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Brian Lehrer: It's The Brian Lehrer Show, on WNYC. Good morning, everyone. The House Republicans ran against DEI, right? Diversity, equity, and inclusion policies. You might say, as they fill out their leadership roles, that they're keeping their campaign promise. As the DC-based Punchbowl News reported on Friday, of the 16 elected House committee chairs, 15 of them are white men. The only exception is Congressman Brian Mast, a Republican from Florida, whose mother is Mexican American.

One of the new committee chairmen, who is not very well known nationally, but will suddenly be a very important person to many things that matter a lot, is Congressman Brett Guthrie of Kentucky, the new chair of the Energy and Commerce Committee. One of our locals, New Jersey Democrat Frank Pallone, is the ranking Democrat, so he'll be important, too, but if energy and Commerce sounds a little obscure, it's not the Judiciary Committee, it's not Ways and Means, it's not the Oversight Committee.

These things that are in the headlines all the time. Consider this. As Pallone's website notes, Energy and Commerce has one of the broadest jurisdictions of any congressional committee. You ready for this? "The committee's jurisdiction includes, but is not limited to,-" the site says, "-issues pertaining to healthcare, energy, environment, commerce, food and drug safety, consumer protection, and communications and technology." Think about that.

Healthcare, suddenly back on more of a front burner after the public reaction to the murder of the United Healthcare CEO. If there are any changes to Obamacare or expansion of insurance protections, anything like that, it goes through the Energy and Commerce Committee. Anything climate-related, or otherwise environmental. One of the stories in the headlines today is the expiration of the EV, electric vehicle, tax credit, at the end of this month.

If President-Elect Trump wants to end or roll back that tax credit, as he has threatened to do, or lots of other ways where drill, baby, drill meets climate laws. Hello, Energy and Commerce Committee. With food and drug safety also in the Energy and Commerce Committee portfolio, they'll be involved with changing vaccine laws, or other things that RFK Jr might want to do.

Climate, energy, food and drugs, health insurance. We haven't even gotten into their communications portfolio. How about all the regulations for the tech giants? They're in people's sites. Keep your eyes and ears on the new Republican chair, Brett Guthrie of Kentucky, we'll hear a clip of him in a minute, and ranking Democrat, New Jersey's Frank Pallone. Here is a clip of Guthrie, since many of you have probably never heard his voice.

This is from 2019. In an interview with the Washington news organization The Hill, he's explaining why he's against Bernie Sanders' Medicare for All approach to health insurance. One reason was his assertion that the profit motive for drug companies helps lead to medical innovations. Not just drug companies, but for the whole medical industry, helps lead to medical innovations that we have in this country more than any other nation in the world, he asserts.

He cited development of a cure for sickle cell anemia recently, also an effective recent drug for stage four melanoma, and other things. He cited the concerns that doctors, hospitals, and other providers have about the current Medicare program.

Congressman Brett Guthrie: The biggest issue with provider groups are reimbursements. You hear that with reimbursements, and I would say most providers-- I don't know if you have provider groups in here, people who represent provider groups, but say, if we had to exist only on what the reimbursement is for Medicaid and Medicare, we couldn't-- [unintelligible 00:04:09] Medicare for All, that we couldn't exist.

There are a lot of price transfers from people in private insurance, people who private pay, people who move forward to cover for people, to cover for the lack of payments through Medicare and Medicaid. That is the biggest concern that you have from hospitals, you have from provider groups. Just the pressure that you hear a lot of, from the bureaucratic pressure, with the medical health records, which was mandated in the Affordable Care Act, which we need to get to.

I'm not criticizing that aspect, but then you have a lot of providers say, "I spend more time creating records than I'm seeing patients." We have to figure that part too, as well.

Brian Lehrer: Republican Congressman Brett Guthrie of Kentucky, incoming chair of the Energy and Commerce committee, in 2019. I chose that relatively old clip because it's relevant to the new discussion about health insurance taking place around the country. Now, Bernie Sanders, with his views, was on NBC's Meet the Press yesterday.

Bernie Sanders: Why we are the only major country on earth not to guarantee health care to all people, why we have a life expectancy which is significantly lower than in other countries, why working class people die 5 to 10 years shorter than the people on top. Kristen, I feel very strongly about this, and I think the time is long overdue for us to guarantee health care to every man, woman, and child, especially at a time when we're spending twice as much per capita on health care as the people of every other nation.

Goal of health care is not to make drug companies and insurance companies phenomenally rich. It's to guarantee quality care to all of our people.

Brian Lehrer: That was Bernie Sanders on yesterday's Meet the Press, with moderator Kristen Welker. With us now, Rachel Cohrs Zhang, chief Washington correspondent for the health-oriented news organization STAT News. She reports on the intersection of politics, business, and health policy. Her bio page says her latest article is called The Pharma Industry Isn't Lobbying Against RFK Jr's Nomination for a Top Health Role.

Very relevant article, as everyone is reporting that Kennedy is heading to Capitol Hill this week to make the case for his confirmation, and news organizations are reporting on a top aide to Kennedy who has campaigned against even the polio vaccine. Rachel, so nice of you to join us. I love STAT News. Welcome to WNYC.

Rachel Cohrs Zhang: Thanks for having me.

Brian Lehrer: We'll get to RFK. First, with the public outcry over health insurance costs and denials, and how it seems to transcend party lines in the general public, from the reporting I've seen, have you been seeing members of Congress saying anything new about health insurance reform? Obviously, they'll denounce the murder, as they should, as Bernie Sanders also did in that interview.

Are these leaders on the Energy and Commerce Committee, from either party, or anyone not named Bernie Sanders or Elizabeth Warren, talking about policy change in any new way?

Rachel Cohrs Zhang: We really aren't. Honestly, we're pretty early in this news cycle, and as I like to explain, Congress is oftentimes operating almost 10 years behind the cutting edge of conversation on healthcare. I think right now, they're talking about reforms to pharmacy middlemen. We started talking about those on Capitol Hill eight years ago, with concerns about EpiPen and price gouging. I think they're addressing that issue now.

We've definitely seen some comments from lawmakers on the outcry that we've seen about health insurance coverage. I think Senator Elizabeth Warren faced some backlash for her comments. I think there are some liberal lawmakers who are trying to walk the line between condemning violence and also explaining the just anger and pain that were brought to light by the shooting. I think we have, certainly, statements from lawmakers, but no concrete action on the core issues that we're talking about here.

Brian Lehrer: The murder was on December 4th. You reported on December 3rd, day before, negotiations were heating up in The House, over a large health care policy package that included a lot of things, extending telehealth medicine flexibility that started during the pandemic, increasing doctor pay for Medicare visits. We heard about in that clip from Congressman Guthrie how that's an issue, low provider reimbursements for Medicare, reforms on how pharmacy benefit managers operate, which you just mentioned, and some other things.

Two days later, so that would have been the day after the murder, you reported the Democrats floated extending enhanced Affordable Care Act subsidies in a year-end deal. I don't know if that proposal came after the killing. Would you tell us about those negotiations, where they stand today, and whether the public outcry has moved the needle on them in any way? That's a lot of interesting policy items.

Rachel Cohrs Zhang: Sure. Yes. This package has been in the works for two years. I don't think it was substantially impacted by the shooting at all. I think, as you said, you had a good list there. Negotiations are ongoing. It has been a long negotiation process. It's been going back and forth just trying to get bipartisan agreement in the House and the Senate, among Republicans and among Democrats. There have been little holdups over the weekend, so certainly, this whole thing isn't baked in.

I think there is an idea that there will be a healthcare package that has some bipartisan agreement from at least the leaders on health care in Congress, but I think it's one piece of a much larger puzzle, of this government spending package that lawmakers are trying to get across the finish line this week, before their break for the holidays. I think certainly, that part seems to-- It's not entirely done, but it's pretty close.

Most of my sources think that it's going to get across the finish line if they can come to an agreement to avoid a government shutdown on other issues. One issue that you mentioned has fallen out of the package, which is subsidies for Affordable Care Act plans. That was an initiative passed by Democrats back in 2021, when they had full control of Washington, and they're set to expire at the end of next year.

Their failure to address this issue right now doesn't necessarily indicate that they'll definitely expire, but with Washington fully under Republican control next year, it's significantly less likely that we'll see those subsidies extended in their current form.

Brian Lehrer: Would that just be an extension of current subsidies for people who get Obamacare policies but are of low enough income, or was it going to expand the subsidies? I don't know if you have any easy for our listeners to understand subsidy numbers at your fingertips [unintelligible 00:11:22].

Rachel Cohrs Zhang: [crosstalk] It's complicated math, but I think-- There were this original level kind of Obamacare subsidies, and Democrats increased those subsidies, and as we've seen in the data, we're not seeing the lowest income people who are enrolling in these plans benefiting the most from these this extra kind of money added on the top. What it did was cap premiums for insurance--

Brian Lehrer: Rachel, you there? Did we lose Rachel Cohrs Zhang from STAT News' line? All right, we'll get her back. In the meantime, listeners, I'm sure we'll have her back in just a second, and of course, we can take phone calls for her on this too. Listeners, who has a question or a comment for Rachel Cohrs Zhang, chief Washington correspondent for the health journalism site STAT News, on the RFK nomination, which we'll get to?

Very interesting that she reported that the drug companies, because if he's opposed to vaccines, remember, that's who he says is foisting these "poisons" on the general public, it's the pharmaceutical companies, so they can make a profit on them. On the RFK nomination, Rachel reports Big Pharma-- maybe not opposing him. She'll tell us why as we go on in this segment. Health insurance reform and Congress now, or anything else on her beat. 212-433-WNYC, 212-433-9692. Rachel, we have you back, right?

Rachel Cohrs Zhang: Yes, I'm here.

Brian Lehrer: Good. On these negotiations for this possible end-of-year health package. You reported that what the Republicans wanted in return for some of the Democrats' priorities was repealing what you call the controversial Biden rule for nursing home staffing requirements. What is that rule, and why is it controversial?

Rachel Cohrs Zhang: It's controversial because it would ensure that nursing homes have to have a certain amount of staff for each kind of resident that they're taking care of. Obviously, the industry doesn't like that at all. There's been this movement, especially among nursing homes that are owned by private equity firms, toward trying to reduce staff to save money, but obviously, that has implications for the care of the residents in these nursing homes.

I think the Democrats have rejected that proposal this time around. I certainly do fully expect Republicans to repeal that rule next year, in talks over healthcare legislation. It saves quite a bit of money if they cancel something that hasn't even gone into effect yet. It's like these weird budget tricks. I think Republicans don't support those-- what they view as government mandates.

The nursing home industry has said that there's not even enough staff for them to hire to meet these levels that the Biden administration has required for them. There has been a lot of back and forth, but ultimately, we expect it to be rescinded, if not now, sometime next year.

Brian Lehrer: Wait, do Republicans really want to be on the side of understaffing nursing homes for grandma in the name of private equity profits? Is that good politics?

Rachel Cohrs Zhang: I think anti-regulation is where they're coming from on that. I think certainly, Democrats will use that argument, and that's, I think, why they didn't get on board with that strategy right now. I think it's hard to make that argument when the regulations haven't actually gone into effect. I think they're taking an anti-regulatory stance.

Brian Lehrer: I saw the dollar figure, you reported that this rule would cost the government $22 billion. I don't know over how many years that is, and that sounds like a lot of money, but do Republicans make the case that nursing homes aren't understaffed and patients aren't suffering, residents aren't suffering as a result of whatever it is that the Biden administration thinks it's trying to address?

Rachel Cohrs Zhang: I think they're just making the case that this federal mandate coming down from on high, from the federal Medicare officials, isn't the way to solve it. I think they would much rather see state-level regulations, and they have been approaching it as more of a workforce issue, that there aren't enough people to hire. It's not fair to ask these nursing homes to meet impossible goals. I think they've just been much more receptive to industry arguments on this issue, which is typical from the Republican Party.

Brian Lehrer: Did that come out of the pandemic, by the way? Because, of course, there were so many deaths in nursing homes early on, from COVID, I think advocates have been talking about this staffing for many years. I'm just curious if the spotlight on nursing home deaths at the beginning of COVID drove this rule.

Rachel Cohrs Zhang: I think that definitely helped drive attention to this issue, as we saw more data come out about different ownership models for different nursing home chains, and outcomes for seniors. There were so, so many deaths in these nursing homes. We really saw them as early hotspots. I think there's been ongoing conversations about staffing, but I think the Biden administration really felt like--

I think you're right, that the pandemic was just another example of why staffing needed to be increased, and that there has been this increase in private equity ownership of nursing homes. I think they took the approach that they'd rather just try these regulations out, and try to force nursing homes to comply, if they could, but ultimately, I think the administration change is going to make these regulations moot.

Brian Lehrer: We played the Bernie Sanders clip in the intro. Does Medicare for All, or anything leaning in that direction, seem to have any new life now, with members of Congress maybe having a new realization about how much people hate their private health insurance companies?

Rachel Cohrs Zhang: Absolutely not. The whole Congress is going to be run by Republicans and we're going to have former President Donald Trump back in the White House. There's, I think, zero chance of that anytime soon.

Brian Lehrer: Well, UnitedHealthcare's new leader himself, I'm sure you saw this, has said some conciliatory things about how they need to do better. Maybe that's just to save the stock price, I don't know, which has dropped considerably since the public backlash to the company started, or maybe there's an opening there, for something, I'm not sure what, with industry's buy-in. Anything that you know of.

Rachel Cohrs Zhang: I would just like to point out that Andrew Witty is not a new executive at UnitedHealth Group. He's the CEO of the umbrella organization, because UnitedHealth is very large. They do have an insurance business, but they also run a pharmacy benefit manager. They own a bunch of doctor's practices. It's a very, very big corporation, so again, he's not new, and kind of the C--

Brian Lehrer: [crosstalk] I stand corrected. He was Brian Thompson's boss already, to begin with.

Rachel Cohrs Zhang: Yes, yes, he was Brian Thompson's boss. That's a good way to put it. Anyway, I think he did. He just realized that there is this PR crisis that the company is facing, with so much anger bubbling up. The op-ed didn't give much concrete examples of what they'd like to see change. I think it's an example of this messaging that we've seen from all different parts of the healthcare industry, where when they are under fire, in the public eye, on Capitol Hill, they just like to point the finger at other parts of the healthcare industry.

Pharmacy middlemen, drug makers, at providers. I think it's just this situation where it's a blame game. I think Congress is focused on doing one kind of sector at a time, and it's just not the insurance industry's turn quite yet. We didn't see many concrete proposals there, but we did see this argument that insurers themselves aren't to blame, that it's this larger system, but it turns out that larger system is really hard to take on, all at once.

Brian Lehrer: You mentioned pharmacy benefit managers. Here's Dick, in Queens, a pharmacist, he says, calling in. Hi, Dick, you're on WNYC.

Dick: Hi, Brian, thanks for taking my call. Just a comment, listening to your sound clip of Mr. Guthrie. I don't really know his policy or anything, but he talked briefly about, in his comment, about PBMs. I think you guys are talking about it, your guest. Wondering what your thoughts are, how you would comment, or your guests would. Pharmacies, on any given day, when they dispense certain medications, are paying more for it than what they are reimbursed for it.

Life-saving medication, whether it's blood thinners or diabetes, they cost more from the wholesalers than what the PBMs are paying for it. A lot of the pharmacies are having trouble keeping up with how to make those losses balance out. Do you guys have any comment on that? Also, there's a lot of soundbite about middlemen and PBMs, but nobody's talking about the three or four giant wholesalers that really have a big hold on the pricing model as well, along with the pharma companies.

Just a comment out there, for everybody to comment on.

Brian Lehrer: Yes, we had another pharmacist who called in on Thursday's show last week, who was telling some of the same things that you just said. Let me key on one of the things that you said there, Dick, did you say that it actually costs the pharmacy more to obtain the drugs than they get reimbursed, once they pass them on to the customer?

Dick: Absolutely. Some of the life-saving medication for diabetes, for example, if the cost is X, we get X minus 2 to 3% back on that. Those numbers can add up very, very quickly.

Brian Lehrer: Rachel, this is incredible, if true. Is this anything you've reported on? How could a company stay in business if they're paying more for the product than they're selling it for?

Rachel Cohrs Zhang: This is an issue that I think pharmacists have been complaining about for a very long time. We don't have final details of what they're thinking about doing, but I think most of the reforms that I've heard about, at least, are kind of focused on the PBM business model in general and trying to make sure that they're not getting paid based on a percentage of a drug's price for their work, or for placing a drug at a certain place on a formulary.

I think we're seeing, certainly in Medicaid, I would say, that there are some reforms that I'm hearing being discussed in Medicaid, where it would prohibit pharmacy benefit managers from charging the Medicaid program more than they're actually paying for the medication, and keeping that difference for themselves. That's a practice that we've seen outlawed in many states, and I think we are seeing interest in that at the federal level.

It remains to be seen whether any reforms that more directly address this issue of pharmacy payment by PBMs, and just making sure that cash flow works for pharmacies, especially small pharmacies, will make it into this final package.

Brian Lehrer: Dick, thank you for helping us shine a light on that. We'll certainly stay on that aspect of it, that's unbelievable to a lot of people, hearing it for the first time. Let's take another call. Kitty, in Manhattan, you're on WNYC. Hi, Kitty, thanks for calling in.

Kitty: Hi, Ryan, thanks for listening. I'm wondering about the impact of Medicare advantages. I understand that 50% of the people in the Medicare system have been transferred over to privatized Medicare Advantage programs, where they promised all manner of everything, eyeglasses, and also coupons to buy food. Isn't this sort of the privatizing of the Medicare system?

How has that happened, that the government turns over money and also pays for the advertising to get people out of traditional Medicare, that's well administered and covers things, to the privatized system, where there's gatekeeping and turning down of claims?

Brian Lehrer: Kitty, thank you. And I'm going to add on one to her very good list of questions, Rachel, which is-- Is the government actually saving any money by privatizing Medicare to that degree, with the Medicare Advantage plans? That's supposed to be the point. They're supposed to deliver as good, or better services, more efficiently. I've also seen that the government actually subsidizes Medicare Advantage plans, so it doesn't actually maybe save Medicare any money. What's the real answer? Do you know?

Rachel Cohrs Zhang: I think that it's true that there has been this big movement to privatize Medicare plans, and as they become more prominent, we have seen more scrutiny of their practices. I am certainly not an expert in MA financing, but what I can say is that there has been definitely some conversation on the Capitol Hill. My colleagues have done reporting on the fact that some of these Medicare Advantage plans, including those owned by United, have used artificial intelligence and algorithms to decide how long a patient should be getting rehab care after a surgery, or something like that.

Instead of kind of the doctor and the patient working together to decide how long that treatment should last, the insurance companies, using these algorithms, have cut off care, and patients and their families have argued that that is detrimental. I think that's just one example of some of this broader scrutiny that we're seeing of Medicare Advantage plans, billing practices. There just are greater questions about whether there really are cost efficiencies, and whether there are enough guardrails around some of these MA plans.

We've seen Biden administration interest, certainly, in regulating these plans more, but we see big supporters coming in, in this new Republican administration. Dr. Mehmet Oz, I think, has expressed significant support for the MA program in his prior comments during his Senate run, a couple years back. We also see, as you mentioned, Congressman Brett Guthrie has been a vocal supporter of MA in his time, so far, on the Hill.

I think we're starting to hear rumblings of that, but I don't think there's anything imminent that's going to be cracking down on some of these practices that we've seen.

Brian Lehrer: Yes. In the intro, I mentioned how many health and environment issues seem to go through the Energy and Commerce Committee. All kinds of issues, including health and environment. It seems like it could be called the Energy and Commerce and Health Environment Committee, at very least. Do you know the reputation, generally, of the incoming chair, Brett Guthrie of Kentucky?

He was already chair of the Health Subcommittee, so these issues are not new to him, I know, and from the videos I've seen of him and things I've read, he looks conservative, but maybe not full repeal Obamacare MAGA, or full RFK. Do you have a basic take on him?

Rachel Cohrs Zhang: Yes, I think that read is pretty accurate. I think there are very few members of Congress who really understand healthcare, because it's so complicated. I think that Congressman Guthrie is one of those members who understands the healthcare system. He's made it a big emphasis, and as you said, the Energy and Commerce Committee has a really wide portfolio, but his top priority has been healthcare. I think that we will see some activity there.

I think he does fall into more the traditional conservative model that we saw with the former chair as well, Cathy McMorris Rogers, where they're a little bit more like pro-business, anti-regulation conservatives, not the populist Trump model that we've seen. However, there are some points of overlap. I'm sure that there will be some bipartisan work on this, but I believe that health care is going to be a top priority for him, even though the committee's jurisdiction is very big.

I don't know that we're going to see a huge departure between what the prior chair had advocated for in advance, and what Congressman Guthrie might pursue in his time as chairman.

Brian Lehrer: How I spent my weekend off watching videos of Brett Guthrie and ranking Democrat Frank Pallone, because I see how important they're going to be in 2025. All right, we'll get to RFK Jr's charm offensive beginning this week on Capitol Hill, and Rachel's article on Big Pharma not opposing his appointment, even as Kennedy takes aim at their vaccines and other products, right after this.

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Brian Lehrer, on WNYC, with Rachel Cohrs Zhang, chief Washington correspondent for STAT News. 212-433-WNYC. Will there be a new health insurance initiative from the Trump administration in this new environment? Maybe not, based on this exchange with moderator Kristen Welker, on Meet the Press last week, but this was recorded after the killing of the CEO.

Kristen Welker: Just very quickly, when will we see your fully developed plan? When are you going to show the public that?

President-Elect Trump: [crosstalk] I don't know that you'll see it at all. I can only say that we have some of the best healthcare people--

Brian Lehrer: Despite the backlash by the public, generally, I don't know that you'll see it at all, maybe no plan at all, but then there was this a few weeks ago, from House Speaker Mike Johnson, on Obamacare.

House Speaker Mike Johnson: Health care reform is going to be a big part of the agenda. When I say we're going to have a very aggressive first hundred days agenda, we got a lot of things on the table.

Speaker: No Obamacare?

House Speaker Mike Johnson: No Obamacare.

Brian Lehrer: I think Johnson walked that back a bit, but once the inauguration happens, we may see assaults on Obamacare subsidies, as we've been discussing, the requirement to cover preexisting conditions, or the expanded Medicaid provision, which extends Medicaid to people with a third over the poverty line. That's only about, say, $33,000 income for a family of three, rather than 25,000, is what I've read. I've read that Republicans want to scale back that offer to the states.

Jerry in Manhattan is calling in with maybe another point of view than what we've been hearing from a lot of other callers, having worked in the insurance industry for a long time. Jerry, you're on WNYC. Thank you for calling in.

Jerry: Thank you. The point I want to make, and before I make the point, I want to make it clear that it does not have anything to do with individual plans, Medicare Advantage plans, or small groups, but the vast majority of private insurance companies plans, and I'm guessing far more than the majority of people covered by these plans are employer-sponsored plans. The employer is basically what the layman calls self-insured.

They do buy a policy called stopgap coverage just in case the expected claims far exceed the typical, but for the most part, it's the employer that sits down with the insurance company and discusses what they want to have covered, and the service they want to have rendered, and the insurance company is basically acting as an administrator of the plan. Before [unintelligible 00:32:14]--

Brian Lehrer: [crosstalk] Right. It's like a giganto deductible where a lot of employers are paying the relatively routine expenses for their employees' medical care, and they have this stopgap measure, kind of a catastrophic backstop if an employee comes down with a serious cancer that costs hundreds of thousands of dollars, that kind of thing?

Jerry: No, no, generally it's not per person. It's here, a plan with 30,000, 40,000 New York State teachers. I think it's well bigger than that. They have a history of claims, and maybe it's $50 million or $150 million. The insurance company says, based on actuarial trending, we think next year, it's going to be 170 million. We'll give you-- Think of it more as the employer is self-insured for the whole plan, and only buys a policy if it goes catastrophic.

The insurance company is just an administrator, and if the plan wants to cover something, then the employer makes those decisions. My point--

Brian Lehrer: How does-- Yes, go ahead, make your main point. How does this inform the health insurance debate?

Jerry: The public's anger at the insurance company might be more appropriately directed for those people in these very large plans, at their employer. Just [inaudible 00:33:51] we want you to get the administrator of your health plan to do this, that, or the other thing,--

Brian Lehrer: Jerry, I'm going to leave it there for time, but thank you for making that point. Rachel, anything on that, briefly?

Rachel Cohrs Zhang: I'll just say that I think, certainly, a lot of Americans do get their insurance from their employers, and I think Congress has been less interested in regulating on these employer-sponsored insurance plans. There's a specific law that regulates what they can do and what they can't do. I think Republicans have just taken the position that government shouldn't be interfering in the commercial market.

I think there's been much less of an appetite to make changes in that market than there has been in Medicare, where the government is paying the bill.

Brian Lehrer: On your earlier comment about how complicated this all is, listener writes, "Keeping healthcare complicated is the end game for the GOP. Young reporters and legislators need not be intimidated." All right, Rachel, your article The Pharma Industry Isn't Lobbying Against RFK Jr's Nomination for a Top Health Role. They're not?

Rachel Cohrs Zhang: No, they're actually not. We reached out to all of our sources in the pharma lobbying world on The Hill, and they just said it's been crickets. There hasn't been a lot of lobbying from the pharmaceutical industry. We've seen that top pharmaceutical executives did visit Mar A Lago to have dinner with President-Elect Trump and Robert F. Kennedy Jr., who is Trump's pick to lead the Department of Health and Human Services, to just have an introductory conversation.

Both Trump and RFK Jr have used inflammatory rhetoric toward drug makers in the past, but we're seeing them try to play nice, at least in the beginning stages of the new administration.

Brian Lehrer: Well, you reported that one reason they may be trying to play nice is they want to scale back the law, that I thought was very popular, allowing Medicare to negotiate price with pharmaceutical companies. Republicans want that scale back in some way, or just the companies, at this point?

Rachel Cohrs Zhang: I think the companies. I wouldn't say that we're expecting any big repeal of the whole provision, or anything like that, but it's little changes around the edges that drug makers are going to try to water this bill down, to give themselves longer protections before negotiations can even start, or just make sure that they get more incentives for developing drugs to treat rare diseases.

So it is, I would say, relatively small changes around the edges here, but I think they're going to start there, and try to just walk back as much as they can of this law that Democrats passed without Republican input, and play into Republicans frustrations being left out of that process.

Brian Lehrer: Have those negotiations over price been saving Medicare a lot of money since they started to take effect, saving the taxpayer a lot of money, or the consumer?

Rachel Cohrs Zhang: They have not taken effect, which I think was a big problem for ex-current President Biden during his campaign, that the prices don't even go into effect until the beginning of 2026. There have been some prices that are announced, but the whole pricing system, as we've talked about this morning, is so complicated, that it is hard to know how much these new prices are going to save consumers.

We're just going to have to wait and see, but I think there has been a little bit of time that it's taking to get this program up and running, and the Trump administration is going to have some time to make their mark on the program, since it is in its early stages.

Brian Lehrer: It'll be interesting to see what emerges in terms of any explicit or behind-the-scenes deal. Yes, we'll give you RFK without opposition if you give us this much less Medicare drug price negotiation, or anything else that Big Pharma wants. Here's an NBC News headline from Friday. Backlash grows over RFK Jr's lawyer asking FDA to revoke approval of polio vaccine. Do you know about the lawyer in that position, on the polio vaccine?

Rachel Cohrs Zhang: Yes, they're talking about Aaron Siri, who is Robert F. Kennedy Jr.'s lawyer. He wasn't necessarily working on behalf of RFK Jr. on that specific case, but these two men have known each other for a very long time, and they've worked on lawsuits together, to various federal agencies, asking for documents about studies on vaccines, trying to build the case that childhood vaccines aren't safe and that the government hasn't studied them enough, or studied the entire collective vaccine schedule enough.

They've worked together for a very long time, and we have seen RFK Jr.'s team distance themselves a little bit from that specific lawsuit, because his name wasn't on it. I think it has really struck a chord on Capitol Hill, where Senator Mitch McConnell, who had polio himself, issued a statement of concern, that RFK Jr would be surrounding himself with people who might believe that the polio vaccine hasn't been studied enough, and should be pulled off the market.

We have seen Siri as a close advisor to RFK Jr., in this transition period. I think there's certainly some concern on Capitol Hill about the relationship between these two men on this issue.

Brian Lehrer: Last question, what do you think RFK is going to do this week, to make himself as confirmable as possible? We saw Pete Hegseth for defense secretary reverse himself the other day, and now support women remaining in combat roles in the military. Expect anything similar from RFK Jr.?

Rachel Cohrs Zhang: I think he's just going to be arguing, as he has recently, that he's going to be trying to say that he's not trying to pull vaccines off the market. He just wants more information, wants more transparency. I think there's a talking point that we've seen from Trump, that if they do more studies and it turns out that vaccines are safe, then that could be potentially a good thing for lawmakers who really do want to see these vaccines continue to be available for children.

I think that he may, specifically, on abortion, give more clarity as to what his current stance would be, because it's not necessarily something that he really emphasized during his presidential campaign, but in the past-- I think Republicans are finding some of his past comments on abortion problematic, if he is coming in in a Republican administration, because he started out this presidential cycle as a Democrat.

I think that we're going to see some concern that he could potentially make some offers to give these Republican senators peace of mind, specifically on his views on abortion. I think if we're going to see any new developments, it would probably be in that area.

Brian Lehrer: Well, we didn't even get to any of the climate-related items that are under the jurisdiction of the Energy and Commerce Committee, this committee that's going to be so much in the spotlight. We'll talk about it a lot. We'll invite that new committee chair, Congressman Brett Guthrie of Kentucky on the show, we'll invite the ranking Democrat, Frank Pallone, of New Jersey, and obviously talk so much about health and environment, among the many issues, in the new year, once the new Congress, the new President, take effect, take office.

For today, we thank Rachel Cohrs Zhang, chief Washington correspondent for the health-oriented news organization STAT News. Thank you very, very much. Great job.

Rachel Cohrs Zhang: Thanks for having me.

 

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