The Host
Mary Agnes Carey
KFF Health News
The midterm elections are months away, yet changes at the Department of Health and Human Services suggest the Trump administration is focusing on how to win on health care, which remains a top concern for voters. Facing growing concern about the administration’s actions on vaccines in particular, the Food and Drug Administration this week reversed course and said it would review a new mRNA-based flu vaccine after all.
And some top HHS officials are changing seats as the Senate prepares for the long-delayed confirmation hearing of President Donald Trump’s nominee for surgeon general, Casey Means.
This week’s panelists are Mary Agnes Carey of KFF Health News, Tami Luhby of CNN, Shefali Luthra of The 19th, and Lauren Weber of The Washington Post.
Panelists
Tami Luhby
CNN
Shefali Luthra
The 19th
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- After a week of bad press, the FDA announced it would review Moderna’s application for a new flu vaccine. Yet the agency’s original refusal fits a pattern of agency decision-making based on individual officials’ views rather than set guidelines — and reinforces a precedent that’s problematic for drug development.
- Those caught up in the latest HHS leadership shake-up include Jim O’Neill, who, as acting director of the Centers for Disease Control and Prevention, signed off on changes to the childhood vaccine schedule. His removal from that role comes as the White House is showing more interest in controlling health care messaging ahead of the midterms — and as polling shows Americans are increasingly concerned about federal vaccine policy.
- Senators will hear from Means next week as they consider her nomination as surgeon general. Means, a key figure in the “Make America Healthy Again” movement, is expected to be asked about her medical credentials and past, problematic claims about medicine.
- And while early numbers show that Affordable Care Act marketplace enrollment has not dipped as much as feared, Americans are still absorbing the rising cost of health care this year. The collapse of congressional efforts to reach a deal on renewing enhanced premium subsidies could be an issue for voters come November.
Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:
Mary Agnes Carey: Politico’s “Why Congress Failed To Reach an Obamacare Deal,” by Robert King and Simon J. Levien.
Lauren Weber: NiemanLab’s “The Atlantic’s Elizabeth Bruenig on Her ‘Hypothetical,’ Heavily Reported Measles Essay,” by Laura Hazard Owen.
Tami Luhby: The City’s “NewYork-Presbyterian Nurses Reject Contract by Overwhelming Margin,” by Claudia Irizarry Aponte and Ben Fractenberg.
Shefali Luthra: NPR’s “Minneapolis Doctors Warn of Lasting Medical Effects, Even After ICE Agents Leave,” by Jasmine Garsd.
Also mentioned in this week’s episode:
- Politico’s “FDA’s Reversal on Moderna Flu Shot Bid Followed White House Pressure,” by Lauren Gardner and Tim Röhn.
- The Washington Post’s “How RFK Jr. Upended the Public Health System,” by Rachel Roubein, Lena H. Sun, and Lauren Weber.
- CNN’s “Trump Promised RFK Jr. Would ‘Restore Faith in American Health Care.’ A Year in, Trust Has Plummeted,” by Meg Tirrell.
- The Washington Post’s “She Left the Medical Mainstream and Rose To Be RFK Jr.’s Surgeon General Pick,” by Lauren Weber and Rachel Roubein.
- KFF’s “KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.
- CNN’s “Trump Wants To Focus on Health Care in the Midterms, Creating Headaches for the GOP,” by Adam Cancryn.
- Health Affairs’ “HHS Proposes Sweeping Changes for 2027 Marketplace Plans (Part 1),” by Katie Keith.
- Health Affairs’ “HHS Proposes Sweeping Changes for 2027 Marketplace Plans (Part 2),” by Katie Keith and Matthew Fiedler.
- Health Affairs’ “HHS Proposes Sweeping Changes for 2027 Marketplace Plans (Part 3),” by Katie Keith.
Click to open the transcript
Transcript: Turnarounds and Shake-Ups
[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.]
Mary Agnes Carey: Hello from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of KFF Health News, sitting in for your host, Julie Rovner. I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 19, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today, we’re joined via video conference by Lauren Weber of The Washington Post.
Lauren Weber: Hello, hello.
Carey: Tami Luhby of CNN.
Tami Luhby: Glad to be here.
Carey: And Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Carey: Let’s start today with the Food and Drug Administration. The FDA has now agreed to review Moderna’s application for a new flu vaccine, reversing the agency’s decision from just a week ago to reject the application because it said the company’s research design was flawed. What happened?
Weber: I think we got to take a step back, and we got to think about this in the lens of the midterms, because, of course, we got to talk about the midterms on this podcast.
Carey: Of course.
Weber: But what we’ve seen, really, since the beginning of January, after [Health and Human Services Secretary] Robert F. Kennedy [Jr.] overhauled the vaccine schedule under Jim O’Neill, is a lot of changes. And part of that, I think, is due to a big poll that came out by a Republican pollster, the Fabrizio poll, that indicated that some of the vaccine changes were making voters nervous. Basically, it told the president, and it told Republicans, that maybe you shouldn’t mess with the vaccine schedule as much. And ever since that poll has kind of reached the ether, you’ve seen a lot more tamping down of conversation about vaccines. So you’ve seen Kennedy stay a lot more on message about food. And then you saw what happened this past week with the Moderna flu reversal. So what ended up happening is the FDA came out and said they were not going to review the Moderna flu vaccine, which was an mRNA vaccine, which, as we all remember, was the vaccine technology that became quite famous during the covid pandemic that [President Donald] Trump really championed in his first term. So the FDA came out and was like, You know what, we’re not going to review this — which was a huge issue. It caused massive shock waves through the vaccine industry. A lot of vaccine and pharma insiders said this could really dampen their ability to develop future vaccines, because they felt like this action was made without enough explanation. And after a week of pretty much bad headlines and bad press, the decision was reversed. And Lauren Gardner from Politico had a great story, along with a colleague [Tim Röhn], where she pointed out that this reversal happened after a meeting with the FDA head in the White House, where Trump expressed some concern over the handling of vaccines. So I think this reversal that you’re seeing fits into the broader picture of the unpopularity of Kennedy’s push around vaccines, and I expect that, considering their hesitancy, along with a really contentious midterms race, we may see more pushback to whether or not Kennedy is able to continue on his push against vaccines.
Carey: So, what are the implications for drug and vaccine manufacturers in the months ahead? How will this impact them? Does it provide stability and reassurance that if you spend billions of dollars on drug development, you’re not going to be stopped by federal agencies?
Weber: I think the reversal maybe does, but, I mean, certainly they’re still spooked. I mean, the reality is that it’s a little unclear. Obviously, there was a pressure campaign to reverse this, and it has been reversed. But the current makeup of the FDA, with Vinay Prasad, has led many to be unclear on what will and will not get approved. Under this HHS administration, there’s been a big push for placebo-controlled trials and so on, and somewhat a shifting of expectations. And I think that while the reversal will settle feelings a bit, you also … this is on a backdrop of hundreds of millions of dollars being canceled in mRNA vaccine contracts. So I think there’s a lot of unease, and there’s a lot of fear that this could continue to [dampen] vaccine development.
Luthra: I think, to add to what Lauren’s saying, it’s just pretty hard to imagine that after the past year and change that anything could really feel predictable if you are in the business of developing biopharmaceuticals in any form. It’s just so much has changed, and so much really seems to depend on the whims of where the politics are and where the different players are and who’s carrying influence. It’s just hard to really think about how you would want to invest — right? — a lot of money in developing these products, where you may or may not have success. But one other thing that I am just so struck by in this whole episode is there is a lot of tension in different parts of the health policy community groups around how the FDA is approaching different policies. And one area I’ve been thinking about a lot is where the FDA has been on abortion is a source of real frustration for a lot of abortion opponents, and seeing this episode play out if the White House did get involved, I think it raises a really interesting question for people who oppose abortion and want the FDA to take a harder look at it. Are they going to expect similar movement from the president, similar intervention, or conversations from the White House? And if they don’t get that, how does that affect, again, just another issue that feels really salient as we head into a midterm election that gets closer and closer.
Carey: And I think you know, this is a sign of what health care might mean and play in the fall election, so we’ll keep our eye on that. Lauren, you just mentioned recently some changes at the Department of Health and Human Services. We’re going to shift from the FDA to HHS, where there’s been a shake-up in top leadership. Jim O’Neill, who had served as the HHS deputy secretary and as acting director for the Centers for Disease Control and Prevention, is leaving those positions. Other agency changes include Chris Klomp, who oversees Medicare, being named chief counselor at HHS, where he will oversee agency operations. And National Institutes of Health. Director Dr. Jay Bhattacharya will also serve as acting director of the CDC. Clearly, there is a lot going on here. Why are these changes happening now?
Weber: So our understanding from reporting is that the White House wanted to shake things up before the midterms. I mean, if you know — kind of what I alluded to in my last comments is, you know, Jim O’Neill was the person who signed off on the childhood vaccine schedule. I mean, his name was plastered all over that in January, and now he’s been shipped off to be head of the National Science Foundation, but certainly not as high profile of an HHS deputy role or CDC acting director. From our understanding, that’s because the White House wants a bit tighter control over messaging and overall thrust of HHS heading into the midterms. And I think it’s noticeable — you mentioned Chris Klomp, I mean, let’s note where he came from. He came from CMS. You know, you’re seeing a fair amount of folks from CMS, from “Oz Land,” come into HHS and exert seemingly, it looks like, more power, based on the White House’s judgment, along with Kennedy. Kennedy is said to have also signed off on these changes. But it remains to be seen how this will impact HHS focus going forward.
Carey: So while we’re talking about HHS, let’s look at Secretary Robert F. Kennedy Jr.’s first year in office. There’s so much we could talk about: the firing of members of the Advisory Committee on Immunization Practices, also known as ACIP, and the addition of several members who oppose some vaccines; major changes in the childhood vaccine schedule, changes that the American Academy of Pediatrics has called “dangerous and unnecessary”; pullbacks of federal funding for vaccination programs at local departments that were later reversed by a federal judge; the firing of Senate-confirmed CDC director Susan Monarez, who had only served in that position for less than a month; new dietary guidelines aimed at getting ultra-processed foods out of our diets, but adding red meat and whole milk — foods that many nutritionists have steered people away from. This is an open question for the panel: What do you make of Kennedy’s tenure so far?
Luhby: I mean, he’s certainly been changing the agency in ways that we somewhat expected and, you know, other ways that we didn’t. I will let the others speak to some of the vaccine and others. But one thing that’s also notable is the makeup of the agency. They’ve laid off or prompted many people to quit or retire. You know, there’s major staffing changes there as well, and there’s a large brain drain, which has concerned a lot of people.
Weber: Yeah, I’ll chime in and say, I mean, I think public health officials have been horrified by his first year in office. There is a growing fear that, obviously, his many vaccine changes could have long-term consequences for vaccine [uptake] and an increase in vaccine hesitancy. There’s been a lot of concern among public health officials and experts that Congress really has not stepped in to stop any of this. That said, there are currently … there’s a lawsuit the AAP has brought against these changes, which could have an outcome in the coming days that may or may not impact whether or not they’re going forward. You mentioned how he reconstituted ACIP, the federal advisory committee on vaccination. You know, what’s really interesting is, right now, we’re unclear if that ACIP meeting is still happening at the end of February. And again, it goes back to my point of vaccines seem to be, after this polling, not where Republicans want to be talking. And so a lot of Kennedy’s primary concern, even though he talked a lot about food in his first year in office, the Post did an analysis of his social media, and he talked way more about food than he talked about vaccines. But his focus, and ultimately, what he was able to upend a lot of, was vaccine infrastructure. And I think this year we will see. More of the impacts of that, and also whether or not he’s allowed to make some of these changes, if there is enough backlash, or if there is enough pushback, or if there is enough political detriment that pushes back on what he has done.
Luthra: And I think a really important thing for us to think about, that Lauren just alluded to, is a lot of the consequences of this first year are things we will be seeing play out for many years to come. There has been this dramatic upending of the vaccine infrastructure. We have seen medical groups try and step in and try and offer independent forms of authority and expertise to give people useful medical information. But that’s a very big role to fill in the context of this tremendous brain drain. And I think what we are waiting to see is, how does that translate to decision-making on the individual level and on the aggregate level? Do people feel like they can trust the information they’re given? Do they get the vaccines they would have gotten in the past for their families, for their children? Is it easier? Is it harder? Does those difficulties matter in the end? And that’s the kind of impact and consequence that we can talk about now, but that we’ll only really understand in years to come when we look at whether and how population health outcomes shift.
Carey: Sure. And so we’re talking about, you know, Lauren and the full panel has made this clear, talking about some of the shifts in the messaging out of HHS as we head into the fall elections. Lauren, if I heard you correctly, you were saying on Secretary Kennedy’s social media feeds, he had talked a lot more about food than vaccines, but yet, the vaccine message seems to have resonated more. So, as you look towards the fall elections, right? We’re talking about affordability, in a moment we’re going to be talking about the Affordable Care Act. We’ve read a lot … and folks have talked on this podcast about drug prices. Are the steps enough that are happening here on the messaging? Is it enough to focus the message, and is it going to land with voters, or will they be looking at it in a different way?
Weber: And will he stay on message?
Carey: Exactly.
Weber: I’ve watched, I’ve watched hundreds of hours of Kennedy speaking, and the man, when let rip — I mean, recently he said in a podcast, he talked about snorting cocaine off a toilet seat. I mean, that was something that came up in a long-form conversation. Obviously, there’s more context around it. But he is known for speaking off the cuff. And so, I think it remains to be seen if, if they are able to see how that messaging — in order to talk about drug prices, talk about affordability — if that continues to play for the midterms, and if it doesn’t, what the consequences of that may be. I think it’s important too … I mean, last night, Trump issued an executive order that is aimed at encouraging the domestic production of glyphosate, which is a really widely used weed killer that has been key in a bunch of health lawsuits around Roundup and other pesticides, is a real shot against, across the bow for the MAHA [“Make America Healthy Again”] crowd, and it puts Kennedy in a tough position. I mean, he’s issued a statement saying he supports the president, but I mean, this is a man who’s advocated against glyphosate and pesticides for years and years and years, and it’s really divided the MAHA movement that, you know … many folks who said they joined MAHA, many MAHA moms, pesticides are a huge issue, and this could fracture this movement, you know, that Republicans so want to keep in line for the midterms, just as they’re starting to try to get on message.
Luhby: One thing also that my colleague, I wanted to talk about, my colleague Meg Tirrell did a fantastic piece last week about Kennedy’s first year, and it’s headlined “Trump Promised RFK Jr. Would ‘Restore Faith in American Health Care’: A Year In, Trust Has Plummeted.” So I think that that’s one thing that also we have to look at is that Trump had said that there would be historic reforms to health and public health, and that, you know, it would bring back people’s trust and confidence in the American health care systems after covid — and you know, after what he criticized the Biden administration for. But also it shows that actually, if you look at recent polling from KFF, it shows that trust in government health agencies has plummeted over the last year. So that’s going to be something that they also will have to contend with, both in the midterms and going forward.
Carey: We’ll keep our eye on those issues now and in the months ahead. And right now, we’re taking a quick break. We’ll be right back.
All right, we’re back and returning to the upcoming confirmation hearing for Dr. Casey Means. She’s President Trump’s nominee to be surgeon general. The Senate Health, Education, Labor & Pensions, or HELP, Committee, as it is known, will consider that nomination next Wednesday, Feb. 25. You might remember that Means’ confirmation hearing was scheduled for late October, but it was delayed when she went into labor. She was expected then to face tough questions about her medical credentials and her stance on vaccines, among other areas. Means is known as a wellness influencer, an entrepreneur, an author, and a critic of the current medical system, which she says is more focused on managing disease than addressing its root causes. If confirmed as surgeon general, she would oversee the more than 6,000 members of the U.S. Public Health Service, which includes physicians, nurses, and scientists working at various federal agencies. What do you expect from the hearing, and what should people look for?
Weber: So I did a longer profile with my colleague Rachel Roubein on Casey Means last fall. And what we learned, in really digging into reading her book, going through her newsletters, going through her public comments, is that this is someone who left the medical establishment. She left her residency near the end of it, and has really promoted and become central in MAHA world due to her book, Good Energy, which, you know, some folks in politics referred to as the bible of MAHA. So if confirmed, I think she could play a rather large role in shepherding the MAHA movement. But I think she’ll face a lot of questions from folks about her medical license and practicing medicine. So Casey Means currently has a medical license in Oregon that she voluntarily placed in inactive status, which, according to the Oregon State Medical Board, means she cannot practice medicine in the state as of the beginning of 2024. Additionally, she has received over half a million dollars in partnerships from various wellness products and diagnostic companies, you know, some of which in her disclosure forms talked about elixirs and supplements and so on. And I expect that will get a lot of scrutiny from senators as well. And I will just note, too, I think it’s important to look at a passage from her book that a lot of public health experts that we spoke to were a bit concerned about, because she wrote in her book that “the ability to prevent and reverse” a variety of ailments, including infertility and Alzheimer’s, “is under your control and simpler than you think.” And statements like that really worried a fair amount of the public health experts I spoke to. [They] said she would have this bully pulpit to speak about health, but they’re concerned that she doesn’t underpin it with enough scientific reasoning. And so we’ll see if those issues and, also obviously having to answer for Kennedy and the HHS shake-ups and Kennedy and vaccines — I’m sure a lot of that will come up as well. It should … I expect it to be a hearing with a fair amount of fireworks.
Carey: Do you think the fact that … they’ve scheduled this hearing means that they have the votes for confirmation? Or is it simply a sign that the administration just wants to get moving on this, or shift a bit from some of the hotter issues that have happened recently?
Weber: I mean, this is a long time for the American public to not have a surgeon general. So I mean, I think they were hoping to get this moving, to get her in the position. As I said, she could be a very strong voice for MAHA, considering her book underpins a lot of the MAHA movement. I think, in general, Republicans do have the votes to confirm her, but it just depends on how much they are agitated by her medical credentials and some of her past comments. I think we could see some fireworks, but, you know, we saw fireworks in the Kennedy hearing, and he got approved. So, you know, I think it remains to be seen what happens next week.
Carey: Sure. Well, thanks for that. Let’s move on to the Affordable Care Act, or the ACA. More Americans than expected enrolled in ACA health plans for this year, even though the enhanced premium subsidies expired Jan. 1. But it’s unclear if these folks are going to keep their coverage as their health care costs increase. Federal data released late last month showed a year-over-year drop of about 1.2 million enrollments across the federal and state marketplaces. But these aren’t the final numbers, right?
Luhby: No. What’s going to happen is people have time now, they still have to pay their premiums. The numbers that were being released were the number of people who signed up for plans. So what experts expect is that, over time, people who receive their bills may not pay them. A lot of people, remember, get automatically enrolled, so they may not be even aware of how much their premiums are going to increase until they actually get their bill. So they may not pay the bills, or they may try to pay the bills for a short time and find that they’re just too high. Remember that the premiums, on average, premium payments were expected to increase by 114% according to KFF. So that just may be unmanageable. The experts I’ve spoken to expect that we should get better numbers around April or so to see what the numbers of actual enrollees are. Because people, actually, if they don’t pay their premiums, can stay in the plants for three months, and then they get washed out. So we’re expecting to see if, hopefully, CMS will release it, but we’re hoping to see better numbers in April.
Carey: Shefali, I know you closely follow abortion. How much has the abortion and the Hyde Amendment played in all these discussions about Congress trying to find, if they really want to find, a resolution to this subsidy issue?
Luthra: It’s so interesting. A lot of anti-abortion activists have been quite firm. They say that there cannot be any permission that ACA-subsidized plans cover abortion if the subsidies are renewed. That, of course, would go against laws in some states that require those claims to cover abortion using state funds, not using federal funds, because of the Hyde Amendment. The president relatively recently, even though it feels like a lifetime, said, Oh, we should be flexible on this abortion restriction that anti-abortion activists want. They were, of course, furious with him and said, We can’t compromise on this. This is very important to our base. And they view it as the federal government making abortion more available. And so I think it’s still an open question as to whether this will ultimately be a factor. It’s, to your point, not really clear that lawmakers are anywhere close to coming to a deal on the subsidies. They very well may not, right? They still have to figure out funding for DHS [Department of Homeland Security]. They have many other things that are keeping them quite occupied. But this is absolutely something that abortion opponents will remain very firm on. And I mean, they haven’t had the victories they really would have hoped for in this administration so far, and I think it’d be very difficult for them to take another loss.
Carey: So, Lauren, what’s going on with the discussions on Capitol Hill about potentially extending the enhanced ACA subsidies? We’re hearing reports from negotiators that the deal might be dead. How would that impact voters in November?
Weber: I think people should be interested in getting a solution, because I think — talk about hitting voters’ pocketbooks and actual consequences. I mean, this seems like this is a thing that’s only going to continue to pick up speed. I was fascinated … I know you want to talk more about that great Politico piece that dives into the ticktock of how this all happened. But …
Carey: Yes, great story.
Weber: I think, in general, the ACA subsidies fall into a trap of most of the contentious two-party system that we’re in right now, where different issues that are issues that we can’t touch end up blowing up problems that affect everyday Americans in their day-to-day, and then no action gets made, and then we end up closer to the midterms, where people actually may or may not want to do something. So I’m not sure that people don’t want to do something. I’m just not sure that there’s enough consensus around what that would be, and in the meantime, actual people are feeling the pain. So we’ll see how that continues to play out.
Carey: Sure.
Luthra: I just wanna say, just to add one more point to what Lauren mentioned about political pressure and backlash. The latest polling from KFF shows that health care costs are voters’ No. 1 affordability concern. And we know there was that brief moment when the president said, We should be the affordability party, not Zohran Mamdani and the Democrats. And so I think that’s really interesting, right? Are they able to stick to that? Are they able to address this policy that voters are saying is such a high priority for them, because it is so visceral, right? You know what you’re paying, and you know that your bills are higher than last year. And if they can’t, is that the kind of thing that actually does shape how voters react in November, especially given so many other cost-of-living concerns many of them have.
Luhby: Right, well, one of my White House colleagues today wrote a great story about how the Trump administration’s messaging, or what they’re suggesting that the GOP message for the midterms is lower drug prices, which is something that they have been very active on. So they don’t want to discuss the exchanges, and we’ll talk a little bit about the new rule that they’ve just proposed. But yeah, I think the administration is going to focus on health care. They’re aware of the concerns of health care, and their message is going to be “most favored nation,” TrumpRx, and the other efforts that they’ve made to lower drug prices, which is something, of course, Trump was also very focused on in his first term as well, but to less effect.
Carey: Speaking of that rule, Tami, can you tell us more about that?
Luhby: Sure. Well, CMS wants to make sweeping changes for ACA plans for 2027. It issued a proposed rule last week that would give more consumers access to catastrophic policies. Now these are policies that have very high deductibles and out-of-pocket costs, generally offer skimpier benefits, but, importantly for the administration, have lower premiums. The proposed rule would also repeal a requirement that exchanges offer standardized plans, which are designed to make it easier for people to compare options. It would ease network adequacy rules and require, as we were just talking about, require more income verifications to get subsidies and crack down on brokers and agents who, we’ve just discussed about, you know, have been … some of whom have been complicit in fraud. The goal is to lower the ACA premiums and give people more choice, according to CMS. Premiums, of course, have been a big issue, as we discussed … because of the increase in monthly payments due to the expiration of the subsidies. But notably, the agency itself says that up to 2 million people could lose ACA coverage because of this proposed rule. It’s a sweeping, 577-page rule, I think? And if you want to get more information, I highly recommend you read Georgetown’s Katie Keith’s extensive three-part breakdown, which was published in Health Affairs.
Carey: All right, well, we’ll have to keep our eye on that rule and all the comments that I am sure will come in.
Luhby: Many comments.
Carey: Many. I’m also intrigued about some of the GOP talking points on potential fraud in the program. For example, the House Judiciary Committee has subpoenaed eight health insurers, asking for information on their subsidized ACA enrollees and potential subsidy-related fraud. It has been a Republican talking point that it’s their perception, for many Republicans, that there is a lot of fraud in the program that needs to be investigated. Is there any merit to the claim, and will this discussion of fraud shift away from this really critical affordability issue that we’re all talking about?
Luhby: Well, we know that there has been fraud in the program, particularly after the enhanced subsidies went into effect. I mean, even the Biden administration released reports and information about brokers and agents that were basically switching people into different plans, switching them into low-cost plans, enrolling them in order to get the commissions. And it’s one that actually played also into the argument on Capitol Hill about extending the subsidies, whereas the Republicans were very forceful about not having zero-premium subsidies, because they felt that this helped contribute to the fraud. So you know, that’s not an issue anymore, because the subsidies were not renewed, but both CMS and Congress are still focused on this idea of fraud with the subsidies.
Carey: All right, well, we’ll keep watching that now and in the months ahead.
So that’s the news for this week. And before we get to our extra credits, we need to correct the name of the winner of our Health Policy Valentines contest. The winner is Andrew Carleen of Massachusetts, and thanks again to everyone who entered.
All right, now it’s time for our extra-credit segment. That’s where we each recognize a story that we read this week and think you should read, too. Don’t worry if you miss it. We’ll post the links in our show notes. Lauren, why don’t you start us off this week?
Weber: Yeah, I have two pieces, a piece from NiemanLab: “The Atlantic’s Elizabeth Bruenig on Her ‘Hypothetical,’ Heavily Reported Measles Essay.” And then I also have one from my publication at The Washington Post. It’s from Scott Nover. The Atlantic’s essay about measles was gut-wrenching. And some readers feel deceived. And for a little bit of background for anyone who didn’t read it, Elizabeth wrote a very striking, beautifully written piece in The Atlantic from the perspective of a mom who lost her child to measles after a fatal complication that can happen for measles. But the way it was written, a lot of people did not realize it was fiction, or creative nonfiction, or creative fiction to some degree. And so it was written from the perspective like it was Bruenig’s story, but at the very end of the piece, and it turns out this was attached later, after publication, was an editor’s note saying this piece is based on interviews. I gotta say, as, when I initially read it, as a savvy consumer, I initially was like, Is this her story? until I got to the editor’s note at the end. The NiemanLab reporting says that that editor’s note wasn’t actually even on the piece when it started. I think this is a fascinating question, in general. I think that in an era where vaccine misinformation is rampant and the truth is important, it seems like having a pretty clear editor’s note at the top of this piece is essential. But that’s just my two cents on that, and I thought both the discussion and the online discussion about it was really fascinating this week.
Carey: That’s fascinating. Indeed. Tami, what’s your extra credit?
Luhby: My extra credit is titled “NewYork-Presbyterian Nurses Reject Contract by Overwhelming Margin,” by Claudia Irizarry Aponte and Ben Fractenberg in The City, an online publication covering New York. We’ve been having a major nurses’ strike in New York City. It’s, you know, notable in the size and number of hospitals and length of the strike, which has been going on already for over a month. It’s affected several large hospitals — Mount Sinai, Montefiore, and NewYork-Presbyterian — with nurses demanding stronger nurse-to-patient staffing ratios, which, you know, has been a long-standing issue at many hospitals. Now, the interesting development is that the city uncovered a rift between NewYork-Presbyterian’s nurses union and their leadership. So what happened is the nurses at Montefiore and Mount Sinai have recently approved their contracts and are back to work, but the NewYork-Presbyterian nurses did not approve their contract because the language differed on the staffing-ratio enforcement and did not guarantee job security for existing nurses. And what actually apparently happened is that the union’s executive committee rejected the contract, but the union leaders still forced the vote on it, which was, actually, ended up voting down. So now the nurses have demanded a formal disciplinary investigation into the union leaders for forcing this vote. So more than 1,500 nurses at NewYork-Presbyterian signed the petition, and more than 50 nurses delivered it to the New York State Nurses Association headquarters. One nurse told The City they are overriding our voices. The union president urged members not to rush to judgment. Now, the NewYork-Presbyterian nurses remain on strike, which has lasted already for more than a month, and it’s going to be interesting to watch how this develops, especially because you have, obviously, the contentious negotiations between the hospital and the nurses union, but now you also have this revolt, and, you know, issues within the nurses union itself.
Carey: Wow, that is also an amazing story. Shefali?
Luthra: Sure. My piece is from NPR. It is by Jasmine Garsd. The headline is “Minneapolis Doctors Warn of Lasting Medical Effects, Even After ICE Agents Leave.” And the story looks at something that we know from research happens, but on the ground in Minneapolis, of people concerned about ICE [Immigration and Customs Enforcement] and immigration presence at medical centers, delaying important health care that can be treatment for chronic ailments, it can also be treatment for acute conditions. And what I like about this story is that it highlights that this is something that is going to have consequences, even now with this surge of DHS law enforcement in Minnesota winding down. The consequences of missed health care can last for a very long time. And something I have heard often when just talking to immigrants and medical providers in the Minneapolis metropolitan area is exactly this fear that they actually don’t know what the coming weeks and months are going to bring. They don’t know when they will feel safe getting health care again, when it will feel as if the consequences of this really concentrated federal blitz will be ameliorated in any way. And I love that this story takes that longer view and highlights that we are going to be navigating the medical effects of something so seismic and frankly pretty unprecedented for quite some time. And I encourage people to read it.
Carey: Thank you for that. My extra credit is from Politico by Robert King and Simon J. Levien, called “Why Congress Failed To Reach an Obamacare Deal.” The piece is an inside look at why and how Congress failed to take action on extending the enhanced Affordable Care Act subsidies, which led to the longest government shutdown in U.S. history and higher ACA premiums for millions of Americans.
OK, that’s this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer and engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us with your comments or questions. We’re at whatthehealth@kff.org, or you can find me on X @maryagnescarey. Lauren, where can people find you these days?
Weber: On X and on Bluesky: @LaurenWeberHP. The HP stands for health policy.
Carey: All right. Shefali.
Luthra: On Bluesky: @shefali
Carey: And Tami.
Luhby: You can find me at cnn.com.
Carey: We’ll be back in your feed next week. Until then, be healthy.
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