\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n After explicitly promising senators during his confirmation hearing that he would not interfere in scientific policy over which Americans should receive which vaccines, Health and Human Services Secretary Robert F. Kennedy Jr. this week fired every member of the Advisory Committee on Immunization Practices, the group of experts who help the Centers for Disease Control and Prevention make those evidence-based judgments. Kennedy then appointed new members, including vaccine skeptics, prompting alarm from the broader medical community.<\/p>\n Meanwhile, over at the National Institutes of Health, some 300 employees \u2014 many using their full names \u2014 sent a letter of dissent to the agency\u2019s director, Jay Bhattacharya, saying the administration\u2019s policies \u201cundermine the NIH mission, waste our public resources, and harm the health of Americans and people across the globe.\u201d<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.<\/p>\n \tAnna Edney \t\t\t \t\t\t \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \tJoanne Kenen \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n After removing all 17 members of the vaccine advisory committee, Kennedy on Wednesday announced eight picks to replace them \u2014 several of whom lack the expertise to vet vaccine research and at least a couple who have spoken out against vaccines. Meanwhile, Sen. Bill Cassidy of Louisiana, the Republican head of the chamber\u2019s health committee, has said little, despite the fact that Kennedy\u2019s actions violate a promise he made to Cassidy during his confirmation hearing not to touch the vaccine panel.<\/p>\n In other vaccine news, the Department of Health and Human Services has canceled private-sector contracts exploring the use of mRNA technology in developing vaccines for bird flu and HIV. The move raises concerns about the nation\u2019s readiness against developing and potentially devastating health threats.<\/p>\n Hundreds of NIH employees took the striking step of signing a letter known as the \u201cBethesda Declaration,\u201d protesting Trump administration policies that they say undermine the agency\u2019s resources and mission. It is rare for federal workers to use their own names to voice public objections to an administration, let alone President Donald Trump\u2019s, signaling the seriousness of their concerns.<\/p>\n Lawmakers have been considering adding Medicare changes to the tax-and-spend budget reconciliation legislation now before the Senate \u2014 specifically, targeting the use of what\u2019s known as \u201cupcoding.\u201d Curtailing the practice, through which medical providers effectively inflate diagnoses and procedures to charge more, has bipartisan support and could increase the savings by reducing the amount the government pays for care.<\/p>\n Also this week, Rovner interviews Douglas Holtz-Eakin, president of the American Action Forum and former director of the Congressional Budget Office, to discuss how the CBO works and why it\u2019s so controversial.<\/p>\n\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> Stat\u2019s \u201cLawmakers Lobby Doctors To Keep Quiet \u2014 or Speak Up \u2014 on Medicaid Cuts in Trump\u2019s Tax Bill<\/a>,\u201d by Daniel Payne.\u00a0\u00a0<\/p>\n Anna Edney:<\/strong> KFF Health News\u2019 \u201cTwo Patients Faced Chemo. The One Who Survived Demanded a Test To See if It Was Safe<\/a>,\u201d by Arthur Allen.\u00a0\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Wired\u2019s \u201cThe Bleach Community Is Ready for RFK Jr. To Make Their Dreams Come True<\/a>,\u201d by David Gilbert.\u00a0\u00a0<\/p>\n Joanne Kenen:<\/strong> ProPublica\u2019s \u201cDOGE Developed Error-Prone AI Tool To \u2018Munch\u2019 Veterans Affairs Contracts<\/a>,\u201d by Brandon Roberts, Vernal Coleman, and Eric Umansky.\u00a0\u00a0<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n The Hill\u2019s \u201cCassidy in a Bind as RFK Jr. Blows Up Vaccine Policy<\/a>,\u201d by Nathaniel Weixel.<\/p>\n JAMA Pediatrics\u2019 \u201cFirearm Laws and Pediatric Mortality in the US<\/a>,\u201d by Jeremy Samuel Faust, Ji Chen, and Shriya Bhat.<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: RFK Jr. Upends Vaccine Policy, After Promising He Wouldn\u2019t<\/strong>\t\t\t\t<\/p>\n [<\/em>Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, June 12, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Anna Edney of Bloomberg News.\u00a0<\/p>\n Anna Edney:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.\u00a0<\/p>\n Joanne Kenen:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> And Sarah Karlin-Smith of the Pink Sheet.\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Hello, everybody.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my interview with Douglas Holtz-Eakin, head of the American Action Forum and former head of the Congressional Budget Office. Doug will talk about what it is that CBO actually does and why it\u2019s the subject of so many slings and arrows. But first, this week\u2019s news.\u00a0<\/p>\n The biggest health news this week is out of the Department of Health and Human Services, where Secretary Robert F. Kennedy Jr. on Monday summarily fired all 17 members of the CDC\u2019s [Centers for Disease Control and Prevention\u2019s] vaccine advisory committee, something he expressly promised Republican Sen. Bill Cassidy he wouldn\u2019t do, in exchange for Cassidy\u2019s vote to confirm him last winter. Sarah, remind us what this committee does and why it matters who\u2019s on it?\u00a0<\/p>\n Karlin-Smith:<\/strong> So, they\u2019re a committee that advises CDC on who should use various vaccines approved in the U.S., and their recommendations translate, assuming they\u2019re accepted by the CDC, to whether vaccines are covered by most insurance plans and also reimbursed. There\u2019s various laws that we have that set out, that require coverage of vaccines recommended by the ACIP [Advisory Committee on Immunization Practices] and so forth. So without ACIP recommendations, you may \u2014 vaccines could be available in the U.S. but extremely unaffordable for many people.\u00a0<\/p>\n Rovner:<\/strong> Right, because they\u2019ll be uncovered.\u00a0<\/p>\n Karlin-Smith:<\/strong> Correct. Your insurance company may choose not to reimburse them.\u00a0<\/p>\n Rovner:<\/strong> And just to be clear, this is separate from the FDA\u2019s [Food and Drug Administration\u2019s] actual approval of the vaccines and the acknowledgment it\u2019s safe and effective. Right, Anna?\u00a0<\/p>\n Edney:<\/strong> Yeah, there are two different roles here. So the FDA looks at all the safety and effectiveness data and decides whether it\u2019s safe to come to market. And with ACIP, they are deciding whether these are things that children or adults or pregnant women, different categories of people, should be getting on a regular basis.\u00a0<\/p>\n Rovner:<\/strong> So Wednesday afternoon, Secretary Kennedy named eight replacements to the committee, including several with known anti-vaccine views. I suppose that\u2019s what we all expected, kind of?\u00a0<\/p>\n Kenen:<\/strong> He also shrunk it, so there are fewer voices. The old panel, I believe, had 17. And the law says it has to have at least eight, and he appointed eight. As far as we know, that\u2019s all he\u2019s appointing. But who knows? A couple of more could straggle in. But as of now, it means there\u2019s less viewpoints, less voices, which may or might not turn out to be a good thing. But it is a different committee in every respect.\u00a0<\/p>\n Edney:<\/strong> And I think it is a bit of what we expected in the sense that these are people who either are outright vaccine critics or, in a case or two, have actually said vaccines do horrible things to people. One of them had said before that the covid vaccine caused an AIDS-like virus in people. And there is a nurse that is part of the committee now that said her son was harmed by vaccines. And not saying that is or isn\u2019t true \u2014 her concerns could be valid \u2014 but that she very much has worked to question vaccines.\u00a0<\/p>\n So I think it is the committee that we maybe would\u2019ve expected from a sense of, I think he\u2019s trying to bring in people who are a little bit mainstream, in the sense if you looked at where they worked or things like that, you might not say, like: Oh, Georgetown University. I get it.<\/em> But they are people who have taken kind of the more of a fringe approach within maybe kind of a mainstream world.\u00a0<\/p>\n Karlin-Smith:<\/strong> I was going to say there\u2019s also many people on the list that it\u2019s just not even clear to me why you would look at their expertise and think, Oh, this is a committee they should serve on<\/em>. One of the people is an MIT [Massachusetts Institute of Technology], essentially, like, business school professor who tangentially I think has worked on health policy to some extent. But, right, this is not somebody who has extreme expertise in vaccinology, immunology, and so forth. You have a psychiatrist whose expertise seems to be on nutrition and brain health.\u00a0<\/p>\n And one thing I think people don\u2019t always appreciate about this committee at CDC is, you see them in these public meetings that happen a few times a year, but they do a lot of work behind the scenes to actually go through data and make these recommendations. And so having less people and having people that don\u2019t actually have the expertise to do this work seems like it could cause a big problem just from that point of view.\u00a0<\/p>\n Edney:<\/strong> And that can be the issue that comes up when Kennedy has said, I don\u2019t want anyone with any conflicts of interest.<\/em> Well, we\u2019ve talked about this. Certainly you don\u2019t want a legit conflict of interest, but a lot of people who are going to have the expertise you need may have a perceived conflict that he doesn\u2019t want on there. So you end up maybe with somebody who works in operations instead of on vaccines.\u00a0<\/p>\n Rovner:<\/strong> You mean maybe we\u2019ll have people who actually have researched vaccines.\u00a0<\/p>\n Edney:<\/strong> Right. Exactly. Yeah.\u00a0<\/p>\n Kenen:<\/strong> The MIT guy is an expert in supply chains. None of us know who the best supply chain business school professor is in the world. Maybe it\u2019s him, but it\u2019s a very odd placement.\u00a0<\/p>\n Rovner:<\/strong> Well, so far Sen. Cassidy hasn\u2019t said very much other than to kind of communicate that he\u2019s not happy right now. Has anybody heard anything further? The secretary has been sort of walking up to the line of things he told the senator he wouldn\u2019t do, but this clearly is over the line of things he told the senator he wouldn\u2019t do. And now it\u2019s done.\u00a0<\/p>\n Kenen:<\/strong> It\u2019s like over the line and he set fire to it. And Cassidy has been pretty quiet. And in fact, when Kennedy testified before Cassidy \u2014 Cassidy is the chairman of the health committee \u2014 a couple of weeks ago, he gave him a really warm greeting and thanked him for coming and didn\u2019t say: You\u2019re a month late. I wanted you here last month.<\/em> The questions were very soft. And things have only gotten more heated since then, with the dissolution of the ACIP committee and this reconstitution of it. And he\u2019s been very quiet for somebody who publicly justified, who publicly wrestled with this, the confirmation, was the deciding vote, and then has been really soft since then \u2014 in public.\u00a0<\/p>\n Rovner:<\/strong> I sent around a story<\/a> this morning to the panelists, from The Hill, which I will link to in the show notes, that quotes a political science professor in Louisiana pointing out that perhaps it would be better for Cassidy politically not to say anything, that perhaps public opinion among Republicans who will vote in a primary is more on the side of Secretary Kennedy than Sen. Cassidy, which raises some interesting questions.\u00a0<\/p>\n Edney:<\/strong> Yeah. And I think that, at least for me, I\u2019m at the point of wondering if Cassidy didn\u2019t know that all along, that there\u2019s a point he was willing to go up to but a line that he is never going to have been willing to cross, and that is actually coming out against Kennedy and, therefore, [President Donald] Trump. He doesn\u2019t want to lose his reelection. I am starting to wonder if he just hoped it wouldn\u2019t come to this and so was able to say those things that got him to vote for Kennedy and then hope that it wouldn\u2019t happen.\u00a0<\/p>\n And I think that was a lot of people. They weren\u2019t on the line like Cassidy was, but I think a lot of people thought, Oh, nothing\u2019s ever going to happen on this.<\/em> And I think another thing I\u2019m learning as I cover this administration and the Kennedy HHS is when they say, Don\u2019t worry about it, look away, we\u2019re not doing anything that big of a deal,<\/em> that\u2019s when you have to worry about it. And when they make a big deal about some policy they\u2019re bringing up, it actually means they\u2019re not really doing a lot on it. So I think we\u2019re seeing that with vaccines for sure.\u00a0<\/p>\n Rovner:<\/strong> Yes, classic watch what they do not what they say.\u00a0<\/p>\n Kenen:<\/strong> But if you\u2019re Cassidy and you already voted to impeach President Trump, which means you already have a target from the right \u2014 he\u2019s a conservative, but it\u2019s from the more conservative, though, the more MAGA [Make America Great Again] \u2014 if you do something mavericky, sometimes the best political line is to continue doing it. But they\u2019ve also changed the voting rules, my understanding is, in Louisiana so that independents are \u2014 they used to be able to cross party lines in the primaries, and I believe you can\u2019t do that anymore. So that also changed, and that\u2019s recent, so that might have been what he thought might save him.\u00a0<\/p>\n Rovner:<\/strong> Well, it\u2019s not just ACIP where Secretary Kennedy is insinuating himself directly into vaccine policy. HHS has also canceled a huge contract with vaccine maker Moderna, which was working on an mRNA-based bird flu vaccine, which we might well need in the near future, and they\u2019ve also canceled trials of potential HIV vaccines. What do we know about what this HHS is doing in terms of vaccine policy?\u00a0<\/p>\n Karlin-Smith:<\/strong> The bird flu contract I think is very concerning because it seems to go along the lines of many people in this administration and Kennedy\u2019s orbit who sometimes might seem a little bit OK with vaccines, more OK than Kennedy\u2019s record, is they are very anti the newer mRNA technology, which we know proved very effective in saving tens of millions of lives. I was looking at some data just even the first year they rolled out after covid. So we know they work. Obviously, like all medical interventions, there are some side effects. But again, the benefits outweigh the risks. And this is the only, really, technology that we have that could really get us vaccines really quickly in a pandemic and bird flu.\u00a0<\/p>\n Really, the fear there is that if it were to jump to humans and really spread from human-to-human transmission \u2014 we have had some cases recently \u2014 it could be much more devastating than a pandemic like covid. And so not having the government have these relationships with companies who could produce products at a particular speed would be probably incredibly devastating, given the other technologies we have to invest in.\u00a0<\/p>\n Edney:<\/strong> I think Kennedy has also showed us that he, and spoken about this, is that he is much more interested in a cure for anything. He has talked about measles and Why can\u2019t we just treat it better?<\/em> And we\u2019re seeing that with the HIV vaccine that won\u2019t be going forward in the same way, is that the administration has basically said: We have the tools to deal with it if somebody gets it. We\u2019re just not going to worry about vaccinating as much.<\/em> And so I think that this is a little bit in that vein as well.\u00a0<\/p>\n Rovner:<\/strong> So the heck with prevention, basically.\u00a0<\/p>\n Edney:<\/strong> Exactly.\u00a0<\/p>\n Rovner:<\/strong> Well, in related news, some 300 employees of the National Institutes of Health, including several institute directors, this week sent an open letter of dissent to NIH Director Jay Bhattacharya that they are calling the \u201cBethesda Declaration.\u201d That\u2019s a reference to the \u201cGreat Barrington Declaration\u201d that the NIH director helped spearhead back in 2020 that protested covid lockdowns and NIH\u2019s handling of the science.\u00a0<\/p>\n The Bethesda Declaration protests policies that the signatories say, quote, \u201cundermine the NIH mission, waste our public resources, and harm the health of Americans and people across the globe.\u201d Here\u2019s how one of the signers, Jenna Norton of the National Institute of Diabetes and Digestive and Kidney Diseases, put it in a YouTube video<\/a>.\u00a0<\/p>\n Jenna Norton:<\/strong> And the NIH that I\u2019m working in now is unrecognizable to me. Every day I go into the office and I wonder what ethical boundary I\u2019m going to be asked to violate, what probably illegal action am I going to be asked to take. And it\u2019s just soul-crushing. And that\u2019s one of the reasons that I\u2019m signing this letter. One of my co-signers said this, but I\u2019m going to quote them because I thought it was so powerful: \u201cYou get another job, but you cannot get another soul.\u201d\u00a0<\/p>\n Rovner:<\/strong> I\u2019ve been covering NIH for a lot of years. I can\u2019t remember pushback like this against an administration by its own scientists, even during the height of the AIDS crisis in the 1980s. How serious is this? And is it likely to have any impact on policy going forward?\u00a0<\/p>\n Edney:<\/strong> I think if you\u2019re seeing a good amount of these signers who sign their actual names and if you\u2019re seeing that in the government, something is very serious and there are huge concerns, I think, because, as a journalist, I try to reach people who work in the government all the time. And if they\u2019re not in the press office, if they speak to me, which is rare, even they do not want me to use their name. They do not want to be identified in any way, because there are repercussions for that.\u00a0<\/p>\n And especially with this administration, I\u2019m sure that there is some fear for people\u2019s jobs and in some instances maybe even beyond. But I think that whether there will be any policy changes, that is a little less clear, how this administration might take that to heart or listen to what they\u2019re saying.\u00a0<\/p>\n Rovner:<\/strong> Bhattacharya was in front of a Senate Appropriations subcommittee this week and was asked about it, but only sort of tangentially. I was a little bit surprised that \u2014 obviously, Republicans, we just talked about Sen. Cassidy, they are afraid to go up against the Trump administration\u2019s choices for some of these jobs \u2014 but I was surprised that even some of the Democrats seemed a little bit hands-off.\u00a0<\/p>\n Edney:<\/strong> Yeah, no one ever asks the questions I want asked at hearings, I have to say. I\u2019m always screaming. Yeah, exactly. I\u2019m always like: No. What are you doing?<\/em>\u00a0<\/p>\n Rovner:<\/strong> That\u2019s exactly how I was, like: No, ask him this.<\/em>\u00a0<\/p>\n Edney:<\/strong> Right.\u00a0<\/p>\n Rovner:<\/strong> Don\u2019t ask him that.<\/em>\u00a0<\/p>\n Edney:<\/strong> Exactly.\u00a0<\/p>\n Rovner:<\/strong> Well, moving on to the Big Budget Bill, which is my new name for it. Everybody else seems to have a different one. It\u2019s still not clear when the Senate will actually take up its parts, particularly those related to health, but it is clear that it\u2019s not just Medicaid and the Affordable Care Act on the table but now Medicare, too. Ironically, it feels like lawmakers could more easily squeeze savings out of Medicare without hurting beneficiaries than either Medicaid or the ACA, or is that just me being too simplistic about this whole thing?\u00a0<\/p>\n Kenen:<\/strong> The Medicare bill is targeted at upcoding, which means insurers or providers sort of describing a symptom or an illness in the most severe terms possible and they get paid more. And everybody in government is actually against that. Everybody ends up paying more. I don\u2019t know what else the small \u2014this has just bubbled up \u2014 but I don\u2019t know if there\u2019s other small print.\u00a0<\/p>\n This alone, if it wasn\u2019t tied to all the politics of everything else in this bill, this is the kind of thing, if you really do a bill that attacks inflated medical bills, you could probably get bipartisan support for. But because \u2014 and, again, I don\u2019t know what else is in, and I know that\u2019s the top line. There may be something that I\u2019m not aware of that is more of a poison pill. But that issue you could get bipartisan consensus on.\u00a0<\/p>\n But it\u2019s folded into this horrendously contentious thing. And it\u2019s easy to say, Oh, they\u2019re trying to cut Medicare,<\/em> which in this case maybe they\u2019re trying to cut it in a way that is smart, but it just makes it more complicated. If they do go for it, if they do decide that this goes in there, it could create a little more wiggle room to not cut some other things quite as deeply.\u00a0<\/p>\n But again, they\u2019re calling everything waste, fraud, and abuse. None of us would say there is no waste, fraud, and abuse in government or in health care. We all know there is waste, fraud, and abuse, but that doesn\u2019t mean that what they\u2019re cutting here is waste, fraud, and abuse in other aspects of that bill.\u00a0<\/p>\n Rovner:<\/strong> Although, as you say, I think there\u2019s bipartisan consensus, including from Mehmet Oz, who runs Medicare, that upcoding is waste and fraud.\u00a0<\/p>\n Kenen:<\/strong> Right. But other things in the bill are being called waste, fraud, and abuse that are not, right? That there\u2019s things in Medicaid that are not waste, fraud, and abuse. They\u2019re just changing the rules. But I agree with you, Julie. I think that in a bill that is not so fraught, it would\u2019ve been easier to get consensus on this particular item, assuming it\u2019s a clean upcoding bill, if you did it in a different way.\u00a0<\/p>\n Rovner:<\/strong> And also, there\u2019s already a bipartisan bill on pharmacy benefit managers kicking around. There are a lot of things that Congress could do on a bipartisan basis to reduce the cost of Medicare and make the program better and shore it up, and that doesn\u2019t seem to be what\u2019s happening, for the most part.\u00a0<\/p>\n Well, we continue to learn things about the House-passed bill that we didn\u2019t know before, and one thing we learned this week that I think bears discussing comes from a new poll<\/a> from our KFF polling unit that found that nearly half those who purchased Affordable Care Act coverage from the marketplaces are Republicans, including a significant percentage who identify themselves as MAGA Republicans.\u00a0<\/p>\n
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