Information has been popping out of Washington, D.C., because the begin of the second Donald Trump administration like water out of a fireplace hose. It might probably really feel unimaginable to remain on prime of all of the modifications.
So on this episode of “An Arm and a Leg,” host Dan Weissmann speaks with KFF Well being Information chief Washington correspondent Julie Rovner to attempt to get a deal with on what’s occurred to this point. Rovner has been overlaying well being care in Washington for almost 40 years and hosts the weekly well being coverage podcast “What the Well being?”They discuss what the top of a little-known federal well being regulatory company may imply for the well being care advantages of hundreds of thousands of People, with some assist from KFF Well being Information senior correspondent Arthur Allen. Then, Rovner talks about efforts to chop Medicaid and why it is probably not really easy to take aside.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought of, Market, the BBC, 99 % Invisible, and Reveal, from the Heart for Investigative Reporting.
Credit
Emily Pisacreta, Claire Davenport
Producers
Adam Raymonda
Audio wizard
Ellen Weiss
Editor
Click on to open the Transcript
Transcript: A Well being Coverage Veteran Places 2025 in Perspective
Notice: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a instrument however test the corresponding audio earlier than quoting the podcast.
Dan: Hey there–
2025 has been a LOT to this point, particularly because the second Trump Administration received began. We hear about plenty of sudden strikes, plenty of cuts, perhaps some reversals — in well being care (and in all places else). With larger strikes perhaps nonetheless to come back.
What’s ACTUALLY occurred to this point? I can’t sustain.
However I do know some individuals who may. Our friends at KFF Well being Information have a complete NEWSROOM — dozens and dozens of individuals — publishing tales day by day.
And one particular person particularly there may be as plugged-in as could be.
Julie Rovner has been overlaying well being care in Washington, DC for longer than anyone. Near 4 a long time.
Once we first begin speaking, Julie gestures behind her. On a bookshelf in her workplace are copies of Congressional Quarterly, the place she began reporting within the Eighties.
Julie Rovner: I imply. Actually each time anyone in Congress sneezed on healthcare, I wrote a narrative. That was my job. For eight years. It was form of the start of my profession, however I’ve form of thought of it ever since.
Dan: Over the a long time, she’s watched large modifications occur incrementally, one sneeze at a time.
Julie coated well being look after NPR for greater than 15 years, and since 2017, she’s hosted KFF’s podcast What the Well being.
Each week, she convenes a roundtable of prime health-care reporters for a complete inside-the-beltway nerd-fest.
And it seems: Even Julie Rovner has a tough time sustaining an up-to-date scorecard.
Julie Rovner: I’m making an attempt to maintain a operating record of what’s been minimize and what’s been restored, and it’s just about unimaginable ’trigger there’s 20 issues day by day. I imply, mainly the best way I do my information podcast now could be I spend 4 days per week making an inventory, after which on the fifth day, I minimize it in half in regards to the issues we will discuss.
Dan: Oh my gosh.
Julie Rovner: And on the day of the podcast, I often minimize it in half once more. Dan: So, the scorecard retains altering too quick. However Julie does see a giant image.
And since she is aware of all the main points– 4 a long time of them– she might help us see it by telling us two tales:
One a few teeny a part of the well being care system that almost all of us have by no means heard about. Which is now one of many too-many-to-keep-track-of workplaces that the Trump Administration has taken a chainsaw to.
Then we’ll take a look at one thing everyone’s heard about — and many individuals are nervous about: Medicaid. And Julie’s gonna present us why it is probably not really easy to take aside.
That is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will perhaps do about it. I’m Dan Weissmann– I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of the vital enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
Our first story — this little company — teeny, by authorities requirements — Julie truly watched it get constructed, early in her profession. And it seems to be a fantastic instance for this present to have a look at.
I imply, right here’s how Julie begins telling its origin story:
Julie Rovner: Within the late Eighties, there was sort of an settlement between Republicans and Democrats that healthcare prices had been going up actually quick and we didn’t know why. And one of many causes is that we didn’t truly know what labored.
Dan: That’s, everyone needed to know: Why does well being care value so freaking a lot, and what can we perhaps do about it?
They usually thought: Perhaps anyone ought to perform some research about what’s truly value paying for. Between Medicare, Medicaid, and well being advantages for presidency staff and veterans, the federal authorities does plenty of the paying.
Julie Rovner: There was consensus that the federal authorities is spending all of this cash on healthcare, they need to spend a minimum of a little bit little bit of it, making an attempt to determine what works. And there needs to be some sort of, you already know, referee, like a authorities company.
Dan: And naturally that company would want a reputation..
Julie Rovner: It was initially gonna be the Company for Healthcare Analysis and Coverage, however anyone discovered on the final minute that that may make its acronym AH-CRAP and so they determined that was a nasty thought.
Dan: So that they reversed the final two bits and known as it the Company for Healthcare Coverage and Analysis.
Julie Rovner: My favourite piece of well being coverage trivia.
Dan: What are you able to inform me in regards to the numerous sneezes and hiccups and coughs alongside the best way?
Julie Rovner: Oh, properly there was fairly a combat in creating “ah-crap.”
Dan: Although the thought had backers amongst each Democrats and Republicans, they needed to cope with constituencies — curiosity teams — with turf to guard.
Julie Rovner: There have been medical organizations and insurance coverage corporations and they didn’t need the federal government dictating how drugs could be practiced. So it was not, you already know, it was not a completed deal. It took plenty of negotiating.
Dan: And in 1989, the primary 12 months of George H.W. Bush’s presidency, neither political get together may muscle something by means of.
Julie Rovner: Democrats are accountable for Congress. Republicans are accountable for the White Home. Therefore, something that’s gonna occur is gonna be bipartisan. Except they’re gonna attempt to override a veto. And trace trace, there have been a few makes an attempt to override George HW Bush vetoes, and
all of them failed by a few votes, totally on abortion stuff. And there was an NIH invoice as a result of I keep in mind obscure issues like this.
Dan: I imply, you see why Julie is THE particular person to offer us this story, proper?
So the company will get created in 1989. and one among its jobs is creating follow pointers. Official federal suggestions about remedies: Which of them labored, which of them don’t.
Julie Rovner: It places out an terrible lot of pointers and shock, a few of them had been actually controversial.
Dan: Some eye medical doctors didn’t like a tenet on cataracts. The Pharma business hated A tenet that really helpful lowering the usage of brand-new medication.
Julie Rovner: Then mid nineties they arrive out with one on again ache, on acute again ache. And one of many issues this guideline discovered at taking a look at. The entire proof is that. Again surgical procedure doesn’t truly work very properly for acute again ache. Um, for sure, the nation’s backbone surgeons weren’t thrilled.
Dan: That guideline got here out in 1994. That November, Republicans scored large majorities in each homes of Congress.
NEWS ANCHOR 1: We start tonight with probably the most easy response we’ve heard all day to the outcomes of yesterday’s election. The Democratic chairman David Wilhelm stated merely,“We received our butts kicked.”
NEWS ANCHOR 2: Republicans known as their guarantees a contract.
GOP MEMBER: Right this moment, we Republicans are signing a contract with America.
Dan: A contract that required, amongst different issues, large price range cuts. And this little company ended up on their hit record.
Julie Rovner: they had been representing their backbone surgeon constituents, and so they had been prepared to only eliminate the entire thing. they tried to only wipe it out within the appropriation invoice and so they got here very shut, however didn’t fairly
Dan: They did minimize funding — together with the cash for creating pointers. They usually didn’t overlook. In 1999, Congress handed laws that formally kicked the company out of the rules enterprise altogether
And gave it a brand new title: The Company for Healthcare Analysis and High quality. AHRQ (arc), for brief.
Julie Rovner: Congress loves to offer well being companies new names – even once they’re the identical company– as a result of they wish to form of rid it of its baggage from the previous. So we’ve renamed it, gotten it out of the rules enterprise, however it’s nonetheless the primary Federal company that appears on the high quality of healthcare and the way healthcare works.
Dan: For instance, Julie says AHRQ runs the Healthcare Price and Utilization Challenge. HUP for brief, after all.Which retains observe of some necessary numbers:
Julie Rovner: How many individuals had been within the hospital for a way lengthy? What number of of them had been youngsters? How many individuals received ambulatory surgical procedure? What number of hospital readmissions had been there? That is that database
Dan: And sustaining that database is a part of AHRQs job.
Julie Rovner: So it’s very small. Nevertheless it’s the one company that mainly does what it does, which is to say we spend a fifth of our economic system on healthcare. We must always attempt to determine how properly it really works. [
Dan: Or relatively it was, till now. In March, officers from the Trump Administration’s Division of Authorities Effectivity — DOGE for brief — held their first assembly with AHRQ’s leaders.
Arthur Allen: it was a gathering in particular person at, at their workplace the place this was completed
Dan: Julie’s KFF Well being Information colleague Arthur Allen talked with a kind of ARQ staffers.
Arthur Allen: It was simply informed, we don’t know what you do. We’re gonna minimize you 80, 90%.
Dan: Arthur says he came upon about the entire thing by following up on a tip in a LinkedIn submit. He says pitching the story wasn’t the simplest promote, even at KFF.
Arthur: All people was making jokes about it, They had been like, yeah, good luck making an attention-grabbing story out of this. You understand, good luck explaining what AHRQ does or making it into one thing anyone would wish to learn.
Dan: He did, and so they printed it. And it led to a brand new tip: As Arthur reported, ARQ was getting merged with one other workplace within the division of Well being and Human Providers– the Assistant Secretary for Planning and Analysis.
Sources from that workplace noticed his ARQ story and informed him: Their workplace was getting minimize dramatically too.
Based on his sources, between the 2 companies, nearly three quarters of the individuals are gone.
Together with: everyone who was concerned in calculating the federal poverty line.
Because the headline for Arthur’s story says: eighty million folks qualify for advantages based mostly on that quantity.
Arthur Allen: It’s utilized by, you already know, actually hundreds of companies, non-public, public, state, native, federal, to determine whether or not folks qualify for advantages: meals stamps, Medicaid, subsidies for childcare– you already know, just about something you may consider the place there’s help to decrease revenue folks.
Dan: One of many fired staff informed Arthur, quote: “There’s actually nobody within the authorities who is aware of find out how to calculate the rules. And since we’re all locked out of our computer systems, we will’t educate anybody find out how to calculate them.”
Arthur Allen: The man had been doing it for like 20 years. He was simply thrown out the door and e mail eliminated. No technique to attain him.
Dan: He informed Arthur that utilizing a special methodology would produce completely different outcomes. If the brand new calculation didn’t absolutely account for inflation, for one instance, some folks may find yourself shedding advantages. And there are plenty of different examples.
Arthur Allen: Over years, you already know, you’re making an attempt to develop the easiest way to do that. Any sort of quantity like this, which you’re making an attempt to hone down and make it as correct as doable, you develop this form of fingerspitzengefühl…
Dan: What’s fingerspitzengefühl?
Arthur Allen: Effectively, it’s a German phrase which means like, feeling on the finish of your fingers, the place it’s like, it, it’s an undefinable potential to do one thing like
Dan: Like decide a lock?
Arthur Allen: Yeah. Yeah. Like Proper. Precisely.
Dan: An HHS spokesperson informed Arthur the division would proceed to adjust to statutory necessities and keep vital applications. After the article was printed, one other spokesperson known as KFF to say “the concept this can come to a halt is completely incorrect. Eighty million folks won’t be affected.”
Arthur Allen: They had been like, there are different folks at HHS who can do this and, you already know, it’s, it’s true. It’s simply, you might have made it a lot simpler. And likewise they haven’t been probably the most dependable all the time by way of, you already know, saying one thing after which following by means of on it. So, you already know, there’s motive to be skeptical.
Dan: Effectively, it’s, it’s a reporter’s credo, proper? In case your mother says she loves you, get one other supply.
Arthur Allen: Yeah.
Dan: So now we’ve truly checked out a COUPLE of small examples. And there are such a lot of extra. Julie Rovner sees them as a part of the larger image..
Julie Rovner: How I’ve been fascinated by that is that our healthcare system is a huge Jenga tower and it’s a little bit wobbly and what holds it up is every little thing that occurs from the Division of Well being and Human Providers, it’s all the foundations of the street. It’s all of the enforcement, it’s all of the protections. In lots of circumstances, it’s truly the funding. It’s what funds plenty of applications for folks with low incomes, the coaching of, not simply medical doctors, however future researchers. They usually’re yanking out sticks from this Jenga tower as quick as they presumably can, and when the entire thing comes down, it’s gonna be very, not fairly.
Dan: She sees all these blocks getting pulled from the Jenga tower. She is aware of why they’re there. And what may occur as they get yanked away.
Julie Rovner: I really feel loads like I did throughout the early elements of the pandemic. It’s simply that feeling of, oh my God, what recent hell is subsequent? And can we ever be capable of repair it? I’m, and I’m actually nervous about that. And you already know, a minimum of throughout the pandemic, I felt like everyone felt that method.
Dan: With cuts and modifications we’ve seen to this point, the administration has acted by itself– and courts could or could not cease or reverse a few of them.
However then there’s one of many large issues numerous folks fear about: large cuts to Medicaid, which insures one thing like 79 million folks.Cuts on the dimensions we’re listening to about would requires Congress to behave. To go laws.
Which Julie Rovner thinksCongress will discover very exhausting to do.
Julie Rovner: Not a lot as a result of it’s exhausting to chop Medicaid, which it’s, however as a result of it’s gonna be actually exhausting for this Congress with these little tiny Republican majorities to agree on something.
Dan: Julie, after all, has some very particular causes these explicit cuts can be so troublesome for these explicit Republican majorities. That’s subsequent.
This episode of An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nonprofit newsroom overlaying well being points in America. Their journalists — like Julie Rovner and Arthur Allen — do wonderful work. We’re honored to be colleagues.
So simply to recap, right here’s why cuts to Medicaid loom so massive.
NEWS ANCHOR 3: Republicans need to slash $2 trillion with a T in long-term spending. And Medicaid may very well be a goal
Dan: Congressional Republicans have handed a price range framework— mainly, an overview — with large cuts unfold throughout ten years.
They’ve assigned committees to seek out particular cuts, and so they’ve given greater than 800 billion {dollars} in cuts to a committee that doesn’t have plenty of different choices
NEWS ANCHOR 4: A brand new evaluation from the Congressional price range workplace reveals the proposed price range would require MASSIVE cuts to Medicaid spending.
NEWS ANCHOR 5: It’s mathematically unimaginable for Republicans to fulfill their very own goal with out reducing Medicaid.
Dan: And Julie says, cuts on this scale may harm lots of people.
Julie: I’ve seen estimates that 20 million folks may lose their Medicaid protection,…it’s perhaps 1 / 4 of the folks on Medicaid.
Dan: Julie says Republicans wish to keep away from saying they’ll make these sorts of cuts. So…
Julie Rovner: You understand, now Republicans are saying we’re not gonna minimize Medicaid, places the air quotes.
Dan: What they’re saying they WILL do, that’s gonna require some unpacking. Right here’s the official line, as Julie places it
Julie Rovner: We’re simply gonna cut back the additional cash that Medicaid pays states for the Medicaid growth, beneath the Reasonably priced Care Act.
Dan: OK. More money for states. Medicaid Growth. Reasonably priced Care Act.
Let’s break that down. The Reasonably priced Care Act is greatest identified for “Obamacare” marketplaces, the place folks should buy medical insurance even when they’ve pre-existing situations.
However one other large factor it did was to broaden Medicaid: It raised revenue cut-off so extra folks may qualify.
Now, the best way Medicaid is designed, states share the fee with the federal authorities. However beneath the ACA, the feds ship extra cash to states, to pay for many of that growth. Like 90 p.c of it.
That’s the context for this line that Congress wouldn’t minimize Medicaid, simply the “additional” cash to states for the growth.
Julie Rovner: And we see plenty of Republicans saying, oh, if states wanna proceed it. They’ll simply pay their common share. Effectively, that common share is $626 billion over the subsequent 10 years that states would cumulatively must give you. Um, states, in contrast to the federal authorities, just about must stability their budgets yearly. They don’t have 626 billion additional {dollars} hanging round to try this.
Dan: Julie thinks plenty of states would find yourself reducing Medicaid. Some would do it routinely, with legal guidelines which are already on the books.
Julie Rovner: We have now 12 states that say if Congress reduces that threshold from 90%, we instantly cancel our Medicaid growth. They’re known as set off legal guidelines and there’s 12 states with set off legal guidelines.
Dan: However some states — not solely do they not have set off legal guidelines. They’ve a giant downside.
Julie Rovner: Three states, three very pink states, Missouri, Oklahoma, and South Dakota. Expanded Medicaid, not simply by poll measure, however by amending their state constitutions.
Dan: Yeah, this was sort of attention-grabbing: All of the states that originally rejected the Medicaid growth had been led by Republican politicians.
It looks like a giant motive they opposed it was as a result of, properly, it was a part of the ACA– ya know, “OBAMA-care”? Their legislators would by no means vote for it.
However increasing Medicaid is fashionable with lots of people. The legislatures in these states didn’t vote for the growth, the folks did — they voted for poll initiatives that really added Medicaid growth into their state constitutions..
Julie Rovner: These three states, that change their constitutions, don’t have set off legal guidelines as a result of they’ve modified their structure. That perhaps helps clarify why Senator Hawley from Missouri, who is just not often known as a giant defender of Medicaid, uh, has stated he’s not gonna vote for Medicaid cuts as a result of his is likely one of the states that may very well be left holding a really massive and costly bag in the event that they’ve rolled again this extra federal match. In order that’s only one instance. You understand, when he first stated it, it’s like, why is Josh Hawley abruptly so gung-ho for Medicaid? Um, that helps clarify why.
Dan: That could be very attention-grabbing. So that is an instance of why it’s exhausting to chop Medicaid. Um,
Julie Rovner: Very, sure.
Dan: And Julie says, there are different causes too.
Julie Rovner: I imply, in the event you return to 2017, when the Republicans attempt to repeal and exchange the Reasonably priced Care Act for the primary time, Medicaid turned out to be a major motive why they couldn’t, as a result of abruptly folks found that Medicaid isn’t just for, you already know, mothers and youngsters on welfare, medicaid pays. The overwhelming majority of the nation’s nursing dwelling payments, so everyone’s grandparents who had been in nursing houses had been most likely getting Medicaid. All of the sudden we found how many individuals had been getting Medicaid and other people found how many individuals had been getting Medicaid, and so they got here to Congress.
NEWS ANCHOR 6: On Capitol Hill the place there have been protests and lots of arrests immediately
Crowd: Kill the invoice.
Information reporter: Senate Republicans immediately obtained a bruising. Welcome again to Capitol Hill…
Crowd: Kill the invoice. Well being care is a human proper.
Julie Rovner:I used to be there and so they stated, we don’t need you to do that, you already know, it, it was very shut, however in the long run, I believe Medicaid was actually a serious motive why Congress proved unable to repeal the ACA, if something, Medicaid is now extra entrenched and there are extra folks on it than there have been in 2017. Um, and Congress has even smaller majorities. You decide how exhausting it’s gonna be.
Dan: And as you’ve stated, three states with two Republican senators every. Julie Rovner: Every. That’s appropriate. So there’s six.
Dan: Republicans maintain 53 Senate seats. They might lose three votes and name in Vice President JD Vance to interrupt a tie. They want 50 votes.
Julie Rovner: So that they have 53 votes and 6 of these votes come from states. That will be left holding a really costly bag. And one other three or 4 senators who voted in opposition to it in 2017 are nonetheless there. So even counting to 50 is tough.
Dan: First, that’s one among Julie’s beloved Corgis within the background, amped up as a result of he hears a neighbor canine outdoors.
Wally: Woof!
Julie Rovner: Wally, are you barking at Churchy? I’ll allow you to go play with him later.
Second, after all we don’t know what Congress will truly do on this very-unusual 12 months.
However it doesn’t matter what, it’s enjoyable speaking about politics with Julie Rovner.
And even when it doesn’t look like a enjoyable time to be Julie Rovner, to be doing the job she does — ingesting from the firehose, as she says — I don’t suppose she’s going wherever.
Julie Rovner: Yeah, I imply, you already know, my mother was a journalist. My dad was a, a political staffer, mainly. He labored on the state, federal, and native stage in his profession and mainly, you already know, made coverage occur. And, , that’s my legacy and I actually care about it.
Dan: And, she is just not taking in completely EVERYTHING. As an example, she has not been watching “The Pitt.” The super-exciting– and super-stressful–new medical drama we talked about final time–the one which chronicles an especially-intense day in a busy city emergency room.
Julie Rovner: I began to look at it –and I watched each episode of ER. I imply, I’m a kind of folks. I’ve additionally seen each episode of Gray’s Anatomy which is insane. Um, however I began to look at the Pitt and I received about three quarters of the best way into the primary episode, and I believed, I can’t cope with this proper now. And I turned it off.
Dan: Yeah.
Julie Rovner: I simply– and I watched severance! I’m like,‘Why am I watching severance? I don’t want something creepy in my life proper now.’ Nevertheless it was excellent. It’s humorous, I may get by means of severance, however I couldn’t get by means of The Pitt.
Dan: So, even Julie Rovner has her limits. Which I believe is nice.
She is doing the factor I remind everybody to do on the finish of each episode of this present: Taking good care of herself.
When you have not subscribed to our First Support Package e-newsletter but, I believe this can be a nice time to test it out.
It’s the place we boil down among the sensible issues we’ve realized about caring for ourselves and one another:
My colleague Claire Davenport has been serving to her roommate combat again in opposition to greater than 14 thousand {dollars} in medical payments. They worn out ten thousand with some due diligence.
And I’m gathering recommendation for what may very well be a one-page useful resource: Some fast recommendation and hyperlinks that everyone ought to get earlier than the primary hospital invoice arrives.
You possibly can join– and skim every little thing we’ve completed to this point — at arm and a leg present dot com, slash first support package.
We’ll be again with a brand new episode in a number of weeks.
Till then, deal with your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann–, with assist from Emily Pisacreta, Claire Davenport, and Zach Dyer of KFF Well being Information –And edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Periods.
Bea Bosco is our consulting director of operations.
Lynne Johnson is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about well being points in America —
and a core program at KFF: an impartial supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present.
An Arm and a Leg is Distributed by KUOW– Seattle’s NPR station. And due to the Institute for Nonprofit Information for serving as our fiscal sponsor. They permit us to simply accept tax-exempt donations. You possibly can study extra about INN at INN.org.
Lastly, thanks to everyone who helps this present financially. You possibly can take part any time at arm and a leg present, dot com, slash: assist. Thanks! And thanks for listening.
“An Arm and a Leg” is a co-production of KFF Well being Information and Public Street Productions.
For extra from the group at “An Arm and a Leg,” subscribe to its weekly e-newsletter, First Support Package. You can even observe the present on Fb and the social platform X. And in the event you’ve received tales to inform in regards to the well being care system, the producers would like to hear from you.
To listen to all KFF Well being Information podcasts, click on right here.
And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you hearken to podcasts.
