President Trump signed an executive order promoting regenerative agriculture to boost soil health, farm resilience, and rural prosperity.

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.

For the second year in a row, Trump administration officials are delaying the distribution of hundreds of millions of dollars in health-related grant funding as political appointees seek to ensure the funding adheres to the administration’s priorities — despite promises to Congress that the money would be spent as directed.

Meanwhile, four years after the Supreme Court overturned the federal right to abortion, nearly half the states have banned or substantially restricted the procedure. But while most voters say they support abortion rights — and majorities in several states have approved ballot measures to enshrine them — that sentiment has not translated into major gains for Democrats running for office.

This week’s panelists are Julie Rovner of KFF Health News, Maya Goldman of Axios, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Rachana Pradhan of KFF Health News.

Panelists Maya Goldman Axios @mayagoldman_ @maya-goldman.bsky.social Read Maya's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen @joannekenen.bsky.social Read Joanne's bio. Rachana Pradhan KFF Health News @rachanadpradhan Read Rachana's stories.

Among the takeaways from this week’s episode:

• Federal funding for health grants and international humanitarian aid is not reaching its recipients, demonstrating that congressionally authorized and appropriated funding is still encountering roadblocks under the Trump administration. At least some of the money is being tied up in review, with political appointees requiring personal signoff on any and all disbursements. While many lawmakers have made their frustrations known, Congress has few levers to ensure the money goes where lawmakers say it should.
• This week marked the fourth anniversary of the Supreme Court case that overturned the constitutional right to an abortion. Yet research shows there were more abortions performed in the U.S. last year than there were in the year before the court’s decision. Access to medication abortion and telehealth prescribing are credited for that increase — two methods that activists who oppose abortion have targeted in their continuing efforts to eliminate it.
• In vaccine policy news, a study showing the effectiveness of the covid vaccine that was spiked by Trump administration officials was recently published in a peer-reviewed medical journal. And Defense Secretary Pete Hegseth reinstated a flu vaccine mandate for the military after a significant flu outbreak at Lackland Air Force Base in Texas.
• Amid concerns over healthcare affordability, two states are taking measures to address prices. A new Indiana law imposes price controls on hospitals, and Colorado has received federal approval to import drugs from Canada — though Canadian distributors have shown no interest in working with American states.

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

Julie Rovner: The Washington Post’s “Tennessee To Restrict Medical Aid for Critically Ill Undocumented Children,” by Silvia Foster-Frau.  

Maya Goldman: Stat’s “Trump Administration Targets Disability Integration Mandate in DOJ Memo,” by O. Rose Broderick.  

Rachana Pradhan: KFF Health News’ “Arrests of Immigrant Parents Create Mental Health Crisis for Children,” by Claudia Boyd-Barrett.  

Joanne Kenen: The Washington Post’s “Why Trump’s Algae Problem Is Much Bigger Than the Reflecting Pool,” by Sarah Kaplan.  

Also mentioned in this week’s podcast:

• NOTUS’ “The Trump Administration Is Holding Up Billions in HHS Funding,” by Eric Katz and Paige Winfield Cunningham.
• Stat’s “Federal Grant Delays Could Jeopardize Essential Disability Services, Research,” by Lauren Chan and O. Rose Broderick.
• ProPublica’s “‘A Huge Grab of Power’: Trump Is Defying Congress on Foreign Aid,” by Anna Maria Barry-Jester.
• KFF Health News’ “A Ban Won’t Stop Abortion Pill Access, Telehealth Providers Say,” by Kate Wells.
• Politico’s “Republicans Don’t Want To Talk About Abortion. In These States, They May Have To,” by Alice Miranda Ollstein.
• KFF Health News’ “Indiana Takes On Powerful Hospitals by Capping Prices They Charge Employers,” by Phil Galewitz and Samantha Liss.
• Stat’s “Eli Lilly Gave Extraordinary Obesity Drug Access to a 79-Year-Old Patient. Who Was It?” by Lizzy Lawrence.

Click to open the transcript Transcript: 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. 

Credits Francis Ying Audio producer Emmarie Huetteman Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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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.

For the second year in a row, Trump administration officials are delaying the distribution of hundreds of millions of dollars in health-related grant funding as political appointees seek to ensure the funding adheres to the administration’s priorities — despite promises to Congress that the money would be spent as directed.

Meanwhile, four years after the Supreme Court overturned the federal right to abortion, nearly half the states have banned or substantially restricted the procedure. But while most voters say they support abortion rights — and majorities in several states have approved ballot measures to enshrine them — that sentiment has not translated into major gains for Democrats running for office.

This week’s panelists are Julie Rovner of KFF Health News, Maya Goldman of Axios, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Rachana Pradhan of KFF Health News.

Panelists Maya Goldman Axios @mayagoldman_ @maya-goldman.bsky.social Read Maya's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen @joannekenen.bsky.social Read Joanne's bio. Rachana Pradhan KFF Health News @rachanadpradhan Read Rachana's stories.

Among the takeaways from this week’s episode:

• Federal funding for health grants and international humanitarian aid is not reaching its recipients, demonstrating that congressionally authorized and appropriated funding is still encountering roadblocks under the Trump administration. At least some of the money is being tied up in review, with political appointees requiring personal signoff on any and all disbursements. While many lawmakers have made their frustrations known, Congress has few levers to ensure the money goes where lawmakers say it should.
• This week marked the fourth anniversary of the Supreme Court case that overturned the constitutional right to an abortion. Yet research shows there were more abortions performed in the U.S. last year than there were in the year before the court’s decision. Access to medication abortion and telehealth prescribing are credited for that increase — two methods that activists who oppose abortion have targeted in their continuing efforts to eliminate it.
• In vaccine policy news, a study showing the effectiveness of the covid vaccine that was spiked by Trump administration officials was recently published in a peer-reviewed medical journal. And Defense Secretary Pete Hegseth reinstated a flu vaccine mandate for the military after a significant flu outbreak at Lackland Air Force Base in Texas.
• Amid concerns over healthcare affordability, two states are taking measures to address prices. A new Indiana law imposes price controls on hospitals, and Colorado has received federal approval to import drugs from Canada — though Canadian distributors have shown no interest in working with American states.

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

Julie Rovner: The Washington Post’s “Tennessee To Restrict Medical Aid for Critically Ill Undocumented Children,” by Silvia Foster-Frau.  

Maya Goldman: Stat’s “Trump Administration Targets Disability Integration Mandate in DOJ Memo,” by O. Rose Broderick.  

Rachana Pradhan: KFF Health News’ “Arrests of Immigrant Parents Create Mental Health Crisis for Children,” by Claudia Boyd-Barrett.  

Joanne Kenen: The Washington Post’s “Why Trump’s Algae Problem Is Much Bigger Than the Reflecting Pool,” by Sarah Kaplan.  

Also mentioned in this week’s podcast:

• NOTUS’ “The Trump Administration Is Holding Up Billions in HHS Funding,” by Eric Katz and Paige Winfield Cunningham.
• Stat’s “Federal Grant Delays Could Jeopardize Essential Disability Services, Research,” by Lauren Chan and O. Rose Broderick.
• ProPublica’s “‘A Huge Grab of Power’: Trump Is Defying Congress on Foreign Aid,” by Anna Maria Barry-Jester.
• KFF Health News’ “A Ban Won’t Stop Abortion Pill Access, Telehealth Providers Say,” by Kate Wells.
• Politico’s “Republicans Don’t Want To Talk About Abortion. In These States, They May Have To,” by Alice Miranda Ollstein.
• KFF Health News’ “Indiana Takes On Powerful Hospitals by Capping Prices They Charge Employers,” by Phil Galewitz and Samantha Liss.
• Stat’s “Eli Lilly Gave Extraordinary Obesity Drug Access to a 79-Year-Old Patient. Who Was It?” by Lizzy Lawrence.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This <a target="_blank" href="https://kffhealthnews.org/podcast/what-the-health-452-trump-grant-delays-abortion-dobbs-june-25-2026/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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WHITESBURG, Ky. — Drugs and the consequences of addiction are woven into the fabric of Jamie Madden’s life.

Her earliest memory is of standing on the passenger seat of her dad’s car as a toddler, wearing a peach-colored blouse, while he drove from their Kentucky home to Florida to pick up drugs. On a stop for a burger, she met Ronald McDonald.

“I grew up with the impression that that’s how you paid your bills,” Madden said. “That’s how your kids got things.”

By 16, she was addicted to pain pills. By 30, methamphetamine. She lost custody of two children and gave up two more for adoption at birth. She served time in the county jail and state prison.

Pregnant again at 40, Madden resolved to stop using. It was then that she learned of The Hub in Whitesburg, a town of 1,575 residents, her hometown.

Over the past two years, the state of Kentucky has sent hundreds of thousands of opioid settlement dollars to the rural eastern region of the state to help minimize the ramifications of drug misuse. The Hub, a program that oversees a network of community centers offering a range of services from recovery peer support to canned food to sterile syringes, is part of that effort.

In April, Kentucky Attorney General Russell Coleman announced $320,000 would be awarded to the Kentucky River District Health Department’s Hub initiative. There are now Hubs in four rural eastern Kentucky counties — Knott, Lee, Letcher, and Owsley, all of which are among the nation’s most impoverished — addressing substance use disorders, housing, hunger, employment, and other challenges. The program also operates The Hub on Wheels, which provides services throughout the district.

In 2025, The Hub received $545,000 from the same source, facilitating expansion from two to five counties. (The fifth Hub will be in Perry County.) The new $320,000 is a two-year grant to develop a program to help women who’ve been incarcerated reintegrate into society.

Both grants are from Kentucky’s approximately $1 billion share of the $57.8 billion for state and local governments from the settlement reached with pharmaceutical companies to resolve litigation for their role in fueling the opioid overdose crisis.

Madden believes investment in harm reduction services is money well spent. She’s witnessed them work in her own life. She’s found solid footing for recovery at The Hub.

The Hub is founded on the principles of harm reduction. Support includes housing, food, healthcare, and overdose prevention tools. (Taylor Sisk for KFF Health News)

But the Trump administration is cutting federal funding for such efforts, disputing their benefits. A July 24 executive order told programs across the country that they could no longer expect federal funding. The order stipulated that discretionary grants issued by the Substance Abuse and Mental Health Services Administration should not be spent on “so-called ‘harm reduction’” efforts, claiming they “only facilitate illegal drug use and its attendant harm.”

Advocates for these services in this rural region, which cast its ballots for President Donald Trump in all three elections, beg to differ.

Meeting Folks Where They Live

Whitesburg — home to a lively cultural scene, including Appalshop, a media, arts, and education center — is a town residents are fiercely proud to call home. The Hub is housed in a storefront on Main Street, neighboring City Hall, Hazard Coffee Company, Cut-Away Barber & Beauty Shop, and the fire station. Like the other Hubs, it provides a range of services targeted to the needs of the community.

The inaugural Hub, launched in 2022 in Beattyville, the Lee County seat, two hours northwest of Whitesburg, offers breakfast and lunch, a food pantry, a clothing closet, a laundry room, and a computer lab. Also: naloxone, a medication that can quickly reverse an opioid overdose; drug test strips; hepatitis C treatment; sterile syringes; and wound care.

The program’s motto is “Meeting you where you are but not leaving you there!” It’s founded on the principles of harm reduction. Harm reduction services are designed to minimize the effects of drug use, keep people safe, and treat them with respect, until they might be ready to enter recovery. The support includes housing, food, healthcare, and overdose prevention tools.

JoAnn Fraley is Kentucky River’s harm reduction program coordinator and its Hub initiative director. “In order for anybody to sustain recovery, they have to have financial stability, they have to have transportation, and they have to have a home,” she said. “We try to fill those gaps.”

While critics suggest that exchanging clean syringes for used ones abets drug use, research published in the Journal of Substance Use and Addiction Treatment indicates that people who participate in syringe services programs are more likely than those who don’t to reduce their injection-drug use or stop using drugs altogether, and that they are more likely to enter and remain in treatment. According to the Centers for Disease Control and Prevention, syringe services programs also reduce the spread of HIV and hepatitis C by about half.

In 2025, Kentucky River’s Hub model was named one of 19 public health best practices award winners by the National Association of County and City Health Officials.

“What jazzes me about it is it’s a community approach to harm reduction,” said Lauren Carr, who advises the Kentucky Association of Counties on how best to utilize opioid settlement funds. “Whether that’s feeding a hungry stomach, or putting clothes on somebody’s back, or giving them clean [syringes], you’re meeting that person’s needs.”

“It can be that lifeline,” Carr said.

Paying Back for Good

Becky Todd, who leads the Beattyville Hub’s team, is a community health worker and peer support specialist. In April 2024, she was released from jail, having served multiple sentences on drug-related charges. She walked 3 miles from jail to The Hub with nowhere else to go. She’s working toward her bachelor’s degree in social work at Eastern Kentucky University.

“I could not have done it without this place,” Todd said. “It’s my saving grace.”

Amber McDaniel recalls the first time she entered The Hub, after more than a decade of addiction, having lost her home, her kids, and her family’s support. “I didn’t know where to turn, didn’t know what to do,” she said. “I mean, I was about to lose my mind.” She’s now a Hub staff member through AmeriCorps.

Hannah Stamper was placed in foster care and began using meth at 14. She was drawn to dealing drugs because “I loved for people to need me.” She’s now on staff as a member of Recovery Corps, a program that trains AmeriCorps members to work in the recovery field. “People today need me in a good way, and I love that.”

Hannah Stamper is a staff member of The Hub in Beattyville, Kentucky, through Recovery Corps, a program that trains AmeriCorps members to work in the recovery field. (Taylor Sisk for KFF Health News)

Fraley has witnessed a transition in Lee County. A half-dozen years ago, conversations in public meetings about addiction and homelessness were strained “because nobody wanted to talk about it or acknowledge it.”

The community sees The Hub’s impact, she said, “and now they’re, like, ‘Whoa. We love you.’”

Scott Lockard, the district’s public health director, said a combination of data and anecdotal observations substantiates the initiative’s success, including an increase in the number of people entering treatment and a decline in reported communicable diseases.

“I’ve been in public health for 36 years, and it’s one of the most effective interventions I’ve seen,” Lockard said.

The Kentucky River team worked to educate the community about the potential outcomes of the Hub model, and Fraley said there was little resistance, just concern that the money be well spent. She said the planning has always included people who have lived with addiction.

“Their voice needs to be at every table,” she said.

Jannie Gatlin, who’s in recovery, comes to The Hub in Whitesburg, Kentucky, almost every day with her son, Hunter. (Taylor Sisk for KFF Health News)

Lockard agrees. To ensure the community is investing this money wisely, he said, “we’ll talk to those people who are experiencing the problem, find out what they think would help them best, and then look for those evidence-based interventions.”

Jannie Gatlin and Mandy Parker, who both are in recovery, attended a recent crafting class at the Whitesburg Hub. Gatlin, who started taking fentanyl in Colorado after her first son died at 2 months old of a digestive disorder, comes almost every day with her toddler, Hunter.

Parker was prescribed opioids for pain from a kidney disorder. When those pills became less available, she turned to street drugs. “That’s just the nature of the beast,” she said.

She believes The Hub is helping break the stigma of substance use disorder in her community. When people see “real change happening,” she said, there’s a ripple effect. “It makes a difference.”

She appreciates that The Hub is here on Main Street — right, she firmly believes, where it should be.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Sen. Ron Wyden and 14 Democratic co-sponsors plan to introduce legislation Thursday to cap consumers’ potential out-of-pocket costs in traditional Medicare, resurfacing a long-running debate over why the program doesn’t limit beneficiary spending.

Even the bill’s backers say securing passage this year is a long shot. But the effort is one more opportunity for Democrats to highlight voters’ frustration about healthcare costs leading into the November election.

Polls show Americans are very concerned about affordability, with a recent Gallup survey finding fewer than half of Americans say they can consistently afford healthcare.

Wyden’s bill would focus on what many consider a critical pocketbook issue in traditional Medicare: There’s no limit on what a beneficiary could pay in cost sharing.

“Everyone else in the health insurance neighborhood has one — employer coverage, the Affordable Care Act, all of them have a cap,” the Oregon Democrat told KFF Health News. “There’s no good, common-sense reason why the flagship health program doesn’t have the same protection.”

Critics of a cap, meanwhile, are likely to pounce on the cost to the federal budget, which could be significant.

Wyden, already making the battle lines clear, added, “I suspect it will come up on the floor of the Senate that Democrats want to give a fair shake to people on traditional Medicare and Republicans want to help billionaires.”

Policy, Political Dynamics at Work

The underlying issue is the 20% share of Medicare costs that enrollees have to pay for medical services after they’ve met any deductibles. Without a ceiling or upper limit, an expensive condition such as cancer or a long hospital stay could result in beneficiaries paying thousands of dollars in costs.

That concern leads about 43% of people enrolled in traditional Medicare to purchase separate insurance, often called Medigap. (Others get such coverage through job-based retiree plans.)

Medigap insurance plans have seen rapid premium increases and can cost thousands of dollars a year, especially for couples. That price tag can be unaffordable for some beneficiaries, who may instead turn to private-sector Medicare Advantage plans offered by commercial insurers, or go without.

The Wyden proposal would set a $5,000 cap in traditional Medicare. Any amounts paid by a Medigap plan or a retiree health plan toward beneficiaries’ care would count toward that cap. It also includes other provisions to help older people with lower incomes, including eliminating an asset test to qualify for special programs that help reduce costs.

Medicare would pick up any amounts over that $5,000 limit, which is lower than the one Congress set for the rival Advantage plans — currently $9,250, although insurers can set smaller amounts.

Setting a cap in the traditional program, proponents argue, would help level the playing field between traditional Medicare and Advantage plans, which often cost consumers far less than traditional Medicare with a Medigap supplement. Premiums for these policies would probably be lower, they say, because the insurers’ financial exposure would be limited.

The Medicare Advantage program has historically had strong support from Republicans, who like its private-sector aspect and note that it can potentially do more to control costs, such as by using specific networks of doctors and hospitals, or requiring preapproval for some services, which the traditional program cannot do.

The plans also offer enrollees additional benefits, such as eyeglasses, hearing aids, and prescription drug coverage, and have now attracted more than half of all Medicare enrollees.

Along with that growth, however, has also come increased scrutiny over concerns about denials of patient services and the challenges some consumers face if they want to switch back to the traditional program. Recently, some health systems have dropped out of Medicare Advantage contracts, citing concerns about tardy payments or prior authorization requirements, while insurers are also scaling back where they offer Advantage coverage.

The bill has not yet been analyzed by the Congressional Budget Office, so there is no official estimate of increased costs to taxpayers for Medicare. Still, it would raise those costs — at a time when other health programs are being cut, the Medicare trust fund is scheduled to start falling short of funding in 2033, and the nation’s debt is growing.

That is likely to draw sharp rebukes from fiscal hawks and other conservatives who question whether billions in tax dollars should be used to pick up costs that would otherwise be paid by enrollees or by the supplemental insurance plans many purchase to do so. They are likely to note that beneficiaries could also choose to join private sector Advantage plans, which eliminate the need for supplementary insurance coverage such as Medigap.

Key Questions: Who Benefits? Who Pays?

A cap’s cost to taxpayers, while not officially scored yet, is likely to be significant, although adding one could also save individual consumers money. A recent study from Brown University gives some clues.

A $5,000 cap could save enrollees an average of about $1,200 a year, the study says, both in direct savings and reductions in their Medigap supplemental premiums. Just over 11% of traditional Medicare beneficiaries, about 3.2 million, would directly benefit from such a cap if it was implemented in 2028, said the study, which did not receive outside funding.

Over the next 10 years, it estimates, just over 52% of all traditional beneficiaries would exceed the $5,000 cap at least once.

Still, lead author Andrew Ryan, a professor at Brown’s School of Public Health, said analysts estimated such a cap “could cost over $50 billion annually, which is a lot of money” to add to the federal balance sheet.

Critics are likely to focus on the cap’s expense and the number of people who might benefit.

“How many people are hitting a level of cost they can’t afford on Medicare? “asked Jackson Hammond, a senior policy analyst with the Paragon Health Institute, a conservative think tank influential with the GOP.

Any cap “is generally going to increase expenses for the program without adding a lot of benefits to enrollees,” said Hammond, who spoke with KFF Health News before the legislation was introduced.

Supporters, though, have a different view.

Certainly, with “any policy that’s going to cost money, there will be an argument over where the money is coming from,” said Brian Keyser, a research associate at the liberal Center for American Progress who also spoke with KFF Health News before the Wyden measure was introduced.

Keyser co-authored a Medicare paper that suggested lawmakers could pay for changes in traditional Medicare, such as an out-of-pocket cap, if they reduced the amount the government pays Medicare Advantage insurers, pointing to government estimates that Advantage would cost the government $76 billion more this year than if the same number of people were in the traditional program.

Finding a way to add a cap “is right and fair because without it, people who become seriously ill can spend their life savings on cost-sharing Medicare,” Keyser said.

Such an idea, however, has been in discussion on and off for years. Knowing that, the bill’s backers acknowledge that passage is unlikely — but they say they’re playing the long game for now.

“We’re going to push for it in the next Congress, when we believe we will be in the majority,” Wyden said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This <a target="_blank" href="https://kffhealthnews.org/medicare/medicare-costs-out-of-pocket-cap-democrats-senate-wyden-midterms/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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HHS announced the successful conclusion of the federal public health response to the Hantavirus exposure event associated with the M/V Hondius cruise ship.

One afternoon in late 2024, a sixth-grader nicknamed Bug came home from school with an announcement to make. Bug, who was assigned female at birth, told his parents he was a boy — and would be using he/him pronouns.

“OK, cool,” his mother, J, remembered saying. (J asked to be identified by only her first initial, and Bug by his nickname, because the family fears harassment.)

“‘What do you need to be supported?’” she recalled asking next. “He asked to get healthcare.” 

This was the kind of moment J had been anticipating since the family had moved earlier that year from Texas to Massachusetts, for its more liberal and inclusive politics. She felt confident they could find the right medical experts. But she hadn’t realized that access to gender-affirming treatment could disappear even when their state’s laws and leaders supported it.

Individual hospitals all over the U.S., in red and blue states, have responded to President Donald Trump’s attacks on transgender healthcare by deciding to withdraw care on their own. At least 20 hospitals did so in the first months of the Trump administration as it threatened to pull back federal funding or initiate fraud or wrongful-claim investigations, and such services have continued to drop off since.

Bug and his younger sister were born in Austin, Texas, but J and her husband became worried after the state outlawed abortion; dismantled diversity, equity, and inclusion programs; and limited medical and civil rights for queer and transgender people. The parents worried the support services they needed for the siblings, both of whom have autism, might be affected, too.

“I had a fear of being like the frog in the boiling water and not realizing what was happening until it was too late,” J said. “I needed to get the kids out of Texas.”

So when Bug came out as trans, J was relieved they’d landed in a state that not only has a “shield” law to protect providers who offer gender-affirming care but also is among 24 states requiring commercial insurance, which Bug’s family has, to cover it.

After Bug’s gender announcement, J’s queries led her to the largest hospital system in the region, Springfield, Massachusetts-based Baystate Health, where they began the months-long process of getting set up to start hormone therapy.

Bug, an artistic 14-year-old who loves horses, cats, and making short films with friends, was too old for puberty blockers, but he was excited about the prospect of starting on testosterone. That would cause his voice to deepen, facial hair to grow, and muscles to get bigger.

“Every part of it sounds fun,” he said.

J (right) and her son, Bug, at their home in western Massachusetts. Bug, who came out as a trans boy in 2024, had turned to Baystate Health for treatment until the health system stopped providing gender-affirming medications to youths. (Karen Brown/New England Public Media)

But this past February, two weeks before Bug was scheduled to start testosterone, Baystate announced it would no longer provide gender-affirming medications to minors, offering only counseling. A letter to patients’ families did not explain why.

Baystate spokesperson Heather Duggan sent a statement that said the decision to end treatment for minors reflected the fact that Baystate could lose “hundreds of millions of dollars in government reimbursement” as a result of the Trump administration’s plans. “Nearly 70 percent of Baystate Health’s patients rely on Medicaid and Medicare for coverage,” it said.

All Bug knew was that the care he’d eagerly awaited was about to vanish.

“I felt frustrated that they would do that,” Bug said.

“I bet there’s tons and tons of kids who are like: ‘OK, I’m going for trans-affirming healthcare. Yay!’” he said. “And then, like, tons and tons of kids were disappointed and sad and frustrated.”

J said it felt as if the floor had fallen out from under them. “Maybe this is naive, but I didn’t think that would happen in Massachusetts,” she said.

Baystate is among the providers still choosing not to offer puberty blockers and hormones as the issue wends its way through the courts. This spring, in a lawsuit that Massachusetts joined, a federal judge concluded that it was unlawful for the Department of Health and Human Services to threaten federal funding for providers that offered gender-affirming care to minors. In June, another federal judge cleared 16 states, including Massachusetts, to move forward with another lawsuit against the administration over its push to criminalize gender-affirming care.

Baystate Medical Center in Springfield, Massachusetts. The Baystate Health system stopped providing gender-affirming medications to youths in February, after the Trump administration said it would pull Medicaid and Medicare funding from hospitals providing them. (Karen Brown/New England Public Media)

The American Academy of Pediatrics declined an interview request but said in a past statement that young patients and their families should make decisions about gender-affirming care with their doctors, “delivered with compassion, and offered without political interference.”

One mother of a former Baystate patient said that before her child came out as a transgender girl, she had been severely depressed, battling suicidal thoughts. (The mother asked that only her first initial, L, be used, because the family also fears harassment.)

After Baystate doctors prescribed puberty blockers and estrogen, her daughter’s mood and grades rose markedly, L said. So when she received the letter announcing Baystate was ending the medical treatment, she was furious. L said she and other parents filed civil rights complaints with the Massachusetts attorney general.

The attorney general’s office did not respond to a request for comment.

“There’s a sense of, ‘How could you?’” L said. “And there’s also the awareness of the impact just pulling care could have on a youth — from a physical health perspective but also from a mental health perspective.”

L and J both found alternatives for their children. L asked the family’s primary care doctor to take over hormone prescriptions. Bug’s family was referred to Transhealth, a private specialty clinic in Northampton, Massachusetts, that said it has taken on about 50 of Baystate’s former patients.

“Transhealth has been staffing ourselves up for a while now in anticipation of the fact that this may be happening across the state,” CEO Jo Erwin said.

Erwin said Transhealth can weather the funding threats because the clinic gets large private donations and is not as dependent on Medicaid and Medicare as most hospitals. But Erwin said that doesn’t entirely reassure the broader LGBTQ+ community, including transgender adults.

“When you see something like that go down, people get scared that it’s ultimately going to happen to everyone,” Erwin said.

In May, Colorado’s Supreme Court ordered a children’s hospital in that state to resume medical treatments for transgender youths, while in Texas a court settlement compelled a children’s hospital there to do the opposite — start the nation’s first “detransition clinic.” The Trump administration has continued to pressure providers, including by seeking the medical records of transgender minors.

After Bug’s false start at Baystate, he was able to start taking testosterone at the new clinic in the spring.

His mother, J, said that the treatment is going smoothly and that Bug has learned how to give himself the injections. But J is nervous that the federal government will find other ways to stop his treatment again. She sometimes second-guesses the family’s move from Texas to Massachusetts, wondering whether they should have gone to Canada instead.

This article is from a partnership that includes New England Public Media, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This <a target="_blank" href="https://kffhealthnews.org/health-industry/gender-affirming-care-trump-hospitals-transgender-massachusetts/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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Bill Curry, 65, raises cattle on the same land in rural Oklahoma once owned by his father and generations before him. Each quarter, for several years, he has made the 2½-hour drive to Oklahoma City for an epidural in his spine to treat his back pain.

But this year, because of a new Medicare program, Curry has traveled a little more often.

In February, during one trip, he was told unexpectedly that he needed preapproval for the procedure. Then he went again a month or so later to get the injection, for a total of 10 hours on the road. His clinic wanted him to come in a third time, which they had never asked of him before. That appointment was “just to fill out a piece of paper to tell them how you feel again,” Curry said, so he hasn’t gone.

In January, Oklahoma became one of six states to begin a pilot program testing the use of preapprovals in traditional Medicare, the federal health insurance program for people 65 and older or with disabilities. Medicare had previously eschewed the practice — also known as prior authorization — which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions.

Epidurals like Curry’s are among 13 medical services subject to the new program because the Trump administration says they’re prone to fraud or misuse. Powered by artificial intelligence, the program — called the Wasteful and Inappropriate Service Reduction Model, or WISeR — is intended to save the federal government money and protect patients from potentially unsafe or unneeded care.

Yet early reviews from Oklahoma and the other pilot states — Arizona, New Jersey, Ohio, Texas, and Washington — suggest WISeR’s rollout has not been smooth. Patients, doctors, and other healthcare professionals who spoke with KFF Health News say the effort has created confusion, errors, long wait times, and stress. Some described the rollout as “horrendous” and say people enrolled in Medicare in the pilot states are now getting ensnared in the same red tape as those with private insurance.

One key concern is that it all happened too hastily. WISeR was announced in June 2025 and launched in mid-January.

That was “quicker than normal” for the federal government, said Todd Baker, who recently stepped down as CEO of the Ohio State Medical Association. Doctors “just sort of had to figure it out,” added Jeb Shepard, director of policy at the Washington State Medical Association.

Government contractors have also acknowledged the rapid pace. “We’ve had an aggressive rollout from the time of being notified to going live,” said Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma. Tech executives servicing other states have said they were still adding features to their products in the spring.

Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which is administering the program, didn’t comment on the rollout schedule. But he said in a statement that the goal of these reforms is to ensure that prior authorization is efficient, fast, and streamlined.

“The model aims to reduce inappropriate care without delaying appropriate care,” he said.

Mehmet Oz, the leader of the Centers for Medicare & Medicaid Services, told NewsNation in December that they were “rolling out some prior authorization on abused practices.”

“The purpose of these is not to deny care,” Oz continued. “It’s to make sure you get the care you need and deserve, not the care some unscrupulous doctor wants to use on you.”

Medicare has struggled in recent years with suspected fraud associated with particular services. The Department of Health and Human Services’ inspector general warned in September that the program’s spending on skin substitutes, for example, had surged nearly 700% over two years, raising “major concerns about fraud, waste, and abuse.” Skin substitutes are among the 13 therapies currently subject to review under WISeR.

The program also imposes prior authorization requirements for kyphoplasty, a surgery for spinal fractures, which a report by the Medicare Payment Advisory Commission flagged as overused.

Sutton acknowledged, however, that “the percentage of providers committing waste, fraud, and abuse is small.”

Consumers and clinicians largely detest prior authorization. Even as federal health officials test the process for Medicare, the Trump administration is trying to scale it back for those with private insurance. According to a KFF poll conducted in January, 69% of insured adults consider prior authorization a burden for care.

Through WISeR, doctors and their staff log in to online portals to submit medical records that justify the procedures. Using artificial intelligence, the systems quickly approve applications that meet the program’s criteria, Friese, Humata’s chief executive, told KFF Health News. He said there is an “immediate yes” in 88% of cases for which clinical data supports an approval.

CMS has touted the process as one in which decisions are returned within 72 hours. After that, clinicians receive a “universal tracking number,” which allows them to schedule the procedure and get paid. In practice, however, participants say the process is anything but easy.

The University of Washington’s medical system alone had nearly 100 patients waiting earlier this year for epidural injections due to WISeR-related delays, according to an April report from the office of U.S. Sen. Maria Cantwell (D-Wash.) that drew on hospital association data. “Now, patients are subject to delays or denials which did not exist prior to the WISeR Model,” the report said.

Curry, the Oklahoma cattle farmer, said he might go to Kansas for future treatments to avoid the approval process. Dorota Gribbin, a New Jersey-based physical medicine and rehabilitation physician, said that by the time authorization came for one of her patients who needed a back pain procedure, the patient had gone to the hospital for more expensive care.

Jennifer Valle, a precertification and insurance supervisor at Clinical Radiology of Oklahoma, said when it comes to kyphoplasties, there has been a lot of “nitpicking” from reviewers. Other times, information her practice provides to CMS gets overlooked, she said, and reviewers ask for imaging that’s already in the file.

Claims with no problems are supposed to be paid within 15 days, said James Webb, a musculoskeletal radiologist in Tulsa, Oklahoma, who has also been frustrated by the prior approval and reimbursement process for kyphoplasties. “Six- to eight-week delays is what we’ve been seeing,” he said.

“It’s been horrendous,” said Jerry Sobel, a Phoenix-area pain management doctor. “Right from the beginning, there seemed to be no organization.” Sobel said that as of May, he hadn’t gotten paid by Medicare for nine epidurals.

“We continuously monitor operations and work closely with stakeholders to address questions and improve the provider experience,” said Sundar Subramanian, the CEO of Zyter, which has the contract for Arizona.

During an April webinar, another Zyter executive acknowledged a large backlog in payments stretching to January. Those backlogs “are currently being resolved,” Medicare’s Sutton said, without providing further detail.

When asked about other issues — including what doctors suspect are AI-driven errors — Medicare’s Sutton said the agency appreciates “feedback on provider experience.” It will be used “to help providers better understand WISeR processes,” he said.

Although CMS vendors say humans make the final decisions on approvals, doctors and their staffs believe artificial intelligence is playing a large role in the process and that denials are sometimes the result of AI hallucinations that garble or make up information.

One Arizona doctor, who wasn’t authorized by his practice to speak, recalled a denial saying his patient wasn’t eligible for procedures in the thoracic region, or mid-back. The patient needed an injection to the neck. Webb, the Oklahoma radiologist, documented four times that a patient lacked numbness, and yet his WISeR application was still denied, citing numbness, which, in the reviewer’s interpretation, would rule out the spinal surgery procedure.

Friese, Humata’s CEO, said he hasn’t heard about any AI hallucinations.

The process is also raising government costs. With more rejections, more appeals are being filed with Medicare’s administrative contractors. The government pays the contractors to handle the appeals, and Medicare’s Sutton acknowledged that the agency has “accounted for potential changes in the volume of Medicare appeals because of the WISeR program and its associated costs.”

Eighty-four percent of commercial insurers already use AI tools, according to a survey released in 2025 by the National Association of Insurance Commissioners, though they have consistently said AI isn’t used to deny prior authorization requests.

Its use in Medicare risks introducing friction and frustration into the program — and piling costs onto its beneficiaries. Prior authorization saves money for insurers partly by making patients pay a price in wait times and inconvenience, said Miranda Yaver, a University of Pittsburgh health policy researcher studying the technique.

“People will end up getting ensnared in a lot of red tape, having to be on hold, and getting rerouted,” she said. She often wonders whether prior authorization simply shifts costs to patients and doctors, rather than saving them.

Some doctors involved in Medicare’s prior authorization experiment believe it will inevitably expand beyond a few services officials in Washington consider fraud-prone.

“Everybody knows that if this pilot project works, it will be prior auth for basically all procedures,” said Mary Clarke, a family practice physician in Stillwater, Oklahoma. “If they can show that they can save money, then that’s going to be extrapolated and rolled out to other procedures and multiple other things in other states.”

When asked whether CMS is considering expansion of its prior authorization pilot, Sutton said in his statement that there are “currently no changes” considered for the list of services subject to the WISeR program, “but CMS continues to assess whether any changes are warranted.”

Do you have an experience with prior authorization you’d like to share? Click here to tell KFF Health News your story.

KFF Health News Southern correspondent Lauren Sausser contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This <a target="_blank" href="https://kffhealthnews.org/medicare/medicare-ai-prior-authorization-wiser-delays-errors/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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HHS announced a coordinated department-wide effort to strengthen America’s leadership in clinical research.

Tired of watching its employers struggle to afford the cost of healthcare, Republican-controlled Indiana is trying a traditionally liberal tactic to control costs: setting government price controls on hospitals.

Under a law enacted last year, five of Indiana’s largest nonprofit hospital systems cannot charge patients covered by job-based health plans more than an established price cap. Hospitals that fail to keep prices below the threshold by 2029 risk losing their tax-exempt status — which would mean owing millions of dollars in state taxes.

Even before that penalty kicks in, the law requires these hospitals, which control nearly half the state’s hospital market, to offer direct-to-employer contracts — bypassing insurers — and stay within limits set by the state. Hospitals that don’t comply face a $10,000-a-day penalty.

Many other Indiana hospitals must comply with this provision beginning in September.

Indiana’s law comes amid growing frustration with rising insurance costs and hospital prices, the biggest driver of growing healthcare costs.

Government price controls, of course, are nothing new in healthcare. Since the mid-1960s, the federal government has set prices it pays hospitals for treating Medicare enrollees, as states do for Medicaid patients. Those two government programs cover more than 135 million people nationwide.

But hospitals face no such government limit on what they charge for the more than 165 million Americans covered by employer-paid insurance.

Indiana isn’t the only state targeting hospital prices. Vermont also limits how much hospitals can charge for people covered by employer plans.

Washington and Oregon have made similar attempts, on a smaller scale, targeting state employee health plans. Oregon’s hospitals cannot charge the state employee plan more than two times the Medicare rate for services. This caps the state payment for a service at $200 if Medicare pays $100. Within the first two years, the plan saved more than $100 million.

Legislation has been proposed in Colorado and New York to enact similar price controls.

Hospital leaders and other opponents of price controls argue that the strategy doesn’t address the root causes of high hospital prices, such as rising labor, drug, and technology costs, and that the caps will force hospitals to cut services. Another challenge is that few employers contract directly with hospitals.

On most policy issues, Indiana and Vermont likely agree on very little, “except for this is one area where they both see that hospital prices are high,” said Brown University economist Christopher Whaley.

Wielding state power to control prices is a strategy typically led by Democrats. But Mike Braun, the Republican governor who helped muscle through the changes over the objections of the Indiana hospital industry, said the healthcare system is too broken to leave alone.

“Government has to intervene, because healthcare is run like an unregulated utility,” he told KFF Health News.

The five Indiana nonprofit hospital systems involved are Ascension St. Vincent, Community Health Network, Franciscan Health, Indiana University Health, and Parkview Health.

The price cap will be based on the statewide average for inpatient and outpatient hospital prices. Indiana will use Medicare as a yardstick by which to measure commercial prices, a comparison commonly used by researchers. This will show how much higher commercial prices are than the government program’s.

By June 30, the state is expected to issue a report showing average hospital prices in the state and where individual hospitals fall on the spectrum.

For years, studies by research group Rand Corp. have found that Indiana hospital prices are some of the highest in the nation.

The latest state report measuring hospital prices, produced in November, found three of the five nonprofit hospital systems exceeded a voluntary benchmark when excluding practitioner services, such as doctor fees.

However, all five hospital systems were below the voluntary benchmark when doctor services were wrapped into the overall score. This finding illustrates how prices for doctor visits may obscure overall hospital prices by bringing down the average, researchers and lobbyists for employers told KFF Health News.

Rand researchers found that while Indiana is home to some of the highest-paid hospitals, its doctors are among the lowest paid in the nation. That’s partly because the doctors don’t have the same negotiating leverage as the handful of large health systems.

This disparity has sparked a debate over which prices should be used to calculate the upcoming cap. Including doctor services would likely allow hospitals to keep prices high because they would be offset by low doctor prices, said Whaley, who has co-authored Rand’s pricing reports. This would let hospitals off the hook from doing the work to “move the needle” on lowering prices, he said.

Indiana Hospital Association President Scott Tittle said it’s unfair to exclude doctor services.

Hospitals often acquire physician practices to help drive admissions, research has found. But Tittle said it also helps keep doctor offices open and preserves access for residents. That comes at a cost, he said.

“We know it is absolutely part of the complete cost of care,” Tittle said.

Despite the hospital lobby’s efforts, Tittle said, the state will exclude doctor services from the cap.

Regardless, Tittle said it’s unnecessary to put price caps in state law. “Hospitals can and have done the hard work to reduce their pricing,” he said.

For employers, rising healthcare costs are a headache. They’re unpredictable and make it difficult to budget each year.

Doug Bawel, chairman of Jasper Holdings, an automotive parts company based in Jasper, Indiana, has tried various strategies to wrestle high healthcare costs. For his workers, he’s purchased diabetes drugs from New Zealand and housed on-site health clinics.

Under the law enacted last year, Indiana hospitals must offer direct contracts to employers for a variety of procedures priced at or below 260% of what Medicare pays for hospital care. That’s setting a ceiling at slightly more than 2.5 times what Medicare pays.

Bawel expects the state’s price controls on direct deals to significantly strengthen his negotiating leverage with hospitals. He belongs to a consortium of southern Indiana employers that buy services directly from area hospitals.

This move represents a departure from the status quo for the business lobby. Ashton Eller, a healthcare lobbyist for the Indiana Manufacturers Association, said the group generally opposes government price controls. But it believes this is a step in the right direction, he said.

“Is this a silver bullet that will bring down prices overnight? We don’t pretend it is,” he said.

No matter what happens in the Hoosier State, Indiana’s experiment with price controls has attracted attention.

“As employers and states are dealing with double-digit premium increases, there is tremendous interest in healthcare affordability, and what happens in Indiana is being closely watched by many states and Washington, D.C.,” Whaley said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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