The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer 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 speeding 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 huge coverage strikes, together with a potential 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 additionally 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 People. They may use the financial savings to bolster Trump priorities, corresponding 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 get together held a bigger Home majority — although the get together appears extra aligned with Trump right this moment than it was then.
- Congress has gotten all the way down to enterprise on messaging payments: It superior laws this week that may ban trans athletes from women’ college sports activities and, individually, a measure to detain and even deport immigrants who’re dwelling within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes corresponding to shoplifting.
- The Supreme Courtroom has agreed to listen to a case later this yr concerning the U.S. Preventive Companies Activity Power — an impartial physique of specialists that points suggestions in illness prevention and drugs. A ruling towards its authority may strip protection for key preventive well being companies from not simply these with Reasonably priced Care Act protection, but additionally these on employer-sponsored well being plans. The query stands: If not this process drive, 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 Pink No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration may upend these and extra rules, although some do align with its coverage pursuits.
Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the newest KFF Well being Information “Invoice of the Month” function, a couple of colonoscopy that got here with a a lot bigger price ticket than estimated. If in case you have a mystifying or outrageous medical invoice you’d wish to share with us, you are able to do that right here.
Plus, for “further credit score,” the panelists recommend well being coverage tales they learn (or wrote) this week that they suppose it’s best to learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Faculties Funnel Extra Docs Into the Main Care Pipeline?” by Felice J. Freyer.
Anna Edney: Bloomberg Information’ “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles,” by Anna Edney.
Joanne Kenen: The Atlantic’s “A Secret Manner 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: Hiya, 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: Hiya and welcome again to “What The Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by among the 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 may need modified by the point you hear this. So, right here we go.
Immediately we’re joined by way of 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 newest KFF Well being Information “Invoice of the Month,” a couple of 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 selecting up on Capitol Hill about rolling the brand new president’s total agenda into, quote, “one huge, stunning 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 may be Medicaid. Sandhya, we’re beginning to get an image of the chances of how they may need to try this. What are among the fundamental issues which are on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made a bit of progress however on the identical time we simply didn’t additionally make a number of progress. The tip of, -ish, final week we obtained a menu of things that Republicans are type of contemplating as issues they might use to offset among the issues that they’d need to do via reconciliation.
Rovner: Like proceed the tax reduce?
Raman: Sure, for the tax cuts and for border safety. So what we now have on the Home facet is a number of issues which are very health-oriented. About half of that listing is health-oriented, and a number of it’s Medicaid. And so among the issues they’ve been floating round are some issues we noticed within the first Trump administration, them attempting to do. We now have 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 type of limits among the social applications for people that aren’t residents to utilize issues like Medicaid, SNAP [the Supplemental Nutrition Assistance Program], and different applications 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 Power and Commerce Republicans to look over at the very least the well being a part of that menu. And speaking to each Power and Commerce Chairman Brett Guthrie and Buddy Carter, who heads the well being subcommittee, it’s simply the beginning. Discussions had been fairly good, nevertheless it’s so early.
Carter stated that he nonetheless desires to get the PBM [pharmacy benefit manager] language from final yr that didn’t make it throughout the end line in there. And Guthrie has stated that among 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 the entire different provisions in there. Some issues are below Methods and Means jurisdictions. Some issues, when you do one and never the opposite, the numbers would change.
So that they’re nonetheless fairly early within the course of, and we don’t know if we’re going to do the “one huge, stunning invoice” or type of what the Senate desires, with two payments, and that may simply type of change what can be performed earlier versus later. However we do have a bit of bit extra of a timeline now in what they’re attempting to do.
Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, once they had a a lot larger Republican majority within the Home, and so they couldn’t get it over the end line. What makes them suppose they’re going to be extra profitable this time?
Raman: I believe 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 growth at this level. We nonetheless have solely the ten holdout growth states. So, I believe, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter automobile we now have, we’ll in all probability hear extra.
And I imply, when you take a look at this state-level already, a number of states are type of couching their bets with Medicaid, simply serious about how they’ll do issues otherwise in case their Medicaid federal funding adjustments over the course of this yr or subsequent yr. So, I believe it actually will depend on what suggestions they’re going to get within the coming weeks and months.
Rovner: Joanne needed so as to add one thing.
Kenen: Yeah, I imply, the fantastic thing about reconciliation when you’re the bulk get together, however a slender majority, which is what’s happening now, is you’d solely want 51 votes within the Senate. You don’t want 60. So on one degree, that appears like they’ve obtained 53. It’s a slam dunk, proper? Nevertheless it’s not, as a result of reconciliation, it’s a seize bag. You set 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 an enormous, difficult mess. Then again, in comparison with the primary Trump administration, it is a extra conservative, or a extra populist, or a extra method — 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 a number 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 appears to be like 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’ll do via waivers. Work necessities they’ll do via 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, nicely, so reconciliation, funds, all of these items continues to be method TBD. Nonetheless, the Republican Congress is getting off to a quick begin, at the very least by way of messaging laws. The Home this week handed a invoice to ban transgender athletes from girls’s college sports activities, and the Senate’s debating a Home-passed invoice that may 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 youngsters to highschool with out being vaccinated. General, it appears the Republicans are type of coalescing round an idea often called “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 believe that it’s at all times been round, however I believe that definitely this resurgence in it’s coming from the truth that folks didn’t belief science through the pandemic. They had been fed up. Communication wasn’t dealt with very nicely, and it nonetheless isn’t dealt with very nicely. I don’t suppose folks have found out methods to discuss these items in measured methods.
I’d suggest 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: Hear, I’m a vaccine skeptic. Like, R.F.Okay. 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 believe that a number of that is stemming from misinformation and miscommunication, and it resonates with folks. I imply, the Republican Social gathering picked up a number of followers in far-left progressives by speaking about this. So I believe they see that as a possibility, too. So it could not simply be grassroots. It might be a bit of 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 concern, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to alter 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 huge obtained via. 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 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 yr of the pandemic nor the Biden administration within the ensuing years, actually managed to clarify the distinction between particular person alternative and the truth that when you get sick, you would possibly survive however you could possibly 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 may very well be actually weak. And that this entire sense of “my physique, my alternative,” doesn’t fly when you could possibly kill anyone else unintentionally. And that type 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 need to put stuff in your lungs, that’s your online business. 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 would possibly bear 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 Ailments that was for thus lengthy headed by the now retired Dr. Tony Fauci?
Raman: I believe in a component that may be a enormous driving issue, if you take a look at a few of his feedback and R.F.Okay. Jr.’s feedback about holistic approaches to well being, that basically 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 believe on the identical time, this has type of been effervescent up earlier than, once we even appeared to final yr. Earlier than we had any of those nominees, earlier than we even knew the end result of the election, we had a push inside Congress from the top of the Home Labor-H Appropriations subcommittee and former Power and Commerce Chairwoman Cathy McMorris Rodgers attempting to reform NIH that method.
We didn’t get that far with it. It was included in among the appropriations payments that didn’t go anyplace but. However I believe it’s simply a part of a broader dialogue that there’s, type of going again to what we had been saying earlier than, among 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 believe that, regardless, we’re going to see extra of this. However I believe 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 lots 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 world understanding of medical analysis, and simply how lots of the medicine 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 may have.
Rovner: And I’d level out, as a result of I stay up the road from NIH, that almost all of what NIH does doesn’t occur on the NIH campus. It’s, as you stated, it’s cash that goes out to each single congressional district. There’s an infinite quantity of backing.
I’d additionally level out that, sure, NIH has gotten type of sprawling with, I believe 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 type of made NIH the sprawl that it’s. I believe there’s been bipartisan settlement that NIH perhaps wants a brand new look.
I assume the query is simply type of what path that’s going to take and whether or not a few of it’s going to be punitive or whether or not they’re truly going to 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 very least — and perhaps Anna, who covers pharma, can inform me if I’m mistaken — however we’re not — NIH additionally does the fundamental, fundamental, fundamental mobile first-step science that finally results in the work that drug firms do to develop medicine. They do the fundamental, what they name bench, science.
I’m not listening to the drug firms communicate out. The ambivalence People have about drug firms, which is hating the costs however liking the medicine, I haven’t heard pharma — Possibly it’s simply too early. Possibly they’re weighing in quietly, and perhaps Anna can inform me I’m mistaken 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 lots of the medicine that maintain us and our aged family alive, together with a number of the positive aspects — we haven’t cured most cancers, however we’ve made positive aspects 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 this planet, and as Julie stated, an enormous driver economically of each single county, each medical college, each public well being, , it has been an financial powerhouse in addition to a information powerhouse.
Edney: And I wouldn’t inform you you’re mistaken. I believe that you simply’re proper. I haven’t heard the pharma firms speaking about it. I believe they’re speaking about a number of issues that they need performed to learn them, and so I’m certain that they’ve made their priorities. We’ll see if this reaches type 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 give attention to persistent illness. It does a number of that. So perhaps that’s not being communicated: It’s not being reduce or left off the desk as a result of we’re doing this. We will do two issues. We will 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 infinite quantity of persistent illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend a number of time, particular person members, telling NIH what it’s they need to be learning, which is a complete different challenge 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 very huge query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly advised a Bloomberg reporter that it’ll ask the Trump administration to, quote, “pause” the Medicare drug worth negotiation program, which after all 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 choice to have Medicare start masking its costly new weight reduction medicine.
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 believe, 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 must do in March. Doubtless? Potential? Will this report have any influence? Or is there simply an excessive amount of different information this week and no one’s going to recollect?
Raman: I believe it’s undoubtedly being talked about quite a bit. We talked to the management of Power 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 obtained the CR [continuing resolution] that we voted into legislation. It simply obtained dropped alongside the best way.
Rovner: When Elon Musk stated the invoice was too huge?
Raman: Yeah. So I believe we type of have two pathways, the place each of them need to get it performed regardless. I believe that it’d rely whether or not they’re able to piece it away and do it as one thing stand-alone, which they need to get it performed sooner relatively than later.
Nevertheless it relies upon a bit of bit extra on the management degree, if there are financial savings from utilizing that invoice for use later down the road once they get reconciliation at a later stage. So I believe that’s what we’re ready on. Would they should put that there? Or would they have the ability to go forth with that now?
Rovner: True. So, it’s a bipartisanly well-liked provision that additionally saves cash, in order that makes it type 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: Nicely, I believe the very first thing I consider with that program is, it saves some huge cash when you’re giving Medicare the power to barter. And so, I simply marvel how that matches into this agenda when you cease it and make it extra favorable in direction of the drugmakers. The place does that slot in with chopping spending and lowering the deficit and all of these issues?
So, I believe that, perhaps they’ve a bit of little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I believe everyone knows that we simply have to attend and see what truly occurs.
Rovner: Yeah, a number of shrug emojis coming.
Edney: Precisely.
Rovner: Nicely, 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 Reasonably priced Care Act that insurance coverage cowl, with out copay, preventive companies like immunizations, most cancers screenings, contraception, and, the topic of this specific case, treatment 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 Activity Power doesn’t have the authority to find out what companies must be on this listing? Which after all is the entity that now determines which companies must be on this listing.
Edney: Nicely, it appears like, then, lots of people don’t get their preventive care coated. As KFF wrote, there may be some that may be nonetheless coated, the mammographies, however not the HIV preventative treatment. Different most cancers screenings included in that as nicely. And so, it appears to throw a wrench, I assume, type of simply asking this of the panel, that businesses then must go make these determinations? Does Congress must make the determinations on what’s coated then?
Rovner: Nicely, that’s after all the massive query. Or, would the secretary, him or herself? Who is permitted? I believe the argument is as a result of the Preventive Well being Companies Activity Power isn’t Senate-confirmed, they’ll’t make these choices.
And naturally, the best way it really works, they don’t make these choices. They suggest them, after which the secretary type of ratifies them. So it’s laborious to inform from this whether or not it actually would go away, or whether or not Congress must step in, or whether or not the secretary may simply do it. I really feel like this creates as many questions because it may solutions.
Kenen: It’s a very broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn totally different tales about this, and so they had totally different lists, together with some ldl cholesterol stuff. And I don’t know, because the lists had been so totally different, I’m undecided precisely which of them are in or which of them had been out. Nevertheless it’s not simply HIV medicine. It’s a number of 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 when you get protection via a job, these necessities additionally apply. So, lots of people would now not have free entry to a number of what we think about preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They simply determined to take it. So, this might be a later in 2025 case. Nicely, 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 may very well be pretty simply undone by incoming officers, however not with out some public ache, which generally is why administrations wait till the final minute to do them, to be a bit of passive aggressive, or perhaps in a few of these instances quite a bit passive aggressive. A number of of those last-minute adjustments come from the Meals and Drug Administration, an company focused for large adjustments below Trump 2.0.
In simply the final 48 hours, the FDA has introduced a coverage that may require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Pink 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 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 stay on for greater than one other week?
Edney: I believe the Pink No. 3 may. We all know that R.F.Okay. Jr.’s talked about meals dyes and eager to get them out of, he particularly stated, cereal, however they’re in a number of issues. So, I see that one.
I believe the business noticed that coming from far-off and has been switching already, after all generally to a different problematic, doubtlessly, meals coloring. However I don’t suppose that is one thing you’re going to see them struggle tremendous laborious for to alter. The nicotine is far 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, type of, we will select what we put in our our bodies. If we need to be hooked on nicotine, that’s our alternative. So, the opposite one, the labels, I’m undecided. They’re not notably highly effective or something. I believed they appeared … After I checked out it, I used to be like, That is complicated and simply appears to be like just like the again, however it’s a little totally different. So, I don’t know. Possibly it survives. I’m undecided how a lot the business 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 mainly one other effort to go after ultra-processed meals. I used to be stunned at how indignant he was at this.
Kenen: I believe he desires them in neon.
Rovner: I believe he desires R.F.Okay. Jr. to have fewer ultra-processed meals accessible. I believe that’s going to be type of the massive takeaway from all of this, I assume.
Kenen: Proper. However we additionally don’t perceive what an ultra-processed meals is, as a result of there’s some meals that aren’t ultra-processed which are dangerous for you. And there’s some meals that do have some type 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 basically aren’t that processed, don’t have a number of 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 very nutritious diet and that meals components … R.F.Okay. Jr. has identified to the meals additive, the place the businesses must get to self-certify, Yeah, that is secure. So, is that one thing that he may 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.Okay. Jr. might 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 Higher Los Angeles space. We now have talked concerning the well being results of fireside 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 are burning however plenty of poisonous substances which are polluting not simply the air but additionally the consuming water.
Are we going to have to start out serious about hearth and well being in a a lot totally different method if not simply distant areas however total suburbs are actually susceptible to burning up on account of our altering local weather?
Edney: It can make us consider a number of issues in several 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 believe the expectation is that may create a long-term challenge, but additionally it could possibly 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 drawback or a coronary heart drawback that may be exacerbated by these fires.
Yeah, I believe there’s a ton to consider. Even consuming water will be impacted extra so when you’ve got energy outages and issues within the areas the place you’re perhaps cleansing that water after which issues like that. So, I believe that’s going to be — masks, N95s is likely to be coming again for a very totally different cause.
Rovner: Nicely, N95s should not sufficient. I imply, I believe that was the factor that type 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 appeared like old-style gasoline masks. I imply, you want type of the following 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 kind of the particular smoke from wooden and whatnot, nevertheless it’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 believe it was the one that you simply despatched round yesterday that mainly that every little thing in our home is, our couches are mainly cubes of plastic wrapped in material and harmful once they’re burned. However I imply, I believe that was the article that additionally stated that a few of these issues which are burning produce like a cyanide type 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 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 wanted. Nicely, turning to abortion, keep in mind all these states final yr that voted to guard abortion rights? Evidently 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 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 the entire state’s restrictions.
This appears to be the inevitable results of what we now 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 function or by chance? And Sandhya, what’s going to occur?
Raman: I don’t know that it could be on function. I believe that these voters that vote for the candidates, if abortion isn’t their high challenge, they’re nonetheless going to vote in the best way that type of allies with them. However then in the event that they’re taking a look at different insurance policies, they’re going to vote for these candidates.
And Missouri, I believe, is fascinating as a result of it has lengthy been, I believe, one of many take a look at instances for a lot within the abortion house, of attempting out new restrictions and what’s going to stick with the wall. And I believe that we’re going to see extra of those type of lengthy, drawn-out battles, provided that the decide stated that some restrictions had been struck down due to the constitutional modification however then others, just like the licensing for abortion services, 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 extensive the hallways must be, I imply, guidelines that had been created to discourage them from providing abortions, not as a result of they had been truly wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion services. They’re not parallel within the different kinds of clinics and hospitals. So it’s focused to them. I believe it’s simply one other instance of it being type 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 may get nationwide consideration for one state or one other.
However, provided that, as they’re type of litigating these and seeing how can we implement the legislation in order that these clinics can open below 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’ll type of function. So I believe that’s one thing to undoubtedly watch, as a few of these states are type of litigating these items, nevertheless 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 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. Nicely, lastly this week, we now have one other entry in our recurring phase, “This Week in Medical Misinformation.” I needed to speak about a little-noted story from the medical information web site MedPage Immediately 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 hundreds of individuals.
What’s troublesome about this story, although, is that the ABIM wouldn’t touch upon particular person physicians, though it did listing this specific physician on his web site as not being licensed. How ought to specialty boards take care of docs who specific views which are, shall we embrace, not in keeping with medical proof? And the way clear ought to they be about telling sufferers once they sanction certainly one of their very own, which is mainly what occurred right here?
Kenen: Nicely, they did put out an announcement, I believe it was the New England Journal of Drugs a couple of yr and a half in the past, saying that they had 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 an enormous can of worms about decertification and the way occasionally it occurs.
So ABIM did put out an announcement, I believe 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 except the state medical board, which is basically the group that pulls a license — that is saying that you simply’re not a board-certified no matter your specialty is below ABIM.
However Lauren [Weber of The Washington Post], who is usually on the web site, had a superb 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 occupation doesn’t do a number of self-policing.
Rovner: Sure, and I’ve been doing this lengthy sufficient to have coated the creation of the Nationwide Practitioner Knowledge Financial institution, when docs who’d had their licenses pulled may 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 normally 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’d suppose they might be the other. You’d suppose that the state boards, when anyone can be a dangerous man or a foul gal, you’d suppose they might say, “We cease them!” Like, “We’re defending your well being.” And as a substitute, it’s been very secretive and really rare.
It’s extra the state licensing board. I imply, certification is 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 newest KFF Well being Information “Invoice of the Month.” Harris, welcome to “What the Well being?”
Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you.
Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he obtained.
Meyer: OK, Julie, it is 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 guide who lives in Chicago. Final spring, Tom seen 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 an enormous 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 as a result of a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for folks with no signs, which are speculated to be free as preventive care below the Reasonably priced Care Act. Diagnostic colonoscopies like this one can require a affected person to satisfy deductible and copay necessities, proper? That’s one thing necessary for folks to know?
Meyer: Sure. There’s a number of confusion about this. I obtained a number of feedback on my Washington Submit article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are performed when there are signs like bleeding or ache. In distinction, screening colonoscopies are really helpful beginning at age 45, even when there are not any signs, to forestall colon most cancers or different critical circumstances.
The Reasonably priced Care Act requires well being insurers to cowl screening colonoscopies for gratis to sufferers. However for a diagnostic colonoscopy, sufferers might must 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 had been taken care of, after which, as we are saying, the invoice got here. How a lot was it?
Meyer: Yeah, Northwestern’s complete cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated fee with Northwestern of a nonetheless important about $6,000. When he obtained 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 complete and he was advised that he would owe about $2,400. My outdoors billing skilled stated $4,100 is sort of a excessive out-of-pocket invoice, although common for instructing hospitals.
Rovner: And he was charged for 2 colonoscopies, proper?
Meyer: Sure. That was a significant cause 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 alternative 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 relatively than one.
Rovner: Which, as you identified initially, it’s not like it is a several-hour surgical procedure. It is a pretty fast process.
Meyer: That’s proper. It’s at most an hour, typically lower than that.
Rovner: So what occurred finally with the invoice?
Meyer: Nicely, Tom appealed the invoice to Northwestern and Aetna and was advised that it was appropriate. He had already paid about $2,400 of the almost $4,100 he owed, however he advised Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they might take him to collections.
Northwestern stated that’s what they had been going to do, and Tom determined to now not use Northwestern or its 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 nice, and — I received’t repeat among the issues that he stated to them.
Rovner: Thanks. It is a household podcast. How can others keep away from falling into this lure? I imply, he obtained an estimate. He had an thought 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 guide, however lots of people get confused by this course of, together with him taken abruptly. He solely appeared on the estimate after he had had the process however earlier than he obtained the ultimate invoice. So, like lots of people, he obtained confused and he didn’t proceed essentially as effectively as he may need. However that’s widespread and never stunning.
Rovner: Even for anyone who’s mainly within the well being care fee enterprise.
Meyer: Sure, that’s appropriate.
Rovner: So be vigilant. Is that mainly the takeaway?
Meyer: Nicely, how will you keep away from falling in the identical lure? Sadly, not simply. Sufferers needing a diagnostic colonoscopy ought to take a look at freestanding endoscopy facilities or ambulatory surgical procedure facilities that aren’t related to a hospital, as a result of they are often cheaper and so they can present good high quality of care.
To cost-shop forward of time, sufferers can 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 may price. Additionally they can lookup 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, relatively than going via insurance coverage.
Plus, there are free web sites corresponding 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 consists of the additional companies, if the gastroenterologist finds and has to take away and biopsy a number of polyps. No less than 40% of colonoscopies do discover polyps.
Now, specialists 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 phase. That’s the place we every acknowledge the story we learn this week we expect 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 cellular system. Anna, why don’t you go first this week?
Edney: I needed to speak about one I wrote final month, and the headline is “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles.” I type of needed to place in a single place speaking about a number of these contamination points which have come up, however notably additionally simply present that, whereas the issues with merchandise continue to grow — certainly one of them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting type of slower on a number of these items. They’re digging in, and so they’re not attempting to speak to the general public concerning the points which have come up. They’ve had since final March of 2024 issues delivered to them about benzene and zits merchandise.
They’ve stated nothing to the general public. They simply maintain saying, We’re taking a look at it. And that’s very totally different from when this primary type of began occurring on a bigger scale, the place it was like, increase, recollects. Now it’s simply type of this struggle to perhaps not have recollects. I don’t know what’s happening of their head.
However there are also some points in there with the tampons had been discovered to comprise a number of heavy metals, FDA additionally slow-walking there. So I needed to level out that piece I wrote if anyone missed it.
Rovner: Sure. Thanks, Anna, on the “every little thing you thought is likely to be secure is definitely harmful” beat.
Edney: I’m the life of each get together.
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. Nicely, 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 Method to Struggle Off Abdomen Bugs,” and the reply is wash your fingers with cleaning soap.
Nevertheless it’s a very well-written — it truly 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 known as “New weight problems definition sidelines BMI to give attention to 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 further physique fats however their organs are nonetheless functioning usually, and scientific weight problems, so when you’ve got that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply alternative ways clinicians are taking a look at this globally.
Rovner: Yeah, it’s actually fascinating as a result of, clearly, each physician says that BMI is a silly and imprecise option to measure this, after which all people makes use of BMI as a result of, in the meanwhile, it’s all we now have. My further credit score this week is a KFF Well being Information story from Felice Freyer. It’s referred to as “Can Medical Faculties Funnel Extra Docs into the Main Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened plenty of new medical faculties over the previous decade and has launched a raft of applications geared toward getting extra graduating docs to enter major care, method too many are nonetheless pursuing specialty care as a substitute. We now have tried, as a society, free tuition and mortgage reimbursement applications, nevertheless it doesn’t appear that medical training debt is the most important drawback.
We’ve additionally tried coaching docs in additional primary-care-centric areas, i.e. in group clinics relatively than in hospitals, however that’s not made an enormous dent, both. Slightly, to cite one of many household drugs specialists within the story: “It’s not the medical faculties which are the issue; it’s the job. The job is simply too poisonous.”
In different phrases, it’s probably not interesting to see too many sufferers for too little time and do tons of combating with insurance coverage firms and digital medical data. Till we as a society begin making major care much more of a satisfying job, it’s not going to matter how a lot it pays. We’re nonetheless going to have a critical scarcity.
All proper, that’s this week’s present. As at all times, when you benefit from the podcast, you may subscribe wherever you get your podcasts. We’d admire it when you left us a evaluation. That helps different folks discover us, too. Particular thanks once more this week to our short-term manufacturing staff, Taylor Prepare dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As at all times, you may electronic mail us your feedback or questions. We’re at whatthehealth@kff.org, or you may nonetheless discover me sometimes at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out today? Anna?
Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social.
Rovner: Joanne.
Kenen: I’m on Bluesky, @joannekenen.bsky.social, very sometimes on X nonetheless, @JoanneKenen.
Rovner: Sandhya.
Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social.
Rovner: We might be again in your feed subsequent week. Till then, be wholesome.
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Lonnie Ro
Audio producer
Emmarie Huetteman
Editor
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