GOP Senators Ruin Their Summer Vacay for Trump Spending Bill

Summary

Podcast Summary: "GOP Senators Ruin Their Summer Vacay for Trump Spending Bill" What A Day
Host: Jane Coaston
Release Date: July 1, 2025

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Introduction

In this episode of What A Day, host Jane Coaston delves into the tumultuous political landscape of summer 2025, highlighting key legislative battles, Supreme Court decisions, and international conflicts. The episode features an in-depth interview with Dr. Alex Dwarak, a prominent advocate for gender-affirming care, providing expert insights into the ongoing debates surrounding healthcare and LGBTQ+ rights.

Senator John Fetterman Opposes Republican Spending Bill

Jane opens the discussion by spotlighting Pennsylvania Democratic Senator John Fetterman’s staunch opposition to the Republican spending bill. Fetterman expressed his frustration, stating, "I've already missed our entire trip to the beach... I'm going to vote no" (00:11), emphasizing his disapproval of the bill's provisions that aim to reduce Medicaid funding and offer tax breaks to billionaires.

Supreme Court Ruling on Gender-Affirming Care

The episode transitions to a significant Supreme Court decision in United States v. Scormetti, which upheld Tennessee's ban on gender-affirming care for minors. The court ruled that the ban does not violate the 14th Amendment's equal protection clause, as it doesn’t discriminate based on sex or gender identity. Jane references data from KFF, noting that 27 states have similar bans, though some are limited to surgical procedures.

Expert Insight: Interview with Dr. Alex Dwarak

A substantial portion of the episode features an interview with Dr. Alex Dwarak, Associate Medical Director of Family Medicine at OneWorld Community Health Centers in Omaha, Nebraska. Dr. Dwarak discusses the implications of the gender-affirming care ban and its impact on patients:

• Defining Gender-Affirming Care: "It's a way of helping people feel more comfortable in their bodies, have better mental health, be more authentically themselves" (02:27).

• Challenges of Practicing in Nebraska: Despite restricted legislation, Dr. Dwarak continues to provide care, highlighting the difficulties posed by mandates such as the required 40 hours of therapy and the need for parental consent. "Nebraska also requires a waiting period and requires that all hormone injections be administered in the physician's office for safety, unless the kid isn't queer..." (04:02).

• Impact on Patients: Dr. Dwarak shares heart-wrenching accounts of families relocating to more accepting states and the emotional toll on healthcare providers dedicated to serving marginalized communities. "People who have no medical training are going to ignore the people they're talking about, the expert clinicians." (05:07).

• Response to Republican Arguments: Addressing claims that gender-affirming care leads to regret, Dr. Dwarak counters with data showing low regret rates and emphasizes the broader societal harm caused by denying such care. "Regret rates are extremely low... This is actively denying." (07:19).

• Message of Hope: He encourages those feeling isolated in red states to find solidarity and highlights the growing number of medical professionals advocating for inclusive care. "You are not alone... I think a hopeful sign is that I have had so, so so many young medical students..." (09:26).

The Republican Spending Bill and Political Maneuvering

Jane details the ongoing negotiations among GOP senators to pass the controversial spending bill before Independence Day. White House Press Secretary Caroline Levitt emphasizes the administration's push: "Republicans need to stay tough and unified during the home stretch..." (12:37). However, internal Republican conflicts persist over Medicaid cuts and other provisions, raising concerns about the bill's impact on healthcare access.

Israel-Palestine Conflict Update

The episode also covers the tense interactions between Israeli and Palestinian representatives at a United Nations hearing:

• Palestinian Deputy Observer Majed Banmiya: "Your systematic killing of Palestinian civilians can never be justified. We are not lesser human beings." (15:07).

• Israeli Ambassador Danny Danone: "If you claim that you represent the Palestinian people, be responsible, be brave and agree with me today that the future of Gaza will not include Hamas." (14:54).

The ongoing violence has resulted in significant casualties, with at least 60 lives lost in Gaza due to Israeli attacks.

President Trump’s Inauguration of "Alligator Alcatraz" Detention Center

A controversial segment covers President Donald Trump's participation in opening a new migrant detention facility in Florida, mockingly dubbed "Alligator Alcatraz." Governor Ron DeSantis praises the location's suitability, while critics, including Dr. Dwarak, condemn the facility's inhumane design and long-term implications:

• Governor DeSantis: "Housing migrants in the middle of America's largest remaining subtropical wilderness is a great idea." (16:35).

• Dr. Alex Dwarak: "What’ll happen is you bring people in there, they ain't going anywhere once they're there..." (16:44).

The facility is intended to process and deport up to 5,000 migrants, with DHS facing criticism for escalating detentions without criminal histories.

Accusations Against Harvard University

The Trump administration has escalated its confrontation with Harvard University, accusing it of violating the Civil Rights Act in its treatment of Jewish and Israeli students. The administration demands unspecified changes, threatening to cut federal funding and revoke tax-exempt status. Harvard has publicly disagreed with these claims, emphasizing its commitment to combating antisemitism.

Conclusion

Jane wraps up the episode by urging listeners to engage in the political process, especially concerning the impending Republican spending bill, which threatens to reduce healthcare and food assistance programs while benefiting the wealthy. She emphasizes the importance of informing loved ones and participating in advocacy efforts.

What A Day continues to provide comprehensive analysis and expert perspectives on the pressing issues shaping today's society, ensuring listeners are well-informed and empowered to take action.

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Notable Quotes:

• Senator John Fetterman: "I've already missed our entire trip to the beach... I'm going to vote no." (00:11)

• Dr. Alex Dwarak: "Gender affirming care is a way of helping people feel more comfortable in their bodies, have better mental health, be more authentically themselves." (02:27)

• Governor Ron DeSantis: "Housing migrants in the middle of America's largest remaining subtropical wilderness is a great idea." (16:35)

• Dr. Alex Dwarak: "You are not alone... I have hundreds of medical colleagues who share my view." (09:26)

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Subscribe to What A Day on your favorite podcast platform and stay informed with Jane Coaston’s insightful coverage of the issues that matter most.

Transcript

[Dr. Alex Dwarak]

Foreign.

[Jane Coston]

July 1st. I'm Jane Coston, and this is what a day. The show that says I get it. Pennsylvania Democratic Senator John Fetterman. I get it.

[Dr. Alex Dwarak]

Oh my God, I just want to go home. I've already my I've missed our entire trip to the beach. My family's going to be back before we so and again, I'm going to vote no.

[Jane Coston]

There's no he goes on to say that he, like every Senate Democrat, is opposed to the Republican spending bill that would gut Medicaid and give tax breaks to billionaires. I don't know if there's another Senate Democrat who sounds as absolutely over it as Fetterman. And as someone who has been over it since Inauguration Day, I get it. On today's show, President Donald Trump heads to Florida for the grand opening of the so called Alligator Alcatraz Migrant Detention Center. And the Trump administration is now accusing Harvard University of violating the Civil Rights Act. But let's start by talking about gender affirming care. Namely, what it actually looks like. The Supreme Court ruled last month in United States v. Scormetti that the state of Tennessee could bar gender affirming care for minors. The ruling itself centered on whether or not such a ban would violate the 14th Amendment's equal protection clause. The court found that because the Tennessee law didn't discriminate on the basis of sex or gender identity, it doesn't. According to the nonpartisan health care policy outlet KFF, 27 states have bans on gender affirming care for minors, though in at least two of those states, Arizona and New Hampshire, those bans only apply to surgical care. Both Arkansas and Montana have had their bans on gender affirming care for minors enjoined by the courts, and challenges to bans from other states are still ongoing. But I wanted to back up a second and ask what does gender affirming care do, and what do the providers working on the ground think of the efforts to ban access to it? I got the chance to speak to one such provider before last week's Supreme Court decision, a doctor who works in a state that has recently restricted gender affirming care for anyone under the age of 19. Dr. Alex Dwarak is the Associate Medical Director of family medicine at OneWorld Community Health Centers. He specializes in LGBTQ medicine and is an advocate for access to gender affirming care for youth in Nebraska. Alex, welcome to Water Day.

[Dr. Alex Dwarak]

Thank you for having me.

[Jane Coston]

What is gender affirming care?

[Dr. Alex Dwarak]

Gender affirming care is something that's thoughtfully done and it's not just done for trans people. It's a way of helping people feel more comfortable in their bodies, have better mental health, be more authentically themselves. And it really has informed the practice of all of my patient care. Having learned to take care of trans people over the last several years, how.

[Jane Coston]

Long have you worked with trans patients to provide this kind of care and what made you decide to get into this line of work?

[Dr. Alex Dwarak]

So I didn't get any exposure to this in medical school or residency. The first patient who I worked with was around 2010, I believe, so shortly after I got done with my residency training. And she was a black trans woman who had HIV and high blood pressure. And those of us who study medicine know that it's not an accident that all those things went together in her literal body. Part of it was being told by one of my mentors that this patient needs her HIV treated or blood pressure managed. I'm like, okay, got that. And refill her hormones while you're at it. And so when I asked her, don't I have to send her to endocrine for that? She gave me this very British look of disappointment that I had seen more than once from her, handed me the guidelines and said, read this and go take care of her. Trusting me to be open minded and welcoming, I went to get additional training starting in 2015. And I've since gotten over 100 hours of CME specific to trans care, as well as helping to teach others. So I've made a very focused effort to get good at this.

[Jane Coston]

Nebraska's ban restricted some of the care that you help provide. How are you negotiating treating your patients?

[Dr. Alex Dwarak]

Well, I am still able to treat them, which is a significant reason why I'm still here in Nebraska for the first time. I thought about leaving Nebraska when the ban was being debated. And it's something that restricts care and has a mandate for 40 hours of therapy. I already was asking for a letter of support from a qualified mental health professional and was never just treating anybody without full informed consent. I have had families where one parent is supportive and the other parent is not. And I can't treat those kids. And I don't. I mean, I talk to them, I talk to the parents, I answer questions, I allay fears. I also say that's a logical fear when they're worried about how their kids might have to move through the world. Nebraska also requires a waiting period and requires that all hormone injections be administered in the physician's office for safety, unless the kid isn't queer and that it's fine to give them at home, or unless the kid is being given much more dangerous hormone, which is insulin. You cannot kill somebody with estrogen or testosterone. Insulin can and does kill people if it's drawn up wrong or something else happens. So I see those contradictions, and I see that only the queer kids are targeted, and that just says it all for me.

[Jane Coston]

And speaking of the kids you work with, how are your patients feeling? Have any of your patients left the state since the ban went into effect?

[Dr. Alex Dwarak]

Yes, several adults left the state even though the ban was aimed at children. One family moved to a sanctuary state along with their other kids. Even before the raft of legislation that started in other states, families had bolt plans. They're thinking about where they're going to go. You know, how would we get there and what would our lives look like? Many adults leave because of politics, and they tell me that specifically. They say we don't feel safe and we don't feel welcome here. I dedicated my life to the care of the underserved. I put my mental health and my physical health on the line and my life on the line during COVID when I knew people were dying and the state relied on my expertise and my professionalism and my sacrifices and what I asked of my family because I didn't want to kill one of my patients by getting sick. I asked my family to isolate hard, too, and they did. To do all that and then to be told, well, your expertise and your sacrifices don't really count for anything. And people who have no medical training are going to ignore the people they're talking about, the expert clinicians. It really made me reconsider Nebraska as my home. I've decided to stay and fight for my patients who can't leave and won't leave. But it still hurts to be treated that way by the state that I have dedicated my life to.

[Jane Coston]

Nebraska Governor Jim Pillin celebrated the ban when it was enacted last year, saying that we need to protect children from, quote, potentially irreversible and regrettable decisions, decisions for which they may not completely understand the consequences. Now, this is a very common argument we hear from Republicans against gender affirming care. It's an argument that drives me personally, absolutely crazy. This entire argument assumes that being trans is bad and that you don't want to be trans and no one should let you be trans, and that if you are trans, it's going to be a mistake that you regret. But I am just an angry person with a podcast. You are an actual healthcare professional. So what's your response to that repeated claim that we keep hearing from Republicans?

[Dr. Alex Dwarak]

Well, I'm an angry health professional who doesn't have a podcast, but it makes me extremely frustrated. Regret rates are extremely low and they're much higher for some other types of procedures, like many other knee surgery. Yes, knee surgery is a big one and lots of other cosmetic procedures and things that we are not restricting. I think it's implied that there's a lot of big business in this, and for me, that's absolutely not the case. I'm a primary care doctor. I work taking care of the underserved, a lot of uninsured people. If I'm making money off of this, somebody tell me where the checks are going. When this is attacked, my autonomy as a physician and again, all the hard work and study I put in is also attacked. Parents have their freedom taken away. The youth and the adults who are saying, this is who I am and this is what I need to be healthy, they're being ignored. The consensus of the literature is being ignored. The level of scientific understanding that I hear from politicians who, as a general rule, don't practice medicine, I think there may be a few physicians in Congress, I don't usually hear them talking as much about this. That perspective of, well, you might regret this. It doesn't talk about the harm. Doing nothing isn't neutral. This is actively denying. And one of the points that jumps out for me with that is The Trevor Project's 2024 report, where having accepting schools and families is a big factor in suicide prevention, even more than access to medical care. And so when your society is rejecting you that way, it's going to make more people hurt themselves, which, as a doctor, that's the opposite of what I'm here to do.

[Jane Coston]

I'm from a red state, the state of Ohio, which keeps getting redder. You are working in a red state, and there are tons and tons of LGBTQ people in red states. President Trump has signed a ton of anti LGBTQ policies since taking office. What is your message to other people in red states or people around the country in general who feel hopeless in this moment, where the only response is just move to somewhere else, but somewhere else might not be better?

[Dr. Alex Dwarak]

No, I think that my response is, you are not alone. There are many, many other people who are here standing up alongside you and with you, and I'm one of them. I have hundreds of medical colleagues who share my view that I just personally know that people should be allowed to access this care. And I think a hopeful sign is that I have had so, so so many young medical students, resident physicians, PA students, NP students, early career physicians who want to learn more about this care, who want to be welcoming, who want to make sure that they're doing this care properly and add it to their skill set.

[Jane Coston]

Alex, thank you so much for being here.

[Dr. Alex Dwarak]

Thank you.

[Jane Coston]

That was my conversation with Dr. Alex Dwarak, Associate Medical Director of Family Medicine at One World Community Health Centers in Omaha, Nebraska. We'll get to more of the news in a moment, but if you like the show, make sure to subscribe. Leave a five star review on Apple Podcasts, watch us on YouTube and share with your friends. Subscribe more to come after some ads What a day is Brought to you by Aura Frames. I have like 60 to 70,000 photos on my phone and most of my friends haven't gotten to see any of them. That's why I'm starting to finally put them to good use with a unique, stylish digital picture frame from Oriframes. It was named the 1 digital picture frame by Wirecutter and for good reason. It's so easy to set up and they have different frame options. Yes, I have thousands of photos, but the best part is that an Aura Frame comes with unlimited storage for my thousands of photos. All you need is the free Aura app and a wifi connection and you can upload as many photos and videos as you want year round. You can save on the perfect gift that keeps on giving by visiting auraframes.com for a limited time. Listeners can get $20 off their best selling Carver mat frame with code Aura20. That's auraframes.com promo code Aura20. Support the show by mentioning us at checkout. Terms and conditions apply.

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[Jane Coston]

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[Jane Coston]

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[Caroline Levitt]

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[Jane Coston]

Here's what else we're following today.

[Caroline Levitt]

Head of Lines the White House and the President are adamant that this bill is passed and that this bill makes its way to his desk. Republicans need to stay tough and unified during the home stretch and we are counting on them to get the job done.

[Jane Coston]

That's White House Press Secretary Caroline Levitt, who is very normal and very calm, pushing Republicans to pass Trump's so called big beautiful bill. As of our recording Monday evening Pacific time, the seemingly endless marathon of voting on proposed amendments was ongoing. Republicans are racing to get the mega bill of tax breaks for billionaires and Medicaid cuts to Trump's desk before the fireworks start popping off on Independence Independence Day, which is now just three days away. Democratic Senate Minority Leader Chuck Schumer of New York had a message for his colleagues Monday.

[Chuck Schumer]

Senate Republicans have to decide choose the American people or bow down to Donald Trump and his coterie of billionaires.

[Jane Coston]

And Republican Senate Majority Leader John Thune of South Dakota put his own spin on the bill.

[Dr. Alex Dwarak]

What we are doing here is extending tax relief for the American people, keeping their rates low, making sure they don't have their child tax credit cut in half, their standard deduction cut in half, including new provisions that provide more relief for working Americans.

[Jane Coston]

Ah yes, I can hear working Americans across the country sighing with relief that their health care is now at risk. But there's still Republican infighting over issues like gutting Medicaid, clean energy and raising the debt limit by trillions of dollars.

[Dr. Alex Dwarak]

A different reality is possible for Palestine, for Israel and for the region. A reality of shared peace, security and prosperity. It starts with ending the genocide, releasing hostages and prisoners, delivering humanitarian aid and the full Israeli withdrawal from Gaza.

[Jane Coston]

Ambassadors from Israel and Palestine engaged in a tense back and forth during a United nations hearing on the ongoing conflicts in the Middle east on Monday. Deputy Permanent observer of Palestine to the UN Majed Banmiya repeatedly called for a ceasefire and accused Israel of violating UN resolutions. Israel's ambassador to the un, Danny Danone, responded to Bamya by asking him to disavow Hamas before any talks could move forward.

[Dr. Alex Dwarak]

So if you claim that you represent the Palestinian people, be responsible, be brave and agree with me today that the future of Gaza will not include Hamas.

[Jane Coston]

But then Bamia accused Danone of using Hamas as a pretext to avoid a ceasefire with Palestine.

[Dr. Alex Dwarak]

Your systematic killing of Palestinian civilians can never be justified. We are not lesser human beings.

[Jane Coston]

Meanwhile, Israeli attacks on Gaza killed at least 60 people.

[Caroline Levitt]

On Monday, President Trump will travel to the great state of Florida to attend the opening of a new illegal alien detention center located at Dade Collier Training in Transition Airport alongside Secretary Kristi Ngo, Governor Ron DeSantis, Congressman Byron Donalds, and other state and local leaders. We hope to see many of you there. The facility is in the heart of the Everglades and will be informally known as Alligator Alcatraz.

[Jane Coston]

That's right. Today, President Trump will personally attend the official opening of Alligator Alcatraz, a brand new institution as preposterously cartoonish as it is cruel. White House Press Secretary Levitt used some of the administration's favorite buzzwords during a press conference Monday.

[Caroline Levitt]

The facility will have up to 5,000 beds to house, process and deport criminal illegal aliens. This is an efficient and low cost way to help carry out the largest mass deportation campaign in American history.

[Jane Coston]

She sounds so excited, doesn't she? Florida Republican Governor Ron DeSantis also said he thinks housing migrants in the middle of America's largest remaining subtropical wilderness is a great idea.

[Dr. Alex Dwarak]

What'll happen is you bring people in there, they ain't going anywhere once they're there, unless you want them to go somewhere because good luck getting the civilization.

[Jane Coston]

Ew. The Trump administration seems to think this is hilarious. Over the weekend, the Department of Homeland Security posted to its Twitter account a photo of alligators wearing Immigration and Customs Enforcement hats with the caption, coming soon. You know, like a serious government agency. The visit comes as CBS News released its analysis of DHS data that found that detentions of immigrants without criminal history have increased significantly, reporting, quote, from the first week of May to the first week of June, new ICE detentions of people facing only civil immigration charges, such as entering the country without authorization, rose by over 250%. So to recap, Trump plans to hold migrants without criminal histories in a facility that was built like a week ago that is basically intended to be a forever prison guarded by alligators. Sure. The Trump administration accused Harvard University of being in, quote, violent violation of the Civil Rights act over its treatment of Jewish and Israeli students. The accusation came in a letter from the Joint Task Force to Combat Antisemitism Monday. Their note also included a threat to cut off all federal funding to the university unless changes are made. And no, they didn't say exactly what those changes are supposed to be. A Harvard spokesperson said the university takes antisemitism seriously and strongly disagrees with the task force findings. This is just the latest escalation in Trump's months long battle with the oldest, richest university in America. The administration has already pulled more than $2 billion in federal funding from Harvard, threatened to revoke its tax exempt status and attempted to stop international students from enrolling. And that's the before we go hey, Republicans in Congress are days away from passing their Big Beautiful Bill. As we've mentioned on the show, it'll cut health care for millions of people to give billionaires another tax break. Hate it. It's a good time to get on the phone with your reps offices. Get everything you need to get started at votesaveamerica.com, paid for by VoteSave America. You can learn more at votesaveamerica.com this ad has not been authorized by any candidate or candidates committee. That's all for today. If you like the show, make sure you subscribe. Leave a review. Seriously. Tell your friends, family, neighbors, lovers, haters and strangers on the street just how bad the Big Beautiful bill is. And tell your friends to listen. And if you're into reading, I'm not just about how despite the Republican spending bell wreaking havoc on health care and food assistance to the benefit of the wealthy, just 48% of Americans have heard anything about it. And just 8% know it would cut Medicaid by billions like me. What a Day is also a nightly newsletter. Check it out and [e-mail] subscribe I'm Jane Coston and folks, you are part of the 48% who know just how ugly this bill is. And if you live in a Republican district, you can make sure they know all about it. What a Day is a production of Crooked Media. It's recorded and mixed by Desmond Taylor. Our associate producer is Emily Foer. Our producer is Michelle Aloy. Our video editor is Joseph Dutra. Our video producer is Johanna Case. We had production help today from Greg Walters, Matt Berg, Sean Ali, Tyler Hill and Laura Newcombe. Our senior producer is Erica Morrison and our Senior Vice President of News and Politics is Adrienne Hill. Our theme music is by Colin Gilliard and Kashaka. Our production staff is proudly unionized with the Writers Guild of America East.

[Al Ledson]

One of the best parts for me about hosting Reveal. You know your favorite weekly investigative podcasts is the Interviews. I love to sit down with people and try to gain a perspective that gives me and our listeners a new way of seeing the world. Which is why we're launching More to the Story with me, Al Ledson. It's a place where I can talk to some of the most intriguing people to bring some context to our changing world. Follow the Reveal podcast feed and look for more to the story every Wednesday.

[Unknown]

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[Chuck Schumer]

The thing that drives me every day as a dad is Dariona. We call him Day Date for short. Every day he's hungry for something, whether it's attention, affection, knowledge. And there's this huge responsibility in making sure that when he's no longer under my wing that he's a good person. I want him to be able to sit back one day and go, we work together. We did a good job.

[Jane Coston]

That's dedication. Find out [e-mail] brought to you by the U.S. department of Health and Human.

[Dr. Alex Dwarak]

Services and the Ad Council.