Live From AHCJ: Shock and Awe in Federal Health Policy

Summary

KFF Health News' "What the Health?" Podcast Episode Summary

Title: Live From AHCJ: Shock and Awe in Federal Health Policy
Release Date: June 2, 2025
Host: Julie Rovner, Chief Washington Correspondent for KFF Health News

Introduction

In this special episode of KFF Health News' "What the Health?", host Julie Rovner moderates a panel titled "Shock and Awe in Federal Health Policy" at the annual meeting of the Association of Health Care Journalists in Los Angeles. The panel features three distinguished experts:

Rachel Newsom: Senior Vice President for Policy at the Commonwealth Fund
Berenice Nunez Constant: Senior Vice President of Government Relations and External Affairs at AltaMed Health Services
Aneesh Mahajian: Chief Deputy Director of the LA County Public Health Department

The discussion centers on the dramatic shifts in federal health policy observed in early 2025, the implications of the proposed budget reconciliation bill, and the potential fallout for healthcare services and public health.

Unprecedented Federal Health Policy Changes

Julie Rovner sets the stage by reflecting on her 40-year career covering health policy in Washington, D.C.:

"What we've witnessed in terms of sweeping policy change these last four months is like nothing that I have ever seen or experienced before." [00:00]

Rovner highlights the unprecedented rate of executive orders and litigation that have created significant uncertainty around longstanding health programs.

Panelist Insights

1. Rachel Newsom on Comprehensive Policy Implications

Rachel Newsom provides an evidence-based perspective from the Commonwealth Fund:

"We saw executive orders kind of at an unprecedented level. Those were then followed by litigation, putting a lot of uncertainty around some of the policies that have been proposed." [02:24]

Key Points:

Significant HHS reorganization and a 20% reduction in federal staff managing critical programs.
The impending $880 billion Medicaid cut proposed in the House budget reconciliation bill, potentially resulting in up to 13.7 million people losing coverage.
Expected job losses and economic impacts on state and local economies.
The bill's complexity, spanning 1,000 pages with rapid development, leaving limited time for thorough analysis ([15:26]).

2. Berenice Nunez Constant on AltaMed Health Services' Challenges

Berenice Nunez Constant discusses the impact on AltaMed, the nation's largest federally qualified health center serving 700,000 patients in LA and Orange counties:

"We've done so much work to make sure that folks feel that they can come in and access their programs." [07:59]

Key Points:

Initial challenges with FQHCs not being able to draw down federal payments were mitigated through emergency drawdowns.
Concerns about grant cancellations, particularly a CDC grant affecting HIV prevention ([08:43]).
The potential dismantling of advanced healthcare delivery systems developed over decades.

3. Aneesh Mahajian on LA County Public Health Department's Struggles

Aneesh Mahajian outlines the severe repercussions for public health in LA County:

"Public health work is nonpartisan, but it's also not well understood by the public." [08:47]

Key Points:

Immediate rescission of key public health grants, including HIV prevention and Emergency Preparedness Grants, risking outbreaks like measles ([13:12]).
Elimination of funds critical for outbreak response, epidemiological studies, and laboratory capacity ([13:25]).
Potential shutdown of essential services such as HIV prevention programs, genomic sequencing, and environmental health monitoring.

Impact of the Proposed Budget Reconciliation Bill

The panel delves into the specifics of the proposed budget bill and its far-reaching consequences:

Medicaid Cuts and Healthcare Delivery System

Rachel Newsom details the staggering $880 billion Medicaid cut:

"It's an $880 billion cut to Medicaid because we just saw some recent polling that showed that 40% of voters, if they know about the bill, they don't know that there's Medicaid cuts in there." [15:26]

Implications:

Closure of safety net hospitals and reduction of services in rural areas.
Loss of coverage for dual eligibles, mental health services, and long-term care.
Ripple effects on Medicare beneficiaries and the broader healthcare infrastructure ([24:38]).

Public Health Emergencies and Preventative Care

Aneesh Mahajian emphasizes the risks to emergency preparedness and preventative measures:

"It's a national grant that supports the emergency preparedness of communities around the country to be ready for things like emerging infectious diseases..." [17:58]

Concerns:

Elimination of the Public Health Emergency Preparedness Grant, jeopardizing responses to infectious diseases and natural disasters.
Threats to vaccination programs, leading to potential outbreaks of diseases like measles and influenza ([27:00]).

Reproductive Health Under Threat

The discussion shifts to reproductive health, highlighting Medicaid's pivotal role:

"Medicaid is the number one payer for live births, for births in this country." [31:57]

Key Points:

Potential cuts to contraceptive coverage and cervical cancer screenings.
Risks to Title X family planning services and the accessibility of abortion services in federated health centers ([33:04]).
The rollback of essential health benefits, previously protected under the Affordable Care Act ([34:13]).

Audience Questions and Expert Responses

Q1: Medicaid Cuts – Terminology and Potential Improvements

Christine Herman from Illinois Public Media questions whether "cuts" accurately describe the proposed "reduction in the rate of growth" of Medicaid expenses.

Rachel Newsom responds:

"It's hard to argue with the Congressional Budget Office that shows the reduction in federal spending... it's fair to say that on the federal side, we are talking about a pretty massive reduction in resources towards the program." [35:40]

Q2: War on Expertise and Research Funding

Concerns are raised about the impact of reduced research funding and the perceived rejection of expertise.

Aneesh Mahajian comments:

"There doesn't seem to be an appreciation widely about the importance of that expertise." [48:07]

Q3: Public Awareness of Medicaid Implications

Drew Hawkins from the Gulf States Newsroom asks why many Medicaid beneficiaries seem unaware of impending cuts.

Rachel Newsom explains:

"Medicaid can be called something different in every state... making it easier to ensure people know their specific program details." [53:16]

Q4: Reallocating Medicaid Dollars

Cassie McGrath from Morning Brew inquires about proposals to reallocate Medicaid funds to other departments like Education.

Rachel Newsom responds:

"Pulling pieces of programs apart and spreading them out doesn't usually provide a more coordinated kind of thoughtful response." [44:37]

Optimism Amidst Challenges

Despite the grim outlook, panelists express cautious optimism driven by advocacy and increasing awareness:

Rachel Newsom:

"Every day there's more understanding and appreciation of what's in the bill, what's at stake." [56:21]

Berenice Nunez Constant:

"The advocacy work that we are doing together is working. Folks are asking the questions." [57:04]

Aneesh Mahajian:

"I'm encouraged by advocacy for sure. And I'm also encouraged by the actions that are being taken in court to ensure that we follow a process." [58:11]

Conclusion

Julie Rovner wraps up the episode by acknowledging the heavy topics discussed and the pivotal role of journalism in informing the public:

"We want to ask one more question... reproductive health hasn't gotten the headlines that it did before, but that doesn't mean it's not still being affected in a big way." [31:29]

Listeners are encouraged to engage with the ongoing discourse to safeguard essential health programs and services.

Notable Quotes with Timestamps

Julie Rovner: "What we've witnessed in terms of sweeping policy change these last four months is like nothing that I have ever seen or experienced before." [00:00]
Rachel Newsom: "It's an $880 billion cut to Medicaid because we just saw some recent polling that showed that 40% of voters, if they know about the bill, they don't know that there's Medicaid cuts in there." [15:26]
Berenice Nunez Constant: "We've done so much work to make sure that folks feel that they can come in and access their programs." [07:59]
Aneesh Mahajian: "Public health work is nonpartisan, but it's also not well understood by the public." [08:47]
Rachel Newsom: "Medicaid can be called something different in every state... making it easier to ensure people know their specific program details." [53:16]

Stay Informed

For more insights and updates on federal health policy changes, listen to the full episode of "What the Health?" and follow KFF Health News for continuous coverage.

Summary

KFF Health News' "What the Health?" Podcast Episode Summary

Title: Live From AHCJ: Shock and Awe in Federal Health Policy
Release Date: June 2, 2025
Host: Julie Rovner, Chief Washington Correspondent for KFF Health News

Introduction

Rachel Newsom: Senior Vice President for Policy at the Commonwealth Fund
Berenice Nunez Constant: Senior Vice President of Government Relations and External Affairs at AltaMed Health Services
Aneesh Mahajian: Chief Deputy Director of the LA County Public Health Department

Unprecedented Federal Health Policy Changes

Julie Rovner sets the stage by reflecting on her 40-year career covering health policy in Washington, D.C.:

"What we've witnessed in terms of sweeping policy change these last four months is like nothing that I have ever seen or experienced before." [00:00]

Rovner highlights the unprecedented rate of executive orders and litigation that have created significant uncertainty around longstanding health programs.

Panelist Insights

1. Rachel Newsom on Comprehensive Policy Implications

Rachel Newsom provides an evidence-based perspective from the Commonwealth Fund:

"We saw executive orders kind of at an unprecedented level. Those were then followed by litigation, putting a lot of uncertainty around some of the policies that have been proposed." [02:24]

Key Points:

Significant HHS reorganization and a 20% reduction in federal staff managing critical programs.
The impending $880 billion Medicaid cut proposed in the House budget reconciliation bill, potentially resulting in up to 13.7 million people losing coverage.
Expected job losses and economic impacts on state and local economies.
The bill's complexity, spanning 1,000 pages with rapid development, leaving limited time for thorough analysis ([15:26]).

2. Berenice Nunez Constant on AltaMed Health Services' Challenges

Berenice Nunez Constant discusses the impact on AltaMed, the nation's largest federally qualified health center serving 700,000 patients in LA and Orange counties:

"We've done so much work to make sure that folks feel that they can come in and access their programs." [07:59]

Key Points:

Initial challenges with FQHCs not being able to draw down federal payments were mitigated through emergency drawdowns.
Concerns about grant cancellations, particularly a CDC grant affecting HIV prevention ([08:43]).
The potential dismantling of advanced healthcare delivery systems developed over decades.

3. Aneesh Mahajian on LA County Public Health Department's Struggles

Aneesh Mahajian outlines the severe repercussions for public health in LA County:

"Public health work is nonpartisan, but it's also not well understood by the public." [08:47]

Key Points:

Immediate rescission of key public health grants, including HIV prevention and Emergency Preparedness Grants, risking outbreaks like measles ([13:12]).
Elimination of funds critical for outbreak response, epidemiological studies, and laboratory capacity ([13:25]).
Potential shutdown of essential services such as HIV prevention programs, genomic sequencing, and environmental health monitoring.

Impact of the Proposed Budget Reconciliation Bill

The panel delves into the specifics of the proposed budget bill and its far-reaching consequences:

Medicaid Cuts and Healthcare Delivery System

Rachel Newsom details the staggering $880 billion Medicaid cut:

"It's an $880 billion cut to Medicaid because we just saw some recent polling that showed that 40% of voters, if they know about the bill, they don't know that there's Medicaid cuts in there." [15:26]

Implications:

Closure of safety net hospitals and reduction of services in rural areas.
Loss of coverage for dual eligibles, mental health services, and long-term care.
Ripple effects on Medicare beneficiaries and the broader healthcare infrastructure ([24:38]).

Public Health Emergencies and Preventative Care

Aneesh Mahajian emphasizes the risks to emergency preparedness and preventative measures:

"It's a national grant that supports the emergency preparedness of communities around the country to be ready for things like emerging infectious diseases..." [17:58]

Concerns:

Elimination of the Public Health Emergency Preparedness Grant, jeopardizing responses to infectious diseases and natural disasters.
Threats to vaccination programs, leading to potential outbreaks of diseases like measles and influenza ([27:00]).

Reproductive Health Under Threat

The discussion shifts to reproductive health, highlighting Medicaid's pivotal role:

"Medicaid is the number one payer for live births, for births in this country." [31:57]

Key Points:

Potential cuts to contraceptive coverage and cervical cancer screenings.
Risks to Title X family planning services and the accessibility of abortion services in federated health centers ([33:04]).
The rollback of essential health benefits, previously protected under the Affordable Care Act ([34:13]).

Audience Questions and Expert Responses

Q1: Medicaid Cuts – Terminology and Potential Improvements

Christine Herman from Illinois Public Media questions whether "cuts" accurately describe the proposed "reduction in the rate of growth" of Medicaid expenses.

Rachel Newsom responds:

"It's hard to argue with the Congressional Budget Office that shows the reduction in federal spending... it's fair to say that on the federal side, we are talking about a pretty massive reduction in resources towards the program." [35:40]

Q2: War on Expertise and Research Funding

Concerns are raised about the impact of reduced research funding and the perceived rejection of expertise.

Aneesh Mahajian comments:

"There doesn't seem to be an appreciation widely about the importance of that expertise." [48:07]

Q3: Public Awareness of Medicaid Implications

Drew Hawkins from the Gulf States Newsroom asks why many Medicaid beneficiaries seem unaware of impending cuts.

Rachel Newsom explains:

"Medicaid can be called something different in every state... making it easier to ensure people know their specific program details." [53:16]

Q4: Reallocating Medicaid Dollars

Cassie McGrath from Morning Brew inquires about proposals to reallocate Medicaid funds to other departments like Education.

Rachel Newsom responds:

"Pulling pieces of programs apart and spreading them out doesn't usually provide a more coordinated kind of thoughtful response." [44:37]

Optimism Amidst Challenges

Despite the grim outlook, panelists express cautious optimism driven by advocacy and increasing awareness:

Rachel Newsom:

"Every day there's more understanding and appreciation of what's in the bill, what's at stake." [56:21]

Berenice Nunez Constant:

"The advocacy work that we are doing together is working. Folks are asking the questions." [57:04]

Aneesh Mahajian:

"I'm encouraged by advocacy for sure. And I'm also encouraged by the actions that are being taken in court to ensure that we follow a process." [58:11]

Conclusion

Julie Rovner wraps up the episode by acknowledging the heavy topics discussed and the pivotal role of journalism in informing the public:

"We want to ask one more question... reproductive health hasn't gotten the headlines that it did before, but that doesn't mean it's not still being affected in a big way." [31:29]

Listeners are encouraged to engage with the ongoing discourse to safeguard essential health programs and services.

Notable Quotes with Timestamps

Julie Rovner: "What we've witnessed in terms of sweeping policy change these last four months is like nothing that I have ever seen or experienced before." [00:00]
Rachel Newsom: "It's an $880 billion cut to Medicaid because we just saw some recent polling that showed that 40% of voters, if they know about the bill, they don't know that there's Medicaid cuts in there." [15:26]
Berenice Nunez Constant: "We've done so much work to make sure that folks feel that they can come in and access their programs." [07:59]
Aneesh Mahajian: "Public health work is nonpartisan, but it's also not well understood by the public." [08:47]
Rachel Newsom: "Medicaid can be called something different in every state... making it easier to ensure people know their specific program details." [53:16]

Stay Informed

For more insights and updates on federal health policy changes, listen to the full episode of "What the Health?" and follow KFF Health News for continuous coverage.

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