\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n The Supreme Court this week ruled in favor of Tennessee\u2019s law banning most gender-affirming care for minors \u2014 a law similar to those in two dozen other states.<\/p>\n Meanwhile, the Senate is still hoping to complete work on its version of President Donald Trump\u2019s huge budget reconciliation bill before the July Fourth break. But deeper cuts to the Medicaid program than those included in the House-passed bill could prove difficult to swallow for moderate senators.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Victoria Knight of Axios, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.<\/p>\n \t\t\t \tVictoria Knight \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \t\t\t \tSandhya Raman \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n 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> The New York Times\u2019 \u201cThe Bureaucrat and the Billionaire: Inside DOGE\u2019s Chaotic Takeover of Social Security<\/a>,\u201d by Alexandra Berzon, Nicholas Nehamas, and Tara Siegel Bernard.\u00a0\u00a0<\/p>\n Victoria Knight:<\/strong> The New York Times\u2019 \u201cThey Asked an A.I. Chatbot Questions. The Answers Sent Them Spiraling<\/a>,\u201d by Kashmir Hill.\u00a0\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Wired\u2019s \u201cWhat Tear Gas and Rubber Bullets Do to the Human Body<\/a>,\u201d by Emily Mullin.\u00a0\u00a0<\/p>\n Sandhya Raman:<\/strong> North Carolina Health News and The Charlotte Ledger\u2019s \u201cAmbulance Companies Collect Millions by Seizing Wages, State Tax Refunds<\/a>,\u201d by Michelle Crouch.\u00a0\u00a0<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Supreme Court Upholds Bans on Gender-Affirming Care\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 Friday, June 20, 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> Sandhya Raman of CQ Roll Call.\u00a0<\/p>\n Sandhya Raman:<\/strong> Good morning.\u00a0<\/p>\n Rovner:<\/strong> And Victoria Knight of Axios News.\u00a0<\/p>\n Victoria Knight:<\/strong> Hello, everyone.\u00a0<\/p>\n Rovner:<\/strong> No interview this week but more than enough news to make up for it, so we will go right to it. It is June. That means it is time for the Supreme Court to release its biggest opinions of the term. On Wednesday, the justices upheld Tennessee\u2019s law banning gender-affirming medical care for trans minors. And presumably that means similar laws in two dozen other states can stand as well. Alice, what does this mean in real-world terms?\u00a0<\/p>\n Ollstein:<\/strong> So, this is a blow to people\u2019s ability to access gender-affirming care as minors, even if their parents support them transitioning. But it\u2019s not necessarily as restrictive a ruling as it could have been. The court could have gone farther. And so supporters of access to gender-affirming care see a silver lining in that the court didn\u2019t go far enough to rule that all laws discriminating against transgender people are fine and constitutional. A few justices more or less said that in their separate opinions, but the majority opinion just stuck with upholding this law, basically saying that it doesn\u2019t discriminate based on gender or transgender status.\u00a0<\/p>\n Rovner:<\/strong> Which feels a little odd.\u00a0<\/p>\n Ollstein:<\/strong> Yes. So, obviously, many people have said, How can you say that laws that only apply to transgender people are not discriminatory?<\/em> So, been some back-and-forth about that. But the majority opinion said, Well, we don\u2019t have to reach this far and decide right now if laws that discriminate against transgender people are constitutional, because this law doesn\u2019t.<\/em> They said it discriminates based on diagnosis \u2014 so anyone of any gender who has the diagnosis of gender dysphoria for medications, hormones, that\u2019s not a gender discrimination. But obviously the only people who do have those diagnoses are transgender, and so it was a logic that the dissenters, the three progressive dissenters, really ripped into.\u00a0<\/p>\n Rovner:<\/strong> And just to be clear, we\u2019ve heard about, there are a lot of laws that ban sort of not-reversible types of treatments for minors, but you could take hormones or puberty blockers. This Tennessee law covers basically everything for trans care, right?\u00a0<\/p>\n Ollstein:<\/strong> That\u2019s right, but only the piece about medications was challenged up to the Supreme Court, not the procedures and surgeries, which are much more rare for minors anyways. But it is important to note that some of the conservatives on the court said they would\u2019ve gone further, and they basically said, This law does discriminate against transgender kids, and that is fine with us.<\/em> And they said the court should have gone further and made that additional argument, which they did not at this time.\u00a0<\/p>\n Rovner:<\/strong> Well, I\u2019m sure the court will get another chance sometime in the future. While we\u2019re on the subject of gender-affirming care in the courts, in Texas on Wednesday, conservative federal district judge Matthew Kacsmaryk \u2014 that\u2019s the same judge who unsuccessfully tried to repeal the FDA\u2019s [Food and Drug Administration\u2019s] approval of the abortion pill a couple of years ago \u2014 has now ruled that the Biden administration\u2019s expansion of the HIPAA [Health Insurance Portability and Accountability Act] medical privacy rules to protect records on abortion and gender-affirming care from being used for fishing expeditions by conservative prosecutors was an overreach, and he slapped a nationwide injunction on those rules. What could this mean if it\u2019s ultimately upheld?\u00a0<\/p>\n Ollstein:<\/strong> I kind of see this in some ways like the Trump administration getting rid of the EMTALA [Emergency Medical Treatment and Labor Act] guidance, where the underlying law is still there. This is sort of an interpretation and a guidance that was put out on top of it, saying, We interpret HIPAA, which has been around a long time, to apply in these contexts<\/em>, because we\u2019re in this brave new world where we don\u2019t have Roe v. Wade<\/em> anymore and states are seeking records from other states to try to prosecute people for circumventing abortion bans. And so, that wasn\u2019t written into statute before, because that never happened before.\u00a0<\/p>\n And so the Biden administration was attempting to respond to things like that by putting out this rule, which has now been blocked nationwide. I\u2019m sure litigation will continue. There are also efforts in the courts to challenge HIPAA more broadly. And so, I would be interested in tracking how this plays into that.\u00a0<\/p>\n Rovner:<\/strong> Yeah. There\u2019s plenty of efforts sort of on this front. And certainly, with the advent of AI [artificial intelligence], I think that medical privacy is going to play a bigger role sort of as we go forward. All right. Moving on. While the Supreme Court is preparing to wrap up for the term, Congress is just getting revved up. Next up for the Senate is the budget reconciliation, quote, \u201cBig Beautiful Bill,\u201d with most of President [Donald] Trump\u2019s agenda in it. This week, the Senate Finance Committee unveiled its changes to the House-passed bill, and rather than easing back on the Medicaid cuts, as many had expected in a chamber where just a few moderates can tank the entire bill, the Finance version makes the cuts even larger. Do we have any idea what\u2019s going on here?\u00a0<\/p>\n Knight:<\/strong> Well, I think mostly they want to give themselves more flexibility in order to pursue some of the tax policies that President Trump really wants. And so they need more savings, basically, to be able to do that and be able to do it for a longer amount of years. And so that\u2019s kind of what I\u2019ve heard, is they wanted to give themselves more room to play around with the policy, see what fits where. But a lot of people were surprised because the Senate is usually more moderate on things, but in this case I think it\u2019s partially because they specifically looked at a provision called provider taxes. It\u2019s a way that states can help fund their Medicaid programs, and so it\u2019s a tax levied on providers. So I think they see that as maybe \u2014 it could still affect people\u2019s benefits, but it\u2019s aimed at providers \u2014 and so maybe that\u2019s part of it as well.\u00a0<\/p>\n Rovner:<\/strong> Well, of course aiming at providers is not doing them very much good, because hospitals are basically freaking out over this. Now there is talk of creating a rural hospital slush fund to maybe try to quell some of the complaints from hospitals and make some of those moderates feel better about voting for a bill that the Congressional Budget Office still says takes health insurance and food aid from the poor to give tax cuts to the rich. But if the Senate makes a slush fund big enough to really protect those hospitals, wouldn\u2019t that just eliminate the Medicaid savings that they need to pay for those tax cuts, Victoria? That\u2019s what you were just saying. That\u2019s why they made the Medicaid cuts bigger.\u00a0<\/p>\n Knight:<\/strong> Yeah. I think there\u2019s quite a few solutions that people are throwing around and proposing. Yeah, but, exactly. Depending on if they do a provider relief fund, yeah, then the savings may need to go to that. I\u2019ve also heard \u2014 I was talking to senators last week, and some of them were like, I\u2019d rather just go back to the House\u2019s version.<\/em> So the House\u2019s version of the bill put a freeze on states\u2019 ability to raise the provider tax, but the Senate version incrementally lowers the amount of provider tax they can levy over years. The House just freezes it and doesn\u2019t allow new ones to go higher. Some senators are like: Actually, can we just do that, go back to that? And we could live with that.<\/em>\u00a0<\/p>\n Even Sen. Josh Hawley, who has been one of the biggest vocal voices on concern for rural hospitals and concern for Medicaid cuts, he told me, Freeze would be OK with me.<\/em> And so, I don\u2019t know. I could see them maybe doing that, but we\u2019ll see. There\u2019s probably more negotiations going on over the weekend, and they\u2019re also going to start the \u201cByrd bath\u201d procedure, which basically determines whether provisions in the bill are related to the budget or not and can stay in the bill. And so, there\u2019s actually gender-affirming care and abortion provisions in the bill that may get thrown out because of that. So\u2014\u00a0<\/p>\n Rovner:<\/strong> Yeah, this is just for those who don\u2019t follow reconciliation the way we do, the \u201cByrd bath,\u201d named for the former Sen. [Robert] Byrd, who put this rule in that said, Look, if you\u2019re going to do this big budget bill with only 50 votes, it\u2019s got to be related to the budget.<\/em> So basically, the parliamentarian makes those determinations. And what we call the \u201cByrd bath\u201d is when those on both sides of a provision that\u2019s controversial go to the parliamentarian in advance and make their case. And the parliamentarian basically tells them in private what she\u2019s going to do \u2014 like, This can stay in,<\/em> or, This will have to go out.<\/em> If the parliamentarian rules it has to go out, then it needs to overcome a budget point of order that needs 60 votes. So basically, that\u2019s why stuff gets thrown out, unless they think it\u2019s popular enough that it could get 60 votes. And sorry, that\u2019s my little civics lesson for the day. Finish what you were saying, Victoria.\u00a0<\/p>\n Knight:<\/strong> No, that was a perfect explanation. Thank you. But I was just saying, yeah, I think that there are still some negotiations going on for the Medicaid stuff. And where also, you have to remember, this has to go back to the House. And so it passed the House with the provider tax freeze, and that still required negotiations with some of the more moderate members of House Republicans. And some of them started expressing their concern about the Senate going further. And so they still need to \u2014 it has to go back through the House again, so they need to make these Senate moderates happy and House moderates happy. There\u2019s also the fiscal conservatives that want deeper cuts. So there\u2019s a lot of people within the caucus that they need to strike a balance. And so, I don\u2019t know if this will be the final way the bill looks yet.\u00a0<\/p>\n Rovner:<\/strong> Although, I think I say this every week, we have all of these Republicans saying: I won\u2019t vote for this bill. I won\u2019t vote for this bill.<\/em> And then they inevitably turn around and vote for this bill. Do we believe that any of these people really would tank this bill?\u00a0<\/p>\n Knight:<\/strong> That\u2019s a great point. Yeah. Sandhya, go ahead.\u00a0<\/p>\n Raman:<\/strong> There are at least a couple that I don\u2019t think, anything that we do, they\u2019re not going to change their mind. There is no courting of Rep. [Thomas] Massie in the House, because he\u2019s not going to vote for it. I feel like in the Senate it\u2019s going to be really hard to get Rand Paul on board, just because he does not want to raise the deficit. I think the others, it\u2019s a little bit more squishy, depends kind of what the parliamentarian pulls out. And I guess also one thing I\u2019m thinking about is if the things they pull out are big cost-savers and they have to go back to the drawing board to generate more savings. We\u2019ve only had a few of the things that they\u2019ve advised on so far, but it\u2019s not health, and we still need to see \u2014 health are the big points. So, I think\u2014\u00a0<\/p>\n Rovner:<\/strong> Well, they haven\u2019t started the \u201cByrd bath\u201d on the Finance provisions\u2014\u00a0<\/p>\n Raman:<\/strong> Yes, or\u2014\u00a0<\/p>\n Rovner:<\/strong> \u2014which is where all the health stuff is.\u00a0<\/p>\n Raman:<\/strong> Yeah.\u00a0<\/p>\n Knight:<\/strong> But that is supposed to be over the weekend. It\u2019s supposed to start over the weekend.\u00a0<\/p>\n Raman: <\/strong>Yes.\u00a0<\/p>\n Rovner:<\/strong> Right.\u00a0<\/p>\n Raman:<\/strong> Yeah. So, I think, depending on that, we will see. Historically, we have had people kind of go back and forth. And even with the House, there were people that voted for it that then now said, Well, I actually don\u2019t support that anymore.<\/em> So I think just going back to just what the House said might not be the solution, either. They have to find some sort of in-between before their July Fourth deadline.\u00a0<\/p>\n Rovner:<\/strong> I was just going to say, so does this thing happen before July Fourth? I noticed that that Susie Wiles, the White House chief of staff said: Continue. It needs to be on the president\u2019s desk by July Fourth.<\/em> Which seems pretty nigh impossible. But I could see it getting through the Senate by July Fourth. I\u2019m seeing some nods. Is that still the goal?\u00a0<\/p>\n Knight:<\/strong> Yeah. I think that\u2019s the goal. That\u2019s what Senate Majority Leader [John] Thune has been telling people. He wants to try to pass it by mid-, or I think start the process by, midweek. And then it\u2019s going to have to go through a \u201cvote-a-rama.\u201d So Democrats will be able to offer a ton of amendments. It\u2019ll probably go through the night, and that\u2019ll last a while. And so, I saw some estimate, maybe it\u2019ll get passed next weekend through the Senate, but that\u2019s probably if everything goes as it\u2019s supposed to go. So, something could mess that up.\u00a0<\/p>\n But, yeah, I think the factor here that has \u2014 I think everyone\u2019s kind of been like: They\u2019re not going to be able to do it. They\u2019re not going to be able to do it.<\/em> With the House, especially \u2014 the House is so rowdy. But then, when Trump calls people and tells them to vote for it, they do it. There\u2019s a few, yeah, like Rand Paul and Massie \u2014 they\u2019re basically the only ones that will not vote when Trump tells them to. But other than that \u2014 so if he wants it done, I do think he can help push to get it done.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I noticed one change, as I was going through, in the Senate bill from the House bill is that they would raise the debt ceiling to $5 trillion. It\u2019s like, that\u2019s a pretty big number. Yeah. I\u2019m thinking that alone is what says Rand Paul is a no. Before we move on, one more thing I feel like we can\u2019t repeat enough: This bill doesn\u2019t just cut Medicaid spending. It also takes aim at the Affordable Care Act and even Medicare. And a bunch of new polls<\/a> this week show that even Republicans aren\u2019t super excited about this bill. Are Republican members of Congress going to notice this at some point? Yeah, the president is popular, but this bill certainly isn\u2019t.\u00a0<\/p>\n Raman:<\/strong> When you look at some of the town halls that they\u2019ve had \u2014 or tried to have \u2014 over the last couple months and then scaled back because there was a lot of pushback directly on this, the Medicaid provisions, they have to be aware. But I think if you look at that polling, if you look at the people that identify as MAGA within Republicans, it\u2019s popular for them. It\u2019s just more broadly less popular. So I think that\u2019s part of it, but\u2014\u00a0<\/p>\n Ollstein:<\/strong> I think that people are very opposed to the policies in the bill, but I also think people are very overwhelmed and distracted right now. There\u2019s a lot going on, and so I\u2019m not sure there will be the same national focus on this the way there was in 2017 when people really rallied in huge ways to protect the Affordable Care Act and push Congress not to overturn it. And so I think maybe that could be a factor in that outrage not manifesting as much. I also think that\u2019s a reason they\u2019re trying to do this quickly, that July Fourth deadline, before those protest movements have an opportunity to sort of organize and coalesce.\u00a0<\/p>\n Just real quickly on the rural hospital slush fund, I saw some smart people comparing it to a throwback, the high-risk pools model, in that unless you pour a ton of funding into it, it\u2019s not going to solve the problem. And if you pour a ton of funding into it, you don\u2019t have the savings that created the problem in the first place, the cuts. And all that is to say also, how do we define rural? A lot of suburban and urban hospitals are also really struggling currently and would be subject to close. And so now you get into the pitting members and districts against each other, because some people\u2019s hospitals might be saved and others might be left out in the cold. And so I just think it\u2019s going to be messy going forward.\u00a0<\/p>\n Rovner:<\/strong> I spent a good part of the late \u201980s and early \u201990s pulling out of bills little tiny provisions that would get tucked in to reclassify hospitals as rural so they could qualify, because there are already a lot of programs that give more money to rural hospitals to keep them open. Sorry, Victoria, we should move on, but you wanted to say one more thing?\u00a0<\/p>\n Knight:<\/strong> Oh, yeah. No. I was just going to say, going back to the unpopularity of the bill based on polling, and I think that we\u2019ll see at least Democrats \u2014 if Republicans get this done and they have the work requirements and the other cuts to Medicaid in the bill, cuts to ACA, no renewal of premium tax credits \u2014 I think Democrats will really try to make the midterms about this, right? We already are seeing them messaging about it really hardcore, and obviously the Democrats are trying to find their way right now post-[Joe] Biden, post-[Kamala] Harris. So I think they\u2019ll at least try to make this bill the thing and see if it\u2019s unpopular with the general public, what Republicans did with health care on this. So we\u2019ll see if that works for them, but I think they\u2019re going to try.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think you\u2019re right. Well, speaking of Medicare, we got the annual trustees report this week, and the insolvency date for Medicare\u2019s Hospital Insurance Trust Fund has moved up to 2033. That\u2019s three years sooner than predicted last year. Yet there\u2019s nothing in the budget reconciliation bill that would address that, not even a potentially bipartisan effort to go after upcoding in Medicare Advantage that we thought the Finance Committee might do, that would save money for Medicare that insurers are basically overcharging the government for. What happened to the idea of going after Medicare Advantage overpayments?\u00a0<\/p>\n Knight:<\/strong> My general vibe I got from asking senators was that Trump said, We\u2019re not touching Medicare in this bill.<\/em> He did not want that to happen. And I think, again, maybe potentially thinking about the midterms, just the messaging on that, touching Medicare, it kind of always goes where they don\u2019t want to touch Medicare, because it\u2019s older people, but Medicaid is OK, even though it\u2019s poor people.\u00a0<\/p>\n Rovner:<\/strong> And older people.\u00a0<\/p>\n Ollstein:<\/strong> And they are touching Medicare in the bill anyway.\u00a0<\/p>\n Rovner:<\/strong> Thank you. I know. I think that\u2019s the part that makes my head swim. It\u2019s like, really? There are several things that actually touch Medicare in this bill, but the thing that they could probably save a good chunk of money on and that both parties agree on is the thing that they\u2019re not doing.\u00a0<\/p>\n Knight:<\/strong> Exactly. It was very bipartisan.\u00a0<\/p>\n Rovner:<\/strong> Yes. It was very bipartisan, and it\u2019s not there. All right. Moving on. Elon Musk has gone back to watching his SpaceX rockets blow up on the launchpad, which feels like a fitting metaphor for what\u2019s been left behind at the Department of Health and Human Services following some of the DOGE [Department of Government Efficiency] cuts. On Monday, a federal judge in Massachusetts ruled that billions of dollars in cuts to about 800 NIH [National Institutes of Health] research grants due to DEI [diversity, equity, and inclusion] were, quote, \u201carbitrary and capricious\u201d and wrote, quote, \u201cI\u2019ve never seen government racial discrimination like this.\u201d And mind you, this was a judge who was appointed by [President] Ronald Reagan. So what happens now? It\u2019s been months since these grants were terminated, and even though the judge has ordered the funding restored, this obviously isn\u2019t the last word, and one would expect the administration\u2019s going to appeal, right? So these people are just supposed to hang out and wait to see if their research gets to continue?\u00a0<\/p>\n Raman:<\/strong> This has been a big thing that has come up in all of the appropriations hearings we\u2019ve had so far this year, that even though the gist of that is to look forward at the next year\u2019s appropriations, it\u2019s been a big topic of just: There is funding that we as Congress have already appropriated for this. Why isn\u2019t it getting distributed?<\/em> So I think that will definitely be something that they push back up on the next ones of those. Some of the different senators have said that they\u2019ve been looking into it and how it\u2019s been affecting their districts. So I would say that. But I think the White House in response to that called the decision political, which I thought was interesting given, like you said, it was a Reagan appointee that said this. So it\u2019ll definitely be something that I think will be appealed and be a major issue.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, and the folks I\u2019ve talked to who\u2019ve been impacted by this stress that you can\u2019t flip funding on and off like a switch and expect research to continue just fine. Once things are halted, they\u2019re halted. And in a lot of cases, it is irreversible. Samples are thrown out. People are laid off. Labs are shut down. Even if there\u2019s a ruling that reverses the policy, that often comes too late to make a difference. And at the same time, people are not waiting around to see how this back-and-forth plays out. People are getting actively recruited by universities and other countries saying: Hey, we\u2019re not going to defund you suddenly. Come here.<\/em> And they\u2019re moving to the private sector. And so I think this is really going to have a long impact no matter what happens, a long tail.\u00a0<\/p>\n Rovner:<\/strong> And yet we got another reminder this week of the major advances that federally funded research can produce, with the FDA approval of a twice-a-year shot that can basically prevent HIV infection. Will this be able to make up maybe for the huge cuts to HIV programs that this administration is making?\u00a0<\/p>\n Raman:<\/strong> It\u2019s only one drug, and we have to see what the price is, what cost\u2014\u00a0<\/p>\n Rovner:<\/strong> So far the price is huge. I think I saw it was going to be like $14,000 a shot.\u00a0<\/p>\n Raman:<\/strong> Which means that something like PrEP [pre-exposure prophylaxis] is still going to be a lot more affordable for different groups, for states, for relief efforts. So I think that it\u2019s a good step on the research front, but until the price comes down, the other tools in the toolbox are going to be a lot more feasible to do.\u00a0<\/p>\n Rovner:<\/strong> Yeah. So much for President Trump\u2019s goal to end HIV. So very first-term. All right. Well, turning to abortion, it\u2019s been almost exactly three years since the Supreme Court overturned the nationwide right to abortion in the Dobbs<\/em> case. In that time we\u2019ve seen abortion outlawed in nearly half the states but abortions overall rise due to the expanded use of abortion medication. We\u2019ve seen doctors leaving states with bans, for fear of not being able to provide needed care for patients with pregnancy complications. And we\u2019ve seen graduating medical students avoiding taking residencies in those states for the same reason. Alice, what\u2019s the next front in the battle over abortion in the U.S.?\u00a0<\/p>\n Ollstein:<\/strong> It\u2019s been one of the main fronts, even before Dobbs,<\/em> but it\u2019s just all about the pills right now. That\u2019s really where all of the attention is. So whether that\u2019s efforts ongoing in the courts back before our friend Kacsmaryk to try to challenge the FDA\u2019s policies around the pills and impose restrictions nationwide, there\u2019s efforts at the state level. There\u2019s agitation for Congress to do something, although I think that\u2019s the least likely option. I think it\u2019s much more likely that it\u2019s going to come from agency regulation or from the courts or from states. So I would put Congress last on the list of actors here. But I think that\u2019s really it. And I think we\u2019re also seeing the same pattern that we see in gender-affirming care battles, where there\u2019s a lot of focus on what minors can access, what children can access, and that then expands to be a policy targeting people of any age.\u00a0<\/p>\n So I think it\u2019s going to be a factor. One thing I think is going to slow down significantly are these ballot initiatives in the states. There\u2019s only a tiny handful of states left that haven\u2019t done it yet and have the ability to do it. A lot of states, it\u2019s not even an option. So I would look at Idaho for next year, and Nevada. But I don\u2019t think you\u2019re going to see the same storm of them that you have seen the last few years. And part of that is, like I said, there\u2019s just fewer left that have the ability. But also some people have soured on that as a tactic and feel that they haven\u2019t gotten the bang for the buck, because those campaigns are extremely expensive, extremely resource-intensive. And there\u2019s been frustration that, in Missouri, for instance, it\u2019s sort of been \u2014 the will of the people has sort of been overturned by the state government, and that\u2019s being attempted in other states as well. And so it has seemed to people like a very expensive and not reliable protection, although I\u2019m not sure in some states what the other option would even be.\u00a0<\/p>\n Rovner:<\/strong> Of course the one thing that is happening on Capitol Hill is that the House Judiciary Committee last week voted to repeal the 1994 Freedom of Access to Clinic Entrances Act, or FACE. Now this law doesn\u2019t just protect abortion clinics but also anti-abortion crisis pregnancy centers. This feels like maybe not the best timing for this sort of thing, especially in light of the shootings of lawmakers in Minnesota last weekend, where the shooter reportedly had in his car a list of abortion providers and abortion rights supporters. Might that slow down this FACE repeal effort?\u00a0<\/p>\n Ollstein:<\/strong> I think it already was going to be an uphill battle in the Senate and even maybe passing the full House, because even some conservatives say, Well, I don\u2019t know if we should get rid of the FACE Act, because the FACE Act also applies to conservative crisis pregnancy centers.<\/em> And lest we forget, only a few short weeks ago, an IVF [in vitro fertilization] clinic was bombed, and it would\u2019ve applied in that situation, too. And so some conservatives are divided on whether or not to get rid of the FACE Act. And so I don\u2019t know where it is going forward, but I think these recent instances of violence certainly are not helping the efforts, and the Trump administration has already said they\u2019re not really going to enforce FACE against people who protest outside of abortion clinics. And so that takes some of the heat off of the conservatives who want to get rid of it. Of course, they say it shouldn\u2019t be left for a future administration to enforce, as the Biden administration did.\u00a0<\/p>\n Raman:<\/strong> It also applies to churches, which I think if you are deeply religious that could also be a point of contention for you. But, yeah, I think just also with so much else going on and the fact that they\u2019ve kind of slowed down on taking some of these things up for the whole chamber to vote on outside of in January, I don\u2019t really see it coming up in the immediate future for a vote.\u00a0<\/p>\n Rovner:<\/strong> Well, at the same time, there are efforts in the other direction, although the progress on that front seems to be happening in other countries. The British Parliament this week voted to decriminalize basically all abortions in England and Wales, changing an 1861 law. And here on this side of the Atlantic, four states are petitioning the FDA to lift the remaining restrictions on the abortion pill, mifepristone, even as \u2014 Alice, as you mentioned \u2014 abortion foes argue for its approval to be revoked. You said that the abortion rights groups are shying away from these ballot measures even if they could do it. What is going to be their focus?\u00a0<\/p>\n Ollstein:<\/strong> Yeah, and I wouldn\u2019t say they\u2019re shying away from it. I\u2019ve just heard a more divided view as a tactic and whether it\u2019s worth it or not. But I do think that these court battles are really going to be where a lot is decided. That\u2019s how we got to where we are now in the first place. And so the effort to get rid of the remaining restrictions on the abortion pill, the sort of back-and-forth tug here, that\u2019s also been going on for years and years, and so I think we\u2019re going to see that continue as well. And I think there\u2019s also going to be, parallel to that, a sort of PR war. And I think we saw that recently with anti-abortion groups putting out their own not-peer-reviewed research to sort of bolster their argument that abortion pills are dangerous. And so I think you\u2019re going to see more things like that attempting to \u2014 as one effort goes on in court, another effort in parallel in the court of public opinion to make people view abortion pills as something to fear and to want to restrict.\u00a0<\/p>\n Rovner:<\/strong> All right. Well, finally this week, a couple of stories that just kind of jumped out at me. First, the AP [Associated Press] is reporting<\/a> that Medicaid officials, over the objections of some at the agency, have turned over to the Department of Homeland Security personal data on millions of Medicaid beneficiaries, including those in states that allow noncitizens to enroll even if they\u2019re not eligible for federal matching funds, so states that use their own money to provide insurance to these people. That of course raises the prospect of DHS using that information to track down and deport said individuals. But on a broader level, one of the reasons Medicaid has been expanded for emergencies and in some cases for noncitizens is because those people live here and they get sick. And not only should they be able to get medical care because, you know, humanity, but also because they may get communicable diseases that they can spread to their citizen neighbors and co-workers. Is this sort of the classic case of cutting off your nose despite your face?\u00a0<\/p>\n Ollstein:<\/strong> I think we saw very clearly during covid and during mpox and measles, yes. What impacts one part of the population impacts the whole population, and we\u2019re already seeing that these immigration crackdowns are deterring people, even people who are legally eligible for benefits and services staying away from that. We saw that during Trump\u2019s first term with the public charge rule that led to people disenrolling in health programs and avoiding services. And that effect continued. There\u2019s research out of UCLA showing that effect continued even after the Biden administration got rid of the policy. And so fear and the chilling effect can really linger and have an impact and deter people who are citizens, are legal immigrants, from using that as well. It\u2019s a widespread impact.\u00a0<\/p>\n Rovner:<\/strong> And of course, now we see the Trump administration revoking the status of people who came here legally and basically declaring them illegal after the fact. Some of this chilling effect is reasonable for people to assume. Like the research being cut off, even if these things are ultimately reversed, there\u2019s a lot of \u2014 depends whether you consider it damage or not \u2014 but a lot of the stuff is going to be hard. You\u2019re not going to be able to just resume, pick up from where you were.\u00a0<\/p>\n Ollstein:<\/strong> And one concern I\u2019ve been hearing particularly is around management of bird flu, since a lot of legal and undocumented workers work in agriculture and have a higher likelihood of being exposed. And so if they\u2019re deterred from seeking testing, seeking treatment, that could really be dangerous for the whole population.\u00a0<\/p>\n Rovner:<\/strong> Yeah. It is all about health. It is always all about health. All right. Well, the last story this week is from The Guardian, and it\u2019s called \u201cVA Hospitals Remove Politics and Marital Status From Guidelines Protecting Patients From Discrimination<\/a>.\u201d And it\u2019s yet another example of how purging DEI language can at least theoretically get you in trouble. It\u2019s not clear if VA [Department of Veterans Affairs] personnel can now actually discriminate against people because of their political party or because they\u2019re married or not married. The administration says other safeguards are still in place, but it is another example of how sweeping changes can shake people\u2019s confidence in government programs. I imagine the idea here is to make people worried about discrimination and therefore less likely to seek care, right?\u00a0<\/p>\n Raman:<\/strong> It\u2019s also just so unusual. I have not heard of anything like this before in anything that we\u2019ve been reporting, where your political party is pulled into this. It just seems so out of the realm of what a provider would need to know about you to give you care. And then I could see the chilling effect in the same way, where if someone might want to be active on some issue or share their views, they might be more reluctant to do so, because they know they have to get care. And if that could affect their ability to do so, if they would have to travel farther to a different VA hospital, even if they aren\u2019t actually denying people because of this, that chilling effect is going to be something to watch.\u00a0<\/p>\n Rovner:<\/strong> And this is, these are not sort of theoretical things. There was a case some years ago about a doctor, I think he was in Kentucky, who wouldn\u2019t prescribe birth control to women who weren\u2019t married. So there was reason for having these protections in there, even though they are not part of federal anti-discrimination law, which is what the Trump administration said. Why are these things in there? They\u2019re not required, so we\u2019re going to take them out.<\/em> That\u2019s basically what this fight is over. But it\u2019s sort of an \u2014 I\u2019m sure there are other places where this is happening. We just haven\u2019t seen it yet.\u00a0<\/p>\n All right, well, that is this week\u2019s news. 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. Victoria, why don\u2019t you go first this week?\u00a0<\/p>\n Knight:<\/strong> Sure thing. My extra credit, it\u2019s from The New York Times. The title is, \u201cThey Asked an A.I. Chatbot Questions. The Answers Sent Them Spiraling<\/a>,\u201d by Kashmir Hill, who covers technology at The Times. I had seen screenshots of this article being shared on X a bunch last week, and I was like, \u201cI need to read this.\u201d\u00a0<\/p>\n Basically it shows that different people who, they may be going through something, they may have a lot of stress, or they may already have a mental health condition, and they start messaging ChatGPT different things, then ChatGPT can kind of feed into their own delusions and their own misaligned thinking. That\u2019s because that\u2019s kind of how ChatGPT is built. It\u2019s built to be, like, they call it in the story, like a sycophant. Is that how you say it? So it kind of is supposed to react positively to what you\u2019re saying and kind of reinforce what you\u2019re saying. And so if you\u2019re feeding it delusions, it will feed delusions back. And so it was really scary because real-life people were impacted by this. There was one individual who thought he was talking to \u2014 had found an entity inside of ChatGPT named Juliet, and then he thought that OpenAI killed her. And so then he ended up basically being killed by police that came to his house. It was just \u2014 yeah, there was a lot of real-life effects from talking to ChatGPT and having your own delusions reinforced. So, and so it was just an effect of ChatGPT on real-life people that I don\u2019t know if we\u2019ve seen illustrated in a news story yet. And so it was very illuminating, yeah.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Not scary much. Sandhya.\u00a0<\/p>\n Raman:<\/strong> My extra credit was \u201cAmbulance Companies Collect Millions by Seizing Wages, State Tax Refunds<\/a>.\u201d It\u2019s by Michelle Crouch for The Charlotte Ledger [and North Carolina Health News]. It\u2019s a story about how some different ambulance patients from North Carolina are finding out that their income gets tapped for debt collection by the state\u2019s EMS agencies, which are government entities, mostly. So the state can take through the EMS up to 10% of your monthly paycheck, or pull from your bank account higher than that, or pull from your tax refunds or lottery winnings. And it\u2019s taking some people a little bit by surprise after they\u2019ve tried to pay off this care and having to face this, but something that the agencies are also saying is necessary to prevent insurers from underpaying them.\u00a0<\/p>\n Rovner:<\/strong> Oh, sigh.\u00a0<\/p>\n Raman:<\/strong> Yeah.\u00a0<\/p>\n Rovner:<\/strong> The endless stream of really good stories on this subject. Alice.\u00a0<\/p>\n Ollstein:<\/strong> So I chose this piece in Wired by Emily Mullin called \u201cWhat Tear Gas and Rubber Bullets Do to the Human Body<\/a>,\u201d thinking a lot about my hometown of Los Angeles, which is under heavy ICE [Immigration and Customs Enforcement] enforcement and National Guard and Marines and who knows who else. So this article is talking about the health impacts of so-called less-lethal police tactics like rubber bullets, like tear gas. And it is about how not only are they sometimes actually lethal \u2014 they can kill people and have \u2014 but also they have a lot of lingering impacts, especially tear gas. It can exacerbate respiratory problems and even cause brain damage. And so it\u2019s being used very widely and, in some people\u2019s view, indiscriminately right now. And there should be more attention on this, as it can impact completely innocent bystanders and press and who knows who else.\u00a0<\/p>\n Rovner:<\/strong> Yeah. There\u2019s a long distance between nonlethal and harmless, which I think this story illustrates very well. My extra credit this week is also from The New York Times. It\u2019s called \u201cThe Bureaucrat and the Billionaire: Inside DOGE\u2019s Chaotic Takeover of Social Security<\/a>,\u201d by Alexandra Berzon, Nicholas Nehamas, and Tara Siegel Bernard. It\u2019s about how the White House basically forced Social Security officials to peddle a false narrative that said 40% of calls to the agency\u2019s customer service lines were from scammers \u2014 they were not \u2014 how DOGE misinterpreted Social Security data and gave a 21-year-old intern access to basically everyone\u2019s personal Social Security information, and how the administration shut down some Social Security offices to punish lawmakers who criticized the president. This is stuff we pretty much knew was happening at the time, and not just in Social Security. But The New York Times now has the receipts. It\u2019s definitely worth reading.\u00a0<\/p>\n OK. That is this week\u2019s show. Thanks as always to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. Also, as always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review. That helps other people find us, too. You can email us your comments or questions. We\u2019re at whatthehealth@kff.org<\/a>. Or you can find me still on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you guys hanging these days? Sandhya.\u00a0<\/p>\n Raman:<\/strong> @SandhyaWrites on X<\/a> and the same on Bluesky<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Alice.\u00a0<\/p>\n Ollstein:<\/strong> @alicemiranda<\/a> on Bluesky and @AliceOllstein<\/a> on X.\u00a0<\/p>\n Rovner:<\/strong> Victoria.\u00a0<\/p>\n Knight:<\/strong> I am @victoriaregisk<\/a> on X.\u00a0<\/p>\n Rovner:<\/strong> We will 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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