\t\t\t<\/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, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n After narrowly passing a budget resolution this spring foreshadowing major Medicaid cuts, Republicans in Congress are having trouble agreeing on specific ways to save billions of dollars from a pool of funding that pays for the program without cutting benefits on which millions of Americans rely. Moderates resist changes they say would harm their constituents, while fiscal conservatives say they won\u2019t vote for smaller cuts than those called for in the budget resolution. The fate of President Donald Trump\u2019s \u201cone big, beautiful bill\u201d containing renewed tax cuts and boosted immigration enforcement could hang on a Medicaid deal.<\/p>\n Meanwhile, the Trump administration surprised those on both sides of the abortion debate by agreeing with the Biden administration that a Texas case challenging the FDA\u2019s approval of the abortion pill mifepristone should be dropped. It\u2019s clear the administration\u2019s request is purely technical, though, and has no bearing on whether officials plan to protect the abortion pill\u2019s availability.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Maya Goldman of Axios, and Sandhya Raman of CQ Roll Call.<\/p>\n \t\t\t \tAnna Edney \t\t\t \t\t\t \t\t\t \t\t\t \tMaya Goldman \t\t\t \t\t\t \t\t\t \t\t\t \tSandhya Raman \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF Health News\u2019 Lauren Sausser, who co-reported and co-wrote the latest KFF Health News\u2019 \u201cBill of the Month<\/a>\u201d installment, about an unexpected bill for what seemed like preventive care. If you have an outrageous, baffling, or infuriating medical bill you\u2019d like to share with us, you can do that here<\/a>.<\/p>\n\n Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> NPR\u2019s \u201cFired, Rehired, and Fired Again: Some Federal Workers Find They\u2019re Suddenly Uninsured<\/a>,\u201d by Andrea Hsu.\u00a0<\/p>\n Maya Goldman:<\/strong> Stat\u2019s \u201cEurope Unveils $565 Million Package To Retain Scientists, and Attract New Ones<\/a>,\u201d by Andrew Joseph.\u00a0<\/p>\n Anna Edney:<\/strong> Bloomberg News\u2019 \u201cA Former TV Writer Found a Health-Care Loophole That Threatens To Blow Up Obamacare<\/a>,\u201d by Zachary R. Mider and Zeke Faux.\u00a0<\/p>\n Sandhya Raman:<\/strong> The Louisiana Illuminator\u2019s \u201cIn the Deep South, Health Care Fights Echo Civil Rights Battles<\/a>,\u201d by Anna Claire Vollers.\u00a0<\/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: Cutting Medicaid Is Hard \u2014 Even for the GOP\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong> This 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> Hello and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, May 8, at 10 a.m. As 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 a videoconference by Anna Edney of Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Maya Goldman of Axios News.\u00a0<\/p>\n Maya Goldman:<\/strong> Great to be here.\u00a0<\/p>\n Rovner:<\/strong> And Sandhya Raman of CQ Roll Call.\u00a0<\/p>\n Sandhya Raman:<\/strong> Good morning, everyone.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my \u201cBill of the Month\u201d interview with my KFF Health News colleague Lauren Sausser. This month\u2019s patient got preventive care they assumed would be covered by their Affordable Care Act health plan, except it wasn\u2019t. But first, this week\u2019s news.\u00a0<\/p>\n We\u2019re going to start on Capitol Hill, where Sandhya is coming directly from, where regular listeners to this podcast will be not one bit surprised that Republicans working on President [Donald] Trump\u2019s one \u201cbig, beautiful\u201d budget reconciliation bill are at an impasse over how and how deeply to cut the Medicaid program. Originally, the House Energy and Commerce Committee was supposed to mark up its portion of the bill this week, but that turned out to be too optimistic. Now they\u2019re shooting for next week, apparently Tuesday or so, they\u2019re saying, and apparently that Memorial Day goal to finish the bill is shifting to maybe the Fourth of July? But given what\u2019s leaking out of the closed Republican meetings on this, even that might be too soon. Where are we with these Medicaid negotiations?\u00a0<\/p>\n Raman:<\/strong> I would say a lot has been happening, but also a lot has not been happening. I think that anytime we\u2019ve gotten any little progress on knowing what exactly is at the top of the list, it gets walked back. So earlier this week we had a meeting with a lot of the moderates in Speaker [Mike] Johnson\u2019s office and trying to get them on board with some of the things that they were hesitant about, and following the meeting, Speaker Johnson had said that two of the things that have been a little bit more contentious \u2014 changing the federal match for the expansion population and instituting per capita caps for states \u2014 were off the table. But the way that he phrased it is kind of interesting in that he said stay tuned and that it possibly could change.\u00a0<\/p>\n And so then yesterday when we were hearing from the Energy and Commerce Committee, it seemed like these things are still on the table. And then Speaker Johnson has kind of gone back on that and said, I said it was likely.<\/em> So every time we kind of have any sort of change, it\u2019s really unclear if these things are in the mix, outside the mix. When we pulled them off the table, we had a lot of the hard-line conservatives get really upset about this because it\u2019s not enough savings. So I think any way that you push it with such narrow margins, it\u2019s been difficult to make any progress, even though they\u2019ve been having a lot of meetings this week.\u00a0<\/p>\n Rovner:<\/strong> One of the things that surprised me was apparently the Senate Republicans are weighing in. The Senate Republicans who aren\u2019t even set to make Medicaid cuts under their version of the budget resolution are saying that the House needs to go further. Where did that come from?\u00a0<\/p>\n Raman:<\/strong> It\u2019s just been a difficult process to get anything across. I mean, in the House side, a lot of it has been, I think, election-driven. You see the people that are not willing to make as many concessions are in competitive districts. The people that want to go a little bit more extreme on what they\u2019re thinking are in much more safe districts. And then in the Senate, I think there\u2019s a lot more at play just because they have longer terms, they have more to work with. So some of the pushback has been from people that it would directly affect their states or if the governors have weighed in. But I think that there are so many things that they do want to get done, since there is much stronger agreement on some of the immigration stuff and the taxes that they want to find the savings somewhere. If they don\u2019t find it, then the whole thing is moot.\u00a0<\/p>\n Rovner:<\/strong> So meanwhile, the Congressional Budget Office at the request of Democrats is out with estimates of what some of these Medicaid options would mean for coverage, and it gives lie to some of these Republican claims that they can cut nearly a trillion dollars from Medicaid without touching benefits, right? I mean all of these \u2014 and Maya, your nodding.\u00a0<\/p>\n Goldman:<\/strong> Yeah.\u00a0<\/p>\n Rovner: <\/strong>All of these things would come with coverage losses.\u00a0<\/p>\n Goldman:<\/strong> Yeah, I think it\u2019s important to think about things like work requirements, which has gotten a lot of support from moderate Republicans. The only way that that produces savings is if people come off Medicaid as a result. Work requirements in and of themselves are not saving any money. So I know advocates are very concerned about any level of cuts. I talked to somebody from a nursing home association who said: We can\u2019t pick and choose. We\u2019re not in a position to pick and choose which are better or worse, because at this point, everything on the table is bad for us.<\/em> So I think people are definitely waiting with bated breath there.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I\u2019ve heard a lot of Republicans over the last week or so with the talking points. If we\u2019re just going after fraud and abuse then we\u2019re not going to cut anybody\u2019s benefits.<\/em> And it\u2019s like \u2014 um, good luck with that.\u00a0<\/p>\n Goldman:<\/strong> And President Trump has said that as well.\u00a0<\/p>\n Rovner:<\/strong> That\u2019s right. Well, one place Congress could recoup a lot of money from Medicaid is by cracking down on provider taxes<\/a>, which 49 of the 50 states use to plump up their federal Medicaid match, if you will. Basically the state levies a tax on hospitals or nursing homes or some other group of providers, claims that money as their state share to draw down additional federal matching Medicaid funds, then returns it to the providers in the form of increased reimbursement while pocketing the difference. You can call it money laundering as some do, or creative financing as others do, or just another way to provide health care to low-income people.\u00a0<\/p>\n But one thing it definitely is, at least right now, is legal. Congress has occasionally tried to crack down on it since the late 1980s. I have spent way more time covering this fight than I wish I had, but the combination of state and health provider pushback has always prevented it from being eliminated entirely. If you want a really good backgrounder, I point you to the excellent piece<\/a> in The New York Times this week by our podcast pals Margot Sanger-Katz and Sarah Kliff. What are you guys hearing about provider taxes and other forms of state contributions and their future in all of this? Is this where they\u2019re finally going to look to get a pot of money?\u00a0<\/p>\n Raman:<\/strong> It\u2019s still in the mix. The tricky thing is how narrow the margins are, and when you have certain moderates having a hard line saying, I don\u2019t want to cut more than $500 billion or $600 billion<\/em>, or something like that. And then you have others that don\u2019t want to dip below the $880 billion set for the Energy and Commerce Committee. And then there are others that have said it\u2019s not about a specific number, it\u2019s what is being cut. So I think once we have some more numbers for some of the other things, it\u2019ll provide a better idea of what else can fit in. Because right now for work requirements, we\u2019re going based on some older CBO [Congressional Budget Office] numbers. We have the CBO numbers that the Democrats asked for, but it doesn\u2019t include everything. And piecing that together is the puzzle, will illuminate some of that, if there are things that people are a little bit more on board with. But it\u2019s still kind of soon to figure out if we\u2019re not going to see draft text until early next week.\u00a0<\/p>\n Goldman:<\/strong> I think the tricky thing with provider taxes is that it\u2019s so baked into the way that Medicaid functions in each state. And I think I totally co-sign on the New York Times article. It was a really helpful explanation of all of this, and I would bet that you\u2019ll see a lot of pushback from state governments, including Republicans, on a proposal that makes severe changes to that.\u00a0<\/p>\n Rovner:<\/strong> Someday, but not today, I will tell the story of the 1991 fight over this in which there was basically a bizarre dealmaking with individual senators to keep this legal. That was a year when the Democrats were trying to get rid of it. So it\u2019s a bipartisan thing. All right, well, moving on.\u00a0<\/p>\n It wouldn\u2019t be a Thursday morning if we didn\u2019t have breaking federal health personnel news. Today was supposed to be the confirmation hearing for surgeon general nominee and Fox News contributor Janette Nesheiwat. But now her nomination has been pulled over some questions about whether she was misrepresenting her medical education credentials, and she\u2019s already been replaced with the nomination of Casey Means, the sister of top [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] aide Calley Means, who are both leaders in the MAHA [\u201cMake America Healthy Again\u201d] movement. This feels like a lot of science deniers moving in at one time. Or is it just me?\u00a0<\/p>\n Edney:<\/strong> Yeah, I think that the Meanses have been in this circle, names floated for various things at various times, and this was a place where Casey Means fit in. And certainly she espouses a lot of the views on, like, functional medicine and things that this administration, at least RFK Jr., seems to also subscribe to. But the one thing I\u2019m not as clear on her is where she stands with vaccines, because obviously Nesheiwat had fudged on her school a little bit, and\u2014\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think she did her residency at the University of Arkansas\u2014\u00a0<\/p>\n Edney:<\/strong> That\u2019s where.\u00a0<\/p>\n Rovner: <\/strong>\u2014and she implied that she\u2019d graduated from the University of Arkansas medical school when in fact she graduated from an accredited Caribbean medical school, which lots of doctors go to. It\u2019s not a sin\u2014\u00a0<\/p>\n Edney:<\/strong> Right.\u00a0<\/p>\n Rovner: <\/strong>\u2014and it\u2019s a perfectly, as I say, accredited medical school. That was basically \u2014 but she did fudge it on her resume.\u00a0<\/p>\n Edney:<\/strong> Yeah.\u00a0<\/p>\n Rovner:<\/strong> So apparently that was one of the things that got her pulled.\u00a0<\/p>\n Edney:<\/strong> Right. And the other, kind of, that we\u2019ve seen in recent days, again, is Laura Loomer coming out against her because she thinks she\u2019s not anti-vaccine enough. So what the question I think to maybe be looking into today and after is: Is Casey Means anti-vaccine enough for them? I don\u2019t know exactly the answer to that and whether she\u2019ll make it through as well.\u00a0<\/p>\n Rovner:<\/strong> Well, we also learned this week that Vinay Prasad, a controversial figure in the covid movement and even before that, has been named to head the FDA [Food and Drug Administration] Center for Biologics and Evaluation Research, making him the nation\u2019s lead vaccine regulator, among other things. Now he does have research bona fides but is a known skeptic of things like accelerated approval of new drugs, and apparently the biotech industry, less than thrilled with this pick, Anna?\u00a0<\/p>\n Edney:<\/strong> Yeah, they are quite afraid of this pick. You could see it in the stocks for a lot of vaccine companies, for some other companies particularly. He was quite vocal and quite against the covid vaccines during covid and even compared them to the Nazi regime. So we know that there could be a lot of trouble where, already, you know, FDA has said that they\u2019re going to require placebo-controlled trials for new vaccines and imply that any update to a covid vaccine makes it a new vaccine. So this just spells more trouble for getting vaccines to market and quickly to people. He also\u2014you mentioned accelerated approval. This is a way that the FDA uses to try to get promising medicines to people faster. There are issues with it, and people have written about the fact that they rely on what are called surrogate endpoints. So not Did you live longer?<\/em> but Did your tumor shrink?<\/em>\u00a0<\/p>\n And you would think that that would make you live longer, but it actually turns out a lot of times it doesn\u2019t. So you maybe went through a very strong medication and felt more terrible than you might have and didn\u2019t extend your life. So there\u2019s a lot of that discussion, and so that. There are other drugs. Like this Sarepta drug for Duchenne muscular dystrophy is a big one that Vinay Prasad has come out against, saying that should have never been approved, because it was using these kind of surrogate endpoints. So I think biotech\u2019s pretty \u2014 thinking they\u2019re going to have a lot tougher road ahead to bring stuff to market.\u00a0<\/p>\n Rovner:<\/strong> And I should point out that over the very long term, this has been the continuing struggle at FDA. It\u2019s like, do you protect the public but make people wait longer for drugs or do you get the drugs out and make sure that people who have no other treatments available have something available? And it\u2019s been a constant push and pull. It\u2019s not really been partisan. Sometimes you get one side pushing and the other side pushing back. It\u2019s really nothing new. It\u2019s just the sort of latest iteration of this.\u00a0<\/p>\n Edney:<\/strong> Right. Yeah. This is the pendulum swing, back to the Maybe we need to be slowing it down<\/em> side. It\u2019s also interesting because there are other discussions from RFK Jr. that, like, We need to be speeding up approvals<\/em> and Trump wants to speed up approvals<\/em>. So I don\u2019t know where any of this will actually come down when the rubber meets the road, I guess.\u00a0<\/p>\n Rovner:<\/strong> Sandhya and Maya, I see you both nodding. Do you want to add something?\u00a0<\/p>\n Raman:<\/strong> I think this was kind of a theme that I also heard this week in the \u2014 we had the Senate Finance hearing for some of the HHS [Department of Health and Human Services] nominees, and Jim O\u2019Neill, who\u2019s one of the nominees, that was something that was brought up by Finance ranking member Ron Wyden, that some of his past remarks when he was originally considered to be on the short list for FDA commissioner last Trump administration is that he basically said as long as it\u2019s safe, it should go ahead regardless of efficacy. So those comments were kind of brought back again, and he\u2019s in another hearing now, so that might come up as an issue in HELP [the Senate Committee on Health, Education, Labor and Pensions] today.\u00a0<\/p>\n Rovner:<\/strong> And he\u2019s the nominee for deputy secretary, right? Have to make sure I keep all these things straight. Maya, you wanting to add something?\u00a0<\/p>\n Goldman:<\/strong> Yeah, I was just going to say, I think there is a divide between these two philosophies on pharmaceuticals, and my sense is that the selection of Prasad is kind of showing that the anti-accelerated-approval side is winning out. But I think Anna is correct that we still don\u2019t know where it\u2019s going to land.\u00a0<\/p>\n Rovner:<\/strong> Yes, and I will point out that accelerated approval first started during AIDS when there was no treatments and basically people were storming the \u2014 literally physically storming \u2014 the FDA, demanding access to AIDS drugs, which they did finally get. But that\u2019s where accelerated approval came from. This is not a new fight, and it will continue.\u00a0<\/p>\n Turning to abortion, the Trump administration surprised a lot of people this week when it continued the Biden administration\u2019s position asking for that case in Texas challenging the abortion pill to be dropped. For those who\u2019ve forgotten, this was a case originally filed by a bunch of Texas medical providers demanding the judge overrule the FDA\u2019s approval of the abortion pill mifepristone in the year 2000. The Supreme Court ruled the original plaintiff lacked standing to sue, but in the meantime, three states \u2014Missouri, Idaho, and Kansas \u2014 have taken their place as plaintiffs. But now the Trump administration points out that those states have no business suing in the Northern District of Texas, which kind of seems true on its face. But we should not mistake this to think that the Trump administration now supports the current approval status of the abortion bill. Right, Sandhya?\u00a0<\/p>\n Raman:<\/strong> Yeah, I think you\u2019re exactly right. It doesn\u2019t surprise me. If they had allowed these three states, none of which are Texas \u2014 they shouldn\u2019t have standing. And if they did allow them to, that would open a whole new can of worms for so many other cases where the other side on so many issues could cherry-pick in the same way. And so I think, I assume, that this will come up in future cases for them and they will continue with the positions they\u2019ve had before. But this was probably in their best interest not to in this specific one.\u00a0<\/p>\n Rovner:<\/strong> Yeah. There are also those who point out that this could be a way of the administration protecting itself. If it wants to roll back or reimpose restrictions on the abortion pill, it would help prevent blue states from suing to stop that. So it serves a double purpose here, right?\u00a0<\/p>\n Raman:<\/strong> Yeah. I couldn\u2019t see them doing it another way. And even if you go through the ruling, the language they use, it\u2019s very careful. It\u2019s not dipping into talking fully about abortion. It\u2019s going purely on standing. Yeah.\u00a0<\/p>\n Rovner:<\/strong> There\u2019s nothing that says, We think the abortion pill is fine the way it is<\/em>. It clearly does not say that, although they did get the headlines \u2014 and I\u2019m sure the president wanted \u2014 that makes it look like they\u2019re towing this middle ground on abortion, which they may be but not necessarily in this case.\u00a0<\/p>\n Well, before we move off of reproductive health, a shoutout here to the incredible work of ProPublica<\/a>, which was awarded the Pulitzer Prize for public service this week for its stories on women who died due to abortion bans that prevented them from getting care for their pregnancy complications. Regular listeners of the podcast will remember that we talked about these stories as they came out last year, but I will post another link to them in the show notes today.\u00a0<\/p>\n OK, moving on. There\u2019s even more drug price news this week, starting with the return of, quote, \u201cmost favored nation\u201d drug pricing. Anna, remind us what this is and why it\u2019s controversial.\u00a0<\/p>\n Edney:<\/strong> Yeah. So the idea of most favored nation, this is something President Trump has brought up before in his first administration, but it creates a basket, essentially, of different prices that nations pay. And we\u2019re going to base ours on the lowest price that is paid for\u2014\u00a0<\/p>\n Rovner:<\/strong> We\u2019re importing other countries\u2019\u2014\u00a0<\/p>\n Edney:<\/strong> \u2014prices.\u00a0<\/p>\n Rovner:<\/strong> \u2014price limits.\u00a0<\/p>\n Edney:<\/strong> Yeah. Essentially, yes. We can\u2019t import their drugs, but we can import their prices. And so the goal is to just basically piggyback off of whoever is paying the lowest price and to base ours off of that. And clearly the drug industry does not like this and, I think, has faced a number of kind of hits this week where things are looming that could really come after them. So Politico broke that news<\/a> that Trump is going to sign or expected to sign an executive order that will direct his agencies to look into this most-favored-nation effort. And it feels very much like 2.0, like we were here before. And it didn\u2019t exactly work out, obviously.\u00a0<\/p>\n Rovner:<\/strong> They sued, didn\u2019t they? The drug industry sued, as I recall.\u00a0<\/p>\n Edney:<\/strong> Yeah, I think you\u2019re right. Yes.\u00a0<\/p>\n Goldman:<\/strong> If I\u2019m remembering\u2014\u00a0<\/p>\n Rovner:<\/strong> But I think they won.\u00a0<\/p>\n Goldman:<\/strong> If I\u2019m remembering correctly, it was an Administrative Procedure Act lawsuit though, right? So\u2014\u00a0<\/p>\n Rovner:<\/strong> It was. Yes. It was about a regulation. Yes.\u00a0<\/p>\n Goldman:<\/strong> \u2014who knows what would happen if they go through a different procedure this time.\u00a0<\/p>\n Rovner:<\/strong> So the other thing, obviously, that the drug industry is freaked out about right now are tariffs, which have been on again, off again, on again, off again. Where are we with tariffs on \u2014 and it\u2019s not just tariffs on drugs being imported. It\u2019s tariffs on drug ingredients being imported, right?\u00a0<\/p>\n Edney:<\/strong> Yeah. And that\u2019s a particularly rough one because many ingredients are imported, and then some of the drugs are then finished here, just like a car. All the pieces are brought in and then put together in one place. And so this is something the Trump administration has began the process of investigating. And PhRMA [Pharmaceutical Research and Manufacturers of America], the trade group for the drug industry, has come out officially, as you would expect, against the tariffs, saying that: This will reduce our ability to do R&D. It will raise the price of drugs that Americans pay, because we\u2019re just going to pass this on to everyone.<\/em> And so we\u2019re still in this waiting zone of seeing when or exactly how much and all of that for the tariffs for pharma.\u00a0<\/p>\n
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