\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 With only a single vote to spare, the House passed a controversial budget bill that includes billions of dollars in tax cuts for the wealthy, along with billions of dollars of cuts to Medicaid, the Affordable Care Act, and the food stamp program \u2014 most of which will affect those at the lower end of the income scale. But the bill faces an uncertain future in the Senate.<\/p>\n Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. released a report from his commission to \u201cMake America Healthy Again\u201d that described threats to the health of the American public \u2014 but notably included nothing on threats from tobacco, gun violence, or a lack of health insurance.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tAnna Edney \t\t\t \t\t\t \t\t\t \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews University of California-Davis School of Law professor and abortion historian Mary Ziegler about her new book on the past and future of the \u201cpersonhood\u201d movement aimed at granting legal rights to fetuses and embryos.<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week they think you should read, too:<\/p>\n Julie Rovner: <\/strong>The Washington Post\u2019s \u201cWhite House Officials Wanted To Put Federal Workers \u2018in Trauma.\u2019 It\u2019s Working<\/a>,\u201d by William Wan and Hannah Natanson.<\/p>\n Alice Miranda Ollstein:<\/strong> NPR\u2019s \u201cDiseases Are Spreading. The CDC Isn\u2019t Warning the Public Like It Was Months Ago<\/a>,\u201d by Chiara Eisner.<\/p>\n Anna Edney:<\/strong> Bloomberg News\u2019 \u201cThe Potential Cancer, Health Risks Lurking in One Popular OTC Drug<\/a>,\u201d by Anna Edney.<\/p>\n Sarah Karlin-Smith:<\/strong> The Farmingdale Observer\u2019s \u201cScientists Have Been Studying Remote Work for Four Years and Have Reached a Very Clear Conclusion: \u2018Working From Home Makes Us Happier,\u2019<\/a>\u201d by Bob Rubila.<\/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: Bill With Billions in Health Program Cuts Passes House\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 Friday, May 23, at 10 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> Anna Edney of Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> And Sarah Karlin-Smith of the Pink Sheet.\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Hello there.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my interview with law professor and abortion historian Mary Ziegler, who has a new book out on the history and possible future of the \u201cpersonhood\u201d movement. But first, this week\u2019s news.\u00a0<\/p>\n So, against all odds and many predictions, including my own, the House around 7 a.m. Thursday morning, after being in session all night, passed President [Donald] Trump\u2019s One Big Beautiful Bill \u2014 that is its actual, official name \u2014 by a vote of 215-214, with one Republican voting present. Before we get into the details of the House-passed bill, what are the prospects for this budget reconciliation bill in this form in the Senate? Very different, I would think.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, this is not going to come out the way it went in. Senate is already openly talking about a \u201c\u2018One, Big Beautiful\u2019 Rewrite\u201d \u2014 that was the headline at Politico<\/a>.\u00a0<\/p>\n And you\u2019re going to see some of the same dynamics. You\u2019re going to see hard-liners saying this doesn\u2019t go far enough, this actually adds a lot to the deficit even with all of the deep cuts to government programs. And you\u2019re going to have moderates who have a lot of people in their state who depend on Medicaid and other programs that are set to be cut who say this goes too far. And so you\u2019re going to have that same push and pull. And the House, barely, by one vote, got this through. And so we\u2019ll see if the Senate is able to do the same.\u00a0<\/p>\n Rovner:<\/strong> Yeah, so all eyes on [Sen.] John McCain in 2017. This year it could be all eyes on Josh Hawley, I suspect, the very conservative senator from Missouri who keeps saying \u201cDon\u2019t touch Medicaid.\u201d\u00a0<\/p>\n But back to the House bill. We don\u2019t have official scores yet from the Congressional Budget Office, and we won\u2019t for a while, I suspect. But given some last-minute changes made to pacify conservatives who, as Alice pointed out, said this bill didn\u2019t cut deeply enough, I think it\u2019s clear that if it became law in this form, it would represent the biggest cuts to federal health programs in the 60-year history of Medicare and Medicaid.\u00a0<\/p>\n Those last-minute changes also took pretty square aim at the Affordable Care Act, too, so much that I think it\u2019s safe to call this even more than a partial repeal of the health law. And Medicare does not go unscathed in this measure, either, despite repeated promises by President Trump on the campaign trail and since he took office.\u00a0<\/p>\n Let\u2019s take these one at a time, starting with Medicaid. I would note that at a meeting with House Republicans on Tuesday, President Trump told them not to expletive<\/em> around with Medicaid. You can go look up the exact quote yourself if you like. But apparently he\u2019s OK with the $700 billion plus that would be cut in the bill, which Republicans say is just waste, fraud, and abuse. Where does that money come from? And would Medicaid really continue to cover everyone who\u2019s eligible now, which is kind of what the president and moderate Republicans are promising?\u00a0<\/p>\n Edney:<\/strong> Well, it sounds like the bulk of it is coming from the work requirements that Alice mentioned earlier. And would it be able to cover them? Sure, but will it? No, in the sense that, as Alice has talked about often on this podcast, it\u2019s basically a time tax. It\u2019s not easy to comply with. All federal regulations, they\u2019re not going to a website and putting in what you did for work. Particularly, if you are a freelancer or something, it can be really difficult to meet all the requirements that they\u2019re looking for. And also, for some people, they just don\u2019t have the ability, even the internet, to be able to do that reliably. So they\u2019re going to save money because people are going to lose their health care.\u00a0<\/p>\n Rovner:<\/strong> I saw a lot of people referring to them this week not as work requirements anymore but as work reporting requirements. Somebody suggested it was like the equivalent of having to file your income taxes every month. It\u2019s not just check a box and say, I worked this month<\/em>. It\u2019s producing documentation. And a lot of people have jobs that are inconsistent. They may work some hours some week and other hours the other week. And even people who work for small businesses, that would put an enormous burden on the employers to come up with all this.\u00a0<\/p>\n Obviously, the CBO thinks that a lot of people won\u2019t be able to do this and therefore people are going to lose their health insurance. But Alice, as you have told us numerous times when we did this in Arkansas, it\u2019s not that people aren\u2019t working \u2014 it\u2019s that people aren\u2019t successfully reporting their work.\u00a0<\/p>\n Ollstein:<\/strong> Right. And we\u2019ve seen this in Georgia, too, where this has been implemented, where there are many different ways that people who are working lose their insurance with this. People who don\u2019t have good internet access struggle. People who have fluctuating work schedules, whether it\u2019s agricultural work, tourism work, things that are more seasonal, they can\u2019t comply with this strict monthly requirement.\u00a0<\/p>\n So there are numerous reports from the ground of people who should be eligible losing their coverage. And I\u2019ll note that one of the last-minute changes the House made was moving up the start date of the requirements. And I\u2019m hearing a lot of state officials and advocates warn that that gives states less time to set up a system where people won\u2019t fall through the cracks. And so the predicted larger savings is in part because they imagine more people will be kicked off the program.\u00a0<\/p>\n Rovner:<\/strong> It\u2019s also the most stringent work requirement we\u2019ve seen. It would cover people from age 19 through age 64, like right up until you\u2019re eligible for Medicare. And if you lose Medicaid because you fail to meet these reporting requirements, you\u2019re no longer eligible for a subsidy to buy insurance in the ACA exchange. Is there a policy point to this? Or are they just trying to get the most people off the program so they can get the most savings?\u00a0<\/p>\n Edney:<\/strong> If you ask Republicans, they would tell you: We\u2019re going to get people back working. We\u2019re going to give them the pride of working<\/em> \u2014 as if people don\u2019t want that on their own. But the actual outcome is not that people end up working more. And there are cases even where they lose their health insurance and can\u2019t work a job they already had. On the surface, and this is why it\u2019s such a popular program, because it seems like it would get more people working. Even a large swath of Democrats support the idea when they just hear the name \u2014 of voters. But the actual outcome, that doesn\u2019t happen. People aren\u2019t in Medicaid because they aren\u2019t working.\u00a0<\/p>\n Rovner:<\/strong> Right. And I get to say for the millionth time, nobody is sitting on their couch living on their Medicaid coverage.\u00a0<\/p>\n Edney:<\/strong> Right, right.\u00a0<\/p>\n Rovner:<\/strong> There\u2019s no money that comes with Medicaid. It\u2019s just health insurance. The health providers get paid for Medicaid and occasionally the managed-care companies. But there\u2019s no check to the beneficiary, so there\u2019s no way to live on your Medicaid.\u00a0<\/p>\n As Alice points out, most of the people who are working and have Medicaid are working at jobs, obviously, that don\u2019t offer employer health insurance. So having, in many cases, as you say, Anna, having Medicaid is what enables you to work.\u00a0<\/p>\n All right, well, our podcast pals Margot Sanger-Katz and Sarah Kliff have an excellent Medicaid story<\/a> out this week on a new study that looks very broadly at Medicaid and finds that it actually does improve the health of its beneficiaries. Now this seems logical, but that has been quite a talking point for Republicans for many years, that we spend all this money and it doesn\u2019t produce better health, because we\u2019ve had a lot of studies that have been kind of neither here nor there on this.\u00a0<\/p>\n Do we finally have proof that Democrats need? Because I have heard, over many years \u2014 there was a big Oregon study in 2011 that found that it helped people financially and that it helped their mental health, but there was not a lot of physical health benefit that they saw. Of course, it was a brief. It was like two years. And it takes a longer time to figure out the importance of health insurance. But I\u2019m wondering if maybe the Democrats will finally be able to put down that talking point. I didn\u2019t hear it, actually, as much this week as I have in years past: Why are we spending all this money on Medicaid when we don\u2019t know whether it\u2019s producing better health?<\/em>\u00a0<\/p>\n Karlin-Smith:<\/strong> One of the interesting things I thought about this study and sort of the timing of it, post-Obamacare expansion of Medicaid and more younger people being covered, is that it seems to really show that, not only does this study show it saves lives, but it\u2019s really helping these younger populations.\u00a0<\/p>\n And I think there are some theories as to why it might have been harder to show the economic cost-effectiveness benefits people were looking for before, when you had Medicaid covering populations that were already either severely ill or older. Which doesn\u2019t mean it\u2019s not valuable, right? To provide health coverage to somebody who\u2019s 75 or 80, but unfortunately we have not found the everlasting secret to life yet.\u00a0<\/p>\n So, but I think for economists who want to be able to show this sort of, as they show in this paper, this \u201cquality-adjusted life year\u201d benefit, this provides some really good evidence of what that expansion of Medicaid \u2014 which is a lot of what\u2019s being rolled back, potentially, under the reconciliation process \u2014 did, which is, helps younger people be healthier and thus, right, hopefully, ideally, live a higher quality of life, and where you need less health coverage over time, and cost the government less.\u00a0<\/p>\n It\u2019s quite interesting, for people who want to go look at the graph The New York Times put in their story, of just where Medicaid fits, in terms of other sort of interventions we spend a lot of money on to help save lives. Because I was kind of surprised, given how much health insurance does cover, that it comes out on sort of the lower end, as being a pretty good bargain.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Well, we don\u2019t have time to get into everything that\u2019s in this bill, and there is a lot. It also includes a full ban of Medicaid coverage for gender-affirming care for both minors and adults. And it cuts reimbursement to states that use their own funds to provide coverage to undocumented people. Is this a twofer for Republicans, saving money while fighting the culture wars?\u00a0<\/p>\n Edney:<\/strong> Certainly. And I was surprised to see some very liberal states on the immigration front saying: We just have to deal with this. And this really sucks, but we have to balance our budget. And if we\u2019re not going to get those tax dollars, then we aren\u2019t going to be able to offer health insurance to people who are undocumented, or Medicaid to people who are undocumented.<\/em>\u00a0<\/p>\n Rovner:<\/strong> Yeah, California, most notably.\u00a0<\/p>\n Edney:<\/strong> Yeah, California for sure. And they found a way to do it, hit them in the pocketbook, and that that\u2019s a way for them to win the culture war, for sure.\u00a0<\/p>\n Rovner:<\/strong> Alice, you\u2019ve spent a lot of time looking at gender-affirming care. Were you surprised to see it banned for adults, too? Obviously the gender-affirming care for minors has been a continuing issue for a while.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, I would say not surprised, because this is sort of a common pattern that we see across different things, including in the abortion space, where first policies are targeted just at minors. That often is more politically palatable. And then it gets expanded to the general population. And so I think, given the wave of state bans on care for minors that we\u2019ve seen, I think a lot of people had been projecting that this was the trajectory.\u00a0<\/p>\n I think that there\u2019s been some really good reporting from The 19th and other outlets about what an impact this would have. Trans people are disproportionately low-income and dependent on Medicaid, and so this would have really sweeping impacts on a lot of people.\u00a0<\/p>\n Rovner:<\/strong> Well, turning to the Affordable Care Act, if you thought Republicans weren\u2019t going to try to repeal the health law this time around, you thought wrong. There are a bucket of provisions in this bill that will make the Affordable Care Act coverage both more expensive and harder to get, so much that some analysts think it could reduce enrollment by as much as half of the 24 million people who have it now. Hasn\u2019t someone told Republicans that many of these people are their voters?\u00a0<\/p>\n Edney:<\/strong> Yeah, that\u2019s a good question. I don\u2019t know what the Republican strategists are telling them. But certainly they needed to save money. And so they found their loopholes and their different things that they thought they could scrape from. And maybe no one will notice? But I don\u2019t think that\u2019s going to happen.\u00a0<\/p>\n A lot of people suddenly have much higher ACA premiums because of the way they\u2019re going to take away this ability that the insurers have had to silver-load, essentially, the way that they deal with the premium tax credits by setting some of the savings, kind of the cost sharing that they need to do, right into the silver plan, because the silver plan is where the premiums are set off of. And so they were able to offer the plans with lower premiums, essentially, but still get paid for cost-sharing reductions. So they were able to still get that money taken away from them.\u00a0<\/p>\n Rovner:<\/strong> So let me see if I can do it. It was, and this was something that Trump tried to do in 2017, that he thought was going to hurt the marketplace plans. And it ended up doing the opposite\u2014\u00a0<\/p>\n Edney:<\/strong> Right.\u00a0<\/p>\n Rovner:<\/strong> \u2014because it basically shifted money from the insurance companies and the beneficiaries back to the federal government, because it made the premium subsidies bigger.\u00a0<\/p>\n So I think the point I want to make is that we\u2019ve been talking all year about these extra subsidies that are going to expire, and that will make premiums go up, and the Republicans did not move to extend those subsidies. But this going back to the government paying these cost-sharing reduction payments is going to basically reverse the accidental lowering of premiums that Trump did in 2017. And therefore, raise them again.\u00a0<\/p>\n So now we have a double whammy. We have premiums going up because the extra subsidies expire, and then we\u2019ll have premiums going up even more because they\u2019re going back to this original cost-sharing reduction. And yet, as we have said many times, a lot of these additional people who are now on the Affordable Care Act are people in the very red states that didn\u2019t expand Medicaid. These are Republican voters.\u00a0<\/p>\n Karlin-Smith:<\/strong> We haven\u2019t talked a lot about the process of how they got this bill through this week. It was incredibly fast and done literally in the dead of night.\u00a0<\/p>\n Ollstein:<\/strong> Multiple nights.\u00a0<\/p>\n Karlin-Smith:<\/strong> So you have to wonder, particularly, if you think back to the last time Republicans tried to overturn Obamacare \u2014 and they did come pretty close \u2014 eventually, I think, that unpalatableness of taking away health care from so many of their own constituents came back to really hurt them. And you do have to wonder if the jamming was in part to make more people unaware of what was happening. You\u2019d still think there\u2019d be political repercussions later down the line when they realize it. But I think, especially, again, just thinking back on all the years when Republicans were saying Democrats were pushing the ACA through too fast and nobody could read the bill, or their CBO scores. This was a much, much faster version of that, with a lot less debate and public transparency and so forth.\u00a0<\/p>\n Rovner:<\/strong> Yeah, they went to the Rules Committee at 1 a.m. Wednesday, so Tuesday night. The Rules Committee went until almost 9 o\u2019clock the next evening, just consecutively. And shout out to Rules Committee chairman Virginia Foxx, who sat there for, I think, the entire time. And then they went straight from rules to the floor.\u00a0<\/p>\n So it\u2019s now Wednesday night at 10 o\u2019clock at night, and then went all the way through and voted, I think, just before 7 a.m. I\u2019ve done a lot of all-nighters in the Capitol. I haven\u2019t seen one that was two nights in a row like this. And I have great admiration for the people who really were up for 48 hours to push this thing through.\u00a0<\/p>\n Well, finally, let\u2019s remember President Trump\u2019s vow not to touch Medicare. Well, Medicare gets touched<\/a> in this bill, too. In addition to restricting eligibility for some legal immigrants who are able to get coverage now, and making it harder for some low-income Medicare beneficiaries to get extra financial help, mostly through Medicaid, the bill as a whole is also likely to trigger a 4% Medicare sequester. Because, even all those other health cuts and food stamp cuts and other cuts don\u2019t pay for all the huge tax breaks in the bill. Alice, you pointed that out. Is there any suggestion that this part might give people some pause, maybe when it gets to the Senate?\u00a0<\/p>\n Edney:<\/strong> I\u2019ve heard the Senate mostly seem upset about Medicaid. And I also feel like this idea that sequestration is coming back up into our consciousness is a little bit new. Like you said, it was pushed through and it was like, Oh, wait, this is enough to trigger sequestration.<\/em> I think it certainly could become a talking point, because Trump said he would not cut Medicare. I don\u2019t think, if senators are worried about Medicaid \u2014 and I think maybe some of us were a little surprised that that is coming from some red-state senators. Medicare is a whole different thing, and in the sense of being even more wildly popular with a lot of members of Congress.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think this whole thing hasn\u2019t, you\u2019re right, sort of seeped into the general consciousness yet. Alice, did you want to say something?\u00a0<\/p>\n Ollstein:<\/strong> Yeah, so a couple things, a couple patterns we\u2019ve seen. So one, there are a lot of lawmakers on the right who have been discrediting the CBO, even in advance of estimates coming out, basically disparaging their methodology and trying to convince the public that it\u2019s not accurate. And so I think that\u2019s both around the deficit projections as well as how many people would be uninsured under different policies. So that\u2019s been one reaction to this.\u00a0<\/p>\n We\u2019ve seen a pattern over many administrations where certain politicians are very concerned about things adding to the deficit when the opposition party is in power. And suddenly those concerns evaporate when their own party is in power and they don\u2019t mind running up the deficit if it\u2019s to advance policies that they want to advance. And so I think, yes, this could bother some fiscal hawks, and we saw that in the House, but I think, also, these other factors are at play.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think this has a long way to go. There\u2019s still a lot that people, I think you\u2019re right, have not quite realized is in there. And we will get to more of it in coming weeks, because this has a long process in the Senate.\u00a0<\/p>\n All right, well, segueing to abortion, the One Big Beautiful Bill also includes a couple of pretty significant abortion provisions. One would effectively ban abortion and marketplace plans for people with lower incomes. Affordable Care Act plans are not currently a big source of insurance coverage for abortion. Many states already ban abortion from coverage in these plans. But this would disrupt one of the big compromises that ultimately got the ACA passed in 2010.\u00a0<\/p>\n The other provision would evict Planned Parenthood from the Medicaid program, even though federal Medicaid funds don\u2019t and never have been used for abortions. Many, many Medicaid patients use Planned Parenthood for routine medical care, including contraception and cancer screenings, and that is covered by Medicaid.\u00a0<\/p>\n But while I see lots of anti-abortion groups taking victory laps over this, when the House passed a similar provision in 2017 as part of its repeal bill, the Senate parliamentarian ruled that it could not go in a budget reconciliation bill, because its purpose was not, quote, \u201cprimarily budgetary.\u201d So is this all for show? Or is there a belief that something different might happen this time?\u00a0<\/p>\n Ollstein:<\/strong> Well, I think there is more interest in ignoring or overruling the parliamentarian among Senate Republicans than there has been in the past. We\u2019re seeing that now on an unrelated environmental issue. And so that could signal that they\u2019re willing to do it more in the future. Of course, things like that cut both ways, and that raises the idea that the Democrats could also do that the next time they\u2019re in power.\u00a0<\/p>\n Rovner:<\/strong> And we should say, that if you overrule the parliamentarian in reconciliation \u2014 it\u2019s a she right now \u2014 when she says it can\u2019t go in reconciliation, that is equivalent to getting rid of the filibuster.\u00a0<\/p>\n Ollstein:<\/strong> Correct.\u00a0<\/p>\n Rovner:<\/strong> So I mean, that\u2019s why both parties say, We want to keep the filibuster.<\/em> But the moment you say, Hey, parliamentarian, we disagree with you and we\u2019re just going to ignore that,<\/em> that has ramifications way beyond budget reconciliation legislation.\u00a0<\/p>\n Ollstein:<\/strong> That\u2019s right. And so that\u2019s been a line that a lot of senators have not been willing to cross, but I think you\u2019re seeing more willingness than before. So that\u2019s definitely something to watch on that. But I think, in terms of abortion, I think this is a real expansion of trends that were already underway, in ever-expanding the concept of what federal dollars going to abortion means. And it\u2019s now in this very indirect way, where it\u2019s reaching into the private insurance market, and it\u2019s using federal funding as a cudgel to prevent groups like Planned Parenthood, and then also these private plans, from using other non-federal money to support abortions. And so it\u2019s a real expansion beyond just you can\u2019t use federal money to pay directly for abortions.\u00a0<\/p>\n Rovner:<\/strong> Well, meanwhile, two other reproductive-associated health stories worth mentioning. In California, a fertility clinic got bombed. The bomber apparently died in the explosion, but this is the first time I can remember a purposeful bombing to a health center that was not an abortion clinic. How significant is it to the debate, that we\u2019re now seeing fertility clinics bombed as well? And what do we know, if anything, about why the bomber went after a fertility clinic?\u00a0<\/p>\n Karlin-Smith:<\/strong> There has been, obviously, some pressure on the right, I think, to go after fertility processes, and IVF [in vitro fertilization], and lump that in with abortion. Although, I think Trump and others have pushed back a bit on that, realizing how common and popular some of these fertility treatments are. And also it conflicts, I think, to some extent with their desire to grow the American population.\u00a0<\/p>\n The motives of this particular person don\u2019t seem aligned with, I guess, the anti-abortion movement. He sort of seems more anti-natalist movement and stuff. So from that perspective, I didn\u2019t see it as being aligned with kind of a bigger, more common political debate we\u2019ve had recently, which is, again, does the Republican Party want to expand the anti-abortion debate even further into fertility treatments and stuff.\u00a0<\/p>\n Rovner:<\/strong> I was going to say, it certainly has drawn fertility clinics into the abortion debate, even if neither side in the abortion debate would presumably have an interest in blowing up a fertility clinic. But it is now sort of, I guess, in the general consciousness of antisocial people, if you will, that\u2019s out there.\u00a0<\/p>\n The other story in the news this week is about a woman named Adriana Smith<\/a>, a nurse and mother from Georgia who was nine weeks pregnant in February when she was declared brain-dead after a medical emergency. Smith has been kept alive on life support ever since, not because her family wants that but because her medical team at Emory University Hospital is worried about running afoul of Georgia\u2019s abortion ban, which prohibits terminations after cardiac activity can be detected. Even if the mother is clinically dead? I feel like this case could have really ominous repercussions at some point.\u00a0<\/p>\n Ollstein:<\/strong> Well, I just want to point out that, yes, the state\u2019s abortion ban is playing a role here, but this was happening while Roe v. Wade<\/em> was still in place. There were cases like this. Some of it has to do with legislation around advanced directives and pregnancy. So I will point out that this is not solely a post-Dobbs<\/em> phenomenon.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think it also bears watching. Well, there was lots of vaccine news this week \u2014 I\u2019m so glad we have Anna and Sarah here \u2014 with both the HHS [Department of Health and Human Services] and FDA [Food and Drug Administration] declaring an end to recommending covid vaccines for what seems to be most of the population. Sarah, what did they do? And what does this mean?\u00a0<\/p>\n Karlin-Smith:<\/strong> So the new director of FDA\u2019s biologics center and the FDA commissioner released a framework for approving covid shots moving forward. And basically they are saying that, because covid, the virus, shifts, and we want to try and update our vaccines at least yearly, usually, to keep up with the changing viruses, but we want to do that in a reasonable time so that by the time when you update the vaccine it\u2019s actually available within that time \u2014 right? \u2014 FDA has allowed companies to do studies that don\u2019t require full clinical trials anymore, because we sort of have already done those trials. We know these vaccines are safe and effective. We\u2019re making minor tweaks to them, and they do immunogenicity studies, which are studies that basically show they mount the proper immune response. And then they approve them.\u00a0<\/p>\n FDA is now, seems to be, saying, We\u2019re only going to allow those studies to approve new covid vaccine updates for people who are over 65, or under 65 and have health conditions, <\/em>because they are saying, in their mind, the risk-benefit balance of offering these shots doesn\u2019t necessarily pan out favorably for younger, healthier populations, and we should do clinical trials.\u00a0<\/p>\n It\u2019s not entirely clear yet, despite them rolling out a framework, how this will actually play out. Can they relabel shots already approved? Will this only impact once companies do need to do a strain change next as the virus adapts? Did they go about doing this in a sort of legal manner? It came out through a journal kind of editorial commentary piece<\/a>, not through the Federal Register or formal guidance. There\u2019s been no notice of comment.\u00a0<\/p>\n So there\u2019s a lot of questions to remain as to how this will be implemented, which products it would affect, and when. But there is a lot of concern that there may be reduced access to the products moving forward.\u00a0<\/p>\n Rovner:<\/strong> That\u2019s because the vaccine makers aren\u2019t going to \u2014 it\u2019s not probably worth it financially to them \u2014 to remount all these studies. Right?\u00a0<\/p>\n Karlin-Smith:<\/strong> First off, a lot of people I\u2019ve talked to, and this came up yesterday at a meeting FDA had, don\u2019t believe it\u2019s actually ethical to do some of the studies FDA is now calling for. Even though the benefits, particularly when you\u2019re talking about boosting people who already had a primary vaccination series for covid, or some covid, is not the same as the benefits of getting an original covid vaccine series.\u00a0<\/p>\n There still are benefits, and there still are benefits for pretty much everybody that outweigh the risks. On average, these are extremely safe shots. We know a lot about their safety, and the balance is positive. So people are saying, once that exists, you cannot ethically test it on placebo. Even as [FDA Commissioner Marty] Makary says, Well, so many Americans are declining to take the shot, so let\u2019s test it and see.<\/em> A lot of ethicists would say it\u2019s actually, even if people are willing to do something that may not be ideal for their health, that doesn\u2019t mean it\u2019s ethical to test it in a trial.\u00a0<\/p>\n So, I think there\u2019s questions about, just, ethics, but also, right, whether companies would want to invest the time and money it would take to achieve and try to do them under this situation. So that is a big elephant in the room here. And I think some people feel like this is just sort of a push by Makary and his new CBER [Center for Biologics Evaluation and Research] director, essentially, to cut off vaccine access in a little bit of a sneaky way.\u00a0<\/p>\n Rovner:<\/strong> Well, I did see, also this week, was I think it was Moderna, that was going to make a combination flu covid vaccine, has decided not to. I assume that\u2019s related to all of this?\u00a0<\/p>\n Karlin-Smith:<\/strong> Right. So Moderna had a, what people call a next-generation vaccine, which is supposed to be an improved update over the original shot, which is a bigger deal than just making a strain change. They actually think they provide a better response to protecting against the virus. And then they also added flu vaccine into it to sort of make it easier for people to get protected from both, and also provided solid data to show it would work well for flu.\u00a0<\/p>\n And they seem to have probably pulled their application at this point over, again, these new concerns, and what we know Novavax went through in trying to get their covid vaccine across the finish line dealing with this new administration. So I think people have their sort of alert lights up going forward as to how this administration is going to handle vaccine approvals and what that will mean for access going forward.\u00a0<\/p>\n Rovner:<\/strong> Well, in somewhat related news, we got the long-awaited report from Health and Human Services Secretary Robert F. Kennedy Jr.\u2019s Make America Healthy Again Commission, which is supposed to lay out a blueprint for an action plan that will come later this summer. Not much in the 68-page report seems all that surprising. Some is fairly noncontroversial, calling for more study of ultra-processed foods and less screen time and more physical activity for kids.\u00a0<\/p>\n And some is controversial but at this point kind of predictable, calling for another look at the childhood vaccine schedule, including, as we just discussed, more placebo studies for vaccines, and also less fluoride available, except in toothpaste. Anything jump out at you guys from the report that we should keep an eye on?\u00a0<\/p>\n Karlin-Smith:<\/strong> I think one thing to think about is what it doesn\u2019t address and doesn\u2019t talk about. It\u2019s not surprising the issues they call out for harming health in America, and some of them are debatable as to how much they do or don\u2019t harm health, or whether their solutions would actually address those problems.\u00a0<\/p>\n But they never talk about the U.S.\u2019 lack of a health insurance system that assures people have coverage. They don\u2019t mention the Republican Party\u2019s and likely president\u2019s willingness to sign onto a major bill that\u2019s going to impact health. They don\u2019t really talk about the socioeconomic drivers that impact health, which I find particularly interesting when they talk about food, because, obviously, the U.S. has a lot of healthy and unhealthy food available. And a lot of people know sort of how they could make better choices, but there are these situational factors outside of, often, an individual\u2019s control to lead to that.\u00a0<\/p>\n And I think the other thing that jumped out to me is, I think The Washington Post<\/a> had a good line in their paragraph about just how many of the points are either overstated or misstated scientific findings. And they did a pretty good job of going through some of those. And it\u2019s a difficult situation, I think, for the public to grapple with when you have leadership and the top echelons of our health department that is pushing so much misinformation, often very carefully, and having to weed out what is correct, where is the grains of truth, where does it go off into misinformation.\u00a0<\/p>\n I don\u2019t know. I find it really hard as a journalist. And so I do worry about, again, how this all plays into public perception and misunderstanding of these topics.\u00a0<\/p>\n Rovner:<\/strong> And apparently they forgot about gun violence in all of this, which is rather notably not there.\u00a0<\/p>\n Ollstein:<\/strong> Cars and guns are the big killers. And yeah, no mention of that.\u00a0<\/p>\n Edney:<\/strong> I thought another glaring omission was tobacco. Kids are using e-cigarettes at high rates. We don\u2019t really know much about them. And to Sarah\u2019s point about misinformation, too, I think the hard part of being able to discern a lot of this, even as a member of the public, is everything they\u2019ve done so far is only rhetoric. There hasn\u2019t been actual regulation, or \u2014 this could be anything that you\u2019re talking about. It could be food dyes. It could be \u201cmost favored nations.\u201d We don\u2019t know what they actually want to implement and what the potential for doing so \u2014 I think maybe on vaccines we\u2019re seeing the most action. But as Sarah mentioned, we don\u2019t know how that, whether it legally is going to be something that they can continue doing.\u00a0<\/p>\n So even with this report, it was highly anticipated, but I don\u2019t think we got anything beyond what I probably heard Kennedy say over and over throughout the campaign and in his bid for health secretary. So I am wondering when they actually decide to move into the policymaking part of it, instead of just telling us they\u2019re going to do something.\u00a0<\/p>\n Rovner:<\/strong> And interestingly, Secretary Kennedy was interviewed on CNN<\/a> last night and walked back some of the timelines, even, including that vow that they were going to know the cause of autism by September and that they were going to have an action plan for this ready in another, I think, a hundred days. So this is going to be a hurry-up-and-wait.\u00a0<\/p>\n All right, well, that is as much news as we have time for in this incredibly busy week. Now we will play my interview with law professor and abortion historian Mary Ziegler, and then we will come back and do our extra credits.\u00a0<\/p>\n I am pleased to welcome back to the podcast Mary Ziegler, the Martin Luther King Jr. professor of law at the University of California-Davis. She\u2019s also a historian of the abortion movement. And her newest book, just out, is called \u201cPersonhood: The New Civil War Over Reproduction.\u201d\u00a0<\/p>\n Mary Ziegler, thanks for joining us again.\u00a0<\/p>\n Mary Ziegler:<\/strong> Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So we\u2019ve talked about personhood a lot on our podcast, including with you, but it means different things to different people. What\u2019s your working definition, at least for the purpose of this book?\u00a0<\/p>\n Ziegler:<\/strong> Yeah, I\u2019m interested in this book in the legal fight for personhood, right? Some people have religious ideas of personhood. Bioethicists have ideas of personhood. Philosophers debate personhood. But I\u2019m really interested in the legal claim that the word \u201cperson\u201d in the 14th Amendment, which gives us liberty and equality, applies the moment an egg is fertilized. Because it\u2019s that legal claim that\u2019s had a lot of knock-on effects with abortion, with IVF, and potentially even beyond.\u00a0<\/p>\n Rovner:<\/strong> So if we as a society were to accept that fetuses or embryos or zygotes were people with full constitutional rights at the moment of creation, that can impact things way beyond abortion, right?\u00a0<\/p>\n Ziegler:<\/strong> Definitely, yeah, especially if you make the moves that the anti-abortion movement, or the pro-life movement, in the United States has made, right? So one of the other things that\u2019s probably worth saying is, if you believe the claim I laid out about fetal personhood, that doesn\u2019t mean you necessarily think abortion should be criminalized or that IVF should be criminalized, either.\u00a0<\/p>\n But the people who are leading the anti-abortion movement do, in large part, right? So it would have ramifications in lots of other contexts, because there\u2019s a conclusion not only that human life begins at fertilization and that constitutional rights begin at fertilization but that the way you honor those constitutional rights is primarily by restricting or criminalizing certain things that threaten that life, in the views of the people who advocate for it.\u00a0<\/p>\n Rovner:<\/strong> Right. And that includes IVF and forms of contraception. That\u2019s where we sort of get to this idea that an abortion is murder or that, in this case, doing anything that harms even a zygote is murder.\u00a0<\/p>\n Ziegler:<\/strong> Yeah. And it gets us to the Adriana Smith case in Georgia, too. So there\u2019s sort of end-of-life cases that emerge. So, it obviously would have a big impact on abortion. So it\u2019s not wrong to think about abortion in this context. It\u2019s just that would definitely not be the stopping point.\u00a0<\/p>\n Rovner:<\/strong> So, many people have only talked about personhood, really, since the Supreme Court overturned Roe<\/em> in 2022, but the concept is a lot older than that. I started covering personhood in like 2010, I think, when a couple of states were trying to vote on it. I didn\u2019t realize until I read your book that it goes back well beyond even that.\u00a0<\/p>\n Ziegler:<\/strong> Yeah. So I think a lot of people had that conception. And in the 2010s, there were state constitutional amendment efforts to write the idea of fetal personhood into state constitutions. And they all failed. So I think the narrative coming out of that was that you had the anti-abortion movement on the one hand, and then you had this more extreme fetal personhood movement on the other hand.\u00a0<\/p>\n And that narrative fundamentally is wrong. There is no one in the anti-abortion movement who\u2019s opposed to fetal personhood. There are disagreements about how and when it can be recognized. There\u2019s strategic disagreements. There are no substantive disagreements much to speak of on the basics of fetal personhood.\u00a0<\/p>\n So the idea goes all the way back to the 1960s, when states were first reforming the 19th-century criminal laws you sometimes see coming back to life as zombie laws. And initially it started as a strategic necessity, because it was very hard for the early anti-abortion movement to stop this reform wave, right? They were saying things like, Oh, abortion is going to lead to more sexual promiscuity,<\/em> or, No one really needs abortion, because pregnancy is no longer dangerous<\/em>. And that just wasn\u2019t getting the job done.\u00a0<\/p>\n So they began to argue that no one had a choice to legalize abortion in worse circumstances, because it would violate the rights of the unborn child. What\u2019s interesting is that argument went from being this kind of strategic expedient to being this tremendously emotionally resonant long-term thing that has lived on the American right for now like a half-century. Even in moments when, I think arguably like right now, when it\u2019s not politically smart to be making the argument, people will continue to, because this speaks to something, I think, for a lot of people who are opposed to abortion and other things like IVF.\u00a0<\/p>\n Rovner:<\/strong> I know you\u2019ve got access in writing this book to a lot of internal documents from people in the anti-abortion movement. I\u2019m jealous, I have to say. Was there something there that surprised you?\u00a0<\/p>\n Ziegler:<\/strong> Yeah, I think I was somewhat surprised by how much people talked this language of personhood when they were alone, right? This was not just something for the consumption of judges, or the consumption of politicians, or sort of like a nicer way to talk about what people really wanted. This was what people said when there was no one else there.\u00a0<\/p>\n That didn\u2019t mean they didn\u2019t say other things that suggested that there were lots of other values and beliefs underlying this concept of personhood. But I think one of the important lessons of that is if you\u2019re trying to understand people who are opposed to abortion, just assuming that everything they\u2019re saying is just pure strategy is not helpful, right? Any more than it would be for people who support reproductive rights, to have it assume that everything they\u2019re saying is not genuine. You just fail to understand what people are doing, I think. And I think that was probably what I was the most surprised about.\u00a0<\/p>\n Rovner:<\/strong> I was struck that you point out that personhood doesn\u2019t have to begin and end with the criminalization of abortion. How could more acceptance of the rights of the unborn change society in perhaps less polarized ways?\u00a0<\/p>\n Ziegler:<\/strong> Yeah, one of the things that\u2019s really striking is that there are other countries that recognize a right to life for a fetus or unborn child that don\u2019t criminalize abortion or don\u2019t enforce criminal abortion laws. And often what they say is that it\u2019s not OK for the state to start with criminalization when it isn\u2019t doing things to support pregnant women, who after all are necessary for a fetus or unborn child to survive, right?\u00a0<\/p>\n So there are strategies that you could use to reduce infant mortality, for example, to reduce neonatal mortality, to reduce miscarriage and stillbirth, to improve maternal health, to really eliminate some of the reasons that people who may want, all things being equal, to carry a child to term. That\u2019s not, obviously, going to be everybody. Some people don\u2019t want to be parents at all.\u00a0<\/p>\n But there are other people for whom it\u2019s a matter of resources, or it\u2019s a matter of overcoming racial discrimination, or it\u2019s a matter of leaving an abusive relationship. And if governments were more committed to doing some of those things, it\u2019s reasonable to assume that a subset of those people would carry pregnancies to term, right?\u00a0<\/p>\n So there are lots of ways that if a state were serious about honoring fetal life, that it could. I think one of the other things that\u2019s striking that I realized in writing the book is that that tracks with what a subset of Americans think. You\u2019ll find these artifacts in polls where you\u2019ll get something like 33% of people in Pew Forum\u2019s 2022 poll saying they thought that life and rights began at conception, but also that abortion shouldn\u2019t be criminalized.\u00a0<\/p>\n So there are a subset of Americans who, whether they\u2019re coming from a place of faith or otherwise, can hold those two beliefs at once. So I think an interesting question is, could we have a politics that accommodates that kind of belief? And at the moment the answer is probably not, but it\u2019s interesting to imagine how that could change.\u00a0<\/p>\n Rovner:<\/strong> It\u2019s nice to know that there is a place that we can hope to get.\u00a0<\/p>\n Ziegler:<\/strong> Yeah, exactly.\u00a0<\/p>\n Rovner:<\/strong> Mary Ziegler, thank you so much for joining us again.\u00a0<\/p>\n Ziegler:<\/strong> Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> OK, we\u2019re back. And now it\u2019s time for our extra-credit segment. That\u2019s where we each recognize a story we read this week we think you should read, too. Don\u2019t worry if you miss it. We will put the links in our show notes on your phone or other mobile devices. Sarah, you chose first this week. You go first.\u00a0<\/p>\n Karlin-Smith:<\/strong> I purposely chose a sort of light story from Australia, where scientists studied remote work, and the headline is \u201c[Scientists Have Been Studying Remote Work for Four Years and Have] Reached a Very Clear Conclusion: \u2018Working From Home Makes Us Happier.\u2019<\/a>\u201d And it just goes through some of the benefits and perks people have found from working remotely, including more sleep, more time with friends and family, things like that. And it just felt like a nice, interesting read in a time where there\u2019s a lot of heavy health news.\u00a0<\/p>\n Rovner:<\/strong> Also, scientific evidence of things that I think we all could have predicted. Anna.\u00a0<\/p>\n Edney:<\/strong> Apologies for going the other direction here, but it\u2019s a story that I wrote this week, an investigation that I\u2019ve been working on for a long time, \u201cThe Potential Cancer, Health Risks Lurking in One Popular OTC Drug<\/a>.\u201d So this is one, in particularly a lot of women have used. You can go in any CVS, Target, Walmart, stores like that, and buy it. Called Azo, for urinary tract infections. And all these stores sell their own generic versions as well, under phenazopyridine.\u00a0<\/p>\n And this drug, I was kind of shocked to learn, is not FDA-approved. There are prescription versions that are not FDA-approved, either. It\u2019s just been around so long that it\u2019s been grandfathered in. And that may not be a big deal, except that this one, the FDA has raised questions about whether it causes cancer and whether it needs a stronger cancer warning, because the National Cancer Institute found in 1978 that it causes tumors in rats and mice. But no other work has been done on this drug, because it hasn\u2019t been approved. So no one\u2019s looked at it in humans. And it masks issues that really need antibiotics and causes a host of other issues.\u00a0<\/p>\n There were \u2014 University of Virginia toxicologists told me they found, in the last 20 years, at least 200 suspected teen suicides where they used this drug, because of how dangerous this drug can be in any higher amounts than what\u2019s on the box. So I went through this drug, but there are other ones on the market as well that are not approved. And there\u2019s this whole FDA system that has allowed the OTC [over-the-counter] market to be pretty lax.\u00a0<\/p>\n Rovner:<\/strong> OK, that\u2019s terrifying. But thank you for your work. Alice.\u00a0<\/p>\n Ollstein:<\/strong> Speaking of terrifying, I chose a piece from NPR called, \u201cDiseases Are Spreading. The CDC Isn\u2019t Warning the Public Like It Was Months Ago.<\/a>\u201d And this is a look at all of the ways our public health agency that is supposed to be letting us know when outbreaks are happening, and where, and how to protect ourselves, they\u2019ve gone dark. They are not posting on social media. They are not sending out alerts. They are not sending out newsletters. And it walks through the danger of all of that happening, with interviews with people who are still on the inside and on the outside experiencing the repercussions.\u00a0<\/p>\n Rovner:<\/strong> Well, my extra credit, it helps explain why Alice\u2019s extra credit, because it\u2019s about all the people who were doing that who have been fired or laid off from the federal government. It\u2019s called, \u201cWhite House Officials Wanted To Put Federal Workers \u2018in Trauma.\u2019 It\u2019s Working<\/a>,\u201d by William Wan and Hannah Natanson.\u00a0<\/p>\n And it\u2019s the result of interviews with more than 30 current and former federal workers, along with the families of some who died or killed themselves. And it\u2019s a review of documents to confirm those stories. It\u2019s a super-depressing but beautifully told piece about the dramatic mental health impact of the federal DOGE [Department of Government Efficiency] layoffs and firings, and the impact that that\u2019s been having on these workers, their families, and their communities.\u00a0<\/p>\n OK, that is this week\u2019s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review. That helps other people find us, too. Thanks to our fill-in editor this week, Rebecca Adams, and our producer, Francis Ying. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org. Or you can find me on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you guys hanging these days? Anna?\u00a0<\/p>\n
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