\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 Congress returns from spring break next week and will get to work crafting a bill that would cut taxes and boost immigration enforcement \u2014 but that also could cut at least $880 billion over the next decade from a pool of funding that includes Medicaid. Some Republicans, however, are starting to question the political wisdom of making such large cuts to a program that provides health coverage to so many of their constituents.<\/p>\n Meanwhile, the Supreme Court heard arguments in a case challenging the requirement that most private insurance cover certain preventive services with no out-of-pocket cost for patients.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \tTami Luhby \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 Health News\u2019 Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.<\/p>\n Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> MedPage Today\u2019s \u201cMedical Journals Get Letters From DOJ<\/a>,\u201d by Kristina Fiore.<\/p>\n Sarah Karlin-Smith:<\/strong> The Tampa Bay Times\u2019 \u201cCountering DeSantis, $10M Hope Florida Donation Came From Medicaid, Draft Shows<\/a>,\u201d by Alexandra Glorioso and Lawrence Mower.<\/p>\n Tami Luhby:<\/strong> Stat\u2019s \u201cIn Ireland, a Global Hub for the Pharma Industry, Trump Tariffs Are a Source of Deep Worry<\/a>,\u201d by Andrew Joseph.<\/p>\n Alice Miranda Ollstein:<\/strong> The New York Times\u2019 \u201cA Scientist Is Paid to Study Maple Syrup. He\u2019s Also Paid to Promote It<\/a>,\u201d by Will Evans, Ellen Gabler, and Anjali Tsui.<\/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: Can Congress Reconcile Trump\u2019s Wishes With Medicaid\u2019s Needs?\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, April 24, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> Tami Luhby of CNN.\u00a0<\/p>\n Tami Luhby:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> And Sarah Karlin-Smith of the Pink Sheet.\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode, we\u2019ll have my interview with my KFF Health News colleague Rae Ellen Bichell about her story about how care options are changing for trans kids in Colorado. But first, this week\u2019s news.\u00a0<\/p>\n We\u2019re going to start this week with Congress, which is still out, by the way, on spring break but does return on Monday. When members get back, it will be full speed ahead on that, quote, \u201cbig, beautiful\u201d reconciliation bill, as the president likes to call it. But there are already some big storm clouds on the horizon, particularly when it comes to cutting Medicaid by $880 billion over the next decade. We would appear to have both moderate and conservative Republicans voicing doubts about those big Medicaid cuts. Or are they hiding behind semantics? Some of them are saying, Well, we don\u2019t want to cut Medicaid, but it would be OK to have work requirements<\/em>, which, as we\u2019ve talked about many times, would cut a lot of people off of Medicaid. Alice, I see you nodding.\u00a0<\/p>\n Ollstein:<\/strong> Yes. So, people really need to pay attention to the specifics and press members on exactly what they mean. What do they mean by \u201ccut\u201d? Because some people don\u2019t consider certain things a cut. Some people consider them efficiency or savings, or there\u2019s a lot of different words we hear thrown around. And also, who is impacted? Who are they OK being impacted? There\u2019s a lot of rhetoric sort of pitting the people on the Medicaid expansion, who are not parents, not people with disabilities, against people on traditional Medicaid in ways that some advocates find offensive or misleading. And so, I think when members say, I am against Medicaid cuts, I will not vote for Medicaid cuts<\/em>, we really need to ask: What do you consider a cut? And who are you OK allowing to be impacted?\u00a0<\/p>\n Luhby:<\/strong> Yeah. Speaker Mike Johnson had a very telling comment on Fox News\u2019 \u201cSunday Morning Futures\u201d earlier this month where he said, \u201cThe president has made absolutely clear many times, as we have as well, that we\u2019re going to protect Medicare, Social Security, Medicaid for people who are legally beneficiaries of those programs.\u201d But then he goes on to say: \u201cAt the same time, we have to root out fraud, waste, and abuse. We have to eliminate on, for example, [on] Medicaid, people who are not actually eligible to be there. Able-bodied workers, for example, young men who should never be on the program at all.\u201d\u00a0<\/p>\n Of course, these folks are legal beneficiaries or legal enrollees of the program thanks to the Affordable Care Act\u2019s Medicaid expansion, which has been expanded in 40 states. But yeah as Alice was saying, they are using language like \u201cprotecting the vulnerable\u201d or people who \u201creally need<\/em> the program.\u201d\u00a0<\/p>\n The new CMS [Centers for Medicare & Medicaid Services] administrator, Mehmet Oz, has also used the same language. So he seems to be in step with them. But yeah I think we\u2019re really going to see work requirements and other methods, such as potentially cutting the FMAP [Federal Medical Assistance Percentage] for the federal matching money for the expansion population, which is set at 90%, which is far higher than it is for the traditional population, which a lot of folks don\u2019t think is fair. But if the federal government, if Congress, does cut that match for the expansion population, we will see a lot of people lose their coverage.\u00a0<\/p>\n Rovner:<\/strong> And for the six people that haven\u2019t heard me say this a thousand times, there are 12 states that automatically end their Medicaid expansion if that 90% match gets cut, because they legit can\u2019t afford to make up the difference. I\u2019ve seen numbers this week. It\u2019s like $620 billion that states would have to make up if Congress just reduces that 90% match to whatever the match is, because each state gets a slightly different match. Poor states get more money from the federal government.\u00a0<\/p>\n For a bill where the repeal of the Affordable Care Act is supposedly not on the table, it is certainly on the menu. One item that I don\u2019t think gets talked about enough is the expiration of the expanded subsidies for ACA coverage that were implemented during the pandemic. That\u2019s effectively doubled ACA marketplace enrollment to 24 million people. And if those subsidies end, which they do at the end of the year in the absence of congressional action \u2014 this isn\u2019t like the Medicaid match where Congress would have to actively go in and lower it. This was temporary, and it expires unless it is renewed. If that happens, a lot of people, including a lot of Republican voters in a lot of very red states, are going to get hit with huge increases starting in 2026.\u00a0<\/p>\n Is that starting to dawn on some Republican members of the House and Senate? And might it change the odds that those subsidies are allowed to expire, which I think we all just assumed when [Donald] Trump got elected last November?\u00a0<\/p>\n Ollstein:<\/strong> You are not hearing as much about it as you are about Medicaid, even from Democrats. So I\u2019m curious, when Congress returns from its recess, if that dynamic is going to change, because even advocacy groups right now are really hammering the Medicaid cuts issue in ads, TV ads, billboards, press conferences. And so I\u2019m not sure if that same messaging will sort of expand to include the people who would be hit by these cost increases, if these supports expire, or if there will be different messaging, or if it\u2019ll get lost in the current fight about Medicaid.\u00a0<\/p>\n Luhby:<\/strong> I was saying it had been discussed quite a bit earlier this year, but then it has completely fallen off the radar. One thing that some folks are also trying to put it now as is saying that it\u2019s also part of the waste, fraud, and abuse, because they\u2019re arguing that a lot of folks, because part of the expansion was that people under 150% of poverty could get pretty much no-cost, no-premium subsidy plans. They could get no-premium plans. And there have been, even during the Biden administration also, there was a lot of accusations that people were fraudulently deflating their income so that they would qualify for this, or brokers were trying to do that for them.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I think the other thing, though, that where the enrollment has gone up the most are in the 10 states that didn\u2019t expand Medicaid, because those are people who are now eligible for, as Tami was saying, these extremely low-cost and, in some cases, free plans, and those would be the people who would be either kicked off or see their costs go way up. I\u2019ll be interested to see what happens when this starts to kind of penetrate the psyches of members as they go through this exercise, which, as I say, is just going to get underway. The big effort launches next week, so we will watch this closely.\u00a0<\/p>\n I wanted to talk about a related subject, Medicare Advantage. Congress could find a lot of savings in Medicare Advantage without cutting Medicaid and without cutting Medicare benefits, or at least directly cutting Medicare benefits. Instead, Medicare Advantage plans are set to get big increases next year, which has boosted insurance stock prices even as the broader stock market has kind of tanked. Yes, as we saw at the confirmation hearing last month for Mehmet Oz to lead the Centers for Medicare & Medicaid Services, some Republicans are actually questioning whether the federal government should continue to overpay those Medicare Advantage plans. Is the tide starting to turn maybe a little bit on this former Republican-favored program?\u00a0<\/p>\n Luhby:<\/strong> We\u2019ll see. Actually, surprisingly, Dr. Oz, who long touted Medicare Advantage plans on his show and in social media, actually also during his confirmation hearing kind of cast a little shade on the insurers. And much of the increase that was announced recently was probably done, obviously, before he took office. So we\u2019ll see what happens next year or during the course of this year. But at this point, it looks like the increase for 2026 is a step back from the Biden administration\u2019s efforts to rein in the costs.\u00a0<\/p>\n Rovner:<\/strong> Yeah but they could, I mean, if they wanted to they could \u2014 people keep talking about Energy and Commerce, House Energy and Commerce Committee, and all the money that it needs to save, presumably from Medicaid. Well, Energy and Commerce also has jurisdiction over Medicare Advantage, and if they wanted to save some of that $880 billion, they could take it out of Medicare Advantage too if they really wanted to. I don\u2019t know that I\u2019m going to bet that they will. I\u2019m just suggesting that they could.\u00a0<\/p>\n All right, well, turning to the Supreme Court, the justices heard oral arguments this week in the case challenging the Affordable Care Act\u2019s no-cost coverage of preventive care. Tami, remind us what this case is about. And what would happen if the court found for the plaintiffs?\u00a0<\/p>\n Luhby:<\/strong> Well, so this is a case that\u2019s been \u2014 it\u2019s not as much of a threat to the Affordable Care Act as previous cases have been. This case surrounds the preventive care mandate in the ACA, which basically says that insurers have to provide no-cost care for a host of different services that are recommended by three different groups. The court case at the Supreme Court was focusing on one set of recommendations, specifically from the U.S. Preventive Services Task Force. And the plaintiffs have said basically that the task force isn\u2019t constitutional and therefore its recommendations can\u2019t be enforced and they shouldn\u2019t have to provide these services at no cost.\u00a0<\/p>\n So it would have actually a big effect on a lot of services. The lower-court ruling was kind of strange in saying that it limited the advances to just those since the enactment of the Affordable Care Act in March of 2010 when the ACA was passed, but it would still affect a host, things like statins, increased cancer screenings for certain groups, and screenings for pregnant women. So there are a lot of things that this would really affect people.\u00a0<\/p>\n And so I listened to the oral arguments, and it was very interesting. A lot of the discussion \u2014 it didn\u2019t really talk about the preventive care and what that would mean for folks \u2014 but there was a lot of discussion about whether the HHS [Department of Health and Human Services] secretary has oversight over this task force or whether the members are independent. And that\u2019s really at the crux of the argument here. And so there were several notable comments from conservative justices, and it seemed generally that folks we spoke to as well as media coverage seemed to say that the Supreme Court was leaning in the direction of the government. And Justice Brett Kavanaugh said that members of the task force are removable at will by the HHS secretary. Truly independent agencies, he noted, typically have legal protections that require a president to show cause before firing members of a board. The\u2014\u00a0<\/p>\n Rovner:<\/strong> Like the head of the Federal Reserve, she inserts.\u00a0<\/p>\n Luhby:<\/strong> Justice Amy Coney Barrett said, who\u2019s another conservative, said that she described the challenger\u2019s position as very maximalist. So it seems that potentially \u2014 we don\u2019t know, of course \u2014 but potentially the government may prevail here.\u00a0<\/p>\n But interestingly, if that does happen, that will actually give HHS Secretary Robert F. Kennedy Jr. more power over preventive services requirements. And as we know, he has a different view on certain public health measures. So we could really see him putting his stamp on the recommendations. Notably, this does not focus on vaccines. That\u2019s a different group. That\u2019s a different group that recommends vaccines, but that is still being discussed in the lower courts. So the vaccine issue isn\u2019t over, but it\u2019s not part of this case, per se.\u00a0<\/p>\n Rovner:<\/strong> This particular case, though, was really about PrEP [pre-exposure prophylaxis], right? It was about HIV preventives.\u00a0<\/p>\n Ollstein:<\/strong> Well, basically, the challengers, these conservative employers in Texas, in going after PrEP specifically, also are going after all preventive services. And the piece of the case that focused specifically on PrEP, where they said that requiring them to cover this HIV prevention drug would violate their religious rights, that piece did not go to the Supreme Court. So, lower courts have allowed these specific employers to opt out of covering PrEP, but because that ruling was not applied to anybody else in the country, the Biden Justice Department did not appeal it up to the Supreme Court. Probably, I\u2019m just reading the tea leaves, not wanting to give this Supreme Court an opportunity to go after that.\u00a0<\/p>\n So that piece of it was not at issue, but the experts I talked to said that PrEP would still be really vulnerable if there was a broader ruling against preventive care, because PrEP is extremely expensive. And unlike other preventive services that insurers may see as really saving them money, they may see this as costing them and would drop that coverage, which could be really devastating to the U.S. effort to end the spread of HIV.\u00a0<\/p>\n Rovner:<\/strong> So I think one of the big surprises in this case was not that the Biden administration sued but that the Trump administration continued the position of the Biden administration. And one theory of why the Trump administration is defending the USPSTF [U.S. Preventive Services Task Force] is that it wants to exercise more power over not just that advisory panel but others, too, which brings us to a report in Politico<\/a> that HHS Secretary Kennedy is considering unilaterally ordering the ACIP \u2014 that\u2019s the advisory committee on immunizations \u2014 to drop its recommendation that children continue to receive the vaccine to protect against covid.\u00a0<\/p>\n Now, Sarah, isn\u2019t this exactly what Kennedy promised Sen. Bill Cassidy that he wouldn\u2019t do during his confirmation hearings? Personally meddle with scientific recommendations?\u00a0<\/p>\n Karlin-Smith:<\/strong> Kennedy did make a very explicit promise related to the vaccine schedule, I think, and I think we\u2019ve seen multiple times already, and I\u2019m sure Bill Cassidy is getting tired of reporters asking him, Are you going to do something about this?<\/em> But I think Kennedy has already probably walked back, really not kept the thrust of a lot of his commitments to Cassidy. And a change to the vaccine schedule for the covid vaccine for children could essentially impact insurance coverage. It might make it no longer eligible for the Vaccines for Children Program, which ensures people with lower incomes or no insurance can afford vaccines for their children. And so I think this is a particularly concerning step for people. Even though it wouldn\u2019t necessarily take the vaccine away, it could make it really inaccessible and unaffordable.\u00a0<\/p>\n I did want to quickly say about the idea in [Kennedy v.<\/em>] Braidwood<\/em> that the government wins, RFK gets more authority. I heard a really interesting comment yesterday about that thread, and the head of the American Public Health Association was trying to emphasize, like, it\u2019s sort of status quo. If the Braidwood<\/em> case goes the way of the government, anybody can technically misuse the authority, and the thing they\u2019ll be watching for is to see what happens there or pushing for a legislative construct so that he can\u2019t really misuse it, because, I think, in their minds, a lot of public health associations and leaders want a win here. So I think they\u2019re sort of pushing back on the messaging about exactly what this means for Kennedy.\u00a0<\/p>\n Rovner:<\/strong> So there are also some indications that the public is starting to buy what RFK Jr. is selling, at least when it comes to vaccines, even as measles and now whooping cough cases continue to mount. A new poll<\/a> from my colleagues here at KFF finds a growing share of adults who have heard the false claims, including that the measles vaccine causes autism or that the vaccine is more dangerous than getting measles, both of which are not true.\u00a0<\/p>\n Sarah, you were at the World Vaccine Congress here in Washington this week. What are the folks there feeling about all of this?\u00a0<\/p>\n Karlin-Smith:<\/strong> So I overheard someone in the hallway say yesterday that everybody here is shell-shocked, and I think that is probably a good characterization of the mood in the vaccine world. The environment they operate in has sort of been turned on its head very quickly, and there is concern about the future.\u00a0<\/p>\n I went to one panel where lawyers were sort of very optimistic that the way the country has sort of set up our vaccine system and authorities, a lot of authority rests in the hands of the states and state laws that may protect our ability to access and get vaccines, as well as they seem to feel that this Supreme Court as well, when it comes to vaccine issues and any attempts by the federal government to encroach more power, would lean in favor of the states and having the power in the states. There was a lot of hope there. I think that does rely on the rule of law sort of being followed by this administration, which doesn\u2019t always happen.\u00a0<\/p>\n The other thing that I think will be interesting to watch moving forward is those assumptions that we have systems in place to protect our vaccine infrastructure and access do rely on the vaccines actually being approved. And to get to that point, particularly with new vaccines, you have to have the federal government approve them. And that the buck could kind of stop there. And we\u2019ve already seen some signs that FDA [Food and Drug Administration] and HHS politicals are interfering in that process. So certainly, again, the vaccine community is nervous and feeling like they have to defend something that, as somebody said, change the world from one where you didn\u2019t know if your children would live to go to school to one where you can just sort of assume that, and that\u2019s a really dramatic difference in our health and our lives.\u00a0<\/p>\n Rovner:<\/strong> Well, that is a perfect segue into what I wanted to talk about next, which was the continuing impact of the cuts at HHS. This week, we\u2019ve learned of the shutting down of some major longitudinal studies, including the landmark Women\u2019s Health Initiative, which has tracked more than 160,000 women in clinical trials and even more outside of them since the 1990s and has led to major changes in how women are diagnosed and treated for a variety of health conditions. Also, apparently being defunded is a multistate diabetes study as well as the CDC\u2019s longitudinal study of maternal health outcomes.\u00a0<\/p>\n Alice, you have a story this week<\/a> on how clinics are starting to close due to the cutoff of Title X family planning funding. A lot of these things are going to be difficult or even impossible to restart even if the courts eventually do say that, No, administration, you didn\u2019t have the authority to do this and you have to restore them<\/em>, right?\u00a0<\/p>\n Ollstein:<\/strong> Yeah. So in the Title X context, I\u2019ve been talking to providers around the country who had tens of millions in funding frozen. And it was frozen indefinitely. They don\u2019t know when or whether they\u2019ll get it. They\u2019re being investigated for possible violations of executive orders. They submitted evidence trying to prove they aren\u2019t in violation, and they just have no idea what\u2019s going to happen, and they\u2019re really struggling to keep the lights on. And they were explaining, yeah. once you lay off staff, once you lay off doctors and nurses, and once you close clinics, you can\u2019t just flip a switch and reopen, and even if the funding comes through again later.\u00a0<\/p>\n And I think that\u2019s true in the research context as well. Once you halt research, once you close down a lab, even if the funding is restored, either as a result of a court case on the sooner side or buy a future administration, you can\u2019t just unplug the government and plug it back in again.\u00a0<\/p>\n Rovner:<\/strong> Atul Gawande has a story<\/a> in The New Yorker this week that I will link to about what\u2019s going on at Harvard, which is, obviously, gets huge headlines because it\u2019s Harvard. But the thing that really jumped out at me was there\u2019s an ongoing study of a potential, a really good, vaccine for TB, which scientists have been looking for for a hundred years, and they were literally just about to do sort of the TB challenge for the macaques who have been given this vaccine, and now everything is frozen. And it seems that it\u2019s not just that it would ruin that, but you would have to start over. It\u2019s a waste of money. That\u2019s what I keep trying to say. This seems like \u2014 this does not seem like it is saving money. This seems like it is just trying to basically wreck the scientific establishment. Or is that just me?\u00a0<\/p>\n Karlin-Smith:<\/strong> No, I think there\u2019s plenty of examples of that where, again, they\u2019ve wrapped a lot of this in the idea that they\u2019re going after government efficiency and waste. And when you look at what is actually falling to the cutting-room floor, there\u2019s a lot of evidence that shows it\u2019s not waste of you think of these long-term studies like the diabetes study or the Woman\u2019s Health Initiative they\u2019ve been running for so many years, to then have to lose those people involved in that and to replicate it would cost, I saw one report was saying, maybe a million dollars just to kind of get it back up and running on the ground again.\u00a0<\/p>\n And it also conflicts with other Kennedy and health administration priorities that they\u2019ve called for, which is to improve chronic disease treatment and management in the U.S. So there\u2019s a lot of misalignment, it seems like, between the rhetoric and what they\u2019re saying and what\u2019s actually happening on the ground.\u00a0<\/p>\n Rovner:<\/strong> Well, Secretary Kennedy does continue to make news himself after last week announcing that he planned to reveal the cause of autism by this September. This week, the secretary says, as part of that NIH [National Institutes of Health]-ordered study, the department will create a registry of people with autism. The idea is to bring together such diverse databases as pharmacy, medication records, private insurance claims, lab tests, and other data from the VA [Department of Veterans Affairs] and the Indian Health Service, even data from smartwatches and fitness trackers. What could possibly go wrong here?\u00a0<\/p>\n Ollstein:<\/strong> There\u2019s a lot of anxiety in the autism community and just among people who are concerned about privacy and concerned about this administration in particular having access to all of these records. There\u2019s concern about people being included or excluded in such a registry in error, since we\u2019ve seen, I think, a lot of what the administration has been doing has been relying on artificial intelligence to make decisions and comb through records. And there have been some very notable errors on that front so far. So, yes, a lot of skepticism, and I think there will be some interesting pushback on this.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I just, I think anytime somebody talks about making registries of people, it does set off alarm bells in a lot of communities.\u00a0<\/p>\n Well, meanwhile, the secretary held a press conference Tuesday to announce that he\u2019s reached an agreement with food-makers to phase out petroleum-based food dyes by next year. Except our podcast pal Rachel Cohrs Zhang over at Bloomberg<\/a> reports that no agreement has actually been reached, and The Wall Street Journal is reporting<\/a> that biotech is warming up to the new leadership at the FDA that\u2019s promising to streamline approval in a number of ways. So, Sarah, which is it? Is this HHS cracking down on manufacturers or cozying up to them?\u00a0<\/p>\n Karlin-Smith:<\/strong> I think it\u2019s a complicated story. I think the food dye announcement is interesting because, again, they sort of suggested they had this big accomplishment, and then you look at the details, and they\u2019re really just asking industry to do something, which I find ironic because Kennedy\u2019s criticism of the FDA and the food industry\u2019s relationship and the fact that we have these ingredients in our food in the first place has been that FDA has been too reliant on the food industry to self-police itself, and they really aren\u2019t starting the regulatory process that would actually ban the products.\u00a0<\/p>\n And again, I think there\u2019s sort of mixed research on how much, if any, harm comes from these products to begin with, so that picture isn\u2019t really great. But there\u2019s, again, these incredible ironies of the reports also coming out this week that they\u2019re not inspecting milk the way they should and other parts of our food system and them touting this as this big health achievement. But at the same time, it does seem like the food industry is somewhat willing to work with them.\u00a0<\/p>\n I think on the biotech side, I maybe take slight disagreement with The Wall Street Journal. I think there are some positive signs for companies in that space from Commissioner [Martin] Makary in terms of his thinking about how to maybe make some products in the rare disease space go through the approval of process faster. I would just caution that Makary was very vague in how he described it, and it\u2019s not even clear if he\u2019s really thinking about something that would be new or what he would implement.\u00a0<\/p>\n And at the same time, again, you have to count all of that with the other elements coming out of the administration, including for Makary, that are kind of concerning about how they view vaccines. Makary also made some comments at the food dye event that are very reminiscent of RFK\u2019s remarks, where he was very critical about the pharmaceutical industry and our use of drugs for treating obesity, depression, and other things that just repeats this sort of thread that kind of undermines the value of pharmaceuticals. So I think people are very hopeful in the industry about Makary and that he\u2019d be a kind of counterbalance to Kennedy, but I think it\u2019s too soon to really say whether he\u2019s going to be a positive for that industry.\u00a0<\/p>\n Rovner:<\/strong> In other words, watch what they say and<\/em> what they do. All right. Well, finally this week, I\u2019m going to do my extra credit early because I want to let you guys comment on it, too. The story\u2019s from MedPage Today. It\u2019s by Kristina Fiore, and it\u2019s called \u201cMedical Journals Get Letters From DOJ<\/a>,\u201d and the story is a lot more dramatic than that.\u00a0<\/p>\n It seems that the interim U.S. attorney here in Washington, D.C., is writing to medical journals \u2014 yes, medical journals \u2014 accusing them of partisanship and failing to take into account, quote, \u201ccompeting viewpoints.\u201d And breaking just this morning<\/a>, the prestigious New England Journal of Medicine has apparently gotten one of these letters, too. Now, none of these are so-called pay-to-play journals, which have their own issues. Rather, these are journals whose articles are peer-reviewed and based on scientific evidence.\u00a0<\/p>\n This strikes me as more than a little bit chilling and not at all in keeping with the radical transparency that this administration has promised. I honestly don\u2019t know what to make of this. I\u2019m curious as to what your guys\u2019 take is. Is this one rogue U.S. attorney or the tip of the spear of an administration that really does want to go after the entire scientific establishment?\u00a0<\/p>\n Ollstein:<\/strong> I think we can see a pattern of the administration going after many entities and institutions that they perceive as providing a check on their power and rhetoric. So we\u2019re seeing that with universities. We\u2019re seeing that with news organizations. We are seeing that with quasi-independent government agencies and nonprofits. Now we\u2019re seeing it with these medical journals.\u00a0<\/p>\n I\u2019m not sure what their jurisdiction is here. These are not federally run or supported entities. These are private entities that theoretically have the right to set their own criteria for publication. But this may be intimidating and, like you said, chilling to some. So we\u2019ll have to see what the response is.\u00a0<\/p>\n Rovner:<\/strong> Sarah, what are you hearing?\u00a0<\/p>\n Karlin-Smith:<\/strong> I think that it is interesting to me that they\u2019re going after medical journals, because I\u2019ve noticed a lot of the parts of the health industry are not willing to speak out and go after [President] Trump, even though probably privately behind the scenes a lot of people are very nervous about some of the activities. And the medical journals have been one place where I think you\u2019ve seen a bit more freedom and seen the editorials and the viewpoints that have been harsher.\u00a0<\/p>\n So I wouldn\u2019t be surprised if these are the entities that are willing to sort of cave to this kind of pressure, but I do think we\u2019re in a very difficult environment. Again, being at this vaccine conference and talking to people about what you are doing to try and preserve your products that are so valuable to society, people don\u2019t know what to do. They don\u2019t know when pushing back will end up with them being in a worse situation. They don\u2019t know when doing nothing will end up with them being in the worse situation. And it\u2019s a really difficult place for all different kinds of groups, whether it\u2019s a medical journal or a university or a drug company, to navigate.\u00a0<\/p>\n Rovner:<\/strong> We\u2019ll add this to the list of stories that we are watching. All right, that is this week\u2019s news. Now, we\u2019ll play my interview with KFF Health News\u2019 Rae Ellen Bichell. Then we will come back and do our extra credits.\u00a0<\/p>\n I am so pleased to welcome back to the podcast my KFF Health News colleague Rae Ellen Bichell, who\u2019s here to talk to us about a story she did<\/a> on how services are changing for transgender youth and their families in Colorado. Hi, Rae.\u00a0<\/p>\n Rae Ellen Bichell:<\/strong> Hi. Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So, Colorado has long been considered a haven for gender-affirming care, but even there, health care for transgender youth temporarily flickered as hospitals responded to executive orders from the Trump administration trying to limit what kinds of care can be provided to minors. Let\u2019s start with, what kind of health care are we talking about?\u00a0<\/p>\n Bichell:<\/strong> There\u2019s a lot of different things that count as gender-affirming care. It can really be anything from talk therapy or a haircut all the way to medications and surgery.\u00a0<\/p>\n For medical interventions, on that side of things, the process for getting those is long and thorough. To give you an idea, the guidelines for this typically come from the World Professional Association for Transgender Health, and the latest document is 260 pages long. So this was very thorough.\u00a0<\/p>\n With medications, there\u2019s puberty blockers that pause puberty and are reversible, and then the ones that are less reversible are testosterone and estrogen. So patients who need and want them will get puberty blockers first as puberty is setting in \u2014 so the timing matters, just to put everything on the ice \u2014 and then would start hormones later on. It is important to note, lots of trans kids don\u2019t get these medications. Researchers found that transgender youth are not likely to get them, and politicians like to talk about surgery, of course, but it\u2019s really rare for teens to get surgery. So for every 100,000 trans minors, fewer than three undergo surgery.\u00a0<\/p>\n Rovner:<\/strong> So when we talk about transgender care, as you said, particularly the Trump administration presents this as go to school one gender and come home another. That\u2019s not what this is.\u00a0<\/p>\n Bichell:<\/strong> It is not an easy or fast process by any measure.\u00a0<\/p>\n Rovner:<\/strong> So, remind us what the president\u2019s executive order said.\u00a0<\/p>\n Bichell:<\/strong> There were two of them. So one, right out of the gate on his first day in office, said it is a, quote, \u201cfalse claim that males can identify as and thus become women and vice versa.\u201d And then a second one called puberty blockers and hormones, for anyone under age 19, a form of chemical, quote, \u201cmutilation\u201d and a, quote, \u201ca stain on our Nation\u2019s history.\u201d And that one directed agencies to take steps to ensure that recipients of federal research or education grants stop providing that care.\u00a0<\/p>\n Rovner:<\/strong> And that\u2019s where the hospitals got involved in this, right?\u00a0<\/p>\n Bichell:<\/strong> Right. That\u2019s where we started to see changes in Colorado and in other states as well. Here, there were three major health care organizations \u2014 so that\u2019s Children\u2019s Hospital Colorado, Denver Health, and UCHealth \u2014 and they all announced changes to the gender-affirming care that they provide to patients under 19. So this is in direct response to the executive order.\u00a0<\/p>\n Those changes were effective immediately and included no new hormone or puberty blocker prescriptions for patients who hadn\u2019t had them before, limited or no renewals for those who had had such prescriptions before, and no surgeries. Some of that care has since resumed, and that happened after Colorado joined a U.S. District Court lawsuit in Washington state. And the situation there is there\u2019s a preliminary injunction that\u2019s blocking the orders from taking effect but only applies to the four states that are involved in the lawsuit.\u00a0<\/p>\n But even though the care has been restored, even though Colorado joined that Washington lawsuit, it was still enough to shake people\u2019s confidence in this state.\u00a0<\/p>\n Here\u2019s Louise. We\u2019re using her middle name. She\u2019s the mom of a trans teenager.\u00a0<\/p>\n Louise:<\/strong> I mean, Colorado, as a state, was supposed to be a safe haven, right? We have a law that makes it a right for trans people to have health care, and yet our health care systems are taking that away and not making sure that our trans people can have health care, especially our trans kids.\u00a0<\/p>\n Rovner:<\/strong> So what kind of impact did that have on patients, even if it was just temporary?\u00a0<\/p>\n Bichell:<\/strong> Pretty profound. One family I spoke to with a 14-year-old, they predicted this might happen. They started stockpiling testosterone, the mom said, as soon as the election happened. And what that means is kind of just saving anything that was left over in the vial after the teen took his dose so they could stretch it for as long as possible.\u00a0<\/p>\n That teen also had a kind of surprise moment where even his birth control came into question. And that\u2019s because his birth control suppresses his period, which is considered part of his gender-affirming care. So his doctor had to have this special meeting just to make sure that he could keep getting that prescription, too.\u00a0<\/p>\n And then one part of this health care that has not turned back on is surgery. And so, even though it\u2019s rare, for the patients who want and need it, that\u2019s a significant gap.\u00a0<\/p>\n Rovner:<\/strong> And what does that mean for patients?\u00a0<\/p>\n Bichell:<\/strong> So, Louise\u2019s son, David \u2014 that\u2019s his middle name, too. He\u2019s 18 years old. And I visited him in his dorm room in Gunnison. That\u2019s a mountain town here. He told me that testosterone has helped him a lot.\u00a0<\/p>\n David:<\/strong> I don\u2019t know if you noticed, but there are no mirrors in here.\u00a0<\/p>\n Bichell:<\/strong> I did not notice that.\u00a0<\/p>\n David:<\/strong> Yeah.\u00a0<\/p>\n Bichell:<\/strong> You\u2019re right.\u00a0<\/p>\n David:<\/strong> My sister and best friend will come up and stay the weekend or something like that. And every time they come up, they complain that I don\u2019t have a mirror. And I\u2019m like, I don\u2019t want to look at myself, because, I don\u2019t know, for the longest time I just had so much body dysphoria and dysmorphia that it can be kind of hard to look in the mirror. But when I do, most of the time I see something that I really like.\u00a0<\/p>\n Bichell:<\/strong> So his confidence and mental health has really improved with the testosterone, but he also would really like to get a mastectomy and thought that he could do it this summer so that he\u2019d have enough recovery time before the new school year started in the fall. But he\u2019s not aware of anyone now in Colorado who will do this surgery for 18-year-old patients, so he has to wait until he turns 19. He has taken a significant mental health hit because of having to wait.\u00a0<\/p>\n The irony here is that he could easily get surgery to enhance his breasts but can\u2019t reduce or remove them. And the other irony here is that cisgender men and boys can still get gender-affirming breast reduction surgeries and do. In fact, they\u2019re more likely to get that kind of surgery than transgender men and boys.\u00a0<\/p>\n Rovner:<\/strong> So what do things look like going forward in Colorado?\u00a0<\/p>\n Bichell:<\/strong> There is a bill making its way through the state capitol right now. It\u2019s about protecting access to gender-affirming care. So let\u2019s see where that lands. But in the meantime, the families that I\u2019ve been speaking with, a moment that really stood out to them was, in early April, the Trump administration came out with a proclamation that said, quote, \u201cOne of the most prevalent forms of child abuse facing our country today is the sinister threat of gender ideology,\u201d end quote. So they\u2019re still feeling pretty apprehensive about the future.\u00a0<\/p>\n Rovner:<\/strong> Well, we\u2019ll watch this as it goes forward. Rae Ellen Bichell, thank you so much.\u00a0<\/p>\n Bichell:<\/strong> Thanks again.\u00a0<\/p>\n Rovner:<\/strong> OK, we\u2019re back. Now it\u2019s time for our extra-credit segment. That\u2019s where we each recognize the story we read this week we think you should read, too. Don\u2019t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. I\u2019ve already done mine. Alice, you\u2019ve got a lighter story this week. Why don\u2019t you go next?\u00a0<\/p>\n Ollstein:<\/strong> A sweeter story, you might say. So I have a piece from The New York Times that is about \u2014 it\u2019s a great expos\u00e9 of a researcher who is in the pocket of Big Maple Syrup, according to this reporting. The article is \u201cA Scientist Is Paid to Study Maple Syrup. He\u2019s Also Paid to Promote It.<\/a>\u201d This is a great piece of how he exaggerated the health benefits of maple syrup. He cherry-picked findings that appeared to make this a health-promotion food more than the findings really showed.\u00a0<\/p>\n But it all really, on a serious note, made me think about the current federal cuts to research and how, in the absence of that taxpayer public support, more and more scientists may need to turn to industry support for their work. And that brings all of these ethical problems that you really see in this article. Pressure to come to certain findings. Pressure to not release certain findings if they don\u2019t fit with the agenda, etc. So I think this is a little bit silly but also serious.\u00a0<\/p>\n Rovner:<\/strong> I was personally disappointed to read this story because maple is my favorite sweetener.\u00a0<\/p>\n Ollstein:<\/strong> Well\u2014\u00a0<\/p>\n Rovner:<\/strong> And I was really happy when I started seeing the research that said it\u2019s really good for you. It will still be my favorite sweetener. Sarah.\u00a0<\/p>\n Karlin-Smith:<\/strong> I took a look at a story from Alexandra Glorioso and Lawrence Mower of the Miami Herald\/[Tampa Bay] Times [\u201cCountering DeSantis, $10M Hope Florida Donation Came From Medicaid, Draft Shows<\/a>\u201d] that documents how it appears that Gov. [Ron] DeSantis in Florida steered about $10 million that the state got back through a settlement with one of their Medicaid contractors to a nonprofit run by his wife, and then seeming to having to kept steering the money to political committees that are supporting Republicans.\u00a0<\/p>\n And as Julie mentioned, this is probably one of those things that would\u2019ve gotten tons of attention, much slower news time, but it\u2019s a fascinating story and just very interesting to watch just how they were able to figure out and document how all this money was being transferred. And that even the, in some of the stories you see, even the Republican lawmakers and Congress and their state legislature are pretty frustrated about it.\u00a0<\/p>\n Rovner:<\/strong> Local journalism still matters. Tami.\u00a0<\/p>\n Luhby:<\/strong> I looked at a story out of Stat News by Andrew Joseph titled \u201cIn Ireland, a Global Hub for the Pharma Industry, Trump Tariffs Are a Source of Deep Worry<\/a>.\u201d So, many of us, including me, have been writing about the potential for tariffs on pharmaceutical imports since Trump, unlike his first term, has been promising to impose them on the drug industry.\u00a0<\/p>\n Well what I liked about this story was that it focused on drug manufacturing in Ireland, with Joseph reporting from Dublin and County Cork. I\u2019d like to get that assignment myself. But he shows how America pharma companies, how important they are to the Irish economy. Ireland has lured them with low taxes and concerted efforts to build its manufacturing workforce. And interestingly, the country started to move foreign investment in the 1950s. It mentions, interestingly, that President Trump had specifically called out pharma operations in Ireland, criticizing the U.S. trade balance while meeting with the Irish prime minister for St. Patrick\u2019s Day.\u00a0<\/p>\n But there were a lot of good details in the piece. Of the 72.6 billion euros\u2019 worth of exports that Ireland sent to the U.S. last year, 58.3 billion were classified as chemical and related products, the bulk of them pharmaceutical goods. The biopharma industry now employs 50,000 people in Ireland.\u00a0<\/p>\n And, another little tidbit that I liked, the National Institute for Bioprocessing Research and Training in Dublin actually has a mock plant where thousands of workers have been trained for careers in the industry. And it talks about, even getting down to the county and local levels, how Ireland is concerned that tariffs could prompt American drugmakers to invest less in the country in the future, which will hurt Ireland\u2019s export business, its corporate tax base, the jobs, and the economy overall.\u00a0<\/p>\n Rovner:<\/strong> Yeah, globalization\u2019s a real thing, and you can\u2019t just turn it off by turning a switch. It was a really interesting story.\u00a0<\/p>\n All right, that is this week\u2019s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We\u2019d appreciate it if you left us a review. That helps other people find us, too. Thanks, as always, to our editor, Emmarie Huetteman, and our producer, Francis Ying. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org. Or you can still find me at X, @jrovner<\/a>, and at Bluesky, @julierovner<\/a>. Where are you guys hanging these days? Sarah.\u00a0<\/p>\n Karlin-Smith:<\/strong> I feel like I\u2019m trying to be everywhere on social media. So you can find me, @SarahKarlin<\/a> or @sarahkarlin-smith<\/a> on Bluesky, LinkedIn<\/a>, all those fun places.\u00a0<\/p>\n Rovner:<\/strong> Alice?\u00a0<\/p>\n Ollstein:<\/strong> Mainly on Bluesky, @alicemiranda<\/a>. Still on X, @AliceOllstein<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Tami.\u00a0<\/p>\n Luhby:<\/strong> Mostly at CNN at cnn.com<\/a>.\u00a0<\/p>\n Rovner:<\/strong> There you go. We\u2019ll be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n \tFrancis Ying \tEmmarie Huetteman 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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