Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Nov. 21, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Rachel Cohrs Zhang of Stat News. 

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning, everyone. 

Rovner: And Riley Ray Griffin of Bloomberg News. 

Riley Ray Griffin: Hey, thanks for having me. 

Rovner: Later in this episode, we’ll talk to my colleague Sarah Varney, who’s been in Idaho covering the trial challenging that state’s abortion ban for its limits on exceptions. But first, this week’s news. 

So, of course, right after we taped last week, President-elect [Donald] Trump did, in fact, name Robert F. Kennedy Jr. as his choice to lead the Department of Health and Human Services, and we will talk more about that shortly. 

But HHS secretary isn’t the only major health policy position Trump has to fill. And on Tuesday, he named Dr. Mehmet Oz, of “Oprah” and talk-show fame, to lead the Centers for Medicare & Medicaid Services. CMS is the agency with responsibility to run not just Medicare and Medicaid but also the Children’s Health Insurance Program, CHIP, and the marketplaces for the Affordable Care Act. Together, CMS oversees the coverage of nearly half of all Americans. So what qualifies Dr. Oz to run this gigantic agency? 

Cohrs Zhang: Well, he’s good on TV. So apparently, that’s enough. 

Rovner: Apparently, that’s the main thing. 

Cohrs Zhang: I mean, his proponents will say, but he’s definitely a nontraditional candidate. Typically, we see more of a policy wonk, somebody who is deeply entrenched in running agencies and has potentially worked at the agency before. And I think last time around, we saw Seema Verma, who had run Medicaid in Indiana. So I think we’ve seen more traditional candidates even from President-elect Trump before. But I think, certainly, his proponents are arguing that he’s a doctor and it’ll be fine, and there are a lot of people under the secretary who will be writing a lot of these regulations and such. 

Rovner: And under the administrator. Right. 

Cohrs Zhang: Right. So I think it’s a nontraditional pick. But yeah, we’ll see. 

Rovner: I mean, it’s only a trillion dollars that he’s going to be overseeing. I was curious, because Sen. Bill Cassidy, who’s the incoming chairman of the Senate health committee, said something about, well, it’s sort of nice to see a doctor heading CMS. It’s not usually a doctor heading CMS. It’s usually a doctor heading FDA [the Food and Drug Administration] or NIH [the National Institutes of Health], but CMS is not really an agency that requires a medical background as much as it requires a financial and administrative and business background. 

Cohrs Zhang: I will say, there have been some interesting clashes lately between CMS and FDA over what Medicare pays for, what’s medically necessary. So I think it will be interesting to see how his medical background plays into those debates. 

Rovner: So Dr. Oz ran unsuccessfully for the Senate from Pennsylvania in 2022, even though he lives mostly in New Jersey, which may have contributed to his loss to John Fetterman. And during that campaign, he did have to opine on programs that would be under his direction should he be confirmed by the Senate or installed by Trump by recess appointment. He seems to be a big fan of Medicare Advantage, which seems relatively noncontroversial, unless you’re the head of CMS. MA could be a big topic next year. Right? 

Raman: I think so. I mean, when we look at how we have what is going to be DOGE [the Department of Government Efficiency] from Elon Musk and Vivek Ramaswamy, and them wanting to really cut down on excessive spending and just reduce the deficit, and then you have something like Medicare Advantage, which is traditionally more expensive, it kind of seems like they would be at odds with each other, and we don’t really know how DOGE will play out. 

It’s not authorized. It doesn’t have any appropriations. But if we get to that stage, with the Republican trifecta next year, I mean, those two could kind of be at odds with each other, just given that he’s been such a proponent on Medicare Advantage. I mean, he even had a “Medicare Advantage for All” kind of plan during his Senate campaign, and those pages are no longer online anymore now that he’s on track to be CMS administrator. But I think that’s going to be an interesting thing to watch if we get to that stage. 

Rovner: I think that’s going to be a tension throughout the entire department. I mean, you have this, on the one hand, part of the incoming administration trying to shrink the federal government, fire people who now work for the federal government, but also fire contractors. Well, Medicare Advantage is the ultimate contractor. I mean, that’s the idea of a public-private mix and the idea of privatizing Medicare. So, I mean, are they contractors, or is that part of privatization? And I’ll be interested to see whether a serious tension arises over that kind of thing. 

Cohrs Zhang: Yeah. I think there’s also just kind of the idea that, generally, Republican administrations are deregulatory, and it sounds like a lot of Robert F. Kennedy Jr.’s plans would increase regulations on ultra-processed food and some other areas he’s looking at. So I think there are going to be some of these contradictions. And so, I agree. I’m interested to see how it’ll all play out. 

Rovner: And you’re segueing perfectly into my next question, which is, as I mentioned, RFK Jr. is Trump’s pick to lead HHS starting next year. It’s not clear he can get confirmed by the Senate, although he has gotten some interesting positive feedback from people like Democratic senator Cory Booker and former congressman and now-Colorado Gov. Jared Polis. But it would seem that his biggest obstacle might be the fact that as a former Democrat, he supports abortion rights. How can all of these pro-life senators possibly get beyond that given that HHS is where almost all reproductive health policy in the federal government is made? 

Griffin: I think one question here that we should be thinking about is how this is playing out in the broader Cabinet, and putting this in perspective with the tap, the pick, the appointee for defense secretary, Pete Hegseth. And you’ve got Doug Collins, another TV personality, for VA [Department of Veterans Affairs] secretary. There are a lot of untraditional picks. And you have to ask yourself: How many Republicans are going to go to bat, be it on RFK Jr. or any of these nominees? 

And so, some of these are likely to get through, surely because it might not be the most contentious pick of the litter. And so, it’s really hard to tell how the abortion politics of all of this is going to play into a Senate decision. I think that’s something where I am trying to temper my expectations for what’s to come, is there is a broader orbit. And the taps, whether it be RFK Jr. or Dr. Oz, it may seem unexpected in the health world, but there are even more unexpected picks that have come out of the broader Cabinet. 

Rovner: Yeah. It makes you think that maybe he selected Matt Gaetz as attorney general so that all the incoming would be aimed at Matt Gaetz and everybody else could sort of slide under the radar, because we know there’s obviously this question of how Senate Republicans perceive that Trump has a mandate, even though, I would note, that the last votes continue to be counted. He has fallen under 50% in the popular vote. So it’s not quite the mandate that it seemed to be right after Election Day. But still, Republicans in the Senate are anxious not to cross the incoming president. 

And if they’re going to stand up to one or two, who knows which ones will make it? But I will say I’m a bit surprised by the anti-abortion movement’s relative silence on the fact that RFK Jr. is publicly pro-choice. Obviously, they must perceive some concern, because this really is what they anticipate is going to happen early on. All this stuff comes from HHS. Have they gotten some assurances that it doesn’t matter what he thinks, that all of those subheads of the agency are going to be anti-abortion and will sort of do their bidding? I mean, Sandhya, are you as surprised as I am at sort of how much this hasn’t resonated yet? 

Raman: I think I’ve heard some pushback from them. And I think the interesting one was, the day after we got the news about RFK Jr., we hear former vice president Mike Pence making a statement saying he is not happy. And he was one of the big drivers on some of these issues during the first Trump administration. And I think also what we are waiting on is when we get to the nomination hearings, and just seeing him put on the record on some of these things, because even in the past year or so, he’s been a little bit flip-floppy in terms of, he was, I guess, a little bit more in line with abortion rights before, and then kind of was more amenable to some of these regulations and things. 

And I think that getting that clarity from him in a nomination hearing might kind of push people in a little bit more of a direction. And I think at this point, right after we get the nominations in general, I think a lot of the statements, unless it is flat-out Will not support, are pretty general. They’re like, I’m excited to hear what they have to say. They’re very forward-looking, rather than giving a clear statement on, I will definitely vote yes. So I think us looking ahead— 

Rovner: A lot of keeping powder dry. 

Raman: Yeah. So I think, going ahead to that point, that will definitely paint a clearer picture, but it definitely raises the flags for certain people that this might be one of their stronger issues within the health portfolio. 

Rovner: So if he does make it in, there is a lot that he could do as secretary. Rachel, you have a really interesting story this week on how doctors get paid under Medicare and how RFK Jr. might want to change that. Why don’t you tell us about it? 

Cohrs Zhang: That was a vintage idea that has come back. I was honestly surprised to hear it this week, but we have heard that RFK Jr. has talked with his advisers about exploring the idea of taking away the American Medical Association’s role in recommending what Medicare pays for certain services. And I think there are certain specialties within the medical field that feel like that the system isn’t working and it’s incentivizing the wrong things, and that it’s a conflict of interest inherently if doctors are recommending what they get paid and then they’re making a bunch of— 

Rovner: And these are the codes, for people who don’t know. These are the— 

Cohrs Zhang: Yes. Yes. They’re medical billing codes. 

Rovner: The CPT [Current Procedural Terminology] codes, that when you get the little piece of paper from your doctor and has all those numbers on it. Those are all put together by the AMA. 

Cohrs Zhang: Yes. The copyright is also owned by the AMA. So they make money on royalties from selling books, from selling the right to use these billing codes in electronic health record software, and then they’re, in theory, using some of that money to lobby Congress for more pay. So I think there are experts who’ve raised concerns about this in the past. 

Republicans have periodically over the years, after the Affordable Care Act, for example, raised the idea of taking this away from the AMA when they’ve been upset. But I think it is an early area of interest for RFK Jr. that we haven’t heard much about, his stances on Medicare payments, but I think he definitely seems like he’s interested in picking a fight early with a very powerful doctors group. 

Rovner: I feel like I need to start an Excel spreadsheet of all the ideas that RFK Jr. has throughout HHS. He could be very, very busy. Well, obviously, the most attention this nomination is engendering is going towards the public health agencies — CDC [Centers for Disease Control and Prevention], NIH, and FDA — where RFK has threatened the biggest changes, potentially firing hundreds of officials and attempting to redirect the drug approval process, food regulations, and vaccines. What could he actually do in that sphere? I mean, a lot of this has been sort of dictated by Congress. I mean, could he just come in and wipe out the committee that advises on vaccine practices? Or would that be something that would end up in court? 

Cohrs Zhang: I would say one thing to remember about Congress is that they love to punt things to the secretary when they can’t agree on things. I’ve been reading through statutes. I’ve been surprised by how many times it says, “The secretary shall,” or how many times there’s leeway to make regulations or to appoint officials, and I think it remains to be seen who he’s going to pick as his general counsel. 

But if they really do take an aggressive stance, I think people would be surprised, honestly, how much they can do. Certainly, it could be litigated and slow things down, like we’ve seen has happened before, but I think people would be surprised, honestly, how much he can do if they were to really push the bounds of that authority. 

Rovner: Yeah. They could be very busy. Riley, did you want to say something? 

Griffin: Yeah. I was just going to say that one thing he can’t do is change how states determine vaccine mandates. And this is always at the state level. It certainly is informed by guidance from the CDC. So that is an important part. And if you see CDC change guidance around pediatric vaccines, maybe that emboldens state officials to take that up, but that is going to play out at the state level still. 

So one of the things I’m most interested is: How are state health officials interpreting this right now? What does it mean for them? And as you hear the tone and tenor around vaccines, particularly for kids, start to change and really give more agency, or seek to give more agency to parents to make independent decisions outside of the mandate world, how are they going to handle that dynamic. …  

I will say, there was a point on the trail early this year that Trump said that he wouldn’t provide funding to schools that implement vaccine mandates. So there might be other ways to get around this, and I don’t actually know how feasible that is, particularly at a time where the Department of Education is also seeing — is under threat. Let’s leave it there. But states are the ones that determine vaccine mandates. And no matter what RFK Jr. says about that, that will be the case. 

Rovner: Right. Well, we could talk about RFK Jr. for the rest of the hour, and we will not, but we will definitely come back to this in the coming weeks. It’s not just the executive branch where we’re seeing a lot of turnover. There are big changes in store on Capitol Hill when it comes to the leadership of the health committee. Sandhya, what do we know as of now about who’s going to lead sort of the health policy parade on Capitol Hill? We have new leadership in the Senate, because it’s changing parties, but we’re also going to have a lot of new leaders in the House even if it’s not changing parties. 

Raman: We are going to have so many changes, and some of the nuance we’re not going to know yet until they finish deciding amongst themselves. So one that I think is going to change the most is Energy and Commerce on the health side. We have, just in the health subcommittee, about half of the Democrats won’t be returning, five out of 12. 

And then on the Republican side, we have … I think that’s as interesting, as we have [Reps.] Larry Bucshon and Michael Burgess, who are big players in some different Medicare policy things, but they’re also two big members of the Doctors Caucus. We have the head of Energy and Commerce overall, [Rep.] Cathy McMorris Rodgers, stepping down after this year, and that just creates a big race to see who does that. 

Rovner: But also a big vacuum in expertise. 

Raman: Yes. Yes. And I think a lot of this shifting is just going to make things complicated, because there are certain things that just are very much pet products of certain members. So you look at a lot of disability policy things. That was a big thing for McMorris Rodgers. And so, when she’s gone it’s: Who will take the gavel on that next? 

Finance is also, on the Senate side, going to be a huge shake-up, with six of the 14 people not returning, possibly more, because Sen. John Thune is on that committee, and given that he’s going to be Senate majority leader next year, it’s not sure if he keeps that role or how that kind of plays out. And so that will also kind of shape just the different things that are prioritized and how we move forward. And obviously, for the Senate, we’re going to have changes in leadership just because the Senate is flipping. 

So we’re going to have [Sen.] Mike Crapo as head of Finance, and then Bill Cassidy the head of HELP [the Senate Health, Education, Labor, and Pensions Committee], and just how their changes are going to be different from the Democrats that have been leading so far. And then even with the [House] Education and Workforce Committee, the chairwoman, [Rep.] Virginia Foxx, also has said that she’s not seeking another waiver to be the head of that committee. 

So, again, we have whoever is going to lead the pack for that, and their health subcommittee chair right now is [Rep.] Bob Good, who lost his primary earlier this year. So I think a lot of these things are just very much in play about who will step up, and some of their priorities are kind of different than who was there in the past. 

Rovner: So even, obviously, with lots of these roles yet to be filled, Republicans on Capitol Hill are already making what appear to be big plans for next year, and Medicaid and the Affordable Care Act, if not Medicare, all look like they might be in the mix. What are we expecting and when? 

Cohrs Zhang: Well, I think there’s a lot of talk about the 100-day agenda. So we’ll see if that happens. But I will say, when we had a Democratic trifecta after President [Joe] Biden took office, we did see a reconciliation bill in the spring. So I don’t think that’s completely off the table, but I think they are kind of making plans, and I think this transition was more organized. People had ideas. 

And I think, again, we’ll see how committed Republicans are to regular order after complaining about it for years on the Senate side. And I will say that in 2021, policymaking was much more top-down. It was still very much like the pandemic time. So I am a bit skeptical that we’re going to see all of these tax and health issues resolved within 100 days, but I think they are going to be trying to move quickly. 

And I think part of that calculus will be: Can they resolve government funding issues at the end of this year? Or are they going to choose to kick that into next March or, I don’t know, next September? And just how busy their calendar is going to be on some of these issues until then. So I think they’re hoping to hit the ground running. We are hearing some of these policies floated. There’s great reporting from The Washington Post on that this week, but I think it remains to be seen exactly what that timeline will look like. 

Rovner: There was nobody in Washington that didn’t expect Medicaid to end up on a large hit list, if only because that’s a way for Republicans to cut the budget and get money to help pay for tax cuts and other things that they want. But you have, once again, given me the perfect segue into my next topic, which is the lame-duck Congress, this gentle reminder that Trump doesn’t take office until Jan. 20 and the new Congress doesn’t get seated until Jan. 3. And there’s still a lot of unfinished work for the current Congress and president, and not a lot of time left to do it. 

The temporary spending bill passed before the election runs out on Dec. 20, I believe, and there are a bunch of impending Medicare cuts that Congress likely wants to avert, plus some unfinished business lawmakers said they wanted to get done — PBMs [pharmacy benefit managers], cough, cough. Sandhya, can you give us an update, please, on where the lame-duck Congress is other than actually here in Washington this week? 

Raman: We have so much to do and so little time, and I think one thing that is also important to keep in mind is that it’s very easy to get very much blinders on about just the health priorities when there are so many other things in the broader policy context that are also going to be taking lawmakers’ time. So they still need NDAA [the National Defense Authorization Act], the farm bill. 

Rovner: The big defense bill. Right. 

Raman: Yes. A debt limit agreement, some of the disaster relief supplemental stuff that has been kind of a big thing this week. And so, keeping that in mind, the biggest priority is finding a spending vehicle to fund the government, whether that’s short-term or long-term. And I think that we’re still in kind of a confusing place, because when I have talked to the appropriators, they’ve kind of said, It’s in Trump’s court, but we would like to kind of just get this done and do kind of a clean slate for next year. 

And then you had Speaker Mike Johnson say earlier this week that he kind of wants the three-month until March that Rachel had mentioned. And so, I think we’re still waiting on what Trump gives his stamp of approval to, to see them kind of moving. And I think because of some of the other priorities right now, whatever movement we see on the spending side is going to be down to the deadline, the last bit of December before that kind of runs out, which is par for the course. 

Rovner: I would say. I have spent the week between Christmas and New Year on Capitol Hill many, many, many times, more times than I care to count. 

Raman: Yeah. And I think that punting it to March is not also an unusual thing. I mean, even this year, we had our funding bill signed into law in March. It was not an election year with all these changes. So it’s not unusual, that if they were to do that. It’s just a matter of: Will they do that? And whether or not they choose to do long-term versus short-term also dictates all the other health things that we’re watching, because if they’re doing something longer, there’s more room to work with and to tack other things onto that spending bill. 

We have all these different things like community health center funding, the National Health Service Corps, diabetes programs, all of these things that also are tied to Dec. 31. So they would get kind of packaged together. But if we do something like just clean extending the funding to March, it’s less likely that we’re going to get on some of the additional things that people were wanting, the things like pandemic preparedness, the drug pricing things that lawmakers have been working on for the past couple years but haven’t been able to attach to anything that we’ve had so far successfully. 

My read is that we would get some of these sort of easier things attached, so some of these reauthorizations, regardless of what spending vehicle we would get. It would be pretty unusual if they didn’t extend at least telehealth flexibilities a little longer, just because those are very popular with Republicans and Democrats, things like that. But some of the other things that are longer-term or more expensive are just really question marks depending on what we have time for this year and what we get to. 

Rovner: Well, I’m so glad that you brought up pandemic preparedness, because I do want to talk about bird flu, specifically the ominous spread of H5N1 bird flu to dairy cows and humans in the U.S. and now in Canada, where a teenager with no preexisting health problems or exposure to known contaminated animals ended up in intensive care with a mutated and potentially more transmissible form of the virus that public health officials are now watching with alarm. We haven’t talked about this very much, because it’s not really most of our panel’s expertise. But Riley, you’ve got a big piece out this week about pandemic preparedness, or lack thereof. Please tell us about it. 

Griffin: Yeah. No, thank you for asking. And I’ll just start with, the bird flu story is one that is raising continuous alarm. I think there have been a couple of headlines in the last few weeks, including seeing a pig get bird flu, which is always a concern because of the way that pigs have immune systems that are not too unlike ours and can both get sick from human flus and bird flus. And so, there’s concerns about the way that interchange exists and could create something new and scary. 

But the bigger point here is, we are entering a new era for pandemic preparedness with RFK Jr. at the helm. When he was launching a presidential bid, he said he would put infectious disease research on a break for eight years. You have also President-elect Donald Trump, who really broke down some global health relations when it comes to the WHO [World Health Organization] and just some norms there. 

And so the question becomes: What is the role of government in preparing and responding to pandemics looking forward? And now is a good time to be having that conversation, because we are actually at the five-year anniversary of covid first beginning to spread in China. December was the period at which countries started to call the WHO and say, Hey, what’s going on in Wuhan? And we know the rest of that story. But we don’t really have a grip on how governments will respond moving forward. 

The piece that I wrote for our December issue of Businessweek, in light of that anniversary, is about one company’s efforts. Everybody here is probably familiar with Abbott Laboratories. I’m sure every one of our listeners has taken one of the diagnostic tests over the years. They have seeded virus hunters around the world, particularly in places most impacted by climate change, to try to get a grip on what might be spreading. 

And the model that they’re taking is actually quite novel. It’s not like wastewater surveillance or some of these other methods that are a bit more passive. They’re going to clinics where people are experiencing fevers of unknown origin, just can’t be diagnosed by the existing tests, and taking those samples and then doing genetic sequencing to see if something new has emerged, and they found 20 new viruses. Those are the new ones that they’ve discovered. 

In addition, they’ve found some novel things, like perhaps the long-existing yellow fever vaccine might not actually work in the face of some mutations that they’re seeing in South America. So they’re just doing really interesting work. But the bigger picture here is, they’re doing this work not just for the good of the people, period, but they’re using that data to create a fleet of prototype tests, and they’ve got about 30 of these tests. And the question for them becomes, should any of these things become a real outbreak, how do they deploy those tests? 

And I tell this story now just because I do think it raises the question of what is the role of industry moving forward, particularly when we’ve seen a lot of other companies like Pfizer just struggle to create a post-pandemic vision. And activist investors have circulated because they don’t want them to talk about pandemics anymore. But, yeah, I think a lot of questions are to be seen. And with the Trump administration taking the Oval again, the reliance on industry should be front of mind. 

Rovner: It’s a really interesting story. I recommend it highly. 

Griffin: Thank you. 

Rovner: All right. Well, that is this week’s news. Now we will play my interview with Sarah Varney, then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my friend and longtime colleague Sarah Varney, who’s helping us out at KFF Health News keeping track of all things abortion and reproductive health this very busy fall. Sarah, welcome back to “What the Health?” 

Sarah Varney: Nice to talk with you, Julie. 

Rovner: So you’ve been in Idaho watching this trial challenging the state’s abortion ban. Who is suing who here, and what are they asking for? 

Varney: Sure. Well, Idaho has actually two laws that make providing abortion care a crime. The laws prohibit abortion in almost all circumstances, except to prevent a pregnant woman’s death and to stave off what’s called “substantial and irreversible impairment of a major bodily function,” or if the pregnancy was a result of a woman or a girl being raped. 

So this case was brought by four women and two physicians and a medical professional group, and they say that this state’s near-total abortion ban is jeopardizing women’s health, that it’s forcing women to carry fetuses with deadly anomalies, and that it’s really preventing doctors from intervening in potentially fatal medical emergencies. The women who brought the case shared this extraordinary, emotional testimony about their serious pregnancy complications, and they all ended up going out of state for abortion care. 

Rovner: Now, this is not the same case that the Supreme Court sent back to Idaho earlier this summer, right? 

Varney: That’s exactly right. Yeah. That case was called Moyle v. United States. And if people remember, after Roe was overturned, the Biden administration issued guidance to hospitals on how to comply with what’s called EMTALA, this emergency care provision. It’s known as the Emergency Medical Treatment and Labor Act, and the Biden administration essentially said all hospitals that accept Medicaid and Medicare dollars, which is just about everybody, has to provide abortion care in emergencies. 

But Idaho argued that EMTALA essentially conflicted with state law. So it went up to the U.S. Supreme Court, and the justices, in a 6-3 decision, they temporarily allowed abortions in medical emergencies in Idaho. It really did not settle the matter. The court dismissed the appeal from Idaho without considering the core issues in that case. 

Rovner: I think we described it when it happened. They said: Uh, never mind. We took this case too soon. 

Varney: Correct. And in fact, actually now, there’s another EMTALA case, as you know, out of Texas that the court did not take up. And so EMTALA is not essentially in effect when it comes to abortion care in the state of Texas. 

Rovner: That’s right. All right. But basically, both of these cases were asking for pretty much the same thing, right, which is clarification of these exceptions? 

Varney: Yeah. The Idaho law is a little different. So it’s in state court. There was a previous attempt in Idaho, a case that was brought by Planned Parenthood that actually challenged the constitutionality of the abortion bans. That went to the Idaho Supreme Court, and that case was rejected by the Supreme Court. So the justices said that there is no constitutional right to abortion in Idaho, and it affirmed that the state’s abortion bans were constitutional. So this case is a much narrower question. It’s essentially asking the court to clarify the medical exceptions. I know we’re going to talk a bit about the testimony, but for days, it was these physicians on the stand essentially saying, I have no idea when I can act. 

Rovner: Right. And we saw basically this same thing in Texas last year, right? 

Varney: Correct. And this was also the same legal advocacy organization called the Center for Reproductive Rights. They brought that case in Texas. As you probably remember, they actually won at the lower court, and then it went to the Texas Supreme Court and they lost. They did get one clarification from the Texas Supreme Court, which was that in the case of what’s called PPROM [preterm premature rupture of membranes]. So this is essentially when the amniotic sac breaks prior to viability, it can be a very dangerous, fast-moving infection. The Texas Supreme Court said in the cases of PPROM, abortion care is allowed. That is not the case in Idaho right now. 

Rovner: So last week in Idaho, we heard from the women who needed but couldn’t get emergency abortion care. What did they have to say? 

Varney: Sure. It was just heartbreaking. So there’s four women. They all had had children before they had a pregnancy with pregnancy complications. And then after this occurred, they all had children after that. So there were actually a number of small children in the courtroom. There were some parents with a stroller with a 10-month-old. 

One of the plaintiffs, Kayla Smith, had her 1-year-old daughter, Nora, on her lap much of the time. And at the same time, the state’s attorney, James Craig, was up there asking witnesses to describe in great detail what an abortion entailed medically. But there were two women I wanted to mention. One is, her name is Jillaine St. Michel, and she was there with her 10-month-old son. She had had a pregnancy where the fetus really did not develop. It was lacking leg and arm bones. It was missing a bladder. Its kidneys were fused together. But she was barred from ending her pregnancy. 

She was told that in the state of Idaho, abortion was not legal and her case was no exception. So under Idaho law, she and anyone else with a fatal fetal anomaly is forced to carry the pregnancy. She, instead, and her husband drove to Seattle for an abortion, and I spoke with her after court one day, and she talked a lot about how the state keeps talking about how abortion is “barbaric,” something that the Idaho attorney said over and over again. 

And she said to me, “The idea of allowing your child to experience suffering beyond what is necessary, to me, that feels barbaric.” And she said, “To put myself through that when that is not something I desired, that feels barbaric.” Another plaintiff, Kayla Smith, she also recalled having a routine anatomy scan for her second pregnancy, which showed that her son had multiple lethal heart defects. She ended up also having to leave the state, also going to Seattle for abortion care. 

Rovner: So this week, we’re hearing from doctors in the case, and we have heard on the podcast about a lot of doctors in Idaho leaving the state because they are worried about legal liability. What are the doctors saying? 

Varney: Yeah. The doctors are, to a one, saying: We don’t understand what this language means. We are not trained to sit around and wait until someone’s health deteriorates to a point where their life is threatened, where death is almost imminent. That is actually the language of the Idaho law. You could only do an abortion to prevent the death of a patient. 

So the doctors were saying: That is not how we’re trained, number one. Number two, we consult with our patients to understand what they want, particularly in the case of these lethal fetal anomalies. These are situations in which the woman’s health is not necessarily imminently in danger, but to carry the pregnancy, you can develop preeclampsia. Lethal pregnancies are far more dangerous than pregnancies that don’t have these types of anomalies. So the doctors are essentially saying, Our hands are tied, and we cannot help our patients. 

Rovner: So why does the state say they don’t need to change the law? 

Varney: Well, the state says this is the policy choice. This is what the lawyer said over and over again. This is the policy choice made by lawmakers in the state of Idaho, that Idaho protects unborn children, and that they believe that preventing abortion protects unborn children from pain. They said that these women have really no standing. Every single time the Idaho attorney got up to cross-examine these women, these plaintiffs, he asked them, “Are you pregnant now?” And the answer was “No.” “Do you plan on being pregnant in the future?” And for some of them, the answer was: “Maybe. I don’t know.” 

So there are cases that these women are not facing emergency situations in which they actually need access to abortion right now, so that they, in a sense, lack standing to bring this. The judge seemed to be less receptive to that argument. They say that it is clear what the exceptions are and that physicians are essentially to blame for this. 

Rovner: So what happens now? 

Varney: Sure. So the court resumes this week, as we talked about. They’ll have other additional testimony from some other physicians, and then the state so far has only one witness that it plans to call, a woman named Dr. Ingrid Skop, who’s a pretty well-known anti-abortion OB-GYN. She also testified in that Texas case that we were talking about. 

Rovner: I think her name is familiar to those who listen regularly to the podcast. 

Varney: Yeah, I’m sure. So no matter what happens, I mean, whether or not the Center for Reproductive Rights wins or the state wins, it’ll get appealed, and then, eventually, it will end up at the Idaho Supreme Court. 

Rovner: Well, Sarah Varney, thank you so much for the update. We will keep an eye on this one. 

Varney: Yeah. Nice to chat with you, Julie. 

Rovner: OK. We’re back, and 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. Sandhya, you chose first this week, so why don’t you go first? 

Raman: So I chose “How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk.” It’s by Annie Waldman for ProPublica. And this was a really interesting investigation, unraveling some of the red tape that’s been employed by UnitedHealth in some of these cases where therapists are getting flagged for having too many appointments with a patient, and then getting pushback from the insurers, quote-unquote “care advocates,” to cut off or deny reimbursements or back pay, and just how that’s playing out. 

And they have some interesting internal documents about how this is happening and some of the barriers to kind of address it, because of just how many plans and permutations of UnitedHealth plans there are, despite there being a lot of lawsuits in different jurisdictions around the country. So, great read. 

Cohrs Zhang: So my story is in CNBC, and the headline is “Dental Supply Stock Surges on RFK’s Anti-Fluoride Stance, Activist Involvement,” by Alex Harring. And I will say, I generally have a fairly low opinion of analysts’ estimates of what’s happening in Washington. But this was a pretty creative story, I think, and maybe a second-order kind of impact that we could see from some of these policy pronouncements. 

I think we’re going to see a lot of volatility. And I think it is entertaining, if not completely informative, to think of it more as a betting market. If people have money to bet on certain outcomes, like, what are they doing? So yeah, I thought it was creative and a little bit of a departure from the just broader takes we’ve seen on the market impact of some of these picks. So I thought it was creative. 

Rovner: I’m amazed that people think they can predict with their money what’s going to happen in Washington, because I certainly don’t use my money to predict, and even I, as I keep saying, am loath to predict what’s about to happen. Riley. 

Griffin: I picked a story called “A.I. Chatbots Defeated Doctors at Diagnosing Illness,” and this was in The New York Times, and it was by Gina Kolata. Mind you, to caveat, it is a small study of ChatGPT, but the findings were rather jarring. What this study found out of Beth Israel Medical Center in Boston was that doctors underperformed chatbots, and doctors plus chatbots underperformed chatbots alone. And that latter point is even more concerning, because what Gina so appropriately homes on is that the doctors, when presented with alternate diagnoses by the chatbots, weren’t willing to consider them or relinquish their fundamental beliefs. 

And people have said that a lot about the medical community, that there’s a kind of stick-in-the-mud approach. Again, it’s one study, and I’m sure we’ll see others that say different things as we continue to see the medical world take on AI. But this one study is pretty damning, and I would just suggest reading a little bit about how these doctors responded to these case studies, and what ChatGPT, something that so many of us have at least played with, was able to identify about patients. 

Rovner: Preparing for our robot overlords. My extra credit this week is also from ProPublica. It’s called “How Lincare Became a Multibillion-Dollar Medicare Scofflaw,” by Peter Elkind. And it’s an excellent reminder that you can campaign all you want on getting fraud and waste out of Medicare, but it is way easier said than done. Lincare is the nation’s largest distributor of home oxygen equipment and has repeatedly been caught and sanctioned for overbilling, overcharging, and paying physician kickbacks, among other violations. 

In fact, it’s been on probation four times since 2001, so almost equally while Democrats and Republicans ran the agency. And quoting from this story, “Despite a pattern not only of fraud, but of breaking its probation agreements, Lincare has never been required to do more than pay settlements that amount to pennies relative to its profits.” The bottom line here is that the company is quite literally too big to kick out of the Medicare program. So it continues to bilk taxpayers and cheat patients, and it’s hard for anyone to do very much about it. So good luck to the next administration. You have your work cut out for you. 

OK. That is this week’s show. As always, 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. Special thanks this week to our temporary production team of Taylor Cook and Lonnie Ro, as well as our editor, Emmarie Huetteman. 

As always, you can email us your comments or questions. We’re at whatthehealth, all one word, @kff.org, or you can still find me at X, @jrovner, and, increasingly, at Bluesky these days, @julierovner.bsky.social. Where are you guys on social media these days? Riley? 

Griffin: I am on X and on Threads, @rileyraygriffin, and I’ve got to get on Bluesky, apparently. That seems to be the trend. 

Rovner: Sandhya. 

Raman: I’m on X and on Bluesky, @SandhyaWrites. 

Rovner: Rachel. 

Cohrs Zhang: I’m on X, @rachelcohrs, and still on LinkedIn a lot. So feel free to follow me there. 

Rovner: Excellent. We will be back in your feed next week. Until then, be healthy.