The Host
Julie Rovner
KFF Health News
@jrovner
@julierovner.bsky.social
Read Julie’s stories.
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Congress returned from its holiday break to the same question it faced in December: whether to extend covid-era premium subsidies for health plans sold under the Affordable Care Act. The expanded subsidies expired at the end of 2025, leaving more than 20 million Americans facing dramatically higher out-of-pocket costs for insurance.
Meanwhile, the Robert F. Kennedy Jr.-led Department of Health and Human Services announced an overhaul of the federal vaccine schedule for children, reducing the number of diseases for which vaccines are recommended from 17 to 11.
This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of Pink Sheet, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Panelists
Sarah Karlin-Smith
Pink Sheet
@SarahKarlin
@sarahkarlin-smith.bsky.social
Read Sarah’s stories.
Alice Miranda Ollstein
Politico
@AliceOllstein
@alicemiranda.bsky.social
Read Alice’s stories.
Lauren Weber
The Washington Post
@LaurenWeberHP
Read Lauren’s stories.
Among the takeaways from this week’s episode:
The conservative movement to end abortion access nationwide has ensnared a last-ditch effort in Congress to help millions afford their health plans. As lawmakers consider a compromise to revive enhanced federal tax credits for ACA plans, some Republicans are arguing that the tax credits should be barred from subsidizing any plan that covers abortion care — even though the federal dollars would not be used to pay for abortions anyway. That change would force some states to choose between dropping their requirements for insurance coverage for abortion care or forgoing that federal assistance.
President Donald Trump this week urged Republicans in Congress to be “flexible” about abortion restrictions. Meanwhile, his health policies so far are not yielding notable benefits for Americans, with most of the savings from his high-profile pharmaceutical deals going to the federal and state Medicaid programs. And the $50 billion federal funding boost for rural health — intended to counterbalance nearly $1 trillion in expected Medicaid spending cuts — is unlikely to make a meaningful dent, in no small part because rural facilities are barred from using the money for general expenses.
While Kennedy announced an overhaul of federal recommendations for childhood vaccines, the action’s impact on vaccination rates and insurance coverage will depend in large part on how various states react, since states are the ones that impose mandates — such as for school enrollment — and regulate some insurers. Nonetheless, it is likely to result in a patchwork of state policies, which is problematic for public health efforts.
Federal health officials also unveiled new nutritional guidelines, turning the decades-old food pyramid upside down. Some of the recommendations adhere to scientific findings, such as cutting added sugar from one’s diet. Others are more controversial, particularly the suggestion that Americans should eat more red meat and the softening of guidelines on saturated fats.
Plus, for “extra credit” the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:
Julie Rovner: KFF Health News’ “Advertisements Promising Patients a ‘Dream Body’ With Minimal Risk Get Little Scrutiny,” by Fred Schulte.
Alice Miranda Ollstein: SFGate’s “A Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose,” by Lester Black and Stephen Council.
Sarah Karlin-Smith: ProPublica’s “The End of Aid: Trump Destroyed USAID. What Happens Now?” by Anna Maria Barry-Jester and Brett Murphy.
Lauren Weber: The Washington Post’s “How RFK Jr. Upended the Public Health System,” by Rachel Roubein, Lena H. Sun, and Lauren Weber.
Also mentioned in this week’s podcast:
click to open the transcript
Transcript: New Year, Same Health Fight
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello from KFF Health News and WAMU Public Radio in Washington, D.C., and welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.
We are joined via videoconference by Lauren Weber of The Washington Post.
Lauren Weber: Hello, hello.
Rovner: Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hi.
Rovner: And Sarah Karlin-Smith of the Pink Sheet.
Sarah Karlin-Smith: Hi, everybody.
Rovner: No interview this week, but tons of news to catch up on, so let us get right to it. So, we start 2026 in health care the same way we ended 2025, with a fight over expiring subsidies for the Affordable Care Act. By the time you hear this, the House will likely have approved a Democratic-sponsored bill to reinstate for three years the expanded ACA subsidies that were in effect from 2021 through the end of 2025.
That vote was made possible by four Republicans crossing party lines in December to sign a discharge petition that forces a floor vote, over the objection to the House leadership. Interestingly, a preliminary vote on the bill on Wednesday drew not just the four moderate Republicans who signed the original discharge petition but five more, for a total of nine. The consensus of political reporters is that the bill is DOA [dead on arrival] in the Senate, which voted an identical proposal down in early December.
But I’m wondering how much heat Republicans were exposed to over the break by constituents whose out-of-pocket costs for insurance were doubling or more, and whether that might change the forecast somewhat. What are you guys hearing?
Weber: So, it seems that there are still some big hurdles to cross. And based on what senators told my colleagues over the past couple days, there’s not even an agreement on what current law is and does, and thus, they can’t agree on how it should change. And so, I’m talking specifically about the still-unresolved abortion issue.
This is the question of whether plans that cover abortion should receive any federal subsidy, even if those subsidies do not directly pay for an abortion. The Republicans are arguing that it’s an indirect subsidy, even though these are going into separate accounts. So, one of the Republican senators who is trying to craft a deal — that’s Bernie Moreno of Ohio — he was saying that they still don’t agree whether, under current law, federal funding is going to abortion.
So, it’s like you don’t even have a shared reality that senators are operating under, and that makes it really hard to come up with a proposal. They say they’re going to have text by Monday, but we’ll see if that actually happens.
Rovner: Yeah. Well, before we get too deeply into the abortion issue, which we will do in a minute, I want to talk a little bit more about that. I won’t even call it an emerging compromise. I’ll call it a potential compromise in the Senate.
Ollstein: Some bullet points were shared.
Rovner: Some bullet points. We know what the bullet points are. They would extend the additional subsidies for two more years, not three, with a couple of changes, including capping income eligibility for those subsidies at 700% of poverty up from 400% that it reverted back to on Jan. 1. It would also replace zero-premium plans with $5-per-month plans. That’s to crack down on brokers who fraudulently sign up people who don’t even know they have insurance so the brokers can collect commissions. And it would allow people to choose whether their enhanced subsidies should go into Republican-favored health savings accounts or directly toward their premiums.
Assuming — and this is obviously a big assumption — they could get past this abortion issue, what are the chances for a compromise that looks something like this? I mean, it sounds like something that could satisfy both Democrats and Republicans, particularly Republicans who are feeling pressured by their own constituents who’ve now seen there — are either dropping their insurance or seeing their out-of-pocket cost just goes wild.
Ollstein: I’ve heard some criticism from the Democratic side about getting rid of zero-premium plans specifically. They’re saying the Republicans want to run on affordability and helping out people who are struggling. How does eliminating the ability to get a zero-premium plan align with that?
And so I expect there will be some clashes over that. But I also think, again, senators aren’t even agreeing on what the current reality is, and that applies there, too. There have been all of these allegations of widespread fraud, and some experts and lawmakers have been pointing out that just because someone who is enrolled doesn’t actually use their benefits, that doesn’t necessarily mean there’s fraud going on.
It does seem like there is some fraud going on. You mentioned the perverse incentives for brokers, but a lot of this is circumstantial evidence rather than direct evidence.
Rovner: Also, one of the ironies here is that if you have somebody who’s healthy, who signs up for health insurance and doesn’t use it, that’s a good thing for the risk pool. You don’t want only sick people.
Ollstein: It helps everyone.
Rovner: There’s a lot of things making my head explode. Well, one of the things that Alice, I know, is making your head explode, too, is this disagreement about reality about abortion. And I would point out that President [Donald] Trump spoke to the retreat of the House Republicans this week and urged some flexibility, put that in air quotes, on this Hyde Amendment issue. Alice, remind us why this is an issue here. Doesn’t the Affordable Care Act already ban federal funding of abortion just like all other federal programs?
Ollstein: Yes. Yes, it does. So basically, this is part of a larger project on the right to expand the definition of Hyde.
Rovner: We should probably go back to the very beginning of what is …
Ollstein: Yes.
Rovner: … the Hyde Amendment because it only applies to annual appropriations, and that’s why it’s been important. I will let you take it from there.
Ollstein: Sure, sure. So, this is a budget rider that dates back to the 1970s that says that there can be no federal funding of abortion, except in a few instances, of there’s a risk to the mother’s life, and rape and incest. And so that has been renewed over and over under administrations of both parties, under Congress majorities of both parties.
And now, what they’re fighting over is, already federal funding that goes to these plans in the form of these subsidies, it does not go to pay for abortion directly. But conservatives are now arguing that if it goes to a plan that covers abortion using other funding, then that functions as an indirect subsidy. This is the same argument they’ve made about Title X, where any federal funding going to a program that uses other funding to pay for abortion, they now consider that sort of an indirect subsidy, even though it’s coming out of different buckets of money.
And so, what they’re pushing for is basically a nationwide restriction on any plan that gets a federal subsidy paying for abortion. So, this would have the most impact in the states where all plans on the ACA market are required to cover abortion, in states like California, New York, and Massachusetts, big states with many, many millions of people. And so that would have a huge impact and force those plans to either drop abortion coverage or forgo the federal subsidy. So, that would have a really big impact.
And Democrats say this is not necessary. There’s already restrictions that prevent federal funding to go to pay for abortion. And that is what the senators and everyone can’t agree on right now.
Rovner: That’s right. And that’s a big fund. Well, we’ll see where that goes. In the meantime, what the president was talking about when he called for flexibility on Hyde was actually health care writ large.
This clearly reflects what we know the president’s pollster has been telling him: that Republicans are currently at a distinct public disadvantage when it comes to health care, and not just the Affordable Care Act. Trump says that Republicans should, again, air quotes, try to “own” the health care issue. And he has spent a good bit of his first year working on health issues. At least he’s been talking about them a lot, but it turns out that his high-profile drug-price deals are not mostly being felt by consumers here in the U.S.
The savings he’s negotiated are mostly going to the state and federal Medicare and Medicaid programs, as well as to people willing and able to pay out-of-pocket for their prescription drugs. And while the administration is making much of its December announcement about the first distribution of rural health funding that was authorized in last summer’s budget bill, that $50 billion in funding won’t make much of a dent compared to the nearly $1 trillion in cuts that were created for Medicaid in that same bill. So, my question from all of this is: Can Republicans use things like this to own the health care issue or at least cut into Democrats’ advantage between now and the midterms?
Weber: Well, I think it depends on what they end up doing with it. He brought up in that same meeting with legislators wanting to own IVF [in vitro fertilization], which is something he floated during his campaign that got a lot of shock from [the] conservative Republican base. So, what does he mean? What is he saying on that? We don’t have particulars.
Bottom line is, voters don’t necessarily know the in-the-weeds policy. So, if he gets out there and says enough things, who knows that they can own the health care issue? But I would say for now that it is solely in the Democrats’ camp and is helping lead them with an advantage for midterms for now.
Rovner: Sarah, he keeps saying on drug prices that he’s done all this stuff, and he has done a lot of stuff, but it hasn’t had a big dent in what people pay for their drugs, right?
Karlin-Smith: Right. And I think the one reason drug pricing has been a popular health policy topic for politicians to focus on is because people really can feel it directly compared to how they feel other health costs. And so, I think that there’s only a certain amount of time where people will just accept Trump saying, Oh, we’re saving you money, without them actually seeing it on the back end. And the problem right now is these most-favored-nation deals where he’s struck privately with a lot of drug companies to get Medicaid, really mostly at this point, in theory lower prices.
It’s not clear how much money it’s actually going to save Medicaid because Medicaid actually gets some of the best deals that the U.S. gets. Most people on Medicaid actually don’t really directly pay copays for most of their products, either. The other problem is they’ve then rolled out a number of other drug-pricing models to try and pair this concept, again, of getting the prices a lot of other countries get for drugs in the U.S., but they then exempted all these companies they’ve struck these private deals with.
So, it’s not really clear who is left in terms of drug companies and drug products. Then you might get cheaper prices under some of these other demonstrations, which by their nature, these are demonstration pilot programs that are not going to reach every Medicare beneficiary they’re pushing for. So, I think it’s going to be a big problem because many people are not actually going to see savings.
For people that have a decent amount of income and can afford some of these direct-to-consumer products where health insurers have often been denying it — like the weight loss, common popular weight loss drugs — some people may feel a little benefit there. But if you’re somebody who’s underinsured or uninsured, even if there’s really good discounts on a direct-to-consumer buying market, you’re probably also still not going to be able to afford these weight loss drugs.
Rovner: Yes, Lauren.
Weber: Just to go back to the rural health fund disbursement, I just have so many thoughts on this, because I mean, at the end of the day, rural hospitals are also the equivalent of rural jobs programs for rural America. And typically, rural hospitals fall in red America. And so, this attempt to prop them up, it sounds flashy, right? I mean, it’s billions of dollars. But when you break it down by the 50 states, it’s hundreds of millions, like tops like $281 million depending on the state.
That’s not going to cover the deficit that the bill has created for those folks. And I understand that it’s meant by the administration to be a flashy way of, Oh, we’re supporting rural health care, but the crushing Medicaid cuts that these rural hospitals are going to face, when they already operate on such thin margins, will be devastating. I mean, it will be devastating for already health care deserts that we already see, and this money is not going to be enough to stop the blood flow there in rural America.
Rovner: And Alice, you guys at Politico pointed out that even this $50 billion was not exactly distributed based on need, right? It was distributed based on deals.
Ollstein: Yes. And to build on Lauren’s point, not only is it not enough to make up for the Medicaid cuts, but there are restrictions. States can only use a little fraction of the money to keep these rural hospitals’ lights on, basically. The money is supposed to be for these transformative projects. It’s very tech focused. It’s very, Let’s try these pilot programs and completely revamp the way rural health care is delivered. Meanwhile, there are all these rural hospitals on the brink of closure, and states aren’t allowed to spend a lot of the money on just paying the salaries of the people who work there, paying for keeping the buildings in good shape. And so, we could see benefit from this money, but we could also, in the meantime, see a bunch more rural hospitals close, as they have been. And once they close, it’s really hard to come back.
And so, to your point, the way the money was distributed is getting a lot of criticism from all around the country because, one, a lot of it was split evenly between states regardless of the size of their population. And so, you saw, for instance, Alaska get more than California despite having a tiny, tiny sliver of its population. And I had people arguing with me online saying, Well, what about the rural population? Yes, California has a huge rural population. It’s not just LA and San Francisco. So, even if you only count the rural population, it’s much, much, much bigger than Alaska.
Also, there were these policy incentives in the program where states that adopted Trump-administration-friendly policies — like restrictions on what people can buy with SNAP [Supplemental Nutrition Assistance Program], on implementing the presidential fitness test, on deregulating short-term insurance plans, which Democrats have criticized and called junk plans — these would get the states more money if they adopted these policies. So, we’ve been digging into that and digging into the struggles on the state level on that front.
Rovner: All right. Well, that’s the rural health news. We’re going to take a quick break. We will be right back.
So, the other big news out of HHS [the Department of Health and Human Services] was on the vaccine front where Secretary Robert F. Kennedy Jr. made unilaterally a major change to the federal government’s childhood vaccine schedule, reducing the number of diseases with explicit vaccine recommendations from 17 to 11. No longer recommended for all children will be vaccines to protect against flu, covid, rotavirus, hepatitis A, and the germs that cause meningitis. Sarah, you’re the mom here on this panel today. How is this schedule change actually going to affect parents and children and doctors?
Karlin-Smith: I think a lot of it is going to depend [on] how the pediatrician health community reacts to this, because there’s been a lot of pushback from the medical public health community that this is not an appropriate or scientifically based change. So, doctors may still guide parents to hopefully making the decision to get these vaccines, but parents who may be a little hesitant, maybe feel more comfortable backing out.
Despite sometimes the rhetoric you hear from this administration, states are really the ones that end up creating policies that end up with actual mandates for people to get vaccinated for school and so forth. So, states may build off this and change their mandates, and that may impact access, but they may also not. So, people may still have to, for school purposes, get some of these shots as well.
Rovner: And I should point out that the American Academy of Pediatrics is fighting this, I would say tooth and nail, but also in court. I mean, they’re actually suing, saying that Kennedy didn’t even have the authority to make this change without going through a much more detailed regulatory process.
So, the administration says that all the vaccines currently on the schedule will remain, quote, “covered by insurance,” but I’m not positive that’s necessarily going to be the case in the long term, right? Isn’t mandatory insurance coverage linked to the recommendations of the CDC [Centers for Disease Control and Prevention]? And if these are no longer actually recommended, are they no longer required to be covered?
I know the insurance industry, we’ve talked about this, has said that they’re going to continue to cover all the vaccines at least through 2026. But I’m wondering about the legality. I tried to track this back, but I couldn’t find it all the way.
Ollstein: We could see a patchwork because a lot of states are moving to change their own laws about insurance coverage and have it be based on something other than these federal recommendations. I think that obviously patchworks are challenging when you’re talking about infectious diseases, which do not respect state or national boundaries, but Sarah can say more.
Rovner: Go ahead, Sarah.
Karlin-Smith: Yeah. To build on Alice’s comment, and the thing that gets really confusing really fast always with U.S. health care is states can regulate certain insurance plans and states cannot regulate certain insurance plans, the ERISA [Employee Retirement Income Security Act] plans. So, you could end up, even if states want to mandate coverage, depending on the type of health care coverage you get in your state, you may live in that state, work in that state, and you’re not going to get covered. So, that adds to the patchwork and always adds to the confusion when trying to explain that issue to people.
But the administration has claimed basically because the vaccines, they’re no longer universally recommended — they’re moving to what’s called the shared decision-making recommendation, where people are supposed to consult with their doctor and figure out whether these vaccines are appropriate for them and their children — that that still, under the way laws and regulations are written, requires the mandatory coverage for health care and no copays and so forth.
And I’ve talked to people who’ve looked at this, and there is precedent for that with other vaccines. I think there’s some concerns, however, that that could be challenged by people in court who don’t want these vaccines to be covered. There’s also concern when it comes to like the HPV [human papillomavirus] vaccine, which they’re now only recommending one shot of instead of two.
In that case, because they’ve really fully eliminated the recommendation for a second shot, if somebody felt like they wanted that two-series shot, I don’t think that would be covered. And the other question is, while they didn’t use the CDC’s Advisory Committee on Immunization Practices to make these changes for the most part. And they are largely advisory, but they do have certain legal authority when it comes to vaccines for children’s program, and their legal authority from Congress very much relates to the coverage and reimbursement. So, it’ll be interesting to see, again, if this all aligns.
Rovner: And we should point out that the Vaccines for Children Program, which many people have never heard of, is actually responsible for vaccinating something like half of all children in the United States. It’s a huge program that’s just basically invisible but really, really important.
Karlin-Smith: Right. And so, I think there’s going to be legal questions that they didn’t vote on those reimbursement questions here.
Rovner: Yeah. There’s a lot that’s going to have to be sorted out here. Well, one of the arguments that HHS officials are making is that they compared the U.S. vaccine schedule to that of, quote, “peer nations” like Denmark, but those peer nations have something the U.S. does not: universal health insurance. That can make a really big difference in vaccine uptake and in just the prevalence of disease, right?
Karlin-Smith: Yeah. And so, one thing that people have tried to look at and explain in recent days is the U.S. isn’t actually that different from most of its peers. Denmark, some have made the case, is actually the outlier. And if you look at Germany, Japan, Canada, Australia, the amount of pathogens, viruses the U.S. is vaccinating against is actually much more in line with most of the peer population. And then when you have a country like Denmark, which has universal health insurance …
Rovner: And a very small population.
Karlin-Smith: Right. I mean, it’s very different, but they’ve made in some cases the calculus that if we don’t vaccinate for rotavirus, and we are able to treat the however many kids each year will need to be hospitalized and treated, and you have a certain comfort — I don’t think that most parents would like the idea of knowing your kid is going to get sick and need to be hospitalized maybe or treated — but there’s a lot more comfort that they would get care, and quick care, and would do better there. But they certainly are not, and there’s data to show, [they] don’t do as well as the U.S. does in terms of the amount of people that get some of these diseases.
The other thing with some of the vaccines I noted that like some of these comparison countries don’t cover is they’re newer and they’re still more expensive. So, sometimes one of the reasons these countries are choosing not to recommend them more broadly is because they’re making decisions based on the fact that they have universal health care — the taxpayers pay for it — and then deciding that at this point, the pricing is not affordable. They’re not making a decision saying if the cost was zero, that the risk-benefit calculus isn’t favorable for people.
Rovner: Right. And it’s all about the risk-benefit calculus. So, one thing we know is that the rise in vaccine hesitancy is leading to outbreaks of previously rare diseases in the U.S., including measles and pertussis, or whooping cough. Lauren, you’ve got a really cool story this week with a tool that can help people figure out if they and their families are at risk. So, tell us about it.
Weber: Yeah. My colleagues at The Washington Post, including Caitlin Gilbert, and I set out last year to tell people across the country what their vaccination rate is at their school. And so, we requested records from all 50 states and were able to get school-based records for about, I think, 36 of them and county-based records for vaccination records for 44 states. So, we have a nifty tool where you can look up in your local community what your vaccination rates are.
But taking a step back, what we found in our reporting is that before the pandemic, rates weren’t looking that great. Only half of the country was making 95% vaccination against measles, which is herd immunity. After the pandemic, that dropped to 28%.
And what we found in digging in a lot deeper is that schools, which were once considered kind of this bulwark against infectious disease, because they’re the ones who would enforce whether or not you needed your shots to attend school, are somewhat stepping away from that responsibility in the politically charged environment that is America today. I spoke to a superintendent in Minnesota, which has seen a large drop in vaccination for measles, who said, Look, I’m a record keeper. It’s not my job to promote a medical decision.
And you see that attitude across the country in school nurses and so on where maybe they’re not being empowered by their superintendent or principal to draw the line, or they’re valuing the child going to school over getting vaccinated. And so, there’s a lot of talk about at the state level that we have these mandates for vaccination, but if they’re not enforced and there’s no mechanism to enforce them, our investigation found that you had these slipping rates.
And a lot of folks are really concerned. Because look to South Carolina. You have hundreds of kids quarantined and missing school; you have hundreds of people infected. And, in general, measles cases were at their highest in 33 years last year. So, we have this rise of infectious disease amid an administration headed by a man who has disparaged vaccines for years and is working to roll back policy around them.
Rovner: Is there any talk from Capitol Hill on … we’ve talked so much about Sen. Bill Cassidy [R-La.], who’s a doctor, who was the deciding vote for RFK Jr. and said that he got RFK Jr. to promise not to change the vaccine schedule, which he just did. But it’s not just Cassidy. There’s 534 other members of Congress. Is anybody pushing back on any of this?
Weber: I mean, Cassidy tweeted after the vaccine change that he was appalled. I’m a physician. My job is to protect children. This is a problem. At the end of the day, the person who runs HHS is a man who has repeatedly linked the rising number of vaccines, which are rising because we have more vaccines that can fight more pathogens, to chronic conditions that experts say is not based in evidence.
And so, no, I do not see a massive Capitol Hill pushback. I mean, you have frustration and irritation, but I don’t see Cassidy hauling Kennedy in for a hearing. Hasn’t happened yet, really, besides those couple that were mandated. So, we’ll see how this continues to play out.
But the reality is amid all of this talk of vaccine schedules, the people on the front lines of this are these school nurses or pediatricians who are met with a wave of parents who are so confused. I talked to so many pediatricians who said, Look, we refer to the AAP, the American Academy of Pediatrics, but it’s really hard when the president and the head of the health system is saying something different to convince parents that may be confused. And oftentimes, if you’re confused, it’s easier to not take action, to not get your child vaccinated than to do so. And…
Rovner: And because pediatricians don’t already have enough to do.
Weber: Right. Many are scared that these trends that we identified in our investigation will continue to worsen in the years to come.
Rovner: Well, also this week we got the new food pyramid recommendations from HHS and the Department of Agriculture. Food, obviously another big priority for RFK Jr., who, as we know, is a fan of red meat and whole-fat dairy. Unlike the vaccine schedule, though, the changes to the food pyramid appear, at least at first blush, to hew to fairly consensus opinions in the nutrition world that whole foods are better than processed foods, protein is good, added sugar and refined carbohydrates are bad.
Still, when you get into the details, there are some things that are likely to cause nutrition scientists, some, shall we say, indigestion. What are some of the more controversial recommendations here other than Dr. [Mehmet] Oz saying in Wednesday’s press briefing that you might not want to drink alcohol for breakfast?
Ollstein: So, the alcohol piece has gotten pushback because it’s weakening the previous recommendation that really no amount of alcohol is safe. We talked before about a report about alcohol as a carcinogen that was buried last year, a government report that had been worked on for years that was supposed to come out that got buried by the Trump administration. And so that I think is reflected in these new recommendations. And I saw a lot of conservatives celebrating this and saying, Happy hour’s back, everyone. But look, there’s real science that shows the dangers of even moderate alcohol consumption, and that’s getting sidelined here.
Rovner: The previous recommendations were that, I would say the previous recommendations were like no more than one drink a day for women and two for men, and they took that away? I think that was the actual change here.
Ollstein: There was a push to say that no amount is safe, basically, that even small amounts are potentially harmful to health.
Rovner: And that didn’t happen.
Ollstein: Correct, correct. The other concern I was hearing is about the emphasis on red meat when that is something that Americans eat too much of already.
Rovner: Although I know there’s an irony here that I think the new recommendations state, you still shouldn’t have more than 10% of your calories from saturated fat. But saturated fat isn’t nearly as bad as we used to think it was, Sarah. I see you nodding.
Karlin-Smith: Yeah. I think the saturated fat and the focus on the sources of fat and protein is one of the biggest controversies here because there is lots of research and evidence that saturated fat can lead to heart disease and other medical complications. And people have long been pushed toward plant-based proteins, leaner proteins, and the role of dairy, and whether you should be doing high-fat dairy as well.
And there’s been some good reporting from Stat and others of recent days that there was a lot of conflicts on the committee who was making these recommendations around their relationships with these various industries. They tried to avoid contradicting the science too much in how they made their push for more red meat and more saturated fat. But it’s probably another area where, if you read it in full, you’re going to get confused and you may not end up making the right decisions because some of the recommendations there are kind of contradictory.
Rovner: Although we’ll point out that the difference between the nutrition guidelines and the vaccine schedule is very large because the new nutrition guidelines are just that. They’re guidelines. They do determine what gets served in school lunches and things like that, but it’s not quite nearly of the level that the vaccine schedule is.
Well, finally this week, turning to reproductive health, the Wyoming Supreme Court struck down two abortion bans, kind of remarkable for one of the reddest states in the nation. Interestingly, one of the reasons the bans were struck down is because the state tried to thwart the Affordable Care Act back in 2012. Alice, explain what these two things have to do with each other.
Ollstein: Yes. So, the state adopted some laws saying that people have the right to make their own health care decisions, and that was squarely aimed at the Affordable Care Act. However, the judges found that it also applied to the right to have an abortion.
Rovner: Oops.
Ollstein: They said, Based on the text of this law, it doesn’t matter what you meant it to say. It matters what it actually says. And we find that it applies here.
That’s actually not the only state where that’s happened over the past few years. There have been other conservative states that have inadvertently protected the right to abortion through these right-to-control-your-own-health care provisions. So, I think we’ve seen over the past few years that state constitutions can be more protective of abortion than the federal Constitution in certain circumstances. But I think it’s also notable that Wyoming had one of the first laws specifically banning abortion pills, and that was also struck down.
So, nothing changes in practice, because these laws were already enjoined and were not being enforced, but it is a big deal. And it could lead to more efforts to hold the ballot referendums that we’ve seen over the past few years. There are set to be a few more this fall, but there could be even more following decisions like this in the courts.
Rovner: Yeah. Along those lines, there’s a really interesting piece in The Guardian that suggests that abortion is waning as a top issue for Democrats, but not so much for Republicans, most of whom still consider it a deal breaker for a candidate not to agree with them. What happened to all that enthusiasm for abortion rights that we saw in 2023 and 2024 to some extent?
Ollstein: Look, there’s a lot going on right now. So, it may be that just other issues are overshadowing this. And also, it’s a long way to go before the elections. We do not know what’s going to happen.
If various court cases lead to a big change, another big change in abortion access, this could rear its head once again. As we’ve discussed many times, this is not really ever over or settled.
Rovner: All right. Well, it is January. All right. That is this week’s news, or at least as much as we had time for.
Now, 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 post the links in our show notes on your phone or other mobile device. Lauren, why don’t you start us off this week?
Weber: Yeah. I have to shout out another investigation my colleagues and I completed led by Rachel Roubein and Lena Sun and I. [“How RFK Jr. Upended the Public Health System”] We dug into the first year of Kennedy in office. In interviews with nearly a hundred folks and documents, we uncovered some of his previously undisclosed shaping of vaccine policy. We got ahold of an email in which a top aide asked to replace the membership of ACIP and reconsider the universal hep B vaccine recommendation and revisit the use of multidose flu shot vials. We also analyzed how while Kennedy has talked about food twice as much as vaccines while in office, one of his advisers, Del Bigtree, told us, Look, food is more popular with the American mom. And I think some of these revelations shape and put into context what we’re seeing now, which is this culmination of changing the vaccine schedule and continued policy to upend public health infrastructure in this country.
Rovner: That’s a really good piece. Alice.
Ollstein: So, I have a very depressing piece out of San Francisco called, “A Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose.” This is yet another death of a young person after heavily using some of these LLMs [large language models] for advice. Some of the chat logs show that he was able to very easily circumvent the protections that were put in place.
ChatGPT is not supposed to give people advice on using drugs recreationally, but that is very easily circumvented by pretending it’s a hypothetical question or various other means. And this article does a good job showing that it’s really a garbage-in-garbage-out scenario. ChatGPT is drawing from the entire internet. And so somebody’s dumb post on Reddit by a person who has a substance abuse issue, for instance, could be informing what advice the bot gives you. And so I think this is especially important to keep in mind as, just this week, ChatGPT is launching, making a big push, launching a whole health-care-focused chatbot and encouraging millions of people to use it.
And so this article … quotes experts who argue that it’s not possible to prevent this bad advice from getting in there, just because these chatbots are trained on huge volumes of text from the entire internet. It’s not possible to weed out things like this. And so I think that’s important to keep in mind.
Rovner: So, what could possibly go wrong? Sarah.
Karlin-Smith: I took a look at some ProPublica pieces on the impact of the U.S.’ USAID cuts [“The End of Aid: Trump Destroyed USAID. What Happens Now?”]. One of the stories that I looked at was “Trump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.” It’s just a really deep dive into the decisions that these political leaders made to cut off aid and support for various countries. This one, in particular, was looking at South Sudan, even though they were warned that they would make certain disease outbreaks and other humanitarian situations worse. And it just goes through the hardship of that, as well as the fact that Trump administration officials were making claims throughout this time, once there was pushback, that they were going to not cut off certain life-supporting aid and so forth. And that was not actually the case. They did cut it off, and they did it in ways that were extremely abrupt and fast, that there could not be any safety valve or stopgap to prevent the harm that occurred.
Rovner: Yeah. It’s quite the series and really heavy but really good. My extra credit this week comes from my colleague Fred Schulte, who’s moved on from uncovering malfeasance in Medicare Advantage to uncovering malfeasance in cosmetic surgery. This one is called “Advertisements Promising Patients a ‘Dream Body’ With Minimal Risk Get Little Scrutiny.”
And if you’ve ever been tempted by one of those body-sculpting commercials promising quick results, little pain, and an immediate return to your daily routine, you really need to read this story first. It includes a long list of patients who either died of complications of allegedly minimally invasive techniques or who ended up in the hospital and with scars that have yet to heal. Many of the lawsuits filed in these cases are still in process, but it is definitely “buyer beware.”
OK, that is this week’s show. Hope you feel at least a little bit caught up. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer engineer, Zach Dyer.
A reminder, What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at [email protected], or you can find me still on X, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Lauren.
Weber: I am on X, @LaurenWeberHP, and same thing on Bluesky these days.
Rovner: Sarah?
Karlin-Smith: Mostly Bluesky and LinkedIn at @sarahkarlin-smith.
Rovner: Alice.
Ollstein: Mostly on Bluesky, @alicemiranda, and still on X, @AliceOllstein.
Rovner: We will be backing your feed next week. Until then, be healthy.
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