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KFF Health News' 'What the Health?': Too Big To Fail? Now It’s ‘Too Big To Hack’
KFF Health News' 'What the Health?'

Too Big To Fail? Now It’s 'Too Big To Hack'

Episode 343

The Host

Mary Agnes Carey
KFF Health News

Lawmakers in Washington this week held the first congressional hearing on the Change Healthcare cyberattack, a breach that sent shock waves through the health care system as payments for care ground to a halt and left some providers in financial trouble. Republicans and Democrats alike zeroed in on how big health care conglomerations — like Change’s parent company, UnitedHealth Group — are leaving patients vulnerable.

And nearly 1 in 4 adults who lost Medicaid coverage in the past year are now uninsured, according to a new KFF survey probing the effects of what’s known as the “unwinding” of enrollments in the government insurance program for low-income people since pandemic-era protections expired.

This week’s panelists are Mary Agnes Carey of KFF Health News, Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of the Pink Sheet, and Lauren Weber of The Washington Post.


Jessie Hellmann
CQ Roll Call
Sarah Karlin-Smith
Pink Sheet
Lauren Weber
The Washington Post

Among the takeaways from this week’s episode:

  • Though the Change Healthcare hearing on Capitol Hill illuminated bipartisan agreement on the perils of vertical integration in health care, lawmakers did not agree on possible solutions. Addressing consolidation, however, could remedy issues in health care beyond cybersecurity.
  • The KFF survey on the unwinding found that nearly half of those who lost coverage signed back up for Medicaid weeks or months later, a signal that those enrollees should never have been dropped in the first place. Even a temporary loss in health coverage can have serious, lingering consequences.
  • Republicans in Arizona are grappling with the fallout from the state’s newly reinstated, Civil War-era abortion law — echoing recent problems for Alabama Republicans after a state Supreme Court ruling upended access to in vitro fertilization there. Softened stances from conservative hard-liners like Senate candidate Kari Lake point to the potential negative consequences for the party in a critical election year.
  • And the Centers for Disease Control and Prevention released new information about the current measles outbreak, revealing that many of those sickened are children, as well as adults who are unvaccinated or whose vaccination status is unknown.

Also this week, Julie Rovner, KFF Health News’ chief Washington correspondent, interviews Caroline Pearson of the Peterson Health Technology Institute.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Mary Agnes Carey: KFF Health News’ “When Rogue Brokers Switch People’s ACA Policies, Tax Surprises Can Follow,” by Julie Appleby. 

Jessie Hellmann: Tampa Bay Times’ “Vulnerable Florida Patients Scramble After Abrupt Medicaid Termination,” by Teghan Simonton. 

Sarah Karlin-Smith: Stat’s “Grocers Are Pushing Legislation They Claim Would Enhance Food Safety. Advocates Say It Would Gut FDA Rules,” by Nicholas Florko. 

Lauren Weber: The New York Times’ “Chinese Company Under Congressional Scrutiny Makes Key U.S. Drugs,” by Christina Jewett. 

Also mentioned on this week’s podcast:

[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.]

Mary Agnes Carey: Hello and welcome back to “What the Health?” I’m Mary Agnes Carey of KFF Health News filling in this week for your usual host, Julie Rovner. I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, April 18, at 10 a.m. Eastern. As always, news happens fast and things might’ve changed by the time you hear this. So here we go. We’re joined today via video conference by Lauren Weber of The Washington Post.

Lauren Weber: Hello, hello.

Carey: Jessie Hellmann of CQ Roll Call.

Jessie Hellmann: Hey, there.

Carey: And Sarah Karlin-Smith of the Pink Sheet.

Sarah Karlin-Smith: Hi, everybody.

Carey: Later in this episode we’ll have Julie’s interview with Caroline Pearson of the Peterson Health Technology Institute. That’s a new nonprofit designed to assess the costs and benefits of new digital health technologies. But first, this week’s news.

Congress jumped in into the Change Healthcare cyberattack story this week with the House Energy and Commerce Committee holding a hearing into the historic theft of medical data that shut down operations at hospitals and pharmacies.

Some of these medical providers are still experiencing revenue losses due to unpaid claims. Representatives of UnitedHealth Group, which owns Change Healthcare, were not present at this hearing, but they promised to testify at a future date. Jessie, you covered the hearing. Start us out. What happened?

Hellmann: There was a lot of frustration from members about how this attack happened and the circumstances that led to us being in this situation. There’s a lot of frustration just about the size of UnitedHealth Group. They’re a massive health care company, one of the biggest in the United States, and there were just a lot of complaints about the vertical integration that just made this cyberattack so much more widespread that there weren’t really many policy solutions that were talked about.

It was like an airing of grievances. So I think we’re still pretty early on in terms of Congress trying to figure out how to respond to these kinds of things and preventing them from happening again. And it already seems like there’s some disagreement from Democrats and Republicans about how to respond to this. Democrats like Sen. Ron Wyden are talking about how there’s really no mandatory cybersecurity requirements for hospitals and other health care sector industries to meet, and he thinks that should change.

And Republicans are talking about how they don’t think that there should be a top-down mandate where we’re requiring health care providers meet cybersecurity requirements. So at this point, it seems like there are some more debate that needs to happen on this, and it’s not very clear how Congress will respond.

Carey: Lauren, jump in.

Weber: Yeah. I just wanted to say, I mean, just to take a step back, we talk about these cyberattacks on hospitals or health care, they can have really serious consequences. There was a study I think that came out that said mortality risks rose by 21%, which is a wild stat when you think about the fact that a lot more hospitals have been held ransom in the last few years, a significantly larger number, to real outcome risks. And the other concern is you have patients’ personal data being leaked.

I just did a story with Dan Diamond and my co-worker Dan Keating about the over $2 billion in Medicare fraud over catheters. I mean, those numbers probably got leaked in some sort of hack or ransomware attack like you’re seeing here. And so on top of obviously the vertical integration of UnitedHealthcare, I think these conversations around the real threat of ransomware attacks really are quite something, and the fact that there are not a lot of solutions is concerning for health care as a whole.

Karlin-Smith: The thing that struck me about the vertical integration component of this and how it made the attack so much worse, is that there are other health policy issues that Congress has been looking at or other parts of the government have been concerned about in health care, where vertical integration is seen as a key problem. So a space I’ve covered a lot lately is the pharmacy benefit managers and some of their role in drug pricing, but I know there’s other concerns around the gobbling up of primary care, other just smaller medical practices and vertical integration.

So I think there’s an interesting hook, I guess, for policymakers and lawmakers to think about if they take on that topic. Do they solve actually multiple problems potentially in the health policy space, not just cybersecurity?

Carey: And might these thoughts be part of the Senate finance hearing? Jessie, you mentioned a moment ago that Ron Wyden, the chair of that committee, is having a hearing. Can you give us any window into that?

Hellmann: Yeah. He was speaking at the American Hospital Association conference this week and he said there was going to be a hearing. It sounds like it’s going to be with UnitedHealth Group CEO Andrew Witty. I don’t think there’s been a date set for that, but reports have indicated it’ll be this month.

And it’ll be the first time that he’s really been questioned publicly about this attack and how it happened and the impact of it. So, I don’t imagine they’ll go very easy on him, especially. … It just seems like lawmakers are getting more and more frustrated as we learn more about this or grappling with the long-term effects of it.

Carey: True, and it’s certainly a very, very expensive thing for UnitedHealth Group. The company on Tuesday reported an $872 million charge for “unfavorable cyberattack effects” in the first quarter. But UnitedHealth didn’t reveal how much or if it had paid ransom to the hackers. So maybe we’ll get more there. Let’s go ahead and move on to Medicaid, specifically Medicaid unwinding and what’s happening there.

This is the process where states are reassessing Medicaid eligibility for millions of Americans who enrolled during the pandemic and dropping those who don’t qualify or perhaps didn’t complete the renewal procedures. The full Medicaid unwinding process won’t be completed until later this year. Recently released data from my KFF colleagues who study the Medicaid program found that nearly a quarter of adults disenrolled from Medicaid in the past year say they are now insured.

The KFF survey details how tens of millions of Americans have struggled to retain coverage in the government insurance program for low-income people after the pandemic-era protections expired last spring. While 23% of those surveyed report being uninsured, an additional 28% found coverage through an employer, Medicare, the Affordable Care Act’s [Health] Insurance Marketplace, or health care for members of the military, the KFF survey found.

So, my question for all of you is were you surprised at these findings? We’ve all been keeping our eyes on the unwinding issue for months. It’s been a topic of discussion many times here on “What the Health?” What’s your take so far?

Weber: I can’t say based on what we all know that it’s surprising. I mean, I think what’s concerning and what we only will see as this continues to play out is what the effect of that loss of coverage is. I think we won’t know for some time because it’ll take research a while to catch up. I mean, we have the anecdotal reports, but I mean, people losing coverage even temporarily can be devastating in terms of their medical outcomes.

I want to point to some of the data from that survey I believe from KFF is the impact on children has been particularly unfortunate. Nearly 5 million children, I believe, have lost Medicaid coverage so far. I think 2 million of them are in three states, Texas, Georgia, and Florida, which have not expanded Medicaid under the Affordable Care Act. And that’s a lot of kids not having access to potentially health care they desperately need, and remains to be seen what the outcomes of that are.

Carey: People might think that the reenrollment certification process is fairly straightforward, right? What are some of the problems that Medicaid beneficiaries are facing as they try to prove that they’re eligible for coverage? Can we unpack that a little bit?

Karlin-Smith: Some of it it just seems like the states don’t actually have enough people and staff to help everybody in an efficient way, and that every state process is different. So that’s been a big barrier.

Weber: There’s also, I mean, the mailing issue is always an issue. This has always been a Medicaid problem. People send mail to old addresses, outdated addresses. Even The New York Times even spoke to someone who they had updated their address, but they still didn’t get their renewal packet at the right place and it impacted their child’s ability to see several specialists.

We all deal with logistical problems when it comes to mail. I know I certainly have missed some mail in the past. But when it comes to your actual health care, especially health care for your children, it’s pretty wild that we rely on this antiquated of a system and this amount of red tape for some of these people’s access.

Karlin-Smith: I was going to say there are reports even of the way the state’s software and processes were going. That they were triggering one child in a family to be kicked off and not the other child. So clearly, again, the systems the states are using to kick people off have their own problems that are improperly booting people who shouldn’t be booted.

Carey: Sure. Jess, did you have any sense of whether, and they don’t have to, but would lawmakers try to jump in as this unwinding unfolds to try to remedy some of these issues that are happening with state systems or on the federal government side? Or is that something you think they’re just going to let it play out and see what happens?

Hellmann: I think if they were going to jump in, they probably would’ve done it already. This process has been playing out for several months now, and it seems like the Biden administration has been pushing states to get a handle on the process and make sure people shouldn’t be losing coverage if they’re still eligible. But it seems like that’s going to continue happening. The survey said that nearly half of the people who lost coverage ended up signing up again weeks or months later, which indicates they probably shouldn’t have been kicked off in the first place.

I was reading stories about how people didn’t find out that they were kicked off until they tried to schedule a medical appointment or their providers told them, “Your coverage isn’t active anymore.” So it just shows that there’s this really big disconnect between people and their states sometimes. It can be hard to reach people.

Carey: Sure. Well, we’ll continue to watch this as I’m sure you all will. But right now I would like to move to a topic that was discussed on last week’s podcast. This is about the Arizona Supreme Court’s ruling that an abortion ban originally passed in 1864 — that’s before the end of the Civil War and decades before Arizona even became a state — that that law could be enforced. And in some other states, including Florida, voters will likely have the chance in November to decide whether to include abortion rights in their state constitutions.

So to that point, Arizona Republicans are trying to figure out how to respond to a planned ballot measure this fall that would enshrine abortion rights. And we have some news on this. On Thursday, Republican lawmakers in the Statehouse blocked an effort to repeal the ban in the state legislature, but then a handful of Republicans in the state Senate sided with Democrats and allowed them to introduce a bill to repeal it.

What does this split among Republican members of the Arizona Legislature mean for the overall GOP’s efforts, not only in this state but nationwide, to take some of the momentum from Democrats on the abortion issue?

Weber: I think what we’re seeing here is what we saw a little bit, obviously, in Alabama with the IVF fallout. You’re seeing Democrats capitalizing on the moment to some extent with their electorate and saying, “Look, Republicans are not on your side. Vote for us, et cetera. We’ll have this ballot measure. We’ll see what the turnout is.”

And as we’ve talked about on this podcast several times, I mean, I think it remains to be seen, especially in a presidential year in which we have two candidates who are historically somewhat unpopular it seems with their parties, how abortion ballot measures across the country could play out in terms of turnout for one party or another, when folks are apathetic about the election as a whole.

So I think there’s a lot of movement and a lot of scurrying in Arizona, which obviously would be an influential state in that presidential election to see how that could influence politics one way or another.

Carey: And they’ve got these additional pressures, right? You’ve got former President Trump, who’s the presumptive GOP nominee, saying that Arizona Republican lawmakers should “act immediately” to repeal this law. You’ve got GOP Senate candidate Kari Lake from Arizona also calling for the overturning of the 1864 law. And we do have voters in about a dozen states that could decide the fate of abortion rights in November with all of these constitutional amendments on the ballot in what is absolutely a pivotal election year.

And that’s including in a lot of battleground states that are key to deciding the presidential race and which party controls Congress. I also think it’s interesting to note, ever since the Supreme Court overturned Roe v. Wade in June of 2022, every ballot measure that has sought to preserve or expand abortion access has been successful, while those that have sought to restrict abortion access have failed, even in states that skew conservative. Is the same thing going to happen this fall? Get out your crystal balls.

Weber: I mean, I think there’s a reason that [Sen.] Josh Hawley is out there not exactly thrilled about an abortion ballot in his state in his election year. I mean, I think if we talk about you see Kari Lake, you see Donald Trump, I think they see the writing on the wall. As we’ve discussed that there’s concerns that these abortion ballots, which have been popular, which have driven turnout, could result in negative downstream consequences for them getting elected.

So it still remains to be seen. It’s very early. But yes, I think there’s a reason you have Kari Lake, Donald Trump, and Josh Hawley all saying those things.

Karlin-Smith: No, I think it’s interesting. I’ve just been thinking about this is you could think about these politicians as being opportunistic and just changing their views because …

Carey: No way!

Karlin-Smith: … they see the tide going in their favor. But on the other hand, I guess maybe in some ways this is how a democracy is supposed to work, that people see how their citizens are feeling and represent them. You can get a little bit cynical watching this in Washington, seeing everybody shift their tune as they realize the popular opinion is not with them.

Carey: Sure. And I think another thing to watch as we go forward is there’ll be a lot of twists and turns in the wording of these amendments on ballots, some of which opponents may say is done intentionally to confuse people. I see people nodding their heads. Anybody want to jump in?

Hellmann: I think The New York Times story this week about the proposed ballot measure on abortion right[s] in Arizona really laid that out. They got access to this presentation that was done by Republican operatives framing these competing abortion ballot measures that they were thinking of [proposing], or putting out there, as being intentionally misleading to people. So that’s definitely part of the strategy that is not very surprising and that they’ve admitted privately.

Carey: Well, we’ll see how that plays out. That’s another fascinating angle that we’ll all be watching. So I’d like to shift gears just a little bit. I want to chat about a new ruling from the U.S. Equal Employment Opportunity Commission that says abortion-related accommodations are included under the Pregnant Workers Fairness Act that was released earlier this week. What are these accommodations?

Karlin-Smith: These are essentially accommodations to ensure people can have unpaid leave for pregnancy-related issues without losing their job. And it’s particularly important for people that do not get covered by FMLA [Family and Medical Leave Act], which protects people who work for larger employers, which actually that was what shocked me about all of this, that there are some people that don’t get the FMLA protections.

Carey: Because they’re too small, right? It’s like 15 and under, you don’t hit that.

Karlin-Smith: Fifty, I think.

Carey: Fifty. Beg your pardon. If you’re a smaller employer, as an employee, you may not be eligible. That’s the takeaway.

Karlin-Smith: Correct. Yeah. There’s controversy over whether abortion should qualify under these protections, although of course, again, you have to remember, abortion care also essentially encompasses things like care for miscarriages and so forth. I think sometimes people create these arbitrary lines between abortion/miscarriage, and it’s all sort of one and the same. I think it becomes really hard to tease that out based on if you’re thinking about pregnancy and the complications that arise with that.

Weber: Just to chime in, I mean too just on the pregnancy protections, I mean, the reason rules like this were protected because back in March, EEOC [Equal Employment Opportunity Commission], they settled an over-$200,000 lawsuit with Walgreens, which essentially did not allow a pregnant woman to go seek emergency medical care when she started spotting and later that day she miscarried. I mean, these are situations that seem hard to believe, but happen every day here in the U.S. So that kind of protection would theoretically, hopefully protect someone in that kind of situation.

Carey: Right, and we should talk to your point, Lauren. I hit on the abortion perspective there with the first question, but this is also talking about things like letting people have water, letting them have a chair, letting them sit down. These are deemed as reasonable accommodations, and some people may still oppose them on religious grounds if it deals with care for an abortion, but we will leave that there and turn to another topic we have talked a lot about: measles.

According to the Centers for Disease Control and Prevention, also known as the CDC, eight more measles cases have been reported, bringing that total to 121 so far this year. Forty-seven percent of those cases are in children ages 5 and younger. And for 82% of individuals who’ve been diagnosed with measles, their vaccination status is either unvaccinated or unknown. And the cases noted this week were in California, Illinois, and Ohio.

Lauren, I know you’ve written a lot about public health officials and their tracking of these kind of things. How are they trying to contain this outbreak?

Weber: Well, it depends on what state you’re in for the answer to that, MAC.

Carey: There you go.

Weber: I would say that in general, what we’re seeing here with this explosion of measles is really the ramifications of the misinformation and anti-vaccine rhetoric whipped up by covid coming to bear. We’ve had the highest rate, according to CDC data from I think it was the 2022-2023 school year, of parents requesting exemptions for their children. In kindergarten, we’re seeing more measles cases, which again is a vaccine-preventable disease.

Most public health officials, the vast majority, are advocating for vaccination, public awareness, bringing up those vaccination numbers, making sure we track down cases. But then you see others in Florida, most notably the surgeon general in the third-most-populous state, not following public health guidance when it comes to measles.

And the concern is, as we move forward, what will happen as you have more measles cases potentially show up in a Florida or in another very red state where a public health official may choose to take a different tack? We’ll see how that continues to play out this year.

Carey: I know, Lauren, you’ve written extensively about this, and others feel free to jump in, but I mean, you’re talking about public health departments that have really been hit: funding cuts, staff reductions. And that’s going to impact their ability to track and contain measles and other highly contagious diseases.

Weber: I mean, I think also we have to talk about the fact that public health as a whole has been incredibly politicized. Anytime you say the word “public health” it usually has a somewhat negative reaction in a post-covid world. I mean, we live with covid, but after the pandemic began. And you are seeing even though health departments did get a boost of funds from covid money and some of the money that passed through the CDC, those funds are going to drop off soon. So you’re even going to see a reduction in workforce from the growth they had to combat those cuts they’d faced for years.

You’re going to have, again, that boom-bust cycle when it comes to public health. And when you have that boom-bust cycle, that means that you don’t have enough public health workers to properly track a measles outbreak or monitor any other water outbreak or other public health issue that we all just live our lives and don’t think about every day. And so it is concerning when you see what is a vaccine-preventable disease and, as many experts have told me, not something we should be seeing in 2024 in America coming up this frequently in children.

And again, let’s just point out that measles can have deadly effects. It can also have very serious health effects. It is not a fun thing for any child or any person to endure. And so a lot of public health experts are just really, frankly, discouraged that message has been lost in some corners of this country.

Carey: All right. Well, that’s the news for this week. Now we’re going to play Julie’s interview with Caroline Pearson and then we’ll come back for our extra credits.

Julie Rovner: I am pleased to welcome to the podcast Caroline Pearson, executive director of the Peterson Health Technology Institute. If that organization sounds familiar, it’s because we talked about the Institute’s first public project a couple of weeks ago. Caroline, thanks for joining us.

Caroline Pearson: I’m so excited to be here, Julie. Thanks so much.

Rovner: So let’s start with what the Peterson Health Technology Institute is and what it does.

Pearson: Wonderful. Well, we are an independent, nonprofit evaluator of digital health tools. So we are trying to figure out what works and what doesn’t in the space of health technology.

Rovner: And there is an awful lot of that to choose from, right?

Pearson: There is indeed, and it’s really hard to sort the wheat from the chaff. And so we hope to be helpful.

Rovner: So for those who don’t remember or weren’t listening a couple of weeks ago, remind us what your first assessment was about and what you found.

Pearson: We conducted an assessment of digital diabetes tools to support adults with Type 2 diabetes, and they rely on noncontinuous glucometers. Those are the ones that you prick your finger with. And then they support the patients with diabetes by encouraging them to take their blood glucose on a regular basis, to make a variety of behavior and lifestyle changes, and really to help with self-management between their clinician visits.

Rovner: All of which sounds cool. What did you find?

Pearson: Well, diabetes is obviously a huge and growing issue in this country, and it really does rely on patients to manage so much on their own. And so it makes sense that these tools were created to be helpful to patients. And if we can help them manage better, in theory, we can help them be healthier. But unfortunately, while many of these tools have been around 10, some of them 15 years at this point, we found very little evidence that they’re having meaningful clinical benefits for patients across the board.

And so we found that really patients weren’t seeing significant improvements in their hemoglobin A1C that were sufficient to change their prognosis or their health spending — and unfortunately, were paying a lot of money both through health plans and through physicians for these digital solutions. And so on net, they’re increasing costs and not delivering a lot of health benefits.

Rovner: And I keep saying this, that every time somebody looks at something that didn’t work, that’s a success, not a failure, right?

Pearson: Well, I’m so excited that we’re just having a serious conversation about evidence. We’ve been excited about health technology. Obviously covid was a huge boom. But as we’re innovating, we need to be measuring and taking a step back and making sure that the tools that we’re using are delivering the value that we want. And if they’re not, we keep innovating. We push forward. But it’s important to bring that real evidence-based framework to this industry.

Rovner: So what are you doing next and how do you decide which specific technology to assess? As you mentioned, there’s an awful lot out there.

Pearson: Well, there’s many to choose from. Our next one is going to be looking at virtual solutions to help with musculoskeletal problems. So these are really, like, virtual physical therapy apps that people can do at home on their own and much more convenient and can really help with access. And then after that, we’ve got hypertension coming up, and mental health for anxiety and depression before the end of the year.

And I think the theme that you’ll see across all four of those is these are really big clinical areas, things that affect a lot of patients and create a lot of health care spending. And places where we’ve seen really a lot of technology investment, and we think there’s some opportunity for evaluation of that investment.

Rovner: So technology assessment has a more controversial history than I think many people realize. I am old enough to remember the congressional Office of Technology Assessment, which was summarily canceled when Republicans took over Congress after the 1994 elections. Why is this subject so touchy and how are you going to avoid falling into the trap of being perceived as unbalanced?

Pearson: Well, first and foremost, we are, I think, the only entity that we know of that really doesn’t have a stake in the game. We’re a philanthropy and we simply want to make health care more effective and more efficient. So we really have the ability to be truly independent, whereas many of the entities in this space are pay-to-play or have some investment interest. I don’t know why it’s been so hard. I really can’t explain. Many people remind me about the OTA and that it did exist once.

Rovner: It was very popular when it existed. They did a lot of good work.

Pearson: It did. It did. Well, I guess no one even needs to vote for my institute. So we’re going to keep doing this good work because we think it’s important and we hope to really drive impact both for patients and those who are purchasing these technologies, but also for folks who are developing these technologies and investing in them. I think everyone wants to be able to figure out what’s really working and put their investment and their energy behind that.

Rovner: Well, absolutely. We will be watching. Caroline Pearson, thank you so much for joining us.

Pearson: Thank you, Julie. Great to be here.

Carey: All right, we’re back. And it’s time for our extra-credit segment. That’s when we each recommend a story that we read this week and think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at and in our show notes on your phone or other mobile device. Lauren, why don’t you start us off with your extra credit?

Weber: I’ll fangirl another former KFF Health News colleague, Christina Jewett, who’s at The New York Times, who basically taught me everything I know. So shoutout on this podcast.

Carey: She’s awesome. I can verify.

Weber: She wrote, as always, a great dive called “Chinese Company Under Congressional Scrutiny Makes Key U.S. Drugs.” It basically gets into how this company, WuXi, I believe is how you say it, but I could be wrong, is behind pretty much, I believe it was a 1 in 4, one-fourth of the drugs used in the U.S. OK, that’s a lot of the drugs used in the U.S., but it is under congressional scrutiny as potentially having too deep of interest from China.

And so there are talks of limiting its access to U.S. companies and limiting its contracts and so on, which could be very devastating to many of the drugs it’s involved with, which include those that treat cystic fibrosis, leukemia, a wide variety of things. Again, if you cover a quarter of the drugs in the U.S., you’re covering a lot of things that are very important. And what Christina did so deftly is there’s all been this talk about this company, it’s all been in the ether, but she went and found out actually what kind of drugs that would impact if there was some sort of ban. And it’s definitely something to be watching when we think about biotech interests abroad and just in general access to the U.S.’s drug supply and our access as patients to its availability.

Carey: Jessie, can you share your extra credit, please?

Hellmann: My story is from the Tampa Bay Times. It’s called “Vulnerable Florida Patients Scramble After Abrupt Medicaid Termination.” It focuses on people who receive the home- and community-based services. Some people in Florida have been finding that they were disenrolled during this redetermination process, and a lot of these people are people who would probably never lose eligibility if not for procedural reasons.

There are people that need a lot of intense care in their homes and they rely on this program for that care. And advocates in Florida have been sending up red flags about what’s going on there. And the state has said in their defense that they’ve reached out to these families and didn’t get any paperwork back.

But I think it’s important to note that these are families and these are individuals who have a lot going on and they’re caring for their loved ones. And it might be easier for them to fall through the cracks, and there are really serious consequences to that.

Carey: Sarah?

Karlin-Smith: I took a look at a Stat story by Nick Florko, “Grocers Are Pushing Legislation They Claim Would Enhance Food Safety. Advocates Say It Would Gut FDA Rules.” And my favorite thing about this story is it focuses on a bill with a title called Food Traceability Enhancement Act, which would make you think, I think, for many people, that the idea is to, again, increase food safety.

And actually it appears to be an effort by food, grocery store lobbyists and so forth to gut FDA safety rules that are set to go into effect in 2026 that would help better control, contain, prevent food outbreaks. So it’s raising alarm, particularly by one of the former FDA heads of the food program, who basically worries it’s going to, again, set back big efforts to better protect all of us who consume food.

Carey: Good reminder. You always got to watch those bill titles. The details may not reflect the title. My extra credit this week is from my KFF Health News colleague Julie Appleby. The headline is “When Rogue Brokers Switch People’s ACA Policies, Tax Surprises Can Follow.” Julie broke that story about ACA enrollees being switched into plans that they didn’t select. That’s a tactic that earned commissions for some dishonest insurance agents, but it’s caused headaches for people who are now on the hook to pay more in taxes for health coverage they didn’t even know that they had.

So that’s our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review. That helps others find us too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at, or you can find me on X @maryagnescarey. Lauren, where are you these days?

Weber: Still only can find me on X. I’m @LaurenWeberHP, the HP is for health policy

Carey: Jessie.

Hellmann: Also still on X @jessiehellmann.

Carey: And Sarah?

Karlin-Smith: I’m at X on @SarahKarlin and the trying to get more into Blue Sky at @sarahkarlin-smith.

Carey: Julie will be back in your feed next week. Until then, be healthy.


Francis Ying
Audio producer
Emmarie Huetteman

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