[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, as all the time, I’m joined by a number of the greatest and smartest well being reporters protecting Washington. We’re taping this week on Thursday, July 23, at 10:30 a.m. As all the time, information occurs quick, and issues may need modified by the point you hear this. So, right here we go.
Today we’re joined by way of video convention by Margot Sanger-Katz of The New York Times.
Margot Sanger-Katz: Hello.
Rovner: Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hi, Julie.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.
Joanne Kenen: Hi, everyone.
Rovner: Later on this episode, we’ll have our “How Would You Fix It?” interview with Louisiana Republican Sen. Bill Cassidy, chairman of the Senate Health, Education, Labor, and Pensions Committee. But first, this week’s information. I wish to begin this week with what I’m calling the “Shrinking Safety Net.” The Center on Budget and Policy Priorities is reporting that total participation in SNAP [Supplemental Nutrition Assistance Program], the nation’s meals stamp program, is down by greater than 4½ million folks. That’s about 11% between final 12 months’s enactment of the Republican funds invoice and this previous April. In Arizona, almost half the recipients have left the rolls, and in Louisiana, Florida, and Oklahoma, it’s nearer to twenty%. Nearly half of these shedding advantages are kids, in accordance with the evaluation, and that is earlier than a number of the greatest cuts to this system even take impact. What does this imply, and what does it portend for Medicaid cuts that the SNAP declines are a lot bigger than had been anticipated when this invoice was handed in 2025?
Sanger-Katz: The Republican invoice put a variety of new burdens on states that to manage SNAP, and it created these penalties that if they’d a variety of errors, then they had been going to finish up having to pay a a lot bigger proportion of that complete invoice. And I feel what’s occurred is that that kind of spooked a bunch of states, and I feel Arizona specifically, is dealing with some difficult politics across the program. And so I feel of their effort to scale back the error charge, they’ve created much more paperwork for beneficiaries to show that they’re eligible, as a result of the state doesn’t wish to take an opportunity that in the event that they return and test later, that there can be some mismatch and they’ll get dinged for making an error. So I feel there are actual classes for what’s going to occur in Medicaid. The SNAP modifications are occurring a bit quicker than the modifications to Medicaid. But I feel there are a variety of the identical incentives. There are also going to be elevated penalties for states which have a excessive error charge in Medicaid, and there are going to be further paperwork necessities added to Medicaid for folks to show that they’re complying with the work requirement and sure different issues that didn’t exist earlier than.
Rovner: And as we’ve mentioned a bunch of instances earlier than, states who’re anticipating these cuts are already making cuts as a result of they should do budgets earlier than a few of these cuts take impact. Joanne, you wished to say one thing?
Kenen: No, I feel that Medicaid modified all of a sudden on June 1, proper? I imply, the protection losses had been anticipated below the laws. That’s how the cash was saved. CBO says folks will lose protection, and that’s the place the financial savings had been, by and enormous. The interim ultimate rule that dropped — however we didn’t know the way dangerous it will be. We didn’t know the way many individuals, partly as a result of states had a good, they’d sure issues they needed to do, however they’d a variety of flexibility in the right way to do them. So that the protection losses had been an unknown, proper? They may need been as dangerous because the liberal critics mentioned, and they may not have been as dangerous as a number of the defenders of the regulation mentioned. It was a wait-and-see. On June 1, as we’ve talked about earlier than on the podcast, CMS [Centers for Medicare & Medicaid Services] dropped an interim ultimate rule, and it modified issues rather a lot. And it mainly took away a variety of the state flexibility. And as a substitute of letting states say, “OK, you have such-and-such a disease. We know you have such a disease. We have your medical records. We have the coding from the bills from Medicaid. This is, clearly, you can’t work.” That’s not adequate. You can’t use their medical historical past. Every single individual who’s sick on Medicaid, who can’t work, who contends they can’t work, has to go for a workup by a doctor. Right now we’re unsure if it’s different well being suppliers, who actually isn’t skilled in incapacity medication. Manatt simply got here out with a research only a day or two in the past saying that the protection losses are going to be a lot increased than anticipated. And there’s a variety of hurdles for people, and there’s a variety of prices for the states. So, like, the SNAP is now, like, OK, that was SNAP, and that is Medicaid. Now it’s simply far more alarming to observe what occurred in SNAP.
Sanger-Katz: I feel one other lesson from SNAP is that we’re going to see a variety of state variability within the outcomes. You know, these are each packages, they’re federally funded, however they’re administered by states, and states have completely different capacities. They have completely different bureaucracies. They have completely different tolerances for spending cash on these packages. And we’re seeing, even in SNAP, there’s sort of like individuals are shedding protection in all places. But like in Arizona, it’s like half of the folks. And I feel that what we’re more likely to see one thing related play out in Medicaid, the place some states both are simply not keen to spend the cash, or they’re very terrified of penalties, and so they’re like actually have very strict standards. And different ones simply, like, gained’t be good at it, and they’ll make a variety of errors, and that can trigger folks to lose protection too. I feel each state is completely different. Every state is constructing this from the bottom up, and there are going to be completely different ranges of coverage planning, danger tolerances, and similar to common glitchiness as they roll it out. And I feel we’re seeing that in SNAP. It’s a lesson of what we’re seeing now that can carry over nearly definitely.
Ollstein: And to that time, I feel, in some locations, like Joanne mentioned, you’re going to should, you understand, mainly get a health care provider’s word as a way to maintain your Medicaid protection. But different states try proper now to give you some sort of method to make that not should occur. So saying, you understand, in case you have X many inpatient visits per 12 months and Y many outpatient visits per 12 months, or you could have this many medicine that you simply’re on, then that’s sufficient proof that you’re too medically frail to work part-time. And so they’re attempting to give you methods to only pull it from information and never should depend on sufferers and suppliers and provides them this further burden. But we’ll see if that’s authorised by CMS. We’ll see if that’s profitable. I imply, CMS’ steering left states a bit bit at the hours of darkness about the right way to operationalize this.
Rovner: Well, that’s the good setup, I might say, for my subsequent query, which is we’ve got a few tales from my colleagues right here at KFF Health News about issues to return from the Medicaid cuts, significantly the work necessities that states have to have in place by subsequent Jan. 1. One of the stories, by Sam Whitehead, is about medical doctors who’re fearful about being swamped by sufferers who want medical documentation that they’re too frail to be topic to the work guidelines. Said one physician within the story. “We’re trained to learn about someone’s symptoms, make diagnoses, treat them. We are not trained to make these kinds of work determinations.” The other story, by Rachana Pradhan, Samantha Liss, and Kate Wells, is about how an automatic eligibility system from IT big Deloitte is rejecting eligible folks with disabilities in a number of states, together with Michigan, Tennessee, and Texas. Deloitte works on Medicaid eligibility programs in additional than half the states. It’s closely concerned in creating these IT programs for his or her work guidelines. Fair to say, each of those issues, as you guys had been all main as much as, don’t bode effectively for what’s about to occur to Medicaid.
Kenen: No, and an further issue, it’s not simply Deloitte. I imply, states had contracted with the distributors. They didn’t have a variety of time. This invoice was signed into regulation nearly a 12 months, nearly precisely a 12 months, in the past, and so they had 18 months to prepare. It’s Jan. 1, 2027. This June change to the principles means they should actually rework a variety of the tech they had been doing, and so they got seven months. So is that this as large as healthcare.gov? No, however it’s difficult, and the kind of blueprint and tech plans they had been doing now should be modified. And they’re nonetheless ready on extra steering. There are nonetheless unknowns.
Rovner: For those that don’t keep in mind healthcare.gov …
Kenen: How can anyone not keep in mind healthcare.gov?
Rovner: There had been individuals who had been not round in 2013, Joanne, when healthcare.gov slightly dramatically didn’t launch. Sorry, Alice, I interrupted you.
Ollstein: Yeah, no, we did some reporting about this weeks in the past, and mainly specialists informed us, Look, it’s problematic if these determinations are left as much as particular person physicians. There may be biases. Physicians aren’t skilled to make these sort of determinations, like you mentioned. People won’t even have the ability to attain a health care provider and make an appointment to get that consequence. But they’re saying if it’s less than physicians, that might be even worse. If it’s as much as some kind of algorithm or some kind of state bureaucratic workplace that by no means even meets the individual and simply makes a dedication, and so they could not know the right way to attraction it. And so states are fearful about it being a lose-lose state of affairs.
Rovner: Yeah, effectively, within the Deloitte story, that’s precisely what it was. It was, you understand, it was mainly an automated system that was bouncing eligible folks, both bouncing them out or placing them in inappropriate packages for which they weren’t eligible. They had been having hassle discovering an actual individual to repair what was clearly a mistake.
Sanger-Katz: And I feel one factor that each of those tales actually emphasised to me is that no matter you consider the deserves of this coverage change, you understand, like I feel there are many Americans who suppose that it’s affordable to have a piece requirement for Medicaid. And I additionally suppose there are tons of people that suppose that you simply shouldn’t simply get out of that as a result of you could have a medical prognosis. That there needs to be some purpose why you can’t work. If we’re requiring folks to work, possibly we wish to require folks to reveal that they can’t work, to get an exception. But no matter you consider the deserves of these arguments, this can be a monumentally troublesome job for states to implement. This just isn’t a straightforward coverage. There isn’t any all-knowing eye that may kind of look over the Medicaid inhabitants and resolve who’s eligible or not eligible in accordance with these standards. States should create guidelines. They should create what sorts of proof they’ll enable. They should construct pc programs that may kind folks and that may make these determinations. And all of that’s new and is very troublesome. And is very sluggish. States, normally, don’t even construct their very own pc programs. They work with these contractors that do it for them, and the contractors have a blended monitor report in actually executing in a very clear means. So, I simply suppose, you understand, whenever you discuss to folks about this, I really feel like we all the time discuss this in healthcare. There’s just like the laws. There’s like the thought, and Congress is attempting to get the concept. These are the those who we wish to get Medicaid, and these are the those who we wish to encourage to work as a way to keep Medicaid. I feel on the theoretical stage, there’s that. But then there’s just like the nitty-gritty implementation, and that’s just like the regulatory course of, that’s the state authorities, that’s the procurement, that’s the contracting. And I simply suppose there’s a variety of sand within the gears of that. This is definitely not straightforward for states to do, and even the states which are devoting a variety of assets to it and wish to get it proper, and even the states that actually consider within the targets of the coverage are most likely like simply bumping into a variety of the difficulties now.
Kenen: And lots of the folks affected have continual ailments; they’re up and down. You can have good intervals when you’re working. You can have dangerous intervals whenever you can’t, and that’s the character of continual ailments for a lot of, many, many people. It’s inconsistent. So if you happen to go to the physician on Jan. 1, that physician actually doesn’t know. I imply, that is true of psychological well being as effectively. You know, how lengthy are you able to work? How constantly you’re employed? There’s simply going to be all kinds of issues, and I promise to cease there.
Rovner: OK. Well, additionally this week there are two immigration-related security internet tales. First, the Trump administration has formally rescinded the Biden administration’s rewrite of the so-called public cost guidelines, that are designed to make sure that authorized immigrants are financially self-sufficient. The new guidelines, or the dearth thereof, give immigration brokers way more leeway to resolve on their very own who may or won’t change into depending on authorities advantages. Alice, you lined this again in Trump I. It ended up with tons of people that had been truly eligible for advantages not utilizing them as a result of they feared changing into or being deemed a public cost when making use of for a inexperienced card or extra everlasting immigration standing. Any purpose to suppose the identical factor isn’t about to occur once more?
Ollstein: No, there isn’t a purpose to suppose that historical past won’t repeat itself. Although I’ll say that the coverage now just isn’t precisely the identical because it was through the first Trump administration. The new coverage simply provides a variety of discretion to particular person immigration officers to make a dedication, taking a look at, like, the totality of somebody’s circumstances. And so, you understand, Medicaid and a few of these different security internet packages that individuals are legally eligible for didn’t used to rely in opposition to somebody after they had been making use of for a inexperienced card, and now they might. Again, it’s not necessary that, Oh, if you’re enrolled in Medicaid, robotically you’re barred. But it’s one thing that an immigration officer could be allowed to contemplate. And so, yeah, a variety of concern not solely from the immigrant ICE [Immigration and Customs Enforcement] group, however from states. I imply, this might have an effect on state funds if individuals are going to want to show for uncompensated care to different suppliers. There’s concern from the general public well being group about if folks don’t have protection to get vaccinated and to get checkups. It’s not like there are islands of immigrants. This is of us [who] are included into our society. We stay in a society, as we found throughout covid, and what impacts some folks impacts everyone.
Rovner: Yeah, and, I suppose as Margot mentioned, it’s certainly one of this stuff the place the idea sounds nice, and the carrying it out is rather a lot tougher. Well, additionally a few weeks in the past, we talked about how nursing properties and assisted residing amenities are freaking out concerning the repeal of short-term protected standing for immigrants from Haiti and Syria as a result of so lots of them work within the long-term care house. This week, The New York Times has a story about how this immigration crackdown is reaching even additional, to seniors who don’t but want medical companies however nonetheless require assist with routine actions, who stay in these, you understand, senior buildings. There’s already a labor scarcity for house well being aides and others in eldercare, which is mostly very laborious work for very low pay. This might spiral into an actual disaster. We’re going to finish up with Gen X and millennials having to handle their very own child boomer dad and mom.
Sanger-Katz: There was a very fascinating research that was printed a couple of months in the past from Jonathan Gruber, the economist at MIT, and a few of his colleagues that mainly discovered that will increase within the inhabitants of immigrants in a given place truly lowered mortality amongst Medicare beneficiaries. It appears actually clear that immigrants are a very vital a part of the caregiving workforce in America proper now. And, as you mentioned, Julie, it’s house well being employees, it’s nursing house staff, it’s individuals who work in hospitals, and it’s additionally people who find themselves doing a few of this sort of, like, casual elder care, serving to out in assisted livings, serving to folks at house. You know, they will not be offering healthcare companies, however they’re serving to aged individuals who have healthcare wants.
Rovner: It’s the individuals who work within the eating rooms. It’s the custodians in these senior buildings. I imply, it’s the individuals who, you understand, who assist folks get round and drive them to physician’s appointments.
Sanger-Katz: I felt like that research — I used to be actually struck by, since you get the sense that it’s not simply that we see these folks in these jobs, however that having extra of them round truly appears to have a well being protecting impact for the those who stay there. Because I feel it does make it simpler to workers all of these jobs and to workers them with people who find themselves competent and who wish to try this sort of work.
Kenen: And who have language abilities. There’s truly been research exhibiting that it helps to have extra Spanish-speaking workers in nursing properties and rehab amenities.
Rovner: All proper. Well, in the meantime, Margot, since you might be right here, allow us to discuss shock medical payments. A number of weeks in the past, we talked concerning the blockbuster story you wrote with Sarah Kliff about how some medical doctors had been getting gigantic multiples of what Medicare or personal insurance coverage would have paid by the negotiation system that was set as much as settle claims between insurers and suppliers. Now the administration says they could want to repair it? Catch us up.
Sanger-Katz: Yeah, I imply this was a little bit of a shock to me, I’ll say. Yesterday there was data that was published that kind of gave us a way of the scope of the system. Wasn’t massively shocking, however the top-line numbers are. It appears just like the sum of money that this method has awarded to medical doctors and different healthcare suppliers elevated from round $4 billion in 2024 to $14 billion in 2025. So you possibly can similar to actually see there’s been an enormous progress within the variety of instances, but it surely additionally looks as if medical doctors are profitable increased awards per case. And so, what’s occurring is that the general value of the system has actually ballooned. The Trump administration has mentioned little or no about this. They did finalize one regulation that had been proposed within the Biden administration that was sort of technical fixes. And yesterday they mentioned that individuals are gaming the system and that they should, quote, “clean it up.” So I do suppose that is the primary indication we’ve seen that there’s concern by Trump officers that there could also be an issue with this arbitration system that medical doctors are utilizing to resolve these disputes. But they offered no specifics in any respect about what they’ll do, what coverage avenues they’ll pursue, and, you understand, in a variety of my conversations with the gamers on this system, folks haven’t recognized, like, actually apparent, straightforward locations the place the regulators could make large modifications. I feel there are some small modifications that the regulators could make, however nearly everybody that I discuss to about this downside appears to suppose that Congress most likely has to make modifications to handle a number of the extreme spending that we’re seeing. And there appears to be little or no urge for food for that. So I’m actually wanting ahead to seeing what it’s the Trump administration has in thoughts, what sorts of insurance policies they’ll pursue right here. But, primarily based on what they’ve mentioned up to now, I don’t know what they’re going for. And I might say, primarily based on what I find out about this matter, it’s not apparent to me what the simple levers are for them to drag.
Rovner: And I’ll add that I … in my interview with Sen. Cassidy, I requested him about this, and he sort of demurred, suggesting that, as you’ll hear, that, Well, if we are able to repair issues with value transparency normally, that might repair this downside. Because then folks gained’t find yourself going to the medical doctors who’re going to go to arbitration and win, you understand, multi-$100,000 awards from these arbitrators. But I feel you’re proper, Margot. I feel we’ll see.
Sanger-Katz: I will simply say, to push again on what Sen. Cassidy apparently informed you, is one factor that actually has labored about this regulation is sufferers are fully protected. In these conditions the place these giant arbitration awards are being generated, sufferers are by no means requested to pay greater than they’re in community value sharing. And so I don’t know the way life like it’s to ask sufferers to vary their procuring habits as a way to resolve these excessive payouts. I feel that the incentives most likely actually should be targeted far more on the insurance coverage corporations and the healthcare suppliers themselves.
Rovner: Yeah, effectively, we are going to see how that goes. All proper, subsequent: testosterone testing on the Department of Defense/War. Really. Secretary Pete Hegseth has ordered that male service members over age 30 will be required to be screened for, quote, “testosterone deficiency” yearly, though testosterone substitute remedy, if a deficiency is discovered, can be voluntary. Hegseth mentioned that is obligatory for troops to function, quote, “at their absolute best.” But medical doctors warn that slightly than keep navy readiness, inappropriate hormone remedy could cause infertility or enhance the possibility of coronary heart rhythm modifications and bone fractures, and that screening at age 30 is inappropriate anyway. And along with every part else, isn’t this mainly gender-affirming care? I assumed this administration was in opposition to that.
Ollstein: So mainly, every part that’s getting restricted for trans folks is far more extensively utilized by cisgendered folks. So most younger people who find themselves placed on puberty blockers should not trans. Most individuals who get high surgical procedure should not trans. And most individuals who, you understand, use these hormone remedies should not trans. And so, sure, that is an instance of that double customary that, you understand, is seen in different areas of drugs coming into play for certain. Not to say the medical dangers that you simply level out. It’s simply kind of a cartoonish thought of what masculinity entails and what contributes to it that doesn’t actually align with science.
Rovner: Yeah, I’ve seen simply an infinite quantity of head-scratching about this entire factor, I imply, I’m simply questioning, is he attempting to deflect consideration from different issues occurring at his division?
Kenen: No, there’s a complete subculture that’s all about extra testosterone. We needs to be clear that there’s some individuals who do, medically, have low testosterone, similar to there’s some individuals who medically have low thyroid or different endocrine issues. I imply, you … and there’s medicine for that, and it’s applicable if you might be clinically, you understand, in that class.
Rovner: Right. And having low testosterone could cause medical issues that may be addressed.
Kenen: Right. So if you happen to are actually low — like not, kind of, what the “Bro World” says is low — however if you happen to’re what, you understand, a medical lab says is low, sure, that’s an applicable, it’s an applicable remedy. But there’s this entire kind of cultural factor that extra testosterone is healthier. And it’s simply certainly one of this stuff — like with many different dietary supplements, however this can be a little bit extra advanced — it has taken off and kind of taken a cultural factor of its personal. I imply, I noticed a quote and I wrote it down, and I forgot to write down down the place I noticed it, so I apologize for that. It may need been The Times, however I don’t know. And it’s an excellent quote from a doctor who mentioned, “If you just dole out the testosterone, the testes will shrink, and you can’t reliably count on them coming back.” That’s simply kind of, like, that’s not penetrating the cultural thought to start out T-maxing.
Rovner: Right, extra testosterone is healthier.
Sanger-Katz: Although I feel our Health and Human Services secretary has additionally mentioned that he himself takes testosterone, so I feel it’s not simply the protection secretary. I feel there are quite a few high-level Trump officers who appear to be fanatics for this explicit variety of remedy.
Rovner: All proper, we’re going to take a fast break. We can be proper again.
So the general public well being panic of the week considerations cyclospora, a parasite that’s laborious to detect, laborious to eliminate, and causes a really nasty gastrointestinal sickness. Cyclosporiasis, which is the ailment the parasite causes, is extra widespread in the summertime as a result of it tends to contaminate contemporary produce, largely lettuce and herbs, and thin-skinned fruit like berries. But this summer time, we’ve seen an explosion of instances (pun supposed): greater than 11,000 in 41 states. It’s possibly up by the point I’m even saying this. Normally, the FDA and the CDC [Centers for Disease Control and Prevention] could be throughout this, attempting to hint again the place the contaminated meals got here from. But we all know that each businesses have misplaced a variety of scientific workers previously 12 months. Over the weekend, the FDA introduced that it had detected the parasite in lettuce from Mexico that wasn’t a part of an preliminary lettuce recall that was linked to Taco Bell and lots of giant grocery chains. Then the FDA backtracked, saying, “Yeah, it was a false positive.” But apparently, that doesn’t imply that the Mexican lettuce from produce big Taylor Farms just isn’t implicated. Now everyone is confused about what’s suitable for eating. Joanne, you wrote a complete ebook about public well being communication. How are we nonetheless so dangerous at speaking this sort of factor?
Kenen: This is a very troublesome factor, proper? It’s very laborious to trace as a result of it takes about two weeks so that you can get signs. And then now, if individuals are sick, they’re going to kind of suppose that is likely to be what they’ve. But you understand, a couple of weeks in the past, earlier than there was publicity, you know, all of us get tummy aches, proper? And you don’t essentially search medical care. In this case … it may well actually go on and be very extreme and may final, and folks will search medical care. But for some folks, it’s not as — we don’t actually know the way many individuals are affected, and we additionally don’t know the way many individuals are presently contaminated and … not but exhibiting signs. It’s large; it’s 1000’s. But the confusion right here, I imply, to begin with, you understand, as you famous, CDC and FDA have each had cutbacks. There’s fewer workers. There’s fewer assets. This is de facto complicated, and it’s been made extra complicated by completely everyone. There have been individuals who … there’s been political contacts. Taylor Farms has contacted the White House. … When the FDA discovered that false pattern, they actually didn’t talk it that effectively. They didn’t say, This is one pattern that may have led us to seek out yet one more supply, however what we’ve informed you is already true. And observe our recommendation. They simply … made it sound prefer it actually wasn’t Taylor Farms. Then there was one other factor the place Taylor Farms mentioned the FDA apologized. The FDA mentioned they didn’t apologize, after which the Taylor Farms bought a variety of consideration as a result of it deleted its social media posts. But I went onto their web site final night time, and it’s nonetheless there. They’re nonetheless saying that the FDA apologized. It’s complicated, too, as a result of it’s primarily iceberg lettuce, however each summer time there’s a few of this, and it’s from cilantro, it’s from basil, it’s from raspberries is a biggie. So the CDC isn’t saying, OK, a variety of that is coming from Taylor Farms, however actually watch out about these different issues as a result of we’re nonetheless investigating. I truly noticed, I gained’t establish the reporter or the publication, however in a significant nationwide report, main nationwide paper, as soon as the lettuce was recognized at Taco Bell, this individual mentioned, “Oh, I’ve had these raspberries in my refrigerator. I’m glad I can eat them now.” Well, we don’t know that they will eat them now, you understand. And then there’s the same old rumors that … in all places there’s rumors, proper? I imply, you can’t cease them. They simply proliferate. So I feel everyone has made a communication mistake each single step of the way in which. And then you could have you understand conspiracy theories about completely every part that, you understand, it’s probably not the lettuce. And then folks suppose … Oh, we’re listening to it was Taco Bell in 5 states. Well, if I didn’t eat Taco Bell, I’m OK. No, since you might have purchased the lettuce, and never all of the lettuce is known as Taylor Farms. And then folks suppose, Well, if I am going to a flowery natural retailer, it’s OK. No, you understand, simply don’t eat uncooked lettuce. The different factor I realized is it’s, like, the contamination. It’s actually, actually troublesome. … If farmworkers should not in a position to, like, wash their arms effectively, and so they had been utilizing hand sanitizer. That’s not adequate to eliminate these things. Chlorine isn’t adequate to get — that is actually a tough parasite to take care of.
Rovner: Yeah, mainly, I feel I’ve heard them say, If you wish to eat lettuce, purchase a head of lettuce and throw away the surface three layers, after which eat the remaining.
Kenen: Right, and then wash the remainder of it. You’re additionally seeing all these recipes now on-line for the right way to stir-fry your lettuce.
Rovner: That’s true, sure. Cooking does kill the parasite.
Kenen: I’m rising my very own. That’s my resolution.
Rovner: I’ve been selecting my very own.
Kenen: Right, proper. But I ran out, so I simply needed to plant extra, however …
Rovner: All proper. Finally, this week on the Department of Health and Human Services, Secretary Robert F. Kennedy introduced the most recent within the division’s fraud crackdown: the withholding of greater than a billion {dollars} in Medicaid funds from Minnesota and California. HHS is accusing these Democratic-governed states of failing to correctly doc shared Medicaid spending, largely for house care companies. Minnesota officers informed Stateline that the feds have but to elucidate precisely what deferrals are for or how they calculated the quantity. Similarly, California officers mentioned HHS is concentrating on the state for political causes, and that house care truly saves the federal authorities cash by maintaining folks out of dearer nursing properties. Now, states and the federal authorities have been preventing over fraud for the reason that starting of the Medicaid program, however that is actually the primary time HHS has withheld this stage of funds. I really feel like this story is sort of flying below the radar. It’s an enormous deal. We spent the entire first a part of this podcast speaking about how states are having to spend effort and time and cash to get these work necessities prepared. I imply, this might actually cripple some states’ Medicaid packages, couldn’t it?
Sanger-Katz: Yeah, that is actual cash, and this can be a sort of rescinding of cash that Centers for Medicare & Medicaid Services actually have nearly by no means achieved earlier than. I feel it’s considerably unpredictable to state. At least with, like, the work requirement, there’s some coverage planning. There’s some consciousness of what the principles of the street are and issues that they will do. I feel there’s a couple issues occurring right here directly. One is that there’s a lot of fraud in Medicaid. The administration is pointing to an issue that’s actual. I really feel just like the feedback of the California officers that home-based look after elder folks saves cash by maintaining folks out of nursing properties — that’s true, however provided that these companies are truly being offered to folks. If there are fraudulent companies in that sector, which we know that there are, that’s probably not benefiting anybody’s well being. That’s simply losing cash and giving it to criminals. So, I feel the administration looks like this fraud message is actually highly effective for them. There’s clearly a variety of political dialogue about healthcare affordability, how healthcare has gotten so costly, and I feel neither get together has a actually nice coverage reply for that. I feel the Trump administration is specializing in this one. They’re saying, “Well, this is just pure waste. If we can get this pure waste out of the system, that will lower the cost of healthcare.” And so I feel they’re sort of banging this drum over and over. But I don’t know that this explicit mechanism helps states truly cut back fraud. I feel it’s extra punishing states which are seen as political enemies, and I do suppose that the lack of these {dollars} is de facto going to have an effect on the functioning of these packages.
Rovner: Well, in the meantime, a brand new ballot from my colleagues right here at KFF means that the administration’s give attention to well being fraud slightly than healthcare value writ giant is likely to be politically misplaced. According to the ballot, almost two-thirds of voters suppose the administration’s anti-fraud efforts in direction of Medicaid are motivated largely by politics, and fewer than half suppose the hassle is more likely to save taxpayers cash. The ballot additionally discovered that greater than two-thirds of respondents, together with half of Republicans, say that guaranteeing Medicaid beneficiaries can get the care they want is a better precedence than stopping fraud. That doesn’t really feel like a very profitable political concern, does it?
Kenen: No. And one other factor that was fascinating in that ballot, I imply, the way in which Dr. [Mehmet] Oz speaks about it’s that there’s lots of people dishonest, and it’s kind of the welfare-ization of Medicaid. You know, these are all lazy bums. I imply, it’s not that there’s no person dishonest on the rolls in any federal program. None of us would say that, however many of the fraud is from suppliers, and that’s clear. These, you understand, big rings of nursing house fraud in Brooklyn, and … each few years there’s this monumental one. And I assumed it was fascinating on the KFF ballot that almost all throughout each events truly suppose it is the suppliers. It wasn’t an enormous majority, I feel it was 55%, thought it was the suppliers, not the people. And however additionally, as you talked about, Julie, they’re retaliating in opposition to blue states.
Rovner: Yeah, yeah. I imply, that is their, kind of, This is how we’re going to handle healthcare affordability, says this administration, and the ballot means that possibly that’s not a very great way to go about it. All proper, that’s this week’s information. Now we’ll play my interview with Sen. Bill Cassidy, after which we are going to come again with our further credit.
I’m so happy to welcome Louisiana Republican Sen. Bill Cassidy to “How Would You Fix It?” Sen. Cassidy is a doctor and the chairman of the Senate Health, Education, Labor, and Pensions Committee, which has been churning out well being laws of late. Sen. Cassidy, thanks for taking the time to affix us.
Bill Cassidy: Julie, thanks for having me.
Rovner: I largely wish to discuss your “MVP” well being agenda, however first, just a bit little bit of present occasions. President Trump has introduced a 100% tariff on imported generic medicine beginning in two years, and a 200% tariff after that, all in an effort to transfer that drugmaking again to the U.S. Do you suppose that’s a good suggestion, and can it work?
Cassidy: Is it a good suggestion? It will depend on whether or not or not it will increase our nationwide safety and whether or not or not it truly finally finally ends up giving sufferers the value of generic medicine at an equal value, and thirdly, whether or not or not we keep away from any contamination or different merchandise like that. The nationwide safety is likely to be one thing value paying for. We know, God forbid, [if] we ever get in a sizzling warfare with China, the query is, can we convey generic medicine, that are principally made throughout the Pacific, throughout the Pacific to assist us. So there may be that nationwide safety side of it. That’s No. 1. No. 2, although, I’ve gone to a Dr. Reddy’s, which is owned out of India, used to have a generic web site in Shreveport, and the associated fee foundation of manufacturing medicine within the United States was simply considerably greater than in India. And so it might be that buyers pay a bit bit extra. I’m hoping there’s an financial evaluation exhibiting if the cost-benefit ratio is ample. I’ll lastly say that I do suppose it’s vital that we’ve got a few of our medicine produced right here. I’m informed that medicine like penicillin and cephalosporins are actually nearly all made in China. Again, going again to: Do we wish China to have that kind of leverage for these medicine to be produced principally, possibly 99%, over there, and we don’t have entry to them if stress rises between the 2 international locations? I do suppose that’s one thing value investing in.
Rovner: So additionally this week, U.S. measles instances have now topped final 12 months’s complete and are on the highest stage in 35 years. You made it clear, even throughout HHS Secretary RFK Jr.’s affirmation listening to, that you simply see the dangers of weakening federal coverage and public confidence in vaccines. Do you suppose that Kennedy ever supposed to maintain the guarantees that he made to you round ACIP [the Advisory Committee on Immunization Practices] and the vaccine schedule? And what would you say to medical doctors who now place some blame on you for creating an atmosphere the place anti-vaccine sentiment is echoed by the nation’s well being division?
Cassidy: Well, first, I can’t get inside someone’s thoughts. If they agree to guardrails and disrespect these guardrails, you possibly can decide me. But you could resolve my judgment wasn’t superb, however I don’t suppose you possibly can say I acted in dangerous religion. Why? Because I’m fairly certain that RFK was going to have the president’s ear whether or not he was in workplace or not. In workplace, we had guardrails that I had the expectation could be stored. Out of workplace, however with affect, there’d be no guardrails. So typically in politics and in life, it’s not a black-or-white selection. It’s not like, oh my gosh, that is the pure pushed means, and that is, you understand, darkness and no matter. No, it’s one thing attempting to resolve what’s the very best with countervailing influences. I feel medical doctors significantly know that, as a result of it’s usually the instances we look after sufferers that you simply should come to one thing that you simply don’t fairly but know what the following step is, and you’re working in direction of it. Perhaps they’ll have extra sympathy in the event that they put it in gentle of their very own medical observe.
Rovner: So, are you going to attempt to have him again and maintain pushing him to maintain the guarantees that he made?
Cassidy: I’ve made a request that he come again earlier than the committee.
Rovner: But we haven’t heard again but?
Cassidy: Not had a affirmation that he’ll but.
Rovner: Well, onto our larger matter. You’ve proposed one thing you’re calling the Money and Value for Patients Agenda, or MVP, as a substitute, I suppose, for the Affordable Care Act. How would that work?
Cassidy: It’s not a substitute for the Affordable Care Act. It is barely restricted to that which is within the employer-sponsored insurance coverage market. And if we are able to have a look at the place individuals are getting subsidies for his or her medical insurance — you could have a classy viewers, so I’ll communicate this fashion— we are able to see that if you happen to’re on Medicaid, you mainly get 100% of your healthcare prices paid for. If you’re on the exchanges and fewer than 250% of federal poverty, it’s like 85%-plus. And then after that, it’s your marginal tax charge. If you’re on the 15% marginal tax charge, you pay your premium on a pretax foundation, which implies you get a 15% break. If you’re on the 37% marginal tax charge, a lot wealthier, you get a 37% pretax break on the cash you paid on your premium. So the people who find themselves middle-income on employer-sponsored insurance coverage are those who’re getting the least help from the tax code or the federal authorities to buy their medical insurance. What?! The people who find themselves attempting to do it the very best — they’re working; they’re not on Medicaid. Some folks on Medicaid work, however many don’t. The people who find themselves working are those who get the least help. So, what are you able to do about that? What I might do in my MVP plan is give an advanceable tax credit score to these on employer-sponsored insurance coverage under a sure marginal tax charge, and if you’re under some p.c, you’d get it.
Rovner: So very wealthy folks wouldn’t get this.
Cassidy: No, it’d be like lower than 22% marginal tax charge. And so these are the individuals who want the assistance. Let’s focus the place folks need assistance. And that’s negotiable, however that’s simply an instance. Under my calculations, a household of 4 might rise up to $2,000. Now, why is that vital? Many households, possibly most, won’t have greater than $2,000 of out-of-pocket expense in a given 12 months. Now, one 12 months they could — the spouse’s pregnant, or the son, you understand, will get in a automotive wreck — however most years they’ll have lower than $2,000. So that might doubtlessly cowl all of their out-of-pocket, significantly if you happen to couple it with the value transparency laws we’ll focus on in a second. And as a result of the household now has $2,000 to cowl their out-of-pocket, they will select a coverage with a better deductible, which implies a decrease premium. OK, so if presently the typical deductible for a small-business plan is about $3,000, you give them $2,000, they’re going to decide on a $5,000 deductible, and that can decrease their premium considerably. I like to talk, Julie, of the price of being insured, which isn’t simply your premiums, however your copays and your deductible. We’re given $2,000 for that copay and that deductible, which lets you take a lower-cost premium, and you place all of it collectively. And my favourite economist, ChatGPT, says that you possibly can doubtlessly save $5,000-$6,000 per 12 months, per household, and that makes a major, significant distinction of their potential to afford life.
Rovner: So, is that this along with employer protection, or would this be as a substitute of employer protection?
Cassidy: No, this is able to be along with employer protection. Right now, we see that small companies are dropping protection, and so this is able to, clearly, if the worker is selecting a less expensive plan as a result of the plan they select is a better deductible, then it turns into inexpensive for the employer. And so they will higher afford to proceed to supply. So this can be a means to assist that small enterprise as effectively. I’ve talked to a small-business proprietor again house, a number of small-business house owners. It’s changing into very troublesome for them to offer wage will increase and/or rent extra folks in the event that they proceed to offer medical insurance. So, if we’re in a position to take a bit little bit of that burden off of the employer to offer an ample insurance coverage coverage, then hopefully they will enhance wages and/or rent extra folks and increase their enterprise. So it’s a profit not only for the household, but in addition for his or her employer. And frankly, the federal authorities finally ends up incomes extra tax {dollars} as a result of, not getting too difficult, however the much less cash you’re spending on a pretax foundation, the more cash going into your post-tax paycheck, the extra taxes you pay for payroll tax, and so on.
Rovner: I’m pondering of personal fairness and a number of the gaming of one of many legal guidelines that you simply had been instrumental in getting handed to stop shock medical payments. How do you attempt to shield shoppers from folks in healthcare who’re actually simply in it for the income?
Cassidy: Why not value transparency? If you don’t know the value of one thing, you can’t get a greater deal. And that’s whether or not you’re the affected person or whether or not you’re the enterprise. And so the preliminary step to ensure that individuals are getting their greatest deal is value transparency. And, by the way in which, the great factor within the final 12 months or so, I’ve been uncovered to folks doing great work, and individuals are creating apps on the cellphone, and you possibly can say, “Hey Siri, where’s the urgent care center near me? What is their price schedule for a routine earache?” OK, I’m going to go to this one close to me as a result of it’s $50, not $150. So I am going there, after which I come out with a prescription. “Hey Siri, where’s the cheapest place to get this prescription for amoxicillin, 500 milligrams BID?” Siri tells you, or the app tells you, not Siri, however the app. And these are, like, being developed now. I imply, this isn’t — no, that is now. And so if you happen to couple cash within the pocket with value transparency, giving the person the flexibility to find out the place to go to get the very best value — and we’ve got another provisions in there that shield the affected person, a variety of provisions — then you’re going to convey worth to the affected person. That’s a part of the answer within the employer-sponsored insurance coverage market.
Rovner: Sen. Bill Cassidy, thanks very a lot.
Cassidy: Thank you, Julie.
Rovner: OK, we’re again. It’s time for our extra-credit phase. That’s the place we every acknowledge a narrative we learn this week we predict it’s best to learn, too. Don’t fear if you happen to miss it. We will submit the hyperlinks in our present notes in your cellphone or different cellular machine. Alice, why don’t you go first this week?
Ollstein: Yeah, I’ve a narrative from our buddies over at Roll Call. This is “Trump Administration Puts Kibosh on HIV Prevention Funding,” by Ariel Cohen. And this is about a latest resolution that, like so many issues nowadays, flies below the radar as a result of there’s a lot occurring directly. And simply within the class of grant cuts, there’s a lot occurring. So that is concerning the sudden slashing of a bunch of HIV prevention grants to group organizations. They’re now saying they’re going to redirect the identical funding to state and native well being departments, and people state and native well being departments can, if they need, then move it on to the group organizations. But 1) that’s, you understand, extra forms, extra complications. But additionally, what this text well factors out is that that then makes the group organizations not eligible for 340B, which was serving to them purchase all of this medicine far more cheaply. And so shedding that designation, shedding these grants, is a very large deal for these teams which are attempting to afford doses of pricy medicine like PrEP to distribute to communities.
Rovner: Yeah, once more, a few of these issues that kind of look small find yourself with far-reaching penalties. Joanne.
Kenen: This was the primary further credit score that really made me invent a phrase, which was “yikes-maxing”! You know, like, it was so wild. It’s from Stat by Adam Feuerstein. I most likely have that improper.
Rovner: Feuerstein.
Kenen: OK, and the headline is “A Most-Wanted Fugitive Appears To Have Been Secretly Working as a Biotech Executive.” So, for 20 years, this man — he was a health care provider. He was convicted of 1 assault. He was pending trial on one other sexual assault allegation, and he disappeared proper earlier than his trial. He left notes that he was going abroad, transferred property to his youngsters, and so on. Well, he didn’t go abroad to stay as a fugitive. He was proper right here posing as a most cancers knowledgeable, and he labored for 2 biotech corporations. And he presupposed to have experience in all this very superior, cutting-edge drug growth for most cancers, which was not his precise background. So, like, how did he get these jobs? Why wasn’t he vetted higher? He was lastly tracked down on a yacht known as the Silver Lining, and, actually, the alleged assault, as a result of certainly one of them wasn’t ever went to trial, was on yacht. Yachts had been his, apparently, his favourite locale for his alleged assaults. So he has been arrested, however it’s not similar to this man must go to trial, however, like, how did these corporations … did they even have a look at his LinkedIn? I imply, he was utilizing a pretend title. How did this occur? It’s an enormous scandal, and it’s additionally an excellent yarn.
Rovner: I can’t wait to see the film that someone’s going to make out of this. Margot.
Sanger-Katz: I wished to advocate an article from Andrea Hsu on All Things Considered and NPR. “Amid Nurse Shortage, a University Rolls Out the Welcome Mat for Men.” And this can be a story a few rising variety of males who’re getting into the nursing occupation, and, specifically, a have a look at the University of Alabama in Birmingham that’s actually attempting to recruit males into the occupation. And you understand, I really feel like caregiving professions have historically been sort of a feminine area, however I feel there’s a brand new openness by males to enter these careers, which I feel may be very fulfilling. They’re very safe. They’re comparatively high-paying. My colleague Claire Cain Miller did a narrative within the Pacific Northwest nearly 10 years in the past, I feel, the place she interviewed quite a few male nurses about their work and had these stunning portraits shot of them, and it simply is a bit that has stayed with me for a very long time. Just fascinated by these males in these caregiving roles and why a few of our, like, extra standard concepts of masculinity forestall males from getting into these professions that I feel may be actually nice careers and actually fulfilling for them. So I simply thought this new story was actually good. I used to be enthusiastic about what this college is doing to recruit males, and I feel the concept of male nurses and a nursing occupation that’s extra gender-diverse is actually fascinating.
Rovner: And in 2026, unlikely to be taken over by AI. It’s a type of uncommon profession paths. It’s most likely nonetheless going to be round for some time. All proper, my further credit score this week is from The New York Times. It’s known as “The Fake Influencers Selling Wellness on Your Feed.” It’s by Arijeta Lajka, Isabelle Niu, Mark Boyer, James Surdam, and Dan T. Peters. It’s a video, and it exhibits how AI-generated medical doctors, Eastern medication well being practitioners, and wellness influencers are throughout social media, making usually harmful well being claims to promote all method of questionable dietary supplements. The cash line from the piece, quote: “Ads like this would be illegal on U.S. television, but on the internet they face little enforcement.” Apparently, some of the large social media corporations are looking for and extinguish advertisements that make deceptive claims or should not famous to be AI. But for now, it’s nonetheless very a lot purchaser and watcher beware.
All proper, that’s this week’s present. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We additionally had manufacturing assist this week from Taylor Cook. A reminder: What the Health? is now accessible on WAMU platforms, the NPR app, and wherever you get your podcasts — in addition to, in fact, kffhealthnews.org. Also, as all the time, you possibly can electronic mail us your feedback or questions. We’re at [email protected]. Or you possibly can nonetheless discover me on X @jrovner, and on Bluesky @julierovner. Where do you guys hold nowadays? Margot.
Sanger-Katz: I’m on social media @sangerkatz, and you may attain me on Signal at sangerkatz.01.
Rovner: Joanne.
Kenen: I’m totally on Bluesky and LinkedIn @JoanneKenen.
Rovner: Alice.
Ollstein: @AliceOllstein on X, and @alicemiranda on Bluesky.
Rovner: We’ll be again in your feed subsequent week. Until then, be wholesome.
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