KFF Health News’ ‘What the Health?’: New Year, New Congress, New Health Agenda
The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
The new, GOP-led, 119th Congress and President-elect Donald Trump have big legislative plans for the year — which mostly don’t include health policy. But health is likely to play an important supporting role in efforts to renew tax cuts, revise immigration policies, and alter trade — if only to help pay for some Republican initiatives.
Meanwhile, the outgoing Biden administration is racing to finish its health policy to-do list, including finalizing a policy that bars credit bureaus from including medical debt on individuals’ credit reports.
This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Panelists
Shefali Luthra
The 19th
Alice Miranda Ollstein
Politico
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- The 119th Congress is now in session. Health care doesn’t make the list of priorities as lawmakers lay the table for the incoming Trump administration — though Republicans have floated Medicaid work requirements to cut federal spending.
- A lot of health legislation hit the cutting-room floor in December, including a bipartisan proposal targeting pharmacy benefit managers — which would have saved the federal government and patients billions of dollars. And speaking of bipartisan efforts, a congressional report from the Senate Budget Committee adds to evidence that private equity involvement in care is associated with worse outcomes for patients — notably, lawmakers’ constituents.
- As the nation bids a final farewell to former President Jimmy Carter, his global health work, in particular, is being celebrated — especially his efforts to eradicate such devastating diseases as Guinea worm disease and river blindness.
- Meanwhile, the Biden administration finalized the rule barring medical debt from appearing on credit reports. The surgeon general cautions that alcohol should come with warning labels noting cancer risk. And the new Senate Republican leader is raising abortion-related legislation to require lifesaving care for all babies born alive — yet those protections already exist.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Wall Street Journal’s “UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare,” by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty.
Alice Miranda Ollstein: The New York Times’ “Ozempic, Lego Bricks and Hearing Aids: What Trump’s Greenland Plan Could Hit,” by Ana Swanson and Jenny Gross.
Shefali Luthra: Vox.com’s “Gigantic SUVs Are a Public Health Threat. Why Don’t We Treat Them Like One?” by David Zipper.
Lauren Weber: The Washington Post’s “Laws Restrict U.S. Shipping of Vape Products. Many Companies Do It Anyway,” by David Ovalle and Rachel Roubein.
Also mentioned in this week’s podcast:
The Senate Budget Committee’s “Profits Over Patients: The Harmful Effects of Private Equity on the U.S. Health Care System.”
CLick here to open the transcript
Transcript: New Year, New Congress, New Health Agenda
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 9, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.
Rovner: Today we are joined via videoconference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hello.
Rovner: Lauren Weber of The Washington Post.
Lauren Weber: Hello hello.
Rovner: And Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Rovner: No interview this week — way too much news to catch up on. So let us get right to it. So, welcome to the 119th Congress and, soon, to a new presidential administration. We’ll go back and recap what happened in late December shortly, but I want to start by looking ahead. What’s on the immediate agenda here in Washington for health care? Anybody?
Ollstein: So health care is not the priority right now for the incoming administration, for the new Republican trifecta in Washington. It can make it in, because they are talking about these massive, conglomerate bills that they have criticized in the past and said that they don’t like doing that, and they would much rather vote on individual things one by one.
But now they’re talking about cramming everything into one giant reconciliation bill early in the new administration. And there will likely be some health care components. We don’t know yet what those will be. Things that purport to save money are a lot more likely than things that purport to cost money. Although, there’s often some funny math in that. Medicaid work requirements have been floated, and so we can talk about that. We know, we’ve seen that movie before, and we know how that can go, both in terms of what it means for people’s coverage and what it means in terms of savings.
But I think that a lot of the ambitious stuff that lawmakers tried to get through at the end of the year is now in question, as to whether it has a future or not. Because the top priorities of the new administration are more on taxes and trade and immigration and things like that and not as much on health policy.
Rovner: Although, I would point out that that end-of-the-year rush that they got — they kept the government open, and they got the government funded — that only goes until March. I saw sort of a plaintive email yesterday from Tom Cole, the Republican chairman of the House Appropriations Committee, saying, Um, we have to start working on the next one soon. Everybody’s busy talking about this huge tax bill, reconciliation. What are we going to do about Medicaid? And it’s like, hello, the current fiscal year is not finished. They just managed to put things off.
Lauren, you wanted to add something?
Weber: Yeah. I just wanted to say, I feel like we’ve entered the era of marketing when it comes to these bills. You’ve got President-elect [Donald] Trump saying he wants one big, beautiful bill. That’s what he wants. He wants one big, beautiful bill. And it’s not just Trump. I mean, let’s look at the MAHA movement, the “Make America Healthy Again” movement.
I mean, I think we’re entering an era in which bills and movements all have catchy slogans. And I mean, heck, the American public may have a better understanding, or at least know what these people are telling them is happening with this marketing, we’ll see. So I just wanted to flag that this seems to be the change over here.
Rovner: And this is when I get to put in my other reality check, which is they keep talking about this big, beautiful reconciliation bill that they only need Republican votes for. I have to remind people every year: In order to do a reconciliation bill, first they must do a budget resolution, in both houses. That has to go to the floor, be debated, has to be reconciled between the House and the Senate, about what the budget resolution looks like.
The whole point of what’s called “reconciliation” is that it reconciles mandatory spending to the terms of the budget resolution. It takes a long time to do a budget resolution, even when you’re rushing it through.
Also, all these things that they’re talking about putting into this reconciliation bill are not allowed to go into budget reconciliation. It’s only about mandatory spending. It is taxes. It is Medicare and Medicaid and other mandatory spending. And it’s the debt ceiling. And those are basically all the things that can go in. Sorry, that’s the end of my lecture.
Alice, did you want to add something?
Ollstein: Sure. I mean, I think we’re already seeing cracks emerging in this great Republican unity that they’re trying to project. I mean, they can’t even agree yet on whether to do one big, beautiful bill or two. And the people pushing for two are pointing out that if you put all your eggs in one basket and that basket breaks and falls apart and all the eggs smash on the floor, then you don’t really have anything to show for your work.
Which of course is a situation Congress has found itself in many times over the past several years. And so, those folks are saying it’s much less risky to break it up and have it in separate bills, so that if one goes down in flames, the other might make it through. But yes, once again, we are seeing both House vs. Senate tensions, as well as Congress vs. Trump and Trump’s advisers tensions. And I imagine that is going to be a constant for the next few years.
Rovner: And if you thought that the House was ungovernable with its tiny Republican majority in the last Congress, it’s even tinier now. In fact, we do have Speaker Mike Johnson. He did get elected on the first ballot, but it was not easy. There were a couple of holdouts who had to take calls from the president-elect in order to change their votes. So it’s pretty tenuous there.
Shefali, before we move on, did you want to add something?
Luthra: No, I mean, I think what will be really interesting, as well, is to see how this emerges in all of the more fractious issues among the Republican Party. I know we’ve talked a lot about how the Republican Party is very divided on a lot of issues of reproductive health, including abortion, something Alice and I both think about all the time. And—
Rovner: And we will get to in a few minutes.
Luthra: We will be getting to that very soon. But it is just very clear that all of these issues, where they project unity, are pretty quickly going to fall apart when it comes to engaging with the fact that this is a very divided coalition, and a lot of the things they’re talking about doing are not very popular with voters. And so we’ll see how that affects them as well.
Rovner: Yes. So let’s move back a little bit. When we left things in December, we were a day away from a possible government shutdown, which did not happen. But the other thing that didn’t happen was a big package with basically an entire year’s worth of bipartisan health policy work in it, everything from new transparency requirements for pharmacy benefits managers [PBMs], to renewals of programs to prepare for the next pandemic and to fight the opioid epidemic, to rolling back cuts to doctors under Medicare. Most of that didn’t make it into the final package that will keep the government running until March.
The tiny things that did make it in were extensions of telehealth authority for Medicare and payments for community health centers and some other expiring programs — but again, only through the middle of March, which is when the rest of this funding bill expires.
So what happens to things like the PBM bill that fell by the wayside? Do we have any reason to think that Congress is going to pick it up and pass it this year? And even if they do that Trump would sign it? Or did all of that work last year, is that all just basically for naught now?
Ollstein: I mean, I think you could make an argument either way. You could make an argument that it has a chance because there is bipartisan support. Some of these things could save the government money and help pay for other things that the Republican majority wants to do, like cut taxes.
Rovner: I would say the PBM bill was like $5 billion in savings, as I recall.
Ollstein: Exactly. And it’s not like PBMs are super-popular and everyone wants to defend them right now. So you can make the argument that it has a chance because of that, but we’ve seen tons of health policies in the past that have bipartisan support that would save money also fall by the wayside, just because they are not priorities. And so, I think, you can make the optimistic or the pessimistic case on this one.
Rovner: Go ahead, Lauren.
Weber: I would just add, I mean, a lot of things that people were pretty upset about, in terms of smaller things, health-wise, also got cut from the bill. I mean, there was funding for 9/11 cancer funds, for those that had been exposed to toxic chemicals, first responders, and so on. A lot of outcry after that got stripped out of the bill. Understandably so, considering, basically all the advocates said: We don’t want to parade our dying first responders to Congress every year to get funds. Really, you cut this out?
So there does seem to be some momentum to potentially add that in again. There was also hullabaloo around childhood cancer research. They ended up passing a separate smaller bill, but it did not include the full measures to really prioritize some pressure on the FDA [Food and Drug Administration] and other funding to improve childhood cancer research. And so I think you’re going to continue to see, at least from the Dems, some pointing out of these issues going forward as, I mean, childhood cancer and 9/11 first responders are pretty sympathetic characters for funding.
Rovner: Yeah, I think it’s going to be — I think a lot of these new committee chairs, particularly in the Senate, where the Republicans are taking over, are going to have to figure their way out and try to pick up some of the pieces. One interesting thing that came through my inbox this week was a bipartisan report from the Senate Budget Committee that found, and I am quoting from the headline in the press release, “Private Equity in Health Care Shown to Harm Patients, Degrade Care and Drive Hospital Closures.” Does this suggest that Congress might try to do something on this extremely fraught subject?
Shefali, you are smiling. I mean—
Luthra: I’m smiling because a couple of things, and the first is that there has been a lot of discourse about private equity’s impact on health care for consumers for years. This is very interesting and important work, and it is not at all surprising.
And the other thing that we have to remember is that Donald Trump will be president. He is ideologically very unpredictable. As an actor, he is very unpredictable. And it’s just very difficult to guess what will actually become law and getting his signature. And part of that is because, we can remember from the last time he was president, he very often would change what he believed based on the last person he spoke to. We saw this all the time with drug pricing.
And I just think that we will see really interesting bipartisan analyses of things that could make real differences for consumers on health care, but whether they become law, whether they change people’s lives, that’s just much, much harder for us to really predict in a meaningful way.
Rovner: Yeah, I think everything’s pretty hard to predict right now. Lauren?
Weber: Yeah, I just wanted to add, I mean, I know, obviously hard to predict, but I think the idea that you have lawmakers issuing pretty strident releases that tie private equity to decrease patient outcomes in their specific districts is a bit of a step forward. I mean, you have [Sen. Charles] Grassley saying: Look, none of these people care about patient care. They only care about shareholders. I do think that is a shift in rhetoric, to an extent. We’ve seen a building for quite some time. We’ve all talked about private equity on this podcast.
But I do think when you have lawmakers making that jump to, Oh, people in my district are getting worse health care because of this, I think you could see more movement.
Rovner: Yeah, it’s something I’m going to keep an eye on. Like I said, I was surprised to see that as a bipartisan report from a committee, even though it’s the Budget Committee that doesn’t really have authority to do anything legislatively. Still, it was worth noting.
Well, in case there wasn’t already enough news this week, here in Washington this very morning, we are bidding farewell to former President Jimmy Carter, who died at age 100 late last month. Carter was one of a long list of Democratic presidents who tried and failed to overhaul the nation’s health care system. You can Google something called “hospital cost containment” if you want to know more. He also created the Health Care Financing Administration to run Medicare and Medicaid, which got renamed the Centers for Medicare & Medicaid Services in the early 2000s.
But Carter’s biggest health achievements came after he left office. His work through his foundation addressed, and in some cases nearly eradicated, some mostly neglected tropical diseases that mostly afflict the poorest and most marginalized people on the planet. That’s going to be one of his real major legacies, was bringing global health home. Right, Alice?
Ollstein: Yeah, and I think that’s interesting, given the recognition of his legacy right now, around his funeral, and lying in state in the Capitol, with the Trump administration coming into office, being very against bodies like the WHO [World Health Organization] and international cooperation on health care, very vocally critical of how international cooperation happened during the covid-19 pandemic. And so I think that is going to be an interesting contrast, given what Carter was able to achieve through such cooperation.
Rovner: Yeah. Lauren?
Weber: Yeah, I just wanted to add, I mean, it’s a model that I think then seeped into other presidents, right? I mean, you’ve seen [former president George W.] Bush’s investment in global health, and so on. And I do think, as Alice smartly pointed out, there is, obviously, a sharp contrast. But I mean, what Carter was able to do for river blindness and Guinea worm is unprecedented. And I think what was most moving in all of the recaps of his work is that these are people that don’t have a voice. They don’t have a position of power in the country they live in. I mean, this is him using his soft power to demand action, by flying out to far-flung corners of the world, to meet with farmers who had been disabled by Guinea worm, to make sure that this didn’t happen to future generations.
And some of these biographers have posited that’s because of his upbringing as a poor farmer in Georgia. So I think this is kind of a once-in-a-generation moment to look at this impact someone has on global health. And as Alice pointed out, I don’t know what we’ll see going forward on that.
Rovner: It’s hard to imagine Donald Trump making eradication of Guinea worm a major priority. Well, we are also bidding farewell over the next two weeks to the Biden administration, which is using its last days to try and get as much done and trumpet as many victories as it can. We’ll start with the Affordable Care Act, where the administration just announced that with a week left to go in the official sign-up period in most states, 24 million people have now been enrolled in ACA plans. That’s up 3 million just from last year and more than double the number from 2021 when [Joe] Biden took office.
Of course, this is likely to be the high water mark. This year marked the first that the so-called Dreamers, those people brought illegally to the U.S. as children by their parents, they could enroll, at least for now. That’s something President Trump and the Republican Congress is considered likely to end. Plus, the additional tax credits that were put in place during the pandemic expire at the end of this year, unless Congress renews them. What’s the outlook for ACA enrollment?
Ollstein: Well, Democratic senators are starting to make a push to extend those subsidies, introducing legislation and making a big splash about it today. There’s been a lot of lobbying from the health care sector, the hospitals, all the players who don’t want to see these tax credits expire, and as well as patient advocacy groups. Really, my inbox has been flooded with things related to that and calling on Congress to extend these subsidies.
Of course, they cost a lot of money, and the new congressional majority definitely has other things they want to spend that money on, that are not helping people buy health insurance plans as part of the Affordable Care Act. And so, I think there is likely to be a lot of wrangling and horse-trading around this. I don’t think the subsidies are necessarily toast, but I don’t think that they’re a done deal, either.
Rovner: Yeah, I mean, I keep saying, I think everybody’s first inclination after Election Day is that they were toast, because Republican trifecta. On the other hand, when you actually dig into the numbers, the biggest increases have come in red states.
Ollstein: Absolutely.
Rovner: So the people who are taking advantage of these extra subsidies are people who are in Republican states and voted for Republicans and are represented by Republicans. And you’ve got to wonder whether they want to, suddenly next January, or really next October, November, when people realize: Oh my goodness, my premiums for my health insurance are going to quadruple. How did this happen? Maybe they’ll think about that when they’re putting all of these big, beautiful bills together, maybe?
Ollstein: Yeah, we’ve started to see some comments from some Republicans. Of course, it’s the ones who have been willing to work with Democrats in the past, like Lisa Murkowski in the Senate, saying that we should look at extending these subsidies. You’re not hearing that from most Republicans by any stretch of the imagination, but I think you’re starting to hear these rumblings because, like you said, Julie, they don’t want to have a bunch of constituents lose their insurance or have their insurance get way more expensive when they’re in power.
Rovner: Yeah, the advantage and disadvantage of the trifecta. Lauren?
Weber: I just wanted to ask, I mean, a question for the panel. I mean, there’s all this talk about “DOGE” [the “Department of Government Efficiency”] and cutting all this money, but as you just stated, Alice, they’re likely not to get rid of these subsidies. Johnson went on the record, I think this week or last week, to say Medicare is not going to get impacted. Medicaid cuts seem to be coming, but dear God, if you don’t cut some of these other things, I don’t know how you would possibly get to the money amounts that they’re talking about, especially in health.
Ollstein: Well, and Elon Musk has already walked back his projection of how much he’ll be able to cut, saying that $2 trillion was aspirational and hopefully they’ll get $1 trillion. And so you’re already starting to see the walk-back of some of the preelection promises on that front as they start to confront some of the realities you mentioned, Lauren.
Rovner: Yeah, there’s nothing like the optimism of early January, when a new Congress and a new president say, We’re going to do all of this in the first hundred days. You would think that Trump of all people would know better, because he tried to repeal the Affordable Care Act in the first hundred days in 2017, and that didn’t go so well. But apparently he has a short memory, too.
Well, speaking of things that are likely to be undone, the Consumer Financial Protection Bureau finalized its rule this week barring the use of medical debt on credit reports. It’s already been sued for exceeding its authority by two trade groups representing creditors. How important would this change be if it actually survives?
Luthra: Something like this could be really meaningful. I remember talking to families about their efforts to buy homes and often struggling to do so because their medical debt had harmed their credit score. And the thing about medical debt is that it’s usually not planned. It is probably actually almost always not planned, because you don’t hope to fall sick. You do not try to get a devastating injury that your insurance will not fully cover the costs for.
And this was something that had really been championed by folks in the consumer advocacy space for a very long time, well before the Biden administration. Losing it would really have implications for people across the political spectrum, especially as we are in this space where housing remains very expensive, where medical debt is a real concern, and where having it affect your credit could really put a reasonable mortgage just out of reach for a lot of Americans.
Rovner: Well, finally, as one of his parting recommendations, outgoing Surgeon General Vivek Murthy has issued a report recommending that alcoholic beverages carrying warning labels that they can cause cancer, just like tobacco products. His report calls alcohol the third-leading preventable cause of cancer. But this doesn’t feel super-likely to happen, between the power of the alcohol industry and the distrust of science, particularly when it recommends things people probably don’t want to hear. I assume nobody here is betting on this happening anytime soon?
Ollstein: No, you’ve already seen members of Congress for whom the alcohol and beverage industry is very economically important for their state, all the folks who represent breweries and distilleries and wineries, already speaking out and sharing concerns about this. But I think that just the surgeon general using the bully pulpit to shine a light on this, it generated a lot of news coverage. That’s important.
It’s important for consumers to see that and be able to make choices. And you’re already seeing some trends of younger folks being more sort of sober-curious. And there’s a lot of talk about Dry January being a healthy thing to do. And a lot more bars you’re seeing offer low-alcohol or nonalcoholic options. And so I think this is something that people are slowly becoming more aware of and more concerned about, whether the government steps in or not.
Rovner: Yeah, I think it may be like tobacco, where everybody smoked and then gradually fewer and fewer and fewer people did. Lauren, did you want to say something?
Weber: Yeah, I mean, I’ve written a lot about food labels in the last couple of years, and, I mean, that’s just been a torturous process. So the idea that anything on alcohol would change at anything faster than a glacial pace I think is probably problematic, considering there’s a lot of lawyers in this town and there’s a lot of money in lawmakers’ pockets in this town. So just wanted to add that.
Rovner: And alcohol’s really popular — and legal. Well, let’s turn to abortion reproductive health. All things considered, it’s actually been sort of quiet on the abortion front for the last few weeks. But there has always been news, as is predictable when Republicans take over the House, Senate, and White House at the same time. New Senate Majority Leader John Thune has announced his intention to bring up an abortion bill. In this case, not a national ban, which President-elect Trump has said he wouldn’t sign, but rather the, quote, “Born-Alive Abortion Survivors Protection Act.” What is this bill? And what would it do? And how is it different from a similar-sounding bill that Congress passed and President George W. Bush signed in 2002?
Luthra: We were chatting about this in advance of taping the podcast, and this is really interesting for a lot of reasons. What this bill would do is, essentially, if someone gives birth, the hospital or the health care provider is required to provide all forms of lifesaving care, even if it seems like the newborn will not live. And this is relevant in a lot of places. It is relevant when, for instance, you maybe experience a very, very early delivery, in which viability is just not on the table.
We do know that the vast majority of abortions happen well before the point when there is actually going to be something that resembles an infant being born. And so what this actually does in practice, a lot of health care providers have sounded the alarms about, is stigmatize abortion and sow more mistrust of the health care providers who perform it. And it also, in cases where someone does give birth to a child that will not live, forces doctors to provide medical interventions that maybe won’t make a difference but that will delay the opportunity or prevent the opportunity for palliative care, which is really sad.
I mean, you give birth to a child that won’t live, and it can’t spend its few moments with some kind of comfort. Instead, it’s given medical treatments that will not really help them. This bill differs from the law signed under President Bush in that it would add penalties. But the other thing that’s worth noting is that killing infants is already illegal. We have laws that ban homicide. And so, when abortion rights supporters and legal scholars say that this kind of law would be redundant, they’re right. We already have ways to penalize killing people. But what we don’t have are national restrictions that stigmatize abortion to the extent that it will be performed less and less.
But the other thing I think is worth noting, to your point, Julie, is that this is a big step back, especially for Senator Thune, who was on the record supporting a 15-week national abortion ban and is now not. And that helps us underscore that national abortion restrictions are very toxic and that, instead, the GOP is really trying to focus on cases where they think they might have a better chance of winning, by focusing on the very end of pregnancy, areas where they see the support for abortion rights publicly go down, and start with restrictions there, before, if they ever want to do something more sweeping, waiting a bit more time for that to be politically viable.
Rovner: Basically, it’s a messaging bill to try and put supporters of abortion rights on the spot and say, If you won’t vote for this, then you’re for infanticide. I mean, that’s essentially what the debate’s going to be. Right, Alice?
Ollstein: Yeah. Well, and just so folks are aware, the timing of this is around the March for Life coming up in a couple days after the inauguration. And almost every year, Republicans in Congress attempt to hold some sort of messaging vote to coincide with that big anti-abortion demonstration in Washington, D.C.
Rovner: I would say the anti-abortion demonstration is when it is because that was the anniversary of Roe v. Wade. That’s why they come to D.C. in January.
Ollstein: Yeah. As an aside, they considered moving it to June to mark the anniversary of Dobbs but decided to keep it in January to continue to observe the anniversary of Roe anyways. But like Shefali said, it’s interesting that, even given that this is just a messaging vote, they’re still aiming a lot lower than they have in the past and not introducing the big, sweeping anti-abortion policies that the advocacy groups on that side want to see, in terms of restrictions on abortion medication, or like in the past, 15-week bans, 20-week bans, something like that. Instead, this is sort of a niche and arguably duplicative policy that they’re putting forward.
Rovner: Well, we will certainly watch that space. Also, over the holiday break, an OB-GYN at the University of Indiana sued the Indiana Department of Health, claiming the state’s new abortion reporting requirements violate the federal HIPAA [Health Insurance Portability and Accountability Act] patient privacy rules. Failure to follow the state law could result in potential criminal liability or loss of medical license, but federal law is supposed to preempt state law.
Along those same lines, Senate Finance Committee Chairman, now ranking member, Ron Wyden of Oregon released a report in December, which followed up on the reporting that we’ve talked about from ProPublica, about pregnant women dying from preventable and/or treatable complications. Wyden’s staff found that doctors in states with abortion bans have been unable to get sufficient legal advice and/or guidance from their hospital officials in a timely way.
Quoting from the report, “Doctors are playing lawyer, and lawyers are playing doctor, while pregnant women experiencing anything short of what amounts to a dire emergency are sent away and told to return to the emergency room once a preventable situation becomes life-threatening.” Is there anything on the horizon that would sort out what doctors can and can’t do in states with abortion bans? This continues to be — we keep hearing story after story after story about this.
Ollstein: So the anti-abortion movement’s response to this is that the laws themselves do not need to be changed, and they instead are introducing these new, what they call “med ed” bills that basically order the government, in collaboration with anti-abortion groups, to develop materials that doctors and medical students will have to review, that purport to explain what is and isn’t allowed in terms of abortion care and emergency care under these restrictions.
One state so far has implemented this, South Dakota, and they are attempting to introduce it in a bunch of other states. Now, the medical community says there’s no way a video is going to solve this. These are incredibly complex situations. You can’t cover everything that might come up. You can’t cover every condition a pregnant person could have. And they see it as sort of a CYA — if folks are familiar with “cover your behind” — move, in terms of liability and an attempt to put the onus on individual doctors who are already struggling, and to say that any of these adverse outcomes are the fault of doctors for not understanding or correctly abiding by these legal restrictions on care.
Whereas the doctors say that: We can’t get guidance from our own employers. We can’t get adequate guidance from the state. And these really tie our hands in these very sensitive, time-sensitive, and medically sensitive situations.
Rovner: And we’ve seen cases, I mean like in Texas, where the attorney general has threatened in writing to prosecute doctors for things that doctors say is standard medical practice.
Ollstein: Right, so even when a doctor came forward and said, It is my medical judgment that this person needs an abortion for medical reasons, we saw the attorney general there step in and say: I am overruling your judgment. No, she does not. And so that has, based on many interviews I’ve done, and I’m sure Shefali has done, created a real chilling effect, where people are afraid of being second-guessed like that. And even short delays, where someone is trying to consult with an attorney on what to do, even a short delay can be deadly for a patient in one of those situations.
Rovner: Well, turning to this week in medical misinformation, the big news, of course, is that Facebook is going to disband its fact-checking unit and basically adopt the anything-goes-and-if-you-don’t-like-it-correct-it-yourself system now used by X. This could have big implications for health misinformation, I would think. Even though Facebook wasn’t doing such a great job before on allowing misinformation and disinformation to spread. Is this going to have a big effect?
Luthra: I mean, I think this is just, to some extent, a sign of Facebook shifting with the political winds, right? I mean, the fact-checking came out in part after the 2016 election when there was a lot of claims of voter fraud. There are a lot of, How did Trump get into office? They instituted fact-checking to allegedly kind of pander to people who felt like that there was a lot of misinformation spread then. Now they’re moving away from fact-checking because they feel like then it gives people the ability to reflect what the community wants. I think it’s reflecting the trend we’re seeing on X. We’ll see more Community Notes. It makes journalists’ job all the more important, to actually distill what’s true and what’s false.
Rovner: You’re our misinformation expert. Oh, go ahead, Alice.
Ollstein: Oh, I wanted to also flag that part of Facebook’s announcement was that they are moving some of their teams from California to Texas, because Californians are too biased to do any content moderation and Texans presumably are not. That was the frame of that announcement, basically. And so that, I’ve already seen, is raising concerns in some groups on the left, and medical groups, about access to information about kinds of care that are restricted in Texas, like abortion care, like trans care.
Will people be able to post about those things, to post accurate things about those things on those platforms? Or will that be restricted in the future? It’s also drawing attention for that reason.
Luthra: And if I can add one more point to what Alice mentioned, I mean, one of the very explicit areas where Mark Zuckerberg said he would like more room for disagreement and more room for discourse is on the lines of gender, and very explicitly removing restrictions on using very, quite frankly, misogynistic terms about how women should exist in our society, about LGBTQ+ people, about explicitly allowing users to call them mentally ill.
And this has very meaningful implications for gender equality, sure, but also for health care, because we are seeing that one of the most politicized areas of health care in our country is access to health care for trans people, is access to health care for women. And it’s just very hard to not look at this and think, oh, there will be no implication for how people conceive of health care and how people conceive of those who receive this kind of health care.
Rovner: And we should point out, which I should have at the beginning, this is not just Facebook — this is all of Meta. So this is Facebook and Instagram and Threads. It’s basically, because I know that only sort of old people like me are still on Facebook, but lots of people are on Instagram and Threads, and this is obviously going to have some pretty big implications as we go forward.
All right, well, speaking of misinformation, one mark of responsible science is fessing up when you are wrong. And this week we have a big wrong thing to talk about. Back in November, we talked about a study that found that black plastic cooking utensils and takeout containers were dangerous because they were made from recycled electronics and were leaching amounts of fire retardants and other chemicals into your food.
Well, it turns out that you probably still should get rid of the black plastic in your kitchen, but know that they’re not quite as dangerous as originally advertised. It turns out that the authors of the study made a math error that exaggerated the levels of toxins by a factor of 10. Still, if you don’t want to be exposed to fire retardants and other nasty stuff, you might want to cook with metal or silicone or something that is not black plastic. I do think this is important, because it does show science is an iterative process. It’s rare to see someone step up and say: Oh, oops, we got this wrong. But here, it doesn’t change our general conclusion about this. But you should know that when we make a mistake, we’re going to fix it. I mean, that seems to be very rare in this world right now.
Ollstein: It’s so hard, because you see the act of admitting error and correcting it — that can fuel distrust. People point to that and say: See, they got that wrong. They must be getting all this other stuff wrong, too. But of course, not correcting misinformation is far worse. And so, in a time of such distrust, communication is really, really hard. And did all the people who saw the first wave of news about the black plastic also see the correction and see that it wasn’t true? How are these things framed? Were the splashy articles that were run, were they corrected? Were they retracted? It’s hard to put the toothpaste back in the tube.
Rovner: Yeah, but science is an imperfect process. And it’s a process. It would help, I think, if people understood that science is more of a process than a, this is what is. But that’s what we’re all here for, and that’s why we all still have jobs. All right, that is the news for this week.
Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry. If you miss it, we will put the links in our show notes on your phone or other mobile device.
Lauren, you were first this week, so why don’t you go first?
Weber: I love this story, and I’m obviously biased, but by my colleagues David Ovalle and Rachel Roubein, on how “Laws restrict U.S. shipping of vape products. Many companies do it anyway.” Essentially, you shouldn’t be shipping flavored vapes across the country, but a bunch of companies do. And my colleagues were able to order and get their hands on quite a few of those flavored vapes.
My favorite part is the kicker in the story, in which one company said, You’re not sanctioned to use our name in any way, when we reached out for comment after they had shipped us vapes illegally. So I thought that was quite something. But essentially, it gets at what is a flaw in this piece of the law, which is that the USPS [U.S. Postal Service] is supposed to enforce, or someone is supposed to enforce, how to stop the shipping of these vapes, but it’s not really happening. So it’s kind of a look at the best intentions may not be the reality on the ground.
Rovner: Often. Alice.
Ollstein: So I have a piece from the New York Times called “Ozempic, Lego Bricks and Hearing Aids: What Trump’s Greenland Plan Could Hit.” And this is coming off of Trump threatening to impose tariffs on Denmark if it refuses to allow the U.S. to take over Greenland, which has become one of Trump’s latest obsessions.
And this piece is pointing out that tariffs on Denmark would impact a lot of things the U.S. population depends on. Specifically, the pharma giant Novo Nordisk is based there and manufactures tons of medications, including Ozempic, and other weight loss drugs and diabetes drugs in that family that are incredibly popular right now, and as well as hearing aids, other medical devices, other medications. And so this could impact consumers, if it ever were to happen, which who even knows.
Rovner: Yes. Well, we will talk more about tariffs and the medical industry in a future podcast, but thank you for noting that. Shefali.
Luthra: My piece is from Vox. It is by David Zipper. The headline is “Gigantic SUVs are a public health threat. Why don’t we treat them like one?”
I think the story is so smart. I love this framing. It first lays out the evidence for why, when cars reach a certain size, they are very dangerous and much more likely to kill people. And then it gets into the conversation: Why don’t we actually treat this as a public health threat?
And they look at the war on tobacco and the war on smoking to think through: What did it look like to take something that was so ubiquitous in our culture and actually convince the American public to shift away from it? I think this is really interesting for a lot of reasons. One is that public health is really expansive and we should think about it in an expansive way and consider all the different elements, like car size, that do affect our lives and life expectancy.
And I also do think this ties really well to the conversation we had about the surgeon general’s alcohol warning, in that even short of policy changes, there is a lot that we can do as a society to shift the public’s understanding of health risks from things that we take for granted, and we can still move people in a direction toward being healthier and keeping our fellow Americans healthier. And that’s really interesting and important to think about.
Rovner: Probably easier to do something about large SUVs than alcohol, but yes, I’m so glad you linked those two things. My story this week is from The Wall Street Journal. It’s called “UnitedHealth’s Army of Doctors Helped It Collect Millions More From Medicare,” by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty. And it’s basically the flip side of the story that Stat News has been all over, about how United has used various methods to deny care to its Medicare Advantage patients to save the insurer money. This is a story about how United is forcing the doctors who work for the company — and there are a lot of them, like 10,000 — to basically run through a checklist of potential diagnoses for every Medicare Advantage patient, to encourage doctors to make those patients seem sicker, even if they’re not, because then the company gets more money for Medicare.
The investigation found that the, quote, “sickness scores” for patients moving from traditional Medicare to United’s Medicare Advantage increased an average of 55%, which was, quoting from the story, “roughly equivalent to every patient getting newly diagnosed with HIV … and breast cancer,” basically maximizing profits from both ends. It is quite the story, and I recommend it highly.
OK, that’s this week’s show. I hope you feel caught up and ready for the rest of 2025. As always, if you enjoy the podcast, you could subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks, again this week, to our temporary production team, Taylor Cook and Lonnie Ro, as well as our editor, Emmarie Huetteman.
As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner, and increasingly at Bluesky, @julierovner.bsky.social. Where are you guys mostly these days? Alice?
Ollstein: I am @alicemiranda on Bluesky, mostly.
Rovner: Shefali.
Luthra: You can find me on Bluesky, @shefali.
Rovner: Lauren.
Weber: Still just chilling on X, @LaurenWeberHP.
Rovner: We will be back in your feed next week. Until then, be healthy.
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The Host
The new, GOP-led, 119th Congress and President-elect Donald Trump have big legislative plans for the year — which mostly don’t include health policy. But health is likely to play an important supporting role in efforts to renew tax cuts, revise immigration policies, and alter trade — if only to help pay for some Republican initiatives.
Meanwhile, the outgoing Biden administration is racing to finish its health policy to-do list, including finalizing a policy that bars credit bureaus from including medical debt on individuals’ credit reports.
This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Panelists
Among the takeaways from this week’s episode:
- The 119th Congress is now in session. Health care doesn’t make the list of priorities as lawmakers lay the table for the incoming Trump administration — though Republicans have floated Medicaid work requirements to cut federal spending.
- A lot of health legislation hit the cutting-room floor in December, including a bipartisan proposal targeting pharmacy benefit managers — which would have saved the federal government and patients billions of dollars. And speaking of bipartisan efforts, a congressional report from the Senate Budget Committee adds to evidence that private equity involvement in care is associated with worse outcomes for patients — notably, lawmakers’ constituents.
- As the nation bids a final farewell to former President Jimmy Carter, his global health work, in particular, is being celebrated — especially his efforts to eradicate such devastating diseases as Guinea worm disease and river blindness.
- Meanwhile, the Biden administration finalized the rule barring medical debt from appearing on credit reports. The surgeon general cautions that alcohol should come with warning labels noting cancer risk. And the new Senate Republican leader is raising abortion-related legislation to require lifesaving care for all babies born alive — yet those protections already exist.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Wall Street Journal’s “UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare,” by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty.
Alice Miranda Ollstein: The New York Times’ “Ozempic, Lego Bricks and Hearing Aids: What Trump’s Greenland Plan Could Hit,” by Ana Swanson and Jenny Gross.
Shefali Luthra: Vox.com’s “Gigantic SUVs Are a Public Health Threat. Why Don’t We Treat Them Like One?” by David Zipper.
Lauren Weber: The Washington Post’s “Laws Restrict U.S. Shipping of Vape Products. Many Companies Do It Anyway,” by David Ovalle and Rachel Roubein.
Also mentioned in this week’s podcast:
The Senate Budget Committee’s “Profits Over Patients: The Harmful Effects of Private Equity on the U.S. Health Care System.”
Credits
To hear all our podcasts, click here.
And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.
