands the list of reasons employees may take paid sick days or use protected unpaid leave to include assisting a family member who is experiencing domestic violence or other violent crimes.

Prescription labels for the visually impaired

Starting this year, pharmacies will be required to provide drug labels and use instructions in Braille, large print, or audio for blind patients.

Advocates of the move said state law, which already required translated instructions in five languages for non-English speakers, has overlooked blind patients, making it difficult for them to monitor prescriptions and take the correct dosage.

Maternal mental health screenings

Health insurers will be required to bolster maternal mental health programs by mandating additional screenings to better detect perinatal depression, which affects 1 in 5 people who give birth in California, according to state data. Pregnant people will now undergo screenings at least once during pregnancy and then six weeks postpartum, with further screenings as providers deem necessary.

Penalties for threatening health care workers (abortion clinics)

With abortion care at the center of national policy fights, California is cracking down on those who threaten, post personal information about, or otherwise target providers or patients at clinics that perform abortions. Penalties for such behavior will increase under AB 2099, and offenders can face felony charges, up to three years in jail, and $50,000 in fines for repeat or violent offenses. Previously, state law classified many of those offenses as misdemeanors.

Insurance coverage for IVF

Starting in July, state-regulated health plans covering 50 employees or more would be required to cover fertility services under SB 729, passed and signed last year. Advocates have long fought for this benefit, which they say is essential care for many families who have trouble getting pregnant and would ensure LGBTQ+ couples aren’t required to pay more out-of-pocket costs than straight couples when starting a family.

In a signing statement, Newsom asked legislators to delay implementation of the law until 2026 as state officials consider whether to add infertility treatments to the list of benefits that insurance plans are required to cover.

It’s unclear whether legislators intend to address that this session, but a spokesperson for the governor said that Newsom “clearly stated his position on the need for an extension” and that he “will continue to work with the legislature” on the matter.

Plans under CalPERS, the California Public Employees’ Retirement System, would have to comply by July 2027.

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

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

USE OUR CONTENT

This story can be republished for free (details).

That seeming contradiction is slated to come to a head this year. People on polar sides of the abortion debate are preparing to fight over how far the protection for abortion extends, and the final say will likely come from the seven-person state Supreme Court. With the arrival of new Chief Justice Cory Swanson, who ran as a judicial conservative for the nonpartisan seat and was sworn in Jan. 6, the court now leans more conservative than before the election.

A similar dynamic is at play elsewhere. Abortion rights supporters prevailed on ballot measures in seven of the 10 states where abortion was up for a vote in November. But even with new voter-approved constitutional protections, courts will have to untangle a web of existing state laws on abortion and square them with any new ones legislators approve. The new makeup of supreme courts in several states indicates that the results of the legal fights to come aren’t clear-cut.

Activists have been working to reshape high courts, which in recent years have become the final arbiters of a patchwork of laws regulating abortions. That’s because the 2022 U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned federal abortion protections, leaving rulemaking to the states.

Since then, the politics of state supreme court elections have been “supercharged” as fights around abortion shifted to states’ top courts, according to Douglas Keith, a senior counsel at the nonpartisan Brennan Center for Justice.

“Because we’re human, you can’t scrub these races of any political connotations at all,” said former Montana Supreme Court Justice Jim Nelson. “But it’s getting worse.”

The wave of abortion litigation in state courts has spawned some of the most expensive state supreme court races in history, including more than $42 million spent on the nonpartisan 2023 Supreme Court race in Wisconsin, where abortion access was among the issues facing the court. Janet Protasiewicz won the seat, flipping the balance of the court to a liberal majority.

In many states, judicial elections are nonpartisan but political parties and ideological groups still lobby for candidates. In 2024, abortion surfaced as a top issue in these races.

In Michigan, spending by non-candidate groups alone topped $7.6 million for the two open seats on the state Supreme Court. The Michigan races are officially labeled as nonpartisan, although candidates are nominated by political parties.

An ad for the two candidates backed by Democrats cautioned that “the Michigan state Supreme Court can still take abortion rights away” even after voters added abortion protections to the state constitution in 2022. The ad continued, “Kyra Harris Bolden and Kimberly Thomas are the only Supreme Court candidates who will protect access to abortion.” Both won their races.

Abortion opponent Kelsey Pritchard, director of state public affairs for Susan B. Anthony Pro-Life America, decried the influence of abortion politics on state court elections. “Pro-abortion activists know they cannot win through the legislatures, so they have turned to state courts to override state laws,” Pritchard said.

Some abortion opponents now support changes to the way state supreme courts are selected.

In Missouri, where voters passed a constitutional amendment in November to protect abortion access, the new leader of the state Senate, Cindy O’Laughlin, a Republican, has proposed switching to nonpartisan elections from the state’s current model, in which the governor appoints a judge from a list of three finalists selected by a nonpartisan commission. Although Republicans have held the governor’s mansion since 2017, she pointed to the Missouri Supreme Court’s 4-3 ruling in September that allowed the abortion amendment to remain on the ballot and said courts “have undermined legislative efforts to protect life.”

In a case widely expected to reach the Missouri Supreme Court, the state’s Planned Parenthood clinics are trying to use the passage of the new amendment to strike down Missouri’s abortion restrictions, including a near-total ban. O’Laughlin said her proposal, which would need approval from the legislature and voters, was unlikely to influence that current litigation but would affect future cases.

“A judiciary accountable to the people would provide a fairer venue for addressing legal challenges to pro-life laws,” she said.

Nonpartisan judicial elections can buck broader electoral trends. In Michigan, for example, voters elected both Supreme Court candidates nominated by Democrats last year even as Donald Trump won the state and Republicans regained control of the state House.

In Kentucky’s nonpartisan race, Judge Pamela Goodwine, who was endorsed by Democratic Gov. Andy Beshear, outperformed her opponent even in counties that went for Trump, who won the state. She’ll be serving on the bench as a woman’s challenge to the state’s two abortion bans makes its way through state courts.

Partisan judicial elections, however, tend to track with other partisan election results, according to Keith of the Brennan Center. So some state legislatures have sought to turn nonpartisan state supreme court elections into fully partisan affairs.

In Ohio, Republicans have won every state Supreme Court seat since lawmakers passed a bill in 2021 requiring party affiliation to appear on the ballot for those races. That includes three seats up for grabs in November that solidified the Republican majority on the court from 4-3 to 6-1.

“These justices who got elected in 2024 have been pretty open about being anti-abortion,” said Jessie Hill, an attorney with the American Civil Liberties Union of Ohio, who has been litigating a challenge to Ohio’s abortion restrictions since voters added protections to the state constitution in 2023.

Until the recent ballot measure vote in Montana, the only obstacle blocking Republican-passed abortion restrictions from taking effect had been a 25-year-old decision that determined Montana’s right to privacy extends to abortion.

Nelson, the former justice who was the lead author of the decision, said the court has since gradually leaned more conservative. He noted the state’s other incoming justice, Katherine Bidegaray, was backed by abortion rights advocates.

“The dynamic of the court is going to change,” Nelson said after the election. “But the chief justice has one vote, just like everybody else.”

Swanson, Montana’s new chief justice, had said throughout his campaign that he’ll make decisions case by case. He also rebuked his opponent, Jerry Lynch, for saying he’d respect the court’s ruling that protected abortion. Swanson called such statements a signal to liberal groups.

At least eight cases are pending in Montana courts challenging state laws to restrict abortion access. Martha Fuller, president and CEO of Planned Parenthood Advocates of Montana, said that the new constitutional language, which takes effect in July, could further strengthen those cases but that the court’s election outcome leaves room for uncertainty.

The state’s two outgoing justices had past ties to the Democratic Party. Fuller said they also consistently supported abortion as a right to privacy. “One of those folks is replaced by somebody who we don’t know will uphold that,” she said. “There will be this period where we’re trying to see where the different justices fall on these issues.”

Those cases likely won’t end the abortion debate in Montana.

As of the legislative session’s start in early January, Republican lawmakers, who have for years called the state Supreme Court liberal, had already proposed eight bills regarding abortion and dozens of others aimed at reshaping judicial power. Among them is a bill to make judicial elections partisan.

Montana Sen. Daniel Emrich, a Republican who requested a bill titled “Prohibit dismembering of person and provide definition of human,” said it’s too early to know which restrictions anti-abortion lawmakers will push hardest.

Ultimately, he said, any new proposed restrictions and the implications of the constitutional amendment will likely land in front of the state Supreme Court.

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 new, GOP-led, 119th Congress and President-elect Donald Trump have big legislative plans for the year — which mostly don’t include health policy. But health is likely to play an important supporting role in efforts to renew tax cuts, revise immigration policies, and alter trade — if only to help pay for some Republican initiatives.

Meanwhile, the outgoing Biden administration is racing to finish its health policy to-do list, including finalizing a policy that bars credit bureaus from including medical debt on individuals’ credit reports.

This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• The 119th Congress is now in session. Health care doesn’t make the list of priorities as lawmakers lay the table for the incoming Trump administration — though Republicans have floated Medicaid work requirements to cut federal spending.
• A lot of health legislation hit the cutting-room floor in December, including a bipartisan proposal targeting pharmacy benefit managers — which would have saved the federal government and patients billions of dollars. And speaking of bipartisan efforts, a congressional report from the Senate Budget Committee adds to evidence that private equity involvement in care is associated with worse outcomes for patients — notably, lawmakers’ constituents.
• As the nation bids a final farewell to former President Jimmy Carter, his global health work, in particular, is being celebrated — especially his efforts to eradicate such devastating diseases as Guinea worm disease and river blindness.
• Meanwhile, the Biden administration finalized the rule barring medical debt from appearing on credit reports. The surgeon general cautions that alcohol should come with warning labels noting cancer risk. And the new Senate Republican leader is raising abortion-related legislation to require lifesaving care for all babies born alive — yet those protections already exist.

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

Julie Rovner: The Wall Street Journal’s “UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare,” by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty.

Alice Miranda Ollstein: The New York Times’ “Ozempic, Lego Bricks and Hearing Aids: What Trump’s Greenland Plan Could Hit,” by Ana Swanson and Jenny Gross.

Shefali Luthra: Vox.com’s “Gigantic SUVs Are a Public Health Threat. Why Don’t We Treat Them Like One?” by David Zipper.

Lauren Weber: The Washington Post’s “Laws Restrict U.S. Shipping of Vape Products. Many Companies Do It Anyway,” by David Ovalle and Rachel Roubein.

Also mentioned in this week’s podcast:

The Senate Budget Committee’s “Profits Over Patients: The Harmful Effects of Private Equity on the U.S. Health Care System.”

[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, Jan. 9, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello hello. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: No interview this week — way too much news to catch up on. So let us get right to it. So, welcome to the 119th Congress and, soon, to a new presidential administration. We’ll go back and recap what happened in late December shortly, but I want to start by looking ahead. What’s on the immediate agenda here in Washington for health care? Anybody? 

Ollstein: So health care is not the priority right now for the incoming administration, for the new Republican trifecta in Washington. It can make it in, because they are talking about these massive, conglomerate bills that they have criticized in the past and said that they don’t like doing that, and they would much rather vote on individual things one by one. 

But now they’re talking about cramming everything into one giant reconciliation bill early in the new administration. And there will likely be some health care components. We don’t know yet what those will be. Things that purport to save money are a lot more likely than things that purport to cost money. Although, there’s often some funny math in that. Medicaid work requirements have been floated, and so we can talk about that. We know, we’ve seen that movie before, and we know how that can go, both in terms of what it means for people’s coverage and what it means in terms of savings. 

But I think that a lot of the ambitious stuff that lawmakers tried to get through at the end of the year is now in question, as to whether it has a future or not. Because the top priorities of the new administration are more on taxes and trade and immigration and things like that and not as much on health policy. 

Rovner: Although, I would point out that that end-of-the-year rush that they got — they kept the government open, and they got the government funded — that only goes until March. I saw sort of a plaintive email yesterday from Tom Cole, the Republican chairman of the House Appropriations Committee, saying, Um, we have to start working on the next one soon. Everybody’s busy talking about this huge tax bill, reconciliation. What are we going to do about Medicaid? And it’s like, hello, the current fiscal year is not finished. They just managed to put things off. 

Lauren, you wanted to add something? 

Weber: Yeah. I just wanted to say, I feel like we’ve entered the era of marketing when it comes to these bills. You’ve got President-elect [Donald] Trump saying he wants one big, beautiful bill. That’s what he wants. He wants one big, beautiful bill. And it’s not just Trump. I mean, let’s look at the MAHA movement, the “Make America Healthy Again” movement. 

I mean, I think we’re entering an era in which bills and movements all have catchy slogans. And I mean, heck, the American public may have a better understanding, or at least know what these people are telling them is happening with this marketing, we’ll see. So I just wanted to flag that this seems to be the change over here. 

Rovner: And this is when I get to put in my other reality check, which is they keep talking about this big, beautiful reconciliation bill that they only need Republican votes for. I have to remind people every year: In order to do a reconciliation bill, first they must do a budget resolution, in both houses. That has to go to the floor, be debated, has to be reconciled between the House and the Senate, about what the budget resolution looks like. 

The whole point of what’s called “reconciliation” is that it reconciles mandatory spending to the terms of the budget resolution. It takes a long time to do a budget resolution, even when you’re rushing it through. 

Also, all these things that they’re talking about putting into this reconciliation bill are not allowed to go into budget reconciliation. It’s only about mandatory spending. It is taxes. It is Medicare and Medicaid and other mandatory spending. And it’s the debt ceiling. And those are basically all the things that can go in. Sorry, that’s the end of my lecture. 

Alice, did you want to add something? 

Ollstein: Sure. I mean, I think we’re already seeing cracks emerging in this great Republican unity that they’re trying to project. I mean, they can’t even agree yet on whether to do one big, beautiful bill or two. And the people pushing for two are pointing out that if you put all your eggs in one basket and that basket breaks and falls apart and all the eggs smash on the floor, then you don’t really have anything to show for your work. 

Which of course is a situation Congress has found itself in many times over the past several years. And so, those folks are saying it’s much less risky to break it up and have it in separate bills, so that if one goes down in flames, the other might make it through. But yes, once again, we are seeing both House vs. Senate tensions, as well as Congress vs. Trump and Trump’s advisers tensions. And I imagine that is going to be a constant for the next few years. 

Rovner: And if you thought that the House was ungovernable with its tiny Republican majority in the last Congress, it’s even tinier now. In fact, we do have Speaker Mike Johnson. He did get elected on the first ballot, but it was not easy. There were a couple of holdouts who had to take calls from the president-elect in order to change their votes. So it’s pretty tenuous there. 

Shefali, before we move on, did you want to add something? 

Luthra: No, I mean, I think what will be really interesting, as well, is to see how this emerges in all of the more fractious issues among the Republican Party. I know we’ve talked a lot about how the Republican Party is very divided on a lot of issues of reproductive health, including abortion, something Alice and I both think about all the time. And— 

Rovner: And we will get to in a few minutes. 

Luthra: We will be getting to that very soon. But it is just very clear that all of these issues, where they project unity, are pretty quickly going to fall apart when it comes to engaging with the fact that this is a very divided coalition, and a lot of the things they’re talking about doing are not very popular with voters. And so we’ll see how that affects them as well. 

Rovner: Yes. So let’s move back a little bit. When we left things in December, we were a day away from a possible government shutdown, which did not happen. But the other thing that didn’t happen was a big package with basically an entire year’s worth of bipartisan health policy work in it, everything from new transparency requirements for pharmacy benefits managers [PBMs], to renewals of programs to prepare for the next pandemic and to fight the opioid epidemic, to rolling back cuts to doctors under Medicare. Most of that didn’t make it into the final package that will keep the government running until March. 

The tiny things that did make it in were extensions of telehealth authority for Medicare and payments for community health centers and some other expiring programs — but again, only through the middle of March, which is when the rest of this funding bill expires. 

So what happens to things like the PBM bill that fell by the wayside? Do we have any reason to think that Congress is going to pick it up and pass it this year? And even if they do that Trump would sign it? Or did all of that work last year, is that all just basically for naught now? 

Ollstein: I mean, I think you could make an argument either way. You could make an argument that it has a chance because there is bipartisan support. Some of these things could save the government money and help pay for other things that the Republican majority wants to do, like cut taxes. 

Rovner: I would say the PBM bill was like $5 billion in savings, as I recall. 

Ollstein: Exactly. And it’s not like PBMs are super-popular and everyone wants to defend them right now. So you can make the argument that it has a chance because of that, but we’ve seen tons of health policies in the past that have bipartisan support that would save money also fall by the wayside, just because they are not priorities. And so, I think, you can make the optimistic or the pessimistic case on this one. 

Rovner: Go ahead, Lauren. 

Weber: I would just add, I mean, a lot of things that people were pretty upset about, in terms of smaller things, health-wise, also got cut from the bill. I mean, there was funding for 9/11 cancer funds, for those that had been exposed to toxic chemicals, first responders, and so on. A lot of outcry after that got stripped out of the bill. Understandably so, considering, basically all the advocates said: We don’t want to parade our dying first responders to Congress every year to get funds. Really, you cut this out? 

So there does seem to be some momentum to potentially add that in again. There was also hullabaloo around childhood cancer research. They ended up passing a separate smaller bill, but it did not include the full measures to really prioritize some pressure on the FDA [Food and Drug Administration] and other funding to improve childhood cancer research. And so I think you’re going to continue to see, at least from the Dems, some pointing out of these issues going forward as, I mean, childhood cancer and 9/11 first responders are pretty sympathetic characters for funding. 

Rovner: Yeah, I think it’s going to be — I think a lot of these new committee chairs, particularly in the Senate, where the Republicans are taking over, are going to have to figure their way out and try to pick up some of the pieces. One interesting thing that came through my inbox this week was a bipartisan report from the Senate Budget Committee that found, and I am quoting from the headline in the press release, “Private Equity in Health Care Shown to Harm Patients, Degrade Care and Drive Hospital Closures.” Does this suggest that Congress might try to do something on this extremely fraught subject? 

Shefali, you are smiling. I mean— 

Luthra: I’m smiling because a couple of things, and the first is that there has been a lot of discourse about private equity’s impact on health care for consumers for years. This is very interesting and important work, and it is not at all surprising. 

And the other thing that we have to remember is that Donald Trump will be president. He is ideologically very unpredictable. As an actor, he is very unpredictable. And it’s just very difficult to guess what will actually become law and getting his signature. And part of that is because, we can remember from the last time he was president, he very often would change what he believed based on the last person he spoke to. We saw this all the time with drug pricing. 

And I just think that we will see really interesting bipartisan analyses of things that could make real differences for consumers on health care, but whether they become law, whether they change people’s lives, that’s just much, much harder for us to really predict in a meaningful way. 

Rovner: Yeah, I think everything’s pretty hard to predict right now. Lauren? 

Weber: Yeah, I just wanted to add, I mean, I know, obviously hard to predict, but I think the idea that you have lawmakers issuing pretty strident releases that tie private equity to decrease patient outcomes in their specific districts is a bit of a step forward. I mean, you have [Sen. Charles] Grassley saying: Look, none of these people care about patient care. They only care about shareholders. I do think that is a shift in rhetoric, to an extent. We’ve seen a building for quite some time. We’ve all talked about private equity on this podcast. 

But I do think when you have lawmakers making that jump to, Oh, people in my district are getting worse health care because of this, I think you could see more movement. 

Rovner: Yeah, it’s something I’m going to keep an eye on. Like I said, I was surprised to see that as a bipartisan report from a committee, even though it’s the Budget Committee that doesn’t really have authority to do anything legislatively. Still, it was worth noting. 

Well, in case there wasn’t already enough news this week, here in Washington this very morning, we are bidding farewell to former President Jimmy Carter, who died at age 100 late last month. Carter was one of a long list of Democratic presidents who tried and failed to overhaul the nation’s health care system. You can Google something called “hospital cost containment” if you want to know more. He also created the Health Care Financing Administration to run Medicare and Medicaid, which got renamed the Centers for Medicare & Medicaid Services in the early 2000s. 

But Carter’s biggest health achievements came after he left office. His work through his foundation addressed, and in some cases nearly eradicated, some mostly neglected tropical diseases that mostly afflict the poorest and most marginalized people on the planet. That’s going to be one of his real major legacies, was bringing global health home. Right, Alice? 

Ollstein: Yeah, and I think that’s interesting, given the recognition of his legacy right now, around his funeral, and lying in state in the Capitol, with the Trump administration coming into office, being very against bodies like the WHO [World Health Organization] and international cooperation on health care, very vocally critical of how international cooperation happened during the covid-19 pandemic. And so I think that is going to be an interesting contrast, given what Carter was able to achieve through such cooperation. 

Rovner: Yeah. Lauren? 

Weber: Yeah, I just wanted to add, I mean, it’s a model that I think then seeped into other presidents, right? I mean, you’ve seen [former president George W.] Bush’s investment in global health, and so on. And I do think, as Alice smartly pointed out, there is, obviously, a sharp contrast. But I mean, what Carter was able to do for river blindness and Guinea worm is unprecedented. And I think what was most moving in all of the recaps of his work is that these are people that don’t have a voice. They don’t have a position of power in the country they live in. I mean, this is him using his soft power to demand action, by flying out to far-flung corners of the world, to meet with farmers who had been disabled by Guinea worm, to make sure that this didn’t happen to future generations. 

And some of these biographers have posited that’s because of his upbringing as a poor farmer in Georgia. So I think this is kind of a once-in-a-generation moment to look at this impact someone has on global health. And as Alice pointed out, I don’t know what we’ll see going forward on that. 

Rovner: It’s hard to imagine Donald Trump making eradication of Guinea worm a major priority. Well, we are also bidding farewell over the next two weeks to the Biden administration, which is using its last days to try and get as much done and trumpet as many victories as it can. We’ll start with the Affordable Care Act, where the administration just announced that with a week left to go in the official sign-up period in most states, 24 million people have now been enrolled in ACA plans. That’s up 3 million just from last year and more than double the number from 2021 when [Joe] Biden took office. 

Of course, this is likely to be the high water mark. This year marked the first that the so-called Dreamers, those people brought illegally to the U.S. as children by their parents, they could enroll, at least for now. That’s something President Trump and the Republican Congress is considered likely to end. Plus, the additional tax credits that were put in place during the pandemic expire at the end of this year, unless Congress renews them. What’s the outlook for ACA enrollment? 

Ollstein: Well, Democratic senators are starting to make a push to extend those subsidies, introducing legislation and making a big splash about it today. There’s been a lot of lobbying from the health care sector, the hospitals, all the players who don’t want to see these tax credits expire, and as well as patient advocacy groups. Really, my inbox has been flooded with things related to that and calling on Congress to extend these subsidies. 

Of course, they cost a lot of money, and the new congressional majority definitely has other things they want to spend that money on, that are not helping people buy health insurance plans as part of the Affordable Care Act. And so, I think there is likely to be a lot of wrangling and horse-trading around this. I don’t think the subsidies are necessarily toast, but I don’t think that they’re a done deal, either. 

Rovner: Yeah, I mean, I keep saying, I think everybody’s first inclination after Election Day is that they were toast, because Republican trifecta. On the other hand, when you actually dig into the numbers, the biggest increases have come in red states. 

Ollstein: Absolutely. 

Rovner: So the people who are taking advantage of these extra subsidies are people who are in Republican states and voted for Republicans and are represented by Republicans. And you’ve got to wonder whether they want to, suddenly next January, or really next October, November, when people realize: Oh my goodness, my premiums for my health insurance are going to quadruple. How did this happen? Maybe they’ll think about that when they’re putting all of these big, beautiful bills together, maybe? 

Ollstein: Yeah, we’ve started to see some comments from some Republicans. Of course, it’s the ones who have been willing to work with Democrats in the past, like Lisa Murkowski in the Senate, saying that we should look at extending these subsidies. You’re not hearing that from most Republicans by any stretch of the imagination, but I think you’re starting to hear these rumblings because, like you said, Julie, they don’t want to have a bunch of constituents lose their insurance or have their insurance get way more expensive when they’re in power. 

Rovner: Yeah, the advantage and disadvantage of the trifecta. Lauren? 

Weber: I just wanted to ask, I mean, a question for the panel. I mean, there’s all this talk about “DOGE” [the “Department of Government Efficiency”] and cutting all this money, but as you just stated, Alice, they’re likely not to get rid of these subsidies. Johnson went on the record, I think this week or last week, to say Medicare is not going to get impacted. Medicaid cuts seem to be coming, but dear God, if you don’t cut some of these other things, I don’t know how you would possibly get to the money amounts that they’re talking about, especially in health. 

Ollstein: Well, and Elon Musk has already walked back his projection of how much he’ll be able to cut, saying that $2 trillion was aspirational and hopefully they’ll get $1 trillion. And so you’re already starting to see the walk-back of some of the preelection promises on that front as they start to confront some of the realities you mentioned, Lauren. 

Rovner: Yeah, there’s nothing like the optimism of early January, when a new Congress and a new president say, We’re going to do all of this in the first hundred days. You would think that Trump of all people would know better, because he tried to repeal the Affordable Care Act in the first hundred days in 2017, and that didn’t go so well. But apparently he has a short memory, too. 

Well, speaking of things that are likely to be undone, the Consumer Financial Protection Bureau finalized its rule this week barring the use of medical debt on credit reports. It’s already been sued for exceeding its authority by two trade groups representing creditors. How important would this change be if it actually survives? 

Luthra: Something like this could be really meaningful. I remember talking to families about their efforts to buy homes and often struggling to do so because their medical debt had harmed their credit score. And the thing about medical debt is that it’s usually not planned. It is probably actually almost always not planned, because you don’t hope to fall sick. You do not try to get a devastating injury that your insurance will not fully cover the costs for. 

And this was something that had really been championed by folks in the consumer advocacy space for a very long time, well before the Biden administration. Losing it would really have implications for people across the political spectrum, especially as we are in this space where housing remains very expensive, where medical debt is a real concern, and where having it affect your credit could really put a reasonable mortgage just out of reach for a lot of Americans. 

Rovner: Well, finally, as one of his parting recommendations, outgoing Surgeon General Vivek Murthy has issued a report recommending that alcoholic beverages carrying warning labels that they can cause cancer, just like tobacco products. His report calls alcohol the third-leading preventable cause of cancer. But this doesn’t feel super-likely to happen, between the power of the alcohol industry and the distrust of science, particularly when it recommends things people probably don’t want to hear. I assume nobody here is betting on this happening anytime soon? 

Ollstein: No, you’ve already seen members of Congress for whom the alcohol and beverage industry is very economically important for their state, all the folks who represent breweries and distilleries and wineries, already speaking out and sharing concerns about this. But I think that just the surgeon general using the bully pulpit to shine a light on this, it generated a lot of news coverage. That’s important. 

It’s important for consumers to see that and be able to make choices. And you’re already seeing some trends of younger folks being more sort of sober-curious. And there’s a lot of talk about Dry January being a healthy thing to do. And a lot more bars you’re seeing offer low-alcohol or nonalcoholic options. And so I think this is something that people are slowly becoming more aware of and more concerned about, whether the government steps in or not. 

Rovner: Yeah, I think it may be like tobacco, where everybody smoked and then gradually fewer and fewer and fewer people did. Lauren, did you want to say something? 

Weber: Yeah, I mean, I’ve written a lot about food labels in the last couple of years, and, I mean, that’s just been a torturous process. So the idea that anything on alcohol would change at anything faster than a glacial pace I think is probably problematic, considering there’s a lot of lawyers in this town and there’s a lot of money in lawmakers’ pockets in this town. So just wanted to add that. 

Rovner: And alcohol’s really popular — and legal. Well, let’s turn to abortion reproductive health. All things considered, it’s actually been sort of quiet on the abortion front for the last few weeks. But there has always been news, as is predictable when Republicans take over the House, Senate, and White House at the same time. New Senate Majority Leader John Thune has announced his intention to bring up an abortion bill. In this case, not a national ban, which President-elect Trump has said he wouldn’t sign, but rather the, quote, “Born-Alive Abortion Survivors Protection Act.” What is this bill? And what would it do? And how is it different from a similar-sounding bill that Congress passed and President George W. Bush signed in 2002? 

Luthra: We were chatting about this in advance of taping the podcast, and this is really interesting for a lot of reasons. What this bill would do is, essentially, if someone gives birth, the hospital or the health care provider is required to provide all forms of lifesaving care, even if it seems like the newborn will not live. And this is relevant in a lot of places. It is relevant when, for instance, you maybe experience a very, very early delivery, in which viability is just not on the table. 

We do know that the vast majority of abortions happen well before the point when there is actually going to be something that resembles an infant being born. And so what this actually does in practice, a lot of health care providers have sounded the alarms about, is stigmatize abortion and sow more mistrust of the health care providers who perform it. And it also, in cases where someone does give birth to a child that will not live, forces doctors to provide medical interventions that maybe won’t make a difference but that will delay the opportunity or prevent the opportunity for palliative care, which is really sad. 

I mean, you give birth to a child that won’t live, and it can’t spend its few moments with some kind of comfort. Instead, it’s given medical treatments that will not really help them. This bill differs from the law signed under President Bush in that it would add penalties. But the other thing that’s worth noting is that killing infants is already illegal. We have laws that ban homicide. And so, when abortion rights supporters and legal scholars say that this kind of law would be redundant, they’re right. We already have ways to penalize killing people. But what we don’t have are national restrictions that stigmatize abortion to the extent that it will be performed less and less. 

But the other thing I think is worth noting, to your point, Julie, is that this is a big step back, especially for Senator Thune, who was on the record supporting a 15-week national abortion ban and is now not. And that helps us underscore that national abortion restrictions are very toxic and that, instead, the GOP is really trying to focus on cases where they think they might have a better chance of winning, by focusing on the very end of pregnancy, areas where they see the support for abortion rights publicly go down, and start with restrictions there, before, if they ever want to do something more sweeping, waiting a bit more time for that to be politically viable. 

Rovner: Basically, it’s a messaging bill to try and put supporters of abortion rights on the spot and say, If you won’t vote for this, then you’re for infanticide. I mean, that’s essentially what the debate’s going to be. Right, Alice? 

Ollstein: Yeah. Well, and just so folks are aware, the timing of this is around the March for Life coming up in a couple days after the inauguration. And almost every year, Republicans in Congress attempt to hold some sort of messaging vote to coincide with that big anti-abortion demonstration in Washington, D.C. 

Rovner: I would say the anti-abortion demonstration is when it is because that was the anniversary of Roe v. Wade. That’s why they come to D.C. in January. 

Ollstein: Yeah. As an aside, they considered moving it to June to mark the anniversary of Dobbs but decided to keep it in January to continue to observe the anniversary of Roe anyways. But like Shefali said, it’s interesting that, even given that this is just a messaging vote, they’re still aiming a lot lower than they have in the past and not introducing the big, sweeping anti-abortion policies that the advocacy groups on that side want to see, in terms of restrictions on abortion medication, or like in the past, 15-week bans, 20-week bans, something like that. Instead, this is sort of a niche and arguably duplicative policy that they’re putting forward. 

Rovner: Well, we will certainly watch that space. Also, over the holiday break, an OB-GYN at the University of Indiana sued the Indiana Department of Health, claiming the state’s new abortion reporting requirements violate the federal HIPAA [Health Insurance Portability and Accountability Act] patient privacy rules. Failure to follow the state law could result in potential criminal liability or loss of medical license, but federal law is supposed to preempt state law. 

Along those same lines, Senate Finance Committee Chairman, now ranking member, Ron Wyden of Oregon released a report in December, which followed up on the reporting that we’ve talked about from ProPublica, about pregnant women dying from preventable and/or treatable complications. Wyden’s staff found that doctors in states with abortion bans have been unable to get sufficient legal advice and/or guidance from their hospital officials in a timely way. 

Quoting from the report, “Doctors are playing lawyer, and lawyers are playing doctor, while pregnant women experiencing anything short of what amounts to a dire emergency are sent away and told to return to the emergency room once a preventable situation becomes life-threatening.” Is there anything on the horizon that would sort out what doctors can and can’t do in states with abortion bans? This continues to be — we keep hearing story after story after story about this. 

Ollstein: So the anti-abortion movement’s response to this is that the laws themselves do not need to be changed, and they instead are introducing these new, what they call “med ed” bills that basically order the government, in collaboration with anti-abortion groups, to develop materials that doctors and medical students will have to review, that purport to explain what is and isn’t allowed in terms of abortion care and emergency care under these restrictions. 

One state so far has implemented this, South Dakota, and they are attempting to introduce it in a bunch of other states. Now, the medical community says there’s no way a video is going to solve this. These are incredibly complex situations. You can’t cover everything that might come up. You can’t cover every condition a pregnant person could have. And they see it as sort of a CYA — if folks are familiar with “cover your behind” — move, in terms of liability and an attempt to put the onus on individual doctors who are already struggling, and to say that any of these adverse outcomes are the fault of doctors for not understanding or correctly abiding by these legal restrictions on care. 

Whereas the doctors say that: We can’t get guidance from our own employers. We can’t get adequate guidance from the state. And these really tie our hands in these very sensitive, time-sensitive, and medically sensitive situations. 

Rovner: And we’ve seen cases, I mean like in Texas, where the attorney general has threatened in writing to prosecute doctors for things that doctors say is standard medical practice. 

Ollstein: Right, so even when a doctor came forward and said, It is my medical judgment that this person needs an abortion for medical reasons, we saw the attorney general there step in and say: I am overruling your judgment. No, she does not. And so that has, based on many interviews I’ve done, and I’m sure Shefali has done, created a real chilling effect, where people are afraid of being second-guessed like that. And even short delays, where someone is trying to consult with an attorney on what to do, even a short delay can be deadly for a patient in one of those situations. 

Rovner: Well, turning to this week in medical misinformation, the big news, of course, is that Facebook is going to disband its fact-checking unit and basically adopt the anything-goes-and-if-you-don’t-like-it-correct-it-yourself system now used by X. This could have big implications for health misinformation, I would think. Even though Facebook wasn’t doing such a great job before on allowing misinformation and disinformation to spread. Is this going to have a big effect? 

Luthra: I mean, I think this is just, to some extent, a sign of Facebook shifting with the political winds, right? I mean, the fact-checking came out in part after the 2016 election when there was a lot of claims of voter fraud. There are a lot of, How did Trump get into office? They instituted fact-checking to allegedly kind of pander to people who felt like that there was a lot of misinformation spread then. Now they’re moving away from fact-checking because they feel like then it gives people the ability to reflect what the community wants. I think it’s reflecting the trend we’re seeing on X. We’ll see more Community Notes. It makes journalists’ job all the more important, to actually distill what’s true and what’s false. 

Rovner: You’re our misinformation expert. Oh, go ahead, Alice. 

Ollstein: Oh, I wanted to also flag that part of Facebook’s announcement was that they are moving some of their teams from California to Texas, because Californians are too biased to do any content moderation and Texans presumably are not. That was the frame of that announcement, basically. And so that, I’ve already seen, is raising concerns in some groups on the left, and medical groups, about access to information about kinds of care that are restricted in Texas, like abortion care, like trans care. 

Will people be able to post about those things, to post accurate things about those things on those platforms? Or will that be restricted in the future? It’s also drawing attention for that reason. 

Luthra: And if I can add one more point to what Alice mentioned, I mean, one of the very explicit areas where Mark Zuckerberg said he would like more room for disagreement and more room for discourse is on the lines of gender, and very explicitly removing restrictions on using very, quite frankly, misogynistic terms about how women should exist in our society, about LGBTQ+ people, about explicitly allowing users to call them mentally ill. 

And this has very meaningful implications for gender equality, sure, but also for health care, because we are seeing that one of the most politicized areas of health care in our country is access to health care for trans people, is access to health care for women. And it’s just very hard to not look at this and think, oh, there will be no implication for how people conceive of health care and how people conceive of those who receive this kind of health care. 

Rovner: And we should point out, which I should have at the beginning, this is not just Facebook — this is all of Meta. So this is Facebook and Instagram and Threads. It’s basically, because I know that only sort of old people like me are still on Facebook, but lots of people are on Instagram and Threads, and this is obviously going to have some pretty big implications as we go forward. 

All right, well, speaking of misinformation, one mark of responsible science is fessing up when you are wrong. And this week we have a big wrong thing to talk about. Back in November, we talked about a study that found that black plastic cooking utensils and takeout containers were dangerous because they were made from recycled electronics and were leaching amounts of fire retardants and other chemicals into your food. 

Well, it turns out that you probably still should get rid of the black plastic in your kitchen, but know that they’re not quite as dangerous as originally advertised. It turns out that the authors of the study made a math error that exaggerated the levels of toxins by a factor of 10. Still, if you don’t want to be exposed to fire retardants and other nasty stuff, you might want to cook with metal or silicone or something that is not black plastic. I do think this is important, because it does show science is an iterative process. It’s rare to see someone step up and say: Oh, oops, we got this wrong. But here, it doesn’t change our general conclusion about this. But you should know that when we make a mistake, we’re going to fix it. I mean, that seems to be very rare in this world right now. 

Ollstein: It’s so hard, because you see the act of admitting error and correcting it — that can fuel distrust. People point to that and say: See, they got that wrong. They must be getting all this other stuff wrong, too. But of course, not correcting misinformation is far worse. And so, in a time of such distrust, communication is really, really hard. And did all the people who saw the first wave of news about the black plastic also see the correction and see that it wasn’t true? How are these things framed? Were the splashy articles that were run, were they corrected? Were they retracted? It’s hard to put the toothpaste back in the tube. 

Rovner: Yeah, but science is an imperfect process. And it’s a process. It would help, I think, if people understood that science is more of a process than a, this is what is. But that’s what we’re all here for, and that’s why we all still have jobs. All right, that is the news for this week. 

Now 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. 

Lauren, you were first this week, so why don’t you go first? 

Weber: I love this story, and I’m obviously biased, but by my colleagues David Ovalle and Rachel Roubein, on how “Laws restrict U.S. shipping of vape products. Many companies do it anyway.” Essentially, you shouldn’t be shipping flavored vapes across the country, but a bunch of companies do. And my colleagues were able to order and get their hands on quite a few of those flavored vapes. 

My favorite part is the kicker in the story, in which one company said, You’re not sanctioned to use our name in any way, when we reached out for comment after they had shipped us vapes illegally. So I thought that was quite something. But essentially, it gets at what is a flaw in this piece of the law, which is that the USPS [U.S. Postal Service] is supposed to enforce, or someone is supposed to enforce, how to stop the shipping of these vapes, but it’s not really happening. So it’s kind of a look at the best intentions may not be the reality on the ground. 

Rovner: Often. Alice. 

Ollstein: So I have a piece from the New York Times called “Ozempic, Lego Bricks and Hearing Aids: What Trump’s Greenland Plan Could Hit.” And this is coming off of Trump threatening to impose tariffs on Denmark if it refuses to allow the U.S. to take over Greenland, which has become one of Trump’s latest obsessions. 

And this piece is pointing out that tariffs on Denmark would impact a lot of things the U.S. population depends on. Specifically, the pharma giant Novo Nordisk is based there and manufactures tons of medications, including Ozempic, and other weight loss drugs and diabetes drugs in that family that are incredibly popular right now, and as well as hearing aids, other medical devices, other medications. And so this could impact consumers, if it ever were to happen, which who even knows. 

Rovner: Yes. Well, we will talk more about tariffs and the medical industry in a future podcast, but thank you for noting that. Shefali. 

Luthra: My piece is from Vox. It is by David Zipper. The headline is “Gigantic SUVs are a public health threat. Why don’t we treat them like one?” 

I think the story is so smart. I love this framing. It first lays out the evidence for why, when cars reach a certain size, they are very dangerous and much more likely to kill people. And then it gets into the conversation: Why don’t we actually treat this as a public health threat? 

And they look at the war on tobacco and the war on smoking to think through: What did it look like to take something that was so ubiquitous in our culture and actually convince the American public to shift away from it? I think this is really interesting for a lot of reasons. One is that public health is really expansive and we should think about it in an expansive way and consider all the different elements, like car size, that do affect our lives and life expectancy. 

And I also do think this ties really well to the conversation we had about the surgeon general’s alcohol warning, in that even short of policy changes, there is a lot that we can do as a society to shift the public’s understanding of health risks from things that we take for granted, and we can still move people in a direction toward being healthier and keeping our fellow Americans healthier. And that’s really interesting and important to think about. 

Rovner: Probably easier to do something about large SUVs than alcohol, but yes, I’m so glad you linked those two things. My story this week is from The Wall Street Journal. It’s called “UnitedHealth’s Army of Doctors Helped It Collect Millions More From Medicare,” by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty. And it’s basically the flip side of the story that Stat News has been all over, about how United has used various methods to deny care to its Medicare Advantage patients to save the insurer money. This is a story about how United is forcing the doctors who work for the company — and there are a lot of them, like 10,000 — to basically run through a checklist of potential diagnoses for every Medicare Advantage patient, to encourage doctors to make those patients seem sicker, even if they’re not, because then the company gets more money for Medicare. 

The investigation found that the, quote, “sickness scores” for patients moving from traditional Medicare to United’s Medicare Advantage increased an average of 55%, which was, quoting from the story, “roughly equivalent to every patient getting newly diagnosed with HIV … and breast cancer,” basically maximizing profits from both ends. It is quite the story, and I recommend it highly. 

OK, that’s this week’s show. I hope you feel caught up and ready for the rest of 2025. As always, if you enjoy the podcast, you could subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks, again this week, to our temporary production team, Taylor Cook and Lonnie Ro, as well as 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 increasingly at Bluesky, @julierovner.bsky.social. Where are you guys mostly these days? Alice? 

Ollstein: I am @alicemiranda on Bluesky, mostly. 

Rovner: Shefali. 

Luthra: You can find me on Bluesky, @shefali. 

Rovner: Lauren. 

Weber: Still just chilling on X, @LaurenWeberHP. 

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).

More than a million California residents living in the U.S. without authorization now qualify for Medi-Cal, the state’s version of Medicaid, making California among the first states to cover low-income people regardless of their immigration status. The state is experimenting with Medicaid money to pay for social services such as housing and food assistance, especially for those living on the streets or with chronic diseases. And the state is forcing the health care industry to rein in soaring costs while imposing new rules on doctors, hospitals, and insurers to provide better-quality, more accessible care.

However, Newsom has so far failed to fully deliver on his most sweeping health care policies — and many changes are not yet visible to the public: Health care costs continue to rise, homelessness is worsening, and many Californians still struggle to get basic medical care.

Now, some of Newsom’s signature health initiatives, which could shape his profile on the national stage, are in peril as Donald Trump returns to the White House. According to national health policy experts, California stands to lose billions of dollars in health care funding should the Trump administration alter Medicaid programs as Republicans have indicated is likely. Such a move could force the state to dramatically slash benefits or eligibility.

And although allowing immigrants without legal status to enroll in free health care has been funded almost entirely with state money, it makes California a political target.

“That is fuel to feed the Republican MAGA argument that we are taking tax dollars from good Americans and providing health care to immigrants,” said Mark Peterson, a health care expert at UCLA, referring to the “Make America Great Again” movement.

Newsom declined an interview with KFF Health News. In a statement, he acknowledged that many of his initiatives are works in progress. But although he will attempt to work with Trump, the governor vowed to protect his health care agenda in his final two years in office.

“We are approaching the incoming administration with an open hand, not a closed fist,” Newsom said. “It is a top priority of my administration to ensure that quality health care is available and affordable for all Californians.”

Mark Ghaly, a former Health and Human Services secretary under Newsom, said transforming the way health care is paid for and delivered can be bumpy. “We didn’t do it perfectly,” Ghaly said. “Implementation is always messy in a state of 40 million people.”

Ahead of Trump’s Jan. 20 inauguration, Newsom has proposed allocating $25 million to challenge Trump on reproductive health care, disaster relief, and other services. His request is pending in the state’s Democratic-controlled legislature.

Here are the major initiatives that will shape Newsom’s health care legacy:

Medicaid

Potential federal cuts loom large in America’s most populous state. Of the whopping $261 billion California spends annually on health care and social services, nearly $116 billion flows from the federal government. Most of that goes to Medicaid, which covers more than 1 in 3 Californians. GOP leaders in Washington have floated ideas to kneecap Medicaid, which could slash benefits or cut enrollment.

In addition, California’s expansion of Medi-Cal to 1.5 million immigrants without legal status is projected to cost the state roughly $6.4 billion for the fiscal year ending June 30. Newsom suggested in early December that the state would continue to fund the immigrant health care expansion in the upcoming budget year but declined to say whether he would preserve the coverage in future years.

Advocacy groups are readying to defend those benefits should Trump target California over the issue. “We want to continue to protect access to care and not see a rollback,” said Amanda McAllister-Wallner, interim executive director of Health Access California.

Generic Drugs

Citing the high cost of prescription drugs, Newsom in 2022 plowed $100 million into his plan to produce generic insulin for California and launch a state manufacturing plant to produce a range of generic drugs. Three years later, California has done neither. Newsom did, however, announce a deal in April to purchase in bulk the opioid reversal drug naloxone, which the state made available to schools, health clinics, and other institutions at a discount.

“It’s certainly disappointing that there isn’t much more progress on it,” said former state Sen. Richard Pan, who authored the original generic drug legislation.

On generic insulin, Newsom acknowledged “that it’s taken longer than we hoped to get insulin on the market, but we remain committed to delivering $30 insulin available to all who need it as soon as we can.”

Abortion

The governor helped lead the successful 2022 campaign to enshrine access to abortion in the state constitution. He signed laws to ensure abortions and miscarriages are not criminalized and to allow out-of-state doctors to perform abortions in California; built a stockpile of abortion medication when mifepristone faced a national ban; and set aside $20 million to help Californians who can’t afford abortion care to access it.

Newsom, who has made reproductive rights a central tenet of his political agenda, also funded ads and traversed the country attacking Trump and other Republicans in red states who have rolled back abortion access.

After Trump won the election, Newsom called a special legislative session to ready for potential legal battles with the federal government. He told KFF Health News the state is preparing “in every possible way to protect the rights guaranteed in California’s Constitution and ensure bodily autonomy for all those in our state.”

Rising Health Care Costs

In 2022, Newsom created the Office of Health Care Affordability to set limits on health care spending and impose penalties on industry payers and providers that fail to meet targets. By 2029, California will cap annual price increases for health insurers, doctors, and hospitals at 3%.

While Trump has voiced concern about the steady rise of health care costs nationally — and the quality of health care Americans are receiving — his ideas have focused on deregulation and replacing the Affordable Care Act, which experts say could cost millions their health coverage and increase patient health care spending. California could potentially lose federal subsidies that have helped offset insurance premiums for most of the roughly 1.8 million people who buy their health coverage from Covered California, the state’s ACA marketplace, which would increase patient out-of-pocket costs.

The state could use money it raises from its own health insurance penalty on the uninsured, which Newsom adopted after the Obamacare individual mandate was zeroed out by Congress in 2017. Those state revenues are projected to be $298 million this fiscal year, according to the state Department of Finance. That’s a fraction of the federal health insurance subsidies California receives — roughly $1.7 billion annually.

Health and Homelessness

Under Newsom, California has spent unprecedented public money on tackling homelessness, yet the crisis has worsened under his watch.

From 2019, when Newsom took office, to 2023, homelessness jumped 20% to more than 181,000, despite his funneling more than $20 billion into trying to get people off the streets, including converting hotels and motels into homeless housing. He has also plowed roughly $12 billion into CalAIM, an experimental effort to infuse Medi-Cal with social services, including rental and eviction assistance.

A state audit last year found the state isn’t doing a good job of tracking the effectiveness of taxpayer money. CalAIM isn’t serving as many Californians as expected and patients face difficulty receiving new benefits from health insurers.

“The homelessness crisis on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”

Experts expect the Trump administration to reverse liberal policies that have allowed Medicaid money to be used for health care experiments through waivers encouraged by the Biden administration. Notably, Trump has attacked Newsom for his handling of the homelessness crisis and has vowed to more forcefully move people off the streets. California’s CalAIM waiver ends at the end of 2026.

Instead of expanding housing and food assistance, for instance, the state could instead see federal moves to end CalAIM benefits and make Medicaid more restrictive.

Mental Health and Substance Use

Newsom has launched the most extensive overhaul of California’s behavioral health system in decades, directing billions in state funding toward a new network of treatment facilities and prevention programs.

Two of his most controversial signature initiatives, Proposition 1 and CARE Court, infuse money into treatment and housing for Californians with behavioral health conditions, especially homeless people living in crisis. And CARE Court allows judges to compel treatment for those suffering from debilitating mental illness and substance use.

Both have been hamstrung by funding challenges, rely on counties for implementation, and could take years to produce noticeable results. Whereas Newsom has sought to expand community-based treatment, Trump has promised a return to institutionalization and suggested homeless people and those with severe behavioral health conditions be moved to “large parcels of inexpensive land.”

Newsom said he hopes his “innovative” approaches will transform behavioral health care with “a laser focus on people with the most serious illness and substance use disorders.”

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

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

USE OUR CONTENT

This story can be republished for free (details).

Más de un millón de residentes de California que viven en Estados Unidos sin papeles ahora califican para Medi-Cal, la versión estatal de Medicaid: ha sido uno de los primeros en cubrir a personas de bajos ingresos independientemente de su estatus migratorio.

El estado también está experimentando con fondos de Medicaid para pagar servicios sociales como asistencia para vivienda y alimentos, especialmente para aquellos que viven en las calles o tienen enfermedades crónicas. Además, está obligando a la industria de la salud a controlar los costos desbordantes mientras impone nuevas reglas a médicos, hospitales y aseguradoras para ofrecer una atención de mejor calidad y más accesible.

Sin embargo, hasta ahora, Newsom no ha logrado cumplir por completo con sus políticas de salud más ambiciosas, y muchos cambios aún no son visibles para el público: los costos de la salud siguen aumentando, la escasez de vivienda está empeorando y muchos californianos todavía luchan por obtener atención médica básica.

Ahora, algunas de las iniciativas emblemáticas de Newsom en materia de salud, que podrían definir su perfil en el escenario nacional, están en peligro con el regreso de Donald Trump a la Casa Blanca.

Según expertos en políticas sanitarias, California podría perder miles de millones de dólares en financiamiento para la atención médica si la nueva administración Trump altera los programas de Medicaid, algo que los republicanos han dicho que es probable. Tal movimiento podría obligar al estado a recortar drásticamente beneficios, e incluso la elegibilidad.

Y aunque la inscripción para que inmigrantes indocumentados obtengan atención médica gratuita se ha financiado casi completamente con dinero estatal, esto convierte a California en un blanco político.

“Eso es combustible para alimentar el argumento de la republicana MAGA de que estamos tomando dólares de impuestos de buenos estadounidenses y proporcionando atención médica a los inmigrantes”, dijo Mark Peterson, experto en atención médica de UCLA, en referencia al movimiento “Make America Great Again”.

Newsom rechazó una entrevista con KFF Health News. En un comunicado, reconoció que muchas de sus iniciativas todavía están en proceso de implementarse. Pero, aunque intentará trabajar con Trump, el gobernador prometió proteger su agenda de atención médica en sus dos últimos años en el cargo.

“Nos estamos acercando a la administración entrante con una mano abierta, no con un puño cerrado”, dijo Newsom. “Es una prioridad principal de mi administración asegurar que la atención médica de calidad esté disponible y sea asequible para todos los californianos”.

Mark Ghaly, ex secretario de Salud y Servicios Humanos bajo Newsom, dijo que transformar la forma en que se paga y ofrece la atención médica puede ser complicado. “No lo hicimos perfectamente”, dijo Ghaly. “La implementación siempre es complicada en un estado de 40 millones de personas”.

Antes de la inauguración de Trump el 20 de enero, Newsom propuso asignar $25 millones para desafiar a Trump en atención reproductiva, ayuda para desastres y otros servicios. Su solicitud está pendiente en la Legislatura estatal controlada por demócratas.

Estas son las principales iniciativas que conformarán el legado de Newsom en salud:

Medicaid

Se avecinan posibles recortes federales en el estado más poblado de Estados Unidos. De los asombrosos $261 mil millones que California gasta anualmente en atención médica y servicios sociales, casi $116 mil millones provienen del gobierno federal. La mayor parte de eso va a Medicaid, que cubre a más de 1 de cada tres californianos. Líderes republicanos en Washington han planteado ideas para debilitar el programa, lo que podría reducir beneficios o disminuir la inscripción.

Además, la expansión de Medi-Cal en California para 1.5 millones de inmigrantes sin papeles se proyecta que costará al estado aproximadamente $6.4 mil millones para el año fiscal que termina el 30 de junio.

A principios de diciembre, Newsom sugirió que el estado continuaría financiando la expansión de atención médica para inmigrantes en el próximo año fiscal, pero no quiso decir si mantendría la cobertura en años futuros.

Grupos de defensa están listos para proteger estos beneficios si Trump hace de California su blanco. “Queremos continuar protegiendo el acceso a la atención y no ver un retroceso”, dijo Amanda McAllister-Wallner, directora ejecutiva interina de Health Access California.

Medicamentos genéricos

Citando el alto costo de los medicamentos recetados, en 2022 Newsom destinó $100 millones a su plan para producir insulina genérica para California y lanzar una planta estatal de fabricación para producir una gama de medicamentos genéricos.

Tres años después, California no ha logrado ninguno de los dos. Sin embargo, en abril Newsom anunció un acuerdo para comprar al por mayor naloxona, el medicamento para revertir las sobredosis de opioides, que el estado puso a disposición de escuelas, clínicas de salud y otras instituciones a un precio reducido.

“Es ciertamente decepcionante que no haya mucho más progreso”, dijo el ex senador estatal Richard Pan, quien redactó la legislación original de medicamentos genéricos.

Sobre la insulina genérica, Newsom reconoció “que ha tomado más tiempo del que esperábamos llevar insulina al mercado, pero seguimos comprometidos a ofrecer insulina a $30 disponible para todos los que la necesiten lo antes posible”.

Aborto

El gobernador ayudó a liderar la exitosa campaña de 2022 para incluir el acceso al aborto en la constitución estatal. Firmó leyes para garantizar que los abortos, espontáneos o no, no fueran criminalizados, para permitir que médicos de otros estados realicen abortos en California, almacenar medicamentos abortivos cuando mifepristona enfrentó una prohibición nacional, y destinó $20 millones para ayudar a los californianos que no pueden pagar el cuidado del aborto.

Newsom, quien ha hecho de los derechos reproductivos un pilar central de su agenda política, también financió anuncios y recorrió el país atacando a Trump y a otros republicanos en estados conservadores que han restringido el acceso al aborto.

Después de la victoria electoral de Trump, Newsom convocó a una sesión legislativa especial para prepararse para posibles batallas legales con el gobierno federal. Dijo a KFF Health News que el estado se está preparando “de todas las maneras posibles para proteger los derechos garantizados en la constitución de California y asegurar la autonomía para todos los que están en nuestro estado”.

Costos crecientes de la atención médica

En 2022, Newsom creó la Office of Health Care Affordability para establecer límites al gasto en salud e imponer sanciones a las aseguradoras y proveedores de atención médica que no cumplieran con los objetivos. Para 2029, California limitará los aumentos anuales de precios para aseguradoras, médicos y hospitales al 3%.

Si bien Trump ha expresado preocupación por el aumento constante de los costos de la atención médica a nivel nacional y la calidad de la atención, sus ideas se han centrado en la desregulación y en reemplazar la Ley de Cuidado de Salud a Bajo Precio (ACA), lo que, según expertos, podría costar a millones su cobertura de salud y aumentar los gastos de los pacientes.

California podría perder subsidios federales que han ayudado a reducir las primas de seguros para la mayoría de los aproximadamente 1.8 millones de personas que compran su cobertura de salud a través de Covered California, el mercado estatal de ACA, lo que aumentaría los gastos de bolsillo de los pacientes.

El estado podría usar el dinero que recauda de sus propias multas por no tener seguro de salud, adoptada por Newsom después que el Congreso eliminara el mandato individual de Obamacare en 2017. Según el Departamento de Finanzas del estado, esos ingresos estatales están proyectados en $298 millones para este año fiscal. Eso es una fracción de los aproximadamente $1.7 mil millones anuales en subsidios federales para seguros de salud que recibe California.

Salud y falta de vivienda

Bajo el liderazgo de Newsom, California ha gastado cantidades sin precedentes de dinero público para abordar la crisis de personas sin hogar, pero la situación ha empeorado bajo su mandato.

Desde 2019, cuando Newsom asumió el cargo, hasta 2023, la falta de vivienda aumentó un 20%: más de 181,000 personas no tienen techo, a pesar que el estado destinó más de $20 mil millones para tratar de sacar a las personas de las calles, incluido un programa para convertir hoteles y moteles en viviendas para los sin hogar.

Además, se han invertido aproximadamente $12 mil millones en CalAIM, un esfuerzo experimental para integrar servicios sociales en Medi-Cal, como asistencia para alquilar y para prevenir desalojos.

El año pasado, una auditoría estatal encontró que el estado no estaba haciendo un buen trabajo en el seguimiento de la efectividad del dinero de los contribuyentes. CalAIM no está sirviendo a tantos californianos como se esperaba, y los pacientes enfrentan dificultades para recibir los nuevos beneficios de los aseguradores de salud.

“La crisis de personas sin hogar en nuestras calles es inaceptable”, reconoció Newsom. “Pero estamos comenzando a ver avances”.

Se espera que la administración Trump revierta las políticas liberales que han permitido el uso de dinero de Medicaid para experimentos de atención médica a través de exenciones alentadas por la administración Biden.

Notablemente, Trump ha criticado a Newsom por su manejo de la crisis de personas sin hogar y ha prometido sacar a las personas de las calles con más fuerza. La exención de CalAIM en California termina a finales de 2026.

Por ejemplo, en lugar de expandir la asistencia de vivienda y alimentos, el estado podría enfrentarse a movimientos federales para terminar los beneficios de CalAIM y hacer que Medicaid sea más restrictivo.

Salud mental y adicciones

Newsom ha lanzado la reforma más extensa del sistema de salud conductual de California en décadas, destinando miles de millones en fondos estatales a una nueva red de instalaciones de tratamiento y programas de prevención.

Dos de sus iniciativas emblemáticas más controvertidas, la Proposición 1 y CARE Court, inyectan dinero en el tratamiento y la vivienda para californianos con afecciones de salud conductual, especialmente personas sin hogar que viven en crisis. CARE Court permite a los jueces ordenar tratamiento para quienes sufren enfermedades mentales debilitantes y trastornos por adicciones.

Ambas iniciativas han enfrentado desafíos de financiamiento, dependen de los condados para su implementación y podrían tardar años en producir resultados visibles.

Mientras que Newsom ha buscado expandir el tratamiento en las comunidades, Trump ha sugerido un regreso a la institucionalización y propuso trasladar a personas sin hogar y a aquellos con graves afecciones de salud conductual a “grandes extensiones de tierra económica”.

Newsom dijo que espera que sus enfoques “innovadores” transformen la atención de salud conductual con “un enfoque en las personas con enfermedades más graves y adicciones”.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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

USE OUR CONTENT

This story can be republished for free (details).

For Shyanne McCoy, 23, that meant the closest hospital with an obstetrician on staff when she was pregnant was a 45-mile drive away over a mountain pass.

When McCoy developed symptoms of preeclampsia last January, she felt she had the best chance of getting the care she needed at a larger hospital in Boise, Idaho, two hours away. She spent the final week of her pregnancy there, too far from home to risk leaving, before giving birth to her daughter.

Six months later, she said it seems clear to her that the health care needs of rural young women like her are largely ignored.

For McCoy and others, figuring out how to obtain adequate care to safely have a baby in Baker City has quickly eclipsed concerns about another medical service lacking in the area: abortion. But in Oregon and elsewhere in the country, progressive lawmakers’ attempts to expand abortion access sometimes clash with rural constituencies.

Oregon is considered one of the most protective states in the country when it comes to abortion. There are no legal limits on when someone can receive an abortion in the state, and the service is covered by its Medicaid system. Still, efforts to expand access in the rural, largely conservative areas that cover most of the state have encountered resistance and incredulity.

It’s a divide that has played out in elections in such states as Nevada, where voters passed a ballot measure in November that seeks to codify abortion protections in the state constitution. Residents in several rural counties opposed the measure.

In Oregon, during the months just before the Baker City closure was announced, Democratic state lawmakers were focused on a proposed pilot program that would launch two mobile reproductive health care clinics in rural areas. The bill specified that the van-based clinics would include abortion services.

State Rep. Christine Goodwin, a Republican from a southwestern Oregon district, called the proposal the “latest example” of urban legislators telling rural leaders what their communities need.

The mobile health clinic pilot was eventually removed from the bill that was under discussion. That means no new abortion options in Oregon’s Baker County — and no new state-funded maternity care either.

“I think if you expanded rural access in this community to abortions before you extended access to maternal health care, you would have an uprising on your hands,” said Paige Witham, 27, a member of the Baker County health care steering committee and the mother of two children, including an infant born in October.

A study published in JAMA in early December that examined nearly 5,000 acute care hospitals found that by 2022, 52% of rural hospitals lacked obstetrics care after more than a decade of unit closures. The health implications of those closures for young women, the population most likely to need pregnancy care, and their babies can be significant. Research has shown that added distance between a patient and obstetric care increases the likelihood the baby will be admitted to a neonatal intensive care unit, or NICU.

Witham said that while she does not support abortion, she believes the government should not “legislate it away completely.” She said that unless the government provides far more support for young families, like free child care and better mental health care, abortion should remain legal.

Conversations with a liberal school board member, a moderate owner of a timber company, members of Baker City’s Republican Party chapter, a local doula, several pregnant women, and the director of the Baker County Health Department — many of whom were not rigidly opposed to abortion — all turned up the same answer: No mobile clinics offering abortions here, please.

Kelle Osborn, a nurse supervisor for the Baker County Health Department, loved the idea of a mobile clinic that would provide education and birth control services to people in outlying areas. She was less thrilled about including abortion services in a clinic on wheels.

“It’s not something that should just be handed out from a mobile van,” she said of abortion services. She said people in her conservative rural county would probably avoid using the clinics for anything if they were understood to provide abortion services.

Both Osborn and Meghan Chancey, the health department’s director, said they would rank many health care priorities higher, including the need for a general surgeon, an ICU, and a dialysis clinic.

Nationally, reproductive health care services of all types tend to be limited for people in rural areas, even within states that protect abortion access. More than two-thirds of people in “maternity care deserts” — all of which are in rural counties — must drive more than a half-hour to get obstetric care, according to a 2024 March of Dimes report. For people in the Southern states where lawmakers installed abortion bans, abortion care can be up to 700 miles away, according to a data analysis by Axios.

Nathan Defrees grew up in Baker City and has practiced medicine here since 2017. He works for a family medicine clinic. If a patient asks about abortion, he provides information about where and how one can be obtained, but he doesn’t offer abortions himself.

“There’s not a lot of anonymity in small towns for physicians who provide that care,” he said. “Many of us aren’t willing to sacrifice the rest of our career for that.”

He also pointed to the small number of patients requesting the service locally. Just six people living in Baker County had an abortion in 2023, according to data from the Oregon Department of Public Health. Meanwhile, 125 residents had a baby that year.

A doctor with obstetric training living in another rural part of the state has chosen to quietly provide early-stage abortions when asked. The doctor, concerned for their family’s safety in the small, conservative town where they live, asked not to be identified.

The idea that better access to abortion is not needed in rural areas seems naive, the doctor said. People most in need of abortion often don’t have access to any medical service not already available in town, the doctor pointed out. The first patient the doctor provided an abortion for at the clinic was a meth user with no resources to travel or to manage an at-home medication abortion.

“It seemed entirely inappropriate for me to turn her away for care I had the training and the tools to do,” the doctor said.

Defrees said it has been easier for Baker County residents to get an abortion since the U.S. Supreme Court overturned Roe v. Wade.

A new Planned Parenthood clinic in Ontario, Oregon, 70 miles away in neighboring Malheur County, was built primarily to provide services to people from the Boise metro area, but it also created an option for many living in rural eastern Oregon.

Idaho is one of the 16 states with near-total bans on abortion. Like many states with bans, Idaho has struggled to maintain its already small fleet of fetal medicine doctors. The loss of regional expertise touches Baker City, too, Defrees said.

For example, he said, the treatment plan for women who have a desired pregnancy but need a termination for medical reasons is now far less clear. “It used to be those folks could go to Boise,” he said. “Now they can’t. That does put us in a bind.”

Portland is the next closest option for that type of care, and that means a 300-mile drive along a set of highways that can be treacherous in winter.

“It’s a lot scarier to be pregnant now in Baker City than it ever has been,” Defrees 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).