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 professional on well being coverage points, Julie is the creator of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.
The 2024 marketing campaign — notably the one for president — has been notably imprecise on coverage. However well being points, particularly these surrounding abortion and different reproductive well being care, have nonetheless performed a key function. And whereas the Reasonably priced Care Act has not been the main focus of debate the way in which it was over the earlier three presidential campaigns, who turns into the subsequent president could have a serious influence on the destiny of the 2010 well being legislation.
The panelists for this week’s particular election preview, taped earlier than a reside viewers at KFF’s places of work in Washington, are Julie Rovner of KFF Well being Information, Tamara Keith of NPR, Alice Miranda Ollstein of Politico, and Cynthia Cox and Ashley Kirzinger of KFF.
Panelists
Ashley Kirzinger
KFF
Cynthia Cox
KFF
Alice Miranda Ollstein
Politico
Tamara Keith
NPR
Learn and hearken to Tamara’s tales.
Among the many takeaways from this week’s episode:
- As Election Day nears, who will emerge victorious from the presidential race is anybody’s guess. Enthusiasm amongst Democratic ladies has grown with the elevation of Vice President Kamala Harris to the highest of the ticket, with extra saying they’re prone to prove to vote. However broadly, polling reveals a margin-of-error race — too near name.
- A number of states have abortion measures on the poll. Proponents of abortion rights are striving to border the difficulty as nonpartisan, acknowledging that current measures have handed thanks partially to Republican assist. For some voters, resisting authorities management of girls’s well being is a conservative worth. Many are keen to separate their votes, supporting each an abortion rights measure and likewise candidates who oppose abortion rights.
- Whereas coverage debates have been noticeably missing from this presidential election, the way forward for Medicaid and the Reasonably priced Care Act hinges on its end result. Republicans need to undermine the federal funding behind Medicaid enlargement, and former President Donald Trump has a file of opposition to the ACA. Probably on the chopping block are the federal subsidies expiring subsequent 12 months which have reworked the ACA by boosting enrollment and decreasing premium prices.
- And as misinformation and disinformation proliferate, one space of concern is the “malleable center”: people who find themselves unsure of whom or what to belief and due to this fact particularly vulnerable to deceptive or downright false info. May a second Trump administration embed misinformation in federal coverage? The push to melt and even get rid of college vaccination mandates exhibits the general public well being penalties of falsehood creep.
Additionally talked about on this week’s podcast:
click on to open the transcript
Transcript: LIVE From KFF: Well being Care and the 2024 Election
[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.]
Emmarie Huetteman: Please put your palms collectively and be a part of me in welcoming our panel and our host, Julie Rovner.
Julie Rovner: Whats up, good morning, 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 absolute best and smartest well being reporters in Washington, together with some very particular visitors at this time. We’re taping this particular election episode on Thursday, October seventeenth, at 11:30 a.m., in entrance of a reside viewers on the Barbara Jordan Convention Heart right here at KFF in downtown D.C. Say hello, viewers.
As at all times, information occurs quick and issues may need modified by the point you hear this. So, right here we go.
So I’m tremendous fortunate to work at and have labored at some fairly nice locations and with some fairly nice, sensible individuals. And after I began to consider who I needed to assist us break down what this 12 months’s elections would possibly imply for well being coverage, it was fairly simple to assemble an all-star forged. So first, my former colleague from NPR, senior White Home correspondent Tamara Keith. Tam, thanks for becoming a member of us.
Tamara Keith: Thanks for having me.
Rovner: Subsequent, our common “What the Well being?” podcast panelist and my proper hand all 12 months on reproductive well being points, Alice Ollstein of Politico.
Alice Miranda Ollstein: Hello Julie.
Rovner: Lastly, two of my unbelievable KFF colleagues. Cynthia Cox is a KFF vice chairman and director of this system on the ACA [Affordable Care Act] and one of many nation’s very prime specialists on what we all know as Obamacare. Thanks, Cynthia.
Cynthia Cox: Nice to be right here.
Rovner: And at last, Ashley Kirzinger is director of survey methodology and affiliate director of our KFF Public Opinion and Survey Analysis Program, and my favourite explainer of all issues polling.
Ashley Kirzinger: Thanks for having me.
Rovner: So, welcome to all of you. Thanks once more for being right here. We’re going to speak amongst ourselves for a half hour or so, after which we are going to open the ground to questions. So be prepared right here within the room. Tam, I need to begin with the massive image. What’s the state of the race as of October seventeenth, each for president and for Congress?
Keith: Effectively, let’s begin with the race for President. That’s what I cowl most intently. That is what you’ll name a margin-of-error race, and it has been a margin-of-error race just about all the time, regardless of some actually dramatic occasions, like an entire new candidate and two assassination makes an attempt and issues that we don’t count on to see in our lifetimes and but they’ve occurred. And but it’s an extremely shut race. What I might say is that at this precise second, there appears to have been a slight shift within the common of polls within the route of former President [Donald] Trump. He’s in a barely higher place than he was earlier than and is in a considerably extra snug place than Vice President [Kamala] Harris.
She has been operating as an underdog the entire time, although there was a time the place she didn’t really feel like an underdog, and proper now she can be operating like an underdog and the vibes have shifted, if you’ll. There’s been a extra dramatic shift within the vibes than there was within the polls. And the factor that we don’t know and we gained’t know till Election Day is in 2016 and 2020, the polls underestimated Trump’s assist. So at this second, Harris seems to be in a weaker place towards Trump than both [Hillary] Clinton or [Joe] Biden . It seems that the polls have been underestimating Trump each of these years. However in 2022 after the Dobbs resolution, the polls overestimated Republican assist and underestimated Democratic assist.
So what’s occurring now? We don’t know. So there you go. That’s my overview, I feel, of the presidential race. The campaigning has actually intensified within the final week or so, like actually intensified, and it’s solely going to get extra intense. I feel Harris has gotten a bit darker in her language and descriptions. The joyful warrior has been changed considerably by the particular person warning of dire penalties for democracy. And when it comes to the Home and the Senate, which is able to matter rather a lot, rather a lot rather a lot, whether or not Trump wins or Harris wins, if Harris wins and Democrats lose the Senate, Harris might not even have the ability to get Cupboard members confirmed.
So it issues rather a lot, and the traditional knowledge — which is as helpful as it’s and generally is just not all that helpful — the traditional knowledge is that one thing form of uncommon might occur, which is that the Home might flip to Democrats and the Senate might flip to Republicans, and normally this stuff don’t transfer in reverse instructions in the identical 12 months.
Rovner: And normally the presidential candidate has coattails, however we’re not likely seeing that both, are we?
Keith: Proper. In actual fact, it’s the reverse. A number of of the Senate candidates in key swing states, the Democratic candidates are polling a lot better than the Republican candidates in these races and polling with larger energy than Harris has in these states. Is that this a polling error, or is that this the return of split-ticket voting? I don’t know.
Rovner: Effectively, leads us to our polling professional. Ashley, what are the most recent polls telling us, and what ought to we take into accout in regards to the limitations of polling? I really feel like yearly individuals rely rather a lot on the polls and yearly we are saying, Don’t rely an excessive amount of on the polls.
Kirzinger: Effectively, can I simply steal Tamara’s line and say I don’t know? So in actually shut elections, when turnout goes to matter rather a lot, what the polls are actually good at is telling us what’s motivating voters to prove and why. And so what the polls have been telling us for some time is that the financial system is prime of thoughts for voters. Now, well being care prices — we’re at KFF. So well being care performs a giant function in how individuals take into consideration the financial system, in actually two massive methods. The primary is sudden prices. So sudden medical payments, well being care prices, are topping the checklist of the general public’s monetary worries, issues that they’re fearful about, what would possibly occur to them or their relations. And pushing aside care. What we’re seeing is a few quarter of the general public today are pushing aside care as a result of they are saying they’ll’t afford the price of getting that wanted care.
So that basically exhibits the way in which that the monetary burdens are enjoying closely on the voters. What we now have seen in current polling is Harris is doing higher on the family bills than Biden did and is healthier than the Democratic Occasion largely. And that’s actually vital, particularly amongst Black ladies and Latina voters. We’re seeing some motion amongst these two teams of the voters saying that Harris is doing a greater job and so they belief her extra on these points. However traditionally, if the election is in regards to the financial system, Republican candidates do higher. The get together does higher on financial points among the many voters.
What we haven’t talked about but is abortion, and that is the primary presidential election since post-Dobbs, within the post-Dobbs period, and we don’t understand how abortion coverage will play in a presidential election. It hasn’t occurred earlier than, in order that’s one thing that we’re additionally keeping track of. We all know that Harris is campaigning round reproductive rights, is working amongst a key group of the voters, particularly youthful ladies voters. She is seen as a real candidate who can discuss these points and an advocate for reproductive rights. We’re seeing abortion rise in significance as a voting concern amongst younger ladies voters, and she or he’s seen as extra genuine on this concern than Biden was.
Rovner: Discuss final week’s ballot about younger ladies voters.
Kirzinger: Yeah, one of many nice issues that we are able to do in polling is, after we see massive modifications within the marketing campaign, is we are able to return to our polls and respondents and ask how issues have modified to them. So we labored on a ballot of girls voters again in June. Heaps have modified since June, so we went again to them in September to see how issues have been altering for this one group, proper? So we went again to the identical individuals and we noticed elevated motivation to prove, particularly amongst Democratic ladies. Republican ladies have been about the identical stage of motivation. They’re extra enthusiastic and happy about their candidate, and so they’re extra prone to say abortion is a serious cause why they’re going to be turning out. However we nonetheless don’t understand how that may play throughout the voters in all of the states.
As a result of for many voters, a candidate’s stance on abortion coverage is only one of many elements that they’re weighing with regards to turnout. And so these are one of many issues that we’re taking a look at as effectively. I’ll say that I’m not a forecaster, thank goodness. I’m a pollster, and polls will not be good at forecasts, proper? So polls are excellent at giving a snapshot of the voters at a second in time. So two weeks out, that’s what I do know from the polls. What’s going to occur within the subsequent two weeks, I’m undecided.
Rovner: Effectively, Alice, simply to select up on that, abortion, reproductive well being writ giant are by far the largest well being points on this marketing campaign. What influence is it having on the presidential race and the congressional races and the poll points? It’s all form of a muddle, isn’t it?
Ollstein: Yeah, effectively, I simply actually need to stress what Ashley stated about this being uncharted territory. So we are able to collect some clues from the previous few years the place we’ve seen these abortion rights poll measures win decisively in very crimson states, in very blue states, in very purple states. However presidential election years simply have a distinct voters. And so, sure, it did encourage extra individuals to prove in these midterm and off-year elections, however that’s simply not the identical group of parents and it’s not the identical teams the candidates want this time, essentially. And likewise we all know that each time abortion has been on the poll, it has gained, however the influence and the way that spills over into partisan races has been an actual combined bag.
So we noticed in Michigan in 2022, it actually helped Democrats. It helped Governor Gretchen Whitmer. It helped Michigan Democrats take again management of the Statehouse for the primary time in many years. However that didn’t work for Democrats in all states. My colleagues and I did an evaluation of a bunch of various states that had these poll measures, and these poll measures largely succeeded due to Republican voters who voted for the poll initiative and voted for Republican candidates. And which may appear contradictory. You’re voting for an abortion rights measure, and also you’re voting for very anti-abortion candidates. We noticed that in Kentucky, for instance, the place lots of people voted for (Sen.) Rand Paul, who may be very anti-abortion, and for the abortion rights facet of the poll measure.
I’ve been on the highway the previous couple of months, and I feel you’re going to see quite a lot of that once more. I simply bought again from Arizona, and lots of people are planning to vote for the abortion rights measure there and for candidates who’ve a file of opposing abortion rights. A part of that’s Donald Trump’s considerably current line of: I gained’t do any form of nationwide ban. I’ll depart it to the states. Lots of people are believing that, regardless that Democrats are like: Don’t consider him. It’s not true. But in addition, like Ashley stated, of us are simply prioritizing different points. And so, sure, whenever you have a look at sure slices of the voters, like younger ladies, abortion is a prime motivating concern. However whenever you have a look at all the voters, it’s, like, a distant fourth after the financial system and immigration and several other different issues.
I discovered the KFF polling actually illuminating in that, sure, most individuals stated that abortion is both simply one in all many elements in deciding their vote on the candidates or not an element in any respect. And most of the people stated that they’d be keen to vote for a candidate who doesn’t share their views on abortion. So I feel that’s actually key right here. And these abortion rights poll measures, the campaigns behind them are being actually deliberate about remaining fully nonpartisan. They should attraction to Republicans, Democrats, independents as a way to cross, however that additionally … So their motivation is to attraction to everybody. Democrats’ motivation is to say: You need to vote for us, too. Abortion rights gained’t be protected if you happen to simply cross the poll measure. You additionally must vote for Democrats up and down the poll. As a result of, they argue, Trump might pursue a nationwide ban that will override the state protections.
Rovner: We’ve seen previously — and that is for each of you — poll measures as a part of partisan methods. Within the early 2000s, there have been anti-gay-marriage poll measures that have been meant to tug out Republicans, that have been meant to drive turnout. That’s not precisely what’s occurring this time, is it?
Keith: So I used to be a reporter within the nice state of Ohio in 2004, and there was an anti-gay-rights poll measure on the poll there, and it was a key a part of George W. Bush’s reelection plan. And it labored. He gained the state considerably narrowly. We didn’t get the outcomes till 5 a.m. the subsequent day, however that’s higher than we’ll probably have this time. And that was a vital a part of driving Republican turnout. It’s exceptional how a lot has modified since then when it comes to public views. It wouldn’t work in the identical method this time.
The attention-grabbing factor in Arizona, as an example, is that there’s additionally an anti-immigration poll measure that’s additionally polling very well that was added by the legislature in type of a rush to attempt to offset the anticipated Democratic-based turnout due to the abortion measure. However as you say, it’s completely potential that there might be quite a lot of Trump abortion, immigration and [House Democrat and Senate candidate] Ruben Gallego voters.
Ollstein: Completely. And I met a few of these voters, and one girl advised me, look, she will get offended when individuals assume that she’s liberal as a result of she recognized as pro-choice. We don’t use that terminology in our reporting, however she recognized as pro-choice, and she or he was saying: Look, to me, this can be a very conservative worth. I don’t need the federal government in my private enterprise. I consider in privateness. And so for her, that doesn’t translate over into, And due to this fact I’m a Democrat.
Rovner: I lined two abortion-related poll measures in South Dakota that have been two years, I feel it was 2006 and 2008.
Ollstein: They’ve one other one this 12 months.
Rovner: Proper. There may be one other one this 12 months. However what was attention-grabbing, what I found in 2006 and 2008 is precisely what you have been saying, that there’s a libertarian streak, notably within the West, of people that vote Republican however who don’t consider that the federal government has any type of enterprise in your private life, not simply on abortion however on any variety of different issues, together with weapons. So that is a kind of points the place there’s type of quite a lot of distinction. Cynthia, that is the primary time in nonetheless many elections the Reasonably priced Care Act has not been an enormous concern, however there’s an terrible lot at stake for this legislation, relying on who will get elected, proper?
Cox: Yeah, that’s proper. I imply, it’s the primary time in current reminiscence that well being care generally, apart from abortion, hasn’t actually been the primary subject of dialog within the race. And a part of that’s that the Reasonably priced Care Act has actually reworked the American well being care system during the last decade or so. The uninsured fee is at a file low, and the ACA marketplaces, which had been actually struggling 10 years in the past, have began to not simply survive however thrive. Perhaps additionally much less to dislike in regards to the ACA, but it surely’s additionally not as a lot a coverage election as earlier elections had been. However sure, the way forward for the ACA nonetheless hinges on this election.
So beginning with President Trump, I feel as anybody who follows well being coverage is aware of, and even politics or simply turned on the TV in 2016 is aware of that Trump has a really, very clear historical past of opposing the Reasonably priced Care Act, or Obamacare. He supported various efforts in Congress to attempt to repeal and change the Reasonably priced Care Act. And when these weren’t profitable, he took various regulatory steps, joined authorized challenges, and proposed in his budgets to slash funding for the Reasonably priced Care Act and for Medicaid. However now in 2024, it’s a bit of bit much less clear precisely the place he’s going.
I might say earlier within the 2024 presidential cycle, he made some very clear feedback about saying Obamacare sucks, for instance, or that Republicans ought to by no means hand over on attempting to repeal and change the ACA, that the failure to take action when he was president was a low level for the get together. However then he additionally has appeared to form of stroll that again a bit of bit. Now he’s saying that he would change the ACA with one thing higher or that he would make the ACA itself a lot, a lot better or make it price much less, however he’s not offering specifics. In fact, within the debate, he famously stated that he had “ideas” of a plan, however there’s no … Nothing actually particular has materialized.
Rovner: We haven’t seen any of these ideas.
Cox: Sure, the idea is … However we are able to have a look at his file. And so we do know that he has a really, very clear file of opposing the ACA and actually taking any steps he might when he was president to attempt to, if not repeal and change it, then considerably weaken it or roll it again. Harris, in contrast, is in favor of the Reasonably priced Care Act. When she was a major candidate in 2020, she had expressed assist for more-progressive reforms like “Medicare for All” or “Medicare for Extra.” However since turning into vice chairman, particularly now because the presidential candidate, she’s taken a extra incremental strategy.
She’s speaking about constructing upon the Reasonably priced Care Act. Specifically, a key side of her file and Biden’s is these enhanced subsidies that exist within the Reasonably priced Care Act marketplaces. They have been first, I feel … They actually intently mirror what Biden had run on as president in 2019, 2020, however they have been handed as a part of covid aid. So that they have been non permanent, then they have been prolonged as a part of the Inflation Discount Act however, once more, briefly. And they also’re set to run out subsequent 12 months, which is establishing a political showdown of types for Republicans and Democrats on the Hill about whether or not or to not lengthen them. And Harris want to make these subsidies everlasting as a result of they’ve been accountable for actually reworking the ACA marketplaces.
The variety of individuals signing up for protection has doubled since Biden took workplace. Premium funds have been minimize nearly in half. And so that is, I feel, a key a part of, now, her file, but in addition what she needs to see go ahead. However it’s going to be an uphill battle, I feel, to increase them.
Rovner: Cynthia, to type of construct on that a bit of bit, as we talked about earlier, a Democratic president gained’t have the ability to get rather a lot completed with a Republican Home and/or Senate and a Republican president gained’t have the ability to get that a lot achieved with a Democratic Home and/or Senate. What are among the issues we would count on to see if both facet wins a trifecta management of the chief department and each homes of Congress?
Cox: So I feel, there … So I assume I’ll begin with Republicans. So if there’s a trifecta, the important thing factor there to bear in mind is whereas there might not be quite a lot of urge for food in Congress to attempt to repeal and change the ACA, since that wasn’t actually a successful concern in 2017, and since then public assist for the ACA has grown. And I feel additionally it’s value noting that the person mandate penalty being lowered to $0. So primarily there’s no particular person mandate anymore. There’s much less to hate in regards to the legislation.
Rovner: All of the pay-fors are gone, too.
Cox: Yeah the pay-fors are gone, too.
Rovner: So the lobbyists have much less to hate.
Cox: Sure, that too. And so I don’t assume there’s a ton of urge for food for this, regardless that Trump has been saying, nonetheless, some detrimental feedback in regards to the ACA. That being stated, if Republicans need to cross tax cuts, then they should discover financial savings someplace. And in order that might be any variety of locations, however I feel it’s probably that sure well being packages and different packages are off-limits. So Medicare in all probability wouldn’t be touched, possibly Social Safety, protection, however that leaves Medicaid and the ACA subsidies.
And so in the event that they want financial savings as a way to cross tax cuts, then I do assume specifically Medicaid is in danger, not simply rolling again the ACA’s Medicaid enlargement but in addition probably block-granting this system or implementing per capita caps or another type of actually proscribing the quantity of federal {dollars} which can be going in direction of Medicaid.
Rovner: And that is form of the place we get into the Challenge 2025 that we’ve talked about rather a lot on the podcast over the course of this 12 months, that, after all, Donald Trump has disavowed. However apparently [Senate Republican and vice presidential candidate] JD Vance has not, as a result of he retains mentioning items of it.
Ollstein: And so they’re solely … They’re simply one in all a number of teams which have pitched deep cuts to well being security internet packages, together with Medicaid. You even have the Paragon group, the place quite a lot of former Trump officers are placing ahead well being coverage pitches and several other others. And so I additionally assume given the uncertainty a few trifecta, it’s additionally value conserving in thoughts what they may do by way of waivers and government actions when it comes to work necessities.
Rovner: That was my subsequent query. I’ve had hassle explaining this. I’ve achieved a bunch of interviews within the final couple of weeks to clarify how way more energy Donald Trump would have, if he was reelected, to do issues by way of the chief department than a President Harris would have. So I’ve not give you a great way to clarify that. Please, one in all you give it a shot.
Keith: Another person.
Rovner: Why is it that President Trump might in all probability do much more together with his government energy than a President Harris might do with hers?
Cox: I feel we are able to look again at the previous couple of years and simply see. What did Trump do together with his government energy? What did Biden do together with his government energy? And so far as the Reasonably priced Care Act is anxious or Medicaid. However Trump, after the failure to repeal and change the ACA, took various regulatory steps. For instance, attempting to increase short-term plans, which aren’t ACA-compliant, and due to this fact can discriminate towards individuals with preexisting situations, or slicing funding for sure issues within the ACA, together with outreach and enrollment help.
And so I feel there have been a quantity — and likewise we’ve talked about Medicaid work necessities within the type of state waivers. And quite a lot of what Biden did, regulatory actions, have been simply rolling that again, altering that, but it surely’s arduous to increase protection or to offer a brand new program with out Congress appearing to authorize that spending.
Kirzinger: I feel it’s additionally actually vital to consider the general public’s view of the ACA at this time limit. I imply, what the polls aren’t combined about is that the ACA has larger favorability than Harris, Biden, Trump, any politician, proper? So we now have about two-thirds of the general public.
Rovner: So Nancy Pelosi was proper.
Kirzinger: I gained’t go that far, however about two-thirds of the general public’s now view the legislation favorably, and the provisions are much more widespread. So whereas, sure, a Republican trifecta could have quite a lot of energy, the general public — they’re going to have a tough time rolling again protections for individuals with preexisting situations, which have bipartisan assist. They’re going to have a tough time making it now not accessible for grownup kids below the age of 26 to be on their dad and mom’ medical insurance. All of these elements of the ACA are actually widespread, and as soon as persons are given protections, it’s actually arduous to take them away.
Cox: Though I might say that there are at the least 10 methods the ACA protects individuals with preexisting situations. I feel on the floor it’s simple to say that you’d shield individuals with preexisting situations if you happen to say {that a} well being insurer has to supply protection to somebody with a preexisting situation. However there’s all these different ways in which they are saying additionally protects preexisting situations, and it makes protection extra complete, which makes protection dearer.
And in order that’s why the subsidies there are key to make complete protection that protects individuals with preexisting situations reasonably priced to people. However if you happen to take these subsidies away, then that protection is out of attain for most individuals.
Rovner: That’s additionally what JD Vance was speaking about with altering danger swimming pools. I imply, which most individuals, it makes your eyes glaze over, however that will be tremendous vital to the affordability of insurance coverage, proper?
Cox: And his remark about danger swimming pools is — I feel lots of people have been attempting to learn one thing into that as a result of it was fairly imprecise. However what lots of people did take into consideration when he made that remark was that earlier than the Reasonably priced Care Act, it was once that if you happen to have been declined medical insurance protection, particularly by a number of insurance coverage corporations, if you happen to have been mainly uninsurable, then you may apply to what existed in lots of states was a high-risk pool.
However the issue was that these high-risk swimming pools have been persistently underfunded. And in most of these high-risk swimming pools, there have been even ready durations or exclusions on protection for preexisting situations or very excessive premiums or deductibles. So regardless that these have been theoretically an possibility for protection for individuals with preexisting situations earlier than the ACA, the shortage of funding or assist made it such that that protection didn’t work very effectively for individuals who have been sick.
Ollstein: And one thing conservatives actually need to do in the event that they acquire energy is go after the Medicaid enlargement. They’ve type of arrange this dichotomy of type of the deserving and undeserving. They don’t say it in these phrases, however they argue that childless adults who’re able-bodied don’t want this security internet the way in which, quote-unquote, “conventional” Medicaid enrollees do. And they also need to go after that a part of this system by decreasing the federal match. That’s one thing I might be careful for. I don’t know in the event that they’ll have the ability to try this. That might require Congress, but in addition a number of states have of their legal guidelines that if the federal matches decreased, they’d robotically unexpand, and that will imply protection losses for lots of people. That might be very politically unpopular.
It’s value conserving in thoughts that quite a lot of states, primarily crimson states, have expanded Medicaid since Republicans final tried to go after the Reasonably priced Care Act in 2017. And so there’s simply much more buy-in now. So it will be politically more difficult to do this. And it was already very politically difficult. They weren’t capable of do it again then.
Rovner: So I really feel like one of many causes that Trump would possibly have the ability to get extra achieved than Harris simply utilizing government authority is the make-up of the judiciary, which has been very conservative, notably on the Supreme Courtroom, and we even have some breaking information on this yesterday. Three of the states who intervened in what was initially a Texas lawsuit attempting to revoke the FDA’s [Federal Drug Administration’s] approval of the abortion capsule mifepristone, formally revived that lawsuit, which the Supreme Courtroom had dismissed as a result of the medical doctors who filed it initially didn’t have standing, in keeping with the Supreme Courtroom.
The states need the courts to invoke the Comstock Act, an 1873 anti-vice legislation banning the mailing and receiving of, amongst different issues, something utilized in an abortion, to successfully ban the drug. That is a kind of ways in which Trump wouldn’t even must raise a finger to result in an abortion ban, proper? I imply, he’d simply must let it occur.
Ollstein: Proper. I feel a lot of this election cycle has been dominated by, Would you signal a ban? And that’s simply the flawed query. I imply, we’ve seen Congress unable to cross both abortion restrictions or abortion protections even when one get together controls each chambers. It’s simply actually arduous.
Rovner: And going again 60 years.
Ollstein: And so I feel it’s far more vital to take a look at what might occur administratively or by way of the courts. And so sure, lawsuits like that, that the Supreme Courtroom punted on however didn’t completely resolve this time period, might completely come again. A Trump administration might additionally direct the FDA to only unauthorize abortion drugs, that are nearly all of abortions that happen throughout the U.S.
And so — or there’s this Comstock Act route. There’s — the Biden administration put out a memo saying, We don’t assume the Comstock Act applies to the mailing of abortion drugs to sufferers. A Trump administration might put out their very own memo and say, We consider the other. So there’s rather a lot that might occur. And so I actually have been annoyed. All the obsessive deal with: Would you signal a ban? Would you veto a ban? As a result of that’s the least probably route that this is able to occur.
Kirzinger: Effectively, and all of those courtroom circumstances create an air of confusion among the many public, proper? And so, that can also have an impact in a method that signing a ban — I imply, if individuals don’t know what’s accessible to them of their state based mostly on state coverage or nationwide coverage.
Ollstein: Or they’re afraid of getting arrested.
Kirzinger: Yeah, even when it’s fully authorized of their state, we’re discovering that folks aren’t conscious of whether or not — what’s accessible to them of their state, what they’ll entry legally or not. And so having these courtroom circumstances pending creates this air of confusion among the many public.
Keith: Effectively, simply to amplify the air of confusion, speaking to Democrats who watch focus teams, they noticed quite a lot of voters blaming President Biden for the Dobbs resolution and saying: Effectively, why couldn’t he repair that? He’s president. At a a lot larger stage, there’s confusion about how our legal guidelines work. There’s quite a lot of confusion about civics, and in consequence, you see blame touchdown in type of sudden locations.
Rovner: That is the vaguest presidential election I’ve ever lined. I’ve been doing this since 1988. We mainly have each candidates refusing to reply particular questions — as a method, I imply, it’s not that I don’t assume — I feel they each would have a reasonably good concept of what it’s they’d do, and each of them discover it to their political benefit to not say.
Keith: I feel that’s completely proper. I feel that the Harris marketing campaign, which I spend extra time overlaying, has the view that if Trump is just not going to reply questions straight and he’s going to speak about “ideas” of a plan, and he’s simply going to type of, like, Effectively, if I used to be president, this wouldn’t be an issue, so I’m not going to reply your query — which is his reply to nearly each query — then there’s not quite a lot of upside for them to get into nice specifics about coverage and to have assume tank nerds telling them it gained’t work, as a result of there’s no upside to it.
Cox: We’re proper right here.
Panel: [Laughing]
Rovner: So common listeners to the podcast will know that one in all my greatest private frustrations with this marketing campaign is the ever-increasing quantity of mis- and outright disinformation within the well being care realm, as we mentioned at some size on final week’s podcast. You may return and pay attention. This has develop into firmly established in public well being, clearly pushed alongside by the divide over the covid pandemic. The New York Instances final week had a fairly scary story by Sheryl Homosexual Stolberg — who’s engaged on a guide about public well being — about how a few of these extra fringe beliefs are getting embedded within the mainstream of the Republican Occasion.
It was once that we noticed most of those form of fringe, anti-science, anti-health beliefs have been on the far proper and on the far left, and that’s much less the case. What might we be wanting ahead to on the general public well being entrance if Trump is returned to energy, notably with the assistance of anti-vaccine activist and now Trump endorser R.F.Okay. [Robert F. Kennedy] Jr.?
Kirzinger: Oh, goodness to me. Effectively, so I’m going to speak a few group that I feel is admittedly vital for us to deal with after we take into consideration misinformation, and I name them the “malleable center.” So it’s that group that when they hear misinformation or disinformation, they’re not sure of whether or not that’s true or false, proper? So that they’re caught on this uncertainty of what to consider and who do they belief to get the best info. It was once pre-pandemic that they’d belief their authorities officers.
We’ve seen declining belief in CDC [Centers for Disease Control and Prevention], all ranges of public well being officers. Who they nonetheless belief is their major care suppliers. Sadly, the teams which can be most vulnerable to misinformation are additionally the teams which can be much less prone to have a major care supplier. So we’re not in an awesome situation, the place we now have a gaggle that’s not sure of who to belief on info and doesn’t have somebody to go to for good sources of data. I don’t have an answer.
Cox: I additionally don’t have an answer.
Rovner: No, I wasn’t — the query isn’t a few answer. The query is about, what can we count on? I imply, we’ve seen the type of mis- and disinformation. Are we going to truly see it embedded in coverage? I imply, we’ve largely not, apart from covid, which clearly now we see the massive distinction in some states the place masks bans are banned and vaccine mandates are banned. Are we going to see childhood vaccines made voluntary for college?
Ollstein: Effectively, there’s already a motion to massively broaden who can apply for an exception to these, and that’s already had some scary public well being penalties. I imply, I feel there are individuals who would completely push for that.
Kirzinger: I feel no matter who wins the presidency, I feel that the misinformation and disinformation goes to have an rising function. Whether or not it makes it into coverage will depend upon who’s in workplace and Congress and all of that. However I feel that it isn’t one thing that’s going away, and I feel we’re simply going to proceed to must battle it. And that’s the place I’m essentially the most nervous.
Keith: And whenever you speak in regards to the belief for the media, these of us who’re sitting right here attempting to get the reality on the market, or to fact-check and debunk, belief for us is, like, within the basement, and it simply retains getting worse 12 months after 12 months after 12 months. And the most recent Gallup numbers have us worse than we have been earlier than, which is simply, like, one other establishment that persons are not turning to. We’re in an period the place some rando on YouTube who stated they did their analysis is extra trusted than what we publish.
Rovner: And a few of these randos on YouTube have hundreds of thousands of viewers, listeners.
Keith: Sure, completely.
Rovner: Subscribers, no matter you need to name them.
Ollstein: One space the place I’ve actually seen this come ahead, and it might positively develop into a part of coverage sooner or later, is there’s simply quite a lot of mis- and disinformation round transgender well being care. There’s polling that present lots of people consider what Trump and others have been saying, that, Oh, children can come house from college and have a intercourse change operation. Which is clearly ridiculous. Everybody who has children in class is aware of that they’ll’t even give them a Tylenol with out parental permission. And it clearly doesn’t occur in a day, however persons are like, Oh, effectively, I do know it’s not occurring at my college, but it surely’s certain occurring someplace. And that’s actually resonating, and we’re already seeing quite a lot of authorized restrictions on that entrance spilling.
Rovner: All proper, effectively, I’m going to open it as much as the viewers. Please wait to ask your query till you may have a microphone, so the individuals who might be listening to the podcast will have the ability to hear your query. And please inform us who you might be, and please make your query or query.
Madeline: Hello, I’m Madeline. I’m a grad pupil on the Milken Institute of Public Well being at George Washington. My query is relating to polling. And I used to be simply questioning, how has polling methodologies or tendencies to over-sample conservatives had on polls within the race? Are you seeing that as a problem or …?
Kirzinger: OK. who’s much less trusted than the media? It’s pollsters, however you’ll be able to belief me. So I feel what you’re seeing is there are actually extra polls than there have ever been, and I need to discuss reliable scientific polls which can be probability-based. They’re not letting individuals choose into taking the survey, and so they’re ensuring their samples are consultant of all the inhabitants that they’re surveying, whether or not or not it’s the voters or the American public, relying on that.
I feel what we now have seen is that there have been some tendencies when individuals don’t just like the ballot outcomes, they have a look at the make-up of that pattern and say, oh, this ballot’s too Democratic, or too conservative, has too many Trump voters. Or no matter it might be. That advantages no pollster to make their pattern not seem like the inhabitants that they’re aiming to signify. And so, sure, there are many actually, actually unhealthy polls on the market, however the ones which can be reliable and scientific are nonetheless striving to purpose to make it possible for it’s consultant. The issue with election polls is we don’t know who the voters’s going to be. We don’t know if Democrats are going to prove greater than Republicans. We don’t know if we’re going to see larger shares of rural voters than we noticed in 2022.
We don’t know. And in order that’s the place you actually see the shifts in error occur.
Keith: And if former President Trump’s — a giant a part of his technique is popping out unlikely voters.
Kirzinger: Yeah. We don’t know who they’re.
Rovner: Effectively, yeah, we noticed in Georgia, their first day of in-person early voting, we had this big upswell of voters, however we don’t know who any of these are, proper? I imply, we don’t know what’s essentially turning them out.
Kirzinger: Precisely. And traditionally, Democrats have been extra prone to vote early and vote by mail, however that has actually shifted because the pandemic. And so that you see these day voting totals now, however that basically doesn’t let you know something at this level within the race.
Rovner: Heaps we nonetheless don’t know. One other query.
Rae Woods: Hello there. Rae Woods. I’m with Advisory Board, which signifies that I work with well being leaders who have to implement based mostly on the insurance policies and the politics and the outcomes of the election that’s developing. My query is, outdoors among the massive issues that we’ve talked about to this point at this time, are there some extra particular, smaller insurance policies or state-level dynamics that you simply assume at this time’s well being leaders might want to reply to within the subsequent six months, the subsequent eight months? What do well being leaders must be centered on proper now based mostly on what might change most shortly?
Ollstein: One thing I’ve been attempting to shine a light-weight on are state Supreme Courts, which the make-up of them might change dramatically this November. States have all types of various methods to … Some elect them on a partisan foundation. Some elect them on a nonpartisan foundation. Some have appointments by the governor, however then they must run in these retention elections. However they’ll simply have a lot energy over … I imply, I’m most centered on the way it can influence abortion rights, however they simply have a lot energy on so many issues.
And given the excessive chance of divided federal authorities, I feel only a ton of well being coverage goes to occur on the state stage. And so I might say the voters usually overlooks these races. There’s an enormous drop-off. Lots of people simply vote the highest of the ticket after which simply depart these races clean. However sure, I feel we must always all be paying extra consideration to state Supreme Courtroom races.
Rovner: I feel the opposite factor that we didn’t, that no one talked about we have been speaking about, what the subsequent president might do, is the influence of the change to the regulatory atmosphere and what the Supreme Courtroom’s resolution overturning Chevron goes to have on the subsequent president. And we did a entire episode on this, so I can hyperlink again to that for many who don’t know. However mainly, the Supreme Courtroom has made it harder for whoever turns into president subsequent time to vary guidelines by way of their government authority, and put extra onus again on Congress. And we are going to see how that every one performs out, however I feel that’s going to be actually vital subsequent 12 months.
Natalie Bercutt: Hello. My identify is Natalie Bercutt. I’m additionally a grasp’s pupil at George Washington. I research well being coverage. I needed to know a bit of bit extra about, clearly, abortion rights, an enormous concern on the poll on this election, however a bit of bit extra about IVF [in vitro fertilization], which I really feel like has form of come to the forefront a bit of bit extra, each in state races but in addition candidates making feedback on a nationwide stage, particularly of us who’ve been out within the subject and interacting with voters. Is that one thing that extra persons are popping out to the poll for, or people who find themselves possibly voting cut up ticket however in assist of IVF, however for Republican candidate?
Ollstein: That’s been fascinating. And so most folk know that this actually exploded into the general public consciousness earlier this 12 months when the Alabama Supreme Courtroom dominated that frozen embryos are individuals legally below the state’s abortion ban. And that disrupted IVF providers briefly till the state legislature swooped in. So Democrats’ argument is that due to these anti-abortion legal guidelines in a lot of totally different states that have been made potential by the Dobbs resolution, a lot of states might develop into the subsequent Alabama. Republicans are saying: Oh, that’s ridiculous. Alabama was solved, and no different state’s going to do it. However they may.
Rovner: Alabama might develop into the subsequent Alabama.
Ollstein: Alabama might actually develop into the subsequent Alabama. Purchase tons of states have very comparable language of their legal guidelines that will make that potential. Whilst you see quite a lot of Republicans proper now saying: Oh, Republicans are … We’re pro-IVF. We’re pro-family. We’re pro-babies. There are quite a lot of divisions on the best round IVF, together with some who do need to prohibit it and others who need to limit the way in which it’s mostly practiced within the U.S., the place extra embryos are created and solely essentially the most viable ones are implanted and the others are discarded.
And so I feel it will proceed to be an enormous battle. Quite a lot of activists within the anti-abortion motion are actually upset about how Republican candidates and officers have rushed to defend IVF and promised to not do something to limit it. And so I feel that’s going to proceed to be an enormous battle it doesn’t matter what occurs.
Rovner: Tam, are you seeing dialogue in regards to the threats to contraception? I do know that is one thing that Democratic candidates are pushing, and Republican candidates are saying, Oh, no, that’s foolish.
Keith: Yeah, I feel Democratic candidates are actually speaking about it. I feel that due to that IVF scenario in Alabama, due to issues that it might transfer to contraception, I feel Democrats have been capable of discuss reproductive well being care in a extra expansive method and in a method that’s maybe extra snug than simply speaking about abortion, in a method that’s extra snug to voters that they’re speaking to again when Joe Biden was operating for president. Instantly when Dobbs occurred, he was like, And this might have an effect on contraception and it might have an effect on homosexual rights. And Biden appeared way more snug in that realm. And so—
Rovner: Yeah, Biden, who waited, I feel it was a 12 months and a half, earlier than he stated the phrase “abortion.”
Keith: To say the phrase “abortion.” Sure.
Rovner: There was an internet site: Has Biden Stated Abortion But?
Keith: Primarily what I’m saying is that there’s this extra expansive dialog about reproductive well being care and reproductive freedom than there had been when Roe was in place and it was actually only a debate about abortion.
Rovner: Ashley, do individuals, notably ladies voters, understand that there’s an actual menace to contraception?
Kirzinger: I feel what Tamara was saying about when Biden was the candidate, I do assume that that was a part of the bigger dialog, that bigger menace. And they also have been extra fearful about IVF and contraception entry throughout that. If you ask voters whether or not they’re fearful about this, they’re not as fearful, however they do give the Democratic Occasion and Harris a a lot stronger benefit on these points. And so if you happen to have been to be motivated by that, you’ll be motivated to vote for Harris, but it surely actually isn’t resonating with ladies voters and the way in which now that abortion, abortion entry is resonating for them.
Rovner: Mainly, it gained’t be resonating till they take it away.
Kirzinger: Precisely. If, I feel, the Alabama Supreme Courtroom ruling occurred yesterday, I feel it will be a a lot larger concern within the marketing campaign, however all of that is timing.
Ollstein: Effectively, and other people actually talked a few believability hole across the Dobbs resolution, regardless that the activists who have been following it intently have been screaming that Roe is toast, from the second the Supreme Courtroom agreed to listen to the case, and particularly after they heard the case and other people heard the tone of the arguments. After which after all the choice leaked, and even then there was a believability hole. And till it was truly gone, lots of people simply didn’t assume that was potential. And I feel you’re seeing that once more across the concept of a nationwide ban, and also you’re seeing it across the concept of restrictions on contraception and IVF. There’s nonetheless this believability hole regardless of the proof we’ve seen.
Rovner: All proper. I feel we now have time for yet one more query.
Meg: Hello, my identify’s Meg. I’m a contract author, and I needed to ask you about one thing I’m not listening to about this election cycle, and that’s weapons. The place do shootings and college shootings and gun violence match into this dialog?
Keith: I feel that we now have heard a good bit about weapons. It’s a part of a laundry checklist, I assume you may say. Within the Kamala Harris stump speech, she talks about freedom. She talks about reproductive freedom. She talks about freedom from being shot, going to the grocery retailer or in school. That’s the place it suits into her stump speech. And definitely when it comes to Trump, he’s very professional–Second Modification and has at instances commented on the varsity shootings in ways in which come throughout as insensitive. However for his base — and he’s solely operating for his base — for his base, being very strongly professional–Second Modification is vital. And I feel there was even a query possibly within the Univision city corridor yesterday to him about weapons.
It’s not the concern on this marketing campaign, however it’s actually an concern if we discuss how a lot politics have modified in a comparatively brief time period. To have a Democratic nominee leaning in on restrictions on weapons is a reasonably large shift. When Hillary Clinton did it, it was like: Oh, gosh. She’s going there. She misplaced. I don’t assume that’s why she misplaced, however actually the NRA [National Rifle Association] spent some huge cash to assist her lose. Biden, clearly an creator of the assault weapons ban, was very a lot in that realm, and Harris has continued shifting in that route together with him, although additionally hilariously saying she has a Glock and she or he’d be keen to make use of it
Ollstein: And emphasizing [Minnesota governor and Democratic vice presidential candidate Tim] Walz’s looking.
Keith: Oh, look, Tim Walz, he’s pheasant looking this weekend.
Rovner: And in contrast to John Kerry, he regarded like he’d achieved it earlier than. John Kerry somewhat famously went out looking and clearly had not.
Keith: I used to be at a rally in 2004 the place John Kerry was carrying the jacket, the barn jacket, and the senator, the Democratic senator from Ohio palms him a shotgun, and he’s like … Ehh.
Kirzinger: I used to be shocked when Harris stated that she had a Glock. I assumed that was a really attention-grabbing response for a Democratic presidential candidate. I do assume it’s possibly a part of her attraction to unbiased voters that, As a gun proprietor, I assist Second Modification rights, however with limitations. And I do assume that that a part of attraction, it might work for a extra reasonable voting block on gun rights.
Rovner: We haven’t seen this type of accountable gun proprietor faction in a very long time. I imply, that was the origin of the NRA.
Keith: However then extra lately, Giffords has actually taken on that mantle as, We personal weapons, however we would like controls.
Rovner: All proper, effectively, I might go on for some time, however that is on a regular basis we now have. I need to thanks all for coming and serving to me have a good time my birthday being a well being nerd, as a result of that’s what I do. We do have cake for these of you within the room. For these of you out in podcast land, as at all times, if you happen to benefit from the podcast, you may subscribe wherever you get your podcast.
We’d recognize it if you happen to left us a overview. That helps different individuals discover us, too. Particular thanks as at all times to our technical guru, Francis Ying, and our editor, Emmarie Huetteman, and our live-show coordinator extraordinaire, Stephanie Stapleton, and our whole live-show workforce. Thanks rather a lot. This takes much more work than you notice. As at all times, you’ll be able to e mail us your feedback or questions. We’re at whatthehealth, all one phrase, @KFF.org, or you’ll be able to nonetheless discover me. I’m at X at @jrovner. Tam, the place are you on social media?
Keith: I’m @tamarakeithNPR.
Rovner: Alice.
Ollstein: @AliceOllstein.
Rovner: Cynthia.
Cox: @cynthiaccox.
Rovner: Ashley.
Kirzinger: @AshleyKirzinger.
Rovner: We might be again in your feed subsequent week. Till then, be wholesome.
Credit
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To listen to all our podcasts, click on right here.
And subscribe to KFF Well being Information’ “What the Well being?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you hearken to podcasts.
