By Megan R. Wilson

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In today’s issue: The escalating battle against the abortion pill. … Two new additions to an influential vaccine advisory panel have questioned the safety of vaccines for pregnant women. … And more.

Good afternoon, and thanks for checking in with Health Brief. About 22.8 million people have signed up for Affordable Care Act marketplace plans so far, according to new government data — including nearly 3 million people who didn’t have individual health insurance the year before. The enrollment represents 1.4 million fewer people than had signed up for ACA plans by this time in 2025.

→ Monthly premiums jumped for millions of patients after enhanced tax credits expired — something a handful of members on Capitol Hill are trying to remedy. The Congressional Budget Office estimated that 4 million people would drop coverage if the tax credits lapsed.

Although enrollment may drop in the coming months if people can’t afford coverage, could this initial smaller number make a deal on the tax credits harder?

Let me know your thoughts and policy prognosis. Also, send your best health policy tips and intel to megan.wilson@washpost.com. If you prefer to message me securely, I’m also on Signal at megan.434.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence.

Sen. Bill Cassidy (R-Louisiana) will lead a Senate Health, Education, Labor, and Pensions Committee hearing on the safety of medication abortion. (Mariam Zuhaib/AP)

	The Lead Brief

— Authored with WP Intelligence lead health analyst Rebecca Adams.

The Senate’s health panel is set to dive into the debate over the safety of mifepristone, the primary drug used in medication abortions, on Wednesday.

The hearing comes against the backdrop of a larger discussion among regulators and medical experts regarding safety of the drug — which regulators and top medical organizations consider safe and effective — and legal challenges from antiabortion advocates about its distribution by mail. Other lawsuits aim to expand access, arguing that federal restrictions are overly burdensome.

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Sen. Bill Cassidy (R-Louisiana), a doctor who leads the Senate Health, Education, Labor and Pensions Committee, led a group of GOP senators to press the Food and Drug Administration about the agency’s approval of another generic version of the medication in October, saying the FDA hadn’t done enough to study its potential harms.

On Tuesday, Louisiana Attorney General Liz Murrill, one of the witnesses at tomorrow’s hearing, announced an indictment and extradition request for a California doctor she accused of sending abortion pills through the mail in violation of state law. It’s the second case her office is pursuing against an out-of-state doctor offering the pills.

“This is not healthcare; it’s drug dealing,” Murrill said in a statement.

Why it matters: Abortion access has become a recurring issue in national elections, with Democrats previously able to seize on public opinion following the U.S. Supreme Court decision overturning Roe v. Wade to drive their base’s turnout. During President Donald Trump’s second term, abortion opponents are hoping to further restrict access to the procedure, which could once again thrust the issue into election politics.

Following Louisiana’s action against the California doctor, Gov. Jeff Landry, a Republican, took aim at California’s governor, a prominent 2028 Democratic presidential contender, on social media: “I know Gavin Newsom supports abortion in all its forms, but that doesn’t work in Louisiana.”

→ It’s a fraught landscape, however. Bloomberg News reported last month that the FDA is delaying the release of a report surrounding mifepristone safety data until after the 2026 midterm elections, which the Trump administration strongly denied.

THE LOOMING DEBATE

Cassidy and antiabortion groups including Susan B. Anthony Pro-Life America argue that the drug can cause serious health complications, and are urging federal regulators to rescind the ability of patients to get it without going to a doctor in person. Cassidy’s office didn’t respond to an inquiry seeking more information on the hearing.

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“The administration can and must act immediately” to end mail-order access, said Kelsey Pritchard, a spokesperson for SBA Pro-Life America, in an email. Roughly 1 in 4 abortions are provided via telehealth appointments.

Meanwhile, Democrats are poised to blame antiabortion politics for the restrictions on the drugs, saying that opponents want to justify further limiting abortion access. The drug is used in nearly two-thirds of all abortions nationwide.

Sen. Patty Murray (Washington), a top Democrat on the health panel, plans to say at the hearing that the safety concerns stem from “debunked junk ‘studies,’” noting that major medical groups affirm use of mifepristone, according to an excerpt from her prepared remarks Rebecca obtained.

The American College of Obstetricians and Gynecologists (ACOG), which represents OB/GYNs, said mifepristone is “a safe, effective, and integral part of the medical care that our members provide to their patients.” The group said that mifepristone’s prescribing requirements are more strict than 99.5 percent of the 20,000 drugs regulated by the FDA.

Critics, including antiabortion advocates, argue that broadening mifepristone access came only after political pressure.

However, a study published in the medical journal JAMA on Monday that looked at more than 5,000 internal agency documents from 2011 to 2023 found the FDA’s decisions about the drug “has been shaped by scientific evidence and a cautious regulatory approach led by scientists at the agency.” (One of the researchers on the study, Joshua M. Sharfstein, was a top FDA official from March 2009 to January 2011.)

	Immunization Update

Health Secretary Robert F. Kennedy Jr. is adding two doctors who have been critical of covid vaccines for pregnant women to the Advisory Committee on Immunization Practices (ACIP), an influential federal vaccine advisory panel.

The new additions — Adam Urato and Kimberly Biss, both trained OB/GYNs — bring ACIP’s voting membership to 13 people, all of whom have been handpicked by Kennedy after he fired the previous members. He charged the prior panel membership with being “plagued with persistent conflicts of interest” that had become a “rubber stamp” for vaccines.

Meanwhile, medical organizations and some public health experts have criticized the updated ACIP for its moves to roll back some immunization recommendations, charging some members with misrepresenting data to undermine vaccines.

→ My colleague Lena H. Sun in The Washington Post newsroom has a new report taking a deep dive into ACIP’s two new members, including their public comments about vaccines.

While her family routinely received their immunizations — including flu shots — Biss remarked on a podcast in 2022 that she’d gone down a “rabbit hole” on vaccines since the beginning of the covid pandemic.

“I was not anti-vaccine. I am now,” said Biss during a 2023 discussion hosted by the Vaccine Safety Research Foundation, repeating some of the podcast anecdote. “And my grandchildren will not get any shots if I can help it. The vaccine industry is disgusting.”

Why it matters: ACIP makes recommendations to the Centers for Disease Control and Prevention on vaccine coverage, which can impact how the shots are obtained. The panel is investigating the use of certain vaccines during pregnancy. Trump has echoed many of Kennedy’s concerns about the safety of several vaccines in the childhood immunization schedule — despite a lack of evidence — and pressed officials to make changes.

“President Trump asked us to bring the childhood immunization schedule in line with gold-standard science,” said Jim O’Neill, the CDC’s acting director and deputy health secretary. “Our new ACIP members have the clinical expertise to make decisions driven by evidence, not dogma.”

THE NEW MEMBERS

— Biss has also said that covid vaccines could lead to an increase in miscarriage, while several studies have been unable to link the shots with pregnancy loss.

— Urato, a vocal critic against using a class of antidepressants called SSRIs during pregnancy, has also suggested that receiving certain vaccinations while pregnant might not be safe, and questioned whether Americans are over-vaccinated generally.

Kennedy said in a statement the two have ”the scientific credentials, clinical experience, and integrity this committee requires.”

While ACIP is questioning the safety of the covid and flu shots for expectant mothers, the Society for Maternal-Fetal Medicine recommends both vaccinations during pregnancy. Medical group ACOG also encourages expectant mothers to get vaccinated.

Over the last year, the CDC has adopted several of ACIP’s recommendations, including eliminating the birth dose of the hepatitis B vaccine for all babies, which had been credited with all but eliminating new infections in children and young adults.

	Jobs Report

— The Partnership for Employer-Sponsored Coverage, an advocacy group representing companies and trade associations that provide health benefits for workers, has named Taylor Hittle as its executive director. She succeeds Neil Trautwein following his retirement last year.

Hittle comes from the firm Washington Council Ernst & Young, and previously worked for GOP members on Capitol Hill, including a top role on the House Education and the Workforce Committee, and at the Department of Health and Human Services during the first Trump administration.

— The Healthcare Distribution Alliance, an industry group for companies that supply pharmacies with medications, has named Julie Galloway Mabeus as its new director of policy. Prior to that, she worked at Mitre Corporation, a research organization, the Society of Thoracic Surgeons and MassHealth, the state of Massachusetts’s Medicaid and children’s health insurance program.The Watch List

	What We’re Reading

The Post’s Peter Whoriskey writes about the trend of full-body MRIs: “A $2,500 full body scan said he was healthy. Then he had a catastrophic stroke.”

“More Americans are surviving cancer — even the deadliest ones,” reports The Post’s Allyson Chiu.

“HHS ousts members of key advisory board for childhood vaccine injury program,” Max Bayer scoops at Endpoints News.

“This California Strategy Safeguarded Some Medicaid Social Services Funding From Trump,” Mark Kreidler writes at KFF Health News.

“Lawsuit dismissed after Trump admin quietly restored tens of millions to Planned Parenthood,” Politico’s Alice Miranda Ollstein reports.