[INSPRATIONAL MUSIC STING] - We are honored, once again, to be joined by Heather Howard who is a former commissioner of the New Jersey State Department of Health and currently professor of the practice, for the School of Public and International Affairs at Princeton University.

Heather, great to have you with us.

- Thank you, Steve.

- Heather, I was just joking, and it's not funny, not a lot going on in the world of public health, huh?

- Right, right.

There's so much to discuss.

You know, I mean, I would start by saying it feels like all of our systems are under assault.

Our entire healthcare system.

- Describe it.

- Well, we've got moving in Congress a budget reconciliation bill that would devastate the healthcare safety net.

It would be the largest cut in healthcare in history, over a trillion dollars.

And its in effect, rolling back most of the Affordable Care Act.

It would mean 16 million people across the country would lose health insurance.

- Hold on one second.

As we speak, toward the end of June, we're taping on the 18th of June, the Big, Beautiful... whatever.

We don't know what's going to happen.

It may pass, it may not.

But also, we don't know how it's going to be changed in the upper house, in the Senate.

So we don't really know.

But as it stands right now, Heather, what would the impact be on millions of Americans if passed with the elements in that legislation that take people off?

Or they're not eligible for the Affordable Care Act?

- So, the Congressional Budget Office, which is the nonpartisan score keeper for Congress.

- Right, the CBO.

- That's right, the CBO has estimated that 16 million people will lose health insurance because of this budget reconciliation bill.

And how that would happen is there's almost a trillion dollars in cuts to Medicaid for New Jersey that would mean over three and a half billion dollars annually in cuts.

So, that's 16 million nationally that would lose health insurance.

Bringing it back to New Jersey, our State Department of Human Services estimates about 350,000 people would lose their Medicaid.

But it's not just people who would lose their health insurance, it's that most of us would also see our costs go up.

For people who get health insurance on Get Covered New Jersey, which is our marketplace, our ACA marketplace, the average premiums will double.

So, it's people losing health insurance, people seeing everyone seeing their costs increase.

And then what I worry about is the downstream impact on the healthcare safety net.

What that means for our hospitals, doctors, and clinics.

I think we're going to see closures and obviously dramatically reduced access to care.

- We're going to put up the Get Covered New Jersey website right now.

And we also are working in cooperation with the New Jersey Department of Health on an initiative.

It's simply called, Vaccines: What You Need to Know.

Put the graphic up.

Vaccines: What You Need to Know.

Also go to the New Jersey State Department of Health website.

They have a significant section dealing with vaccines.

We'll talk about vaccines in a minute.

But I'm curious about this.

Why do you think, Heather, given your expertise in healthcare public policy, what would be the benefit?

What would be the payoff if leaders in Congress along with the White House were to do what you just said?

What's the benefit?

- There isn't one.

I mean, it's really shortsighted.

It's basically rolling back most of the gains from the Affordable Care Act that was enacted 15 years ago.

We finally, we brought uninsurance rates down to the lowest that we've been recording.

We're the only wealthy country that has this problem of uninsurance, that doesn't have a national healthcare system that covers everybody.

And so this would be rolling back all that progress.

And I think, you know the benefit is that, I think to the people drafting the bill is that it produces a lot of savings that can be used to extend the tax cuts.

Which are really skewed towards the highest income earners.

They're in a pickle, right.

The tax cuts expire this year and they need to extend them.

And to pay for it, they're cutting healthcare.

- But Heather, a lot of the argument is, and when Elon Musk was engaged and involved in this with DOGE.

Come on, we're cutting waste, fraud, and abuse and a lot of it is going on in the public health infrastructure.

And we have to cut that out.

And that's what people voted for.

You say?

- Yeah, I mean I think that's just, there's no factual basis for that.

The money they're cutting is reimbursements to hospitals, doctors, and clinics.

Medicaid is not a cash assistance program.

People don't get checks.

People get healthcare that is paid for.

So when you cut that money, when you cut three and a half billion dollars from the state budget, the state either has to make it up or more likely, given that we know our state budget is always so constrained, is they're going to cut reimbursements to doctors, hospitals, clinics.

So there isn't...

I mean, we all talk, when I was Commissioner of Health we talked often, the state has many plans in process to check for waste, fraud, and abuse.

But the waste, fraud, and abuse that does happen happens on a scale with providers doing improper billings.

It's not people seeking services and doctors getting reimbursed for those services.

So, I think that's just a smokescreen to cover that they're enacting the largest cut in history to pay for these tax cuts.

- In the state of New Jersey there'll be a new governor in 2026 in January.

Either Jack Ciattarelli, the Republican, Mikie Sherrill the Democrat.

What the heck can a new governor and a state legislature do if, in fact, these cuts on the federal level which greatly impact New Jersey residents, what would a new governor and legislature do, if anything?

What should they do, Heather?

- Well, I mean their hands are really going to be tied.

It's going to dramatically reduce revenue coming in.

The bill is sort of exquisitely designed to target state- - The federal bill.

- The federal bill.

- As we speak, go ahead.

- Right, seems- - And we don't know what it's going to look like in the end but go ahead, Heather.

- Right, it's moving through the legislative process, but it's pretty clear its designed to penalize states that have been more generous in expanding programs and providing health coverage to their residents, right.

- Like New Jersey.

- Like New Jersey, which has expanded Medicaid, which has its own marketplace, Get Covered New Jersey, which has done, really leaned into the Affordable Care Act and said, we want to expand that.

We have a maternal health crisis, especially among black women.

We have too many uninsured.

And so New Jersey's been making tremendous progress under this governor and the state legislature.

And its really targeting those states and penalizing them.

And so I think whoever is the next governor is going to inherit a really tough situation.

But this is going to be true across the country.

And I think all those governors are going to be lining up next year going to Congress saying, you have to help bail us out.

- Where would people go for their health coverage, for their healthcare, if in fact, this were to happen, Heather?

- Well, that's my concern, right?

Is that if we see hospitals close, we'll see reduced capacity.

If the state reduces what it reimburses, positions for seeing Medicaid patients, then doctors will stop seeing Medicaid patients.

So we're squeezing the healthcare system, which is always under, at capacity and under stress.

And so that's my fear is that its going to devastate that healthcare safety net.

So when people who are watching think, well, this doesn't affect me.

I think it affects everybody.

It affects working families, kids, seniors in nursing homes because it's going to shred that safety net that we all rely on.

- We're going to take a break.

When we come back, we'll talk to Heather Howard about an op-ed that she wrote recently about the defunding of Planned Parenthood and what the impact would be on millions of women and their families.

Stay with us, we'll be right back.

(grand music) - [Announcer] To see more State of Affairs with Steve Adubato programs, find us online and follow us on social media.

- We continue our very important conversation about public health with Heather Howard from Princeton University.

She's the former Commissioner of the Department of Health in the great state of New Jersey with nine million people in our state.

Heather, you wrote an op-ed recently, an opinion piece that talked about certain policies that would, in fact, defund, essentially defund Planned Parenthood.

What the heck is the policy?

What would the impact be on Planned Parenthood?

And why should everyone, whether they're engaged and connected to Planned Parenthood or not, care?

Please.

- So, I wrote the op-ed because this provision has gotten too little attention, I think.

- What provision is it?

- So the provision says, so in addition to all the cuts to healthcare generally, there's a provision that says, and it doesn't name Planned Parenthood-- - Excuse me, is this in the bill that's floating through Washington right now?

- That's right.

- Again, we don't know what's going to happen with it, but proposed by President Trump.

Examined by both houses of the legislature.

Passed in the lower house, went to the Senate.

As we tape on the 18th, we don't know where it's going.

But go ahead.

- So, it's a very live political issue, as you know, right.

And so the bill has a provision that basically says, Planned Parenthood cannot be reimbursed for seeing patients who are on Medicaid.

It defunds Planned Parenthood from the Medicaid program.

And we know Medicaid does not use federal funds to pay for abortion.

This is Medicaid paying for sexual reproductive health, like prenatal care, testing for sexually transmitted infections, contraception.

Medicaid cannot pay for that.

So what that means in a state like New Jersey, we have 23 Planned Parenthood health centers around the state.

A third of the patients who come to Planned Parenthood are using Medicaid.

So they're low income people from working families.

Low income people who are using Medicaid will not be able to see Planned Parenthood using their Medicaid.

So it's starving Planned Parenthood.

- But Heather, people have talked about doing away with Planned Parenthood, reducing funding in the past.

Why is this different?

- This is different because in the past they said, we won't fund abortion.

Now they're going after non-abortion services like contraception and cancer screenings.

And they're going after a significant portion of Planned Parenthood's funding.

Now the goal is to shutdown Planned Parenthood so that there's no access to abortion services.

But they're doing it by eliminating access to all these services.

- But Heather, how do you know that's the goal?

- Because they say it's the goal.

And because it's so clear what the impact's going to be, right?

So, in a state like New Jersey, in states where abortion is legal, it could still have the impact of reducing access to all kinds of reproductive healthcare.

I mean, I'll give you an example.

- Sure.

- New Jersey last year, there were over 13,000 cancer screenings at Planned Parenthood centers in New Jersey.

So a third of those were people who were using Medicaid as their health insurance, won't be able to access that care.

And I'll tell you why also we know this is about hurting Planned Parenthood.

It's the only healthcare provision in this federal bill that actually costs money, right.

So the rest of the bill is cuts to healthcare to save money to pay for the tax cuts.

But this provision, the CBO, the scorekeeper.

- Congressional Budget Office.

- Congressional Budget Office has said will cost healthcare programs 300 million dollars nationwide.

Why?

Because it's going to mean increased unintended pregnancies.

Increased reproductive health cancers.

Increased sexually transmitted infections, because people are going to have reduced access to care.

So, it's not about supporting access to care.

It's reducing access to care, and specifically harming Planned Parenthood, the largest provider of reproductive health services.

- All right, switch gears again.

The graphic will come up, Vaccines: What You Need to Know.

It is something that we've been doing, which we believe is very important.

The role of the media is to inform people with accurate, credible information.

And also go to the State Department of Health that Heather previously headed up in a previous administration.

Check out that website.

There's a section on vaccines.

From your perspective, Heather Howard, as a public policy expert in the field of public health, what does the public need to know about vaccines A and B.

What are they hearing from prominent government officials, particularly in Washington, who head up public health policy?

- Well, it starts with vaccines are safe and effective and are one of the most important public health advances of the last century, right.

So we start with that premise, have saved millions of lives and are a vital tool in our public health toolbox.

Unfortunately, as you note, we're getting, despite how clear it is, the evidence, that they're safe and effective and go through rigorous testing with our federal drug, the Food and Drug Administration.

We're getting people in Washington who are sowing distrust and adding confusion.

And fortunately, we have strong leadership in New Jersey who are continuing to confirm the safety and efficacy of vaccines.

And people, when they go to their doctors, will hear that language also from their doctors or their healthcare providers.

But I worry that the new federal officials in Washington are trying to sow distrust, are undermining decades of progress that we've made.

- To what end, Heather?

- To, I think, create confusion.

And to scare people.

And so we need- - To what end?

See, that is an affect, an impact.

- Right.

- But my question really comes down to, what would be the goal?

Because if, in fact, federal officials, more specifically RFK Jr., does away with a vaccine advisory council of 17 members, I believe and then puts in a brand new group of people who he says will be more science based.

Why would one do that?

It's not just to sow public distrust.

Isn't it something greater than that?

As it relates to vaccine acceptance, and or resistance?

- Yes, I mean I think that's definitely true that they're trying to undermine.

They'll raise unfounded concerns about specific vaccines, but the goal is really to raise concerns about vaccines more broadly, despite the clear evidence.

And I think it's actually even bigger than that, though.

I think it's about undermining trust in scientific agencies more broadly.

Whether it's the EPA or the CDC, right?

So, I think it's about undermining trust in agencies that have, unfortunately, that have had our back, that have had public health's back, but they're trying to undermine all of their recommendations.

Whether it's about Clean Air Act regulations, or about food safety recommendations.

That's my fear.

- Heather, we cannot thank you enough with your busy schedule.

For staying with us to take all this time.

Heather, I guarantee you that we'll continue to do our work as long as we can.

Informing people with factual, important public health information.

Heather Howard, the former Commissioner of Health in New Jersey.

A professor of the practice for the School of Public and International Affairs at Princeton University.

A little school in New Jersey.

Heather, thank you so much.

We'll talk soon.

- Thank you.

Thank you.

- You got it, I'm Steve Adubato, that's Heather Howard.

We'll see you next time.

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