\n<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.\t\t<\/p>\n At the Trump administration\u2019s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November\u2019s midterm elections.<\/p>\n Meanwhile, the administration\u2019s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It\u2019s a significant number, but less drastic than cuts it proposed for fiscal 2026.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.<\/p>\n \tMaya Goldman \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \tLauren Weber \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> The Atlantic\u2019s \u201cHHS Officials\u2019 Year in Purgatory Is Ending<\/a>,\u201d by Katherine J. Wu.<\/p>\n Maya Goldman:<\/strong> KFF Health News\u2019 \u201cTrump\u2019s Personnel Agency Is Asking for Federal Workers\u2019 Medical Records<\/a>,\u201d by Amanda Seitz and Maia Rosenfeld.<\/p>\n Lauren Weber:<\/strong> CNN\u2019s \u201cThese Common Drug Tests Lead to Tens of Thousands of Wrongful Arrests a Year, Experts Say. One State Is Fighting Back<\/a>,\u201d by Holly Yan.<\/p>\n Alice Miranda Ollstein:<\/strong> Politico\u2019s \u201cA Slowdown in US Visa Processing Is Wreaking Havoc on Foreign Doctors\u2019 Lives<\/a>,\u201d by Simon J. Levien.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Abortion Pills, the Budget, and RFK Jr.<\/strong>\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong>\u00a0This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong>\u00a0Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to\u00a0What the Health?<\/em>\u00a0I\u2019m\u00a0Julie Rovner, chief Washington correspondent for KFF Health News, and\u00a0I\u2019m\u00a0joined by some of the best and smartest health reporters covering Washington.\u00a0We\u2019re\u00a0taping this week on Thursday,\u00a0April 9, at 9:30\u00a0a.m.\u00a0As always, news happens fast, and things might have changed by the time you hear this. So here we go.\u00a0<\/p>\n Today, we are joined via video conference by Lauren Weber\u00a0of\u00a0The Washington Post.\u00a0<\/p>\n Lauren Weber:<\/strong>\u00a0Hello,\u00a0hello.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Alice Miranda\u00a0Ollstein\u00a0of Politico.\u00a0<\/p>\n Alice Miranda\u00a0Ollstein:<\/strong>\u00a0Hi,\u00a0everybody.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And my fellow Michigan Wolverine this national championship week,\u00a0Maya Goldman of Axios.\u00a0Go,\u00a0Blue!\u00a0<\/p>\n Maya Goldman:<\/strong>\u00a0Go,\u00a0Blue.\u00a0<\/p>\n Rovner:\u00a0<\/strong>No interview this week, but plenty of news.\u00a0So\u00a0let\u2019s\u00a0get right\u00a0to\u00a0it.\u00a0We\u2019re\u00a0going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill\u00a0mifepristone.\u00a0Wait, what? Please explain,\u00a0Alice,\u00a0how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yeah.\u00a0So\u00a0this has been building for a while, and it is not the only lawsuit of its kind out there. There are several.\u00a0A\u00a0bunch of different state attorneys general,\u00a0who are very conservative and anti-abortion, have been suing the FDA\u00a0in an attempt to\u00a0either completely get\u00a0rid of the availability\u00a0of the abortion pill\u00a0mifepristone\u00a0or reimpose previous restrictions on it.\u00a0So right now, at least according to federal rules, not according to every state\u2019s\u00a0rules,\u00a0you can get it via telehealth.\u00a0You can get it delivered by\u00a0mail. You can pick it up at a retail\u00a0pharmacy. You\u00a0don\u2019t\u00a0have to get it in person handed to you from a doctor like you used to.\u00a0So\u00a0these lawsuits are\u00a0attempting\u00a0to bring back those restrictions or get the kind of national ban that a lot of groups want.\u00a0And\u00a0so\u00a0you have\u00a0other ones\u00a0pending:\u00a0Florida, Texas,\u00a0Missouri,\u00a0you have a bunch of ones.\u00a0So\u00a0this is the Louisiana version. And the Trump administration,\u00a0it\u2019s\u00a0important to note, they are not defending the FDA or the abortion pill on the merits. They are saying,\u00a0we\u00a0don\u2019t\u00a0want this lawsuit and this court to force us to do something.\u00a0We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions<\/em>. But\u00a0they\u2019re\u00a0asking courts to give them the time and space to complete that process and saying, you know,\u00a0This\u00a0is our power we should have in the executive branch<\/em>. And so,\u00a0in this case, the judge,\u00a0in ruling for the Trump administration,\u00a0basically just\u00a0hit pause. This\u00a0doesn\u2019t\u00a0get rid of the case. It just puts\u00a0a stay on it for now, and\u00a0that\u2019s\u00a0important.\u00a0In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here.\u00a0So\u00a0this\u00a0doesn\u2019t\u00a0mean that abortion pills are going to be available forever. This\u00a0doesn\u2019t\u00a0mean\u00a0nothing\u2019s\u00a0going to happen,\u00a0and\u00a0they\u2019re\u00a0going to be banned. This just means, you know,\u00a0we\u2019re\u00a0kicking the can down the road.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0I was saying,\u00a0just to be clear. I mean, we know that this FDA quote-unquote\u00a0\u201cstudy\u201d\u00a0\u2014\u00a0whether it is or isn\u2019t going on\u00a0\u2014\u00a0is part of, kind of,\u00a0a delaying tactic by the administration, because they don\u2019t want to really make abortion a big front-and-center issue in the midterms.\u00a0So\u00a0they\u2019re\u00a0trying to\u00a0sort of run\u00a0the clock out here. Is that not\u00a0sort of the\u00a0interpretation\u00a0that\u2019s\u00a0going on right now?\u00a0\u00a0<\/p>\n Ollstein:<\/strong>\u00a0That\u2019s\u00a0what people on both sides assume is going on.\u00a0It\u2019s\u00a0really been fascinating how everyone is being kept in the dark about\u00a0what\u2019s\u00a0happening inside the FDA\u00a0\u2014\u00a0and if this review is even happening, if\u00a0it\u2019s\u00a0real, if\u00a0it\u2019s\u00a0in good faith, what is it based on? And\u00a0so\u00a0it\u2019s\u00a0become this sort of Rorschach test,\u00a0where people on the left are saying, you know,\u00a0They\u2019re\u00a0laying the groundwork to do a national ban. This is just\u00a0political\u00a0cover. They just want to wait until after the midterms, and then\u00a0they\u2019re\u00a0going to go for it<\/em>. And people on the right are saying, you know,\u00a0The\u00a0administration is cowardly, and they\u00a0aren\u2019t\u00a0really doing anything, and\u00a0they\u2019re\u00a0just trying to get us to shut up and be patient<\/em>. We\u00a0don\u2019t\u00a0know if either of those interpretations or\u00a0neither of\u00a0them\u00a0are true.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Lauren,\u00a0you\u00a0want to add something?\u00a0<\/p>\n Weber:<\/strong>\u00a0I just think it\u2019s\u00a0pretty clear\u00a0this is also just on a\u00a0[Health and Human Services Secretary Robert F.]\u00a0Kennedy\u00a0[Jr.]\u00a0priority.\u00a0I mean,\u00a0let\u2019s\u00a0go back. The man\u00a0\u2026\u00a0comes from one\u00a0of\u00a0the top Democratic political families originally. You know,\u00a0there\u2019s\u00a0obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously,\u00a0he\u2019s\u00a0on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other\u00a0hot issues\u00a0that,\u00a0[if]\u00a0I had to guess,\u00a0I\u00a0don\u2019t\u00a0think that\u00a0they\u2019re\u00a0trying to rock the boat on this one.\u00a0\u2026\u00a0I think, some background context too, to some of\u00a0what\u2019s\u00a0going on.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0We\u2019ll\u00a0get to some of those hotter issues. But,\u00a0meanwhile, the Journal of the American Medical Association\u00a0[Internal Medicine]\u00a0has a\u00a0study out this week<\/a>\u00a0suggesting that medication abortion is so safe that it could be provided over the counter\u00a0\u2014\u00a0that\u2019s\u00a0without any consultation with a medical professional, either in person or online. This\u00a0doesn\u2019t\u00a0feel like\u00a0it\u2019s\u00a0going to happen anytime soon, though, right? While\u00a0we\u2019re\u00a0still debating the existence of medication abortion in general.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0That\u2019s\u00a0right. I mean, there are a lot of people who\u00a0can\u2019t\u00a0get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter,\u00a0whereas\u00a0in the United States, the most common way to have a medication abortion is with a two-pill combination,\u00a0mifepristone\u00a0and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is\u00a0effective\u00a0and it is\u00a0largely safe.\u00a0It\u2019s\u00a0slightly less safe than using both pills together. And\u00a0so\u00a0I think\u00a0there\u2019s\u00a0a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor\u2019s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could.\u00a0But because of bans and restrictions, they\u00a0can\u2019t. And\u00a0so\u00a0people are turning to these activist groups.\u00a0<\/p>\n Rovner:\u00a0<\/strong>I will point out, as a person who covered the entirety of the fight to have emergency contraception\u00a0\u2014\u00a0which is not the abortion pill\u00a0\u2014\u00a0made over the\u00a0counter,\u00a0it took like, 15 years. It shortened my\u00a0life\u00a0covering that story. Lauren, did you\u00a0want to add something?\u00a0\u00a0<\/p>\n Weber:<\/strong>\u00a0Yeah, I just wanted to say I find it\u00a0really interesting.\u00a0Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter.\u00a0But there are a lot of things that are considered potentially more dangerous that you can\u00a0order up\u00a0in\u00a0a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate.\u00a0So\u00a0I think the differences\u00a0of\u00a0access\u00a0of\u00a0this compared to other less studied, potentially more unsafe medication is quite striking.\u00a0<\/p>\n Goldman:<\/strong>\u00a0Part of\u00a0[President Donald]\u00a0Trump\u2019s\u00a0\u201cGreat\u00a0Healthcare\u00a0Plan\u201d\u00a0is making more medications available over the counter.\u00a0So\u00a0this is certainly something that they have said they want to do, in general.\u00a0This is a political nightmare, though, to do that for abortion.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yeah,\u00a0and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes.\u00a0And\u00a0you\u2019ve\u00a0seen that, and that comes up in lawsuits and political arguments about this. And I think,\u00a0you know, people can point to this as another example.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So last week, we\u00a0talked about the federal family planning program\u00a0Title\u00a0X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some\u00a0big changes\u00a0to the program, and now those have finally been announced. Tell us what the plan is for a program that\u2019s provided birth control and other types of primary and preventive care since the early 1970s.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Well, the changes have\u00a0sort of<\/em>\u00a0been announced. They\u2019ve\u00a0more been teased. What we are still waiting for is an actual rule,\u00a0like we saw in the first Trump administration, that would impose conditions on the program. And\u00a0so\u00a0what we saw recently, it was part of a wonky document called a\u00a0\u201cNotice of Funding Opportunity,\u201d\u00a0or NOFO, for those in the D.C.\u00a0lingo. And\u00a0basically\u00a0it was signaling that when groups reapply\u00a0\u2014\u00a0they just got this year\u2019s money,\u00a0but when they reapply for next year\u2019s money\u00a0\u2014\u00a0it sets up\u00a0sort of new\u00a0priorities and a new focus for the entire program. And what was really striking to me is, you\u00a0know,\u00a0this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can\u2019t afford it around the country, providing it to millions of people\u00a0who\u00a0depend on this program, and the word\u00a0\u201ccontraception\u201d\u00a0did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote,\u00a0\u201cfamily formation.\u201d\u00a0So\u00a0this is really striking to me.\u00a0I think we\u00a0saw some signs that something like this was coming. You know, about a year ago, there was some\u00a0Title\u00a0X\u00a0money approved to focus on helping people struggling with infertility.\u00a0But that was\u00a0sort of just\u00a0a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program.\u00a0So\u00a0I think when the actual rule to this effect drops, and we\u00a0don\u2019t\u00a0know when that will be\u00a0\u2014\u00a0will they wait till after the midterms\u00a0to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then.\u00a0But I think right now, this is just sort of a sign of where they want to go in the future.\u00a0And\u00a0it\u2019s\u00a0important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year\u2019s funding going out to\u00a0all of\u00a0the clinics that got it before, including Planned Parenthood\u00a0clinics.\u00a0The\u00a0anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future,\u00a0right now.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Just to remind people that the ban on Planned Parenthood\u00a0funding from\u00a0last year was for Medicaid, not for the\u00a0Title\u00a0X\u00a0program.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Right.\u00a0<\/strong>\u00a0<\/p>\n Rovner:\u00a0<\/strong>And that\u2019s why Planned Parenthood got money.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yes, and Planned Parenthood is not allowed to use any Medicaid or\u00a0Title\u00a0X\u00a0money\u00a0for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be\u00a0cut\u00a0off.\u00a0So\u00a0they were very pissed that this money went out to Planned Parenthood. And so very quickly after,\u00a0the administration put out this document, saying,\u00a0Look, we are taking things in another direction, and it is not the direction of Planned Parenthood<\/em>.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Lauren,\u00a0you\u00a0want to add something?\u00a0<\/p>\n Weber<\/strong>:\u00a0Oh, I just wanted to say Alice has really been owning the beat on all the\u00a0Title\u00a0X\u00a0coverage, so\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0Absolutely.\u00a0\u00a0<\/p>\n Weber:<\/strong>\u00a0\u2026\u00a0glad we\u00a0are able to\u00a0have her explain it to us.\u00a0But\u00a0just wanted to throw out\u00a0a\u00a0kudos for breaking all the news on that front.\u00a0\u00a0<\/p>\n Goldman:<\/strong>\u00a0Yeah, great coverage.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yes.\u00a0Very happy\u00a0to have you\u00a0for\u00a0this. Turning to the budget, which is normally the major activity for Congress\u00a0in the spring, we finally got President Trump\u2019s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about\u00a0$15 billion,\u00a0but those cuts are far less deep than those proposed last year.\u00a0And,\u00a0as we have noted, Congress didn\u2019t\u00a0actually cut\u00a0the HHS budget last year by much at all.\u00a0And many programs, like the National Institutes of Health,\u00a0actually got\u00a0small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to\u00a0Health and\u00a0Human\u00a0Services programs\u00a0aren\u2019t\u00a0actually popular\u00a0with the public or with Congress, for that matter, going into a midterm election?\u00a0<\/p>\n Weber:<\/strong>\u00a0I think\u00a0it\u2019s\u00a0that last little piece you mentioned there, Julie. I think\u00a0it\u2019s\u00a0the\u00a0\u201cgoing into the midterm election.\u201d\u00a0I think you\u00a0hit the nail on the head\u00a0there. Cuts are also not good economically for many Republicans.\u00a0You know, we saw Katie Britt be one of the\u00a0\u2014 the\u00a0Alabama Republican senator\u00a0\u2014\u00a0be one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year.\u00a0So\u00a0I think what\u00a0you\u2019re\u00a0hinting at, and what\u00a0we\u2019re\u00a0getting at, is that\u00a0it\u2019s\u00a0not politically\u00a0popular,\u00a0it can be economically problematic, on top of the scientific advances that are not found.\u00a0So\u00a0I suspect you are right\u00a0on\u00a0that.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>The administration knows that this is\u00a0\u201chopes and dreams\u201d\u00a0and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like\u00a0Title\u00a0X, because at the same\u00a0time they put out this guidance from HHS about the future of\u00a0Title\u00a0X, moving away from contraception,\u00a0in the\u00a0president\u2019s budget he\u00a0proposed completely getting rid of\u00a0Title\u00a0X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that\u00a0doesn\u2019t\u00a0exist?\u00a0<\/p>\n Goldman:\u00a0<\/strong>I think,\u00a0also, this is the second budget that\u00a0they\u2019re\u00a0putting out in this administration, right? So now they are just a little more used to\u00a0what\u2019s\u00a0going on, and they have more of their feet under them.\u00a0<\/p>\n Weber:<\/strong>\u00a0As\u00a0a preview for listeners,\u00a0too,\u00a0I\u2019m\u00a0sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget.\u00a0So\u00a0I am sure that we will hear a lot more on this front in the\u00a0weeks to come.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, I would say that\u2019s one thing that the budget process does, is when the\u00a0president finally puts out a budget, the Cabinet\u00a0secretaries travel to all of the various committees on Capitol Hill to, quote,\u00a0\u201cdefend the\u00a0president\u2019s budget,\u201d\u00a0which is sometimes or,\u00a0I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week\u00a0\u2014\u00a0that was supposed to be private, but ended up being\u00a0live-streamed\u00a0\u2014\u00a0said, and I quote,\u00a0\u201cIt\u2019s not possible for us to take care of day\u00a0care, Medicare, Medicaid, all these individual things.\u201d The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote,\u00a0\u201cmilitary protection.\u201d\u00a0Did\u00a0I just\u00a0hear\u00a0a thousand\u00a0Democratic campaign ads bloom?\u00a0<\/p>\n Goldman:\u00a0<\/strong>I think this\u00a0is a prime example of when you should take Trump seriously, but\u00a0not literally. I\u00a0don\u2019t\u00a0think that\u00a0there\u2019s\u00a0any world, at least in the\u00a0foreseeable future, where the federal government\u00a0isn\u2019t\u00a0funding Medicare.\u00a0But,\u00a0you know, you certainly\u00a0have to\u00a0watch at\u00a0the margins.\u00a0It\u2019s\u00a0like,\u00a0it\u2019s\u00a0not a secret that this is something that\u00a0they\u2019re\u00a0interested in cutting back\u00a0spending on.\u00a0It\u2019s\u00a0super politically difficult to do that, and they know that, and that\u2019s part of why, which\u00a0I\u2019m\u00a0sure\u00a0we\u2019ll\u00a0talk about in a little bit,\u00a0they bumped up the payment rate for 2027 to Medicare Advantage plans.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Which we will get to.\u00a0<\/p>\n Goldman:\u00a0<\/strong>Yeah, so I mean,\u00a0it\u2019s\u00a0certainly an eye-opening statement, and you should remember it. But I\u00a0don\u2019t\u00a0think that\u00a0we\u2019re\u00a0in immediate jeopardy here.\u00a0<\/p>\n Rovner:\u00a0<\/strong>This is the\u00a0president who ran in 2024,\u00a0you know, saying that he was going to protect Medicare and Medicaid. I mean,\u00a0it\u2019s\u00a0been, you know, against some of the recommendations of his own administration. I was just\u00a0sort of shocked\u00a0to see these words come out of his mouth. Lauren,\u00a0you wanted\u00a0to say\u00a0something?\u00a0\u00a0<\/p>\n Weber:<\/strong>\u00a0I mean,\u00a0it\u2019s\u00a0not\u00a0that surprising, though. I mean, look at what the\u00a0One\u00a0Big\u00a0Beautiful Bill\u00a0[Act]\u00a0did to Medicaid.\u00a0He\u2019s\u00a0already pushed through massive Medicaid cuts, which are\u00a0essentially being\u00a0offloaded to the states.\u00a0So, I mean, I think this ideology has already\u00a0borne\u00a0out and will continue to bear out, and obviously\u00a0it\u2019s\u00a0happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, meanwhile,\u00a0Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year\u2019s\u00a0Big\u00a0Beautiful\u00a0Bill, except this time it\u2019s essentially just to fund the military and\u00a0ICE\u00a0[Immigration and Customs Enforcement]\u00a0and\u00a0border\u00a0control, because Democrats won\u2019t vote for those things, at least they won\u2019t vote for additional military spending.\u00a0What are the prospects for that to\u00a0actually happen?\u00a0And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and\/or Medicaid, as some\u00a0have suggested?\u00a0<\/p>\n Goldman:\u00a0<\/strong>You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of\u00a0blowback\u00a0from politicos, from advocates, from, you know,\u00a0kind of across\u00a0the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health\u00a0care as an offset. But I would say that Republicans are\u00a0pretty good\u00a0at rhetoric, right?\u00a0That\u2019s\u00a0one of the things that\u00a0they\u2019re\u00a0known for right now, and\u00a0there\u2019s\u00a0always a way to spin it.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I\u00a0didn\u2019t\u00a0think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have.\u00a0<\/p>\n Goldman:\u00a0<\/strong>And\u00a0I think that\u00a0is something that you\u00a0do in\u00a0between election years.\u00a0That\u2019s\u00a0not something you do in an\u00a0election year.\u00a0<\/p>\n Rovner:\u00a0<\/strong>That\u2019s\u00a0true, yes\u00a0\u2026\u00a0you do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but \u2026\u00a0<\/p>\n Ollstein:\u00a0<\/strong>And\u00a0I think\u00a0it\u2019s\u00a0important to remember that the reason Republicans are in this bind and that they feel like they\u00a0have to\u00a0keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement.\u00a0And\u00a0so\u00a0they feel pressured to put all their effort and political capital towards that, and\u00a0don\u2019t\u00a0want to mess that up by adding a bunch of other\u00a0health\u00a0care things that could cause fights and lose\u00a0them\u00a0votes.\u00a0\u00a0<\/p>\n Goldman:<\/strong>\u00a0The money\u00a0has got to\u00a0come from somewhere.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And\u00a0health\u00a0care is where all the money is.\u00a0Speaking of Medicare and Medicaid,\u00a0where most of the money is,\u00a0there is news on those fronts,\u00a0too.\u00a0Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember,\u00a0we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically?\u00a0Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year.\u00a0That\u2019s\u00a0compared to the less than 1% increase in the proposed rule.\u00a0That\u2019s\u00a0a difference of about\u00a0$13 billion.\u00a0The final rule also\u00a0eliminated\u00a0many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage?\u00a0Are their\u00a0lobbyists really that good?\u00a0<\/p>\n Goldman:\u00a0<\/strong>Their lobbyists are\u00a0pretty good. This was a year where there were\u00a0\u2014\u00a0I think CMS\u00a0[the Centers for Medicare & Medicaid Services]\u00a0said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think\u00a0it\u2019s\u00a0also not that surprising. Historically, the final rate announcement for Medicare Advantage is\u00a0almost always\u00a0a little higher than the proposed because they incorporate\u00a0additional\u00a0data from the end of the previous year that\u00a0wasn\u2019t\u00a0available when first rate is proposed, the\u00a0initial\u00a0rate is\u00a0proposed.\u00a0But\u00a0certainly\u00a0they backed away from\u00a0a big change\u00a0to risk adjustment, or,\u00a0like, the way to adjust payment based on how sick a\u00a0plan\u2019s\u00a0enrollees are. You get more pay\u00a0\u2026\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Because\u00a0that\u2019s where the overbilling was happening,\u00a0that we\u2019d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn\u2019t necessarily have them or didn\u2019t have a severe\u00a0illness, and\u00a0using that to get additional payments.\u00a0<\/p>\n Goldman:\u00a0<\/strong>Right.\u00a0And they did move forward with a plan to prevent diagnoses that are not linked to information\u00a0that\u2019s\u00a0in a patient\u2019s medical chart from being used for risk adjustment. But a lot of plans\u00a0had\u00a0said, like,\u00a0Yeah, this is,\u00a0that\u2019s\u00a0the right thing to do, and\u00a0it\u2019s\u00a0not going to be that impactful for us<\/em>. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said,\u00a0We\u2019re\u00a0still really focused on trying to right-size this program.\u00a0That\u2019s\u00a0still a priority for us as an\u00a0administration, but we also want to safeguard it<\/em>. And\u00a0so\u00a0I think insurers\u00a0are not\u00a0off the hook entirely.\u00a0There\u2019s\u00a0still going to be a lot of scrutiny, but their lobbyists are\u00a0pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And we have\u00a0seen this before, that when Congress cuts\u00a0\u201coverfunding\u201d\u00a0for Medicare Advantage, the plans,\u00a0seeing that they\u00a0can\u2019t\u00a0make its big profits,\u00a0drop out or they cut back on those extra benefits. And the beneficiaries complain because they\u2019re losing their plans, or they\u2019re losing their extra benefits, and they don\u2019t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So,\u00a0in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.\u00a0\u00a0<\/p>\n Well, apparently, one\u00a0group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year\u2019s budget bill focused on the cuts to Medicaid.\u00a0But\u00a0we at KFF Health News have a story this week<\/a>\u00a0about legal immigrants\u00a0who\u2019ve\u00a0paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is\u00a0apparently the\u00a0first time an entire category of beneficiaries\u00a0are\u00a0having their Medicare taken away.\u00a0I\u2019m\u00a0surprised there\u00a0hasn\u2019t\u00a0been more attention to this, or\u00a0if\u00a0it\u2019s\u00a0just too\u00a0much\u00a0all happening at once.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>I mean,\u00a0there\u2019s\u00a0a lot happening at once, and even just in the space of immigrants\u2019\u00a0access to health care, there is so much happening at once. And\u00a0so\u00a0this is obviously having\u00a0a huge impact\u00a0on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with\u00a0a thousand\u00a0other things, Medicaid cuts, you know, these\u00a0federal changes,\u00a0work requirements,\u00a0are grappling with this\u00a0as well.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Lauren,\u00a0you wanted\u00a0to add something?\u00a0<\/p>\n Weber:<\/strong>\u00a0Yeah. I mean, I thought it was, there was a striking quote in the story from Michael\u00a0Cannon, who\u00a0basically said,\u00a0The\u00a0reason this\u00a0isn\u2019t\u00a0resonating is because this\u00a0won\u2019t\u00a0upset the Republican base<\/em>. And I think\u00a0that\u2019s\u00a0a striking quote to be\u00a0considered.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Michael\u00a0Cannon, libertarian health policy expert,\u00a0just\u00a0kind of an\u00a0observer to this one. But\u00a0yeah, I think\u00a0that\u2019s\u00a0true. I mean, or at least the perception is that these are not Republican voters, although, you know, as\u00a0we\u2019ve seen, you know, Congress has tried to take aim at people they think aren\u2019t their voters, and it\u2019s turned out that those are their voters.\u00a0So\u00a0we will see how this all plays out.\u00a0\u00a0<\/p>\n Well,\u00a0at the same time that\u00a0this is all going on, the folks over at the newsletter\u00a0\u201cHealthcare\u00a0Dive\u201d\u00a0are reporting that the Centers for Medicare\u00a0&\u00a0Medicaid Services are trying to embark on all these new initiatives on fraud,\u00a0and work requirements,\u00a0and artificial intelligence with a diminished workforce.\u00a0While CMS lost far fewer workers in the\u00a0DOGE [Department of Government Efficiency]\u00a0cuts last year than many other of the HHS agencies\u00a0\u2014\u00a0it was in the hundreds rather than the\u00a0thousands\u00a0\u2014\u00a0CMS has long been understaffed,\u00a0given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and\u00a0Medicaid, but also the Children\u2019s Health Insurance Program and the Affordable Care Act. I know last week, FDA\u00a0Commissioner Marty\u00a0Makary\u00a0said he wants to hire more workers to replace the 3,000 who were\u00a0RIF\u2019ed\u00a0or took early retirement there at the FDA.\u00a0And CMS does have lots of job openings\u00a0being advertised.\u00a0But\u00a0it\u2019s\u00a0hard to see how replacing trained and experienced workers with untrained, inexperienced ones\u00a0are\u00a0going to improve efficiency, right?\u00a0<\/p>\n Goldman:<\/strong>\u00a0Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they\u2019re often the ones coming to CMS and proposing ideas and working with CMS on it. I\u00a0don\u2019t,\u00a0I think that\u00a0is a dynamic that far predates this administration, but\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0Oh, absolutely.\u00a0<\/p>\n Goldman:<\/strong>\u00a0But\u00a0it\u2019s\u00a0certainly interesting. And\u00a0\u2026\u00a0CMS has\u00a0very ambitious\u00a0plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this\u00a0CMS, they are generally like, pretty support-\u00a0\u2026\u00a0like,\u00a0they say that they think they\u2019re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they\u2019ve been doing, which I think is notable.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And as we have mentioned many times, you know, Dr.\u00a0[Mehmet]\u00a0Oz, the head of CMS, is very serious about his job and doing a lot of\u00a0really interesting\u00a0things.\u00a0It\u2019s\u00a0just,\u00a0it\u2019s\u00a0hard, you know, in the federal government, if you\u00a0don\u2019t\u00a0have the resources that you want to\u00a0\u2026\u00a0if you\u00a0don\u2019t\u00a0have the resources to match your ambitions.\u00a0Let\u2019s\u00a0put it that way.\u00a0\u00a0<\/p>\n Well, meanwhile, on the Medicaid front,\u00a0we\u2019re\u00a0already seeing states cutting back, and some of the results of those cutbacks.\u00a0Stateline has a piece<\/a>\u00a0on\u00a0how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people\u00a0and also\u00a0tend to lose money.\u00a0And\u00a0The New York Times has a\u00a0heartbreaking story<\/a>\u00a0of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed\u00a0funding\u00a0the\u00a0program, but\u00a0obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations\u00a0wouldn\u2019t\u00a0see their services cut. But\u00a0that\u2019s\u00a0not how this is playing out, right?\u00a0\u00a0<\/p>\n Weber:<\/strong>\u00a0I just\u00a0think the story by Ellen Barry, who you should always read\u00a0on\u00a0mental health issues in\u00a0The New York Times,\u00a0\u201cIdaho Cut Services for People With Schizophrenia, Then the Deaths Began<\/a>,\u201d\u00a0is such an\u00a0illustrative example of unintended consequences from these cuts.\u00a0And the reason that\u00a0they\u2019re\u00a0being reversed\u00a0\u2014\u00a0by Republican legislators, no less\u00a0\u2014\u00a0in Idaho, is because\u00a0it\u2019s\u00a0more expensive to have cut the money from it than it is efficient. I mean, what they found was, is\u00a0that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations,\u00a0that this avoided. And I think\u00a0it\u2019s\u00a0a real canary in the coal\u00a0mine\u00a0situation, because\u00a0we\u2019re\u00a0only starting to see these states cut these things off. And this was\u00a0a pretty immediate\u00a0multiple-death consequence. And I think\u00a0we\u2019re\u00a0going to see a lot of stories like this, of a variety of programs that we all\u00a0don\u2019t\u00a0even have any idea that\u00a0exist\u00a0in the safety net across the country that\u00a0are\u00a0being\u00a0chipped away at.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, turning to\u00a0other news from the Department of Health and Human Services,\u00a0we\u2019re\u00a0getting some more competition here at\u00a0What\u00a0the Health?<\/em>\u00a0Health\u00a0secretary Kennedy has announced\u00a0he\u2019ll\u00a0be unveiling his own podcast,\u00a0called\u00a0The Secretary Kennedy\u00a0Podcast<\/em>, next week. He promises to,\u00a0according to the trailer posted online on Wednesday, quote,\u00a0\u201cname the names of the forces that obstruct the paths to public health.\u201d\u00a0OK\u00a0then,\u00a0we look forward to listening.\u00a0\u00a0<\/p>\n Meanwhile, in actual secretarial work, the\u00a0secretary this week also unveiled changes to the charter of the Advisory Committee on\u00a0[Immunization]\u00a0Practices after a federal judge last month invalidated both the replacement members that he\u2019d appointed last\u00a0year\u00a0and the changes made to the\u00a0federally recommended vaccine schedule.\u00a0So\u00a0what\u2019s\u00a0going to happen here\u00a0now?\u00a0Will this get around the judge\u2019s ruling by watering down the\u00a0expertise\u00a0that members of this advisory committee are supposed to have in vaccines? And why hasn\u2019t the administration\u00a0appealed\u00a0the judge\u2019s\u00a0ruling yet?\u00a0<\/p>\n Goldman:\u00a0<\/strong>You know, I don\u2019t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the\u00a0secretary and HHS\u00a0says,\u00a0OK, you don\u2019t like it that way?\u00a0We\u2019ll\u00a0do it this way<\/em>, and then\u00a0they\u2019ll\u00a0do it another way, and advocates will sue, and\u00a0we\u2019ll\u00a0see how this plays out going forward in the courts.\u00a0I think this\u00a0is not the end of the story.\u00a0Even though the judge\u2019s decision was a big win for vaccine advocates,\u00a0it\u2019s\u00a0just\u00a0we\u2019re\u00a0in the midpoint, if that.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And Lauren, speaking of vaccines, your colleague Lena\u00a0H. Sun has\u00a0quite the scoop<\/a>\u00a0on HHS and vaccine policy.\u00a0<\/p>\n Weber:<\/strong>\u00a0Yeah, Lena\u00a0Sun is always delivering.\u00a0She found out that the acting director of the CDC\u00a0[Centers for Disease Control and Prevention]\u00a0at the time delayed publication of a report showing that the covid-19 vaccine[s]\u00a0cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting,\u00a0that some of his underlings are not necessarily touting the benefits of\u00a0vaccine, so to speak.\u00a0And I\u2019m very curious, going back to Kennedy\u2019s podcast, I found the rollout of that so interesting because the teaser\u00a0was very\u00a0leaning into\u00a0the Kennedy\u00a0that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public,\u00a0and so on. And then the press team had these statements of,\u00a0like,\u00a0Kennedy will investigate the affordability of health\u00a0costs and food\u00a0and nutrition.<\/em>\u00a0And I think this dichotomy of who Kennedy is and who the\u00a0White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast.\u00a0So\u00a0I think we will all be listening to hear how that goes.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, we keep hearing about\u00a0how the\u00a0secretary is being, you know,\u00a0sort of put\u00a0on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite\u00a0at odds\u00a0with him having his own podcast. Alice,\u00a0do you want\u00a0to \u2026?\u00a0<\/p>\n Weber:<\/strong>\u00a0I guess, it depends on\u00a0who\u2019s\u00a0editing the podcast and who they have on.\u00a0I\u2019m\u00a0just very\u00a0\u2026\u00a0you could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see\u00a0guests on it.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>I mean,\u00a0it\u2019s\u00a0also worth noting that this is an administration of podcasters. I mean, you have\u00a0Kash\u00a0Patel,\u00a0you have so many of these folks who have a history of podcasting,\u00a0clearly have a passion for it, just\u00a0can\u2019t\u00a0let it go while working a\u00a0full-time, high-pressure\u00a0government job.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>We shall see.\u00a0Meanwhile, HHS, together with the Environmental Protection Agency, is waging\u00a0war\u00a0on microplastics, those\u00a0nearly too\u00a0impossible\u00a0to\u00a0detect bits of plastic that are getting into our lungs and stomachs and body tissues through\u00a0air and water\u00a0and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we\u00a0don\u2019t\u00a0have enough information to regulate them yet.\u00a0I would think this would be one of those things that\u00a0pleases\u00a0both MAHA\u00a0[Make America Healthy Again]\u00a0and the science community, right? Or is it just,\u00a0as one MAHA\u00a0supporter\u00a0called it,\u00a0theater?\u00a0<\/p>\n Goldman:\u00a0<\/strong>I think this\u00a0is\u00a0a great example\u00a0of the,\u00a0you know, part of the\u00a0reason why\u00a0MAHA\u00a0is so interesting to such a wide swath of people.\u00a0Like,\u00a0there\u2019s\u00a0a lot of legitimate concern, not that other concerns\u00a0aren\u2019t\u00a0necessarily legitimate, but\u00a0there\u2019s\u00a0a lot of concern over,\u00a0from the scientific community, over microplastics.\u00a0I\u2019m\u00a0honestly surprised that\u00a0we\u2019re\u00a0this far into the administration with this announcement. I would have thought that this\u00a0is\u00a0something they would have done sooner, but they obviously had other priorities\u00a0as well.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr.\u00a0Oz are declaring war on junk food in hospitals. Again, this seems like a popular and\u00a0fairly harmless\u00a0crusade;\u00a0hospitals\u00a0shouldn\u2019t\u00a0be serving their patients\u00a0ultraprocessed\u00a0food.\u00a0Except,\u00a0almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who,\u00a0because of medications they\u2019re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health\u00a0care is as simple as it seems, right?\u00a0\u00a0<\/p>\n Weber<\/strong>:\u00a0I think\u00a0what\u2019s\u00a0also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I\u00a0just am\u00a0curious to see how fast that gets implemented. And\u00a0it\u2019s\u00a0a very\u00a0valid\u00a0\u2014\u00a0a lot of people complain about hospital food.\u00a0It\u2019s\u00a0a very valid thing to push for better food. But I also question, as I understand\u00a0it,\u00a0this seems more like a carrot than a stick when it comes to the regulation they put out.\u00a0<\/p>\n Rovner:<\/strong>\u00a0As it were.\u00a0<\/p>\n Weber:<\/strong>\u00a0As it were.\u00a0And\u00a0so\u00a0I\u2019m\u00a0curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves\u00a0\u2014\u00a0the Northwell\u00a0[Health]\u00a0example in New York is a good example\u00a0\u2014\u00a0to really improve their hospital food. And frankly,\u00a0it\u2019s\u00a0a money maker. If your food\u2019s better, people come to your hospital, especially\u00a0in\u00a0an urban area where there is hospital competition.\u00a0So\u00a0you know, like most MAHA\u00a0topics, there\u2019s a lot of interesting points in there, and then there\u2019s a lot of what\u2019s\u00a0the reality\u00a0and what\u2019\u00a0actually going\u00a0to happen. And\u00a0so\u00a0I\u2019\u00a0very curious to see how this continues to play.\u00a0<\/p>\n Rovner:\u00a0<\/strong>I\u00a0did\u00a0a big\u00a0story,\u00a0like,\u00a010 years ago on a hospital chain that had its own\u00a0gardens,\u00a0that\u00a0literally grew\u00a0its own healthy food.\u00a0So\u00a0this is not completely new but,\u00a0again, interesting.\u00a0<\/p>\n All right, that is this week\u2019s news. Now\u00a0it\u2019s\u00a0time for our\u00a0extra-credit\u00a0segment.\u00a0That\u2019s\u00a0where we each recognize a story we read this\u00a0week\u00a0we think you should read,\u00a0too.\u00a0Don\u2019t\u00a0worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don\u2019t you start us off this week?\u00a0<\/p>\n Ollstein:\u00a0<\/strong>I\u00a0have a piece from my co-worker Simon\u00a0[J.]\u00a0Levien, and it is called\u00a0\u201cA Slowdown in US Visa Processing Is Wreaking Havoc on Foreign Doctors\u2019 Lives<\/a>.\u201d\u00a0This is about\u00a0thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and,\u00a0in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can\u2019t practice because their paperwork isn\u2019t getting processed in time. And\u00a0so\u00a0they\u2019re\u00a0sort of in\u00a0this scary limbo, and\u00a0that\u2019s\u00a0putting these hospitals and clinics that they work in in a\u00a0really tough\u00a0bind. And\u00a0so\u00a0they\u2019re\u00a0hammering the Trump administration to give them answers about what their fate is. You know,\u00a0they\u2019re\u00a0not trying to deport them yet, but\u00a0they\u2019re\u00a0not allowing them to continue working either.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>For an\u00a0administration that\u2019s been pushing\u00a0really hard\u00a0to improve rural health care, this does not seem to be a way to improve rural health care.\u00a0Maya.\u00a0<\/p>\n Goldman:\u00a0<\/strong>My extra credit this week is called\u00a0\u201cTrump\u2019s Personnel Agency Is Asking for Federal Workers\u2019 Medical Records<\/a>.\u201d\u00a0It\u2019s\u00a0a great\u00a0KFF\u00a0Health\u00a0News\u00a0scoop\u00a0from Amanda Seitz and\u00a0Maia Rosenfeld. It\u2019s a really great example of the administration, you know, sort of moving in silence,\u00a0doing\u00a0these small regulatory announcements that could have\u00a0big\u00a0impact.\u00a0Basically, the\u00a0Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get\u00a0very detailed\u00a0medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And,\u00a0obviously,\u00a0there is a strong\u00a0concern that\u00a0that could be used against them.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah\u00a0\u2026\u00a0this was quite a scoop. Really,\u00a0really<\/em>\u00a0interesting\u00a0story. Lauren.\u00a0<\/p>\n Weber:<\/strong>\u00a0Mine\u00a0was\u00a0a pretty alarming\u00a0story by Holly Yan at CNN:\u00a0\u201cThese Common Drug Tests Lead to Tens of Thousands of Wrongful Arrests a Year, Experts Say. One State Is Fighting Back<\/a>.\u201d\u00a0And basically there\u2019s this type of drug test that the scientists have found is not that effective, and it\u2019s led to things like bird poop being scraped off a man\u2019s car appearing on a drug test as cocaine, a great-grandmother\u2019s medication testing positive for cocaine, and a toddler\u2019s ashes registering as meth or\u00a0ecstasy, and horrible legal and other consequences of this\u00a0kind of misdiagnosis in the field. And the reason these drug tests are often done is because\u00a0they\u2019re\u00a0cheaper.\u00a0There\u2019s\u00a0a more expensive, more\u00a0accurate\u00a0version, but these are cheaper.\u00a0They\u2019re\u00a0done in the field.\u00a0But the potential side effects and horrible, wrongly accused effects are quite large, and so\u00a0Colorado has passed this law to try and move away from this. And\u00a0it\u2019s\u00a0curious to see if other\u00a0states will follow suit.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from\u00a0The Atlantic by\u00a0Katherine\u00a0[J.] Wu,\u00a0and\u00a0it\u2019s\u00a0called\u00a0\u201cHHS Officials\u2019 Year in Purgatory Is Ending<\/a>.\u201d And it\u2019s about how some of the very top career officials from the NIH\u00a0[National Institutes of Health],\u00a0the CDC,\u00a0and other agencies have, after having been put on leave more than a year ago, finally been reassigned to\u00a0far-flung\u00a0outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now,\u00a0if these officials\u2019\u00a0skills matched those needed by the Indian Health Service, this all might make some sense.\u00a0But what\u00a0the IHS\u00a0most\u00a0needs\u00a0are active clinicians:\u00a0doctors and nurses and social workers and lab technicians.\u00a0And those who are now being reassigned are largely managers, including\u00a0\u2014\u00a0and here I\u2019m reading from the story,\u00a0quote\u00a0\u2014 \u201cthe directors of several NIH institutes, leaders of several CDC centers, a\u00a0top-ranking\u00a0official from the FDA tobacco-products\u00a0center, a bioethicist, a human-resources manager, a communications director,\u00a0and a technology-information officer.\u201d\u00a0The\u00a0Native populations who are\u00a0ostensibly being\u00a0helped here\u00a0aren\u2019t\u00a0very happy\u00a0about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American\u00a0who\u2019s\u00a0now running for governor in New Mexico, called the reassignment proposals, quote,\u00a0\u201cshameful\u201d\u00a0and\u00a0\u201cdisrespectful.\u201d\u00a0Also, and this is my\u00a0addition, not a very efficient use of human capital.\u00a0<\/p>\n OK, that\u2019s this week\u2019s show.\u00a0Thanks\u00a0this week to our fill-in editor,\u00a0Mary-Ellen\u00a0Deily, and our producer-engineer,\u00a0Francis Ying.\u00a0A reminder:\u00a0What the Health?<\/em>\u00a0is now available on WAMU platforms, the NPR app, and wherever you get your podcasts \u2014 as well as, of course,\u00a0kffhealthnews.org<\/a>. Also,\u00a0as always, you can email\u00a0us\u00a0your comments or questions.\u00a0We\u2019re\u00a0at whatthehealth@kff.org.\u00a0Or you can find me on X\u00a0@jrovner<\/a>, or on Bluesky\u00a0@julierovner<\/a>.\u00a0Where do\u00a0you guys\u00a0hang\u00a0these days? Maya.\u00a0<\/p>\n Goldman:<\/strong>\u00a0I am on LinkedIn under my first and last name,\u00a0Maya Goldman<\/a>, and on\u00a0X\u00a0at\u00a0@mayagoldman_<\/a>.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Alice.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0I\u2019m\u00a0on\u00a0Bluesky\u00a0@alicemiranda<\/a>\u00a0and on\u00a0X\u00a0@AliceOllstein<\/a>.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Lauren.\u00a0<\/p>\n Weber:<\/strong>\u00a0Still\u00a0@LaurenWeberHP\u00a0on\u00a0both\u00a0X<\/a>\u00a0and\u00a0Bluesky<\/a>.\u00a0<\/p>\n Rovner:\u00a0<\/strong>We will be back in your feed next week.\u00a0Until then, be healthy.<\/p>\n \tFrancis Ying \tMary-Ellen Deily
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