The Host
Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.The enhanced premium tax credits that since 2021 have helped millions of Americans pay for insurance on the Affordable Care Act marketplaces will expire Dec. 31, despite a last-ditch effort by Democrats and some moderate Republicans in the House of Representatives to force a vote to continue them. That vote will happen, but not until Congress returns in January.
Meanwhile, the Department of Health and Human Services canceled a series of grants worth several million dollars to the American Academy of Pediatrics after the group again protested HHS Secretary Robert F. Kennedy Jr.’s changes to federal vaccine policy.
This week’s panelists are Julie Rovner of KFF Health News, Lizzy Lawrence of Stat, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.
Panelists
Lizzy Lawrence STAT News @LizzyLaw_ @lizzylawrence.bsky.social Ready Lizzy's stories. Tami Luhby CNN @Luhby Read Tami's stories. Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories.Among the takeaways from this week’s episode:
- The House on Wednesday passed legislation containing several GOP health priorities, including policies that expand access to association health plans and lower the federal share of some Affordable Care Act exchange marketplace premiums. It did not include an extension of the expiring enhanced ACA premium tax credits — although, also on Wednesday, four Republicans signed onto a Democratic-led discharge petition forcing Congress to revisit the tax credit issue in January.
- In vaccine news, the American Academy of Pediatrics spoke out against the federal government’s recommendation of “individual decision-making” when it comes to administering the hepatitis B vaccine to newborns — and HHS then terminated multiple research grants to the AAP. Meanwhile, the Centers for Disease Control and Prevention is funding a Danish study of the hepatitis B vaccine in West Africa through which some infants will not receive a birth dose, a strategy that critics are panning as unethical.
- Also, a second round of personnel cuts at the Department of Veterans Affairs is expected to exacerbate an existing staffing shortage and further undermine care for retired service members.
- The FDA is considering rolling back labeling requirements on supplements — a “Make America Health Again”-favored industry that is already lightly regulated.
- And abortion opponents are pushing for the Environmental Protection Agency to add mifepristone to the list of dangerous chemicals the agency tracks in the nation’s water supply.
Also this week, Rovner interviews Tony Leys, who wrote the latest “Bill of the Month” feature, about an uninsured toddler’s expensive ambulance ride between hospitals.
Plus, for a special year-end “extra-credit” segment, the panelists suggest what they consider 2025’s biggest health policy themes:
Julie Rovner: The future of the workforce in biomedical research and health care.
Lizzy Lawrence: The politicization of science.
Tami Luhby: The systemic impacts of cuts to the Medicaid program.
Alice Miranda Ollstein: The resurgence of infectious diseases.
Also mentioned in this week’s podcast:
Click to open the transcript Transcript: Time’s Up for Expanded ACA Tax Credits[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, from KFF Health News and WAMU Public Radio in Washington, D.C., and welcome 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, Dec. 18, 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 video conference by Tami Luhby of CNN.
Tami Luhby: Hello.
Rovner: Alice Ollstein of Politico.
Alice Miranda Ollstein: Hi, there.
Rovner: And I am pleased to welcome to the podcast panel Lizzy Lawrence of Stat News. Lizzy, so glad you’ll be joining us.
Lizzy Lawrence: Thanks so much for having me. I’m excited.
Rovner: Later in this episode, we’ll have my interview with Tony Leys, who reported and wrote the latest KFF Health News “Bill of the Month” about yet another very expensive ambulance ride. But first, this week’s news.
Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of the additional ACA [Affordable Care Act] subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House, along party lines, passed a bill that Republicans are calling the “Lower Healthcare Premiums for All [Americans] Act,” which actually doesn’t, but we’ll get to that in a moment. Notably, not part of that bill was any extension of the enhanced tax credits that now are going to expire at the end of this year, thus doubling or, in some cases, tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue the additional subsidies with some changes, but in the end, he didn’t.
So, four of those Republicans, from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed on to a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell us what’s in that bill that just passed the House.
Luhby: Well, there are four main measures in it, but none of them, as you say … they will lower potentially some premiums for certain people, but they’re really a bit of a laundry list of Republican favorite provisions.
So, one of the main ones is association health plans. They would allow more small businesses — and, importantly, the self-employed — to band together across industries. This could lower health insurance premiums for some people, but these plans also don’t have to adhere to all of the ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure.
There are some PBM, pharmacy benefit manager, reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have … the experts I spoke to said it’s really just tinkering around at the edges and may not be that consequential.
Rovner: And it’s not even as robust a PBM bill as Republicans and Democrats had agreed to last year …
Luhby: Exactly.
Rovner: … that Elon Musk got struck at the last minute because the bill was too long.
Luhby: Exactly, it’s a narrower transparency. There are narrower transparency provisions. It would also, importantly, refund the cost-sharing provisions. And remember, there are two types of subsidies in the Affordable Care Act. There are the premium subsidies, which is what everyone is talking about, the enhanced premium subsidies. But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, their out-of-pocket expenses.
President [Donald] Trump, during his first term, in an effort to weaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them. So what the insurers did was they increased the premiums of the “silver” plans in order to make up some of the difference, but those silver plans, remember, are tied to … the cost of those silver plans are what determines the premium subsidies that people get. So, basically, by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will, in turn, lower the premium subsidies that the government has to pay and save the government money.
The people in silver plans probably won’t be affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy “gold” plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy “bronze” plans for really cheap. So basically, this provision will end, will reduce the premium assistance that people get, and it’ll effectively raise premium payments for people in a lot of plans, which will make it more difficult for them.
Rovner: Which was a wonderful explanation, by the way, of something that’s super complicated.
Luhby: Thank you.
Rovner: But I’ve been trying to say it basically moves money around. It takes money that had been … it lowers how much the federal government will have to pay, while at the same time loading that back onto consumers.
Luhby: Right.
Rovner: So, hence my original statement that the “Lower Premiums for All” Act doesn’t lower premiums for all. So, this is …
Luhby: No, there’ll be a lot of people in gold and bronze and “platinum” plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care.
And then there’s a fourth provision that’s not as consequential: It’s called choice plans. It’s to help employers give … it’s to make it easier for employers to give money to people to buy coverage on the exchanges.
Rovner: Yeah, which I think nobody disagrees with. But Alice, there’s another even catch to the cost-sharing reductions, which is that it’s only for states that ban abortion or that don’t ban abortion. Now I forget, which is it?
Ollstein: So, it’s, yeah. So the great compromise of the Affordable Care Act was that it’s up to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s 50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provision sought to penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets.
And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday, it’s nowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way as an impediment, including in the Senate as well.
Rovner: Yeah. So, what are the prospects for these additional subsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies — in January, after they’ve expired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here? Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds?
Ollstein: Well, Democrats and advocacy groups are trying to ramp up that pressure. We’ve been covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this. They’re highlighting the stories of individual, sympathetic-character folks who are having their premiums go way up.
So, there were press conferences just this week I saw with retirees and people who are on Social Security Disability and small-business owners and single parents, and it’s not hard to find these stories; this is happening to tens of millions of people. And so, I think this is going to be a major, major political message going into next year. Whether it’s enough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree on some kind of an extension, that remains to be seen. And we really haven’t, despite the defection of a small handful this week in joining the Democrats on an extension — which was really notable and a sign that Speaker Johnson is not keeping his caucus in array. But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise. It can go either way.
Rovner: I saw a lot of people yesterday saying that, Well, even if the House were to pass the clean three-year extension of the enhanced subsidies — which is what’s in the Democrats’ bill — the Senate just voted on it last week and voted it down, so it wouldn’t have any chance. To which my response was, “Hey, Epstein files.” When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you; you wanted to say something.
Luhby: No, I was just going to say that yes, things can certainly change and there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all been writing stories about the cancer survivors or cancer patients who may have to drop their coverage in the middle of their treatment because they can’t afford the new premiums, or all of these stories. So, none of this is new, but we’ll see. There’s obviously … what is somewhat new is the administration’s message on increasing affordability, and this is a huge affordability issue. So, maybe that will spur some change in votes or change in mindset.
Rovner: Well, definitely a January story too.
Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official — after being blessed by the acting director of the agency, who is neither a doctor nor a public health professional — the U.S. government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991.
And merging two stories from this week, there’s also news about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will “harm children, their families, and the medical professionals who care for them.” And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesday terminated seven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, and identifying autism early. According to The Washington Post, which broke the story, an HHS spokesman said the grants were canceled because they “no longer align with the Department’s mission or priorities.”
First, this is not normal. Second, however, it’s HHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy, you’re nodding.
Lawrence: Absolutely. Yeah, I think this has become very commonplace in this administration. And also interestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea, West Africa, to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so, we’re seeing an active removal of funds from the American Academy of Pediatricians [Pediatrics], and then giving funds now to research. And this is a research group actually that RFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will be really interesting to see if this is a trend that continues, if they’re kind of … we already know that HHS, the CDC’s vaccine panel, there’s been discussions about making our vaccine schedule closer to Denmark’s. Now there’s this money being given to Danish researchers who align with the way that they think about vaccines is similar to Kennedy and to another official at FDA, called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So, yeah.
Rovner: And who is Danish, I believe.
Lawrence: Yes, her husband is Danish, and so she lived in Denmark for many years.
Rovner: I saw some scientists complain about that study in Guinea-Bissau, because they say it’s actually unethical to use a placebo to study the hepatitis B vaccine because we know that it works. So if you’re giving a placebo to children, you’re basically exposing them to hepatitis B.
Lawrence: Right.
Ollstein: Yeah. I saw that too. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people of colonial experiments in medicine that were really unethical and subjected people to more risks than would be allowed here. And like you said, basically knowingly withholding something that is safe and effective and giving someone a placebo instead.
Another issue I saw raised was that it is not a double-blind study; it is a single-blind study. And so, that allows for potential biases there as well.
Lawrence: Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027.
Rovner: Oops.
Lawrence: So, that’s a crazy … yeah, you have babies born before that year who are not given this dose, and then after … so yeah, it raises all kinds of ethical concerns, and it’s just remarkable that the government would just pull away and offer this money to them.
Rovner: HHS in 2025. Specifically on the covid vaccine, there were two stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated against covid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at MedPage Today, editor Jeremy Faust, who’s both a doctor and a health researcher, says that FDA vaccine chief Vinay Prasad overstated his case when he said the agency has found at least 10 children who’ve died as a result of receiving the covid vaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. This isn’t great evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest.
Lawrence: Right, right. Yeah, the memo that Vinay Prasad sent, which was immediately leaked, was remarkable in that it included no data backing up his claims. And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues. I think sometimes it’s hard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately, and it’s a really severe claim to say that this has killed 10 children. And so, that discussion needs to be shared transparently and allow for experts to really weigh in.
Rovner: Yeah. Well, another issue that’s going to bleed over into January. All right, we’re going to take a quick break. We will be right back.
So in other administration health news, it appears, at least according to The Washington Post, that the on-again, off-again cuts to medical personnel at the Department of Veterans Affairs are on again. The Post is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel. That’s on top of a cut of 30,000 people earlier in 2025. Altogether, it’s about a 10% cut in total. Apparently, most of the positions are currently unfilled, but that doesn’t mean that they’re unneeded, particularly after Congress dramatically expanded the number of veterans eligible for health benefits by passing the PACT Act during the Biden administration. That’s the bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’ ability to get timely care from the VA? Nothing good, I imagine.
Luhby: Well, I’ve been speaking over the past year or two to a VA medical staffer, who wishes to remain anonymous for obvious reasons. And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’ shift. And they’ve asked if the boss is going to be replaced because they obviously can’t do two people’s jobs well, and they’ve been told that the boss will not be replaced.
There’s also, on top of all of this, there’s a hiring freeze and there’s restrictions in hiring. So, it’s been very difficult for agencies, including the VA, including the medical personnel, to get new people. And again, the person I’ve spoken to said that the veterans are not getting the care, as good care as they were last year because this person just can’t do two people’s jobs. And it’s on the medical side, but the source also said that it’s throughout the hospital with the support staff and even the custodial staff. I mean, just … there’s a lot of unfilled positions that are affecting overall care.
Rovner: I feel like a big irony here is that during the first Trump administration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, here he’s basically undoing everything that he did for veterans during the first administration.
All right. Well, meanwhile, NBC is reporting that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994 — I still have scars from that fight — following a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval, as long as customers were informed that they were not intended to “diagnose, treat, cure, or prevent any disease,” a phrase that I’m sure you’ve heard many times in commercials. Of course, diet supplements are practically an article of faith for followers of the “Make America Healthy Again” movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the “aggressive suppression” of vitamins and dietary supplements. Lizzy, you’re nodding.
Lawrence: Yeah, this is super interesting because this was one of the first things a year ago, when RFK was announced as the HHS secretary, when people were speculating on what some of his priorities would be, deregulating supplements was a big one. And so, I think this will be a really interesting space to watch and see. And it’s emblematic, too, of the uneven view of products regulated by the FDA, where there are some products where there’s … that RFK and other leaders at the FDA are super “pro” and well, we don’t actually need as much evidence here. And then others, like vaccines or SSRIs [selective serotonin reuptake inhibitors], where it seems that they want to really raise evidence standards, which is not how the FDA is supposed to work. It’s supposed to be dispassionately, with no bias, reviewing medical products.
Rovner: And I would point out, in case I wasn’t clear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something.
Ollstein: Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and, like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, if you’re taking a prescription drug, it’s been tested a lot more than if you’re taking a supplement.
Rovner: Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists, Joanne Kenen and Paige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act. I think I noted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress: flatter them and take their parochial concerns seriously. That’s something that his boss, RFK Jr., has most certainly not mastered as of yet. And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year?
Luhby: Well, one thing that’s interesting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, because it’s obviously something that he had promoted on his shows. It’s something that the Biden administration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And he said basically, “You guys have to step up,” and so, it’ll be interesting to see going forward what additional measures they take. But yeah, he’s certainly not bending over to the insurers.
Rovner: Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing, that somebody had briefed him well. Apparently, according, I think it was in Joanne’s story, he’s been talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list.
Luhby: Well, and one thing to also point out that was really interesting in Paige’s story, particularly, is that what we’ve been hearing at other agencies — the CDC, and across the Trump administration — that a lot of the political appointees are really at odds with the staff. They’re not communicating with the staff; there were concerns about that after the CDC shooting over the summer. And one thing that, obviously, Dr. Oz is very personable, he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paige detailed about how he really is interacting a lot with the staff. And I’m sure that’s obviously helping morale and helping the mission at CMS. Also, of course, it’s an agency that RFK has not focused on.
Rovner: I say, what a shock, treating career staff with some respect, like they know what they’re doing.
All right. Well, finally, we end this year on reproductive health, pretty much the same way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability, even across state lines, of medication abortion. Alice, you’ve got quite the story this week about an unusual way to go after the pill. Tell us about it.
Ollstein: Yeah. So this is a trend I’ve been covering for the last few years, and it’s anti-abortion groups trying to use various environmental laws to achieve the ban on the pills that they want to achieve. And so, there’s been some various iterations of this over the years. The latest one is that groups are jumping on a EPA [Environmental Protection Agency] public comment process that’s going to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country. So this is a big deal. It costs a lot to track these chemicals. There can only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list.
Rovner: This is wastewater, right? Not drinking water?
Ollstein: No, this is drinking water.
Rovner: Oh, it is drinking water.
Ollstein: There are other efforts to use wastewater laws to restrict abortion pills, yes. So we talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we have scientists in our story talking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list.
So, just to zoom out a little bit, while this particular campaign tactic, whatever you want to call it, may not succeed, I think it’s part of a bigger project to sow doubt in the public’s mind about the safety of mifepristone in various ways. We’ve been seeing this all year, and for several years. But I think that this kind of gross-out factor of there’s abortions in the water! Even without scientific evidence of that, I think it contributes to the public perception. And KFF had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, if not quite yet at federal agencies.
Rovner: Another one we will be watching. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Tony Leys, and then we’ll come back and do our very special year-end extra credits.
I am pleased to welcome back to the podcast KFF Health News’ Tony Leys, who reported and wrote the latest KFF Health News “Bill of the Month.” Tony, welcome back.
Tony Leys: Thanks for having me, Julie.
Rovner: So, this month’s patient had a very expensive ambulance ride, alas, a story we’ve heard as part of this series several times. Tell us who he is and what prompted the need for an ambulance.
Leys: He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called [staphylococcal] scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER, where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton, about 40 miles away. They put in an IV and then put him in the ambulance. His mom went with and said the driver didn’t go particularly fast or use the siren, but did get them there in about 40 minutes.
Rovner: But it still was an ambulance ride. So, how big was the bill?
Leys: $9,250.
Rovner: Whoa. Now, this family doesn’t have insurance, which we’ll talk about in a minute. So, it wasn’t an in- or out-of-network thing. Was this unreasonably high compared to other ground ambulance rides of this type?
Leys: It’s really hard to say because the charges can be all over the place, is what national experts told me. But if Darragh had been on Medicaid, the ambulance company would’ve been paid about $610, instead of $9,200.
Rovner: Whoa. So, what eventually happened with the bill?
Leys: The company agreed to reduce it about 40% to $5,600 if the family would pay it in one lump sum. They did, they wound up putting it on a credit card, a no-interest credit card, so they could pay it off overtime.
Rovner: Now, as we mentioned, this family doesn’t have insurance, but they belong to something called a health sharing ministry. What is that?
Leys: Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would cover maybe about three-quarters of what they owed, so …
Rovner: Have they heard about that yet?
Leys: I have not heard.
Rovner: OK. So, what’s the takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, you shouldn’t just bundle them into your car instead, right?
Leys: I sure wouldn’t. Yeah, no. I mean, at that point, she felt like she had no choice. I mean, she did say if she would’ve just driven straight to the children’s hospital instead of stopping at the local hospital, they would’ve gotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So, that’s in retrospect what she wishes she would’ve done. But if they’d had insurance, the insurer would’ve presumably negotiated a lower rate, and they wouldn’t have had to do the negotiation themselves.
Rovner: So, they are paying this off, basically?
Leys: Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice.
Rovner: All right. Tony Leys, thank you very much.
Leys: Thanks for having me, Julie.
Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s usually where we each recognize a story we read this week we think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different. I’ve asked each of our panelists to take a minute or two to talk about what they see, not necessarily as the biggest single health story of the year, but the most important theme that we’ll remember 2025 for. Tami, why don’t you start us off?
Luhby: OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill [Act], which Congress passed over the summer. The legislation enacts historic cuts to [the] nation’s safety net, with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than $900 billion from Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come from Congress adding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do … well, the Trump administration allowed certain states to do that. It really only took effect in Arkansas, and about 18,000 people lost coverage within months from the work requirements, many of whom, the advocates say, many people are working, they’re going to get caught up in red tape. They’re either working or they’re eligible for exemptions, but they’ll get caught up in red tape.
So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or [dependent] children under age 14 would have to work, volunteer, or attend school or job training programs at least 80 hours a month to remain eligible, unless they qualify for another exemption, such as being medically frail or having substance abuse disorder. The package also limits immigrants’ eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source for states and which will have ripple effects across hospitals and across states in general.
Now, what’s important to note is, most of these provisions haven’t taken effect yet. Most of them actually take effect after the midterm elections next year. So, they’ll be rolling out in coming years and the full impact is yet to come.
Rovner: Alice.
Ollstein: So, I have chosen the resurgence of infectious diseases that we are seeing right now. I think measles is really the canary in the coal mine. Because it’s so infectious, that’s what’s showing up first, but it’s not going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so, I think that a lot of different policies and trends are feeding into this. And I think we have the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies that we’re seeing. And then just cuts to public health and public health staff, cuts to surveillance, so it’s just harder to know where the outbreaks are happening and how bad they are. It’s hard to get reliable data on that. And so I think, yes, we’re seeing measles first, but now we are starting to see whooping cough, we’re starting to see some other things, and it’s really troubling, and it could have a political impact too.
I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say, “This is the consequence of Republican health policies, and this is why you should vote for me.” So, I would be keeping an eye on that in the coming year.
Rovner: Lizzy.
Lawrence: So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, but there’s been the politicization of science in every agency. And this is something that used to be pretty taboo, right? I keep thinking these days about the [Barack] Obama HHS secretary, Kathleen Sebelius, and the legal and political repercussions she faced when she vetoed an FDA decision to make Plan B over-the-counter. And those days seem very far away, because now we’re seeing at the FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices.
At the FDA and CDC, you’re seeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or even really no or debunked evidence.
You’re seeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries. You’re seeing NIH [the National Institutes of Health] pull funding from research studies that go against Trump administration ideology. So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world.
And then I’d say that has a trickle-down effect to the way that everyday people think about science, and it calls everything into question and makes … People look to politicians and to the heads of public health agencies to tell them the truth. I mean, maybe not politicians, but it seems that doctors and medical experts’ voices are increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So, I think this is a very important topic and one that I’ll keep watching closely in the next year.
Rovner: Yep. So my topic builds on Lizzy’s. It’s how this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and health care workforce well into the future. The administration has frozen or terminated literally billions of dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest.
And as we’ve talked about so many times before in this year’s podcast, the administration also seems intent on basically choking off the future health care workforce. The big budget bill includes caps on how much medical students can borrow in federal loans. That’s an effort to get medical schools to lower their tuition, but most observers think that’s unlikely to happen. The Education Department has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a “profession,” thus also limiting how much they can borrow. And a new $100,000 visa fee is going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers are literally the only ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in 2026.
OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at [email protected], or you can still find me on X @jrovner, or on Bluesky @julierovner. Where are you guys hanging these days, Alice?
Ollstein: Mostly on Bluesky @alicemiranda, and still on X @AliceOllstein.
Rovner: Tami.
Luhby: You could find me at cnn.com.
Rovner: Lizzy.
Lawrence: You can find me at Stat News, on LinkedIn at Lizzy Lawrence, on X @LizzyLaw_, and on Bluesky — and I forget my username, but I’m somewhere there.
Rovner: Don’t worry about it. OK, we will be back in your feed in January. Until then, be healthy.
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