Julie Rovner is “worried.” Checking in with a veteran DC reporter.

Dan: Hey there. It was just a little more than a year ago, in May 2025, the last time I checked in with my colleague Julie Rovner. She’s the chief Washington correspondent for our pals at KFF Health News and in what I would call a normal world, like a little more than a year would be really, really soon to talk with her again on this show.

Cause when I started making An Arm and a Leg, I didn’t expect that trying to keep up with the news was gonna be anything I would really have to think about too much. Like, I was setting out to understand and explain a multi-trillion dollar chunk of the economy that isn’t the tech industry, so I was like, how fast could it possibly move? And Julie Rovner’s thing is fast-moving news. On her weekly podcast, What The Health?, she leads a round table of health policy experts and journalists, and pours over a steady stream of headlines. Like whatever happens, big or small, Julie is tracking it. 

And then came 2025, and suddenly there’s this avalanche of news, and it’s big. Like, the Trump administration was making these sweeping changes, cuts to federal health programs. It was a ton of change, and I wanted to talk to Julie to try and wrap my head around it. And she told me even she was struggling to keep up. 

Here’s what she said then.

Julie Rovner: I’m trying to keep a running list of what’s been cut and what’s been restored, yeah, and it’s virtually impossible because there’s 20 things every day.

Dan: Yeah. And a lot’s happened since then. Like, Congress has added work requirements to Medicaid. It allowed federal subsidies for Obamacare to expire for millions of people. And those are, like, the biggest picture items. The rest of it feels like a blur. So, pop quiz: do we have a permanent FDA commissioner, CDC director, surgeon general?

I looked it up. As of July 21 the answer is no, in all three cases. It is an avalanche. So I wanted to talk to Julie again to get a glimpse at that avalanche from, like, further up the mountain, so to speak. 

Julie, thank you so much for coming back.

Julie Rovner: Always a pleasure, Dan.

Dan: Well, we’ll see how much of a pleasure it is to talk about the American healthcare system, but let’s give it a shot. 

Dan: This is An Arm and a Leg, a show about why healthcare costs so freaking much and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter. I like a challenge, so the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful. This time with help from Julie Rovner. Here we go.

Julie, last time we talked, you were astonished and worried about the pace of change and, like, destruction given all the cuts at the Department of Health and Human Services. And here’s what you said then…

Julie Rovner: How I’ve been thinking about this is that our healthcare system is a giant Jenga tower and it’s a little wobbly and what holds it up is everything that happens from the Department of Health and Human Services and they’re yanking out sticks from this Jenga tower as fast as they possibly can and when the whole thing comes down, it’s gonna be very not pretty.

Dan: So you said that a year and change ago, and just like the news I’m seeing this week, we’re taping more than a week before we’re gonna publish this, but there’s been a huge public health story in the news. You know, this outbreak of a foodborne parasite called cyclospora that causes explosive diarrhea.

Boris Sanchez: a warning to more sensitive viewers, this next story is kind of gross.

Caitríona Perry: If you are about to tuck into a bowl of raspberries or a big plate of salad, we’re very sorry because we may be about to put you off your food.

Dr. Richard Smith: If you’re somebody that’s into going to salad bars on a weekly basis Just give that a rest for a week or two

Dan: Yeah again, we’re taping this in mid-July, so maybe this all gets cleared up by the time we publish, but right now, like, I’m personally having early COVID flashbacks trying to figure out what fruits and vegetables are safe to eat and how long I have to cook them.

And you know, sure enough, folks are pointing out that among last year’s many cuts at HHS was federal tracking of a half dozen foodborne pathogens, including this one, cyclospora. So I mean, it all feels a little on the nose. Julie, how are you seeing all this play out?

Julie Rovner: Yeah, it does feel very on the nose, if you will, um, because we’re, like, a month into this outbreak, and it’s a very big outbreak. But we still don’t know what’s causing it. So now we’re having, you know, I saw this morning, uh, a recommendation from a doctor said, “Just don’t eat any fresh fruits and vegetables for the next week or so,” um, because this is unfortunately a parasite that doesn’t –  you can’t necessarily get rid of by washing.

Which is not to say don’t wash your fruits and vegetables. Do wash your fruits and vegetables, but that’s not enough in this case. Um, but yeah, in an, in a normal world, we would know by now what it was, and nobody knows what’s safe to eat, and that’s what happens when you pull those pieces out of the Jenga tower.

Dan: Yeah. And again, like, a week from now when we publish this, who knows what we’ll know, who knows what we’ll be eating. But it seems symbolic.

Julie Rovner: Yeah, I think one of the things that’s going on, you know, last year when we had sort of DOGE cutting and, you know, there were headlines everywhere, and this, these many people were being laid off, and these many people were taking early buyouts and, you know, there was, there was all of this sort of coverage if you will, of all of these cuts.

Things are still not happening, and things are still getting cut, and it’s much quieter. You know, money that officials promised would get distributed as Congress ordered, um, is not getting distributed as Congress ordered. 

So, you know, there are people who are waiting for grants that have not come. Things are still getting cut. Um, political appointees are still making decisions that often, that in the past were always made by career professional scientists, um, doctors, um, people with long experience. As we know, we’ve seen large cuts at a lot of these agencies, so there’s a lot of expertise that’s walked out the door.

So even if there are people still there, they don’t necessarily know as much as they used to. Um, things are sort of going on at that lower level that are not making headlines, but that are still, for the people who are involved in them, or at least what they tell me, are not great.

Dan: Yeah. And what are you seeing play out as a result of the cuts that we’ve seen so far? Like, what are you hearing about that I – like, what do I not know that my neighbors might be experiencing, but I just don’t happen to be hearing about?

Julie Rovner: What you don’t know is how many people are not getting needed medical care because they can’t afford it, whether because they lost their subsidies for the Affordable Care Act and they couldn’t continue to afford their insurance, or in even more cases, their subsidies went down and they bought down into less generous policies and now they have, you know, five-figure deductibles, and so they have insurance, but they still can’t afford to get care.

Or they may be legal immigrants who lost their eligibility for health insurance that they used to have, um, or they may be part of a mixed-status family that dropped insurance because they were afraid of getting targeted by immigration authorities even though, you know, some, some people in the family, were perfectly eligible for these programs.

And we have seen states that are starting to cut back on Medicaid in anticipation of some of these federal cuts that mostly take effect next January, but that are starting to take effect in states already. 

Adam Atchison: Some individual caregivers in Colorado are about to see their Medicaid funding cut.

Michael Perchick: Tonight, the major question remains what can North Carolina do to make up for that major funding shortfall? 

Justin Corr: One of the biggest issues we knew the Idaho Legislature would debate this year. Now Medicaid cuts are moving forward.

Julie Rovner: And we’re seeing states that are cutting back on optional programs, which, you know, members of Congress last year when they were debating this bill said, “Oh, we’re not gonna go after people, you know, who are seniors or who have disabilities.”

Um, except those are the programs that are optional, and when states have to roll back their Medicaid programs, that’s what they roll back, and indeed, that’s what’s happening, and we’re seeing, you know, story after story. But again, these are happening a little more quietly, making fewer headlines. But for the people they’re hurting, they are really hurting.

Dan: Wow. Yeah, I mean, a couple of stories that I, you know, you’re reminding me of, right, that, um, new federal rules keep rolling out, and some of them include eligibility for Medicaid for, like, people giving care or, or what it means to be medically frail and not be able to work, right? Tightening those restrictions and saying, “Look, it’s, you’re gonna have to jump through a lot more hoops to prove that you can’t work.”

Julie Rovner: Yeah, almost all of these rules are being … Those are not finalized yet, but almost all of these rules are also being challenged in court, um, by states, by, uh, healthcare providers, who obviously wouldn’t get paid anymore for providing this care, um, and by patients. So we will see, you know, how these ultimately play out.

But there are, you know, a — this administration has been sort of cut first, answer questions later. That’s been kind of the theme from the beginning, and that is still what’s going on. You know, one of the things we’re gonna talk about, um, on our podcast this week, uh, are stories of family caregivers, people who are losing eligibility for their families, uh, to help take care of them. You know, and, uh, Dr. Oz, who’s the head of Medicare and Medicaid, you know, has been talking about people who are, you know, collecting money for, you know, going to the grocery store or bringing in the newspaper…

Dr. Oz: Something called personal care services. You’ve never heard of that. Personal care services, basically, you’re paying your kids to carry the groceries upstairs, but you’re not actually paying. The state’s paying, and then the federal government’s paying the state back.

Julie Rovner: That’s not what these people are doing. These are people who are changing feeding tubes and, you know, helping people who are not ambulatory in and out of bed and on and off the toilet. I mean, this is … these are very, very difficult jobs, um, that, yes, sometimes family members are paid to do, but if they make it impossible, a lot of these people don’t know where they’re going to get help, and in some cases, these patients are gonna end up in institutions, and that’s gonna end up costing the federal government and taxpayers even more money in the long run.

Dan: And, and these cutoffs are happening now? 

Julie Rovner: They are. 

Dan: Like, folks are, folks are getting notices or being told, like, “No, your check for taking care of mom isn’t coming this week. You’re not getting that.”

Julie Rovner: That’s exactly what’s going on. In, in, in my home state of Maryland, they are cutting off this program. I believe… I can’t remember the exact date. It may be, there may be another month or so, but it’s, you know, they are getting notices that these programs are ending and I think Maryland is one of a half a dozen states that’s doing that.

Dan: Wow. And it’s, it’s like you said, these huge stories, they’re not grabbing a lot of headlines. I mean, like recently on your show, you were like, “What was shocking last year is now kind of status quo,” like at least in terms of media attention. But you’re still tracking all of it. 

And, all this reminded me of what you said when I talked with you the first time last year. So our Zoom meeting started, we started rolling tape. I said, “How are you?” And this is what you said:

Julie Rovner: I have a shirt that says, “Up and not crying.” I also have a shirt that says, “This is not normal.”

Dan: And I wanted to ask you, like, how are you doing now? Are y- d- are those shirts still in your wardrobe?

Julie Rovner: They are, and I have another one that says, “This is my living in unprecedented times shirt.” And I kind of rotate them.

Dan: And, and how, because many of us have the option, I always figured I did, of like, “Yeah, I’m gonna, I’m gonna titrate my exposure to news. I’m gonna calibrate, like this is how much I, you know, is good for me, is healthy for me to have right now.” And you know, some people turn it off altogether. And you do not have that option, unless you choose to do something entirely different. But like, I wanna ask you personally, like what is that like for you? 

Julie Rovner: It’s exhausting. 

Dan: Yeah.

Julie Rovner: I mean, I, and I worry. I worry about people, um, who need healthcare and aren’t getting it. I worry about students who, um, are trying to decide whether they can actually pursue their dreams of becoming a healthcare practitioner or a scientific researcher who are seeing sort of their pipelines cut off. That’s, that’s a big concern for me right now.

And I see things like Ben Sasse, the former senator who was very near death from pancreatic cancer, suddenly being able to take a new drug. And he said that, you know, his cancer is 99% gone. I mean, you see these medical breakthroughs that frankly government-sponsored research has helped bring to us, um, and I worry about whether they’re gonna be there for the next generation.

I mean, that’s something that’s, that’s really sort of jumping out at me. It’s like, look at all the things that we can do. Do you know why we’ve been able to do this? We’ve had this bipartisan agreement that investing in science and medicine is a good thing. That’s separate and apart from the fact that our healthcare system is messed up and costs too much, which I know is what you concentrate on – thank you very much. Um, but, you know, both of them are in trouble right now. And as I say, it’s not so much … You know, last year it was all the headlines. Now it’s just sort of, as I said, it’s kind of become the status quo that things are crumbling, and that worries me even more than when it was all over the headlines.

Dan: Coming up, I get Julie’s take on what’s happening to the Affordable Care Act and what she thinks is gonna happen in 2028 and beyond. That’s next

Dan: This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom covering health issues in America.

The folks at KFF Health News are amazing journalists like, you know, today’s guest, Julie Rovner. Their work wins all kinds of awards every year, and we are honored to work with them

Dan: So, Julie, you know, since the last time we talked, as you noted: some Obamacare subsidies ended, and premiums went through the roof. Millions of people have dropped their insurance. And lots have signed up for cheaper plans that cover less.

And now, the Trump administration has been rewriting the rules for next year to encourage more people to sign up for plans that would cover a lot less, like including plans that require you to spend $30,000 or more to cover your family before insurance kicks in at all. And, you know, like, the two pillars of the Affordable Care Act were, like, let’s use subsidies to make non-crummy private insurance affordable for most people, and let’s expand Medicaid.

So, Republicans kept saying they just wanted to repeal the ACA, but, you know, they never did. And now I’m wondering, like, are we seeing something that’s, like, effectively kind of a slow motion repeal of the ACA by other means?

Julie Rovner: Oh, absolutely. No question about it. Um, most of the Affordable Care Act has been dismantled over, you know, th- th- this was … Several people have written this story. It’s like, you know, Republicans failed on their repeal and replace when they called it repeal. But basically, over the last 10 years, look at all the things we’ve taken away.

All the taxes that supported the financing of this have gone away. So the supporting taxes which were on mostly individ- you know, they were on health insurers, and drug companies, and, and large businesses, most of those have been, have gone away. Thank you lobbyists, you know, who came and said, “We don’t wanna pay these taxes.” Um, so basically the money’s just coming out of the treasury now. 

The- one of the things that the Republican budget bill did last year um, it didn’t roll back the explicit, expansion of Medicaid, but now we’re gonna have these work requirements, which, what we know from other states that have done work requirements end up, yes, taking off people who are, who simply refuse to work, but also because of the bureaucracy involved, end up cutting off people who are working, and who are eligible, and who do need the, the health insurance coverage. We have seen this.

You know, most of the people who end up getting kicked off the program get kicked off for what are called administrative reasons, which means they just could not navigate all of the required paperwork and bureaucracy. Um, so I mean, we really are seeing a slow motion repeal of the Affordable Care Act.

Dan: And so what might happen? I mean, Like, you’ve been looking at this for 40 years, and I’m, I am old enough to remember as a young person noticing that, like, when Bill Clinton ran for president in the early 1990s, you know, a big piece of the pitch was like, “Healthcare costs too much. Not enough people have insurance. We gotta do something about it.” And it, you know, they weren’t able to pass a law. But where might things go?

Julie Rovner: So let me tell you one of the things that kind of freaks me out. Um, would, and you go back to sort of the Affordable Care Act. I covered the Clinton health plan, and it- it died, as I like to describe, because, you know, everybody, all of those special interests wanted to cut off just one finger of it, and in the end, the patient bled to death. That’s sort of been my go-to metaphor for the Clinton healthcare plan. 

So what happened when they tried to put together the Obama healthcare plan is it like- like rather than have all of the special interest outside of the tent, let’s get all the special interest into the tent, and one of the ways they did that is said, “Look, if more people are insured, then you’re gonna get more of your bills paid.”

And particularly, you know, the hospitals and the drug companies said, “Yeah, that sounds good. We would like people to be able to pay for the things that we provide.” Um, well, so what are we doing now? We’re taking this apart, and we’re having people not be able to pay for things, and we’re having states not be able to pay for things.

States had used what was called creative financing for their portion of Medicaid, which remember, is a shared expense between the federal government and the states. So now you’ve got hospitals freaking out, and you also … I mean, we’re seeing hospitals close. It starts with rural hospitals. But, you know, I- I like to say it’s not just people without insurance who are gonna be impacted by this.

If health providers can no longer keep their doors open, then even if you have insurance, you may not have any place to go to get it. We’re already seeing healthcare deserts in, you know, less populated parts of the country. What is this gonna do when you see fewer people with health insurance, fewer people with Medicaid, fewer people with the Affordable Care Act?

Dan: Umm. Wow. 

Julie Rovner: Sorry, I’m just a continuing ray of sunshine. 

Dan: No, no, no. No, no, you’re, you’re like– I’m asking you what might happen, you’re like, “Well, here’s the worst that might happen.” But, um, you know, what might a path look like to changing course?

Julie Rovner: Well, I feel like, you know, and when it comes to healthcare, the left is moving to the left and the right is moving to the right. Um, you know, we’ve always in, in the 40 years I’ve been doing this, um, and even going back to things like Medicare in 1965, what has gotten things done is when people, is when the two sides come together in a compromise. Those are the only big achievements in healthcare. Um, with the possible exception of the Affordable Care Act, which Republicans say, you know, “Oh, that wasn’t, you know, that w- that was only, that passed only with Democratic votes,” but it was a Republican idea. It was pulled from what Mitt Romney did in Massachusetts in 2006. So it was intended as a compromise, um, even if in the end the Republicans … The Republicans started moving right, I think, before the Democrats started moving left. 

But now you’re seeing, you know, most of the Democratic candidates, I’m looking in the midterms, you know, are, are back to the mantra of Medicare for All. Joe Biden was one of the few candidates in 2020 who did not endorse Medicare for All. He wanted to just expand the Affordable Care Act. That’s what was seen as a middle ground. 

Now nobody seems to want a middle ground. You know, the right wants to just take everything apart and get government out of healthcare in general and let people, you know, sort of give people a little bit of money and have them, you know, have the free market take over. And the left wants Medicare for All, which is, you know, the, the U.S. has tried to, to do what every other country has done and have universal coverage, and has so far not really succeeded at that. Although I will say at its peak, the, when the Affordable Care Act had the expanded subsidies, we were down to about an 8% uninsurance rate, which was the lowest since anybody had been keeping track. So it was, it was getting closer. 

Um, but now I see the parties moving apart. Will they move back together again at some point? I don’t know. Um, but, but for, I think, the immediate future, we’re seeing them retreat to their corners. And in healthcare that really, even though sometimes at the 30,000-foot level they’ve been fighting about that, at the 5,000-foot level they’ve been able to get together and do things. Um, a good example is the No Surprises Act, you know, the let’s get rid of surprise bills. 

Um, I’m not sure I even see them coming together on sort of the little stuff right now. Everybody is just very, very, very unhappy with everybody else.

Dan: Wow. Well. Okay. Uh, it’s not the cheerfulest thing I ever

Julie Rovner: You look like you’re, you’re processing that.

Dan: I am. I am. I am. I am. And of course, you know, as you say, during this period when people had, when the, the greatest proportion of people had insurance, uh, you know, I’m still doing this show. I mean, people have insurance, but having insurance doesn’t necessarily mean you have healthcare that you need and can afford.

Julie Rovner: Yes, everything. We will both be employed for as long as we want talking about the foibles of the U.S. healthcare system.

Dan: I mean…

Julie Rovner: That I am con- that prediction I am very confident of

Dan: I will never run out of material – that’s the crappy thing. But things are, like we said, they’re accelerating, they’re different, and I’m wondering how is all this changing how you see your job going forward?

Julie Rovner: Well, one thing that I’m, working towards myself, is I am predicting that we are going to have another major political throw down over healthcare in the coming years. Not necessarily next year, but probably, you know, the … I think this will be a big focus of the 2028 presidential campaign, and in 2029 we’re gonna have a big debate.

Are we gonna solve anything? I have no idea. But in preparation for that debate, I feel like there’s a whole generation that sort of didn’t live through the Clinton health plan, and that didn’t even live through the fight over the Affordable Care Act, and that one of the things that I would like to do as sort of a public service, um, is throw all of the options back on the table for people to see that, you know, that if this was easy, we would’ve solved it a long time ago. 

So I am … One of the things that we’re doing as part of our podcast is a special project called How Would You Fix It? I am sort of calling every smart person I know from across the ideological spectrum and asking them, “Okay, how would you fix it?”

I mean, I’m nearing retirement myself. I feel like I have this obligation to kind of, you know, shepherd the people who wanna learn through another round of this, um, so that we can have an educated debate and decide what we as a society wanna do about healthcare.

Dan: Wow. You think there will be a great big conversation, there will be a great big change. 

Julie Rovner: Uh, I think there will be a great big conversation. I don’t know that I think there will be great big change. I’ve, I’ve, I have covered enough of unsuccessful ones of these. I, I am not predicting its success, I am simply predicting the fight.

Dan: Fair, fair, fair. But, uh, even so, um, having a big public conversation seems better than not. 

Julie Rovner: As a journalist, I would think that. As somebody, and who’s … As somebody who cares about the, the, the sorry state of our healthcare system, I, I think it would be — I think it’s time.

Frankly, one of the reasons I think this is about to happen is that when in the early 2000s, when we were sort of building up to the fight over the Affordable Care Act, you could sort of see it coming because everybody was unhappy, and everybody wanted to sue for peace.

Um, you know, that the, the hospitals were unhappy, the drug companies were unhappy, the doctors were unhappy. You know, the, the employers were unhappy. The labor unions were unhappy. I feel like that is true again, and it’s more true.

And now even the haves, what we call them, the people who have insurance and don’t want, you know, are afraid of change, even the haves are unhappy. Everybody thinks they’re paying too much, which is why I’m predicting we’re gonna have another big public debate about this in the next four or five years.

Dan: I think the prospect of having a big public debate about a big public problem also strikes me as like an optimistic stance for anyone who cares about, you know, living in a democracy where people have a say in, in democracy where people have a say in what happens.  

Julie Rovner: It is, I, I’m sort of clinging to it as a, as a hope

Dan: Mm-hmm. I, uh, I just really appreciate that.

Julie Rovner, thank you so much for joining me. It’s been such a pleasure. Um, till next time, I’ll be listening to “How Did You Fix It?”

Julie Rovner: Thank you, Dan. And see, talking to you makes me feel better.

Dan: All right. That’s what I’m going for. That’s what I’m going for. Let, let’s stay in touch. 

Julie Rovner: We will. 

Dan: All right. Great. Take care. 

Julie Rovner: Thanks, Dan. 

Dan: Bye-bye. 

Dan: Okay, so I asked Julie Rovner how the avalanche of change has her thinking about her job description these days, and I wanna share how I’ve been thinking about mine.

You might have noticed over the last couple of months we’ve taken a break from producing podcast episodes, and here’s why. Basically, in April a few family health issues blossomed all at once. And as I turned my attention there, I realized I had some health issues of my own that needed attention. 

I started making this show eight years ago. I’ve been running it on a shoestring ever since, and that has meant running myself a little ragged sometimes. Honestly, too often and for too long. That’s not good for my health, and it’s not good for An Arm and a Leg, ’cause a ragged version of me does not make the best version of this show.

I needed some time just to break some habits — I called it detox from workaholism — and I needed to attend to my own health.

Like, earlier this year, I’d scheduled a little surgery, and I put it off ’cause I got sick from — you guessed it — running myself so ragged. And of course I was still trying to run so hard, I couldn’t imagine when I might reschedule it. So honestly, it wasn’t until I put myself on break for a minute that I even thought, “Oh yeah, I, I could do that surgery now.”

So surgery happened in early June. I’m all healed up, and I’ve been working with a really excellent therapist, and I’ve been incredibly grateful to my colleagues for their patience and for keeping things running. And together, we are starting to put together some new ways of doing things. It’s gonna be a work in progress.

There are so many things we wanna do. But I can’t be a workaholic anymore. So for our next episode, we’re gonna bring back one more favorite from our archives, give ourselves a running start, and then we’ve got some incredible, important stories and projects we just can’t wait to get back to. For now, thank you so much for sticking with us. It is a privilege to get to do this work, make this show for you, and to work with my incredible colleagues.

I will catch you soon. Till then let’s all take care of ourselves.

This episode of An Arm and a Leg was produced by Emily Pisacreta, with help from our summer intern, Lynn Barbera (welcome, Lynn!) — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Amanda Boyd is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

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