The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous knowledgeable on well being coverage points, Julie is the creator of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.
Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already dashing to work his priorities into laws, eyeing cuts to Medicaid to pay for brand new tax and immigration priorities. However even in its waning days, the Biden administration continues to make massive coverage strikes, together with a attainable order for tobacco firms 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 in addition poisonous substances launched by burning plastic and different man-made supplies — in addition to the risk posed to each air and water high quality.
This week’s panelists are Julie Rovner of KFF Well being Information, Anna Edney of Bloomberg Information, Joanne Kenen of the Johns Hopkins College Bloomberg College of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins College and Politico
Sandhya Raman
CQ Roll Name
Among the many takeaways from this week’s episode:
- Republican lawmakers are weighing choices to chop federal spending on Medicaid, the almost $900-billion-a-year authorities program that covers 1 in 5 People. They might use the financial savings to bolster Trump priorities, akin 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 ladies’ faculty 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 akin to shoplifting.
- The Supreme Courtroom has agreed to listen to a case later this 12 months concerning the U.S. Preventive Companies Process Drive — an impartial physique of consultants that points suggestions in illness prevention and drugs. A ruling in opposition to its authority might strip protection for key preventive well being providers from not simply these with Inexpensive Care Act protection, but in addition these on employer-sponsored well being plans. The query stands: If not this activity drive, who would make the determinations about what preventive care must be lined?
- And the outgoing Biden administration issued a slew of well being laws this week, together with a ban on the dye Crimson No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration might upend these and extra laws, although some do align with its coverage pursuits.
Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month” characteristic, a couple of colonoscopy that got here with a a lot bigger price ticket than estimated. When 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 suppose it’s best to learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Colleges Funnel Extra Medical doctors Into the Main Care Pipeline?” by Felice J. Freyer.
Anna Edney: Bloomberg Information’ “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles,” by Anna Edney.
Joanne Kenen: The Atlantic’s “A Secret Approach To Struggle Off Abdomen Bugs,” by Daniel Engber.
Sandhya Raman: Nature’s “New Weight problems Definition Sidelines BMI To Deal with Well being,” by Giorgia Guglielmi.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: Good day, 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: 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 few 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.
In the present day we’re joined by way of videoconference by Anna Edney of Bloomberg Information.
Anna Edney: Hello, everyone.
Rovner: Sandhya Raman of CQ Roll Name.
Sandhya Raman: Good morning, everybody.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico Journal.
Joanne Kenen: Hello, everyone.
Rovner: Later on this episode we’ll have my interview with Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month,” a couple of affected person whose colonoscopy invoice was lots 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 selecting up on Capitol Hill about rolling the brand new president’s whole agenda into, quote, “one massive, 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 probabilities of how they may need to do this. What are a few of the primary issues which can be on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made slightly progress however on the identical time we simply didn’t additionally make numerous progress. The tip of, -ish, final week we bought a menu of things that Republicans are sort of contemplating as issues they’d use to offset a few of the issues that they’d need to do via reconciliation.
Rovner: Like proceed the tax lower?
Raman: Sure, for the tax cuts and for border safety. So what now we have on the Home facet is numerous issues which can be very health-oriented. About half of that listing is health-oriented, and numerous it’s Medicaid. And so a few of the issues they’ve been floating round are some issues we noticed within the first Trump administration, them making an attempt to do. We now have per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid enlargement, and issues like altering the general public cost rule to again the way it was within the Trump administration.
Rovner: Remind individuals what the general public cost rule is.
Raman: The general public cost rule sort of limits a few of the social packages for folk 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 have been fairly good, however 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 few of the numbers that we’ve seen of how a lot cash from Medicaid they might presumably save are actually in flux due to how they work together with all the different provisions in there. Some issues are beneath Methods and Means jurisdictions. Some issues, in case 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 massive, lovely invoice” or sort of what the Senate desires, with two payments, and that might simply sort of change what could be achieved earlier versus later. However we do have slightly bit extra of a timeline now in what they’re making an attempt to do.
Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, after they had a a lot larger Republican majority within the Home, they usually couldn’t get it over the end line. What makes them suppose they’re going to be extra profitable this time?
Raman: I feel a part of it’s that — that is nonetheless early on. Whenever you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid enlargement at this level. We nonetheless have solely the ten holdout enlargement states. So, I feel, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter car now we have, we’ll in all probability hear extra.
And I imply, in case you have a look at this state-level already, numerous states are sort of couching their bets with Medicaid, simply eager about how they will do issues in another way in case their Medicaid federal funding adjustments 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 wished so as to add one thing.
Kenen: Yeah, I imply, the great thing about reconciliation in case 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? However it’s not, as a result of reconciliation, it’s a seize bag. You place a lot stuff in there, and all you want is one provision that this individual received’t vote for or that individual received’t vote for.
So this seemingly easy slam dunk for a narrow-majority Senate is definitely a giant, sophisticated 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 numerous 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 proper now? No, it’ll change. How a lot will it change is basically an open query.
Keep in mind, there’s some issues they will do via waivers. Work necessities they will do via waivers. Though prior to now, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache.
Rovner: Yeah, nicely, so reconciliation, finances, all of these items continues to be method 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 girls’s faculty sports activities, and the Senate’s debating a Home-passed invoice that might permit the deportation of undocumented people who find themselves accused however not but convicted of violent crimes.
In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued govt orders making it simpler for folks to ship their youngsters to highschool with out being vaccinated. General, it appears the Republicans are sort of coalescing round an idea referred to as “medical freedom,” which to me appears identical to a rejection of public well being usually. Or am I lacking one thing? Is there one thing extra to this?
Edney: No, I feel that it’s all the time been round, however I feel that definitely this resurgence in it’s coming from the truth that individuals didn’t belief science through the pandemic. They have been fed up. Communication wasn’t dealt with very nicely, and it nonetheless isn’t dealt with very nicely. I don’t suppose individuals have found out discuss these items in measured methods.
I’d advocate if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Instances a couple of days in the past on vaccination that I assumed was actually good as a result of he’s like: Hear, 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 numerous that is stemming from misinformation and miscommunication, and it resonates with individuals. I imply, the Republican Get together picked up numerous followers in far-left progressives by speaking about this. So I feel they see that as a possibility, too. So it might not simply be grassroots. It might be slightly little bit of a possibility they see.
Kenen: Anti-vaccination sentiment has been round so long as vaccines. It really goes again to smallpox. There has all the time been a certain quantity of worry, skepticism, no matter. It had been historically amongst Democrats and Republicans. It really 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 best — began making an attempt to water down mandates for colleges. At that time, I don’t suppose something massive bought via. However we started to see this emergence of a deeper politicization of vaccination. And it was on the best, and it’s what we now discuss 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 through 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 in case you get sick, you would possibly survive however you possibly can endanger anyone else.
You don’t know who the individual 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 weak. And that this complete sense of “my physique, my selection,” doesn’t fly when you possibly can kill anyone else unintentionally. And that kind 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 need to put stuff in your lungs, that’s your corporation. However you don’t actually get the best 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 would possibly keep in mind for the company, together with de-emphasizing infectious illness analysis and focusing extra on persistent illness.
On condition that the most important institute at NIH is already the Nationwide Most cancers Institute, which focuses on a persistent illness, is that this simply Republicans’ method of punishing the Nationwide Institute of Allergy and Infectious Illnesses that was for thus lengthy headed by the now retired Dr. Tony Fauci?
Raman: I feel in a component that could be a enormous driving issue, while you have a look at a few of his feedback and R.F.Ok. Jr.’s feedback about holistic approaches to well being, that basically while 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 identical time, this has sort of been effervescent up earlier than, after we even regarded to final 12 months. Earlier than we had any of those nominees, earlier than we even knew the result of the election, we had a push inside Congress from the pinnacle of the Home Labor-H Appropriations subcommittee and former Vitality and Commerce Chairwoman Cathy McMorris Rodgers making an attempt to reform NIH that method.
We didn’t get that far with it. It was included in a few of the appropriations payments that didn’t go anyplace but. However I feel it’s simply a part of a broader dialogue that there’s, sort of going again to what we have been saying earlier than, a few of the wanting extra management of what you see, by way of medical freedom, and that they need to know extra about what’s occurring.
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, ? 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 world 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 dwell up the road from NIH, that almost all of what NIH does doesn’t occur on the NIH campus. It’s, as you stated, it’s cash that goes out to each single congressional district. There’s an 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 type of has been added by Congress. NIH can’t create its personal institutes. Solely Congress can do this. So, Congress has kind of made NIH the sprawl that it’s. I feel there’s been bipartisan settlement that NIH possibly wants a brand new look.
I assume the query is simply kind of what course that’s going to take and whether or not a few of it will be punitive or whether or not they’re really going to have 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 possibly Anna, who covers pharma, can inform me if I’m flawed — however we’re not — NIH additionally does the essential, fundamental, fundamental mobile first-step science that finally results in the work that drug firms do to develop medication. They do the essential, what they name bench, science.
I’m not listening to the drug firms converse out. The ambivalence People have about drug firms, which is hating the costs however liking the medication, I haven’t heard pharma — Perhaps it’s simply too early. Perhaps they’re weighing in quietly, and possibly 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 maintain us and our aged relations alive, together with numerous the features — we haven’t cured most cancers, however we’ve made features on most cancers. That wouldn’t have occurred. It’s not simply the premier analysis institute in America. It’s the premier analysis institute on the earth, and as Julie stated, a giant driver economically of each single county, each medical faculty, each public well being, , it has been an financial powerhouse in addition to a data powerhouse.
Edney: And I wouldn’t let you know you’re flawed. I feel that you just’re proper. I haven’t heard the pharma firms speaking about it. I feel they’re speaking about numerous issues that they need achieved to learn them, and so I’m positive that they’ve made their priorities. We’ll see if this reaches kind of a boiling level, the place they do find yourself weighing in. And I additionally simply need to say, NIH, I do know they need to deal with persistent illness. It does numerous that. So possibly that’s not being communicated: It’s not being lower or left off the desk as a result of we’re doing this. We will do two issues. We will stroll and chew gum.
Rovner: Sure, I do know, and that was the purpose I used to be making an attempt to make. It’s like, there’s an unlimited quantity of persistent illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend numerous time, particular person members, telling NIH what it’s they need to be finding out, which is a complete different situation that we’ll get to a different time.
However I need to keep on the subject of drug costs, as a result of that’s a extremely massive query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly instructed a Bloomberg reporter that it’ll ask the Trump administration to, quote, “pause” the Medicare drug worth negotiation program, which in fact is simply getting underway.
In fact, that’s occurring at the same time as Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration resolution to have Medicare start masking its costly new weight reduction medication.
In the meantime, on its method 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 would possibly attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to need to do in March. Probably? Doable? Will this report have any affect? Or is there simply an excessive amount of different information this week and no one’s going to recollect?
Raman: I feel it’s undoubtedly being talked about lots. 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 massive?
Raman: Yeah. So I feel we sort of have two pathways, the place each of them need to get it achieved regardless. I feel that it’d rely whether or not they can piece it away and do it as one thing stand-alone, which they need to get it achieved sooner moderately than later.
However it relies upon slightly bit extra on the management degree, if there are financial savings from utilizing that invoice for use later down the road after they get reconciliation at a later stage. So I feel that’s what we’re ready on. Would they should put that there? Or would they be capable of go forth with that now?
Rovner: True. So, it’s a bipartisanly widespread provision that additionally saves cash, in order that makes it sort of engaging 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 in case you’re giving Medicare the power to barter. And so, I simply marvel how that matches into this agenda in case you cease it and make it extra favorable in direction of the drugmakers. The place does that slot in with reducing spending and decreasing the deficit and all of these issues?
So, I feel that, possibly they’ve slightly little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I feel everyone knows that we simply have to attend and see what really occurs.
Rovner: Yeah, numerous shrug emojis coming.
Edney: Precisely.
Rovner: Properly, in the meantime, throughout the road from Capitol Hill, the Supreme Courtroom has agreed to listen to that preventive well being care case out of, altogether now, Texas. The case challenges the necessities within the Inexpensive Care Act that insurance coverage cowl, with out copay, preventive providers like immunizations, most cancers screenings, contraception, and, the topic of this specific case, medicine to forestall HIV.
What occurs if the courtroom guidelines with the plaintiffs on this case who argue that the CDC’s [Centers for Disease Control and Prevention’s] Preventive Well being Companies Process Drive doesn’t have the authority to find out what providers must be on this listing? Which in fact is the entity that now determines which providers must 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 medicine. Different most cancers screenings included in that as nicely. And so, it appears to throw a wrench, I assume, kind of simply asking this of the panel, that companies then must go make these determinations? Does Congress need to make the determinations on what’s lined then?
Rovner: Properly, that’s in fact the large 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 Process Drive isn’t Senate-confirmed, they will’t make these choices.
And naturally, the way in which it really works, they don’t make these choices. They advocate them, after which the secretary kind 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 might simply do it. I really feel like this creates as many questions because it might solutions.
Kenen: It’s a extremely broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn totally different tales about this, they usually had totally different lists, together with some ldl cholesterol stuff. And I don’t know, because the lists have been so totally different, I’m undecided precisely which of them are in or which of them have been out. However it’s not simply HIV medication. It’s numerous stuff.
So it could definitely intestine one thing that folks depend on now. I imply these are free not slightly below an ACA plan however in case you get protection via a job, these necessities additionally apply. So, lots of people would now not have free entry to numerous what we take into account preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They simply determined to take it. So, this can be a later in 2025 case. Properly, the flip facet of an incoming administration are all of the issues the outgoing administration tries to slide via on its method out of city, and this week has seen a bunch of these.
Most of these items might be pretty simply undone by incoming officers, however not with out some public ache, which typically is why administrations wait till the final minute to do them, to be slightly passive aggressive, or possibly in a few of these instances lots passive aggressive. A number of of those last-minute adjustments come from the Meals and Drug Administration, an company focused for giant adjustments beneath Trump 2.0.
In simply the final 48 hours, the FDA has introduced a coverage that might require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Crimson Dye No. 3, a controversial additive already banned in lots of different international locations which has been proven to trigger most cancers in rodents. And it proposed a significant change in meals labels to require them to indicate on the entrance of packaging whether or not the meals’s sodium, sugar, and saturated fats ranges are low, medium, or excessive. Do any of those proposals dwell on for greater than one other week?
Edney: I feel the Crimson No. 3 might. We all know that R.F.Ok. Jr.’s talked about meals dyes and eager to get them out of, he particularly stated, cereal, however they’re in numerous issues. So, I see that one.
I feel the business noticed that coming from far-off and has been switching already, in fact typically to a different problematic, probably, meals coloring. However I don’t suppose that is one thing you’re going to see them struggle tremendous exhausting for to vary. The nicotine is way more iffy. Large Tobacco continues to be an enormous drive, and Trump will get funding for his marketing campaign and issues from firms who’ve a stake on this.
And a few of that would align with this concept of not essentially medical freedom however, kind of, we are able to select what we put in our our bodies. If we need to be hooked on nicotine, that’s our selection. So, the opposite one, the labels, I’m undecided. They’re not notably highly effective or something. I assumed they regarded … After I checked out it, I used to be like, That is complicated and simply seems just like the again, however it’s a little totally different. So, I don’t know. Perhaps it survives. I’m undecided 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 principally one other effort to go after ultra-processed meals. I used to be shocked 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 kind of the large 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 dangerous for you. And there’s some meals that do have some sort of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t let you know. There’s some issues which can be, quote, “ultra-processed” that basically aren’t that processed, don’t have numerous components. They’ve one thing.
So the entire categorization wants extra work, each for public understanding and political understanding. There’s no one who’s going to say that People have a extremely nutritious diet and that meals components … R.F.Ok. Jr. has identified to the meals additive, the place the businesses need to get to self-certify, Yeah, that is protected. So, is that one thing that he might get widespread help on? Sure, however there’s a complete lot of different issues that he says that folks weren’t going to agree with.
Rovner: And I’ll remind that we not solely don’t know if R.F.Ok. Jr. can be confirmed, however they nonetheless don’t also 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 Higher Los Angeles space. We now have talked concerning the well being results of fireplace earlier than. It’s not precisely information that fireside and smoke are dangerous for human well being, however what appears to make these fires totally different is that they’re not principally timber and brush and different bits of nature which can be burning however a number of poisonous substances which can be polluting not simply the air but in addition the consuming water.
Are we going to have to start out eager about fireplace and well being in a a lot totally different method if not simply distant areas however whole suburbs at the moment are vulnerable to burning up on account of our altering local weather?
Edney: It’ll make us consider numerous issues in numerous methods, and notably well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that comprise excessive ranges of formaldehyde, issues like that.
I feel the expectation is that may create a long-term situation, but in addition it may possibly 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 difficulty 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 consuming water might be impacted extra so when you might have energy outages and issues within the areas the place you’re possibly 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 totally different motive.
Rovner: Properly, N95s are usually not sufficient. I imply, I feel that was the factor that sort of jumped out at me. In case you watch the information protection of it, the reporters aren’t sporting N95s anymore. They’re sporting what regarded like old-style gasoline masks. I imply, you want kind 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, however it’s fairly scary.
I imply, much more individuals than ever earlier than have N95s hanging round their home, however they definitely don’t have these next-level respirators, which is what I maintain listening to docs calling for.
Kenen: And the article you — I feel it was the one that you just despatched round yesterday that principally that the whole lot in our home is, our couches are principally cubes of plastic wrapped in material and harmful after 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 gasoline, 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 making an attempt to place a hose on a burning tree.
Rovner: Yeah. Much more issues to consider, which is simply what we would have liked. Properly, turning to abortion, bear in mind all these states final 12 months that voted to guard abortion rights? Plainly was removed from the ultimate phrase.
We’re seeing courtroom case after courtroom case to find out which abortion restrictions can keep and which might’t on account of passage of these poll measures. That is occurring notably in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a decide invalidated some however not all the state’s restrictions.
This appears to be the inevitable results of what now we have 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 accidentally? 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 isn’t their high situation, 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 making an attempt out new restrictions and what’s going to keep on with the wall. And I feel that we’re going to see extra of those sort of lengthy, drawn-out battles, provided that the decide stated that some restrictions have been struck down due to the constitutional modification however then others, just like the licensing for abortion services, 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 huge the hallways should be, I imply, guidelines that have been created to discourage them from providing abortions, not as a result of they have been really wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion services. They’re not parallel within the different forms 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 prior to now few years we’ve seen a lot extra consideration on state supreme courtroom races, which I really feel like a couple of years in the past that was not one thing that might get nationwide consideration for one state or one other.
However, provided that, as they’re sort of litigating these and seeing how can we implement the regulation in order that these clinics can open beneath the constitutional modification, it depends on them, and simply how a lot cash that’s being fueled to have the ability to not come down on the opposite facet 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 these items, however it’s going to be an extended, 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, now we have one other entry in our recurring section, “This Week in Medical Misinformation.” I wished to speak about a little-noted story from the medical information web site MedPage In the present day 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 cope with docs who categorical views which can be, shall we embrace, not in line with medical proof? And the way clear ought to they be about telling sufferers after they sanction considered one of their very own, which is principally what occurred right here?
Kenen: Properly, they did put out a press release, I feel it was the New England Journal of Drugs a couple of 12 months and a half in the past, saying that they have been going to crack down on this. I’m undecided 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 after I say telling sufferers, I imply telling the general public.
Kenen: Proper. However I don’t know that any of the boards do this in any — it’s a giant can of worms about decertification and the way occasionally 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 a couple of, however not lots. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So except the state medical board, which is basically the group that pulls a license — that is saying that you just’re not a board-certified no matter your specialty is beneath ABIM.
However Lauren [Weber of The Washington Post], who is typically on the web site, had an excellent piece a few months in the past about how few state boards have acted to sanction docs who say incorrect issues about vaccines. And that goes again method earlier than covid. The medical career doesn’t do numerous 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 docs who’d had their licenses pulled might simply go to a different state, and there was no method for that state to simply discover out that that physician had had his or her license revoked.
And that was often not for saying issues however for doing issues that ended up with having the physician decreed not certified to observe drugs anymore. So, I imply, this is a matter that goes again an extended methods.
Kenen: And you’ll suppose they’d be the alternative. You’d suppose that the state boards, when anyone can be a dangerous man or a nasty gal, you’ll suppose they’d 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 necessary, however actually the ability to de-license anyone is within the state boards.
Rovner: Yeah, nicely, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we are going to maintain watching. All proper, that’s the information for this week. Now, we are going to play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our further credit.
I’m happy to welcome to the podcast Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month.” Harris, welcome to “What the Well being?”
Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you.
Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he bought.
Meyer: OK, Julie, this can be a story about excessive costs, complicated payments, and lack of worth transparency for a quite common process. The affected person is Tom Contos, a 45-year-old well being care advisor 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 result of a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for individuals with no signs, which can be speculated to be free as preventive care beneath the Inexpensive Care Act. Diagnostic colonoscopies like this one can require a affected person to satisfy deductible and copay necessities, proper? That’s one thing necessary for individuals to know?
Meyer: Sure. There’s numerous confusion about this. I bought numerous feedback on my Washington Publish 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 really useful beginning at age 45, even when there are not any signs, to forestall colon most cancers or different severe circumstances.
The Inexpensive Care Act requires well being insurers to cowl screening colonoscopies for gratis to sufferers. However for a diagnostic colonoscopy, sufferers might need to pay a deductible and copayment, although 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 have been taken care of, after which, as we are saying, the invoice got here. How a lot was it?
Meyer: Yeah, Northwestern’s whole cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated fee with Northwestern of a nonetheless vital 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 whole and he was instructed that he would owe about $2,400. My outdoors billing knowledgeable stated $4,100 is kind 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 motive that the invoice was so excessive. Northwestern billed him for 2 colonoscopies, which Tom didn’t perceive, since he had solely obtained one. It seems that suppliers routinely invoice for 2 procedures if the gastroenterologist removes and biopsies two polyps in two other ways throughout the identical process.
The second process is billed at a reduced fee. Now, this appears unusual to laypeople, however that is how suppliers receives a commission for the additional work of eradicating two polyps moderately than one.
Rovner: Which, as you identified at the start, 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, usually lower than that.
Rovner: So what occurred finally with the invoice?
Meyer: Properly, Tom appealed the invoice to Northwestern and Aetna and was instructed that it was right. He had already paid about $2,400 of the almost $4,100 he owed, however he instructed 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 might take him to collections.
Northwestern stated that’s what they have been going to do, and Tom determined to now not use Northwestern or its docs sooner or later.
Rovner: Though I assume he did pay the quantity that they stated he owed.
Meyer: No, he stated: Take me to collections. I’m not paying it. My credit score is sweet, and — I received’t repeat a few 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 advisor, however lots of people get confused by this course of, together with him taken without warning. 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 widespread and never stunning.
Rovner: Even for anyone who’s principally within the well being care fee enterprise.
Meyer: Sure, that’s right.
Rovner: So be vigilant. Is that principally the takeaway?
Meyer: 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 they usually can present good high quality of care.
To cost-shop forward of time, sufferers can have a look at the hospital’s worth web site and their insurer’s price estimator web site to get a way of how a lot a diagnostic colonoscopy might price. In addition they can search for a so-called good religion estimate of the money worth, which means the process might be cheaper in the event that they pay money, moderately than going via insurance coverage.
Plus, there are free web sites akin to Turquoise Well being and Truthful Well being for checking costs for colonoscopies and different procedures. Now, as soon as they get a worth estimate from the supplier, there’s yet one more wrinkle. Sufferers ought to ask whether or not that worth contains the additional providers, if the gastroenterologist finds and has to take away and biopsy a number of polyps. At the very least 40% of colonoscopies do discover polyps.
Now, consultants say it’s unlucky that getting a diagnostic colonoscopy might be so costly and complicated billing-wise, however don’t hesitate, as a result of it may be a lifesaving process for many individuals.
Rovner: All wonderful recommendation. Harris Meyer, thanks a lot.
Meyer: Thanks, Julie.
Rovner: OK, we’re again, and it’s time for our extra-credit section. That’s the place we every acknowledge the story we learn this week we predict it’s best to learn, too. Don’t fear. In case you miss it, we are going to put the hyperlinks in our present notes in your telephone or different cell gadget. Anna, why don’t you go first this week?
Edney: I wished 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 wished to place in a single place speaking about numerous these contamination points which have come up, however notably additionally simply present that, whereas the issues with merchandise continue to grow — considered one of them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting kind of slower on numerous these items. They’re digging in, they usually’re not making an attempt to speak to the general public concerning the points which have come up. They’ve had since final March of 2024 issues dropped at them about benzene and pimples merchandise.
They’ve stated nothing to the general public. They simply maintain saying, We’re it. And that’s very totally different from when this primary sort of began occurring on a bigger scale, the place it was like, growth, remembers. Now it’s simply kind of this struggle to possibly not have remembers. I don’t know what’s occurring of their head.
However there are also some points in there with the tampons have been discovered to comprise numerous heavy metals, FDA additionally slow-walking there. So I wished 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 undecided 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 Approach to Struggle Off Abdomen Bugs,” and the reply is wash your palms with cleaning soap.
However it’s a extremely well-written — it really makes you snicker 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 scientific weight problems, so when you might have that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply other ways clinicians are this globally.
Rovner: Yeah, it’s actually fascinating as a result of, clearly, each physician says that BMI is a silly and imprecise approach to measure this, after which everyone makes use of BMI as a result of, for the time being, it’s all now we have. My further credit score this week is a KFF Well being Information story from Felice Freyer. It’s referred to as “Can Medical Colleges Funnel Extra Medical doctors into the Main Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened a number of new medical colleges over the previous decade and has launched a raft of packages geared toward getting extra graduating docs to enter main care, method too many are nonetheless pursuing specialty care as a substitute. We now have tried, as a society, free tuition and mortgage compensation packages, however it doesn’t appear that medical training debt is the most important downside.
We’ve additionally tried coaching docs in additional primary-care-centric places, i.e. in neighborhood clinics moderately than in hospitals, however that’s not made an enormous dent, both. Slightly, to cite one of many household drugs consultants within the story: “It’s not the medical colleges which can be the issue; it’s the job. The job is just too poisonous.”
In different phrases, it’s probably not interesting to see too many sufferers for too little time and do tons of combating with insurance coverage firms and digital medical information. Till we as a society begin making main 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 severe scarcity.
All proper, that’s this week’s present. As all the time, in case you benefit from the podcast, you possibly can subscribe wherever you get your podcasts. We’d recognize it in case you left us a evaluate. That helps different individuals discover us, too. Particular thanks once more this week to our non permanent manufacturing workforce, Taylor Cook dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As all the time, you possibly can e-mail us your feedback or questions. We’re at whatthehealth@kff.org, or you possibly can nonetheless discover me often at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out today? Anna?
Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social.
Rovner: Joanne.
Kenen: I’m on Bluesky, @joannekenen.bsky.social, very often on X nonetheless, @JoanneKenen.
Rovner: Sandhya.
Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social.
Rovner: We can be again in your feed subsequent week. Till then, be wholesome.
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Taylor Cook dinner
Audio producer
Lonnie Ro
Audio producer
Emmarie Huetteman
Editor
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