The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer of the critically praised reference ebook “Well being Care Politics and Coverage A to Z,” now in its third version.
Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already dashing to work his priorities into laws, eyeing cuts to Medicaid to pay for brand new tax and immigration priorities. However even in its waning days, the Biden administration continues to make huge coverage strikes, together with a doable order for tobacco corporations to dramatically lower the quantity of nicotine in cigarettes.
In the meantime, the fires in Los Angeles are drawing new consideration to the well being risks of not simply smoke from natural matter, but additionally poisonous substances launched by burning plastic and different man-made supplies — in addition to the menace posed to each air and water high quality.
This week’s panelists are Julie Rovner of KFF Well being Information, Anna Edney of Bloomberg Information, Joanne Kenen of the Johns Hopkins College Bloomberg College of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins College and Politico
Sandhya Raman
CQ Roll Name
Among the many takeaways from this week’s episode:
- Republican lawmakers are weighing choices to chop federal spending on Medicaid, the practically $900-billion-a-year authorities program that covers 1 in 5 People. They may use the financial savings to bolster Trump priorities, comparable to extending the 2017 tax cuts. The GOP made splashy however unsuccessful makes an attempt to chop Medicaid when Trump first took workplace and the occasion held a bigger Home majority — although the occasion appears extra aligned with Trump immediately than it was then.
- Congress has gotten all the way down to enterprise on messaging payments: It superior laws this week that might ban trans athletes from women’ faculty sports activities and, individually, a measure to detain and even deport immigrants who’re residing within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes comparable to shoplifting.
- The Supreme Court docket has agreed to listen to a case later this yr in regards to the U.S. Preventive Companies Process Power — an impartial physique of specialists that points suggestions in illness prevention and drugs. A ruling in opposition to its authority might strip protection for key preventive well being companies from not simply these with Reasonably priced Care Act protection, but additionally these on employer-sponsored well being plans. The query stands: If not this job power, who would make the determinations about what preventive care must be lined?
- And the outgoing Biden administration issued a slew of well being laws this week, together with a ban on the dye Crimson No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration might upend these and extra laws, although some do align with its coverage pursuits.
Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month” function, a few colonoscopy that got here with a a lot bigger price ticket than estimated. When you have a mystifying or outrageous medical invoice you’d prefer to share with us, you are able to do that right here.
Plus, for “additional credit score,” the panelists counsel well being coverage tales they learn (or wrote) this week that they assume you must learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Faculties Funnel Extra Medical doctors Into the Main Care Pipeline?” by Felice J. Freyer.
Anna Edney: Bloomberg Information’ “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles,” by Anna Edney.
Joanne Kenen: The Atlantic’s “A Secret Means To Struggle Off Abdomen Bugs,” by Daniel Engber.
Sandhya Raman: Nature’s “New Weight problems Definition Sidelines BMI To Deal with Well being,” by Giorgia Guglielmi.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: Hi there, Trump. Bye-Bye, Biden.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hi there and welcome again to “What The Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by among the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 16, at 10 a.m. As all the time, information occurs quick and issues may need modified by the point you hear this. So, right here we go.
At the moment we’re joined by way of videoconference by Anna Edney of Bloomberg Information.
Anna Edney: Hello, everyone.
Rovner: Sandhya Raman of CQ Roll Name.
Sandhya Raman: Good morning, everybody.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico Journal.
Joanne Kenen: Hello, everyone.
Rovner: Later on this episode we’ll have my interview with Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month,” a few affected person whose colonoscopy invoice was rather a lot greater than he anticipated. However first, this week’s information.
So we at the moment are 4 days from the second swearing-in of Donald Trump as president, and discussions are already choosing up on Capitol Hill about rolling the brand new president’s total agenda into, quote, “one huge, lovely invoice,” as Trump has put it. There are many variations of opinions between Republicans which might be nonetheless to be labored out, however one goal for cost-cutting is fairly clear, and that might be Medicaid. Sandhya, we’re beginning to get an image of the chances of how they could wish to do this. What are among the most important issues which might be on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made slightly progress however on the identical time we simply didn’t additionally make quite a lot of progress. The top of, -ish, final week we received a menu of things that Republicans are sort of contemplating as issues they might use to offset among the issues that they’d wish to do via reconciliation.
Rovner: Like proceed the tax reduce?
Raman: Sure, for the tax cuts and for border safety. So what we’ve got on the Home aspect is quite a lot of issues which might be very health-oriented. About half of that record is health-oriented, and quite a lot of it’s Medicaid. And so among the issues they’ve been floating round are some issues we noticed within the first Trump administration, them making an attempt to do. Now we have per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid enlargement, and issues like altering the general public cost rule to again the way it was within the Trump administration.
Rovner: Remind folks what the general public cost rule is.
Raman: The general public cost rule sort of limits among the social packages for people that aren’t residents to utilize issues like Medicaid, SNAP [the Supplemental Nutrition Assistance Program], and different packages like that.
Rovner: And people are for people who find themselves right here legally?
Raman: Sure. So this week, Tuesday, we had our first assembly from the Home Power and Commerce Republicans to look over at the least the well being a part of that menu. And speaking to each Power and Commerce Chairman Brett Guthrie and Buddy Carter, who heads the well being subcommittee, it’s simply the beginning. Discussions had been fairly good, but it surely’s so early.
Carter stated that he nonetheless needs to get the PBM [pharmacy benefit manager] language from final yr that didn’t make it throughout the end line in there. And Guthrie has stated that among the numbers that we’ve seen of how a lot cash from Medicaid they may presumably save are actually in flux due to how they work together with the entire different provisions in there. Some issues are beneath Methods and Means jurisdictions. Some issues, should you do one and never the opposite, the numbers would change.
So that they’re nonetheless fairly early within the course of, and we don’t know if we’re going to do the “one huge, lovely invoice” or sort of what the Senate needs, with two payments, and that might simply sort of change what could be finished earlier versus later. However we do have slightly bit extra of a timeline now in what they’re making an attempt to do.
Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, after they had a a lot greater Republican majority within the Home, and so they couldn’t get it over the end line. What makes them assume they’re going to be extra profitable this time?
Raman: I believe a part of it’s that — that is nonetheless early on. While you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid enlargement at this level. We nonetheless have solely the ten holdout enlargement states. So, I believe, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter car we’ve got, we’ll in all probability hear extra.
And I imply, should you take a look at this state-level already, quite a lot of states are sort of couching their bets with Medicaid, simply fascinated with how they will do issues in a different way in case their Medicaid federal funding adjustments over the course of this yr or subsequent yr. So, I believe it actually is determined by what suggestions they’re going to get within the coming weeks and months.
Rovner: Joanne needed so as to add one thing.
Kenen: Yeah, I imply, the great thing about reconciliation should you’re the bulk occasion, however a slender majority, which is what’s occurring now, is you’d solely want 51 votes within the Senate. You don’t want 60. So on one stage, that seems like they’ve received 53. It’s a slam dunk, proper? Nevertheless it’s not, as a result of reconciliation, it’s a seize bag. You place a lot stuff in there, and all you want is one provision that this particular person received’t vote for or that particular person received’t vote for.
So this seemingly easy slam dunk for a narrow-majority Senate is definitely a giant, difficult mess. Then again, in comparison with the primary Trump administration, it is a extra conservative, or a extra populist, or a extra method — I imply, the ideology or worldview of the Republicans in Congress is nearer to Trump than it was in 2017.
However yeah, they failed at what they thought was going to be straightforward. They thought repealing the ACA [Affordable Care Act] and altering, which included quite a lot of Medicaid stuff, they thought it was a slam dunk. And as an alternative, it was a year-long slog that failed. So is Medicaid going to look the way in which it appears to be like proper now? No, it’ll change. How a lot will it change is de facto an open query.
Bear in mind, there’s some issues they will do via waivers. Work necessities they will do via waivers. Though previously, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache.
Rovner: Yeah, nicely, so reconciliation, finances, all of these things remains to be means TBD. Nonetheless, the Republican Congress is getting off to a quick begin, at the least when it comes to messaging laws. The Home this week handed a invoice to ban transgender athletes from girls’s faculty sports activities, and the Senate’s debating a Home-passed invoice that might permit the deportation of undocumented people who find themselves accused however not but convicted of violent crimes.
In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued government orders making it simpler for fogeys to ship their kids to highschool with out being vaccinated. Total, it appears the Republicans are sort of coalescing round an idea generally known as “medical freedom,” which to me appears identical to a rejection of public well being usually. Or am I lacking one thing? Is there one thing extra to this?
Edney: No, I believe that it’s all the time been round, however I believe that definitely this resurgence in it’s coming from the truth that folks didn’t belief science throughout the pandemic. They had been fed up. Communication wasn’t dealt with very nicely, and it nonetheless isn’t dealt with very nicely. I don’t assume folks have discovered the best way to discuss this stuff in measured methods.
I’d suggest if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Occasions a couple of days in the past on vaccination that I assumed was actually good as a result of he’s like: Pay attention, I’m a vaccine skeptic. Like, R.F.Ok. Jr. [Robert F. Kennedy Jr.] is a vaccine cynic. There’s the distinction, and right here’s what it’s. And he laid it on the market. And he’s a pediatrician, and he additionally serves on FDA’s [the Food and Drug Administration’s] advisory committee for vaccines.
So I believe that quite a lot of that is stemming from misinformation and miscommunication, and it resonates with folks. I imply, the Republican Social gathering picked up quite a lot of followers in far-left progressives by speaking about this. So I believe they see that as a possibility, too. So it might not simply be grassroots. It could be slightly little bit of a possibility they see.
Kenen: Anti-vaccination sentiment has been round so long as vaccines. It truly goes again to smallpox. There has all the time been a certain quantity of concern, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to vary two or three years earlier than the pandemic.
Some state legislatures — and this was the medical freedom, this was on the correct — began making an attempt to water down mandates for faculties. At that time, I don’t assume something huge received via. However we started to see this emergence of a deeper politicization of vaccination. And it was on the correct, and it’s what we now discuss as medical freedom.
So as an alternative of being one thing that’s throughout the political spectrum, it’s now a politicized motion, on a libertarian Authorities can’t inform me what to do. And we noticed this throughout the pandemic. And neither administration, neither the Trump administration within the first yr of the pandemic nor the Biden administration within the ensuing years, actually managed to clarify the distinction between particular person selection and the truth that should you get sick, you would possibly survive however you would endanger any individual else.
You don’t know who the particular person on the bus subsequent to you is. You don’t know who the child in your classroom is. You don’t know who you’re standing subsequent to on the grocery retailer. They could possibly be actually susceptible. And that this entire sense of “my physique, my selection,” doesn’t fly when you would kill any individual else unintentionally. And that type of has been misplaced, or folks don’t care.
Rovner: Yeah, I imply we’ve seen that with tobacco over what number of generations. It’s like, you wish to put stuff in your lungs, that’s what you are promoting. However you don’t actually get the correct to place stuff in different folks’s lungs since you want to smoke.
In the meantime, persevering with with the Republican agenda, my former KFF Well being Information colleague Anna Maria Barry-Jester has a extremely good story this week about what Nationwide Institutes of Well being director candidate Jay Bhattacharya would possibly take into consideration for the company, together with de-emphasizing infectious illness analysis and focusing extra on continual illness.
On condition that the largest institute at NIH is already the Nationwide Most cancers Institute, which focuses on a continual illness, is that this simply Republicans’ means of punishing the Nationwide Institute of Allergy and Infectious Ailments that was for therefore lengthy headed by the now retired Dr. Tony Fauci?
Raman: I believe in a component that could be a enormous driving issue, whenever you take a look at a few of his feedback and R.F.Ok. Jr.’s feedback about holistic approaches to well being, that basically whenever you take a look at what one thing like NIAID does, which is so infectious-disease-driven, versus the issues like with most cancers and different issues.
However I believe on the identical time, this has sort of been effervescent up earlier than, once we even appeared to final yr. Earlier than we had any of those nominees, earlier than we even knew the result of the election, we had a push inside Congress from the pinnacle of the Home Labor-H Appropriations subcommittee and former Power and Commerce Chairwoman Cathy McMorris Rodgers making an attempt to reform NIH that means.
We didn’t get that far with it. It was included in among the appropriations payments that didn’t go wherever but. However I believe it’s simply a part of a broader dialogue that there’s, sort of going again to what we had been saying earlier than, among the wanting extra management of what you see, when it comes to medical freedom, and that they wish to know extra about what’s taking place.
So I believe that, regardless, we’re going to see extra of this. However I believe one factor that was actually attention-grabbing in what she’d been writing was simply the NIH is a lot greater than simply NIH, you understand? It’s so lots of the folks which might be benefited by it, which might be working with this grant cash, are states nationwide. And it’s simply the medical analysis is for a world understanding of medical analysis, and simply how lots of the medication that we see come from NIH cash. So even when there’s a broader push for reform, that it’s very delicate into how broad of an impact that might have.
Rovner: And I’d level out, as a result of I dwell up the road from NIH, that almost all of what NIH does doesn’t occur on the NIH campus. It’s, as you stated, it’s cash that goes out to each single congressional district. There’s an infinite quantity of backing.
I’d additionally level out that, sure, NIH has gotten sort of sprawling with, I believe there’s 27 institutes now. Each single a type of has been added by Congress. NIH can’t create its personal institutes. Solely Congress can do this. So, Congress has type of made NIH the sprawl that it’s. I believe there’s been bipartisan settlement that NIH perhaps wants a brand new look.
I assume the query is simply type of what course that’s going to take and whether or not a few of it’ll be punitive or whether or not they’re truly going to take a look at it in a matter of what would profit the nation, as a result of it will get some huge cash, and that’s additionally been bipartisan.
Kenen: Proper. What we’re not listening to but, or at the least — and perhaps Anna, who covers pharma, can inform me if I’m incorrect — however we’re not — NIH additionally does the fundamental, fundamental, fundamental mobile first-step science that finally results in the work that drug corporations do to develop medication. They do the fundamental, what they name bench, science.
I’m not listening to the drug corporations converse out. The ambivalence People have about drug corporations, which is hating the costs however liking the medication, I haven’t heard pharma — Possibly it’s simply too early. Possibly they’re weighing in quietly, and perhaps Anna can inform me I’m incorrect and they’re and I simply didn’t discover. However that’s additionally an enormous constituency, an enormous, highly effective constituency. As a result of with out the NIH, we wouldn’t have lots of the medication that hold us and our aged kinfolk alive, together with quite a lot of the good points — we haven’t cured most cancers, however we’ve made good points on most cancers. That wouldn’t have occurred. It’s not simply the premier analysis institute in America. It’s the premier analysis institute on the earth, and as Julie stated, a giant driver economically of each single county, each medical faculty, each public well being, you understand, it has been an financial powerhouse in addition to a information powerhouse.
Edney: And I wouldn’t let you know you’re incorrect. I believe that you simply’re proper. I haven’t heard the pharma corporations speaking about it. I believe they’re speaking about quite a lot of issues that they need finished to learn them, and so I’m positive that they’ve made their priorities. We’ll see if this reaches type of a boiling level, the place they do find yourself weighing in. And I additionally simply wish to say, NIH, I do know they wish to concentrate on continual illness. It does quite a lot of that. So perhaps that’s not being communicated: It’s not being reduce or left off the desk as a result of we’re doing this. We will do two issues. We will stroll and chew gum.
Rovner: Sure, I do know, and that was the purpose I used to be making an attempt to make. It’s like, there’s an infinite quantity of continual illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend quite a lot of time, particular person members, telling NIH what it’s they need to be learning, which is a complete different subject that we’ll get to a different time.
However I wish to keep on the subject of drug costs, as a result of that’s a extremely huge query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly informed a Bloomberg reporter that it’s going to ask the Trump administration to, quote, “pause” the Medicare drug value negotiation program, which in fact is simply getting underway.
In fact, that’s taking place at the same time as Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration resolution to have Medicare start overlaying its costly new weight reduction medication.
In the meantime, on its means out the door, the Biden administration’s Federal Commerce Fee dropped a report that discovered that the nation’s three largest PBMs, which collectively management about 80% of the U.S. prescription drug market, drove up drug costs by an estimated $7.3 billion from 2017 to 2022.
I noticed someplace this week, and I believe, Sandhya, you talked about this, a suggestion that Republicans would possibly attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to need to do in March. Possible? Potential? Will this report have any affect? Or is there simply an excessive amount of different information this week and no one’s going to recollect?
Raman: I believe it’s positively being talked about rather a lot. We talked to the management of Power and Commerce. It’s a precedence for each of them, each for Carter and for Guthrie, as a result of they labored so intently on it earlier than. It was included in a bipartisan deal that we had earlier than we received the CR [continuing resolution] that we voted into regulation. It simply received dropped alongside the way in which.
Rovner: When Elon Musk stated the invoice was too huge?
Raman: Yeah. So I believe we sort of have two pathways, the place each of them wish to get it finished regardless. I believe that it’d rely whether or not they’re able to piece it away and do it as one thing stand-alone, which they wish to get it finished sooner quite than later.
Nevertheless it relies upon slightly bit extra on the management stage, if there are financial savings from utilizing that invoice for use later down the road after they get reconciliation at a later stage. So I believe that’s what we’re ready on. Would they should put that there? Or would they be capable of go forth with that now?
Rovner: True. So, it’s a bipartisanly well-liked provision that additionally saves cash, in order that makes it sort of enticing to lawmakers who’re placing collectively issues which may, as Joanne would say, embrace spinach.
Anna, what extra broadly do you see because the outlook on drug costs?
Edney: Effectively, I believe the very first thing I consider with that program is, it saves some huge cash should you’re giving Medicare the power to barter. And so, I simply surprise how that matches into this agenda should you cease it and make it extra favorable in direction of the drugmakers. The place does that slot in with chopping spending and decreasing the deficit and all of these issues?
So, I believe that, perhaps they’ve slightly little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I believe everyone knows that we simply have to attend and see what truly occurs.
Rovner: Yeah, quite a lot of shrug emojis coming.
Edney: Precisely.
Rovner: Effectively, in the meantime, throughout the road from Capitol Hill, the Supreme Court docket has agreed to listen to that preventive well being care case out of, altogether now, Texas. The case challenges the necessities within the Reasonably priced Care Act that insurance coverage cowl, with out copay, preventive companies like immunizations, most cancers screenings, contraception, and, the topic of this explicit case, treatment to stop HIV.
What occurs if the courtroom guidelines with the plaintiffs on this case who argue that the CDC’s [Centers for Disease Control and Prevention’s] Preventive Well being Companies Process Power doesn’t have the authority to find out what companies must be on this record? Which in fact is the entity that now determines which companies must be on this record.
Edney: Effectively, it seems like, then, lots of people don’t get their preventive care lined. As KFF wrote, there’s some that might be nonetheless lined, the mammographies, however not the HIV preventative treatment. Different most cancers screenings included in that as nicely. And so, it appears to throw a wrench, I assume, type of simply asking this of the panel, that companies then must go make these determinations? Does Congress need to make the determinations on what’s lined then?
Rovner: Effectively, that’s in fact the massive query. Or, would the secretary, him or herself? Who is allowed? I believe the argument is as a result of the Preventive Well being Companies Process Power is just not Senate-confirmed, they will’t make these choices.
And naturally, the way in which it really works, they don’t make these choices. They suggest them, after which the secretary type of ratifies them. So it’s arduous to inform from this whether or not it actually would go away, or whether or not Congress must step in, or whether or not the secretary might simply do it. I really feel like this creates as many questions because it might solutions.
Kenen: It’s a extremely broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn totally different tales about this, and so they had totally different lists, together with some ldl cholesterol stuff. And I don’t know, for the reason that lists had been so totally different, I’m unsure precisely which of them are in or which of them had been out. Nevertheless it’s not simply HIV medication. It’s quite a lot of stuff.
So it will definitely intestine one thing that individuals rely on now. I imply these are free not slightly below an ACA plan however should you get protection via a job, these necessities additionally apply. So, lots of people would not have free entry to quite a lot of what we think about preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They only determined to take it. So, this might be a later in 2025 case. Effectively, the flip aspect of an incoming administration are all of the issues the outgoing administration tries to slide via on its means out of city, and this week has seen a bunch of these.
Most of this stuff could possibly be pretty simply undone by incoming officers, however not with out some public ache, which generally is why administrations wait till the final minute to do them, to be slightly passive aggressive, or perhaps in a few of these circumstances rather a lot passive aggressive. A number of of those last-minute adjustments come from the Meals and Drug Administration, an company focused for giant adjustments beneath Trump 2.0.
In simply the final 48 hours, the FDA has introduced a coverage that might require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Crimson Dye No. 3, a controversial additive already banned in lots of different international locations which has been proven to trigger most cancers in rodents. And it proposed a significant change in meals labels to require them to indicate on the entrance of packaging whether or not the meals’s sodium, sugar, and saturated fats ranges are low, medium, or excessive. Do any of those proposals dwell on for greater than one other week?
Edney: I believe the Crimson No. 3 might. We all know that R.F.Ok. Jr.’s talked about meals dyes and desirous to get them out of, he particularly stated, cereal, however they’re in quite a lot of issues. So, I see that one.
I believe the business noticed that coming from far-off and has been switching already, in fact generally to a different problematic, probably, meals coloring. However I don’t assume that is one thing you’re going to see them struggle tremendous arduous for to vary. The nicotine is rather more iffy. Huge Tobacco remains to be an enormous power, and Trump will get funding for his marketing campaign and issues from corporations who’ve a stake on this.
And a few of that would align with this concept of not essentially medical freedom however, type of, we are able to select what we put in our our bodies. If we wish to be hooked on nicotine, that’s our selection. So, the opposite one, the labels, I’m unsure. They’re not notably highly effective or something. I assumed they appeared … After I checked out it, I used to be like, That is complicated and simply appears to be like just like the again, however it’s a little totally different. So, I don’t know. Possibly it survives. I’m unsure how a lot the business is engaged on this.
Rovner: [Sen.] Bernie Sanders of all folks excoriated the meals labels, saying we don’t placed on cigarette packages whether or not the cancers they trigger are low, medium, or excessive. Why ought to we do that? I imply, that is principally one other effort to go after ultra-processed meals. I used to be shocked at how offended he was at this.
Kenen: I believe he needs them in neon.
Rovner: I believe he needs R.F.Ok. Jr. to have fewer ultra-processed meals accessible. I believe that’s going to be type of the massive takeaway from all of this, I assume.
Kenen: Proper. However we additionally don’t perceive what an ultra-processed meals is, as a result of there’s some meals that aren’t ultra-processed which might be dangerous for you. And there’s some meals that do have some sort of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t let you know. There’s some issues which might be, quote, “ultra-processed” that basically aren’t that processed, don’t have quite a lot of components. They’ve one thing.
So the entire categorization wants extra work, each for public understanding and political understanding. There’s no one who’s going to say that People have a extremely nutritious diet and that meals components … R.F.Ok. Jr. has identified to the meals additive, the place the businesses need to get to self-certify, Yeah, that is protected. So, is that one thing that he might get widespread assist on? Sure, however there’s a complete lot of different issues that he says that individuals weren’t going to agree with.
Rovner: And I’ll remind that we not solely don’t know if R.F.Ok. Jr. might be confirmed, however they nonetheless don’t actually have a date for his affirmation listening to, as a result of they’re nonetheless ready on the paperwork. All proper, shifting on.
As we taped this morning, there are nonetheless a number of fires burning within the Larger Los Angeles space. Now we have talked in regards to the well being results of fireside earlier than. It’s not precisely information that fireside and smoke are dangerous for human well being, however what appears to make these fires totally different is that they’re not largely bushes and brush and different bits of nature which might be burning however plenty of poisonous substances which might be polluting not simply the air but additionally the ingesting water.
Are we going to have to start out fascinated with hearth and well being in a a lot totally different means if not simply distant areas however total suburbs at the moment are liable to burning up on account of our altering local weather?
Edney: It’s going to make us consider quite a lot of issues in numerous methods, and notably well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that include excessive ranges of formaldehyde, issues like that.
I believe the expectation is that may create a long-term subject, but additionally it could within the second create extra deaths simply on the time, not as a result of it immediately kills but when you have already got a difficulty and you’ve got a respiratory drawback or a coronary heart drawback that may be exacerbated by these fires.
Yeah, I believe there’s a ton to consider. Even ingesting water might be impacted extra so when you’ve got energy outages and issues within the areas the place you’re perhaps cleansing that water after which issues like that. So, I believe that’s going to be — masks, N95s is perhaps coming again for a completely totally different motive.
Rovner: Effectively, N95s should not sufficient. I imply, I believe that was the factor that sort of jumped out at me. In case you watch the information protection of it, the reporters aren’t sporting N95s anymore. They’re sporting what appeared like old-style gasoline masks. I imply, you want type of the following stage of masking as a result of N95s don’t filter out a few of these poisonous substances that at the moment are floating within the air. I imply, they do filter out the type of the particular smoke from wooden and whatnot, but it surely’s fairly scary.
I imply, much more folks than ever earlier than have N95s hanging round their home, however they definitely don’t have these next-level respirators, which is what I hold listening to medical doctors calling for.
Kenen: And the article you — I believe it was the one that you simply despatched round yesterday that principally that every part in our home is, our couches are principally cubes of plastic wrapped in material and harmful after they’re burned. However I imply, I believe that was the article that additionally stated that a few of these issues which might be burning produce like a cyanide sort of gasoline, that the firefighters can’t even be uncovered. They’ll’t stand in entrance of a home with a hose for a very long time.
It could possibly be killing or injuring firefighters. So, it additionally hampers — they’re not simply making an attempt to place a hose on a burning tree.
Rovner: Yeah. Much more issues to consider, which is simply what we wanted. Effectively, turning to abortion, bear in mind all these states final yr that voted to guard abortion rights? Plainly was removed from the ultimate phrase.
We’re seeing courtroom case after courtroom case to find out which abortion restrictions can keep and which might’t on account of passage of these poll measures. That is taking place notably in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a decide invalidated some however not the entire state’s restrictions.
This appears to be the inevitable results of what we’ve got seen in different elections, the place the identical voters endorse abortion rights however then flip round and vote for candidates, together with judges, who don’t. Is the gridlock right here on function or accidentally? And Sandhya, what’s going to occur?
Raman: I don’t know that it will be on function. I believe that these voters that vote for the candidates, if abortion is just not their prime subject, they’re nonetheless going to vote in the way in which that sort of allies with them. However then in the event that they’re different insurance policies, they’re going to vote for these candidates.
And Missouri, I believe, is attention-grabbing as a result of it has lengthy been, I believe, one of many check circumstances for a lot within the abortion house, of making an attempt out new restrictions and what is going to keep on with the wall. And I believe that we’re going to see extra of those sort of lengthy, drawn-out battles, provided that the decide stated that some restrictions had been struck down due to the constitutional modification however then others, just like the licensing for abortion amenities, which we’ve seen for years, can keep. And that simply makes it in order that they will’t actually function.
Rovner: Yeah. They’ve issues like how extensive the hallways have to be, I imply, guidelines that had been created to discourage them from providing abortions, not as a result of they had been truly wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion amenities. They’re not parallel within the different forms of clinics and hospitals. So it’s focused to them. I believe it’s simply one other instance of it being sort of an uphill battle for them, as a result of now, I imply, even previously few years we’ve seen a lot extra consideration on state supreme courtroom races, which I really feel like a couple of years in the past that was not one thing that might get nationwide consideration for one state or one other.
However, provided that, as they’re sort of litigating these and seeing how can we implement the regulation in order that these clinics can open beneath the constitutional modification, it depends on them, and simply how a lot cash that’s being fueled to have the ability to not come down on the opposite aspect in order that they will sort of function. So I believe that’s one thing to positively watch, as a few of these states are sort of litigating this stuff, but it surely’s going to be a protracted, drawn-out battle, even when it’s already been a number of months since seven out of 10 states final yr voted in favor of abortion rights.
Rovner: Yeah, this continues, and naturally, we’ll wait and see what occurs on the federal stage, when the Trump administration will get going. Effectively, lastly this week, we’ve got one other entry in our recurring section, “This Week in Medical Misinformation.” I needed to speak about a little-noted story from the medical information web site MedPage At the moment in regards to the American Board of Inside Medication pulling the board certification of a Texas heart specialist who made controversial and unfaithful claims about covid and the covid vaccine, together with that vaccine had killed tens of 1000’s of individuals.
What’s troublesome about this story, although, is that the ABIM wouldn’t touch upon particular person physicians, though it did record this explicit physician on his web site as not being licensed. How ought to specialty boards take care of medical doctors who specific views which might be, let’s say, not in step with medical proof? And the way clear ought to they be about telling sufferers after they sanction one in all their very own, which is principally what occurred right here?
Kenen: Effectively, they did put out an announcement, I believe it was the New England Journal of Medication a few yr and a half in the past, saying that they had been going to crack down on this. I’m unsure if there’s, for any of the boards, if there’s a mechanism for telling sufferers, as a result of how do you even know who all of the sufferers or potential sufferers are?
Rovner: However once I say telling sufferers, I imply telling the general public.
Kenen: Proper. However I don’t know that any of the boards do this in any — it’s a giant can of worms about decertification and the way sometimes it occurs.
So ABIM did put out an announcement, I believe it was two years in the past now, and there’s been a course of for a couple of, however not rather a lot. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So until the state medical board, which is de facto the group that pulls a license — that is saying that you simply’re not a board-certified no matter your specialty is beneath ABIM.
However Lauren [Weber of The Washington Post], who is usually on the web site, had piece a few months in the past about how few state boards have acted to sanction medical doctors who say incorrect issues about vaccines. And that goes again means earlier than covid. The medical career doesn’t do quite a lot of self-policing.
Rovner: Sure, and I’ve been doing this lengthy sufficient to have lined the creation of the Nationwide Practitioner Knowledge Financial institution, when medical doctors who’d had their licenses pulled might simply go to a different state, and there was no means for that state to simply discover out that that physician had had his or her license revoked.
And that was often not for saying issues however for doing issues that ended up with having the physician decreed not certified to apply drugs anymore. So, I imply, this is a matter that goes again a protracted methods.
Kenen: And you’ll assume they might be the other. You’d assume that the state boards, when any individual can be a dangerous man or a foul gal, you’ll assume they might say, “We cease them!” Like, “We’re defending your well being.” And as an alternative, it’s been very secretive and really rare.
It’s extra the state licensing board. I imply, certification is vital, however actually the ability to de-license any individual is within the state boards.
Rovner: Yeah, nicely, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we are going to hold watching. All proper, that’s the information for this week. Now, we are going to play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our additional credit.
I’m happy to welcome to the podcast Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month.” Harris, welcome to “What the Well being?”
Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you.
Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he received.
Meyer: OK, Julie, it is a story about excessive costs, complicated payments, and lack of value transparency for a quite common process. The affected person is Tom Contos, a 45-year-old well being care guide who lives in Chicago. Final spring, Tom seen blood in his stool. He went to see his household doctor at Northwestern Medication.
The physician referred him for a diagnostic colonoscopy due to the bleeding and due to his household historical past of significant colon points. Then in June, he went in for a colonoscopy at Northwestern Memorial Hospital, which is a giant educating hospital in downtown Chicago.
A Northwestern gastroenterologist carried out the process, which took lower than an hour. He discovered and eliminated two polyps, which a pathologist later discovered weren’t cancerous. The gastroenterologist concluded that Tom’s rectal bleeding was because of a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for folks with no signs, which might be imagined to be free as preventive care beneath the Reasonably priced Care Act. Diagnostic colonoscopies like this one can require a affected person to satisfy deductible and copay necessities, proper? That’s one thing vital for folks to know?
Meyer: Sure. There’s quite a lot of confusion about this. I received quite a lot of feedback on my Washington Publish article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are finished when there are signs like bleeding or ache. In distinction, screening colonoscopies are advisable beginning at age 45, even when there aren’t any signs, to stop colon most cancers or different critical situations.
The Reasonably priced Care Act requires well being insurers to cowl screening colonoscopies for gratis to sufferers. However for a diagnostic colonoscopy, sufferers might need to pay a deductible and copayment, despite the fact that that process equally can stop colon most cancers. It doesn’t—
Rovner: It may be complicated.
Meyer: It’s complicated, yeah.
Rovner: So he has a process, which discovered some minor indications that had been taken care of, after which, as we are saying, the invoice got here. How a lot was it?
Meyer: Yeah, Northwestern’s complete cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated fee with Northwestern of a nonetheless important about $6,000. When he received his insurance coverage clarification of profit assertion, he noticed that he owed about $4,100, with the insurer paying about $2,000.
He was bewildered as a result of he had requested Northwestern for an estimate of how a lot he would owe in complete and he was informed that he would owe about $2,400. My outdoors billing skilled stated $4,100 is sort of a excessive out-of-pocket invoice, although commonplace for educating hospitals.
Rovner: And he was charged for 2 colonoscopies, proper?
Meyer: Sure. That was a significant motive that the invoice was so excessive. Northwestern billed him for 2 colonoscopies, which Tom didn’t perceive, since he had solely obtained one. It seems that suppliers routinely invoice for 2 procedures if the gastroenterologist removes and biopsies two polyps in two other ways throughout the identical process.
The second process is billed at a reduced fee. Now, this appears unusual to laypeople, however that is how suppliers receives a commission for the additional work of eradicating two polyps quite than one.
Rovner: Which, as you identified firstly, it’s not like it is a several-hour surgical procedure. It is a pretty fast process.
Meyer: That’s proper. It’s at most an hour, typically lower than that.
Rovner: So what occurred finally with the invoice?
Meyer: Effectively, Tom appealed the invoice to Northwestern and Aetna and was informed that it was right. He had already paid about $2,400 of the practically $4,100 he owed, however he informed Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they may take him to collections.
Northwestern stated that’s what they had been going to do, and Tom determined to not use Northwestern or its medical doctors sooner or later.
Rovner: Though I assume he did pay the quantity that they stated he owed.
Meyer: No, he stated: Take me to collections. I’m not paying it. My credit score is sweet, and — I received’t repeat among the issues that he stated to them.
Rovner: Thanks. It is a household podcast. How can others keep away from falling into this entice? I imply, he received an estimate. He had an thought of what he was going to be charged, and but he was nonetheless charged significantly greater than that estimate.
Meyer: Yeah, he’s a well being care guide, however lots of people get confused by this course of, together with him taken abruptly. He solely appeared on the estimate after he had had the process however earlier than he received the ultimate invoice. So, like lots of people, he received confused and he didn’t proceed essentially as effectively as he may need. However that’s frequent and never shocking.
Rovner: Even for any individual who’s principally within the well being care fee enterprise.
Meyer: Sure, that’s right.
Rovner: So be vigilant. Is that principally the takeaway?
Meyer: Effectively, how will you keep away from falling in the identical entice? Sadly, not simply. Sufferers needing a diagnostic colonoscopy ought to take a look at freestanding endoscopy facilities or ambulatory surgical procedure facilities that aren’t related to a hospital, as a result of they are often cheaper and so they can present good high quality of care.
To cost-shop forward of time, sufferers can take a look at the hospital’s value web site and their insurer’s price estimator web site to get a way of how a lot a diagnostic colonoscopy might price. Additionally they can lookup a so-called good religion estimate of the money value, which means the process could possibly be cheaper in the event that they pay money, quite than going via insurance coverage.
Plus, there are free web sites comparable to Turquoise Well being and Honest Well being for checking costs for colonoscopies and different procedures. Now, as soon as they get a value estimate from the supplier, there’s yet another wrinkle. Sufferers ought to ask whether or not that value consists of the additional companies, if the gastroenterologist finds and has to take away and biopsy a number of polyps. At the least 40% of colonoscopies do discover polyps.
Now, specialists say it’s unlucky that getting a diagnostic colonoscopy might be so costly and complicated billing-wise, however don’t hesitate, as a result of it may be a lifesaving process for many individuals.
Rovner: All wonderful recommendation. Harris Meyer, thanks a lot.
Meyer: Thanks, Julie.
Rovner: OK, we’re again, and it’s time for our extra-credit section. That’s the place we every acknowledge the story we learn this week we expect you must learn, too. Don’t fear. In case you miss it, we are going to put the hyperlinks in our present notes in your cellphone or different cell machine. Anna, why don’t you go first this week?
Edney: I needed to speak about one I wrote final month, and the headline is “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles.” I sort of needed to place in a single place speaking about quite a lot of these contamination points which have come up, however notably additionally simply present that, whereas the issues with merchandise continue to grow — one in all them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting type of slower on quite a lot of this stuff. They’re digging in, and so they’re not making an attempt to speak to the general public in regards to the points which have come up. They’ve had since final March of 2024 issues delivered to them about benzene and pimples merchandise.
They’ve stated nothing to the general public. They only hold saying, We’re it. And that’s very totally different from when this primary sort of began taking place on a bigger scale, the place it was like, increase, remembers. Now it’s simply type of this struggle to perhaps not have remembers. I don’t know what’s occurring of their head.
However there are also some points in there with the tampons had been discovered to include quite a lot of heavy metals, FDA additionally slow-walking there. So I needed to level out that piece I wrote if anyone missed it.
Rovner: Sure. Thanks, Anna, on the “every part you thought is perhaps protected is definitely harmful” beat.
Edney: I’m the life of each occasion.
Rovner: There you go. Joanne.
Kenen: I’m unsure if that is an additional credit score or a public service announcement, however there’s a nice piece in The Atlantic by Daniel Engber. Effectively, everyone knows there’s a ton of abdomen bugs and norovirus going round, and it’s fairly extreme this yr. And the headline is “A Secret Strategy to Struggle Off Abdomen Bugs,” and the reply is wash your arms with cleaning soap.
Nevertheless it’s a extremely well-written — it truly makes you giggle about abdomen bugs. It’s a really well-written, good story. And no, for this bug, hand sanitizers don’t work.
Rovner: Sandhya.
Raman: My additional credit score this week known as “New weight problems definition sidelines BMI to concentrate on well being,” and it’s by Giorgia Guglielmi for Nature. And it takes a take a look at — we had a revised definition of measuring and diagnosing weight problems within the Lancet Diabetes & Endocrinology this week.
So, as an alternative of BMI [body mass index], which is weight- and height-linked, they’re suggesting a few alternate options: preclinical weight problems, which is an individual with additional physique fats however their organs are nonetheless functioning usually, and scientific weight problems, so when you’ve got that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply other ways clinicians are this globally.
Rovner: Yeah, it’s actually attention-grabbing as a result of, clearly, each physician says that BMI is a silly and imprecise strategy to measure this, after which everyone makes use of BMI as a result of, for the time being, it’s all we’ve got. My additional credit score this week is a KFF Well being Information story from Felice Freyer. It’s referred to as “Can Medical Faculties Funnel Extra Medical doctors into the Main Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened plenty of new medical faculties over the previous decade and has launched a raft of packages aimed toward getting extra graduating medical doctors to enter major care, means too many are nonetheless pursuing specialty care as an alternative. Now we have tried, as a society, free tuition and mortgage compensation packages, but it surely doesn’t appear that medical schooling debt is the largest drawback.
We’ve additionally tried coaching medical doctors in additional primary-care-centric areas, i.e. in neighborhood clinics quite than in hospitals, however that’s not made an enormous dent, both. Quite, to cite one of many household drugs specialists within the story: “It’s not the medical faculties which might be the issue; it’s the job. The job is just too poisonous.”
In different phrases, it’s not likely interesting to see too many sufferers for too little time and do tons of preventing with insurance coverage corporations and digital medical data. Till we as a society begin making major care much more of a satisfying job, it’s not going to matter how a lot it pays. We’re nonetheless going to have a critical scarcity.
All proper, that’s this week’s present. As all the time, should you benefit from the podcast, you may subscribe wherever you get your podcasts. We’d admire it should you left us a evaluate. That helps different folks discover us, too. Particular thanks once more this week to our non permanent manufacturing staff, Taylor Prepare dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As all the time, you may e-mail us your feedback or questions. We’re at whatthehealth@kff.org, or you may nonetheless discover me often at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out lately? Anna?
Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social.
Rovner: Joanne.
Kenen: I’m on Bluesky, @joannekenen.bsky.social, very often on X nonetheless, @JoanneKenen.
Rovner: Sandhya.
Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social.
Rovner: We might be again in your feed subsequent week. Till then, be wholesome.
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Taylor Prepare dinner
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Lonnie Ro
Audio producer
Emmarie Huetteman
Editor
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