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 knowledgeable on well being coverage points, Julie is the creator of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.
With abortion shaping up as a key subject for the November elections, the motion that united to overturn Roe v. Wade is split over going additional, sooner — together with by punishing those that have abortions and banning contraception or IVF. Politicians who oppose abortion are already experiencing backlash in some states.
In the meantime, unhealthy actors are bilking the well being system in numerous new methods, from switching folks’s insurance policy with out their consent to pocket extra commissions, to hacking the information of main well being programs and demanding thousands and thousands of {dollars} in ransom.
This week’s panelists are Julie Rovner of KFF Well being Information, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Submit, and Joanne Kenen of the Johns Hopkins faculties of public well being and nursing and Politico Journal.
Panelists
Alice Miranda Ollstein
Politico
Joanne Kenen
Johns Hopkins College and Politico
Rachel Roubein
The Washington Submit
Among the many takeaways from this week’s episode:
- It seems that abortion opponents are studying it’s loads simpler to agree on what you’re towards than for. Now that the constitutional proper to an abortion has been overturned, political leaders are contending with vocal teams that wish to push additional — equivalent to by banning entry to IVF or contraception.
- A Louisiana invoice designating abortion tablets as managed substances targets folks within the state, the place abortion is banned, who’re discovering methods to get the drug. And abortion suppliers in Kansas are suing over a brand new legislation that requires sufferers to report their causes for having an abortion. Such state legal guidelines have a cumulative chilling impact on abortion entry.
- Some Republican lawmakers appear to be making an attempt to dodge voter dissatisfaction with abortion restrictions on this election yr. Sen. Ted Cruz of Texas and Sen. Katie Britt of Alabama launched laws to guard IVF by pulling Medicaid funding from states that ban the fertility process — nevertheless it has holes. And Gov. Larry Hogan of Maryland declared he’s pro-choice, regardless that he largely dodged the difficulty throughout his eight years as governor.
- Former President Donald Trump is within the information once more for feedback that appeared to depart the door open to restrictions on contraception — which could be the case, although he’s recognized to make such obscure coverage options. Trump’s insurance policies as president did prohibit entry to contraception, and his allies have proposed going additional.
Additionally this week, Rovner interviews Shefali Luthra of The nineteenth about her new e book on abortion in post-Roe America, “Undue Burden.”
Plus, for “additional credit score,” the panelists recommend well being coverage tales they learn this week that they assume it’s best to learn, too:
Julie Rovner: The nineteenth’s “What Happens to Clinics After a State Bans Abortion? They Fight To Survive,” by Shefali Luthra and Chabeli Carrazana.
Alice Miranda Ollstein: Stat’s “How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations,” by Eric Boodman.
Rachel Roubein: The Washington Submit’s “What Science Tells Us About Biden, Trump and Evaluating an Aging Brain,” by Joel Achenbach and Mark Johnson.
Joanne Kenen: ProPublica’s “Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe,” by Sharon Lerner; and The Guardian’s “Microplastics Found in Every Human Testicle in Study,” by Damian Carrington.
Additionally talked about on this week’s podcast:
Click on to open the Transcript
Transcript: Anti-Abortion Onerous-Liners Converse Up
[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.]
Mila Atmos: The way forward for America is in your fingers. This isn’t a film trailer, and it’s not a political advert, however it’s a name to motion. I’m Mila Atmos, and I’m enthusiastic about unlocking the ability of on a regular basis residents. On our podcast Future Hindsight, we take huge concepts about civic life and democracy and switch them into motion objects for you and me. Each Thursday, we speak to daring activists and civic innovators that will help you perceive your energy and your energy to alter the established order. Discover us at futurehindsight.com or wherever you hearken to podcasts.
Julie Rovner: Good day, 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 greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, Could 23, at 10 a.m. As at all times, information occurs quick and issues would possibly’ve modified by the point you hear this. So, right here we go. We’re joined at present through a video convention by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Good day.
Rovner: Rachel Roubein of The Washington Submit.
Rachel Roubein: Hello, thanks for having me.
Rovner: And Joanne Kenen of the Johns Hopkins faculties of public well being and nursing and Politico Journal.
Joanne Kenen: Hello, all people.
Rovner: Later on this episode, we’ll have my interview with podcast panelist Shefali Luthra of The nineteenth. Shefali’s new e book about abortion within the post-Roe [v. Wade] world, referred to as “Undue Burden,” is out this week. However first, this week’s information. We’re going to begin with abortion this week with a subject I’m calling “Abolitionists in Ascendance,” and a shoutout right here to NPR’s Sarah McCammon with a great piece on this that we are going to hyperlink to within the present notes. Evidently whereas Republican politicians, not less than on the federal stage, are form of going to floor on this subject, and we’ll speak extra about that in a bit, those that would take the ban to the furthest by prosecuting ladies, and/or banning IVF and contraception, are elevating their voices. How a lot of a break up does this portend for what, till the overturn of Roe, had been a reasonably unified motion? I imply they have been all unified in “Let’s overturn Roe,” and now that Roe has gone, boy are they dividing.
Ollstein: Yeah, it’s loads simpler to agree on what you’re towards than on what you’re for. We wrote in regards to the break up on IVF particularly a bit in the past, and it’s actually attention-grabbing. Plenty of anti-abortion advocates are disillusioned within the Republican response and the Republican rush to say, “No, let’s depart IVF completely alone” as a result of these teams assume, some assume it some ought to be banned, some assume that there ought to be quite a lot of restrictions on the best way it’s presently practiced. So not a complete ban, however issues like you possibly can solely produce a sure variety of embryos, you possibly can solely implant a sure variety of embryos, you possibly can solely create those you propose to implant, and so that may utterly upend the best way IVF is presently practiced within the U.S.
So, we all know the anti-abortion motion is nice at enjoying the lengthy recreation, and so a few of them have informed me that they see this sort of just like the marketing campaign to overturn Roe v. Wade. They perceive that Republicans are reacting for political causes proper now, and they’re assured in successful them over for restrictions in the long run.
Rovner: I’ve been fascinated by, I’d say, by issues like Kristan Hawkins of College students for Life [of America] who’s been kind of the far-right fringe of the anti-abortion motion trying like she’s the reasonable now with a few of these folks, and their discussions of “We must always cost ladies with homicide and have the demise penalty if mandatory.” Sorry, Rachel, you wish to say one thing?
Roubein: That is one thing that Republicans, they don’t wish to be requested about this on the marketing campaign. The extra hard-line abolitionist motion is one thing extra mainstream teams have been taking quite a lot of pains to distance themselves and say that we don’t prosecute ladies, and primarily no one needs to speak about this forward of 2024. GOP doesn’t wish to be seen as that occasion that’s going after that.
Kenen: And the divisions existed when Roe was nonetheless the legislation of the land, and we’d all write in regards to the divisions and what they have been pushing for, and it was partly strategic. How far do you push? Do you push for laws? Do you push for the courts? Do you push for 20 weeks for fetal ache? Nevertheless it was like rape exceptions and below what phrases and issues like that. So it was kind of a lot later in being pregnant, and with extra restrictions, and the battle was about precisely the place do you draw that line. This abolition of all abortion below all circumstances, or personhood, solely a few years in the past, have been the perimeter. Personhood was kind of like, “Oh, they’re on the market, nobody will go for that.” And now I don’t assume it’s the dominant voice. I don’t assume we but know what their dominant voice is, nevertheless it’s a participant on this dialog.
On the identical time, on the opposite facet, the pro-abortion rights folks, there’s polls displaying us this many Individuals assist abortion, nevertheless it’s subtler too. Even when folks assist abortion rights, it doesn’t imply that they’re not, some subset are in favor of some restrictions, or the place that’s going to settle. Proper now, a 15-week ban, which might’ve appeared draconian a yr or two in the past, now looks like the reasonable place. It has not shaken out, and …
Rovner: Nicely, let’s speak …
Kenen: It’s not going to shake out for a while.
Rovner: Let’s speak about just a few specifics. The Louisiana State Legislature on Tuesday accredited a invoice that may put the medicine utilized in medicine abortion, mifepristone and misoprostol, on the state’s record of managed substances. This has gotten quite a lot of publicity. I’m questioning what the precise impact is likely to be right here although since abortion is already banned in Louisiana. Clearly, these medicine are used for different issues, however they wouldn’t be unavailable. They might simply be put on this class of harmful medicine.
Ollstein: So, officers know that folks in banned states, together with Louisiana, are acquiring abortion tablets from out of state, whether or not by telehealth from states with defend legal guidelines or by these gray-area teams abroad which might be mailing tablets to anybody it doesn’t matter what state they reside in or what restrictions are in place. So I believe as a result of it could be very troublesome to truly implement this legislation, in need of going by folks’s properties and their mail, this is only one extra layer of a chilling impact and making folks afraid to hunt out these mail order companies.
Rovner: So it’s extra, once more, for the looks of it than the reality of it.
Ollstein: It additionally units up one other state versus federal legislation conflict, probably. We’ve seen this enjoying out in courts in West Virginia and in North Carolina, principally. Can states prohibit and even utterly ban a medicine that the FDA says is protected and efficient? And that query is percolating in just a few totally different courts proper now.
Rovner: Together with kind of the Supreme Court docket. We’re nonetheless ready for his or her abortion capsule resolution that we count on now subsequent month. In the meantime, in Kansas, the place voters accredited a giant abortion rights referendum in 2022 — bear in mind, it was the primary a kind of — abortion suppliers are suing to cease a brand new state legislation enacted over the governor’s veto that may require them to report back to the state ladies’s causes for having an abortion. Now it’s not that tough to see how that data may very well be misused by folks with other forms of intents, proper?
Ollstein: Nicely, it additionally brings up proper to free speech points, compelled speech. I believe I’ve seen this pop up in abortion lawsuits even earlier than Dobbs [v. Jackson Women’s Health Organization], this very subject as a result of there have been situations the place both medical doctors are required to offer data that they are saying that they consider is medically inaccurate. That’s a difficulty in a number of states proper now. After which this demanding data from sufferers. Plenty of clinics that I’ve spoken to are so afraid of subpoenas from officers in-state, from out of state, that they deliberately don’t ask sufferers for sure sorts of information regardless that it could actually assist medically or organizationally for them to have that knowledge. However they’re so afraid of it being seized, they determine nicely, they’ll’t seize it in the event that they’re … doesn’t exist within the first place. And so I believe this sort of legislation is in direct battle with that.
Roubein: It additionally will get on the query of medical privateness that we’ve been seeing within the Biden administration’s efforts over HIPAA and defending sufferers’ information and making it more durable for state officers to try to grab.
Rovner: Yeah, that is clearly going to be a battle in quite a lot of states the place voters versus Republican legislatures, and we’ll kind of see how that every one performs out. So even whereas this is occurring in a bunch of the states, quite a lot of Republicans, together with some who’ve been and stay strongly anti-abortion, are doing what I’m calling ducking-and-covering on quite a lot of these points. Living proof, Texas Republican Sen. Ted Cruz and Alabama Republican Sen. Katie Britt this week launched a invoice they are saying would defend IVF, which is form of ironic on condition that each of them voted towards a invoice to guard IVF again in, checking notes, February. What’s the distinction right here? What are these guys making an attempt to do?
Kenen: Theirs is narrower. They are saying that the unique invoice, which was a Democratic invoice, was larded with abortion rights sorts of issues. I’ve not learn your complete invoice, I simply learn the abstract of it. And on this one, if a state restricts somebody who had — somebody be at liberty to appropriate me if I’m lacking one thing right here as a result of I don’t have deep information of this invoice — but when a state doesn’t defend IVF, they’d lose their Medicaid fee. And I used to be not clear whether or not that meant each penny of Medicaid, together with nursing properties, or if it’s a subsection of Medicaid, as a result of it looks like a giant can of worms.
Ollstein: Yeah, so the important thing distinction in these payments is the phrase ban. The Republican invoice says that if states ban IVF, then these penalties kick in for Medicaid, however they are saying that there will be “well being and security rules,” and in order that could be very open to interpretation. That may embody the issues we talked about earlier than about you possibly can solely produce a sure variety of embryos, you possibly can solely implant a sure variety of embryos, and you may’t discard them. And so even what Alabama did was not an outright ban. So even one thing like that that minimize off companies for plenty of folks wouldn’t be thought-about a ban below this Republican invoice. So I believe there’s kind of a semantic recreation occurring right here the place restrictions would nonetheless be allowed in the event that they have been in need of a blanket ban, whereas the democratic invoice would additionally stop restrictions.
Rovner: Nicely, and alongside these very same strains, in Maryland, former two-term Republican governor Larry Hogan, who’s managed to dodge the abortion subject in his main run to grow to be the Senate nominee, now that he’s the Republican candidate for the open Senate seat, has declared himself, his phrases, “pro-choice,” and says he would vote to revive Roe within the Senate if given the chance. However as I recall, and I reside in Maryland, he vetoed a few payments to develop abortion rights in very blue Maryland. Is he going to have the ability to have this each methods? He appears to be doing the [Sen.] Susan Collins script the place he will get to say he’s pro-choice, however he doesn’t essentially must vote for abortion rights payments.
Kenen: Hogan is a extremely popular reasonable Republican governor in a Democratic state. He’s a robust Senate candidate. His opponent, a Democrat, Angela Alsobrooks, has a stronger abortion rights file. I don’t assume that’s going to be the decisive subject in Maryland. I believe it could assist him just a little bit, however I believe in Maryland, if the Senate was 55-45, quite a lot of Democrats like Hogan and would possibly need one other reasonable Republican within the Senate. However on condition that that is going to be about management of the Senate, abortion might be an element, I don’t assume abortion goes to be the dominant issue on this explicit race.
If she have been to win and there’s two black ladies, I imply that may be the primary time that two black ladies ever served within the Senate without delay, and I believe they’d solely be quantity three and quantity 4 in historical past. So race and Affirmative Motion might be components, however I believe that Democrats who would possibly in any other case lean towards him, as a result of he was thought-about a great governor. He was well-liked. This can be a 50-50ish Senate, and that’s the deciding factor for anybody who pays consideration, which in fact is an entire different can of worms as a result of no one actually pays consideration. They only do issues.
Roubein: I believe it’s additionally price noting this tact to the left comes as Maryland voters might be voting on an abortion rights poll measure in 2024. So that every one kind of in context, we’ve seen what’s occurred with the opposite abortion measures, abortion rights have received, so.
Rovner: And Maryland is a very blue state, so one would count on it …
Kenen: There’s no query that the Maryland …
Rovner: Yeah.
Kenen: I imply, and all of us would fall flat on our faces if the abortion measure fails in Maryland. However I consider that is the primary one on the poll alongside a presidential election, and a few of them have been in particular elections. It’s unclear the correlation between, you possibly can vote for a Republican candidate and nonetheless vote for a pro-abortion rights initiative. We’ll be taught much more about how that break up occurs in November. I imply, is Kansas going to go for Biden? Unlikely. However Kansas went actually sturdy for abortion rights. In case you’re not a single-issue voter, you possibly can, the truth is, have it each methods.
Rovner: Sure, and we’re already seeing that within the polls. Nicely, in fact then there’s the king of making an attempt to have it each methods: former President Trump. He’s both contemplating restrictions on contraception, as he informed an interviewer earlier this week, promising a proposal quickly, or he’ll, all caps, as he placed on Fact Social, by no means advocate imposing restrictions on contraception. So which is it?
Ollstein: So this got here out of Trump’s verbal tick of claiming “We’ll have a plan in just a few weeks,” which he says about every part. However on this context it made it sound like he was leaving the door open to restrictions on contraception, which very nicely is likely to be the case. So what my colleague and I wrote about is he says he would by no means prohibit contraception. Plenty of issues he did in his first administration did prohibit entry to contraception. It was not a ban. Once more, we’re getting again into the semantics of ban. It was not a ban, however his Title X rule led to a drop in a whole lot of hundreds of individuals accessing contraception. He allowed extra sorts of employers to refuse to cowl their staff’ contraception on their well being plans, and the plans his allies are creating on this Undertaking 2025 blueprint would reimpose these restrictions and go even additional in several ways in which would have the impact of proscribing entry to contraception. And so I believe this can be a good occasion of have a look at what folks do, not what they are saying.
Rovner: So now that we’re with regards to marketing campaign 2024, President Biden’s marketing campaign launched a $14 million advert purchase this week that features the warning that if Trump turns into president once more he’ll attempt to repeal the Inexpensive Care Act. Maybe health care will be an issue in this election after all? I don’t have a rooting curiosity someway. I’m simply curious to see how a lot of a difficulty well being might be past reproductive rights.
Kenen: Nicely, as Alice simply identified, Trump’s promised plans often do not materialize, and we’re nonetheless ready to see his alternative plan eight years later. I believe he’s being informed to kind of go sluggish on this. I imply, not which you could management what Trump says, however he didn’t run on well being care till the tip, in 2016. It was an in depth race, and he ran towards Hillary Clinton, and it was the final 10 or so days that he actually got here down arduous as a result of it was proper when ACA enrollment was about to start and premiums got here in and so they have been excessive. He pivoted. So is that this going to be a well being care election from day one? And I’m placing abortion apart for one second when it comes to my definition of well being take care of this explicit section. Is it going to be a well being care election when it comes to ACA, Medicare, Medicaid? At this level, in all probability not. However is it going to emerge at numerous occasions by one or the opposite facet in politically opportune methods? I’d be shocked if Biden’s not elevating it. The ACA is prospering below Biden.
Rovner: Nicely, he’s. That’s the entire level. He simply took out a $14 million advert purchase.
Kenen: Proper. However once more, we don’t know. Is it a well being care election or is it a pair adverts? We don’t know. So sure, it’s going to be a well being care election as a result of all elections are well being care elections. How a lot it’s outlined by well being care in comparison with immigration? No, at this level, that’s not what we’re anticipating. In comparison with the financial system? No, at this level. However is it a difficulty for some voters? Sure. Is it going to be a difficulty extra prominently relying on how different issues play out? It’ll have its peaks. We simply don’t understand how constant it’ll be.
Roubein: Biden would like to run on the Inflation Discount Act and politically widespread insurance policies like permitting Medicare to barter drug costs. One of many issues of that’s polls, together with from KFF, has proven that almost all of voters don’t find out about that. And a few of these insurance policies, the large ones, haven’t even gone into impact. CMS [Centers for Medicare & Medicaid Services] goes by the negotiation course of, however that’s not going to hit folks’s pocketbooks till after the election.
Kenen: The cliff for the ACA subsidies, which is in 2025, I imply I’d think about Democrats might be campaigning on, “We’ll prolong the subsidies,” and once more, in some locations greater than others, however that’s a time-sensitive huge factor taking place subsequent yr.
Rovner: However speak about a difficulty that folks don’t know that’s coming. Nicely, in the meantime, for Trump, reproductive well being isn’t the one subject the place he’s doing a not-so-delicate dance. Apparently fearful about Robert F. Kennedy Jr. stealing anti-vax [vaccine] votes from him, Trump is now calling RFK Jr. a faux anti-vaxxer. Besides I’m sufficiently old to recollect when Trump bragged repeatedly about how briskly his administration developed and introduced the covid vaccine to market. That was one among his huge promoting factors. Now he’s making an attempt to be anti-vax, too?
Kenen: Not solely did he brag about bringing it to the market. The way in which he used to speak about it, it was like he was there in his lab coat inventing it. Operation Warp Pace was successful. It obtained vaccines out in file time, approach past what many individuals anticipated. Democrats gave him credit score for that one coverage in well being care. He obtained a vaccine out and out there in lower than a yr, and he obtained vaccinated and boasted about being vaccinated. He was open about it. Now we don’t know if he’s been boosted. He actually backed off. As quickly as any person booed him, and it wasn’t quite a lot of boos, at one rally when he talked about vaccination and he obtained pushed again, that was the tip.
Rovner: So, yeah, so I count on that to kind of proceed on this election season, too.
Kenen: However we don’t count on RFK to flip.
Rovner: No, we don’t. Proper. Nicely, transferring on to this weekend’s “Cyber Hacks,” a brand new characteristic, the fallout continues from the hack of Ascension [health care company]. That’s the Catholic hospital system with services in 19 states. In Michigan, sufferers have been unable to make use of hospital pharmacies and their medical doctors have been unable to ship digital prescriptions, in order that they’re having to write down them out by hand. And in Indiana orders for exams and check outcomes are being delayed by as a lot as a day for hospital sufferers. Not an awesome factor.
And simply in time, or possibly just a little late, the U.S. Division of Well being and Human Companies, by the newly created ARPA-H [Advanced Research Projects Agency for Health] that we have now talked about, this week introduced the launch of a brand new program to assist hospitals make safety patches and updates to their programs with out taking them offline, which is clearly a significant cause so many of those programs are so weak to cyberhacking.
In fact, this announcement from HHS is simply to solicit concepts for grants to assist make that occur. So it’s going to be some time earlier than we get any of those safety adjustments. I’m questioning, what number of programs are going to attempt to construct much more redundancy into them? Within the meantime, are we listening to something about what they’ll do within the quick time period? It seems like your complete well being care system is form of a sitting duck for this group of cyberhackers who assume they’ll get in simply and get ransom.
Kenen: There’s a cause they assume that.
Rovner: They will.
Roubein: Fascinated about hospitals and medical doctors utilizing this manually, paper-based system and the way that’s delaying getting your outcomes and simply there’s been these tales about sufferers. Just like the nervousness that that’s understandably inflicting sufferers, and we’ll see kind of whether or not Congress can grapple with this, and there’s probably not a lot laws that’s going to maneuver, so …
Kenen: However I used to be shocked that they have been calling on ARPA-H. I imply, that’s purported to be a biotech- curing-diseases factor, and not one of the 4 of us are cybersecurity specialists, and none of us actually concentrate on overlaying the digital facet of the digital facet of well being, nevertheless it simply appears to me, I simply thought that was an odd factor. Initially, a few of these are simply programs that haven’t been upgraded or particular person clinicians who don’t improve or don’t do their double authorization. A few of it’s kind of cyberhygiene, and a few of it’s clearly just like the change factor. They’re actually refined criminals, nevertheless it’s not one thing that one would assume you possibly can’t get forward of, proper? They’re good, good-guy know-how folks. It’s not just like the unhealthy guys are the one ones who perceive know-how. So why are the good good guys not doing their job? And likewise, in all probability, well being care programs must have some form of safety checks on their very own members to ensure they’re following all the protection guidelines and a few form of penalties in case you’re not, apart from being embarrassed.
Rovner: I’ve simply been kind of bemused by all of this, how each sufferers and suppliers complain loudly and incessantly in regards to the frustrations of a few of these digital file programs. And naturally, within the locations that they’re happening and so they’ve had to return to paper, individuals are like, “Please give us our digital programs again.” So it doesn’t take lengthy to get used to a few of these issues and be sorry after they’re gone, even when it’s solely quickly. It’s clearly been …
Kenen: However like what Rachel mentioned, in case you’re within the hospital, you’re sick, and do your clinicians want your lab outcomes? Sure. I imply a few of them are extra necessary than others, and I’d hope that hospitals are determining the best way to prioritize. However yeah, this can be a disaster. In case you’re within the hospital and so they don’t know what’s mistaken with you and so they’re making an attempt to determine do you’ve got X, Y, or Z, ready till subsequent week is just not actually an awesome concept.
Rovner: Nevertheless it wasn’t that a few years in the past that their existence …
Kenen: Proper, no, no, no.
Rovner: … didn’t contain …
Kenen: [inaudible 00:21:28].
Rovner: … digital medical file.
Kenen: Proper. Proper.
Rovner: They knew the best way to get check outcomes forwards and backwards even when it was sending an intern to go fetch them. Lastly, this week, we have now some updates on some tales that we’ve talked about in earlier episodes. First, thanks partially to the wonderful reporting of my colleague and sometime-pod-panelist Julie Appleby, the Senate Finance Committee Chairman Ron Wyden is demanding that HHS [U.S. Department of Health and Human Services] officers do extra to rein in rogue insurance coverage brokers who’re reaping additional commissions by switching sufferers’ Inexpensive Care Act plans with out their information, typically subjecting them to greater out-of-pocket prices and separating them from the suppliers that they’ve chosen. Sen. Wyden mentioned he would introduce laws to make such schemes a criminal offense, however within the meantime he wants Biden officials to do more, on condition that they’ve obtained greater than 90,000 complaints within the first quarter of 2024 alone about unauthorized switches and enrollments. Criminals go the place the cash is, proper? You’ll be able to both cyberhack or you possibly can grow to be a dealer and swap folks to ACA plans so you may get extra commissions.
Kenen: I’d assume there may very well be a bipartisan, I imply it’s arduous to get something achieved in Congress. There’s no must-pass payments within the speedy future which might be related. And the concept that a dealer is secretly doing one thing that you simply don’t need them to do and that’s costing you cash and making them cash. I may see, these 90,000 individuals are from purple and blue states and so they vote, it’s going to have an effect on constituents nationwide. Perhaps they’ll do one thing. Perhaps the business can even… There’s the Nationwide Affiliation … I forgot the acronym, however there’s a dealer’s group, that there are in all probability issues that they’ll additionally do to sanction. States can even do some issues to brokers, however whether or not there’s a nationwide resolution or piecemeal, I don’t know, nevertheless it’s so outrageous that it’s not a right-left subject.
Rovner: Sure, one would assume that there’ll be not less than some form of congressional motion constructed into one thing …
Kenen: One thing or different, proper.
Rovner: … Congress that manages to do earlier than the tip of the yr. Nicely, and in a kind of seemingly uncommon circumstances the place laws truly does what it was supposed to do, the White Home this week introduced that it has accredited greater than 1,000,000 claims below the 2022 PACT Act, which made veterans injured on account of publicity to burn pits and different poisonous substances eligible for VA [Veterans Affairs] incapacity advantages. Then again, the VA continues to be working its approach by one other 3 million claims which were submitted. I really feel like even when it’s not fairly often, generally it’s price noting that there are bipartisan issues from Washington, D.C., that really get handed and truly assist the folks that they’re supposed to assist. It’s form of unhappy that that is notable as an exception of one thing that occurred and is working.
Roubein: In kind of the, I suppose, Division of Unintended Aspect Results right here, my colleague Lisa Rein had a very attention-grabbing story out this morning that talked in regards to the PACT Act, however principally that regardless of a federal legislation that prohibits charging veterans for assist in making use of for incapacity advantages, for-profit corporations are making thousands and thousands. She did a evaluation of as much as like 100 unaccredited for-profit corporations who’ve been charging veterans wherever from like $5,000 to $20,000 for serving to file incapacity claims as a result of …
Rovner: That’s the theme of this week. Anyplace that there’s some huge cash in well being care, there have been individuals who will wish to are available and take what’s not theirs. That’s the place we’ll depart the information this week. Now we’ll play my interview with Shefali Luthra, then we’ll come again with our additional credit.
I’m so happy to welcome again to the podcast my former colleague and present “What The Well being?” panelist Shefali Luthra. You haven’t heard from her shortly as a result of she’s been engaged on her first e book, referred to as “Undue Burden,” that’s out this week. Shefali, nice to see you.
Luthra: Thanks a lot for having me Julie.
Rovner: In order the title suggests, “Undue Burden” is in regards to the difficulties for each sufferers and suppliers within the wake of the overturn of Roe v. Wade. We speak a lot in regards to the politics of this subject, and so little about the true people who find themselves affected. Why did you wish to take this explicit angle?
Luthra: To me, that is what makes this matter so necessary. Well being care and abortion are actually essential political points. They sway elections. They’re prone to be very consequential on this coming presidential election. However this issues to us as reporters and to us as folks due to the life-or-death stakes and even past the life-or-death stakes, the stakes of the way you select to reside your life and what it means to be pregnant and to be a father or mother. These are actually troublesome tales to inform due to the sources concerned. And I wished to write down a e book that simply obtained at the entire totally different the reason why folks pursue abortion and why they supply abortion and the way that’s modified up to now two years. As a result of it felt to me like one of many few methods we may actually perceive simply how seismic the implications of overturning Roe has been.
Rovner: And in contrast to these of us who speak to politicians on a regular basis, you have been actually on the bottom speaking to sufferers and medical doctors, proper?
Luthra: That was actually, actually necessary to the e book. I spent quite a lot of time touring the nation, in clinics speaking to individuals who have been capable of get abortions, who have been unable to get abortions, and it was simply actually compelling for me to see how a lot entry to care had the capability to alter their lives.
Rovner: So what sort of limitations then are we speaking about that cropped up? And I suppose it wasn’t even simply the wake of the overturn of Roe. In Texas we had kind of a yearlong dry run.
Luthra: Precisely, and the e book begins earlier than Roe is overturned in Texas when the state enacted SB 8, the six-week abortion ban that successfully minimize off entry. And the primary fundamental character readers meet is that this younger lady named Tiffany, and she or he’s a teen when she turns into pregnant, and she or he would like to get an abortion. However she is a minor. She lives very removed from any abortion supplier. She doesn’t know the best way to self-manage an abortion. She doesn’t know the place to search out tablets. She has no connections into the well being care system. She has no impartial revenue. And she or he completely can’t journey wherever for care. In consequence, she has a baby earlier than she turns 18. And what this story highlights is that there are simply so many limitations to getting an abortion. Many already existed: The unbelievable price for process not lined by medical health insurance, the geographic distance, folks already needed to journey, the additional restrictions on minors.
However the overturning of Roe has amplified these, it’s so costly to get an abortion. It may be troublesome to know you’re pregnant, particularly if you’re not making an attempt to grow to be pregnant. You’ve gotten a really quick time window. You could want to search out childcare. You could have to discover a automobile, get time without work work, and produce all of those totally different forces collectively in order that you’ll be able to make a journey that may be days and pay for a visit that may price hundreds of {dollars}.
Rovner: One of many issues that I believe shocked me was that states that proclaimed themselves abortion “havens” truly did so little to assist their clinics that predictably obtained swamped by out-of-state sufferers. Why do you assume that was the case, and is it any higher now?
Luthra: I believe issues have definitely modified. We now have seen far more motion in states, equivalent to Illinois, the place we see extra folks touring there for care than wherever else within the nation. However it’s price going again to the summer time that Roe was overturned. The governor promised to name a particular session and put all these sources into ensuring that Illinois may very well be a sanctuary. He by no means referred to as that particular session. And clinics felt like they have been hanging out to dry, simply ready to get some assist, and in the intervening time, doing the very best they might.
One factor that I believe this e book actually will get at is we’re beginning to see extra efforts from these bluer states, the Illinois, the Californias, the New Yorks, and so they speak loads about eager to be abortion havens, partially as a result of it’s nice politics in case you’re a Democrat, however there’s solely a lot you are able to do. California has seen additionally fairly a big improve in out-of-state sufferers. However I’ve spoken to so many individuals who simply can’t conceivably go to California. They will barely go to Illinois. Making that journey when you find yourself younger, in case you don’t have some huge cash, in case you reside in South Texas, in case you reside in Louisiana, it’s simply probably not possible. And the locations which might be arrange as these entry factors simply can’t actually fill within the gaps that they are saying they are going to.
Rovner: As you level out within the e book, quite a lot of this was utterly predictable. Was there one thing in your reporting that really did shock you?
Luthra: That’s an awesome query, and what did shock me was partially one thing that we’ve begun to see borne out within the reporting, is there are very efficient telemedicine methods. We now have begun to see physicians residing in blue states, the New Yorks, Massachusetts, Californias, prescribing and mailing abortion tablets to folks in states with bans. That is fairly highly effective. It has expanded entry to lots of people. What was actually hanging to me, although, at the same time as I reported in regards to the experiences of sufferers searching for care, is that whereas that has achieved a lot to develop entry within the face of abortion bans, it isn’t an answer that everybody can use. There have been a number of folks I met who didn’t desire a medicine abortion, who didn’t really feel protected having tablets mailed into their properties, or whose being pregnant issues and questions have been simply too complicated to be solved by a digital seek the advice of after which tablets being mailed to them to soak up the consolation of their home.
Rovner: Aren’t these difficulties precisely what the anti-abortion motion wished? Didn’t they need clinics so swamped they couldn’t serve all people who wished to return, and abortion to be so troublesome to get that ladies would find yourself carrying their pregnancies to time period as a substitute?
Luthra: Sure and no, I’d argue. I believe you might be completely proper that one of many main objectives of the anti-abortion motion was to make abortion unavailable, to make it more durable to amass, to have extra folks not get abortions and as a substitute have youngsters. However once I communicate to of us within the anti-abortion motion, they’re very troubled by how many individuals are touring out of state to get care. They see these actually lengthy wait occasions in Kansas, in, till lately, Florida, in Illinois, in New Mexico, as a symptom of one thing that they should tackle, which is that so many individuals are nonetheless discovering a solution to battle unbelievable odds to entry abortion.
Rovner: Is there one factor that you simply hope folks take away after they’re completed studying this?
Luthra: There are two issues that I’ve spent quite a lot of time fascinated with as I’ve reported this e book. The primary is simply who will get abortions and below what circumstances. And so typically within the nationwide press, in nationwide politics, we speak about these actually excessive life-or-death circumstances. We speak about individuals who grew to become septic and wanted an abortion as a result of their water broke early, or we speak about youngsters who’ve been sexually assaulted and grow to be pregnant. However we don’t speak about most individuals who get abortions; who’re often moms, who’re often folks of colour, who’re of their 20s and simply know that they’ll’t be pregnant. I believe these are actually necessary tales to inform as a result of they’re the true face of who’s most affected by this, and it was necessary to me that this e book embody that.
The opposite factor that I’ve thought of so typically in reporting this and writing that is abortion calls for have an unequal impression. That’s true if you’re poor, if you’re an individual of colour, in case you reside in a rural space, et cetera. You’ll in all probability see a higher impact. That mentioned, the overturning of Roe v. Wade is so super that it has affected folks in each state. It impacts you if you may get pregnant. It impacts you if you need contraception. It impacts you in case you require reproductive well being care in some kind. That is simply such a seismic change to our well being care system that I actually hope individuals who learn this e book perceive that this isn’t a distinct segment subject. That is one thing worthy of our collective consideration and concern as journalists and as folks.
Rovner: Shefali Luthra, thanks a lot for this, and we’ll see you quickly on the panel, proper?
Luthra: Completely. Thanks, Julie. I’m so glad we obtained to do that.
Rovner: OK, we’re again. It’s time for our extra-credit section. That’s once we every suggest a narrative we learn this week we expect it’s best to learn, too. As at all times, don’t fear in case you miss it. We’ll publish the hyperlinks on the podcast page at kffhealthnews.org and in our present notes in your telephone or different cell system. Joanne, why don’t you go first this week?
Kenen: This was a pair of articles, a protracted one and a shorter, associated one. There’s an amazingly great piece in ProPublica by Sharon Lerner, and it’s referred to as “Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe.” I’m going to return again and speak about it briefly in a second, however the associated story was in The Guardian by Damian Carrington: “Microplastics Found in Every Human Testicle in Study.” Now, that was a small research, however there could also be a hyperlink to the declining sperm depend due to these eternally chemical compounds.
The ProPublica story, it was a younger girl scientist. She labored for 3M. They stored telling her her outcomes was mistaken, her equipment was soiled, over and again and again till she questioned herself and her findings. She was purported to be trying on the blood of 3M staff who have been, it turned out, the corporate knew all this already and so they have been hiding it, and she or he in contrast the blood of the 3M staff to non-3M staff, and she or he discovered these plastic chemical compounds in all people’s blood all over the place, and she or he was principally gaslit out of her job. She continued to work for 3M, however in a unique capability.
The article’s actually scary in regards to the impression for human well being. It additionally has splendidly attention-grabbing little nuggets all through about how numerous 3M merchandise have been developed, some accidentally. One thing spilled on any person’s sneaker and it didn’t stain it, and that’s how we obtained these sprays for our upholstery. Or any person wanted one thing to search out the pages of their church hymnal, and that’s how we obtained Submit-it notes. It’s a devastating however very readable, and it makes you offended.
Rovner: Yeah, I really feel like there’s much more we’re going to must say about eternally chemical compounds going ahead. Alice.
Ollstein: So I’ve a reasonably miserable story from Stats. It’s referred to as “How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations,” by Eric Boodman. And it’s about folks with sickle cell, and that’s overwhelmingly black ladies, and so they felt pressured to conform to be completely sterilized after they have been going to offer beginning due to the upper dangers. And the medical doctors mentioned, as a result of we’re already doing a C-section and we’re already doing surgical procedure on you, to not must do an extra surgical procedure with extra dangers, they felt pressured to simply signal that they may very well be sterilized proper then and there and got here to remorse it later and actually wished extra youngsters. And so, that is an occasion of individuals feeling coerced, and when folks take into consideration pro-choice or the selection debate about replica they largely take into consideration the best to an abortion. However I believe that the best to have extra youngsters, if you wish to, is the opposite facet of that coin.
Rovner: It’s. Rachel.
Roubein: My additional credit score, it’s referred to as “What Science Tells Us About Biden, Trump and Evaluating an Aging Brain,” by Joel Achenbach and Mark Johnson from The Washington Submit. And principally, they form of took a really science-based have a look at the 2024 election. They principally referred to as it a crash course in gerontology as a result of former President Donald Trump might be 78 years outdated. President Biden might be a pair weeks away from turning 82. And clearly that’s getting quite a lot of consideration on the marketing campaign path. They talked to medical and scientific specialists who have been primarily warning that information reviews, political punditry in regards to the candidates’ psychological health, has primarily been marred by misinformation right here in regards to the getting old course of. One of many issues they dived into was these gaffes or what the general public sees as senior moments and what specialists had informed them is, that’s not essentially an indication of dementia or predictive of cognitive decline. There must be form of additional scientific analysis for that. However there have been some requires simply the best way to form of standardize and require a sure stage of transparency for candidates when it comes to disclosing their well being data.
Rovner: Sure, which we’ve been speaking about for some time, and can proceed to. My additional credit score this week is from our visitor, Shefali Luthra, and her colleague at The nineteenth Chabeli Carrazana, and it’s referred to as “What Happens to Clinics After a State Bans Abortion? They Fight To Survive.” And for all of the speak about medical doctors and different staffers both transferring out of or not transferring into states with abortion bans, I believe much less has been written about whole enterprises that usually present way over simply abortion companies having to close down as nicely. We noticed this in Texas within the mid-2010s, when a legislation that shut down lots of the clinics there was struck down by the Supreme Court docket in 2016. However a lot of these clinics have been unable to reopen. They only couldn’t reassemble, principally, their leases and gear and employees. The identical may nicely occur in states that this November vote to reverse a few of these bans. And it’s not simply abortion, as we’ve mentioned. When these clinics shut, it typically means much less household planning, much less STI [sexually transmitted infection] screening and different preventive companies as nicely, so it’s undoubtedly one thing to proceed to look at.
Earlier than we go this week, I wish to be aware the passing of a well being coverage journalism large with the demise of Marshall Allen. Marshall, who labored tirelessly, first in Las Vegas and extra lately at ProPublica, to show among the most unfair and infuriating components of the U.S. well being care system, was on the podcast in 2021 to speak about his e book, “By no means Pay the First Invoice, and Different Methods to Battle the Well being Care System and Win.” I’ll publish a hyperlink to the interview on this week’s present notes. Condolences to Marshall’s family and friends.
OK, that’s our present. As at all times, in case you benefit from the podcast, you possibly can subscribe wherever you get your podcast. We’d admire it in case you left us a evaluation. That helps different folks discover us too. Particular thanks as at all times to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As at all times, you possibly can e mail us your feedback or questions. We’re at whatthehealth@kff.org, or you possibly can nonetheless discover me at X, @jrovner. Joanne, the place are you?
Kenen: We’re at Threads @JoanneKenen.
Rovner: Alice.
Ollstein: Nonetheless on X @AliceOllstein.
Rovner: Rachel.
Roubein: On X, @rachel_roubein.
Rovner: We might be again in your feed subsequent week. Till then, be wholesome.
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