Trump Officials Still Delaying Funds

[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

Julie Rovner: Hello from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and as always I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 25, 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 Maya Goldman of Axios News. 

Maya Goldman: Hello. 

Rovner: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hey, everybody. 

Rovner: And my KFF Health news colleague Rachana Pradhan. 

Rachana Pradhan: Hey, Julie. 

Rovner: No interview this week, but way too much news, so let’s see how much we can squeeze in. We’re going to start this week at the Department of Health and Human Services, where we have a pair of stories about grant funding passed by Congress and signed into law by President [Donald] Trump still not getting where it’s supposed to go. Over at NOTUS, our podcast pal Paige Winfield Cunningham reports that states and health organizations are waiting for nearly half a billion dollars for a variety of programs, including suicide hotlines and opioid addiction treatment centers, because of a convoluted clearance process that involves artificial intelligence and political appointee sign-offs to, quote, “ensure alignment with Agency priorities.” Quoting from Paige’s story: “One former career staffer at the CDC who served under four administrations said fewer than five or six grant notices in a year would typically get reviewed at the HHS level. Now it’s all of them.” Stat has a similar story, except this one is about delays in grant funding from the National Institutes of Health, where with just three months left in the fiscal year, 90% of the $37 million in grant funding from the National Institute on Disability, Independent Living, and Rehabilitation [Research] has yet to be released. I know I sound like a broken record, but that’s not how any of this is supposed to work, right? 

Goldman: Right. 

Pradhan: No, I think this is, more or less, some version of this has been going on since January, February of 2025, but I think now it’s being more institutionalized in federal policy. That’s what they’re attempting to do. Whereas in the first few months of the current Trump administration, it was instituted at — “haphazard” probably doesn’t really do it justice — but it was sort of this very chaotic process of instituting these new layers of political appointee review on what federal money was funding, ultimately, right? And whether political appointees decided that it was something that they thought the federal government should be doing. 

Rovner: At the beginning, they just froze everything. 

Pradhan: Right. 

Kenen: They cut everything. 

Pradhan: And then they— 

Rovner: Then they cut everything 

Pradhan: —started cutting things. Right. Things like which we’ve all talked about and done plenty of reporting on, right? Things that aren’t supported by political appointees, regardless of their scientific merit, right? And so now this has sort of taken on an even broader evolution, so that it is formal federal government policy regulation that political appointees can review every dollar that goes out for anything, almost, right? All grantmaking, which is just an extraordinary sum of money. 

Goldman: Yeah. 

Rovner: And Congress, remember Congress, which owns this spending power, said in last year’s appropriations, You will spend this money the way we are telling you to. And the president signed those bills, promising to do that, and now is not. Maya, you wanted to say something. 

Goldman: I was just going to say, I think there was so much focus — like Rachana said, when in the DOGE [Department of Government Efficiency] era — on federal funding in healthcare and getting trapped in this purgatory space, and I think there’s maybe a misconception that that has kind of stopped. But it’s still, like you said, it’s becoming institutionalized. It’s the opposite of stopped. And like you said, Congress, this was not Congress’ intention. So it’ll be very interesting to see what happens, especially as these OMB [Office of Management and Budget], this OMB guidance for— 

Rovner: Which we’ll get to in a second. But before we get there, this is not just happening at HHS. It’s happening in other parts of the Trump administration. Former KFF Health Newser Anna Maria Barry-Jester reports for ProPublica that over at the State Department, the administration is defying congressional orders to continue to spend money on food, medicine, and other humanitarian foreign aid that used to go out under the auspices of USAID [the U.S. Agency for International Development], which the administration dissolved last year without congressional permission. As at HHS, State Department officials are not only not spending the money as Congress directed, but when members of Congress have asked, officials have simply not responded to their request. Not surprisingly, for those who have been paying attention, a lot of this circles back to Russell Vought at the Office of Management and Budget, who has said many times he believes that the president, rather than Congress, should exercise the majority of federal spending power, regardless of what the Constitution said. Is there a point where Congress, which is increasingly unhappy with the president over a lot of things right now, including a lot of Republicans, does take its spending power back? 

Kenen: But they can’t cut the check. Congress has made its displeasure on the spending, they voiced it before. Congress is getting a little friskier right now, but they yielded a lot of their power to the executive branch, and there’s a lot more tension going on right now on other things. They can yell and scream and pass bills, but if the executive branch of OMB, which has explicitly basically said: Congress, you give advice. You don’t decide. Even though that’s pretty much what they’ve said since 2025. So Congress can’t run over to the OMB and get into the federal treasury and take out a bunch of cash and go give it to some rural hospital somewhere, or NIH, or some scientists. They can pass the law, but they can’t — it’ll probably, this too, will end up with the Supreme Court at some point. But they’ve been reluctant to, certain battles they have, everybody’s sort of constitutional crises, they’ve tried to avoid to date, although not entirely. 

Pradhan: Well, like Joanne said: What can they really do? I’m not a lawyer. I don’t know. What beyond sort of kicking and screaming can they do? 

Kenen: Well, they can, I think they could probably take it to court on a separation of powers or constitutional powers, but I think that that’s the ultimate constitutional crisis that people have been afraid to hit that button. 

Rovner: There was a Supreme Court decision in the Nixon administration that said the administration can’t impound money appropriated by Congress, and that’s what Russell Vought would like to have go back to the Supreme Court, because he thinks this Supreme Court might overturn it, but they haven’t yet. I guess everybody’s afraid to kind of call the bluff. 

Kenen: Because it gets us into an even messier territory than we are already in, and we are in a very messy territory. 

Rovner: We are definitely in a very messy territory. Algae filled. 

Kenen: Algae-filled, yes. 

Rovner: We’ll get to that. Moving on, as Maya already hinted, there are these proposed new rules from the aforementioned Office of Management and Budget that would give political appointees even more power over how federal grant funding is distributed. It turns out that buried in that proposal is language that would effectively disqualify from funding most research into diversity, equity, and inclusion, what this administration defines as, quote, “woke.” I would add, this comes as the journal Science reports that a 20-year study of scientists who are women or from underrepresented racial and ethnic groups found that those who participated in a special undergraduate program sponsored by the National Institutes of Health were twice as likely to earn their PhD than peers who didn’t participate in those programs. In other words, at least in this case, DEI works if your goal is to achieve more representation in science. But I guess that’s no longer the goal, right? 

Goldman: I think there’s also so many research questions that have real impact on people’s health that just must by nature incorporate words that would be flagged as DEI, and so we could miss out on real scientific breakthroughs if this goes through. 

Rovner: Yeah, they’ve apparently got these AI programs that are just grabbing off words like “gender” or things that might in scientific contexts have nothing to do with DEI. 

Pradhan: And I think one of the things about DEI, too, that probably gets lost in the current era is that it definitely has, of course, a racial and ethnic component, but also it has a big gender component. In science and across fields, DEI programs have benefited women, wholesale. So I think, and if that’s the goal, to undo these things, it won’t necessarily just have consequences for racial and ethnic minorities but women scientists in other fields also. 

Rovner: One of the big stories I covered in the early ’90s was the fact that women weren’t allowed to participate in most clinical trials, because scientists were afraid that they would, the fact that: Oh my God. They have hormones. They would mess up the results. And as a result, so many medical breakthroughs, we had no idea if they worked on women or not, because women were never tested. That only changed when women members of Congress insisted that the NIH start including women in their clinical trials. And again, a lot of these programs to bring more women into science have helped. There have been blind spots about gender, so it really has been, if not for quote-unquote “affirmative action” for women, there would be an awful lot of stuff that we simply would not know about women’s health. I only add that up as: These things in the 1990s were really bipartisan.  

So Wednesday was the fourth anniversary of the Supreme Court’s Dobbs decision that overturned the five-decade-old right to abortion under Roe v. Wade. And in a twist I don’t think any of us could have predicted, even though nearly half the states have banned or severely restricted abortion during that time, there were nearly twice as many abortions in 2025 as in 2021, the last full year before Roe was overturned. Rachana, how did this happen and how much does it have to do with mail order abortion drugs? 

Pradhan: Quite a lot. Yes, I don’t think this is something that anti-abortion groups at all expected or wanted to see. Certainly not what they wanted to see. After Roe v. Wade was overturned, pills being sent via telemedicine or telehealth is a big part of this. Even women in states that have enacted almost total bans on abortion are still able to get pills in the mail, and that is responsible for this, in large part. 

Rovner: And of course, anti-abortion groups are furious that the Trump administration’s FDA [Food and Drug Administration] has not rolled back the policy yet that the Biden administration put in during covid allowing the mailing of these pills. Now they’re agitating for acting attorney general Todd Blanche to drop the government’s defense of a case that was filed by Louisiana challenging that mail delivery of mifepristone. But even if that were to happen, medication abortions can continue just by using the second pill in the two-pill combination that’s used for abortion, which is misoprostol. And states can’t really ban misoprostol, because it’s used for so many other things, right? 

Pradhan: Right, they would be — I don’t know. Never say “never,” I guess. But it would be, it’s hard to see a path for that. Yeah, so our colleague Kate Wells, who’s based in Michigan, wrote this great story this week stating this exact thing, right? Because even though the research shows that the combination of two drugs for medication abortion, so mifepristone and misoprostol, taken together is the most effective, but that doesn’t mean the misoprostol alone does not work. And so it does work — it’s just not as effective. And there might be some greater potential for side effects — right? — if you only take the latter medication. So yeah, it’s not, so it’s not so easy — right? — to cut off access. 

Rovner: Meanwhile, let’s talk about the politics of this. Democrats who had been hoping to ride support for abortion rights to electoral ascendance may either be over- or underconfident. That’s according to an excellent piece by our podcast panelist Alice Ollstein of Politico. Since Dobbs was overturned, voters, even in some pretty red states — I’m looking at you, Missouri — have approved ballot initiatives to ensure abortion rights in those states. But that hasn’t translated into votes for Democrats in many of those states. Voters approved the abortion rights referendums and voted back in Republicans who are anti-abortion. What’s up with this? 

Goldman: I think one interesting point that Alice made in that article is that a lot of voters think, OK, I voted for abortion rights, so now I can vote for other candidates based on other issues. Which is a super interesting trend to watch, especially to see if that trickles into other policy areas, too. 

Rovner: Yeah, I had not thought about that until I read Alice’s piece, and it’s like, yeah, that makes good sense. In the past, I think anti-abortion voters have very much been single-issue voters, but abortion rights voters have not. They want abortion rights, but they also want other things, and I think a lot of them in some of these states think, Well, we’re protecting abortion rights here in our state, so it’s OK to vote for this anti-abortion politician, even though they didn’t think all the way through that that anti-abortion politician in a federal office might vote for a federal ban that would override what you just voted for in your state. Joanne, you wanted to say something. 

Kenen: I think a lot of people don’t connect dots or don’t think things through. We know that in these very, very, very red, some of the most conservative states in the country, have voted big for Medicaid expansion when it became a ballot initiative, and then they went ahead and voted the same people who had fought it for years back into the governor’s mansion and back into the legislature. So I think, whether people don’t connect dots or that all of us can hold contradictory, more than — all human beings have some contradictory thoughts and impulses. I can’t explain exactly why this is happening . But it’s not only abortion. It’s particularly acute. Americans are for more gun control than our lawmakers, or gun regulation, than our lawmakers enact, and yet they keep voting in people who limit gun ownership or gun rights more stringently than the public in polls says they want. So this is one of several hot-button political issues — abortion and gun control, arguably the most domestically hot-button there are — that there is this inconsistency, and I don’t know that anyone’s really successfully explained it. It’s not just low information. It’s more than that. It’s, Yes, I want this, but I also want that. 

Rovner: Right. It’s holding two thoughts at the same time. You’re right. It’s a human thing. 

Pradhan: Well, and Julie, you mentioned this, right? Which is that a single-issue voting on abortion on the left is not — yeah. And Alice says this in the lead of her story — right? — which is the main issues of the day right now are affordability concerns across gas, food, housing. That does seem to still be the driving concern, and understandably so, right? Everything is more expensive, much more expensive than it was two years ago. So people are hurting, and so I don’t know that abortion rights would surpass, or people who are more likely to support an abortion rights ballot initiative are ones that are also not going to be inclined to vote for Republicans on the ballot during the midterm elections, because they’re not happy with some of those other, broader affordability issues. 

Rovner: Yeah, I think affordability is clearly going to be the issue of the moment, probably still when we get to the midterms. But who knows. We’ve got a whole summer to get through. All right, we’re going to take a quick break. We’ll be right back. 

Moving on to vaccine policy, you might remember back in April when we talked about a study by researchers at the Centers for Disease Control and Prevention that found last year’s covid vaccine reduced hospital visits and hospitalizations by more than half. It was supposed to appear in the CDC’s journal, the Morbidity and Mortality Weekly Report, but it was spiked by NIH director and acting CDC director Jay Bhattacharya, who said the study had methodological issues. Well, apparently that wasn’t a problem for the peer reviewers at the Journal of the American Medical Association, because the study is in this week’s JAMA Network Open journal. But even though it’s out there now, how is the public to have any idea who to trust when it comes to science policy? We’re now here, we have peer-reviewed journals that are publishing one thing and the government saying, No, this is not good enough. Did the doubters win simply by sowing doubt? 

Goldman: It’s a great question, and I think that’s a very interesting dynamic with this administration, is that the health officials in this administration have rose to prominence on a platform of bringing trust back into federal health policy. And I think for many people you could argue that there is less trust than there was at the beginning of the administration. And certainly not for everybody, but it’s just there are a lot of wires being crossed in different directions, and it’s hard to know where to go. 

Pradhan: I think one of the things I think about when it comes to trust in the government, like Maya said, right? We have, OK, so there are definitely certain voters that now do not trust the CDC and the government nearly as much, if it all, because of who is in charge. So distrust has arisen among those people. But when I talk to people who are supporters of the “medical freedom” movement and who are very skeptical of vaccines for themselves, for their children, I’ve asked them sometimes, Look, you’re seeing these changes, even going back to last year. This year, the CDC Advisory Committee on Immunization Practices, they made a bunch of changes to the U.S.’ vaccine schedule. And I asked, I remember one time I did an interview and I said, “Well, do you trust the CDC now?” And it’s not a slam dunk. People who are so distrustful of institutions and government agencies and even the medical system or our healthcare system, it’s not like they’re like, “Oh, yes, please, like everything the government says now, you know, I’m just going to take it at face value and just believe it.” It’s almost like it’s like a misunderstanding. I kind of wonder this for the people who are in charge, like leaving government now. It’s like: Do you understand this? Because they’re not just automatically going to take what you say. It’s sort of antithetical to years of thinking, potentially, that they’ve had, right? So— 

Goldman: That’s such a good point. 

Pradhan: I don’t know that now, all of a sudden, are they going to become just a mouthpiece for what RFK Jr. [HHS Secretary Robert F. Kennedy Jr.] and his political appointees are saying. I don’t think so. 

Rovner: I think they’re just making everybody mistrust everything. Joanne, you wanted to add something. 

Kenen: I think, I do a lot of work on trust in healthcare, and I’ve been all over the country the last couple of months since our book came out, talking about it and being on panels. And it’s really, I mean, it’s a cliche to say distrust in healthcare or the health system or public health is an existential crisis. It’s a cliche we’ve heard all the time. But just because it’s a cliche doesn’t mean it’s not a crisis. The divisions in our country spill over from the politics into things that determine whether or not we and our families and our friends and our kids are healthy or not healthy, and I think this sort of whiplash of deep distrust of the other side is probably going to continue for some years as political officeholders and appointees change. But this, the CDC, I’m not — the last poll I saw, I’m not sure if it’s a record low of trust, but it’s definitely plummeted. But it’s the Democrats who used to trust the CDC, now don’t. Now, maybe that’ll rise again when the new CDC director, she’s confirmed, which is likely. Maybe she’ll be able to rebuild, and maybe things will get a little bit better. But right now, there’s so — a combination of deep distrust and a whole lot of mixed messaging. It can be very confusing to understand medical advice, and it can be very hard to access our medical system. So it’s just this really toxic brew of risk factors mixed in with the distrust. 

Rovner: Meanwhile, we had a real-world example of distrust and re-trust in public health this week. Secretary of Defense Pete Hegseth has quietly reinstated requirements for new military recruits to be vaccinated against the flu after a flu outbreak at Lackland Air Force Base sickened more than 200 recruits, with four people hospitalized. Hegseth had removed the mandate, which had been in effect since the end of World War II, with much fanfare back in April. Didn’t take long to kind of see why that mandate made sense, right? 

Kenen: Yes, because this is actually a force readiness issue. It’s not just, Oh, people got sick. Most young, healthy people, and most people in military service — most, not all — are young and healthy. These were recruits. These were young. Most of them are going to be OK. But first of all, not all of them are going to necessarily be OK. There’s one possible death. The last I heard that somebody had died, but it wasn’t necessarily from flu, and that was under investigation. And one of you may have more recent information than what I read a few days ago. So, we have four people hospitalized. We do not have a confirmed death. But it was 160 people, which is a whole lot of people. And if it happened here, it’s a big red flag, because your soldiers are supposed to be ready to fight, not in the bed with the flu. So, it happened in one particular location, but it really should have showed this national security interest. You really don’t want your fighting force with a 104 fever and feeling crappy. 

Rovner: I would say it’s also completely predictable that when you bring— 

Kenen: Yes. 

Rovner: —a whole bunch of people in and have them sleep together in close quarters and stress them physically and mentally, which is what basic training does, and then somebody gets sick, it’s going to spread. 

Kenen: It’s also one, that’s really one of the big causes of the spread of the 2018-2019 — I mean, excuse me, the 1918-1919 so-called Spanish flu, which it wasn’t. It was actually, a lot of it was spread — it was just as we were getting into World War I. There was a lot of young recruits. A lot of it’s — there’s argument about exactly what happened where, but certainly a base in Kansas was one of the big spreaders of that, of what became a global pandemic. 

Rovner: In other words, we’ve seen this TV program before. 

Kenen: We didn’t have —right. We didn’t have vaccines yet. It wasn’t— 

Rovner: We didn’t have TV either, but, yeah. 

Kenen: We had imagination, right? 

Rovner: Point taken. 

Kenen: We had carrier pigeons. 

Rovner: All right. 

Pradhan: I feel like anyone with school-age children or kids who are in college could’ve. It’s like, Oh, who could have predicted? You have — 

Rovner: Yeah, yeah. 

Pradhan: —massive numbers— 

Rovner: Any parent. 

Pradhan: —of people in a small place, and Oh, look, a flu outbreak. It’s as inevitable as things can be these days, right? I think that this probably is pretty high up there, right? 

Rovner: Yeah. All right. Well, so, moving on. In things I definitely did not have on my bingo card for 2026, Indiana is imposing price controls on hospitals. Under the new law, as reported by my KFF Health News colleagues Phil Galewitz and Samantha Liss, hospitals in the state will have to charge employer health insurance plans no more than a multiple of what they pay Medicare, or else run the risk of losing their tax-exempt status. Now, Vermont also does this, but Indiana is politically very much not like Vermont. Is this the leading edge of a Republican backlash to high healthcare prices? 

Kenen: Maybe. We just don’t know. You know — Indiana’s Indiana. But we have, and we’ve talked about it— 

Rovner: Indiana’s really red, though, and they have a really red governor who used to be a really red senator. 

Kenen: Yes, but we don’t know what’s going to spread, right? But what we’ve talked in the podcast frequently over the last couple of months, hospitals are in the spotlight about pricing in a way that they haven’t. We’ve been really focused on drug prices. And we’ve sort of, we have a different relationship with hospitals. And we also all don’t get hit by hospitals every year, where most of us do buy drugs, so — but hospitals are really getting a lot of attention, bipartisan, I mean, in red and blue states, in Congress. There have been hearings. It’s not like the tobacco executive hearings, but it is sort of a lot more skeptical of why do hospitals, are they — to use the buzzword of the day — why are they so unaffordable? Why are your bills so inexplicable? Why can’t you understand? So, the whole system is based on cost shift, and one reason hospitals have been pressed to charge a lot more than Medicare is they say that Medicare payments don’t cover their costs, and they — it’s the great big, the shell game of American healthcare. But I don’t know that we know what the next step is state-wise. But you know what? It may be a domino. We don’t know yet. 

Rovner: I know I’m interested watching the backlash of Republicans against high healthcare spending. They’re coming out against managed care. They’re coming out against hospital prices. I will point out that for my entire career, the person who’s been loudest about nonprofit hospitals overcharging has been [Sen.] Chuck Grassley. 

Kenen: Right. 

Rovner: Very Republican senator from Iowa. 

Kenen: It’s not just that they — right. He’s been consistent on this for decades, and he’s said that it’s not just that they charge a lot. It’s that: What are they really doing to deserve that? They’re supposed to get a tax break in exchange for community benefits. But show me the benefit. How are you defining and measuring? And is it truly a benefit to the community, as a layperson would think of, Oh, benefiting the community? Or is it some little niche thing that they say is their public service. 

Pradhan: And one thing about Indiana in particular, I think Samantha Liss, who’s one of the reporters on the story you mentioned. Right, Julie? Actually two years ago, what’s really interesting is she had written also about, I think, and this is sort of a case study, I think, somewhat — right? — in how consolidated your healthcare markets are. Right? I think that that’s a big driver as to whether a state or a governor or anyone wants to take action on these things. I remember she wrote about these two rival hospitals that were in Terre Haute, Indiana. They were seeking to merge, and then they pulled back their merger application because there were so much opposition, because it would have left — Terre Haute is like a city of maybe close to 60,000 people, and for that city and the surrounding area, they would have had only one hospital operator. So, and that was a big deal at the time. So I think Terre Haute, Indiana, is far from the only place where that is sort of a living reality, right? And that’ll be a big motivator, I think, sometimes, too. 

Rovner: But, yes, I will say that both Indiana and Vermont have a lot of these small, sort of midsize consolidated areas where hospitals can basically charge at will. Maya, did you want to say something? 

Goldman: Yeah, I was going to add, I think Indiana has been on the cutting edge of a lot of health policy, especially among red states. They’ve done a lot with price transparency and employer advocacy, and so it’s not surprising to see Indiana do this as much as it would be a different red state. I think it does really indicate to me that people in the state, state governments, and citizens are really frustrated that Congress isn’t acting fast enough for them. They’re, like Joanne said, there’s a lot of discussion happening in Congress around hospitals and needing to lower prices, but there’s not a lot of action happening. And people have power to do that at the state level, and they’re exercising it. So I think we will see more happen there. 

Rovner: Here’s another issue where states sort of have power. While we were talking about strange bedfellows, Colorado has become the second state, after Florida, to get FDA approval for a plan to import cheaper prescription drugs from Canada. Except Florida hasn’t been able to get its program up and running, because it can’t find a Canadian wholesaler that’s willing to sell the drugs to them. What makes Colorado think that they’re going to have any better luck? And mightn’t both of these states just take a page from Indiana and think about their own price controls, if that’s what they want, rather than importing Canada’s price controls? 

Kenen: I can’t imagine if Colorado decided to do price controls that it wouldn’t be stuck in court. We’ve joked over the years that if you want your child to have full employment for life, become a healthcare lawyer? I think that if Colorado were to do that, which it really just suggested, it would not be immediately reality for consumers. There’s so much cost shifting in healthcare, because our system is just insane, that everybody can say, honestly, I’m not the only culprit. The whole system is too expensive with all this indirect shifts of costs and confusing charges, and it’s hard for experts to understand. 

Rovner: I feel like a lot of federal members of Congress have also sort of looked at these. Let’s import cheaper drugs from somewhere else.  

Kenen: Because it sounds good. 

Rovner: This has been going on since the ’90s. 

Kenen: Yeah. 

Rovner: And nobody’s been able to make it work. And Canada has said very clearly, it’s like: We can’t sell you all of our drugs or we won’t have enough drugs for the people here, which is who we buy drugs for. 

Kenen: But it sounds good. 

Rovner: It does sound good. 

Kenen: And that’s why it’s gone on for 30 years now, closer to 40. 

Rovner: Yeah it is 30 years now. 

Kenen: Yeah, and if you live in New England, you can go to Canada and get them, but there’s been sort of on-paper authorizations to do it for quite a — I don’t remember when the first one was, Julie. It was a long time ago. 

Rovner: Yeah. Well, they’re — yes, they allowed the FDA to allow states. The first one that actually sort of in theory became legal was the Florida one. And again, that was a couple of years ago, and it’s not off the ground. All right. Well, finally this week, in a drug price adjacent story, props to our podcast pal Lizzy Lawrence at Stat for the buzziest story of the week. Lizzy revealed that drugmaker Eli Lilly granted compassionate use to an unnamed 79-year-old individual to use its still-investigational obesity drug retatrutide, which trials have so far shown to be even more potent than Lilly’s other blockbuster obesity drug, tirzepatide. Now, compassionate use is supposed to allow people with terminal conditions to get early access to promising drugs that are not yet approved. Apparently, this patient is not only obese but has obstructive sleep apnea and pulmonary hypertension. Yet both of those conditions, while very serious, are not considered terminal. So the obvious question here is: Who is this 79-year-old patient, and is he named Donald Trump? So far, nobody’s been able to find out, though the White House has been very adamant, at least after Lizzy’s story came out, that it is not the president. So, why is everybody so excited about this story? 

Kenen: Because it’s weird. 

Rovner: Fair. 

Kenen: Lizzie’s story is great, but it’s just a strange saga, right? And in her first story, she said someone who was 79 at the time, which was a couple of months ago, because President Trump just turned— 

Rovner: Turned 80. 

Kenen: Right. The idea that one person and only one person would get this drug. And we all remember he did get — and that was life-threatening. I’m not saying he shouldn’t have gotten it, but he did get it, a monoclonal antibody, when he was hospitalized with covid in his first term. And it may have saved his life. But that was a life-threatening situation. 

Rovner: Yes, that’s what compassionate use is supposed to be used for. 

Goldman: Right. And I think it obviously does matter who, if this person is President Trump. But I think Lizzy does a really good job in the story of explaining that, regardless of who this person is, this is not typically how this program is used, and so it should raise eyebrows that the administration and Eli Lilly are allowing this to happen, regardless of who the person that’s getting this is. 

Kenen: And it could be somebody who has a connection to Lilly. It could be anything, right? It’s a tantalizing question, but we don’t know. 

Pradhan: Yeah, and I do think it sort of begs the question. The White House, after the story published, only firmly said it was not the president. Probably would have been very helpful for them to have said that prior to the story publishing. Why they— 

Rovner: And they were asked. 

Pradhan: Of course, they were asked, right? They were asked, and they did not directly answer. I don’t pretend to know why that decision was made, but I think it probably would have been a good public service to definitively say whether it was the president or not before the story first ran, before it sort of caused this big hullabaloo on social media and elsewhere, right? 

Rovner: And perhaps predictably, Democratic Sen. Maggie Hassan of New Hampshire has now written a stern letter to the administration, demanding — and I believe also to Lily — demanding to know if not who this is, at least how this happened, because it is an unusual use of the compassionate use exception. 

Pradhan: Can I ask a question also? This is one thing that I was wondering when reading Lizzy’s story is, so clearly certain people in the NIH and the FDA are HIPAA-protected individuals. So if they were to release or leak identifying information about this patient, that’s not allowed. But not everyone is, surely. Do we really think — someone must have seen the details of who this person is. And they would not be subject to HIPAA [the Health Insurance Portability and Accountability Act] if they were to cough up the name, right? 

Rovner: Well, I’m sure that people will continue to see, including those of us here at KFF Health News. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognized a story we read this week we think you should read, too. Don’t worry if you miss it, we will post the links in our show notes on your phone or other mobile device. Joanne, your extra credit involves the second-buzziest story of the week, the saga of the green Reflecting Pool. Please tell us about it. 

Kenen: OK, one story that’s my extra credit, and one story I’m also going to, related story, that I’m going to just give a shout out to. Sarah Kaplan at The [Washington] Post wrote “Why Trump’s Algae Problem Is Much Bigger Than the Reflecting Pool.” And basically she talks about climate change and health, and that the reason that there’s this algae — and actually there’s many kinds of algae. I’m not an expert on all the kinds of algae. But there is one called cyanobacteria, which is highly toxic. It is present — my understanding is it’s among several kinds of algae in the Reflecting Pool. But it is becoming more dominant because of climate change. And that’s toxic. That’s not a good thing to have. What I didn’t know — I don’t want to go on too long — but it’s sort of fascinating that they fill the Reflecting Pool with water from the Tidal Basin, which is the surrounding, the water that, for the people who aren’t in Washington, is the water around the Jefferson Monument and the cherry trees and all that, which in turn comes from the Potomac River, which is polluted. And painting a reflecting pool and then pouring in polluted water might not have been the smartest thing to do. And also apparently the American flag blue is darker than the old gray and it retains more heat and makes the problem worse. So sort of the big public health message is that — here the big joke is Making Algae Great Again — but that there is saying something about the state of our planet and the state of our water, and that even things that we think of as harmless are not necessarily harmless. And then, just relatedly, for anyone who’s really interested in good reporting on this and great writing on this is the cultural critic of The Washington Post, Philip Kennicott, has been writing a lot about the changes to Washington, and he wrote about the Reflecting Pool and called, he said it looked like a kale smoothie. 

Pradhan: Oh. 

Rovner: Vivid. OK, Maya. 

Goldman: My extra credit this week is from Stat. It is an article by O. Rose Broderick called “Trump Administration Targets Disability Integration Mandate in DOJ Memo.” And I think this is a potentially very consequential move from the Trump administration that isn’t getting enough coverage. The SparkNotes version is that the Supreme Court held in 1999 a decision known as Olmstead that said you can’t have unjustified institutional isolation of people with disabilities — that’s a form of discrimination. The Trump administration put out a memo sort of reinterpreting what unjustified institutional isolation means. This notably doesn’t change existing laws around integration requirements for people with disabilities, but it signals where the Trump administration’s head is at with regards to disability rights. And the article also notes that the motivation for this change isn’t really clear, especially since community care is usually cheaper than institutional care. But it does mention that one possible factor could be to give the government more flexibility to tackle homelessness, perhaps by forced institutionalization. So, certainly one to watch. 

Rovner: Yeah, definitely. Rachana. 

Pradhan: So my extra credit is a story [“Arrests of Immigrant Parents Create Mental Health Crisis for Children”] written by our [KFF Health News] colleague Claudia Boyd-Barrett. It is just devastating. If I, so — grab a tissue box if you’re going to read it. She wrote about how, the consequences for children who have parents that are either detained by ICE [Immigration and Customs Enforcement] or deported out of the United States, and she has these incredible, really just heartbreaking stories of these children who have been separated from their parents and sort of the emotional toll that it is taking on them. So it’s, the way I think about it is it’s, during the first Trump administration there was a big thing about families being separated at the border, and it was the family separation crisis. But now it’s happening again, just not at the border necessarily. 

Rovner: Yeah. It is quite a story. Well, my story affects both immigration and disability. It’s from The Washington Post. It’s by Sylvia Foster-Frau, and it’s called “Tennessee To Restrict Medical Aid for Critically Ill Undocumented Children.” Now, this is a state program that’s separate from Medicaid, called Children’s Special Services, that helps low-income families with children with disabilities pay for critical things like wheelchairs and feeding tubes and ventilators. Until now, it has served families with no other way to get care, including those who are undocumented and therefore ineligible for Medicaid. But now, the 400 families on the program have been notified by the state that if they want to keep their benefits, their immigration status will be reported to federal authorities. The story profiles one family, asylum seekers from Honduras who have a 10-year-old with spina bifida and autism and whose care, including wheelchairs and catheters, has so far been paid for by the program. Now the mom says she’s going to have to drop out of the program rather than risk being deported, but she has no idea how she will pay for the care that her son needs. It is also pretty wrenching. 

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder, What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me still on X, @jrovner, or on Bluesky, @julierovner. Where are you guys these days? Joanne. 

Kenen: I am mostly on LinkedIn and Bluesky, @joannekenen. 

Rovner: Maya. 

Goldman: I am also on LinkedIn and still on X, @mayagoldman_. 

Rovner: Rachana. 

Pradhan: You can find me on X, Bluesky, and LinkedIn, @rachanadpradhan. 

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