The Host
Julie Rovner
KFF Health News
@julierovner.bsky.social
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.
The actions of federal Immigration and Customs Enforcement agents are having ramifications far beyond immigration. Medical groups say that ICE agents in health facilities in Minneapolis and other cities are imperiling patient care, while in Washington, the backlash from a second fatal shooting by agents in Minnesota has stalled action on an eleventh-hour suite of spending bills.
Meanwhile, anti-abortion groups remain unhappy with the Trump administration over what they see as its reluctance to scale back the availability of the abortion pill mifepristone.
This week’s panelists are Julie Rovner of KFF Health News, Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post.
Panelists
Maya Goldman
Axios
@maya-goldman.bsky.social
Read Maya’s stories.
Alice Miranda Ollstein
Politico
@alicemiranda.bsky.social
Read Alice’s stories.
Rachel Roubein
The Washington Post
Read Rachel’s stories.
Among the takeaways from this week’s episode:
- Concerns intensified this week over President Donald Trump’s immigration sweep after federal agents killed a second citizen in the midst of the crackdown in Minneapolis. Democrats in Congress are blocking approval of government spending as they call for renegotiating Department of Homeland Security funding, potentially forcing a partial government shutdown this weekend. In Minnesota and elsewhere, there are reports of patients postponing medical care and doctors pushing back on the presence of federal agents in hospitals.
- After the Department of Health and Human Services cut off some federal funding to Minnesota over allegations of Medicaid fraud, other Democratic-led states in particular are fearing HHS could do the same to them. Typically the federal government conducts investigations and imposes sanctions in response to concerns of fraud; it’s unusual that HHS has opted to halt some funding instead.
- Abortion opponents last week held their annual March for Life in Washington. The Trump administration marked the occasion by reinstating and expanding policies imposed during the president’s first term, including a ban on fetal tissue research and what’s known as the Mexico City Policy. Still, the administration has not made notable progress on a key goal of the anti-abortion movement: barring access to medication abortion.
- Meanwhile, senators are still trying to sort out a bipartisan compromise to restart the enhanced Affordable Care Act premium subsidies that expired last year. And insurance company executives appeared before House lawmakers last week to answer questions about affordability as the Trump administration announced a plan to keep reimbursement rates nearly flat next year for private Medicare Advantage plans.
And KFF Health News’ annual Health Policy Valentine contest is open. You can enter the contest here.
Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: Science’s “U.S. Government Has Lost More Than 10,000 STEM Ph.D.s Since Trump Took Office,” by Monica Hersher and Jeffrey Mervis.
Maya Goldman: NBC News’ “Many Obamacare Enrollees Have Switched to Cheaper Bronze Plans. Here’s Why That Could Be Risky,” by Berkeley Lovelace Jr.
Alice Miranda Ollstein: The New York Times’ “After Donations, Trump Administration Revoked Rule Requiring More Nursing Home Staff,” by Kenneth P. Vogel and Christina Jewett.
Rachel Roubein: Stat’s “HHS Appoints 21 New Members to Federal Autism Advisory Committee,” by O. Rose Broderick.
Also mentioned in this week’s episode:
- Axios’ “Fear of ICE Is Driving Patients Away From Medical Care,” by Maya Goldman.
- Annals of Internal Medicine’s “Unexplained Pauses in Centers for Disease Control and Prevention Surveillance: Erosion of the Public Evidence Base for Health Policy,” by Jeremy W. Jacobs, Garrett S. Booth, Noel T. Brewer, and Janet Freilich.
- Politico’s “Trump Asks Federal Court To Hit Pause on Abortion Pill Case, Citing Ongoing Study,” by Alice Miranda Ollstein.
- The Washington Post’s “Freeze of Public Health Funds for States, Then Reversal, Sows Confusion,” by Lena H. Sun and Rachel Roubein.
- The Georgetown University Center for Children and Families’ “CMS Weaponizes Fraud Against Medicaid in Minnesota,” by Andy Schneider.
- KFF’s “KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.
[Clarification: This article was revised at 12:30 p.m. ET on Jan. 30, 2026, to clarify that the agents involved in the Trump administration’s immigration crackdown represent not only the U.S. Immigration and Customs Enforcement agency but also the broader Department of Homeland Security.]
Click to open the transcript
Transcript: The Hazards of ICE for Public Health
[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.]
Julie Rovner: Hello from KFF Health News and WAMU public radio in Washington, D.C. Welcome 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, Jan. 29, at 10 a.m. As always, news happens fast and things might have changed 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: Maya Goldman of Axios News.
Maya Goldman: Hi.
Rovner: And Rachel Roubein of The Washington Post.
Rachel Roubein: Hi, everyone.
Rovner: No interview this iced-in week here in Washington, but still lots of news. So last week at this time, Congress was busy patting itself on the back for being poised to pass all 12 annual appropriation bills before their Jan. 30 deadline, including the two biggest ones, those funding the Departments of Defense and Health and Human Services. Still, as I believe I said at the time, it’s not done until it’s done, and, well, it’s not done. What happened, of course, is that after the House passed the remaining six spending bills and left for a week’s recess, on Saturday, federal [Border Patrol] officers shot and killed a VA [Department of Veterans Affairs] ICU nurse, Alex Pretti, on the streets of Minneapolis, where he was participating in an ICE [Immigration and Customs Enforcement] protest. That second killing of a civilian in three weeks turned Senate Democrats, who were supposed to approve the spending package this week, unanimously against the spending bill for the Department of Homeland Security, which includes ICE and which is included within the appropriations package passed by the House last week. But it’s not as easy as splitting off the Homeland Security bill and passing the other five. If the Senate changes anything about the package, it has to go back to the House, which, as I mentioned, isn’t even in town this week. So where are we? And how likely is it that we’re going to look at a partial government shutdown come Saturday?
Ollstein: So it’s really a mess right now. You have some in both parties who are calling for passing the rest of the bills and pulling out the Homeland Security funding to keep negotiating. Some people are saying they should do a very short-term CR [continuing resolution] — a week, a couple weeks — in order to give Congress more time to negotiate these reforms and restrictions that Democrats are demanding. But then you have House Republicans who are saying, Oh, if we’re opening this all back up again, we have some demands, too, and we want more of this and more of that and XYZ. And so they’re saying, We’re gonna defund all sanctuary cities. So, like you said, once you open this back up, it opens up a whole can of worms. That said, the Democrats’ base is really saying don’t give one penny more to this agency that they see as completely running amok and violating life and civil liberties. And so we’re really at kind of an impasse right now.
Rovner: This is a classic never-count-your-chickens in Congress. Maya, you want to add something.
Goldman: Yeah, I was going to say, it seems like the health care package is collateral damage here, right? There’s a lot of agreement, bipartisan agreement, that these changes that they’re trying to make, PBM [pharmacy benefit manager] changes, things like that, should be passed. But then, like you said, Julie, it’s never over till it’s over, and more time between getting a bill negotiated and actually passing it just gives interest groups more time to get things changed. So that will be interesting to see.
Rovner: And just a reminder for those who aren’t following this as closely as we are, there is this health package that’s riding along in this spending-bill package that includes the PBM reform and extensions for things like home health care and telehealth and other things that are not technically spending-bill issues but that need to be renewed periodically by Congress. So that’s also sitting out there waiting to see what the Senate decides to do and then what the House decides to do, depending on what the Senate decides to do.
Roubein: And the last government shutdown, in the fall, was based on health care. But as you mentioned, the fight was over Affordable Care Act subsidies, which is not part of this package that Julie mentioned.
Rovner: That’s right. So that will continue. But I want to talk about ICE. We have tiptoed into the immigration debate as it impacts health care in recent months, but now it’s really front and center, and I’m talking about more than just the fight over ICE tactics in Minnesota and blocking the spending bill for the entire Department of Health and Human Services. Maya, you have a story about how ICE presence in hospitals and other health care facilities is having an impact on patient care. Tell us what you found.
Goldman: Yeah, a lot of physicians and nurses in Minneapolis, Twin Cities, and also across the country are saying that this is approaching, or has already become, a public health crisis. And the problem is twofold. It’s, Part 1, patients aren’t coming to get the care that they need, because they’re worried about leaving their homes. And one doctor during a press conference said she even has patients who don’t want to take telehealth appointments, because they’re afraid of getting on the phone or getting on the computer, because they’re worried they’re being surveilled. So that’s a huge problem. And then some doctors are also saying that ICE presence in and around hospitals is making it harder for them to do their jobs of providing care, because there are reports of agents being aggressive and sort of being in places where they are not supposed to be, or are physically impeding care. So two sides of the coin.
Rovner: Yeah, a reminder that ICE was largely forbidden from operating in, quote, “sensitive” areas like schools and churches and health facilities, in both Republican and Democratic administrations, until [President Donald Trump] changed it last January. We’ve heard a lot since then about ICE being in all of these sensitive locations, right?
Goldman: Yeah, yeah. And I think it’s important to note the Department of Homeland Security, when I reached out to them, said that they are not conducting enforcement operations in hospitals, even though they are now allowed to. If they take a patient who’s in custody to the hospital, they are in the hospital. They can get a warrant to come into the hospital. They can be in public spaces like parking lots and waiting rooms, waiting for people.
Rovner: And as we’re hearing, that’s exactly what they’ve been doing.
Goldman: Exactly.
Rovner: Even though they’re not, quote-unquote, “conducting enforcement operations” there. Doesn’t mean they’re not there. So even the American Medical Association, not exactly a left-wing group, issued a statement expressing concern about ICE activity in and around hospital emergency rooms, which it called a, quote, “tactic fueling fear among patients and hospital staff alike.” Are we starting to turn a corner here? I feel like this is, maybe it was a combination of what happened last week, coincided with the big snowstorm in half the country and people were stuck inside watching TV. I do feel like there’s way more awareness than there was even two or three weeks ago of this stuff.
Ollstein: I think it remains to be seen whether there is a meaningful policy and practice change or just a sort of symbolic or rhetorical change. There’s a different tone being struck. There’s sort of backpedaling on the immediate reaction from government officials we heard, which was to blame the people who were killed for their own killings. There are calls for investigations coming from both sides of the aisle. There are calls for some top officials’ resignations. But again, we’re hearing from people on the ground that things have not actually shifted in the enforcement behavior of these agents. And so I think it really remains to be seen what happens in Congress in terms of passing policies. There’s discussion of putting limitations in the spending bill on what ICE can do. But again, there is a lot of concern that I’ve heard from the advocacy community that they’re going to set up some government official — whether it’s [Homeland Security Secretary] Kristi Noem or [Trump deputy chief of staff] Stephen Miller or, already we’ve seen [Border Patrol official Gregory] Bovino — to be a fall guy and then nothing will actually change substantially beyond that. And so there’s continued anxiety around that.
Rovner: Yeah, and just a reminder that even if the spending bill doesn’t, for the Department of Homeland Security, didn’t pass and they didn’t even do a continuing resolution, ICE has I believe it’s $75 billion from the budget bill that passed last year. So they have a big chunk of money to keep operating regardless. Talk about collateral damage — it would be all of these other agencies that would have to sort of stop operating if there is some kind of a shutdown.
Well, meanwhile, it’s not just ICE that’s going after the state of Minnesota. The Centers for Medicare & Medicaid Services earlier this month cut off a chunk of the state’s Medicaid funding going forward. They’re charging that the state is, quote, “operating its program in substantial noncompliance” with rules to detect waste, fraud, and abuse. This is not how this is supposed to work. CMS can sanction states for their anti-fraud efforts being lacking, but there’s supposed to be a lot of due process first, with lots of hearings and appeals and fact-finding and all kinds of mumbo jumbo that we do go through before people actually get sanctioned. That’s apparently not what’s happening here. Although the ICE headlines are overshadowing the other punitive measures the federal government is taking toward Minnesota, I’m kind of surprised this aspect of the story isn’t getting more attention. Might it when other governors realize that this could happen to them, too, even if they didn’t happen to be on the ballot against Trump in the last election, like Minnesota Gov. [Tim] Walz was?
Goldman: Yeah, I was talking to somebody in the Medicaid space from a different blue state who was saying this feels like a turning point, something that they are scared of happening in their state as well. And, yeah, I think there are a lot of things that we need to see how they’ll play out, but this is definitely raising eyebrows.
Rovner: Yeah, and I will post in the show notes a link to a piece by Andy Schneider — who’s at Georgetown University and who wrote, when he worked on the Hill, wrote a lot of the Medicaid statute — explaining how this is all supposed to work and quite how different this is. But I would expect to be hearing more about this in the coming days and weeks, particularly if the administration doesn’t back off, because it’s a lot of money and, as we know, Medicaid is a huge, huge piece of every single state’s budget.
Well, meanwhile, on the abortion front, last week was the annual March for Life, marking the anniversary of the now overturned Supreme Court decision Roe v. Wade, and it’s fair to say that the anti-abortion movement is not happy with the Trump administration’s actions so far on the issue. Let’s start with what the administration did do to prove its devotion to the anti-abortion cause, To mark the movement’s big day in D.C., the Department of Health and Human Services reinstated its first-Trump-term ban on the use of fetal tissue in biomedical research, which President [Joe] Biden had reversed, and it expanded pretty dramatically the so-called Mexico City Policy that bans U.S. funding for international groups that, quote, “perform” or “promote” abortion. Now things like DEI [diversity, equality, and inclusion] and gender-affirming care are included, too. Alice and Rachel, you guys cover this. What should we know about these two new policies? It doesn’t seem like much, because they had both been in effect before, but it’s pretty big.
Ollstein: So the fetal tissue ban is also, research, is also an expansion of the first-term version, just like the Mexico City Policy. It goes further than before. And so the new version bans not only in-house government research but also government funding of research at outside institutions that use fetal tissue that was donated from abortions, and that has been used in all kinds of really important medical research, development of vaccines, etc. And so there is a lot of concern about that. They also imposed new restrictions on accepting new stem cell lines. There are lots of existing stem cell lines that they just keep propagating over and over from a long time ago, but they’re pausing accepting new ones while, they say, they’re exploring alternatives that they find more ethical. All of this has really rattled the research community.
And as for the Mexico City Policy, the expansion there is far beyond the issue of abortion. It’s banning funding going to groups that promote what they consider DEI and what they consider gender ideology. And so this is groups that serve the trans community in other countries and have programs for specific marginalized groups. So again, a lot of concern in the public health world because in order to tackle big public health problems, you often need to direct resources to the communities most at risk, and often that is the trans community, that is racial minorities. And so there’s a fear of this really impeding the delivery of services in a way that will impact the broader population.
Rovner: All right, so now to what the administration didn’t do that makes the anti-abortion movement so unhappy — anything further to restrict the abortion pill mifepristone. In fact, as expected, the Justice Department filed its brief in a closely watched lawsuit out of Louisiana this week, urging the court to pause the suit while the FDA [Food and Drug Administration] finishes its study of mifepristone, a study that abortion opponents say is the FDA purposely using to drag its feet on any action. So what the heck is going on here? Rachel, you start.
Roubein: Yeah, basically the Department of Justice asked for a stay in this lawsuit in Louisiana, and basically their justification was that: The Food and Drug Administration is reviewing mifepristone. We need time to do that. So that was basically what their ask was, was, like: Put this on pause. We will do this review that, as you said, anti-abortion advocates have been upset and said that it has been moving too slowly.
Ollstein: So I really saw the legal brief was kind of a Rorschach test that people could see different things and signs in it, because you had the pro-abortion-rights community looking at them saying: Look, they’re saying that the FDA didn’t properly review this in the past, and that’s why they’re doing this rigorous review now. That’s a sign that they’re going to impose restrictions. Also, the anti-abortion side looked at it and they were upset, one, that the Justice Department is arguing that the FDA allowing telemedicine doesn’t harm the states, and the states believe that it does, and so they’re saying: You can’t prove harm. You don’t have standing to bring this case. I think really the common theme in this filing and in some other ones last year related to these state abortion lawsuits is that the Trump administration is defending federal power and federal decision-making, and that can cut both ways. And so they’re saying, Leave it to us. And the anti-abortion groups are saying: We don’t trust you. We don’t want to leave it to you. We want to let these state lawsuits move forward.
Just to very quickly go back, the Trump administration did one other thing around the March for Life as a bone to the anti-abortion community, throwing them a bone, and that is they are attempting to claw back tens of millions of dollars in covid loans that went to Planned Parenthood affiliates. A lot of these loans were already forgiven by the Biden administration, but they are trying anyways to claim there was fraud going on and to get their money back. This boils down to sort of wonky arguments of whether the specific state Planned Parenthood chapters are considered enough part of national Planned Parenthood that they can’t claim to be a small business. This is going to be a legal fight. Planned Parenthood maintains they did absolutely nothing wrong. The state affiliates are separate from the national group, but—
Rovner: Which they are, by the way.
Ollstein: They are. They are. And courts have found that they are in the past. However, the anti-abortion movement was very excited about this. They see it as the first step towards declaring all Planned Parenthoods ineligible for any government funding, something they’re calling debarment, which they’ve been pushing for for a while. So that’s one other thing to keep an eye on.
Rovner: And a reminder, many, many Planned Parenthoods don’t and never have offered abortion. Well we won’t get as far into the weeds as we could here, but if you press me, I will. All right, we’re going to take a quick break. We will be right back.
So over at the Department of Health and Human Services, we have yet another mysterious case of stopping funding and then almost immediately restarting it. Earlier this month, the Substance Abuse and Mental Health Services Administration cut off nearly $2 billion worth of grants to drug abuse and mental health providers, only to reverse that decision a day later. Now, nearly the same thing has basically happened with about $5 billion worth of grants from the Centers for Disease Control and Prevention to all 50 state health departments for things like community outreach, emergency preparedness, and disease outbreaks. According to The Washington Post, which broke the story, notices to states were sent out Friday and barely 12 hours later, an HHS official told the Post the funding pause, quote, “had been lifted.” Still, it apparently took several more days for states to be able to access their funding portals. You can’t help but think that at least some of this is an actual effort to destabilize the nation’s public health infrastructure, right? They can’t be that sort of disorganized that they’re going to cut off funding and put it back. There has to be a reason here. Rachel, you’re smiling.
Roubein: My colleague Lena Sun and I were hearing about this on Saturday, ahead of the big storm. State officials were trying to kind of figure out what’s going on. With the mental health grants, you saw a very kind of concerted push from the advocacy community, from Republicans and Democrats on the Hill, to push for, that was a termination of those grants, to be rescinded, and they were within about a day. This happened sort of over the weekend, and it happened very quickly. So, I can’t say what the result of sort of the change was, because the notices were dated Friday, but state officials didn’t really start getting them till on Saturday. And then we’d heard sort of midday Saturday that the temporary pause was lifted. But it definitely threw, sort of, state and local health departments that we were talking about into sort of a state of confusion trying to figure out sort of what they needed to do and by when.
Rovner: Yeah, and we have seen this repeatedly from this administration. These are sort of two dramatic cases just this month, but the stopping and starting of grant funding is making it impossible to do any planning and figure out what you can do when. It’s just, it feels like just a matter of, Let’s make it as hard as possible for these people to do their jobs.
Goldman: Yeah, and—
Rovner: By “these,” yeah, I’d say by “these people” I mean the grant recipients, not the people who are overseeing the money.
Goldman: I can’t claim to know exactly what’s going on behind the scenes, but I think, what do you expect to happen when you gut all of the administrative functions of these agencies, which is what HHS did earlier this year? And of course, some of those people have come back, but there’s a lot of instability in HHS’ rank-and-file workforce itself, and so that naturally will trickle down to their grantees.
Rovner: Right, and particularly at the CDC. Well, adding to that, elsewhere at the CDC, some key databases, mostly concerning vaccines, are not being updated. That’s according to a study in this week’s Annals of Internal Medicine medical journal. The study found what the authors called “unexplained pauses” in nearly half of the 82 databases they studied that are normally updated monthly. Eighty-seven percent of those databases were on vaccination-related topics. Now, this could be political. It could also be due, as Maya was just saying, to the budget and personnel cuts at CDC that we’ve talked about so much over the past year. But it does seem that we’re continuing to fly ever more blind on things like disease surveillance, right?
Goldman: Yeah, and then when you couple that with the state and local public health divisions are the ones who would be the backstop there, but if their funding is in question now, that is even more concerning for public health surveillance.
Rovner: Yeah, and of course, we are in the middle of big measles outbreaks in South Carolina and Texas and trying to watch that closely, but it’s hard to do if you only have sort of state-by-state backups to look at.
All right. Well, before we go, we need to talk about the Affordable Care Act. Remember the Affordable Care Act? Before it was subsumed by all the other headlines? Apparently, the Senate is still working on a bipartisan compromise that could restart lapsed subsidies that have spiked health insurance premiums for millions of Americans. And apparently things aren’t going all that well. And to add to it, here’s the headline on the press release for the latest KFF poll, hot off the presses just this morning — quote, “Health Care Costs Tops the Public’s Economic Worries as the Runup to the Midterms Begin; Independent Voters Are More Likely to Trust Democrats than Republicans on the Issue.” On the other hand, the poll did find that Republicans still trust Republicans more. And while the ACA remains pretty popular overall, it is less popular with Republicans than it was before last fall’s campaign by Republicans to blame all of the health care system’s ills on the 2010 health law. So where does that leave us? We’re with — this is the end of January. People who have been sort of reenrolled in the ACA are starting to get these huge premium notices that they may or may not be able to pay. Has Congress just kind of moved onto the next crisis?
Ollstein: So some people in Congress are still trying to resolve this crisis, even as new crises pile up. The bipartisan talks are still going on, but there is just not a lot of optimism here. There is not really agreement on lots of aspects of extending the subsidies, and all of this is really discussing, at most, sort of a one-year extension. And so they would just have to have this whole fight all over again. But yes, I would say things are looking more bleak on that front than even a few weeks ago. I don’t know what my fellow panelists think.
Rovner: And any anybody have optimism for getting these subsidies extended? I’m not seeing anybody raising their hand. Well, we will continue, obviously, to watch this space.
All right. Lastly, health insurers are starting to get the same heartburn as the pharmaceutical industry. Last week, in back-to-back hearings at the House Energy and Commerce and Ways and Means committees, the heads of five of the biggest health insurers got pretty much filleted by members of both parties. Then this week, the Trump administration kind of shocked the markets by offering a much-smaller-than-expected increase for private Medicare Advantage plans. Those have been the darlings of Republicans for a couple of decades now. Maybe Republicans do really mean it when they say they want to stop giving so much taxpayer money to health insurers?
Goldman: I was a little bit struck by how surprised everybody was at this, because I think [CMS Administrator] Dr. Mehmet Oz has been hinting that he’s much more amenable to cracking down on reported improper behavior among Medicare Advantage plans than people anticipated the next Trump administration would be. And there’s really this groundswell in the House of Representatives as well among Republicans to sort of rein in improper spending in Medicare Advantage.
Rovner: Sen. Bill Cassidy has been pretty—
Goldman: Yes.
Rovner: —outspoken on it, which surprised a lot of people. Now his, the committee that he’s the chairman of doesn’t have jurisdiction over this, but he is also a member of the Finance Committee, which does have jurisdiction over this.
Goldman: Exactly. Exactly. And so to me it wasn’t that surprising, I have to say. But it sent shock waves through the markets? Obviously, insurers are saying that if this is finalized as proposed, they’re going to have to cut benefits for seniors even more, they’re going to have to raise premiums and things like that. And of course this could be a bad political move, potentially, for Republicans. But I think—
Rovner: Because there are lots of Republican voters who are in Medicare Advantage plans—
Goldman: Absolutely.
Rovner: —and don’t want to see their benefits cut.
Goldman: Absolutely, and Medicare Advantage insurers have been saying this over and over again. The Biden administration was also pretty conservative on Medicare Advantage. I guess maybe “conservative” is a funny word choice, but—
Rovner: Light-handed.
Goldman: Yes.
Rovner: Were light-handed.
Goldman: Yes, I think, and insurers were largely able to weather that. Of course, there are some changes that they’re making this year. We’re seeing some market realignment. So it, another year of that, who knows what would happen. But I think it still remains to be seen how impactful this will actually be for beneficiaries.
Rovner: Yeah, well, another constituency to get riled up in the run-up to the midterms. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think that you should read, too. Don’t worry if you miss it. We’ll post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?
Ollstein: Yeah. So I have this fascinating investigation from The New York Times. The headline is “After Donations, Trump Administration Revoked Rule Requiring More Nursing Home Staff.” So this is a story about these nursing home industry groups making massive donations to Trump’s super PAC and, after that, gaining a lot of access to him and using that access to lobby for the scrapping of a rule that required minimum staffing in nursing homes. And that rule was already not really being enforced, but now they are getting rid of it formally. And so I think the story does a good job of saying, Look, we can’t prove exactly that they got rid of this rule because of the donations, but it is part of a pattern where people who have given a lot of money to the president’s various groups have gotten just an incredible amount of access to him and other top officials. And the story also stresses why we should care about all of this. There’s just been a lot of horrific data coming out of nursing homes of problems caused by understaffing, patients experiencing preventable injuries, infections and other health problems that go unnoticed until it’s too late or it gets way more serious, and even facilities using, basically drugging patients to keep them easy to control and complacent, because there just isn’t enough staff to attend to them. People who have dementia and other things need a lot of care and can get upset and disoriented. And instead of taking care of them, they’re putting them on heavy psychotropic drugs. And so it’s a really sad and serious situation, and this article shows some potential pay to play.
Rovner: Yeah, I tend to be, in general, skeptical of administrations doing things that we thought they were going to do anyway and someone else happened to give them money. But this draws a pretty clear line. They did do what they were going to do anyway, which was going to sort of not really enforce these regulations. Anyway it’s really good story. Should read it. Maya.
Goldman: My extra credit this week is “Many Obamacare Enrollees Have Switched to Cheaper Bronze Plans. Here’s Why That Could Be Risky,”on NBC News by Berkeley Lovelace Jr. And it’s one of those stories that, wow, I wish I had written this. It’s a really great explanation of one of the sort of lesser-talked-about side effects of losing enhanced ACA subsidies, which is that people are going into plans that are — they’re still opting to be in insurance, but they’re taking plans that are lower premiums but much higher deductibles, which means that their coverage is less valuable. And they might still have to pay a lot of money out-of-pocket for most services, and then they might not seek those services, which sort of negates the purpose of having health insurance and its effect on public health. And this story shows that Kentucky, Idaho, Massachusetts, New York, Virginia, Rhode Island, California are all seeing decreases in “silver” plan enrollment, which is sort of that lower-deductible, higher-premium tier, and increases in “bronze” enrollment, which is super-high-deductible. So huge thing to watch.
Rovner: Really, really good explanation. Rachel.
Roubein: My extra credit is by Stat News. The headline is “HHS Appoints 21 New Members to a Federal Autism Advisory Committee,” by O. Rose Broderick. And the story lays out how the Department of Health and Human Services yesterday, on Wednesday, announced the appointment of new members to a federal committee that will advise Secretary [Robert F.] Kennedy [Jr.] on autism. Broderick reports that many of the new members of the committee, which is called the Interagency Autism Coordinating Committee, have publicly expressed or belonged to groups that have publicly expressed a belief in the debunked claim that vaccines can cause autism. Stat had also reported earlier this week that the members of the committee had met in secret and that some members of the kind of broader autism community were worried about the panel. And just kind of for sort of the big-picture point of view, Kennedy, last year, pledged to find the causes of autism. And during his tenure as HHS secretary, he’s challenged years of public health messaging on vaccines, such as instructing the CDC to contradict the long-settled scientific conclusion that vaccines do not cause autism. Kennedy, in a press release yesterday, called the researchers “the most qualified experts — leaders with decades of experience studying, researching, and treating autism.”
Rovner: Yet another piece of this. There’s a lot of advisory committees at HHS, and there are many of them worth keeping a close eye on. All right, my extra credit this week is from Science magazine, by Monica Hersher and Jeffrey Mervis. It’s called “U.S. Government Has Lost More Than 10,000 Stem Ph.D.s Since Trump Took Office,” and it puts some actual numbers to the science brain drain that we’ve been talking about. The authors looked at 14 agencies across the federal government, including the NIH [National Institutes of Health], FDA, and CDC at HHS. They noted that those 10,000-plus experts represented only 3% of the more than 300,000 federal workers who’ve left employment since Trump took office, but they represent 14% of the total number of Ph.D.s in science, technology, engineering, math, and health fields. Most quit or retired after taking buyouts rather than being fired, according to the data. But as the authors noted, quote, “these departing Ph.D.s took with them a wealth of subject matter expertise and knowledge about how these agencies operate.” Certainly a win for the Trump administration, which wants to remake the federal government’s approach to science. For the rest of us, we will have to wait and see.
OK, that’s this week’s show. Before we go, a reminder that our annual KFF Health Policy Valentine contest is open. We want to see your clever, heartfelt, or hilarious tributes to the policies that shape health care. Submit your poem, whether conventional, free-form, or haiku, by noon Eastern on Wednesday, Feb. 4. The winning poem will receive a custom comic illustration in the Morning Briefing on Feb. 13. I will post a link to the formal announcement in our show notes.
As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. 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 folks these days? Maya?
Goldman: You can find me on LinkedIn under my name or on X, @mayagoldman_.
Rovner: Alice.
Ollstein: Still on X, @AliceOllstein, and on Bluesky, @alicemiranda.
Rovner: Rachel.
Roubein: LinkedIn under my name. Bluesky, @rachelroubein. X, @rachel_roubein.
Rovner: We will be back in your feed next week. Until then, be healthy.
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