\t\t\t<\/p>\n
\tEmmarie Huetteman
\n\tKFF Health News<\/p>\n
\t\t\tEmmarie Huetteman,\u00a0senior editor, oversees a team of Washington reporters, as well as \u201cBill of the Month\u201d\u00a0and KFF Health News\u2019 \u201cWhat the Health?\u201d She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy debates in Washington and on the campaign trail.\u00a0\t\t<\/p>\n
The secretary of Health and Human Services, Robert F. Kennedy Jr., contradicted his agency\u2019s researchers this week with unsubstantiated or outright false claims about autism spectrum disorder and those with the condition. His public remarks were not the only recent example of Kennedy speaking against his employees; during an introductory appearance at the FDA, Kennedy said the staff \u2014 reeling from the layoffs of 3,500 colleagues \u2014 had become beholden to the industries they regulate.<\/p>\n
Meanwhile, President Donald Trump issued an executive order aimed at lowering drug prices as his administration signaled that tariffs on pharmaceuticals and pharmaceutical ingredients could be on deck. And new data shows that the number of abortions performed nationwide increased slightly last year, as travel and telehealth prescribing maintained access for some patients in states with abortion bans.<\/p>\n
This week\u2019s panelists are Emmarie Huetteman of KFF Health News, Anna Edney of Bloomberg News, Jessie Hellmann of CQ Roll Call, and Shefali Luthra of The 19th.<\/p>\n
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\tAnna Edney
\n\tBloomberg News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\t \tJessie Hellmann \t\t\t \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, Julie Rovner of KFF Health News interviews Krista Harrison and Robbie Zimbroff, health policy researchers at the University of California-San Francisco. They share some background on a case before the Supreme Court next week, Kennedy v. Braidwood Management<\/em>, which challenges the ability of the U.S. Preventive Services Task Force to make expert recommendations for American health.<\/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:<\/p>\n Emmarie Huetteman:<\/strong> KFF Health News\u2019 \u201cStates Push Medicaid Work Rules, but Few Programs Help Enrollees Find Jobs<\/a>,\u201d by Sam Whitehead, Phil Galewitz, and Katheryn Houghton.<\/p>\n Anna Edney:<\/strong> ProPublica\u2019s \u201cUnsanitary Practices Persist at Baby Formula Factory Whose Shutdown Led to Mass Shortages, Workers Say<\/a>,\u201d by Heather Vogell.<\/p>\n Jessie Hellmann:<\/strong> The Hill\u2019s \u201cMilitary\u2019s Use of Toxic \u2018Forever Chemicals\u2019 Leaves Lasting Scars<\/a>,\u201d by Sharon Udasin and Rachel Frazin.<\/p>\n Shefali Luthra:<\/strong> The 19th\u2019s \u201cTrump\u2019s Push for \u2018Beautiful Clean Coal\u2019 Could Lead to More Premature Births<\/a>,\u201d by Jessica Kutz.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tClick to open the transcrippt\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: On Autism, It\u2019s the Secretary\u2019s Word vs. the CDC\u2019s<\/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 Emmarie Huetteman:<\/strong> Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Emmarie Huetteman, a senior editor for KFF Health News filling in this week for Julie Rovner. I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, April 17, at 10 a.m. As always, and I know I don\u2019t have to remind you, news happens fast and things might\u2019ve changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we\u2019re joined via video conference by Shefali Luthra of The 19th.\u00a0<\/p>\n Shefali Luthra:<\/strong> Hello.\u00a0<\/p>\n Huetteman:<\/strong> Jessie Hellmann of CQ Roll Call.\u00a0<\/p>\n Jessie Hellmann:<\/strong> Hi there.\u00a0<\/p>\n Huetteman:<\/strong> And Anna Edney of Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong> Hi.\u00a0<\/p>\n Huetteman:<\/strong> Later in this episode we\u2019ll have Julie\u2019s interview with two health policy researchers at the University of California-San Francisco, Krista Harrison and Robbie Zimbroff. They will share some background on an important Supreme Court case being argued next week. That case challenges the ability of the U.S. Preventive Services task force to make expert recommendations for American health.\u00a0<\/p>\n But first, this week\u2019s news. The secretary of Health and Human Services roiled the health community on Wednesday by claiming, without evidence, that autism is preventable. He also directly contradicted his own agency\u2019s research on the causes of autism. Secretary Robert F. Kennedy Jr.\u2019s comments came during a press conference about a new CDC [Centers for Disease Control and Prevention] report. That report showed that the percentage of American children estimated to have autism spectrum disorder continued to rise in 2022. CDC researchers found that the rate among 8-year-olds was 1 in 31. That\u2019s nearly five times as high as the rate in 2000 when the CDC started keeping track. The report attributed some of the increase to more screening, but on Wednesday, Kennedy repeatedly dismissed that finding from his own agency\u2019s researchers. Kennedy also chastised what he called \u201cepidemic deniers\u201d for focusing on possible genetic causes of autism. That\u2019s despite the fact that scientists have known for decades that genetics are at least a contributing factor. Jessie, you were at Kennedy\u2019s press conference. What else did he say, and did he discuss how HHS plans to respond to the rise in autism rates?\u00a0<\/p>\n Hellmann:<\/strong> He said they\u2019re going to be announcing a series of studies within the next few weeks looking at dozens of what he says are potential environmental contributors to autism. He specifically mentioned mold, pesticides, foods, medicines. He didn\u2019t specifically mention vaccines, and reporters did not get a ton of time to ask questions about that, but he kind of just made this argument that scientists have been censored or stifled in their efforts to find the true causes of autism. And, like you said, he downplayed what many scientists say, which is that they think it\u2019s predominantly genetics. Maybe some environmental exposures can play a role here, but he seemed to argue that a big part of it is environmental toxins, and once they find out what that is, they\u2019re going to eliminate it, and that\u2019s going to solve the problem.\u00a0<\/p>\n Huetteman: <\/strong>Now that seems to be getting quite ahead of the notion of trying to do more research to find out the causes of autism, right? He\u2019s kind of saying, We\u2019re dismissing this notion and we\u2019re only going to focus on environmental toxins<\/em>. Is that right?\u00a0<\/p>\n Hellmann: <\/strong>Yeah. He also mentioned some other things, like parental age. He mentioned ultrasounds. He mentioned a whole litany of things, but, yeah, he literally said that looking at genetics is a dead end in terms of finding the causes of autism, which is something that many scientists disagree with. And he reiterated a promise he made last week that there would be answers by September, which is a timeline many scientists questioned and Kennedy hasn\u2019t really explained. People have been looking at this for decades<\/em>, and it\u2019s been really slow work trying to find answers. So such an expedited timeline has raised a lot of questions too, and makes people worry that he kind of already has a predetermined conclusion.\u00a0<\/p>\n Huetteman: <\/strong>Actually, can anyone remind us why is it problematic to claim that autism is preventable? One of the kind of headline claims that he made at this press conference.\u00a0<\/p>\n Edney: <\/strong>Well, I feel like that puts the blame on either the mother or the child for something that no one has said is anyone\u2019s fault, except maybe RFK Jr. It doesn\u2019t help with treatment when you think that you can just not live near, I don\u2019t know, an asbestos mine. I have no idea what the idea would be, but it puts the onus on the people who are suffering the most, when clearly what\u2019s needed is more resources for people with autism for their families to access, which are also things that it seems that this administration has been trying to take away.\u00a0<\/p>\n Luthra: <\/strong>And if I can add one more point, Emmarie, I do think it\u2019s worth flagging the extent to which RFK Jr.\u2019s remarks suggest he doesn\u2019t really understand what autism looks like in reality and in terms of how people with autism live in the world, which is very often quite normally as very high-functioning, productive members of society. He sort of used this language saying, Oh, if you have autism, you\u2019ll never play baseball. You\u2019ll never pay taxes. You\u2019ll never go on a date.<\/em> And that is just simply not true. Many people have autism and go on dates and get married and have children or pay taxes or play baseball, and I think it\u2019s important for us to recognize that when he\u2019s talking about this thing that he says is an epidemic with real public health harm and societal harm and is at the same time completely mischaracterizing what it actually looks like.\u00a0<\/p>\n Huetteman: <\/strong>That is such a great point. Thanks for adding that, Shefali. Well, Wednesday\u2019s press conference is not the only recent example of Kennedy speaking out against his own employees. Last week, Kennedy visited the FDA to introduce himself to staff, not by laying out his vision for the future, but instead by talking about their alleged failings. In his remarks, Kennedy accused FDA employees of becoming a sock puppet of the industries they regulate and asserted that the \u201cdeep state\u201d is real.\u00a0<\/p>\n That did not sit well with many staffers at the FDA who are reeling from the layoff of 3,500 of their colleagues in recent weeks. Several reportedly walked out while Kennedy was talking. And, well, the backlash is growing. Also last week, the American Public Health Association issued an extraordinary statement calling for Kennedy to resign. The statement cited Kennedy\u2019s \u201cimplicit and explicit bias and complete disregard for science.\u201d The American Public Health Association is the oldest and the largest association of public health officials in the world. In its 150-year history, the group has never called for the resignation of a health secretary. Is there any indication that the Trump administration is responding to the health community\u2019s concerns about their actions so far?\u00a0<\/p>\n Edney: <\/strong>Not that I\u2019ve seen. I know the APHA is a long-standing, very well-respected group. I don\u2019t think that matters, unfortunately, in the case of speaking up for science right now. And maybe Jessie and Shefali, you\u2019ve heard something different, but I certainly don\u2019t think that President Trump is that concerned with what RFK Jr. is doing for the most part and seems to agree at least implicitly with the things he\u2019s said. I mean, Trump himself has talked about a \u201cdeep state,\u201d so I don\u2019t think that anyone saying there\u2019s this exodus of people, that\u2019s a problem. I think it\u2019s what they wanted.\u00a0<\/p>\n Luthra: <\/strong>And to add to that, Anna, I mean one thing that I think is really relevant when we think about how the president approaches health policy is that he\u2019s never shown much interest in it. Even in his first presidency, it was largely outsourced to people who came from Mike Pence\u2019s orbit and to members of Congress and everything that they pushed on health policy he signed off on but didn\u2019t really spend a lot of time advocating for or pushing himself. And so I think with that in mind, it\u2019s hard to imagine that the backlash to RFK Jr. from the health community would really resonate that much when this is never a community that\u2019s really held much sway in his orbit.\u00a0<\/p>\n Huetteman: <\/strong>Absolutely. It seems like from the outside that Robert Kennedy is getting a lot of space to do what he\u2019d like when it comes to health care, at least in terms of the policy changes that HHS is undergoing while Trump is taking, let\u2019s say, more of a hands-off approach, at least from what we can look at. Although speaking of, Donald Trump has expressed some particular concern about certain health care issues the past, and one of them came up this week. As Americans weigh the day-to-day consequences of trade wars and isolationist policies, President Donald Trump revived a top pocketbook issue this week: He put out an executive order aimed at lowering drug prices. Now Trump\u2019s order in part calls for changes to the Medicare drug negotiation program, but the changes could actually increase drug costs for the federal government by further delaying the program, which it\u2019s worth noting is something that drugmakers have been pushing for.\u00a0\u00a0<\/p>\n Trump\u2019s order also directs the FDA to make it easier for states to gain approval to import drugs from other countries, including Canada. But Canada has been reticent to export drugs to the U.S. And, well, that\u2019s before the recent cross-border tensions over tariffs and territory, of course. And there\u2019s another complication. It also came out this week that the secretary of Commerce is investigating the national security effects of importing pharmaceuticals and pharmaceutical ingredients, suggesting that tariffs on drugs could be just around the corner. Anna, what would this executive order do to lower drug prices?\u00a0<\/p>\n Edney: <\/strong>I\u2019m not completely sure because I felt like a lot of it was d\u00e9j\u00e0 vu. A lot of it was recycled ideas from the first Trump administration. We know \u2026 particularly you laid out some of the issues with importing drugs from Canada, and we know particularly that Florida tried to do this when rules were loosened previously, and they have in place the ability now but aren\u2019t doing it. I mean, it\u2019s just not a viable option for people. Canada doesn\u2019t really want it, and then now we know if these tariffs are coming up, they could cost more to get them from Canada. So I don\u2019t understand really the thinking here. It seems not unusual, to be honest, for the administration to kind of be working against itself in different ways. And for the one new thing, I mean, there were changes that the pharmaceutical industry has been asking for a while to the IRA, which would kind of \u2026\u00a0<\/p>\n Huetteman: <\/strong>The Inflation Reduction Act.\u00a0<\/p>\n Edney:<\/strong> \u2026 yeah, with Medicare negotiation, they basically want to fix this pill loophole, that they call it, or this problem with the fact that pills are subject to this faster than biologic drugs, drugs that are kind of more complex. And so, if Trump does take that up, which he seems he\u2019s kind of directed Congress to do something about it, then that would be something that would cost the government money. So I don\u2019t know that that\u2019s even anything Congress is that interested in doing at the moment because they would have to find the \u201cpay-for.\u201d\u00a0<\/p>\n Huetteman: <\/strong>That\u2019s a great point. And right now they\u2019re preoccupied with looking at ways to pay for other things, right?\u00a0<\/p>\n Luthra: <\/strong>Yeah, definitely.\u00a0<\/p>\n Huetteman: <\/strong>Tax cuts and border security, in particular, as the budget reconciliation process continues. Actually, and I think it\u2019s really notable that we learned in the same week, that the federal government is exploring tariffs on pharmaceuticals. Could tariffs undermine these efforts to lower drug prices?\u00a0<\/p>\n Edney: <\/strong>Certainly. There are many parts of our medications, particularly active ingredients or even finished pills, particularly generics that we get from other countries. India is a very big one that\u2019s involved in this. We even do get a lot of them and brand-name drugs from Europe. So there is concern that with tariffs, pretty much any drug is going to be touched in some way and potentially significantly enough to impose a tariff on it. So the drug companies will have to figure out, are we going to eat those increases and reduce our research and development, or are we going to raise prices even more in the country that pays the most for our drugs?\u00a0<\/p>\n Huetteman: <\/strong>There\u2019s some theories that this could lead to even drug shortages. Is that right?\u00a0<\/p>\n Edney: <\/strong>Yeah, I think that\u2019s absolutely possible because there will be companies and generics, this happens all the time already, that decide this isn\u2019t worth it for us. The profit margin is just so, so low, and if it gets hit even more, then they\u2019ll step out. And there are many generics that are so old and so unprofitable, or not unprofitable, that just they don\u2019t make much at all. That if one thing disrupts, then we saw this with cancer drugs recently, there\u2019s a shortage and people have to scramble to try to find it.\u00a0<\/p>\n Huetteman: <\/strong>Yeah, absolutely. We\u2019ll be keeping an eye on that, among other things. And well, it\u2019s been a couple of weeks since layoffs began at HHS, but the picture is still coming into focus. Continuing our coverage, here\u2019s a very incomplete list of notable staffing cuts that have come to light. In a major blow, NIH [the National Institutes of Health] is preparing to lose the majority of its staff who work on contracts. The Trump administration laid off the entire staff of the Low-Income Home Energy Assistance Program. That program helps about 6.2 million people pay their utility bills. Also cut the entire CDC labs studying hepatitis, all full-time CDC employees who inspect cruise ships. And, by the way, fees are paid by cruise ship operators to cover those jobs, not tax dollars.\u00a0<\/p>\n Also cut the entire HHS office that sets poverty levels to determine who is eligible for government benefits including Medicaid. That last scoop<\/a> came from my KFF Health News colleague, Arthur Allen. One laid-off employee told Arthur about the cuts: \u201cIt was random, as far as we can tell.\u201d Meanwhile, Wired reports<\/a> that cuts to staff at HHS are endangering the technological and cybersecurity infrastructure underpinning the entire health system. Is there a common thread here? Are there ways to summarize what\u2019s been cut and why?\u00a0<\/p>\n Edney: <\/strong>I don\u2019t know if there\u2019s really a great way to summarize it. I think a lot of them are, what you just mentioned with the Wired story, are kind of people who create the scaffolding to hold HHS up essentially, who do IT security, who order supplies, who make sure that inspectors can safely get to their locations and have what they need. It\u2019s people like that who seem to have just been completely decimated. And then you do have the bucket of anything that seems to indicate diversity, equity, inclusion, which we know is something that this administration does not agree with. And we have seen a lot of top people step down on their own as well, leadership disagreeing with what ways the administration has talked about different things. So I think there are at least some buckets, but it does seem pretty random, I\u2019m sure, to a lot of the workers. But if you do even look at the people who calculate the poverty levels, that kind of goes towards the diversity, equity, inclusion, maybe lump kind of low-income in there where those are the things that they\u2019d like to get rid of.\u00a0<\/p>\n Hellmann: <\/strong>And there have been people that has been \u201cRIF\u2019ed,\u201d or received a reduction in force, and then have been asked to come back and help wind down an office, which I feel like shows that there might not have been a lot of thinking about some of these positions that they\u2019re eliminating and how it could affect the agencies. And there\u2019s already been a lot of stories about how things are getting really bogged down at the FDA and drug approvals are getting delayed and companies are having to delay clinical trials because they\u2019re just not getting a lot of communication from the people that work there. And in some cases they may not work there anymore.\u00a0<\/p>\n Huetteman: <\/strong>That\u2019s true. There was reporting out this week too, or who can even tell which week it was, that talked about how the FDA was bringing back laid-off employees or hiring contractors to cover food and drug safety that they had kind of not thought all the way through before they let go those workers. It\u2019s just a lot of confusion, I think it\u2019s a good way to sum it up. And Julie and I talk a lot about ways to describe this that aren\u2019t just using the word \u201cchaos,\u201d but it\u2019s true. There\u2019s a lot of people around Washington who just have no sense of what\u2019s going on and then the ripples out into the rest of the country and the health system from people who are trying to decide how to plan for their businesses, how to plan for their health clinic, how to order supplies. It\u2019s an incredible sense of upheaval, I can say, in the way that it looks from here.\u00a0\u00a0<\/p>\n All right, there\u2019s much more to be learned, and if you\u2019re a fan of sunshine, I do have some good news. Wired reports<\/a> that the government accountability office is collecting information from Elon Musk\u2019s DOGE effort about their work with Americans\u2019 private data, including at HHS. That report is expected to be released this spring. In abortion news, the Guttmacher Institute is out this week with new data, which shows that the number of abortions in the United States increased slightly last year. For the second year in a row, there were more than 1 million abortions performed nationally. Shefali, what does this data tell us, and what are we seeing in states with abortion bans compared to those without?\u00a0<\/p>\n Luthra: <\/strong>I think what this shows us is that in the almost three years since Roe v. Wade<\/em> was overturned, we settled into this deeply unequal state around the country in which in some states it is much easier to get abortions and others very difficult. And at the same time, people are really turning to immense workarounds to continue accessing abortion care. The data, if you look into it, shows the number of abortions really fell quite dramatically in a lot of states. For instance, Florida and South Carolina, states that enacted six-week abortion bans in the study period. And other places like Illinois, like Virginia, like New Mexico and Kansas, the number of abortions continues to go up. Virginia is interesting because it is now the only state in the South to allow abortions for much of pregnancy, and it is seeing a lot of people travel there from Florida, from South Carolina, Georgia, etc.\u00a0<\/p>\n I think what\u2019s really important for us to also understand is how deeply fragile this whole ecosystem is. The Guttmacher data showed that 15% of people getting abortions are traveling out of state for that care. That is very expensive, often an inherently unplanned expense, and people are spending, in some cases, thousands of dollars to make this journey, sometimes even more. And the funds that have allowed them in many cases to pay for that travel are running out of resources and seeing declines in support even as need grows.\u00a0<\/p>\n Other people are accessing abortion through telehealth, getting medication mailed to them in their home states, using providers who are protected by their state shield laws. And those are also under threat \u2014 whether that comes from federal conversations on whether to change how those medications are prescribed and how they can legally be used, or bills in individual states where abortion opponents and anti-abortion lawmakers see that these workarounds are very effective and are trying to find ways to stop people from ordering medication into their state.\u00a0<\/p>\n I think the most important thing for us to understand right now is that people are going to immense means to get abortions. Some of them, and the data can\u2019t fully paint this picture, are not able to do this so successfully. And there are real inequalities in terms of who can and who can\u2019t. And even this status quo is so deeply fragile. I wouldn\u2019t be surprised at all if it changes again or looks dramatically different in the next few years.\u00a0<\/p>\n Huetteman: <\/strong>Absolutely. Actually, to that end, I\u2019m wondering what\u2019s the significance of Guttmacher\u2019s work now that the Trump administration is in place? How is that data collection going nationwide?\u00a0<\/p>\n Luthra: <\/strong>Frankly, work like this is going to be so crucial because we aren\u2019t going to have a lot of places that will be tracking abortion or the impact of overturning Roe<\/em> in a meaningful way. When we look at the HHS grants, the NIH grants that have been cut, some of that was in fact to research that would have followed people who tried to get abortions or were denied abortions and helped us illustrate the health consequences of that. So we don\u2019t know if government-funded research will continue to help us better understand the impact of abortion bans. Organizations like Guttmacher, like the Society for Family Planning are really our only option at this point unless we see private donors step in and try and support researchers to make sure we keep getting information without which we could very well be in the dark while people\u2019s health and economic well-being is dramatically affected.\u00a0<\/p>\n Huetteman: <\/strong>Well put. OK, that\u2019s this week\u2019s news. Now we\u2019ll play Julie\u2019s interview with UCSF researchers Krista Harrison and Robbie Zimbroff, and then we\u2019ll come back and do our extra credits.\u00a0<\/p>\n Julie Rovner:<\/strong> I am so pleased to welcome to the podcast Krista Harrison and Robbie Zimbroff from the University of California-San Francisco, who have written about what could happen if the Supreme Court rules that the members of the U.S. Preventive Services Task Force were not constitutionally appointed and how that could impact what kind of preventive care will be covered by insurance without cost sharing. The Supreme Court is hearing the case Kennedy v. Braidwood<\/em> on Monday, April 21. Drs. Harrison and Zimbroff, welcome to \u201cWhat the Health?\u201d\u00a0<\/p>\n Krista Harrison:<\/strong> Thank you so much for having us.\u00a0<\/p>\n Robbie Zimbroff:<\/strong> Thank you.\u00a0<\/p>\n Rovner: <\/strong>Let\u2019s start by talking about what the USPSTF is and what it does. Robbie, you want to start off?\u00a0<\/p>\n Zimbroff: <\/strong>Sure. The USPSTF stands for the United States Preventive Services Task Force. It is an independent advisory board within the Department of Health and Human Services. They are volunteer physicians, experts in epidemiology, preventive care who make the best possible recommendations about which preventive services can help Americans live longer, healthier lives.\u00a0<\/p>\n Rovner: <\/strong>And they basically grade them like you do in school, right?\u00a0<\/p>\n Zimbroff: <\/strong>Yeah. So they make recommendations based on the quality of evidence and the magnitude of the net benefit of how much a preventive service might help a given individual. And they can either say, yes, that gets an A, that is strongly recommended by the USPSTF, a B, or an I, if it\u2019s sort of not totally known yet, there\u2019s not enough evidence to say We recommend this<\/em>. Overall, there are over 90 USPSTF recommendations that span from pre and perinatal care all the way to cancer screenings and care of older adults.\u00a0<\/p>\n Rovner: <\/strong>And just to be clear, this task force has been around since the 1980s. This is not something that was created by the Affordable Care Act, right? They\u2019ve been making these recommendations and people have been using these recommendations to decide what to cover, right?\u00a0<\/p>\n Zimbroff: <\/strong>Absolutely.\u00a0<\/p>\n Harrison: <\/strong>Absolutely.\u00a0<\/p>\n Rovner: <\/strong>So what is the issue now and here and what does it have to do with the Affordable Care Act?\u00a0<\/p>\n Harrison: <\/strong>So when the Affordable Care Act was being designed and enacted, their goal was to improve health and well-being for the most people possible by improving coverage. And of course, one of the things research has shown over time is that one of the best ways to do that is to reduce the amount that people have to pay to get preventive services. Because, of course, if you catch things before they become big problems, they\u2019re often either cheaper or you just have people live in better health longer, which allows them to do more things and be in greater health. So when the Affordable Care Act got enacted, they said, Well, since we\u2019re requiring all of this new coverage, we will use what is already out there, this existing task force, these existing recommendations<\/em>. And if this independent task force says this is a high-quality recommendation, we will require all insurers who are participating, who are not grandfathered into a different echelon, to provide this care at no cost so that more people get preventive services<\/em>.\u00a0<\/p>\n Rovner: <\/strong>Because we know that even small copays, even small requirements, can deter people. Right?\u00a0<\/p>\n Harrison: <\/strong>Exactly. That is what the research says.\u00a0<\/p>\n Zimbroff: <\/strong>The copays that deter many patients from seeking care that we know works and help people live longer is as low as $5; it\u2019s not a copay that is $0 to $500 \u2014 $5, $10, under $100. There is data for every cut point of what price will deter people from being able to afford medication that can help keep them healthier.\u00a0<\/p>\n Rovner: <\/strong>And \u2026 going and taking time out of your day to go have a medical procedure is not always something people are really gung-ho to do. So who\u2019s challenging it?\u00a0<\/p>\n Zimbroff: <\/strong>The challengers are a set of plaintiffs who actually are bringing a religious freedom claim against preventive services that are covered or recommended by the USPSTF and thus have a mandate to be covered by insurers and payers without any cost sharing. Those specific services initially spanned from ASIP, the committee that makes independent recommendations about vaccines for HPV vaccines, but also in this case it is strictly focused on the USPSTF\u2019s recommendations about HIV preexposure prophylaxis, more commonly known as PrEP. The claim from the plaintiffs is that it is not in line with their religious beliefs to be providing these services and they should not be required to. The lawsuit is about whether the USPSTF is constitutionally structured as one argument against why they should not be mandated to provide this coverage to their employees.\u00a0<\/p>\n Rovner: <\/strong>So what would happen if the Supreme Court ruled that the task force members were not appropriately appointed? Would all free preventive care just stop?\u00a0<\/p>\n Harrison: <\/strong>Well, we don\u2019t entirely know, because it hasn\u2019t happened yet. But the guess is that a lot of insurers will decide that they don\u2019t in fact want to cover certain types of preventive services, particularly for things that are long in the future. So if somebody is being screened for something that is likely to develop after age 65, insurers might decide, well, that\u2019s Medicare\u2019s problem. We don\u2019t want to put in the money. We\u2019ll just assume that if they get sick, we won\u2019t have to pay for it. And so that could really result in quite a bit of coverage being dropped,\u00a0<\/p>\n Rovner: <\/strong>Although things that were pre-the ACA would continue, right?\u00a0<\/p>\n Zimbroff: <\/strong>Yes. The recommendations don\u2019t go away and the coverage is still possible to be offered with zero cost to patients. There\u2019s just a lot of uncertainty. I think the uncertainty both offers insurers a lot of options for trying to shift costs back to patients, but it also provides uncertainty to patients about whether they will have to pay for a colon cancer screening or a lung cancer screening. That might be another deterrent from them going, just not knowing one way or the other.\u00a0<\/p>\n Rovner: <\/strong>And there are potential health implications here, right?\u00a0<\/p>\n Zimbroff: <\/strong>Yeah. I think one of the great examples of the effect of this provision of the Affordable Care Act has been lung cancer screening. So this was initially a recommendation that was made by the United States Preventive Services Task Force in 2013, and since that was after the Affordable Care Act, its implementation for coverage by payers has been cost-free to patients. It has lowered barriers to getting lung cancer screening. And there\u2019s research that estimates that over 80,000 life years have been added to Americans by catching cancer early or pre-malignant lesions on low-dose CT scans for millions of Americans across the board.\u00a0<\/p>\n Rovner: <\/strong>So I was a little bit surprised that the Trump administration decided to defend this case. Asking for expert medical advice doesn\u2019t seem to be on Secretary Kennedy\u2019s short list of priorities, or do you think he has other plans for the task force?\u00a0<\/p>\n Harrison: <\/strong>That\u2019s a good question. I don\u2019t know if we\u2019ve seen much evidence, that you would think that this very much aligns with Secretary Kennedy\u2019s focus on preventing and reducing the burden of chronic diseases. Certainly lung cancer and colorectal cancer fall in those categories. But on the other hand, we\u2019re seeing a lot of changes to how this administration thinks about external advisory groups that were formerly independent or considered to be independent. So again, we\u2019re just seeing \u2014 and the word \u201cunprecedented\u201d doesn\u2019t really cut it anymore \u2014 but a novel amount of uncertainty and change.\u00a0<\/p>\n Zimbroff: <\/strong>Julie, I was also surprised that the administration initially decided to maintain their posture of the prior administration. Reading their most recent filings \u2014 again, with the full disclaimer that I\u2019m not a constitutional scholar and so take my read with a grain of salt \u2014 is that the reading of the powers of the Health and Human Services secretary, who\u2019s a political appointee overseeing this independent agency, the secretary actually has at-will removal powers for any task force member with which the secretary may disagree, may be able to delay the implementation of those recommendations and effectively veto a recommendation. The language is pretty strong by my, again, non-legal read of the reply brief from the government in this take, which I think is a different relationship or different understanding of the role of the secretary in evaluating and potentially vetoing expert recommendations that are designed to be explicitly nonpartisan and evidence-based.\u00a0<\/p>\n Rovner: <\/strong>So we will have to see what happens in this case, Dr. Krista Harrison and Dr. Robbie Zimbroff, thank you so much for joining us.\u00a0<\/p>\n Harrison: <\/strong>Our pleasure.\u00a0<\/p>\n Zimbroff: <\/strong>Thanks for having us.\u00a0<\/p>\n Harrison: <\/strong>Thank you for having us.\u00a0<\/p>\n Huetteman: <\/strong>OK, we\u2019re back. Now it\u2019s time for our extra-credit segment. That\u2019s where we each recognize a story we read this week that we think you should read, too. Don\u2019t worry if you miss it. We\u2019ll put the links in our show notes on your phone or other mobile device. Shefali, why don\u2019t you go first this week?\u00a0<\/p>\n Luthra: <\/strong>Absolutely. This story is from my colleague Jessica Kutz, who covers gender, climate and sustainability for The 19th. The headline is \u201cTrump\u2019s Push for \u2018Beautiful Clean Coal\u2019 Could Lead to More Premature Births<\/a>.\u201d The headline says what the story is about. She examines the potential implications for an executive order meant to bring what he calls \u201cclean coal\u201d as a more meaningful resource, again, to expand coal mining in public lands. And what I like about this story is that it reminds us who is affected and what the implications would be. I think the research that she cites about the relationship between coal mining and premature birth, which can lead to infant mortality, is really compelling and really important as we consider the talk about building a pro-family administration, a pro-life administration, and at the same time embracing these environmental policies, but could be quite harmful for people\u2019s health, and particularly for the health of people who are already in many cases left out of what this administration\u2019s embraced policy is around access to health care.\u00a0<\/p>\n Huetteman: <\/strong>Thanks for that. Anna, why don\u2019t you go next?\u00a0<\/p>\n Edney: <\/strong>Sure. Mine is by Heather Vogell in ProPublica. It\u2019s titled \u201cUnsanitary Practices Persist at Baby Formula Factory Whose Shutdown Led to Mass Shortages, Workers Say<\/a>.\u201d This was just a brilliant follow-up to all the issues that went on with Abbott Laboratories a couple years ago that led to huge infant formula shortages across the U.S. The lab was unsanitary. The FDA had to basically tell them, You need to shut this down and fix everything<\/em>.\u00a0<\/p>\n And they were able to work with FDA, get back open, take care of a lot of the shortages, but she talked to several workers who are concerned that they\u2019re just back to their unsanitary practices. Again, there\u2019s a lot of disturbing detail in here that I think is worth a read and also something really worthy of keeping an eye on for accountability because the Food and Drug Administration\u2019s new head of food is an industry lawyer, Kyle Diamantas, who has defended Abbott in his past life, working at a big law firm. So what FDA will do here will be interesting as well, whether they\u2019ll go back there and see if they see the same things that this reporter was told was going on.\u00a0<\/p>\n Huetteman: <\/strong>Wow. We\u2019ll keep an eye on that. Jessie, your turn.\u00a0<\/p>\n Hellmann: <\/strong>My extra credit is from Sharon Udasin and Rachel Frazin at The Hill. It\u2019s titled, \u201cMilitary\u2019s Use of Toxic \u2018Forever Chemicals\u2019 Leaves Lasting Scars<\/a>.\u201d It\u2019s an excerpt from an entire book that they did called \u201cPoisoning the Well,\u201d focusing on how synthetic chemicals known as PFAS have been tied to health issues despite scientists knowing for decades that these products are dangerous and linked to many health problems, including cancer. So this specific excerpt looks at the military\u2019s use of firefighting foam in military bases and how it has leached into water supplies all across the country and has made people really sick, and some people have even died. The military continued to use this foam for decades, and they\u2019re doing evaluations now to determine which bases require cleanup, but that\u2019s something that could take decades and communities are continuing to experience the fallout from this. And it\u2019s just one example of the impact of PFAS in America and the kind of impact that it has on communities and something that, I think, deserves more attention even as we\u2019re all just dealing with an onslaught of health news right now.\u00a0<\/p>\n Huetteman: <\/strong>Well, thanks for bringing attention to that one. I appreciate it. And my extra credit this week is from my KFF Health News colleagues Sam Whitehead, Phil Galewitz, and Katheryn Houghton. This headline is \u201cStates Push Medicaid Work Rules, but Few Programs Help Enrollees Find Jobs<\/a>.\u201d We all know from this podcast that Republicans in several states and in Congress are considering work requirements, which would mandate that many people have jobs in order to qualify for Medicaid coverage. So my colleagues explored what Medicaid health plans do to help people find work. They found that few Medicaid programs offer job help, and it can be transformative, but for the most part, these programs have low enrollment and they don\u2019t collect the data to know if they work. As the story points out, there\u2019s limited demand for employment help. And well, here\u2019s the rub for GOP claims about the significance of work requirements: There\u2019s limited demand because most people on Medicaid already work, just not in jobs that provide health benefits.\u00a0\u00a0<\/p>\n OK, that\u2019s this week\u2019s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left a review; that helps other people find us, too. Thanks as always to our producer, Francis Ying, and to Stephanie Stapleton, our substitute editor while I\u2019m on the other side of the mic this week. As always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org, or you can find me on LinkedIn<\/a>. Where are you guys these days?\u00a0<\/p>\n Edney: <\/strong>I\u2019m also on LinkedIn<\/a> and on Bluesky<\/a> or Twitter [X] at @annaedney<\/a>.\u00a0<\/p>\n Huetteman: <\/strong>Shefali?\u00a0<\/p>\n Luthra: <\/strong>I am at Bluesky, @shefali<\/a>.\u00a0<\/p>\n Huetteman: <\/strong>And Jessie.\u00a0<\/p>\n Hellmann: <\/strong>I\u2019m on LinkedIn<\/a> and I\u2019m on X<\/a> and Bluesky<\/a>, @jessiehellmann.\u00a0<\/p>\n Huetteman: <\/strong>Julie will be back next week. Until then, be healthy.\u00a0<\/p>\n \tFrancis Ying \tStephanie Stapleton To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n And subscribe to KFF Health News\u2019 \u201cWhat the Health?\u201d on\u00a0Spotify<\/a>,\u00a0Apple Podcasts<\/a>,\u00a0Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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