\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, “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.\t\t<\/p>\n Congress returned from its holiday break to the same question it faced in December: whether to extend covid-era premium subsidies for health plans sold under the Affordable Care Act. The expanded subsidies expired at the end of 2025, leaving more than 20 million Americans facing dramatically higher out-of-pocket costs for insurance.<\/p>\n Meanwhile, the Robert F. Kennedy Jr.-led Department of Health and Human Services announced an overhaul of the federal vaccine schedule for children, reducing the number of diseases for which vaccines are recommended from 17 to 11.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of Pink Sheet, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.<\/p>\n \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \t\t\t \tLauren Weber \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> KFF Health News\u2019 \u201cAdvertisements Promising Patients a \u2018Dream Body\u2019 With Minimal Risk Get Little Scrutiny<\/a>,\u201d by Fred Schulte.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> SFGate\u2019s \u201cA Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose<\/a>,\u201d by Lester Black and Stephen Council.\u00a0\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> ProPublica\u2019s \u201cThe End of Aid: Trump Destroyed USAID. What Happens Now?<\/a>\u201d by Anna Maria Barry-Jester and Brett Murphy.\u00a0\u00a0<\/p>\n Lauren Weber:<\/strong> The Washington Post\u2019s \u201cHow RFK Jr. Upended the Public Health System<\/a>,\u201d by Rachel Roubein, Lena H. Sun, and Lauren Weber.\u00a0\u00a0<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tClick to Open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: New Year, Same Health Fight<\/strong>\t\t\t\t<\/p>\n [<\/em>Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em> <\/p>\n Julie Rovner:<\/strong> Hello from KFF Health News and WAMU Public Radio in Washington, D.C., and welcome to What the Health?<\/em> I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, Jan. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. <\/p>\n We are joined via videoconference by Lauren Weber of The Washington Post. <\/p>\n Lauren Weber:<\/strong> Hello, hello. <\/p>\n Rovner:<\/strong> Alice Miranda Ollstein of Politico. <\/p>\n Alice Miranda Ollstein:<\/strong> Hi. <\/p>\n Rovner:<\/strong> And Sarah Karlin-Smith of the Pink Sheet. <\/p>\n Sarah Karlin-Smith:<\/strong> Hi, everybody. <\/p>\n Rovner:<\/strong> No interview this week, but tons of news to catch up on, so let us get right to it. So, we start 2026 in health care the same way we ended 2025, with a fight over expiring subsidies for the Affordable Care Act. By the time you hear this, the House will likely have approved a Democratic-sponsored bill to reinstate for three years the expanded ACA subsidies that were in effect from 2021 through the end of 2025. <\/p>\n That vote was made possible by four Republicans crossing party lines in December to sign a discharge petition that forces a floor vote, over the objection to the House leadership. Interestingly, a preliminary vote on the bill on Wednesday drew not just the four moderate Republicans who signed the original discharge petition but five more, for a total of nine. The consensus of political reporters is that the bill is DOA [dead on arrival] in the Senate, which voted an identical proposal down in early December. <\/p>\n But I\u2019m wondering how much heat Republicans were exposed to over the break by constituents whose out-of-pocket costs for insurance were doubling or more, and whether that might change the forecast somewhat. What are you guys hearing? <\/p>\n Weber:<\/strong> So, it seems that there are still some big hurdles to cross. And based on what senators told my colleagues over the past couple days, there\u2019s not even an agreement on what current law is and does, and thus, they can\u2019t agree on how it should change. And so, I\u2019m talking specifically about the still-unresolved abortion issue. <\/p>\n This is the question of whether plans that cover abortion should receive any federal subsidy, even if those subsidies do not directly pay for an abortion. The Republicans are arguing that it\u2019s an indirect subsidy, even though these are going into separate accounts. So, one of the Republican senators who is trying to craft a deal \u2014 that\u2019s Bernie Moreno of Ohio \u2014 he was saying that they still don\u2019t agree whether, under current law, federal funding is going to abortion. <\/p>\n So, it\u2019s like you don\u2019t even have a shared reality that senators are operating under, and that makes it really hard to come up with a proposal. They say they\u2019re going to have text by Monday, but we\u2019ll see if that actually happens. <\/p>\n Rovner:<\/strong> Yeah. Well, before we get too deeply into the abortion issue, which we will do in a minute, I want to talk a little bit more about that. I won\u2019t even call it an emerging compromise. I\u2019ll call it a potential compromise in the Senate. <\/p>\n Ollstein:<\/strong> Some bullet points were shared. <\/p>\n Rovner:<\/strong> Some bullet points. We know what the bullet points are. They would extend the additional subsidies for two more years, not three, with a couple of changes, including capping income eligibility for those subsidies at 700% of poverty up from 400% that it reverted back to on Jan. 1. It would also replace zero-premium plans with $5-per-month plans. That\u2019s to crack down on brokers who fraudulently sign up people who don\u2019t even know they have insurance so the brokers can collect commissions. And it would allow people to choose whether their enhanced subsidies should go into Republican-favored health savings accounts or directly toward their premiums. <\/p>\n Assuming \u2014 and this is obviously a big assumption \u2014 they could get past this abortion issue, what are the chances for a compromise that looks something like this? I mean, it sounds<\/em> like something that could satisfy both Democrats and Republicans, particularly Republicans who are feeling pressured by their own constituents who\u2019ve now seen there \u2014 are either dropping their insurance or seeing their out-of-pocket cost just goes wild. <\/p>\n Ollstein:<\/strong> I\u2019ve heard some criticism from the Democratic side about getting rid of zero-premium plans specifically. They\u2019re saying the Republicans want to run on affordability and helping out people who are struggling. How does eliminating the ability to get a zero-premium plan align with that? <\/p>\n And so I expect there will be some clashes over that. But I also think, again, senators aren\u2019t even agreeing on what the current reality is, and that applies there, too. There have been all of these allegations of widespread fraud, and some experts and lawmakers have been pointing out that just because someone who is enrolled doesn\u2019t actually use their benefits, that doesn\u2019t necessarily mean there\u2019s fraud going on. <\/p>\n It does seem like there is some fraud going on. You mentioned the perverse incentives for brokers, but a lot of this is circumstantial evidence rather than direct evidence. <\/p>\n Rovner:<\/strong> Also, one of the ironies here is that if you have somebody who\u2019s healthy, who signs up for health insurance and doesn\u2019t use it, that\u2019s a good thing for the risk pool. You don\u2019t want only sick people. <\/p>\n Ollstein:<\/strong> It helps everyone. <\/p>\n Rovner:<\/strong> There\u2019s a lot of things making my head explode. Well, one of the things that Alice, I know, is making your head explode, too, is this disagreement about reality about abortion. And I would point out that President [Donald] Trump spoke to the retreat of the House Republicans this week and urged some flexibility, put that in air quotes, on this Hyde Amendment issue. Alice, remind us why this is an issue here. Doesn\u2019t the Affordable Care Act already ban federal funding of abortion just like all other federal programs? <\/p>\n Ollstein:<\/strong> Yes. Yes, it does. So basically, this is part of a larger project on the right to expand the definition of Hyde. <\/p>\n Rovner:<\/strong> We should probably go back to the very beginning of what is \u2026 <\/p>\n Ollstein:<\/strong> Yes. <\/p>\n Rovner:<\/strong> \u2026 the Hyde Amendment because it only applies to annual appropriations, and that\u2019s why it\u2019s been important. I will let you take it from there. <\/p>\n Ollstein:<\/strong> Sure, sure. So, this is a budget rider that dates back to the 1970s that says that there can be no federal funding of abortion, except in a few instances, of there\u2019s a risk to the mother\u2019s life, and rape and incest. And so that has been renewed over and over under administrations of both parties, under Congress majorities of both parties. <\/p>\n And now, what they\u2019re fighting over is, already federal funding that goes to these plans in the form of these subsidies, it does not go to pay for abortion directly. But conservatives are now arguing that if it goes to a plan that covers abortion using other funding, then that functions as an indirect subsidy. This is the same argument they\u2019ve made about Title X, where any federal funding going to a program that uses other funding to pay for abortion, they now consider that sort of an indirect subsidy, even though it\u2019s coming out of different buckets of money. <\/p>\n And so, what they\u2019re pushing for is basically a nationwide restriction on any plan that gets a federal subsidy paying for abortion. So, this would have the most impact in the states where all plans on the ACA market are required to cover abortion, in states like California, New York, and Massachusetts, big states with many, many millions of people. And so that would have a huge impact and force those plans to either drop abortion coverage or forgo the federal subsidy. So, that would have a really big impact. <\/p>\n And Democrats say this is not necessary. There\u2019s already restrictions that prevent federal funding to go to pay for abortion. And that is what the senators and everyone can\u2019t agree on right now. <\/p>\n Rovner:<\/strong> That\u2019s right. And that\u2019s a big fund. Well, we\u2019ll see where that goes. In the meantime, what the president was talking about when he called for flexibility on Hyde was actually health care writ large. <\/p>\n This clearly reflects what we know the president\u2019s pollster has been telling him: that Republicans are currently at a distinct public disadvantage when it comes to health care, and not just the Affordable Care Act. Trump says that Republicans should, again, air quotes, try to \u201cown\u201d the health care issue. And he has spent a good bit of his first year working on health issues. At least he\u2019s been talking about them a lot, but it turns out that his high-profile drug-price deal<\/a>s are not mostly being felt by consumers here in the U.S. <\/p>\n The savings he\u2019s negotiated are mostly going to the state and federal Medicare and Medicaid programs, as well as to people willing and able to pay out-of-pocket for their prescription drugs. And while the administration is making much of its December announcement about the first distribution of rural health funding that was authorized in last summer\u2019s budget bill, that $50 billion in funding won\u2019t make much of a dent compared to the nearly $1 trillion<\/em> in cuts that were created for Medicaid in that same bill. So, my question from all of this is: Can Republicans use things like this to own the health care issue or at least cut into Democrats\u2019 advantage between now and the midterms? <\/p>\n Weber:<\/strong> Well, I think it depends on what they end up doing with it. He brought up in that same meeting with legislators wanting to own IVF [in vitro fertilization], which is something he floated during his campaign that got a lot of shock from [the] conservative Republican base. So, what does he mean? What is he saying on that? We don\u2019t have particulars. <\/p>\n Bottom line is, voters don\u2019t necessarily know the in-the-weeds policy. So, if he gets out there and says enough things, who knows that they can own the health care issue? But I would say for now that it is solely in the Democrats\u2019 camp and is helping lead them with an advantage for midterms for now. <\/p>\n Rovner:<\/strong> Sarah, he keeps saying on drug prices that he\u2019s done all this stuff, and he has done a lot of stuff, but it hasn\u2019t had a big dent in what people pay for their drugs, right? <\/p>\n Karlin-Smith:<\/strong> Right. And I think the one reason drug pricing has been a popular health policy topic for politicians to focus on is because people really can feel it directly compared to how they feel other health costs. And so, I think that there\u2019s only a certain amount of time where people will just accept Trump saying, Oh, we\u2019re saving you money,<\/em> without them actually seeing it on the back end. And the problem right now is these most-favored-nation deals where he\u2019s struck privately with a lot of drug companies to get Medicaid, really mostly at this point, in theory lower prices. <\/p>\n It\u2019s not clear how much money it\u2019s actually going to save Medicaid because Medicaid actually gets some of the best deals that the U.S. gets. Most people on Medicaid actually don\u2019t really directly pay copays for most of their products, either. The other problem is they\u2019ve then rolled out a number of other drug-pricing models to try and pair this concept, again, of getting the prices a lot of other countries get for drugs in the U.S., but they then exempted all these companies they\u2019ve struck these private deals with. <\/p>\n So, it\u2019s not really clear who is left in terms of drug companies and drug products. Then you might get cheaper prices under some of these other demonstrations, which by their nature, these are demonstration pilot programs that are not going to reach every Medicare beneficiary they\u2019re pushing for. So, I think it\u2019s going to be a big problem because many people are not actually going to see savings. <\/p>\n For people that have a decent amount of income and can afford some of these direct-to-consumer products where health insurers have often been denying it \u2014 like the weight loss, common popular weight loss drugs \u2014 some people may feel a little benefit there. But if you\u2019re somebody who\u2019s underinsured or uninsured, even if there\u2019s really good discounts on a direct-to-consumer buying market, you\u2019re probably also still not going to be able to afford these weight loss drugs. <\/p>\n Rovner:<\/strong> Yes, Lauren. <\/p>\n Weber:<\/strong> Just to go back to the rural health fund disbursement, I just have so many thoughts on this, because I mean, at the end of the day, rural hospitals are also the equivalent of rural jobs programs for rural America. And typically, rural hospitals fall in red America. And so, this attempt to prop them up, it sounds flashy, right? I mean, it\u2019s billions of dollars. But when you break it down by the 50 states, it\u2019s hundreds of millions, like tops like $281 million depending on the state. <\/p>\n That\u2019s not going to cover the deficit that the bill has created for those folks. And I understand that it\u2019s meant by the administration to be a flashy way of, Oh, we\u2019re supporting rural health care,<\/em> but the crushing Medicaid cuts that these rural hospitals are going to face, when they already operate on such thin margins, will be devastating. I mean, it will be devastating for already health care deserts that we already see, and this money is not going to be enough to stop the blood flow there in rural America. <\/p>\n Rovner:<\/strong> And Alice, you guys at Politico pointed out that even this $50 billion was not exactly distributed based on need, right? It was distributed based on deals. <\/p>\n Ollstein:<\/strong> Yes. And to build on Lauren\u2019s point, not only is it not enough to make up for the Medicaid cuts, but there are restrictions. States can only use a little fraction of the money to keep these rural hospitals\u2019 lights on, basically. The money is supposed to be for these transformative projects. It\u2019s very tech focused. It\u2019s very, Let\u2019s try these pilot programs and completely revamp the way rural health care is delivered.<\/em> Meanwhile, there are all these rural hospitals on the brink of closure, and states aren\u2019t allowed to spend a lot of the money on just paying the salaries of the people who work there, paying for keeping the buildings in good shape. And so, we could see benefit from this money, but we could also, in the meantime, see a bunch more rural hospitals close, as they have been. And once they close, it\u2019s really hard to come back. <\/p>\n And so, to your point, the way the money was distributed is getting a lot of criticism from all around the country because, one, a lot of it was split evenly between states regardless of the size of their population. And so, you saw, for instance, Alaska get more than California despite having a tiny, tiny sliver of its population. And I had people arguing with me online saying, Well, what about the rural population?<\/em> Yes, California has a huge rural population. It\u2019s not just LA and San Francisco. So, even if you only count the rural population, it\u2019s much, much, much bigger than Alaska. <\/p>\n Also, there were these policy incentives in the program where states that adopted Trump-administration-friendly policies \u2014 like restrictions on what people can buy with SNAP [Supplemental Nutrition Assistance Program], on implementing the presidential fitness test, on deregulating short-term insurance plans, which Democrats have criticized and called junk plans \u2014 these would get the states more money if they adopted these policies. So, we\u2019ve been digging into that and digging into the struggles on the state level on that front. <\/p>\n Rovner:<\/strong> All right. Well, that\u2019s the rural health news. We\u2019re going to take a quick break. We will be right back. <\/p>\n So, the other big news out of HHS [the Department of Health and Human Services] was on the vaccine front where Secretary Robert F. Kennedy Jr. made unilaterally a major change to the federal government\u2019s childhood vaccine schedule, reducing the number of diseases with explicit vaccine recommendations from 17 to 11. No longer recommended for all children will be vaccines to protect against flu, covid, rotavirus, hepatitis A, and the germs that cause meningitis. Sarah, you\u2019re the mom here on this panel today. How is this schedule change actually going to affect parents and children and doctors? <\/p>\n Karlin-Smith:<\/strong> I think a lot of it is going to depend [on] how the pediatrician health community reacts to this, because there\u2019s been a lot of pushback from the medical public health community that this is not an appropriate or scientifically based change. So, doctors may still guide parents to hopefully making the decision to get these vaccines, but parents who may be a little hesitant, maybe feel more comfortable backing out. <\/p>\n Despite sometimes the rhetoric you hear from this administration, states are really the ones that end up creating policies that end up with actual mandates for people to get vaccinated for school and so forth. So, states may build off this and change their mandates, and that may impact access, but they may also not. So, people may still have to, for school purposes, get some of these shots as well. <\/p>\n Rovner:<\/strong> And I should point out that the American Academy of Pediatrics is fighting this, I would say tooth and nail, but also in court. I mean, they\u2019re actually suing, saying that Kennedy didn\u2019t even have the authority to make this change without going through a much more detailed regulatory process. <\/p>\n So, the administration says that all the vaccines currently on the schedule will remain, quote, \u201ccovered by insurance,\u201d but I\u2019m not positive that\u2019s necessarily going to be the case in the long term, right? Isn\u2019t mandatory insurance coverage linked to the recommendations of the CDC [Centers for Disease Control and Prevention]? And if these are no longer actually recommended, are they no longer required to be covered? <\/p>\n I know the insurance industry, we\u2019ve talked about this, has said that they\u2019re going to continue to cover all the vaccines at least through 2026. But I\u2019m wondering about the legality. I tried to track this back, but I couldn\u2019t find it all the way. <\/p>\n Ollstein:<\/strong> We could see a patchwork because a lot of states are moving to change their own laws about insurance coverage and have it be based on something other than these federal recommendations. I think that obviously patchworks are challenging when you\u2019re talking about infectious diseases, which do not respect state or national boundaries, but Sarah can say more. <\/p>\n Rovner:<\/strong> Go ahead, Sarah. <\/p>\n Karlin-Smith:<\/strong> Yeah. To build on Alice\u2019s comment, and the thing that gets really confusing really fast always with U.S. health care is states can regulate certain insurance plans and states cannot regulate certain insurance plans, the ERISA [Employee Retirement Income Security Act] plans. So, you could end up, even if states want to mandate coverage, depending on the type of health care coverage you get in your state, you may live in that state, work in that state, and you\u2019re not going to get covered. So, that adds to the patchwork and always adds to the confusion when trying to explain that issue to people. <\/p>\n But the administration has claimed basically because the vaccines, they\u2019re no longer universally recommended \u2014 they\u2019re moving to what\u2019s called the shared decision-making recommendation, where people are supposed to consult with their doctor and figure out whether these vaccines are appropriate for them and their children \u2014 that that still, under the way laws and regulations are written, requires the mandatory coverage for health care and no copays and so forth. <\/p>\n And I\u2019ve talked to people who\u2019ve looked at this, and there is precedent for that with other vaccines. I think there\u2019s some concerns, however, that that could be challenged by people in court who don\u2019t want these vaccines to be covered. There\u2019s also concern when it comes to like the HPV [human papillomavirus] vaccine, which they\u2019re now only recommending one shot of instead of two. <\/p>\n In that case, because they\u2019ve really fully eliminated the recommendation for a second shot, if somebody felt like they wanted that two-series shot, I don\u2019t think that would be covered. And the other question is, while they didn\u2019t use the CDC\u2019s Advisory Committee on Immunization Practices to make these changes for the most part. And they are largely advisory, but they do have certain legal authority when it comes to vaccines for children\u2019s program, and their legal authority from Congress very much relates to the coverage and reimbursement. So, it\u2019ll be interesting to see, again, if this all aligns. <\/p>\n Rovner:<\/strong> And we should point out that the Vaccines for Children Program, which many people have never heard of, is actually responsible for vaccinating something like half of all children in the United States. It\u2019s a huge program that\u2019s just basically invisible but really, really important. <\/p>\n Karlin-Smith:<\/strong> Right. And so, I think there\u2019s going to be legal questions that they didn\u2019t vote on those reimbursement questions here. <\/p>\n Rovner:<\/strong> Yeah. There\u2019s a lot that\u2019s going to have to be sorted out here. Well, one of the arguments that HHS officials are making is that they compared the U.S. vaccine schedule to that of, quote, \u201cpeer nations\u201d like Denmark, but those peer nations have something the U.S. does not: universal health insurance. That can make a really big difference in vaccine uptake and in just the prevalence of disease, right? <\/p>\n Karlin-Smith:<\/strong> Yeah. And so, one thing that people have tried to look at and explain in recent days is the U.S. isn\u2019t actually that different from most of its peers. Denmark, some have made the case, is actually the outlier. And if you look at Germany, Japan, Canada, Australia, the amount of pathogens, viruses the U.S. is vaccinating against is actually much more in line with most of the peer population. And then when you have a country like Denmark, which has universal health insurance \u2026 <\/p>\n Rovner:<\/strong> And a very small population. <\/p>\n Karlin-Smith:<\/strong> Right. I mean, it\u2019s very different, but they\u2019ve made in some cases the calculus that if we don\u2019t vaccinate for rotavirus, and we are able to treat the however many kids each year will need to be hospitalized and treated, and you have a certain comfort \u2014 I don\u2019t think that most parents would like the idea of knowing your kid is going to get sick and need to be hospitalized maybe or treated \u2014 but there\u2019s a lot more comfort that they would get care, and quick care, and would do better there. But they certainly are not, and there\u2019s data to show, [they] don\u2019t do as well as the U.S. does in terms of the amount of people that get some of these diseases. <\/p>\n The other thing with some of the vaccines I noted that like some of these comparison countries don\u2019t cover is they\u2019re newer and they\u2019re still more expensive. So, sometimes one of the reasons these countries are choosing not to recommend them more broadly is because they\u2019re making decisions based on the fact that they have universal health care \u2014 the taxpayers pay for it \u2014 and then deciding that at this point, the pricing is not affordable. They\u2019re not making a decision saying if the cost was zero, that the risk-benefit calculus isn\u2019t favorable for people. <\/p>\n Rovner:<\/strong> Right. And it\u2019s all about the risk-benefit calculus. So, one thing we know is that the rise in vaccine hesitancy is leading to outbreaks of previously rare diseases in the U.S., including measles and pertussis, or whooping cough. Lauren, you\u2019ve got a really cool story this week with a tool that can help people figure out if they and their families are at risk. So, tell us about it. <\/p>\n Weber:<\/strong> Yeah. My colleagues at The Washington Post, including Caitlin Gilbert, and I set out last year to tell people across the country what their vaccination rate is at their school<\/a>. And so, we requested records from all 50 states and were able to get school-based records for about, I think, 36 of them and county-based records for vaccination records for 44 states. So, we have a nifty tool where you can look up in your local community what your vaccination rates are. <\/p>\n But taking a step back, what we found in our reporting is that before the pandemic, rates weren\u2019t looking that great. Only half of the country was making 95% vaccination against measles, which is herd immunity. After the pandemic, that dropped to 28%. <\/p>\n And what we found in digging in a lot deeper is that schools, which were once considered kind of this bulwark against infectious disease, because they\u2019re the ones who would enforce whether or not you needed your shots to attend school, are somewhat stepping away from that responsibility in the politically charged environment that is America today. I spoke to a superintendent in Minnesota, which has seen a large drop in vaccination for measles, who said, Look, I\u2019m a record keeper. It\u2019s not my job to promote a medical decision.<\/em> <\/p>\n And you see that attitude across the country in school nurses and so on where maybe they\u2019re not being empowered by their superintendent or principal to draw the line, or they\u2019re valuing the child going to school over getting vaccinated. And so, there\u2019s a lot of talk about at the state level that we have these mandates for vaccination, but if they\u2019re not enforced and there\u2019s no mechanism to enforce them, our investigation found that you had these slipping rates. <\/p>\n And a lot of folks are really concerned. Because look to South Carolina. You have hundreds of kids quarantined and missing school; you have hundreds of people infected. And, in general, measles cases were at their highest in 33 years last year. So, we have this rise of infectious disease amid an administration headed by a man who has disparaged vaccines for years and is working to roll back policy around them. <\/p>\n Rovner:<\/strong> Is there any talk from Capitol Hill on \u2026 we\u2019ve talked so much about Sen. Bill Cassidy [R-La.], who\u2019s a doctor, who was the deciding vote for RFK Jr. and said that he got RFK Jr. to promise not to change the vaccine schedule, which he just did. But it\u2019s not just Cassidy. There\u2019s 534 other members of Congress. Is anybody pushing back on any of this? <\/p>\n Weber:<\/strong> I mean, Cassidy tweeted after the vaccine change that he was appalled. I\u2019m a physician. My job is to protect children. This is a problem.<\/em> At the end of the day, the person who runs HHS is a man who has repeatedly linked the rising number of vaccines, which are rising because we have more vaccines that can fight more pathogens, to chronic conditions that experts say is not based in evidence. <\/p>\n And so, no, I do not see a massive Capitol Hill pushback. I mean, you have frustration and irritation, but I don\u2019t see Cassidy hauling Kennedy in for a hearing. Hasn\u2019t happened yet, really, besides those couple that were mandated. So, we\u2019ll see how this continues to play out. <\/p>\n But the reality is amid all of this talk of vaccine schedules, the people on the front lines of this are these school nurses or pediatricians who are met with a wave of parents who are so confused. I talked to so many pediatricians who said, Look, we refer to the AAP,<\/em> the American Academy of Pediatrics, but it\u2019s really hard when the president and the head of the health system is saying something different to convince parents that may be confused.<\/em> And oftentimes, if you\u2019re confused, it\u2019s easier to not take action, to not get your child vaccinated than to do so. And\u2026 <\/p>\n Rovner:<\/strong> And because pediatricians don\u2019t already have enough to do. <\/p>\n Weber:<\/strong> Right. Many are scared that these trends that we identified in our investigation will continue to worsen in the years to come. <\/p>\n Rovner:<\/strong> Well, also this week we got the new food pyramid recommendations from HHS and the Department of Agriculture. Food, obviously another big priority for RFK Jr., who, as we know, is a fan of red meat and whole-fat dairy. Unlike the vaccine schedule, though, the changes to the food pyramid appear, at least at first blush, to hew to fairly consensus opinions in the nutrition world that whole foods are better than processed foods, protein is good, added sugar and refined carbohydrates are bad. <\/p>\n Still, when you get into the details, there are some things that are likely to cause nutrition scientists, some, shall we say, indigestion. What are some of the more controversial recommendations here other than Dr. [Mehmet] Oz saying in Wednesday\u2019s press briefing that you might not want to drink alcohol for breakfast? <\/p>\n Ollstein:<\/strong> So, the alcohol piece has gotten pushback because it\u2019s weakening the previous recommendation that really no amount of alcohol is safe. We talked before about a report about alcohol as a carcinogen that was buried last year, a government report that had been worked on for years that was supposed to come out that got buried by the Trump administration. And so that I think is reflected in these new recommendations. And I saw a lot of conservatives celebrating this and saying, Happy hour\u2019s back, everyone!<\/em> But look, there\u2019s real science that shows the dangers of even moderate alcohol consumption, and that\u2019s getting sidelined here. <\/p>\n Rovner:<\/strong> The previous recommendations were that, I would say the previous recommendations were like no more than one drink a day for women and two for men, and they took that away? I think that was the actual change here. <\/p>\n Ollstein:<\/strong> There was a push to say that no amount is safe, basically, that even small amounts are potentially harmful to health. <\/p>\n Rovner:<\/strong> And that didn\u2019t happen. <\/p>\n Ollstein:<\/strong> Correct, correct. The other concern I was hearing is about the emphasis on red meat when that is something that Americans eat too much of already. <\/p>\n Rovner:<\/strong> Although I know there\u2019s an irony here that I think the new recommendations state, you still shouldn\u2019t have more than 10% of your calories from saturated fat. But saturated fat isn\u2019t nearly as bad as we used to think it was, Sarah. I see you nodding. <\/p>\n Karlin-Smith:<\/strong> Yeah. I think the saturated fat and the focus on the sources of fat and protein is one of the biggest controversies here because there is lots of research and evidence that saturated fat can lead to heart disease and other medical complications. And people have long been pushed toward plant-based proteins, leaner proteins, and the role of dairy, and whether you should be doing high-fat dairy as well. <\/p>\n And there\u2019s been some good reporting from Stat and others of recent days that there was a lot of conflicts on the committee<\/a> who was making these recommendations around their relationships with these various industries. They tried to avoid contradicting the science too much in how they made their push for more red meat and more saturated fat. But it\u2019s probably another area where, if you read it in full, you\u2019re going to get confused and you may not end up making the right decisions because some of the recommendations there are kind of contradictory. <\/p>\n Rovner:<\/strong> Although we\u2019ll point out that the difference between the nutrition guidelines and the vaccine schedule is very large because the new nutrition guidelines are just that. They\u2019re guidelines. They do determine what gets served in school lunches and things like that, but it\u2019s not quite nearly of the level that the vaccine schedule is. <\/p>\n Well, finally this week, turning to reproductive health, the Wyoming Supreme Court struck down two abortion bans, kind of remarkable for one of the reddest states in the nation. Interestingly, one of the reasons the bans were struck down is because the state tried to thwart the Affordable Care Act back in 2012. Alice, explain what these two things have to do with each other. <\/p>\n Ollstein:<\/strong> Yes. So, the state adopted some laws saying that people have the right to make their own health care decisions, and that was squarely aimed at the Affordable Care Act. However, the judges found that it also applied to the right to have an abortion. <\/p>\n Rovner:<\/strong> Oops. <\/p>\n Ollstein:<\/strong> They said, Based on the text of this law, it doesn\u2019t matter what you meant it to say. It matters what it actually says. And we find that it applies here.<\/em> <\/p>\n That\u2019s actually not the only state where that\u2019s happened over the past few years. There have been other conservative states that have inadvertently protected the right to abortion through these right-to-control-your-own-health care provisions. So, I think we\u2019ve seen over the past few years that state constitutions can be more protective of abortion than the federal Constitution in certain circumstances. But I think it\u2019s also notable that Wyoming had one of the first laws specifically banning abortion pills, and that was also struck down. <\/p>\n So, nothing changes in practice, because these laws were already enjoined and were not being enforced, but it is a big deal. And it could lead to more efforts to hold the ballot referendums that we\u2019ve seen over the past few years. There are set to be a few more this fall, but there could be even more following decisions like this in the courts. <\/p>\n Rovner:<\/strong> Yeah. Along those lines, there\u2019s a really interesting piece in The Guardian that suggests that abortion is waning as a top issue for Democrats<\/a>, but not so much for Republicans, most of whom still consider it a deal breaker for a candidate not to agree with them. What happened to all that enthusiasm for abortion rights that we saw in 2023 and 2024 to some extent? <\/p>\n Ollstein:<\/strong> Look, there\u2019s a lot going on right now. So, it may be that just other issues are overshadowing this. And also, it\u2019s a long way to go before the elections. We do not know what\u2019s going to happen. <\/p>\n If various court cases lead to a big change, another big change in abortion access, this could rear its head once again. As we\u2019ve discussed many times, this is not really ever over or settled. <\/p>\n Rovner:<\/strong> All right. Well, it is January. All right. That is this week\u2019s news, or at least as much as we had time for. <\/p>\n Now, it\u2019s time for our extra credit segment. That\u2019s where we each recognize the story we read this week. We think you should read, too. Don\u2019t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lauren, why don\u2019t you start us off this week? <\/p>\n Weber:<\/strong> Yeah. I have to shout out another investigation my colleagues and I completed led by Rachel Roubein and Lena Sun and I. [\u201cHow RFK Jr. Upended the Public Health System<\/a>\u201d] We dug into the first year of Kennedy in office. In interviews with nearly a hundred folks and documents, we uncovered some of his previously undisclosed shaping of vaccine policy. We got ahold of an email in which a top aide asked to replace the membership of ACIP and reconsider the universal hep B vaccine recommendation and revisit the use of multidose flu shot vials. We also analyzed how while Kennedy has talked about food twice as much as vaccines while in office, one of his advisers, Del Bigtree, told us, Look, food is more popular with the American mom.<\/em> And I think some of these revelations shape and put into context what we\u2019re seeing now, which is this culmination of changing the vaccine schedule and continued policy to upend public health infrastructure in this country. <\/p>\n Rovner:<\/strong> That\u2019s a really good piece. Alice. <\/p>\n Ollstein:<\/strong> So, I have a very depressing piece out of San Francisco called, \u201cA Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose.<\/a>\u201d This is yet another death of a young person after heavily using some of these LLMs [large language models] for advice. Some of the chat logs show that he was able to very easily circumvent the protections that were put in place. <\/p>\n ChatGPT is not supposed to give people advice on using drugs recreationally, but that is very easily circumvented by pretending it\u2019s a hypothetical question or various other means. And this article does a good job showing that it\u2019s really a garbage-in-garbage-out scenario. ChatGPT is drawing from the entire internet. And so somebody\u2019s dumb post on Reddit by a person who has a substance abuse issue, for instance, could be informing what advice the bot gives you. And so I think this is especially important to keep in mind as, just this week, ChatGPT is launching, making a big push, launching a whole health-care-focused chatbot and encouraging millions of people to use it. <\/p>\n And so this article \u2026 quotes experts who argue that it\u2019s not possible to prevent this bad advice from getting in there, just because these chatbots are trained on huge volumes of text from the entire internet. It\u2019s not possible to weed out things like this. And so I think that\u2019s important to keep in mind. <\/p>\n Rovner:<\/strong> So, what could possibly go wrong? Sarah. <\/p>\n Karlin-Smith:<\/strong> I took a look at some ProPublica pieces on the impact of the U.S.\u2019 USAID cuts [\u201cThe End of Aid: Trump Destroyed USAID. What Happens Now?<\/a>\u201d]. One of the stories that I looked at was \u201cTrump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.<\/a>\u201d It\u2019s just a really deep dive into the decisions that these political leaders made to cut off aid and support for various countries. This one, in particular, was looking at South Sudan, even though they were warned that they would make certain disease outbreaks and other humanitarian situations worse. And it just goes through the hardship of that, as well as the fact that Trump administration officials were making claims throughout this time, once there was pushback, that they were going to not cut off certain life-supporting aid and so forth. And that was not actually the case. They did cut it off, and they did it in ways that were extremely abrupt and fast, that there could not be any safety valve or stopgap to prevent the harm that occurred. <\/p>\n Rovner:<\/strong> Yeah. It\u2019s quite the series and really heavy but really good. My extra credit this week comes from my colleague Fred Schulte, who\u2019s moved on from uncovering malfeasance in Medicare Advantage to uncovering malfeasance in cosmetic surgery. This one is called \u201cAdvertisements Promising Patients a \u2018Dream Body\u2019 With Minimal Risk Get Little Scrutiny<\/a>.\u201d <\/p>\n And if you\u2019ve ever been tempted by one of those body-sculpting commercials promising quick results, little pain, and an immediate return to your daily routine, you really need to read this story first. It includes a long list of patients who either died of complications of allegedly minimally invasive techniques or who ended up in the hospital and with scars that have yet to heal. Many of the lawsuits filed in these cases are still in process, but it is definitely \u201cbuyer beware.\u201d <\/p>\n OK, that is this week\u2019s show. Hope you feel at least a little bit caught up. As always, thanks to our editor, Emmarie Huetteman, and this week\u2019s producer engineer, Zach Dyer. <\/p>\n A reminder, What the Health?<\/em> is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org<\/a>. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org<\/a>, or you can find me still on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you folks hanging these days? Lauren. <\/p>\n Weber:<\/strong> I am on X, @LaurenWeberHP<\/a>, and same thing on Bluesky<\/a> these days. <\/p>\n Rovner:<\/strong> Sarah? <\/p>\n Karlin-Smith:<\/strong> Mostly Bluesky<\/a> and LinkedIn<\/a> at @sarahkarlin-smith. <\/p>\n Rovner:<\/strong> Alice. <\/p>\n Ollstein:<\/strong> Mostly on Bluesky, @alicemiranda<\/a>, and still on X, @AliceOllstein<\/a>. <\/p>\n Rovner:<\/strong> We will be backing your feed next week. Until then, be healthy. <\/p>\n \tZach Dyer \tEmmarie Huetteman Click here to find all our podcasts.<\/a><\/em><\/p>\n And subscribe to \u201cWhat the Health? From KFF Health News\u201d on Apple Podcasts<\/a>, Spotify<\/a>, the NPR app<\/a>, YouTube<\/a>, Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n\n\t\tPanelists\t<\/h3>\n
<\/p>\n
\n\tPink Sheet<\/p>\n
\n\t\t\t\t@SarahKarlin\t\t\t<\/a><\/p>\n
\n\t\t\t\t@sarahkarlin-smith.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Sarah’s stories.\t\t\t<\/a><\/p>\n<\/p>\n
\n\tPolitico<\/p>\n
\n\t\t\t\t@AliceOllstein\t\t\t<\/a><\/p>\n
\n\t\t\t\t@alicemiranda.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Alice’s stories.\t\t\t<\/a><\/p>\n<\/p>\n
\n\tThe Washington Post<\/p>\n
\n\t\t\t\t@LaurenWeberHP\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Lauren’s stories.\t\t\t<\/a><\/p>\n\n
\n
\n\t\tCredits\t<\/h3>\n
\n\tAudio producer<\/p>\n
\n\tEditor <\/p>\nUSE OUR CONTENT<\/h3>\n