The Host
Julie Rovner
KFF Well being Information
Learn Julie’s tales.
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.
Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already dashing to work his priorities into laws, eyeing cuts to Medicaid to pay for brand spanking new tax and immigration priorities. However even in its waning days, the Biden administration continues to make huge coverage strikes, together with a potential order for tobacco corporations to dramatically lower the quantity of nicotine in cigarettes.
In the meantime, the fires in Los Angeles are drawing new consideration to the well being risks of not simply smoke from natural matter, but additionally poisonous substances launched by burning plastic and different man-made supplies — in addition to the menace posed to each air and water high quality.
This week’s panelists are Julie Rovner of KFF Well being Information, Anna Edney of Bloomberg Information, Joanne Kenen of the Johns Hopkins College Bloomberg Faculty of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins College and Politico
Sandhya Raman
CQ Roll Name
Among the many takeaways from this week’s episode:
- Republican lawmakers are weighing choices to chop federal spending on Medicaid, the almost $900-billion-a-year authorities program that covers 1 in 5 Individuals. They may use the financial savings to bolster Trump priorities, similar to extending the 2017 tax cuts. The GOP made splashy however unsuccessful makes an attempt to chop Medicaid when Trump first took workplace and the celebration held a bigger Home majority — although the celebration appears extra aligned with Trump immediately than it was then.
- Congress has gotten all the way down to enterprise on messaging payments: It superior laws this week that might ban trans athletes from women’ college sports activities and, individually, a measure to detain and even deport immigrants who’re dwelling within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes similar to shoplifting.
- The Supreme Court docket has agreed to listen to a case later this 12 months concerning the U.S. Preventive Companies Job Drive — an impartial physique of specialists that points suggestions in illness prevention and medication. A ruling in opposition to its authority may strip protection for key preventive well being providers from not simply these with Reasonably priced Care Act protection, but additionally these on employer-sponsored well being plans. The query stands: If not this job pressure, who would make the determinations about what preventive care ought to be lined?
- And the outgoing Biden administration issued a slew of well being rules this week, together with a ban on the dye Purple No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration may upend these and extra rules, although some do align with its coverage pursuits.
Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the newest KFF Well being Information “Invoice of the Month” function, a few colonoscopy that got here with a a lot bigger price ticket than estimated. In case you have a mystifying or outrageous medical invoice you’d wish to share with us, you are able to do that right here.
Plus, for “further credit score,” the panelists recommend well being coverage tales they learn (or wrote) this week that they assume you need to learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Faculties Funnel Extra Docs Into the Main Care Pipeline?” by Felice J. Freyer.
Anna Edney: Bloomberg Information’ “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles,” by Anna Edney.
Joanne Kenen: The Atlantic’s “A Secret Means To Combat Off Abdomen Bugs,” by Daniel Engber.
Sandhya Raman: Nature’s “New Weight problems Definition Sidelines BMI To Give attention to Well being,” by Giorgia Guglielmi.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: Howdy, Trump. Bye-Bye, Biden.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Howdy 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 a number of the greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 16, at 10 a.m. As all the time, information occurs quick and issues might need modified by the point you hear this. So, right here we go.
At the moment we’re joined by way of videoconference by Anna Edney of Bloomberg Information.
Anna Edney: Hello, everyone.
Rovner: Sandhya Raman of CQ Roll Name.
Sandhya Raman: Good morning, everybody.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico Journal.
Joanne Kenen: Hello, everyone.
Rovner: Later on this episode we’ll have my interview with Harris Meyer, who reported and wrote the newest KFF Well being Information “Invoice of the Month,” a few affected person whose colonoscopy invoice was so much larger than he anticipated. However first, this week’s information.
So we at the moment are 4 days from the second swearing-in of Donald Trump as president, and discussions are already choosing up on Capitol Hill about rolling the brand new president’s whole agenda into, quote, “one huge, lovely invoice,” as Trump has put it. There are many variations of opinions between Republicans which can be nonetheless to be labored out, however one goal for cost-cutting is fairly clear, and that might be Medicaid. Sandhya, we’re beginning to get an image of the chances of how they could wish to try this. What are a number of the essential issues which can be on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made a bit of progress however on the similar time we simply didn’t additionally make lots of progress. The top of, -ish, final week we bought a menu of things that Republicans are sort of contemplating as issues they might use to offset a number of the issues that they’d wish to do by means of reconciliation.
Rovner: Like proceed the tax reduce?
Raman: Sure, for the tax cuts and for border safety. So what we’ve on the Home aspect is lots of issues which can be very health-oriented. About half of that listing is health-oriented, and lots of it’s Medicaid. And so a number of the issues they’ve been floating round are some issues we noticed within the first Trump administration, them attempting to do. We have now per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid growth, and issues like altering the general public cost rule to again the way it was within the Trump administration.
Rovner: Remind individuals what the general public cost rule is.
Raman: The general public cost rule sort of limits a number of the social packages for people that aren’t residents to utilize issues like Medicaid, SNAP [the Supplemental Nutrition Assistance Program], and different packages like that.
Rovner: And people are for people who find themselves right here legally?
Raman: Sure. So this week, Tuesday, we had our first assembly from the Home Vitality and Commerce Republicans to look over at the least the well being a part of that menu. And speaking to each Vitality and Commerce Chairman Brett Guthrie and Buddy Carter, who heads the well being subcommittee, it’s simply the beginning. Discussions had been fairly good, nevertheless it’s so early.
Carter stated that he nonetheless desires to get the PBM [pharmacy benefit manager] language from final 12 months that didn’t make it throughout the end line in there. And Guthrie has stated that a number of the numbers that we’ve seen of how a lot cash from Medicaid they may presumably save are actually in flux due to how they work together with the entire different provisions in there. Some issues are underneath Methods and Means jurisdictions. Some issues, when you do one and never the opposite, the numbers would change.
So that they’re nonetheless fairly early within the course of, and we don’t know if we’re going to do the “one huge, lovely invoice” or sort of what the Senate desires, with two payments, and that might simply sort of change what can be achieved earlier versus later. However we do have a bit of bit extra of a timeline now in what they’re attempting to do.
Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, once they had a a lot larger Republican majority within the Home, and so they couldn’t get it over the end line. What makes them assume they’re going to be extra profitable this time?
Raman: I feel a part of it’s that — that is nonetheless early on. While you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid growth at this level. We nonetheless have solely the ten holdout growth states. So, I feel, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter automobile we’ve, we’ll in all probability hear extra.
And I imply, when you have a look at this state-level already, lots of states are sort of couching their bets with Medicaid, simply serious about how they will do issues in another way in case their Medicaid federal funding modifications over the course of this 12 months or subsequent 12 months. So, I feel it actually will depend on what suggestions they’re going to get within the coming weeks and months.
Rovner: Joanne needed so as to add one thing.
Kenen: Yeah, I imply, the fantastic thing about reconciliation when you’re the bulk celebration, however a slender majority, which is what’s occurring now, is you’d solely want 51 votes within the Senate. You don’t want 60. So on one degree, that feels like they’ve bought 53. It’s a slam dunk, proper? But it surely’s not, as a result of reconciliation, it’s a seize bag. You place a lot stuff in there, and all you want is one provision that this particular person received’t vote for or that particular person received’t vote for.
So this seemingly easy slam dunk for a narrow-majority Senate is definitely a giant, difficult mess. Alternatively, in comparison with the primary Trump administration, this can be a extra conservative, or a extra populist, or a extra strategy — I imply, the ideology or worldview of the Republicans in Congress is nearer to Trump than it was in 2017.
However yeah, they failed at what they thought was going to be straightforward. They thought repealing the ACA [Affordable Care Act] and altering, which included lots of Medicaid stuff, they thought it was a slam dunk. And as a substitute, it was a year-long slog that failed. So is Medicaid going to look the way in which it seems to be proper now? No, it’ll change. How a lot will it change is actually an open query.
Keep in mind, there’s some issues they will do by means of waivers. Work necessities they will do by means of waivers. Though previously, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache.
Rovner: Yeah, properly, so reconciliation, price range, all of these things continues to be means TBD. Nonetheless, the Republican Congress is getting off to a quick begin, at the least by way of messaging laws. The Home this week handed a invoice to ban transgender athletes from ladies’s college sports activities, and the Senate’s debating a Home-passed invoice that might enable the deportation of undocumented people who find themselves accused however not but convicted of violent crimes.
In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued government orders making it simpler for fogeys to ship their kids to highschool with out being vaccinated. General, it appears the Republicans are sort of coalescing round an idea often called “medical freedom,” which to me appears similar to a rejection of public well being basically. Or am I lacking one thing? Is there one thing extra to this?
Edney: No, I feel that it’s all the time been round, however I feel that actually this resurgence in it’s coming from the truth that individuals didn’t belief science throughout the pandemic. They had been fed up. Communication wasn’t dealt with very properly, and it nonetheless isn’t dealt with very properly. I don’t assume individuals have discovered the best way to speak about this stuff in measured methods.
I’d advocate if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Instances just a few days in the past on vaccination that I assumed was actually good as a result of he’s like: Pay attention, I’m a vaccine skeptic. Like, R.F.Ok. Jr. [Robert F. Kennedy Jr.] is a vaccine cynic. There’s the distinction, and right here’s what it’s. And he laid it on the market. And he’s a pediatrician, and he additionally serves on FDA’s [the Food and Drug Administration’s] advisory committee for vaccines.
So I feel that lots of that is stemming from misinformation and miscommunication, and it resonates with individuals. I imply, the Republican Celebration picked up lots of followers in far-left progressives by speaking about this. So I feel they see that as a chance, too. So it might not simply be grassroots. It might be a bit of little bit of a chance they see.
Kenen: Anti-vaccination sentiment has been round so long as vaccines. It truly goes again to smallpox. There has all the time been a specific amount of worry, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to vary two or three years earlier than the pandemic.
Some state legislatures — and this was the medical freedom, this was on the correct — began attempting to water down mandates for colleges. At that time, I don’t assume something huge bought by means of. However we started to see this emergence of a deeper politicization of vaccination. And it was on the correct, and it’s what we now speak about as medical freedom.
So as a substitute of being one thing that’s throughout the political spectrum, it’s now a politicized motion, on a libertarian Authorities can’t inform me what to do. And we noticed this throughout the pandemic. And neither administration, neither the Trump administration within the first 12 months of the pandemic nor the Biden administration within the ensuing years, actually managed to clarify the distinction between particular person selection and the truth that when you get sick, you may survive however you may endanger any person else.
You don’t know who the particular person on the bus subsequent to you is. You don’t know who the child in your classroom is. You don’t know who you’re standing subsequent to on the grocery retailer. They might be actually susceptible. And that this entire sense of “my physique, my selection,” doesn’t fly when you may kill any person else unintentionally. And that form of has been misplaced, or individuals don’t care.
Rovner: Yeah, I imply we’ve seen that with tobacco over what number of generations. It’s like, you wish to put stuff in your lungs, that’s what you are promoting. However you don’t actually get the correct to place stuff in different individuals’s lungs since you want to smoke.
In the meantime, persevering with with the Republican agenda, my former KFF Well being Information colleague Anna Maria Barry-Jester has a extremely good story this week about what Nationwide Institutes of Well being director candidate Jay Bhattacharya may take note of for the company, together with de-emphasizing infectious illness analysis and focusing extra on power illness.
Provided that the largest institute at NIH is already the Nationwide Most cancers Institute, which focuses on a power illness, is that this simply Republicans’ means of punishing the Nationwide Institute of Allergy and Infectious Ailments that was for therefore lengthy headed by the now retired Dr. Tony Fauci?
Raman: I feel in an element that may be a enormous driving issue, whenever you have a look at a few of his feedback and R.F.Ok. Jr.’s feedback about holistic approaches to well being, that actually whenever you have a look at what one thing like NIAID does, which is so infectious-disease-driven, versus the issues like with most cancers and different issues.
However I feel on the similar time, this has sort of been effervescent up earlier than, once we even regarded to final 12 months. Earlier than we had any of those nominees, earlier than we even knew the end result of the election, we had a push inside Congress from the pinnacle of the Home Labor-H Appropriations subcommittee and former Vitality and Commerce Chairwoman Cathy McMorris Rodgers attempting to reform NIH that means.
We didn’t get that far with it. It was included in a number of the appropriations payments that didn’t go wherever but. However I feel it’s simply a part of a broader dialogue that there’s, sort of going again to what we had been saying earlier than, a number of the wanting extra management of what you see, by way of medical freedom, and that they wish to know extra about what’s taking place.
So I feel that, regardless, we’re going to see extra of this. However I feel one factor that was actually fascinating in what she’d been writing was simply the NIH is a lot larger than simply NIH, you recognize? It’s so most of the individuals which can be benefited by it, which can be working with this grant cash, are states nationwide. And it’s simply the medical analysis is for a worldwide understanding of medical analysis, and simply how most of the medication that we see come from NIH cash. So even when there’s a broader push for reform, that it’s very delicate into how broad of an impact that might have.
Rovner: And I’d level out, as a result of I stay up the road from NIH, that almost all of what NIH does doesn’t occur on the NIH campus. It’s, as you stated, it’s cash that goes out to each single congressional district. There’s an unlimited quantity of backing.
I’d additionally level out that, sure, NIH has gotten sort of sprawling with, I feel there’s 27 institutes now. Each single a kind of has been added by Congress. NIH can’t create its personal institutes. Solely Congress can try this. So, Congress has form of made NIH the sprawl that it’s. I feel there’s been bipartisan settlement that NIH perhaps wants a brand new look.
I assume the query is simply form of what route that’s going to take and whether or not a few of it’s going to be punitive or whether or not they’re truly going to take a look at it in a matter of what would profit the nation, as a result of it will get some huge cash, and that’s additionally been bipartisan.
Kenen: Proper. What we’re not listening to but, or at the least — and perhaps Anna, who covers pharma, can inform me if I’m flawed — however we’re not — NIH additionally does the fundamental, primary, primary mobile first-step science that finally results in the work that drug corporations do to develop medication. They do the fundamental, what they name bench, science.
I’m not listening to the drug corporations communicate out. The ambivalence Individuals have about drug corporations, which is hating the costs however liking the medication, I haven’t heard pharma — Possibly it’s simply too early. Possibly they’re weighing in quietly, and perhaps Anna can inform me I’m flawed and they’re and I simply didn’t discover. However that’s additionally an enormous constituency, an enormous, highly effective constituency. As a result of with out the NIH, we wouldn’t have most of the medication that hold us and our aged family alive, together with lots of the beneficial properties — we haven’t cured most cancers, however we’ve made beneficial properties on most cancers. That wouldn’t have occurred. It’s not simply the premier analysis institute in America. It’s the premier analysis institute on the earth, and as Julie stated, a giant driver economically of each single county, each medical college, each public well being, you recognize, it has been an financial powerhouse in addition to a information powerhouse.
Edney: And I wouldn’t inform you you’re flawed. I feel that you simply’re proper. I haven’t heard the pharma corporations speaking about it. I feel they’re speaking about lots of issues that they need achieved to learn them, and so I’m certain that they’ve made their priorities. We’ll see if this reaches form of a boiling level, the place they do find yourself weighing in. And I additionally simply wish to say, NIH, I do know they wish to deal with power illness. It does lots of that. So perhaps that’s not being communicated: It’s not being reduce or left off the desk as a result of we’re doing this. We are able to do two issues. We are able to stroll and chew gum.
Rovner: Sure, I do know, and that was the purpose I used to be attempting to make. It’s like, there’s an unlimited quantity of power illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend lots of time, particular person members, telling NIH what it’s they need to be learning, which is a complete different problem that we’ll get to a different time.
However I wish to keep on the subject of drug costs, as a result of that’s a extremely huge query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly advised a Bloomberg reporter that it’ll ask the Trump administration to, quote, “pause” the Medicare drug value negotiation program, which in fact is simply getting underway.
In fact, that’s taking place whilst Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration resolution to have Medicare start overlaying its costly new weight reduction medication.
In the meantime, on its means out the door, the Biden administration’s Federal Commerce Fee dropped a report that discovered that the nation’s three largest PBMs, which collectively management about 80% of the U.S. prescription drug market, drove up drug costs by an estimated $7.3 billion from 2017 to 2022.
I noticed someplace this week, and I feel, Sandhya, you talked about this, a suggestion that Republicans may attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to should do in March. Doubtless? Doable? Will this report have any impression? Or is there simply an excessive amount of different information this week and no person’s going to recollect?
Raman: I feel it’s undoubtedly being talked about so much. We talked to the management of Vitality and Commerce. It’s a precedence for each of them, each for Carter and for Guthrie, as a result of they labored so carefully on it earlier than. It was included in a bipartisan deal that we had earlier than we bought the CR [continuing resolution] that we voted into regulation. It simply bought dropped alongside the way in which.
Rovner: When Elon Musk stated the invoice was too huge?
Raman: Yeah. So I feel we sort of have two pathways, the place each of them wish to get it achieved regardless. I feel that it’d rely whether or not they’re able to piece it away and do it as one thing stand-alone, which they wish to get it achieved sooner slightly than later.
But it surely relies upon a bit of bit extra on the management degree, if there are financial savings from utilizing that invoice for use later down the road once they get reconciliation at a later stage. So I feel that’s what we’re ready on. Would they should put that there? Or would they have the ability to go forth with that now?
Rovner: True. So, it’s a bipartisanly fashionable provision that additionally saves cash, in order that makes it sort of enticing to lawmakers who’re placing collectively issues that may, as Joanne would say, embrace spinach.
Anna, what extra broadly do you see because the outlook on drug costs?
Edney: Properly, I feel the very first thing I consider with that program is, it saves some huge cash when you’re giving Medicare the flexibility to barter. And so, I simply surprise how that matches into this agenda when you cease it and make it extra favorable in the direction of the drugmakers. The place does that slot in with chopping spending and lowering the deficit and all of these issues?
So, I feel that, perhaps they’ve a bit of little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I feel everyone knows that we simply have to attend and see what truly occurs.
Rovner: Yeah, lots of shrug emojis coming.
Edney: Precisely.
Rovner: Properly, in the meantime, throughout the road from Capitol Hill, the Supreme Court docket has agreed to listen to that preventive well being care case out of, altogether now, Texas. The case challenges the necessities within the Reasonably priced Care Act that insurance coverage cowl, with out copay, preventive providers like immunizations, most cancers screenings, contraception, and, the topic of this specific case, remedy to forestall HIV.
What occurs if the court docket guidelines with the plaintiffs on this case who argue that the CDC’s [Centers for Disease Control and Prevention’s] Preventive Well being Companies Job Drive doesn’t have the authority to find out what providers ought to be on this listing? Which in fact is the entity that now determines which providers ought to be on this listing.
Edney: Properly, it feels like, then, lots of people don’t get their preventive care lined. As KFF wrote, there’s some that might be nonetheless lined, the mammographies, however not the HIV preventative remedy. Different most cancers screenings included in that as properly. And so, it appears to throw a wrench, I assume, form of simply asking this of the panel, that businesses then must go make these determinations? Does Congress should make the determinations on what’s lined then?
Rovner: Properly, that’s in fact the massive query. Or, would the secretary, him or herself? Who is permitted? I feel the argument is as a result of the Preventive Well being Companies Job Drive shouldn’t be Senate-confirmed, they will’t make these selections.
And naturally, the way in which it really works, they don’t make these selections. They advocate them, after which the secretary form of ratifies them. So it’s exhausting to inform from this whether or not it actually would go away, or whether or not Congress must step in, or whether or not the secretary may simply do it. I really feel like this creates as many questions because it may solutions.
Kenen: It’s a extremely broad array of advantages that — it’s not simply the HIV PrEP preventive medication. And I learn completely different tales about this, and so they had completely different lists, together with some ldl cholesterol stuff. And I don’t know, for the reason that lists had been so completely different, I’m unsure precisely which of them are in or which of them had been out. But it surely’s not simply HIV medication. It’s lots of stuff.
So it could actually intestine one thing that individuals depend on now. I imply these are free not just below an ACA plan however when you get protection by means of a job, these necessities additionally apply. So, lots of people would now not have free entry to lots of what we think about preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They simply determined to take it. So, this will likely be a later in 2025 case. Properly, the flip aspect of an incoming administration are all of the issues the outgoing administration tries to slide by means of on its means out of city, and this week has seen a bunch of these.
Most of this stuff might be pretty simply undone by incoming officers, however not with out some public ache, which generally is why administrations wait till the final minute to do them, to be a bit of passive aggressive, or perhaps in a few of these instances so much passive aggressive. A number of of those last-minute modifications come from the Meals and Drug Administration, an company focused for large modifications underneath Trump 2.0.
In simply the final 48 hours, the FDA has introduced a coverage that might require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Purple Dye No. 3, a controversial additive already banned in lots of different nations which has been proven to trigger most cancers in rodents. And it proposed a significant change in meals labels to require them to indicate on the entrance of packaging whether or not the meals’s sodium, sugar, and saturated fats ranges are low, medium, or excessive. Do any of those proposals stay on for greater than one other week?
Edney: I feel the Purple No. 3 may. We all know that R.F.Ok. Jr.’s talked about meals dyes and desirous to get them out of, he particularly stated, cereal, however they’re in lots of issues. So, I see that one.
I feel the business noticed that coming from far-off and has been switching already, in fact generally to a different problematic, probably, meals coloring. However I don’t assume that is one thing you’re going to see them struggle tremendous exhausting for to vary. The nicotine is way more iffy. Massive Tobacco continues to be an enormous pressure, and Trump will get funding for his marketing campaign and issues from corporations who’ve a stake on this.
And a few of that might align with this concept of not essentially medical freedom however, form of, we will select what we put in our our bodies. If we wish to be hooked on nicotine, that’s our selection. So, the opposite one, the labels, I’m unsure. They’re not significantly highly effective or something. I assumed they regarded … After I checked out it, I used to be like, That is complicated and simply seems to be just like the again, however it’s a little completely different. So, I don’t know. Possibly it survives. I’m unsure how a lot the business is engaged on this.
Rovner: [Sen.] Bernie Sanders of all individuals excoriated the meals labels, saying we don’t placed on cigarette packages whether or not the cancers they trigger are low, medium, or excessive. Why ought to we do that? I imply, that is mainly one other effort to go after ultra-processed meals. I used to be stunned at how indignant he was at this.
Kenen: I feel he desires them in neon.
Rovner: I feel he desires R.F.Ok. Jr. to have fewer ultra-processed meals accessible. I feel that’s going to be form of the massive takeaway from all of this, I assume.
Kenen: Proper. However we additionally don’t perceive what an ultra-processed meals is, as a result of there’s some meals that aren’t ultra-processed which can be unhealthy for you. And there’s some meals that do have some sort of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t inform you. There’s some issues which can be, quote, “ultra-processed” that actually aren’t that processed, don’t have lots of components. They’ve one thing.
So the entire categorization wants extra work, each for public understanding and political understanding. There’s no person who’s going to say that Individuals have a extremely nutritious diet and that meals components … R.F.Ok. Jr. has identified to the meals additive, the place the businesses should get to self-certify, Yeah, that is protected. So, is that one thing that he may get widespread assist on? Sure, however there’s a complete lot of different issues that he says that individuals weren’t going to agree with.
Rovner: And I’ll remind that we not solely don’t know if R.F.Ok. Jr. will likely be confirmed, however they nonetheless don’t actually have a date for his affirmation listening to, as a result of they’re nonetheless ready on the paperwork. All proper, shifting on.
As we taped this morning, there are nonetheless a number of fires burning within the Better Los Angeles space. We have now talked concerning the well being results of fireplace earlier than. It’s not precisely information that fireplace and smoke are unhealthy for human well being, however what appears to make these fires completely different is that they’re not largely timber and brush and different bits of nature which can be burning however numerous poisonous substances which can be polluting not simply the air but additionally the ingesting water.
Are we going to have to begin serious about hearth and well being in a a lot completely different means if not simply distant areas however whole suburbs at the moment are vulnerable to burning up because of our altering local weather?
Edney: It can make us consider lots of issues in several methods, and significantly well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that include excessive ranges of formaldehyde, issues like that.
I feel the expectation is that may create a long-term problem, but additionally it will probably within the second create extra deaths simply on the time, not as a result of it straight kills but when you have already got a problem and you’ve got a respiratory downside or a coronary heart downside that may be exacerbated by these fires.
Yeah, I feel there’s a ton to consider. Even ingesting water may be impacted extra so when you could have energy outages and issues within the areas the place you’re perhaps cleansing that water after which issues like that. So, I feel that’s going to be — masks, N95s may be coming again for a very completely different purpose.
Rovner: Properly, N95s are usually not sufficient. I imply, I feel that was the factor that sort of jumped out at me. For those who watch the information protection of it, the reporters aren’t sporting N95s anymore. They’re sporting what regarded like old-style fuel masks. I imply, you want form of the following degree of masking as a result of N95s don’t filter out a few of these poisonous substances that at the moment are floating within the air. I imply, they do filter out the kind of the particular smoke from wooden and whatnot, nevertheless it’s fairly scary.
I imply, much more individuals than ever earlier than have N95s hanging round their home, however they actually don’t have these next-level respirators, which is what I hold listening to medical doctors calling for.
Kenen: And the article you — I feel it was the one that you simply despatched round yesterday that mainly that the whole lot in our home is, our couches are mainly cubes of plastic wrapped in fabric and harmful once they’re burned. However I imply, I feel that was the article that additionally stated that a few of these issues which can be burning produce like a cyanide sort of fuel, that the firefighters can’t even be uncovered. They will’t stand in entrance of a home with a hose for a very long time.
It might be killing or injuring firefighters. So, it additionally hampers — they’re not simply attempting to place a hose on a burning tree.
Rovner: Yeah. Much more issues to consider, which is simply what we wanted. Properly, turning to abortion, keep in mind all these states final 12 months that voted to guard abortion rights? Plainly was removed from the ultimate phrase.
We’re seeing court docket case after court docket case to find out which abortion restrictions can keep and which might’t because of passage of these poll measures. That is taking place significantly in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a decide invalidated some however not the entire state’s restrictions.
This appears to be the inevitable results of what we’ve seen in different elections, the place the identical voters endorse abortion rights however then flip round and vote for candidates, together with judges, who don’t. Is the gridlock right here on goal or by chance? And Sandhya, what’s going to occur?
Raman: I don’t know that it could be on goal. I feel that these voters that vote for the candidates, if abortion shouldn’t be their prime problem, they’re nonetheless going to vote in the way in which that sort of allies with them. However then in the event that they’re different insurance policies, they’re going to vote for these candidates.
And Missouri, I feel, is fascinating as a result of it has lengthy been, I feel, one of many take a look at instances for a lot within the abortion area, of attempting out new restrictions and what’s going to follow the wall. And I feel that we’re going to see extra of those sort of lengthy, drawn-out battles, on condition that the decide stated that some restrictions had been struck down due to the constitutional modification however then others, just like the licensing for abortion amenities, which we’ve seen for years, can keep. And that simply makes it in order that they will’t actually function.
Rovner: Yeah. They’ve issues like how vast the hallways have to be, I imply, guidelines that had been created to discourage them from providing abortions, not as a result of they had been truly wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion amenities. They’re not parallel within the different kinds of clinics and hospitals. So it’s focused to them. I feel it’s simply one other instance of it being sort of an uphill battle for them, as a result of now, I imply, even previously few years we’ve seen a lot extra consideration on state supreme court docket races, which I really feel like just a few years in the past that was not one thing that might get nationwide consideration for one state or one other.
However, on condition that, as they’re sort of litigating these and seeing how can we implement the regulation in order that these clinics can open underneath the constitutional modification, it depends on them, and simply how a lot cash that’s being fueled to have the ability to not come down on the opposite aspect in order that they will sort of function. So I feel that’s one thing to undoubtedly watch, as a few of these states are sort of litigating this stuff, nevertheless it’s going to be a protracted, drawn-out battle, even when it’s already been a number of months since seven out of 10 states final 12 months voted in favor of abortion rights.
Rovner: Yeah, this continues, and naturally, we’ll wait and see what occurs on the federal degree, when the Trump administration will get going. Properly, lastly this week, we’ve one other entry in our recurring phase, “This Week in Medical Misinformation.” I needed to speak about a little-noted story from the medical information web site MedPage At the moment concerning the American Board of Inner Drugs pulling the board certification of a Texas heart specialist who made controversial and unfaithful claims about covid and the covid vaccine, together with that vaccine had killed tens of 1000’s of individuals.
What’s troublesome about this story, although, is that the ABIM wouldn’t touch upon particular person physicians, though it did listing this specific physician on his web site as not being licensed. How ought to specialty boards take care of medical doctors who specific views which can be, shall we embrace, not according to medical proof? And the way clear ought to they be about telling sufferers once they sanction one in all their very own, which is mainly what occurred right here?
Kenen: Properly, they did put out a press release, I feel it was the New England Journal of Drugs a few 12 months and a half in the past, saying that they had been going to crack down on this. I’m unsure if there’s, for any of the boards, if there’s a mechanism for telling sufferers, as a result of how do you even know who all of the sufferers or potential sufferers are?
Rovner: However once I say telling sufferers, I imply telling the general public.
Kenen: Proper. However I don’t know that any of the boards try this in any — it’s a giant can of worms about decertification and the way sometimes it occurs.
So ABIM did put out a press release, I feel it was two years in the past now, and there’s been a course of for just a few, however not so much. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So until the state medical board, which is actually the group that pulls a license — that is saying that you simply’re not a board-certified no matter your specialty is underneath ABIM.
However Lauren [Weber of The Washington Post], who is typically on the web site, had a great piece a few months in the past about how few state boards have acted to sanction medical doctors who say incorrect issues about vaccines. And that goes again means earlier than covid. The medical occupation doesn’t do lots of self-policing.
Rovner: Sure, and I’ve been doing this lengthy sufficient to have lined the creation of the Nationwide Practitioner Information Financial institution, when medical doctors who’d had their licenses pulled may simply go to a different state, and there was no means for that state to simply discover out that that physician had had his or her license revoked.
And that was normally not for saying issues however for doing issues that ended up with having the physician decreed not certified to follow medication anymore. So, I imply, this is a matter that goes again a protracted methods.
Kenen: And you’ll assume they might be the alternative. You’ll assume that the state boards, when any person is known as a unhealthy man or a foul gal, you’ll assume they might say, “We cease them!” Like, “We’re defending your well being.” And as a substitute, it’s been very secretive and really rare.
It’s extra the state licensing board. I imply, certification is vital, however actually the facility to de-license any person is within the state boards.
Rovner: Yeah, properly, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we’ll hold watching. All proper, that’s the information for this week. Now, we’ll play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our further credit.
I’m happy to welcome to the podcast Harris Meyer, who reported and wrote the newest KFF Well being Information “Invoice of the Month.” Harris, welcome to “What the Well being?”
Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you.
Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he bought.
Meyer: OK, Julie, this can be a story about excessive costs, complicated payments, and lack of value transparency for a quite common process. The affected person is Tom Contos, a 45-year-old well being care marketing consultant who lives in Chicago. Final spring, Tom observed blood in his stool. He went to see his household doctor at Northwestern Drugs.
The physician referred him for a diagnostic colonoscopy due to the bleeding and due to his household historical past of great colon points. Then in June, he went in for a colonoscopy at Northwestern Memorial Hospital, which is a giant educating hospital in downtown Chicago.
A Northwestern gastroenterologist carried out the process, which took lower than an hour. He discovered and eliminated two polyps, which a pathologist later discovered weren’t cancerous. The gastroenterologist concluded that Tom’s rectal bleeding was as a consequence of a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for individuals with no signs, which can be alleged to be free as preventive care underneath the Reasonably priced Care Act. Diagnostic colonoscopies like this one can require a affected person to satisfy deductible and copay necessities, proper? That’s one thing vital for individuals to know?
Meyer: Sure. There’s lots of confusion about this. I bought lots of feedback on my Washington Put up article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are achieved when there are signs like bleeding or ache. In distinction, screening colonoscopies are advisable beginning at age 45, even when there aren’t any signs, to forestall colon most cancers or different critical situations.
The Reasonably priced Care Act requires well being insurers to cowl screening colonoscopies for free of charge to sufferers. However for a diagnostic colonoscopy, sufferers could should pay a deductible and copayment, though that process equally can forestall colon most cancers. It doesn’t—
Rovner: It may be complicated.
Meyer: It’s complicated, yeah.
Rovner: So he has a process, which discovered some minor indications that had been taken care of, after which, as we are saying, the invoice got here. How a lot was it?
Meyer: Yeah, Northwestern’s complete cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated charge with Northwestern of a nonetheless important about $6,000. When he bought his insurance coverage rationalization of profit assertion, he noticed that he owed about $4,100, with the insurer paying about $2,000.
He was bewildered as a result of he had requested Northwestern for an estimate of how a lot he would owe in complete and he was advised that he would owe about $2,400. My outdoors billing skilled stated $4,100 is sort of a excessive out-of-pocket invoice, although common for educating hospitals.
Rovner: And he was charged for 2 colonoscopies, proper?
Meyer: Sure. That was a significant purpose that the invoice was so excessive. Northwestern billed him for 2 colonoscopies, which Tom didn’t perceive, since he had solely acquired one. It seems that suppliers routinely invoice for 2 procedures if the gastroenterologist removes and biopsies two polyps in two alternative ways throughout the identical process.
The second process is billed at a reduced charge. Now, this appears unusual to laypeople, however that is how suppliers receives a commission for the additional work of eradicating two polyps slightly than one.
Rovner: Which, as you identified at first, it’s not like this can be a several-hour surgical procedure. It is a pretty fast process.
Meyer: That’s proper. It’s at most an hour, typically lower than that.
Rovner: So what occurred finally with the invoice?
Meyer: Properly, Tom appealed the invoice to Northwestern and Aetna and was advised that it was appropriate. He had already paid about $2,400 of the almost $4,100 he owed, however he advised Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they may take him to collections.
Northwestern stated that’s what they had been going to do, and Tom determined to now not use Northwestern or its medical doctors sooner or later.
Rovner: Though I assume he did pay the quantity that they stated he owed.
Meyer: No, he stated: Take me to collections. I’m not paying it. My credit score is nice, and — I received’t repeat a number of the issues that he stated to them.
Rovner: Thanks. It is a household podcast. How can others keep away from falling into this entice? I imply, he bought an estimate. He had an concept of what he was going to be charged, and but he was nonetheless charged significantly greater than that estimate.
Meyer: Yeah, he’s a well being care marketing consultant, however lots of people get confused by this course of, together with him taken abruptly. He solely regarded on the estimate after he had had the process however earlier than he bought the ultimate invoice. So, like lots of people, he bought confused and he didn’t proceed essentially as effectively as he might need. However that’s frequent and never shocking.
Rovner: Even for any person who’s mainly within the well being care cost enterprise.
Meyer: Sure, that’s appropriate.
Rovner: So be vigilant. Is that mainly the takeaway?
Meyer: Properly, how are you going to keep away from falling in the identical entice? Sadly, not simply. Sufferers needing a diagnostic colonoscopy ought to take a look at freestanding endoscopy facilities or ambulatory surgical procedure facilities that aren’t related to a hospital, as a result of they are often cheaper and so they can present good high quality of care.
To cost-shop forward of time, sufferers can have a look at the hospital’s value web site and their insurer’s price estimator web site to get a way of how a lot a diagnostic colonoscopy may price. In addition they can search for a so-called good religion estimate of the money value, that means the process might be cheaper in the event that they pay money, slightly than going by means of insurance coverage.
Plus, there are free web sites similar to Turquoise Well being and Truthful Well being for checking costs for colonoscopies and different procedures. Now, as soon as they get a value estimate from the supplier, there’s yet one more wrinkle. Sufferers ought to ask whether or not that value contains the additional providers, if the gastroenterologist finds and has to take away and biopsy a number of polyps. A minimum of 40% of colonoscopies do discover polyps.
Now, specialists say it’s unlucky that getting a diagnostic colonoscopy may be so costly and complicated billing-wise, however don’t hesitate, as a result of it may be a lifesaving process for many individuals.
Rovner: All wonderful recommendation. Harris Meyer, thanks a lot.
Meyer: Thanks, Julie.
Rovner: OK, we’re again, and it’s time for our extra-credit phase. That’s the place we every acknowledge the story we learn this week we expect you need to learn, too. Don’t fear. For those who miss it, we’ll put the hyperlinks in our present notes in your telephone or different cellular machine. Anna, why don’t you go first this week?
Edney: I needed to speak about one I wrote final month, and the headline is “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles.” I sort of needed to place in a single place speaking about lots of these contamination points which have come up, however significantly additionally simply present that, whereas the issues with merchandise continue to grow — one in all them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting form of slower on lots of this stuff. They’re digging in, and so they’re not attempting to speak to the general public concerning the points which have come up. They’ve had since final March of 2024 considerations dropped at them about benzene and pimples merchandise.
They’ve stated nothing to the general public. They simply hold saying, We’re it. And that’s very completely different from when this primary sort of began taking place on a bigger scale, the place it was like, growth, remembers. Now it’s simply form of this struggle to perhaps not have remembers. I don’t know what’s occurring of their head.
However there are also some points in there with the tampons had been discovered to include lots of heavy metals, FDA additionally slow-walking there. So I needed to level out that piece I wrote if anyone missed it.
Rovner: Sure. Thanks, Anna, on the “the whole lot you thought may be protected is definitely harmful” beat.
Edney: I’m the life of each celebration.
Rovner: There you go. Joanne.
Kenen: I’m unsure if that is an additional credit score or a public service announcement, however there’s a nice piece in The Atlantic by Daniel Engber. Properly, everyone knows there’s a ton of abdomen bugs and norovirus going round, and it’s fairly extreme this 12 months. And the headline is “A Secret Technique to Combat Off Abdomen Bugs,” and the reply is wash your palms with cleaning soap.
But it surely’s a extremely well-written — it truly makes you snort about abdomen bugs. It’s a really well-written, good story. And no, for this bug, hand sanitizers don’t work.
Rovner: Sandhya.
Raman: My further credit score this week is named “New weight problems definition sidelines BMI to deal with well being,” and it’s by Giorgia Guglielmi for Nature. And it takes a have a look at — we had a revised definition of measuring and diagnosing weight problems within the Lancet Diabetes & Endocrinology this week.
So, as a substitute of BMI [body mass index], which is weight- and height-linked, they’re suggesting a few alternate options: preclinical weight problems, which is an individual with further physique fats however their organs are nonetheless functioning usually, and medical weight problems, so when you could have that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply alternative ways clinicians are this globally.
Rovner: Yeah, it’s actually fascinating as a result of, clearly, each physician says that BMI is a silly and imprecise strategy to measure this, after which everyone makes use of BMI as a result of, in the intervening time, it’s all we’ve. My further credit score this week is a KFF Well being Information story from Felice Freyer. It’s known as “Can Medical Faculties Funnel Extra Docs into the Main Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened numerous new medical colleges over the previous decade and has launched a raft of packages aimed toward getting extra graduating medical doctors to enter major care, means too many are nonetheless pursuing specialty care as a substitute. We have now tried, as a society, free tuition and mortgage compensation packages, nevertheless it doesn’t appear that medical schooling debt is the largest downside.
We’ve additionally tried coaching medical doctors in additional primary-care-centric areas, i.e. in neighborhood clinics slightly than in hospitals, however that’s not made an enormous dent, both. Quite, to cite one of many household medication specialists within the story: “It’s not the medical colleges which can be the issue; it’s the job. The job is simply too poisonous.”
In different phrases, it’s probably not interesting to see too many sufferers for too little time and do tons of preventing with insurance coverage corporations and digital medical information. Till we as a society begin making major care much more of a satisfying job, it’s not going to matter how a lot it pays. We’re nonetheless going to have a critical scarcity.
All proper, that’s this week’s present. As all the time, when you benefit from the podcast, you may subscribe wherever you get your podcasts. We’d recognize it when you left us a overview. That helps different individuals discover us, too. Particular thanks once more this week to our momentary manufacturing workforce, Taylor Cook dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As all the time, you may e mail us your feedback or questions. We’re at [email protected], or you may nonetheless discover me sometimes at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out nowadays? Anna?
Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social.
Rovner: Joanne.
Kenen: I’m on Bluesky, @joannekenen.bsky.social, very sometimes on X nonetheless, @JoanneKenen.
Rovner: Sandhya.
Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social.
Rovner: We will likely be again in your feed subsequent week. Till then, be wholesome.
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Lonnie Ro
Audio producer
Emmarie Huetteman
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