End-of-Year Chaos on Capitol Hill

The Host

After weeks of painstaking negotiations, Democrats and Republicans in the House and Senate agreed to a major year-end package of health bills, including new regulations for drug companies and pharmacy benefit managers, and renewals of programs to combat opioid abuse and prepare for the next possible pandemic. But the effort could be all for naught, as President-elect Donald Trump and his government-cutting adviser, Elon Musk, complained it gave Democrats too much of what they wanted and threatened Republicans who might vote for it with challenges in upcoming primary elections.

Meanwhile, Texas Attorney General Ken Paxton sued a doctor in New York for prescribing abortion pills via telemedicine to a patient in Texas, in the first major test of whether “shield laws” — intended to protect doctors in states like New York where abortion remains legal — can protect against other states’ enforcement efforts.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Victoria Knight of Axios, and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s episode:

• Congress looked to be on the cusp of passing its government spending bills this week, then Trump spoke out. The package featured robust, bipartisan policies — including things that Trump himself has endorsed, such as reforming the pharmacy benefit manager system. Now, it’s not only those policies, plus key extensions on the Medicare telehealth program, opioids, and more, that Trump has undermined: A government shutdown could also furlough the federal employees helping his team transition ahead of his inauguration next month.
• Meanwhile, Robert F. Kennedy Jr. has been making the rounds on Capitol Hill to gain support for his confirmation to lead the Department of Health and Human Services. And many senators seem surprisingly supportive of his bid. Some are leaning on shared goals such as limiting ultraprocessed foods. In general, Republican senators do not seem too concerned about RFK Jr.’s nomination — despite a track record of opposing scientific consensus on vaccines and supporting abortion rights.
• New government data shows health care spending is up. The recent fatal shooting of an insurance executive has triggered a backlash against the insurance industry, yet the data shows costs are going up due to higher utilization — not necessarily because of factors within insurers’ control. Bottom line: In a system of constant finger-pointing, insurers have earned ire for questionable coverage decisions and lack of transparency — but they’re not the main, or only, culprits of high costs and access problems.
• And, in reproductive health news, the attorney general of Texas is suing a New York doctor for prescribing the abortion pill to a patient in Texas. New York, like other more Democratic states, has a shield law protecting providers, yet this case will be the first test of such a law.

Also this week, Rovner interviews KFF President and CEO Drew Altman about what happened in health policy in 2024 and what to expect in 2025.

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

Julie Rovner: Vox.com’s “The Deep Roots of Americans’ Hatred of Their Health Care System,” by Dylan Scott.

Alice Miranda Ollstein: KFF Health News’ “Native American Patients Are Sent to Collections for Debts the Government Owes,” by Katheryn Houghton and Arielle Zionts.

Jessie Hellmann: KFF Health News’ “How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices,” by Arthur Allen.

Victoria Knight: Bloomberg News’ “The Weight-Loss Drug Gold Rush Has a Dangerous Prescription Problem,” by Madison Muller.

Also mentioned in this week’s podcast:

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