The following is a transcript of the podcast episode:
Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.
Today, we are talking with Kristina Fiore about how the federal government has been targeting gender-affirming care for youth. Then I’ll share which states have passed laws making ivermectin available over-the-counter (OTC), and which states might follow suit. To round out the episode, Joyce Frieden will highlight some under-the-radar provisions in the so-called “Big Beautiful Bill” that haven’t gotten much media attention.
The federal government has youth gender-affirming care in its crosshairs, and it’s made some big moves in recent weeks. The U.S. Department of Justice (DOJ) issued more than 20 subpoenas to doctors and clinics involved in youth gender care, and the Federal Trade Commission (FTC) held a day-long workshop focused on all the downsides of such care. Kristina Fiore is here to tell us more about the recent federal attention to this medical issue.
Kristina, can you tell us first about the DOJ’s action? Do we know who exactly received the subpoenas?
Kristina Fiore: We don’t know who exactly received the subpoenas, but we do know that there are several clinics across the U.S. that offer youth gender-affirming services. CMS recently sent letters to some of those facilities asking for more information on their services. We don’t know exactly what is in the subpoenas, but the DOJ has said that the investigations include healthcare fraud and false statements.
DOJ chief of staff Chad Mizelle said at the FTC hearing that the gender-affirming care industry has “perpetuated one of the greatest frauds on the American public.” This certainly isn’t the Trump administration’s first action against youth gender care. It all started in January with an executive order on, “Defending Women from Gender Ideology Extremism.” We also saw a massive 400-page report on gender dysphoria from HHS in May.
Robertson: And now we have the FTC workshop. What happened there?
Fiore: I think it’s pretty remarkable that this is the FTC which, under the Biden administration, had very different priorities, like tackling the influence of private equity in healthcare. Now this new FTC is holding a hearing that’s pretty one-sided, and only invited detransitioners and healthcare providers who have criticized gender care. Experts in gender care were notably absent from the FTC meeting.
One woman who detransitioned shared her story about feeling pushed into puberty blockers at age 12 and a double mastectomy at age 13, and she’s filed a lawsuit over all of this. There was an attorney for Protect Kids California who actually shared pictures and names of individual doctors and clinics that she said were “experimenting on children.”
There had been some pushback ahead of this workshop from within the FTC. A group of anonymous FTC staff issued a statement that this hearing wasn’t in the FTC’s lane, and they stood up for their LGBTQ colleagues, but an FTC spokesperson basically said that they were free to resign.
Scott Leibowitz, MD, the co-lead for the WPATH [World Professional Association for Transgender Health] Standards of Care Version 8 adolescent guidelines — now, this is the industry-standard guidance for treating transgender people — he called the workshop politically motivated and said that it sowed misinformation and promoted fringe opinions.
Robertson: You also had some other DC-related news for us this week, right?
Fiore: Oh, yeah. But it’s not about gender care, but it’s on another favorite topic of the administration, which is advisory committees. So HHS Secretary Robert F. Kennedy Jr. abruptly canceled a meeting of the U.S. Preventive Services Task Force, or USPSTF. An HHS spokesperson didn’t give us a reason for canceling the meeting, which was set to discuss diet, physical activity, and weight loss to prevent cardiovascular disease in adults.
We were told by a source that this came as a shock, as all the participants were prepared for the meeting, and their travel accommodations had all been booked, and there’s no known plan to reschedule, the source told us. So as you can imagine, public health experts are getting nervous, because we all saw what happened with CDC’s Advisory Committee on Immunization Practices. Kennedy dismissed all 17 of those panelists, and the question now is, will USPSTF see a similar fate?
Robertson: We certainly hope not, and we’ll be standing by to find out. Thank you so much, Kristina.
Fiore: Thanks, Rachael.
Robertson: Now it’s actually time for you to switch seats with me and take the host seat for this next segment.
Fiore: Okay. A handful of states have passed legislation allowing ivermectin to be sold and purchased over-the-counter, and other state legislatures have their sights set on doing the same. Rachael Robertson will fill us in on where this legislation has passed already and where it’s gotten traction.
Rachael, why is there momentum to get this antiparasitic drug over-the-counter in the first place?
Robertson: During the pandemic, there was a lot of misinformation circling about ivermectin. Some people falsely claimed that it was a treatment for COVID, though research continues to show that it is not effective against the disease. Ivermectin tablets are FDA approved at specific doses for treating some parasitic worms and as topical formulations of ivermectin are also FDA approved for certain skin conditions and for head lice, but neither formulations are FDA approved for preventing or treating COVID.
Fiore: Which states have already made ivermectin available over-the-counter?
Robertson: So far, four states have made this move, and none of the laws have information about dosing. The first state to do it was Tennessee back in April 2022. That legislation authorizes ivermectin “suitable for human use” to be sold or purchased over-the-counter “without a prescription or consultation with a pharmacist or other healthcare professional.”
Three years later, this past spring, Arkansas and Idaho passed similar legislation. The fourth and final state to have passed OTC ivermectin legislation so far is Louisiana, whose legislation went into effect on June 20. Ralph Abraham, MD, who is the state’s Surgeon General, backed the bill. The Louisiana law specifies that a pharmacist can dispense ivermectin to adults, “pursuant to a standing order issued by a healthcare professional with prescriptive authority,” and requires the pharmacist to provide the patient with information on indications and contraindications, as well as a screening risk assessment tool. For this service, the pharmacy may charge an administrative fee.
Fiore: So what states have over-the-counter ivermectin legislation in the works?
Robertson: There are nine other states with OTC legislation and various points in the pipeline: Texas, New Hampshire, North Carolina, Pennsylvania, Georgia, Alabama, West Virginia, Missouri, and South Carolina. Nearly all of the bills have been proposed in the months since President Trump’s second term. Most of the legislation has the same formula as the laws already passed. Some require the pharmacist to dispense information sheets on side effects and contraindications, and many have protections against disciplinary actions for healthcare professionals.
New Hampshire’s bill, which was introduced back in May, has a kind of unique approach. It lumps together ivermectin access with an unrelated Medicaid provision. And then Georgia’s bill, which would remove ivermectin from the state’s list of dangerous drugs, which is another barrier it would face there. South Carolina and Missouri’s bills seek to make both ivermectin and hydroxychloroquine over-the-counter. We’ll be following if any of these states push through their legislation.
Fiore: Okay, great. Well, keep us posted on that. Thanks so much, Rachael.
Robertson: Thanks, Kristina. I’ll take it from here.
Earlier this month, President Trump’s reconciliation bill, which he refers to as the “Big Beautiful Bill,” passed by narrow margins. The bill has some pretty controversial provisions, like a nearly $1 billion cut in Medicaid funding, a Medicaid work requirement, and cuts to the food stamp program. But as Washington editor Joyce Frieden is about to explain, there are some provisions in the bill that didn’t garner quite as much attention.
Joyce, let’s start with you telling us about the provision involving Medicaid provider taxes.
Joyce Frieden: Hi, Rachael. Well, many states currently impose taxes on Medicaid providers to increase the amount of Medicaid matching funds they receive from the federal government. They then redistribute those taxes back to the same providers. Some conservative groups in the Trump administration have criticized the practice as “money laundering.” But under the new law, states won’t be able to establish new provider taxes or increase the rate for existing ones.
Zachary Baron, JD, a director of the Center for Health Policy in the Law at Georgetown University’s O’Neill Institute, told me it was interesting to see people criticize the provider tax “when Medicaid has a host of arrangements and waivers … for states that didn’t expand Medicaid to try and find ways to better support providers in those states.”
Robertson: Interesting. What about the provisions in the bill involving Planned Parenthood?
Frieden: Yeah, well, under those provisions, the use of federal Medicaid funds for so-called “prohibited entities” is barred for one year. Prohibited entities include nonprofit organizations, like Planned Parenthood, that are primarily engaged in family planning and reproductive health services that provide abortions, beyond those for pregnancies resulting from rape or incest or those required to save the mother’s life, and that received at least $800,000 in federal and state Medicaid funds in fiscal year 2023. Unlike many other provisions of the law, which have implementation dates in 2026 or even further out, this provision takes effect right away. However, Planned Parenthood and several of its affiliates sued almost immediately after the bill became law, and now a federal judge in Massachusetts has issued a temporary restraining order against the provision.
Robertson: There’s also a provision regarding a small business tax deduction. How will that provision impact private practice doctors?
Frieden: Yes, this provision has a funny name. It’s called the deduction for pass-through entity taxes. Pass-through entities are businesses in which the profits “pass through” from the businesses to the owners, and the owners pay the taxes individually. The law eliminates the federal tax deduction for state level pass-through entities and the American Osteopathic Association opposes this change, which it says “will increase the tax burden on small physician owned practices, many of which operate as S corporations or partnerships, jeopardizing their financial ability and potentially reducing access to care.” And you know, these are just a few of the many provisions affecting health professionals. I’m sure we will hear about more of them as time goes on.
Robertson: Thank you so much, Joyce.
Frieden: Thanks, Rachael.
Robertson: And that is it for today. If you like what you heard, leave us a review wherever you listen to podcasts and hit subscribe if you haven’t already. We’ll see you again soon.
This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were MedPage Today reporters Kristina Fiore, Rachael Robertson, and Joyce Frieden. Links to their stories are in the show notes. Our theme music is by Palomar.
MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.
