The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly well being coverage information podcast, “What the Health?” A famous knowledgeable on well being coverage points, Julie is the writer of the critically praised reference guide “Health Care Politics and Policy A to Z,” now in its third version.
The Biden administration continued a bipartisan, decades-long effort to make sure that medical health insurance treats psychological diseases the identical as different illnesses, with a brand new set of laws geared toward guaranteeing that providers are literally out there with out years-long waits or extreme out-of-pocket prices.
Meanwhile, two extra committees in Congress permitted payments this week geared toward reining within the energy of pharmacy profit managers, who’re accused of protecting prescription drug costs excessive to extend their backside traces.
This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sarah Karlin-Smith of the Pink Sheet.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico
Sarah Karlin-Smith
Pink Sheet
Among the takeaways from this week’s episode:
- The Biden administration’s new guidelines to implement federal psychological well being parity necessities embrace no menace of sanctions when well being plans don’t comply; noncompliance with even probably the most minimal federal guidelines has been an issue courting to the Nineties. Improving entry to psychological well being care will not be a brand new coverage precedence, nor a partisan one, but it stays troublesome to attain.
- With the anniversary of the 988 Suicide & Crisis Lifeline, extra individuals are changing into conscious of learn how to entry assist and get it. Challenges stay, nevertheless, such because the hotline service’s lack of ability to attach callers with native care. But this system seizes on the ability of an preliminary connection for somebody in a second of disaster and gives a lifeline for a nation experiencing excessive charges of melancholy, anxiousness, and suicide.
- In information concerning the so-called Medicaid unwinding, 12 states have paused disenrollment efforts amid issues they don’t seem to be following renewal necessities. A significant consideration is that the majority people who find themselves disenrolled would qualify to acquire cheap and even free protection via the Affordable Care Act. But reenrollment could be difficult, significantly for these with language obstacles or housing insecurity, as an example.
- With a flurry of committee exercise, Congress is revving as much as cross laws by 12 months’s finish concentrating on the position of pharmacy profit managers — and, based mostly on the commercials blanketing Washington, PBMs are nervous. It seems laws would enhance transparency and inform policymakers as they ponder additional, extra substantive modifications. That could possibly be a tricky promote to a public crying out for reduction from excessive well being care prices.
- Also on Capitol Hill, far-right lawmakers are pushing to insert abortion restrictions into annual authorities spending payments, threatening one more authorities shutdown on Oct. 1. The challenge is inflicting heartburn for much less conservative Republicans who don’t need extra abortion votes forward of their reelection campaigns.
- And the injury to a Pfizer storage facility by a twister is amplifying issues about drug shortages. After troubling issues with a manufacturing unit in India triggered shortages of vital most cancers medicine, decision-makers in Washington have been maintaining a tally of the rising points, and a response could also be brewing.
Also this week, Rovner interviews KFF Health News’ Céline Gounder concerning the new season of her “Epidemic” podcast. This season chronicles the profitable public well being effort to eradicate smallpox.
Plus, for “extra credit,” the panelists recommend well being coverage tales they learn this week that they suppose it is best to learn, too:
Julie Rovner: The Nation’s “The Anti-Abortion Movement Gets a Dose of Post-Roe Reality,” by Amy Littlefield.
Joanne Kenen: Food & Environment Reporting Network’s “Can Biden’s Climate-Smart Agriculture Program Live Up to the Hype?” by Gabriel Popkin.
Anna Edney: Bloomberg’s “Mineral Sunscreens Have Potential Hidden Dangers, Too,” by Anna Edney.
Sarah Karlin-Smith: CNN’s “They Took Blockbuster Drugs for Weight Loss and Diabetes. Now Their Stomachs Are Paralyzed,” by Brenda Goodman.
Also talked about on this week’s episode:
click on to open the transcript
Transcript: Another Try for Mental Health ‘Parity’
KFF Health News’ ‘What the Health?’Episode Title: Another Try for Mental Health ‘Parity’Episode Number: 307Published: July 27, 2023
[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]
Julie Rovner: Hello and welcome again to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by a few of the greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, July 27, 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. We are joined in the present day through video convention by Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.
Joanne Kenen: Hi, everyone.
Rovner: Sarah Karlin-Smith, the Pink Sheet.
Sarah Karlin-Smith: Hi, Julie.
Rovner: And Anna Edney of Bloomberg News.
Edney: Hello.
Rovner: Later on this episode, we’ll have my interview with my KFF colleague Céline Gounder concerning the new season of her podcast “Epidemic,” which tracks one of many final nice public well being success tales, the eradication of smallpox. But first, this week’s information. I need to begin this week with psychological well being, which we haven’t talked about shortly — particularly, psychological well being parity, which is each a legislation and an idea, that psychological illnesses needs to be coated and reimbursed by medical health insurance the identical manner as a damaged bone or case of pneumonia or another — air quotes — “physical ailment.” Policymakers, Republican and Democrat, and the psychological well being neighborhood have been preventing just about nonstop for the reason that mid-Nineties to require parity. And regardless of a minimum of 5 separate acts of Congress over that point — I appeared it up this week — we’re nonetheless not there but. To today, sufferers with psychiatric diseases discover their care denied reimbursement, made troublesome to entry, or in any other case handled as lesser. This week, the Biden administration is taking one other whack on the challenge, placing out proposed guidelines it hopes will begin to shut the remaining parity hole, amongst different issues by requiring well being plans to investigate their networks and prior authorization guidelines and different potential obstacles to care to make sure that members really can get the care they want. What I didn’t see within the guidelines, although, was any new menace to sanction plans that don’t comply — as a result of plans have been not complying for a few many years now. How a lot may these new guidelines assist in the absence of a few multimillion-dollar fines?
Edney: I had that very same query once I was contemplating this as a result of I didn’t see like, OK, like, nice, they’re going to do their self-policing, after which what? But I do suppose that there’s the chance, and this has been utilized in well being care earlier than, of public shaming. If the administration will get to look over this knowledge and not directly compile it and say, right here’s the nice guys, right here’s the dangerous guys, perhaps that will get us someplace.
Rovner: You know, it strikes me, this has been occurring for thus very lengthy. I imply, at first it was the employer neighborhood really that did many of the negotiating, not the insurers. Now that it’s required, it’s the insurers who’re answerable for it. But it has been simply this unbelievable mountain to scale, and no person has been capable of do it but.
Kenen: And it’s at all times been bipartisan.
Rovner: That’s proper.
Kenen: And it actually goes again to largely, you realize, the late Sen. [Paul] Wellstone [(D-Minn.)] and [Sen. Pete] Domenici [(R-N.M.)], each of whom had shut relations with critical psychological sickness. You know, Domenici was pretty conservative and conventional conservative, and Wellstone was extraordinarily liberal. And they simply mentioned, I imply, this — the parity transfer started — the unique parity laws, a minimum of the primary one I’m conscious of. And it was like, I feel it was earlier than I got here to Washington. I feel it was within the ’80s, definitely the early — by the ’90s.
Rovner: It was 1996 when when the primary one really handed. Yeah.
Kenen: I imply, they began speaking about it earlier than that as a result of it took them seven or eight years. So this isn’t a brand new thought, and it’s not a partisan thought, and it’s nonetheless not completed. It’s nonetheless not there.
Edney: I feel there’s some societal shift too, presumably. I imply, we’re seeing it, and perhaps we’re getting nearer. I’ve seen loads of billboards currently. I’ve completed some work journey. When I’m on the street, I really feel like I’m at all times seeing these billboards which might be saying psychological well being care is well being care. And attempting to hammer that via has actually taken a very long time.
Rovner: So whereas we’re with reference to psychological well being, one of many good issues I feel the federal government has completed within the final 12 months is begin the 988 Suicide & Crisis Lifeline, which turned 1 this month. Early knowledge from shifting the hotline from a 10-digit quantity to a three-digit one which’s rather a lot simpler to recollect does recommend that extra individuals are changing into conscious of instant assist and extra individuals are getting it. At the identical time, it’s been capable of sustain with the demand, even enhancing name answering occasions — I do know that was a giant concern — however there’s nonetheless a protracted approach to go, and that is hardly a panacea for what we all know is an ongoing psychological well being disaster, proper?
Karlin-Smith: This is an efficient first step to get folks in disaster assist with out a few of the dangers that we’ve seen. If you go in direction of the 911 route, generally police aren’t properly educated to deal with these calls and so they finish in worse outcomes than needed. But then you must have that second half, which is what we had been speaking about earlier than, which is the entry to the longer-term psychological well being assist to really obtain the remedy you want. There’s additionally some points with this hotline going ahead by way of long-term funding and, you realize, different tweaks they should work out to ensure, once more, that people who find themselves not anticipating to work together with legislation enforcement really don’t find yourself not directly getting there and issues like that as properly.
Kenen: Do any of you realize whether or not there’s dialogue of form of making individuals who don’t keep in mind it’s 988 and so they name 911 — as an alternative of dispatching cops, are the dispatchers being educated to simply switch it over to 988?
Rovner: That I don’t know.
Kenen: I’m not conscious of that. But it simply form of appears widespread sense.
Rovner: One factor I do know they’re engaged on is, proper now I feel there’s no geolocation. So whenever you name 988, you don’t essentially get routinely referred to assets which might be in your neighborhood as a result of they don’t essentially know the place you’re calling from. And I do know that’s an effort. But yeah, I’m certain there both is or goes to be some effort to work together between 988 and 911.
Kenen: It’s widespread sense to us. It doesn’t imply it’s really taking place. I imply, that is well being care.
Rovner: As we level out, that is psychological well being care, too.
Kenen: Yeah, proper.
Rovner: It’s a step.
Kenen: But I feel that, you realize, form of the ability of that preliminary connection is one thing that’s straightforward for folks to underestimate. I imply, my son in faculty was doing a helpline throughout 2020-2021. You know, he was educated, and he was additionally educated, like, in the event you suppose that is past what a college-aged volunteer, that in the event you’re unsure, you simply switched instantly to a psychological well being skilled. But generally it’s simply, folks really feel actually dangerous and simply having a voice will get them via a disaster second. And as everyone knows, there are lots of people having loads of disaster moments. I doubt any of us don’t know of a suicide within the final 12 months, and perhaps not in our instant circle, however a buddy of a buddy, I imply, or, you realize — I do know a number of. You know, we’re actually at a second of utmost disaster. And if a telephone name can assist some proportion of these folks, then, you realize, it must be publicized much more and improved so it may be greater than a pleasant voice, plus a connection to what, ending this repetition of disaster.
Rovner: I really feel just like the individuals who labored onerous to get this applied are fairly joyful a 12 months later at how, you realize — clearly there’s additional to go — however they’re proud of how far they’ve come. Well, so, most likely the one factor worse than not getting care coated that needs to be is shedding your well being protection altogether, which brings us to the Medicaid unwinding, as states redetermine who’s nonetheless eligible for Medicaid for the primary time for the reason that begin of the pandemic. Our podcast colleague Tami Luhby over at CNN had a narrative Friday that I nonetheless haven’t seen anyplace else. Apparently 12 states have put their disenrollments on pause, says Tami. But we don’t know which 12, in accordance with the KFF disenrollment tracker. As of Wednesday, July 26, a minimum of 3.7 million folks have been disenrolled from the 37 states which might be reporting publicly, practically three-quarters of these folks for, quote, “procedural reasons,” that means these folks may nonetheless be eligible however for some motive didn’t full the renewal course of. The dozen states on pause are apparently ones that HHS [the Department of Health and Human Services] thinks aren’t following the renewal necessities and presumably ones whose disenrollments are out of line. The Centers for Medicare & Medicaid Services, which is overseeing this, will not be naming these states, however this factors up precisely what lots of people predicted would occur when states began taking a look at eligibility once more, that lots of people who had been fairly seemingly nonetheless eligible had been merely going to lose their insurance coverage altogether, proper?
Edney: Yeah, it appeared like there was loads of preparation in some methods to anticipating this. And then, yeah, clearly you had the states that had been simply raring to go and attempt to get folks off the rolls. And yeah, it could be very fascinating to know what these 12 are. I feel Tami’s reporting was stellar and he or she did a extremely good job. But that’s, like, one piece of the puzzle we’re lacking. And I do know CMS mentioned that they’re not naming them as a result of they’re working properly with them to attempt to repair it.
Rovner: The one factor we clearly do know is that there are a number of states which might be doing this quicker than is required — in reality, quicker than is advisable. And what we all know is that the quicker they do it, the extra seemingly they’ll have folks form of fall between the cracks. The people who find themselves decided to be now not eligible for Medicaid are speculated to be guided to packages for which they’re eligible. And presumably most of them, until they’ve, you realize, gotten a extremely nice job or hit the lottery, will nonetheless be eligible a minimum of for subsidies underneath the Affordable Care Act. And they’re speculated to be guided to these packages. And it’s not clear but whether or not that’s taking place, though I do know there are an terrible lot of people who find themselves watching this beautiful intently. There had been over 90 million folks on Medicaid by the tip of the pandemic, by the purpose at which states now not needed to preserve folks on. That’s much more folks than Medicaid usually has. It’s normally extra round 70 and even 80 million. So there’s extra folks. And the query is what’s going to occur to these folks and whether or not they’re going to have some form of medical health insurance. And I assume it’s going to be greater than a few months earlier than we all know that. Yes, Joanne.
Kenen: I feel that it’s vital to do not forget that there’s no open enrollment season for Medicaid the best way there’s for the ACA, in order that in the event you’re disenrolled and also you get sick and also you go to a physician or a hospital, they will requalify you and you will get it once more. The drawback is individuals who suppose that they’re disenrolled or are informed that they’re disenrolled could not notice. They could not go to the physician as a result of they suppose they will’t afford it. They could not perceive there’s a public training marketing campaign there, too, that I haven’t seen. You know, in the event you get neighborhood well being clinics, hospitals, they will do Medicare, Medicaid certification. But it’s harmful, proper? If you suppose, oh, I’m going to get a invoice I can’t afford and I’m simply going to see if I can robust this out, that’s not the best way to maintain your well being. So there’s that further conundrum. And then, you realize, I feel that HHS could be versatile on particular enrollment intervals for individuals who aren’t Medicaid-eligible and are ACA-eligible, however most of them are nonetheless Medicaid-eligible.
Rovner: If you get kicked off of Medicaid, you get an automated particular enrollment for the ACA anyway.
Kenen: But not ceaselessly. If the difficulty is it’s in a language you don’t converse or at an handle you don’t stay in, otherwise you simply threw it out since you didn’t perceive what it was — there’s institutional failures within the well being care system, after which there’s folks have completely different addresses in three years, significantly poor folks; they transfer round. There’s a communication hole. You know, I talked to a well being care system some time in the past in Indiana, a security web, that was going via digital well being data and contacting folks. And but that’s Indiana and so they, you realize, I feel it was Tami who identified just a few weeks in the past on the podcast, Indiana will not be doing nice, despite, you realize, actually extra of a concerted effort than different states or a minimum of different well being programs, not that I speak to each single well being system within the nation. I used to be actually impressed with how proactive they had been being. And nonetheless individuals are falling, not simply via the cracks. I imply, there’s simply tons of cracks. It’s like, you realize, this entire panorama of cracks.
Rovner: I feel everyone knew this was going to be a giant enterprise. And clearly the states which might be attempting to do it with some care are having issues as a result of it’s a giant enterprise. And the states which might be doing it with just a little bit much less care are throwing much more folks off of their medical health insurance. And we’ll proceed to comply with this. So it’s the finish of July. I’m nonetheless undecided how that occurred.
Kenen: ’Cause after June, Julie.
Rovner: Yes. Thank you. July is usually when committees in Congress rush to mark up payments that they hope to get to the ground and presumably to the president in that temporary interval when lawmakers return from the August recess earlier than they exit for the 12 months, normally round Thanksgiving. This 12 months is clearly no exception. While Sen. Bernie Sanders [(I-Vt.)] on the Health, Education, Labor and Pensions Committee has delayed consideration of that main care-community well being heart invoice that we talked about final week till September, after Republicans rebelled in opposition to what was speculated to have been a bipartisan invoice, committee motion on pharmacy profit managers and different Medicare points did happen yesterday within the Senate Finance Committee and the House Ways and Means Committee. Sarah, you’re following this, proper? What’s taking place? And I imply, so we’ve now had mainly all 4 of the committees which have some sort of jurisdiction over this who’ve acted. Is one thing going to occur on PBM regulation this 12 months?
Karlin-Smith: Actually, 5 committees have acted as a result of the House Ed[ucation] and Workforce Committee has additionally acted on the subject. So there’s loads of committees with a stake on this. I feel there’s definitely arrange for one thing for the autumn, finish of the 12 months, to occur within the pharmacy profit supervisor area. And there’s a good quantity of bipartisanship across the challenge, relying on precisely which committee you’re taking a look at. But even when the insurance policies that haven’t gotten via haven’t been bipartisan, I feel there’s normal bipartisan curiosity amongst all of the committees of tackling the difficulty. The query is how significant, I assume, the insurance policies that we get completed are. Right now it seems like what we’re going to finish up with is a few sort of transparency measure. It jogged my memory just a little little bit of our dialogue of the psychological well being stuff [President Joe] Biden is doing going ahead. Essentially what it’s going to finish up doing is get the federal government loads of detailed knowledge about how PBMs function, how this vertical integration of PBMs — so there’s loads of widespread possession between PBMs, medical health insurance plans, pharmacies and so forth — could also be impacting the price of our well being care and maybe in a unfavourable manner. And then from that time, the thought can be that later Congress might return and really do the form of coverage reforms that may be wanted. So I do know there are some folks which might be tremendous enthusiastic about this transparency as a result of it’s such an opaque trade. But on the identical level, you possibly can’t sort of go to your constituents and say, “We’ve changed something,” immediately or, you realize, “We’re going to save you a ton of money with this kind of legislation.”
Rovner: You might inform how anxious the PBMs are by how a lot promoting you see, in the event you nonetheless watch TV that has promoting, which I do, as a result of I watch cable information. I imply, the PBMs are clearly anxious about what Congress may do. And given the truth that, as you level out and as we’ve been saying for years, drug costs are a really bipartisan challenge — and it’s sort of shocking, like psychological well being, it’s bipartisan, and so they nonetheless haven’t been capable of push this so far as I feel each Democrats and Republicans would really like for it to go. Is there something in these payments that stunned you, that goes additional than you anticipated or much less far than anticipated?
Karlin-Smith: There’s been efforts to form of delink PBM compensation from rebates. And up to now, when Congress has tried to look into doing this, it’s ended up being extraordinarily pricey to the federal government. And they found out on this set of insurance policies form of how to do that with out these prices, which is mainly, they’re ensuring that the PBMs don’t have this perverse incentive to generate profits off of higher-priced medicine. However, the well being plans are nonetheless going to have the ability to do this. So it’s not clear how a lot of a profit this may actually be, as a result of at this level, the well being plans and the PBMs are basically one and the identical. They have the identical possession. But, you realize, I do suppose there was some sort of creativity and thoughtfulness on Congress’ a part of, OK, how will we deal with this with out additionally really growing how a lot the federal government spends? Because the federal government helps assist loads of the premiums in these medical health insurance packages.
Rovner: Yeah. So the federal government has fairly a fairly a monetary stake in how this all seems. All proper. Well, we will certainly watch that area intently. Let us transfer on to abortion. In addition to it being markup season for payments like PBMs, it’s additionally appropriations season on Capitol Hill, with the Sept. 30 deadline looming for a completion of the 12 annual spending payments. Otherwise, massive elements of the federal government shut down, which now we have seen earlier than in recent times. And regardless that Democrats and Republicans thought they’d a spending detente with the approval earlier this spring of laws to raise the nation’s debt ceiling, Republicans within the House produce other concepts; they not solely need to lower spending even additional than the degrees agreed to within the debt ceiling invoice, however they need to add abortion and different social coverage riders to a protracted record of spending payments, together with not simply the one for the Department of Health and Human Services however the one for the Food and Drug Administration, which is within the agriculture appropriations, for causes I’ve by no means fairly decided; the monetary providers invoice, which incorporates funding for abortion within the federal medical health insurance plan for presidency staff; and the spending invoice for Washington, D.C., which needs to make use of its personal taxpayer cash for abortion, and Congress has been making that unlawful just about for many years. In addition to abortion bans, conservatives need riders to ban gender-affirming care and even bar the FDA from banning menthol cigarettes. So it’s not simply abortion. It’s actually a protracted record of social points. Now, that is nothing new. A half a dozen spending payments have carried a Hyde [Amendment] kind of abortion ban language for many years, as neither Republicans nor Democrats have had the votes to both broaden or take away the prevailing restrictions. On the opposite hand, these conservatives pushing all these new riders don’t appear to care if the federal government shuts down if these payments cross. And that’s one thing new, proper?
Kenen: Over abortion it’s one thing new, however they haven’t cared. I imply, they’ve shut down the federal government earlier than.
Rovner: That’s true. The final time was over Obamacare.
Kenen: Right. And, which, the nice irony is the one factor they — after they shut down the federal government as a result of Obamacare was obligatory, not simply discretionary funding, Obamacare went forward anyway. So, I imply, minor particulars, however I feel that is most likely going to be an annual battle to any extent further. It relies upon how onerous they struggle for the way lengthy. And with a few of these very conservative, ultra-conservative lawmakers, we’ve seen them dig in on abortion, on different points just like the protection appointees. So I feel it’s going to be a messy October.
Rovner: Yeah, I went again and pulled a few of my outdated clips. In the early Nineties I used to actually preserve a spreadsheet, and I feel that’s earlier than we had Excel, of which invoice, which of the appropriations payments had abortion language and what the standing was of the fights, as a result of they had been the identical fights 12 months after 12 months after 12 months. And as I mentioned, they sort of reached a rapprochement at one level, or not even a rapprochement — neither aspect might transfer what was already there. At some level, they sort of stopped attempting, though now we have seen liberals the previous few years attempt to make a run on the precise, the unique Hyde Amendment that bans federal funding for many abortions — that’s within the HHS invoice — and unsuccessfully. They haven’t had the votes to try this. Presumably, Republicans don’t have the votes now to get any of those — a minimum of definitely not within the Senate — to get any of those new riders in. But as we level out, they might positively preserve the federal government closed for some time over it. I imply, within the Clinton administration, President [Bill] Clinton really needed to swallow a bunch of recent riders as a result of both it was that or preserve the federal government closed. So that’s sort of how they’ve gotten in there, is that one aspect has form of pushed the opposite to the brink. You know, everyone appears to imagine at this level that we’re cruising in direction of a shutdown on Oct. 1. Does anyone suppose that we’re not?
Kenen: I imply, I’m not on the Hill anymore, however I definitely count on a shutdown. I don’t understand how lengthy it lasts or the way you resolve it. And I — much more sure we’ll have one subsequent 12 months, which, the identical points shall be scorching buttons 5 weeks earlier than the elections. So no matter occurs this 12 months is prone to be much more intense subsequent 12 months, though, you realize, subsequent 12 months’s distant and the information cycle’s about seven seconds. So, you realize, I feel this could possibly be an annual struggle and for a while to come back, and a few years shall be extra intense than others. And you possibly can create a deal about one thing else. And, you realize, the House moderates are — there aren’t many moderates — however they’re form of extra conventional conservatives. And there’s a cut up within the Republican Party within the House, and we don’t know who’s going to fold when, and we don’t — we haven’t had this type of a showdown. So we don’t actually understand how lengthy the House will maintain out, as a result of a few of the extra reasonable lawmakers who’re — they’re all up for reelection subsequent 12 months. I imply, a few of them don’t agree. Some of aren’t as all or nothing on abortion because the —
Rovner: Well, there are what, a dozen and a half Republicans who’re in districts that President Biden received who don’t need to vote on any of these items and have made it pretty clear to their management that they don’t need to vote on any of these items. But clearly the conservatives do.
Kenen: And they’ve been public about that. They’ve mentioned it. I imply, we’re not guessing. Some of them spoke up and mentioned, you realize, go away it to the states. And that’s what the courtroom determined. And they don’t need to nationalize this even additional than it’s nationalized. And I feel, you realize, when you may have the Freedom Caucus taking out Marjorie Taylor Greene, I imply, I don’t know what’s subsequent.
Rovner: Yeah, issues are odd. Well, I need to point out another abortion story this week that I learn within the e-newsletter “Abortion, Every Day,” by Jessica Valenti. And shoutout right here: If you’re on this challenge and also you don’t subscribe, you’re lacking out. I’ll embrace the hyperlink within the present notes. The story’s about Texas and the examination to change into a board-certified obstetrician-gynecologist. The board that conducts the examination is predicated in Dallas and has been for many years, and Texas is historically the place this check has been administered. During the pandemic, the examination was given nearly as a result of nothing was actually in individual. But this 12 months, if a physician needs to change into board-certified, she or he must journey to Texas this fall. And loads of OB-GYNs don’t need to do this, for pretty apparent causes, like they’re afraid of getting arrested and despatched to jail due to Texas’ excessive anti-abortion legal guidelines. And yikes, actually, this doesn’t appear to be an insignificant authorized threat right here for docs who’ve been performing abortions in different states. This is sort of the dilemma, isn’t it?
Karlin-Smith: Well, the opposite factor I assumed was fascinating about — learn a part of that piece — is simply, she was declaring that you just may not simply need to promote in a state the place lots of people are anti-abortion that each one of those individuals who carry out abortions are all going to be on the identical place on the identical time. So it’s not simply that they’re going to be in Texas. Like, if anyone needs to go after them, they know precisely the place they’re. So it could actually create, if nothing else, similar to a chance for giant demonstrations or interactions that may disrupt sort of the traditional move of the exam-taking.
Kenen: Or violence. Most people who find themselves anti-abortion are clearly not violent, however now we have seen political violence on this nation earlier than. And you simply want one individual, which, you realize, we appear to have loads of people who find themselves prepared to shoot at different folks. I assumed it was a wonderful piece. I imply, I had not come throughout that earlier than till you despatched it round, and there’s an answer — you realize, like, in the event you did it nearly earlier than — and I wasn’t clear, or perhaps I simply didn’t listen: Was this certification or additionally recertification?
Rovner: No, this was simply certification. Recertification’s separate. So these are these are younger docs who need to change into board-certified for the primary time.
Kenen: But the recertification points shall be comparable. And this can be a yearly — I imply, I don’t see why they simply don’t give folks the choice of doing it digital.
Rovner: But we’ll see in the event that they again down. But you realize, I had the identical thought that Sarah did. It’s like, nice, let’s promote that everyone’s going to be in a single place at one time, you realize, taking this examination. Well, we’ll see how that one performs out. Well, lastly this week, constructing on final week’s dialogue on well being and local weather change and on drug shortages, a twister in Rocky Mount, North Carolina, significantly broken an enormous Pfizer drug storage facility, probably worsening a number of completely different drug shortages. Sarah, I keep in mind when the hurricane in Puerto Rico appeared to mild a fireplace underneath the FDA and the drug trade concerning the risks of producing being too centralized in a single place. Now now we have to fret about storage, too? Are we going to finish up, like, burying all the pieces underground in Fort Knox?
Karlin-Smith: I feel there’s been a spotlight even since earlier than [Hurricane] Maria, however that definitely introduced up that there’s an absence of redundancy in U.S. medical provide chains and, actually, world provide chains. It’s not a lot that they have to be buried, you realize, that we’d like bunkers. It’s simply that — Pfizer needed to revise the numbers, however I feel the proper quantity was that that facility produces about 8% of the sterile sort of injectables used within the U.S. well being system, 25% of all Pfizer’s — it’s extra like every firm or the completely different vegetation that produce these medicine, it must be completed in additional locations in order that when you have these extreme climate occasions in a single a part of the nation, there’s one other facility that’s additionally producing these medicine or has storage. So I don’t know that these options have to be as excessive as you introduced up. But I feel the issue has been that when options to drug shortages have come up in Congress, they have a tendency to concentrate on FDA authorities or issues that sort of nibble across the edges of this challenge, and nobody’s ever actually been capable of handle a few of the underlying financial tensions right here and the incentives that these corporations need to put money into redundancy, put money into higher manufacturing high quality, and so forth. Because on the finish of the day these are sometimes a few of the oldest and least expensive medicine now we have, however they’re not essentially really the best to provide. While oftentimes we’re speaking about very costly, high-cost medicine right here, this can be a case the place now we have to consider whether or not we’ve let the costs drop too low and that’s form of protecting a market that works if all the pieces’s going completely properly however then results in these shortages and different issues in well being care.
Rovner: Yeah, the entire just-in-time provide chain. Well, earlier than we go away this, Anna, because you’re our knowledgeable on this, significantly worldwide manufacturing, I imply, has form of what’s been taking place domestically lit a fireplace underneath anyone who’s additionally anxious about a few of these, you realize, abroad vegetation not residing as much as their security necessities?
Edney: Well, I feel there are these scary issues occur like a twister or hurricane and everyone is sort of out of the blue paying consideration. But I feel that the decision-makers within the White House or on Capitol Hill have been paying consideration just a little bit longer. We’ve seen these most cancers — I imply, for a very long time not getting something completed, as Sarah talked about — however just lately, it’s form of I feel the preliminary spark there was these most cancers drug shortages that, you realize, folks not with the ability to get their chemo. And that was from an abroad manufacturing unit; that was from a manufacturing unit in India that had loads of points, together with shredding all of their high quality testing paperwork and throwing them in a truck, attempting to get it out of there earlier than the FDA inspectors might even see it.
Kenen: That’s at all times very reassuring.
Edney: It is. Yeah. It makes you are feeling actually good. And one bag didn’t make it out of the plant in time, so they simply threw acid on it as an alternative of letting FDA inspectors take a look at it. So it’s positively constructing on this twister. And what may come out of it if there are loads of shortages, I haven’t seen enormous concern but from the FDA on that entrance. But I feel that it’s one thing that simply retains taking place. It’s not letting up. And, you realize, my colleagues did a extremely good story yesterday. There’s a scarcity of a sure kind of penicillin you give to pregnant individuals who have syphilis. If you cross syphilis on to your child, the child can die or be born with loads of points — it’s not like if an grownup will get syphilis — and so they’re having to ration it, and adults aren’t getting handled absolutely for syphilis as a result of the infants want it extra so, and so this is sort of a regular march that simply retains occurring. And there’s so many points with the trade, form of the way it’s arrange, what Sarah was speaking about, that we haven’t seen anyone actually be capable of contact but.
Rovner: We will proceed to remain on high of it, even when no person else does. Well, that’s this week’s information. Now we’ll play my interview with KFF’s Céline Gounder, after which we’ll come again and do our additional credit score. I’m happy to welcome again to the podcast Dr. Céline Gounder, KFF senior fellow and editor-at-large for public well being, in addition to an infectious illness specialist and epidemiologist in New York and elsewhere. Céline is right here in the present day to inform us concerning the second season of her podcast, “Epidemic,” which tells the story of the profitable effort to eradicate smallpox and explores whether or not public well being can accomplish such massive issues ever once more. Céline, thanks for becoming a member of us.
Céline Gounder: It’s nice to be right here, Julie.
Rovner: So how did you be taught concerning the final steps within the journey to finish smallpox, and why did you suppose this was a narrative value telling broadly now?
Gounder: Well, that is one thing I really studied again once I was in faculty within the ’90s, and I did my senior thesis in faculty on polio eradication, and this was within the late ’90s, and now we have but to eradicate polio, which fits to point out you the way troublesome it’s to eradicate an infectious illness. And in the middle of doing that analysis, I used to be an intern on the World Health Organization for a summer time after which continued to do analysis on it throughout my senior 12 months. I additionally realized rather a lot about smallpox eradication. I obtained to satisfy loads of the outdated leaders of that effort, of us like D.A. Henderson and Ciro de Quadros. And fast-forward to the current day: I feel popping out of covid we’re sadly not studying what a minimum of I feel are the teachings of that pandemic. And I feel generally it’s simpler to return in time in historical past, and that helps to depoliticize issues, when folks’s feelings aren’t working as excessive a couple of explicit matter. And my thought was to return and take a look at smallpox: What are the teachings from that effort, a profitable effort, and likewise to ensure to get that historical past whereas we nonetheless have a few of these leaders with us in the present day.
Rovner: Yes, you’re singing my track right here. I observed the primary episode is named “The Goddess of Smallpox.” Is there actually a goddess of smallpox?
Gounder: There is: Shitala Mata. And the purpose of this episode was actually twofold. One was to speak the significance of understanding native tradition and beliefs, to not dismiss these as superstitions, however actually as methods of adapting to what was, on this case, a really centuries-long actuality of residing with smallpox. And the best way folks thought of it was that in some methods it was a curse, however in some methods it was additionally a blessing. And understanding that dichotomy can be vital, whether or not it’s with smallpox or different infectious illnesses. It’s vital to know that whenever you’re attempting to speak about social and public well being interventions.
Rovner: Yeah, as a result of I feel folks don’t perceive that public well being is so distinctive to every place. I really feel like within the final 50 years, even via HIV and different infectious illnesses, the industrialized world nonetheless hasn’t realized very properly learn how to cope with creating international locations by way of cultural sensitivity and the necessity for native belief. Why is that this a lesson that governments preserve having to relearn?
Gounder: Well, I’d argue we don’t even do it properly in our personal nation. And I feel it’s as a result of we consider well being by way of well being care, not public well being, within the United States. And that additionally implies a really biomedical strategy to well being points. And I feel the mindset right here may be very a lot, oh, properly, after getting the biomedical instruments — the vaccines, the diagnostics, the medicine — drawback solved. And that’s not likely fixing the issue in a pandemic, the place a lot of your problem is basically social and political and financial and cultural. And so in the event you don’t give it some thought in these phrases, you’re actually going to have a flat-footed response.
Rovner: So what ought to now we have realized from the smallpox eradication effort that may have helped us cope with covid or may assist us sooner or later cope with the subsequent pandemic?
Gounder: Well, I feel one aspect of that is actually understanding what the native tradition was, spending time with folks in neighborhood to construct belief. I feel we got here round to understanding it partially, in some methods, in some populations, in some geographies, however sadly, I feel it was very a lot within the disaster and never essentially a long-term concerted effort to do that. And that I feel is regarding as a result of we’ll face different epidemics and pandemics sooner or later. So, you realize, how do you lose belief? How do you construct belief? I feel that’s a extremely key piece. Another massive one is dreaming massive. And Dr. Bill Foege — he was one of many leaders of smallpox eradication, went on to be the director of the CDC [Centers for Disease Control and Prevention] underneath President [Jimmy] Carter — one of many items of recommendation he’s given to me as a mentor over time is you’ve obtained to be virtually foolishly optimistic about getting issues completed, and don’t take heed to the cynics and pessimists. Of course, you need to be pragmatic and perceive what’s going to or received’t work, however to tackle such enormous endeavors as eradicating smallpox, you do need to be very optimistic and remind your self day-after-day that that is one thing you are able to do in the event you put your thoughts to it.
Rovner: I observed, a minimum of within the first couple of episodes that I’ve listened to, the media doesn’t come out of this trying significantly good. You’re each a journalist and a medical knowledgeable. What recommendation do you may have for journalists attempting to cowl massive public well being tales like this, like covid, like issues which might be actually vital in the way you talk this to the general public?
Gounder: Well, I feel one is attempt to be hyperlocal in a minimum of a few of your reporting. I feel one mistake throughout the pandemic was having this very top-down perspective of “here is what the CDC says” or “here is what the FDA says” or whomever in D.C. is saying, and that doesn’t actually resonate with folks. They need to see their very own experiences mirrored within the reporting and so they need to see folks from their neighborhood, folks they belief. And so I feel that’s one thing that we must always do higher at. And sadly, we’re additionally considerably hampered in doing so as a result of there’s been an actual collapse of native journalism in many of the nation. So it actually does fall to locations like KFF Health News, for instance, to attempt to do a few of that vital reporting.
Rovner: We will all preserve at it. Céline Gounder, thanks a lot for becoming a member of us. You can discover Season 2 of “Epidemic,” referred to as “Eradicating Smallpox,” wherever you get your podcasts.
Gounder: Thanks, Julie.
Rovner: OK, we’re again. It’s time for our additional credit score phase. That’s once we every advocate a narrative we learn this week we expect it is best to learn too. As at all times, don’t fear in the event you miss it. We will put up the hyperlinks on the podcast web page at kffhealthnews.org and in our present notes in your telephone or different cell gadget. Sarah, why don’t you go first this week?
Karlin-Smith: Sure. I took a take a look at a chunk from Brenda Goodman at CNN referred to as “They Took Blockbuster Drugs for Weight Loss and Diabetes. Now Their Stomachs Are Paralyzed,” and it’s a extremely good deep dive into — folks most likely have heard of Ozempic, Wegovy — these what are referred to as GLP-1 medicine which were used for diabetes. And we’ve realized in increased doses even for folks with out diabetes, they usually are very useful at shedding pounds, that that’s partially as a result of they gradual the passage of meals via your abdomen. And there are questions on whether or not for some folks that’s resulting in abdomen paralysis or different excessive unwanted side effects. And I feel it’s a extremely fascinating deep dive into the sophisticated world of determining, Is this attributable to the drug? Is it attributable to different circumstances that folks have? And then how do you have to counsel folks about whether or not they need to obtain the medicine and the advantages outweighing the dangers? So I feel it’s like only a good factor for folks to learn whenever you form of hear all this hype a couple of product and the way nice they have to be, that it’s at all times just a little bit extra sophisticated than that. And it additionally introduced up one other facet of it, which is how these medicine could influence people who find themselves going to get surgical procedure and anesthesia and simply the significance of speaking this to your physician in order that they know learn how to appropriately deal with the medicine. Because in the event you nonetheless have meals content material in your abdomen throughout a surgical procedure, that may be extraordinarily harmful. And I assumed simply that facet alone of this story is basically fascinating, as a result of they discuss folks perhaps not desirous to even let their docs know they’re on these medicine due to stigma surrounding weight reduction. And simply once more, when you get a brand new medication that may find yourself being taken by lots of people, the issues or, you realize, there’s the dynamics of the way it impacts different elements of medication, and we have to modify.
Rovner: Yeah. And I feel the opposite factor is, you realize, we all know these medicine are protected as a result of folks with diabetes have been taking them for, what, six or seven years. But inevitably, anytime you get a drug that tons extra folks take, then you definately begin to see the outlier unwanted side effects, which, if it’s lots of people, can have an effect on lots of people. Joanne.
Kenen: I’ve a chunk from FERN, which is the Food & Environment Reporting Network and in partnership with Yale Environ 360, and it’s by Gabriel Popkin. And it’s referred to as “Can Biden’s Climate-Smart Agriculture Program Live Up to the Hype?” And I knew nothing about sensible agriculture, which is why I discovered this so fascinating. So, that is an intersection of local weather change and meals, which is clearly additionally a consider local weather change. And there’s some huge cash from the Biden administration for farmers to make use of new strategies which might be extra green-friendly as a result of as everyone knows, you realize, beef and dairy, issues that we thought had been simply good for us — perhaps not beef a lot — however, like, they’re actually not so good for the planet we stay on. So are you able to do issues like, as an alternative of utilizing fertilizer, plant cowl crops within the offseason? I imply, there’s a complete record of issues that — none of us are farmers, however there’s additionally questions on are they going to work? Is it greenwashing? Is it stuff that can work however not in the time-frame that this program is funding? How a lot of it’s going to go to massive agribusiness, and the way a lot of it will go to small farmers? So it’s one hand, it’s one other. You know, there’s loads of low-tech practices. We’re going to need to do completely all the pieces we are able to on local weather. We’re going to have to make use of a wide range of — you realize, very massive toolkit. So it was fascinating to me studying about these items that you are able to do that make agriculture, you realize, nonetheless develop our meals with out hurting the planet, but additionally loads of questions on, you realize, is that this actually an answer or not? But, you realize, I didn’t know something about it. So it was a really fascinating learn.
Rovner: And boy, you suppose the drug corporations are influential on Capitol Hill. Try going with massive agriculture. Anna.
Edney: I’m going to toot my very own horn for a second right here —
Rovner: Please.
Edney: — and do one among my mini-investigations that I did, “Mineral Sunscreens Have Potential Hidden Dangers, Too.” So there’s been loads of speak: Use mineral sunscreen to save lots of the setting or, you realize, to your personal well being probably. But they’re white, they’re very thick. And, you realize, folks don’t need to look fairly that ghostly. So what’s been taking place currently is that they’ve been getting higher. But what I came upon is loads of that is because of a chemical — that’s what individuals are attempting to maneuver away from, is chemical sunscreens — however the sunscreen-makers are utilizing this chemical referred to as butyloctyl salicylate. And you possibly can learn the article for sort of the problems with it. I assume the principle one I’d level out is, you realize, I talked to the Environmental Working Group as a result of they do these verifications of sunscreens based mostly on their take a look at how good are they to your well being, and a few their mineral ones had this ingredient in it. So once I requested them about it, they mentioned, Oh, whoops; like, we do really must revisit this as a result of it’s a chemical that’s not advisable for kids underneath 4 to be utilizing on their our bodies. So there’s different points with it, too — simply the query of whether or not you’re actually being reef-safe if it’s in there, and different issues as properly.
Rovner: It is tough to be protected and be good to the planet. My story this week is by Amy Littlefield of The Nation journal, and it’s referred to as “The Anti-Abortion Movement Gets a Dose of Post-Roe Reality.” It’s about her go to to the annual convention of the National Right to Life Committee, which for many years was the nation’s main anti-abortion group, though it’s been eclipsed by some others extra just lately. The story consists of a few eye-opening observations, together with that the anti-abortion motion is stunned that each one these bans didn’t really scale back the variety of abortions by very a lot. As we all know, girls who’re searching for abortions usually will discover a approach to get them, both in state or out of state or underground or no matter. And we additionally realized on this story that some within the motion are prepared to permit rape and incest exceptions in abortion payments, which they’ve historically opposed, as a result of they need to use these as sweeteners for payments that might make it simpler to implement bans, stronger bans, issues like the thought in Texas of permitting particular person residents to make use of civil lawsuits and forbidding native prosecutors from declining to prosecute abortion circumstances. We’re seeing that in some form of blue cities in crimson states. It’s a extremely fascinating learn and I actually advocate it. OK. That is our present for this week. As at all times, in the event you loved the podcast, you possibly can subscribe the place ever you get your podcasts. We’d respect it in the event you left us a overview; that helps different folks discover us, too. Special thanks, as at all times, to our producer, Francis Ying. Also as at all times, you possibly can electronic mail us your feedback or questions. We’re at whatthehealth@kff.org. Or you possibly can tweet me. I’m @jrovner, and I’m on Bluesky and Threads. Joanne.
Kenen: @joannekenen1 at Threads.
Rovner: Sarah.
Karlin-Smith: I’m @SarahKarlin or @sarah.karlinsmith, relying on which of those many social media platforms you’re taking a look at, although.
Rovner: Anna.
Edney: @annaedney on Twitter and @anna_edneyreports on Threads.
Rovner: You can at all times discover us right here subsequent week the place we’ll at all times be in your podcast feed. Until then, be wholesome.
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