The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the creator of the critically praised reference ebook “Well being Care Politics and Coverage A to Z,” now in its third version.
As a part of a media blitz geared toward girls voters, Vice President Kamala Harris this week rolled out a plan for Medicare to supply in-home long-term care companies. It’s common, notably for households struggling to take care of each younger youngsters and older kin, however its monumental expense has prevented comparable plans from being applied for many years.
In the meantime, President Joe Biden referred to as out former President Donald Trump by identify for having “led the onslaught of lies” in regards to the federal efforts to assist individuals affected by hurricanes Helene and Milton. Even some Republican officers say the misinformation about hurricane reduction efforts is threatening public well being.
This week’s panelists are Julie Rovner of KFF Well being Information, Shefali Luthra of The nineteenth, Jessie Hellmann of CQ Roll Name, and Joanne Kenen of the Johns Hopkins faculties of public well being and nursing and Politico.
Panelists
Jessie Hellmann
CQ Roll Name
Joanne Kenen
Johns Hopkins College and Politico
Shefali Luthra
The nineteenth
Among the many takeaways from this week’s episode:
- Vice President Kamala Harris’ plan to develop Medicare to cowl extra long-term care is common however not new, and up to now has proved prohibitively costly.
- Former President Donald Trump has deserted help for a drug value coverage he pursued throughout his first time period. The thought, which might decrease drug costs within the U.S. to their ranges in different industrialized nations, is vehemently opposed by the drug {industry}, elevating the query of whether or not Trump is softening his arduous line on the difficulty.
- Abortion continues to be the most important well being coverage situation of 2024, as Republican candidates — in what appears to be a replay of 2022 — attempt to distance themselves from their help of abortion bans and different limits. Voters proceed to favor reproductive rights, which creates a model drawback for the GOP. Trump’s going forwards and backwards on his abortion positions is an exception to the tack different candidates have taken.
- The Supreme Courtroom returned from its summer season break and instantly declined to listen to two abortion-related circumstances. One case pits Texas’ near-total abortion ban towards a federal regulation that requires emergency abortions to be carried out in sure circumstances. The opposite challenges a ruling earlier this 12 months from the Alabama Supreme Courtroom discovering that embryos frozen for in vitro fertilization have the identical authorized rights as born people.
- The 2024 KFF annual employer well being advantages survey, launched this week, confirmed a roughly 7% improve in premiums, with common household premiums now topping $25,000 per 12 months. And that’s with most employers not overlaying two common however costly medical interventions: GLP-1 medication for weight reduction and IVF.
Additionally this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris marketing campaign about well being care points.
Plus, for “additional credit score,” the panelists counsel well being coverage tales they learn this week they assume it’s best to learn, too:
Julie Rovner: KFF Well being Information’ “A Boy’s Bicycling Dying Haunts a Black Neighborhood. 35 Years Later, There’s Nonetheless No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly.
Shefali Luthra: The nineteenth’s “Arizona’s Poll Measure May Shift the Narrative on Latinas and Abortion,” by Mel Leonor Barclay.
Jessie Hellmann: The Meeting’s “Helene Left Some NC Elder-Care Houses With out Energy,” by Carli Brosseau.
Joanne Kenen: The New York Occasions’ “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It,” by Kate Morgan.
Additionally talked about on this week’s podcast:
Click on to open the Transcript
Transcript: But One other Promise for Lengthy-Time period Care Protection
[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: 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 a number of the greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, October tenth, 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.
Immediately we’re joined by way of teleconference by Shefali Luthra of The nineteenth.
Shefali Luthra: Good day.
Rovner: Jesse Hellmann of CQ Roll Name.
Jessie Hellmann: Hello there.
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 some excerpts from the Newsmaker lunch we had right here at KFF this week with Mark Cuban — “Shark Tank” star, part-owner of the Dallas Mavericks NBA workforce, and, for the needs of our dialogue, co-founder of the industry-disrupting pharmaceutical firm Value Plus Medication. However first, this week’s information.
We’re going to begin this week with Vice President [Kamala] Harris, who’s been making the media rounds on women-focused podcasts and TV exhibits like “The View.” To associate with that, she’s launched a proposal to develop Medicare to incorporate home-based long-term care, to be paid for partially by increasing the variety of medication whose value Medicare can negotiate. Sounds easy and actually common. Why has nobody else ever proposed one thing like that? she asks, understanding full nicely the reply. Joanne, inform us!
Kenen: Because the one full-fledged member of the sandwich era right here, who has lived the expertise of being a household caregiver whereas elevating youngsters and dealing full time, long-term care is the unfulfillable, extraordinarily costly, however extremely essential lacking hyperlink in our well being care system. We don’t have a system for long-term care, and other people don’t notice that. Many individuals assume Medicare will, actually, cowl it, the place Medicare covers it in a really restricted, short-term foundation. So the estimates of what households spend each when it comes to misplaced work hours and what they put out-of-pockets is in, I believe it’s one thing like $400 billion. It’s terribly excessive. However the motive it’s been arduous to repair is it’s terribly costly. And though Harris put out a plan to pay for this, that plan goes to need to be vetted by economists and finances scorers and skeptical Republicans. And possibly some skeptical Democrats. It’s actually costly. It’s actually arduous to do. Julie has lined this for years, too. It’s simply—
Rovner: I’d say that is the place I get to say one in every of my favourite issues, which is that I began overlaying well being care in 1986, and in 1986 my first large function was: Why don’t now we have a long-term care coverage on this nation? Thirty-eight years later, and we nonetheless don’t, and never that folks haven’t tried. There, actually, was a long-term-care-in-the-home piece of the Reasonably priced Care Act that handed Congress, and HHS [the Department of Health and Human Services] found that they may not implement it in the best way it was written, as a result of solely the individuals who would’ve wanted it will’ve signed up for it. It could’ve been too costly. And there it went. So that is the persevering with promise of one thing that everyone agrees that we’d like and no person has ever been ready to determine find out how to do. Shefali, I see you nodding right here.
Luthra: I imply, I’m simply pondering once more in regards to the pay-fors in right here, that are largely the financial savings from Medicare negotiating drug costs. And what Harris says in her plan is that they’re going to get extra financial savings by increasing the checklist of medication that get decrease costs. However that additionally feels very politically suspect when now we have already heard congressional Republicans say that they want to weaken a few of these drug negotiation value provisions. And we additionally know that Democrats, even when they win the presidency, usually are not prone to have Congress. It actually takes me again to 2020, after we are simply speaking about concepts that Democrats would like to do if they’d full energy of Congress, whereas all of us in Washington type of know that that’s simply not going to occur.
Rovner: Sure, I like that one of many pay-fors for that is slicing Medicare fraud. It’s like, the place have we heard that earlier than? Oh, sure. In each Medicare proposal for the final 45 years.
Kenen: And it additionally entails closing some type of worldwide tax loopholes, and that additionally sounds simple on paper, and nothing with taxes is ever simple. The Democrats in all probability usually are not going to have the Senate. No person actually is aware of in regards to the Home. It appears to be like just like the Democrats could have a slim edge in that, however we’re going to have extra years of gridlock until one thing actually adjustments politically, like one thing extraordinary adjustments politically. The Republicans usually are not going to provide a President Harris, if she is actually President Harris, her want checklist on a golden platter. However there’s want for this.
Rovner: However in equity, that is what the marketing campaign is for.
Kenen: Proper. There’s a want for one thing on long-term care.
Rovner: And all people’s complaining: Effectively, what would she do? What would she do if she was elected? Effectively, right here’s one thing she stated she would do if she may, if she was elected. Effectively, in the meantime, former President [Donald] Trump has apparently deserted a proposal that he made throughout his first time period to require drugmakers to decrease their costs for Medicare to not more than they cost in different developed nations the place their costs are government-regulated. Is Trump going tender on the drug {industry}? Trump has been, what, the Republican, I believe, who’s been most hostile in direction of the drug {industry} till now.
Hellmann: I’d say perhaps. I believe the “most favored nation” proposal is one thing that the pharmaceutical {industry} has feared much more than the Democrats’ Medicare negotiation program. And it’s one thing that Trump actually pursued in his first time period however wasn’t in a position to get accomplished. In such a decent race, I believe he’s actually anxious about angering pharmaceutical firms, particularly after they have been simply type of dealt this loss with Medicare value negotiation. And if he does win reelection, he’s going to be type of restricted in his means to weaken that program. It’s going to be arduous to repeal it. It’s extraordinarily common, and he might be able to weaken it.
Rovner: “It” that means value negotiation, not the “most favored nations” costs.
Hellmann: Yeah. It’s going to be actually arduous to repeal that, and he might be able to weaken it by means of the negotiation course of with drug firms. It’s positively an attention-grabbing flip.
Rovner: Joanne, you need to add one thing?
Kenen: Trump rhetorically was very harsh on the drug firms proper across the time of his inauguration. I believe it was the week earlier than, if I keep in mind accurately. Stated loads of very powerful stuff on medication. Put out an inventory of one thing like dozens of potential steps. The drug firms have a lot of allies in each events, and extra in a single than the opposite, however they’ve allies on the Hill, and nothing revolutionary occurred on drug pricing underneath Trump.
Rovner: And his HHS secretary was a former drug firm government.
Kenen: Sure, Eli Lilly. So we additionally identified right here that former President Trump shouldn’t be constant in coverage proposals. He says one factor, after which he says one other factor, and it’s very arduous to know the place he’s going to return down. So Trump and drug pricing is an open query.
Rovner: Sure, we are going to see. All proper, nicely, shifting on. Drug costs and Medicare apart, the most important well being situation of Marketing campaign 2024 continues to be abortion and different reproductive well being points. And it’s not simply Trump making an attempt to again away from his anti-abortion file. We’ve had a spate of tales over the previous week or so of Republicans working for the Home, the Senate, and governorships who’re making an attempt to actually reinvent themselves as, if not truly supportive of abortion rights, not less than anti abortion bans. And that features Republicans who haven’t simply voted for and advocated for bans however who’ve been outspokenly supportive of the anti-abortion effort, individuals like North Carolina Republican gubernatorial candidate Mark Robinson, New Hampshire Republican gubernatorial candidate and former U.S. Senator Kelly Ayotte, together with former Michigan Republican consultant and now Senate candidate Mike Rogers. Donald Trump has gotten away repeatedly, as Joanne simply stated, with altering his positions, even on hot-button points like abortion. Are these candidates going to have the ability to get away with doing the identical factor, Shefali?
Luthra: I believe it’s simply a lot harder when your identify shouldn’t be Donald Trump. And that’s as a result of we all know from focus group after focus group, and survey after survey, that voters type of give Trump extra leeway on abortion. Particularly unbiased voters will have a look at him and say, Effectively, I don’t assume he truly opposes abortion, as a result of I’m positive he’s paid for them. They usually don’t have that very same grace that they provide to Republican lawmakers and Republican candidates, as a result of the occasion has a nasty model on abortion at giant, and Trump is seen as this sort of maverick determine. However voters know that Republicans have a historical past of opposing abortion, of supporting restrictions.
While you have a look at surveys, if you discuss to voters, what they are saying is, Effectively, I don’t belief Republicans to characterize my pursuits on this situation, as a result of they largely help entry. And one factor that I do assume is basically attention-grabbing is, as soon as once more, what we’re seeing is type of a repeat of the 2022 elections after we noticed some very brazen efforts by Republican candidates for the Home and Senate attempt to scrub references to abortion and to fetal personhood from their web sites. And it didn’t work, as a result of individuals have eyes and other people have reminiscences, and, additionally, campaigns have entry to the web archive and are in a position to present folks that, even a couple of weeks in the past, Republican candidates have been saying one thing very completely different from what they’re saying now. I don’t assume Mark Robinson can actually escape from his comparatively latest and really public feedback about abortion.
Rovner: Effectively, alternatively, there’s some issues that don’t change. Republican vice presidential candidate JD Vance informed RealClearPolitics final week that if Trump is elected once more, their administration would lower off funding to Deliberate Parenthood as a result of, he stated, and I quote, “We don’t assume that taxpayers ought to fund late-term abortions.” However, in fact, that even earlier than the overturn of Roe, lower than half of all Deliberate Parenthoods even carried out abortions and nearly none of those that did carry out them later in being pregnant. Is it truthful to say that Vance’s anti-abortion slip is displaying?
Luthra: I believe it is perhaps. And I’ll say, Julie, once I noticed that he stated that, I may hear you in my head simply yelling in regards to the Hyde Modification, as a result of we all know that Deliberate Parenthood doesn’t use taxpayer cash to pay for abortions. However we additionally know that JD Vance has seen that he and his ticket are type of in a troublesome nook speaking about abortion. He has stated many instances, We have to rebrand — he’s very trustworthy about that, not less than — and making an attempt to focus as an alternative on this nonmedical time period of “late time period” abortions.
It’s a raffle. It’s hoping that voters will probably be extra sympathetic to that as a result of they’ll assume, Oh, nicely, that sounds very excessive. They usually’re making an attempt to shift again who’s seen as credible and who shouldn’t be, by specializing in one thing that traditionally was much less common. However once more, it’s once more difficult as a result of after we have a look at the polling, voters’ understanding of abortion has shifted and they’re now extra prone to perceive that when you could have an abortion later in being pregnant, it’s usually for very medically complicated causes. And somebody very high-profile who just lately stated that’s Melania Trump in her new memoir, speaking about how she helps abortion in any respect phases of being pregnant as a result of usually these are very heart-wrenching circumstances and never form of the homicide that Republicans have tried to characterize them as.
Rovner: I believe you’re proper. I believe that is the continuation of the 2022 marketing campaign, besides that we’ve had so many extra girls come ahead. We’ve seen precise circumstances. It was once anti-abortion forces would say, Oh, nicely, this by no means occurred. I imply, these are wrenching, terrible issues that occurred to loads of these sufferers with being pregnant problems late in being pregnant. And it’s, I do know, as a result of I’ve talked to them. It’s very arduous to get them to speak publicly, as a result of then they get trolled. Why ought to they step ahead?
Effectively, now we’ve seen loads of these girls stepping ahead. So we now see a public that is aware of that this occurs, as a result of they’re listening to from the folks that it’s occurred to and so they’re listening to from their docs. I do know additionally from the polling that there are people who find themselves going to vote in these 10 states the place abortion is on the poll. Lots of them are going to vote for abortion entry after which flip round and vote for Republicans who help restrictions, as a result of they’re Republicans. It might or is probably not their most essential situation, however I nonetheless assume it’s a giant query mark the place that occurs and the way it shakes out. Joanne, did you need to add one thing?
Kenen: You’re seeing two competing issues on the identical time. You might have plenty of Republicans making an attempt to reasonable their stance or not less than sound like they’re moderating their stance. On the identical time, you even have the entire, the place the Republican Occasion is on abortion has shifted to the correct. They’re speaking about personhood in the meanwhile of conception, the embryo — which is, scientifically put, a small ball of cells nonetheless at that time — that they really have the identical authorized rights as another post-birth individual.
In order that’s turn into a reasonably frequent view within the Republican Occasion, versus one thing that simply 5 or 6 years in the past was seen as the perimeter. And Trump goes round saying that Democrats permit infants to be executed after beginning, which isn’t true. They usually’re notably saying that is true in Minnesota due to [Gov.] Tim Walz, and a few voters should consider it, proper? As a result of they preserve saying it. So you could have this development that Shefali simply described and that you just’ve described, Julie, about this form of making an attempt to win again belief, as Vance stated. And it sounded extra reasonable, and similtaneously you’re listening to this rhetoric about personhood and execution. So I don’t assume the Republicans have but solved their very own whiplash post-Roe.
Rovner: In the meantime, the abortion debate is getting mired within the free-speech debate. In Florida, Republican governor Ron DeSantis is threatening authorized motion towards TV stations airing an advert in help of the poll measure that may overturn the state’s six-week abortion ban. That has in flip triggered a rebuke from the top of the Federal Communications Fee warning that political speech continues to be protected right here in the USA. Shefali, that is actually type of on the market, isn’t it?
Luthra: It’s simply so fascinating, and it’s actually a part of a much bigger effort by Ron DeSantis to attempt to leverage something that he can politically or, frankly, in his capability as head of the state to attempt to weaken the marketing campaign for the poll measure. They’ve used the well being division in different methods to attempt to ship out materials suggesting that the marketing campaign’s speaking factors, that are largely centered on the futility of exceptions to the abortion ban, they’re making an attempt to argue that that’s misinformation, and that’s not true. They usually’re utilizing the state well being division to make that argument, which is one thing we don’t actually see fairly often, as a result of often well being departments are purported to be nonpartisan. And what I’ll say is, on this case, not less than to your level, Julie, the FCC has weighed in and stated: You possibly can’t do that. You possibly can’t cease a TV station from airing a political advert that was purchased and paid for. And the advertisements haven’t stopped displaying at this level. I simply heard from household yesterday in Florida who’re seeing the advertisements in query on their TV, and it’s nonetheless—
Rovner: And I’ll publish a hyperlink to the advert simply so you possibly can see it. It’s a few lady who’s pregnant and had most cancers and wanted most cancers therapy and wanted to terminate the being pregnant as a way to get the most cancers therapy. It stated that the exception wouldn’t permit her to, which the state says isn’t true and which is clearly one in every of this stuff that’s debatable. That’s why we’re having a political debate.
Luthra: Precisely. And one factor that I believe is value including in right here is, I imply, this actually intense effort from Governor DeSantis and his administration comes at a time when already this poll measure faces in all probability the hardest struggle of any abortion rights measure. And now we have seen abortion rights win many times on the poll, however in Florida you want 60% to go. And in case you look throughout the nation at each abortion rights measure that has been voted on since Roe v. Wade was overturned, solely two have cleared 60, and they’re in California and they’re in Vermont. So these extra conservative-leaning states, and Florida is one in every of them, it’s simply, it’s actually, actually arduous to see the way you get to that quantity. And we even noticed this week there’s polling that means that the marketing campaign has loads of work to do in the event that they’re hoping to clear that threshold.
Rovner: And, in fact, now they’ve two hurricanes to take care of, which we are going to take care of in a couple of minutes. However first, the Supreme Courtroom is again in session right here in Washington, and despite the fact that there’s no large abortion case on its official docket as of now this time period, the courtroom rapidly declined to listen to two circumstances on its first day again, one involving whether or not the abortion ban in Texas can override the federal emergency therapy regulation that’s supposed to ensure abortion entry in medical emergencies threatening the pregnant lady’s life or well being. The courtroom additionally declined to overrule the Alabama Supreme Courtroom’s ruling that frozen embryos will be thought-about legally as unborn youngsters. That’s what Joanne was simply speaking about. The place do these two choices go away us? Neither one truly resolved both of those questions, proper?
Luthra: I imply, the EMTALA [Emergency Medical Treatment and Labor Act] query continues to be ongoing, not due to the Texas case however due to the Idaho case that’s asking very comparable questions that we’ve talked about beforehand on this podcast. And the top of final time period, the courtroom kicked that again right down to the decrease courts to proceed making its method by means of. We anticipate it should finally come again to the Supreme Courtroom. So this can be a query that we are going to, actually, be listening to on in some unspecified time in the future.
Rovner: Though, the irony right here is that in Idaho, the ban is on maintain as a result of there was a courtroom keep. And in Texas, the ban shouldn’t be on maintain, despite the fact that we’re speaking about precisely the identical query: Does the federal regulation overrule the state’s ban?
Luthra: And what that type of highlights — proper? — is simply how a lot entry to abortion, even underneath states with comparable legal guidelines or legislatures, actually does rely on so many components, together with what circuit courtroom you fall into or the make-up of your state Supreme Courtroom and the way judges are appointed or whether or not they’re elected. There’s simply a lot at play that makes entry so variable. And I believe the opposite factor that one may speculate that perhaps the courtroom didn’t need headlines round reproductive well being so quickly into an election, however it’s not as if this is a matter that they’re going to be avoiding within the medium- or long-term future. These are questions which can be simply too urgent, and they are going to be coming again to the Supreme Courtroom in some type.
Rovner: Sure, I’d say within the IVF [in vitro fertilization] case, they merely principally stated, Go away for now. Proper?
Luthra: Yeah. And, I imply, proper now in Alabama, individuals are largely in a position to get IVF due to the state regulation that was handed, even when it didn’t contact the substance of that state courtroom’s ruling. That is one thing, for now, individuals can form of assume is perhaps uninterrupted, at the same time as everyone knows that the ideological and political groundwork is being laid for a for much longer and extra intense struggle over this.
Rovner: Effectively, keep in mind again final week after we predicted that the decide’s determination overturning Georgia’s six-week ban was unlikely to be the final phrase? Effectively, positive sufficient, the Georgia Supreme Courtroom this week overturned the speedy overturning of the ban, which formally went again into impact on Monday. Like these different circumstances, this one continues, proper?
Luthra: Sure, this continues. The Georgia case continued for some time, and it simply form of underscores once more what we’ve been speaking about, simply how a lot entry actually adjustments forwards and backwards. And I used to be speaking to an abortion clinic supplier who has clinics in North Carolina and Georgia. She actually came upon in regards to the determination each instances and adjusted her plans for the subsequent day as a result of I texted her asking her for remark. And suppliers and sufferers are being tasked with maintaining with a lot. And it’s simply very, very tough, as a result of Georgia additionally has a 24-hour ready interval for abortions, which implies that each time the choice round entry has modified — and we all know it very nicely may change once more as this case progresses — individuals must scramble in a short time. And in Georgia, they’ve additionally been making an attempt to try this on high of navigating the fallout of a hurricane.
Rovner: Yeah. And as we identified a few weeks in the past when the courtroom overturned the North Dakota ban, there are not any abortion suppliers left in North Dakota. Now that there’s no ban, it’s solely in idea that abortion is now as soon as once more allowed in North Dakota. Effectively, earlier than we go away abortion for this week, now we have two new research displaying how abortion bans are impacting the well being care workforce. In a single survey, greater than half of oncologists, most cancers docs, who have been finishing their fellowships, so individuals prepared to enter observe, stated they might contemplate the affect of abortion restrictions of their choices about the place to arrange their observe. And a 3rd stated abortion restrictions hindered their means to supply care.
In the meantime, a survey of OBGYNs in Texas by the consulting group Manatt Well being discovered “a big majority of training OB/GYN physicians … consider that the Texas abortion legal guidelines have inhibited their means to supply highest-quality and medically mandatory care to their sufferers,” and that many have already made or are contemplating making adjustments to their observe that may “scale back the provision of OB/GYN care within the state.” What’s the anti-abortion response to this rising physique of proof that abortion bans are having deleterious results on the provision of different kinds of well being care, too? I imply, I used to be notably taken by the oncologists, the concept that you may not be capable to get most cancers care as a result of most cancers docs are anxious about treating pregnant girls with most cancers.
Luthra: They’re blaming the docs. And we noticed this in Texas when the Zurawski case was argued and girls sufferers and docs within the state stated that they’d not been in a position to get important, lifesaving medical care due to the state’s abortion ban and lack of readability round what was truly permitted. And the state argued, and now we have heard this speaking level many times, that really the docs are simply not prepared to do the arduous work of training drugs and making an attempt to interpret, Effectively, clearly this qualifies. That’s one thing we’ve seen within the Florida arguments. They are saying: Our exceptions are so clear, and in case you aren’t in a position to navigate these exceptions, nicely, that’s your drawback, since you are being risk-averse, and sufferers ought to actually take this up with their docs, who’re simply irresponsible.
Rovner: Sure, that is clearly a difficulty that’s going to proceed. Effectively, shifting on. The price of well being care continues to develop, which isn’t actually information, however this week now we have extra arduous proof, courtesy of my KFF colleagues by way of the annual 2024 Employer Well being Profit Survey, which finds the typical household premium rose 7% this 12 months to $25,572, with employees contributing a mean of $6,296 in direction of that price. And that’s with a definite minority of corporations overlaying two very fashionable however very costly medical interventions, GLP-1 [glucagon-like peptide-1] medication for weight problems and IVF, which we’ve simply been speaking about. Anything on this survey leap out at anyone?
Hellmann: I imply, that’s only a huge sum of money. And the employer is basically paying nearly all of that, however that doesn’t imply it doesn’t have an effect on individuals. Meaning it’s going to restrict how a lot your wages go up. And one thing I considered once I learn this examine is these lawsuits that we’re starting to see, accusing employers of not doing sufficient to guarantee that they’re limiting well being care prices. They’re not enjoying sufficient of a job in what their advantages appear like. They’re type of outsourcing this to consultants. And so if you have a look at this knowledge and also you see $25,000 they’re spending per 12 months per household on well being care premiums, you marvel, what are they doing?
Well being care, sure, it’s clearly very costly, however you simply type of query, what function are employers truly enjoying in making an attempt to drive down well being care prices? Are they only taking what they get from consultants? And one other factor that type of stood out to me from that is, I believe it’s stated in there, employers are having a tough time these days of passing these prices on to staff, which is basically attention-grabbing. It’s due to the tight labor market. However clearly well being care continues to be very costly for workers — $6,000 a 12 months in premiums for household protection shouldn’t be a small sum of money. So employers are simply persevering with to soak up that, and it does actually affect everybody.
Rovner: It’s humorous. Earlier than the Reasonably priced Care Act, it was employers who have been form of driving the, You have to do one thing about the price of well being care, as a result of inflation was so quick. After which, in fact, we noticed well being care inflation, not less than, decelerate for a number of years. Now it’s choosing up once more. Are we going to see employers form of getting again into this leaping up and down and saying, “We’ve received to do one thing about well being care prices”?
Hellmann: I really feel like we’re seeing extra of that. You’re starting to listen to extra from employers about it. I don’t know. It’s simply such a tough situation to resolve, and I’ve seen an increasing number of curiosity from Congress about this, however they actually battle to manage the business market. So …
Rovner: Sure, as we discuss at size each week. But it surely’s nonetheless essential, and they’re going to nonetheless go for it. Effectively, lastly, this week in well being misinformation. Allow us to discuss hurricanes — the general public well being misinformation that’s being unfold each about Hurricane Helene that hit the Southeast two weeks in the past, and Hurricane Milton that’s exiting Florida at the same time as we’re taping this morning. President [Joe] Biden addressed the press yesterday from the White Home, calling out former President Trump by identify together with Georgia Republican congresswoman Marjorie Taylor Greene for spreading deliberate misinformation that’s not simply undermining efforts at storm reduction however truly placing individuals in additional hazard. Now, I keep in mind Hurricane Katrina and all of the criticism that was heaped, largely deservedly, on George W. Bush and his administration, however I don’t keep in mind deliberate misinformation like this. I imply, Joanne, have you ever ever seen something like this? You lived in Florida for some time.
Kenen: I went by means of Andrew, and there’s at all times a sure — there’s confusion and chaos after a giant storm. However there’s a distinction between stuff being flawed that may be corrected and stuff being deliberately stated that then on this form of divided, suspicious, two-realities world we’re now dwelling in, that’s being repeated and perpetuated and amplified. It damages public well being. It damages individuals economically making an attempt to get better from this disastrous storm or in some circumstances storms. I don’t understand how many individuals truly consider that Marjorie Taylor asserted that the Democrats are controlling the climate and sending storms to suppress Republican voters. She nonetheless has a following, proper? However different issues …
Rovner: She nonetheless will get reelected.
Kenen: … being informed that in case you go to FEMA [the Federal Emergency Management Agency] for assist, your property will probably be confiscated and brought away from you. I imply, that’s in every single place, and it’s not true. Even plenty of Republican lawmakers within the affected states have been on social media and making statements on native TV and no matter, saying: This isn’t true. Please, FEMA is there that can assist you. Let’s get by means of this. Cease the lies. A variety of Republicans have truly been fairly blunt in regards to the misinformation coming from their colleagues and urging their constituents to hunt and take the assistance that’s obtainable.
That is the general public well being disaster. We don’t understand how many individuals have been killed. I don’t assume now we have an correct complete remaining depend from Helene, and we positive don’t have from Milton. I imply, the individuals did appear to take this storm severely and evacuated, however it additionally spawned one thing like three dozen tornadoes in locations the place individuals hadn’t been informed, there’s usually no must evacuate. There’s flooding. It’s a devastating storm. So when individuals are flooding, energy outages, electrical energy, arduous to get entry to well being care, you possibly can’t refrigerate your insulin. All these—
Rovner: Poisonous floodwaters, I imply, the one factor …
Kenen: Poisonous, yeah.
Rovner: … we learn about hurricanes is that they’re extra harmful within the aftermath than throughout the precise storm when it comes to public well being.
Kenen: Proper. It is a life-threatening public well being emergency to actually tens of millions of individuals. And misinformation, not simply getting one thing flawed after which making an attempt to right it, however intentional disinformation, is one thing we haven’t seen earlier than in a pure catastrophe. And we’re solely going to have extra pure disasters. And it was actually — I imply, Julie, you already pointed this out — however it was actually uncommon how exact Biden was yesterday in calling out Trump by identify, and I consider at two completely different instances yesterday. So I heard one, however I believe I examine what I believe was the second actually saying, laying it at his toes that that is harming individuals.
Rovner: Yeah, like I stated, I keep in mind Katrina vividly, and that was clearly a extremely devastating storm. I do additionally keep in mind Democrats and Republicans, even whereas they have been criticizing the federal authorities response to it, not spreading issues that have been clearly unfaithful. All proper. Effectively, that’s the information for this week. Now we are going to play a phase from our Newsmaker interview with Mark Cuban, after which we will probably be again with our additional credit.
On Tuesday, October eighth, Mark Cuban met with a bunch of reporters for a Newsmaker lunch at KFF’s places of work in Washington, D.C. Cuban, a billionaire greatest referred to as a panelist on the ABC TV present “Shark Tank,” has taken an curiosity in well being coverage up to now a number of years. He’s been consulting with the marketing campaign of Vice President Harris, though he says he’s positively not serious about a authorities publish if she wins. Cuban began out speaking about how, as he sees it, the most important drawback with drug costs within the U.S. is that nobody is aware of what anybody else is paying.
Mark Cuban: I imply, once I discuss to companies and I’ve tried to elucidate to them how they’re getting ripped off, the most important of the most important stated, Effectively, so-and-so PBM [pharmacy benefit manager] is passing by means of all of their rebates to us.
And I’m like: Does that embrace the subsidiary in Scotland or Japan? Is that the place the opposite one is?
I don’t know.
And it doesn’t. By definition, you’re passing by means of all of the rebates with the corporate you contracted with, however they’re not passing by means of all of the rebates that they get or that they’re holding of their subsidiary. And so, yeah, I really, actually consider from there all people can argue about the easiest way. The place do you utilize synthetic intelligence? The place do you do that? What’s the EHR [electronic health record? What’s this? We can all argue about best practices there. But without a foundation of information that’s available to everybody, the market’s not efficient and there’s no place to go.
Rovner: He says his online generic drug marketplace, costplusdrugs.com, is already addressing that problem.
Cuban: The crazy thing about costplusdrugs.com, the greatest impact we had wasn’t the markup we chose or the way we approach it. It’s publishing our price list. That changed the game more than anything. So when you saw the FTC [Federal Trade Commission] go after the PBMs, they used loads of our pricing for all of the non-insulin stuff. While you noticed these articles written by the Occasions and others, and even higher but, there was analysis from Vanderbilt, I believe it was, that claims 9 oncology medication, in the event that they have been bought by Medicare by means of Value Plus, would save $3.6 billion. These 15, no matter medication would save six-point-whatever billion. All as a result of we revealed our value checklist, individuals are beginning to notice that issues are actually out of whack. And in order that’s why I put the emphasis on transparency, as a result of whether or not it’s inside of presidency or inside firms that self-insure, particularly, they’re going to have the ability to see. The primary rule of well being care contracts, notably PBM contracts, is you possibly can’t discuss PBM contracts.
Rovner: Cuban additionally says that extra transparency can tackle issues in the remainder of the well being care system, not only for drug costs. Right here’s how he responded to a query I requested describing his subsequent large plan for well being care.
We’ve had, clearly, points with the system being run by the federal government not very effectively and being run by the non-public sector not very effectively.
Cuban: Very effectively, yeah.
Rovner: And proper now we appear to have this form of working at cross-purposes. For those who may design a system from the bottom up, which might you let do it? The federal government or—
Cuban: I don’t assume that’s actually the difficulty. I believe the difficulty is an absence of transparency. And also you see that in any group. The extra communication and the extra the tradition is open and clear, the extra individuals maintain one another accountable. And I believe you get fiefdoms in non-public {industry} and also you get fiefdoms in authorities, as nicely, as a result of they know that if nobody can see the outcomes of their work, it doesn’t matter. I can say my deal was the very best and I did the very best and our outcomes are the very best, however there’s no strategy to query it. And so speaking to the Harris marketing campaign, it’s like in case you introduce transparency, even to the purpose of requiring PBMs and insurers to publish their contracts publicly, you then begin to introduce an environment friendly market. And upon getting an environment friendly market, then individuals are higher in a position to make choices after which you possibly can maintain them extra accountable.
And I believe that’s going to spill over past pharm. We’re engaged on — it’s not an organization — however we’re engaged on one thing referred to as Value Plus Wellness, the place we’re consuming our personal pet food. And it’s not an organization that’s going to be a for-profit or perhaps a nonprofit, for that matter, only for the lives that I cowl for my firms, that we self-insure. We’re doing direct contracting with suppliers, and we’re going to publish these contracts. And half and parcel to that’s going by means of the — and I apologize if I’m stumbling right here. I haven’t slept in two days, so bear with me. However going by means of the hierarchy of care and following the cash, if you concentrate on after we discuss to CFOs and CEOs of suppliers, one of many issues that was gorgeous to me that I by no means imagined is the connection between deductibles for self-insured firms and payers, and the danger related to amassing these deductibles to suppliers.
And I believe individuals don’t actually notice the connection there. So whoever does Ann’s care [KFF Chief Communications Officer Ann DeFabio, who was present] — nicely, Kaiser’s a bit of bit completely different, however let’s simply say you’re employed at The Washington Submit or whoever and you’ve got a $2,500 deductible. And one thing occurs. Your child breaks their leg and goes to the hospital, and also you’re out of market, and it’s out of community. Effectively, no matter hospital you go to there, you would possibly give your insurance coverage card, however you’re accountable for that first $2,500. And that supplier, relying on the place it’s positioned, may need assortment — dangerous debt, slightly — of fifty% or extra.
So what does that imply when it comes to how they need to set their pricing? Clearly, that pricing goes up. So there’s actually a relationship between, notably on pharmacy, if my firm takes a much bigger rebate, which in flip means I’ve the next deductible as a result of there’s much less accountability for the PBM-slash-insurance firm. My larger deductible additionally implies that my sickest staff are those paying that deductible, as a result of they’re those which have to make use of it. And my older staff who’ve ongoing well being points and have persistent diseases and want remedy, they’re paying larger copays. However after they need to go to the hospital with that very same deductible, as a result of I took extra of a rebate, the hospital is taking extra of a credit score threat for me. That’s insane. That makes completely no sense.
And so what I’ve stated is as a part of our wellness program and what we’re doing to — Challenge Alpo is what we name it, consuming our personal pet food. What I’ve stated is, we’ve gone to the suppliers and stated: Look, we all know you’re taking this deductible threat. We’ll pay you money to remove that. However wait, there’s extra. We additionally know that if you undergo a typical insurer, even when it’s a self-insured employer utilizing that insurer and also you’re simply utilizing the insurance coverage firm not for insurance coverage companies however as a TPA [third-party administrator], the TPA nonetheless performs video games with the supplier, and so they underpay them on a regular basis.
And so what occurs on account of the underpayment is that supplier has to have places of work and places of work filled with administrative assistants and legal professionals, and so they need to not solely pay for these individuals, however they’ve the related overhead and burden and the time. After which speaking to them, to a giant hospital system, they stated that’s about 2% of their income. So due to that, that’s 2%. Then, wait, there’s extra. You might have the pre-ops, and you’ve got the TPAs who struggle you on the pre-ops. However the downstream financial impacts are monumental as a result of, first, the physician has to ask for the pre-op. That’s consuming physician’s time, and they also see fewer sufferers. After which not solely does the physician need to take care of them, they go to HR on the firm who self-insures and says, Wait, my worker can’t come to work, as a result of their baby is sick, and also you gained’t approve this course of or, no matter, this process, as a result of it has to undergo this pre-op.
Or if it’s on medicines, it’s you need to undergo the step-up course of otherwise you need to undergo a unique utilization since you get extra rebates. All these items are intertwined, and we don’t have a look at it holistically. And so what we’re saying with Value Plus Wellness is, we’re going to do that all in a money foundation. We’re going to belief docs in order that we’re not going to undergo a pre-op. Now we’ll belief however confirm. In order we undergo our inhabitants and we have a look at all of our claims, as a result of we’ll personal all of our claims, we’re going to look to see if there are repetitive points with someone who’s simply making an attempt to —there’s a lot of again surgical procedures or there’s a lot of this or there’s a lot of that — to see if someone’s abusing us. And since there’s no deductible, we pay it, and we pay it proper when the process occurs or proper when the remedy is prescribed. Due to all that, we would like Medicare pricing. No person’s saying no. And in some circumstances I’m getting decrease than Medicare pricing for major care stuff.
Rovner: OK, we’re again. Now it’s time for our additional credit. That’s after we every advocate a narrative we learn this week we predict it’s best to learn too. Don’t fear in case you miss the small print. We are going to embrace the hyperlinks to all these tales in our present notes in your telephone or different machine. Joanne, why don’t you go first this week.
Kenen: There was a captivating story in The New York Occasions by Kate Morgan. The headline was “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It.” So I knew nothing about this, and it was so attention-grabbing. Placentas have wonderful therapeutic properties for wound care, burns, infections, ache management, regenerating pores and skin tissue, simply many, many issues. And it’s been well-known for years, and it’s not broadly used. It is a story particularly a few actually extreme burn sufferer in a fuel explosion and the way her face was completely restored. We don’t use this, partly as a result of placenta — each childbirth, there’s a placenta. There are many them round. There’s I believe three and a half million births a 12 months, or that’s the estimate I learn within the Occasions. One of many causes they weren’t getting used is, throughout the AIDS disaster, there was some growth towards utilizing them, after which the AIDS disaster, there was a concern of contamination and spreading the virus, and it stopped many years later.
Now we have much more methods of detecting, controlling, determining whether or not one thing’s contaminated by AIDS or whether or not a affected person has been uncovered. It’s getting used once more on a restricted foundation after C-sections, however it appears to have fairly astonishing — take into consideration all of the wound take care of simply diabetes. I’m not a scientist, however I simply regarded on the story and stated, it looks as if lots of people could possibly be healed faster and extra safely and earlier if this was developed. They’re thrown away now. They’re despatched to hospital waste incinerators and biohazard waste. They’re rubbish, and so they’re truly drugs.
Rovner: Positively a scientist’s cool story. Shefali.
Luthra: My story is from my good colleague Mel Leonor Barclay. The headline is “Arizona’s Poll Measure May Shift the Narrative on Latinas and Abortion,” and as a part of this actually great sequence that she has working this week, how Latinas as a way more influential and growingly influential voter group may form gun violence, abortion rights, and housing. And on this story, which I actually love, she went to Arizona and hung out speaking to of us on all sides of the difficulty to raised perceive how Latinas are affected by abortion rights and in addition how they’ll be voting on this.
And he or she actually challenges the narrative that has existed for thus lengthy, which is that Latinas are largely Catholic, largely extra conservative on abortion. And he or she finds one thing far more complicated, which is that really polls actually present that a big share of Latina voters in Arizona and comparable states help abortion rights and will probably be voting in favor of measures just like the Arizona constitutional modification. However on the identical time, there are actual divides throughout the neighborhood, and other people discuss their religion differently and the way it connects their stance on abortion. They discuss their relationships with household in several methods, and I believe it simply underscores how not often Latina voters are handled with actual nuance and care and thoughtfulness when speaking about one thing as complicated as abortion and abortion politics. And I actually love the best way that she approaches this piece.
Rovner: It was a super-interesting story. Jesse.
Hellmann: My story is from The Meeting. It’s an outlet in North Carolina. It’s referred to as “Helene Left Some North Carolina Elder-Care Houses With out Energy.” Some assisted dwelling amenities have been with out energy and water for the reason that hurricane hit. A number of amenities needed to evacuate residents, and the story simply type of will get into how North Carolina has extra lax guidelines round emergency preparedness. Whereas they do require nursing properties be ready to supply backup energy, the identical necessities don’t apply to assisted dwelling amenities. And it’s as a result of there’s been {industry} pushback towards that due to the fee. However as we see some extra of those excessive climate occasions, it looks as if one thing must be accomplished. We can’t simply permit susceptible individuals dwelling in these amenities to go hours and hours with out energy and water. And I noticed that there was a facility the place they evacuated dozens of people that had dementia, and that’s simply one thing that’s actually upsetting and traumatizing for individuals.
Rovner: Yeah, as soon as once more, now we’re seeing these excessive climate occasions in locations that, not like Florida and Texas, usually are not arrange and used to excessive climate occasions. And it’s one thing I believe that lots of people are beginning to consider. Effectively, my story this week is from our KFF Well being Information public well being undertaking referred to as Well being Beat, and it’s referred to as “A Boy’s Bicycling Dying Haunts a Black Neighborhood. 35 Years Later, There’s Nonetheless No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly. And it’s a kind of tales you by no means actually take into consideration till it’s identified that in areas, notably people who had been redlined, particularly, the dearth of security infrastructure that the majority of us take without any consideration — crosswalks, sidewalks, visitors lights usually are not actually there. And that’s a public well being disaster of its personal, and it’s one which not often will get addressed, and it’s a extremely infuriating however a extremely good story.
All proper, that’s our present. Subsequent week, for my birthday, we’re doing a reside election preview present right here at KFF in D.C., as a result of I’ve a barely warped concept of enjoyable. And also you’re all invited to affix us. I’ll put a hyperlink to the RSVP within the present notes. I’m promised there will probably be cake.
As at all times, in case you benefit from the podcast, you possibly can subscribe wherever you get your podcast. We’d recognize it in case you left us a evaluation. That helps different individuals discover us, too. Thanks as at all times to our technical guru, Francis Ying, and our fill-in editor this week, Stephanie Stapleton. Additionally, as at all times, you possibly can electronic mail us your feedback or questions. We’re at whatthehealth, all one phrase, @kff.org, or you possibly can nonetheless discover me for the second at X. I’m @jrovner. Joanne, the place are you?
Kenen: @JoanneKenen generally on Twitter and @joannekenen1 on Threads.
Rovner: Jessie.
Hellmann: @jessiehellmann on Twitter.
Rovner: Shefali.
Luthra: @shefalil on Twitter.
Rovner: We will probably be again in your feed subsequent week. Till then, be wholesome.
Credit
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Audio producer
Stephanie Stapleton
Editor
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