The idea that any administration would have that much power over the scientific agenda is certainly not the way I think most scientists say is the best way to run science in the United States, no matter where you are ideologically.

Hey, everyone from KQED in San Francisco.

This is Political Breakdown.

I'm Lesley McClurg.

I'm filling in today for Marisa Lagos.

Today on the Breakdown politics is reshaping American science.

Since Robert F. Kennedy Jr.

Took over as Health Secretary, billions of dollars in research funding have been cut.

Grants have been canceled, clinical trials have been really disrupted.

Scientists say they're scaling back ambitious projects and We're probably gonna stop publishing in the Lancet, New England Journal of Medicine, JAMA and those other journals, because they're all corrupt.

Kennedy says he's restoring trust in a broken system, but critics say America is really risking its scientific edge.

We'll discuss the facts, but first we're joined by KQED politics correspondent Guy Marzorati.

We're gonna talk about a proposed tax bill that could raise premiums on Californians.

Welcome Guy.

Hey.

So let's just set the stage a little bit.

Recently, Newsom passed a state budget.

Within that, there's been quite a debate over Medi-Cal.

What has happened and why has that been such a sticking point?

Yeah, huge sticking point.

It's become recently, in recent years, just a big political battleground in budget talks year after year.

Medi-Cal, which is our state version of Medicaid healthcare for low income Californians.

Part of this, Leslie, is just the size of the program.

When you're talking about Medi-Cal, it is the second biggest piece of the general funds in the state budget after education, 20% of the general funds and it's growing.

We now have more than a third of Californians on Medi-Cal.

And I think increasingly concerning for lawmakers is the costs are being driven not just by like more people entering the system, but by the per person cost.

You know, the benefits, the payments that are going for Medi-Cal patients, this system is growing in size.

And so when you look at a budget situation like we've had the last few years where there do need to be cuts made, Medi-Cal is a place where Newsom controversially has looked, and you've seen a lot of back and forth between the governor and legislative Democrats on how those cuts kind of take shape.

And part of it is politics.

Look, healthcare spending, Medi-Cal spending is much more politically controversial than education spending.

That's just the fact on the national level.

This has become a big pull, push and pull between Democrats and Republicans.

And it expected to be in this midterm year after Republicans made big cuts to Medi-Cal.

Well, let's talk how it's, or let's talk about how it's been traditionally funded.

Yeah, so you've got federal matching funds as well as these health plan taxes.

It's kind of complicated, but try to simplify it for us.

Yeah, look, this is the, the health plan taxes is a huge way that California has paid for Medi-Cal in in recent years.

The way it works is the state taxes, health plans that cover Medi-Cal.

So think about Kaiser, Anthem, and then is able to use that to get matching funds from the federal government.

So let's say hypothetically they tax these health plans, they're getting $3 billion in revenue.

They're able to unlock through that 3 billion more dollars from the federal government.

The way it works, interestingly though, is the money that they're getting from those health plans is returned back to the health plans.

It's through the capitation rate, it's through what the state is paying to these health plans through the Medi-Cal system.

So the net effect is the health plans are made whole, they're taxed, but then they're getting the money back.

The real net result is the state is coming up with billions of more dollars from the federal government every year.

This though, is all changing.

This was a huge focal point of the Medi-Cal, the Medicaid cuts that the Republicans and, and the Trump administration enacted in their budget bill.

So all of this is changing, right?

As California is trying to negotiate this budget And meaning that all of that money is no longer on the table to help fund Medi-Cal.

So Newsom comes out with a $2 billion plan.

What is in that plan to help shore up Medi-Cal?

Yeah, so what the Trump administration said in H.R.

1, in the budget bill, was the state is no longer able to enact these taxes on Medicaid plans in ways that they're not doing for private plans.

So California overnight had to basically reduce this tax on Medicaid plans.

So you go from Leslie, $7 billion, $8 billion coming in every year to basically nothing, tens of millions of dollars overnight.

Newsom is trying to figure out a way, okay, how do I make up for this in some way and bring in more money for this really expensive system?

What he lands it on is putting a new tax on private healthcare plans.

Now, the reason why this is politically sticky is those costs are likely going to get passed down to consumers, to people who have private healthcare plans at a time when Newsom and Democrats are railing against Republicans for cutting subsidies to private healthcare plants.

So it, it becomes a difficult political issue when you're talking about something that could end up costing folks a hundred dollars a year in premium increases and even more political politically sticky Newsom has to get federal approval for this because it's this kind of interplay between federal and state dollars.

He has to go to the Trump administration and say, can I go ahead and do this?

And that's where we are right now, waiting for that decision.

And this then lies with Dr.

Oz, who is the US Centers for Medicare and Medicaid Services.

He's in charge.

Do we have any sense which way he's likely gonna fall?

No, but we have heard from Republicans in the state assembly saying, reject this, saying, you know, it's not worth it to bring in money for Medi-Cal to have people pay higher premiums.

Even if yes, this could end up in, in cuts to healthcare for low income Californias they're saying reject this.

And so now, yeah, it's the, the political football is up in the air.

Dr.

Oz could reject this, but then it kind of turns back the other way For Republicans, maybe Newsom is then able to say, look, we're having to enact these cuts because the Trump administration blocked what we trying to do.

This might be all complicated enough that it's hard to see as just like a direct tax that is being passed down to, to consumers and more something that is being enacted on health plans that then gets trickled down.

So where the politics ends up on this is, is still kind of unclear.

So a hundred dollars potentially for the average person or healthcare for low income residents.

Yeah, that's the, the debate on the table.

What are the other pieces of Medi-Cal that have been hot this year?

Yeah, again, this was a huge piece of where Newsom looked to balance the budget.

One of the most controversial areas was basically the income, the amount of money, the assets that seniors could have and still qualify for Medi-Cal.

That was $130,000.

Newsom wanted to bring that down to $2,000.

You can understand the outcry senior you're saying 2000 do I'm, that's all I can have in my bank account if I'm living in the Bay $2,000.

So there's a lot of pushback on that.

And then the other area that year after year we see as politically controversial is Medi-Cal benefits for undocumented Californians.

Last year, Newsom went ahead and, and his plan was to freeze new enrollment for undocumented adults in Medi-Cal.

He came back this year with a proposal to raise premiums.

And so all of that I think has, has, has added up to get a lot of pushback, especially from immigrant advocates.

I talked to Masih Fouladi who has the California Immigrant Policy Center.

Here's what he had to say about where he felt Newsom landed on this.

I think when Governor Newsom came into office, he had the bold vision for a system that cared for health for everyone regardless of status.

And he was able to implement that by 2024.

And unfortunately over the last two years, we've seen cuts to that vision.

So you see the pushback from advocates.

Newsom will say, I've done more than any governor in California history to expand coverage to undocumented residents.

But the budget realities are really catching up these last couple years.

What was fascinating to me this year, Lesley, was the pushback from Democrats and the legislature.

Usually the governor drives the train when it comes to the budget.

This year you really saw legislative Democrats push back and a lot of those things I discussed, the the change in the asset limit got punted to next year the, the change to premiums for undocumented residents that got punted.

So you really, for the first time I started to smell duck lame duck.

You started to see Newsom's in his last year and you saw a lot of Democrats really stand up to that and kind of push this issue to next year.

So we push it to next year.

What happens to the state budget in the meantime?

Good question.

So I think this now becomes an issue for whoever the next governor is, likely Xavier Becerra the Democrat.

And you saw this week Newsom sign a bill that would basically require the next governor to bring forth new revenue ideas for Medi-Cal.

What that means in practice is come up with ideas for how businesses who employ a lot of people on Medi-Cal to maybe have to pay some kind of tax or fee.

He did a whole signing ceremony.

Guess who wasn't at the signing ceremony?

Xavier Becerra.

It's gonna be his problem because I really see this could go one of two directions, right?

There's IPOs, there's a, you know, more tax revenue coming in from Silicon Valley and this is no problem.

Next year they're able to to fund Medi-Cal or it goes the other direction.

And Xavier Becerra in his first months in office has to deal with what is a mounting fiscal crisis, really with our state's healthcare safety net.

And again, that is 15 million Californians in their healthcare.

on the line?

Yeah.

KQED politics correspondent Guy Marzorati.

Thanks so much.

Thank you.

I am joined now by Julie Rovner.

She's the chief Washington correspondent for KFF Health News.

Let's talk about how politics is now shaping the country's science agenda.

Welcome Julie.

Thanks for having me.

So a recent move that was a bit of the sleeper in the news cycle, but actually really, really important was, you know, the Trump administration has put out this proposal that would allow the administration to block federal grants that don't satisfy the president's agenda.

In broad strokes, what is in this 400 page proposal?

Well, this is something that the first Trump administration wanted to, in fact, Russell Vought, who's the head of the Office of Management and Budget, it's been his sort of fondest wish that anything that ever happens in an administration be under the purview of political appointees.

And that's not how the federal government has worked for 250 years or the, I guess 230 years, however long we've had it.

It's certainly not how science has worked at the Department of Health and Human Services.

Basically, political appointees set the agenda, but things like research grants are all handled by outside peer reviewers, inside civil servants who remain in, you know, through Democratic and Republican administrations.

It's never been politicized, if you will.

And that's clearly the effort here.

I mean, they don't deny that that's what they want.

They basically wanna say, we don't think we should be sending money out the door if it doesn't agree with our priorities.

Congress has something to say about that because the administration's supposed to be sending out things according to Congress' priorities.

They are under the constitution, the ones who have the spending power.

And what exactly is in this proposal and and how is it different than what has already been tried in terms of they've already tried to cut federal grants, they've already tried to make major changes.

What's new in this proposal?

Right.

Well this would basically, you know, make it official.

They have tried to do all of these things on their own.

Most of them have been stopped in court.

Although we are having another fight this year about money that's supposed to be going out the door, not going out the door.

You know, HHS officials, including the secretary, came to Capitol Hill, told members of the, the House and Senate Appropriations Committee, the people who actually, you know, write these bills and say how much money goes where.

And they say, oh, this year we're gonna get it all out in time.

And it's now July, almost the end of the fiscal year, which ends September 30th, and a lot of money is still being held up, but basically this 400 page proposed regulation would say we, the Executive branch are in charge and we don't actually care what you want Congress, we're gonna do what we want.

And what is the president's agenda?

Basically, he said, anything that's not, that's anti-American will no longer get federal funds.

What does that mean In science?

They wanna cut anything that has to do with DEI, diversity, equity, inclusion, and basically anything that they politically disagree with.

So, you know, all of these things about anything, they're, they now have, you know, some words that they actually use AI to go through and, you know, pull things out.

And diversity is one of those words and gender is one of those words.

And often they're sort of snagging things that really don't have anything to do with DEI.

It's just the way scientific, you know, study is done.

But basically if they, if it does not align with their priorities, I believe those are the exact words, then they don't think they should have to fund it.

And how much more power does this?

Would this, if it went through, give the White House?

Well, it would give the White House a lot more power.

One presumes it would end up at the Supreme Court.

But of course we've seen that the Supreme Court seems pretty willing to give the executive a lot of power.

I'd be very interested in this.

It does seem to fly directly in the face of Congress, has the spending power and the administration, whichever administration it is, is supposed to carry out Congress' wishes on how money is spent.

What are the practical implications?

So let's say the Supreme Court does rubber stamp this, what would, what could unfold and what would it look like?

It seems like it'd be a massive log jam.

It would, I mean, if you can just imagine, you know, science is not a straight line.

These are often grants that, you know, go that string on for many, many years.

A lot of really important scientific achievements have taken years, if not decades to make.

So if you have administrations changing and then one, you know, one money stream is gonna stop and another one's gonna start every four years or even every eight years, that's not really how science is best done.

I mean, you know, that, that it's been the one thing I've been doing this 40 years I've been following Department of Health and Human Services and funding through the National Institutes of Health and, you know, all of the, the various public health infrastructure and basically a lot of it has gone on, there's been huge bipartisan agreement that the US has been a leader in science and that the US should remain a leader in science.

And that one way to do that is to leave most science to the scientists, which is not to say there are not a lot of controversial things that administrations will differ on and that they will, you know, argue about.

But the idea that any administration would have that much power over the scientific agenda is certainly not the way I think most scientists say is the best way to run science in the United States, no matter where you are ideologically.

In other words, federal grants would not be vetted based on their merits of the quality of the work or the quality of the idea or the quality of where it would take us.

It would be whether or not it fit into the President's agenda.

Well, presumably it would be both.

I mean, you know, they'll say it's, you know, that, that we're still gonna look at these things based on, you know, we have the, the Secretary of Health and Human Services, reparative Kennedy Jr.

Likes to talk about gold standard science.

But you know what, what he considers gold standard science does not seem to be what a lot of other scientists consider gold standard science.

So they will say that, yes, you know, we're doing this according to the best science, but also according to our agenda.

And that is something that we have not seen before.

As I say, you know, when administrations change, and it's not always Democrat to Republican, sometimes it's Republican to Republican or Democrat to Democrat.

There are differences in priorities and there are differences around the edges and there are differences in, you know, we want you to do this, but not that.

But generally, I mean, when the, when the administration has refused to spend money the way Congress has ordered them to and has passed legislation, the president has signed legislation saying they will, administration officials are called up on the carpet and saying, you know, Congress will say, we told you this is how you're supposed to spend this money.

This is how you're supposed to spend this money.

That's not what's happening with this administration.

You pointed there that RFK has a, a gold standard of science that he says he is moving towards.

What is that gold standard that he appears to be going towards?

Well, it's not entirely clear what the gold standard is that he is going towards, but he certainly has his own priorities.

I mean, you know, we, we, he's he's basically told us about them.

He wants fewer people on antidepressants.

He wants, you know, more studies of vaccines.

He clearly does not believe that most vaccines are worthwhile.

He's made that clear in some of the appointments that he's made and some of the things that he said, he wants better food in hospitals.

He wants better food in general.

He wants to determine what goes on at other departments.

He has stopped the State Department from giving money to the Global Vaccine Alliance.

He has tried to stop the Environmental Protection Agency from allowing the use of Roundup, the, the pesticide, pesticide, glyphosate.

So, you know, he's, these are things that he doesn't actually even have power over that he's trying to do.

So he, he clearly has a whole list of priorities.

He calls them gold standard science.

As I say, others don't.

He has pushed back against, I mean, historically we've used scientific journals to vet the science that's been a primary mechanism.

He does not like scientific journals.

He's kind of, he calls them corrupt.

What is his reasoning for that, considering he wants a gold standard?

Well, most scientific journals are in fact supported to some extent, or sometimes to a large extent by pharmaceutical advertising, which he says, you know, basically pollutes their content and they say it does not, that that's a legitimate argument, but they're not, they're certainly not the people who do the peer review of a lot of these journals that we have used for generations now to advance science.

Certainly don't consider themselves captive of the pharmaceutical industry in the way that he does.

And just a month or two ago, you know, when a, a journal retracted a couple of studies that were, that suggested links between vaccines and some other health issues, he demanded to know, you know, to see the scientific evidence that they used to retract those studies.

I mean, they retracted them the way scientific journals retract studies all the time.

They said that, you know, there was a complaint, they looked into it, they thought that the methodology did not prove what the study said that it found, and therefore they're gonna, you know, take it down.

That's how the scientific process works.

Things do get retracted sometimes Kennedy was very upset because some of these were some of the studies that had been used by some of the vaccine skeptics and vaccine deniers to suggest that vaccines are dangerous.

So instead of scientific journals, what is he proposing we use instead?

Well, I mean, he would like to see more He calls, you know, placebo controlled double blind experiments, placebo doubleblind studies.

Thank you.

Double-blind placebo controlled trials.

Controlled studies, right.

Controlled trials, which we have had, by the way, on most vaccines, I think perhaps all vaccines.

I mean, he, he often says things that, you know, turn out not to be completely true or sometimes not to be true at all.

But he, you know, he does not like science as it has been carried out for the last few generations.

And I, and we know that before he came to this job, you know, he worked as a lawyer suing a lot of these companies, suing pesticide companies, suing vaccine companies, suing drug companies.

So it's not that he's being, you know, not that he's changed his mind on any of this, but he has sort of a, a different view, shall we say, of how science works.

If we decided that we wanted to take out the pharma funding, which you just said is, you know, a corrupt part potentially in, in the scientific journals, what are some alternatives that researchers are suggesting we could do to, to, to create a more fair, valid system instead?

Well, somebody, I mean, it's not, it isn't, science isn't free.

You know, we, we actually, the United States spends a lot of money on science through the government, and as I say, it's supposed to be relatively apolitical.

I will never say that science is completely apolitical and, you know, there are some journals that, that don't take pharmaceutical money there.

But it, it's hard to really figure out, you know, how we can do this without saying either the government is going to pay for it or do we wanna rely on wealthy individuals to pay for it.

You know, how it, it's, there's always gonna be somebody who's gonna pay for it, and we're gonna have to, you know, decide for ourselves whether or not we can keep the editorial content different from the, the people who were paying for it.

As I say, we've built up over many generations now, a scientific enterprise that's aimed at keeping as much, you know, special interest out that we have.

You know, people have to, to say if they have any financial interests in any of the things that they're testing.

At least we've been relying trying to rely on more transparency.

Is it ever gonna get pure, I doubt it.

He's called out three specific journals, JAMA Lancet and the New England Journal of Medicine.

Those journals have been pretty critical of the Trump administration.

Do you think this is retaliation on his part?

I think he thought this before, but I think he thinks it more now.

I mean, and obviously, you know, JAMA, the, the Journal of the American Medical Association does not carry the water, if you will, for the American Medical Association.

The organization that actually does lobby and make policy.

You know, JAMA is quite separate.

You know, again, the New England Journal of Medicine comes out of, you know, a group of doctors who, you know, the New England Medical Society, again, they are slight slightly separate from the editorial content.

As someone who's been a journalist all of my life, you know, I've worked for private entities that have had owners and they don't interfere with the editorial content.

I, from everything I know most of the journals don't have their editorial content interfered with either.

But obviously this is, you know, he is, I'm, he likes to see conspiracies and he sees a lot of everything that goes on with sort of the medical journal complex, if you will, as you know, being dictated by the funders.

And that's not always the case.

He's even threatened to prosecute the journals.

Have we seen any action on that front and do you foresee him actually following through with that threat?

You know, the one thing that this administration has tried to do that I think judges have all pushed back on pretty hard is, you know, what they consider to be violations of the First Amendment.

So I, it, it would be hard for me to see how he could really punish the journals.

I mean, he has threatened to ban HHS scientists from publishing in the journals.

He could presumably do that, although, you know, these are the journals that most members of the scientific community and most doctors read those, these are the sort of the, the, the three biggest ones.

And that's sort of cutting off your nose, to spite your face.

If he says he wants to have better science, it would be pretty hard to have them, but not have, you know, your, your work publicized by the places where most people will see it.

We're seeing now, as we build up towards the midterms towards the fall, that HHS, the Health and Human Service Secretary is, is beginning, the RFK is beginning to pivot, maybe potentially towards drug pricing, towards food safety over vaccines.

Do you think that's an actual shift in priorities or do you think that's responding to what they think will work going into the midterms?

Well, we've been told that that RFK Jr.

has been told that polling shows that vaccines are still actually pretty popular and maybe he should back off of the anti-vaccine stuff and concentrate on other things.

And that does seem to be what he's doing.

You know, then there are sort of continuing rumors about, you know, is he gonna stay?

Is he gonna go, what's he gonna work on?

We are supposed, we actually have had nominated a new Deputy Secretary of Health and Human Services named Chris Klomp, who's sort of more of a sort of someone who's, who's been sort of working around the entire department really on an ad hoc basis for the last couple of months, trying to get things to simmer down, if you will, and run a little bit more regularly now.

I mean, it's important to remember that even before RFK Jr.

was confirmed, DOGE had come in and cut HHS dramatically.

The department had about 80,000 full-time employees.

It was down at one point to I think around 60,000.

So a lot of people left, a lot of people either took early retirement, were laid off, were sent packing in one way or another.

Some people simply quit.

They decided they could not work for this administration and that the politicization of what had been, you know, as I say, a fairly apolitical civil service, they're trying to rehire now, if not rehire, at least refill some of those empty jobs.

But we're seeing sort of every week more things that aren't getting done.

As I say, money not going out the door that's been appropriated by Congress.

We have a, you know, a a a serious outbreak now of cyclospora that apparently the FDA lab that's supposed to test for it has been dismantled.

We don't know if it's been put back up and running.

So there are a lot of things that used to just happen behind the scenes that aren't happening right now.

You're beginning to see the rubber hit the road on some of those.

Yeah, we, we got all those people and it actually makes quite a difference.

Do you think that Trump sees Kennedy as a liability or as a positive going into the midterms?

I think it's both.

I think, you know, obviously Kennedy has a big following with this Make America Healthy Again movement.

And that was why Trump wanted him.

He wanted the, the sort of the people that Kennedy could bring along.

On the other hand, the Make America Healthy movement is not very happy with Kennedy right now.

They're not very happy with the HHS they've done, you know, they've lost their fights over things like glyphosate.

They don't think he's been strong enough on some other things.

They think he's been too strong on some things, not, not everybody in the Make America Healthy Again movement is anti-vaccine.

So it's hard to know whether this is gonna be a net benefit, you know, or a net negative for the Trump administration and Republicans in general.

When you get down to November, How do you think his popularity stacks up against other members of the cabinet?

The, the last I saw, it's not very high.

I mean, he's been divisive.

He, he prides himself on being divisive.

I don't think he minds that he's divisive.

I think he likes to be divisive, but, you know, that does not make for, you know, a very high approval rating.

And as I say, he's, this administration in general, and HHS in general has managed to make a lot of people angry as HHS always will because it touches so much of everybody's lives.

I mean, it's, you know, it is basically the entire scientific and medical community and the human services side.

I mean, there's just, there are a lot of programs that come out of HHS and if they don't run the way people want them to, people are going to be unhappy.

We will be following your reporting.

Thank you so much, Julie.

My pleasure.

Julie Rovner is the chief Washington correspondent for KFF Health News.

Our video team includes Derek Lartaud, Hazel Tesoro, Matt Morales, Vivian Morales, Kate Lowpenski, and Gilare Zada.

I'm Lesley McClurg.

See you next time.