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 writer of the critically praised reference ebook “Health Care Politics and Policy A to Z,” now in its third version.
Autumn is for pumpkins and raking leaves — and open enrollment for well being plans. Medicare’s annual open enrollment started Oct. 1 and runs by Dec. 7. It shall be adopted shortly by the Affordable Care Act’s annual open enrollment, which begins Nov. 1 and runs till Jan. 15 in most states. But what was once a reasonably easy annual activity — renewing an current well being plan or selecting a brand new one — has develop into a complicated, time-consuming mess for a lot of, as a consequence of our convoluted well being care system.
Meanwhile, Ohio would be the subsequent state the place voters will resolve whether or not to guard abortion rights. Those on each side of the talk are gearing up for the November vote, with anti-abortion forces hoping to interrupt a shedding streak of state poll measures associated to abortion for the reason that 2022 overturn of Roe v. Wade.
This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Panelists
Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico
Alice Miranda Ollstein
Politico
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- The U.S. House of Representatives has been with out an elected speaker since Oct. 4. That means lawmakers can not conduct any legislative enterprise, with a number of vital well being payments pending — together with renewal of the favored worldwide HIV/AIDS program, PEPFAR.
- Open enrollment isn’t just for folks seeking to change medical health insurance plans. Plans themselves change, and those that do nothing threat persevering with in a plan that not meets their wants.
- A brand new spherical of lawsuits has sprung up associated to “abortion reversals,” a controversial observe by which a affected person, having taken the primary dose of a two-dose abortion remedy routine, takes a excessive dose of the hormone progesterone slightly than the second remedy that completes the abortion. In Colorado, a Catholic-affiliated well being clinic says a state regulation banning the observe violates its non secular rights, whereas in California, the state lawyer normal is suing two faith-based chains that function being pregnant “crisis centers,” alleging that by promoting the process they’re making “fraudulent and misleading” claims.
- The newest survey of employer medical health insurance by KFF reveals annual household premiums are once more escalating quickly — up a median of seven% from 2022 to 2023, with even bigger will increase anticipated for 2024. It’s not clear whether or not the already excessive price of offering insurance coverage to staff — an annual household coverage now averages slightly below $24,000 — will dampen corporations’ enthusiasm for offering the profit.
Also this week, Rovner interviews KFF Health News’ Arielle Zionts, who reported and wrote the newest KFF Health News-NPR “Bill of the Month” characteristic in regards to the broad price variation of chemotherapy from state to state. If you have got an outrageous or inscrutable medical you’d prefer to ship us, you are able to do that right here.
Plus, for “extra credit,” the panelists counsel well being coverage tales they learn this week they assume you must learn, too:
Julie Rovner: NPR’s “How Gas Utilities Used Tobacco Tactics to Avoid Gas Stove Regulations,” by Jeff Brady.
Lauren Weber: KFF Health News’ “Doctors Abandon a Diagnosis Used to Justify Police Custody Deaths. It Might Live On, Anyway,” by Markian Hawryluk and Renuka Rayasam.
Joanne Kenen: The Washington Post’s “How Lunchables Ended Up on School Lunch Trays,” by Lenny Bernstein, Lauren Weber, and Dan Keating.
Alice Miranda Ollstein: KFF Health News’ “Pregnant and Addicted: Homeless Women See Hope in Street Medicine,” by Angela Hart.
Also talked about on this week’s episode:
Click to open the transcript
Transcript: The Open Enrollment Mixing Bowl
KFF Health News’ ‘What the Health?’Episode Title: The Open Enrollment Mixing BowlEpisode Number: 319Published: Oct. 19, 2023
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: 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 this week on Thursday, Oct. 19, at 10 a.m. As all the time, information occurs quick, and issues may need modified by the point you hear this. So right here we go. Today, we’re joined through video convention by Alice Ollstein of Politico.
Alice Miranda Ollstein: Good morning,
Rovner: Lauren Weber of The Washington Post.
Lauren Weber: Hello, hey.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.
Joanne Kenen: Hi, everyone.
Rovner: Later on this episode, we’ll have my interview with Arielle Zionts, who reported and wrote the newest KFF Health News-NPR “Bill of the Month” about how chemotherapy can price 5 occasions extra in a single state than in one other. But first this week’s information. So, it’s Oct. 19, the House of Representatives continues to be with no speaker. That’s 2½ weeks now. That means laws can’t transfer. Are there well being care objects which might be beginning to stack up? And what wouldn’t it imply if the House finally ends up with an anti-federal authorities conservative like Rep. Jim Jordan, who, a minimum of as of this second, will not be but the speaker and doesn’t but appear like he has the votes?
Ollstein: So by way of unfinished well being care enterprise, the three massive issues we’re monitoring are issues that truly lapsed on the finish of September. Congress did handle to maintain the federal government open, however they allowed three massive well being care issues to fall by the wayside, and people are PEPFAR, the worldwide HIV/AIDS program, the SUPPORT Act, the applications for opioids and dependancy, and PAHPA, the general public well being, pandemics, biohazards massive invoice. And so these …
Rovner: I believe a type of P’s stands for “preparedness,” proper?
Ollstein: Exactly, sure. But it’s associated to pandemics, and you’ll assume in any case we simply went by that that may be extra of a precedence, however right here we’re. The reauthorization of all three of these is simply dangling on the market and it’s unclear if and when Congress can act on them. There is a few degree of bipartisan assist for all of them, however that’s what is stacking up, and nothing is admittedly occurring on these fronts, in response to my conversations with sources on the Hill as a result of every part has simply floor to a halt due to the speaker mess.
Rovner: And, in fact, we’re lower than a month away from the present persevering with decision operating out once more, and we might undergo — who is aware of? They might get a brand new speaker after which he might lose his job or her job as soon as they attempt to hold the federal government open in November. It’s a multitude. I’ve by no means seen something like this …
Kenen: Also, along with these three very political … even public well being and pandemics at the moment are politics … that Alice appropriately identified, these three large ideological, how are we going to get them reauthorized within the subsequent 30 days? But there’s additionally extra routine issues that aren’t controversial however are caught up on this equivalent to group well being middle funding, which has bipartisan assist, however they want their apropos and all that stuff. So along with these type of red-blue fights, there’s simply, how can we hold the doorways open for individuals who want entry to well being care? That’s not the one program. There are many day-to-day applications that like every part else within the authorities are up within the air.
Rovner: I imply, we should always level out that is unprecedented. The solely different time the House has been with no speaker this lengthy was one 12 months after they didn’t are available at the start of the Congress till later in January. It’s actually the one time. There’s by no means been a mid-session speakerless House. So every part that occurs from right here is unprecedented. Well, in the meantime, when you have turned on a TV up to now week, you already know this, however Medicare open enrollment started final Sunday, Oct. 15. To be clear, whenever you first develop into eligible for Medicare, you possibly can join anytime within the three months earlier than or after your birthday. But when you enroll in a non-public Medicare Advantage plan or a non-public prescription drug plan, and most of the people are in a single or the opposite or each, open enrollment is when you possibly can add or change protection. This was once fairly simple, but it surely’s solely gotten extra complicated as non-public plans have proliferated. This 12 months the Biden administration is making an attempt to battle again in opposition to among the deceptive advertising and marketing efforts. Politico studies that the federal government has rejected some 300 completely different adverts. Is that sufficient to quell the confusion? I’m already seeing adverts and form of have a look at it, like, “I don’t think that says what it means to say.”
Weber: Yeah, we see this yearly. It’s a ton of adverts. It’s a barrage of adverts that each one say, “Hey, this plan is going to get you X, Y, Z, and that’s better than traditional Medicare.” But you bought to learn the wonderful print, and I believe that’s the massive factor for all the parents which might be taking a look at this each time. Open enrollment may be very complicated, and a variety of occasions persons are making an attempt to promote you issues that aren’t what they seem. So it does seem that there was extra motion to crack down on these adverts. But look, the members of the family I talked to are nonetheless confused, so I don’t know the way a lot that’s proliferating down fairly but.
Kenen: And even when the adverts had been sincere, our well being system is so complicated. Even when you’re at an employer well being system. All of us are employed, all of us get insurance coverage at work, and none of us actually know we’ve made your best option. I imply, you want a crystal ball to know what sickness you and your kinfolk are going to get that 12 months, and what the copays and deductibles for that particular situation. I’ve by no means been positive. I’ve three decisions. They’re all first rate, whether or not it’s one of the best for me and my household, with all that I find out about well being care, I nonetheless don’t know I made your best option ’trigger I don’t have a crystal ball or not one which works.
Rovner: Right. I even have decisions, and I did my mother’s Medicare for years, as Joanne remembers …
Kenen: You did an excellent piece on that one.
Rovner: … that is the best way I bear in mind it. I did do a bit on that. Long time in the past, after they had been first beginning the prescription drug profit and also you needed to type of join through a pc, and in 2006, not that many seniors knew how one can use computer systems. At least we’re type of over that, however there’s nonetheless complaints in regards to the official web site Medicare.gov, which does a fairly good job. It’s simply received an terrible lot of steps. It’s a type of issues, it’s like, “OK, set aside two hours,” and that’s if you realize what you’re doing to do that. So in the meantime, if this isn’t all complicated sufficient, open enrollment for the Affordable Care Act opens in two weeks, and whereas Medicare open enrollment ends Dec. 7, ACA enrollment goes by Jan. 15 in most, however not each, state. In each instances, when you get your insurance coverage by Medicare or by the ACA, you must look to see what modifications your plan could be making. I ought to say additionally, if it’s open enrollment on your employer insurance coverage, plans make modifications just about yearly. So chances are you’ll find yourself, even when you’re in the identical plan, with a plan that you just don’t like or a plan that you just don’t like as a lot as you prefer it now. This is insanely difficult, as you level out, for everyone with insurance coverage. Is there any solution to make it simpler?
Kenen: There’s no politically palatable solution to make it simpler. And then issues they’ve achieved to attempt to make it simpler, like constant claims kinds, which most of us don’t need to fill out anymore. Most of that’s achieved on-line, however they’re not utilizing constant declare kinds and there’s nothing easy and there’s nothing that’s getting easier. And we’re all savvy …
Rovner: It’s what retains our “Bill of the Month” challenge in enterprise.
Kenen: Right. We’re all fairly savvy and none of us are sensible sufficient to resolve each well being care drawback of us and our household.
Rovner: It’s a type of issues the place compromise really makes for complexity. When policymakers can’t do one thing they actually wish to do, they do one thing smaller and extra incremental. And so what you find yourself with is that this constructed on, in each which approach, form of well being care system that no person is aware of the way it works.
Kenen: Like the 12 months I harm each a finger and a toe. And I had a deductible for the finger, however not for the toe. Explain that!
Rovner: I assume it was out and in of community or not even.
Kenen: No. They had been each in community. All of my digits are in community.
Weber: I simply received a covid take a look at invoice from 2020 that I had beforehand knocked down by calling, however they rebilled me once more. And as a result of I’m a savvy well being care reporter, I used to be like, “I’m not paying this. I know that I don’t have to pay this.” But it took in all probability 10 hours to resolve, I imply, and that’s not even choosing insurance coverage. So I’m simply saying it’s an extremely complicated market. Shout-out to Vox who had a very nice sequence that attempted to make it simpler for folks to grasp the variations between Medicare and Medicare Advantage, open enrollment, what that each one means. If you haven’t seen that and also you’re confused about your insurance coverage choices, I’d extremely advocate it.
Rovner: And I’ll hyperlink to the Vox sequence, which is admittedly good, but it surely was form of taking a look at it. I imply, they needed to write six completely different tales. It’s like that’s how complicated issues are, which is admittedly form of unhappy right here, however we are going to transfer on as a result of we’re not going to resolve this one at this time. So talking of issues which might be difficult and getting extra so, let’s flip to reproductive well being. Alice, the massive occasion that folks on each side are ready for — a type of occasions, a minimum of — is a poll measure in Ohio that may set up a state constitutional proper to abortion. So far, each state poll measure we’ve seen has gone in favor of the abortions rights facet. How are abortion opponents making an attempt to flip the script right here?
Ollstein: So I used to be in Ohio a few weeks in the past and was actually centered on that very query, simply what are they doing otherwise? How are they studying classes from all the losses final 12 months? And why do they assume Ohio shall be any completely different? I’ll say, since my piece got here out, there was the primary ballot I’ve seen of how persons are approaching the November referendum, and it confirmed overwhelming assist for the abortion rights facet, similar to in each different state. So have that coloration, what I’m about to say subsequent, which is that the anti-abortion facet thinks they will win as a result of they’ve a variety of structural components working of their favor. They have the governor of Ohio actually actively campaigning in opposition to the modification. So that’s in distinction to [Gov. Gretchen] Whitmer in Michigan final 12 months, campaigning actively for it. When you have got a reasonably well-liked governor, that does have an effect, they’re a recognized trusted voice to many. Also …
Rovner: And the governor of Ohio can be a former senator and I imply a very well-known man.
Ollstein: Yeah. Yeah, precisely. You simply have the whole state construction working to defeat this modification. They tried in a particular election in August to vary the principles. That didn’t work. Now, you simply have all of those prime officers utilizing their bully pulpit and their platforms to attempt to steer the vote within the anti-abortion route. Also, the precise marketing campaign itself is making an attempt to be taught classes from final 12 months and doing a couple of issues otherwise. They’re going actually aggressively after the African American vote, significantly by Black church buildings. And in order that’s not one thing I noticed within the states I reported on final 12 months, they usually’re actually aggressively going after the scholar vote. And I went to a scholar campus occasion at Ohio State that the anti-abortion facet was holding, and it appeared fairly efficient. There was a ton of confusion among the many college students. Loads of the scholars are like, “Wait, didn’t we just vote on this?” referring to the August particular. They stated, “Wait a minute, which side means yes, and which side means no?” There was simply rampant confusion, and it wasn’t helped … I noticed the anti-abortion facet, telling folks some deceptive issues about what the modification would and wouldn’t do. And so all of that might undoubtedly have an effect. But like I stated, since my story got here out, a ballot got here out exhibiting actually robust assist for the abortion rights modification, which might block the state’s six-week ban, which is now held up in court docket, however the court docket leans fairly far to the precise. This would block that from going again into impact probably.
Rovner: Ohio, the final word swing state, in all probability the reddest swing state within the nation. But Ohio will not be the one state having an off-year election subsequent month. Virginia doesn’t have an abortion measure on the poll, however its total state House and Senate are up for reelection. And from nearly each advert I’ve seen from Democrats, it mentions abortion, and there’s a variety of adverts right here within the Washington, D.C., space for among the Virginia elections. Republican Gov. Glenn Youngkin, who’s not on the poll this 12 months, thinks he has a approach of speaking about abortion that may give his facet the sting. What are we going to have the ability to inform from the final word make-up of the very narrowly divided Virginia Legislature when that is all stated and achieved?
Kenen: It gained’t be veto-proof. Unlike North Carolina now, even when it’s the Democrats maintain the one chamber they’ve or win each of them, and it’s actually shut. These are very intently divided, so we actually don’t know the way it’s going to end up. But I imply he …
Rovner: One 12 months it was so shut that they actually had to attract rocks out of a bowl.
Kenen: Yeah, proper. There’s extremely unlikely that there shall be a situation the place there’s a very strongly Democratic legislature with a Republican governor. That’s unlikely. What’s probably is a really narrowly divided, and we don’t know who has the sting by which chamber. So the governor can’t simply do issues unilaterally, however the way it performs out. And Youngkin’s backing a 15-week ban with some exceptions after that for all times and well being. A 12 months in the past, that may’ve appeared like an excessive measure. And now it appears average, I imply in comparison with zero weeks and no exceptions. So Virginia’s a purple state, it’s swung blue. It’s now reddish once more, I imply, it’s not a swing state a lot in presidential, however on the bottom, it’s a swing state. And …
Rovner: But I assume that’s what I used to be getting at was Youngkin’s making an attempt to type of paint his assist as one thing average …
Kenen: That’s how he’s been making an attempt to string this needle ’trigger he comes throughout as average after which he comes throughout as extra conservative. And on abortion, what’s average now? I imply, within the present panorama amongst Republican governors, you might say his is average, however Alice follows the politics extra intently, however half the nation doesn’t assume that’s average.
Rovner: If the Democrats retain or win each homes of the legislature, I imply, will that ship us a message about abortion or is that simply going to ship us a message about Virginia being a really narrowly divided state?
Ollstein: I believe each. I believe Joanne is correct in that the polling and the voting file over the past 12 months replicate that lots of people will not be shopping for the concept 15 weeks is average. And a variety of polls present that when offered the selection between a complete ban and whole protections, even people who find themselves uncomfortable with the concept of abortions later in being pregnant go for whole protections. And so that you’ve seen that play out. At the identical time, there’s lots of people on the precise who appropriately argue that the overwhelming majority of abortions occur earlier than 15 weeks, and so 15 weeks will not be going far sufficient. And they’re not in favor of that as so-called compromise or average coverage. And so …
Rovner: There are not any compromises in abortion.
Ollstein: Truly, really.
Rovner: If we’ve discovered something, we’ve discovered that.
Ollstein: And whenever you attempt to please everybody, typically you please nobody, as we’ve seen with each candidates and insurance policies that attempt to thread this needle. And so I believe it is going to be a very attention-grabbing take a look at as a result of sure, proper now the legislature is type of the firewall between what the governor desires to do on abortion, and whether or not that can proceed to be true is a very attention-grabbing query.
Rovner: Meanwhile, we’ve dueling abortion reversal lawsuits happening in each Colorado and California. Abortion reversal, for many who don’t comply with all of the jargon, is the idea of interrupting the two-medication regime for abortion by capsule. And as an alternative of taking the second remedy, the pregnant particular person takes massive doses of the hormone progesterone. The American College of Obstetricians and Gynecologists says there isn’t any proof that this works to reverse a drugs abortion and that it’s unethical for medical doctors to prescribe it. But in Colorado, a Christian well being clinic is charging {that a} state regulation that bans the observe providing abortion reversal violates their freedom of faith. In California, it’s really the alternative. The state lawyer normal is suing a being pregnant disaster middle for false promoting, selling the observe. Alice, how massive a deal may this battle over abortion reversal develop into? And that’s assuming that the capsule stays broadly accessible, which goes to be determined by one more lawsuit.
Ollstein: Yeah, completely. Although it’ll be a very long time earlier than we all know whether or not mifepristone is legally accessible on a federal foundation. But I’ve been watching this bubble up for years, but it surely’s up until now been extra of a rhetorical battle by way of: “Abortion reversal is a thing.” “No, it’s not.” “Yes, it is.” “No, it’s not.” “Here’s my expert saying it is.” “Here’s my expert saying it’s not.” But that is actually transferring it right into a extra type of concrete, authorized realm, and never simply rhetoric. And so it’s an escalation, and it is going to be attention-grabbing to see. Mainstream well being care organizations don’t assist this observe. There was a scientific trial of it happening that was really known as off due to the potential risks concerned and dangers to contributors …
Rovner: Of doing the abortion reversal technique …
Ollstein: Exactly. Yes.
Rovner: … of making an attempt to interrupt a drugs abortion.
Ollstein: Yes. This is admittedly on the slicing fringe of the place medication and politics are clashing proper now.
Rovner: Yeah, we’ll see the way it, and, in fact, in the event that they find yourself somewhere else, this may very well be one thing else that leads to entrance of the Supreme Court. And that is, I believe, much less of an argument about non secular freedom than an argument in regards to the capacity of medical organizations to find out what’s or isn’t normal of observe based mostly on proof. I imply, I assume in some methods it turns into the identical factor because the broader mifepristone case, the place it’s like, do you belief the FDA to find out what’s secure? And now, it’s like, do you belief ACOG and the AMA [American Medical Association] and different organizations of medical doctors to resolve what must be allowed?
Kenen: I imply, progesterone has medical functions, it’s used to stop miscarriages, but it surely’s off-label. It goes into these different questions, which all of us have written about — ivermectin, and who will get authorized substances, and the way do you employ them correctly, and what’s the hazard? And there’s a bunch of them.
Weber: I believe the battle over normal of care has actually develop into the subsequent frontier in medical lawsuits. I imply, we’ve all written about this, however ivermectin, clearly, misinformation, prescribing hydroxychloroquine, all of this stuff at the moment are entering into the authorized discipline. Is that the usual of care? What is the usual of care and the way does that play out? So I agree with you. I believe that is going to finish up by the Supreme Court and I believe it has a lot broader implications than simply for mifepristone and abortion medicine too.
Rovner: Yeah, I do too. Well, lastly, in an replace I didn’t have on my post-Roe Bingo card, it seems that vasectomies are up in some states, together with Oregon, the place abortion continues to be authorized, and Oklahoma, the place it’s not very broadly accessible. Are males lastly taking extra accountability for not getting the ladies they’ve intercourse with pregnant? That could be an enormous sea change.
Ollstein: Yeah, we’ve been listening to anecdotally that this has been the case undoubtedly since Dobbs and even earlier than that as abortion restrictions had been mounting. Politico Magazine did a pleasant piece on this final 12 months profiling vasectomy [in] a cellular van. And it’s additionally simply fascinating and lots of people have been highlighting simply how few restrictions on vasectomies there are in comparison with extra everlasting sterilization for ladies: no ready intervals, no preventing about it. And so it does present an attention-grabbing distinction there.
Rovner: I do know there have been tales over time about how the demand for vasectomies goes up proper earlier than the NCAA event in March and April as a result of males determine that they will simply recuperate whereas watching basketball.
Ollstein: I assumed that was a fantasy then I seemed it up and it’s completely true.
Rovner: It is completely true.
Kenen: I imply, it additionally appears to be extra frequent amongst older males who’ve had a household and since it’s everlasting, I imply normally everlasting. It’s normally everlasting and proper, it’s one factor to resolve after a sure level in your life whenever you’ve already had your children. I imply, it’s not going to be an possibility for youthful males who haven’t had youngsters.
Rovner: It’s additionally dependable, it’s a type of issues that you just don’t have to fret about.
Kenen: Even although I seemed up the figures as soon as, it’s a really, very low failure fee, but it surely’s not zero.
Rovner: True. We are transferring on to what I name this week in declining life expectancy. I’m glad that Lauren is again with us as a result of The Washington Post has revealed the subsequent items of its deep dive into the U.S. inhabitants’s declining life expectancy. And we’re going to begin with a narrative that was co-written by Lauren, however that’s Joanne’s additional credit score this week. So Joanne, you begin, after which Lauren, you possibly can chime in.
Kenen: OK. It’s “How Lunchables Ended Up on School Lunch Trays.” For these of you who’ve by no means been in a grocery store or who’ve closed your eyes in sure aisles, Lunchables are closely processed, encased in plastic, small lunchboxes of a — it’s not even a lot of a meal or small — which you should purchase within the grocery store. And now two of them have been modified in order that they’re allowed in colleges as wholesome sufficient …
Rovner: They’re quote, unquote, “balanced” as a result of it’s a little bit piece of meat and a little bit piece of cheese.
Kenen: They have to date only a turkey cheese possibility that qualifies for colleges and a pizza that qualifies for colleges. Not an entire pizza, a little bit … however the child within the story, the second grader within the story, didn’t even understand it was turkey. It has 14 components. He thought it was ham. So I imply, that simply type of says it, but it surely’s past the shortage of diet, it began out type of like what is that this youngster placing in his mouth and why is it known as faculty lunch? But the story was deeper as a result of it was a really lengthy investigation by Lauren and Dan Keating on the connection between the meals trade, the commerce group, and the federal government regulation. And simply say, it leaves quite a bit to be desired. And you must all learn the story solely as a result of you possibly can click on on the story of the outsized Cheez-It.
I imply, it’s a pretend one, however the duplicate of this as massive because the planet Mars. I imply, it’s simply this large Cheez-It. And it’s a very good story as a result of it’s overprocessed meals is admittedly unhealthy for us. And I imply, scientists have matched the rise of this overprocessed stuff that started as meals and the rise of weight problems in America. And it’s not simply taking the salt out of it, which they’re doing, the sodium out of or including a little bit calcium or one thing to those processed meals. They’re ultra-processed meals, and that’s not what our physique wants.
Rovner: So, Lauren, I imply, how does this relate to the remainder of this declining life expectancy challenge and what else is there to come back?
Weber: This is our massive tranche of tales. I imply, we should always have some follows, however that’s it. And nicely, Joanne, thanks for the sort phrases on it. We actually admire that. But I imply, I believe the purpose that she made that I wish to spotlight for this basically is what was wild in investigating this story is pizza sauce is a vegetable within the U.S. on the subject of faculty lunch and french fries are additionally a vegetable. And that’s actually all you have to sum up how the trade affect in Congress has resulted in what children are having for his or her faculty lunch at this time. One of the issues we received to do for the story is go to the nationwide School Nutrition Association convention, which is the place we noticed the large Cheez-It. And it’s this huge commerce honest of all these corporations the place they throw events for the college diet personnel to attempt all of the completely different meals. And it’s wild to see in actual life. And what Joanne made a very good level of about ultra-processed meals and what the principles do proper now could be they don’t think about the integrity of the meals. They set limits on energy and sodium, however they don’t think about what children are literally consuming. And so you find yourself with these ultra-processed meals that rising physique of analysis suggests actually have some detrimental well being penalties for you. And so, as Joanne talked about, and as our sequence will get into, weight problems is an actual drawback on this nation, and weight problems has large, long-lasting, life-shortening impacts. One of the parents we talked to for the piece, Michael Moss, stated, he worries that processed meals is the brand new tobacco as a result of he looks like smoking’s taking place, however weight problems’s going up. And one thing he stated to me that didn’t make the piece, however I assumed was actually attention-grabbing is that sooner or later he thinks there’ll be some type of class-action lawsuit in opposition to ultra-processed meals, very similar to a cigarette lawsuit-
Rovner: Like with tobacco.
Weber: Like a tobacco lawsuit, like an opioid lawsuit. I believe that’s form of attention-grabbing to consider, however this was simply one of many many life expectancy tales. I wish to shout out my colleague Frances Stead Sellers’ story, which talked about the way it in contrast is sensible. It in contrast two sisters with rheumatoid arthritis, one who lives within the U.S. and one who lives in Portugal. They’re each from Portugal. The one in Portugal has all this fabulous major well being care. The medical doctors even name her on Christmas they usually’re like, “We’re worried you’re going to have chocolate cherries with brandy that would interact with your medicine.” Whereas the one within the U.S. has to go to the ER on a regular basis as a result of she doesn’t have regular well being care and she will be able to’t appear to make it work, ends meet. She doesn’t have a major well being care system. She’s a disjointed physician system. And the top of the story is the sister within the U.S. who has this extreme well being drawback is transferring to Portugal as a result of it’s simply so significantly better there for major care. And I believe that will get at a variety of what our tales on life expectancy have talked about, which is that major care, preventative care within the U.S. will not be a precedence and it ends in a variety of downstream penalties which might be shortening America’s life expectancy.
Rovner: Well, I hope when this challenge is all revealed that you just put all of the tales collectively and ship them to each faculty of public well being within the United States. That could be pretty helpful. I guess public well being professors would admire it.
Weber: Thank you.
Rovner: So it’s mid-October, meaning it’s time for the annual KFF survey of employer medical health insurance. And for the primary time for the reason that pandemic, most premiums are up markedly, a median of seven% from 2022 to 2023 with indications of even bigger will increase coming for 2024. Now, to folks like me and Joanne, who’ve been doing this for a very long time, lived by years of double-digit will increase within the early 2000s, 7% doesn’t appear that massive, however at this time, the typical household medical health insurance premium is about the identical as the price of a small automotive. So is there a breaking level for the employer well being system? I imply, one of many issues — to return to what we had been speaking about at the start — one of many compromised methods we’ve stored the system useful is by permitting these items to stay in items. Employers have needed to supply medical health insurance. It’s an vital fringe profit to assist appeal to staff. But you’re paying $25,000 a 12 months for a household plan, until you’re a very massive firm. And even if you’re a very massive firm, that’s an terrible lot of cash.
Kenen: One of the issues that struck me is, we’re at some extent once we’ve had a variety of strikes and reactivated labor motion, however 20 years in the past, the fights had been about the price of well being care. The well-known Verizon strike. They had been massive strikes that had been about well being care, the price. And proper now, I’m probably not listening to that an excessive amount of. I’m positive it’s a part of the dialog, but it surely’s not the highest. It’s not the headline of what these strikes are about. They’re about salaries largely and dealing circumstances with nurses and ratios and issues like that. I’m not listening to well being care prices, however I type of assume we are going to as a result of, sure, we’re being sponsored by our employers, most of us. But you stated, “What’s the breaking point?” Well, apparently there isn’t one. We’ve requested ourselves that each single 12 months. And when can we cease doing it? No one has a very good reply for that. And associated is to what Lauren was simply speaking about, life expectancy. The lack of major care on this nation, along with enhancing our well being, it might in all probability convey down price. We used to spend 6 cents on the greenback on major care, 6 cents. Other international locations spend much more. Now, we’re all the way down to 4.5 cents. So the stuff that retains you nicely and spots issues and has someone who acknowledges when one thing’s going fallacious in you since you’re their affected person versus … there’s nothing. I don’t imply that pressing care doesn’t have a spot. It does, but it surely’s not the identical factor as someone who offers you continuity of care. So these are all associated. I’ll cease. It’s a multitude. Someone else can say it’s a multitude now.
Rovner: It’s undoubtedly a multitude and we aren’t going to repair it at this time, however we’ll hold making an attempt.
Kenen: Maybe subsequent week.
Rovner: All proper. Yeah, possibly subsequent week. That is that this week’s information. Now, we are going to play my “Bill of the Month” interview with Arielle Zionts. And then we are going to come again and do our additional credit.
I’m happy to welcome to the podcast my KFF Health News colleague Arielle Zionts who reported and wrote the newest KFF Health News-NPR “Bill of the Month” installment. Arielle, welcome to the podcast.
Arielle Zionts: Thanks for having me.
Rovner: So this month’s affected person is grappling with a grave most cancers analysis, a toddler, and a few inexplicable payments from hospitals in two completely different states. Tell us a little bit bit about her.
Zionts: Sure. So Emily Gebel is from Alaska and has a husband and two younger children. She home-schools them. She actually likes the outside, studying, foraging, and she or he was identified with breast most cancers. Just one thing that makes me so unhappy is she discovered when she was mainly breastfeeding as a result of she felt a lump. And then when she was identified, her child was asleep in her arms when she received that decision. So it simply actually reveals what it’s prefer to be a mother and to have most cancers. She was dwelling in Juneau on the time. Her associates who’ve had most cancers steered [they] needed to go to an even bigger metropolis. Whether it’s true or not, the concept was, OK, greater cities are going to have greater care. Juneau will not be an enormous metropolis, and you can not drive there. You need to take a ferry or you must fly in, and that is the capital of Alaska. So that may …
Rovner: Yes, I’ve been there. It’s very picturesque and really small and really laborious to get to.
Zionts: Yeah, in order that could be shocking for some folks. The closest main American metropolis is Seattle. So she went there for her surgical procedure after which she determined to have chemo, and she or he opted for this particular kind of chemo that makes use of decrease dose, however extra frequent doses. The thought is that it creates much less of the unintended effects, and she or he went to this standalone clinic in Seattle, flying there each week. It’s not a fast flight. It can take as much as two hours and 45 minutes. And that simply received actually tiring. I imply, bodily …
Rovner: And she’s received children at residence.
Zionts: Yes, bodily and mentally and simply taking over time. So she determined to modify to the native hospital in Juneau. So that they had payments from the primary clinic in Seattle, after which they received some estimates from the one in Juneau after which lastly received a invoice from there as nicely.
Rovner: Yes, as we are saying, “Then the bill came.” And, boy, there was an enormous distinction between the identical chemotherapy in Seattle and in Juneau, Alaska, proper?
Zionts: I in contrast two of Emily’s remedies that used an analogous combine of medication and likewise had overlapping non-drug costs, equivalent to how a lot it prices for the primary hour of therapy, subsequent hours. And within the Seattle clinic, one spherical price about $1,600. And then in Juneau it price greater than $5,000, so greater than thrice larger. And we had been ready to take a look at particular costs. So that first hour of chemo was $1,000 in Juneau, which is greater than twice the speed within the Seattle clinic. There was a drug that price greater than thrice the worth on the clinic. And then even the cheaper costs had been costlier. So the hospital charged $19.15 for Benadryl, which is about 22 occasions the worth on the clinic, which was 87 cents.
Rovner: Now to be clear, the Gebel household appears to have fairly complete insurance coverage. So this case wasn’t as a lot about their out-of-pocket prices as among the different Bills of the Month that we’ve coated, however they did wish to know why there was such an enormous distinction, and what did they, and we discover out?
Zionts: Yeah. So we began the story for NPR, we mainly began saying, “Hey, this is a little different than the other ones because the family has met their maximum out-of-pocket.”
Rovner: For the 12 months?
Zionts: Yes. Once you pay a sure sum of money for the 12 months, your insurance coverage will cowl every part, and that may be a excessive quantity. But when you have most cancers, most cancers’s costly, so you’ll in all probability hit it sooner or later. By the time she switched her therapy to Juneau, she had met that, so she wouldn’t really owe something.
Rovner: But what did they discover out however, about why it prices that rather more in Juneau than it did in Seattle?
Zionts: Yes. So Jered, her husband, he’s considerably of a self-taught medical billing professional. He gained this information by listening to “Bill of the Month” after which studying some books about this. I imply, at first, he thought possibly they’d owe cash, however then he discovered they wouldn’t. But he nonetheless didn’t assume it was honest. I imply, he didn’t assume it was honest for the insurance coverage corporations. And he did catch two errors. One of them, an estimate, was fallacious. The hospital stated, “Oh, it looks like there was a computer error,” and that was lowered. And then when it got here for the precise invoice, there was a coding error. It made one of many medicine not coated when it ought to have been. So that may’ve really left them out-of-pocket prices. So he was in a position to decrease an estimate, decrease the invoice. But once more, even with these modifications, it was nonetheless a lot costlier. And that’s once I known as some specialists and somebody’s intestine response or preliminary speculation could be, “Well, of course, it’s more expensive in Alaska. Alaska is small, it’s remote. I mean, it’s just going to cost more to ship things there. You need to pay doctors more to entice them to live there.”
Rovner: And it prices extra for medical doctors to reside there anyway, proper?
Zionts: Yes.
Rovner: The price of dwelling is excessive in Alaska.
Zionts: Yes. The professional I spoke with, an economist who has studied this challenge. He stated, “Yes, that is part of it.” Like you stated, every part is costlier in Alaska, however even when accounting for that, the costs are even larger. So the expansion of price within the well being care sector in Alaska is larger than the expansion of general price. And he listed some insurance policies or traits that may clarify that. There’s one that basically stood out, which is one thing known as the “80th percentile rule,” but it surely was meant to comprise price for whenever you’re seen by out-of-network suppliers. And plainly it could have really backfired, and the state is contemplating repealing that. But as Elisabeth Rosenthal, one in every of our editors at KFF Health News, and she or he’s written a whole ebook about this, as she stated, “This is how our health system works. There’s no law saying, this is how much you can upcharge for some intrinsic value of a medicine or of a service. So hospitals can do what they want.” So …
Rovner: And we should always level out, I imply, this isn’t a for-profit hospital, proper? It’s owned by town.
Zionts: Yes. This is a nonprofit hospital owned by town, they usually don’t get a ton of cash from town or state, which is attention-grabbing although. So they’re actually getting their funding from the companies they supply. And the hospital stated they attempt to make it honest by evaluating it to wholesale prices, what different hospitals within the area are charging. But in addition they stated, “Yes, we do need to account for the higher costs.”
Rovner: So what’s the takeaway right here? I imply, mainly what it prices goes to rely upon the place you reside?
Zionts: Basically, what we’ve discovered from all these Bill of the Months is that it’s going to range relying on what facility you go to. And that may very well be inside one metropolis, the costs may range. And then you definitely would possibly see some extra variation between states and particularly in states the place the price of dwelling is larger or it’s extra distant.
Rovner: Of which Alaska is each.
Zionts: Yes. And really, one thing so as to add is that the sum of money that this hospital has to spend to fly in medical doctors and nurses and likewise simply workers, even nonmedical workers, they spent practically $11 million final 12 months to move them and pay them as a result of they don’t have sufficient native folks. And the opposite takeaway, although, is that sure, this may be defined, but in addition, it’s unexplainable within the sense that our well being care system doesn’t have some magic system or some laborious guidelines about what’s, quote, “fair.”
Rovner: Yes, a minimum of on the subject of Medicare, Congress has been making an attempt to try this for, oh, I don’t know, about 50 years now. Still engaged on it. Arielle Zionts, thanks very a lot for becoming a member of us.
Zionts: Thank you for having me.
Rovner: OK. We are again, and it’s time for our extra-credit section. That’s once we every advocate a narrative we learn this week we predict you must learn, too. As all the time, don’t fear when you miss it. We will submit the hyperlinks on the podcast web page at kffhealthnews.org and in our present notes in your cellphone or different cellular machine. Joanne, you’ve already achieved yours. Alice, why don’t you go subsequent?
Ollstein: I did a bit by my former colleague Angela Hart for KFF Health News, and it’s about road medication. So groups of medical doctors working with unhoused folks, and that is profiling primarily in Northern California, but it surely’s type of discussing this throughout the nation. And along with the actually very transferring private tales that she present in her reporting, she additionally talked about among the structural stuff that’s supporting the growth of this type of well being care. And so California was already placing some huge cash into well being care companies for the homeless, however in hospitals and in clinics, they had been discovering that folks simply aren’t in a position to are available. Whether it’s as a result of they don’t wish to depart all of their earthly possessions unguarded or as a result of they will’t get the transportation or no matter. And so that cash’s now being redirected into having the medical doctors go to them, which appears to be profitable in some methods, however the depth of well being care issues is simply so deep. And …
Rovner: But additionally, actually the significance of major care.
Ollstein: Absolutely. And so what they’re discovering is simply a variety of pregnancies and issues with being pregnant within the homeless inhabitants. And so that they’re doing extra companies round that and extra providing contraception and prenatal look after the people who find themselves already pregnant. It’s very unhappy, however considerably hopeful. And the opposite extra structural factor is altering guidelines in order that medical doctors can get reimbursed at a good fee for offering road medication versus in brick-and-mortar services.
Rovner: Thanks. Lauren?
Weber: So I even have a KFF particular from my former colleagues, Markian [Hawryluk] and Renu [Rayasam]. It’s only a nice piece. It’s known as “Doctors Abandon a Diagnosis Used to Justify Police Custody Deaths. It Might Live On, Anyway.” So what the piece does is it interviews the physician who helped debunk what excited delirium is for his medical group, but it surely reveals that that won’t assist by way of court docket instances which have already been determined and by way of science basically. And I believe it’s so fascinating as a result of what this piece does is it will get at what occurs when flawed science then is used for lawsuits and consequential issues for a lot of, a few years to come back. I believe we’ve seen a variety of tales this 12 months about flawed science and what the precise ramifications are after, and that is clearly horrible ramifications right here. And it’s simply form of an enchanting query of how does that ever get made proper and the way do issues slowly or ever return to what they need to be after flawed science is revealed? So actually, actually nice work from the group.
Rovner: Yeah, it’s actually good piece. Well, retaining with the theme of selecting tales by our former colleagues. Mine is from a former colleague at NPR, Jeff Brady, and it’s “How Gas Utilities Used Tobacco Tactics to Avoid Gas Stove Regulations.” And when you don’t know what that refers to, I’ve a ebook or a number of for you in regards to the large sums of cash that the tobacco trade paid over many many years to have captive, scientific, quote-unquote, “experts” counterclaims that smoking is unhealthy on your well being. It seems that the fuel range trade likewise knew that fuel stoves had been worse on your well being than electrical ones, and that these vent hoods don’t actually maintain all the issues of the issues that fuel stoves emit. And that it additionally paid for research supposed to muddy the waters and confuse each prospects and regulators. It’s a fairly damning story, and I say that as somebody who may be very a lot connected to my fuel range however am now having second ideas.
OK, that’s our present for this week. As all the time, when you benefit from the podcast, you possibly can subscribe wherever you get your podcasts. We’d admire it when you left us a overview; that helps different folks discover us too. Special thanks as all the time to our superb and affected person engineer, Francis Ying. Also, as all the time, you possibly can electronic mail us your feedback or questions. We’re at whatthehealth@kff.org, or you possibly can nonetheless discover me holding down the fort at X, I’m @jrovner or @julierovner at Bluesky and Threads. Joanne, the place are you today?
Kenen: I’m extra on Threads, @joannekenen1. I nonetheless have a Twitter account, @JoanneKenen, the place I’m not very energetic.
Rovner: Alice?
Ollstein: I’m @AliceOllstein on X and @alicemiranda on Bluesky.
Rovner: Lauren?
Weber: I’m @LaurenWeberHP on X, the HP stands for well being coverage, as I like to inform folks.
Rovner: We shall be again in your feed subsequent week. Until then, be wholesome.
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