{"id":2143097,"date":"2026-01-15T15:20:00","date_gmt":"2026-01-15T20:20:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?p=2143097&#038;post_type=podcast&#038;preview_id=2143097"},"modified":"2026-01-16T16:36:10","modified_gmt":"2026-01-16T21:36:10","slug":"what-the-health-429-obamacare-abortion-pill-mifepristone-hhs-january-15-2026","status":"publish","type":"podcast","link":"https:\/\/kffhealthnews.org\/news\/podcast\/what-the-health-429-obamacare-abortion-pill-mifepristone-hhs-january-15-2026\/","title":{"rendered":"What the Health? From KFF Health News: Culture Wars Take Center Stage"},"content":{"rendered":"\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\"><div class=\"block--iframe\">\n\t<iframe\n\t\tallow=\"fullscreen\"\n\t\tframeborder=\"0\"\n\t\theight=\"188\"\n\t\tsrc=\"https:\/\/play.prx.org\/e?ge=prx_14448_e5165ad6-0451-484c-8512-add786e97b7d&#038;uf=https%3A%2F%2Fwhatthehealth.feeds.wamu.org\"\n\t\twidth=\"100%\"\n\t><\/iframe>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people block--people\">\n\t\t<h3 class=\"people-title\">\n\t\tThe Host\t<\/h3>\n\t\t<div class=\"people-card-container single\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg 1100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=768,768 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Julie Rovner<\/div>\n\t<div class=\"author-affiliation\">KFF Health News<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/jrovner\" title=\"@jrovner\">\n\t\t\t\t@jrovner\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/julierovner.bsky.social\" title=\"@julierovner.bsky.social\">\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/kffhealthnews.org\/news\/author\/julie-rovner\/\"> \n\t\t\t\tRead Julie&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, &quot;What the Health?&quot; A noted expert on health policy issues, Julie is the author of the critically praised reference book &quot;Health Care Politics and Policy A to Z,&quot; now in its third edition.\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<p>Millions of Americans are facing dramatically higher health insurance premium payments due to the Jan. 1 expiration of enhanced Affordable Care Act subsidies. But much of Washington appears more interested at the moment in culture war issues, including abortion and gender-affirming care.<\/p>\n\n\n\n<p>Meanwhile, at the Department of Health and Human Services, personnel continue to be fired and rehired, and grants terminated and reinstated, leaving everyone who touches the agency uncertain about what comes next.<\/p>\n\n\n\n<p>This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.<\/p>\n\n\n\n<div class=\"wp-block-people block--people\">\n\t\t<h3 class=\"people-title\">\n\t\tPanelists\t<\/h3>\n\t\t<div class=\"people-card-container threewide\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg 959w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=500,501 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=768,769 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=630,631 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Anna Edney<\/div>\n\t<div class=\"author-affiliation\">Bloomberg News<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/annaedney\" title=\"@annaedney\">\n\t\t\t\t@annaedney\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/annaedney.bsky.social\" title=\"@annaedney.bsky.social\">\n\t\t\t\t@annaedney.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/www.bloomberg.com\/authors\/AP519FMOg7w\/anna-edney\"> \n\t\t\t\tRead Anna&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg 483w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Kenen_438sq.jpg?resize=315,315 315w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Joanne Kenen<\/div>\n\t<div class=\"author-affiliation\">Johns Hopkins University and Politico<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/JoanneKenen\" title=\"@JoanneKenen\">\n\t\t\t\t@JoanneKenen\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/joannekenen.bsky.social\" title=\"@joannekenen.bsky.social\">\n\t\t\t\t@joannekenen.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/hbhi.jhu.edu\/expert\/joanne-kenen\"> \n\t\t\t\tRead Joanne&#039;s bio.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg 800w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=768,768 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Ollstein_800sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Alice Miranda Ollstein<\/div>\n\t<div class=\"author-affiliation\">Politico<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/AliceOllstein\" title=\"@AliceOllstein\">\n\t\t\t\t@AliceOllstein\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/alicemiranda.bsky.social\" title=\"@alicemiranda.bsky.social\">\n\t\t\t\t@alicemiranda.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/www.politico.com\/staff\/alice-miranda-ollstein\"> \n\t\t\t\tRead Alice&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<p>Among the takeaways from this week\u2019s episode:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Congress remains undecided on a deal to renew enhanced ACA premium subsidies, as it is on spending plans to keep the federal government running when the existing, short-term plan expires at the end of the month. While some of the bigger appropriations hang-ups are related to immigration and foreign affairs, there are also hurdles to passing spending for HHS.<\/li>\n\n\n\n<li>ACA plan enrollment is down about 1.5 million compared with last year, with states reporting that many people are switching to cheaper plans or dropping coverage. Enrollment numbers are likely to drop further in the coming months as more-expensive premium payments come due and some realize they can no longer afford the plans they\u2019re enrolled in.<\/li>\n\n\n\n<li>A key Senate health committee on Wednesday hosted a hearing on the abortion pill mifepristone, focused on the safety concerns posed by abortion foes \u2014 though those concerns are unsupported by scientific research and decades of experience with the drug. Many abortion opponents are frustrated that the Trump administration has not taken aggressive action to restrict access to the abortion pill.<\/li>\n\n\n\n<li>As the Trump administration moved this week to rehire laid-off employees and abruptly cancel, then restore, addiction-related grants, overall government spending is up, despite the administration\u2019s stated goal of saving money by cutting the federal government\u2019s size and activities. It turns out the churn within the administration is costing taxpayers more. And new data, revealing that more federal workers left on their own than were laid off last year, shows that a lot of institutional memory was also lost.<\/li>\n<\/ul>\n\n\n\n<p>Also this week, Rovner interviews KFF Health News\u2019 Elisabeth Rosenthal, who created the \u201cBill of the Month\u201d series and wrote <a href=\"https:\/\/kffhealthnews.org\/news\/article\/scorpion-peppers-spicy-food-colorado-bill-of-the-month-december-2025\/\">the latest installment<\/a>, about a scorpion pepper, an ER visit, and a ghost bill. If you have a baffling, infuriating, or exorbitant bill you\u2019d like to share with us, <a href=\"https:\/\/kffhealthnews.org\/send-us-your-medical-bills\/\">you can do that here<\/a>.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"87a489a56a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/podcast\/2143097\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n\n\n\n<p><strong>Julie Rovner:<\/strong> The New York Times\u2019 \u201c<a href=\"https:\/\/www.nytimes.com\/2026\/01\/12\/climate\/trump-epa-air-pollution.html?smtyp=cur&amp;utm_social_handle_id=807095&amp;smid=tw-nytimes&amp;utm_social_post_id=650100429\">E.P.A. to Stop Considering Lives Saved When Setting Rules on Air Pollution<\/a>,\u201d by Maxine Joselow.<\/p>\n\n\n\n<p><strong>Alice Miranda Ollstein:<\/strong> ProPublica\u2019s \u201c<a href=\"https:\/\/www.propublica.org\/article\/fluoride-supplements-fda-rfk-jr-ken-paxton-restrictions\">After Sowing Distrust in Fluoridated Water, Kennedy and Skeptics Turn to Obstructing Other Fluoride Sources<\/a>,\u201d by Anna Clark.<\/p>\n\n\n\n<p><strong>Joanne Kenen:<\/strong> The New Yorker\u2019s \u201c<a href=\"https:\/\/www.newyorker.com\/culture\/the-lede\/what-the-pitt-taught-me-about-being-a-doctor\">What \u2018The Pitt\u2019 Taught Me About Being a Doctor<\/a>,\u201d by Dhruv Khullar.<\/p>\n\n\n\n<p><strong>Anna Edney:<\/strong> MedPage Today\u2019s \u201c<a href=\"https:\/\/www.medpagetoday.com\/pediatrics\/vaccines\/119409?xid=nl_mpt_DHE_2026-01-13&amp;mh=ea3f9ca37fc2855fb915b8bee6da0f9f&amp;zdee=gAAAAABm4u34wDjjPbj8HzT9SwTG9cRpDgRth3cYlhZszFXSMZNxtYFb0zY5SCeq3jArr3U0KNT1nZcVY9TKOWX3I8je5PGXBw%3D%3D&amp;utm_source=Sailthru&amp;utm_medium=email&amp;utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202026-01-13&amp;utm_term=NL_Daily_DHE_dual-gmail-definition\">Worried About Liability After CDC Vaccine Changes? You Shouldn\u2019t Be<\/a>,\u201d by Joedy McCreary.<\/p>\n\n\n\n<p>Also mentioned in this week\u2019s podcast:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The Washington Post\u2019s \u201c<a href=\"https:\/\/www.washingtonpost.com\/politics\/2026\/01\/10\/house-republicans-narrow-majority\/\">A Majority in Name Only? House Republicans Are Barely Hanging On<\/a>,\u201d by Paul Kane.<\/li>\n\n\n\n<li>HealthAffairs\u2019 \u201c<a href=\"https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2025.01683\">National Health Care Spending Increased 7.2 percent in 2024 as Utilization Remained Elevated<\/a>,\u201d by Mica Hartman, Anne B. Martin, David Lassman, and Aaron Catlin.<\/li>\n\n\n\n<li>Politico\u2019s \u201c<a href=\"https:\/\/www.politico.com\/news\/2026\/01\/13\/lawsuit-dismissed-after-trump-admin-quietly-restored-tens-of-millions-to-planned-parenthood-00723369\">Lawsuit Dismissed After Trump Admin Quietly Restored Tens of Millions to Planned Parenthood<\/a>,\u201d by Alice Miranda Ollstein.<\/li>\n\n\n\n<li>JAMA\u2019s \u201c<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2843710\">The US Food and Drug Administration\u2019s Regulation of Mifepristone<\/a>,\u201d by Sophie Dilek, Joanne Rosen, Anna Levashkevich, Joshua M. Sharfstein, and G. Caleb Alexander.<\/li>\n<\/ul>\n\n\n\n<section class=\"block--expandable has-label\"\n\t\t\tid=\"podcast-expandable\"\n\t>\n\t\t\t<input type=\"checkbox\" name=\"expandable-radio\" id=\"transcript-culture-wars-take-center-stage\">\n\t\t<label class=\"expandable__title-label\" for=\"transcript-culture-wars-take-center-stage\">\n\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__label  \"\n\t\t\t\t\tstyle=\"background-color: #cb1919;\"\n\t\t\t\t>\n\t\t\t\t\tclick to open the transcript\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__title\"\n\t\t\t\t\tstyle=\"font-size: 36px;\"\n\t\t\t\t>\n\t\t\t\t\t\tTranscript: Culture Wars Take Center Stage\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\t\t<div class=\"expandable__content--container\">\n\t\t<div class=\"expandable__content\">\n\t\t\t\n\n<p><strong><em>[Editor\u2019s note:<\/em><\/strong><em>&nbsp;This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Julie Rovner:<\/strong>&nbsp;Hello from KFF Health News and WAMU&nbsp;public&nbsp;radio in Washington, D.C., and welcome to&nbsp;<em>What the Health?<\/em>&nbsp;I\u2019m&nbsp;Julie Rovner, chief Washington correspondent for KFF Health News, and&nbsp;I\u2019m&nbsp;joined by some of the best and smartest health reporters in Washington.&nbsp;We\u2019re&nbsp;taping this week on Thursday, Jan. 15, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.&nbsp;<\/p>\n\n\n\n<p>Today,&nbsp;we are joined via video conference by Anna Edney&nbsp;of&nbsp;Bloomberg News.&nbsp;<\/p>\n\n\n\n<p><strong>Anna Edney:<\/strong>&nbsp;Hi, everyone.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Alice [Miranda]&nbsp;Ollstein&nbsp;of Politico.&nbsp;<\/p>\n\n\n\n<p><strong>Alice Miranda&nbsp;Ollstein:<\/strong>&nbsp;Hello.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And&nbsp;Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.&nbsp;<\/p>\n\n\n\n<p><strong>Joanne Kenen:<\/strong>&nbsp;Hi, everybody.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Later in this episode,&nbsp;we\u2019ll&nbsp;have my interview with KFF Health News\u2019&nbsp;Elisabeth Rosenthal, who reported and wrote the latest&nbsp;\u201cBill of the Month,\u201d&nbsp;about an ER trip, a scorpion pepper, and a ghost bill. But first,&nbsp;this week\u2019s news.&nbsp;Let\u2019s&nbsp;start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three&nbsp;years&nbsp;the Affordable Care Act\u2019s expanded subsidies&nbsp;\u2014&nbsp;the ones that expired Jan. 1.&nbsp;&nbsp;<\/p>\n\n\n\n<p>The Senate also turned back an effort to cancel the Trump administration\u2019s regulation covering the ACA, which, although it has gotten far less attention than the subsidies, would also result in a lot of people losing or dropping health insurance coverage.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Meanwhile, in the House, Republicans are struggling just to keep the lights on. Between resignations, illnesses, and deaths, House Republicans are&nbsp;very nearly&nbsp;\u2014&nbsp;in the words of longtime Congress watcher&nbsp;<a href=\"https:\/\/www.washingtonpost.com\/politics\/2026\/01\/10\/house-republicans-narrow-majority\/\" target=\"_blank\" rel=\"noreferrer noopener\">Paul Kane of The Washington Post<\/a>&nbsp;\u2014&nbsp;a&nbsp;[majority]&nbsp;in name only, which I guess is pronounced&nbsp;\u201cMINO.\u201d&nbsp;Their majority is now so thin that one or two votes can hand Democrats a win, as we saw earlier this week in a surprise defeat on an otherwise&nbsp;fairly routine&nbsp;labor bill.&nbsp;Which brings us to the prospects for renewing those Affordable Care Act subsidies. When the dust cleared from last week\u2019s House vote, 17 Republicans joined all the&nbsp;House\u2019s Democrats&nbsp;to pass&nbsp;the bill and send&nbsp;it to the Senate.&nbsp;But it seems that the bipartisan efforts in the Senate to get a deal are losing steam.&nbsp;What\u2019s the latest you guys are hearing?&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:<\/strong>&nbsp;Yeah, so it&nbsp;wasn\u2019t&nbsp;a good sign when the person who has&nbsp;sort of come&nbsp;out as a leader of these bipartisan negotiations,&nbsp;Ohio Sen.&nbsp;Bernie&nbsp;Moreno, at first came out&nbsp;very strong&nbsp;and said,&nbsp;<em>We\u2019re&nbsp;in the end zone.&nbsp;We\u2019re&nbsp;very&nbsp;close&nbsp;to a deal.&nbsp;We\u2019re&nbsp;going to have&nbsp;bill&nbsp;text.<\/em>&nbsp;And that was several days ago, and now&nbsp;they\u2019re&nbsp;saying that&nbsp;maybe&nbsp;they\u2019ll&nbsp;have something by the end of the month. But the initial enthusiasm very quickly fizzled as they really got into the negotiations, and,&nbsp;from what my colleagues have reported, there\u2019s still disagreements on several fronts, you know, including this idea of having a minimum charge for all plans, no zero-premium plans anymore, which the right says is to crack down on fraud, and the left says would really deter low-income people from getting coverage. And there, of course, is, as always, a fight about abortion, as we spoke about on this podcast before.&nbsp;There is&nbsp;not&nbsp;agreement on how Obamacare currently treats abortion, and thus there can be no agreement on how it&nbsp;should&nbsp;treat abortion.&nbsp;<\/p>\n\n\n\n<p>And&nbsp;so&nbsp;the two sides have not come to any kind of compromise. And I don\u2019t know what compromise would be possible, because all of the anti-abortion activist groups and their allies in Congress, of which there are many, say that the only thing they\u2019ll accept is a blanket national ban on any plan that covers abortion receiving a subsidy, and that\u2019s a&nbsp;nonstarter&nbsp;for most, if not all, Democrats.&nbsp;So&nbsp;I&nbsp;don\u2019t&nbsp;know where we&nbsp;go&nbsp;from here.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Well, we will talk more about both abortion and the ACA in a minute, but first, lawmakers have just over two weeks to finish the remaining spending bills, or else risk yet another government shutdown. They&nbsp;seem to&nbsp;[be]&nbsp;making some headway on many of those spending bills, but not so much on the bill that funds most of the Department of Health and Human Services. Any chance they can&nbsp;come up with&nbsp;a bill that can get 60 votes in the Senate and a majority in the much more conservative House?&nbsp;That is a pretty narrow needle to thread.&nbsp;I&nbsp;don\u2019t&nbsp;think abortion is going to be a&nbsp;huge issue in&nbsp;Labor,&nbsp;HHS,&nbsp;because&nbsp;that\u2019s&nbsp;where the Hyde Amendment lives, and we usually see the Hyde Amendment renewed. But, you know, I see a lot of Democrats and, frankly, Republicans in the Senate wanting to put money back for a lot of the things that HHS has cut, and the&nbsp;House&nbsp;[is]&nbsp;probably not so excited about putting all of that money back.&nbsp;I\u2019m&nbsp;just wondering if there really is a deal to be had, or if&nbsp;we\u2019re&nbsp;going to see for the,&nbsp;you know, however many&nbsp;year[s]&nbsp;in a row, another continuing resolution, at least for the Department of Health and Human Services.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:<\/strong>&nbsp;Well,&nbsp;you\u2019re&nbsp;hearing a lot more optimism from lawmakers about the spending bill than you are about a[n]&nbsp;Obamacare subsidy deal or any of the other things that&nbsp;they\u2019re&nbsp;fighting about. And I would say,&nbsp;on the&nbsp;spending,&nbsp;I think the much bigger fights&nbsp;are going to be outside the health care space. I think&nbsp;they\u2019re&nbsp;going to be about immigration, with everything&nbsp;we\u2019re&nbsp;seeing about foreign policy, whether and how to put restraints on the Trump administration, on both of those fronts.&nbsp;On health,&nbsp;yes, I think&nbsp;you\u2019ve&nbsp;seen efforts to restore funding for programs that was slashed by the Trump administration, and you are seeing some Republican support for that. I mean, it&nbsp;impacts&nbsp;their districts and their voters too. So that makes sense.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>We\u2019ve&nbsp;also seen the Congress vote for spending that the administration&nbsp;hasn\u2019t&nbsp;been spent.&nbsp;So&nbsp;Congress has just voted on a series of things about science funding and other&nbsp;health-related&nbsp;issues, including global health. But it remains to be seen whether this administration takes appropriations as law or&nbsp;suggestion.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So&nbsp;while the effort to revive the&nbsp;additional&nbsp;ACA subsidies appears to be losing steam, there does seem to be some new hope for a bipartisan health package that almost became law at the end of 2024, so 13 months ago.&nbsp;Back then, Elon Musk got it stripped from the year-end spending bill because the bill, or so Musk said, had gotten too big. That health package includes things like reforms for pharmacy benefits managers and hospital&nbsp;outpatient payments,&nbsp;and continued funding for community health centers. Could that finally become law? That thing that they said,&nbsp;<em>Oh,&nbsp;we\u2019ll&nbsp;pass it first thing next year<\/em>, meaning 2025.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>I think&nbsp;it\u2019s&nbsp;certainly looking more likely than the subsidies that&nbsp;we\u2019ve&nbsp;been talking about. But I do think&nbsp;we\u2019ve&nbsp;been here before several times, not just at the end of last year&nbsp;\u2014&nbsp;but,&nbsp;like with these PBM reforms, I feel like they have certainly gotten to a point where&nbsp;it\u2019s&nbsp;like,&nbsp;<em>This&nbsp;is happening.&nbsp;It\u2019s&nbsp;gonna&nbsp;happen.<\/em>&nbsp;And, I mean,&nbsp;it\u2019s&nbsp;been years, though, that&nbsp;we\u2019ve&nbsp;been talking about pharmacy benefit manager reforms in the space of drug pricing.&nbsp;So basically, you&nbsp;know, from&nbsp;when&nbsp;[President Donald]&nbsp;Trump won. And so, you know, I say this with, like, a huge amount of caution:&nbsp;Maybe.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, we will, but&nbsp;we\u2019ll&nbsp;believe it when&nbsp;\u2026&nbsp;we get to the signing ceremony.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:<\/strong>&nbsp;Exactly.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Well, back to the Affordable Care Act, for which enrollment in most states&nbsp;end&nbsp;today.&nbsp;We\u2019re getting an early idea of how many people actually are dropping coverage because of the expiration of those subsidies.&nbsp;Sign-ups on the federal marketplace are down about&nbsp;1.5&nbsp;million from the end of last year\u2019s enrollment period, and&nbsp;that\u2019s&nbsp;before most people&nbsp;have to&nbsp;pay their first bill. States that run their own marketplaces are also reporting that people are dropping coverage, or else trying to shift to cheaper plans.&nbsp;I\u2019m&nbsp;wondering if these early numbers&nbsp;\u2014&nbsp;which are&nbsp;actually stronger&nbsp;than many predicted, with fewer people&nbsp;actually dropping&nbsp;coverage&nbsp;\u2014&nbsp;reflect people who signed up hoping that Congress might&nbsp;actually renew&nbsp;the subsidies this month. Since we kept saying that was&nbsp;possible.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>I would bet that most people are not following the&nbsp;minutiae of&nbsp;what\u2019s&nbsp;happening on Capitol Hill and have no&nbsp;idea&nbsp;the mess&nbsp;we\u2019re&nbsp;in,&nbsp;and&nbsp;why,&nbsp;and&nbsp;who\u2019s&nbsp;responsible. I would love to be wrong about that. I would&nbsp;love for&nbsp;everyone to be super informed.&nbsp;Hopefully&nbsp;they&nbsp;listen&nbsp;to this podcast. But you know, I think that a lot of people just&nbsp;sign up&nbsp;year after year and&nbsp;aren\u2019t&nbsp;sure of&nbsp;what\u2019s&nbsp;going on until&nbsp;they\u2019re&nbsp;hit with the giant bill.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Yeah.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:<\/strong>&nbsp;One thing I will point out about the emerging numbers is it does show,&nbsp;at least early indications,&nbsp;that the steps a lot of states are taking to make up for the shortfalls and put their own funding into helping people and subsidizing plans,&nbsp;that\u2019s really working.&nbsp;You\u2019re&nbsp;seeing&nbsp;enrollment up&nbsp;in some of those states, and so I wonder if&nbsp;that\u2019ll&nbsp;encourage any others to get on board as well.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>But&nbsp;\u2026 I think what Julie said&nbsp;is&nbsp;it\u2019s&nbsp;\u2026&nbsp;the follow-up is less than expected. But for the reasons Julie just&nbsp;said&nbsp;is that you haven\u2019t gotten your bill yet.&nbsp;So&nbsp;either you&nbsp;haven\u2019t&nbsp;been paying attention, or&nbsp;you\u2019re&nbsp;an optimist and think&nbsp;there\u2019ll&nbsp;be a solution.&nbsp;So, and&nbsp;people might even pay their first bill thinking that&nbsp;there\u2019ll&nbsp;be a solution next month, or that&nbsp;we\u2019re&nbsp;close. I mean, I would think&nbsp;there\u2019d&nbsp;be drop-off soon, but there might be a steeper&nbsp;cliff a month or two from now, when people realize this is it for the year, and not just a tough, expensive month or two. So just because&nbsp;they\u2019re&nbsp;not as bad as some&nbsp;people&nbsp;forecast&nbsp;doesn\u2019t&nbsp;say that this is going to be a robust coverage year.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>And I think,&nbsp;I mean, they are the whole picture when you\u2019re talking about who\u2019s signing up, but a lot of these people that I\u2019ve read about or heard about are on the radio programs and different things are signing up,&nbsp;are drastically changing their lives to be able to afford what they think might be their insurance. So how does that play out&nbsp;in other aspects?&nbsp;I&nbsp;think&nbsp;will be&nbsp;..&nbsp;of the economy of jobs, like, where does that lead&nbsp;us? I&nbsp;think&nbsp;will be something to watch out for too.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And by the way, in case you\u2019re wondering why health insurance is so expensive, we got the&nbsp;<a href=\"https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2025.01683\" target=\"_blank\" rel=\"noreferrer noopener\">2024 national health spending numbers this week<\/a>, and total health expenditures grew by 7.2% from the previous year to&nbsp;$5.3 trillion, or 18% of the nation\u2019s GDP&nbsp;[gross domestic product],&nbsp;up from 17.7% the year before. Remember, these are the numbers for 2024,&nbsp;not 2025,&nbsp;but it makes&nbsp;it&nbsp;pretty&nbsp;hard&nbsp;for Republicans to blame the Affordable Care Act itself for rising insurance premiums. Insurance is more expensive because&nbsp;we\u2019re&nbsp;spending more on health care.&nbsp;It\u2019s not really that complicated, right?&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>This 17%-18% of GDP has been&nbsp;pretty consistent, which&nbsp;doesn\u2019t&nbsp;mean&nbsp;it\u2019s&nbsp;good;&nbsp;it just means&nbsp;it\u2019s&nbsp;been around that level for many, many, many years. Despite all the talk about&nbsp;how it\u2019s&nbsp;unsustainable,&nbsp;it\u2019s&nbsp;been sustained,&nbsp;with pain, but sustained.&nbsp;$5.7 trillion,&nbsp;even if&nbsp;you&#8217;ve&nbsp;been doing&nbsp;this&nbsp;a long time&nbsp;\u2026&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;It\u2019s&nbsp;$5.3 trillion.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:<\/strong>&nbsp;$5.3 trillion.&nbsp;It\u2019s&nbsp;a mind-boggling&nbsp;number.&nbsp;It\u2019s&nbsp;a lot of dollars!&nbsp;So the ACA made insurance more&nbsp;\u2014&nbsp;the out-of-pocket cost of insurance for millions of Americans, 20-ish million&nbsp;\u2014&nbsp;but the underlying burden we\u2019ve not solved&nbsp;the \u2014 to use the word of the moment, the&nbsp;\u201caffordability\u201d&nbsp;crisis in health&nbsp;care is still with us and arguably getting worse. But like, I think&nbsp;we\u2019re&nbsp;sort of numb. These numbers are just so insane, and yet you say&nbsp;it\u2019s&nbsp;unsustainable, but&nbsp;\u2026&nbsp;I think it&nbsp;was&nbsp;Uwe\u2019s&nbsp;line, right?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>It was, it was a famous&nbsp;Uwe&nbsp;Reinhardt line.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>No,&nbsp;it\u2019s&nbsp;sustainable, if&nbsp;we\u2019re&nbsp;sustaining it at a high&nbsp;\u2014&nbsp;in&nbsp;economically&nbsp;\u2014&nbsp;zany price.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Right.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:<\/strong>&nbsp;And, like, the other thing is, like, where is the money?&nbsp;Right? Everybody in health&nbsp;care says they&nbsp;don\u2019t&nbsp;have any money, so I&nbsp;can\u2019t&nbsp;figure out who has the&nbsp;$5 trillion.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, well, it\u2019s not&nbsp;\u2026&nbsp;it does not seem to be the insurance companies as much as it is,&nbsp;you know, if you look at these numbers&nbsp;\u2014&nbsp;and I\u2019ll post a link to them&nbsp;\u2014&nbsp;you know, it\u2019s hospitals and drug companies and doctors and all of those who are part of the health&nbsp;care industrial complex, as I like to call&nbsp;it.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>All&nbsp;of them say they&nbsp;don\u2019t&nbsp;have enough.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Right.&nbsp;All right. So we know that the Affordable Care Act subsidies are hung up over abortion, as Alice pointed out, and we know that the big abortion demonstration, the March for Life, is coming up next week, so I guess it shouldn\u2019t be surprising that Senate&nbsp;health&nbsp;committee&nbsp;chairman and ardent anti-abortion&nbsp;senator Bill Cassidy would hold a hearing not on changes to the vaccine schedule, which he has loudly and publicly complained about, but instead about&nbsp;the reputed dangers of the abortion pill,&nbsp;mifepristone.&nbsp;Alice, like me, you watched yesterday\u2019s hearing. What was your takeaway?&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>So, you know, in a sense, this was a show hearing. There&nbsp;wasn\u2019t&nbsp;a bill under consideration. They&nbsp;didn\u2019t&nbsp;have anyone from the administration to grill. And&nbsp;so&nbsp;this is just&nbsp;sort of your&nbsp;typical&nbsp;each side&nbsp;tries to make their point hearing. And the bigger picture here is that conservatives, including senators and the activist groups who are sort of goading them on from the outside&nbsp;\u2014&nbsp;they\u2019re really frustrated right now about the Trump administration and the lack of action they\u2019ve seen in this first year of this administration on their top priority, which is restricting the abortion pill.&nbsp;Their bigger goal is outlawing all abortion,&nbsp;but since abortion pills comprise the majority of abortions these days, that\u2019s what they\u2019re targeting.&nbsp;And&nbsp;so&nbsp;they\u2019re&nbsp;frustrated that, you know, both&nbsp;[Robert&nbsp;F.]&nbsp;Kennedy&nbsp;[Jr.]&nbsp;and&nbsp;[Marty]&nbsp;Makary have promised some sort of review or action on the abortion pill, and they say,&nbsp;<em>We&nbsp;want to see it<\/em>.&nbsp;<em>Why haven\u2019t you done it yet?<\/em>&nbsp;And&nbsp;so&nbsp;I think that pressure&nbsp;is only going to mount, and this hearing was part of that.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I was fascinated by the Louisiana&nbsp;attorney&nbsp;general saying,&nbsp;basically,&nbsp;the&nbsp;quiet part&nbsp;out loud, which is that&nbsp;<em>we banned abortion, but because of these abortion pills, abortions are still going up in our state.<\/em>&nbsp;That was the first time I&nbsp;think&nbsp;I\u2019d&nbsp;heard an official say that. I mean that,&nbsp;if you wonder why&nbsp;they\u2019re&nbsp;going after the abortion pill,&nbsp;that\u2019s&nbsp;why&nbsp;\u2014&nbsp;because they&nbsp;struck down&nbsp;<em>Roe<\/em>&nbsp;<em>[v. Wade]<\/em>&nbsp;and assumed that the number of abortions would go down, and it really has not, has it?&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>That\u2019s&nbsp;right. And so not only are people increasingly using pills to&nbsp;terminate&nbsp;pregnancies, but&nbsp;they\u2019re&nbsp;increasingly getting them via telemedicine.&nbsp;And you know, that\u2019s absolutely true in states with bans, but it\u2019s also true in states where abortion is legal.&nbsp;You know, a lot of people just really prefer the telemedicine option,&nbsp;whether because&nbsp;it\u2019s cheaper, or they live really far away from a doctor who is willing to prescribe this, or, you know, any other reasons.&nbsp;So&nbsp;the right&nbsp;\u2014&nbsp;you know, again, including senators like Cassidy, but also these activist groups&nbsp;\u2014&nbsp;they\u2019re&nbsp;saying, at a bare minimum, we want the Trump administration to ban telemedicine for the pills and reinstate the in-person dispensing requirement. That would really roll back access across the country. But what they really want is for the pills to be taken off the market altogether. And&nbsp;they\u2019re&nbsp;pretty open&nbsp;about saying that.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Well, rather&nbsp;convenient timing from the&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2843710\" target=\"_blank\" rel=\"noreferrer noopener\">Journal of the American Medical Association this week<\/a>, which published a peer-reviewed study of 5,000 pages of documents from the FDA that found that over the last dozen years, when it comes to the abortion pill and its availability, the agency followed the evidence-based recommendations of its scientists every single&nbsp;time, except once, and that once was during the first Trump administration.&nbsp;Alice,&nbsp;is there anything that will convince people that the scientific evidence shows that mifepristone is both safe and effective and actually has a very low rate of serious complications?&nbsp;There were,&nbsp;how many, like 100,&nbsp;more than 100 peer-reviewed&nbsp;studies that&nbsp;basically&nbsp;show&nbsp;this,&nbsp;plus the experience of many millions of women in the United States and around the world.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>Well, just like&nbsp;I\u2019m&nbsp;skeptical that&nbsp;there\u2019s&nbsp;any compromise that can be found on the Obamacare subsidies,&nbsp;there\u2019s&nbsp;just no compromise here. You know, you have the groups that are making these arguments about the pills\u2019&nbsp;safety say very openly that, you know, the reason they oppose the pills is because they cause abortions. They say it&nbsp;can\u2019t&nbsp;be health care if&nbsp;it\u2019s&nbsp;designed to end a life, and that kind of rhetoric. And&nbsp;so&nbsp;the focus on the rate of complication&nbsp;\u2026&nbsp;I mean,&nbsp;I\u2019m&nbsp;not saying&nbsp;they\u2019re&nbsp;not genuinely concerned. They may be, but, you know, this is one of many tactics&nbsp;they\u2019re&nbsp;using to try to curb access to the pills.&nbsp;So&nbsp;it\u2019s&nbsp;just one argument in their arsenal.&nbsp;It\u2019s&nbsp;not&nbsp;their,&nbsp;like,&nbsp;primary driving, overriding goal is, is the safety which, like you said, has been well&nbsp;established&nbsp;with many, many peer-reviewed studies over the last several years.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:\u00a0<\/strong>So, in between these big, high-profile anti-abortion actions like Senate hearings, those supporting abortion rights are actually still prevailing in court, at least in the lower courts. This week, [a lawsuit filed by the American Civil Liberties Union and the National Family Planning and Reproductive Health Association against the Trump administration <a href=\"https:\/\/www.politico.com\/news\/2026\/01\/13\/lawsuit-dismissed-after-trump-admin-quietly-restored-tens-of-millions-to-planned-parenthood-00723369\">was quietly dropped<\/a> after the administration also quietly gave Planned Parenthood and other family planning groups] back the Title X family planning money that was appropriated to it by Congress. That was what Joanne was referring to, that Congress has been appropriating money that the administration hasn\u2019t been spending. But this wasn\u2019t really the big pot of federal money that Planned Parenthood is fighting to win back, right?<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>It was one pot of money&nbsp;they\u2019re&nbsp;fighting to win back. But yes, the much bigger Medicaid cuts that Congress passed over last&nbsp;summer,&nbsp;those are still in place. And so&nbsp;that\u2019s&nbsp;an order of magnitude more than this pot of&nbsp;Title&nbsp;X&nbsp;family planning money that they just got back. So that aside,&nbsp;I\u2019ve&nbsp;seen a lot of conservatives conflate the two and accuse the Trump administration of violating the law that Congress passed and restoring funding to Planned Parenthood. This is different funding, and&nbsp;it\u2019s&nbsp;a lot less than the cuts that happened. And so I talked to the organizations impacted, and it was clear that even though they\u2019re getting this money back, for some it came too late, like they already closed their doors and shut down clinics in a lot of states, and they can\u2019t reopen them with this chunk of money. This money is when you give a service to a&nbsp;patient,&nbsp;you can then&nbsp;submit&nbsp;for reimbursement. And&nbsp;so&nbsp;if the clinic\u2019s not there,&nbsp;it\u2019s&nbsp;not like they can use this money to, like, reopen the clinic, sign a lease, hire people, etc.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah.&nbsp;The wheels of the courts, as we have seen, have moved very slowly.&nbsp;<\/p>\n\n\n\n<p>OK,&nbsp;we\u2019re&nbsp;going to take a quick break. We will be right back.&nbsp;<\/p>\n\n\n\n<p>So&nbsp;while abortion gets most of the headlines,&nbsp;it\u2019s&nbsp;not the only culture war issue in play. The Supreme Court this week heard oral arguments in a case challenging two of the 27 state laws barring transgender athletes from competing on women\u2019s sports teams. Reporters covering the argument said it seemed unlikely that&nbsp;a majority of&nbsp;justices would strike down the laws,&nbsp;which would allow all of those bans to stand. Meanwhile, the other two branches of the federal government have also weighed in on the gender issue&nbsp;in recent weeks.&nbsp;The House passed a bill in December, sponsored by now former Republican&nbsp;congresswoman&nbsp;Marjorie Taylor Greene that would make it a felony for anyone to provide gender-affirming care to minors nationwide.&nbsp;And the Department of Health and Human Services issued proposed regulations just before Christmas that&nbsp;wouldn\u2019t&nbsp;go quite that&nbsp;far, but&nbsp;would have&nbsp;roughly the&nbsp;same effect. The regulations would ban hospitals from providing gender-affirming care to minors or risk losing their Medicare and Medicaid&nbsp;funding, and&nbsp;would bar funding for gender-affirming care for minors by Medicaid or the Children\u2019s Health Insurance Program. At the same time, Health and Human Services Secretary Kennedy issued a declaration, which is already being challenged in court, stating that gender-affirming care, quote,&nbsp;\u201cdoes not meet professionally recognized standards of health care,\u201d&nbsp;and therefore practitioners who deliver it can be excluded from federal health programs. I get that sports&nbsp;team&nbsp;exclusions have a lot of public support, but does the public really support effectively ending all gender-affirming care for minors?&nbsp;That\u2019s&nbsp;what this would do.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Well, I think that when a lot of people hear that, they think of surgery, which is the much, much, much, much, much less likely scenario here that&nbsp;we\u2019re&nbsp;even talking about. And so those who are against it have done an effective job of making that&nbsp;the issue. And so there&nbsp;\u2026&nbsp;who support gender-affirming care, who have&nbsp;looked into&nbsp;it, would see that a lot of this is hormone treatment, things like that, to drugs&nbsp;\u2026&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Puberty blockers!&nbsp;<\/p>\n\n\n\n<p><strong>Edney:<\/strong>&nbsp;\u2026&nbsp;they&#8217;re taking&nbsp;\u2014&nbsp;exactly&nbsp;\u2014&nbsp;and so it\u2019s not, this isn\u2019t like a permanent under-the-knife type of thing that a lot of people are thinking about, and I think,&nbsp;too,&nbsp;talking about, like mental health, with being able to get some of these puberty blockers, the effect that it can have on a minor who doesn\u2019t want to live the way they\u2019ve been living, so it\u2019s so helpful to them.&nbsp;So&nbsp;I think that there\u2019s just a lot that has, you know, there\u2019s been a lot of misinformation out there about this, and I feel like&nbsp;that that\u2019s kind of winning the day.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>I think,&nbsp;like,&nbsp;from the beginning, because, like, five or six years ago was the first time I wrote about this. The&nbsp;playbook has been very much like the anti-abortion playbook. They talk about it in terms of protecting women\u2019s health, and now&nbsp;they\u2019re&nbsp;talking about it in protecting children\u2019s health. And,&nbsp;as Anna said,&nbsp;they\u2019re&nbsp;using words like mutilation. Puberty blockers are not&nbsp;mutilation. Puberty&nbsp;blockers are a medication that delays the onset of puberty, and it is not irreversible.&nbsp;It\u2019s&nbsp;like a&nbsp;brake. You take your foot off the brake,&nbsp;and puberty starts.&nbsp;There\u2019s&nbsp;some controversy about what age and how long, and&nbsp;there\u2019s&nbsp;some&nbsp;possible bone&nbsp;damage. I mean, there\u2019s some questions that are raised that need to be answered, but the conversation that\u2019s going on now&nbsp;\u2014&nbsp;most of the experts in this field, who are endocrinologists and psychologists and other people who are working with these kids,&nbsp;cite a lot of data saying that not only this is safe, but it\u2019s beneficial for a kid who really feels like they\u2019re trapped in the wrong body.&nbsp;So&nbsp;you know, I think it\u2019s really important to repeat&nbsp;\u2026&nbsp;the point that Anna made, you know, 12-year-olds are not getting major surgery.&nbsp;Very few minors are, and when they are,&nbsp;it\u2019s&nbsp;closer&nbsp;\u2026 they&nbsp;may be under 18,&nbsp;it\u2019s&nbsp;rare. But if&nbsp;you\u2019re&nbsp;under 18,&nbsp;you\u2019re&nbsp;closer to 18,&nbsp;it\u2019s&nbsp;later in&nbsp;teens. And&nbsp;it\u2019s&nbsp;not like you walk into an operating room and say, you know,&nbsp;<em>do this to me<\/em>.&nbsp;There\u2019s&nbsp;years of counseling and evaluation and professional teams. It really did strike a nerve in the campaign. I think Pennsylvania,&nbsp;in particular.&nbsp;This is something that people&nbsp;don\u2019t&nbsp;understand and get&nbsp;very upset&nbsp;about, and the inflammatory&nbsp;language,&nbsp;it\u2019s&nbsp;not creating understanding.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>We\u2019ll&nbsp;see how&nbsp;this one plays&nbsp;out. Finally, this week, things at the Department of Health and Human Services&nbsp;continues&nbsp;to be chaotic. In the latest round of&nbsp;\u201cwe\u2019re cutting you off because you don\u2019t agree with us,\u201d&nbsp;the Substance Abuse and Mental Health Services Administration sent hundreds of letters Tuesday to grantees&nbsp;canceling&nbsp;their funding&nbsp;immediately.&nbsp;It\u2019s&nbsp;not entirely clear how many grants or how much money was involved, but it&nbsp;appeared to be&nbsp;something&nbsp;in the neighborhood of&nbsp;$2 billion&nbsp;\u2014&nbsp;that\u2019s&nbsp;around a fifth of SAMHSA\u2019s&nbsp;entire budget. SAMHSA, of course, funds programs that provide addiction and mental health treatment, treatment for homelessness and suicide prevention, among other things. Then,&nbsp;Wednesday night, after a furious backlash from Capitol Hill and&nbsp;just about every&nbsp;mental health and substance abuse group in the country, from what I could tell from my email, the administration canceled the cuts.&nbsp;Did they miscalculate the scope of the reaction here, or was chaos the actual goal in this?&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>That is&nbsp;a great question. I really&nbsp;don\u2019t&nbsp;know the answer. I don\u2019t know what it could serve anyone by doing this and reversing it in 24 hours, as far as the chaos angle, but it does seem, certainly,&nbsp;like there was a&nbsp;miscalculation of how Congress would react to this, and it was a bipartisan reaction that wanted to know why, what is it even your justification? Because these programs do seem to support the priorities of this administration and HHS.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I&nbsp;didn\u2019t&nbsp;count, but I got dozens of emails yesterday.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Edney:<\/strong>&nbsp;Yeah.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>My entire email box was overflowing with people&nbsp;basically freaking&nbsp;out about these cuts&nbsp;to SAMHSA. Joanne,&nbsp;you wanted&nbsp;to say something?&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>I think that one of the shifts over&nbsp;\u2014&nbsp;I\u2019m not exactly sure how many years&nbsp;\u2014&nbsp;7,&nbsp;8,&nbsp;9, years, whatever we\u2019ve been dealing with this opioid crisis, the country has really changed and how we see addiction, and that we are much more likely to view addiction not as a criminal justice issue, but as a mental health issue.&nbsp;It\u2019s&nbsp;not that everybody thinks that.&nbsp;It\u2019s&nbsp;not that every lawmaker thinks that, but we have really turned this into, we&nbsp;have seen it as, you know, a health problem and a health problem that strikes red states and blue states. You know, we are all familiar with the&nbsp;\u201cdeaths of despair.\u201d&nbsp;Many of us know at least an acquaintance or an acquaintance\u2019s family that have experienced an overdose death. This is a bipartisan shift. It is,&nbsp;you know,&nbsp;you\u2019ve&nbsp;had plenty of conservatives speaking out for both more money and more compassion. So I think that the backlash yesterday, I mean, we saw the public backlash, but I think there was probably a behind-the-scenes&nbsp;\u2014&nbsp;some of the&nbsp;\u201cOpioid&nbsp;Belts\u201d&nbsp;are very conservative states,&nbsp;and Republican governors, you know, really saying we\u2019ve had progress.&nbsp;Right? The last couple of years, we have made progress. Fatal overdoses have gone down, and Narcan is available. And just like our inboxes, I think their&nbsp;telephones, they&nbsp;were bombarded.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah.&nbsp;Well, meanwhile, several&nbsp;hundred&nbsp;workers have&nbsp;reportedly been&nbsp;reinstated at the National Institute of Occupational Safety and Health&nbsp;\u2014&nbsp;that\u2019s&nbsp;a&nbsp;subagency of CDC&nbsp;[the Centers for Disease Control and Prevention].&nbsp;Except that those RIF&nbsp;[reduction in force]&nbsp;cancellations came nine months after the original RIFs, which were back in April. Does the administration think these folks are just sitting around waiting to be called back to work?&nbsp;And in news from the National Institutes of Health,&nbsp;Director Jay Bhattacharya told a podcaster last week that the DEI-related&nbsp;[diversity, equity, and inclusion]&nbsp;grants that were canceled and then reinstated due to court orders are likely to simply not be renewed. And at the FDA, former longtime drug regulator Richard&nbsp;Pazdur&nbsp;said at the J.P.&nbsp;Morgan&nbsp;[Healthcare] Conference in San Francisco this week that the&nbsp;firewall&nbsp;between the political appointees at the agency and its career&nbsp;drug reviewers has been,&nbsp;quote,&nbsp;\u201cbreached.\u201d&nbsp;How is the rest of HHS expected to actually, you know, function with even so much uncertainty about who works there and who\u2019s calling the shots?&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>Not to mention&nbsp;all of&nbsp;this back and forth and chaos and starting and stopping is costing more,&nbsp;is costing taxpayers more.&nbsp;Overall spending is up. After all of the&nbsp;DOGE&nbsp;[Department of Government Efficiency]&nbsp;and&nbsp;RIFs&nbsp;and all of it, they have not cut spending at all because it\u2019s more expensive to pay people to be on administrative leave for a long time and then try to bring them back and then shut down a lab and then reopen a lab. And all of this has not only meant, you know, programs not serving people, research not happening, but it&nbsp;hasn\u2019t&nbsp;even saved the government any money, either.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>Like, you know, the game we played when we were kids, remember,&nbsp;\u201cRed&nbsp;Light-Green&nbsp;Light,\u201d&nbsp;you know, you\u2019d&nbsp;run in one direction, you run back. And if you were&nbsp;8&nbsp;years old, it would end with someone crying. And that\u2019s&nbsp;sort of the&nbsp;way&nbsp;we\u2019re&nbsp;running the government&nbsp;these&nbsp;days&nbsp;<em>[laughs]<\/em>.&nbsp;The amount of people fired, put on leave. The CDC has had this incredible yo-yoing of people. You&nbsp;can\u2019t&nbsp;even keep track. You&nbsp;don\u2019t&nbsp;even know what email to use if&nbsp;you\u2019re&nbsp;trying to&nbsp;keep&nbsp;in&nbsp;touch&nbsp;with them&nbsp;anymore. The churn,&nbsp;with what logic?&nbsp;It\u2019s, as Alice said,&nbsp;just&nbsp;more expensive, but it\u2019s,&nbsp;it&#8217;s&nbsp;also just&nbsp;\u2026&nbsp;like&nbsp;you&nbsp;can\u2019t&nbsp;get your job done.&nbsp;Even if you want a smaller government, which many of conservatives and Trump people do,&nbsp;you still want certain functions fulfilled.&nbsp;But there\u2019s still a consensus in society that we need some kind of functioning health system and health oversight and health monitoring.&nbsp;I mean, the American public is not against research, and the American public is not against keeping people alive.&nbsp;You know, the inconsistency is pretty mind-boggling.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Well, there\u2019s a lot of rank-and-file, but we\u2019re seeing a lot of heads of parts of the agencies where, like at the FDA, with the drug center, or many of the different institutes at NIH that really don\u2019t have anyone in place that is leading them. And I think that that, to me, like this is just my humble opinion, is&nbsp;it&nbsp;kind of seems&nbsp;like the message as&nbsp;<em>anybody can do this part, because&nbsp;it&#8217;s&nbsp;all coming from one place<\/em>. There\u2019s really just one leader, essentially, RFK, or maybe it\u2019s Trump, or they want everyone to do it the way that they\u2019re going to comply with the different,&nbsp;like you said, everyone wants research, but I,&nbsp;Joanne, but I do think they only want certain kinds of research in this case.&nbsp;So&nbsp;it\u2019s&nbsp;been interesting to watch how many leaders in these agencies that are going away and not being replaced.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;And all the institutional memory&nbsp;that\u2019s&nbsp;walking out the door. I mean,&nbsp;more people&nbsp;\u2014&nbsp;and to&nbsp;Alice\u2019s point about how this&nbsp;hasn\u2019t&nbsp;saved money&nbsp;\u2014&nbsp;more people have taken early retirement than have&nbsp;been actually, you&nbsp;know,&nbsp;RIF\u2019d&nbsp;or fired or let go. I mean, they\u2019ve just&nbsp;\u2026&nbsp;a lot of people&nbsp;have basically, including&nbsp;a lot of leaders of many of these agencies, said,&nbsp;<em>We&nbsp;just&nbsp;don&#8217;t&nbsp;want to be here under these circumstances<\/em>.&nbsp;<em>Bye.<\/em>&nbsp;Assuming at some point this government does want to use the Department of Health and Human Services to get things done,&nbsp;there might not be the personnel around to actually effectuate it.&nbsp;But we will continue to watch that space.&nbsp;<\/p>\n\n\n\n<p>OK, that\u2019s this week\u2019s news. Now we will play my&nbsp;\u201cBill of the&nbsp;Month\u201d&nbsp;interview with Elisabeth Rosenthal, and then we will come back and do our extra credits.&nbsp;<\/p>\n\n\n\n<p>I am pleased to welcome back to the podcast Elisabeth Rosenthal, senior contributing editor at&nbsp;KFF&nbsp;Health&nbsp;News and originator of our&nbsp;\u201cBill of the Month\u201d&nbsp;series, which in its&nbsp;nearly eight&nbsp;years has analyzed&nbsp;nearly $7 million&nbsp;in dubious, infuriating,&nbsp;or inflated medical charges. Libby also wrote the latest&nbsp;\u201cBill of the&nbsp;Month,\u201d&nbsp;which&nbsp;we\u2019ll&nbsp;talk about in a minute. Libby, welcome back to the podcast.&nbsp;<\/p>\n\n\n\n<p><strong>Elisabeth Rosenthal:<\/strong>&nbsp;Thanks for having me back.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;So&nbsp;before we get to this month\u2019s patient, can you reflect for a moment on the impact this series has had, and how frustrated&nbsp;are you that eight years on,&nbsp;it\u2019s&nbsp;as relevant as it was when we began?&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:<\/strong>&nbsp;We were&nbsp;worried it&nbsp;wouldn\u2019t&nbsp;last a year, and here we are, eight years later, still finding plenty to write about. I mean,&nbsp;we\u2019ve&nbsp;had some wins.&nbsp;I think we&nbsp;helped contribute to the&nbsp;No&nbsp;Surprises&nbsp;Act being passed.&nbsp;There are&nbsp;states clamping down on facility fees, you know, and making sure that when you get something done in a hospital rather than an outpatient clinic,&nbsp;it\u2019s&nbsp;the same cost. The&nbsp;country\u2019s&nbsp;starting to address drug prices.&nbsp;But,&nbsp;you know, we&nbsp;seem to be&nbsp;the billing&nbsp;police, and&nbsp;that\u2019s&nbsp;not good.&nbsp;We\u2019ve&nbsp;gotten a lot of bills written off for our individual patients. Suddenly, when a reporter calls,&nbsp;they\u2019re&nbsp;like,&nbsp;<em>Oh, that was a mistake<\/em>&nbsp;or&nbsp;<em>Yeah,&nbsp;we&#8217;re&nbsp;going to write that off<\/em>. And&nbsp;I\u2019m&nbsp;like,&nbsp;<em>You\u2019re&nbsp;not writing that off;&nbsp;that&nbsp;shouldn\u2019t&nbsp;have been billed<\/em>. So sadly, the series is still going strong, and medical billing has proved endlessly creative. And you know, I think the sad thing for me is our success is a sign of a deeply, deeply dysfunctional system&nbsp;that&nbsp;has&nbsp;left,&nbsp;as we know, you know, 100 million adult Americans with medical debt.&nbsp;So&nbsp;we will keep going until&nbsp;it\u2019s&nbsp;solved,&nbsp;I hope.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Well, getting on to this month\u2019s patient, he gives new meaning to the phrase&nbsp;\u201cIt must have been something I ate.\u201d&nbsp;Tell us what it was and how he ended up in the emergency room.&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:&nbsp;<\/strong>Well, Maxwell&nbsp;[Kruzic]&nbsp;loves eating spicy foods, but&nbsp;he\u2019s&nbsp;never had a problem with it. And suddenly, one night, he had just&nbsp;excruciating, crippling abdominal pain. He drove himself to the emergency room. It was so bad he had to stop three times, and when he got there, it was mostly on the right-lower quadrant. You know, the doctors were so convinced, as he was, that he had appendicitis, that they called a surgeon right away, right?&nbsp;So&nbsp;they were all&nbsp;like,&nbsp;ready to go to the operating room. And then the scan came back, and it was like,&nbsp;whoops,&nbsp;his appendix is normal. And then,&nbsp;<em>oh, could he have kidney stones?<\/em>&nbsp;And&nbsp;it\u2019s&nbsp;like no sign of that either. And finally, he thought, or someone asked,&nbsp;<em>Well, what did you eat last night?<\/em>&nbsp;And of course, Maxwell had ordered the hottest chili peppers from a bespoke chili pepper-growing company in New Mexico. They have some chili pepper rating of 2 million&nbsp;[Scoville heat units], which is,&nbsp;like,&nbsp;through the roof, and it was a reaction to the chili peppers.&nbsp;I didn\u2019t even know that could happen, and I trained as a doctor, but I guess your intestines don\u2019t like really, really, really hot stuff.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So&nbsp;in the end, he was&nbsp;OK.&nbsp;And the story here isn\u2019t even really about what kind of care he got, or how much it cost.&nbsp;The $8,000 the hospital charged for his few hours in the ER&nbsp;doesn\u2019t&nbsp;seem all that out of line compared to some of the bills&nbsp;we\u2019ve&nbsp;seen.&nbsp;What was most notable in this case was the fact that the bill didn\u2019t actually come until two years later.&nbsp;How much was he asked to pay two years after the hot pepper incident?&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:&nbsp;<\/strong>Well, he was asked to pay a little over $2,000,&nbsp;which was his coinsurance for the emergency room visit. And as he said, you know, $8,000&nbsp;\u2026&nbsp;now we go,&nbsp;<em>well,&nbsp;that\u2019s&nbsp;not bad<\/em>.&nbsp;I mean, all they did,&nbsp;actually, was do a couple of scans and give him some IV fluids.&nbsp;But&nbsp;in this day and age,&nbsp;you\u2019re&nbsp;like, wow, he got away&nbsp;\u2014 you know, from&nbsp;a&nbsp;\u201cBill of a&nbsp;Month\u201d&nbsp;perspective, he got away cheap, right?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>But I would say, is it even legal to send a bill two years after the fact? Who sends a bill two years later?&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:&nbsp;<\/strong>That\u2019s&nbsp;the problem,&nbsp;like,&nbsp;and Maxwell&nbsp;\u2014&nbsp;he\u2019s&nbsp;a pretty smart guy, so he was checking his portal repeatedly. I mean, he paid something upfront at the ER, and he kept&nbsp;thinking,&nbsp;I must owe something. And he checked and he&nbsp;checked&nbsp;and he checked and it kept saying zero. He actually called his&nbsp;insurer and&nbsp;to make sure that was right. And they said,&nbsp;<em>No, no, no,&nbsp;it\u2019s&nbsp;right. You owe zero<\/em>. And then, you know, after like, six months, he thought,&nbsp;<em>I guess I&nbsp;owe zero<\/em>. But then he&nbsp;didn\u2019t&nbsp;think about it, and then almost two years later, this bill arrives in the mail, and&nbsp;he\u2019s&nbsp;like,&nbsp;<em>What?!<\/em>&nbsp;And what I discovered, which is a little disturbing, is it is not, I wouldn\u2019t say normal, but we see a bunch of these ghost bills at&nbsp;\u201cBill of the&nbsp;Month,\u201d&nbsp;and in many cases, it\u2019s legal, because&nbsp;of&nbsp;what was going on in those two-year periods. And of course, I called the hospital, I called the insurer, and they were like,&nbsp;<em>Yeah, you know, someone was away on vacation, and someone left their job, and we&nbsp;couldn&#8217;t<\/em>&nbsp;\u2026&nbsp;you know, the hospital&nbsp;billed them&nbsp;correctly. And the hospital said,&nbsp;<em>No, we&nbsp;didn&#8217;t<\/em>.&nbsp;And they were just&nbsp;kind of doing&nbsp;the usual&nbsp;back-end negotiations to figure out what a service is worth.&nbsp;And when they finally agreed two years later&nbsp;what should be paid,&nbsp;that\u2019s&nbsp;when they sent Maxwell the bill. And the problem&nbsp;is,&nbsp;whether&nbsp;it\u2019s&nbsp;legal really depends on your insurance contracts, and whether they allow this kind of late billing.&nbsp;I do not know to this day if Maxwell\u2019s did, because as soon as I called the insurer&nbsp;and&nbsp;the hospital, they were like,&nbsp;<em>Never&nbsp;mind. He&nbsp;doesn\u2019t&nbsp;owe&nbsp;anything<\/em>. And you know, as he said,&nbsp;he\u2019s&nbsp;a geological engineer. He has lots of clients, and as he said, you know, if I called them two years later and said,&nbsp;<em>Whoops, I forgot to bill for something<\/em>, they would be like,&nbsp;<em>Forget&nbsp;it!<\/em>&nbsp;you&nbsp;know.&nbsp;So&nbsp;I do think this is something that needs to be addressed at a policy level, as we so often discover on&nbsp;\u201cBill of the&nbsp;Month.\u201d&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So&nbsp;what should you do if you get one of these ghost bills? I should say&nbsp;I\u2019m&nbsp;still negotiating bills from a surgery that I had six months ago.&nbsp;So&nbsp;I guess I should&nbsp;count&nbsp;myself lucky.&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:&nbsp;<\/strong>Well, I think you should check with your insurer and check with the hospital. I think more&nbsp;with&nbsp;your insurer&nbsp;\u2014&nbsp;if the contract says this is legal to bill.&nbsp;It\u2019s&nbsp;unclear&nbsp;to me,&nbsp;in this case, whether it was.&nbsp;The hospital was very much like,&nbsp;<em>Oh, we made a mistake;&nbsp;because it took so long,&nbsp;we&nbsp;actually&nbsp;couldn\u2019t&nbsp;bill Maxwell<\/em>.&nbsp;So&nbsp;I think in his case, it&nbsp;probably was&nbsp;in the contract that this was too late to&nbsp;bill. But, you know, I think a lot of hospitals, I hate to say it, have this attitude.&nbsp;<em>Well,&nbsp;doesn\u2019t&nbsp;hurt to try, you know,&nbsp;maybe&nbsp;they\u2019ll&nbsp;pay&nbsp;it<\/em>. And people are afraid of bills, right? They&nbsp;pay&nbsp;them.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;I know the feeling.&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:<\/strong>&nbsp;Yeah, I do think, you know, they should check with their insurer about whether there\u2019s a statute of limitations,&nbsp;essentially,&nbsp;on billing, because there may well be and I would say it\u2019s a great asymmetry, because if you submit an insurance claim more than six months late, they can say,&nbsp;<em>Well, we won\u2019t pay this<\/em>.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And just to tie this one up with a bow, I assume that Maxwell has changed his pepper-eating ways, at least&nbsp;modified&nbsp;them?&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:&nbsp;<\/strong>He said he will never eat&nbsp;scorpion peppers again.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Libby Rosenthal, thank you so much.&nbsp;<\/p>\n\n\n\n<p><strong>Rosenthal:<\/strong>&nbsp;Oh, sure.&nbsp;Thanks&nbsp;for having me.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>OK,&nbsp;we\u2019re&nbsp;back, and now&nbsp;it\u2019s&nbsp;time for our&nbsp;extra-credit&nbsp;segment.&nbsp;That\u2019s&nbsp;where we each recognize a story we read this&nbsp;week&nbsp;we think you should read,&nbsp;too.&nbsp;Don\u2019t&nbsp;worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Anna, why don\u2019t you start us off this week?&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Sure.&nbsp;So&nbsp;my extra credit is from&nbsp;MedPage&nbsp;Today:&nbsp;\u201c<a href=\"https:\/\/www.medpagetoday.com\/pediatrics\/vaccines\/119409?xid=nl_mpt_DHE_2026-01-13&amp;mh=ea3f9ca37fc2855fb915b8bee6da0f9f&amp;zdee=gAAAAABm4u34wDjjPbj8HzT9SwTG9cRpDgRth3cYlhZszFXSMZNxtYFb0zY5SCeq3jArr3U0KNT1nZcVY9TKOWX3I8je5PGXBw%3D%3D&amp;utm_source=Sailthru&amp;utm_medium=email&amp;utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202026-01-13&amp;utm_term=NL_Daily_DHE_dual-gmail-definition\" target=\"_blank\" rel=\"noreferrer noopener\">Worried About Liability After CDC Vaccine Changes? You Shouldn\u2019t Be<\/a>.\u201d&nbsp;I appreciated this article because it answered some questions that I had,&nbsp;too,&nbsp;after the sweeping change to the childhood vaccine schedule. There&nbsp;was&nbsp;just a lot of discussions I had about, you know, well, what does this really mean on the ground? And will&nbsp;parents&nbsp;be confused? Will pediatricians&nbsp;\u2014&nbsp;how will they be talking about this? You know, will they stick to the schedule we knew before? And there was an article in JAMA&nbsp;Perspectives&nbsp;that lays out, essentially, to&nbsp;clinicians, you know, that they should not fear malpractice&nbsp;..&nbsp;issues if&nbsp;they\u2019re&nbsp;going to talk about the old schedule and not adhere to the newer schedule. And&nbsp;so&nbsp;it lays out some of those issues.&nbsp;And I thought that was really helpful.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, this was a big question that I had,&nbsp;too.&nbsp;Alice, why don\u2019t you go next?&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:&nbsp;<\/strong>Yeah, so I have a piece from ProPublica.&nbsp;It\u2019s&nbsp;called&nbsp;\u201c<a href=\"https:\/\/www.propublica.org\/article\/fluoride-supplements-fda-rfk-jr-ken-paxton-restrictions\" target=\"_blank\" rel=\"noreferrer noopener\">After Sowing Distrust in Fluoridated Water, Kennedy and Skeptics Turn to Obstructing Other Fluoride Sources<\/a>.\u201d&nbsp;So&nbsp;this is about how&nbsp;there\u2019s&nbsp;been this huge push on the right to end public water fluoridation that has succeeded in a&nbsp;couple&nbsp;places and could spread more. And the proponents of doing that say that&nbsp;it\u2019s&nbsp;fine because there are all these other sources of fluoride. You can get&nbsp;a treatment&nbsp;at the&nbsp;dentist,&nbsp;you can get it in stuff you buy at the drugstore and take yourself. But at the same time, the people who&nbsp;arepushing&nbsp;for ending fluoridated public drinking water&nbsp;are also pushing for restricting those other sources. There have been state and federal efforts to crack down on them, plus&nbsp;all of&nbsp;the just rhetoric about fluoride, which is very misleading. It misrepresents studies about its alleged&nbsp;neurological impacts. But it also,&nbsp;that kind of rhetoric makes people afraid to have fluoride in any form, and people are very worried about that, what&nbsp;that\u2019s&nbsp;going to do to the nation\u2019s teeth?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah,&nbsp;it\u2019s&nbsp;like vaccines. The more you&nbsp;talk&nbsp;it&nbsp;down,&nbsp;the less people want to do it.&nbsp;Joanne.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:&nbsp;<\/strong>This is&nbsp;a piece by&nbsp;Dhruv Khullar&nbsp;in&nbsp;The New Yorker called&nbsp;\u201c<a href=\"https:\/\/www.newyorker.com\/culture\/the-lede\/what-the-pitt-taught-me-about-being-a-doctor\" target=\"_blank\" rel=\"noreferrer noopener\">What \u2018The Pitt\u2019 Taught Me About Being a Doctor<\/a>,\u201d&nbsp;and it was really great, because there\u2019s certain things I think that we who&nbsp;\u2014&nbsp;like, I don\u2019t know how all of you watch it&nbsp;\u2014&nbsp;but like, there\u2019s certain things that didn\u2019t even strike me, because I\u2019m so used to writing about, like, the connection between poverty, social determinants of health, and, like, of course, people who come to the ED&nbsp;[emergency department]&nbsp;have, you know, homelessness problems and can\u2019t afford food and all that. But&nbsp;Dhruv&nbsp;talked&nbsp;about&nbsp;how it&nbsp;sort&nbsp;of brought that home to him, how our social safety net, the holes in it, end up in our&nbsp;EDs.&nbsp;And he also talked about some of it is dramatized more for TV, that not everybody\u2019s heart stops every 15 minutes. He said that sort of happens to one patient&nbsp;a&nbsp;day. But he talked about compassion and how that is rediscovered in this frenetic ED\/ER&nbsp;scene.&nbsp;It\u2019s&nbsp;just a very thoughtful piece about why we all love that TV show. And&nbsp;it\u2019s&nbsp;not just because of&nbsp;Noah Wyle.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Although that helps. My extra credit this week is from&nbsp;The New York Times.&nbsp;It\u2019s&nbsp;called&nbsp;\u201c<a href=\"https:\/\/www.nytimes.com\/2026\/01\/12\/climate\/trump-epa-air-pollution.html?smtyp=cur&amp;utm_social_handle_id=807095&amp;smid=tw-nytimes&amp;utm_social_post_id=650100429\" target=\"_blank\" rel=\"noreferrer noopener\">E.P.A. to Stop Considering Lives Saved When Setting Rules on Air Pollution<\/a>,\u201d by Maxine&nbsp;Joselow.&nbsp;And while it\u2019s not about HHS, it most definitely is about health.&nbsp;It seems that for the first time in literally decades, the Environmental Protection Agency will no longer calculate the cost&nbsp;to&nbsp;human health when setting clean air rules for ozone and fine particulate matter, quoting the story:&nbsp;\u201cThat would most likely lower costs&nbsp;for companies while resulting in dirtier air.\u201d&nbsp;This is just another reminder that the federal government is&nbsp;charged with ensuring the help of Americans from a broad array of agencies, aside from HHS&nbsp;\u2014&nbsp;or in this case, not so much.&nbsp;&nbsp;<\/p>\n\n\n\n<p>OK, that\u2019s this week\u2019s show.&nbsp;As always, thanks to our editor, Emmarie&nbsp;Huetteman,&nbsp;and our producer-engineer, Francis Ying.&nbsp;We also had&nbsp;help&nbsp;this week from producer Taylor Cook.&nbsp;A&nbsp;reminder:&nbsp;<em>What the&nbsp;Health?<\/em>&nbsp;is now available on WAMU platforms, the NPR app,&nbsp;and wherever you get your podcasts, as well as, of course, at&nbsp;kffhealthnews.org.&nbsp;Also, as always, you can email us your comments or questions.&nbsp;We\u2019re&nbsp;at&nbsp;<a href=\"mailto:whatthehealth@kff.org\" target=\"_blank\" rel=\"noreferrer noopener\">whatthehealth@kff.org<\/a>,&nbsp;or you can find me still on X&nbsp;<a href=\"https:\/\/twitter.com\/jrovner\" target=\"_blank\" rel=\"noreferrer noopener\">@jrovner<\/a>, or on Bluesky&nbsp;<a href=\"https:\/\/bsky.app\/profile\/julierovner.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">@julierovner<\/a>.&nbsp;Where are you folks hanging these days?&nbsp;Alice.&nbsp;<\/p>\n\n\n\n<p><strong>Ollstein:<\/strong>&nbsp;Mostly&nbsp;on&nbsp;Bluesky&nbsp;<a href=\"https:\/\/bsky.app\/profile\/alicemiranda.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">@alicemiranda<\/a>&nbsp;and still on&nbsp;X&nbsp;<a href=\"https:\/\/x.com\/aliceollstein?lang=en\" target=\"_blank\" rel=\"noreferrer noopener\">@AliceOllstein<\/a>.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Joanne.&nbsp;<\/p>\n\n\n\n<p><strong>Kenen:<\/strong>&nbsp;I\u2019m&nbsp;mostly on&nbsp;<a href=\"https:\/\/bsky.app\/profile\/joannekenen.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">Bluesky<\/a>&nbsp;or on&nbsp;<a href=\"https:\/\/www.linkedin.com\/in\/joannekenen\/\" target=\"_blank\" rel=\"noreferrer noopener\">LinkedIn<\/a>&nbsp;<a href=\"https:\/\/x.com\/JoanneKenen\" target=\"_blank\" rel=\"noreferrer noopener\">@JoanneKenen<\/a>.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Anna.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong><a href=\"https:\/\/bsky.app\/profile\/annaedney.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">Bluesky<\/a>&nbsp;or&nbsp;X&nbsp;<a href=\"https:\/\/x.com\/annaedney\" target=\"_blank\" rel=\"noreferrer noopener\">@annaedney<\/a>.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>We will be back&nbsp;in your feed next week. Until then, be healthy.&nbsp;<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/section>\n\n\n\n<div class=\"wp-block-credits block--credits\">\n\t\t<h3 class=\"credits-title\">\n\t\tCredits\t<\/h3>\n\t\t<div class=\"credits-card-container twowide\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Francis Ying<\/div>\n\t<div class=\"author-affiliation\">Audio producer<\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Emmarie Huetteman <\/div>\n\t<div class=\"author-affiliation\">Editor <\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><em><a href=\"https:\/\/kffhealthnews.org\/our-podcasts\/\"><u>Click here to find all our podcasts.<\/u><\/a><\/em><\/p>\n\n\n\n<p><em>And subscribe to &#8220;What the Health? From KFF Health News&#8221; on <a href=\"https:\/\/podcasts.apple.com\/us\/podcast\/what-the-health\/id1253607372?mt=2\"><u>Apple Podcasts<\/u><\/a>, <a href=\"https:\/\/open.spotify.com\/show\/32EdsB662C3oyIrqLMmBXI?si=TQhRjzzLTgWtK3crfbOFtA\"><u>Spotify<\/u><\/a>, <a href=\"https:\/\/app.npr.org\/aggregation\/fis-1269164038\"><u>the NPR app<\/u><\/a>, <a href=\"https:\/\/www.youtube.com\/playlist?list=PL5Qew-7pSXbAucCUQnyRx6qpLglzrxzFb\" target=\"_blank\" rel=\"noopener\">YouTube<\/a>, <a href=\"https:\/\/play.pocketcasts.com\/web\/podcasts\/a379e280-3f57-0135-9028-63f4b61a9224\"><u>Pocket Casts<\/u><\/a>, or wherever you listen to podcasts.<\/em><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>With lawmakers still mired over renewing enhanced tax credits for Affordable Care Act plans, much of Washington has turned to culture war issues. Meanwhile, \u201cconfusion\u201d remains the watchword at HHS as personnel and funding decisions continue to be made and unmade with little notice. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico join KFF Health News\u2019 Julie Rovner to discuss those stories and more. Also this week, Rovner interviews KFF Health News\u2019 Elisabeth Rosenthal, who wrote the latest \u201cBill of the Month\u201d report.<\/p>\n","protected":false},"featured_media":2103181,"template":"","meta":{"_cr_original_post":"2103176","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_kicker":"What the Health? 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