In this edition of the Situation Report, we examine a series of developments that signal growing political influence over public health and health policy. From high-profile testimony alleging scientific suppression at the CDC, to the looming threat of a government shutdown that could halt ACA subsidies and delay research funding, to the launch of a $50 billion rural health transformation fund, each raises urgent questions about the role of evidence in shaping policy.
In today’s issue:
- Former CDC Official Testify, Raising Concerns of Scientific Integrity and Political Interference
- As Government Shutdown Looms, Health Care Premium Subsidies Remain a Key Issue
- CMS Launches Rural Health Transformation Fund
- Vaccine Panel Expands, Poised to Reverse Hep B Recommendation
- Bipartisan Congressional Letter Presses HRSA on Organ Transplant Oversight
Former CDC Officials Testify, Raising Concerns of Scientific Integrity and Political Interference
Susan Monarez, former Director of the CDC who was ousted 29 days after her Senate confirmation, and former CDC Chief Medical Officer Debra Houry testified during yesterday’s Senate HELP committee. Focal topics of the meeting included the details of Monarez’s firing, the scientific integrity of the newly reconstructed Advisory Committee on Immunization Practices (ACIP), and the dismissal of career scientists. Monarez testified that she was pressured to endorse ACIP recommendations without supporting scientific evidence and that disagreements with leadership over this issue led to her departure. She also described instances where CDC leadership was publicly criticized in ways she felt undermined the agency’s scientific mission.
Houry, who resigned after Monarez was fired, testified that she could not stay in her position because CDC officials were being treated as rubber stamps to support non-evidence-based policies. She reiterated that she learned of the CDC’s change in COVID-19 vaccine guidance via social media, that the agency had not received any evidence suggesting a change in recommendations, and that any expected changes to the Hep B vaccine recommendation would not be based in scientific evidence. She called for Kennedy’s resignation and expressed concern that CDC scientists were being sidelined in the policymaking process and urged stronger protections to safeguard scientific independence at the agency.
For health services researchers, this hearing underscores critical concerns about the governance and accountability of public health agencies and highlights how growing political pressures override scientific independence and integrity. Such dynamics pose significant risks to the data-to-practice pipeline and distorts the information used to guide key public health policy decisions that ultimately affect the health of all.
As Government Shutdown Looms, Health Care Premium Subsidies Remain a Key Issue
The House has failed to pass a stopgap funding proposal, raising the odds of a government shutdown. The proposal, critically, did not extend the Affordable Care Act (ACA) health care premium subsidies or restore Medicaid funding, both key issues for Democratic leadership. Recent analyses show that premiums for individuals who purchase their health insurance through the ACA exchanges would increase more than 75 percent on average, and about four million more people would become uninsured by the year 2034. Although Democrats had previously voted to extend federal funding with short-term, “clean” continuing resolutions, party leaders note that the calculus has changed in light of the Trump administration’s Medicaid spending cuts, freezing of research grants, and claw back of additional funds. Republican leadership has signaled a willingness to address the health care premium subsidies following passage of a clean stop-gap resolution, while Democratic leaders indicated they may develop their own short-term funding bill to stave off rising health care costs and restrict the President’s pocket recission powers. Policymakers have until September 30th to avoid a government shutdown, the impacts of which will certainly be felt by health services researchers, as NIH would be prevented from admitting new patients or processing grant applications.
CMS Launches Rural Health Transformation Fund
States can now apply for the $50 billion, five-year Rural Health Transformation Program, sponsored by the Centers for Medicare & Medicaid Services (CMS), which was created to at least partially supplement the incoming $1 trillion Medicaid cuts. As part of the budget reconciliation bill , CMS will disperse $5 billion each fiscal year amongst approved states, allocating the remaining $5 billion at CMS’ discretion. According to Department of Health and Human Services Secretary Robert F. Kennedy Jr., the rural health fund “tackles the root causes of rural healthcare failure... [and] gives states the tools to design solutions that last.” Importantly, federal Medicaid spending in rural areas is expected to decrease by $137 billion over the next decade under the enacted reconciliation package, according to KFF estimates. In doing so, rural areas will lose $87 billion in Medicaid funding, even when accounting for the rural health fund.
According to CMS, the program aims to strengthen rural health through five strategic goals: the promotion of preventative care and chronic disease management; attracting and retaining health care workers serving rural communities; the development and implementation of innovative payment models; the improvement of rural providers’ sustainability and efficiency; and increasing access to remote care and digital tools and technologies. Applicants must plan to utilize program funds for a minimum of three of 11 permissible uses, nine of which are statute specific with the additional two being “as determined by the Administrator.” The notice also highlights funding restrictions, which include general operating expenses, clinician salaries, and the replacement of services reimbursable by insurance. According to the Notice of Funding Opportunity, states have until November 5th to apply to the program, with awardees being announced by CMS by December 31st.
Vaccine Panel Expands, Poised to Reverse Hep B Recommendation
According to two former senior officials from the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices (ACIP) is expected to vote to recommend delaying the hepatitis B vaccine from its current administering to newborns until age 4. This change would alter over 30 years of consistent recommendation for the first three shots of the hepatitis B vaccine to be administered shortly after birth. In that time, since 1990, cases of hepatitis B per 100,000 people 19 years old or younger in the U.S. plummeted from 3.03 to less than 0.1. Waiting to vaccinate children until age 4 opens the window for the virus to spread. Usually, the ACIP would carefully analyze data before changing vaccine recommendations. This review process had not begun as of the end of August, which Demetre Daskalakis, the former director of the National Center for Immunization and Respiratory Diseases, called unusual, noting there was no work group convened to discuss.
The committee is scheduled to meet Sept. 18 and 19 and includes five new members, all of who were selected mere days ago by Health Secretary Robert F. Kennedy Jr. While Deputy Secretary of Health and Human Services and Acting Director of the CDC Jim O'Neill touted the “real-world public health experience” the new members bring, others, such as former ACIP member Noel Brewer, are concerned about the committee's vaccinology expertise.
Wednesday, amidst anticipation for vaccine recommendation changes, the AHIP released a statement regarding vaccine coverage. In it, the national trade association representing the health insurance industry affirmed its commitment to maintaining affordable vaccine access and stated that “health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.”
For health services researchers, particularly those with expertise in vaccinology, this moment underscores the importance of ensuring research evidence is accessible and visible to policymakers as vaccine recommendations are debated.
Bipartisan Congressional Letter Presses HRSA on Organ Transplant Oversight
Leaders of the House Energy and Commerce Committee have requested a briefing from HRSA regarding its ongoing oversight of patient safety within the organ procurement and transplant system. The request follows a July hearing examining a March 2025 HRSA report, which identified significant patient safety concerns at the Kentucky Organ Donor Affiliates (KYDA) and raised broader questions about systemic issues at other Organ Procurement Organizations (OPOs). A subsequent corrective action plan issued by HRSA directs the OPTN to implement safety improvements and develop new policies to address risks associated with donation after circulatory death. Committee leaders emphasized the need for continued oversight to ensure public trust in the system. This ongoing oversight is particularly important for health services researchers, as it highlights systemic gaps in quality, patient safety, and accountability within health systems.
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This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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