\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 It\u2019s been a tough week for Health and Human Services Secretary Robert F. Kennedy Jr. In addition to Kennedy having surgery to repair a torn rotator cuff, personnel issues continue to plague the department: The nominee to become surgeon general, an ally of Kennedy\u2019s, may lack the votes for Senate confirmation. The controversial head of the Food and Drug Administration\u2019s vaccine center will be resigning next month. And a new survey finds Americans have less trust in HHS leaders now than they did during the pandemic.<\/p>\n Meanwhile, the Trump administration continues its crackdown over claims of rampant health care fraud. In addition to targeting the Medicaid programs in states led by Democratic governors, the Centers for Medicare & Medicaid Services is also taking aim at previously sacrosanct Medicare Advantage plans.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th.<\/p>\n \tAnna Edney \t\t\t \t\t\t \t\t\t \tJoanne Kenen \t\t\t \t\t\t \t\t\t \tShefali Luthra \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews Andy Schneider of Georgetown University about the Trump administration\u2019s crackdown on what it alleges is rampant Medicaid fraud in Democratic-led states.<\/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 Marshall Project\u2019s \u201cThe Harrowing Journey Home for Families Leaving Immigration Detention<\/a>,\u201d by Shannon Heffernan, Jesse Bogan, and Anna Flagg.<\/p>\n Anna Edney:<\/strong> The Wall Street Journal\u2019s \u201cThe Boom in Autism Therapy Is Medicaid\u2019s Fastest-Growing Jackpot<\/a>,\u201d by Christopher Weaver, Tom McGinty, and Anna Wilde Mathews.<\/p>\n Shefali Luthra:<\/strong> The New York Times\u2019 \u201cStates Move To Limit Access to H.I.V. Treatment<\/a>,\u201d by Apoorva Mandavilli.<\/p>\n Joanne Kenen:<\/strong> The Idaho Capital Sun\u2019s \u201c988 Ended His Call. Now an Idaho Teen Is Pushing for a Fix to State\u2019s Parental Consent Law<\/a>,\u201d by Laura Guido.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n Clarification:<\/em><\/strong>\u00a0This page was updated at 5:10 p.m. ET on March 12, 2026, to clarify that Vinay Prasad, the FDA\u2019s vaccine chief, will be leaving his job in April. In an email after publication, William Maloney, an HHS spokesperson, said Prasad is \u201cleaving of his own accord.\u201d<\/em><\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: RFK Jr.\u2019s Very Bad Week\t\t\t\t<\/p>\n [<\/em>Editor\u2019s note:<\/em><\/strong>\u00a0This transcript\u00a0was generated\u00a0using both transcription software and a human\u2019s light touch. It has\u00a0been edited\u00a0for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong>\u00a0Hello from\u00a0KFF\u00a0Health\u00a0News and WAMU\u00a0public radio\u00a0in Washington, D.C. Welcome to\u00a0What the\u00a0Health?<\/em>\u00a0I\u2019m\u00a0Julie Rovner,\u00a0chief Washington correspondent for\u00a0KFF Health\u00a0News, and\u00a0I\u2019m\u00a0joined by\u00a0some of\u00a0the best and smartest reporters covering Washington. We are taping this week on Thursday, March 12, at 10\u00a0a.m.\u00a0As always, news happens fast and things might have changed by the time you hear this. So,\u00a0here we go.\u00a0<\/p>\n Today\u00a0we\u00a0are joined\u00a0via videoconference by Shefali Luthra\u00a0of the 19th.\u00a0<\/p>\n Shefali Luthra:<\/strong>\u00a0Hello.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Anna\u00a0Edney of\u00a0Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong>\u00a0Hi,\u00a0everybody.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And\u00a0Joanne\u00a0Kenen\u00a0at the Johns Hopkins Bloomberg School of Public Health and\u00a0Politico\u00a0Magazine.\u00a0<\/p>\n Joanne Kenen:<\/strong>\u00a0Hi,\u00a0everybody.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Later in this episode,\u00a0we\u2019ll\u00a0have my interview with Andy Schneider of Georgetown University, who will try to explain how the federal government\u2019s fraud crackdown on blue-state Medicaid programs\u00a0is something\u00a0completely different from any fraud-fighting effort\u00a0we\u2019ve\u00a0seen before. But first,\u00a0this week\u2019s news\u00a0\u2014\u00a0and\u00a0some of\u00a0last\u00a0week\u2019s.\u00a0<\/p>\n Let\u2019s\u00a0start at the Department of Health and Human Services, where I think\u00a0it\u2019s\u00a0safe to say Secretary Robert F Kennedy Jr.\u00a0is not having\u00a0a great week. The\u00a0secretary\u00a0reportedly had\u00a0to have his rotator cuff surgically repaired on Tuesday.\u00a0It\u2019s\u00a0not clear if he injured it during one of his famous video workouts. But it is clear, at least according to\u00a0a new survey<\/a>\u00a0from the University of Pennsylvania\u2019s Annenberg Center, that the American public is not buying what\u00a0he\u2019s\u00a0selling when it comes to policy. According to the survey, public trust in HHS agencies, which already took a dive during the pandemic, has fallen even more since Kennedy took over the department. Although, interestingly, public trust in career HHS officials is higher than it is for their political leaders. And trust in outside professional health organizations, places like the American Heart Association and the American Academy of Pediatrics, is higher than for any of the government entities.\u00a0<\/p>\n Perhaps related to that is another piece of HHS\u00a0news from\u00a0this week.\u00a0The FDA\u00a0[Food and Drug Administration]\u00a0approved a label change for the drug leucovorin, which Secretary Kennedy last fall very aggressively touted as a potential treatment for autism. But the drug\u00a0wasn\u2019t\u00a0approved\u00a0to treat autism. Rather, the label changes to treat a rare genetic condition. Kennedy bragged about leucovorin, by the way, at\u00a0the same press conference that President\u00a0[Donald]\u00a0Trump urged pregnant women not to take Tylenol, which has not\u00a0been shown\u00a0to contribute to the rise in autism.\u00a0Maybe it\u2019s\u00a0fair to say the public is paying attention to the\u00a0news\u00a0and that helps explain the results of this Annenberg Center survey?\u00a0<\/p>\n Luthra:\u00a0<\/strong>Maybe.\u00a0I was just thinking, we do know that Tylenol prescriptions for people who are pregnant did go down,\u00a0right? There\u2019s research that shows,\u00a0after that press conference,\u00a0behaviors did change. And\u00a0so\u00a0to your point,\u00a0it\u2019s\u00a0clear there is\u00a0a lot of\u00a0confusion, and confusion\u00a0maybe breeds\u00a0mistrust. But I\u00a0don\u2019t\u00a0know that we can necessarily say that American voters and the public at large are very obviously informed as\u00a0much\u00a0as they are\u00a0perhaps disenchanted\u00a0by things that seem as if they\u00a0were told\u00a0would restore trust and make things clearer and in fact have not done so.\u00a0<\/p>\n Rovner:<\/strong>\u00a0That\u2019s\u00a0a\u00a0fair assessment.\u00a0Anna.\u00a0<\/p>\n Edney:<\/strong>\u00a0Yeah, I think\u00a0there\u2019s a lot of overpromising and underdelivering, and that can kind of create this issue where this administration\u00a0\u2014\u00a0and RFK Jr.\u00a0has been doing this as well\u00a0\u2014\u00a0kind of is making these decisions from the top, rather than having these normal conversations with the career scientists and things like that, where the public can kind of follow along on why the scientific decisions are being made if they so choose to,\u00a0or at least\u00a0have an idea that there was a discussion out there. And\u00a0that\u2019s\u00a0not happening. So\u00a0that\u2019s\u00a0not something\u00a0that\u2019s\u00a0creating\u00a0a lot of\u00a0trust.\u00a0I think people\u00a0are seeing that as unscientific and chaotic.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I was\u00a0particularly interested in one of the findings in the survey,\u00a0is that Dr.\u00a0Fauci, Dr.\u00a0Tony Fauci, who was\u00a0sort of\u00a0the\u00a0b\u00eate noire\u00a0of the pandemic, has a higher approval rating than either RFK Jr.\u00a0or\u00a0some of\u00a0his top deputies.\u00a0Joanne, I see you nodding.\u00a0<\/p>\n Kenen:<\/strong>\u00a0Yeah\u00a0that was so\u00a0stri\u2014\u00a0I mean,\u00a0it\u2019s\u00a0still not high. It was,\u00a0I believe it\u00a0was\u00a0\u2014\u00a0I\u2019m\u00a0looking for my note\u00a0\u2014\u00a0but I\u00a0think\u00a0was 54%,\u00a0which is not great. But it\u00a0was better than\u00a0Dr.\u00a0[Mehmet]\u00a0Oz\u00a0[head of the Centers for Medicare & Medicaid Services]. It was better than Kennedy. It\u00a0was better than a bunch of people.\u00a0So,\u00a0but it also shows that\u00a0half\u00a0the country still\u00a0doesn\u2019t\u00a0trust him.\u00a0It was\u00a0a really interesting\u00a0survey, but the gaps in trust in credible science are still significant. What was interesting is the declining trust in our government officials in health\u00a0care, but\u00a0there\u2019s\u00a0still,\u00a0nationally, the U.S.\u00a0population,\u00a0there\u2019s\u00a0still\u00a0a lot of\u00a0skepticism of science and public health. Maybe not as bad as it was, but still\u00a0pretty bad.\u00a0<\/p>\n Luthra:<\/strong>\u00a0And Julie, you alluded to these famous push-up and workout videos. And part of what\u00a0you\u2019re\u00a0getting at\u00a0\u2014\u00a0right?\u00a0\u2014\u00a0is that the communications that we see\u00a0are targeted\u00a0toward a not necessarily\u00a0very large\u00a0audience.\u00a0It is these people who are hyper-online,\u00a0in particular internet\u00a0spaces and communities, and that\u2019s\u00a0somewhat divorced\u00a0from most people and how they live their lives.\u00a0And when you focus\u00a0your message and you\u2019re campaigning on this very particular slice, it\u2019s just\u00a0a lot\u00a0easier to lose sight of where people are and what they want from their government and what they will\u00a0actually appreciate.\u00a0<\/p>\n Rovner:\u00a0<\/strong>It\u2019s\u00a0true.\u00a0The online\u00a0America is very separate from the rest of America, which is a\u00a0whole lot bigger.\u00a0Well\u2014\u00a0<\/p>\n Kenen:<\/strong>\u00a0And\u00a0there\u2019s\u00a0also the young people who\u00a0probably\u00a0aren\u2019t\u00a0in these surveys who,\u00a0teenagers,\u00a0who\u00a0are getting\u00a0a lot of\u00a0information on TikTok about supplements and raw milk.\u00a0And the young men and the teenage boys and the supplements\u00a0is a big deal, and\u00a0that\u2019s\u00a0online. And\u00a0also\u00a0we have been\u00a0seeing\u00a0for a while, but I think\u00a0it\u2019s\u00a0probably creeping\u00a0up,\u00a0the recommendations about psychedelics.\u00a0So\u00a0there\u2019s\u00a0all this stuff out there that\u00a0isn\u2019t\u00a0going to\u00a0be picked\u00a0up by that poll. But yes, it was an interesting poll.\u00a0<\/p>\n Rovner:<\/strong>\u00a0All right. Well, meanwhile over at the Food and Drug Administration, in-again\u00a0out-again in-again\u00a0vaccine chief Vinay Prasad is\u00a0apparently out\u00a0again, or\u00a0will be as of later this spring. I feel like Prasad\u2019s very rocky\u00a0tenure has been\u00a0kind of a\u00a0microcosm for the difficulties this administration has had working with\u00a0career\u00a0scientists at FDA and elsewhere, at HHS.\u00a0Anna, what made him so controversial?\u00a0<\/p>\n Edney:<\/strong>\u00a0Well, I think, Prasad was an FDA critic before he came to the agency. And so\u00a0essentially,\u00a0when he was out in public, particularly during covid, but there were even criticisms he had before that.\u00a0He was criticizing these career scientists at the agency. And\u00a0so\u00a0he got there, and the way he appeared to\u00a0operate\u00a0was that he knew\u00a0best\u00a0and he\u00a0didn\u2019t\u00a0need to talk to any of these people that had been there,\u00a0some\u00a0for decades, and that was getting him in\u00a0a lot of\u00a0trouble. But he was\u00a0being defended\u00a0and protected by FDA\u00a0Commissioner Martin Makary, and he really supported Prasad, and he called him a genius and wanted him to stay on.\u00a0So\u00a0the first time Prasad left, he convinced him to come back. And now this time, I think, things\u00a0maybe just\u00a0went\u00a0a bridge too far when there was sort of this behind-the-scenes but very public fight with a company trying to make a rare-disease drug. And this is something that,\u00a0particularly,\u00a0several\u00a0senators really, really hate, is when the FDA is getting in the way of a rare-disease drug getting to market, because they don\u2019t think that that\u2019s something the agency should be trying to do unless the drug is\u00a0maybe wholly\u00a0unsafe. But they think\u00a0anyone\u00a0should be able to try it. And\u00a0so\u00a0when this exploded and FDA officials were and HHS officials were behind the scenes, but very publicly, calling this company a liar, it was just a bridge too far.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Well, and he,\u00a0this was,\u00a0this incredibly unusual\u00a0phone call with reporters<\/a>\u00a0in which he tried to not be quoted by name, but kind of hard when the head of the agency, or the head of the\u00a0center at FDA is basically trashing a company,\u00a0trying to do it on background. Was that kind of the last straw?\u00a0<\/p>\n Edney:<\/strong>\u00a0Yeah, I think so. And\u00a0sort of an\u00a0aside\u00a0on\u00a0that.\u00a0I\u2019m\u00a0curious how that phone call\u00a0even\u00a0was\u00a0allowed\u00a0to be set up and called.\u00a0Because,\u00a0it\u2019s\u00a0not like he did it on his own. There\u00a0were,\u00a0there was an infrastructure around him that helped him set that up.\u00a0So\u00a0I\u2019m\u00a0curious about why that even went down, but\u00a0I think that\u00a0was\u00a0definitely what\u00a0pushed him out the door. You know, this company wanted to get this drug approved. The FDA had said,\u00a0No, not unless you do this extremely difficult trial<\/em>, which the company said would require drilling holes in people\u2019s heads,\u00a0for what they were trying to get approved, and that it would be a placebo, essentially, for some of those patients, even when you get a hole drilled in your head, and this could be a 10-hour sham surgery, is what the company said. And then\u00a0Prasad comes\u00a0out and\u00a0says:\u00a0No,\u00a0they\u2019re\u00a0lying.\u00a0That\u00a0definitely could\u00a0be a half-hour.\u00a0No big deal.<\/em>\u00a0And\u00a0I just think that there\u00a0were\u00a0senators frustrated with this, the White House\u00a0not wanting to\u00a0see another thing blow\u00a0up over rare-disease drugs, because that has, there\u00a0have\u00a0been\u00a0a lot of\u00a0issues at FDA under his tenure, of just drugs not being able to get to market. Or\u00a0having issues with vaccines that have been years in development not being able to\u00a0get even reviewed, and then that\u00a0being reversed.\u00a0So\u00a0it was\u00a0just,\u00a0that was\u00a0kind of the\u00a0last straw.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And\u00a0of\u00a0course\u00a0President Trump himself has been a big proponent of this whole Right to Try effort,\u00a0that it should be easier for people with, particularly with terminal diseases to be able to try drugs that may or may not help.\u00a0Joanne, you want to add something.\u00a0<\/p>\n Kenen:<\/strong>\u00a0Also\u00a0wasn\u2019t\u00a0he still,\u00a0Prasad, still living in California and running up\u00a0really huge\u00a0travel bills and\u2014\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yes.\u00a0<\/p>\n Kenen:<\/strong>\u00a0\u2014not being at the FDA very much, at a time when everybody else has\u00a0been forced\u00a0to come back to work?\u00a0So,\u00a0but I do confess that I keep looking at my phone to check if\u00a0he\u2019s\u00a0still out or\u00a0is he\u00a0already back again.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Right.\u00a0<\/p>\n Kenen:<\/strong>\u00a0I\u2019m\u00a0really not\u00a0totally convinced that this is the end of Prasad, but\u00a0yeah.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah,\u00a0I was not kidding when I said\u00a0on-again\u00a0off-again on-again\u00a0off-again. All right. Well, moving over to the National Institutes of Health, which also has a director\u00a0that\u2019s\u00a0doing more than one job in more than one place. I know there\u2019s so much news that it\u2019s hard to keep track of it all, but I do think it\u2019s important to continue to follow things that look to\u00a0be settled, like funding for the NIH,\u00a0which Congress\u00a0actually increased\u00a0in the spending bill that passed at the end of January. To that end, a shout-out to our podcast panelist\u00a0Sandhya Raman, formerly of CQ,\u00a0now at Bloomberg, for\u00a0reporting that<\/a>\u00a0grant funding that still pays for most of the nation\u2019s basic biomedical research is still being held up. This is months after it\u00a0was ordered\u00a0resumed by courts and appropriated by Congress.\u00a0<\/p>\n Shout-out as well to my\u00a0KFF Health\u00a0News colleagues\u00a0Rachana Pradhan\u00a0and Katheryn\u00a0Houghton for\u00a0their project<\/a>\u00a0on the people and research projects that have been disrupted by all the cuts at NIH,\u00a0as well as new bureaucratic hurdles put in place. I feel like if there weren\u2019t so much else going on, what\u2019s happening at\u00a0basically the\u00a0economic and health engine of NIH would be getting much,\u00a0much,\u00a0much\u00a0more attention, particularly because of the continuing brain drain with researchers moving to other countries and students choosing different careers rather than becoming researchers. I wonder if this sort\u00a0of drip,\u00a0drip, drip at NIH is going to turn into a very long-term hole\u00a0that\u2019s\u00a0going to be\u00a0very difficult\u00a0to fill.\u00a0A\u00a0lot of\u00a0these things have years-\u00a0if not decades-long runways.\u00a0These great scientific achievements start somewhere, and it looks like\u00a0they\u2019re\u00a0just\u00a0sort of pulling\u00a0out the whole starting part.\u00a0<\/p>\n Kenen:<\/strong>\u00a0It\u2019s\u00a0already affecting the pipeline. In graduate schools,\u00a0many\u00a0schools fund their PhD candidates, and\u00a0it\u2019s\u00a0NIH money, or partly NIH money.\u00a0It\u2019s\u00a0different\u00a0\u2014\u00a0I\u2019m\u00a0not an expert in every single school\u2019s\u00a0support\u00a0systems\u00a0for PhD candidates, but I do know that the pipeline has\u00a0been shrunken\u00a0in\u00a0some\u00a0fields at\u00a0some\u00a0schools, and\u00a0that\u2019s\u00a0been\u00a0reported\u00a0on\u00a0widely. And\u00a0there\u2019s\u00a0been\u00a0a lot of\u00a0coverage about years and\u00a0years of research. You\u00a0can\u2019t\u00a0just restart a multiyear,\u00a0complicated clinical trial or research project. Once you stop it,\u00a0you\u2019re\u00a0losing everything to date, right? You\u00a0can\u2019t\u00a0just\u00a0sort of say,\u00a0Oh,\u00a0I\u2019ll\u00a0put it on hold for a couple of years and resume it.<\/em>\u00a0You\u00a0can\u2019t\u00a0do that.\u00a0So\u00a0we\u2019ve already reached\u00a0some kind of\u00a0a\u00a0critical\u00a0point.\u00a0It\u2019s\u00a0just a matter of how much worse it gets, or whether the ship begins to stabilize in any way going forward. But there\u2019s already damage.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I say,\u00a0are you guys as surprised as I am, though, that this isn\u2019t\u00a0\u2014\u00a0the NIH has been this sort of bipartisan jewel that everybody has supported over the decades that I\u2019ve been covering it, and now it\u2019s\u00a0basically being\u00a0dismantled in front of our eyes, and nobody\u2019s saying very much about\u00a0it.\u00a0<\/p>\n Kenen:<\/strong>\u00a0It\u2019s\u00a0also an engine of economic growth.\u00a0You see different ROI\u00a0[return on investment]\u00a0numbers when you look at NIH, but I think the lowest number you hear is\u00a0two and a half dollars of benefit for every dollar we invest. And\u00a0I\u2019ve\u00a0seen\u00a0reports\u00a0up to $7.\u00a0I\u00a0don\u2019t\u00a0know what the magic number is, but this is an engine of economic growth in the United States. This is basic biomedical research that the private sector or the academic sector cannot do.\u00a0It\u00a0has to\u00a0come from the government.\u00a0And I\u00a0don\u2019t\u00a0think any of us have really gotten our heads around\u00a0\u2014 why harm the NIH\u00a0when it is\u00a0bipartisan,\u00a0it is economically successful,\u00a0and it has humanitarian value.\u00a0It\u2019s\u00a0the basis.\u00a0The drug companies develop the drug and bring it to the market. But that basic, basic,\u00a0earlier\u00a0what\u2019s\u00a0called bench science,\u00a0that\u2019s\u00a0funded by the\u00a0NIH.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I know.\u00a0It\u2019s\u00a0a mystery. Well, adding to RFK Jr.\u2019s bad week are the growing divisions within his base,\u00a0the\u00a0Make America\u00a0Healthy\u00a0Again\u00a0movement. While the White House, seeing that the public doesn\u2019t really support\u00a0MAHA\u2019s\u00a0anti-vaccine positions,\u00a0is trying to get HHS to tone it down, there was a major MAHA\u00a0meetup just blocks from the White House this week, with sessions urging a complete end to the childhood vaccine schedule and the removal of all vaccines from the market, quote, until they can be proven\u00a0\u201csafe and effective.\u201d\u00a0By the way,\u00a0most\u00a0of\u00a0them have\u00a0been already. Meanwhile,\u00a0lots of\u00a0MAHA\u00a0followers are still angry that the White House is supporting the continuing production of glyphosate, the weed killer sold commercially as Roundup. Democrats,\u00a0according to Politico<\/a>, are trying to exploit the divisions in the MAHA movement, which leads to the question:\u00a0Will\u00a0MAHA\u00a0be a net plus or a net minus for this fall\u2019s midterm elections?\u00a0On the one hand,\u00a0I think Trump\u00a0appointed Kennedy because he was hoping that\u00a0the MAHA movement would be\u00a0a boost to turnout.\u00a0On the other hand, MAHA\u00a0seems\u00a0pretty split\u00a0right now.\u00a0<\/p>\n Edney:<\/strong>\u00a0Well, I think\u00a0that\u2019s\u00a0the million-dollar question,\u00a0is\u00a0which way\u00a0they\u2019re\u00a0going to swing if they swing at all. And it\u2019s hard to say right now, because\u00a0I think they\u00a0are angry at certain aspects of things this administration is doing,\u00a0the two things you mentioned,\u00a0on\u00a0Roundup and on vaccines, kind of telling RFK to kind of talk a little bit less about those. But will they be able to then vote for Democrats instead? I\u00a0think,\u00a0it\u2019s\u00a0only March,\u00a0so\u00a0it\u2019s\u00a0so difficult to say\u00a0what will happen between now and then.\u00a0I think there\u2019s still things that the health secretary could do on food that\u00a0he\u2019s\u00a0talked about, that could draw attention away from that anger, that might make\u00a0many\u00a0of them happy.\u00a0I think there\u00a0were\u00a0some\u00a0things he\u00a0kind of started\u00a0doing early in his term\u00a0that\u00a0hasn\u2019t\u00a0been talked\u00a0about as much.\u00a0And also, I think there\u2019s still the prospect of Casey\u00a0Means becoming\u00a0surgeon\u00a0general\u00a0\u2014\u00a0or not\u00a0\u2014\u00a0out there, and that\u2019s\u00a0kind of a\u00a0big piece of this.\u00a0If she is to get into the administration, and that is sort of up in the\u00a0air\u00a0right now, then that could\u00a0kind of give\u00a0them something else to focus on, because she is a large part of this playbook of the MAHA movement.\u00a0<\/p>\n Rovner:<\/strong>\u00a0That\u2019s\u00a0right.\u00a0And we are waiting to see sort of if she can get the votes even to get out of committee, much less get to the floor, see\u00a0whether we\u2019re going to have, as\u00a0some\u00a0are saying, the first\u00a0surgeon\u00a0general who does not have an active license to practice medicine. Shefali, you wanted\u00a0to add something.\u00a0<\/p>\n Luthra:<\/strong>\u00a0No, I just think\u00a0we\u2019ve\u00a0talked about this before on the podcast, that the food stuff is much more popular than the vaccine stuff. The vaccine components of\u00a0MAHA\u00a0remain very unpopular.\u00a0It\u2019s\u00a0difficult to really see or say sort of what the White House can do on food in a sustained, focused way,\u00a0without going\u00a0off-script, that is also popular. But I think to Anna\u2019s point,\u00a0it\u2019s\u00a0just so hard to say to what extent this\u00a0ultimately matters\u00a0in November, because there are just so many concerns right now. People\u00a0can\u2019t\u00a0afford their health insurance, and gas prices are going up. And\u00a0I just think we\u00a0have to\u00a0wait and see to what extent people are voting based on food policy.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, well, we will see. All\u00a0right,\u00a0we\u2019re\u00a0going to take a quick break. We will be right back.\u00a0<\/p>\n OK, turning to another Trump administration priority, fighting fraud. This week, the administration accused another\u00a0Democratic-led state, New York, of not policing Medicaid fraud forcefully enough. This comes after the Centers for Medicare\u00a0&\u00a0Medicaid Services said it will withhold hundreds of millions of dollars from Minnesota, which our guest,\u00a0Andy Schneider,\u00a0will talk about at more length. Minnesota, by the way, last\u00a0week sued the federal government over its Medicaid efforts. So that fight will continue for a while. But\u00a0it\u2019s\u00a0not just blue states, and\u00a0it\u2019s\u00a0not just Medicaid. In something I\u00a0didn\u2019t\u00a0have on my bingo card, this administration is also going after fraud in the Medicare Advantage\u00a0program, which has long been a Republican darling.\u00a0<\/p>\n Last week, CMS banned the Medicare Advantage plan\u00a0operated\u00a0by\u00a0Elevance\u00a0Health, which has\u00a0nearly 2\u00a0million Medicare patients currently enrolled,\u00a0from adding any new enrollees starting March 31,\u00a0for what the agency described as, quote,\u00a0\u201csubstantial and persistent noncompliance with Medicare Advantage risk adjustment data.\u201d\u00a0And on Tuesday, the\u00a0congressional Joint Economic Committee reported that overpayments to those Medicare Advantage\u00a0plans raised premiums by an estimated $200 per Medicare enrollee annually\u00a0\u2014\u00a0and\u00a0that\u2019s\u00a0all Medicare enrollees, not just those in the private Medicare Advantage plans. Is this the end of the honeymoon for Medicare Advantage? Joanne, you were there with me when Republicans were pushing this.\u00a0<\/p>\n Kenen:<\/strong>\u00a0I\u2019ve\u00a0been surprised, as you have,\u00a0Julie, because\u00a0basically Medicare\u00a0Advantage has been the\u00a0darling, and it\u00a0is popular with people.\u00a0It\u2019s grown and grown and grown,\u00a0not because the government forced people in. It has good marketing and\u00a0some\u00a0benefits for the younger, healthier post-65 population, gyms and things like that.\u00a0But\u00a0\u2014\u00a0and vision and dental, which\u00a0are a big deal. But\u00a0we\u2019ve\u00a0also seen a backlash, in\u00a0some\u00a0ways, because there\u2019s the prior authorization issues in Medicare Advantage have gotten\u00a0a lot of\u00a0attention\u00a0the last couple of years. But not just am I surprised by\u00a0sort\u00a0of\u00a0the\u00a0swing\u00a0that\u00a0we\u2019re\u00a0hearing\u00a0about\u00a0generally.\u00a0I\u2019m\u00a0surprised by Dr.\u00a0Oz, because when he ran for Senate a couple\u00a0years\u00a0ago in Pennsylvania, and\u00a0much\u00a0of his public persona has been really, really,\u00a0really gung-ho, pro Medicare Advantage.\u00a0<\/p>\n And yet,\u00a0some of\u00a0you were at or,\u00a0like me, watched the live stream of\u00a0\u2014\u00a0he did\u00a0a very interesting, thoughtful, and,\u00a0I\u2019ve mentioned this at least one time before, hourlong conversation with\u00a0a lot of\u00a0Q&A at the Aspen Institute here in D.C.\u00a0a couple of months ago. And one of the questions was someone said:\u00a0Dr.\u00a0Oz,\u00a0you\u2019ve\u00a0just turned 65.\u00a0Are you doing Medicare Advantage, or\u00a0are\u00a0you doing traditional Medicare?<\/em>\u00a0And the expected answer for me was, well, I knew that\u00a0he\u2019s\u00a0on government insurance now.\u00a0So\u00a0he, you\u00a0have to,\u00a0at 65 you\u00a0have to\u00a0go into Medicare Advanta\u2014\u00a0Medicare A,\u00a0whether\u00a0you\u00a0\u2014\u00a0that\u2019s automatic.\u00a0That\u2019s\u00a0the hospital part. But you have the choice. But if\u00a0you\u2019re\u00a0still working and getting insurance or government\u00a0\u2014\u00a0he\u2019s\u00a0on a government plan. He\u00a0doesn\u2019t\u00a0have to do that. But\u00a0he actually, and\u00a0he pointed that out, but the next sentence really surprised me, because he said:\u00a0I\u00a0don\u2019t\u00a0know. My wife and I are still talking about that.<\/em>\u00a0And I thought that was\u00a0A)\u00a0a\u00a0very honest answer. He\u00a0didn\u2019t\u00a0have to even\u00a0say. But it was also,\u00a0it just was interesting to me that after all that\u00a0Rah-rah\u00a0Medicare Advantage<\/em>\u00a0we were hearing about, his own personal choice\u00a0was,\u00a0Not\u00a0sure if that one\u2019s right for me.\u00a0<\/em>So\u00a0\u2014\u00a0<\/p>\n Rovner:<\/strong>\u00a0I was going to say,\u00a0I feel like the Republicans are sort of twisting right now between Medicare Advantage, which they\u2019ve always pushed\u00a0\u2014\u00a0they want to privatize Medicare because they don\u2019t like government health insurance\u00a0\u2014\u00a0and then there\u2019s\u00a0the current populist\u00a0push against big insurance companies, because, of course, all those Medicare Advantage\u00a0plans belong to those big insurance companies that Republicans are suddenly saying are too big and getting too much money.\u00a0So\u00a0they\u2019re\u00a0sort of caught\u00a0between\u00a0trying to have it both ways.\u00a0I\u2019ll\u00a0be interested to see how they come down. One of the things that did strike me, though, even before Dr.\u00a0Oz\u00a0sort of started\u00a0his little crusade against Medicare Advantage, was,\u00a0I think it\u00a0was at Kennedy\u2019s confirmation hearing that Sen.\u00a0Bill Cassidy was suddenly questioning Medicare Advantage. That was, I think, the first Republican I saw to like,\u00a0Oh<\/em>.\u00a0That made me raise my eyebrows.\u00a0And I think since then, I\u2019ve\u00a0kind of seen\u00a0why.\u00a0<\/p>\n Kenen:<\/strong>\u00a0The\u00a0populist talk\u00a0against\u00a0insurance companies,\u00a0not giving money to insurance companies,\u00a0is part of the Republican\u00a0\u2014\u00a0and,\u00a0specifically, President Trump\u2019s\u00a0\u2014\u00a0desire to not extend the ACA,\u00a0the Affordable Care Act,\u00a0enhanced subsidies. That was the basic:\u00a0Well,\u00a0we\u2019re\u00a0not going to do this,\u00a0because\u00a0we\u2019re\u00a0just throwing money at these insurance companies. And we\u00a0don\u2019t\u00a0want to do that. We want to empower\u00a0the patients.<\/em>\u00a0That was\u00a0the,\u00a0I\u2019m\u00a0not, and the missing piece of that argument is:\u00a0Yes, the ACA subsidies go to insurance companies. However, all of us are benefiting in\u00a0some\u00a0way or other from government policies that\u00a0benefit\u00a0insurance companies.\u00a0The tax breaks our employers get. The tax breaks we get for our insurance.\u00a0And then the biggie, of course, is Medicare Advantage.\u00a0<\/p>\n We are paying Medicare Advantage more than we are paying traditional Medicare.\u00a0So\u00a0Medicare Advantage is\u00a0private\u00a0insurance\u00a0companies, and the government has\u00a0been just\u00a0sending them\u00a0lots\u00a0and\u00a0lots of\u00a0money for years.\u00a0So\u00a0I\u2019m not sure it\u2019s\u00a0\u2014\u00a0this Medicare Advantage thing is just bubbling up, and we\u2019re not\u00a0really sure\u00a0how this plays out. But\u00a0I think that\u00a0the rhetoric\u00a0against insurance companies\u00a0is\u00a0the rhetoric\u00a0against the ACA.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Oh, it is.\u00a0<\/p>\n Kenen:<\/strong>\u00a0Rather that\u00a0hasn\u2019t\u00a0yet\u00a0been connected\u00a0to the Medicare Advantage. I think\u00a0they\u2019re,\u00a0yes, we all know\u00a0they\u2019re\u00a0connected. But I think the political debate, it\u2019s\u00a0not Medicare\u00a0Advantage\u00a0is bad because insurance companies are bad.\u00a0It\u2019s the\u00a0ACA is bad because it enriches insurance companies.\u00a0There\u2019s\u00a0a different ideological parade going down the road.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I was going to say,\u00a0it\u2019s\u00a0important to remember at the beginning of Medicare Advantage, which was a Republican proposal back in 2003,\u00a0they purposely overpaid it. They gave it more money because they know that when they give them more money, the insurance companies\u00a0are required\u00a0to\u00a0return\u00a0some of\u00a0that money to beneficiaries in the form of these extra benefits.\u00a0That\u2019s\u00a0why there are gym memberships and dental and vision and hearing coverage in these Medicare Advantage plans. It does make them popular, so people sign up. And that was\u00a0sort of Republicans\u2019\u00a0intent at the beginning. It was to\u00a0sort of not\u00a0so much push people into it but entice people into it.\u00a0<\/p>\n Kenen:<\/strong>\u00a0And\u00a0then\u2014\u00a0<\/p>\n Rovner:<\/strong>\u00a0And then maybe cut it back later.\u00a0<\/p>\n Kenen:<\/strong>\u00a0No, but\u00a0it\u2019s exceeded\u00a0expectations.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Absolutely.\u00a0<\/p>\n Kenen:<\/strong>\u00a0The number of people going into Medicare Advantage has been\u00a0really high, higher than people expected.\u00a0And\u00a0it\u2019s\u00a0also hard to get out, depending on what state you live in.\u00a0It\u2019s\u00a0not impossible, but\u00a0it\u2019s\u00a0costly and difficult, except for\u00a0a few,\u00a0I think\u00a0it\u2019s\u00a0seven or eight\u00a0states\u00a0make it\u00a0pretty easy. But also remember that the earlier version of what we now call Medicare Advantage was\u00a0\u2014\u00a0which\u00a0was the\u00a0\u201990s, right Julie?\u00a0\u2014\u00a0I think the Medicare Part C,\u00a0and that failed.\u00a0So\u00a0\u2014\u00a0<\/p>\n Rovner:<\/strong>\u00a0Well after,\u00a0that failed because they cut it when they were\u00a0\u2014\u00a0<\/p>\n Kenen:<\/strong>\u00a0Right.\u00a0Right.\u00a0<\/p>\n Rovner:<\/strong>\u00a0They cut all the funding when they were balancing the budget\u00a0\u2014\u00a0<\/p>\n Kenen:<\/strong>\u00a0Right.\u00a0<\/strong>\u00a0<\/p>\n Rovner:<\/strong>\u00a0\u2014\u00a0in\u00a01997.\u00a0<\/p>\n Kenen:<\/strong>\u00a0But that\u00a0gave them\u00a0the\u00a0excu\u2014\u00a0right.\u00a0<\/p>\n Rovner:<\/strong>\u00a0They made it\u00a0fail.\u00a0<\/p>\n Kenen:<\/strong>\u00a0That\u00a0gave them an excuse to give them more money later that, when they revived it, renamed it,\u00a0and launched it\u00a0in\u00a02003 legislation,\u00a0that initial push to give them a ton of money, because they could say,\u00a0Well, we didn\u2019t give them enough money, and that\u2019s why they<\/em>\u00a0fa<\/em>\u2014.\u00a0<\/em>There\u00a0are\u00a0all sorts of political\u00a0things going on that\u00a0weren\u2019t\u00a0strictly money. But\u00a0yeah,\u00a0it was part of the narrative of\u00a0Why we\u00a0have to\u00a0give them more money<\/em>,\u00a0is\u00a0They need it.<\/em>\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah.\u00a0Anyway,\u00a0we\u2019ll\u00a0also watch that space. Well, finally, this week, there\u2019s news on the reproductive health front, because there\u2019s always news on the reproductive health front. Shefali,\u00a0Wyoming has become the latest state to enact a so-called heartbeat ban, barring abortions when cardiac activity can\u00a0be detected.\u00a0That\u2019s\u00a0often around six weeks, which is before\u00a0many\u00a0people are even aware of being pregnant. I thought the Wyoming Supreme Court said just this past January that its constitution prevents abortion bans.\u00a0So\u00a0what\u2019s\u00a0up here?\u00a0<\/p>\n Luthra:<\/strong>\u00a0They did, in fact, say that, and so we are seeing this law taken to court.\u00a0It was\u00a0actually added\u00a0in a court filing to a preexisting case challenging other abortion restrictions in the state.\u00a0I\u2019m\u00a0sure\u00a0that\u2019s\u00a0going to play out for quite\u00a0some\u00a0time. But\u00a0what\u2019s\u00a0interesting about the Wyoming\u00a0Constitution\u00a0\u2014\u00a0right?\u00a0\u2014\u00a0is that it protects the right to make health care decisions,\u00a0in an effort to\u00a0sort\u00a0of\u00a0fight against the ACA. That was this\u00a0conservative approach that now has come to really\u00a0benefit\u00a0abortion rights supporters as well. But what I think\u00a0this underscores\u00a0is that even as we are seeing\u00a0fairly little\u00a0abortion policy in Washington, at least in a meaningful way,\u00a0a lot\u00a0is still happening on the state level. That really is where the bulk of action is, whether you see that in Wyoming,\u00a0in Missouri, where\u00a0they\u2019re\u00a0trying to undo the abortion rights protections there, and just\u2014\u00a0<\/p>\n Rovner:<\/strong>\u00a0The ones that passed by voters.\u00a0<\/p>\n Luthra:<\/strong>\u00a0Exactly. And\u00a0so\u00a0what we\u2019re really thinking about is anti-abortion activists are not really that confident in the\u00a0president\u2019s desire, interest, ability, what have you, to get their agenda items done. And for now, they are really focusing on the states, and that is where their interest, I think, will only remain, at least until the primary for the next presidential race begins in earnest.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Well,\u00a0Shefali,\u00a0I also want to ask you about\u00a0a story that you wrote<\/a>\u00a0this week on just how many things ripple out economically from abortion restrictions. Now\u00a0it\u2019s\u00a0having an impact on rent prices?\u00a0Please explain.\u00a0<\/p>\n Luthra:<\/strong>\u00a0I thought\u00a0this was so interesting. It was this\u00a0NBER\u00a0[National Bureau of Economic Research]\u00a0paper that came out this week, and they looked at comparably trending rental markets in states with abortion bans and those without them. And what they saw was that after the\u00a0Dobbs<\/em>\u00a0decision, rental prices declined\u00a0relative\u00a0to places without bans, compared to those in those that had them.\u00a0And this is\u00a0really interesting.\u00a0It just\u00a0sort of continues.\u00a0Rental prices went down,\u00a0and also\u00a0vacancies went up.\u00a0And what the researchers say is this is\u00a0a very, very dramatic\u00a0and clear relationship, and it illustrates that people, when they have a choice, are considering abortion rights in terms of where they want to live. And anecdotally, we know that,\u00a0because\u00a0we\u2019ve\u00a0seen residents make choices about where they will practice.\u00a0We\u2019ve\u00a0seen doctors decide where they will live. We have seen people move. Companies offer relocation benefits if people want them. And this is more data that illustrates that\u00a0actually that\u00a0affects the economy of communities, and it really underscores that where we live just simply will look different based on things\u00a0like abortion rights and abortion policy and other of these things that\u00a0are treated\u00a0as social but really do affect people\u2019s economic behaviors.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And as we pointed out before,\u00a0it\u2019s\u00a0not just about quote-unquote\u00a0\u201cabortion,\u201d\u00a0because when doctors choose not to live in a certain place,\u00a0it\u2019s\u00a0other types of health\u00a0care.\u00a0It\u2019s\u00a0all\u00a0health\u00a0care. And we know that doctors tend to marry or partner with other doctors. So sometimes if an OB GYN\u00a0doesn\u2019t\u00a0want to move to a certain place, then that OB-GYN\u2019s\u00a0partner, who may be\u00a0some\u00a0completely other type of\u00a0doctor,\u00a0isn\u2019t\u00a0going to move there either.\u00a0So\u00a0we are starting to see\u00a0some of\u00a0these geographical shifts going on.\u00a0<\/p>\n Luthra:<\/strong>\u00a0And one point\u00a0actually that\u00a0the researcher made that I thought was so interesting was that abortion policy, it can be emblematic, in and of itself, a reason people choose not to live somewhere, but people may also be making these decisions because of what it represents. Do I look at an abortion policy and say,\u00a0Oh, this reflects social values or gender beliefs<\/em>?\u00a0Or does it also suggest\u00a0maybe more\u00a0anti-LGBTQ+\u00a0laws?\u00a0And all of that can create a picture that is broader than simply abortion or\u00a0not, and\u00a0determine\u00a0where and how people want to live their lives.\u00a0<\/p>\n Rovner:<\/strong>\u00a0It\u2019s\u00a0a really interesting\u00a0story.\u00a0We will\u00a0link\u00a0to it.\u00a0All right, that is this week\u2019s news. Now\u00a0I\u2019ll\u00a0play my interview with Andy Schneider of Georgetown University, and then we will be back to do our extra credits.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I am pleased to welcome to the podcast Andy Schneider, a research professor of the practice at the Georgetown University McCourt School of Public Policy. And he spent\u00a0many\u00a0years on Capitol Hill helping write and shape Medicaid law as a top aide to California Democratic\u00a0congressman\u00a0Henry Waxman\u00a0\u2014\u00a0and\u00a0many\u00a0hours explaining it to me.\u00a0I have asked him here to help untangle the Medicaid fraud fight now taking place between the federal government and,\u00a0at least so far, mostly\u00a0Democratic-led states. Andy, thanks for being here.\u00a0<\/p>\n Andy Schneider:<\/strong>\u00a0Thanks for having me,\u00a0Julie.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So,\u00a0it\u2019s\u00a0not like fraud in Medicaid\u00a0\u2014\u00a0and other health programs,\u00a0for that matter\u00a0\u2014\u00a0is anything new.\u00a0Who are the major perpetrators of health care fraud?\u00a0It\u2019s\u00a0not usually the\u00a0patients, is it?\u00a0<\/p>\n Schneider:<\/strong>\u00a0No,\u00a0it\u2019s\u00a0usually\u00a0some\u00a0bad-actor providers or bad-actor businesspeople.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So how are fraud-fighting efforts at both the federal and state level, since Medicaid funding\u00a0is shared, supposed to work?\u00a0How does the federal government and the state government\u00a0sort of try\u00a0and make fraud as minimal as possible? Since\u00a0presumably they\u2019re\u00a0never going to get\u00a0rid of it.\u00a0<\/p>\n Schneider:<\/strong>\u00a0Unfortunately, I\u00a0don\u2019t\u00a0think\u00a0you\u2019re\u00a0ever going to get rid of it in Medicaid or Medicare or private insurance or in other\u00a0walks of life. There are bad actors out there.\u00a0They\u2019re\u00a0going to try to take\u00a0advantage.\u00a0So\u00a0you need your defenses up.\u00a0So\u00a0the short of this is,\u00a0Medicaid\u00a0is administered\u00a0on a day-to-day basis by the states. The federal government\u00a0pays for\u00a0a majority of\u00a0it and oversees how the states run their programs. In that context, the state Medicaid agency and the state\u00a0fraud\u00a0control\u00a0unit have a\u00a0primary role in\u00a0identifying\u00a0where there might be fraud, investigating,\u00a0and then,\u00a0in\u00a0appropriate cases,\u00a0prosecuting. The federal government also has a role, however. Depending on the scope of the fraud, it could involve the FBI. It could involve the Office of Inspector General at the Department of Health and Human Services.\u00a0So\u00a0there\u2019s\u00a0both federal and state presence, but the primary responsibilities were the\u00a0states\u2019.\u00a0<\/p>\n Rovner:<\/strong>\u00a0We know that Minnesota has been experiencing a Medicaid fraud problem,\u00a0because both the state and the federal government have been working on it for more than a year now. What is the Trump administration doing in Minnesota?\u00a0And why is\u00a0this\u00a0different from what the federal government has traditionally done when\u00a0it\u2019s\u00a0trying to ensure that states are appropriately trying to minimize fraud?\u00a0<\/p>\n Schneider:<\/strong>\u00a0Well, usually the\u00a0vice\u00a0president of the United States does not get up at a White House press conference and announce he and the Centers for Medicare\u00a0&\u00a0Medicaid\u00a0Services are\u00a0withholding $260 million in federal funds,\u00a0called\u00a0a\u00a0deferral. That is highly, highly unusual. And normally\u00a0the\u00a0head of the Centers\u00a0for Medicare\u00a0&\u00a0Medicaid Services does not\u00a0go and make\u00a0videos in the state before something like this\u00a0is announced.\u00a0So\u00a0I would say that this is\u00a0way out\u00a0of the ordinary, and\u00a0I think it\u00a0has to do with\u00a0some\u00a0animus in the administration towards\u00a0Gov.\u00a0[Tim]\u00a0Walz and his administration.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Right.\u00a0Gov.\u00a0Walz, for those who\u00a0don\u2019t\u00a0remember, was the\u00a0vice presidential\u00a0candidate in 2024 running against President Trump, who did win, in fact. But there have been two different efforts to withhold Medicaid money for Minnesota, right?\u00a0<\/p>\n Schneider:<\/strong>\u00a0Yeah. Now\u00a0you\u2019re\u00a0into\u00a0the Medicaid\u00a0weeds, but since you asked the question,\u00a0I\u2019ll\u00a0take you there. So in January, the\u00a0administra\u2014\u00a0the Center for Medicare\u00a0&\u00a0Medicaid Services\u00a0\u2014\u00a0we\u2019ll call them CMS here\u00a0\u2014\u00a0they announced they were going to withhold about\u00a0$2 billion\u00a0a year going forward, not looking back\u00a0but going forward,\u00a0in matching funds that the federal government would otherwise pay to the state of Minnesota for the services that it was providing to its over 1 million beneficiaries. In February at this White House press conference, what the\u00a0vice\u00a0president announced was withholding temporarily\u00a0\u2014\u00a0we\u2019ll see how temporary it is\u00a0\u2014\u00a0but withholding temporarily\u00a0$260 million in federal Medicaid matching funds that applied to state spending that\u2019s already occurred, happened in the past, happened in the quarter ending Sept.\u00a030, 2025.\u00a0So\u00a0both the past expenditures and future expenditures are targets for these CMS actions.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So\u00a0what happens if the federal government\u00a0actually doesn\u2019t\u00a0pay the state this money? I assume more than people who are committing fraud would\u00a0be\u00a0impacted.\u00a0<\/p>\n Schneider:<\/strong>\u00a0Well,\u00a0let\u2019s\u00a0be clear.\u00a0The\u00a0amounts of money here,\u00a0there\u2019s\u00a0no relationship between those and however\u00a0much\u00a0fraud is going on in Minnesota. And there has been fraud against Medicaid in Minnesota.\u00a0Everybody\u2019s\u00a0clear about that. The state is clear about it. The feds are clear about it. But\u00a0$2 billion\u00a0going forward in a year,\u00a0$1 billion\u00a0going,\u00a0looking backwards,\u00a0$260 million times four\u00a0\u2014\u00a0there\u2019s\u00a0no relationship between those amounts, right? Should they\u00a0come to pass\u00a0\u2014and all of this is still in process\u00a0\u2014\u00a0should those amounts\u00a0come to pass, you\u2019re looking at, depending on who\u2019s doing the estimates, between\u00a07\u00a0and 18% of the amount of money the federal government pays,\u00a0helps the state with,\u00a0each year in Medicaid.\u00a0That\u2019s\u00a0just an enormous hole for a state to fill, and it\u00a0doesn\u2019t\u00a0have\u00a0many\u00a0good options. It can cut eligibility. It can cut services. It can cut reimbursement rates. Filling in that hole with state revenues,\u00a0that\u2019s\u00a0going to be a real stretch.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So\u00a0it\u2019s\u00a0not just Minnesota. Now the administration says it is seeing concerning things going on in New York and has launched a probe\u00a0there. Is there any\u00a0indication\u00a0that this administration is going after states that\u00a0are not run\u00a0by Democrats?\u00a0<\/p>\n Schneider:<\/strong>\u00a0So\u00a0the only letters that\u00a0we\u2019ve\u00a0seen from the administration have been to California, New York,\u00a0and Maine. There may be other letters out there. We only access the public\u00a0record.\u00a0So\u00a0so\u00a0far, based on what we know,\u00a0it\u2019s\u00a0just\u00a0been\u00a0Democratically\u00a0run\u00a0states.\u00a0<\/p>\n Rovner:<\/strong>\u00a0As long as\u00a0I\u2019ve\u00a0been covering this, which is now a long time, fraud-fighting has been\u00a0pretty bipartisan.\u00a0It\u2019s\u00a0been something that Congress has worked on, Democrats and Republicans in Congress, Democrats and Republicans in the\u00a0states.\u00a0What\u2019s\u00a0the danger of politicizing fraud-fighting,\u00a0which is what\u00a0certainly seems to be\u00a0going on right now?\u00a0<\/p>\n Schneider:<\/strong>\u00a0Yeah,\u00a0that\u2019s\u00a0a terrific point.\u00a0So\u00a0it\u00a0always has\u00a0been\u00a0bipartisan, because\u00a0money is green.\u00a0It\u2019s\u00a0not red.\u00a0It\u2019s\u00a0not blue.\u00a0It\u2019s\u00a0green. And trying to keep bad actors from ripping it off from Medicaid or Medicare\u00a0has always been a bipartisan undertaking. The reason that\u2019s important, particularly in a program like Medicaid, where the federal government and the state\u00a0have to\u00a0talk to one another when they are flagging potential fraud, when they\u2019re investigating it, when they\u2019re prosecuting it, you don\u2019t want the agencies tripping all over one another. You want them\u00a0sharing\u00a0information\u00a0as necessary,\u00a0etc.\u00a0When that gets politicized,\u00a0it\u2019s\u00a0very bad\u00a0for the results and for the effective operation of the program.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Well\u00a0we will keep watching this space, and\u00a0we\u2019ll\u00a0have you back to explain it more. Andy Schneider, thank\u00a0you very much.\u00a0<\/p>\n Schneider:<\/strong>\u00a0Julie\u00a0Rovner, thank you very much.\u00a0<\/p>\n Rovner:<\/strong>\u00a0OK,\u00a0we\u2019re\u00a0back.\u00a0Now\u00a0it\u2019s\u00a0time for our\u00a0extra-credit\u00a0segment.\u00a0That\u2019s\u00a0where we each recognize the 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. Anna, why don\u2019t you start us off\u00a0this week?\u00a0<\/p>\n Edney:<\/strong>\u00a0Sure.\u00a0Mine is in\u00a0The Wall Street Journal.\u00a0It\u2019s\u00a0[\u201cThe Boom in Autism Therapy Is Medicaid\u2019s Fastest-Growing Jackpot<\/a>\u201d].\u00a0This is a look at the booming business of providing therapy to children with autism. And\u00a0that\u2019s\u00a0particularly\u00a0been big in the Medicaid\u00a0program. And I\u00a0don\u2019t\u00a0want to give away too much, because there\u00a0are\u00a0just so many jaw-dropping details\u00a0in\u00a0this.\u00a0So\u00a0I guess the reporters\u00a0were able to\u00a0kind of go\u00a0through the data and billing records in a way that showed\u00a0some of\u00a0these companies and what they were doing and how they were becoming millionaires, people who had never done anything in autism before.\u00a0So\u00a0if you enjoy a sort of jaw-dropping read, I think you should\u00a0take a look\u00a0at it.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, jaw-dropping is\u00a0definitely the\u00a0right description.\u00a0Joanne.\u00a0<\/p>\n Kenen:<\/strong>\u00a0So\u00a0I\u00a0sort of rummaged\u00a0around the internet to the less widely read sources, and I came across this\u00a0great story\u00a0from the Idaho\u00a0Capital\u00a0Sun by Laura Guido. It has a long headline.\u00a0Reminder that 988 is the mental health crisis line and suicide help. The headline is:\u00a0\u201c988\u00a0Ended\u00a0His Call.\u00a0Now\u00a0an\u00a0Idaho\u00a0Teen Is Pushing for a Fix to the State\u2019s Parental Consent Law.<\/a>\u201d\u00a0The story is that a 15-year-old boy named Jace\u00a0Woods called\u00a0two years ago\u00a0\u2014\u00a0so this still\u00a0hasn\u2019t\u00a0been fixed\u00a0after two years\u00a0\u2014\u00a0and they cut\u00a0him\u00a0off. They\u00a0sort of gently\u00a0cut\u00a0him\u00a0off. But they\u00a0can\u2019t\u00a0talk to these kids who have,\u00a0who are in crisis,\u00a0without parental consent. They do a quick assessment. If they think someone\u2019s life is\u00a0immediately\u00a0in\u00a0danger\u00a0right then and there, they can stay on. But a kid\u00a0who\u2019s\u00a0what they call suicidal ideation, seriously depressed and at risk, and knows\u00a0he\u2019s\u00a0at risk or\u00a0she\u2019s\u00a0at risk, and made this phone\u00a0call,\u00a0they\u00a0don\u2019t\u00a0talk to them unless they think\u00a0it\u2019s\u00a0imminent.\u00a0So\u00a0it also affects,\u00a0these parental,\u00a0it affects sexual health and STDs and abortion and\u00a0whole\u00a0lot of other\u00a0things.\u00a0<\/p>\n Rovner:<\/strong>\u00a0That\u2019s\u00a0what it was for.\u00a0<\/p>\n Kenen:<\/strong>\u00a0That was the\u00a0initial\u00a0reason, but it got bigger.\u00a0So\u00a0a kid who calls in a crisis can get no help at all. And even in those emergency situations where they can stay on the line and try to get emergency help if they do\u00a0think\u00a0a\u00a0kid\u2019s\u00a0in imminent danger,\u00a0they\u2019re\u00a0not allowed to make a follow-up call to make sure\u00a0they\u2019re\u00a0OK.\u00a0So\u00a0this kid has been trying for two years.\u00a0There\u2019s\u00a0a state lawmaker.\u00a0They\u2019re\u00a0refining a law. They say\u00a0it\u2019s,\u00a0they\u2019re\u00a0refining a bill.\u00a0They say\u00a0it\u2019s\u00a0going to go through. But really this,\u00a0talk about unintended consequences. We have a national mental health crisis, particularly acute for teens. This is not solving any problems.\u00a0<\/p>\n Rovner:<\/strong>\u00a0It is not.\u00a0Shefali.\u00a0<\/p>\n
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
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