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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
Hello and welcome to Health Affairs This Week. I'm your host, Jeff Byers. We're recording this on 09/25/2025. This is your last call for our prior authorization insider event on September 29 next Monday. It has great speakers, including Michael Ann Kyle, Ravi Gupta, Christina Andrews, and Mark Fendrick.
Jeff Byers:Check it out. Join Insider. Also, for Insider, we have an event on immigration policies and their impact on health care on October 15. Today, you know, we're gonna talk about what's on everyone's mind. Jimmy Kimmel, the power of celebrity and political power, and with me to talk about that is Ellen Baier.
Jeff Byers:Ellen, welcome to the program.
Ellen Bayer:Thanks, Jeff. Happy to be here.
Jeff Byers:Yeah. Yeah. So I'm just kidding. I'm I we like to kid around here. Today's main focus of today's episode is a recent strategy report released by a Trump administration commission earlier this month on an issue they've made a high priority, and that is childhood chronic disease.
Jeff Byers:So soon after president Trump took office in February 2025, he issued an executive order establishing the Make America Healthy Commission, which is chaired by HHS secretary, RFK junior, and ordering it to undertake three activities. Number one, study the scope of childhood chronic disease and any potential causes. Two, advise and assist the president on informing the American public about the crisis. And three, provide government wide recommendations on policy and strategy to address the contributing causes in the end of the crisis. So in May 2025, the commission delivered the assessment required under the first part of this order, And then on 09/09/2025, they delivered the third part, a report on their policy and strategy, which are described in the report as plans rather than recommendations.
Jeff Byers:So, Ellen, before we dive into the details of this plan, you know, some might call it a strategy document, some might call it a vision board, but it is, the MAHA document on childhood chronic disease that you may have been seeing going around. So Ellen, can you give us a little bit background on the problem that they're trying to address?
Ellen Bayer:Thanks, Jeff. Sure. First off, according to the CDC, chronic disease like heart disease, cancer, and diabetes are the leading causes of death and disability in The US, and three out of four American adults have at least one chronic condition, and over half have two or more. And many preventable chronic diseases are caused by smoking, poor nutrition, physical inactivity, and excessive alcohol use. Chronic disease among children has become an increasing problem in the last couple of decades.
Ellen Bayer:The prevalence of chronic disease or functional limitations among children aged five to 17 increased from about twenty three percent in the period 1999 to 2000 to more than thirty percent in the year from 2017 to 2018. And that translates into about one hundred and thirty thousand more children every year with a chronic disease, according to an article that was recently published in the journal Academic Pediatrics. And researchers found that the increase has been driven mainly by three conditions. One is attention deficit hyperactivity disorder, the second is autism, and the third is asthma. And the administration's strategy aims to end federal practices that they say exacerbate the child chronic disease crisis, or unsuccessfully try to address it, and also to quote, unquote, add powerful new solutions that will end childhood chronic disease.
Jeff Byers:Yeah. So there's a lot in the report to digest, and none of it relates to the presidential physical fitness awards that we may have experienced in elementary school, but it does include a myriad of talking points ranging from air quality to breastfeeding to direct to consumer pharma advertising, which we actually might get into a later episode. Ellen, can you talk us through the overall approach, and what are some of the highlights?
Ellen Bayer:First, it's important to recognize that this is the strategy report of the MAHA Commission, which includes not only HHS, but also the Departments of Agriculture, Education, the Environmental Protection Agency, the Department of Veterans Affairs, and the Department of Housing and Urban Development. So even though the report is health focused, many of the strategies presented would require action by agencies other than HHS. And the report's about 17 pages, divided into four main sections. The first is, research. The second is a section on so called realigning incentives, which includes policy deregulation and agency restructuring.
Ellen Bayer:The third is on increasing public awareness, and the fourth is on partnering with the private sector. And so we're a policy journal, so I'll focus mainly on the policy piece. The policy section, like the rest of the document, is made up of a series of short policy statements, mostly one or two sentences, on a total of 34 topics. And food and nutrition issues account for over half of of those action items.
Jeff Byers:Yeah. So we are gonna talk mostly about the food and nutrition pieces on today's episode. But, Ellen, what are some of the other points that are in the document?
Ellen Bayer:Well, it's really mixed bag. There are several strategies related to Medicaid and the Children's Health Insurance Program or CHIP. The report says that CMS will work with states to create quality metrics for Medicaid managed care plans that incorporate nutrition coaching to promote measurable improvements in children's health. The strategy also calls for prior authorization in Medicaid for prescribing medications that the administration believes are overused among school age children, and they call out ADHD medications specifically. The report says that CMS will collaborate with states on prevention and wellness initiatives.
Ellen Bayer:The strategy also covers a wide range of issues, including, even sunscreen, saying that, FDA will promote innovation in the sunscreen market. It says that HHS, the Department of Labor, and the Treasury Department will implement the president's executive order on the transparency of hospital and insurer prices. There's a section on developing a new vaccine framework and a lot more. We don't have time, of course, to get into all the issues covered in the strategy document, but we'll put a link to it in the show notes.
Jeff Byers:Yeah. So they are reestablishing the presidential physical fitness test. Is that right?
Ellen Bayer:That is correct. It says that HHS and Department of Education will help states and schools reestablish the presidential fitness test.
Jeff Byers:Well, to all the young parents out there, you'll look forward to those pieces of paper disintegrating on your refrigerator for for years to come. Back to the food and nutrition issues, which account for more than half of the strategies. What are some of the highlights?
Ellen Bayer:Well, the strategy picks up on several nutrition policies that were underway during the Biden administration. The USDA and HHS will move forward with updating the 2025 to 2030 dietary guidelines for Americans. And just by way of background, so in December 2024, the advisory committee working on the guidelines submitted its scientific report, which was intended to provide independent evidence based advice to the secretaries of HHS and the USDA to consider in the process of developing the guidelines. And under the MAHA strategy, HHS and USDA plan to reform, the process of developing the guidelines, including making changes to the structure and members of the advisory committee and the scientific review process. There's also continued focus on artificial food dyes.
Ellen Bayer:At the end of the Biden administration, the FDA revoked its authorization for the use of red dye number three in food, drugs, and supplements. And under the MAHA strategy, the FDA will expand this approach by implementing policies to limit or prohibit the use of all petroleum based food dyes. And the FDA will consider revising the proposed rule, which was issued at the end of the Biden administration to provide simple nutrition information on the front of food packaging to indicate if the amount of fat, sodium, and sugar is low, medium, or high. And the FDA will consider the public comments that have been submitted and move toward developing the final rule.
Jeff Byers:Yeah. And Ellen, I think we can say, like, a lot of this stuff, at least in the food and nutrition and physical, fitness space, is a lot of a continuation on some previous ideas. Right?
Ellen Bayer:Sure. Certainly some of it. Yes. Absolutely.
Jeff Byers:I I guess it's like these are things, especially as much like chronic diseases, are not gonna go away anytime soon as far as public interest. As our listeners know, health affairs published a theme issue on food nutrition health in April. Ellen, you and health affairs deputy editor Jess Beiliner were the assigned editors for that theme issue. Looking at the MAHA strategy report document through that lens, what stands out to you?
Ellen Bayer:Well, two things that caught my eye in particular were the strategies related to ultra processed foods and the plan to create guidelines limiting the direct marketing of unhealthy foods to children. The overview paper in our theme issue by Seth Berkowitz and colleagues makes the point that improving people's diet quality and health may require addressing challenges at multiple levels, including not only individual and household challenges like lack of knowledge and time, but also major environmental challenges, including the marketing of unhealthy foods. Federal government efforts to limit the marketing of unhealthy foods to children are not new. And in fact, during the Obama administration, back in 02/2011, the Federal Trade Commission issued voluntary industry guidelines, that attempted to do this. But ultimately, that effort was not successful, so we're still grappling with the issue today.
Jeff Byers:So, are there other efforts and programs ongoing in the government or private sector that can help create a better food and nutrition environment for children?
Ellen Bayer:Certainly, there's a lot that's happened, since the twenty tens in the food and nutrition space, and there is a lot going on. So that brings me to another concept, that was highlighted in our food nutrition and health theme issue, that's related to the MAHA strategy report. A major effort underway across the country, that aims to address environmental challenges to healthy eating is an initiative known as Food is Medicine. And Food is Medicine is defined as an intervention in the context of a healthcare system that incorporates nutrition related services in medical care as part of a patient's care plan to prevent or treat disease. And food as medicine emphasizes healthy whole foods in place of ultra processed foods.
Ellen Bayer:And the MAHA strategy document states that USDA, HHS, and FDA will continue efforts to develop a US definition for ultra processed foods to support future research and policy activity. Food as medicine programs use three interventions: medically tailored meals, medically tailored groceries, and produce prescriptions. Food as medicine is not age specific, but some food as medicine programs have been implemented for pediatric populations, and they have been incorporated in some state Medicaid programs, which serve families with children. And evidence from demonstration projects, quasi experimental interventions, and randomized trials has shown that food as medicine programs increase the consumption of nutritious foods, reduce chronic disease risk factors, and efficiently use health care resources. An important thing to keep in mind about food as medicine is that it's an intervention that's provided within the context of the health care system, and that comes with some challenges, given that many health care providers are not familiar with the concept and they don't discuss food and nutrition issues with their patients.
Ellen Bayer:Some of the options that have been proposed to increase, healthcare providers' awareness of food and nutrition issues and improve their ability to work on these issues with patients include adding nutrition education to medical school curricula and including nutrition competencies in medical program accreditation standards. So the strategy report, says that HHS will reform the accreditation system to increase nutrition education and quote unquote ensure medical school curricula better align with making America healthy again.
Jeff Byers:And a lot of these strategies kinda hinges on some, different relationships like private public partnerships. Is that correct?
Ellen Bayer:So the entire last section of the document focuses on collaborating with the private sector for a variety of health related purposes, including to increase access to whole healthy foods. And, of course, the the concept of public private partnership to advance nutrition related goals is not new. For example, following the twenty twenty two White House conference on hunger and nutrition and health, HHS established four public private partnerships to support the agency's priorities around food as medicine. HHS has partnered with the Rockefeller Foundation, which has committed a $100,000,000 to food as medicine since 2019 to speed up the adoption of food as medicine in health systems. HHS has partnered with Food and Society at the Aspen Institute to advance a unified food as medicine policy and practice.
Ellen Bayer:HHS also has partnered with Instacart to support and scale food as medicine interventions. And Feeding America, which is a nationwide network of food banks, food pantries, local meal programs, has joined HHS in a partnership to bring together health systems and food banks to advance food as medicine programs.
Jeff Byers:Well, it sounds like the groundwork for at least some of the strategies outlined in the MAHA report are already in place. It should be noted that the reaction to this document has been mixed. One would imagine that advocating for less chronic disease would be an easy thing that many can rally behind, but you'd be wrong in this age of political polarization. Axios reported on September 10 with the headline, MAHA faithful still divide over priorities after report, which focuses on the MAHA report. And The Wall Street Journal on September 9 noted that, quote, some MAHA supporters aren't impressed, unquote, over the document.
Jeff Byers:So with this document, as in life, you can't please everyone, it seems. So it remains to be seen how and to what extent the administration will reshape the current food and nutrition policy landscape to align with MAHA goals, including the goal of ending childhood chronic disease. And I think that's a good place to wrap up, so we'll leave it at there for today. Ellen Baer, thanks again for joining us today on Health First This Week.
Ellen Bayer:Thank you, Jeff.
Jeff Byers:And if you, the listener, enjoyed this episode, please send it to the ABC affiliate in your life. And with that, we'll see you next week. Thanks all.