Health Wanted: Inflammation

The Episode

There’s a war raging. No, not that one—a smaller one, inside your body. It’s your immune system vs your immune system.

This week on Health Wanted, we’re talking about the wellness industry’s hottest new catch-all: inflammation.

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The Listener Questions

Are pediatric vaccines not on the CDC schedule still covered by insurance? 

Changes to CDC’s vaccine recommendations impact insurance coverage and cost, because anything that’s recommended by the CDC legally has to be covered by private insurance. So, when the CDC removed a bunch of vaccines from the schedule (primarily childhood vaccines), states started to make their own rules to tell insurance companies they need to cover the cost of vaccines for people in those states.

Then AHIP—which is the largest trade organization for private insurance and includes some heavy hitters like Aetna, Kaiser, and Cigna—said that they would continue to cover the cost of all vaccines that had been on the schedule prior to September of 2025 through the end of 2027.

So, what will happen to pediatric vaccine coverage for people who do not live in a state that has enacted their own insurance coverage requirements when January 1 comes?

The American Academy of Pediatrics and other scientific groups brought a lawsuit against HHS and Secretary Kennedy saying that firing former members of the CDC’s advisory committee and replacing them with people hand-picked by Kennedy was a violation of procedure. They say that, because of this violation,  the changes that were made to the vaccine schedule and any votes by the new committee should not be valid. A judge recently ruled that the changes will be blocked while the lawsuit continues.

So currently, everyone everywhere should be covered when it comes to all the pediatric vaccines that were recommended prior to the changes that started in September of 2025. How long that will last? We don’t know. Lawsuits have a tendency to drag on, so we’ll just have to see when that might be decided.

What are the new Medicaid work requirements?

There are some new rules for how states enforce Medicaid coverage. The rule change is part of the Trump administration’s “One Big Beautiful Bill,” and it requires individuals enrolled in Medicaid to prove that they are performing 80 hours per month of work, community service, enrollment in an educational program, or some combination of these activities. There are exemptions for certain groups of people like those who are pregnant, postpartum, disabled, or medically frail. But, this of course presents its own challenges for people who now have to prove they need an exemption. 

So who will be affected?

• There are currently 41 states that have expanded their Medicaid programs under the ACA, and they are now subject to this work requirement. 
• States with 1115 waiver programs (which are programs that allows states to test experimental ways of distributing Medicaid funds) are also included. Because of this, three non-expansion states (Georgia, Tennessee, and Wisconsin) are also subject to this rule.
• The only states where Medicai work requirements are not changing are Alabama, Florida, Kansas, Mississippi, South Carolina, Texas, and Wyoming. 

The timeline on this has been pretty swift. HHS provided implementation guidance to states on June 1 of this year, and the rule must be implemented no later than January 1, 2027. So, states essentially have only six months to completely revamp their systems.

It typically takes states months, and usually years, to make the types of changes to their systems that they will need to enforce a rule like this. And given that the document detailing the rules for the work requirement itself is nearly 400 pages long, this is definitely a tall order. Such a short timeline is also likely to lead to errors, confusion, and coverage loss among people who are, in fact, eligible. 

So why implement work requirements in the first place? Dr. Oz and others in the Trump administration have touted this rule as a “path to prosperity" and a way to get people “back into the workforce.” To support this, HHS published a brief estimating that the new requirements could reduce poverty by 1.6 to 2.9 million people. 

This brief has been met with criticism for several reasons:

• For starters, the brief only cites 10 outside sources to back up its findings, which, given the extensive amount of literature on the topic, isn’t a lot.
• Several of these cited researchers have expressed concerns that the brief misinterpreted their work or drew overly broad conclusions from their research. The brief tends to inflate the benefits of work requirements while ignoring most of the costs. 
• The brief also mentions a review they commissioned on the scientific literature on “work promotion strategies" to support their argument. But, of the 132 studies included in this systematic review, only seven involved work requirements and none included Medicaid participants in their study population. 

But, aside from this rather questionable brief, two real-world applications of Medicaid work requirements show that these rules don’t actually achieve the path to prosperity they’re hoping for.

Arkansas implemented a work requirements program in June 2018, but it ended in March 2019 after a federal judge struck it down due to the number of eligible people it caused to lose insurance. During the nine-month period the work requirement was in effect, 18,000 Medicaid enrollees lost coverage, many simply because they couldn’t figure out how to navigate the reporting requirements, or because they didn’t know the requirement existed and simply got dropped.

And those of us here in Georgia may be familiar with the Pathways to Coverage program that began in July of 2023. This is an example of an 1115 waiver program, and it allows certain low-income adults who didn't previously qualify to receive Medicaid benefits under the condition that they meet work requirements. The program only achieved about 17% of its projected first-year enrollment, and the strict requirements for documenting and reporting work hours have prevented about 42% of people interested in Pathways to Coverage from applying in its first year. 

Plus, in both Arkansas and Georgia, work requirements have not increased employment.

To be clear, most adults enrolled in Medicaid work. In fact, 92% of people who are targeted by this work requirement are already working. The problem is largely that the reporting requirements can be extremely difficult to navigate and put an unnecessary burden on people in order to keep their coverage. Plus, poverty can make it hard to get and keep a job. People who lack access to reliable transportation or childcare can have a hard time holding down employment that they want.

This is a huge policy shift that will have wide-ranging implications, but the full impact of these changes will depend a lot on how the Centers for Medicare & Medicaid Services interprets, implements, and monitors these new requirements. 

The current rules for the work requirements are up for public comment until July 31, which could lead to some revisions. But, regardless of how each state approaches this policy, implementing Medicaid work requirements is expected to be a significant undertaking for states and Medicaid members alike. And with 5.5 to 6.3 million people projected to lose Medicaid coverage due to the work requirement, it’s going to impact more than just people on Medicaid.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel