\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’ 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.\t\t<\/p>\n As he had wanted, President Donald Trump signed his big budget bill into a big budget law in a White House ceremony on July 4, cementing, among other things, billions of dollars in cuts to health programs such as Medicaid. The new law will also reshape rules for the Affordable Care Act, Medicare, and other health programs.\u00a0<\/p>\n Meanwhile, the threat of layoffs continues to hang over the heads of employees at the Department of Health and Human Services, and funding for health-related contracts and grants remains stalled.\u00a0<\/p>\n This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Bloomberg News, Rachel Roubein of The Washington Post, and Tami Luhby of CNN.<\/p>\n \t\t\t \tRachel Cohrs Zhang \t\t\t \t\t\t \tRachel Roubein \t\t\t \t\t\t \t\t\t \tTami Luhby \t\t\t \t\t\t Among the takeaways from this week’s episode:<\/p>\n Also this week, Rovner interviews KFF Health News’ Julie Appleby, who reported the latest KFF Health News’ “Bill of the Month<\/a>” feature, about some very expensive childhood immunizations. If you have a medical bill that’s exorbitant, baffling, or confusing, send it to us here<\/a>.<\/p>\n\n Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> The New England Journal of Medicine’s “The Corporatization of U.S. Health Care \u2014 A New Perspective Series<\/a>,” by Debra Malina, et al.<\/p>\n Rachel Roubein:<\/strong> The Associated Press’ “RFK Jr. Promoted a Food Company He Says Will Make Americans Healthy. Their Meals Are Ultraprocessed<\/a>,” by Amanda Seitz and JoNel Aleccia.<\/p>\n Rachel Cohrs Zhang:<\/strong> The Wall Street Journal’s “Prosecutors Question Doctors About UnitedHealth’s Medicare Billing Practices<\/a>,” by Christopher Weaver and Anna Wilde Mathews.<\/p>\n Tami Luhby:<\/strong> The Washington Post’s “A New D.C. Hospital Grapples With Too Many Patients and Too Few Nurses<\/a>,” by Jenna Portnoy.<\/p>\n Also mentioned in this week’s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Digesting Trump’s Big Budget Law\t\t\t\t<\/p>\n [Editor’s note:<\/em><\/strong> This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> 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, July 10, at 10 a.m. As always, 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 Rachel Cohrs Zhang of Bloomberg News.\u00a0<\/p>\n Rachel Cohrs Zhang:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Tami Luhby of CNN.\u00a0<\/p>\n Tami Luhby:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> And Rachel Roubein of The Washington Post.\u00a0<\/p>\n Rachel Roubein:<\/strong> Hey, everyone.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode, we’ll have my interview with my colleague Julie Appleby, who reported and wrote the latest KFF Health News “Bill of the Month,” about some very expensive immunizations that shouldn’t have been. So two Julies and two Rachels this week \u2014 we will work hard to keep it all straight. On to the news.\u00a0<\/p>\n We’re going to start this week with President [Donald] Trump’s big budget reconciliation bill, which he signed, as was his desire, on July Fourth. To paraphrase one analyst, for a tax cut energy border enforcement bill, it sure has a lot of health care provisions in it. If you’re a regular podcast listener, you’ll know it represents the biggest cutback of federal safety net programs ever, and in particular the biggest cuts to the Medicaid health program since that program’s inception 59 years and 11 months ago. But while we’ve talked about Medicaid work requirements and state provider taxes at some length \u2014 you can go back to last week or the week before’s podcast if you want to hear that \u2014 I wanted to talk about a few things this week that are now law and haven’t gotten as much attention.\u00a0<\/p>\n First, the cutback to coverage for legal immigrants. We know that the House-passed efforts to punish states that use their own funds to cover undocumented people were axed by the Senate parliamentarian, but there are also lots of cutbacks not just to Medicaid eligibility but also to the Affordable Care Act eligibility and even Medicare for people who are here legally. Is this something Republicans think is going to be popular, to go after legal immigrants, not just people who are here undocumented?\u00a0<\/p>\n Luhby:<\/strong> Well, the way that they’re describing it is they’re describing it as illegal immigrants. So they did that with the tax provisions as well as in the health insurance provisions. But actually, as you say, it basically bars legal immigrants, including refugees, asylees, people who are victims of domestic violence or sex or labor trafficking. They can no longer sign up for Medicaid, Affordable Care Act subsidies, SNAP [the Supplemental Nutrition Assistance Program], or food stamps, and Medicare actually as well. So yes, it’s actually taking away benefits from legal immigrants. But as we know, this is a hot-button topic for the Republicans, so they’re able to say that they’re cutting back on waste, fraud, and abuse.\u00a0<\/p>\n Rovner:<\/strong> This was a big fight in the 1990s when they did the welfare reform bill, which is when I think some of these limits first went into effect, and it was a huge to-do about rolling back eligibility for, as you say, people who are here legally. This time it feels like it was just kind of an afterthought.\u00a0<\/p>\n Luhby:<\/strong> Well, there were so many provisions in this bill. I think it was difficult for both lawmakers and journalists to cover everything. So there was coverage about this. I wrote a story<\/a> after the House bill, and there were other stories about it. But when you have so many other changes happening in the bill with, as you say, work requirements, provider taxes, eligibility restrictions, and so many other things, it’s hard, I guess, for people and lawmakers to highlight everything.\u00a0<\/p>\n Rovner:<\/strong> And it did happen really fast, at least by congressional standards. I don’t think anybody thought that they were really going to get this done and to the president by July Fourth. I’m still kind of wrapping my head around that. Well, the bill, now law, also caps federal loans for those attending medical school at $200,000, which sounds like a lot except that the average medical student’s loan balance when they finish med school is more than $260,000 if you count their undergraduate loans, too. Is the idea here that medical schools are just going to lower their tuition? And has anything like this ever happened before? I don’t remember seeing this. This is the federal government trying to force down tuition? Or force not-rich people to not be able to go to medical school?\u00a0<\/p>\n Luhby:<\/strong> That is another thing that has actually not been covered widely in the bill, which is surprising, is the House version actually had much more draconian changes to the student loan program. The Senate bill did not adopt all of them, but it did adopt caps on graduate as well as professional programs, including the medical school as well as parent PLUS [Parent Loan for Undergraduate Students] programs. So yes, the other option will be for students to seek out private loans. I think part of the issue was distancing the federal government from the student loan program. Again, the Senate bill was not as harsh as the House bill, but it will force people, as you say, to either choose not to go, to have to rely more on friends and family, or to rely on private loans that have fewer benefits.\u00a0<\/p>\n Rovner:<\/strong> I want to underscore something Tami just said. This is not just aimed at medical students. It’s aimed at medical students and law students, and basically it’s the student loan program writ large. But it’s going to have a particular impact at a time we know that we’re facing a doctor shortage. It’s either going to make it harder for some people to go to medical school or they think they’re going to force medical schools to lower their tuition, which feels unlikely, but we’ll have to see how that one plays out. Well, finally, one thing that was not in this bill \u2014 elimination of taxes on Social Security, something that the president promised when he was running for office. That’s because Congress can’t amend Social Security in budget reconciliation. They wrote that into law decades ago. But that didn’t stop the Trump administration from sending every Social Security and Medicare recipient an email taking credit for ending Social Security taxation. Tami, you wrote about this<\/a>. What the heck was this?\u00a0<\/p>\n Luhby:<\/strong> Yeah, let me clarify also. It’s ending taxation on Social Security benefits, not on Social Security, not the payroll taxes that we all pay. But this was one of the president’s big promises that he was going to end the taxation on tips, overtime, and Social Security benefits. He did accomplish temporary ending of taxation on a certain amount of tips and overtime compensation, but as you said, they can’t do Social Security benefits. So what they did was they did a temporary enhanced standard deduction for senior citizens at $6,000 for four years from 2025 to 2028, through 2028. And the Social Security Administration quickly sent out a message heralding the great accomplishment that seniors will be paying more, and the government has kind of straddled the line between saying that this is a cut on Social Security benefits or at least promises made, promises kept.\u00a0<\/p>\n So no, there were two issues with that email that was sent out. One, it wasn’t quite accurate. That definitively did not cut income taxes on Social Security benefits. But the other thing is there was a lot of question that typically agencies don’t send out laudatory emails based on congressional actions. So there was some concern in some circles of the politicization of Social Security and of the agency. So I will be actually hopefully writing a story on that to clarify. We wrote a story, as you said, last week to clarify it, but hopefully I’ll have another one coming soon.\u00a0<\/p>\n Rovner:<\/strong> Yeah, good, because I know people are confused. And I should point out that the original tax on Social Security benefits was implemented to shore up the Medicare trust fund. So if you take it away, you’ll put Medicare in financial trouble.\u00a0<\/p>\n Moving on, federal courts have already stepped in to block at least one provision of the brand-new budget law, the one-year ban on Medicaid funding to Planned Parenthood that would prevent even those clinics that don’t do abortions from getting funding for non-abortion services like family planning and cancer screenings. Planned Parenthood argued that the provision violates their free-speech rights for supporting abortion, but this is far from the last word on this provision, right?\u00a0<\/p>\n Roubein:<\/strong> As you said, there was the lawsuit. This has been a big political fight for years and years and years. And what they ended up doing in the bill is it’s one year \u2014 right? \u2014 for Planned Parenthood. And so this is something that I think Planned Parenthood has said would impact roughly one-third of its nearly 600 clinics. I think the organization, their numbers are that roughly one-third of its nearly 600 clinics could close if this provision went into effect.\u00a0<\/p>\n Rovner:<\/strong> And this was just, I think, a two-week block so they can have another hearing so this can continue, but this is the first time that \u2014 as long as Congress has been trying to defund Planned Parenthood, this is really the first time they’ve managed to actually do it, even though it wasn’t for as long as I think that the House bill had. So we’ll see if this ultimately gets through or not.\u00a0<\/p>\n Well, we also heard from the Supreme Court this week. While the court may be technically out for the year, it’s still pumping out decisions on the so-called shadow docket. This week the court ruled that President Trump can so lay off thousands of federal workers by executive order \u2014 or did it? Tami, you wrote about this decision<\/a>. What does it actually mean for these people who work for federal agencies and are afraid of losing their jobs?\u00a0<\/p>\n Luhby:<\/strong> Well, they’re very concerned right now. The court case is still ongoing. The Supreme Court lifted the block that a lower court had had. So as we know, there are agencies that had these RIF, being reduction in force, plans and reorganization plans, and several heads of agencies have said that they’re only in a holding pattern, because they’re going to adhere to the courts’ and judges’ rulings, so now they’re free to do that. And HHS [the Department of Health and Human Services] emailed me back to say that they have a plan and that they plan to proceed, and other agencies are expected to proceed. So The Washington Post<\/a> actually had a really good story talking to various federal workers who are now very concerned that they were going to start actually losing their jobs. Federal workers have been in a holding pattern for months now, being put on administrative leave, being let go, being reinstated, temporarily reinstated, back on administrative leave. So they’ve really been through a roller coaster, and it’s not necessarily over yet for them, but it does seem like many folks may be losing their jobs soon.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Wow.\u00a0<\/p>\n Roubein:<\/strong> The Department of Health and Human Services RIFs that came down April 1 was about roughly 10,000 people. Now, as Tami said, there were, for instance \u2014 I tend to focus on the FDA [Food and Drug Administration] \u2014 there were some people in departments that were brought back, but it’s hard to get actual numbers on how many that is. But there have been a lot of people that were on admin leave through June 2 who have just kind of continued to be on admin leave and be in sort of this limbo since April 1.\u00a0<\/p>\n Rovner:<\/strong> Wow. It’s amazing that any work is getting done. We’re going to get to HHS in a second. We’ve got one more court case. Public health groups led by the American Academy of Pediatrics sued HHS Secretary Robert F. Kennedy Jr. over his decision to withdraw the recommendations for covid vaccines. Rachel, this is just one part of an effort by some of these groups to effectively substitute their own recommendations for those of the now mostly anti-vax government Advisory Committee on Immunization Practices, right?\u00a0<\/p>\n Cohrs Zhang:<\/strong> Right. I think what we’ve seen here is kind of the first example of a policy challenge by some of these public health groups. There certainly were lawsuits related to the reductions in force that felt a little bigger-picture, and again, we’ve seen this playing out at the Supreme Court. But this is a specific challenge that Secretary Kennedy’s decision to unilaterally change vaccine recommendations for healthy children and pregnant women was arbitrary and capricious. They pointed out some different policies across different subagencies that seemed to conflict, and the fact that it was announced in a social media video, and that they ignored the advice of expert advisers, which is kind of the structure that Congress set up for these recommendations to happen. So I think it will be a really important litmus test for whether lawsuits are going to be an effective tool for some of these outside groups concerned about some of these policy changes to slow down or stop some of the changes they’re most worried about at HHS.\u00a0<\/p>\n Rovner:<\/strong> And we’re seeing, I know, I think both of you have written about some of these groups wanting to, basically, since they’re saying they can no longer trust the government immunization advisory panel, they want to put out their own recommendations and work with insurance companies to cover things that \u2014 based on some of these groups instead. It’s fracturing the way things are done, right?\u00a0<\/p>\n Cohrs Zhang:<\/strong> Right. It’s true, and insurance policies are based on all sorts of different things. It’s not like there’s one kind of rule. And I think we’re really testing the boundaries and kind of figuring out that there’s a lot of variability here, and I think there’s a lot of uncertainty, especially going to next year. Generally, insurance plans are kind of set for what they’re going to cover this year, but some of the language in general policies kind of leaves a gray area. If this expert advisory panel that RFK Jr. has fired all the members and put in new members, if they start taking votes that are changing recommendations for previous vaccines that the government has recommended, I think it really throws a lot of coverage into question, and we know that even small copays can discourage people from getting vaccines. And there are these other government programs that provide vaccines for low-income children that are also in question if this panel continues to take votes on existing vaccines in addition to new ones. So I think there is just going to be tough decisions by the insurance industry as to where they’re going to look for these recommendations.\u00a0<\/p>\n Rovner:<\/strong> And of course, overlaying all of this is the fact that we learned this week that measles cases are now at a three-decade high and likely to continue to spread. It’s summer, and kids are going to camp and other group activities, and families are traveling. And Rachel R., you wanted to add something.\u00a0<\/p>\n Roubein:<\/strong> Oh, yeah. Just on this effort to kind of create this parallel system of recommending, potentially distributing, vaccines. It really marks an escalation of concern from public health experts. My colleague Lena Sun and I dug into it a little bit<\/a>, and as the other Rachel mentioned, insurance was one of the biggest questions we got from people. But there are other things that they’re mobilizing a little bit behind the scenes on, which is like discussing: Could groups order vaccines directly from manufacturers? Could they give greater weight to recommendations from medical associations like the American Academy of Pediatrics, etc.? So I’ve talked to people who I know are spending a lot of time on this each day. And yeah, like you said, there are a lot of questions how this kind of creates potentially tension and a fractured environment at the same time.\u00a0<\/p>\n Rovner:<\/strong> Speaking of Secretary Kennedy and his personal takeover of HHS advisory committees, just days after the Supreme Court ruled for the Biden administration that members of the U.S. Preventive Services Task Force don’t have to be confirmed by the Senate, because they are under the direct authority of the HHS secretary, HHS Secretary Kennedy took that to heart and yesterday canceled a meeting of the group scheduled for today, without stating a reason. Is this a prelude to doing to the U.S. Preventive Health Services Task Force what he’s already done to the immunization panel, basically fire them all and replace them with handpicked people?\u00a0<\/p>\n Luhby:<\/strong> That’s the main concern. We don’t know yet. He hasn’t done that yet. That is what folks are very concerned about. And I spoke yesterday to Dr. Aaron Carroll, who’s also the CEO of AcademyHealth and a big public health expert, and he had some very strong words and was very concerned about it, saying, again, that the task force is roughly 40 years old and it’s worked across both Republican and Democratic administrations. It’s a trusted source of science-based guidance. And his concern is that if Secretary Kennedy again removes everybody who’s on it now and puts in more his own people that the process could be either actually undermined and considered partisan or ideological, or at least viewed that way, which will also cause problems and a lack of trust.\u00a0<\/p>\n Rovner:<\/strong> Yeah, we will have to see how that goes. Well, meanwhile, within HHS, as we’ve already mentioned, things aren’t going great. My KFF Health News colleagues Rachana Pradhan and Arthur Allen have a pretty devastating piece<\/a> about chaos at the National Cancer Institute, where lifesaving research is being held up in the wake of cuts and funding freezes. Things apparently aren’t much better over at the Food and Drug Administration. Both The New York Times<\/a> and Stat<\/a> have in-depth stories this week \u2014 and we will link to all of these stories \u2014 about the agency’s growing inability to get its required work done, between layoffs and buyouts and people just plain quitting or retiring because of the political interference. Rachel R., you covered the FDA. Is this what you’re hearing, too?\u00a0<\/p>\n Roubein:<\/strong> Yeah, I would say these stories track with what I’ve been hearing. A lot of this comes back to, which I think the New York Times story also led with, a tweet from Kennedy before the election saying the FDA is going to change, people who work there should pack their bags, preserve their records. And that caused a lot of concern from career officials. And they were wondering: Is he going to make good on this pledge to cut staff? And the FDA saw, under the RIF, it was like 3,500. Again, we don’t know exactly the number that’s been brought back, but from what I’ve heard from officials inside the agency, there’s been a lot of concern and confusion.\u00a0<\/p>\n Additionally, if you look at the leadership of the agency, like the center directors who are career officials, almost all of them have turned over, whether it’s deciding to leave on their own, whether it’s Peter Marks, who was the top vaccine regulator, being pushed out, or Brian King, who was the tobacco center leader, also being pushed out. So you can sort of see how that leadership has revolved and changed among top career officials, and not just the political posts.\u00a0<\/p>\n Rovner:<\/strong> And I know we talk about this pretty much every week, but it continues to be news. HHS is not just cutting staff. It’s sitting on money that’s supposed to be going out the door to recipients of grants and contracts. And it’s looking increasingly like the plan is to run out the clock to the end of the fiscal year at the end of September by not spending money that Congress has appropriated and President Trump has signed into law. At some point this is going to come to a head in court, I imagine.\u00a0<\/p>\n Cohrs Zhang:<\/strong> Yeah, the other Rachel’s colleagues at The Washington Post had a great story<\/a> about how that is the plan, to test Congress’ authority and appropriations power. And right now, I think Congress has talked about this week a rescissions package, which allows them to rescind the money that was initially appropriated. So I think that this is an interesting dynamic to watch as to whether they simply won’t spend money that’s appropriated and then later ask Congress to rescind it. So it is kind of a strange setup, but again, I think it is important to note that there will be different dynamics on appropriations this cycle, given that now Congress is through the One Beautiful Bill and Republican leadership has a little bit more practice. And so I think these appropriations conversations will be different this year. So definitely one to watch.\u00a0<\/p>\n Rovner:<\/strong> Yeah, and I want to mention that rescissions bill, because it includes rescissions for a lot of international aid, including PEPFAR [President’s Emergency Plan for AIDS Relief], and we’re seeing it passed the House by one vote. I think everything that passes the House now passes by one vote. But the Senate has been kind of slow-walking it. There’s a deadline of July 18 for when the administration sends up a rescission package. Congress has 45 days to act on it, and those 45 days end on July 18. Now, it looks like the Senate isn’t going to just sort of put it on the floor and try to pass what the House did but they’re going to amend it, which would, of course, have to send it back to the House. Are they trying to run the clock out here without actually saying to the president, No, we don’t want you to not spend this money that we already told you to spend<\/em>?\u00a0<\/p>\n Cohrs Zhang:<\/strong> I don’t know if we can read their minds. Deliberation takes time. Maybe it’s deliberate. I don’t know. I don’t think we’re in a position to say that yet.\u00a0<\/p>\n Luhby:<\/strong> There are a lot of concerns with the bill, on both sides, but one thing that \u2014 this is supposed to be the beginning of the great cuts that DOGE, the Department of Government Efficiency, Elon Musk’s former program that was going to cut a trillion dollars from the federal deficit. And one thing that’s being mentioned is the fact that if they can’t get this pretty small rescissions package through, what does it mean for the rest of these potential spending cuts that they want to implement?\u00a0<\/p>\n Rovner:<\/strong> Yeah, I’m surprised that it’s July and that this hasn’t all come to a head yet, but we will see. Well, finally this week, a segment I’m calling “Important Stuff We Missed While We Were All Too Busy Covering the Budget Bill.” First up is an actual big case of health care fraud being prosecuted by the Trump Justice Department. Well, the Trump administration got to announce it. It was actually an investigation first started by the Biden administration, first uncovered by a group of accountable care organizations who noticed an unusual number of urinary catheters being ordered for their patients, but not by them, and first written about<\/a> in early 2024 by your colleagues at The Post, Rachel R., including our podcast panelist Lauren Weber. This is a pretty impressive prosecution, even by Medicare standards. It’s a $10.6 billion fraud scheme that involved all kinds of fraudulent medical equipment charges. I wonder if we can expect more like this or if we think this is a one-off that the Biden administration started. Do we know anything about the Trump administration’s pursuit of Medicare fraud?\u00a0<\/p>\n Roubein:<\/strong> As you mentioned, this is something my colleagues Dan Diamond and Lauren Weber have been covering really closely. I just kind of wanted to lay out a number that I thought was really stark when reading the piece, which was that companies collectively submitted fraudulent claims to Medicare for more than 1 billion urinary catheters. And my colleagues talked to someone at HHS inspector general’s office about this, and he said that he didn’t even know if the United States has the ability to manufacture 1 billion catheters in such a short time. So I thought that was pretty stark. I don’t know exactly what the next big investigation is going to be, but I think the piece kind of lays out how they want to try and catch things before money goes out the door.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think that for a long time they tried to catch fraud sort of after the fact and recoup, and now I think at least there’s an effort \u2014 there was an effort under the Biden administration and I think the first Trump administration \u2014 to try and be a little bit more proactive about Medicare fraud.\u00a0<\/p>\n Cohrs Zhang:<\/strong> There is now. I was just going to say that during public appearances, CMS [Centers for Medicare & Medicaid Services] Administrator Mehmet Oz has talked about having a quote-unquote “war room” with fraud at CMS. I think it is very much under the DOGE ethos that’s taken over the agencies. So again, who’s to say what’s next? But I think there are some good targets out there that they’re definitely spending energy on.\u00a0<\/p>\n Rovner:<\/strong> All right, well, also last month the Trump administration announced a deal negotiated with major insurers to maybe back off of the overuse of prior authorization. That’s where insurance claims get denied before care prescribed by a doctor is delivered. Now, this is not just not a new issue. It dates back to the end of the last century during the fight over something called the Patient’s Bill of Rights, which was eventually folded into the Affordable Care Act. And yet here we are 15 years after that, still fighting about insurance companies second-guessing doctors. Why is this still a thing?\u00a0<\/p>\n Luhby:<\/strong> Well, it is one way that insurance companies are able to control costs, which is what they’re being slammed for now. And of course it is more in the news now after the murder of UnitedHealth’s Brian Thompson last December, which we saw actually a lot of people on social media \u2014 they didn’t quite say he got what he deserved, but it really\u2014\u00a0<\/p>\n Rovner:<\/strong> Some of them did.\u00a0<\/p>\n Luhby:<\/strong> Yeah. It unleashed the fury that people have had and maybe some have been storing up, but it really showed that this is a huge issue. So on earnings calls, we’ve seen before, but particularly after, insurers saying that they’re going to do more to try to streamline prior authorization and have it affect patients less and doctors less. And this was this combined effort that they announced, and interestingly announced before the administration did, which I thought was notable. But we’ll see. We’ve seen these announcements and efforts before. So we’ll have to be on top of whether it actually happens.\u00a0<\/p>\n Cohrs Zhang:<\/strong> It does seem like a microcosm of some of these larger problems with the American health care system. Like you said, this has been going on for a century, and honestly it’s\u2014\u00a0<\/p>\n Rovner:<\/strong> Well, not for a century. Since the 1990s.\u00a0<\/p>\n Cohrs Zhang:<\/strong> Sure. Yeah, since the last century I guess, but since the ’90s. But honestly, some practices are still using fax machines. There are different requirements for every single insurer, which I think is part of the problem that they’re trying to address here, that it’s hard for physicians to manage all of these different requirements for these different companies as they’re trying to care for patients, and also just trying to get everybody into the new century in terms of technology and making sure everything’s electronic. It seems like really basic stuff, but it just hasn’t happened yet. So it fits into this larger model that we’ve seen from the Trump administration HHS so far where they want voluntary cooperation from companies, and they prefer that to regulation, but have seemed to leave the door open to regulation if these things don’t work out as promised.\u00a0<\/p>\n Rovner:<\/strong> And of course some of it is too much new technology, because we’ve seen both The Wall Street Journal<\/a> and Stat<\/a> have written at length about UnitedHealthcare using AI to do some of these prior authorization decisions so that \u2014 it used to be they would complain because it was a nurse instead of a doctor who would look at these requests. Now it’s a computer program looking at these requests, which makes some people unhappy. Tami, you want to add something.\u00a0<\/p>\n Luhby:<\/strong> And just talking about technology, though, one thing that is interesting that they’re pushing is real-time decisions. So it will be interesting to see, and it could really benefit both patients and doctors if they’re in there, in the visit, and the doctor puts in the procedure or drug or whatever and immediately gets back like, Yes, we’ll approve,<\/em> or No, we won’t,<\/em> to give the doctor and the patient time to discuss alternatives. So that would be an interesting technological advance if that happens.\u00a0<\/p>\n Rovner:<\/strong> As usual, technology cuts both ways in health care, as everything else. All right, well, that is this week’s news. Now we will play my “Bill of the Month” interview with Julie Appleby, and then we will come back and do our extra credits.\u00a0<\/p>\n I am pleased to welcome back to the podcast KFF Health News’ Julie Appleby, who reported and wrote the latest KFF Health News “Bill of the Month<\/a>.” Julie, welcome back.\u00a0<\/p>\n Appleby:<\/strong> Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So this month’s patient \u2014 or patients, plural \u2014 are a bunch of kids in Texas whose parents took them to make sure all their shots were up to date, particularly because, as we’ve talked about at length on the podcast, Texas is at the center of a pretty big measles outbreak this year. Tell us who the family is and what kind of care they got.\u00a0<\/p>\n Appleby:<\/strong> Well, this is the Nguyen family, and they’re living in Texas because Mr. Nguyen is a postdoc fellow in public health and infectious disease, interestingly enough, at the University of Texas Medical Branch in Galveston. And so he was very concerned about the measles outbreak. His 4-year-old son had had the first dose of the measles vaccine when he was much younger, because that’s when you get it, but he needed a second dose. So he took his family to a primary care clinic at UTMB, and he asked, Hey, they need a checkup \u2014 will their vaccines be covered?<\/em> And he was assured that they would. So they went in. His 4-year-old son had several shots. He had three shots, actually, but he had one that we’re writing about here. It was the measles, mumps, rubella, and chickenpox is also called varicella vaccine, and he also had a couple of other shots. So they got all those. His daughters had already been vaccinated for measles, so they got different vaccinations. And then they all went home, and they thought everything was fine.\u00a0<\/p>\n Rovner:<\/strong> Now, they have insurance, but they still got a big bill. How big was it, and why weren’t the shots covered? Isn’t that required under the Affordable Care Act?\u00a0<\/p>\n Appleby:<\/strong> Yes, and yes, they got a very big bill. Altogether, all three kids, because he’s got 11-year-old twin daughters and his 4-year-old son, their bills came close to $5,000, but we were mainly focusing on his son’s bill. So his son’s bill was $2,500 approximately for the office visits and the three shots. And of that, the MMRV vaccine, the measles vaccine was $1,422, plus $161 to administer it. And yes, the Affordable Care Act does require that preventive care be covered without a copay, and these vaccinations would be considered preventive care. However, Mr. Nguyen’s family is covered under a separate policy he bought for his wife and kids, and it’s basically a short-term travel medical insurance type of policy. And those short-term policies do not have to meet the rules of the Affordable Care Act. And this one it did not. It did not cover preventive care like vaccinations.\u00a0<\/p>\n Rovner:<\/strong> So he has student insurance, right? Because he’s technically a student?\u00a0<\/p>\n Appleby:<\/strong> He’s technically a student. He does have insurance through his job, because he is working, actually, at UTMB, but it was very expensive to add his wife and family. And this plan was a lot less expensive to cover them for the entire year separately.\u00a0<\/p>\n Rovner:<\/strong> So even before the Affordable Care Act, the federal government created a program called Vaccines for Children that was intended to make sure that people who don’t have insurance coverage for vaccines can get their kids immunized, too. Why didn’t that kick in?\u00a0<\/p>\n Appleby:<\/strong> Yeah, the Vaccines for Children Program was started after a big epidemic in 1989 to 1991 where there were many, many cases and many, many deaths. And they found out that, a lot of these kids, that cost was the factor. Even some of them that had insurance, cost was just a factor. So this program was set up. It does cover kids who are either underinsured for vaccines or uninsured, and it covers them pretty much for free, like a little $13 administration fee. But in this case, UTMB said that there were several errors that occurred, and one of the errors happened when he was at the office and they entered his insurance information incorrectly. So it did not pick up that it was one of these short-term plans that doesn’t cover vaccinations. Otherwise, UTMB told me that they would have looked to the Vaccines for Children Program, but in this case that was one of the mistakes. His insurance was entered incorrectly, so they didn’t even check. They didn’t even check if he would qualify for the Vaccines for Children Program.\u00a0<\/p>\n Rovner:<\/strong> So what eventually happened with this bill?\u00a0<\/p>\n Appleby:<\/strong> So he asked for some relief from UTMB, and they initially gave him a 50% discount for being a self-paid patient, basically an uninsured patient. And the bill was still pretty hefty. It was still $1,266, of which the vaccine was $711. But after we contacted UTMB, they looked into it a little bit further and discovered a couple things. One, that he should have qualified for the Vaccines for Children Program, which they hadn’t entered in correctly. And two, that they had updated their chargemaster, which is a list of prices, several months earlier, and had mistakenly entered some of the vaccine prices, according to UTMB, at much higher levels than they should have been, so he kind of got hit with a double whammy. So at the end of the day, what they did was they waived all the vaccine costs for him, and he just ended up paying about $200 for the child’s office visit. And a similar thing happened with his daughters, who had also received other vaccinations.\u00a0<\/p>\n Rovner:<\/strong> So what’s the takeaway here? It sounds like the family did exactly what they thought they should have. They had insurance, they were told that it would be covered, and yet they still got socked with this enormous bill.\u00a0<\/p>\n Appleby:<\/strong> Yeah, they did do pretty much everything. I think one thing that experts always tell us is that you should always check with your insurer before you go in for some kind of elective thing, just to double-check. And in this case, they would’ve told him, Hey, vaccinations are not covered.<\/em> So that’s always a good idea. He also did the right thing by asking for a self-paid discount. And if you’re in a situation where you need vaccines for yourself or your kids and you are uninsured, check to see if they qualify for some kind of government program, through a public health agency or the Vaccines for Children Program, or some other low-cost method of getting those vaccinations.\u00a0<\/p>\n Rovner:<\/strong> Yeah, because vaccines should be available for not-prohibitive costs, right? Isn’t that the goal here?\u00a0<\/p>\n Appleby:<\/strong> That is the goal here, especially during a measles outbreak. That does seem like this guy was trying to do all the right things and take care of his family and did get hit with a series of mistakes that led to this large bill.\u00a0<\/p>\n Rovner:<\/strong> And if all else fails, you can write to us. Julie Appleby, thank you so much.\u00a0<\/p>\n Appleby:<\/strong> Thank you.\u00a0<\/p>\n Rovner:<\/strong> OK, we are back. It’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Rachel Z., why don’t you go first this week?\u00a0<\/p>\n Cohrs Zhang:<\/strong> OK, yeah. My story was from The Wall Street Journal, and it was a follow-on to some of the reporting we discussed earlier. The headline is “Prosecutors Question Doctors About UnitedHealth’s Medicare Billing Practices<\/a>,” by Christopher Weaver and Anna Wilde Mathews. And it’s just a discussion and kind of illuminating some of the details of where federal investigators are looking into some of their investigations into UnitedHealth. And it really seems that they’re looking into billing codes and what sorts of incentives or pressure that doctors faced to put certain billing codes on patients’ files. And I just thought it was a really great piece of reporting. And it’s hard to report on federal investigations, and they got some people on the record here. So just as a piece of craft, I really admired it.\u00a0<\/p>\n Rovner:<\/strong> It is \u2014 and we should be talking more about the investigation to UnitedHealth. And we will. I promise. Tami.\u00a0<\/p>\n Luhby:<\/strong> Well, I have a good piece that I looked at from Jenna Portnoy of The Washington Post. It’s headlined, “A New D.C. Hospital Grapples With Too Many Patients and Too Few Nurses<\/a>.” And the show has discussed the impact of the Big Beautiful Bill on hospitals and how they could, may be struggling in the future from Medicaid cuts. But here we have a hospital that opened in April in D.C. This is an in-depth story about Cedar Hill Regional Medical Center GW Health and how it was immediately inundated with too many patients and too few staffers, particularly nurses. Portnoy explains the challenges of running a hospital in a low-income area when there’s a nursing shortage. One great example that she gave was that the chief operating officer is cleaning beds.\u00a0<\/p>\n One issue that’s particularly notable from a health perspective is that the hospital had to turn away ambulances five times between mid-April and the end of June because its ER was full or because it had equipment failures. And one thing that she brought up, which is interesting, is that the hospital is trying to educate local residents about when one needs to visit an ER versus an urgent care center, to help lighten the hospital’s load. So it’s a good read and very illuminating.\u00a0<\/p>\n Rovner:<\/strong> It is, and it’s a brand-new hospital in a very underserved part of D.C. Really good story. Rachel R.\u00a0<\/p>\n Roubein:<\/strong> My extra credit this week is by The Associated Press. The headline is “RFK Jr. Promoted a Food Company He Says Will Make Americans Healthy. Their Meals Are Ultraprocessed<\/a>,” by Amanda Seitz and JoNel Aleccia. The story is about Secretary Kennedy praising a company that delivers meals directly to the homes of Medicaid and Medicare enrollees, and he thanks this company, called Mom’s Meals, for sending taxpayer-funded meals without additives to the homes of sick and elderly Americans. The Associated Press reviewed the menu, the ingredients, and the nutrition labels, and also spoke to experts. And what the reporters found is that the company offers these heat-and-eat, ultraprocessed foods that Kennedy kind of routinely criticizes for making people sick. Marion Nestle, who’s a longtime nutrition researcher, told the AP that she felt like there are other companies that would be able to produce better, healthier products, but they, of course, do cost more. Mom’s Meals, the company, when AP asked them about it, said that their meals don’t include some ingredients that Kennedy has railed against, like synthetic dyes, for instance.\u00a0<\/p>\n Rovner:<\/strong> Oh, that’s something. It’s a really good story. All right, well, for the second week in a row, my extra credit this week is from a medical journal. This week it’s a new series being launched by the New England Journal of Medicine called “The Corporatization of U.S. Health Care<\/a>.” It’s pretty nerdy, but I feel like the continuing march towards more and more of health care being consolidated under the control and direction of for-profit entities is at the heart of a lot of our system’s dysfunction. Which is not to suggest the business shouldn’t play a role in our health care system, even a large role, just that if we’re really going to go in this direction, maybe we should do it with an end goal in mind rather than just letting it happen. It’s a really good introduction to the subject. I’m looking forward to reading the rest of this series, both nerdy and really, really important if you want to understand health policy.\u00a0<\/p>\n OK. That is this week’s show. Thanks as always to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you folks hanging these days? Tami?\u00a0<\/p>\n Luhby:<\/strong> I’m at cnn.com<\/a>.\u00a0<\/p>\n Rovner:<\/strong> There you go. Rachel R.\u00a0<\/p>\n Roubein:<\/strong> My Bluesky is @rachelroubein<\/a>, my X is @rachel_roubein<\/a>, and you can always catch me on email or LinkedIn<\/a>.\u00a0<\/p>\n Rovner:<\/strong> And Rachel Z.\u00a0<\/p>\n Cohrs Zhang:<\/strong> I’m spending a lot of time on LinkedIn<\/a> these days and on X, @rachelcohrs<\/a>.\u00a0<\/p>\n Rovner:<\/strong> We will be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n \tFrancis Ying \tEmmarie Huetteman To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n And subscribe to KFF Health News’ “What the Health?” on\u00a0Spotify<\/a>,\u00a0Apple Podcasts<\/a>,\u00a0Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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