\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n After all-night markups, two key House committees approved GOP budget legislation that would cut hundreds of billions of dollars from federal health programs over the next decade, mostly from the Medicaid program for people with low incomes or disabilities. The legislation is far from a done deal, though, with at least one Republican senator voicing opposition to Medicaid cuts.<\/p>\n Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. testified before Congress for the first time since taking office. In sometimes surprisingly combative exchanges with lawmakers in the House and Senate, Kennedy denied cutting programs despite evidence to the contrary and said at one point that he doesn\u2019t think Americans \u201cshould be taking medical advice from me.\u201d<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Julie Appleby of KFF Health News, Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tJulie Appleby \t\t\t \t\t\t \t\t\t \tJoanne Kenen \t\t\t \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> The New York Times\u2019 \u201cElizabeth Holmes\u2019s Partner Has a New Blood-Testing Start-Up<\/a>,\u201d by Rob Copeland.\u00a0\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> ProPublica\u2019s \u201cHe Became the Face of Georgia\u2019s Medicaid Work Requirement. Now He\u2019s Fed Up With It.<\/a>\u201d by Margaret Coker, The Current.<\/p>\n Julie Appleby:<\/strong> Scientific American\u2019s \u201cHow Trump\u2019s National Weather Service Cuts Could Cost Lives<\/a>,\u201d by Andrea Thompson.\u00a0\u00a0<\/p>\n Joanne Kenen:<\/strong> The Atlantic\u2019s \u201cNow Is Not the Time To Eat Bagged Lettuce<\/a>,\u201d by Nicholas Florko.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: GOP Poised To Cut Billions in Health Benefits\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, May 15, at 9:30 a.m. As always, and particularly this week, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.\u00a0<\/p>\n Joanne Kenen:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> And my KFF Health News colleague Julie Appleby.\u00a0<\/p>\n Julie Appleby:<\/strong> Hi.\u00a0<\/p>\n Rovner:<\/strong> No interview this week because so much news, so we will get straight to it. So, quiet week, huh? Just kidding. The House Ways and Means and Energy and Commerce committees completed all-nighter markups on their portions of President [Donald] Trump\u2019s \u201cone big, beautiful\u201d reconciliation bill. And in fact, Ways and Means is officially calling it the \u201cOne, Big, Beautiful Bill\u201d in its summary of the measure.\u00a0<\/p>\n We will start with Energy and Commerce, which after a 26-hour marathon, one hour short of the record it set in 2017, voted out its part of the bill Wednesday afternoon, including an estimated $715 billion in reductions to health programs, mostly Medicaid, over the next 10 years. Now, the final committee bill does not include the threatened cuts to the 90% match for the Affordable Care Act expansion population, nor does it include the per capita cap for that population.\u00a0<\/p>\n Nonetheless, it would represent the biggest cut to Medicaid in the program\u2019s 60-year history. Guys, tell us some of the things that it would do instead to get to that $715 billion amount.\u00a0<\/p>\n Kenen:<\/strong> The 715 includes some ACA cuts as well. It\u2019s not 100% Medicaid, but it\u2019s largely Medicaid. The biggest one is the one that we knew was almost inevitable given the current Congress, which is work requirements. It is something the Republicans have wanted a long time. In the prior administration, a few states did pass them. Arkansas got going with them. The courts stopped it.\u00a0<\/p>\n The Medicaid statute is pretty clear that it\u2019s about health, not about health for working people. The courts today are different. If I had to guess, I would guess there will be a legal battle and that the courts are likely to uphold work requirements.\u00a0<\/p>\n Rovner:<\/strong> We\u2019ll talk more about work requirements in a minute. But what else is in the bill?\u00a0<\/p>\n Kenen:<\/strong> There\u2019s lots of extra layers of verification. Supposedly, it\u2019s about fraud. We can get to the Kennedy testimony later, but there were some assertions that did not add up for me. The biggest thing is work requirements, and there\u2019s other things that will make it harder to maintain coverage, that it\u2019s not that tou\u2019re getting kicked off, per se. And there are also some copays. There are some copays for the upper rank. There\u2019s been a lot of information this week. And if I get any details wrong, because we\u2019ve all had to absorb a lot in 48 hours, someone correct me. But my recollection was a $35 copay for certain treatments for the people who are on the higher end of the income.\u00a0<\/p>\n Rovner:<\/strong> Right, meaning over 100% of poverty\u2014\u00a0<\/p>\n Kenen:<\/strong> Right.\u00a0<\/p>\n Rovner:<\/strong> \u2014but still under the level required to qualify for Medicaid.\u00a0<\/p>\n Appleby:<\/strong> Right. It would require states actually to impose these cost sharings of up to $35 per service. Although they\u2019re excluding some things like primary care, emergency stuff, that kind of thing, for people in that 100% of poverty to 138% of poverty, and there\u2019s also an upper limit of 5% of the family\u2019s income. But that\u2019s a lot for people in that category.\u00a0<\/p>\n Rovner:<\/strong> And we know, there is an enormous body of research that says when you put copays on services, people get fewer of them. And it\u2019s not like people who are just scraping by have a lot of extra money to spend. So we know that one of the ways that they\u2019ll save money is that people won\u2019t get services, presumably needed services.\u00a0<\/p>\n Kenen:<\/strong> Although the primary care exemption is important, because primary care, which also usually includes pediatricians, are considered primary care, can deal with a lot of diseases that you don\u2019t always need to see a specialist. I\u2019m not saying it\u2019s a good idea. I\u2019m just saying in terms of an incentive to get basic care, keeping primary care free is an important distinction.\u00a0<\/p>\n Rovner:<\/strong> Well, I do want to talk a little bit about that work requirement, which Massachusetts Democratic Rep. Jake Auchincloss called not a work requirement but a paperwork requirement. Once more, for those who haven\u2019t heard us explain this 100 times, it\u2019s not just people who don\u2019t work who lose coverage because of this. I see you nodding, Alice. Please explain this again.\u00a0<\/p>\n Ollstein:<\/strong> Yes. So Democrats really hammered over the course of this 26-hour hearing that the only states that have made a foray in this direction so far, Arkansas and Georgia, have seen that these work requirements do not boost employment. They kick people off who should have been eligible because they can\u2019t navigate, like you said, the paperwork. And so it was really striking, over this hearing, where \u2014 I watched from 8 a.m. Wednesday to 2 p.m. Wednesday \u2014 and during that whole time, every single amendment vote was party-line. Nobody crossed in either direction. So this was really a political exercise in Democrats because they were not able to convince Republicans to change or soften the bill at all. They really focused on branding it, branding it as punishing the poor and threatening their health care.\u00a0<\/p>\n And so they were pointing to what happened in Arkansas, what happened in Georgia, where the work requirements really were successful in only that they cut people from the rolls and saved the states money, not successful in helping people find work or helping people get coverage. They also made an effort to brand the copays issue. I heard Democrats calling it a \u201csick tax.\u201d We\u2019ll see if that phrase sticks around throughout this process.\u00a0<\/p>\n Rovner:<\/strong> So kind of in an interesting twist, the work requirements in the bill don\u2019t become mandatory until the year 2029. That suggests to me that those who voted for this don\u2019t really want it to take effect, but they do want to be able to count the savings to pay for other things in the bill. And then, cherry on top of the sundae, if Democrats want to repeal the work requirements later, they would have to find a way to pay for them, because the savings would get built into the budget baseline. Or is that just me being cynical because I\u2019ve only had like five hours of sleep this week?\u00a0<\/p>\n Kenen:<\/strong> Well, there are two important dates between now and 2029. One is the 2026 off-year elections, the House elections and some Senate, and then 2028 is the presidential. So there\u2019s several things that have changed politically about Medicaid in recent years, which we can talk to and which I\u2019ve written about quite extensively. One of them is that a lot of people who are Trump\u2019s base are now on Medicaid and particularly that expansion population, and nobody likes having their health care taken away from them, particularly if it\u2019s free or very, very heavily subsidized in the lower ranks of the exchanges.\u00a0<\/p>\n So if you\u2019re going to kick your own voters off of their health care, you\u2019re probably more likely to want to do it after they voted for you again. It is not uniquely cynical. We have seen both parties do similar things over the years, either for budgetary game-playing or for political things. It\u2019s quite notable that this goes into effect in 2029.\u00a0<\/p>\n Ollstein:<\/strong> It\u2019s just interesting that this is getting criticized from both sides. So Democrats are upset that Republicans want to reap the nominal savings but not have to look like the bad guy. And conservative Republicans are upset that this doesn\u2019t kick in sooner, because they want stricter work requirements even sooner to cut the program even more. So it\u2019s pleasing few.\u00a0<\/p>\n Rovner:<\/strong> Well, as Joanne alluded to, it\u2019s not just Medicaid. This bill is also a bit of a stealth assault on the Affordable Care Act, too. Right, Julie? We haven\u2019t talked about it a lot, but this administration seems to be working very hard to make the ACA a lot less effective. And the combination of reductions in Medicaid and changes to the ACA will mean lots more people will be uninsured if this bill becomes law in its current form. Yes?\u00a0<\/p>\n Appleby:<\/strong> There are a lot of moving parts to this. So yeah, let\u2019s back up just briefly and look at March, when the Trump administration did propose their first major rule affecting the Affordable Care Act, and it\u2019s called the Patient Protection and Affordable Care Act; Marketplace Integrity \u2026 it\u2019s a long-name rule. Anyway, it does a bunch of things. For one, it shortens the open enrollment period by about a month. So open enrollment would end on Dec. 15. And notably, this would apply to all states that run their own state-based marketplaces, as well as the federal marketplace. So there\u2019s 16 plus D.C. that do that. So they would all also be tied to this. So that\u2019s one of the things that the rule would do if it\u2019s finalized in its form.\u00a0<\/p>\n It would also end a special enrollment period that allows low-income people to essentially enroll anytime during the year. And people who are automatically reenrolled in a zero-premium plan would instead be charged a $5 premium for reenrollment in that same plan until they confirm their eligibility. Now, the Trump administration says that a lot of these rules are in part to try to combat what they say is fraud and waste, and they point to situations where people are being enrolled without their permission or switched to different plans, generally these zero-premium plans, by unscrupulous brokers who are trying to get commissions.\u00a0<\/p>\n We\u2019ve written a lot about that over the past year. So they\u2019re saying that, Oh, we need to do this so that people know they\u2019ve been enrolled.<\/em> The special enrollment period for low-income people they thought was part of that. That\u2019s disputed by a number of places. And some of the states have pushed back on this, too, and said, Hey, we don\u2019t have this problem with fraud, so why would this now apply to us?<\/em> Why would the special enrollment period, the shortened enrollment period, etc., etc.?<\/em>\u00a0<\/p>\n So those are things in the proposed rule. And the proposed rule acknowledges that it would reduce enrollment by about up to 2 million people in 2026, with coverage losses concentrated in a bunch of states like Alabama, Florida, Georgia, etc. So that\u2019s the proposed rule. And then if you look at the House bill, like, for example, Energy and Commerce, these would codify some of those proposals from that ACA rule. So it would make it harder for a future president to change the rule and that kind of thing.\u00a0<\/p>\n So those things that are codified would be \u2014 there\u2019d be more hoops to jump through to verify income, for one thing. That special enrollment period based on income would be barred, and the shorter enrollment period would be in it. And if this goes through, these changes are set to go into effect next year. So a lot of insurers and states would have to scramble to try to get this put in place by then. So that\u2019s just a short thing about what some of the ACA effects would be.\u00a0<\/p>\n Rovner:<\/strong> So, it feels like there\u2019s kind of a theme here that\u2019s going to make it harder for people to get on and stay on both the ACA and Medicaid. Is that sort of a fair way to describe this?\u00a0<\/p>\n Appleby:<\/strong> Yeah, that\u2019s fair. In the House bills, there are also a lot of things that would bar automatic reenrollment, which a lot of people rely on. People just don\u2019t go back in and sign up for their coverage. They\u2019re automatically reenrolled. The bills differ a little bit. The harshest one would require everybody to sort of verify their income before they can reenroll. There would be a lot more of that. So it would essentially bar reenrollment. And we haven\u2019t even talked about the enhanced tax credits, because that\u2019s also sort of fitting here.\u00a0<\/p>\n Rovner:<\/strong> Which was my, yes, my next question. So there\u2019s been a lot of fighting this week about how many people would lose coverage as a result of this bill, and a lot of it is sort of philosophical fighting. We don\u2019t have final CBO [Congressional Budget Office] numbers yet. We may not have them for another week, I am told. But what we do know is one of the things this bill could do but doesn\u2019t do is re-up those additional subsidies that were installed during the Biden administration, during covid, that basically effectively doubled the number of people who enrolled under the marketplaces, right?\u00a0<\/p>\n Appleby:<\/strong> It certainly added a lot. Most people who get a subsidy are benefiting from the enhanced subsidies. And remember, these sort of expanded at the lower end and it cut off that cliff at 400% of the poverty level that used to exist where you wouldn\u2019t get a subsidy if you made more than that. So it smoothed all that out. So a lot of people are getting these extra subsidies.\u00a0<\/p>\n And a lot of the data I\u2019ve seen have said \u2014 I\u2019m looking at an Oliver Wyman report earlier \u2014 something like, if these enhanced subsidies are allowed to expire at the end of this year, which they\u2019re poised to do unless Congress acts, that, on average, premiums would go up by about 90%. That will be enough to cause a lot of people not to reenroll. So that\u2019s where we\u2019ve seen some of these estimates of I think it\u2019s around 5 million people may not reenroll as a result of that over time.\u00a0<\/p>\n That\u2019s a pretty big number. But like you said, there\u2019s a lot of numbers in the mix, but the enhanced premium subsidies do cost taxpayers. It\u2019s not inexpensive. So if they\u2019re looking for savings, which they are, Congress may decide not to extend them. But at the same time, many people and in a lot of states that are dominated by the GOP and others, people are getting these subsidies, and it would suddenly be a huge hit to many people to have a 90% increase in their premiums, for example.\u00a0<\/p>\n Rovner:<\/strong> Yeah, as Joanne said. Which you\u2019re about to say again, right? These are Republican voters now, right?\u00a0<\/p>\n Kenen:<\/strong> I think that\u2019s more mixed, the upper income within the ACA. We\u2019ve expected that to go away, because there\u2019s a difference between Congress having to yank something away versus something in the law that expires and they have to proactively renew it. We have always anticipated that enhanced subsidies would decline this year. But I just sort of want to point out, during the first Trump administration, without all this coverage, the uninsurance rate rose in the country.\u00a0<\/p>\n And that even before \u201929, there are all sorts of things, with shortened enrollment periods, how much outreach they do, there\u2019s lots of things even before 2029 that we can expect a fairly significant erosion of health coverage. Not to what it was in pre-ACA levels \u2014 it\u2019s not going to be that extreme, and not all the benefits that those of us with employer-sponsored insurance also get, some things through the ACA.\u00a0<\/p>\n So this is not repeal \u2014 it\u2019s damage. And it\u2019s more damage than they did in the first Trump administration. All of us would be extremely surprised if there was not a significant drop in the number of insured Americans one, two years from now.\u00a0<\/p>\n Rovner:<\/strong> One of the ways conservatives hope to secure the votes for this bill in the House is a provision that would bar Planned Parenthood from the Medicaid program. This would certainly be popular in the House. But when it was in the Affordable Care Act repeal bill in 2017, the Senate parliamentarian ruled that it couldn\u2019t be included in budget reconciliation, because it is not primarily budgetary. Alice, are House leaders just hoping no one will remember that?\u00a0<\/p>\n Ollstein:<\/strong> If at first you don\u2019t succeed, try, try again. Yes, I think so. And especially because we just got a new CBO estimate of what the budgetary impact of cutting these funds would be. And it\u2019s, like they have found before, it does not save money. It actually costs the government money because people lose access to contraception and don\u2019t have other sources that they can afford to obtain contraception. And it\u2019s a lot more expensive to have a baby on Medicaid than to access contraception. So I think that also contributes to the parliamentarian problem.\u00a0<\/p>\n Rovner:<\/strong> Yes. You can put stuff in reconciliation that costs money, but that was sort of not the intent here. Joanne, you wanted to say something.\u00a0<\/p>\n Kenen:<\/strong> And we should point out that this is still at the committee level, right? Is it going to get through the House in this exact form? We can\u2019t be sure yet. Is something going to get through the House at the end of the day? Yes. Yes. But is all of this going to get in? Is this the final draft? Probably not. You have moderates who are still, don\u2019t like some of the things in here, and you have conservatives who think it doesn\u2019t go far enough.\u00a0<\/p>\n As we said at the beginning, as far as it does go, it does not go anywhere near as far as the initial, of some of the things that were being discussed, which really would have ended Medicaid as an entitlement. These are big changes. They\u2019re not existential in the same way that a per capita cap or a block grant or blowing up the ACA expansion by changing the rates. There are things they could have done that were far more radical that they don\u2019t have the votes for. And\u2014\u00a0<\/p>\n Rovner:<\/strong> But they still can only lose, what, three or four votes and get something through the House.\u00a0<\/p>\n Kenen:<\/strong> Right. Right. Because Medicaid is actually quite popular, and people in both parties are covered by it. We still don\u2019t know the pathway, what gets through the House at the end of the day. Something does, right? We all think that they will, somehow or other. Not necessarily by Memorial Day, right? But something at some point will get through the House, and we don\u2019t know exactly what it looks like.\u00a0<\/p>\n Rovner:<\/strong> For the record, I\u2019m still shrugging. I think something gets\u2014\u00a0<\/p>\n Kenen:<\/strong> And it is a bigger question mark, you know?\u00a0<\/p>\n Rovner:<\/strong> Which is my next question. What are the prospects for this bill in the Senate? Do we really believe that the very conservative Missouri Republican Josh Hawley would vote against this? He had a piece in The New York Times this week saying, \u201cDon\u2019t Cut Medicaid<\/a>.\u201d\u00a0<\/p>\n Kenen:<\/strong> He\u2019s been really consistent. Have we seen politicians do huge flip-flops in our years of covering Congress and politics? Yes. He\u2019s really out there on this. It\u2019s sort of hard to see how he just says, Whoops, I didn\u2019t really mean it.<\/em> But right now in terms of who\u2019s out there in public, we don\u2019t have a critical mass of people who\u2019ve said they can\u2019t vote for this. But we do know there are provisions in this very extensive bill that some people don\u2019t like. It will go through changes in the Senate.\u00a0<\/p>\n I don\u2019t have a grasp and I don\u2019t think any of us have a grasp on exactly what\u2019s going to change. I think work requirements, depending on what bells and whistles are attached, could get through the Senate. There might be changes like making it a state option or redefining certain things with it. I think there probably are 51 votes for a work requirement of some type in the Senate.\u00a0<\/p>\n That doesn\u2019t mean the way this has been written survives. And there\u2019s just \u2014 these are big cuts. And there\u2019s also, remember, we\u2019re only talking about the health stuff. There\u2019s a lot. There\u2019s energy. There\u2019s all sorts of \u2014 this is a big bill. This is a big, historic bill. There\u2019s lots and lots of hurdles. We all remember that the ACA repeal, it took several tries. It was really harder than expected. It finally got through the House, and it did die in the Senate. So this is not the last word. We don\u2019t have to shut the podcast.\u00a0<\/p>\n Rovner:<\/strong> Yes, long way to go. All right, moving on. Health and Human Services Secretary Robert F. Kennedy Jr. testified before not one but two committees on Wednesday: the House labor, HHS Appropriations subcommittee in the morning and the Senate Health, Education, Labor, and Pensions Committee in the afternoon. And shall we say it didn\u2019t all go swimmingly. Right off the bat, this was the greeting he got from House Appropriations Committee ranking member Rosa DeLauro of Connecticut. DeLauro basically saying, Everything you\u2019re doing is illegal.<\/em>\u00a0<\/p>\n Rep. Rosa DeLauro:<\/strong> Mr. Secretary, this administration is recklessly and unlawfully freezing and stealing congressionally appropriated funds from a wide swath of agencies, programs, and services across the government that serve the American people. And recall that this is a violation of the Constitution.\u00a0<\/p>\n The power of the purse resides with the Congress. It\u2019s Article 1, Section 9, Clause 7. Yourself and President Trump and Elon Musk are attacking health programs to pay for tax cuts for billionaires. And by promoting quackery, we are endangering the health of the American people with pseudoscience, fearmongering, and misinformation.\u00a0<\/p>\n Rovner:<\/strong> If you want to hear more, we did a live recap of the hearings yesterday afternoon. You can find that on KFF\u2019s YouTube page<\/a>. But I want to know what you all took away from the hearings. Joanne, you watched most of them, right?\u00a0<\/p>\n Kenen:<\/strong> I watched a lot of it. I did not watch every minute of both hearings, but I watched enough. And I thought that very first exchange with DeLauro was really striking because she kept saying, over and over and over again she kept saying: Congress appropriated this money. You don\u2019t have the right to not spend it.<\/em> And he kept saying, If you appropriate the money, I will spend it.<\/em> And she said, We have appropriated the money, and you\u2019re not spending it.<\/em> And he said, If you appropriate the money \u2026<\/em>\u00a0<\/p>\n And she explained. What a continuing wrestle. It was like this endless \u2014 well, it wasn\u2019t endless, but it was repeated when she kept saying, We appropriated it,<\/em> and he kept saying, Huh?<\/em> And she actually said the first time sort of under her breath, but the mic picked it up, and then she said it again. She said, \u201cUnbelievable.\u201d She\u2019s not known for understatement, but she said, \u201cUnbelievable.\u201d And then she said it again. \u201cUnbelievable.\u201d So that was sort of \u2014 the rest of the day was sort of there.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I personally found it refreshing that someone finally called out HHS, saying: You know, there was an appropriations bill that got signed by the president, and you are withholding this money. And this is our province. We get to decide how the money is spent. You don\u2019t get to decide how the money is spent.<\/em> The other big headline that came out of this hearing was when Kennedy said that, after being raked over the coals again about his vaccine comments, he said, Well, you shouldn\u2019t be taking medical advice from me.<\/em> And I\u2019m like, isn\u2019t that the job of the HHS secretary?\u00a0<\/p>\n Ollstein:<\/strong> It was very clear that, like in the markups of the bill, Democrats, unless Republicans are willing to cross the aisle and join them, are just left sort of railing against what\u2019s happening and not really having any power to impact it. We did see some Republicans expressing some concern about the cuts that have happened. But unless that turns into real oversight action, real legislative action, I just imagine we\u2019re set up for this to happen again where Congress appropriates and the cuts happen anyway.\u00a0<\/p>\n Rovner:<\/strong> I was surprised at how much Sen. Cassidy, Sen. Bill Cassidy, the chairman of the HELP Committee, didn\u2019t say. He basically said when he voted for Kennedy\u2019s nomination that he was torn. He believes in vaccines. He\u2019s a practicing doctor. He, Cassidy. And he made Kennedy promise that he wasn\u2019t going to change any of these vaccine rules, which he\u2019s already done. And he\u2019s installed anti-vax people at many levels of HHS. And yet Cassidy was incredibly conciliatory in his opening statement.\u00a0<\/p>\n And it was left to Chris Murphy of all people, the firebrand Democrat from Connecticut, to basically be Cassidy\u2019s anger manager. And sort of, he said, \u201cIf I were the chairman \u2026 my head would be exploding,\u201d which I believe is a line that I\u2019ve been saying for the last several months. What\u2019s happening with Cassidy? Do we know? He can\u2019t be happy with what\u2019s happening here.\u00a0<\/p>\n Ollstein:<\/strong> This was well previewed by everything Cassidy has sort of put out publicly since the confirmation hearing. If you track his press releases, they\u2019ve been sort of selectively praising HHS for doing certain things and being silent on the things that we imagine he might not like on the vaccine front. And so that dynamic carried forward right into this hearing, which was the first opportunity for Congress to really grill Kennedy since he\u2019s taken office.\u00a0<\/p>\n And so many people have pointed out that Cassidy is up for reelection. He is facing a primary challenge from the right. He wants to align himself with the Trump administration and with the sort of \u201cMAGA [Make America great Again]\u201d movement. And he has pushed back on accusations that his treatment of Kennedy is influenced by that, but people can draw their own conclusions.\u00a0<\/p>\n Kenen:<\/strong> I also wanted to point out that Kennedy insisted that he hadn\u2019t fired any scientists, and he made that assertion a few times, which I think the Democrats, their jaws collectively dropped in unison. The cuts to NIH [the National Institutes of Health] have been extreme, in the billions. And in addition to the NIH scientists, there are also the ripple effect of training the next generation of scientists, because of the cuts to universities.\u00a0<\/p>\n And also Kennedy, I sort of noticed at one point he was saying something about some universities don\u2019t need this money, but then he mentioned specifically but Maine, where Susan Collins is the chair of the Appropriations Committee of the Senate, and Alabama, where Katie Britt has been, Sen. Katie Britt, has been sort of vocal about this, which is also, people don\u2019t think of or may not realize that University of Alabama is a huge scientific center.\u00a0<\/p>\n It is a powerhouse, but it is a state-funded university without such a big environment. Kennedy said: You know what? We\u2019re going to make these cuts. But maybe not Maine and Alabama.<\/em> It was like \u2014 talk about politics. But I think that they were really floored when he said over and over again that no scientists have been let go.\u00a0<\/p>\n Rovner:<\/strong> You were right. There was also a lot of sort of ad hoc, If you have a particular problem, why don\u2019t you\u2014\u00a0<\/p>\n Kenen:<\/strong> Call my office.<\/em>\u00a0<\/p>\n Rovner:<\/strong> \u2014call my office. <\/em>Yeah. And we can take care of it.<\/em> Which seemed just sort of mind-blowing to me. It\u2019s like, this is how we\u2019re making policy now. And somebody, I meant to go back and look at who, somebody in the morning at the House hearing, one of the Democrats, said, Is there a special phone number for Democrats to call your office to see if we can get some of these cuts restored?<\/em> That literally seems to be how HHS is being run right now.\u00a0<\/p>\n Ollstein:<\/strong> And I think it\u2019s reflected across the government. When Elon Musk was more involved directly with the DOGE [Department of Government Efficiency] stuff, he was reportedly telling Republican senators the same. Oh, if you have an issue, you know, just text me, just call me.<\/em> And folks who study government pointed out that this smacks of the kind of personalism that has defined some authoritarian governments in the past where things happen more through favors than through normal government processes that are more transparent.\u00a0<\/p>\n Kenen:<\/strong> And a phone call from your senator is not how you should be able to get back into a clinical trial. There was also a lot of exchanges about what\u2019s happening to clinical trials and harm to patients, which he was \u2014 there was some gaps there. And you\u2019re watching him saying, Oh yeah, I can get her in. Just, you call me tomorrow. Call my office,<\/em> to Sen. [Patty] Murray. And the state of him asserting that not much has changed and anything we got wrong we\u2019ll fix versus the fact that huge numbers of things have changed that have affected both patients and future patients.\u00a0<\/p>\n One of the Democrats said: What\u2019s wrong with researching cancer and Alzheimer\u2019s, particularly if you\u2019re trying to deal with chronic diseases? These are chronic conditions, and we\u2019re gutting research into them.<\/em> So there was a lot of disconnects. There was some, also\u2014\u00a0<\/p>\n Rovner:<\/strong> It\u2019s not just cuts. They are pushing the \u201cMake America Healthy Again\u201d agenda. Just this week the FDA [Food and Drug Administration] is moving to ban fluoride supplements<\/a> for kids. These are generally drops, tablets, and lozenges prescribed to kids who live in places that don\u2019t have fluoridated water.\u00a0<\/p>\n This move contradicts recommendations from both the CDC [Centers for Disease Control and Prevention] and the U.S. Preventive Health Services Task Force. And RFK was taken to task at the House hearing by Congressman Mike Simpson of Idaho, who\u2019s one of a handful of dentists in the chamber. I have to say I didn\u2019t have eliminating fluoride on my 2025 public health bingo card.\u00a0<\/p>\n Ollstein:<\/strong> Yes. And I think that this is raising concerns for a few reasons. One, the public health impact. This goes against decades of research and evidence and the medical community\u2019s consensus. But this also is moving sort of beyond the personal-choice, medical freedom kind of framing that has been used to argue about fluoridating public water. This is taking away a parent\u2019s choice, potentially. If they want these supplements for their kids, they\u2019re not going to be available any longer. And this is exactly what people fear could extend into the vaccine space. It\u2019s not just that it\u2019s going to not have mandates for schools or rules around that, that it won\u2019t even be an option for the people who want it.\u00a0<\/p>\n
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n\n\t\tPanelists\t<\/h3>\n
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\n\tKFF Health News<\/p>\n
\n\t\t\t\t@Julie_appleby\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n<\/p>\n
\n\tJohns Hopkins University and Politico<\/p>\n
\n\t\t\t\t@JoanneKenen\t\t\t<\/a><\/p>\n
\n\t\t\t\t@joannekenen.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Joanne’s bio.\t\t\t<\/a><\/p>\n<\/p>\n
\n\tPolitico<\/p>\n
\n\t\t\t\t@AliceOllstein\t\t\t<\/a><\/p>\n
\n\t\t\t\t@alicemiranda.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Alice’s stories.\t\t\t<\/a><\/p>\n\n
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