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 professional on well being coverage points, Julie is the creator of the critically praised reference e-book “Health Care Politics and Policy A to Z,” now in its third version.
Ohio voters — in a uncommon August election — turned out in unexpectedly excessive numbers to defeat a poll measure that will have made it more durable to move an abortion-rights constitutional modification on the poll in November. The election was virtually a yr to the day after Kansas voters additionally shocked observers by supporting abortion rights in a poll measure.
Meanwhile, the proportion of Americans with out medical insurance dropped to an all-time low of seven.7% in early 2023, reported the Department of Health and Human Services. But that’s not more likely to proceed, as states boot from the Medicaid program thousands and thousands of people that acquired protection below particular eligibility guidelines in the course of the pandemic.
This week’s panelists are Julie Rovner of KFF Health News, Emmarie Huetteman of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachel Roubein of The Washington Post.
Panelists
Emmarie Huetteman
KFF Health News
Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico
Rachel Roubein
The Washington Post
Among the takeaways from this week’s episode:
- It mustn’t have come as a lot of a shock that Ohio voters sided with abortion-rights advocates. Abortion rights thus far have prevailed in each state that has thought of a associated poll measure because the Supreme Court overturned Roe v. Wade, together with in politically conservative states like Kentucky and Montana.
- Moderate Republicans and independents joined Democrats in defeating the Ohio poll query. Opponents of the measure — which might have elevated the brink of votes wanted to approve state constitutional amendments to 60% from a easy majority — had not solely cited its ramifications for the upcoming vote on statewide abortion entry, but in addition for different points, like elevating the minimal wage.
- A Texas case about exceptions below the state’s abortion ban awaits the enter of the state’s Supreme Court. But the painful private experiences shared by the plaintiffs — notable partly as a result of such personal tales had been as soon as scarce in public discourse — pressed abortion opponents to deal with the implications for ladies, not fetuses.
- The uninsured fee hit a report low earlier this yr, a milestone that has since been washed away by states’ efforts to strip newly ineligible Medicaid beneficiaries from their rolls because the covid-19 public well being emergency ended.
- The promise of diabetes medicine to help in weight reduction has attracted loads of consideration, but with their excessive value tags and protection points, one thorny impediment to entry stays: How may we, individually and as a society, afford this?
- Lawmakers are asking extra questions in regards to the nature of nonprofit, or tax-exempt, hospitals and the care they supply to their communities. But they nonetheless face an uphill battle in difficult the highly effective hospital trade.
Also this week, Rovner interviews Kate McEvoy, government director of the National Association of Medicaid Directors, about how the “Medicaid unwinding” goes as thousands and thousands have their eligibility for protection rechecked.
Plus, for “extra credit” the panelists counsel well being coverage tales they learn this week that they assume you must learn, too:
Julie Rovner: KFF Health News’ “How the Texas Trial Changed the Story of Abortion Rights in America,” by Sarah Varney.
Joanne Kenen: Fox News’ “Male Health Care Leaders Complete ‘Simulated Breastfeeding Challenge’ at Texas Hospital: ‘Huge Eye-Opener’,” by Melissa Rudy.
Rachel Roubein: Stat’s “From Windows to Wall Art, Hospitals Use Virtual Reality to Design More Inclusive Rooms for Kids,” by Mohana Ravindranath.
Emmarie Huetteman: KFF Health News’ “The NIH Ices a Research Project. Is It Self-Censorship?” by Darius Tahir.
Also talked about on this week’s episode:
click on to open the transcript
Transcript: On Abortion Rights, Ohio Is the New Kansas
KFF Health News’ ‘What the Health?’Episode Title: On Abortion Rights, Ohio Is the New KansasEpisode Number: 309Published: Aug. 10, 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 among the greatest and smartest well being reporters in Washington. We’re taping a day early this week, on Wednesday, Aug. 9, at 3:30 p.m. As all the time, information occurs quick, and issues might need modified by the point you hear this. So right here we go. We are joined at the moment through video convention by Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.
Joanne Kenen: Hey, all people.
Rovner: Rachel Roubein of The Washington Post.
Rachel Roubein: Hi, all people.
Rovner: And my colleague and editor right here at KFF Health News Emmarie Huetteman.
Emmarie Huetteman: Hey, everybody. Glad to be right here.
Rovner: So later on this episode, we’ll have my interview with Kate McEvoy, government director of the National Association of Medicaid Directors. She’s bought her pulse on how that large post-public well being emergency “Medicaid unwinding” goes. And she’ll share a few of that with us. But first, this week’s information. I assume the largest information of the week is out of Ohio, which, in virtually a rerun of what occurred in Kansas virtually precisely a yr in the past, voters soundly defeated a poll problem that will have made it more durable for different voters this fall to reverse the legislature’s strict abortion ban. If you’re having bother following that, so did they in Ohio. [laughs] This time, the truth that the abortion rights facet gained wasn’t as a lot of a shock as a result of each statewide abortion poll query has gone for the abortion rights facet since Roe v. Wade was overturned final yr. What can we take away from Ohio? Other than it regarded so much like … the cut up regarded so much like Kansas. It was virtually 60-40.
Kenen: It reveals that there’s a coalition round this problem that’s larger than Democrat or Republican. Ohio was the traditional swing state that has changed into a conservative Republican-voting state — not on this problem. This was clearly independents, average Republicans joined Democrats to … 60-40, roughly, is a reasonably large win. Yes, we’ve seen it in different states. It’s nonetheless a reasonably large win.
Roubein: I agree. And I believe one among my colleagues, Patrick Marley, and I spent a while simply driving round and touring Ohio in July. And one of many issues that we did discover is that — this poll measure to extend the brink for constitutional amendments is 60% — it had in some, in lots of, methods changed into a proxy conflict over abortion. But, in some methods, either side additionally didn’t discuss abortion once they had been, you realize, canvassing totally different voters. You know, they use totally different instruments within the toolbox. I used to be following round somebody from Ohio Right to Life and, you realize, he very a lot mentioned, “Abortion is the major issue to me.” But, you realize, they tried to sort of convey collectively the facet that supported this. Other points like legalizing marijuana and elevating the minimal wage, and, you realize, the abortion rights facet was very a lot part of, you realize, the opposition right here. But when some canvassers went out — my colleague Patrick had traveled and adopted some, and a few, you realize, sort of targeted on different points like, you realize, voters having a voice in coverage and maintaining a easy majority rule.
Rovner: Yeah, I believe it’s necessary — for many who haven’t been following this as intently as we’ve got — what the poll measure was was to make future poll measures — and so they mentioned they weren’t going to have them in August anymore, which, this was the final one — with the intention to amend the structure by referendum, you would want a 60% majority moderately than a 50% majority. And simply coincidentally, there may be an abortion poll measure on Ohio’s poll for November, and it’s polling at about 58%. But, sure, this may have utilized to every part, and it was defeated.
Kenen: And it’s half of a bigger development. It started earlier than the overturning of Roe v. Wade. Over the final couple of years, you’ve seen conservative states transfer to tighten these guidelines for poll initiatives. And that’s as a result of extra liberal positions have been profitable. I imply, Medicaid, the Medicaid growth on the poll, has gained, and gained large. Only one was even shut …
Rovner: In very purple states!
Kenen: They typically gained very large in plenty of very, very conservative states, locations like Idaho and Nebraska. So, you realize, there’s all the time been … the traditional knowledge is that, you realize, the political events are extra excessive than many citizens, that the Democratic Party is for the left and the Republican Party is for the proper. And there are lots of people who determine with one celebration or the opposite however aren’t … who’re extra average or, on this case, extra liberal on Medicaid. And Medicaid … what was it, seven states? I believe it’s seven. Seven actually conservative states. And then the abortion has gained in each single state. And there’s just a little little bit of dialog and it’s … very early. And I don’t know if it’s going to go anyplace, but when I’ve heard it and written a bit about it, conservative lawmakers have heard about it, too, which is there are teams inquisitive about making an attempt to get some gun security initiatives on ballots. So that’s sophisticated. And it could not occur. But they’re seeing, I imply, that’s the traditional instance of each a legal justice and a public well being problem — so we are able to discuss it — a traditional instance the place the nation is rather more within the middle.
Rovner: Well, allow us to transfer to Texas, as a result of that’s the place we all the time find yourself once we discuss abortion. You might keep in mind that lawsuit the place a number of girls who almost died from being pregnant issues sued the state to make clear when medical personnel are capable of intercede with out being subjected to fines and/or jail sentences. Well, the ladies gained, a minimum of for a few days. A Texas district decide who heard the case dominated of their favor, briefly blocking the Texas ban for ladies with being pregnant issues. But then the state appealed, and a Texas appeals court docket blocked the lower-court decide’s blocking of a part of the ban. If you didn’t observe that, it simply implies that legally nothing has modified in Texas. And now the case goes to the Texas Supreme Court, which has a conservative majority. So we just about know what’s going to occur. But whether or not these girls finally win or lose their case will not be a very powerful factor. And, to clarify why I’m going to do my additional credit score early this week. It’s by my KFF Health News colleague Sarah Varney. It’s referred to as “How the Texas Trial Changed the Story of Abortion Rights in America.” She writes that this trial was significantly important as a result of it put abortion foes on the defensive by graphically depicting hurt to girls of abortion bans — moderately than to fetuses. And it’s additionally in regards to the energy of individuals publicly telling their tales. I’ve completed numerous tales through the years about girls whose very wished pregnancies went very unsuitable, very late. And, I’ve to inform you, it’s been laborious to search out these girls. And whenever you discover them, it’s been actually laborious to get them to speak to a journalist. So, the truth that we’re seeing increasingly folks truly come out publicly, you realize, might do for this problem what, you realize, maybe what homosexual rights, you realize, what folks popping out as homosexual did for homosexual marriage? I don’t know. What do you guys assume?
Kenen: Well, I believe these tales have been actually compelling, however they’re additionally, they’re probably the most dramatic and perhaps best to push again. But it’s, you realize, there’s an entire lot of different causes girls need abortions. And the main focus — and it’s life and loss of life, so the main focus, fairly rightfully, needs to be on these actually excessive instances. But that’s not … it’s nonetheless in some methods shifting consideration from the bigger political dialogue about selection and rights. But, clearly, a few of these states, we’ve seen so many tales of girls who, their lives are at stake, their docs understand it, and so they simply don’t assume they’ve the authorized energy; they’re afraid of the implications in the event that they’re second-guessed. There are great monetary and imprisonment [risks] for a physician who’s deemed to have completed an pointless abortion. And this concept that’s taken maintain … amongst some conservatives is that there’s by no means a necessity for a medical abortion. And that’s simply not true.
Rovner: And but, I imply, what this trial and numerous issues in Sarah’s piece too level out is that that line between miscarriage and abortion is actually sort of fuzzy in numerous instances. You know, for those who go to the hospital with a miscarriage and so they’re going to say, “Well, did you initiate this miscarriage?” And we’ve seen girls thrown in jail earlier than for shedding pregnancies, with them saying, “You know, you threw yourself down the stairs to end this pregnancy.” That truly occurred, I believe it was in Indiana. So that is —
Kenen: And miscarriage is quite common.
Rovner: That was what I used to be saying.
Kenen: Early miscarriage is quite common. Very, quite common.
Huetteman: One of the issues that’s so placing in regards to the previous yr, since Dobbs overturned Roe v. Wade ,is that we’ve seen this sort of nationwide schooling about what being pregnant is and the way harmful it may be and the way care wants to essentially be versatile to fulfill these types of challenges. And this truly bought me fascinated about one thing that one other acquainted voice on this podcast, Alice Miranda Ollstein, and a few colleagues wrote this morning in regards to the Ohio end result, which is that they identified that the anti-abortion motion actually hasn’t developed when it comes to the arguments that they’re making up to now yr about why abortion ought to proceed to be much less and fewer out there. Meanwhile, we’ve bought these, like, actually unimaginable, actually emotional, shifting tales from girls who’ve skilled this firsthand. And that’s a tough message to beat whenever you’re making an attempt to succeed in voters specifically.
Rovner: And it’s fascinating; either side prefer to take — you realize, all of them go to the toughest instances. So, for years and years, the anti-abortion facet has, you realize, has gone to the toughest instances. And that’s why they discuss abortion within the ninth month up until start, which isn’t a factor, however they discuss it. And you realize, now the abortion rights facet has some laborious instances now that abortions are more durable to get. Well, whereas we’re as regards to Texas lawsuits, States Newsroom — and thanks for sending this my method, Joanne — has a narrative reporting that the writer of the scientific paper that each the decrease court docket decide and the appeals court docket judges used to conclude that the abortion drug mifepristone causes frequent issues — it doesn’t — is being reviewed for potential scientific misconduct. The paper comes from the Charlotte Lozier Institute, which is the analysis arm of the anti-abortion group the Susan B. Anthony List. Sage, which is the writer of the journal that the paper appeared in, has posted one thing referred to as an expression of concern, saying that the writer and editor, quote, “were alerted to potential issues regarding the representation of data in the article and author conflicts of interest. SAGE has contacted the authors of this article and an investigation is underway.” This was type of a whistleblower by a pharmacist who regarded on the method the information on this paper was put collectively and says, “No, that’s really very misleading.” I don’t assume I’ve ever seen this, although; I’ve by no means seen a scientific paper that’s now being questioned for its political bent, a peer-reviewed scientific paper. I imply, this might change numerous issues, couldn’t it?
Kenen: Well, not if folks resolve that they nonetheless assume it’s true. I imply, take a look at — you realize, the vaccine autism paper was retracted. That wasn’t initially political. It’s change into extra political through the years; it wasn’t political on the time. That was retracted. And folks have been leaping up and down screaming, “It was retracted! It was retracted!” And, you realize, thousands and thousands of individuals nonetheless consider it. So, I imply, legally, I’m undecided how a lot it modifications. I imply, I assumed we had all heard that there have been flaws on this examine. This article was good as a result of I hadn’t been conscious of how deeply flawed and in all the numerous methods it was flawed. And additionally the whistleblower yarn was fascinating. I’m undecided how a lot it modifications something.
Rovner: Well, I’m considering not when it comes to this case. And by the way in which, I believe we didn’t say this, that the examine was of emergency room visits by girls who’d had both surgical or medical abortions. And the rivalry was that medical abortions had been extra harmful than surgical abortions as a result of extra girls ended up within the emergency room. But as a number of folks have identified, extra folks ended up within the emergency room after medical abortions as a result of there have been so many extra medical abortions through the years. I imply, you don’t truly need to be a knowledge scientist to see among the issues.
Kenen: Right. And a few of them additionally weren’t that — actually, had been nervous, and so they didn’t know what was regular and so they went to the ER as a result of they had been scared and so they actually had been secure. They weren’t — they didn’t want — you realize, they only weren’t positive how a lot ache and discomfort or bleeding you’re alleged to have. And they went and so they had been reassured and had been despatched house. So it’s not even that they actually had a medical emergency or that they had been harmed.
Rovner: Or that they’d a complication.
Kenen: Right. There had been many flaws identified with this analysis.
Rovner: But my broader query is, I imply, if persons are going to start out questioning the politics of scientific papers, I imply, I may see the opposite facet going after this.
Kenen: Well, there’s local weather science, too, that’s unhealthy. I imply, I don’t assume that is truly distinctive. I believe it’s egregious. But there have been research minimizing the danger of smoking, which was additionally a political enterprise, industrial. Climate is actually political. I imply, I believe that is type of probably the most politicized and most acute instance, however I don’t assume it’s the one one.
Roubein: And I believe, Julie, as you’d talked about, I believe when [U.S. District Judge] Matthew Kacsmaryk in Texas got here down together with his determination — you realize, as an example, there are media shops — that my colleagues on the Post did a narrative simply sort of unpacking among the sort of flaws and among the research that had been used to make, you realize, a court docket determination.
Rovner: Yeah, to offer the decide what he assumes to be proof that this can be a harmful drug. So it’s — yeah.
Kenen: Which he got here in believing, we all know, from the profiles of him and his background.
Rovner: Right. All proper, effectively, allow us to transfer on. The official Census Bureau estimate of how many individuals lack medical insurance gained’t be out till subsequent month. But the Department of Health and Human Services is out with a report based mostly on that different large federal inhabitants survey that reveals the uninsured fee early this yr was at its lowest degree since information began being stored, which I believe was within the Eighties: 7.7%. Now, that’s clearly going to be the excessive level for the fewest variety of folks uninsured, a minimum of for some time, as a result of clearly not the entire thousands and thousands of people who find themselves shedding or about to lose their Medicaid protection are going to finish up with different insurance coverage. But I bear in mind — Joanne, you’ll, too — when the speed was nearer to 18% … was an enormous information story, and the factor that triggered the entire well being reform debate within the first place. I’m stunned that there’s been so little consideration paid to this.
Kenen: Because, you realize … [unintelligible] … it’s so yesterday. And additionally, as you alluded to, you realize, we’re in the midst of the Medicaid unwinding. So the numbers are going up once more now. And we don’t know. We know that it’s a few million folks. I believe 3 million is perhaps the final —
Rovner: I believe it’s 4 [million], it’s as much as 4.
Kenen: Four, OK. And a few of them will get lined once more and a few of them will discover different sources of protection. But proper now, there’s an uptick, not a downtick.
Roubein: And I believe whenever you take a look at simply, like, estimates of what the insured and the uninsured charges can be in 2030, like, the CMS’ [Centers for Medicare & Medicaid Services] evaluation, one of many different questions is, you realize, whether or not the improved Obamacare subsidies proceed previous 2025. So there’s Medicaid after which there’s additionally another sort of query marks and cliffs arising on how and whether or not it is going to fluctuate.
Rovner: No, it’s value watching. And bear in mind, when the census numbers come out, these might be for 2022. Well, shifting on, we’ve got two tales this week trying on the potential price of these breakthrough weight problems medicine, however by way of two very totally different lenses. One is from my KFF Health News colleague Rachana Pradhan, particulars how the makers of the present “it” drug, Ozempic, which is Novo Nordisk, in an effort to get the votes to raise the Medicare fee ban on weight reduction medicine, is quietly contributing massive quantities of cash to teams just like the Congressional Black Caucus Foundation and the Congressional Hispanic Caucus Institute. It’s type of a backdoor lobbying that’s fairly age-old, however that doesn’t imply it doesn’t work. The different story, by Elaine Chen at Stat, appears to be like at how well being insurers are pushing again laborious in opposition to the off-label use of diabetes medicines that additionally work to assist folks shed extra pounds. They’re doing issues like permitting the costlier weight reduction medicine provided that folks have tried and failed different strategies or disallowing them if the opposite strategies had been barely profitable. So, for those who take a lesser drug and also you lose sufficient weight, they gained’t allow you to take the higher drug as a result of, look, you misplaced weight on the opposite drug. We’ve talked about this, clearly, earlier than: These medicine, on the one hand, have the potential to make lots of people each more healthy and happier. There’s a examine out this week that reveals that Mounjaro, the Eli Lilly drug, truly reduces coronary heart illness by 20%.
Kenen: In individuals who have coronary heart illness.
Rovner: Right, in individuals who have coronary heart illness.
Kenen: It’s not reducing all people’s threat.
Rovner: But nonetheless, I imply, all people’s — effectively, I imply, there are medical indications for utilizing these medicine for weight reduction. But if all people who needs them may get them, it will actually break the financial institution. Nobody can afford to offer all people who’s eligible for these medicine these medicine. Is the winner right here going to be the facet with the best lobbying, or is that too cynical?
Huetteman: Isn’t that all the time the winner? Speaking of cynical.
Rovner: Yeah, in well being care.
Kenen: Well, I imply, I additionally assume there’s questions on, like, these medicine clearly are actually fantastic for individuals who they had been designed for; you don’t need to be on insulin. They’re having not simply weight reduction and diabetes. There are apparently cardiac and different — you realize, these are most likely actually good medicine. But there are lots of people who shouldn’t have diabetes or coronary heart illness who need them as a result of they need to lose 20 kilos. And a few of them are being advised it’s a must to take it for the remainder of your life. I imply, I simply know this anecdotally, and I’m positive everyone knows it anecdotally.
Rovner: Right. It’s like statins.
Kenen: Yes.
Rovner: Or blood strain remedy. If you cease taking your blood strain remedy, your blood strain goes again up.
Kenen: Right. So, I imply, ought to the purpose for the load loss be, “OK, this is going to help you take off that weight and then you’re going to have to maintain it through diet and exercise and healthy lifestyle,” blah, blah, blah, which is tough for folks. We know that. Or are we placing wholesome folks on a extremely costly drug that modifications an terrible lot of issues about their physique indefinitely? We don’t have security information for lifelong use in in any other case wholesome folks. So, you realize, I’m all the time just a little nervous as a result of even the most effective medical trial is small in comparison with the whole — it’s small and it’s time-limited. And perhaps these medicine are going to change into completely phenomenal and we’re going to all stay one other 20 wholesome years. But perhaps not, you realize. Or perhaps they’re going to be actually nice for a sure subpopulation, however, you realize, we’re not going to need to put it within the water provide. So, I nonetheless assume that there’s this type of pell-mell rush. And I believe it’s partly as a result of there’s some huge cash at stake. And it’s additionally, like, most people who find themselves chubby have tried to lose it, and it’s very troublesome to lose and keep weight. So, you realize, folks need a neater technique to do it. And I believe the opposite factor is true now it’s an injection. There are unwanted side effects for some folks on discomfort. There most likely might be an oral model, a capsule, someday pretty quickly, which is able to open — you realize, there are individuals who don’t need to take a shot who would take a capsule. It additionally means you would possibly have the ability to inform — I imply, I don’t know the science of the capsules, however it will make sense to me that you can take a decrease dose, you realize, perhaps ease into it with out the unwanted side effects, or may you keep on it longer with fewer issues? I imply, we’re simply the very starting of this, but it surely’s an enormous amount of cash.
Rovner: Yeah. You may see — I imply, my large query, although, is why can’t we power the drugmakers to decrease the value? That would, if not resolve the issue, make it so much higher. I imply, actually, we’re going to have to attend till there may be generic competitors?
Kenen: It’s not simply this.
Rovner: Yeah.
Kenen: I imply, it’s all types of most cancers therapies and it’s hepatitis therapies. And it’s, I imply, there’s numerous costly medicine on the market. So, this one simply has numerous demand as a result of it makes you skinny.
Rovner: Well, that was the factor. We went by way of this with the hepatitis C medicine, which had been actually tremendous costly. It’s rather more like that.
Kenen: Well, they appeared tremendous costly on the time —
Rovner: Not a lot anymore.
Kenen: — however perhaps for a thousand {dollars}, looking back.
Rovner: All proper. Well, let’s transfer on. So, talking of highly effective lobbies, let’s discuss hospitals. Iowa Republican Sen. Chuck Grassley and Massachusetts Democrat Elizabeth Warren — now, there may be an unlikely couple — are amongst these asking the IRS to extra rigorously study tax-exempt hospitals to verify they’re truly benefiting the neighborhood in trade for not paying taxes, which is meant to be the deal. Now, Sen. Grassley has been on this explicit hobbyhorse for a lot of, a few years, I believe most likely greater than 20, however not a lot ever appears to come back of this. I can’t inform you what number of workshops I’ve been to on, you realize, the right way to measure neighborhood advantages that tax-exempt hospitals are offering. Any inkling that this time goes to be any totally different?
Roubein: Well, hospitals don’t are typically type of the losers. They attempt to sort of body themselves as, like, “We’re your sort of friendly neighborhood hospital,” and each — I imply, each congressman, most congressmen have, you realize, hospitals of their district. So they they get lobbied so much, although, you realize — I imply, this can be a totally different problem, however significantly on the House facet, hospitals are going through site-neutral funds, which if that really went by way of Congress can be a loss. So yeah, however lawmakers have discovered it basically laborious to tackle the hospital trade.
Rovner: Yeah, very a lot so.
Kenen: Yeah. I imply, I believe that we consider nonprofits and for-profits as, they’re totally different, however they’re not as totally different as we predict they’re, in that, you realize, nonprofits are getting a tax break and so they need to reinvest their income. But it doesn’t imply they’re not making some huge cash. Some of them are. I imply, a few of them have, you realize, we’ve all walked into fancy nonprofits with, you realize, fancy artwork and marble flooring and so forth and so forth. And we’ve all been in nonprofits which might be barely maintaining their doorways open. So it’s your tax standing. It’s probably not, you realize, your moral standing or the standard of care. I imply, there’s good nonprofits, there’s good for-profits. You know, this complete factor is like, if I had been a hospital, I’d be getting this big tax break, and what am I doing to deserve it? And that’s the query.
Rovner: And I believe the argument is, you realize, that the 7.7% uninsured we had been speaking about, that hospitals are alleged to be offering care as a part of their neighborhood profit that the federal authorities now could be ending up paying for. I believe that’s type of the frustration. If nonprofit hospitals had been doing what they had been alleged to do, it will price federal and state governments much less cash, which all the time surprises me as a result of this isn’t gone after extra. I imply, Grassley has spent his complete profession engaged on varied varieties of authorities fraud. So that is completely in line for him. But it’s by no means simply appeared to be an enormous precedence for any administration.
Huetteman: There’s just a little little bit of an X issue right here. Look at the truth that Grassley and Warren are speaking about this publicly now. Maybe I’m simply actually optimistic from all of the journalism we’ve been doing about tasks like “Bill of the Month.” But the truth is that lots of people at the moment are seeing reporting that’s exhibiting to them what nonprofit hospitals are literally doing in relation to pursuing sufferers who don’t pay payments. And what it means to have neighborhood profit comes into query so much whenever you discuss wage garnishment, suing sufferers who’re low-income for his or her medical debt. These are issues that journalists have uncovered over and over, occurring at — ding, ding, ding — nonprofit hospitals. It’s more durable to argue that hospitals are simply doing their greatest for folks when you may have these tales of poor people who find themselves shedding their houses over unpaid medical payments, as an example. And I believe that proper now, once we’re on this political second the place well being care prices are so, so potent to folks and so necessary, I imply, may we see that it will truly be simpler, that we’re heading in direction of one thing that’s simpler? Maybe.
Rovner: Well, repeats the journalist, as all of us are, the facility of storytelling. Definitely the general public is primed. I think about that’s why they’re doing it now. We’ll see what comes of it.
Kenen: assume the general public is primed for unhealthy practices. I’m undecided what number of sufferers perceive if the hospital they go to is a nonprofit or a for-profit. I believe the general public understands that every part in well being care prices an excessive amount of and that there are unhealthy actors and greed. There’s a distinction between revenue and greed, and I believe many individuals would say that we’re now in an period of greed. And not all people within the well being care sector — earlier than anyone calls us up and shouts, “Not everybody who provides care is greedy” — however we’ve seen, you realize, it’s clearly on the market. You know, you had Zeke Emanuel on a few weeks in the past. Remember what he mentioned, that, you realize, 10 years in the past, some folks nonetheless favored their well being care and now no one likes their well being care, wealthy or poor.
Rovner: Yeah, he’s proper. All proper. Well, that’s this week’s information. Now, we’ll play my interview with Kate McEvoy of the National Association of Medicaid Directors about how the Medicaid unwinding goes. And one notice earlier than you hear: Kate often refers back to the federal CMCS, which isn’t a misspeak; it stands for the Center for Medicaid and CHIP Services, which is the department of CMS, the Centers for Medicare & Medicaid Services, that offers with Medicaid. So, right here’s the interview:
I’m happy to welcome to the podcast Kate McEvoy, government director of the National Association of Medicaid Directors, which is just about precisely what the title says, a gaggle the place state Medicaid officers can share info and concepts. Kate, welcome to “What the Health?”
Kate McEvoy: Good afternoon. Thanks for having me.
Rovner: Obviously, the Medicaid unwinding, which we’ve got talked about so much on the podcast, is Topic A on your members proper now. Remind us once more which Medicaid recipients are having their protection eligibility rechecked? It’s not simply these within the growth group from the Affordable Care Act, proper?
McEvoy: It’s not, no. Each and each individual served by the nation nationwide needs to be reevaluated from an eligibility standpoint this yr.
Rovner: What can we learn about the way it’s going? We’re seeing a number of reviews that counsel the overwhelming majority of individuals shedding protection are for paperwork causes, not as a result of they’ve been discovered to be not eligible. I do know you latterly surveyed your members. What are they telling you about this?
McEvoy: So, I first need to say that is an unprecedented job and it’s clearly traditionally important for everybody served by this system. The quantity of the work, and in addition the complexity, makes it a difficult job for all states and territories. But what we’re seeing thus far is a couple of issues. First, we’ve got seen an unimaginable effort on the a part of states and territories to saturate actually each technique of speaking with their membership, actually getting out that message round connecting with the packages, particularly if a person has moved in the course of the interval of the pandemic, which may be very typical for folks served by Medicaid. So that saturation of messaging and use of latest technique of connecting with folks, like texting, actually does signify an amazing advance for the Medicaid program that has historically relied on numerous advanced, formal, authorized notices to folks. So that looks like a really optimistic factor. What we’re seeing, and this isn’t surprising, is that, you realize, for causes associated to advanced life circumstances and competing issues, many individuals are usually not responding to these notices, regardless of how we’re transmitting these messages. And so that may be a piece that’s of nice curiosity and concern to all of us, notably Medicaid administrators desirous to make it possible for eligible of us don’t lose protection just because they don’t seem to be conscious of the requests for extra info. So we’re at some extent the place we’re past that preliminary push round messaging and now are actually targeted on technique of defending individuals who stay eligible, both by way of automated assessment of their eligibility — the ex parte course of — or by restoring them by way of such means as reconsideration. That’s actually the primary focus proper now.
Rovner: And there’s that 90-day reconsideration window. Is that … how does that work?
McEvoy: So the federal legislation provides this era of 90 days to households and kids inside which they are often renewed with little or no effort, primarily eradicating the accountability to finish a brand new software. We even have long-standing assist to folks referred to as “presumptive eligibility.” So if somebody goes to a federally certified well being middle or, extra sadly, goes to the hospital, lots of these varieties of suppliers can restore somebody’s eligibility. So these are necessary protecting items. We additionally know from the survey that you just talked about of our membership that many states and territories are extending these reconsideration protections to all protection teams — additionally together with older adults and folks with disabilities.
Rovner: So are there any states which might be doing something that’s totally different and modern? I bear in mind when CHIP [the federal Children’s Health Insurance Program] was being stood up — and boy, that was a very long time in the past, like 1999 — South Carolina put flyers in pizza packing containers, and another state put flyers in sneaker packing containers for back-to-school stuff. Are there higher methods to perhaps get ahold of those folks?
McEvoy: So I believe the reply is: numerous totally different channels. Our colleagues in Louisiana have a partnership with Family Dollar shops to primarily characteristic this info on receipts. There’s numerous work at pharmacy counters. Some of the massive chain pharmacies have QR codes and different technique of prompting folks round their Medicaid eligibility. There’s going to be an enormous push for the back-to-school effort. And I believe CMS and states are actually , significantly in making certain that kids don’t lose protection even when their mother and father have regained employment and so they’re not eligible. Another factor that’s occurring is numerous innovation within the technique of enabling entry to info. So many states have put in place private apps by way of which individuals can monitor their very own eligibility. There’s curiosity and a few uptake of the so-called pizza-tracker operate — so you possibly can sort of see the place you’re located in that pipeline — and in addition numerous use of automation to assist name folks again in the event that they’re making an attempt to get to state name facilities. So actually, all of these varieties of methods … we’re seeing an enormous quantity of effort throughout the nation.
Rovner: How’s the cooperation going with the Department of Health and Human Services? I do know that … they appear to be not pleased with some states. Are they being useful, basically?
McEvoy: They’re being terribly useful. I’d say that we frequently discuss Medicaid representing a federal-state fairness partnership, and we’ve seen that manifest from the start of the primary discover of the knowledge across the begin of the unwinding. CMCS has constantly supplied steering to states. They work with states utilizing a mitigation method versus shifting quickly to compliance. We really feel mitigation is one of the best ways of primarily figuring out the methods which might be going to greatest defend persevering with eligibility for folks on the state degree. And we actually admire CMS’ efforts on that. We perceive they do have to make sure accountability throughout the nation, and we’re mutually dedicated to that.
Rovner: You higher clarify mitigation methods.
McEvoy: Yeah, so this can be a yr the place we’re calling the query on eligibility requirements that assist be sure that the pathway to Medicaid protection is a clean one, and in addition that there’s continuity of protection. So, for any state that wasn’t but assembly all these requirements, CMCS primarily entered into an settlement with the state or territory to say, right here is how you’ll get there. And that would have concerned some technique of bettering the automated renewals for Medicaid. It may have meant counting on an built-in eligibility processes. There are numerous totally different instruments and techniques that had been put in place, however primarily that may be a path to each state and territory coming into full compliance.
Rovner: Is there something surprising that’s occurring? I do know a lot of this was predicted, and it was predicted that the states that went first that, you realize, had been actually in a rush to get additional folks off of their rolls appear to be doing simply that: getting additional folks off of their rolls. Are you stunned on the variations amongst states?
McEvoy: I believe that there have positively been variations amongst states when it comes to the instruments they’ve used from a system standpoint, however I don’t see any variations when it comes to retention of eligible folks. That stays a shared purpose throughout the whole nation. And once more, this can be a watershed level the place we’ve got the chance to convey everybody to the identical requirements, ongoing, in order that we assist to forestall among the heartache of the eligibility course of for people ongoing.
Rovner: Anything else I didn’t ask?
McEvoy: Well, I believe that piece across the reconsideration interval is especially necessary. We are struck by there being most likely much less literacy round that possibility, and that’s one thing we need to proceed to advertise. The different piece I’d wind up by saying is that the Medicaid program is all the time out there for people who find themselves eligible. So within the worst-case state of affairs by which an in any other case eligible individual loses protection, they will all the time come again and be lined. This is in distinction to personal insurance coverage which will have an annual open enrollment interval. Medicaid, as you realize, is obtainable on a rolling foundation, and we need to maintain reinforcing that theme in order that nobody goes with a niche in protection.
Rovner: Kate McEvoy, thanks very a lot. And I hope we are able to name you again in a few months.
McEvoy: I’d be very completely satisfied to listen to from you.
Rovner: OK. We are again and it’s time for our additional credit score section. That’s once we every suggest a narrative we learn this week we predict you must learn too. As all the time, don’t fear for those who 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 cellular gadget. I did mine already. Emmarie, why don’t you go subsequent?
Huetteman: My story this week comes from KFF Health News, my colleague Darius Tahir. He has a narrative referred to as “The NIH Ices a Research Project. Is It Self-Censorship?” Now, the story talks about the truth that the previous head of NIH Francis Collins, was, as he was leaving, saying an effort to review well being communications. And we’re speaking about not simply doctor-to-patient communications, however truly additionally how mass communications impression American well being. But as Darius came upon, the performing director quietly ended this system as NIH was making ready to open its grant functions. And officers who spoke with us mentioned that they assume political strain over misinformation is responsible. Now, we don’t need to look too far for examples of conservative strain over misinformation and data today. In explicit, there’s a notable one from simply final month out of a Louisiana court docket, the federal court docket determination that blocked authorities officers from speaking with social media firms. You actually don’t need to look too far to see that there’s a chilling impact on info. And we’re speaking in regards to the NIH was going to review or moderately fund research into communication and data. Not misinformation, info: how folks get details about their well being. So it’s a fairly fascinating instance and a extremely nice story value your learn.
Rovner: And I’ve completed nothing however preach about public well being communication for 3 years now.
Kenen: It’s an excellent story.
Rovner: Yeah, it was a extremely good story. Rachel, you’re subsequent.
Roubein: All proper. This story known as “From Windows to Wall Art, Hospitals Use Virtual Reality to Design More Inclusive Rooms for Kids,” by Stat News, by Mohana Ravindranath. And I assumed this story was actually fascinating as a result of she sort of dived into what Mohana referred to as “a budding movement to make architecture more inclusive” for the folks and sufferers who’re spending so much, numerous time in hospital partitions. And what some researchers are doing is utilizing digital actuality to primarily gauge how comfy kids who’re sufferers are in hospital rooms. And she talked to researchers at Berkeley who had been utilizing these, like, digital actuality headsets to sort of examine and discover mocked-up hospital rooms. And, I didn’t know a ton about this subject. I imply, apparently it’s not new, but it surely’s this sort of rising type of motion to make sufferers extra comfy within the house that they’re inhabiting for maybe lengthy durations of time.
Rovner: I went to a convention on structure, hospital structure, making it extra patient-centered, 10 years in the past. But my favourite factor that I nonetheless bear in mind from that’s they talked about placing artwork on the ceiling as a result of persons are both in mattress or they’re in gurneys. They’re trying up on the ceiling so much. And ceilings are scary in hospitals. So that was one of many issues that I took away from that. OK, Joanne, now it’s your flip.
Kenen: OK. This is from Fox News. And sure, you probably did hear that proper. It’s by Melissa Rudy, and the headline is “Male Health Care Leaders Complete ‘Simulated Breastfeeding Challenge’ at Texas Hospital: ‘Huge Eye-Opener’.” So at Covenant Health, they’d a bunch of high-level guys in fits fake they had been nursing and/or pumping moms, and so they needed to nurse each three hours for 20 minutes at a time. And they discovered it was fairly troublesome and fairly cumbersome and so they didn’t have sufficient privateness. And as one among them mentioned, “There was no way to multitask.” But belief me, you probably have two children, it’s a must to determine that out, too. So it was a extremely good story.
Rovner: Some of these items that we really feel like needs to be required in all places, but it surely was an excellent learn; it was a extremely good story. OK, that’s our present for this week. As all the time, for those who benefit from the podcast, you possibly can subscribe wherever you get your podcasts. We’d admire it for those who left us a assessment; that helps different folks discover us too. Special thanks this week to Zach Dyer, sitting in for the indefatigable Francis Ying. And as all the time, you possibly can e-mail us your feedback or questions. We’re at whatthehealth@kff.org. Or you possibly can tweet me or X me or no matter; I’m @jrovner. And additionally on Bluesky and Threads. Rachel?
Roubein: @rachel_roubein — that’s on Twitter.
Rovner: Joanne.
Kenen: In most locations I’m @JoanneKenen. On Threads, I’m @joannekenen1.
Rovner: Emmarie.
Huetteman: And I’m @emmarieDC.
Rovner: We might be again in your feed subsequent week. Until then, be wholesome.
Credits
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Senior Audio Producer
Emmarie Huetteman
Editor
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