Rae Woods (00:02):
From Advisory Board, we are bringing you a live Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. These live episodes have become a special part of our events at Advisory Board, and this one is the first of 2026. And because the event was hosted in Washington DC, the Radio Advisory team decided we had to focus the conversation on the state and the future of health policy. And to do that, I've invited guest Julie Rovner, Chief Washington correspondent at KFF Health News and host of the weekly health policy podcast, What the Health. If you don't know Julie, you should. She's been covering health policy for four decades. She's reported through multiple administrations and multiple major health reform fights. I'm talking about the attempt at Clinton Care, of course, the Affordable Care Act, the many, many attempts to repeal and replace it and last year's One Big Beautiful Bill Act.

(01:02):
Julie has seen moments of sweeping change, moments of stalemate, and long stretches where policy reshaped our industry quietly through rules rather than laws. And that's actually the perspective I want to tap into in this conversation because health policy doesn't feel settled. We don't know what the next major reform effort will look like or even when it will come. The One Big Beautiful Bill Act has passed, but its impact hasn't actually landed yet. So we find ourselves in this in between phase. And in the meantime, rules, regulations, enforcement decisions, they're all reshaping our industry in very, very real ways. When I sat down with Julie, I had a clear goal. It's to help you understand which policy signals matter most in the next 12 months. What should actually meaningfully change your strategy and what might be just noise?

(01:55):
And because I know you, our listeners, have your own questions, we actually invited the audience to participate, so pay attention for my asking of their questions. Without further ado, here's my conversation with Julie Rovner, live at the Advisory Board Summit in Washington, DC. Julie, welcome to Radio Advisory.

Julie Rovner (02:21):
Thank you for having me.

Rae Woods (02:23):
How does it feel to be out of the host seat? You are officially in the guest position.

Julie Rovner (02:28):
Oh, it's much easier to be in the guest position than the host position. I don't have to worry about time. I don't have to worry about people not talking, which happens a lot, you'd be surprised. The things that we cut out of the podcast, I'll ask my very carefully crafted question and nothing will happen. I'll say, "Please someone say something."

Rae Woods (02:46):
And I am confident that will not happen with you because you have been in my seat many, many times before.

Julie Rovner (02:51):
Yes, we're up over 500 podcasts now. We've been doing this almost every week since 2017.

Rae Woods (02:57):
I want to talk about what's different in health policy today. And I want to start with the people because health policy is still made and shaped by people and this generation of policymakers feels different. What is your reporting revealing about the people in Congress in HHS in CMS?

Julie Rovner (03:17):
I feel like there are a lot of beginners that we've had sort of a generational change in health policy. For a long time we had both members of Congress and staff and people in the administration, career people, not the political appointees who come and go with each administration, who had been doing this for a long time. And I think a lot of those people are gone and/or retired and/or whatever, and we have a lot of people who are trying to find their way at a particularly difficult time for the healthcare system. I think the public is very unhappy with the functioning in the healthcare system. I would say more unhappy than they were in 2005, 2006 when things were gearing up for the Affordable Care Act, when everybody was so miserable that they were willing to give something up to get change. And I think we are approaching, if not at that point again, and yet we don't have a lot of people who make the policy who have made it before, so it's kind of a tenuous time.

Rae Woods (04:19):
That showed up quite a bit in my conversations with healthcare leaders last summer. If I can reveal, I had a conversation with an executive who found himself actually explaining to a member of Congress why you could not turn away a patient who showed up in the emergency department. This is what we mean when we say lack of expertise can become difficult when you're the ones actually trying to talk to those particular policymakers. And so, our perspective at Advisory Board is to engage with these people differently. Do you have any examples of that or ways that we should be engaging with this particular administration with this particular set of policymakers?

Julie Rovner (04:56):
I think it is always helpful to assume that people aren't familiar with what you do and what you need and what you're talking about. And if they are, then you can count yourself lucky. I noticed that Dr. Oz was at the Politico Summit. The very first thing he did was say, "Hey, you want to come to work for CMS?" And I'm like, "Gee, maybe that DOGE thing didn't work out so well." CMS actually had lost way fewer people than most of the other agencies at HHS.

Rae Woods (05:24):
And we should say that there are still folks left that, frankly, are probably your and my friends, you've been in the DC area longer than I have. They're just many layers down. And so that's one piece of advice that we're seeing with health leaders, is maybe it's not good to go to the top, go a couple layers down to the people who are still trying to shape and make progress on a lot of the longstanding goals that we all frankly have in healthcare. So that's the people. Now, let's talk about the way that policy is made. You've been covering this for I think at least six major health reform fights.

Julie Rovner (06:00):
Something like that.

Rae Woods (06:01):
Remind us where does the most meaningful policy change happen traditionally? Is it in Congress? Is it in the courts? Is it at the state level? Is it in the private sector? What's not so traditional about those mechanisms these days?

Julie Rovner (06:17):
It usually not only starts in Congress, it starts at the subcommittee level in Congress. It starts with the people who, until recently, had been doing it for 10 or 15 or 20 or 40 years and who have worked veterans of previous efforts knew what didn't work and what did. They had the expertise and they were able to reach out to the stakeholders. It's sort of the old schoolhouse rock, I'm just a bill, this is how a bill becomes law.

Rae Woods (06:46):
So the subcommittees though.

Julie Rovner (06:47):
Yeah. So things start at, yes, at the subcommittee level, there would be hearings, and then you would have subcommittee markups, and then you would have full committee markups, and then they would get together because in healthcare, as you all know, bridge is the jurisdiction of many, many committees in Congress, so you would have to have these sort of work-it-all-out kinds of meetings, and then something would come to the floor, and that would be in one house, and then we would do it again in the other house. Then they would get together in a conference. I'm old enough to remember when conference committee meetings used to be open. There was a thing called regular order and that was how bills became law, and we haven't had regular order in a long time.

Rae Woods (07:23):
There's some other kind of assumptions that I think of when I think about the Hill that I'm not sure hold or at least didn't hold last summer. Thinking of the Senate as this great softener. That was not something that we saw in the conversation around what would become the One Big Beautiful Bill Act. Certainly, the focus on the so called war on fraud, very, very focused on fraud, waste and abuse. That's a difference that we're seeing today, certainly more partisanship.

Julie Rovner (07:50):
Although partisanship, it comes and goes. It's not so much the partisanship, it's the fear of compromise. And I think those are two different things. It's one thing everybody's always been partisan, and what I used to say about health policy is that at the 30,000-foot level, they couldn't agree on anything, but at the 5,000-foot level, they would agree on a lot, and that's how a lot of health policies gotten made over the last 40 years is at that 5,000 foot level. That's where we got MTALA, where you couldn't turn somebody away from your emergency room. That's how we got COBRA, till we got literally dozens of programs that were created on a bipartisan basis because they were able to agree, even though they disagreed on how the healthcare system writ large should run. I think that doesn't happen anymore.

(08:35):
The last big bill that I can remember that was really bipartisan was MACRA in 2015. I remember explaining this past the House Energy and Commerce Committee on a unanimous recorded vote. That doesn't happen, and it passed the Ways and Means Committee on a unanimous recorded vote. That's the last real big piece of bipartisan effort that I can really remember.

Rae Woods (08:58):
More than a decade ago. And so this is why, and I think a sentiment that we've heard again and again is that health policy feels and perhaps is more volatile today. My question though is, we are, again, not at the point of the next big reform fight. We're in this in between moment. Why does this in between moment feel particularly volatile?

Julie Rovner (09:22):
I think because all of the norms are gone. This administration has come in and done things and basically wiped out a lot of these things that were bipartisan to start with. The Agency for Healthcare Research and Quality, which was created again in a budget reconciliation bill in a bipartisan way. There was some fighting about it in the late '90s and they basically reconstructed how it would be put together also bipartisan and spearheaded by Bill Frisk. Again, a lot of these things were completely bipartisan and this administration came in and said, "We don't know what this is so we're getting rid of it."

(09:55):
In my 40 years, this is like nothing I've ever seen before. As I say, administrations come and go, parties change, parties take over Congress, parties take over the administration. Priorities change, what you're working on changes, but this wholesale, let's just toss it all out. And it's not even a matter of toss it all out and start over. It's just, let's just toss it all out is what a lot of this has seemed to be.

Rae Woods (10:18):
Yeah. For me, I had described the in between moments between reform fights as something where policy is reshaped but somewhat more quietly. And here's why I think this is not a quiet moment at all. First, the rule, regulation and enforcement changes are big changes right now. Changes on faster timelines, changes that are more subject to whiplash, and I'm truly talking about 180 degrees in the opposite direction. I know I have some examples that I can share of those, but I'm curious if you have some examples of these rule or regulation or enforcement changes that are bigger changes, faster timelines, more whiplash.

Julie Rovner (10:57):
There have been a lot of them, it's hard to keep track. So many things have sort of gone back and forth. Obviously, what's going on with vaccine policy is a big one.

Rae Woods (11:05):
Yes. Perfect example of a reversal. And by the way, a reversal where I'm not sure the reversal in policy change actually matters, because the damage to the public is kind of already done and we'll be dealing with the ramifications of lack of trust around vaccines.

Julie Rovner (11:17):
And of course, we've had reversals of reversals because of courts.

Rae Woods (11:19):
We've had reversals of reversals in the last 72 hours really.

Julie Rovner (11:22):
Yeah, we're just going to say.

Rae Woods (11:23):
Should we talk about?

Julie Rovner (11:24):
Sure.

Rae Woods (11:24):
I know you cover the abortion beat as an example.

Julie Rovner (11:26):
Yes, I do.

Rae Woods (11:27):
We talk about what's happened with the abortion pills.

Julie Rovner (11:29):
Right. Reproductive health is obviously a big, big part of my beat. This has been an interesting year to follow reproductive health because ... Trump is many things, but he's very good at reading the room, and he could see that the room was not for more restrictions on abortion. And of course, the original lawsuit challenging the abortion pills availability, basically at that point it was challenging. Its entire approval was thrown out by the Supreme Court because the plaintiffs didn't have standing. But now, Louisiana has sued and the administration asked to have the lawsuit put on hold infuriated their anti-abortion allies by saying they want it put on hold because we're doing a study at the FDA, a new study of the safety of mifepristone. There have been hundreds of studies over the last 27 years since it's been approved that have found it to be mostly safe and effective. But this was their way of pushing this off until after the midterms. And then, of course, the state went to the appeals court and the Fifth Circuit Court of Appeals, if you're not aware is-

Rae Woods (12:28):
On Friday, just a few days ago.

Julie Rovner (12:29):
Yeah. Right. That said, "Yeah, we're going to roll back availability and all this telehealth and ways to get the abortion pill that are not having the doctor actually hand it to you in his or her office. We're going to make them go away." And they did it on a Friday at 5:00.

Rae Woods (12:43):
That's right.

Julie Rovner (12:44):
Everybody over the weekend was like, "What the heck just happened?" Completely blew up an awful lot of things.

Rae Woods (12:50):
Until Monday.

Julie Rovner (12:51):
Until Monday when the manufacturers went to the Supreme Court and said, "Look, these are judges undoing FDA scientific findings. We can't have this not just for abortion, but for the entire drug industry. It sets everything into a path of uncertainty."

Rae Woods (13:07):
And that uncertainty is really difficult for business leaders to navigate around. If the regulatory foundation of care models can literally shift overnight and then shift back several days later, that becomes really difficult to think about care models, to think about your business strategy. That's what I mean when I talk about the volatility of this moment, even though we aren't talking about a major legislative fight. One way to characterize this is whiplash, as we've been discussing. But another way to characterize it would be some welcome reversibility, and that brings me actually to my first audience question that came in. This is a question that I get in, I would say, eight out of 10 conversations that I have with executives today, which is, I'll just read it kind of bluntly. Will the One Big Beautiful Bill Act survive after this current administration? Do you have thoughts?

Julie Rovner (13:58):
I have thoughts. One of the things that would make it hard to repeal is the money part of it. In theory, you would have to find money to pay to restore the cuts Democrats would have to get, who knows if they win back majorities, what kind of majorities they would need.

Rae Woods (14:13):
Yeah. First of all, it's only actually worth entertaining this idea if there's a shakeup.

Julie Rovner (14:17):
Right. Also if there's a Democratic president, because they're not going to get 60 votes.

Rae Woods (14:20):
That's right.

Julie Rovner (14:20):
That seems implausible. Although today, who knows?

Rae Woods (14:24):
And are you willing to then wait that long and risk the coverage churn that you might be facing in just eight months? I'm not sure that that is worth the risk.

Julie Rovner (14:34):
Yeah, I think everything is up in the air right now. I have given up predicting things.

Rae Woods (14:39):
As you probably should, Julie. I'll say, there's also an argument that we've learned a lot actually from the repeal and replace battles that was ultimately a failed attempt at repealing and replacing these things.

Julie Rovner (14:48):
I don't think I would agree that those were failed attempts anymore because I think the One Big Beautiful bill was repeal and replace called something else.

Rae Woods (14:55):
Yes. You're right.

Julie Rovner (14:55):
I think it did as much to undo the Affordable Care Act as the 2017 bill that didn't pass would have.

Rae Woods (15:02):
And if I take that a step further, the fight that we would market as the 2017, here's when it was really obvious we are trying to repeal and replace. And when that effort did not work and instead we had to kind of change the way that we shape and market what this legislation actually looks like, I think the Democrats have learned a lot from the GOP in what did not work in 2017, what is hard to undo, what political capital you are willing to waste, especially if you are not likely to succeed. I was in a conversation recently where folks also reminded me that it is hard to undo processes when they are set up. And so, if we are effective in setting up some of the processes around work requirements over the next several years, it's actually hard to undo those things.

Julie Rovner (15:49):
Although, look at all the things that DOGE managed to undo at HHS. The idea that they literally stopped the National Institutes of Health in its tracks. Money was not going out, study sections were not meeting. Even grants that had been funded was not happening. I'm still kind of admiring in a way of how they were able to just say, "Nope, we're not doing this anymore." So it may not be that hard. Certainly, what you're saying is the conventional wisdom that it is much harder to stop something once it's going, just the inertia.

Rae Woods (16:20):
But you're right. Something that is new is increasingly the willingness to really shake things up. But there's other examples of this balance between inevitability and reversibility. Some other examples that came up, and there was an audience question about this, is what about things like telehealth flexibilities? What about things like hospital at home? It's hard again to plan your strategy if you aren't sure if some of these things are going to stick. How do you think about the balance of inevitability versus reversibility, knowing that these are unprecedented times?

Julie Rovner (16:55):
I think I'm really glad I'm a reporter and not running a business. I have great empathy for the people who are trying to plan right now. And it's not just in healthcare. As you can see, it's everything. It's tariffs that change from day-to-day. It's immigration policy that changes from day-to-day. It's education policy that changes from day-to-day. Everything that I think the strategy of this administration is to make things as uncertain as possible and they've done a really good job.

Rae Woods (17:22):
Mm-hmm. All right, let's take the temperature check of the room. I'm going to commit a podcasting faux pas here, and I'm going to ask you all to raise your hands, to share with us your posture towards planning your strategy around some of the changes in health policy. Raise your hand if your strategy is wait-and-see. You are trying to make as few changes as possible.

Julie Rovner (17:47):
Only a couple.

Rae Woods (17:49):
Short-term changes only. That's the majority of the room. Who's doing long-term structural change to your strategy to adapt to health policy? Julie, what's your take on their response?

Julie Rovner (18:05):
I think the middle one is definitely the majority of the room.

Rae Woods (18:09):
Definitely the majority of the room.

Julie Rovner (18:10):
I could see how that would make sense from a business point of view.

Rae Woods (18:14):
I will say, dare I say pleasantly surprised maybe of the number of folks who said, "No, no, we're going all-in and we're fundamentally changing."

Julie Rovner (18:23):
Well, there are other things that are obviously fundamentally changing, things like AI. The health system is always evolving no matter what, regardless of what policy says. Policy is usually four or five steps behind. That's part of the problem.

Rae Woods (18:35):
And we should acknowledge the long-term policy shifts. If I had the opportunity to ask two or three follow-up questions to our audience, I'm willing to bet that folks are probably saying, "Yeah, structural change as it relates to the slow march to value-based care, as it relates to managing an aging population and a sicker younger population." Those make sense when we think about big strategic changes that are also impacted, shaped, accelerated often by health policy.

Julie Rovner (19:00):
That's right. And sometimes health policy can thwart it and sometimes health policy can help it. The truism is that health policy is always changing, but what we've not seen is it changing as rapidly and changing back and forth as rapidly as we've seen it this year.

Rae Woods (19:16):
The reason why I wanted to poll the audience is I want to connect it to a larger observation that I'm tracking in my conversations with health leaders, which is that incumbent organizations, their position when it comes to reform is often to actually push back. They are often quick to say, "The change that is on the table is too much or it's too fast. This is something that is going to deeply impact my business. It's going to impact our patients. It's going to impact our communities." Some of that might be true, but if we really look in the mirror, some of that might also kind of be stonewalling. And if there's one thing that is clear about this administration is that they are willing to push forward rapidly on fundamental change even when there is no consensus.

Julie Rovner (20:05):
Pull down the East Wing and then ask to build the ballroom.

Rae Woods (20:07):
Yes, that is a great example. With so much focus on enforcement, frankly, my question is, can enforcement push our industry towards a future that I actually think we all want, but has long been out of reach. I'm talking about a future of meaningful interoperability, a future of alternative payment models, a future of meaningful consumer engagement, things that I'm willing to bet most, if not, all of us in this room want.

Julie Rovner (20:34):
It depends who's doing the enforcing, and I'm not trying to be flip. I'm just wondering who's still home at HHS and the FTC and wherever else this would all go on to make this happen. Do we still have a cadre of workers, nonpartisan career people dedicated to creating the policies that everybody in this room probably wants? And I answer to that is, I don't know.

Rae Woods (21:01):
Yeah. But certainly, this administration's going to try. If I think about a difference between this moment and previous moments, as you said, saying we're going to try something and then wait to see what happens with the courts. We're going to enforce and then reverse if we need to. That's part of the volatility that we're all kind of experiencing, and frankly, leading through right now. Julie, you've said in your reporting that we're in between battles for health reform, and you believe that we could be headed towards another ACA level fight. When do you think that could happen?

Julie Rovner (21:34):
I don't think it could happen before the 2028 elections. I think we're looking at 2029 if we're going to have another fight. But I do feel like everything is setting up to have another big fight. And the reason I say that is because it's not just the stakeholders now who are unhappy with the status quo, but it's the patients. There are very few people, even people with good insurance who are happy with the way the health system is functioning. Everywhere I go, people saying, "This healthcare system is so broken. It just doesn't work. Doctors are unhappy. Other healthcare workers are unhappy. Patients are unhappy."

Rae Woods (22:09):
The healthcare leaders admitted this themselves.

Julie Rovner (22:11):
The healthcare leaders are unhappy, yeah.

Rae Woods (22:11):
We admit to the faults in our structures and our systems. One of the conditions we have to think about for reform is not just who's in charge, but also what does the combination of public sentiment and the sentiment of policymakers look like, and everyone's kind of pointing fingers at us. They're increasingly willing to demand major transformation in our industry.

Julie Rovner (22:34):
Yeah. I think we don't know what it looks like. I'm actually starting on the podcast a project that's called How Would Yo Fix It? And where I'm basically going to call in everybody who has an idea and say, "Okay, what would you do if you could fix the healthcare system?" Because I think it's time to start re-airing even some of the ideas that have been around for a long time because we have a whole generation that hasn't sat through this fight.

Rae Woods (22:54):
That's exactly right. To your point, let's bring out the old ideas. Let's bring out the old ideas from the basement and shake the dust off of them and see what could happen. That actually brings me to my next question. If we think that the next big health reform fight could happen in 2029, do you have any sense of what the goal would be? Because if I reflect on the last several efforts at major reform, if I think about the Affordable Care Act, for example, the ACA's major win was actually all about coverage. The combination of Medicaid expansion, the exchanges, we were able to get record lows in the uninsured rate here in the United States. That is, by the way, eroding. We expect that low, low rate of uninsured to start to rise. So my question is, should or would it necessitate then a 2029 health reform battle to be about clawing back coverage or could we get to some other goals? Affordability, affordability for whom? Something else entirely? What might the goal of the next era of health reform look like?

Julie Rovner (23:53):
Well, dirty little secret, the goal of the Affordable Care Act was affordability too. It's just that was the part that didn't take.

Rae Woods (23:59):
That's right.

Julie Rovner (24:00):
There were a lot of things in that bill that were aimed at making things more affordable that the stakeholders ultimately pushed back and said, "Yeah, no." We had bipartisan like, "Oh, we can't have a tax on medical devices or we can't have a tax on Cadillac health plans or we can't have a tax on health insurers." All the taxes ended up going away. The only thing that was left was the coverage expansion.

Rae Woods (24:24):
So if we're shaking old ideas, shaking the dust off old ideas, you think affordability is back on the table?

Julie Rovner (24:29):
Oh yeah. Oh yeah.

Rae Woods (24:29):
That's certainly what the public is frustrated with, but I will say the public's version of affordability and their frustration is quite different than the policymaker's version of affordability, which is also probably different than health leaders definition of affordability. So where does that leave us?

Julie Rovner (24:46):
About to have another fight. It's about trade-offs. What are you willing to give up for something that you think might be better? In the end, what worked about the Affordable Care Act is that Congress said to all those stakeholders, "We're going to give all these people insurance and so you won't have to have as much uncompensated care, you're going to get paid. So therefore, let us put these taxes on you, because you're going to make more in the end." And then, of course, they ended up repealing all the taxes. It's hard to make powerful interests give things up.

Rae Woods (25:15):
But I think that's actually the most important thing that you've shared. I was actually in a conversation with Zeke Emmanuel the other day where he said the same thing, that his biggest difference between 2026 and 2006 is that big powerful stakeholders were at least willing to have the conversation about what to give up. Now, I want to give credit to the folks in this room and the leaders listening at home, protecting your margin, keeping your business open is the major priority, especially if 14% of rural hospitals are on the verge of closing any day, 35% of health systems margins are in the red before any of these cuts actually start taking place.

(25:51):
I would forgive any leader that is just focused on protecting their own margin, but big changes in healthcare policy have ultimately come from powerful leaders who've been saying, "Here's what I'm willing to give up to make the system better and stronger and navigate us towards a better future." And it will take that again when we come to 2029.

(27:07):
All right, Julie, I want to move to a little bit of a lightning round and we've gotten several questions from the audience. First question has to be about the elections. We're six months out from the midterms. If control of the House or the Senate or both were to flip, where would that matter the most for health policy?

Julie Rovner (27:25):
Obviously, it will matter for health policy. I think also what happens on the ground with some of these cuts is going to matter. That has the potential to change some minds, particularly of Republicans who might have voted reluctantly for some of these things. We have seen marches to undo things.

Rae Woods (27:42):
Are there any particular races that you're going to be watching closely in November?

Julie Rovner (27:46):
Mostly it's going to be for control of the chambers because of control of the committees. Obviously, one big race that I'm watching, even in a primary, is a Louisiana Senate race, where Bill Cassidy, the chairman of the Senate Health Education, Labor and Pensions Committee is being challenged.

Rae Woods (28:00):
Perfect example of one of the leaders that has, first of all, is a physician, has a lot of the expertise and knowledge that we talk about craving in 2026-

Julie Rovner (28:10):
And has done a lot of bipartisan work over the years. What I'm really looking at is, see if he loses his primary and becomes a lame duck, whether that will free him to do more or whether he'll be more worried about being even more subservient to try and get a job after he's losing his current post.

Abby Burns (28:30):
Hey, this is Radio Advisory host, Abby Burns, jumping in with an update. Rae and Julie recorded this conversation on May 4, before the Louisiana primary took place. In that election, Republican Senator Bill Cassidy did in fact lose his seat. So as Julie suggests, we're going to be watching for how that impacts his posture toward health policy for the remainder of his term. Back to you, Rae.

Rae Woods (28:53):
So that's elections. Let's talk about officials. Are you anticipating any major shakeups in, say, HHS?

Julie Rovner (29:01):
Everything is always subject to shakeup. There are three stories out today that say that Marty Makary, the head of the FDA is on thin ice.

Abby Burns (29:09):
Hey, it's Abby again. Last introduction from me. A few days after this recording, Marty Makary resigned as commissioner of the FDA. In his place, FDA Deputy Commissioner for Food, Kyle Diamantas, will serve as acting FDA commissioner. Okay, back to the conversation.

Rae Woods (29:26):
What about Secretary Kennedy? We saw shakeups in Trump 1.0 in terms of Secretary of Health and Human Services.

Julie Rovner (29:33):
I don't know. This is so different from Trump 1.0. the idea of somebody using the official airplane to do sort of unofficial things, it's like, "I think we've seen that in Trump 2.0 and he's still the head of the FBI."

Rae Woods (29:44):
Yeah. For those who don't remember, Tom Price, the first Secretary of HHS under Trump 1.0, ended up resigning over his own personal use of public airplanes. That was actually a scoop from friend of the pod, former Advisory Board colleague, Dan Diamond, but less confidence about will this health secretary?

Julie Rovner (30:03):
I don't know what it would take to make Trump turn against Robert F. Kennedy. I'm watching this with avid interest.

Rae Woods (30:11):
Or even him to move on to other things. He's joining our careers and launching a podcast, would he want to step down and move on to other things is another question.

Julie Rovner (30:19):
I think he's making so much basically unilateral policy. I'm guessing, I don't think he steps down. I think the only way he leaves is he gets pushed out.

Rae Woods (30:27):
We did elections and officials. Now, there's a question about the actual providers of care. Do we know how the current policy instability has led to any changes in healthcare professionals that are willing to enter this business, enroll in nursing school, enroll in medical school? What have we seen there?

Julie Rovner (30:44):
This is a big concern. This is actually a piece that I'm working on, on what we're doing to the pipeline. And when I talk about the pipeline, I mean the research pipeline, the medical professional pipeline, the government pipeline, the people who want to get in and actually make policy. And in all of them, I can see young people either going to other countries, pursuing other careers, getting out of early career positions, either getting thrown out of early career positions or deciding that this is not a good place to make their future. And I worry as I'm in my 60s, I worry about who's going to be there to sort of take care of me in 10 or 15 years when I'm going to need presumably a lot more care. I am really worried about the medical and research and policy pipeline.

Rae Woods (31:27):
Yeah. We often talk about the supply-demand mismatch when it comes to the clinical pipeline. Not just in terms of people, but in terms of expertise to be able to manage higher acuity population and a significant population at that. I know we've seen some of this even with residency match programs and how we saw several folks that are not born in the United States not match into residency programs, for example. So something that in the early phase of their career is ultimately going to affect their long-term trajectory to be able to provide care. You've reported on some of that.

Julie Rovner (31:57):
Yeah. This is another issue of a lot of our medical workforce comes from other countries, which is good and bad. There was concern about brain drains from all of the medical professionals, all the nurses that we bring in from the Philippines, all the healthcare workers we bring in from Africa, all the doctors we bring in from India. But the fact is that's who is staffing most of our rural healthcare workforce. And if we're going to make it harder for them to come or charge $100,000 for a visa or make them not give them visas, which was on the table for a while, apparently that's been reversed. That's going to be also a big issue.

(32:31):
You've got people who may not want to go into these jobs. You've got people who would want to come from other countries but can't. And then, adding to that is a piece I did last year on abortion bans, where you have, remember these are mostly medical professionals of childbearing age. It's not just people not wanting to go be an OB/GYN in a state with an abortion ban. It's someone not wanting to go have a baby, get pregnant and potentially have a complication in a state with an abortion ban because they may have problems getting care if they have problems with their pregnancies. We're already starting to see some of the movement of young people be impacted by this. So it's a lot of different things from this administration that are coming together.

Rae Woods (33:13):
And what you're getting at has been a lot of the focus of our conversation across the entire summit, which is that the ripple effects can potentially have just as big, if not more of an impact, than what has directly changed themselves. Let me hit you with a pretty loaded question that just came in. We've also spent a lot of time across the last day talking about trust, talking about how trust has eroded all across the healthcare industry. Even trust with doctors, trust with nurses, certainly trust of hospitals and health systems, pharmaceutical companies, manufacturers, health insurance companies, everybody's on a downswing. The question is, how do we restore trust and credibility in healthcare in this political environment?

Julie Rovner (33:55):
I wish I knew. My concern, it's not just trust. We've developed this antipathy towards expertise, which I think in some ways is more scary. I'm an influencer, so therefore, what I say is just as important as somebody who knows 50 times more than me. My opinion is just as valid as your opinion. It obviously got supercharged by the pandemic. Let us question authority everywhere.

Rae Woods (34:20):
From my perspective, I think there's a level of acceptance that I hope everyone in this room at least has gotten to, that this is something that is happening. Not all of it is our fault as health leaders. Some of it might actually rest with us. But it is certainly our responsibility to change. It is our responsibility to try to build back, win back that trust. And it's multidimensional. It's with the public, it's with our patients, it's with our staff, and it's with these policymakers, which is no easy task when there are so many fires that need to be put out. But I have to acknowledge, they're not all fires. We have focused a lot of this conversation on the headwinds that health leaders are facing, and that's because we need to be clear-eyed about the future that is ahead of us.

(34:59):
But there are tailwinds too. There are opportunities that leaders can chase. There are opportunities in policy. There are shifts in policy that leaders can harness both to protect their business and to protect their communities. My question for you is, where do you want to see leaders, like those in this room, actually assert their agency and their power productively when it comes to the future of health policy?

Julie Rovner (35:24):
I would like people to think long and hard about what doesn't work in the healthcare system and how we could fix it and what you would be willing to give up to have more stability and earn the trust basically.

Rae Woods (35:37):
Prove it. Actually prove it. But that didn't get me to tailwinds. That didn't get me to opportunities that leaders can chase. I'm curious if you have any other examples of folks actually going to Congress or the agencies and harnessing policy for positive.

Julie Rovner (35:53):
Well, the story that I think has amused me the most of the last couple of months is the effort by RFK Jr. to get medical schools to teach more about nutrition. I've been covering reforming medical education for decade and a half now, and I can tell you that most medical schools have already done that. In fact, I was at two medical schools in California just this February. I was in the kitchen at one of them watching a nutrition class and they all jumped on. It's like, "Oh yeah, we can do this." And it's like, "Yeah, you're already doing it."

Rae Woods (36:22):
Yeah. The problem is not education. The problem is time to be able to actually educate and do the care management with the patient in the moment between your visits. And that's, by the way, something that you do have control over changing. What's the care team model? How are you thinking about pre-visit planning? How are you thinking about maximizing the visit? That is something that's absolutely in your control. I'll share my positive example and I'll cheat because it's actually one that we just recently covered on Radio Advisory that my co-host, Abby Burns, just hosted a conversation on, which is harnessing price transparency in your favor. This is a good example of a policy change that we thought was going to have one outcome, enabling consumers to understand more about the price of the service that they are going to pay, and therefore, hopefully, make better shopping decisions.

(37:07):
That didn't happen. So now, we're seeing leaders try to harness this policy change and saying, "How can I understand what rate you are getting, what price you are charging, and how can I change my business model now that I have more of this information?" An example of trying to harness change in favor of your business practice.

Julie Rovner (37:28):
Although, as my podcast panelist, Margot Sanger-Katz so avidly demonstrated with Danish concrete, sometimes transparency can end up raising prices.

Rae Woods (37:37):
That is exactly right.

Julie Rovner (37:37):
It's like, "Oh, they're getting that much money? We could be getting that much money too."

Rae Woods (37:41):
That is exactly it.

Julie Rovner (37:41):
Transparency is definitely a double-edged sword.

Rae Woods (37:43):
Definitely a double-edged sword. Julie, you teed me up for kind of the perfect final question. You admitted that on your podcast, which is focused on health policy, you're inviting in this new segment on, "How would you fix it?" You're trying to have as many conversations with people to again, shake the old ideas out, bring in the new ideas for how we could fix healthcare. Well, I'm in the host seat today, so I'm going to ask you, when it comes to healthcare in 2026, what would you fix and where would you start?

Julie Rovner (38:15):
I don't know. One of the reasons I wanted to do this project is because I want to get some more ideas because I don't honestly know. People say, "Oh, are you a Medicare-for-All person or are you a public option person?" And it's like, first of all, I'm a reporter. I'm not supposed to have any of these preferences, but in fact-

Rae Woods (38:32):
Neither are we, as a nonpartisan organization.

Julie Rovner (38:34):
In fact, at the moment, I don't know how to fix it, and I'm hoping that one of the people that I end up with on the podcast will convince me of at least a way to start, because all I can say now as a observer diagnostician is that the system is a bigger mess than I've ever seen it in my entire life. It's harder to use. It's prohibitively expensive for many, if not, most people. Nobody's happy. Every time I go to see my doctor, I get an earful because he knows what I do.

Rae Woods (39:06):
Same. I can't go to the doctor and talk about me anymore.

Julie Rovner (39:09):
Right. Just talk about everything that's really terrible in the healthcare system. I can diagnose all the things that are wrong with it, but if I knew how to fix it, I think I probably wouldn't be a reporter.

Rae Woods (39:19):
Is there a part of the country or a part of healthcare that you think will be the place to go to for those ideas? Is it going to happen, for example, at the states instead of at the federal level?

Julie Rovner (39:30):
I think it has to happen from the top down. We've tried the state thing. We've tried the local thing. I can't tell you how many hours I've spent at sort of incubator meetings where it's like, "We're doing this and we're trying to figure out how to scale it." It's really hard. There's some wonderful local and regional programs that work on a variety of things, but nobody's been able to figure out how to scale it.

Rae Woods (39:55):
Well, if there's one clear action item that I'm taking away from this conversation is that this in-between moment, volatile as it may feel, chaotic as it may feel, it is important to bring your ideas to the table. Not just to have reporters like Julie, not just to your local policymakers, not just to your congressperson or your state senator, but we've got to go back to our own efforts, our own attempts, shake that tree and figure out what could be on the table, so that when we have a fight in 2029, it is an effective fight that actually moves our industry towards a future that I know, Julie, you want and everyone in this room wants as well. Thanks so much for coming on Radio Advisory.

Julie Rovner (40:39):
My pleasure.

Rae Woods (40:40):
Thank you, everyone.

(41:09):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. We'll see you next week.