1. Overton’s vaccine drive
2. Lame-duck outlook
3. USAID funds in limbo
4. Gottlieb’s AI idea
5. New GLP-1 study

Medicare open enrollment season begins today with seniors facing a higher Part D out-of-pocket cap and a higher deductible for 2027.

US healthcare spending is projected to hit $9 trillion a year within a decade, consuming a fifth of the economy. As Americans look for someone to blame for ever-increasing costs, every player is eager to offer up a villain.

Doctors blame hospital systems and PE firms for buying up private practices to boost profits. Drugmakers say pharmacy benefit managers are inflating drug prices. Workers fault insurers and employers for their ballooning bills. Insurers peg hospitals and pharma for higher premiums. There’s a reason why President Donald Trump promised 20 million Medicare enrollees a one-time $90 government rebate ahead of the midterm elections.

After more than a decade covering healthcare in Washington, I’ve learned that the singular villain theory of healthcare economics doesn’t hold up. The decisions driving up healthcare costs are often wrapped in financial and political incentives that usually require trade-offs ill-suited for this polarized era.

That’s where this newsletter comes in.

Each week, I’ll unpack the business, political, and policy forces reshaping the healthcare system in the US and around the world. Along the way, I’ll deliver scoops, interviews, and insight to help make sense of it all.

So send me tips! I’m also eager for feedback on what you think would make this messy world of healthcare a bit easier to understand.

Trump’s FDA pick shaped vaccine overhaul

Heidi Overton, President Donald Trump’s nominee to run the Food and Drug Administration, played a larger role in driving the process to reduce the number of vaccines the government recommends to children than emerged during her Senate confirmation last month, when Republican senators asked her whether she’d stand up to anti-vaccine voices in the administration.

An aide on the president’s Domestic Policy Council, Overton helped edit and craft a scientific justification that was used to underpin cutting recommendations from 17 to 11 vaccines, according to a senior administration official and three people familiar with the process.

“It was Heidi driving this whole thing,” said a former senior administration official, noting that Health Secretary Robert F. Kennedy Jr. supported the policy push.

The Senate health committee did not vote on whether to advance Overton to the Senate floor before departing earlier this month, leaving the decision for the lame duck session. If Republicans ultimately support her, Overton will lead the agency responsible for vaccine policy after making a bigger contribution to the Trump administration’s effort to reverse decades of American policy on childhood vaccines than was widely understood.

Healthcare agenda slows on the Hill

Congressional Republican leaders will return to Washington after the midterms with a huge to-do list and limited time to achieve anything — likely bad news for pending healthcare bills.

Several of those bills are awaiting action on the Senate floor, including a price transparency measure and a sweeping bipartisan proposal to lower insulin costs. House members also want the Senate to act on maternal health research, consider changes to the federal government’s 340B rebate model on drug discounts, and pass pharmacy benefit manager reform. But all of those are competing for floor time with government funding that expires Dec. 11, a revival of expired surveillance laws, and a bipartisan permitting bill that’s gaining momentum.

GOP leaders are making no commitments, and Democratic victories could leave the opposing party less inclined to compromise. Republicans also may opt to do a third party-line bill if they lose, which could include some health priorities.

The bottom line: Any health legislation might need to get tacked onto other bills to become law before year’s end.

— Burgess Everett and Nicholas Wu

Where did USAID’s unspent funds go?

Congress and global health groups are still trying to understand what happened to $1.35 billion in unspent US Agency for International Development funds lawmakers had appropriated last year for work on tuberculosis, malaria, HIV, and maternal healthcare.

On Sept. 24, Senate Appropriations Chair Susan Collins, R-Maine, urged the Trump administration to spend the global health funds, but a spokesperson said the committee has not heard back from the administration. The White House directed questions to the Office of Management and Budget, which didn’t provide a comment in time for publication.

The continued questions about the funding come amid the turn of the fiscal year at the start of the month — and there are concerns that global health efforts will continue to erode without clarity. The spending’s nebulous status could endanger global health work on limiting the spread of diseases like tuberculosis, especially if the White House continues to delay distributing the money, according to health nonprofit Partners in Health.

“That is a big concern we have, it’s more dynamic, more creative than something as in your face as a pocket rescission,” said Vincent Lin, the nonprofit’s associate director of health policy and advocacy.

FDA’s answer to clinical AI

Clinical use of AI is heading toward a two-tiered system that will ultimately stifle innovation, former FDA Commissioner Scott Gottlieb argues in a new policy paper in JAMA Health Forum.

Gottlieb sees a parallel between the early days of hospitals developing in-house tests, and hospitals today training in-house AI. Back then, the goal was to detect existing problems; today, it is to predict new ones, like which patients are likely to develop sepsis. On lab tests, regulators made a mistake initially in allowing an informal, exception-based system to incentivize in-house innovation at the expense of broad commercial development, he said.

“Congress has the chance to do better with clinical AI,” Gottlieb writes, “through a framework that carefully balances the need for local innovation and wider access.”

Could GLP-1s help patients stay employed?

Growing research suggests GLP-1 drugs can help alcohol use disorder, and a new clinical study will go further: testing whether the drugs can reduce alcohol and opioid use among people at risk for criminal involvement and improve their employment, housing, and health outcomes, too.

Arnold Ventures, a billionaire-backed philanthropy that advocates for evidence-based policymaking, is supporting a $13.3 million randomized controlled trial launching early next year through the Center for Addiction Science, Policy, and Research and the Allegheny County Department of Human Services.

The trial will enroll up to 1,200 adults across multiple sites. Unlike a typical industry-sponsored drug trial, this project will attempt to measure not only how a drug affects individual health outcomes, but broader well-being.

“What this study is going to do is look at some of those downstream outcomes that we know can be associated with using drugs and alcohol,” said Nathan Weil, director of criminal justice research at Arnold Ventures.

The Federation of American Hospitals tapped HCA Healthcare CEO Sam Hazen to be its board chair for 2027.

Stephen Lewerenz joined private equity and global affairs firm Nestpoint Group as a senior adviser. He most recently served as communications director for the Senate HELP Committee under Chair Bill Cassidy, R-La.

Former House majority leader Eric Cantor officially starts as President and CEO of PhRMA, on Nov. 9.

• The number of people who carry individual health insurance dropped 18% over the 12 months prior to June, according to a new analysis from KFF’s Matt McGough, Justin Lo, and Cynthia Cox. The health policy researchers estimate that individual market enrollment has fallen by 4.6 million people — one of the concrete consequences of enhanced premium tax credits lapsing.
• STAT’s Helen Branswell, a prominent infectious disease reporter, died this week at 69. She made her mark during the COVID-19 pandemic, expressing concern as far back as December 2019 about reports of unexplained pneumonia in China. Branswell spent years chronicling the spread of diseases from influenza to Ebola, providing clarity to readers about how they impact society.
• HHS is touting efforts to cut back Affordable Care Act subsidies for 189,000 people who were also enrolled in duplicative Medicaid, Medicare, or Children’s Health Insurance Program coverage, Fierce Healthcare’s Paige Minemyer reports. The focus on cutting fraud, waste and abuse has been a throughline of the Trump administration’s efforts on healthcare ahead of the midterm elections — but the less exciting term one health policy expert texted me to describe the latest announcement was “program integrity.”