\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\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 As had been rumored for weeks, Health and Human Services Secretary Robert F. Kennedy Jr. unveiled a plan to reorganize the department. It involves the downsizing of its workforce, which formerly was roughly 80,000 people, by a quarter and consolidating dozens of agencies that were created and authorized by Congress.<\/p>\n Meanwhile, in just the past week, HHS abruptly cut off billions in funding to state and local public health departments, and canceled all research studies into covid-19, as well as diseases that could develop into the next pandemic.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Maya Goldman of Axios News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tMaya Goldman \t\t\t \t\t\t \t\t\t \tJoanne Kenen \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF senior vice president Larry Levitt about the 15th anniversary of the signing of the Affordable Care Act and the threats the health law continues to face.<\/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> CNN\u2019s \u201cState Lawmakers Are Looking To Ban Non-Existent \u2018Chemtrails.\u2019 It Could Have Real-Life Side Effects<\/a>,\u201d by Ramishah Maruf and Brandon Miller.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> The New York Times Wirecutter\u2019s \u201c23andMe Just Filed for Bankruptcy. You Should Delete Your Data Now<\/a>,\u201d by Max Eddy.\u00a0<\/p>\n Maya Goldman:<\/strong> KFF Health News\u2019 \u201c\u2018I Am Going Through Hell\u2019: Job Loss, Mental Health, and the Fate of Federal Workers<\/a>,\u201d by Rachana Pradhan and Aneri Pattani.\u00a0<\/p>\n Joanne Kenen:<\/strong> The Atlantic\u2019s \u201cAmerica Is Done Pretending About Meat<\/a>,\u201d by\u00a0Yasmin Tayag.\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: The Ax Falls at HHS<\/strong>\t\t\t\t<\/p>\n [<\/em>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, March 27, at 10 a.m. As always, news happens fast \u2014 really fast this week \u2014 and things might well have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.\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 Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.\u00a0<\/p>\n Joanne Kenen:<\/strong> Hi everybody.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my interview with KFF Senior Vice President Larry Levitt, who will riff on the 15th anniversary of the signing of the Affordable Care Act and what its immediate future might hold. But first, this week\u2019s news.\u00a0<\/p>\n So for this second week in a row, we have news breaking literally as we sit down to tape, this time in the form of an announcement from the Department of Health and Human Services with the headline \u201cHHS Announces Transformation to Make America Healthy Again.\u201d The plan calls for 10,000 full-time employees to lose their jobs at HHS, and when combined with early retirement and other reductions, it will reduce the department\u2019s workforce by roughly 25%, from about 82,000 to about 62,000. It calls for creation of a new \u201cAdministration for a Healthy America\u201d that will combine a number of existing HHS agencies, including the Health Resources and Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health under one umbrella.\u00a0<\/p>\n Reading through the announcement, a lot of it actually seems to make some sense, as many HHS programs do overlap. But the big overriding question is: Can they really do this? Isn\u2019t this kind of reorganization Congress\u2019 job?\u00a0<\/p>\n Ollstein:<\/strong> Congress has not stood up for itself in its power-of-the-purse role so far in the Trump administration. They have stood by, largely, the Republican majorities in the House and Senate, or they\u2019ve offered sort of mild concerns. But they have not said, Hey guys, this is our job,<\/em> all of these cuts that are happening.<\/em> There\u2019s talk of a legislative package that would codify the DOGE [Department of Government Efficiency] cuts that are already happening, rubber-stamping it after the fact. But Congress has not made moves to claw back its authority in terms of saying, Hey, we approved this funding, and you can\u2019t just go back and take it.<\/em> There\u2019s lawsuits to that effect, but not from the members \u2014 from outside groups, from labor unions, from impacted folks, but not our dear legislative branch.\u00a0<\/p>\n Rovner:<\/strong> You know, Joanne, you were there for a lot of this. We covered the creation of a lot of these agencies. Agency for Healthcare Research and Quality, I covered the creation of its predecessor agency, which there were huge compromises that went into this, lots of policymaking. It just seems that RFK [Robert F. Kennedy] Jr. going to say: We don\u2019t actually care all these things you did. We\u2019re just going to redo the whole thing.<\/em>\u00a0<\/p>\n Kenen:<\/strong> As many of the listeners know, many laws that Congress passes have to be reauthorized every five years or every 10 years. Five is the most typical, and they often don\u2019t get around to it and they extend and blah, blah, blah, blah, blah. But basically the idea is that things do change and things do need to be reevaluated. So, normally when you do reauthorization \u2014 we all just got this press release announcing all these mergers of departments and so forth at HHS. None of us are experts in procurement and IT. Maybe those two departments do need to be merged. I mean, I don\u2019t know. That\u2019s the kind of thing that, reauthorization, Congress looks at and Congress thinks about. Well, and agencies and legislation do get updated. Maybe the NIH [National Institutes of Health] doesn\u2019t need 28 institutes and they should have 15 or whatever. But it\u2019s just sort of this, somebody coming in and waving a magic DOGE wand, and Congress is not involved. And there\u2019s not as much public input and expert input as you\u2019d have because Congress holds hearings and listens to people who do have expertise.\u00a0<\/p>\n So it\u2019s not just Congress not exercising power to make decisions. It\u2019s also Congress not deliberating and learning. I mean all of us learned health policy partly by listening to experts at congressional panels. We listen to people at Finance, and Energy and Commerce, and so forth. So it\u2019s not just Congress\u2019 voice being silenced. It\u2019s this whole review and fact-based \u2014 and experts don\u2019t always agree and Congress makes the final call. But that\u2019s just been short-circuited. And I mean we all know there\u2019s duplication in government, but this isn\u2019t the process we have historically used to address it.\u00a0<\/p>\n Rovner:<\/strong> You know, one other thing, I think they\u2019re merging agencies that are in different locations, which on the one hand might make sense. But if you have one central IT or one central procurement agency in Washington or around Washington, you\u2019ve got a lot of these organizations that are outside of Washington. And they\u2019re outside of Washington because members of Congress put them there. A lot of them are in particular places because they were parochial decisions made by Congress. That may or may not make sense, but that\u2019s where they are. It might or might not make sense. Maya, sorry I interrupted you.\u00a0<\/p>\n Goldman:<\/strong> No, I was just going to add to Joanne\u2019s point. Julie, I think before we started recording you mentioned that the administration is saying: We\u2019ve thought this all out. These are well-researched decisions.<\/em> But they\u2019ve been in office for two months. How much research can you really do in that time and how intentional can those decisions really be in that time frame?\u00a0<\/p>\n Ollstein:<\/strong> Especially because all of the leaders aren\u2019t even in place yet. Some people were just confirmed, which we\u2019re going to talk about. Some people are on their way to confirmation but not there yet. They haven\u2019t had the chance to talk to career staff, figure out what the redundancies are, figure out what work is currently happening that would be disrupted by various closures and mergers and stuff. So Maya\u2019s exactly right on that.\u00a0<\/p>\n Goldman:<\/strong> You know there\u2019s \u2014 the administration chose a lead for HRSA and other offices. And so what happens to those positions now? Do they just get demoted effectively because they\u2019re no longer heads of offices? I would be pretty\u2014\u00a0<\/p>\n Rovner:<\/strong> But we have a secretary of education whose job is to close the department down, so\u2014.\u00a0<\/p>\n Goldman:<\/strong> Good point.\u00a0<\/p>\n Rovner:<\/strong> That\u2019s apparently not unprecedented in this administration. Well, as Alice was saying, into this maelstrom of change comes those that President [Donald] Trump has selected to lead these key federal health agencies. The Senate Tuesday night confirmed policy researcher Jay Bhattacharya to head the NIH and Johns Hopkins surgeon and policy analyst Marty Makary to head the Food and Drug Administration. Bhattacharya was approved on a straight party-line vote, while Makary, who I think it\u2019s fair to say was probably the least controversial of the top HHS nominees, won the votes of three Democrats: Minority Whip Dick Durbin of Illinois and New Hampshire\u2019s Democrats, [Sens.] Maggie Hassan and Jeanne Shaheen, along with all of the Republicans. What are any of you watching as these two people take up their new positions?\u00a0<\/p>\n Kenen:<\/strong> Well, I mean, the NIH, Bhattacharya \u2014 who I hope I\u2019ve learned to pronounce correctly and I apologize if I have not yet mastered it \u2014 he\u2019s really always talked about major reorganization, reprioritization. And as I said, maybe it\u2019s time to look at some overlap, and science has changed so much in the last decade or so. I mean are the 28 \u2014 I think the number\u2019s 28 \u2014 are the 28 current institutes the right\u2014\u00a0<\/p>\n Rovner:<\/strong> I think it\u2019s 27.\u00a0<\/p>\n Kenen:<\/strong> Twenty-seven. I mean, are there some things that need to be merged or need to be reorganized? Probably. You could make a case for that. But that\u2019s just one thing. The amount of cuts that the administration announced before he got there, and there is a question in some things he\u2019s hinted at, is he going to go for that? His background is in academia, and he does have some understanding of what this money is used for. We\u2019ve talked before, when you talk to a layperson, when you hear the word \u201coverhead,\u201d \u201cindirect costs,\u201d what that conjures up to people as waste, when in fact it\u2019s like paying for the electricity, paying for the staff to comply with the government regulations about ethical research on human beings. It\u2019s not parties. It\u2019s security. It\u2019s cleaning the animal cages. It\u2019s all this stuff. So is he going to cut as deeply as universities have been told to expect? We don\u2019t know yet. And that\u2019s something that every research institution in America is looking at.\u00a0<\/p>\n The FDA, he\u2019s a contrarian on certain things but not across the board. I mean, as you just said, Julie, he\u2019s a little less controversial than the others. He is a pancreatic surgeon. He does have a record as a physician. He has never been a regulator, and we don\u2019t know exactly where his contrarian views will be unconventional and where \u2014 there\u2019s a lot of agreement with certain things Secretary Kennedy wants to do, not everything. But there is some broad agreement on, some of his food issues do make sense. And the FDA will have a role in that.\u00a0<\/p>\n Rovner:<\/strong> I will say that under this reorganization plan the FDA is going to lose 3,500 people, which is a big chunk of its workforce.\u00a0<\/p>\n Kenen:<\/strong> Well things like moving SAMHSA [the Substance Abuse and Mental Health Services Administration], which is the agency that works on drug abuse within and drug addiction within HHS, that\u2019s being folded into something else. And that\u2019s been a national priority. The money was voted to help with addiction on a bipartisan basis several times in recent years. The grants to states, that\u2019s all being cut back. The subagency with HHS is being folded into something else. And we don\u2019t know. We know 20,000 jobs are being cut. The 10 announced today and the 10 we already knew about. We don\u2019t know where they\u2019re all coming from and what happens to the expertise and experience addressing something like the addiction crisis and the drug abuse crisis in America, which is not partisan.\u00a0<\/p>\n Rovner:<\/strong> All right. Well we\u2019ll get to the cuts in a second. Also on Tuesday, the Senate Finance Committee voted, also along party lines, to advance to the Senate floor the nomination of Dr. Mehmet Oz to head the Centers for Medicare & Medicaid Services. And while he would seem likely to get confirmed by the full Senate, I did not have on my bingo card Dr. Oz\u2019s nomination being more in doubt due to Republicans than Democrats. Did anybody else?\u00a0<\/p>\n Ollstein:<\/strong> Based on our reporting, it\u2019s not really in doubt. [Sen.] Josh Hawley has raised concerns about Dr. Oz being too squishy on abortion and trans health care, but it does not seem that other Republicans are really jumping on board with that crusade. It sort of reminds me of concerns that were raised about RFK Jr.\u2019s background on abortion that pretty much just fizzled and Republicans overwhelmingly fell in line. And that seems to be what\u2019s going to happen now. Although you never know.\u00a0<\/p>\n Rovner:<\/strong> At least it hasn\u2019t been, as you point out, it hasn\u2019t failed anybody else. Well, the one nominee who did not make it through HHS was former Congressman Dave Weldon to head the CDC [Centers for Disease Control and Prevention]. So now we have a new nominee. It\u2019s actually the acting director, Susan Monarez, who by the way has a long history in federal health programs but no history at the CDC. Who can tell us anything about her?\u00a0<\/p>\n Goldman:<\/strong> She seems like a very interesting and in some ways unconventional pick, especially for this administration. She was a career civil servant, and she worked under the Obama administration. And it\u2019s interesting to see them be OK with that, I think. And she also has a lot of health care background but not in CDC. She\u2019s done a lot of work on AI in health care and disaster preparedness, I think. And clearly she\u2019s been leading the CDC for the last couple months. So she knows to that extent. But it will be very interesting when she gets around to confirmation hearings to hear what her priorities are, because we really have no idea.\u00a0<\/p>\n Rovner:<\/strong> Yeah, she\u2019s not one of those good-on-Fox News people that we\u2019ve seen so many of in this administration. So while Monarez\u2019s nomination seems fairly noncontroversial, at least so far, the nominee to be the new HHS inspector general is definitely not. Remember that President Trump fired HHS IG Christi Grimm just days after he took office, along with the IGs of several other departments. Grimm is still suing to get her job back, since that firing violated the terms of the 1978 Inspector General Act. But now the administration wants to replace her with Thomas Bell, who\u2019s had a number of partisan Republican jobs for what\u2019s traditionally been a very nonpartisan position and who was fired by the state of Virginia in 1997 for apparently mishandling state taxpayer funds. That feels like it might raise some eyebrows as somebody who\u2019s supposed to be in charge of waste, fraud, and abuse. Or am I being naive?\u00a0<\/p>\n Goldman:<\/strong> My eyebrows were definitely raised when I saw that news. I, to be honest, don\u2019t know very much about him but will be very interested to see how things go, especially given that fraud, waste, and abuse and rooting out fraud, waste, and abuse are high priorities for this administration, but also things that are very up to interpretation in a certain way.\u00a0<\/p>\n Ollstein:<\/strong> Yes, although it\u2019s clearly been very mixed on that front because the administration is also dismantling entire agencies that go after fraud and abuse\u2014\u00a0<\/p>\n Goldman:<\/strong> Exactly.\u00a0<\/p>\n Ollstein:<\/strong> \u2014like the Consumer Financial Protection Bureau. So there is some mixed messaging on that front for sure.\u00a0<\/p>\n Rovner:<\/strong> Well, as Joanne mentioned, the DOGE cuts continue at the NIH. In just the last week, billions of dollars in grants have been terminated that were being used to study AIDS and HIV, covid and other potential pandemic viruses, and climate change, among other things. The NIH also closed its office studying long covid. Thank you, Alice, for writing that story<\/a>. This is, I repeat, not normal. NIH only generally cancels grants that have been peer reviewed and approved for reasons of fraud or scientific misconduct, yet one termination letter obtained by Science Magazine<\/a> simply stated, quote, \u201cThe end of the pandemic provides cause to terminate COVID-related grant funds.\u201d Why aren\u2019t we hearing more about this, particularly for members of Congress whose universities are the ones that are being cut?\u00a0<\/p>\n Kenen:<\/strong> I mean, the one Republican we heard at the very beginning was [Sen.] Katie Britt because the University of Alabama is a big, excellent, and well-respected national medical and science center, and they were targeted for a lot of cuts. She\u2019s the only Republican, really, and she got quiet. I mean, she raised her voice very loud and clear. We may go into a situation \u2014 and everybody sort of knows this is how Washington sometimes works \u2014 where individual universities will end up negotiating with NIH over their funds and that\u2014\u00a0<\/p>\n Rovner:<\/strong> Columbia. Cough, cough.\u00a0<\/p>\n Kenen:<\/strong> Right. And Alabama may come out great and Columbia might not, or many other leading research institutions. But these job cuts affect people in every congressional district across the country. And the funding cuts affect every congressional district across the country. So it\u2019s not just their constitutional responsibilities. It\u2019s also, like, their constituents are affected, and we\u2019re not hearing it.\u00a0<\/p>\n Rovner:<\/strong> And as I point out for the millionth time, it\u2019s not a coincidence that these things are located in every congressional district. Members of Congress, if not the ones who are currently in office then their predecessors, lobbied and worked to get these funds to their states and to their district. And yet the silence is deafening.\u00a0<\/p>\n Ollstein:<\/strong> To state the obvious, one, covid is not over. People are still contracting it. People are still dying from it. But not only that, a lot of this research was about preparing for the inevitable next pandemic that we know is coming at some point and to not be caught as unawares as we were this past time, to be more prepared, to have better tools so that there don\u2019t have to be widespread lockdowns, things can remain open because we have more effective prevention and treatment efforts. And that\u2019s what\u2019s being defunded here.\u00a0<\/p>\n Kenen:<\/strong> The other thing is that long covid is in fact a chronic disease and even though it\u2019s caused by an infectious disease, a virus. But people have long covid but it is a chronic disease, and HHS says that\u2019s their priority, chronic disease, but they\u2019re not including long covid. And there\u2019s also more and more. When we think of long covid, we think of brain fog and being short of breath and tired and unable to function. There\u2019s increasing evidence or conversation in the medical world about other problems people have long-term that probably stem from covid infections or multiple covid infections. So this is affecting millions of Americans as a chronic disease that is not well understood, and we\u2019ve just basically said, That one doesn\u2019t count,<\/em> or: We\u2019re not going to pay attention to that one. We\u2019re going to, you know, we\u2019re looking at diabetes.<\/em> Yeah, we need to look at diabetes. That\u2019s one of the things that Kennedy has bipartisan support. This country does not eat well. I wrote about this<\/a> about a week ago. But what he can and can\u2019t do, because he can\u2019t wave a magic wand and have us all eating well. But it\u2019s very selective in how we\u2019re defining both the causes of diseases and what diseases we\u2019re prioritizing. We basically just shrunk addiction.\u00a0<\/p>\n Goldman:<\/strong> In the press release announcing the reorganization this morning, there was a line talking about how the HHS is going to create this new Administration for a Healthy America to investigate chronic disease and to make sure that we have, I think it was, wholesome food, clean water, and no environmental toxins, in order to prevent chronic disease. And those are the only three things that it mentions that lead to chronic disease.\u00a0<\/p>\n Rovner:<\/strong> And none of which are under HHS\u2019 purview.\u00a0<\/p>\n Goldman:<\/strong> Right, right. Yeah.\u00a0<\/p>\n Rovner:<\/strong> With the exception of\u2014\u00a0<\/p>\n Goldman:<\/strong> There are things that HHS does in that space. But yeah, we\u2019re being very selective about what constitutes a chronic disease and what causes a chronic disease. If you\u2019re trying to actually solve a problem, maybe you should be more expansive.\u00a0<\/p>\n Kenen:<\/strong> So HHS has some authority over food, not significant authority of it, but it is shared with the USDA [U.S. Department of Agriculture]. Like school lunches are USDA, the nutritional guidelines are shared between USDA and HHS, things like that. So yeah, it has some control about, over food but not entirely control over food.\u00a0<\/p>\n And then EPA [Environmental Protection Agency], which has also been completely reoriented to be a pro-fossil-fuel agency, is in charge of clean water and the environmental contaminants. That\u2019s not an HHS bailiwick. And Kennedy is not aligned with other elements of the administration on environmental issues. And also genetics, right? Genetics is also, you know, who knows? That\u2019s NIH? But who knows what\u2019s going to happen to the National Cancer Institute and other genetic research at NIH? We don\u2019t know.\u00a0<\/p>\n Rovner:<\/strong> Yes. Clearly much to be determined. Well, speaking of members of Congress whose states and districts are losing federal funds, federal aid is also being cut by the CDC. In a story first reported by NBC News<\/a>, CDC is reportedly clawing back more than $11 billion in covid-related grants. Among other things, that\u2019s impacting funding that was being used in Texas to fight the ongoing measles outbreak. How exactly does clawing back this money from state and local public health agencies make America healthy again?\u00a0<\/p>\n Goldman:<\/strong> That\u2019s a great question, and I\u2019m curious to see how it plays out. I don\u2019t have the answer.\u00a0<\/p>\n Rovner:<\/strong> And it\u2019s not just domestic spending. The fate of PEPFAR [the President\u2019s Emergency Plan for AIDS Relief], the international AIDS\/HIV program that\u2019s credited with saving more than 20 million lives, remains in question. And The New York Times<\/a> has gotten hold of a spreadsheet including more global health cuts, including those for projects to fight malaria and to pull the U.S. out of Gavi. That\u2019s the global vaccine alliance that\u2019s helped vaccinate more than 1.1 billion children in 78 countries. Wasn\u2019t there a court order stopping all of these cuts?\u00a0<\/p>\n Ollstein:<\/strong> So there was for some USAID [U.S. Agency for International Development] work, but not all of these things fall under that umbrella. And that is still an ongoing saga that has flipped back and forth depending on various rulings. But I think it\u2019s worth pointing out, as always, that infectious diseases don\u2019t respect international borders, and any pullback on efforts to fight various things abroad inevitably will impact Americans as well.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I mean, we\u2019ve seen these measles cases obviously in Texas, but now we\u2019re getting measles cases in other parts of the country, and many of them are people coming from other countries. We had somebody come through Washington, D.C.\u2019s Union Station with measles, and we\u2019ve had all of these alerts. I mean, this is what happens when you don\u2019t try and work with infectious diseases where they are, then they spread. That\u2019s kind of the nature of infectious disease.\u00a0<\/p>\n Well, at the same time, HHS Secretary RFK Jr. is putting his Make America Healthy Again agenda into practice in smaller ways as well. First up, remember that study that Kennedy promised again to look into any links between childhood vaccines and autism? It will reportedly be led by a vaccine skeptic who was disciplined by the Maryland Board of Physicians for practicing medicine without a license and who has pushed the repeatedly debunked assertion that autism can be caused by the preservative thimerosal, which used to be used in childhood vaccines but has long since been discontinued. One autism group referred to the person who\u2019s going to be running this study as, quote, \u201ca known conspiracy theorist and quack.\u201d Sen. [Bill] Cassidy seemed to promise us that this wasn\u2019t going to happen.\u00a0<\/p>\n Kenen:<\/strong> Well, we think that Sen. Cassidy was promised it wouldn\u2019t happen, and it\u2019s all happening. And in fact, when a recent hearing, he was very outspoken that there\u2019s no need to research the autism link, because it\u2019s been researched over and over and over and over and over again and there\u2019s a lot of reputable scientific evidence establishing that vaccination does not cause autism. We don\u2019t know what causes autism, so\u2014\u00a0<\/p>\n Rovner:<\/strong> But we know it\u2019s not thimerosal.\u00a0<\/p>\n Kenen:<\/strong> Right, which has been removed from many vaccines, in fact, and autism rates went up. So Cassidy has not come out and said, Yeah, I\u2019m the guy who pulled the plug on Weldon.<\/em> But it\u2019s sort of obvious that he had, at least was, a role in. It is widely understood in Washington that he and a few other Republicans, [Sens. Lisa] Murkowski and [Susan] Collins, I believe \u2014 I think Murkowski said it in public \u2014 said that the CDC could not go down that route.\u00a0<\/p>\n Rovner:<\/strong> Well, I would like to be inadvertently invited to the Signal chat between Secretary Kennedy and Sen. Cassidy. I would very much wish to see that conversation.\u00a0<\/p>\n Meanwhile, in Texas, where HHS just confiscated public health funding, as we said, a hospital in Lubbock says it\u2019s now treating children with liver damage from too much vitamin A, which Secretary Kennedy recommended as a way to prevent and or treat measles. Which it doesn\u2019t, by the way. But that points to, that some of these \u2014 I hesitate of how to describe these people who are \u201cmaking America healthy again.\u201d But some of the things that they point to can be actively dangerous, not just not helpful.\u00a0<\/p>\n Goldman:<\/strong> Yeah. And I think it also shows how much messaging from the top matters, right? People are listening to what Secretary Kennedy says, which makes sense because he\u2019s the secretary of health and human services. But if he\u2019s pedaling misinformation or disinformation, that can have real harmful effects on people.\u00a0<\/p>\n Kenen:<\/strong> And his messages are being amplified even if some people are not, their parents, who aren\u2019t maybe directly tuned in to what Kennedy personally is saying, but they follow various influencers on health who are then echoing what Kennedy\u2019s saying about vitamin A. Yeah, we all need vitamin A in our diet. It\u2019s something, part of healthy nutrition. But this supplement\u2019s unnecessary, or excess supplements, vitamin A or cod liver oil or other things that can make them sick, including liver damage. And that\u2019s what we\u2019re seeing now. Vitamin A does have a place in measles under very specific circumstances, under medical supervision in individual cases. But no, people should not be going to the drugstore and pouring huge numbers of tablets of vitamin C down their children\u2019s throat. It\u2019s dangerous.\u00a0<\/p>\n Rovner:<\/strong> And actually the head of communications at the CDC not only quit his job this week but wrote a rather impassioned op-ed in The Washington Post<\/a>, which I will post in our show notes, talking about he feels like he cannot work for an agency that is not giving advice that is based in science and that that\u2019s what he feels right now. Again, that\u2019s before we get a new head of the CDC. Well, MAHA is apparently spreading to the states as well. West Virginia Republican Gov. Patrick Morrisey this week signed a bill to ban most artificial food coloring<\/a> and two preservatives in all foods sold in the state starting in 2028. Nearly half the rest of the states are considering similar types of bans. But unless most of those other states follow, companies aren\u2019t going to remake their products just for West Virginia, right?\u00a0<\/p>\n Kenen:<\/strong> West Virginia is not big enough, but they sometimes do remake their products for California, which is big. The whole food additive issue is, traditionally the food manufacturers have had a lot of control over deciding what\u2019s safe. It\u2019s the industry that has decided. Kennedy has some support across the board and saying that\u2019s too loose and we should look at some of these additives that have not been examined. There are others, including some preservatives, that have been studied and that are safe. Some preservatives have not been studied and should be studied. There are others that have been studied and are safe and they keep food from going rotten or they can prevent foodborne disease outbreaks. Something that does make our food healthy, we probably want to keep them in there. So, and are there some that\u2014\u00a0<\/p>\n Rovner:<\/strong> I think people get mixed up between the dyes and the preservatives. Dyes are just to make things look more attractive. The preservatives were put there for a reason.\u00a0<\/p>\n Kenen:<\/strong> Right. And there\u2019s some healthy ways of making dyes, too, if you need your food to be red. There\u2019s berry abstracts instead of chemical extracts. So things get overly simplified in a way that does not end up necessarily promoting health across the board.\u00a0<\/p>\n Rovner:<\/strong> Well, not all of the news is coming from the Trump administration. The Supreme Court next week will hear a case out of South Carolina about whether Medicaid recipients can sue to enforce their right to get care from any qualified health care providers. But this is really another case about Planned Parenthood, right, Alice?\u00a0<\/p>\n Ollstein:<\/strong> Yep. If South Carolina gets the green light to kick Planned Parenthood out of its Medicaid program, which is really what is at the heart of this case, even though it\u2019s sort of about whether beneficiaries can sue if their rights are denied. A right isn\u2019t a right if you can\u2019t enforce it, so it\u2019s expected that a ruling in that direction would cause a stampede of other conservative states to do the same, to exclude Planned Parenthood from their Medicaid programs. Many have tried already, and that\u2019s gone around and around in the courts for a while, and so this is really the big showdown at the high court to really decide this.\u00a0<\/p>\n And as I\u2019ve been writing about, this is just one of many prongs of the right\u2019s bigger strategy to defund Planned Parenthood. So there are efforts at the federal level. There are efforts at the state level. There are efforts in the courts. They are pushing executive actions on that front. We can talk. There was some news on Title X this week.\u00a0<\/p>\n Rovner:<\/strong> That was my next question. Go ahead.\u00a0<\/p>\n Ollstein:<\/strong> Some potential news.\u00a0<\/p>\n Rovner:<\/strong> What\u2019s happening with Title X?\u00a0<\/p>\n Ollstein:<\/strong> Yeah. So HHS told us when we inquired that nothing\u2019s final yet, but they\u2019re reviewing tens of millions of Title X federal family planning grants that currently go to some Planned Parenthood affiliates to provide subsidized contraception, STI [sexually transmitted infection] screenings, various non-abortion services. And so they are reviewing those grants now. They are supposed to be going out next week, so we\u2019ll have to see what happens there. There was some sort of back-and-forth in the reporting about whether they\u2019re going to be cut or not.\u00a0<\/p>\n Rovner:<\/strong> What surprises me about the Title X grant, and there has been, there have been efforts, as you point out, going back to the 1980s to kick Planned Parenthood out of the Title X program. That\u2019s separate from kicking Planned Parenthood out of Medicaid, which is where Planned Parenthood gets a lot more money.\u00a0<\/p>\n But the first Trump administration did kick Planned Parenthood out of Title X, and they went through the regulatory process to do it. And then the Biden administration went through the regulatory process to rescind the Trump administration regulations that kicked them out. Now it looks like the Trump administration thinks that it can just stop it without going through the regulatory process, right?\u00a0<\/p>\n Ollstein:<\/strong> That\u2019s right. So not only are they going around Congress, which approves Title X funding every year, they are also going around their own rulemaking and just going for it. Although, again, it has not been finally announced whether or not there will be cuts. They\u2019re just reviewing these grants.\u00a0<\/p>\n Rovner:<\/strong> But I repeat for those in the back, this is not normal. It\u2019s not how these things are supposed to work it.\u00a0<\/p>\n Kenen:<\/strong> It\u2019s normal now, Julie.\u00a0<\/p>\n Rovner:<\/strong> Yeah, clearly it\u2019s becoming normal. Well, finally this week, another case of a woman arrested for a poor pregnancy outcome. This happened in Georgia where the woman suffered a natural miscarriage, not an abortion, which was confirmed by the medical examiner, but has been arrested on charges of improperly disposing of the fetal remains. Alice, this is turning into a trend, right?\u00a0<\/p>\n Ollstein:<\/strong> Yes. And it\u2019s important for people to remember that this was happening before Dobbs.<\/em> This was happening when Roe v. Wade<\/em> was still in place. This has happened since then in states where abortion is legal. Some prosecutors are finding other ways to charge people. Whether it\u2019s related to, yeah, the disposal of the fetus, whether it\u2019s related to substance abuse, substance use during pregnancy, even sometimes the use of substances that are actually legal, but people have been charged, arrested for using them during pregnancy. So yes, it\u2019s important to remember that even if there\u2019s not a quote-unquote \u201cabortion ban\u201d on the books, there are still efforts underway in many places to criminalize pregnancy loss however it happens, naturally or via some abortifacient method.\u00a0<\/p>\n Rovner:<\/strong> Well, something else we\u2019ll be keeping an eye on. All right, that\u2019s as much news as we have time for this week. Now, we will play my interview with KFF\u2019s Larry Levitt. Then we\u2019ll come back and do our extra credits.\u00a0<\/p>\n So, last Sunday was the 15th anniversary of President Barack Obama\u2019s signing of the original Affordable Care Act. And before you ask, yes, I was there in the White House East Room that day. Anyway, to discuss what the law has meant to the U.S. health system over the last decade and a half and what its future might be, I am so pleased to welcome back to the podcast my KFF colleague Larry Levitt, executive vice president for health policy.\u00a0<\/p>\n Larry, thanks for joining us again.\u00a0<\/p>\n Larry Levitt:<\/strong> Oh, thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So, [then-House Speaker] Nancy Pelosi was mercilessly derided when she said that once the American people learned exactly what was in the ACA, they would come to like it. But that\u2019s exactly what\u2019s happened, right?\u00a0<\/p>\n Levitt:<\/strong> It is. Yes. I think people took her comments so out of context, but the ACA was incredibly controversial and divisive when it was being debated. Frankly, after a pass, the ACA became pretty unpopular. If you go back to 2014, just before the main provisions of the ACA were being implemented, there was all this controversy over the individual mandate, over people\u2019s plans being canceled because they didn\u2019t comply with the ACA\u2019s rules. And then, of course, healthcare.gov, the website, didn\u2019t work. So the ACA was very underwater in public opinion. And even after it first went into effect and people started getting coverage, that didn\u2019t necessarily turn around immediately, there was still a lot of divisiveness over the law.\u00a0<\/p>\n What changed is, No. 1, over time, more and more people got covered, people with preexisting conditions, people who couldn\u2019t afford health insurance, people who turned 26 or could stay on their parents\u2019 plans until 26 and then could enroll in the ACA or Medicaid after turning 26. All these people got coverage and started to see the benefits of the law. The other thing that happened was in 2017, Republicans tried unsuccessfully to repeal and replace the ACA, and people really realized what they could be missing if the law went away.\u00a0<\/p>\n Rovner:<\/strong> So what\u2019s turned out to be the biggest change to the health care system as a result of the ACA? And is it what you originally thought it would be?\u00a0<\/p>\n Levitt:<\/strong> Well, yeah, in this case it was not a surprise, I think. The biggest change was the number of people getting covered and a big decrease in the number of people uninsured. We have been at the lowest rate of uninsurance ever recently due to the ACA and some of the enhancements, which we\u2019ll probably talk about. And that was what the law was intended to do, was to get more people covered. And I think you\u2019d have to call that a success, in retrospect.\u00a0<\/p>\n Rovner:<\/strong> I will say I was surprised by how much Medicaid dominated the increased coverage. I know now it\u2019s sort of balanced out because of reductions in premiums for private coverage, I think in large part. But I think during the 2017 fight to undo the ACA, that was the first time since I\u2019ve been covering Medicaid that I think people really realized how big and how important Medicaid is to the health care system.\u00a0<\/p>\n Levitt:<\/strong> No, that\u2019s right. I mean the ACA marketplace, healthcare.gov, the individual mandate, preexisting condition protections, I mean, those are the things that got a lot of the public attention. But in fact, yeah, in the early years of the ACA, I mean really up until just the last couple years, the Medicaid expansion in the ACA was really the engine of coverage. And that\u2019s not what a lot of people expected. In fact, Congressional Budget Office in their original projections kind of got that wrong, too.\u00a0<\/p>\n Rovner:<\/strong> So what was the biggest disappointment about something the ACA was supposed to do but didn\u2019t do or didn\u2019t do very well?\u00a0<\/p>\n Levitt:<\/strong> Yeah, I mean, I would have to point to health care costs as the biggest disappointment. The ACA really wasn\u2019t intended to address health care costs head-on. And that was both a policy judgment but also a political decision. If you go back to the debate over the Clinton health plan in the early \u201990s, which failed spectacularly \u2014 you and I were both there \u2014 it addressed health care costs aggressively, took on every segment of the health care industry, and died under that political weight. The political judgment of Obama and Democrats in Congress with the ACA was to not take on those vested health care interests and not really address health care costs head-on. That\u2019s what enabled it to get passed. But it sort of lacked teeth in that regard. There were some things in the ACA like expansion of ACOs, accountable care organizations, which maybe had some promise but frankly have not done a whole lot.\u00a0<\/p>\n Rovner:<\/strong> And of course, Congress undoing what teeth there were in the ensuing years probably didn\u2019t help very much, either.\u00a0<\/p>\n Levitt:<\/strong> No. I mean there was this provision in the ACA called the Cadillac plan tax, right? The idea was to tax so-called Cadillac health plans, very generous health plans. That probably would\u2019ve had an effect. I\u2019m not sure it would\u2019ve done what people intended for it to do. I mean, I think it would\u2019ve actually shifted costs to workers and caused deductibles to rise even higher. But no one but economists liked that Cadillac plan tax, and it was repealed.\u00a0<\/p>\n Rovner:<\/strong> So, as you mentioned, you and I are both also veterans of the 1993, 1994 failed effort by President Bill Clinton to overhaul the nation\u2019s health care system, which, like the fight over the ACA, featured large-scale, deliberate mis- and disinformation by opponents about what a major piece of health legislation could do. In fact, and I have done lots of stories on this, scare tactics about the possible impact of providing universal health insurance coverage date back to the early 1900s and have been a feature of every single major health care debate since then. What did we learn from the ACA debate about combating this kind of deliberate misinformation?\u00a0<\/p>\n Levitt:<\/strong> Yeah, you\u2019re so right about the disinformation, and I was actually looking yesterday \u2014 we have a timeline of health policy over the decades in our KFF headquarters in San Francisco, and we have an ad up there from the debate over the Truman health plan. You and I were not there for that debate.\u00a0<\/p>\n Rovner:<\/strong> Thank you.\u00a0<\/p>\n Levitt:<\/strong> And the AMA [American Medical Association] opposed that as socialized medicine and ran these ads featuring robots who were going to be your doctor if the Truman plan passed. So this is certainly nothing new. And we saw it in the ACA with death panels, right? I mean, which just spread like wildfire through the media and over social media. I would kind of hope we learned some lessons from the ACA. I\u2019m not sure we have. And I kind of worry that with declining trust in institutions, particularly government institutions, I just wonder whether we\u2019ll get back to a place where, yeah, we\u2019ll disagree about policy. There will be spin, there will be scare tactics, but at least there\u2019s some trusted source of facts and data that we can rely on, and I\u2019m not so hopeful there.\u00a0<\/p>\n Rovner:<\/strong> Somebody asked former [HHS] Secretary Kathleen Sebelius at a 15th-anniversary event what she regretted most about not having in the ACA, and she said, With all the talk of our actually taking over the health care system, we should have just taken over the health care system<\/em>, since that\u2019s what everybody was accusing it of. It might\u2019ve worked better.\u00a0<\/p>\n Levitt:<\/strong> Yeah, there is \u2014 we could have a whole other session on \u201cMedicare for All\u201d and single payer and the pros and cons of that. But one thing I think we did learn from the ACA, that complexity is just a huge problem. Even what\u2019s supposed to be the simplest part of our health care system now, Medicare, has become incredibly complex with Part A and Part B and Part C and Part D. Seniors kind of scratch their heads trying to figure out what to do, and the ACA even more so.\u00a0<\/p>\n And I think back to your original question, part of what made the ACA so hard for people to grasp is there was not one single, Oh, I\u2019m going to sign up for the ACA.<\/em> There were so many pieces of it. And over time, I\u2019m not even sure people identify those pieces with the ACA anymore.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Oh, no, I am surprised at how many younger people have no idea of what the insurance market was like before the ACA and how many people were simply redlined out of getting coverage.\u00a0<\/p>\n Levitt:<\/strong> Right. No. I mean, once you fix those problems, then people don\u2019t see them anymore.\u00a0<\/p>\n Rovner:<\/strong> So let\u2019s look forward quickly. It seemed at least for a while after the Republicans failed in 2017 to repeal and replace the law that efforts to undo it were finally over. But while this administration isn\u2019t saying directly that they want to end it, they do have some big targets for undoing big pieces of it. What are some of those and what are the likelihood of them happening?\u00a0<\/p>\n Levitt:<\/strong> Yeah, in some ways we have an ACA repeal-and-replace debate going on right now, just not in name. And there are really kind of two big pieces on the table. One, of course, is potential cuts to Medicaid. The House has passed a budget resolution calling for $880 billion in cuts, by the Energy and Commerce Committee, which has jurisdiction over Medicaid. The vast majority of those cuts would have to be in Medicaid. The math is simply inescapable. And a big target on the table is that expansion of Medicaid that was in the ACA.\u00a0<\/p>\n And interestingly, you\u2019re even hearing Republicans on the Hill talking about repealing the enhanced federal matching payments for the ACA Medicaid expansion and saying: Well, that\u2019s not Medicaid cuts. That\u2019s Obamacare. That\u2019s not Medicaid.<\/em> But 20 million people are covered under that Medicaid expansion. So it would lead to the biggest increase in the number of people uninsured we\u2019ve ever had, if that gets repealed.\u00a0<\/p>\n The other issue really has not gotten a lot of attention yet this year, which is the extra premium assistance that was passed under [President Joe] Biden and by Democrats in Congress. And that\u2019s led to a dramatic increase in ACA marketplace enrollment. ACA enrollment has more than doubled to 24 million since 2020. Those subsidies expire at the end of this year. So if Congress does nothing, people would be faced with very big out-of-pocket premium increases. And I suspect it\u2019s going to get more attention as we get closer to the end of the year, but so far there hasn\u2019t been a big debate over it yet.\u00a0<\/p>\n Rovner:<\/strong> Well, we\u2019ll continue to talk about it. Larry Levitt, thank you so much.\u00a0<\/p>\n Levitt:<\/strong> Oh, thanks. Great conversation.\u00a0<\/p>\n
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