The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous professional on well being coverage points, Julie is the creator of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.
Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already speeding to work his priorities into laws, eyeing cuts to Medicaid to pay for brand spanking new tax and immigration priorities. However even in its waning days, the Biden administration continues to make large coverage strikes, together with a attainable order for tobacco corporations to dramatically lower the quantity of nicotine in cigarettes.
In the meantime, the fires in Los Angeles are drawing new consideration to the well being risks of not simply smoke from natural matter, but 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 Faculty of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins College and Politico
Sandhya Raman
CQ Roll Name
Among the many takeaways from this week’s episode:
- Republican lawmakers are weighing choices to chop federal spending on Medicaid, the almost $900-billion-a-year authorities program that covers 1 in 5 Individuals. They may use the financial savings to bolster Trump priorities, comparable 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 social gathering held a bigger Home majority — although the social gathering appears extra aligned with Trump as we speak than it was then.
- Congress has gotten all the way down to enterprise on messaging payments: It superior laws this week that will ban trans athletes from women’ faculty sports activities and, individually, a measure to detain and even deport immigrants who’re residing within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes comparable to shoplifting.
- The Supreme Courtroom has agreed to listen to a case later this yr concerning the U.S. Preventive Companies Process Pressure — 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 companies 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 job pressure, who would make the determinations about what preventive care must be coated?
- And the outgoing Biden administration issued a slew of well being rules 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 rules, 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 few colonoscopy that got here with a a lot bigger price ticket than estimated. In case you have a mystifying or outrageous medical invoice you’d wish to share with us, you are able to do that right here.
Plus, for “additional credit score,” the panelists counsel well being coverage tales they learn (or wrote) this week that they suppose it is best to learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Faculties Funnel Extra Docs Into the Major 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 Method To Combat Off Abdomen Bugs,” by Daniel Engber.
Sandhya Raman: Nature’s “New Weight problems Definition Sidelines BMI To Concentrate on Well being,” by Giorgia Guglielmi.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: Howdy, Trump. Bye-Bye, Biden.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Howdy and welcome again to “What The Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by a number of the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 16, at 10 a.m. As at all times, information occurs quick and issues might need modified by the point you hear this. So, right here we go.
Immediately we’re joined through videoconference by Anna Edney of Bloomberg Information.
Anna Edney: Hello, all people.
Rovner: Sandhya Raman of CQ Roll Name.
Sandhya Raman: Good morning, everybody.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico Journal.
Joanne Kenen: Hello, all people.
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 few affected person whose colonoscopy invoice was quite a bit larger than he anticipated. However first, this week’s information.
So we are actually 4 days from the second swearing-in of Donald Trump as president, and discussions are already choosing up on Capitol Hill about rolling the brand new president’s total agenda into, quote, “one large, lovely invoice,” as Trump has put it. There are many variations of opinions between Republicans which are nonetheless to be labored out, however one goal for cost-cutting is fairly clear, and that will be Medicaid. Sandhya, we’re beginning to get an image of the probabilities of how they may wish to try this. What are a number of the major issues which are on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made slightly progress however on the similar time we simply didn’t additionally make lots of progress. The tip of, -ish, final week we received a menu of things that Republicans are form of contemplating as issues they’d use to offset a number of the issues that they’d wish to do by means of reconciliation.
Rovner: Like proceed the tax lower?
Raman: Sure, for the tax cuts and for border safety. So what we’ve on the Home aspect is lots of issues which are very health-oriented. About half of that checklist is health-oriented, and lots of it’s Medicaid. And so a number of the issues they’ve been floating round are some issues we noticed within the first Trump administration, them attempting to do. We’ve got per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid growth, and issues like altering the general public cost rule to again the way it was within the Trump administration.
Rovner: Remind folks what the general public cost rule is.
Raman: The general public cost rule form of limits a number 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, but it surely’s so early.
Carter stated that he nonetheless desires to get the PBM [pharmacy benefit manager] language from final yr that didn’t make it throughout the end line in there. And Guthrie has stated that a number of the numbers that we’ve seen of how a lot cash from Medicaid they may probably 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 the event 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 large, lovely invoice” or form of what the Senate desires, with two payments, and that will simply form of change what can be finished earlier versus later. However we do have slightly bit extra of a timeline now in what they’re attempting to do.
Rovner: I really feel prefer it’s price 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. While you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid growth at this level. We nonetheless have solely the ten holdout growth states. So, I feel, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter car we’ve, we’ll in all probability hear extra.
And I imply, in the event you take a look at this state-level already, lots of states are form of couching their bets with Medicaid, simply eager about how they’ll do issues in another way in case their Medicaid federal funding adjustments over the course of this yr or subsequent yr. So, I feel it actually depends upon 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 fantastic thing about reconciliation in the event you’re the bulk social gathering, 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 received 53. It’s a slam dunk, proper? Nevertheless 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 particular person received’t vote for or that particular person received’t vote for.
So this seemingly easy slam dunk for a narrow-majority Senate is definitely a giant, difficult mess. Then again, 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 simple. They thought repealing the ACA [Affordable Care Act] and altering, which included lots of Medicaid stuff, they thought it was a slam dunk. And as a substitute, it was a year-long slog that failed. So is Medicaid going to look the best way it seems proper now? No, it’ll change. How a lot will it change is actually an open query.
Bear in mind, there’s some issues they’ll do by means of waivers. Work necessities they’ll do by means of waivers. Though previously, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache.
Rovner: Yeah, effectively, so reconciliation, finances, all of these things 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 will enable the deportation of undocumented people who find themselves accused however not but convicted of violent crimes.
In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued govt orders making it simpler for folks to ship their kids to highschool with out being vaccinated. General, it appears the Republicans are form of coalescing round an idea often called “medical freedom,” which to me appears identical to a rejection of public well being basically. Or am I lacking one thing? Is there one thing extra to this?
Edney: No, I feel that it’s at all times been round, however I feel that definitely this resurgence in it’s coming from the truth that folks didn’t belief science throughout the pandemic. They have been fed up. Communication wasn’t dealt with very effectively, and it nonetheless isn’t dealt with very effectively. I don’t suppose folks have found out the right way to speak about this stuff in measured methods.
I’d advocate if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Occasions just a few days in the past on vaccination that I believed was actually good as a result of he’s like: Pay attention, I’m a vaccine skeptic. Like, R.F.Ok. Jr. [Robert F. Kennedy Jr.] is a vaccine cynic. There’s the distinction, and right here’s what it’s. And he laid it on the market. And he’s a pediatrician, and he additionally serves on FDA’s [the Food and Drug Administration’s] advisory committee for vaccines.
So I feel that lots of that is stemming from misinformation and miscommunication, and it resonates with folks. I imply, the Republican Social gathering picked up lots of 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 truly goes again to smallpox. There has at all times been a certain quantity of worry, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to vary two or three years earlier than the pandemic.
Some state legislatures — and this was the medical freedom, this was on the appropriate — began attempting to water down mandates for faculties. At that time, I don’t suppose something large received by means of. However we started to see this emergence of a deeper politicization of vaccination. And it was on the appropriate, and it’s what we now speak about as medical freedom.
So as a substitute of being one thing that’s throughout the political spectrum, it’s now a politicized motion, on a libertarian Authorities can’t inform me what to do. And we noticed this throughout the pandemic. And neither administration, neither the Trump administration within the first yr of the pandemic nor the Biden administration within the ensuing years, actually managed to elucidate the distinction between particular person alternative and the truth that in the event you get sick, you may survive however you may endanger someone else.
You don’t know who the particular person on the bus subsequent to you is. You don’t know who the child in your classroom is. You don’t know who you’re standing subsequent to on the grocery retailer. They may very well be actually weak. And that this entire sense of “my physique, my alternative,” doesn’t fly when you may kill someone else unintentionally. And that kind of has been misplaced, or folks don’t care.
Rovner: Yeah, I imply we’ve seen that with tobacco over what number of generations. It’s like, you wish to put stuff in your lungs, that’s your enterprise. However you don’t actually get the appropriate to place stuff in different folks’s lungs since you wish to smoke.
In the meantime, persevering with with the Republican agenda, my former KFF Well being Information colleague Anna Maria Barry-Jester has a very good story this week about what Nationwide Institutes of Well being director candidate Jay Bhattacharya may keep in mind for the company, together with de-emphasizing infectious illness analysis and focusing extra on persistent illness.
On condition that the largest 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 therefore lengthy headed by the now retired Dr. Tony Fauci?
Raman: I feel in a component that may be a enormous driving issue, if you take a look at a few of his feedback and R.F.Ok. Jr.’s feedback about holistic approaches to well being, that actually if you take a look at what one thing like NIAID does, which is so infectious-disease-driven, versus the issues like with most cancers and different issues.
However I feel on the similar time, this has form of been effervescent up earlier than, after we even seemed to final yr. 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 top of the Home Labor-H Appropriations subcommittee and former Vitality and Commerce Chairwoman Cathy McMorris Rodgers attempting to reform NIH that method.
We didn’t get that far with it. It was included in a number 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, form of going again to what we have been saying earlier than, a number of the wanting extra management of what you see, by way of medical freedom, and that they wish to know extra about what’s taking place.
So I feel that, regardless, we’re going to see extra of this. However I feel one factor that was actually attention-grabbing in what she’d been writing was simply the NIH is a lot larger than simply NIH, you already know? It’s so most of the folks which are benefited by it, which are working with this grant cash, are states nationwide. And it’s simply the medical analysis is for a worldwide understanding of medical analysis, and simply how most of the medication that we see come from NIH cash. So even when there’s a broader push for reform, that it’s very delicate into how broad of an impact that will have.
Rovner: And I’d level out, as a result of I reside 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 form 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 try 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 suppose the query is simply kind of what path that’s going to take and whether or not a few of it will be punitive or whether or not they’re truly going to take a look at it in a matter of what would profit the nation, as a result of it will get some huge cash, and that’s additionally been bipartisan.
Kenen: Proper. What we’re not listening to but, or at the least — and possibly Anna, who covers pharma, can inform me if I’m improper — however we’re not — NIH additionally does the fundamental, fundamental, fundamental mobile first-step science that finally results in the work that drug corporations do to develop medication. They do the fundamental, what they name bench, science.
I’m not listening to the drug corporations converse out. The ambivalence Individuals have about drug corporations, which is hating the costs however liking the medication, I haven’t heard pharma — Possibly it’s simply too early. Possibly they’re weighing in quietly, and possibly Anna can inform me I’m improper 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 lots of the good points — we haven’t cured most cancers, however we’ve made good points 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, you already know, it has been an financial powerhouse in addition to a information powerhouse.
Edney: And I wouldn’t inform you you’re improper. I feel that you simply’re proper. I haven’t heard the pharma corporations speaking about it. I feel they’re speaking about lots of issues that they need finished to profit them, and so I’m certain 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 wish to say, NIH, I do know they wish to deal with persistent illness. It does lots of 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 are able to do two issues. We are able to stroll and chew gum.
Rovner: Sure, I do know, and that was the purpose I used to be attempting to make. It’s like, there’s an unlimited quantity of persistent illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend lots of time, particular person members, telling NIH what it’s they need to be learning, which is a complete different difficulty that we’ll get to a different time.
However I wish to keep on the subject of drug costs, as a result of that’s a very large query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly advised a Bloomberg reporter that it’s going to ask the Trump administration to, quote, “pause” the Medicare drug worth negotiation program, which in fact is simply getting underway.
In fact, that’s taking place whilst Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration choice to have Medicare start protecting 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 may attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to should do in March. Probably? Doable? Will this report have any impression? Or is there simply an excessive amount of different information this week and no person’s going to recollect?
Raman: I feel it’s undoubtedly being talked about quite a bit. 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 intently on it earlier than. It was included in a bipartisan deal that we had earlier than we received the CR [continuing resolution] that we voted into legislation. It simply received dropped alongside the best way.
Rovner: When Elon Musk stated the invoice was too large?
Raman: Yeah. So I feel we form of have two pathways, the place each of them wish to get it finished 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 wish to get it finished sooner fairly than later.
Nevertheless 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 to go forth with that now?
Rovner: True. So, it’s a bipartisanly in style provision that additionally saves cash, in order that makes it form of enticing to lawmakers who’re placing collectively issues which 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 the event you’re giving Medicare the power to barter. And so, I simply surprise how that matches into this agenda in the event you cease it and make it extra favorable in the direction of the drugmakers. The place does that slot in with chopping 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 truly occurs.
Rovner: Yeah, lots of 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 companies like immunizations, most cancers screenings, contraception, and, the topic of this specific case, remedy 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 Pressure doesn’t have the authority to find out what companies must be on this checklist? Which in fact is the entity that now determines which companies must be on this checklist.
Edney: Properly, it feels like, then, lots of people don’t get their preventive care coated. As KFF wrote, there may be some that will be nonetheless coated, the mammographies, however not the HIV preventative remedy. Different most cancers screenings included in that as effectively. And so, it appears to throw a wrench, I suppose, kind of simply asking this of the panel, that companies then must go make these determinations? Does Congress should make the determinations on what’s coated then?
Rovner: Properly, that’s in fact the large query. Or, would the secretary, him or herself? Who is allowed? I feel the argument is as a result of the Preventive Well being Companies Process Pressure shouldn’t be Senate-confirmed, they’ll’t make these choices.
And naturally, the best way it really works, they don’t make these choices. They advocate them, after which the secretary kind of ratifies them. So it’s onerous 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 very broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn completely different tales about this, they usually had completely different lists, together with some ldl cholesterol stuff. And I don’t know, because the lists have been so completely different, I’m undecided precisely which of them are in or which of them have been out. Nevertheless it’s not simply HIV medication. It’s lots of stuff.
So it could definitely intestine one thing that individuals depend on now. I imply these are free not slightly below an ACA plan however in the event you get protection by means of a job, these necessities additionally apply. So, lots of people would not have free entry to lots of what we take into account preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They only determined to take it. So, this will likely be a later in 2025 case. Properly, the flip aspect of an incoming administration are all of the issues the outgoing administration tries to slide by means of on its method out of city, and this week has seen a bunch of these.
Most of this stuff may very well 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 circumstances quite a bit 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 will 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 nations which has been proven to trigger most cancers in rodents. And it proposed a significant change in meals labels to require them to point out 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 reside 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 desirous to get them out of, he particularly stated, cereal, however they’re in lots of issues. So, I see that one.
I feel the trade 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 combat tremendous onerous for to vary. The nicotine is rather more iffy. Large Tobacco continues to be an enormous pressure, and Trump will get funding for his marketing campaign and issues from corporations who’ve a stake on this.
And a few of that might align with this concept of not essentially medical freedom however, kind of, we will select what we put in our our bodies. If we wish to be hooked on nicotine, that’s our alternative. So, the opposite one, the labels, I’m undecided. They’re not significantly highly effective or something. I believed they seemed … 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 completely different. So, I don’t know. Possibly it survives. I’m undecided how a lot the trade is engaged on this.
Rovner: [Sen.] Bernie Sanders of all folks 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 stunned at how indignant he was at this.
Kenen: I feel he desires them in neon.
Rovner: I feel he desires R.F.Ok. Jr. to have fewer ultra-processed meals accessible. I feel that’s going to be kind of the large takeaway from all of this, I suppose.
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 are unhealthy for you. And there’s some meals that do have some form of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t inform you. There’s some issues which are, quote, “ultra-processed” that actually aren’t that processed, don’t have lots of components. They’ve one thing.
So the entire categorization wants extra work, each for public understanding and political understanding. There’s no person who’s going to say that Individuals have a very nutritious diet and that meals components … R.F.Ok. Jr. has identified to the meals additive, the place the businesses should get to self-certify, Yeah, that is protected. So, is that one thing that he might get widespread assist on? Sure, however there’s a complete lot of different issues that he says that individuals weren’t going to agree with.
Rovner: And I’ll remind that we not solely don’t know if R.F.Ok. Jr. will likely be confirmed, however they nonetheless don’t actually have a date for his affirmation listening to, as a result of they’re nonetheless ready on the paperwork. All proper, transferring on.
As we taped this morning, there are nonetheless a number of fires burning within the Better Los Angeles space. We’ve got talked concerning the well being results of fireplace earlier than. It’s not precisely information that fireside and smoke are unhealthy for human well being, however what appears to make these fires completely different is that they’re not principally timber and brush and different bits of nature which are burning however numerous poisonous substances which are polluting not simply the air but in addition the ingesting water.
Are we going to have to begin eager about hearth and well being in a a lot completely different method if not simply distant areas however total suburbs are actually susceptible to burning up because of our altering local weather?
Edney: It’s going to make us consider lots of issues in several methods, and significantly well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that include excessive ranges of formaldehyde, issues like that.
I feel the expectation is that may create a long-term difficulty, but in addition it might probably within the second create extra deaths simply on the time, not as a result of it instantly kills but when you have already got a problem and you’ve got a respiratory downside or a coronary heart downside that may be exacerbated by these fires.
Yeah, I feel there’s a ton to consider. Even ingesting water will be impacted extra so when you will 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 is likely to be coming again for a completely completely different motive.
Rovner: Properly, N95s will not be sufficient. I imply, I feel that was the factor that form of jumped out at me. For those who watch the information protection of it, the reporters aren’t carrying N95s anymore. They’re carrying what seemed like old-style fuel masks. I imply, you want kind of the subsequent degree of masking as a result of N95s don’t filter out a few of these poisonous substances that are actually floating within the air. I imply, they do filter out the type of the particular smoke from wooden and whatnot, but it surely’s fairly scary.
I imply, much more folks 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 simply despatched round yesterday that principally that every thing 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 are burning produce like a cyanide form of fuel, that the firefighters can’t even be uncovered. They’ll’t stand in entrance of a home with a hose for a very long time.
It may very well be killing or injuring firefighters. So, it additionally hampers — they’re not simply attempting to place a hose on a burning tree.
Rovner: Yeah. Much more issues to consider, which is simply what we would have liked. Properly, turning to abortion, bear in mind all these states final yr 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 may’t because of passage of these poll measures. That is taking place significantly in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a choose invalidated some however not all the state’s restrictions.
This appears to be the inevitable results of what we’ve seen in different elections, the place the identical voters endorse abortion rights however then flip round and vote for candidates, together with judges, who don’t. Is the gridlock right here on function or accidentally? And Sandhya, what’s going to occur?
Raman: I don’t know that it could be on function. I feel that these voters that vote for the candidates, if abortion shouldn’t be their high difficulty, they’re nonetheless going to vote in the best way that form 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 attention-grabbing as a result of it has lengthy been, I feel, one of many check circumstances for a lot within the abortion house, of attempting out new restrictions and what is going to follow the wall. And I feel that we’re going to see extra of those form of lengthy, drawn-out battles, on condition that the choose stated that some restrictions have been struck down due to the constitutional modification however then others, just like the licensing for abortion amenities, which we’ve seen for years, can keep. And that simply makes it in order that they’ll’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 truly wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion amenities. They’re not parallel within the different kinds of clinics and hospitals. So it’s focused to them. I feel it’s simply one other instance of it being form of an uphill battle for them, as a result of now, I imply, even previously few years we’ve seen a lot extra consideration on state supreme courtroom races, which I really feel like just a few years in the past that was not one thing that will get nationwide consideration for one state or one other.
However, on condition that, as they’re form of litigating these and seeing how can we implement the legislation 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 aspect in order that they’ll form of function. So I feel that’s one thing to undoubtedly watch, as a few of these states are form of litigating this stuff, but it surely’s going to be a protracted, drawn-out battle, even when it’s already been a number of months since seven out of 10 states final yr voted in favor of abortion rights.
Rovner: Yeah, this continues, and naturally, we’ll wait and see what occurs on the federal degree, when the Trump administration will get going. Properly, lastly this week, we’ve one other entry in our recurring section, “This Week in Medical Misinformation.” I wished to speak about a little-noted story from the medical information web site MedPage Immediately concerning the American Board of Inner Medication 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 checklist this specific physician on his web site as not being licensed. How ought to specialty boards cope with docs who specific views which are, shall we embrace, not according to 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 Medication a few yr 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 try this in any — it’s a giant can of worms about decertification and the way sometimes it occurs.
So ABIM did put out a press release, I feel it was two years in the past now, and there’s been a course of for just a few, however not quite a bit. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So until the state medical board, which is actually the group that pulls a license — that is saying that you simply’re not a board-certified no matter your specialty is beneath ABIM.
However Lauren [Weber of The Washington Post], who is usually 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 lots of self-policing.
Rovner: Sure, and I’ve been doing this lengthy sufficient to have coated 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 a protracted methods.
Kenen: And you’d suppose they’d be the alternative. You’ll suppose that the state boards, when someone is known as a unhealthy man or a nasty gal, you’d 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 someone is within the state boards.
Rovner: Yeah, effectively, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we’ll maintain watching. All proper, that’s the information for this week. Now, we’ll play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our additional 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 received.
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 seen blood in his stool. He went to see his household doctor at Northwestern Medication.
The physician referred him for a diagnostic colonoscopy due to the bleeding and due to his household historical past of significant colon points. Then in June, he went in for a colonoscopy at Northwestern Memorial Hospital, which is a giant instructing 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 attributable to a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for folks with no signs, which are presupposed 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 folks to know?
Meyer: Sure. There’s lots of confusion about this. I received lots of feedback on my Washington Publish article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are finished when there are signs like bleeding or ache. In distinction, screening colonoscopies are beneficial beginning at age 45, even when there are not any signs, to forestall colon most cancers or different critical circumstances.
The Inexpensive Care Act requires well being insurers to cowl screening colonoscopies for free of charge to sufferers. However for a diagnostic colonoscopy, sufferers could should pay a deductible and copayment, though that process equally can stop 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 important about $6,000. When he received his insurance coverage clarification 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 advised that he would owe about $2,400. My outdoors billing professional stated $4,100 is sort of a excessive out-of-pocket invoice, although common for instructing 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 acquired 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 fairly than one.
Rovner: Which, as you identified at first, it’s not like this can be a several-hour surgical procedure. This can be 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 advised that it was right. He had already paid about $2,400 of the almost $4,100 he owed, however he advised Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they may take him to collections.
Northwestern stated that’s what they have been going to do, and Tom determined to 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 number of the issues that he stated to them.
Rovner: Thanks. This can be a household podcast. How can others keep away from falling into this entice? I imply, he received 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 abruptly. He solely seemed on the estimate after he had had the process however earlier than he received the ultimate invoice. So, like lots of people, he received confused and he didn’t proceed essentially as effectively as he might need. However that’s frequent and never stunning.
Rovner: Even for someone who’s principally within the well being care cost 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 try 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 take 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. Additionally they can search for a so-called good religion estimate of the money worth, that means the process may very well be cheaper in the event that they pay money, fairly than going by means of insurance coverage.
Plus, there are free web sites comparable 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 another wrinkle. Sufferers ought to ask whether or not that worth contains the additional companies, if the gastroenterologist finds and has to take away and biopsy a number of polyps. Not less than 40% of colonoscopies do discover polyps.
Now, consultants say it’s unlucky that getting a diagnostic colonoscopy will 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 glorious 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 is best to learn, too. Don’t fear. For those who miss it, we’ll put the hyperlinks in our present notes in your cellphone or different cellular 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 form of wished to place in a single place speaking about lots of these contamination points which have come up, however significantly additionally simply present that, whereas the issues with merchandise continue to grow — 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 lots of this stuff. They’re digging in, they usually’re not attempting to speak to the general public concerning the points which have come up. They’ve had since final March of 2024 considerations dropped at them about benzene and pimples merchandise.
They’ve stated nothing to the general public. They only maintain saying, We’re it. And that’s very completely different from when this primary form of began taking place on a bigger scale, the place it was like, growth, remembers. Now it’s simply kind of this combat 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 include lots of 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 “every thing you thought is likely to be protected is definitely harmful” beat.
Edney: I’m the life of each social gathering.
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 yr. And the headline is “A Secret Strategy to Combat Off Abdomen Bugs,” and the reply is wash your palms with cleaning soap.
Nevertheless it’s a very well-written — it truly makes you giggle 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 additional credit score this week is known as “New weight problems definition sidelines BMI to deal with well being,” and it’s by Giorgia Guglielmi for Nature. And it takes a take 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 options: preclinical weight problems, which is an individual with additional physique fats however their organs are nonetheless functioning usually, and medical weight problems, so when you will 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 attention-grabbing as a result of, clearly, each physician says that BMI is a silly and imprecise technique to measure this, after which all people makes use of BMI as a result of, for the time being, it’s all we’ve. My additional credit score this week is a KFF Well being Information story from Felice Freyer. It’s known as “Can Medical Faculties Funnel Extra Docs into the Major Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened numerous new medical faculties over the previous decade and has launched a raft of packages aimed toward getting extra graduating docs to enter main care, method too many are nonetheless pursuing specialty care as a substitute. We’ve got tried, as a society, free tuition and mortgage compensation packages, but it surely doesn’t appear that medical training debt is the largest downside.
We’ve additionally tried coaching docs in additional primary-care-centric places, i.e. in group clinics fairly than in hospitals, however that’s not made an enormous dent, both. Quite, to cite one of many household drugs consultants within the story: “It’s not the medical faculties which are 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 preventing with insurance coverage corporations 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 critical scarcity.
All proper, that’s this week’s present. As at all times, in the event you benefit from the podcast, you possibly can subscribe wherever you get your podcasts. We’d recognize it in the event you left us a evaluation. That helps different folks discover us, too. Particular thanks once more this week to our non permanent manufacturing workforce, Taylor Prepare dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As at all times, you possibly can e mail us your feedback or questions. We’re at whatthehealth@kff.org, or you possibly can nonetheless discover me 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 will likely be again in your feed subsequent week. Till then, be wholesome.
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Taylor Prepare dinner
Audio producer
Lonnie Ro
Audio producer
Emmarie Huetteman
Editor
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