Dan Weissmann
News has been popping out of Washington, D.C., for the reason that begin of the second Donald Trump administration like water out of a hearth hose. It can really feel unimaginable to remain on high of all of the modifications.
So on this episode of “An Arm and a Leg,” host Dan Weissmann speaks with KFF Health News chief Washington correspondent Julie Rovner to attempt to get a deal with on what’s occurred thus far. Rovner has been masking well being care in Washington for almost 40 years and hosts the weekly well being coverage podcast “What the Health?”They discuss what the top of a little-known federal health regulatory agency may imply for the well being care advantages of tens of millions of Americans, with some assist from KFF Health News senior correspondent Arthur Allen. Then, Rovner talks about efforts to chop Medicaid and why it might not be really easy to take aside.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Transcript: A Health Policy Veteran Puts 2025 in Perspective
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a instrument however examine the corresponding audio earlier than quoting the podcast.
Dan: Hey there–
2025 has been a LOT thus far, particularly for the reason that second Trump Administration obtained began. We hear about loads of sudden strikes, loads of cuts, possibly some reversals — in well being care (and in every single place else). With greater strikes possibly nonetheless to return.
What’s ACTUALLY occurred thus far? I can’t sustain.
But I do know some individuals who would possibly. Our friends at KFF Health News have a complete NEWSROOM — dozens and dozens of individuals — publishing tales daily.
And one individual specifically there’s as plugged-in as will be.
Julie Rovner has been masking well being care in Washington, DC for longer than anyone. Close to 4 many years.
When we first begin speaking, Julie gestures behind her. On a bookshelf in her workplace are copies of Congressional Quarterly, the place she began reporting within the Eighties.
Julie Rovner: I imply. Literally each time any person in Congress sneezed on healthcare, I wrote a narrative. That was my job. For eight years. It was form of the start of my profession, however I’ve form of considered it ever since.
Dan: Over the many years, she’s watched massive modifications occur incrementally, one sneeze at a time.
Julie coated well being look after NPR for greater than 15 years, and since 2017, she’s hosted KFF’s podcast What the Health.
Every week, she convenes a roundtable of high health-care reporters for a complete inside-the-beltway nerd-fest.
And it seems: Even Julie Rovner has a tough time sustaining an up-to-date scorecard.
Julie Rovner: I’m making an attempt to maintain a operating checklist of what’s been reduce and what’s been restored, and it’s nearly unimaginable ’trigger there’s 20 issues daily. I imply, principally the way in which I do my information podcast now could be I spend 4 days every week making a listing, after which on the fifth day, I reduce it in half concerning the issues we will discuss.
Dan: Oh my gosh.
Julie Rovner: And on the day of the podcast, I normally reduce it in half once more. Dan: So, the scorecard retains altering too quick. But Julie does see an enormous image.
And as a result of she is aware of all the small print– 4 many years of them– she can assist us see it by telling us two tales:
One a few teeny a part of the well being care system that almost all of us have by no means heard about. Which is now one of many too-many-to-keep-track-of places of work that the Trump Administration has taken a chainsaw to.
Then we’ll have a look at one thing everyone’s heard about — and plenty of persons are apprehensive about: Medicaid. And Julie’s gonna present us why it might not be really easy to take aside.
This is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann– I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take probably the most enraging, terrifying, miserable elements of American life, and convey you one thing entertaining, empowering, and helpful.
Our first story — this little company — teeny, by authorities requirements — Julie truly watched it get constructed, early in her profession. And it seems to be an important instance for this present to take a look at.
I imply, right here’s how Julie begins telling its origin story:
Julie Rovner: In the late Eighties, there was type of an settlement between Republicans and Democrats that healthcare prices had been going up actually quick and we didn’t know why. And one of many causes is that we didn’t truly know what labored.
Dan: That is, everyone needed to know: Why does well being care price so freaking a lot, and what can we possibly do about it?
And they thought: Maybe any person ought to perform a little research about what’s truly value paying for. Between Medicare, Medicaid, and well being advantages for presidency employees and veterans, the federal authorities does loads of the paying.
Julie Rovner: There was consensus that the federal authorities is spending all of this cash on healthcare, they need to spend at the very least a little bit little bit of it, making an attempt to determine what works. And there needs to be some type of, you already know, referee, like a authorities company.
Dan: And after all that company would wish a reputation..
Julie Rovner: It was initially gonna be the Agency for Healthcare Research and Policy, however any person found out on the final minute that that might make its acronym AH-CRAP they usually determined that was a foul thought.
Dan: So they reversed the final two bits and referred to as it the Agency for Healthcare Policy and Research.
Julie Rovner: My favourite piece of well being coverage trivia.
Dan: What are you able to inform me concerning the numerous sneezes and hiccups and coughs alongside the way in which?
Julie Rovner: Oh, nicely there was fairly a combat in creating “ah-crap.”
Dan: Even although the concept had backers amongst each Democrats and Republicans, they needed to cope with constituencies — curiosity teams — with turf to guard.
Julie Rovner: There had been medical organizations and insurance coverage corporations and they didn’t need the federal government dictating how medication can be practiced. So it was not, you already know, it was not a finished deal. It took loads of negotiating.
Dan: And in 1989, the primary 12 months of George H.W. Bush’s presidency, neither political get together may muscle something via.
Julie Rovner: Democrats are answerable for Congress. Republicans are answerable for the White House. Hence, something that’s gonna occur is gonna be bipartisan. Unless they’re gonna attempt to override a veto. And trace trace, there have been a few makes an attempt to override George HW Bush vetoes, and
all of them failed by a few votes, totally on abortion stuff. And there was an NIH invoice as a result of I bear in mind obscure issues like this.
Dan: I imply, you see why Julie is THE individual to present us this story, proper?
So the company will get created in 1989. and one among its jobs is creating apply pointers. Official federal suggestions about therapies: Which ones labored, which of them don’t.
Julie Rovner: It places out an terrible lot of pointers and shock, a few of them had been actually controversial.
Dan: Some eye medical doctors didn’t like a tenet on cataracts. The Pharma trade hated A tenet that beneficial lowering the usage of brand-new medicine.
Julie Rovner: Then mid nineties they arrive out with one on again ache, on acute again ache. And one of many issues this guideline discovered at . All of the proof is that. Back surgical procedure doesn’t truly work very nicely for acute again ache. Um, for sure, the nation’s backbone surgeons weren’t thrilled.
Dan: That guideline got here out in 1994. That November, Republicans scored massive majorities in each homes of Congress.
NEWS ANCHOR 1: We start tonight with probably the most simple response we’ve heard all day to the outcomes of yesterday’s election. The Democratic chairman David Wilhelm mentioned merely,“We got our butts kicked.”
NEWS ANCHOR 2: Republicans referred to as their guarantees a contract.
GOP MEMBER: Today, we Republicans are signing a contract with America.
Dan: A contract that required, amongst different issues, massive funds cuts. And this little company ended up on their hit checklist.
Julie Rovner: they had been representing their backbone surgeon constituents, they usually had been prepared to only do away with the entire thing. they tried to only wipe it out within the appropriation invoice they usually got here very shut, however didn’t fairly
Dan: They did reduce funding — together with the cash for creating pointers. And they didn’t neglect. In 1999, Congress handed laws that formally kicked the company out of the rules enterprise altogether
And gave it a brand new identify: The Agency for Healthcare Research and Quality. AHRQ (arc), for brief.
Julie Rovner: Congress loves to present well being businesses new names – even once they’re the identical company– as a result of they wish to form of rid it of its baggage from the previous. So we’ve renamed it, gotten it out of the rules enterprise, however it’s nonetheless the primary Federal company that appears on the high quality of healthcare and the way healthcare works.
Dan: For instance, Julie says AHRQ runs the Healthcare Cost and Utilization Project. HUP for brief, after all.Which retains observe of some essential numbers:
Julie Rovner: How many individuals had been within the hospital for the way lengthy? How lots of them had been youngsters? How many individuals obtained ambulatory surgical procedure? How many hospital readmissions had been there? This is that database
Dan: And sustaining that database is a part of AHRQs job.
Julie Rovner: So it’s very small. But it’s the one company that principally does what it does, which is to say we spend a fifth of our economic system on healthcare. We ought to strive to determine how nicely it really works. [
Dan: Or somewhat it was, till now. In March, officers from the Trump Administration’s Department of Government Efficiency — DOGE for brief — held their first assembly with AHRQ’s leaders.
Arthur Allen: it was a gathering in individual at, at their workplace the place this was finished
Dan: Julie’s KFF Health News colleague Arthur Allen talked with a type of ARQ staffers.
Arthur Allen: It was simply informed, we don’t know what you do. We’re gonna reduce you 80, 90%.
Dan: Arthur says he came upon about the entire thing by following up on a tip in a LinkedIn publish. He says pitching the story wasn’t the best promote, even at KFF.
Arthur: Everybody was making jokes about it, They had been like, yeah, good luck making an fascinating story out of this. You know, good luck explaining what AHRQ does or making it into one thing anyone would wish to learn.
Dan: He did, they usually printed it. And it led to a brand new tip: As Arthur reported, ARQ was getting merged with one other workplace within the division of Health and Human Services– the Assistant Secretary for Planning and Evaluation.
Sources from that workplace noticed his ARQ story and informed him: Their workplace was getting reduce dramatically too.
According to his sources, between the 2 businesses, nearly three quarters of the persons are gone.
Including: everyone who was concerned in calculating the federal poverty line.
As the headline for Arthur’s story says: eighty million folks qualify for advantages primarily based on that quantity.
Arthur Allen: It’s utilized by, you already know, actually hundreds of businesses, personal, public, state, native, federal, to resolve whether or not folks qualify for advantages: meals stamps, Medicaid, subsidies for childcare– you already know, just about something you’ll be able to consider the place there’s help to decrease earnings folks.
Dan: One of the fired employees informed Arthur, quote: “There’s literally no one in the government who knows how to calculate the guidelines. And because we’re all locked out of our computers, we can’t teach anyone how to calculate them.”
Arthur Allen: The man had been doing it for like 20 years. He was simply thrown out the door and e-mail eliminated. No solution to attain him.
Dan: He informed Arthur that utilizing a special methodology would produce completely different outcomes. If the brand new calculation didn’t absolutely account for inflation, for one instance, some folks may find yourself shedding advantages. And there are loads of different examples.
Arthur Allen: Over years, you already know, you’re making an attempt to develop one of the simplest ways to do that. Any type of quantity like this, which you’re making an attempt to hone down and make it as correct as attainable, you develop this form of fingerspitzengefühl…
Dan: What’s fingerspitzengefühl?
Arthur Allen: Well, it’s a German phrase which means like, feeling on the finish of your fingers, the place it’s like, it, it’s an undefinable potential to do one thing like
Dan: Like choose a lock?
Arthur Allen: Yeah. Yeah. Like Right. Exactly.
Dan: An HHS spokesperson informed Arthur the division would proceed to adjust to statutory necessities and keep important packages. After the article was printed, one other spokesperson referred to as KFF to say “the idea that this will come to a halt is totally incorrect. Eighty million people will not be affected.”
Arthur Allen: They had been like, there are different folks at HHS who can do this and, you already know, it’s, it’s true. It’s simply, you possibly can have made it a lot simpler. And additionally they haven’t been probably the most dependable all the time by way of, you already know, saying one thing after which following via on it. So, you already know, there’s motive to be skeptical.
Dan: Well, it’s, it’s a reporter’s credo, proper? If your mother says she loves you, get one other supply.
Arthur Allen: Yeah.
Dan: So now we’ve truly checked out a COUPLE of small examples. And there are such a lot of extra. Julie Rovner sees them as a part of the larger image..
Julie Rovner: How I’ve been eager about that is that our healthcare system is a huge Jenga tower and it’s a little bit wobbly and what holds it up is every part that occurs from the Department of Health and Human Services, it’s all the principles of the street. It’s all of the enforcement, it’s all of the protections. In many instances, it’s truly the funding. It’s what funds loads of packages for folks with low incomes, the coaching of, not simply medical doctors, however future researchers. And they’re yanking out sticks from this Jenga tower as quick as they probably can, and when the entire thing comes down, it’s gonna be very, not fairly.
Dan: She sees all these blocks getting pulled from the Jenga tower. She is aware of why they’re there. And what may occur as they get yanked away.
Julie Rovner: I really feel so much like I did in the course of the early elements of the pandemic. It’s simply that feeling of, oh my God, what contemporary hell is subsequent? And will we ever be capable to repair it? I’m, and I’m actually apprehensive about that. And you already know, at the very least in the course of the pandemic, I felt like everyone felt that approach.
Dan: With cuts and modifications we’ve seen thus far, the administration has acted by itself– and courts might or might not cease or reverse a few of them.
But then there’s one of many massive issues numerous folks fear about: enormous cuts to Medicaid, which insures one thing like 79 million folks.Cuts on the dimensions we’re listening to about would requires Congress to behave. To move laws.
Which Julie Rovner thinksCongress will discover very arduous to do.
Julie Rovner: Not a lot as a result of it’s arduous to chop Medicaid, which it’s, however as a result of it’s gonna be actually arduous for this Congress with these little tiny Republican majorities to agree on something.
Dan: Julie, after all, has some very particular causes these specific cuts will likely be so troublesome for these specific Republican majorities. That’s subsequent.
This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom masking well being points in America. Their journalists — like Julie Rovner and Arthur Allen — do wonderful work. We’re honored to be colleagues.
So simply to recap, right here’s why cuts to Medicaid loom so massive.
NEWS ANCHOR 3: Republicans want to slash $2 trillion with a T in long-term spending. And Medicaid may very well be a goal
Dan: Congressional Republicans have handed a funds framework— principally, an overview — with massive cuts unfold throughout ten years.
They’ve assigned committees to search out particular cuts, they usually’ve given greater than 800 billion {dollars} in cuts to a committee that doesn’t have loads of different choices
NEWS ANCHOR 4: A brand new evaluation from the Congressional funds workplace reveals the proposed funds would require MASSIVE cuts to Medicaid spending.
NEWS ANCHOR 5: It’s mathematically unimaginable for Republicans to fulfill their very own goal with out slicing Medicaid.
Dan: And Julie says, cuts on this scale may damage lots of people.
Julie: I’ve seen estimates that 20 million folks may lose their Medicaid protection,…it’s possibly 1 / 4 of the folks on Medicaid.
Dan: Julie says Republicans wish to keep away from saying they’ll make these sorts of cuts. So…
Julie Rovner: You know, now Republicans are saying we’re not gonna reduce Medicaid, places the air quotes.
Dan: What they’re saying they WILL do, that’s gonna require some unpacking. Here’s the official line, as Julie places it
Julie Rovner: We’re simply gonna cut back the additional cash that Medicaid pays states for the Medicaid growth, beneath the Affordable Care Act.
Dan: OK. Extra cash for states. Medicaid Expansion. Affordable Care Act.
Let’s break that down. The Affordable Care Act is greatest identified for “Obamacare” marketplaces, the place folks should buy medical insurance even when they’ve pre-existing circumstances.
But one other massive factor it did was to broaden Medicaid: It raised earnings cut-off so extra folks may qualify.
Now, the way in which Medicaid is designed, states share the fee with the federal authorities. But beneath the ACA, the feds ship extra cash to states, to pay for many of that growth. Like 90 % of it.
That’s the context for this line that Congress wouldn’t reduce Medicaid, simply the “extra” cash to states for the growth.
Julie Rovner: And we see loads of Republicans saying, oh, if states wanna proceed it. They can simply pay their common share. Well, that common share is $626 billion over the subsequent 10 years that states would cumulatively should provide you with. Um, states, in contrast to the federal authorities, just about should stability their budgets yearly. They don’t have 626 billion further {dollars} hanging round to try this.
Dan: Julie thinks loads of states would find yourself slicing Medicaid. Some would do it robotically, with legal guidelines which might be already on the books.
Julie Rovner: We have 12 states that say if Congress reduces that threshold from 90%, we instantly cancel our Medicaid growth. They’re referred to as set off legal guidelines and there’s 12 states with set off legal guidelines.
Dan: But some states — not solely do they not have set off legal guidelines. They have an enormous downside.
Julie Rovner: Three states, three very crimson states, Missouri, Oklahoma, and South Dakota. Expanded Medicaid, not simply by poll measure, however by amending their state constitutions.
Dan: Yeah, this was type of fascinating: All the states that originally rejected the Medicaid growth had been led by Republican politicians.
It looks as if an enormous motive they opposed it was as a result of, nicely, it was a part of the ACA– ya know, “OBAMA-care”? Their legislators would by no means vote for it.
But increasing Medicaid is common with lots of people. The legislatures in these states didn’t vote for the growth, the folks did — they voted for poll initiatives that truly added Medicaid growth into their state constitutions..
Julie Rovner: These three states, that change their constitutions, don’t have set off legal guidelines as a result of they’ve modified their structure. That possibly helps clarify why Senator Hawley from Missouri, who is just not referred to as an enormous defender of Medicaid, uh, has mentioned he’s not gonna vote for Medicaid cuts as a result of his is likely one of the states that may very well be left holding a really massive and costly bag in the event that they’ve rolled again this extra federal match. So that’s only one instance. You know, when he first mentioned it, it’s like, why is Josh Hawley all of a sudden so gung-ho for Medicaid? Um, that helps clarify why.
Dan: That may be very fascinating. So that is an instance of why it’s arduous to chop Medicaid. Um,
Julie Rovner: Very, sure.
Dan: And Julie says, there are different causes too.
Julie Rovner: I imply, in case you return to 2017, when the Republicans attempt to repeal and substitute the Affordable Care Act for the primary time, Medicaid turned out to be a essential motive why they couldn’t, as a result of all of a sudden folks found that Medicaid isn’t just for, you already know, mothers and children on welfare, medicaid pays. The overwhelming majority of the nation’s nursing house payments, so everyone’s grandparents who had been in nursing houses had been most likely getting Medicaid. Suddenly we found how many individuals had been getting Medicaid and other people found how many individuals had been getting Medicaid, they usually got here to Congress.
NEWS ANCHOR 6: On Capitol Hill the place there have been protests and lots of arrests at present
Crowd: Kill the invoice.
News reporter: Senate Republicans at present obtained a bruising. Welcome again to Capitol Hill…
Crowd: Kill the invoice. Health care is a human proper.
Julie Rovner:I used to be there they usually mentioned, we don’t need you to do that, you already know, it, it was very shut, however in the long run, I believe Medicaid was actually a significant motive why Congress proved unable to repeal the ACA, if something, Medicaid is now extra entrenched and there are extra folks on it than there have been in 2017. Um, and Congress has even smaller majorities. You decide how arduous it’s gonna be.
Dan: And as you’ve mentioned, three states with two Republican senators every. Julie Rovner: Each. That’s appropriate. So there’s six.
Dan: Republicans maintain 53 Senate seats. They may lose three votes and name in Vice President JD Vance to interrupt a tie. They want 50 votes.
Julie Rovner: So they’ve 53 votes and 6 of these votes come from states. That can be left holding a really costly bag. And one other three or 4 senators who voted in opposition to it in 2017 are nonetheless there. So even counting to 50 is tough.
Dan: First, that’s one among Julie’s beloved Corgis within the background, amped up as a result of he hears a neighbor canine exterior.
Wally: Woof!
Julie Rovner: Wally, are you barking at Churchy? I’ll allow you to go play with him later.
Second, after all we don’t know what Congress will truly do on this very-unusual 12 months.
But it doesn’t matter what, it’s enjoyable speaking about politics with Julie Rovner.
And even when it doesn’t seem to be a enjoyable time to be Julie Rovner, to be doing the job she does — consuming from the firehose, as she says — I don’t assume she’s going wherever.
Julie Rovner: Yeah, I imply, you already know, my mother was a journalist. My dad was a, a political staffer, principally. He labored on the state, federal, and native degree in his profession and principally, you already know, made coverage occur. And, , that’s my legacy and I actually care about it.
Dan: And, she is just not taking in completely EVERYTHING. For occasion, she has not been watching “The Pitt.” The super-exciting– and super-stressful–new medical drama we talked about final time–the one which chronicles an especially-intense day in a busy city emergency room.
Julie Rovner: I began to observe it –and I watched each episode of ER. I imply, I’m a type of folks. I’ve additionally seen each episode of Grey’s Anatomy which is insane. Um, however I began to observe the Pitt and I obtained about three quarters of the way in which into the primary episode, and I assumed, I can not cope with this proper now. And I turned it off.
Dan: Yeah.
Julie Rovner: I simply– and I watched severance! I’m like,‘Why am I watching severance? I do not need anything creepy in my life right now.’ But it was excellent. It’s humorous, I may get via severance, however I couldn’t get via The Pitt.
Dan: So, even Julie Rovner has her limits. Which I believe is nice.
She is doing the factor I remind everybody to do on the finish of each episode of this present: Taking care of herself.
If you haven’t subscribed to our First Aid Kit e-newsletter but, I believe this can be a nice time to test it out.
It’s the place we boil down a number of the sensible issues we’ve realized about caring for ourselves and one another:
My colleague Claire Davenport has been serving to her roommate combat again in opposition to greater than 14 thousand {dollars} in medical payments. They worn out ten thousand with some due diligence.
And I’m amassing recommendation for what may very well be a one-page useful resource: Some fast recommendation and hyperlinks that everyone ought to get earlier than the primary hospital invoice arrives.
You can enroll– and skim every part we’ve finished thus far — at arm and a leg present dot com, slash first help package.
We’ll be again with a brand new episode in just a few weeks.
Until then, care for your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann–, with assist from Emily Pisacreta, Claire Davenport, and Zach Dyer of KFF Health News –And edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Sessions.
Bea Bosco is our consulting director of operations.
Lynne Johnson is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Health News. That’s a nationwide newsroom producing in-depth journalism about well being points in America —
and a core program at KFF: an impartial supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present.
An Arm and a Leg is Distributed by KUOW– Seattle’s NPR station. And because of the Institute for Nonprofit News for serving as our fiscal sponsor. They permit us to just accept tax-exempt donations. You can study extra about INN at INN.org.
Finally, thanks to everyone who helps this present financially. You can take part any time at arm and a leg present, dot com, slash: help. Thanks! And thanks for listening.
“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.
For extra from the crew at “An Arm and a Leg,” subscribe to its weekly e-newsletter, First Aid Kit. You may also observe the present on Facebook and the social platform X. And in case you’ve obtained tales to inform concerning the well being care system, the producers would like to hear from you.
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