The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Oct. 1 is the start of the next fiscal year, and unless Congress reaches agreement on continued spending, big parts of the government could shut down that day. Democrats, whose votes will be needed in the Senate, would like Republicans to extend the Biden-era extra tax credits for Affordable Care Act insurance plans as part of a compromise, but so far Republicans don’t seem willing.
Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. released his much-anticipated “Make America Healthy Again” blueprint to improve children’s health, but the report contained few specifics on how his goals would be reached.
This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Sandhya Raman of CQ Roll Call, and Lauren Weber of The Washington Post.
Panelists
Anna Edney
Bloomberg News
Sandhya Raman
CQ Roll Call
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- Congress has less than three weeks to approve federal government spending for the new fiscal year and avert a shutdown. Democrats are pushing for the legislation to include an extension of enhanced subsidies for those covered by ACA plans, which otherwise will expire at the end of the year and contribute to an increase in premium costs. But that proposal is already getting bogged down in longtime fights over abortion funding.
- The Department of Health and Human Services is expected to cite the use of Tylenol during pregnancy in a pending report on the causes of autism — despite a lack of definitive scientific evidence. And the remade Advisory Committee on Immunization Practices is scheduled to meet next week, while some Americans are struggling to access the covid vaccine.
- The lack of teeth in the MAHA report — along with the White House’s lengthy review before publication — suggests industry officials helped shape the final product. Plus, its calls for things like healthier meals in schools and hospitals amid federal funding cuts raise an important question: Who will pay for these policy changes?
- And the Trump administration is seeking changes to federal regulations on pharmaceutical advertising that could effectively kill drug ads on television, though free-speech rights could complicate that effort.
Plus, for “extra credit” the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:
Julie Rovner: NPR’s “What Kind of Dairy Does a Body Good? Science Is Updating the Answer,” by Will Stone.
Anna Edney: Bloomberg News’ “The Implants Were Supposed to Dissolve. They Didn’t,” by Anna Edney and Tanaz Meghjani.
Sandhya Raman: The Texas Tribune’s “Texas’ New Parental Consent Law Leaves School Nurses Confused About Which Services They Can Provide to Students,” by Jaden Edison.
Lauren Weber: ProPublica’s “‘Just Let Me Die,’” by Duaa Eldeib.
Also mentioned in this week’s podcast:
click to open the transcript
Transcript: Countdown to Government Shutdown
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Sept. 11, 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 are joined via videoconference by Anna Edney of Bloomberg News.
Anna Edney: Hey, everybody.
Rovner: Lauren Weber of The Washington Post.
Lauren Weber: Hello, hello.
Rovner: And Sandhya Raman of CQ Roll Call.
Sandhya Raman: Hello, everyone.
Rovner: No interview this week, but plenty of news. So let us dive right in. As of today, we are less than three weeks away from a government shutdown if Congress can’t pass all 12 spending bills — spoiler, that is not going to happen — or pass some sort of continuing resolution to keep the government funded while lawmakers continue working on the spending bills. Now, even though Republicans control the House, Senate, and the White House, it will take Democratic votes, at least in the Senate, to make any of this happen, because appropriations bills, unlike that budget reconciliation bill that passed earlier this summer, require 60 votes to pass rather than just 51. So how’s it all going, appropriations watchers? Sandhya, you’re there on the Hill.
Raman: It’s a work in progress. You know, I think there are a lot of different options kind of being floated around right now to try to avoid a government shutdown. So something our budget reporters reported yesterday is that House Republican leaders are trying to bring a clean CR to the floor next week, so the same spending levels that we have now through late November, early December. But that would include the ACA [Affordable Care Act] subsidy extension that the Democrats want.
There’s also, in the works right now, they’re voting as we speak, kind of, in the House on advancing three of the spending bills, but not HHS [the Department of Health and Human Services] and maybe attaching a clean CR for the rest to that. And whether or not that could eventually include something else that the Democrats want is unclear. Or it’s still in play where just now Democrats were speaking about how they want a very bipartisan — they won’t come to the table unless they’re getting their voice at the table. So it’s unclear if any of these three options are going to happen, just because so much is in flux right now and we’re still a couple weeks out from their deadline. And you know how Congress can be about this.
Rovner: Yes, three whole weeks — why should they do anything? Let’s talk about those ACA subsidies for a minute. We talked about them last week. Republicans are finally realizing that if they don’t extend the Biden-era tax credits that it’s going to be a lot of their voters who are going to see these sort of eye-popping premium increases. And the Democrats would like to sort of do a deal, but so far I’ve seen Republicans saying, Nope, not going to happen. At least not as part of this, keep-the-government-open continuing resolutions. That where they still are?
Raman: I think it depends on who you talk to. When you talk to some of the more hard-line Republicans, they just don’t want this continued. It’s something that you have to offset with a lot of money, and so they’re not on board at all. There are some of the more moderate Republicans in the House that have signed onto a bill last week that would extend it for a little bit, and so others have been a little bit more wishy-washy. But where they fall, I think that complicates things. We also have a new breakdown in the House right now where the Republicans only have a two-person majority, so it just makes it even more narrow for them to get something across if not everyone is aligned on this.
Rovner: And of course, because this is the Affordable Care Act we’re talking about, we’re going to have an abortion fight with this too, right?
Raman: You know I was just saying earlier that everything old is new again, that anytime that we get into this, we get into the debate of whether or not we include some sort of Hyde Amendment kind of language to say no federal funding for abortion except in rare circumstances. And so the anti-abortion groups have signed on and said, You should not support any sort of ACA subsidy extension that doesn’t have that language. Some of the Democrats have already come out saying that that’s a no-go. In the past, generally when we’ve had funding for health care, either if it’s in the approps cycle or something separate, there has been that language, so I’m not sure where that will land if they get to an extension. Just 15 minutes or so ago, House and Senate Democrats had said they really want to get to a bipartisan deal, but they didn’t kind of draw a line in the sand that if the ACA subsidies weren’t in whatever spending deal we get in the next few weeks that that would be a deal-breaker. So it’s complicated in terms of where the cards may land in the next few weeks.
Rovner: Long way to go.
Raman: Yeah.
Rovner: Well, meanwhile, the House Appropriation Committee this week approved its version of the bill that would fund the Department of Health and Human Services along with the Departments of Labor and Education. The House committee bill cuts HHS funding, but by far less than the Trump administration had asked, but still by a lot more than the more bipartisan bill approved by the Senate Appropriations Committee just before they left for the August recess. What is the outlook for HHS funding going forward?
Raman: I don’t think that we’ll see, whenever we get to some sort of deal, something super close to what we had advanced by House appropriators today, but I also don’t think that we’re going to see something identical to what the Senate did before recess. My guess would be a little bit more aligned with what the Senate did. They’re both run by Republicans, but that one did get, in the Senate, bipartisan support, and since they do need Democrats to pass it in the Senate, I could see it being a little bit more aligned there.
The Senate one had slightly higher spending and didn’t have as many of the new riders as in the House related to abortion and trans health and things like that. But we are in kind of a weird circumstance in that, earlier this year, instead of doing new funding, they renewed funding at the same level as last year for another year. So that’s also a possibility, which is not something that happens super often, in the past, and I don’t really see we’re getting a lot happening in either chamber until we get kind of a deal, just because they don’t have an agreement on any of the other funding really, either.
Rovner: One of the things that we do see particularly appropriators complaining about with, and we’ve talked about this, is this whole pocket rescission thing, the idea that they’ve appropriated this money, they’ve gotten a deal to pass this spending, Congress is supposed to be in charge of spending, and the administration isn’t spending money that’s been appropriated. Is there some possibility of putting in some kind of You must spend this money guarantee, or at least an effort to make a guarantee, in one of these bills? Or are they just sort of tiptoeing around this?
Raman: They’ve kind of tiptoed around that. I mean, they’re supposed to spend money. If they don’t, they can have the impoundment issues that they’ve had this year where they aren’t spending the money and get told that you’re violating the Impoundment Act, but that hasn’t seemed to stop some of these cases. I think there’s also a lot of things happening in this that haven’t happened before. We’ve had Russell Vought just kind of say that appropriations should be less of a bipartisan process than it has been. So I’m not sure if even adding that kind of language would necessarily mean that that wouldn’t happen or there wouldn’t be different ways around that.
Rovner: And of course, Russell Vought, the head of OMB [the Office of Management and Budget], is just itching to take this to the Supreme Court so that they can say that the Impoundment Act is illegal and that the administration can decide whether or not it wants to spend money that Congress has appropriated, which is obviously something that we will get to at some point with the Supreme Court, but I think we’re not quite there yet.
Well, moving on, the fallout continues from efforts at the Department of Health and Human Services to translate Secretary Robert F. Kennedy Jr.’s anti-vaccine views into policy. We now know that the ousted director of the Centers for Disease Control and Prevention, Susan Monarez, is scheduled to testify before the Senate HELP [Health, Education, Labor, and Pensions] Committee next week. That’s the committee chaired by Sen. Bill Cassidy, the Republican doctor who cast the deciding vote to confirm Kennedy back in the winter. The meeting of the CDC’s advisory committee on vaccines is also scheduled for next week. Do we know if that’s going to happen? I know several officials, including Cassidy, have called on it to be postponed. Anna, are you planning for it to take place?
Edney: I think, so far, planning for it to take place, but maybe not so sure what they’re going to discuss and whether the covid vaccines will be something that they’ll vote on, at least, because that’s what a lot of people are waiting on. That’s what has caused a lot of confusion is that the FDA [Food and Drug Administration] gave its limited approval to some of these, and then we haven’t heard ACIP’s [the Advisory Committee on Immunization Practices’] vote on that, or it hasn’t been held. And so insurers are finding ways not to cover those vaccines for some people, and people are confused whether they can get them. Pharmacies in some states need prescriptions to be able to give them out. So there’s just a lot of confusion around and people — the middle of September is already late, and so people were hoping, at least people who are interested and, once the confusion cleared up, were hoping that this will come up. But no indication for sure yet.
Rovner: One of Kennedy’s most stubborn pushbacks at last week’s hearing at the Senate Finance Committee was that he has not prevented people from getting the covid vaccine. Except in the ensuing days we’ve seen story after story about people who should be eligible for covid boosters but still haven’t been able to get them or, and as you said, haven’t been able to get them covered by insurance, even in some states where governors have tried to intervene to make them more available. I had a note from a friend in Oregon whose 80-plus-year-old husband couldn’t get the vaccine. I mean, obviously over 65 and couldn’t get a prescription from his doctor to get the vaccine because — and, of course, one of those states that doesn’t have MinuteClinics where you can go and get a nurse practitioner to give you the vaccine. I mean, what are you guys hearing about people’s ability to actually get this vaccine? We’ve now been sort of conditioned to: OK. it’s September. Kids are back to school. We should go and get our flu shots and our covid boosters.
Edney: Yeah, I think that Secretary Kennedy had said everyone can get it, and maybe there’s a tiny kernel of truth in there in the sense that if you knew all the work-arounds you could do it. Maybe you could find a way to get someone to put the shot in your arm. Who would pay for it, though? I mean, we’ve heard of people postponing because they’re hoping that insurance will cover it. They’d rather not pay $200. So essentially this is causing a lot of people to gamble with their health because they’re hoping in the next few weeks they don’t get covid while they’re waiting on insurance to possibly cover it and on direction.
So it’s not true that just anyone can get it if they want to, I don’t think, or those aren’t the stories that I’m reading, that I’m seeing, or even hearing. There was a colleague, actually, she had an interesting story. Her husband had, instead of signing up on the website for a pharmacy, because you have to answer the questions if you have any preexisting conditions, a lot of people don’t if they’re under 65. He just walked in and he said: Well, the pharmacist didn’t ask me anything there. They just gave it to me. So, I mean, people are finding ways, but it doesn’t mean that everyone can do it or pay for it.
Rovner: I feel like Kennedy has sort of conflated the I didn’t ban it with the Everybody can get it. Those are two very different things. Lauren, yes.
Weber: I mean, Kennedy also has previously said that the covid vaccine is the deadliest vaccine ever made and then claimed that [President Donald] Trump should get the Nobel Peace Prize for Operation Warp Speed. So there is a lot of dissonance between the secretary’s statements and sometimes with the reality.
Rovner: And I will note, actually going back to our budget discussion, that there was a bipartisan amendment at the House Appropriations Committee to restore the money for mRNA vaccine research that Kennedy cut. Who knows whether we’ll ever see that into law, but I was interested to see that Republicans joined with Democrats to sort of push back at that.
Edney: Yeah, I think mRNA has a lot of applications beyond vaccines that even hard-line anti-vaxxers could see. Is curing cancer a good idea, or treating it? I mean, it has a lot of other things that mRNA really is meant for.
Rovner: Yeah, and also the speed with which, I mean, that was what made Operation Warp Speed work was the speed with which you can actually make vaccines using the mRNA technology. Well, now, apparently, at least according to The Wall Street Journal, HHS is planning to link Tylenol taken in pregnancy to the rise of autism. Just the story appearing on the website tanked the stock of the drugmaker that makes Tylenol last week and has prompted quite the pushback from doctors and researchers as well as drugmakers. What do we know about the links between Tylenol, acetaminophen, and autism?
Edney: I think what we know is that there are mixed results in studies out there, that no one has definitively linked it. No one has definitively, either way. I think there’s sort of confusion. But the big study that they’re using out of Harvard to kind of say that Tylenol use during pregnancy causes autism, even the study’s authors say: That’s not what we were saying. We were saying that there is an association, but that doesn’t mean causation. I think that’s something we always come back to when we’re talking about studies. And in this sense, I think it’s unfortunate that the discussion is happening without more definitive answers.
Because when you’re talking about pregnancy, and if acetaminophen is the only thing a pregnant woman can take when she has a very high fever, then high fever can cause a lot of problems as well, and you’re scaring women off from, even, it can cause birth defects if the fever is high enough. The March of Dimes actually says there is concern that a high fever during pregnancy in the first trimester is linked to autism. So you just have this circle that nobody actually has any answers, and unfortunately I don’t anticipate that the autism report is going to provide them. It might provide more fear for pregnant women.
Rovner: Lauren, you want to add something
Weber: Yeah, I mean, Robert F. Kennedy Jr. has promised to have the cause of autism by September, which, many medical experts and autism researchers have cautioned, seems like that may not be a complete report, as this is something that has been examined for many years and it seems to be multifaceted. But I think it’s worth noting that in the lead-up to this report being due, we at The Washington Post, in looking at MAHA influencers, noticed that Tylenol has been 15 times more likely to be mentioned by these influencers in August as opposed to April. So there seems to be a lot of MAHA contingent around the Tylenol hypothesis that also potentially could be driving some of this, but we’ll see what happens when we see more of the report.
Rovner: So where exactly is President Trump on this whole vaccine issue? On the one hand, he’s been pro-vaccine in some of the comments that he’s made since Kennedy’s confrontational appearance last week at the Finance Committee. But he also posted on, he the president, also posted on his social media a video pushing the long-since discredited accusation that autism is linked to the vaccine preserved with thimerosal, which hasn’t even been in most childhood vaccines for the last two decades. I feel like the president’s kind of walking this fine line waiting to see which way public opinion falls.
Weber: I think that’s right, Julie. I think also we have to go back. The president has a history of making vaccine-skeptical comments. I mean, in presidential debates he’s asked questions about vaccines being too big for a horse for children. I mean, he’s said, certainly, things that are of vaccine-skeptical rhetoric. That said, I think he and others have seen polling recently that shows that vaccines are overwhelmingly popular. The vast majority of Americans do vaccinate their children, and while he is conscious that Kennedy and the MAHA movement brought him voters, I think he’s maybe being counseled by others that he could lose voters if he goes too far. So if anything, the man has a shrewd assessment of what’s going to win him political points. So it seems to me that it’s a messaging to both sides of the fence and it’s kind of a You pick the message you want to hear so you can stay in the tent kind of vibe is how I am interpreting it.
Rovner: Yeah, that’s my impression, too. And as we know, he’s very good at being on all sides of an issue until he actually has to come down one way or the other. Well, there was a lot more from the Department of Health and Human Services this week than just vaccine news. Secretary Kennedy issued the second part of his long-awaited Make America Healthy Again strategy to improve children’s health. It didn’t mention some of the biggest threats that we know about for children’s health, like gun violence, climate change, or tobacco. It did mention things Kennedy has talked about a lot, like exposure to chemicals and ultraprocessed food, but it didn’t really lay out concrete plans for how the administration plans to address those concerns. So what does this report say? And do we think it got watered down by the White House? Do we think it might’ve been stronger at some point?
Edney: I think with what I saw with the report when I read the report is sort of a list of a lot of the things that Kennedy would like to focus on that he sees as the biggest threats to children. Although it got watered down, I think, for sure throughout this process and certainly potentially as the White House held it for about a month or so from coming out. But a lot of people have made the point that Kennedy had to work with the heads of the EPA [Environmental Protection Agency] and the Agriculture Department on this, who are in many ways more aligned with the chemical companies and the big farmers than Kennedy himself might be or had wanted to be in this.
So you kind of lost any ability to maybe go after chemicals in the food supply or things like that. And so there weren’t a lot of concrete things that it would do or ways forward, which I would expect in a large administration report like this is kind of more of the next steps, not just the list of what’s going on. And I imagine we’ll talk about it, but there was one piece in that with drug ads that it kind of simultaneously came out with the report.
Rovner: Yes, we’ll get to that next.
Edney: Yeah, so I assume we’ll talk about that. So maybe they have some plans on some things that we just don’t know about yet. But I think that that has, for me, been a struggle in covering and watching this administration is there’s been a lot of talk and it’s hard to know what the rhetoric is versus what is actually being done. And I kind of see that continuing, and even with drug ads, when we talk about that and get there.
Rovner: Yeah. Lauren, you’ve obviously been following the MAHA movement pretty closely. What was your take from this report?
Weber: Well, my takeaway from this report is I was fascinated there were no footnotes, so there could be no AI conversation like the last time we talked about this on the podcast. But no, my other takeaway was, clearly, as Anna pointed out, it seems like industry influence had watered down some of the big pushes of the MAHA movement around pesticides. And I also, my biggest takeaway is: Who’s paying for all of this? I mean, they promised healthy, nutritious foods in schools, VAs [Department of Veterans Affairs facilities], hospitals. These are things that nutritionists have wanted for a very long time. There was talk of MAHA boxes. Where’s the funding? I mean, as far as I understand, all the funding’s getting cut everywhere I turn around. So I’m curious where the funding for this transformation of America’s health care is coming from. And I also think it’s worth noting that in there there was a conversation around some pet projects among folks that are involved in the Trump administration. I’m very curious. Right now it was basically a bullet points with no action plan. So as Anna smartly pointed out: When will the rhetoric become reality? We shall see.
Raman: I was just going to agree with Lauren. That was kind of exactly my takeaway is that if you’re calling for more research and this and this and then the White House at the same time, when they put out their budget proposal, they called for a 40% decrease in NIH [National Institutes of Health] funding. It just seems counterintuitive. And even thus far in the appropriations process, the Senate didn’t even have money for MAHA in theirs. The House did. But we don’t know if that happens. And so I am very curious how they would get to do some of these things that they’re exploring, because it really did seem more like an executive order in the formatting, is like: This is early on. Explore this issue. Rather than Here are concrete things we need you to do.
Rovner: And I would just, to underscore something that Lauren said, a lot of talk about how to improve nutrition for kids and things about the SNAP [Supplemental Nutrition Assistance Program] food stamp program, then at the same time that the “Big Beautiful Bill” cut food stamps. So there is sort of right hand not recognizing what the left hand is doing. Well, Anna, as you mentioned, on the same day, the administration issued its not-so-earth-shaking MAHA report, the president signed an order that could end those annoying direct-to-consumer TV ads for pharmaceuticals, at least as we know them.
This is the moment where I get to repeat the fact that the U.S. and New Zealand are the only developed countries that allow drugmakers to advertise their products on TV. The executive order purports to return to the status quo before 1997, when drug companies basically couldn’t advertise on TV, because they were required to talk at so much length about possible side effects and contraindications. Now, I think both Republicans and Democrats in the past 28 years would’ve loved to have taken this same action. Drug ads aren’t exactly popular with the public. But there’s a First Amendment issue here, right? Something about commercial speech?
Edney: Yes. Yeah, certainly. It seems like long ago the train left the station on banning these pharmaceutical ads completely, because the free-speech protection seems to have encompassed this and it feels like no getting rid of them. There’s been no successful effort. So what the Trump administration has said that they’re going to do is change that regulation that allowed them, the drugmakers, to water down their statement in those ads on all of the awful side effects that can happen to you by taking drugs. And so right now in a drug ad, they can just say, Talk to your doctor and visit this website to see what the side effects are.
And so they want to roll that back and so be able to take it back to having to list all of them