The Host

Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Members of Congress are back in Washington this week, and Republicans are facing hard decisions on how to reduce Medicaid spending, even as new polling shows that would be unpopular among their voters.

Meanwhile, with President Donald Trump marking 100 days in office, the Department of Health and Human Services remains in a state of confusion, as programs that were hastily cut are just as hastily reinstated — or not. Even those leading the programs seem unsure about the status of many key health activities.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Alice Miranda Ollstein of Politico, and Margot Sanger-Katz of The New York Times.

Panelists

Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Margot Sanger-Katz The New York Times @sangerkatz Read Margot's stories.

Among the takeaways from this week’s episode:

• How and what congressional Republicans will propose cutting from federal government spending is still up in the air — one big reason being that the House and Senate have two separate sets of instructions to follow during the budget reconciliation process. The two chambers will need to resolve their differences eventually, and many of the ideas on the table could be politically risky for Republicans.
• GOP lawmakers are reportedly considering imposing sweeping work requirements on nondisabled adults to remain eligible for Medicaid. Only Georgia and Arkansas have tried mandating that some enrollees work, volunteer, go to school, or enroll in job training to qualify for Medicaid. Those states’ experiences showed that work requirements don’t increase employment but are effective at reducing Medicaid enrollment — because many people have trouble proving they qualify and get kicked off their coverage.
• New reporting this week sheds light on the Trump administration’s efforts to go after the accreditation of some medical student and residency programs, part of the White House’s efforts to crack down on diversity and inclusion initiatives. Yet evidence shows that increasing the diversity of medical professionals helps improve health outcomes — and that undermining medical training could further exacerbate provider shortages and worsen the quality of care.
• Trump’s upcoming budget proposal to Congress could shed light on his administration’s budget cuts and workforce reductions within — and spreading out from — federal health agencies. The proposal will be the first written documentation of the Trump White House’s intentions for the federal government.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: KFF Health News’ “As a Diversity Grant Dies, Young Scientists Fear It Will Haunt Their Careers,” by Brett Kelman. 

Joanne Kenen: NJ.com’s “Many Nursing Homes Feed Residents on Less Than $10 a Day: ‘That’s Appallingly Low’” and “Inside the ‘Multibillion-Dollar Game’ To Funnel Cash From Nursing Homes to Sister Companies,” by Ted Sherman, Susan K. Livio, and Matthew Miller. 

Alice Miranda Ollstein: ProPublica’s “Utah Farmers Signed Up for Federally Funded Therapy. Then the Money Stopped,” by Jessica Schreifels, The Salt Lake Tribune.  

Margot Sanger-Katz: CNBC’s “GLP-1s Can Help Employers Lower Medical Costs in 2 Years, New Study Finds,” by Bertha Coombs.  

Also mentioned in this week’s podcast:

• MedPage Today’s “Trump Order Targets Med School, Residency Accreditors Over ‘Unlawful’ DEI Standards,” by Cheryl Clark.
• Stat’s “Despite Kennedy’s Stated Support, Funding for Women’s Health Initiative Remains in Limbo,” by Elizabeth Cooney.
• CBS News’ “FDA Head Falsely Claims No Scientists Laid Off, as Agency Shutters Food Safety Labs,” by Alexander Tin.
• The New York Times’ “F.D.A. Scientists Are Reinstated at Agency Food Safety Labs,” by Christina Jewett.

click to open the transcript Transcript: 100 Days of Health Policy Upheaval

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, May 1, at 10:30 a.m. As always, news happens fast and things might change by the time you hear this. So, here we go. 

Today we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Margot Sanger-Katz of The New York Times. 

Margot Sanger-Katz: Good morning, everybody. 

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode we’ll have a special report on the first 100 days of the second Trump administration and what’s happened in health policy. But first, as usual, this week’s news. 

So Congress is back from its spring break and studying for midterms. Oops. I mean it’s getting down to work on President [Donald] Trump’s, quote, “big, beautiful” budget reconciliation bill. For those who may have forgotten, the House Energy and Commerce Committee is tasked with cutting $880 billion over the next decade from programs it oversees. Although the only programs that could really get to that total are Medicare and Medicaid, and Medicare has been declared politically off-limits by President Trump. So what are the options you guys are hearing for how to basically cut Medicaid by 10%, which is effectively what they’re trying to do? 

Sanger-Katz: I think it’s a bit of a scramble to decide. My sense is, there’s been for some time a menu of changes that would pull money out of the Medicaid program. There’s also kind of a small menu of other things that the committee has jurisdiction over. And as far as I can tell, all of the various options on that menu are kind of just in a constant rotation of discussion with different members endorsing this one or that one. The president weighs in occasionally or voices from the White House, but I think the committee is waiting on scores from the Congressional Budget Office, so they have to hit this $880 billion number. And so it’s kind of a complicated puzzle to put together the pieces to get to that number and they don’t know what they need. But I also think that they are facing some really difficult politics inside their own caucus in trying to decide what to do and how they can message it in a way that kind of checks everyone’s boxes. 

There are some people who have made promises to their constituents that they’re not going to cut Medicaid. There are some people who have said that they only want to do things that would target fraud and abuse. There are some people who have said that they want to make major structural changes to the program. And all of those people are sort of disagreeing about the exact mechanisms. 

Rovner: The phrase I keep hearing is that the math doesn’t math. 

Sanger-Katz: Yeah. I also think some of them are going to be surprised when the Congressional Budget Office gives them the scores. I think that the leadership has been reassuring a lot of these members, when they voted on these earlier budget bills that were more vague, more theoretical. I think that there were promises that were made to them that, Don’t worry about this. We’re going to solve your problems. This isn’t going to be a huge political headache for you. And I think the reality is is a) The cuts are going to have to be big. That’s what $880 billion means. And b) I think that they are going to be estimated to have pretty big effects on health insurance coverage, because if you’re going to cut $880 billion from Medicaid, that probably means that fewer people are going to be covered. I think some members are going to be surprised by that. 

And the other thing is, I think they’re going to start to see in the analyses and hear from local people that some states are going to get hit harder than others. I think there are some states that these members come from where the cuts are going to disproportionately fall. Now we could talk more about the options on the menu. I think some of them will hurt some states more and others will hurt other states more. And I think that is part of the politicking and debate that’s happening as well, where each of these legislators is trying to figure out how they can hit this target, keep their promises, and also protect their own districts to the best of their ability. 

Rovner: It seems like one of the things at the top of every Republican’s list that would be quote-unquote “acceptable” would be work requirements. And I heard numbers this week that the CBO is estimating something like more than $200 billion over 10 years in work requirements, which would be pretty strong work requirements. But Alice, you’re our work requirements queen here. We know that the stronger those work requirements are, the more people end up falling off who are still eligible, because most people on Medicaid already work, right? 

Ollstein: Yes. The only places in the country that have implemented work requirements for Medicaid have found that it does not increase employment, but it does kick people off the program who should qualify, either because they are working or they have a legitimate reason, they’re a full-time caretaker, they’re a student, they have a disability to not be able to work, and they lose their coverage anyway because they can’t navigate the bureaucracy. And I think what Margot is really getting to is, the fundamental dilemma that Republicans are facing right now as they try to put this together is that the proposals that are most politically palatable to them, like work requirements, won’t get them anywhere near the amount of money they need to cut, that they’ve promised to cut, that they’ve passed a bill pledging to cut in this space. And so that will mean that other things will have to be considered. 

And again, I feel like I say this every time, but we really have to be paying very close attention to semantics here. What one person considers a cut when they say the word “cut” is not necessarily what all of us would consider a cut. What some people in power are labeling waste, fraud, and abuse is people getting health care under the law legitimately. They think they shouldn’t, but they do. And so I think we really need to scrutinize the exact language people are using here. 

Rovner: There does seem to be kind of a zeroing in on what we call the expansion population, the population that was added to Medicaid under the Affordable Care Act, which were people who were not the traditional welfare moms and kids and people with disabilities and seniors in nursing homes. These were people who were otherwise low-income but didn’t have health insurance, which is kind of the point. That’s why we say most of these people are already working. You’re not going to live on your Medicaid benefits. There’s no cash involved. The cash goes to the people who provide the actual health care or in some cases the insurers. But that seems to be when — you were talking about semantics — you see Republicans talking about protecting the most vulnerable. That sounds like they really do want to go after this expansion population. But Margot, as you said, a lot of this expansion population is in red states, right? 

Sanger-Katz: Yeah. I think there’s another dynamic that’s going on right now that is important to keep track of, which is we’re at the sort of beginning of this process. So both the House and Senate have passed budgets. Those lay out these numbers, and they’ve laid out this very high number. It’s a high threshold for the Energy and Commerce Committee in the House. They have to find this $880 billion. After they do that, the entire House has to vote on the entire reconciliation package, which includes not just these changes to Medicaid but also a series of tax changes, changes to defense and homeland security spending, probably reductions in SNAP [the Supplemental Nutrition Assistance Program] and education funding. Then the whole thing goes to the Senate and the Senate has to do its own version.  

And the budget itself is a very weird document. Usually what you see with these budgets is that what the instructions are for the House and the Senate match. In this case, they do not. So the House still has to find these very large Medicaid cuts that I think will be politically problematic for certain House members. But the Senate actually doesn’t. It’s very unclear what the Senate’s plan is and whether they are going to try to go as far. And so I think it creates a difficult dynamic where I think some of these House members may not want to take a hard vote on major budget cuts, that could be politically costly to them, if it’s not even going to become law. And so I think that there’s a lot of kind of meeting of reality that is happening right now, which I think doesn’t mean that they won’t come up with a plan. It doesn’t mean that they won’t pass a plan, and it doesn’t mean that they won’t pass a plan that will affect those budgets of their home states. 

But I do think that they are in a little bit of a politically uncomfortable position right now, where they’re being asked to vote for something that is going to be unpopular in some quarters and where they don’t even really know if the Senate is going to hold their hand and go along with it. 

Ollstein: Just one point. We talk a lot about red states and blue states, but it’s important to remember that blue states have a lot of districts represented by Republicans, and that’s arguably the reason they even have a House majority. And so if they pass something that really sticks it to New York and California, there’s a lot of Republican House members who might be at risk. 

Rovner: Yes. And they’re already making noise. And that’s what I was going to say. The last time Republicans went hard after Medicaid after the expansion was during the effort to repeal the Affordable Care Act in 2017, obviously, and we have a brand-new poll out today from KFF, shows that, if anything, Medicaid is even more relevant to Republicans than it was eight years ago. Today’s poll found that more than three-quarters of those polled say they oppose major cuts to Medicaid, including 55% of Republicans and 79% of independents. Those are pretty big numbers. I guess it helps explain why we’re seeing so many Republicans who are looking — there’s so much hand-wringing right now when they’re trying to figure out how to get to these numbers. Go ahead, Joanne. 

Kenen: The other thing, it’s not just people who have increasingly, across party lines, grown in their affection for Medicaid, which is paying for all sorts of things. It’s paying for long-term care. It’s paying for almost half the births in this country. It’s paying for postpartum care. It’s paying for kids. It’s paying for the disabled. It is paying for a lot of drug and opioid treatment and substance abuse. It is paying for a lot of things. But in addition to the politics of individuals and families relying on — they call it an entitlement for a reason. People feel entitled to it. But once you give it to them, they don’t want to give it away. And it’s hard for politicians. They don’t want to give it up, and it’s hard for politicians to take it away. But the other thing is it’s also incredibly important to health care providers, specifically hospitals, because nursing homes are not going to get cut the way hospitals are vulnerable. 

Rural hospitals, urban hospitals — this is just a, particularly in areas where hospitals are already closing and rural states, it would be devastating to hospitals. You’re beginning to hear them talk more and more and more. Ultimately, I think this is going to come down to three syllables: Donald Trump. We are hearing all sorts of things, right?. He is really good at getting what he wants in the House, even if it’s politically difficult. Someone says, I can’t vote for it, they go back, Speaker [Mike] Johnson goes back in wherever he goes back with them and they come out and vote for it, right? It can take a day, it can take a few hours, but Trump hasn’t lost anything on the floor on the budget so far. We’ve gotten to this point. If Trump decides that he’s going to bite this bullet and go for the $800 [billion], he can probably get it through the House if he really decides that that’s what he wants. Unless they really convince him that it’ll cost the Republicans in the House, and then he has to believe them. He has to think that he really is vulnerable and that the Republicans can lose. And there’s all sorts of questions about what elections are going look like in two years. 

But I think that the providers, they’re lobbying in ways that we can see and they’re lobbying in ways that we can’t see. So that’s a part of it. And then the other thing is that there’s a really interesting dynamic with the expansion of states. The states that have not expanded Medicaid tend to be mostly, not all, in the South, Republican states. Their people are not covered. The people who fall in the gap are still not covered. So they don’t have such a dog in this fight. But as we’ve already mentioned, places with a lot of working-class Republicans, the irony is to order, to get states to accept Medicaid expansion in the first place under the ACA, the federal government gave a lot of money — 90%, right? There was more originally. They’re still paying 90%. And that cost the federal government a lot, but states don’t want to give that money up. It’s free dollars. 

And another layer of weird dynamics is a lot of the conservative states that did expand Medicaid did so with what they call a trigger. If the payment changes, the Medicaid expansion collapses. It’s gone. So there’s this weird dynamic of the states who were most skeptical of Medicaid expansion, ended up making it safe by putting in those triggers because no one wants to pull or press the trigger. 

Sanger-Katz: Can I say one more thing— 

Rovner: Yes, go ahead. 

Sanger-Katz: —about the state-by-state dynamics? Because I’ve actually been thinking about this a lot and doing a lot of reporting on this. Joanne is a 100% right. There are these states that have these triggers. They are predominantly Republican states. So those are states where, again, you’re going to see a lot of people losing coverage, because the state is just going to automatically pull back on all of the coverage for these working-class people who are getting Medicaid because they have a low income. But that’s not universally the case. I did a story a couple of weeks ago. There are three Republican states that actually have constitutional amendments that they have to cover this population. So even more so than the blue states— 

Rovner: We talked about your story, Margot. 

Sanger-Katz: Yeah? I love it. I love it. But even more so than the blue states, these are states that are really locked in. Those state governments and those state hospitals, to Joanne’s point, are going to face some really, really tough choices if we see the funding go away. And then another option that’s on this menu — and again we don’t know what they’re going to choose — but one possibility that I think a lot of the kind of right-leaning wonks are really pushing is to get rid of something called provider taxes, Medicaid provider taxes. And we don’t need to get into, fully into the weeds of how these work, because they are sort of complicated. But what I will say is that because of the way that Medicaid is financed and because of the history of how these taxes have proliferated and expanded across the country, there are quite a few Republican-led states that would be disproportionately harmed by that policy. 

So I just think all of this is a little messy. I think there’s not an easy way — even setting aside the point that Alice made that of course there are Republican lawmakers from blue states. But even if you’re only concerned about the red states, say you’re only concerned about getting the Senate votes and not the House votes, I still think it’s pretty tricky to come up with one of these policies that’s sort of just taking the money out of states where you don’t need votes. 

Rovner: Well, they’re supposed to, the committee is supposed to, start marking up its bill next week. I am dubious as to whether that is actually going to happen on time, but we shall see. Obviously much more on this to come. But I want to move on to news from the Trump administration. Last week we talked about threatening letters sent by the interim U.S. attorney in Washington, D.C., to some major medical journals, including the New England Journal of Medicine. This week we have another story from our friends over at MedPage Today about the administration going after medical student and residency accreditation agencies for their DEI [diversity, equity, and inclusion] efforts, because both organizations have long had robust programs to require medical schools and residency programs to recruit and retain racial and ethnic minorities who are underrepresented in medicine. Now, this isn’t about being woke. Racial and ethnic representation in the health care workforce is an actual health care issue, right? 

Kenen: There’s data. There’s a fair amount of data that shows that this kind of representation, patients having providers that they feel can identify with and understand them and come from a similar background. They’re not always a similar background, but there’s this perception of shared understanding. And there’s a ton of data. Not one or two little studies. There’s a ton of data that it actually improves outcomes. I’m actually working on a piece about this right now, so I’ve just read a bunch of it. 

Rovner: I had a feeling you would know this. 

Kenen: And it’s been pointed out, there was some research in The Milbank Quarterly, too. And I should disclose that Milbank is one of my funders at Hopkins, but they don’t control what I do journalistically. When the courts ruled against DEA in admissions, DEI in admissions, they were looking at sort of the intake, who comes in. And they really weren’t looking at the data of what happens to health care when the workforce is diverse. So there’s a lot of numbers on this, and they looked at one set of numbers and they didn’t look at another pretty solidly researched for many years, like: What is the impact on patients and what is the impact on American health? So if you’re talking about making America healthy again and you want everybody to be healthy, there’s really a good case to be made for a diverse, a competent, well-trained — we’re not talking about letting people in because they’re a token but getting people in who could become qualified doctors, nurses, respiratory therapists, whatever, right? And that data was sort of ignored. The outcomes, the down-the-road impact on health was ignored in that court case. 

Rovner: Also, the practical implications of this are kind of terrifying. Yanking accrediting responsibilities from these groups could make a big mess out of training the health care workforce. These groups have decades of experience devising and enforcing guidelines for medical education, much more than just DEI — what you have to teach, what they have to learn, what they have to be competent in. If the administration takes away these organizations’ recognition, it could raise real questions about the uniformity of medical education around the U.S., not to mention deprive lots of programs of lots of federal funding, because programs have to be accredited in order to draw federal funding. This could turn into a really big deal. 

Kenen: If they go away, what happens? 

Rovner: There would be alternate accrediting bodies. 

Kenen: But I have — when I read about the threats on the current accreditation bodies, I did not see, in what I read last night, I did not see: Then what? That blank was not filled in as far as I am aware. 

Rovner: I don’t think there is a then what. There are some efforts to stand up alternate accrediting bodies, but I don’t think they exist at the moment. And as I said, these are the bodies that have been doing it for now generations of medical students and medical residents. All right, well we also learned this week that the Government Accountability Office, the GAO is investigating 39 different cases of potentially illegal funding freezes, except the agency’s director told a Senate committee, the administration is not cooperating. I think I’ve said this just about every week since February, but there is a law against the administration refusing to spend money appropriated by Congress. And it feels pretty clear in many of these cases that the administration is violating it. 

Why aren’t we hearing more about impoundments and rescissions? The administration says they’re going to send up a rescission request, which is what they are supposed to do when they don’t want to spend money. They have to say: Hey, Congress, we don’t think we should spend this money. Will you vote to let us not spend this money? And yet all we do is talk about all of these cases where the administration is not spending money that’s been appropriated. 

Ollstein: You’re seeing it in grants, and you’re also seeing it in the mass layoffs of agency employees who are in many cases working on congressionally mandated programs, some of them signed into law by President Trump himself in his first term. I’m thinking of the 9/11 health program, some of the firefighter health and safety programs through NIOSH [the National Institute for Occupational Safety and Health]. So this is something I’ve been looking into. But when the enforcement mechanism is really the court’s rule and hope that the rulings are followed, and when they’re not, we’re really running into what people are calling a constitutional crisis, where the normal checks and balances are not working. And we’re finding out that a lot of it has really been on an honor system this whole time. 

Rovner: Margot. 

Sanger-Katz: I was just going to say, I think this is a huge constitutional issue that this administration is facing down. There’s this question about who gets to decide how the money is spent? The Constitution seems to say that it’s Congress. The administration is saying, no, the executive has a lot of authority to just ignore those appropriations requests. There are several cases in the courts right now on this issue related to various programs that the administration has declined to fund. But courts move pretty slowly. There have been some preliminary rulings. I think the preliminary rulings have tended to say that the money should be continuing to flow. But this is one of these issues that is absolutely a thousand percent headed to the Supreme Court and hasn’t gotten there yet. And I think the intensity of the constitutional crisis that Alice is warning about will really become more evident when the court decides. 

But I feel like I can’t talk about this issue without also talking about Congress. Because the Constitution is very clear that Congress has the power of the purse. And Congress has passed these appropriations bills over many years that include very specific funding levels. There’s a whole process. There’s a lot of people that do a lot of work. And Congress has been very weak in asserting its constitutional authority to ensure that this money is spent. We have heard very little, a few little peeps about specific things. But in general I would say the congressional leadership, and the leaders of the Appropriations Committee who have made this their lives’ work, have just not been screaming and yelling and jumping up and down about how their constitutional power has been usurped by the executive. 

And so I think that is also part of the reason why this is continuing to go on, because you see this acquiescence where Republicans in Congress are basically saying to Trump: Okay. Like, please send us a rescission package, but like we’ll go along with this for now. So I do think that we’re sort of waiting on the Supreme Court to try to issue some really definitive legal ruling, and that that is when we’re going to probably have the bigger conversation about who really gets to decide what money is spent. 

Kenen: Susan Collins, who’s the chairman of the Senate Appropriations Committee, did put out a statement yesterday that is stronger than her usual, what we’ve heard to date. But it wasn’t a line in the sand, like, I’m not going let you do this, and I’m going to go to the Supreme Court. So it was more of a toe in the water than I had seen from her before. 

Rovner: I watched that hearing, because I wanted to. This was the first hearing in the Senate Appropriations Committee this year, so the first time they’ve had a formal chance to speak. And it was on biomedical research and the state of biomedical research. And I was the one that was yelling and screaming because neither Susan Collins nor Patty Murray, the ranking Democrat, they both talked about how terrible these cuts are, without saying that they could do something about it. It’s like, you’re the Senate Appropriations Committee. This is your power that they’re taking away, and you’re both saying this is awful without suggesting that You’re taking this from us. So I got a little bit of exercise just watching it. 

Kenen: They put out a statement highlighting— 

Rovner: I know. I heard her, listened. She read the statement. 

Kenen: But what they, how they framed it in the statement was a little bit more pointed. But no, I agree it was not a call to arms. 

Rovner: No. 

Kenen: It was a statement that I hadn’t seen yet. 

Rovner: I watched it live. It didn’t come across as: Hey, this is our responsibility. We passed these bills. You’re supposed to spend this money. I’ve seen a little bit of that coming from the House. I was surprised to not see it coming more from the Senate. We do have to move on. Meanwhile, HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr. continues to make headlines for his questionable takes on science and medicine. In an interview this week on the “Dr. Phil” show, Kennedy said that parents, quote, should do their “own research” before having their children vaccinated. And he said that, quote, “new drugs are approved by outside panels,” which they most certainly are not. Those outside panels make recommendations that the FDA [Food and Drug Administration] usually follows but sometimes doesn’t. Yet there’s still not much in the way of opprobrium coming from Republicans inside and outside the administration. Is it just not news anymore when the secretary of health and human services says kind of outlandish and false things? Is it baked in? 

Kenen: Well, we’re waiting. So far. They approved him, and Sen. Bill Cassidy of Louisiana said, I’m going to be in close contact with him, and we’re going to be talking, and I’m going to make sure nothing terrible happens. And lots of things have happened. So at this point, yeah, he’s doing what he wants without — they have said they are going to call him, but I haven’t seen a date set for the hearing. 

Rovner: There’s not a date set for the hearing. 

Kenen: Right. So at some point, at some place, he will eventually be asked about something or other maybe. But at this point, no. He’s MAHA-ing his way through HHS and cuts galore and really things that they were started before he took his job, stuff that Elon Musk started. But now that the team of FDA, C— well, not CDC [the Centers for Disease Control and Prevention] but FDA and NIH [National Institutes of Health] leadership is there, it’s going Kennedy’s way. They’re not standing up and saying, It’s my institute, and I’m going to run it the way I see fit. It’s very, particularly FDA, people who thought that he was the least radical of the officials to be appointed. 

Rovner: He, Marty Makary, the FDA commissioner. 

Kenen: Yes. Some of what he said about vaccines just this week has shocked people who thought he would be a little bit more, not a traditionalist but more traditional in how the FDA did its business. 

Rovner: More science-based, might be a fair way to put it. Well, I want to talk about the continuing cuts at HHS because things are, in a word, confusing. Last week we talked about the cancellation of the Women’s Health Initiative. That’s a decades-old project that has led to a long list of changes in how women are diagnosed and treated for a wide range of conditions. Late in the week, former California first lady and longtime women’s health advocate Maria Shriver announced on social media that she convinced her cousin, RFK Jr., not to cancel the study. But this week Stat reports that Women’s Health Initiative officials around the country have not been officially notified that the cancellation has been rescinded, so they’re kind of frozen in place and can’t really plan anything. 

Similarly, on April 25, The New York Times reported that the FDA had reversed a decision to fire scientists at its food safety lab. But that was days after FDA Commissioner Marty Makary insisted that no scientists had been terminated. Quoting from the CBS News story on Makary’s claims, quote: “‘That just made me so mad … he said no scientists were cut,’ said one laid-off FDA scientist, a chemist who had worked at the agency for years.’” Which kind of leads to the question: Are they just confused at HHS, or are they trying to sort of obfuscate what’s really happening there? I’m hearing department-wide about claims made by spokespeople about funding that’s been, quote, “restored” but that’s still not flowing, according to the people who are trying to get it. Margot, I see you nodding. 

Sanger-Katz: I think there’s just a great deal of confusion. There’s a lot of people missing, too. So I think that just some of the kind of basic mechanics of how you turn things on and off is a little bit broken. But I also think that there are disagreements among the decision-makers about what they want to turn on and off. And we have seen this throughout the Trump administration, not just at HHS but in other places where top officials have said that they’re going to restore funding that was cut or a court has ordered them to restore funding that has been cut, and then, lo and behold, the money doesn’t turn back on. So I just think there’s — this is why it’s a good time to be a journalist. I think it really bears a lot of reporting and follow-up and checking on whether they’re doing the things that they say they’re doing. Some of these things might just be confusion — it’ll take a minute. And some of them, maybe they’ve changed their minds. 

Kenen: Or like the AID [U.S. Agency for International Development] global AIDS money, which they said they were restoring, and it’s questionable still. It’s unclear how much. We certainly know not all of it’s been restored, and it’s unclear. I haven’t done any firsthand reporting on this, but from reading, it’s just uncertain how much. Some is getting through but not what they said they were going to do. I sent an email to some at the CDC yesterday asking, and I had to say: Excuse me. I’m not being facetious. It’s just hard to keep track. Is your division still there? So yes, he was still there. I couldn’t find a master list of which CDC departments are still functioning and which are not. What Elon Musk said was, We’re going to move fast and break things, which is the Silicon Valley mantra, and that We can always fix it. We’ve seen them moving fast, and we’ve seen them breaking things, but we’re waiting on the fixing it. 

Ollstein: And I think it’s been interesting that Secretary Kennedy has said publicly now, on more than one occasion, that these cuts, these program eliminations, certain ones are a mistake. He didn’t even know they happened. He said this in interviews. And then with some of the ones that they’re claiming, they’re restoring, the national firefighters union, the IAFF [International Association of Fire Fighters], said that when they met with HHS leadership, they were told that the HHS blamed mid-level bureaucrats for incorrectly canceling some of these programs. All of this sort of begs the question: Who’s in charge over there? Who’s making these decisions? Is the secretary even in the loop on them? Is this all coming from DOGE [the Department of Government Efficiency]? Yeah, and so I think Margot’s absolutely right about we just really need to keep reporting and not take what they say at face value. And we should do that for any administration. 

Sanger-Katz: The president is scheduled — any day now, we don’t know — to release his, what they’re calling the skinny budget. So this is a document from the White House that says what their spending priorities are for the next fiscal year. We think it’s just going to deal with discretionary spending, but I think it will give us some really good clues about what parts of the various cuts in HHS and other parts of the government were sort of part of the plan or will continue to be part of the plan going forward and which of the cuts were made randomly or haphazardly or at the behest of someone who hadn’t talked to the White House. I definitely am very interested to see that document when it comes out, because I think it is the first time that we’ll really see, written down in one place, what it is that the White House is intending to cut in the federal government. 

Rovner: Yeah, the appropriations committees are very interested in seeing that document, too, so they say. Also the other thing that getting a budget will trigger is having to have some of these people come to Capitol Hill to justify their budget and having Congress get a chance to ask questions. 

Finally, in this week’s news, we haven’t talked about abortion in a while. Not that there isn’t news there, it’s just been eclipsed by all of the bigger news. So I want to catch up. Well, speaking of funding being restored, Alice, you were the first to report that the Trump administration has quietly resumed Title X family planning funding to Oklahoma and Tennessee, even while it’s still frozen for some other states. Not so coincidentally, Oklahoma and Tennessee had their Title X money cut off during the Biden administration, because they were out of compliance with the Title X rules requiring women with unintended pregnancies to be counseled on all of their options, including pregnancy termination. I guess this shouldn’t be surprising except for the fact that the grant notices to these states said the money was being restored pursuant to settlement agreements that apparently don’t exist? 

Ollstein: Yes, these states are still not complying with the Title X requirements. That’s what they went to court about. Those cases have not been settled. These states weren’t even expecting this money and were surprised about it and now have to come up with how to actually administer it, because the money was going to other groups in those states that were providing services. And so, it’s really thrown everyone for a loop. And this is coming at a time when grants for a lot of other Title X providers who say they are following the rules have been indefinitely frozen. They’re allegedly being investigated for violating orders on DEI and immigration, but they have heard nothing about where that investigation stands, whether the money is coming. And in the meantime, a lot of people, hundreds of thousands, according to the National Family Planning and Reproductive Health Association, that represents all these providers, are said to lose services. And again, this is access to birth control for low-income people, STI [sexually transmitted infection] testing, a lot of things people need. 

Rovner: So, when we last visited Texas, abortion opponents and women who’d had pregnancy complications were fighting over a bill that was supposed to clarify that the state’s 2022 ban would allow pregnancy terminations in emergency medical situations. Well, apparently they reached a rapprochement, because the Texas Senate this week passed a bill by a 31-0 vote. Alice, what broke the logjam? And will this bill ultimately get signed by the governor? Is there a deal here? 

Ollstein: Well, we’ll have to see. Medical experts have been very skeptical about the provisions here and don’t trust Texas lawmakers to have patients’ best interest in mind, given the impact of previous policies on this front. And so just given the makeup of the state legislature and the officials in power, it’s definitely very possible it will become law. There could be court challenges. We’ll just have to see how it plays out. 

Rovner: Well, this is obviously not any kind of sign that Texas is going soft on abortion, because the Senate also this week passed a bill that would basically extend the state’s bounty hunter abortion law, that lets private individuals sue doctors or others who help people get abortions, would extend that to manufacturers, mailers, and deliverers of abortion pills. Alice, this would be a pretty big step in the state’s efforts to curtail abortions, right? 

Ollstein: Yeah, I think we should think about bills like this like a lot of other bills that are already in place, in that it’s not possible to fully enforce them. It’s not possible to prevent — short of opening everyone’s mail and surveilling everyone in the state — it’s not really possible to prevent medication abortion being mailed. And in the case that’s already in court about a New York doctor who is providing pills to patients in Texas and other states under a shield law, New York has said: We are not turning over this doctor. We are not going to enforce. What she’s doing is legal in our state. It’s legal in the place where she is doing the action, so you can’t have her. 

So I think the main issue here is the chilling effect. It’s a law that makes people more afraid potentially to go and order these pills online or over the phone. And so they’re hoping that that deters people, because, I think, it’s totally possible that, like the New York doctor, we’ve already seen, they pick a few cases to make an example of people and to further that chilling effect, because it’s not possible to go after everybody. 

Sanger-Katz: It just really highlights, I think, the challenges of President Trump’s approach to this issue, which is, he basically said: Let’s just leave it to the states. Let’s not have a lot of federal policy on abortion. Now, there are things that are being done through the Title X funding and everything that affect reproductive health. But in general, there just does not seem to be an appetite for big sweeping regulations that would make abortion substantially harder to get everywhere or any kind of law that would ban or restrict abortion nationwide. And the problem is is if you’re a Texas legislator and you were trying to prevent abortions in Texas, it’s a really frustrating situation, because the state boundaries are just so porous. And particularly because of these abortion pills that can be easily smuggled in through various ways, through mail or someone walking across the border or someone going and coming back, there are still a lot of abortions that are happening in Texas. 

And so I think if you’re someone whose public policy goal is to restrict or stop abortions in Texas, you start having to have to think creatively about even some of these kinds of enforcement mechanisms that, as Alice said, are kind of hard to achieve and probably are going to have a selective enforcement approach. But I think they just haven’t really been able to achieve their goals. And you look at the national abortion statistics and when you look at some of the data on even the state of residency of people who are getting abortions of various types, there just haven’t been big declines. Even in Texas, even in this very big state that has very restrictive laws, there are a lot of women from Texas who are continuing to get abortions. And I think that’s why we’re seeing the state legislature continue to reach for more ambitious ways to curtail it. 

Rovner: Yes. Much to the frustration of the people who are making the anti-abortion laws in Texas. All right. That is this week’s news. Now I want to spend a few minutes trying to synthesize all that’s happened in health policy in the now 102 days since Donald Trump began his second term. I’ve asked each of the panelists to give us a just quick summary of some specific topics. Joanne, why don’t you kick us off with how public health has changed in these last couple of months? 

Kenen: Yeah. Basically if you — when I started writing it down, I couldn’t fit it on a page. If you name anything in public health, it’s been cut or reduced or put in jeopardy. We’ve talked extensively about what’s going on. And by public health, I’m talking about federal down to cities, because they’ve lost their money. So, whether you’re in a red state or a blue, you have less to spend, you’re not allowed to talk about certain things. HIV money has been affected. Global health has been affected. Obviously measles — we did not have whatever the number of measles cases, I believe it’s over a thousand by now. I haven’t seen the last number. Data has vanished. And that data, there are some nonprofits that are trying to collate it and make it available, but years and years and years of data, which was the foundation of data-based, reality-based, and measuring gains and losses in public health, that’s been obliterated. Things are being stopped at NIH. That’s the future of public health, right? 

If you’re stopping training, if you’re stopping universities, if you’re stopping postdocs, if you’re stopping graduate school funding, that’s not just public health today but public health as far as we can see in the future. The anti-smoking, anti-tobacco-use, the suicide helpline is in danger. Mental health, opioid treatment is being rolled back. Pretty much if you think of public health, it’s really hard to think of anything that has not been affected. 

Rovner: Thank you. That was a pretty good summation. Margot, if you had to write a one-page elementary school book report on DOGE and what’s happened at HHS, what would it be? 

Sanger-Katz: Well, I think it’s highly overlapping with a lot of what Joanne was talking about. I think we’ve seen these outsiders who came into the government and just started kind of hacking and slashing. They have eliminated a lot of functions of HHS that have existed for a really long time, not just individual people who have lost their jobs but whole offices that have disappeared, whole functions that existed for a long time and don’t exist anymore. I do think — I was talking about the skinny budget — we’re going to find out the president’s plan for this. I will give Secretary Kennedy some credit for releasing a sort of blueprint for what his goals were in trying to reorganize HHS. It seemed like they did have an idea in some cases of what they were trying to do — consolidate duplication, centralize certain functions, de-emphasize and reemphasize other priorities. 

Rovner: Cut NIH from 27 institutes to eight. 

Sanger-Katz: Right. Eliminate regional offices in various ways. But I think it is worthwhile to think about the DOGE effort in terms of what its goals are and whether those goals are really aligned with particular goals around health policy. In some cases, I do think Secretary Kennedy has directed them to do things that are in line with his goals for health policy, but I think a lot of this cutting was really just cutting for cutting’s sake, trying to hit certain budgetary target numbers, trying to reduce funding to some percentage of contracts, some percentage of grants. And of course, there has also been, from the White House, a desire to target particular political enemies of the president. So we’ve seen, all the NIH grants canceled to universities where he’s having feuds over other issues, huge categories of research funding just drying up because they’re at odds with various political priorities of the president. 

So there are multiple power centers that are all kind of wrestling over this future of HHS. You have the secretary himself, you have the White House, and you have this DOGE entity, which was kind of on the outside now and now is on the inside. And I think part of what we have seen is a real wrestling around that. And just very, very large reductions across all of the functions of what the department does. 

Kenen: Some of these things that Margot and I are talking about do have, in fact — they’re about chronic disease. So if Kennedy is trying to reorient our health system to fight chronic disease, then why are you cutting diabetes programs and why are you cutting long-term women’s health studies? These are chronic disease. Diabetes is the great example of a chronic disease that we really could do better on prevention, making sure people don’t get it. But not everybody — we could make gains there. And yet some of these key programs that are supposedly in line with his priorities are also on the cutting-room floor. And I will stop there. 

Rovner: And I have said, and I made this point before, but I will make it again here because I think it’s relevant, which is that I feel like HHS is part of the Jenga tower that holds up the nation’s health care system writ large, and that they’re kind of yanking pieces out willy-nilly. And I do worry that the whole thing is going to come crumbling down at some point. Obviously it hasn’t yet, but we’re going to see what happens when they take away a lot of these things. Like I said, yanking the ability of accreditation agencies to do their jobs, things that happen in the background that are going away, that won’t happen anymore. And we’re going to have to see what happens with that. 

Sanger-Katz: And I do think some of this really long-term research, both the collection of government data and also the funding of these very large longitudinal studies, I think those are the kinds of cuts that you don’t really see the effects of those right away. It’s the things that you don’t know in the future. And I think that we see a lot of cuts of that sort, where you see the DOGE team come in and they say: Oh, data. Oh, analysis. Like, we can do this better with our own tools. We have technical expertise. We don’t need this whole office of people that are doing data. And across the government, you’re seeing this real loss of long-term data collection and analysis, data sets and studies and surveys that have been conducted for decades, and there are just going to be holes in those. And we may not know the effects of those losses for some time. 

Rovner: I think that, too. Well, Alice, I don’t want to leave without touching on reproductive health. I’m actually a little surprised at all this administration has not done on abortion, as Margot was talking about, and other reproductive issues. So what have they done? 

Ollstein: Yeah, so I kind of have organized my thoughts into three buckets. So, it’s things they’ve done that the anti-abortion movement likes, things that the anti-abortion movement wants them to do that they haven’t done yet, and things that they’ve done that have actually pissed off the anti-abortion movement. These are not equal buckets — they’re just three categories. 

So, OK. What they have done: The anti-abortion movement was very pleased that the Trump administration rolled back a lot of Biden policies making abortion more accessible for veterans and service members. Also got reimposed the Mexico City policy, which restricts international aid for family planning programs that talk about abortion or refer people to abortion services. Of course, that’s been overshadowed by the just total decimation of foreign aid in general, but it’s still meaningful. I would say that the Trump administration switching sides in a legal battle over emergency room abortions was one of the biggest developments. We are still waiting to find out if they’re also going to switch sides in ongoing litigation over FDA regulation of abortion pills. That’s TBD but could be very big no matter which way they go. And the freeze on Title X funding that we’ve already discussed. The anti-abortion movement has been pleased by that because a lot of that has hit Planned Parenthood. Of course, it’s hitting providers beyond Planned Parenthood as well. 

So I also find it interesting that they have not done a lot of what the anti-abortion movement wants in terms of reimposing restrictions on abortion pills, saying they can’t be sent by mail, can’t be prescribed by telemedicine. So there’s a big push underway to pressure the administration to make those changes. Could still happen, but it has definitely not been something that they’ve prioritized at the beginning of the administration. 

And in this much smaller category of things they’ve done that have angered the anti-abortion movement, I’m thinking mainly of an executive order that didn’t actually do anything but purported to promote IVF [in vitro fertilization]. And he ordered his administration to study ways to make IVF more accessible and affordable. And a lot of anti-abortion groups view IVF as it’s currently practiced as akin to abortion, because some embryos are discarded. So, I sort of think of it like Trump has governed so far on abortion, a lot like he campaigns, trying to please the moderates and the conservatives and not really pleasing everyone fully and being a little all over the place. 

Rovner: Thank you. That was a great summary, and we’re on to the next hundred days. All right. That’s the news for this week. Now it is time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Joanne, why don’t you go first this week? 

Kenen: Yeah. This is a pair of articles [“Many Nursing Homes Feed Residents on Less Than $10 a Day: ‘That’s Appallingly Low’” and “Inside the ‘Multibillion-Dollar Game’ To Funnel Cash From Nursing Homes to Sister Companies”] published by New Jersey Advance but in conjunction with papers in, The Oregonian in Oregon, MLive in Michigan, and in Alabama, and it’s by Ted Sherman, Susan Livio, and Matthew Miller. And it’s a really deep two-part investigation into, basically, greed at nursing homes. I don’t think they use the word “greed,” but that’s what it is. Feeding people, like, a food budget of $10 or less a day. Splitting the ownership so that there’s various interconnected businesses, so it looks like the nursing home doesn’t have enough money, because they’re actually paying somebody else for services provided at the nursing home that has the same owner, so it’s sort of financial gamesmanship. And just not taking care of people. Really well documented. They had thousands of pages of CMS [Centers for Medicare & Medicaid] files. They had university professors and data experts helping them analyze it. There’s never been an analysis, they say, this extensive. And it just shows tremendous abuse and just asks a What next? question and Why is this allowed to happen? question. 

Rovner: It’s a really good piece. Margot. 

Sanger-Katz: I want to highlight a piece from CNBC called “GLP-1s Can Help Employers Lower Medical Costs in 2 Years, New Study Finds.” I have some cautions about this study because the full study has not been made public. It has not been published in a peer-reviewed journal, and I still have lots of questions about it. Nevertheless, I read the story and I thought about it a lot and I have been thinking about it a lot since. And so I still feel like it is worth reading and talking about. This study was done by Aon, which is a big benefits consultant, and they pooled all this data from lots of employers who are covering these anti-obesity drugs for their workers. And basically what they say they found in the story is that among those people who continued to take the drug, who had what they called very high adherence to the drug, for two years, they actually found that their health improved so much that they saved their employers health plan money over that two-year period, even when compared to the very high cost of these drugs. 

So I would say this is a pretty surprising result. These drugs are expensive, and I think there was always an expectation that they were going to reduce people’s health care needs because they prevent diabetes and cardiac events and all of these other serious diseases. But I think there was always an expectation that the payback period would be much longer because the cost is so high. One more thing that jumped out at me in this study is there are some published studies from the clinical trials of Wegovy, the first anti-obesity drug that got approved by the FDA, that found that cardiac events among people taking those drugs were significantly diminished. But I think in a clinical trial where everything is perfect, you always expect those results to look a little bit better. 

This study, again, we can’t totally look under the hood, but they found 44% reduction in major cardiac incidents among working-age people who are taking these drugs in just two years. If that holds up, I think it just is additional evidence that these drugs are really, really promising for public health. Reducing heart attacks and strokes is just — and that’s compared to the standard of care. That’s compared to other people who had employer insurance who were of similar health, who were presumably taking statins and blood pressure drugs and the other things that you do to prevent cardiac events. So, I think, let’s not overinterpret this study. There could be something weird about it. But I do think it’s another promising indication that these drugs have the potential to have big public health impact and to potentially be a little less expensive for the system than we have been thinking of them. 

Rovner: And of course there are still efforts to lower the prices, which would obviously increase the benefit. 

Sanger-Katz: The big question I have is what percentage of people who are prescribed the drug are in this very adherent group, right? Because the companies are spending a lot of money giving people drugs who then stop taking them for various reasons or take them in a way that doesn’t produce these big health results. It could still be hugely expensive relative to the savings. But at least in this group that was taking the drugs, it seems like they’re getting healthier pretty quickly. 

Rovner: Interesting. 

Kenen: But if people aren’t taking it, if — adherence is often meant, like: Oh, I take it some days and not others, I forget to take my cholesterol drug, whatever. But if people stop taking it because there are side effects, then the cost also drops off. 

Rovner: Right. Yeah. We’ll see. Alice. 

Ollstein: So I chose a sad story from ProPublica. It’s called, “Utah Farmers Signed Up for Federally Funded Therapy. Then the Money Stopped.” And this is about a program through USDA [the U.S. Department of Agriculture] to offer to fund vouchers for farmers to be able to access mental health care. Farmers are notoriously very high-risk for suicide. There are a lot of challenges in that population. And this allowed people to, sometimes for the first time in their lives, to get these services. And the federal money has run out. There’s no sign it’s getting renewed. And while some states have stepped in and provided state money to continue these programs, Utah and some others have not, and people have lost that access. And the article is about the sad consequences of that. So, highly recommend. 

Rovner: All right. My extra credit this week is from my KFF Health News colleague Brett Kelman, and it’s called “As a Diversity Grant Dies, Young Scientists Fear It Will Haunt Their Careers.” It’s about a unique early-career grant program at the NIH, now canceled by the Trump administration, aimed at boosting the careers of young scientists from backgrounds that are underrepresentative, which includes not just race, gender, and disability but also those from rural areas or who grew up poor or who were the first in their family to attend college. It’s not only a waste of money — canceling multi-year grants in the middle essentially throws away the money that went before — but in this case it’s yet another way this administration is telling young scientists that they’re essentially not wanted and maybe they should consider another career or, as many seem to be doing, seek employment in other countries. As the old saying goes, it feels an awful lot like eating the seed corn. 

All right. That is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special 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’re at whatthehealth@kff.org. Or you can still find me on X, @jrovner, or on Bluesky, @julierovner. Where are you guys hanging these days? Joanne? 

Kenen: I’m at Bluesky, @joannekenen, or I use LinkedIn more than I used to. 

Rovner: Margot? 

Sanger-Katz: I’m @sangerkatz in all the places, including on Signal. If you guys want to send me tips, I’m @sangerkatz.01. 

Rovner: Excellent. Alice? 

Ollstein: @AliceOllstein on Twitter and @alicemiranda on Bluesky. 

Rovner: We will be back in your feed next week. Until then, be healthy. 

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This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.