{"id":862338,"date":"2025-07-13T23:13:41","date_gmt":"2025-07-14T04:13:41","guid":{"rendered":"https:\/\/newsycanuse.com\/index.php\/2025\/07\/13\/kff-health-news-what-the-health-cutting-medicaid-is-hard-even-for-the-gop\/"},"modified":"2025-07-13T23:13:41","modified_gmt":"2025-07-14T04:13:41","slug":"kff-health-news-what-the-health-cutting-medicaid-is-hard-even-for-the-gop","status":"publish","type":"post","link":"https:\/\/newsycanuse.com\/index.php\/2025\/07\/13\/kff-health-news-what-the-health-cutting-medicaid-is-hard-even-for-the-gop\/","title":{"rendered":"KFF Health News’ ‘What the Health?’: Cutting Medicaid Is Hard \u2014 Even for the GOP"},"content":{"rendered":"
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[Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n

Julie Rovner:<\/strong> Hello and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, May 8, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n

Today we are joined via a videoconference by Anna Edney of Bloomberg News.\u00a0<\/p>\n

Anna Edney:<\/strong> Hi, everybody.\u00a0<\/p>\n

Rovner:<\/strong> Maya Goldman of Axios News.\u00a0<\/p>\n

Maya Goldman:<\/strong> Great to be here.\u00a0<\/p>\n

Rovner:<\/strong> And Sandhya Raman of CQ Roll Call.\u00a0<\/p>\n

Sandhya Raman:<\/strong> Good morning, everyone.\u00a0<\/p>\n

Rovner:<\/strong> Later in this episode we\u2019ll have my \u201cBill of the Month\u201d interview with my KFF Health News colleague Lauren Sausser. This month\u2019s patient got preventive care they assumed would be covered by their Affordable Care Act health plan, except it wasn\u2019t. But first, this week\u2019s news.\u00a0<\/p>\n

We\u2019re going to start on Capitol Hill, where Sandhya is coming directly from, where regular listeners to this podcast will be not one bit surprised that Republicans working on President [Donald] Trump\u2019s one \u201cbig, beautiful\u201d budget reconciliation bill are at an impasse over how and how deeply to cut the Medicaid program. Originally, the House Energy and Commerce Committee was supposed to mark up its portion of the bill this week, but that turned out to be too optimistic. Now they\u2019re shooting for next week, apparently Tuesday or so, they\u2019re saying, and apparently that Memorial Day goal to finish the bill is shifting to maybe the Fourth of July? But given what\u2019s leaking out of the closed Republican meetings on this, even that might be too soon. Where are we with these Medicaid negotiations?\u00a0<\/p>\n

Raman:<\/strong> I would say a lot has been happening, but also a lot has not been happening. I think that anytime we\u2019ve gotten any little progress on knowing what exactly is at the top of the list, it gets walked back. So earlier this week we had a meeting with a lot of the moderates in Speaker [Mike] Johnson\u2019s office and trying to get them on board with some of the things that they were hesitant about, and following the meeting, Speaker Johnson had said that two of the things that have been a little bit more contentious \u2014 changing the federal match for the expansion population and instituting per capita caps for states \u2014 were off the table. But the way that he phrased it is kind of interesting in that he said stay tuned and that it possibly could change.\u00a0<\/p>\n

And so then yesterday when we were hearing from the Energy and Commerce Committee, it seemed like these things are still on the table. And then Speaker Johnson has kind of gone back on that and said, I said it was likely.<\/em> So every time we kind of have any sort of change, it\u2019s really unclear if these things are in the mix, outside the mix. When we pulled them off the table, we had a lot of the hard-line conservatives get really upset about this because it\u2019s not enough savings. So I think any way that you push it with such narrow margins, it\u2019s been difficult to make any progress, even though they\u2019ve been having a lot of meetings this week.\u00a0<\/p>\n

Rovner:<\/strong> One of the things that surprised me was apparently the Senate Republicans are weighing in. The Senate Republicans who aren\u2019t even set to make Medicaid cuts under their version of the budget resolution are saying that the House needs to go further. Where did that come from?\u00a0<\/p>\n

Raman:<\/strong> It\u2019s just been a difficult process to get anything across. I mean, in the House side, a lot of it has been, I think, election-driven. You see the people that are not willing to make as many concessions are in competitive districts. The people that want to go a little bit more extreme on what they\u2019re thinking are in much more safe districts. And then in the Senate, I think there\u2019s a lot more at play just because they have longer terms, they have more to work with. So some of the pushback has been from people that it would directly affect their states or if the governors have weighed in. But I think that there are so many things that they do want to get done, since there is much stronger agreement on some of the immigration stuff and the taxes that they want to find the savings somewhere. If they don\u2019t find it, then the whole thing is moot.\u00a0<\/p>\n

Rovner:<\/strong> So meanwhile, the Congressional Budget Office at the request of Democrats is out with estimates of what some of these Medicaid options would mean for coverage, and it gives lie to some of these Republican claims that they can cut nearly a trillion dollars from Medicaid without touching benefits, right? I mean all of these \u2014 and Maya, your nodding.\u00a0<\/p>\n

Goldman:<\/strong> Yeah.\u00a0<\/p>\n

Rovner: <\/strong>All of these things would come with coverage losses.\u00a0<\/p>\n

Goldman:<\/strong> Yeah, I think it\u2019s important to think about things like work requirements, which has gotten a lot of support from moderate Republicans. The only way that that produces savings is if people come off Medicaid as a result. Work requirements in and of themselves are not saving any money. So I know advocates are very concerned about any level of cuts. I talked to somebody from a nursing home association who said: We can\u2019t pick and choose. We\u2019re not in a position to pick and choose which are better or worse, because at this point, everything on the table is bad for us.<\/em> So I think people are definitely waiting with bated breath there.\u00a0<\/p>\n

Rovner:<\/strong> Yeah, I\u2019ve heard a lot of Republicans over the last week or so with the talking points. If we\u2019re just going after fraud and abuse then we\u2019re not going to cut anybody\u2019s benefits.<\/em> And it\u2019s like \u2014 um, good luck with that.\u00a0<\/p>\n

Goldman:<\/strong> And President Trump has said that as well.\u00a0<\/p>\n

Rovner:<\/strong> That\u2019s right. Well, one place Congress could recoup a lot of money from Medicaid is by cracking down on provider taxes<\/a>, which 49 of the 50 states use to plump up their federal Medicaid match, if you will. Basically the state levies a tax on hospitals or nursing homes or some other group of providers, claims that money as their state share to draw down additional federal matching Medicaid funds, then returns it to the providers in the form of increased reimbursement while pocketing the difference. You can call it money laundering as some do, or creative financing as others do, or just another way to provide health care to low-income people.\u00a0<\/p>\n

But one thing it definitely is, at least right now, is legal. Congress has occasionally tried to crack down on it since the late 1980s. I have spent way more time covering this fight than I wish I had, but the combination of state and health provider pushback has always prevented it from being eliminated entirely. If you want a really good backgrounder, I point you to the excellent piece<\/a> in The New York Times this week by our podcast pals Margot Sanger-Katz and Sarah Kliff. What are you guys hearing about provider taxes and other forms of state contributions and their future in all of this? Is this where they\u2019re finally going to look to get a pot of money?\u00a0<\/p>\n

Raman:<\/strong> It\u2019s still in the mix. The tricky thing is how narrow the margins are, and when you have certain moderates having a hard line saying, I don\u2019t want to cut more than $500 billion or $600 billion<\/em>, or something like that. And then you have others that don\u2019t want to dip below the $880 billion set for the Energy and Commerce Committee. And then there are others that have said it\u2019s not about a specific number, it\u2019s what is being cut. So I think once we have some more numbers for some of the other things, it\u2019ll provide a better idea of what else can fit in. Because right now for work requirements, we\u2019re going based on some older CBO [Congressional Budget Office] numbers. We have the CBO numbers that the Democrats asked for, but it doesn\u2019t include everything. And piecing that together is the puzzle, will illuminate some of that, if there are things that people are a little bit more on board with. But it\u2019s still kind of soon to figure out if we\u2019re not going to see draft text until early next week.\u00a0<\/p>\n

Goldman:<\/strong> I think the tricky thing with provider taxes is that it\u2019s so baked into the way that Medicaid functions in each state. And I think I totally co-sign on the New York Times article. It was a really helpful explanation of all of this, and I would bet that you\u2019ll see a lot of pushback from state governments, including Republicans, on a proposal that makes severe changes to that.\u00a0<\/p>\n

Rovner:<\/strong> Someday, but not today, I will tell the story of the 1991 fight over this in which there was basically a bizarre dealmaking with individual senators to keep this legal. That was a year when the Democrats were trying to get rid of it. So it\u2019s a bipartisan thing. All right, well, moving on.\u00a0<\/p>\n

It wouldn\u2019t be a Thursday morning if we didn\u2019t have breaking federal health personnel news. Today was supposed to be the confirmation hearing for surgeon general nominee and Fox News contributor Janette Nesheiwat. But now her nomination has been pulled over some questions about whether she was misrepresenting her medical education credentials, and she\u2019s already been replaced with the nomination of Casey Means, the sister of top [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] aide Calley Means, who are both leaders in the MAHA [\u201cMake America Healthy Again\u201d] movement. This feels like a lot of science deniers moving in at one time. Or is it just me?\u00a0<\/p>\n

Edney:<\/strong> Yeah, I think that the Meanses have been in this circle, names floated for various things at various times, and this was a place where Casey Means fit in. And certainly she espouses a lot of the views on, like, functional medicine and things that this administration, at least RFK Jr., seems to also subscribe to. But the one thing I\u2019m not as clear on her is where she stands with vaccines, because obviously Nesheiwat had fudged on her school a little bit, and\u2014\u00a0<\/p>\n

Rovner:<\/strong> Yeah, I think she did her residency at the University of Arkansas\u2014\u00a0<\/p>\n

Edney:<\/strong> That\u2019s where.\u00a0<\/p>\n

Rovner: <\/strong>\u2014and she implied that she\u2019d graduated from the University of Arkansas medical school when in fact she graduated from an accredited Caribbean medical school, which lots of doctors go to. It\u2019s not a sin\u2014\u00a0<\/p>\n

Edney:<\/strong> Right.\u00a0<\/p>\n

Rovner: <\/strong>\u2014and it\u2019s a perfectly, as I say, accredited medical school. That was basically \u2014 but she did fudge it on her resume.\u00a0<\/p>\n

Edney:<\/strong> Yeah.\u00a0<\/p>\n

Rovner:<\/strong> So apparently that was one of the things that got her pulled.\u00a0<\/p>\n

Edney:<\/strong> Right. And the other, kind of, that we\u2019ve seen in recent days, again, is Laura Loomer coming out against her because she thinks she\u2019s not anti-vaccine enough. So what the question I think to maybe be looking into today and after is: Is Casey Means anti-vaccine enough for them? I don\u2019t know exactly the answer to that and whether she\u2019ll make it through as well.\u00a0<\/p>\n

Rovner:<\/strong> Well, we also learned this week that Vinay Prasad, a controversial figure in the covid movement and even before that, has been named to head the FDA [Food and Drug Administration] Center for Biologics and Evaluation Research, making him the nation\u2019s lead vaccine regulator, among other things. Now he does have research bona fides but is a known skeptic of things like accelerated approval of new drugs, and apparently the biotech industry, less than thrilled with this pick, Anna?\u00a0<\/p>\n

Edney:<\/strong> Yeah, they are quite afraid of this pick. You could see it in the stocks for a lot of vaccine companies, for some other companies particularly. He was quite vocal and quite against the covid vaccines during covid and even compared them to the Nazi regime. So we know that there could be a lot of trouble where, already, you know, FDA has said that they\u2019re going to require placebo-controlled trials for new vaccines and imply that any update to a covid vaccine makes it a new vaccine. So this just spells more trouble for getting vaccines to market and quickly to people. He also\u2014you mentioned accelerated approval. This is a way that the FDA uses to try to get promising medicines to people faster. There are issues with it, and people have written about the fact that they rely on what are called surrogate endpoints. So not Did you live longer?<\/em> but Did your tumor shrink?<\/em>\u00a0<\/p>\n

And you would think that that would make you live longer, but it actually turns out a lot of times it doesn\u2019t. So you maybe went through a very strong medication and felt more terrible than you might have and didn\u2019t extend your life. So there\u2019s a lot of that discussion, and so that. There are other drugs. Like this Sarepta drug for Duchenne muscular dystrophy is a big one that Vinay Prasad has come out against, saying that should have never been approved, because it was using these kind of surrogate endpoints. So I think biotech\u2019s pretty \u2014 thinking they\u2019re going to have a lot tougher road ahead to bring stuff to market.\u00a0<\/p>\n

Rovner:<\/strong> And I should point out that over the very long term, this has been the continuing struggle at FDA. It\u2019s like, do you protect the public but make people wait longer for drugs or do you get the drugs out and make sure that people who have no other treatments available have something available? And it\u2019s been a constant push and pull. It\u2019s not really been partisan. Sometimes you get one side pushing and the other side pushing back. It\u2019s really nothing new. It\u2019s just the sort of latest iteration of this.\u00a0<\/p>\n

Edney:<\/strong> Right. Yeah. This is the pendulum swing, back to the Maybe we need to be slowing it down<\/em> side. It\u2019s also interesting because there are other discussions from RFK Jr. that, like, We need to be speeding up approvals<\/em> and Trump wants to speed up approvals<\/em>. So I don\u2019t know where any of this will actually come down when the rubber meets the road, I guess.\u00a0<\/p>\n

Rovner:<\/strong> Sandhya and Maya, I see you both nodding. Do you want to add something?\u00a0<\/p>\n

Raman:<\/strong> I think this was kind of a theme that I also heard this week in the \u2014 we had the Senate Finance hearing for some of the HHS [Department of Health and Human Services] nominees, and Jim O\u2019Neill, who\u2019s one of the nominees, that was something that was brought up by Finance ranking member Ron Wyden, that some of his past remarks when he was originally considered to be on the short list for FDA commissioner last Trump administration is that he basically said as long as it\u2019s safe, it should go ahead regardless of efficacy. So those comments were kind of brought back again, and he\u2019s in another hearing now, so that might come up as an issue in HELP [the Senate Committee on Health, Education, Labor and Pensions] today.\u00a0<\/p>\n

Rovner:<\/strong> And he\u2019s the nominee for deputy secretary, right? Have to make sure I keep all these things straight. Maya, you wanting to add something?\u00a0<\/p>\n

Goldman:<\/strong> Yeah, I was just going to say, I think there is a divide between these two philosophies on pharmaceuticals, and my sense is that the selection of Prasad is kind of showing that the anti-accelerated-approval side is winning out. But I think Anna is correct that we still don\u2019t know where it\u2019s going to land.\u00a0<\/p>\n

Rovner:<\/strong> Yes, and I will point out that accelerated approval first started during AIDS when there was no treatments and basically people were storming the \u2014 literally physically storming \u2014 the FDA, demanding access to AIDS drugs, which they did finally get. But that\u2019s where accelerated approval came from. This is not a new fight, and it will continue.\u00a0<\/p>\n

Turning to abortion, the Trump administration surprised a lot of people this week when it continued the Biden administration\u2019s position asking for that case in Texas challenging the abortion pill to be dropped. For those who\u2019ve forgotten, this was a case originally filed by a bunch of Texas medical providers demanding the judge overrule the FDA\u2019s approval of the abortion pill mifepristone in the year 2000. The Supreme Court ruled the original plaintiff lacked standing to sue, but in the meantime, three states \u2014Missouri, Idaho, and Kansas \u2014 have taken their place as plaintiffs. But now the Trump administration points out that those states have no business suing in the Northern District of Texas, which kind of seems true on its face. But we should not mistake this to think that the Trump administration now supports the current approval status of the abortion bill. Right, Sandhya?\u00a0<\/p>\n

Raman:<\/strong> Yeah, I think you\u2019re exactly right. It doesn\u2019t surprise me. If they had allowed these three states, none of which are Texas \u2014 they shouldn\u2019t have standing. And if they did allow them to, that would open a whole new can of worms for so many other cases where the other side on so many issues could cherry-pick in the same way. And so I think, I assume, that this will come up in future cases for them and they will continue with the positions they\u2019ve had before. But this was probably in their best interest not to in this specific one.\u00a0<\/p>\n

Rovner:<\/strong> Yeah. There are also those who point out that this could be a way of the administration protecting itself. If it wants to roll back or reimpose restrictions on the abortion pill, it would help prevent blue states from suing to stop that. So it serves a double purpose here, right?\u00a0<\/p>\n

Raman:<\/strong> Yeah. I couldn\u2019t see them doing it another way. And even if you go through the ruling, the language they use, it\u2019s very careful. It\u2019s not dipping into talking fully about abortion. It\u2019s going purely on standing. Yeah.\u00a0<\/p>\n

Rovner:<\/strong> There\u2019s nothing that says, We think the abortion pill is fine the way it is<\/em>. It clearly does not say that, although they did get the headlines \u2014 and I\u2019m sure the president wanted \u2014 that makes it look like they\u2019re towing this middle ground on abortion, which they may be but not necessarily in this case.\u00a0<\/p>\n

Well, before we move off of reproductive health, a shoutout here to the incredible work of ProPublica<\/a>, which was awarded the Pulitzer Prize for public service this week for its stories on women who died due to abortion bans that prevented them from getting care for their pregnancy complications. Regular listeners of the podcast will remember that we talked about these stories as they came out last year, but I will post another link to them in the show notes today.\u00a0<\/p>\n

OK, moving on. There\u2019s even more drug price news this week, starting with the return of, quote, \u201cmost favored nation\u201d drug pricing. Anna, remind us what this is and why it\u2019s controversial.\u00a0<\/p>\n

Edney:<\/strong> Yeah. So the idea of most favored nation, this is something President Trump has brought up before in his first administration, but it creates a basket, essentially, of different prices that nations pay. And we\u2019re going to base ours on the lowest price that is paid for\u2014\u00a0<\/p>\n

Rovner:<\/strong> We\u2019re importing other countries\u2019\u2014\u00a0<\/p>\n

Edney:<\/strong> \u2014prices.\u00a0<\/p>\n

Rovner:<\/strong> \u2014price limits.\u00a0<\/p>\n

Edney:<\/strong> Yeah. Essentially, yes. We can\u2019t import their drugs, but we can import their prices. And so the goal is to just basically piggyback off of whoever is paying the lowest price and to base ours off of that. And clearly the drug industry does not like this and, I think, has faced a number of kind of hits this week where things are looming that could really come after them. So Politico broke that news<\/a> that Trump is going to sign or expected to sign an executive order that will direct his agencies to look into this most-favored-nation effort. And it feels very much like 2.0, like we were here before. And it didn\u2019t exactly work out, obviously.\u00a0<\/p>\n

Rovner:<\/strong> They sued, didn\u2019t they? The drug industry sued, as I recall.\u00a0<\/p>\n

Edney:<\/strong> Yeah, I think you\u2019re right. Yes.\u00a0<\/p>\n

Goldman:<\/strong> If I\u2019m remembering\u2014\u00a0<\/p>\n

Rovner:<\/strong> But I think they won.\u00a0<\/p>\n

Goldman:<\/strong> If I\u2019m remembering correctly, it was an Administrative Procedure Act lawsuit though, right? So\u2014\u00a0<\/p>\n

Rovner:<\/strong> It was. Yes. It was about a regulation. Yes.\u00a0<\/p>\n

Goldman:<\/strong> \u2014who knows what would happen if they go through a different procedure this time.\u00a0<\/p>\n

Rovner:<\/strong> So the other thing, obviously, that the drug industry is freaked out about right now are tariffs, which have been on again, off again, on again, off again. Where are we with tariffs on \u2014 and it\u2019s not just tariffs on drugs being imported. It\u2019s tariffs on drug ingredients being imported, right?\u00a0<\/p>\n

Edney:<\/strong> Yeah. And that\u2019s a particularly rough one because many ingredients are imported, and then some of the drugs are then finished here, just like a car. All the pieces are brought in and then put together in one place. And so this is something the Trump administration has began the process of investigating. And PhRMA [Pharmaceutical Research and Manufacturers of America], the trade group for the drug industry, has come out officially, as you would expect, against the tariffs, saying that: This will reduce our ability to do R&D. It will raise the price of drugs that Americans pay, because we\u2019re just going to pass this on to everyone.<\/em> And so we\u2019re still in this waiting zone of seeing when or exactly how much and all of that for the tariffs for pharma.\u00a0<\/p>\n

Rovner:<\/strong> And yet Americans are paying \u2014 already paying \u2014 more than they ever have. Maya, you have a story<\/a> just about that. Tell us.\u00a0<\/p>\n

Goldman:<\/strong> Yeah, there was a really interesting report from an analytics data firm that showed the price that Americans are paying for prescriptions is continuing to climb. Also, the number of prescriptions that Americans are taking is continuing to climb. It certainly will be interesting to see if this administration can be any more successful. That report, I don\u2019t think this made it into the article that I ended up writing, but it did show that the cost of insulin is down. And that\u2019s something that has been a federal policy intervention. We haven\u2019t seen a lot of the effects yet of the Medicare drug price negotiations, but I think there are signs that that could lower the prices that people are paying. So I think it\u2019s interesting to just see the evolution of all of this. It\u2019s very much in flux.\u00a0<\/p>\n

Rovner:<\/strong> A continuing effort. Well, we are now well into the second hundred days of Trump 2.0, and we\u2019re still learning about the cuts to health and health-related programs the administration is making. Just in this week\u2019s rundown are stories about hundreds more people being laid off at the National Cancer Institute, a stop-work order at the National Institute of Allergy and Infectious Diseases research lab at Fort Detrick, Maryland, that studies Ebola and other deadly infectious diseases, and the layoff of most of the remaining staff at the National Institute for Occupational Safety and Health.\u00a0<\/p>\n

A reminder that this is all separate from the discretionary-spending budget request that the administration sent up to lawmakers last week. That document calls for a 26% cut in non-mandatory funding at HHS, meaning just about everything other than Medicare and Medicaid. And it includes a proposed $18 billion cut to the NIH [National Institutes of Health] and elimination of the $4 billion Low Income Home Energy Assistance Program, which helps millions of low-income Americans pay their heating and air conditioning bills. Now, this is normally the part of the federal budget that\u2019s deemed dead on arrival. The president sends up his budget request, and Congress says, Yeah, we\u2019re not doing that.<\/em> But this at least does give us an idea of what direction the administration wants to take at HHS, right? What\u2019s the likelihood of Congress endorsing any of these really huge, deep cuts?\u00a0<\/p>\n

Raman:<\/strong> From both sides\u2014\u00a0<\/p>\n

Rovner:<\/strong> Go ahead, Sandhya.\u00a0<\/p>\n

Raman:<\/strong> It\u2019s not going to happen, and they need 60 votes in the Senate to pass the appropriations bills. I think that when we\u2019re looking in the House in particular, there are a lot of things in what we know from this so-called skinny budget document that they could take up and put in their bill for Labor, HHS, and Education. But I think the Senate\u2019s going to be a different story, just because the Senate Appropriations chair is Susan Collins and she, as soon as this came out, had some pretty sharp words about the big cuts to NIH. They\u2019ve had one in a series of two hearings on biomedical research. Concerned about some of these kinds of things. So I cannot necessarily see that sharp of a cut coming to fruition for NIH, but they might need to make some concessions on some other things.\u00a0<\/p>\n

This is also just a not full document. It has some things and others. I didn\u2019t see any to FDA in there at all. So that was a question mark, even though they had some more information in some of the documents that had leaked kind of earlier on a larger version of this budget request. So I think we\u2019ll see more about how people are feeling next week when we start having Secretary Kennedy testify on some of these. But I would not expect most of this to make it into whatever appropriations law we get.\u00a0<\/p>\n

Goldman:<\/strong> I was just going to say that. You take it seriously but not literally, is what I\u2019ve been hearing from people.\u00a0<\/p>\n

Edney:<\/strong> We don\u2019t have a full picture of what has already been cut. So to go in and then endorse cutting some more, maybe a little bit too early for that, because even at this point they\u2019re still bringing people back that they cut. They\u2019re finding out, Oh, this is actually something that is really important and that we need<\/em>, so to do even more doesn\u2019t seem to make a lot of sense right now.\u00a0<\/p>\n

Rovner:<\/strong> Yeah, that state of disarray is purposeful, I would guess, and doing a really good job at sort of clouding things up.\u00a0<\/p>\n

Goldman:<\/strong> One note on the cuts. I talked to someone at HHS this week who said as they\u2019re bringing back some of these specialized people, in order to maintain the legality of, what they see as the legality of, the RIF [reduction in force], they need to lay off additional people to keep that number consistent. So I think that is very much in flux still and interesting to watch.\u00a0<\/p>\n

Rovner:<\/strong> Yeah, and I think that\u2019s part of what we were seeing this week is that the groups that got spared are now getting cut because they\u2019ve had to bring back other people. And as I point out, I guess, every week, pretty much all of this is illegal. And as it goes to courts, judges say, You can\u2019t do this.<\/em> So everything is in flux and will continue.\u00a0<\/p>\n

All right, finally this week, Health and Human Services Secretary Robert F. Kennedy Jr., who as of now is scheduled to appear before the Senate Health, Education, Labor, and Pensions Committee next week to talk about the department\u2019s proposed budget, is asking CDC [the Centers for Disease Control and Prevention] to develop new guidance for treating measles with drugs and vitamins. This comes a week after he ordered a change in vaccine policy you already mentioned, Anna, so that new vaccines would have to be tested against placebos rather than older versions of the vaccine. These are all exactly the kinds of things that Kennedy promised health committee chairman Bill Cassidy he wouldn\u2019t do. And yet we\u2019ve heard almost nothing from Cassidy about anything the secretary has said or done since he\u2019s been in office. So what do we expect to happen when they come face-to-face with each other in front of the cameras next week, assuming that it happens?\u00a0<\/p>\n

Edney:<\/strong> I\u2019m very curious. I don\u2019t know. Do I expect a senator to take a stand? I don\u2019t necessarily, but this\u2014\u00a0<\/p>\n

Rovner:<\/strong> He hasn\u2019t yet.\u00a0<\/p>\n

Edney:<\/strong> Yeah, he hasn\u2019t yet. But this is maybe about face-saving too for him. So I don\u2019t know.\u00a0<\/p>\n

Rovner:<\/strong> Face-saving for Kennedy or for Cassidy?\u00a0<\/p>\n

Edney:<\/strong> For Cassidy, given he said: I\u2019m going to keep an eye on him. We\u2019re going to talk all the time, and he is not going to do this thing without my input.<\/em> I\u2019m not sure how Cassidy will approach that. I think it\u2019ll be a really interesting hearing that we\u2019ll all be watching.\u00a0<\/p>\n

Rovner:<\/strong> Yes. And just little announcement, if it does happen, that we are going to do sort of a special Wednesday afternoon after the hearing with some of our KFF Health News colleagues. So we are looking forward to that hearing. All right, that is this week\u2019s news. Now we will play my \u201cBill of the Month\u201d interview with Lauren Sausser, and then we will come back and do our extra credits.\u00a0<\/p>\n

I am pleased to welcome back to the podcast KFF Health News\u2019 Lauren Sausser, who co-reported and wrote the latest KFF Health News \u201cBill of the Month<\/a>.\u201d Lauren, welcome back.\u00a0<\/p>\n

Lauren Sausser:<\/strong> Thank you. Thanks for having me.\u00a0<\/p>\n

Rovner:<\/strong> So this month\u2019s patient got preventive care, which the Affordable Care Act was supposed to incentivize by making it cost-free at the point of service \u2014 except it wasn\u2019t. Tell us who the patient is and what kind of care they got.\u00a0<\/p>\n

Sausser:<\/strong> Carmen Aiken is from Chicago. Carmen uses they\/them pronouns. And Carmen made an appointment in the summer of 2023 for an annual checkup. This is just like a wellness check that you are very familiar with. You get your vaccines updated. You get your weight checked. You talk to your doctor about your physical activity and your family history. You might get some blood work done. Standard stuff.\u00a0<\/p>\n

Rovner:<\/strong> And how big was the bill?\u00a0<\/p>\n

Sausser:<\/strong> The bill ended up being more than $1,400 when it should, in Carmen\u2019s mind, have been free.\u00a0<\/p>\n

Rovner:<\/strong> Which is a lot.\u00a0<\/p>\n

Sausser:<\/strong> A lot.\u00a0<\/p>\n

Rovner:<\/strong> I assume that there was a complaint to the health plan and the health plan said, Nope, not covered<\/em>. Why did they say that?\u00a0<\/p>\n

Sausser:<\/strong> It turns out that alongside with some blood work that was preventive, Carmen also had some blood work done to monitor an ongoing prescription. Because that blood test is not considered a standard preventive service, the entire appointment was categorized as diagnostic and not preventive. So all of these services that would\u2019ve been free to them, available at no cost, all of a sudden Carmen became responsible for.\u00a0<\/p>\n

Rovner:<\/strong> So even if the care was diagnostic rather than strictly preventive \u2014 obviously debatable \u2014 that sounds like a lot of money for a vaccine and some blood test. Why was the bill so high?\u00a0<\/p>\n

Sausser:<\/strong> Part of the reason the bill was so high was because Carmen\u2019s blood work was sent to a hospital for processing, and hospitals, as you know, can charge a lot more for the same services. So under Carmen\u2019s health plan, they were responsible for, I believe it was, 50% of the cost of services performed in an outpatient hospital setting. And that\u2019s what that blood work fell under. So the charges were high.\u00a0<\/p>\n

Rovner:<\/strong> So we\u2019ve talked a lot on the podcast about this fight in Congress to create site-neutral payments. This is a case where that probably would\u2019ve made a big difference.\u00a0<\/p>\n

Sausser:<\/strong> Yeah, it would. And there\u2019s discussion, there\u2019s bipartisan support for it. The idea is that you should not have to pay more for the same services that are delivered at different places. But right now there\u2019s no legislation to protect patients like Carmen from incurring higher charges.\u00a0<\/p>\n

Rovner:<\/strong> So what eventually happened with this bill?\u00a0<\/p>\n

Sausser:<\/strong> Carmen ended up paying it. They put it on a credit card. This was of course after they tried appealing it to their insurance company. Their insurance company decided that they agreed with the provider that these services were diagnostic, not preventive. And so, yeah, Carmen was losing sleep over this and decided ultimately that they were just going to pay it.\u00a0<\/p>\n

Rovner:<\/strong> And at least it was a four-figure bill and not a five-figure bill.\u00a0<\/p>\n

Sausser:<\/strong> Right.\u00a0<\/p>\n

Rovner:<\/strong> What\u2019s the takeaway here? I imagine it is not that you should skip needed preventive\/diagnostic care. Some drugs, when you\u2019re on them, they say that you should have blood work done periodically to make sure you\u2019re not having side effects.\u00a0<\/p>\n

Sausser:<\/strong> Right. You should not skip preventive services. And that\u2019s the whole intent behind this in the ACA. It catches stuff early so that it becomes more treatable. I think you have to be really, really careful and specific when you\u2019re making appointments, and about your intention for the appointment, so that you don\u2019t incur charges like this. I think that you can also be really careful about where you get your blood work conducted. A lot of times you\u2019ll see these signs in the doctor\u2019s office like: We use this lab. If this isn\u2019t in-network with you, you need to let us know.<\/em> Because the charges that you can face really vary depending on where those labs are processed. So you can be really careful about that, too.\u00a0<\/p>\n

Rovner:<\/strong> And adding to all of this, there\u2019s the pending Supreme Court case that could change it, right?\u00a0<\/p>\n

Sausser:<\/strong> Right. The Supreme Court heard oral arguments. It was in April. I think it was on the 21st. And it is a case that originated out in Texas. There is a group of Christian businesses that are challenging the mandate in the ACA that requires health insurers to cover a lot of these preventive services. So obviously we don\u2019t have a decision in the case yet, but we\u2019ll see.\u00a0<\/p>\n

Rovner:<\/strong> We will, and we will cover it on the podcast. Lauren Sausser, thank you so much.\u00a0<\/p>\n

Sausser:<\/strong> Thank you.\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. Maya, you were the first to choose this week, so why don\u2019t you go first?\u00a0<\/p>\n

Goldman:<\/strong> My extra credit is from Stat. It\u2019s called \u201cEurope Unveils $565 Million Package To Retain Scientists, and Attract New Ones<\/a>,\u201d by Andrew Joseph. And I just think it\u2019s a really interesting evidence point to the United States\u2019 losses, other countries\u2019 gain. The U.S. has long been the pinnacle of research science, and people flock to this country to do research. And I think we\u2019re already seeing a reversal of that as cuts to NIH funding and other scientific enterprises is reduced.\u00a0<\/p>\n

Rovner:<\/strong> Yep. A lot of stories about this, too. Anna.\u00a0<\/p>\n

Edney:<\/strong> So mine is from a couple of my colleagues that they did earlier this week. \u201cA Former TV Writer Found a Health-Care Loophole That Threatens To Blow Up Obamacare<\/a>.\u201d And I thought it was really interesting because it had brought me back to these cheap, bare-bones plans that people were allowed to start selling that don\u2019t meet any of the Obamacare requirements. And so this guy who used to, in the \u201980s and \u201990s, wrote for sitcoms \u2014 \u201cCoach\u201d or \u201cNight Court,\u201d if anyone goes to watch those on reruns. But he did a series of random things after that and has sort of now landed on selling these junk plans, but doing it in a really weird way that signs people up for a job that they don\u2019t know they\u2019re being signed up for. And I think it\u2019s just, it\u2019s an interesting read because we knew when these things were coming online that this was shady and people weren\u2019t going to get the coverage they needed. And this takes it to an extra level. They\u2019re still around, and they\u2019re still ripping people off.\u00a0<\/p>\n

Rovner:<\/strong> Or as I\u2019d like to subhead this story: Creative people think of creative things.\u00a0<\/p>\n

Edney:<\/strong> \u201cCreative\u201d is a nice word.\u00a0<\/p>\n

Rovner:<\/strong> Sandhya.\u00a0<\/p>\n

Raman:<\/strong> So my pick is \u201cIn the Deep South, Health Care Fights Echo Civil Rights Battles<\/a>,\u201d and it\u2019s from Anna Claire Vollers at the Louisiana Illuminator. And her story looks at some of the ties between civil rights and health. So 2025 is the 70th anniversary of the bus boycott, the 60th anniversary of Selma-to-Montgomery marches, the Voting Rights Act. And it\u2019s also the 60th anniversary of Medicaid. And she goes into, Medicaid isn\u2019t something you usually consider a civil rights win, but health as a human right was part of the civil rights movement. And I think it\u2019s an interesting piece.\u00a0<\/p>\n

Rovner:<\/strong> It is an interesting piece, and we should point out Medicare was also a huge civil rights, important piece of law because it desegregated all the hospitals in the South. All right, my extra credit this week is a truly infuriating story from NPR by Andrea Hsu. It\u2019s called \u201cFired, Rehired, and Fired Again: Some Federal Workers Find They\u2019re Suddenly Uninsured<\/a>.\u201d And it\u2019s a situation that if a private employer did it, Congress would be all over them and it would be making huge headlines. These are federal workers who are trying to do the right thing for themselves and their families but who are being jerked around in impossible ways and have no idea not just whether they have jobs but whether they have health insurance, and whether the medical care that they\u2019re getting while this all gets sorted out will be covered. It\u2019s one thing to shrink the federal workforce, but there is some basic human decency for people who haven\u2019t done anything wrong, and a lot of now-former federal workers are not getting it at the moment.\u00a0<\/p>\n

OK, that is this week\u2019s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate 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 wh***********<\/span>@*<\/span>ff.org<\/span>, or you can still find me on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you folks hanging these days? Sandhya?\u00a0<\/p>\n

Raman:<\/strong> I\u2019m on X, @SandhyaWrites<\/a>, and also on Bluesky, @SandhyaWrites<\/a> at Bluesky.\u00a0<\/p>\n

Rovner:<\/strong> Anna.\u00a0<\/p>\n

Edney:<\/strong> X<\/a> and Bluesky<\/a>, @annaedney.\u00a0<\/p>\n

Rovner:<\/strong> Maya.\u00a0<\/p>\n

Goldman:<\/strong> I am on X, @mayagoldman_<\/a>. Same on Bluesky<\/a> and also increasingly on LinkedIn<\/a>.\u00a0<\/p>\n

Rovner:<\/strong> All right, we\u2019ll be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n<\/p><\/div>\n

Thomas Roberie
Read More<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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