Hey, Trump. Bye-Bye, Biden. – KFF Well being Information

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Anti-Abortion Hard-Liners Speak Up - KFF Health News

The Host

Julie Rovner
KFF Well being Information


@jrovner


Read Julie’s stories.

Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous professional on well being coverage points, Julie is the writer of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.

Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already speeding to work his priorities into laws, eyeing cuts to Medicaid to pay for brand spanking new tax and immigration priorities. However even in its waning days, the Biden administration continues to make huge coverage strikes, together with a potential order for tobacco corporations to dramatically lower the quantity of nicotine in cigarettes. 

In the meantime, the fires in Los Angeles are drawing new consideration to the well being risks of not simply smoke from natural matter, but additionally poisonous substances launched by burning plastic and different man-made supplies — in addition to the risk posed to each air and water high quality.

This week’s panelists are Julie Rovner of KFF Well being Information, Anna Edney of Bloomberg Information, Joanne Kenen of the Johns Hopkins College Bloomberg Faculty of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.

Panelists

Anna Edney
Bloomberg


@annaedney


Read Anna’s stories.

Joanne Kenen
Johns Hopkins College and Politico


@JoanneKenen


Read Joanne’s stories.

Sandhya Raman
CQ Roll Name


@SandhyaWrites


Read Sandhya’s stories.

Among the many takeaways from this week’s episode:

  • Republican lawmakers are weighing choices to chop federal spending on Medicaid, the almost $900-billion-a-year authorities program that covers 1 in 5 People. They might use the financial savings to bolster Trump priorities, resembling extending the 2017 tax cuts. The GOP made splashy however unsuccessful makes an attempt to chop Medicaid when Trump first took workplace and the social gathering held a bigger Home majority — although the social gathering appears extra aligned with Trump as we speak than it was then.
  • Congress has gotten all the way down to enterprise on messaging payments: It superior laws this week that may ban trans athletes from ladies’ college sports activities and, individually, a measure to detain and even deport immigrants who’re dwelling within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes resembling shoplifting.
  • The Supreme Court docket has agreed to listen to a case later this 12 months in regards to the U.S. Preventive Companies Job Pressure — an unbiased physique of consultants that points suggestions in illness prevention and drugs. A ruling towards its authority might strip protection for key preventive well being providers from not simply these with Reasonably priced Care Act protection, but additionally these on employer-sponsored well being plans. The query stands: If not this job drive, who would make the determinations about what preventive care needs to be lined?
  • And the outgoing Biden administration issued a slew of well being laws this week, together with a ban on the dye Purple No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration might upend these and extra laws, although some do align with its coverage pursuits.

Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the most recent KFF Well being Information “Bill of the Month” function, a few colonoscopy that got here with a a lot bigger price ticket than estimated. When you’ve got a mystifying or outrageous medical invoice you’d wish to share with us, you can do that here.

Plus, for “additional credit score,” the panelists counsel well being coverage tales they learn (or wrote) this week that they assume it’s best to learn, too: 

Julie Rovner: KFF Well being Information’ “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” by Felice J. Freyer.

Anna Edney: Bloomberg Information’ “It’s Not Just Sunscreen. Toxic Products Line the Drugstore Aisles,” by Anna Edney.

Joanne Kenen: The Atlantic’s “A Secret Way To Fight Off Stomach Bugs,” by Daniel Engber.

Sandhya Raman: Nature’s “New Obesity Definition Sidelines BMI To Focus on Health,” by Giorgia Guglielmi.

Additionally talked about on this week’s podcast:

Click on to open the transcript

Transcript: Hey, Trump. Bye-Bye, Biden.

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hey and welcome again to “What The Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by among the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 16, at 10 a.m. As all the time, information occurs quick and issues may need modified by the point you hear this. So, right here we go. 

At this time we’re joined through videoconference by Anna Edney of Bloomberg Information. 

Anna Edney: Hello, all people. 

Rovner: Sandhya Raman of CQ Roll Name. 

Sandhya Raman: Good morning, everybody. 

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico Journal. 

Joanne Kenen: Hello, all people. 

Rovner: Later on this episode we’ll have my interview with Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month,” a few affected person whose colonoscopy invoice was lots greater than he anticipated. However first, this week’s information. 

So we are actually 4 days from the second swearing-in of Donald Trump as president, and discussions are already selecting up on Capitol Hill about rolling the brand new president’s complete agenda into, quote, “one huge, lovely invoice,” as Trump has put it. There are many variations of opinions between Republicans which might be nonetheless to be labored out, however one goal for cost-cutting is fairly clear, and that may be Medicaid. Sandhya, we’re beginning to get an image of the probabilities of how they may need to do this. What are among the foremost issues which might be on the desk? 

Raman: So the reconciliation talks are very a lot underway, and we’ve made a little bit progress however on the similar time we simply didn’t additionally make numerous progress. The tip of, -ish, final week we received a menu of things that Republicans are type of contemplating as issues they might use to offset among the issues that they’d need to do by means of reconciliation. 

Rovner: Like proceed the tax minimize? 

Raman: Sure, for the tax cuts and for border safety. So what we’ve got on the Home facet is numerous issues which might be very health-oriented. About half of that checklist is health-oriented, and numerous it’s Medicaid. And so among the issues they’ve been floating round are some issues we noticed within the first Trump administration, them making an attempt to do. We have now per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid growth, and issues like altering the general public cost rule to again the way it was within the Trump administration. 

Rovner: Remind folks what the general public cost rule is. 

Raman: The general public cost rule type of limits among the social applications for folk that aren’t residents to utilize issues like Medicaid, SNAP [the Supplemental Nutrition Assistance Program], and different applications like that. 

Rovner: And people are for people who find themselves right here legally? 

Raman: Sure. So this week, Tuesday, we had our first assembly from the Home Power and Commerce Republicans to look over at the least the well being a part of that menu. And speaking to each Power and Commerce Chairman Brett Guthrie and Buddy Carter, who heads the well being subcommittee, it’s simply the beginning. Discussions had been fairly good, but it surely’s so early. 

Carter mentioned that he nonetheless desires to get the PBM [pharmacy benefit manager] language from final 12 months that didn’t make it throughout the end line in there. And Guthrie has mentioned that among the numbers that we’ve seen of how a lot cash from Medicaid they might presumably save are actually in flux due to how they work together with all the different provisions in there. Some issues are underneath Methods and Means jurisdictions. Some issues, for those who do one and never the opposite, the numbers would change. 

In order that they’re nonetheless fairly early within the course of, and we don’t know if we’re going to do the “one huge, lovely invoice” or type of what the Senate desires, with two payments, and that may simply type of change what can be completed earlier versus later. However we do have a little bit bit extra of a timeline now in what they’re making an attempt to do. 

Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, once they had a a lot greater Republican majority within the Home, and so they couldn’t get it over the end line. What makes them assume they’re going to be extra profitable this time? 

Raman: I feel a part of it’s that — that is nonetheless early on. If you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid growth at this level. We nonetheless have solely the ten holdout growth states. So, I feel, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter car we’ve got, we’ll most likely hear extra. 

And I imply, for those who have a look at this state-level already, numerous states are type of couching their bets with Medicaid, simply interested by how they’ll do issues otherwise in case their Medicaid federal funding modifications over the course of this 12 months or subsequent 12 months. So, I feel it actually depends upon what suggestions they’re going to get within the coming weeks and months. 

Rovner: Joanne wished so as to add one thing. 

Kenen: Yeah, I imply, the fantastic thing about reconciliation for those who’re the bulk social gathering, however a slender majority, which is what’s occurring now, is you’d solely want 51 votes within the Senate. You don’t want 60. So on one degree, that feels like they’ve received 53. It’s a slam dunk, proper? Nevertheless it’s not, as a result of reconciliation, it’s a seize bag. You set a lot stuff in there, and all you want is one provision that this particular person received’t vote for or that particular person received’t vote for. 

So this seemingly easy slam dunk for a narrow-majority Senate is definitely an enormous, sophisticated mess. Alternatively, in comparison with the primary Trump administration, it is a extra conservative, or a extra populist, or a extra method — I imply, the ideology or worldview of the Republicans in Congress is nearer to Trump than it was in 2017. 

However yeah, they failed at what they thought was going to be simple. They thought repealing the ACA [Affordable Care Act] and altering, which included numerous Medicaid stuff, they thought it was a slam dunk. And as an alternative, it was a year-long slog that failed. So is Medicaid going to look the best way it appears proper now? No, it’ll change. How a lot will it change is admittedly an open query. 

Bear in mind, there’s some issues they’ll do by means of waivers. Work necessities they’ll do by means of waivers. Though up to now, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache. 

Rovner: Yeah, effectively, so reconciliation, finances, all of these items continues to be method TBD. Nonetheless, the Republican Congress is getting off to a quick begin, at the least by way of messaging laws. The Home this week handed a invoice to ban transgender athletes from girls’s college sports activities, and the Senate’s debating a Home-passed invoice that may enable the deportation of undocumented people who find themselves accused however not but convicted of violent crimes. 

In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued government orders making it simpler for fogeys to ship their kids to high school with out being vaccinated. Total, it appears the Republicans are type of coalescing round an idea generally known as “medical freedom,” which to me appears similar to a rejection of public well being normally. Or am I lacking one thing? Is there one thing extra to this? 

Edney: No, I feel that it’s all the time been round, however I feel that definitely this resurgence in it’s coming from the truth that folks didn’t belief science throughout the pandemic. They had been fed up. Communication wasn’t dealt with very effectively, and it nonetheless isn’t dealt with very effectively. I don’t assume folks have discovered how one can discuss these items in measured methods. 

I might suggest if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Instances a couple of days in the past on vaccination that I believed was actually good as a result of he’s like: Pay attention, I’m a vaccine skeptic. Like, R.F.Okay. Jr. [Robert F. Kennedy Jr.] is a vaccine cynic. There’s the distinction, and right here’s what it’s. And he laid it on the market. And he’s a pediatrician, and he additionally serves on FDA’s [the Food and Drug Administration’s] advisory committee for vaccines. 

So I feel that numerous that is stemming from misinformation and miscommunication, and it resonates with folks. I imply, the Republican Celebration picked up numerous followers in far-left progressives by speaking about this. So I feel they see that as a chance, too. So it might not simply be grassroots. It might be a little bit little bit of a chance they see. 

Kenen: Anti-vaccination sentiment has been round so long as vaccines. It truly goes again to smallpox. There has all the time been a certain quantity of worry, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to vary two or three years earlier than the pandemic. 

Some state legislatures — and this was the medical freedom, this was on the proper — began making an attempt to water down mandates for faculties. At that time, I don’t assume something huge received by means of. However we started to see this emergence of a deeper politicization of vaccination. And it was on the proper, and it’s what we now discuss as medical freedom. 

So as an alternative of being one thing that’s throughout the political spectrum, it’s now a politicized motion, on a libertarian Authorities can’t inform me what to do. And we noticed this throughout the pandemic. And neither administration, neither the Trump administration within the first 12 months of the pandemic nor the Biden administration within the ensuing years, actually managed to clarify the distinction between particular person selection and the truth that for those who get sick, you may survive however you would endanger any individual else. 

You don’t know who the particular person on the bus subsequent to you is. You don’t know who the child in your classroom is. You don’t know who you’re standing subsequent to on the grocery retailer. They could possibly be actually susceptible. And that this entire sense of “my physique, my selection,” doesn’t fly when you would kill any individual else unintentionally. And that type of has been misplaced, or folks don’t care. 

Rovner: Yeah, I imply we’ve seen that with tobacco over what number of generations. It’s like, you need to put stuff in your lungs, that’s what you are promoting. However you don’t actually get the proper to place stuff in different folks’s lungs since you wish to smoke. 

In the meantime, persevering with with the Republican agenda, my former KFF Well being Information colleague Anna Maria Barry-Jester has a really good story this week about what Nationwide Institutes of Well being director candidate Jay Bhattacharya may take note of for the company, together with de-emphasizing infectious illness analysis and focusing extra on continual illness. 

Provided that the most important institute at NIH is already the Nationwide Most cancers Institute, which focuses on a continual illness, is that this simply Republicans’ method of punishing the Nationwide Institute of Allergy and Infectious Ailments that was for therefore lengthy headed by the now retired Dr. Tony Fauci? 

Raman: I feel in an element that could be a big driving issue, if you have a look at a few of his feedback and R.F.Okay. Jr.’s feedback about holistic approaches to well being, that actually if you have a look at what one thing like NIAID does, which is so infectious-disease-driven, versus the issues like with most cancers and different issues. 

However I feel on the similar time, this has type of been effervescent up earlier than, after we even regarded to final 12 months. Earlier than we had any of those nominees, earlier than we even knew the result of the election, we had a push inside Congress from the top of the Home Labor-H Appropriations subcommittee and former Power and Commerce Chairwoman Cathy McMorris Rodgers making an attempt to reform NIH that method. 

We didn’t get that far with it. It was included in among the appropriations payments that didn’t go anyplace but. However I feel it’s simply a part of a broader dialogue that there’s, type of going again to what we had been saying earlier than, among the wanting extra management of what you see, by way of medical freedom, and that they need to know extra about what’s taking place. 

So I feel that, regardless, we’re going to see extra of this. However I feel one factor that was actually fascinating in what she’d been writing was simply the NIH is a lot greater than simply NIH, you already know? It’s so lots of the folks which might be benefited by it, which might be working with this grant cash, are states nationwide. And it’s simply the medical analysis is for a world understanding of medical analysis, and simply how lots of the medicine that we see come from NIH cash. So even when there’s a broader push for reform, that it’s very delicate into how broad of an impact that may have. 

Rovner: And I might level out, as a result of I stay up the road from NIH, that the majority of what NIH does doesn’t occur on the NIH campus. It’s, as you mentioned, it’s cash that goes out to each single congressional district. There’s an infinite quantity of backing. 

I might additionally level out that, sure, NIH has gotten type of sprawling with, I feel there’s 27 institutes now. Each single a kind of has been added by Congress. NIH can’t create its personal institutes. Solely Congress can do this. So, Congress has type of made NIH the sprawl that it’s. I feel there’s been bipartisan settlement that NIH possibly wants a brand new look. 

I suppose the query is simply type of what course that’s going to take and whether or not a few of it will be punitive or whether or not they’re truly going to take a look at it in a matter of what would profit the nation, as a result of it will get some huge cash, and that’s additionally been bipartisan. 

Kenen: Proper. What we’re not listening to but, or at the least — and possibly Anna, who covers pharma, can inform me if I’m mistaken — however we’re not — NIH additionally does the essential, fundamental, fundamental mobile first-step science that finally results in the work that drug corporations do to develop medicine. They do the essential, what they name bench, science. 

I’m not listening to the drug corporations converse out. The ambivalence People have about drug corporations, which is hating the costs however liking the medicine, I haven’t heard pharma — Perhaps it’s simply too early. Perhaps they’re weighing in quietly, and possibly Anna can inform me I’m mistaken and they’re and I simply didn’t discover. However that’s additionally an enormous constituency, an enormous, highly effective constituency. As a result of with out the NIH, we wouldn’t have lots of the medicine that preserve us and our aged kinfolk alive, together with numerous the positive aspects — we haven’t cured most cancers, however we’ve made positive aspects on most cancers. That wouldn’t have occurred. It’s not simply the premier analysis institute in America. It’s the premier analysis institute on this planet, and as Julie mentioned, an enormous driver economically of each single county, each medical college, each public well being, you already know, it has been an financial powerhouse in addition to a information powerhouse. 

Edney: And I wouldn’t inform you you’re mistaken. I feel that you just’re proper. I haven’t heard the pharma corporations speaking about it. I feel they’re speaking about numerous issues that they need completed to learn them, and so I’m certain that they’ve made their priorities. We’ll see if this reaches type of a boiling level, the place they do find yourself weighing in. And I additionally simply need to say, NIH, I do know they need to give attention to continual illness. It does numerous that. So possibly that’s not being communicated: It’s not being minimize or left off the desk as a result of we’re doing this. We will do two issues. We will stroll and chew gum. 

Rovner: Sure, I do know, and that was the purpose I used to be making an attempt to make. It’s like, there’s an infinite quantity of continual illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend numerous time, particular person members, telling NIH what it’s they need to be finding out, which is a complete different difficulty that we’ll get to a different time. 

However I need to keep on the subject of drug costs, as a result of that’s a extremely huge query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly instructed a Bloomberg reporter that it’s going to ask the Trump administration to, quote, “pause” the Medicare drug value negotiation program, which in fact is simply getting underway. 

In fact, that’s taking place at the same time as Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration resolution to have Medicare start masking its costly new weight reduction medicine. 

In the meantime, on its method out the door, the Biden administration’s Federal Commerce Fee dropped a report that discovered that the nation’s three largest PBMs, which collectively management about 80% of the U.S. prescription drug market, drove up drug costs by an estimated $7.3 billion from 2017 to 2022. 

I noticed someplace this week, and I feel, Sandhya, you talked about this, a suggestion that Republicans may attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to need to do in March. Possible? Doable? Will this report have any affect? Or is there simply an excessive amount of different information this week and no one’s going to recollect? 

Raman: I feel it’s positively being talked about lots. We talked to the management of Power and Commerce. It’s a precedence for each of them, each for Carter and for Guthrie, as a result of they labored so intently on it earlier than. It was included in a bipartisan deal that we had earlier than we received the CR [continuing resolution] that we voted into legislation. It simply received dropped alongside the best way. 

Rovner: When Elon Musk mentioned the invoice was too huge? 

Raman: Yeah. So I feel we type of have two pathways, the place each of them need to get it completed regardless. I feel that it would rely whether or not they’re able to piece it away and do it as one thing stand-alone, which they need to get it completed sooner moderately than later. 

Nevertheless it relies upon a little bit bit extra on the management degree, if there are financial savings from utilizing that invoice for use later down the road once they get reconciliation at a later stage. So I feel that’s what we’re ready on. Would they should put that there? Or would they have the ability to go forth with that now? 

Rovner: True. So, it’s a bipartisanly in style provision that additionally saves cash, in order that makes it type of engaging to lawmakers who’re placing collectively issues that may, as Joanne would say, embody spinach. 

Anna, what extra broadly do you see because the outlook on drug costs? 

Edney: Effectively, I feel the very first thing I consider with that program is, it saves some huge cash for those who’re giving Medicare the power to barter. And so, I simply surprise how that matches into this agenda for those who cease it and make it extra favorable in direction of the drugmakers. The place does that slot in with chopping spending and lowering the deficit and all of these issues? 

So, I feel that, possibly they’ve a little bit little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I feel everyone knows that we simply have to attend and see what truly occurs. 

Rovner: Yeah, numerous shrug emojis coming. 

Edney: Precisely. 

Rovner: Effectively, in the meantime, throughout the road from Capitol Hill, the Supreme Court docket has agreed to listen to that preventive well being care case out of, altogether now, Texas. The case challenges the necessities within the Reasonably priced Care Act that insurance coverage cowl, with out copay, preventive providers like immunizations, most cancers screenings, contraception, and, the topic of this explicit case, treatment to forestall HIV. 

What occurs if the courtroom guidelines with the plaintiffs on this case who argue that the CDC’s [Centers for Disease Control and Prevention’s] Preventive Well being Companies Job Pressure doesn’t have the authority to find out what providers needs to be on this checklist? Which in fact is the entity that now determines which providers needs to be on this checklist. 

Edney: Effectively, it feels like, then, lots of people don’t get their preventive care lined. As KFF wrote, there’s some that may be nonetheless lined, the mammographies, however not the HIV preventative treatment. Different most cancers screenings included in that as effectively. And so, it appears to throw a wrench, I suppose, type of simply asking this of the panel, that businesses then must go make these determinations? Does Congress need to make the determinations on what’s lined then? 

Rovner: Effectively, that’s in fact the large query. Or, would the secretary, him or herself? Who is allowed? I feel the argument is as a result of the Preventive Well being Companies Job Pressure shouldn’t be Senate-confirmed, they’ll’t make these choices. 

And naturally, the best way it really works, they don’t make these choices. They suggest them, after which the secretary type of ratifies them. So it’s arduous to inform from this whether or not it actually would go away, or whether or not Congress must step in, or whether or not the secretary might simply do it. I really feel like this creates as many questions because it might solutions. 

Kenen: It’s a extremely broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn completely different tales about this, and so they had completely different lists, together with some ldl cholesterol stuff. And I don’t know, for the reason that lists had been so completely different, I’m unsure precisely which of them are in or which of them had been out. Nevertheless it’s not simply HIV medicine. It’s numerous stuff. 

So it will definitely intestine one thing that individuals rely on now. I imply these are free not slightly below an ACA plan however for those who get protection by means of a job, these necessities additionally apply. So, lots of people would now not have free entry to numerous what we think about preventive care. 

Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They only determined to take it. So, this can be a later in 2025 case. Effectively, the flip facet of an incoming administration are all of the issues the outgoing administration tries to slide by means of on its method out of city, and this week has seen a bunch of these. 

Most of these items could possibly be pretty simply undone by incoming officers, however not with out some public ache, which typically is why administrations wait till the final minute to do them, to be a little bit passive aggressive, or possibly in a few of these instances lots passive aggressive. A number of of those last-minute modifications come from the Meals and Drug Administration, an company focused for large modifications underneath Trump 2.0. 

In simply the final 48 hours, the FDA has introduced a coverage that may require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Purple Dye No. 3, a controversial additive already banned in lots of different nations which has been proven to trigger most cancers in rodents. And it proposed a serious change in meals labels to require them to indicate on the entrance of packaging whether or not the meals’s sodium, sugar, and saturated fats ranges are low, medium, or excessive. Do any of those proposals stay on for greater than one other week? 

Edney: I feel the Purple No. 3 might. We all know that R.F.Okay. Jr.’s talked about meals dyes and eager to get them out of, he particularly mentioned, cereal, however they’re in numerous issues. So, I see that one. 

I feel the trade noticed that coming from distant and has been switching already, in fact typically to a different problematic, probably, meals coloring. However I don’t assume that is one thing you’re going to see them battle tremendous arduous for to vary. The nicotine is rather more iffy. Massive Tobacco continues to be an enormous drive, and Trump will get funding for his marketing campaign and issues from corporations who’ve a stake on this. 

And a few of that would align with this concept of not essentially medical freedom however, type of, we are able to select what we put in our our bodies. If we need to be hooked on nicotine, that’s our selection. So, the opposite one, the labels, I’m unsure. They’re not notably highly effective or something. I believed they regarded … Once I checked out it, I used to be like, That is complicated and simply appears just like the again, however it’s a little completely different. So, I don’t know. Perhaps it survives. I’m unsure how a lot the trade is engaged on this. 

Rovner: [Sen.] Bernie Sanders of all folks excoriated the meals labels, saying we don’t placed on cigarette packages whether or not the cancers they trigger are low, medium, or excessive. Why ought to we do that? I imply, that is principally one other effort to go after ultra-processed meals. I used to be stunned at how offended he was at this. 

Kenen: I feel he desires them in neon. 

Rovner: I feel he desires R.F.Okay. Jr. to have fewer ultra-processed meals accessible. I feel that’s going to be type of the large takeaway from all of this, I suppose. 

Kenen: Proper. However we additionally don’t perceive what an ultra-processed meals is, as a result of there’s some meals that aren’t ultra-processed which might be dangerous for you. And there’s some meals that do have some type of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t inform you. There’s some issues which might be, quote, “ultra-processed” that actually aren’t that processed, don’t have numerous components. They’ve one thing. 

So the entire categorization wants extra work, each for public understanding and political understanding. There’s no one who’s going to say that People have a extremely nutritious diet and that meals components … R.F.Okay. Jr. has identified to the meals additive, the place the businesses need to get to self-certify, Yeah, that is protected. So, is that one thing that he might get widespread assist on? Sure, however there’s a complete lot of different issues that he says that individuals weren’t going to agree with. 

Rovner: And I’ll remind that we not solely don’t know if R.F.Okay. Jr. can be confirmed, however they nonetheless don’t actually have a date for his affirmation listening to, as a result of they’re nonetheless ready on the paperwork. All proper, transferring on. 

As we taped this morning, there are nonetheless a number of fires burning within the Better Los Angeles space. We have now talked in regards to the well being results of fireplace earlier than. It’s not precisely information that fireplace and smoke are dangerous for human well being, however what appears to make these fires completely different is that they’re not largely timber and brush and different bits of nature which might be burning however numerous poisonous substances which might be polluting not simply the air but additionally the consuming water. 

Are we going to have to begin interested by fireplace and well being in a a lot completely different method if not simply distant areas however complete suburbs are actually liable to burning up on account of our altering local weather? 

Edney: It is going to make us consider numerous issues in numerous methods, and notably well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that comprise excessive ranges of formaldehyde, issues like that. 

I feel the expectation is that may create a long-term difficulty, but additionally it could actually within the second create extra deaths simply on the time, not as a result of it instantly kills but when you have already got a problem and you’ve got a respiratory drawback or a coronary heart drawback that may be exacerbated by these fires. 

Yeah, I feel there’s a ton to consider. Even consuming water will be impacted extra so when you’ve energy outages and issues within the areas the place you’re possibly cleansing that water after which issues like that. So, I feel that’s going to be — masks, N95s may be coming again for a very completely different purpose. 

Rovner: Effectively, N95s are usually not sufficient. I imply, I feel that was the factor that type of jumped out at me. When you watch the information protection of it, the reporters aren’t carrying N95s anymore. They’re carrying what regarded like old-style fuel masks. I imply, you want type of the following degree of masking as a result of N95s don’t filter out a few of these poisonous substances that are actually floating within the air. I imply, they do filter out the kind of the particular smoke from wooden and whatnot, but it surely’s fairly scary. 

I imply, much more folks than ever earlier than have N95s hanging round their home, however they definitely don’t have these next-level respirators, which is what I preserve listening to medical doctors calling for. 

Kenen: And the article you — I feel it was the one that you just despatched round yesterday that principally that every part in our home is, our couches are principally cubes of plastic wrapped in fabric and harmful once they’re burned. However I imply, I feel that was the article that additionally mentioned that a few of these issues which might be burning produce like a cyanide type of fuel, that the firefighters can’t even be uncovered. They’ll’t stand in entrance of a home with a hose for a very long time. 

It could possibly be killing or injuring firefighters. So, it additionally hampers — they’re not simply making an attempt to place a hose on a burning tree. 

Rovner: Yeah. Much more issues to consider, which is simply what we wanted. Effectively, turning to abortion, keep in mind all these states final 12 months that voted to guard abortion rights? Evidently was removed from the ultimate phrase. 

We’re seeing courtroom case after courtroom case to find out which abortion restrictions can keep and which might’t on account of passage of these poll measures. That is taking place notably in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a choose invalidated some however not all the state’s restrictions. 

This appears to be the inevitable results of what we’ve got seen in different elections, the place the identical voters endorse abortion rights however then flip round and vote for candidates, together with judges, who don’t. Is the gridlock right here on goal or accidentally? And Sandhya, what’s going to occur? 

Raman: I don’t know that it will be on goal. I feel that these voters that vote for the candidates, if abortion shouldn’t be their high difficulty, they’re nonetheless going to vote in the best way that type of allies with them. However then in the event that they’re taking a look at different insurance policies, they’re going to vote for these candidates. 

And Missouri, I feel, is fascinating as a result of it has lengthy been, I feel, one of many check instances for a lot within the abortion house, of making an attempt out new restrictions and what is going to persist with the wall. And I feel that we’re going to see extra of those type of lengthy, drawn-out battles, provided that the choose mentioned that some restrictions had been struck down due to the constitutional modification however then others, just like the licensing for abortion amenities, which we’ve seen for years, can keep. And that simply makes it in order that they’ll’t actually function. 

Rovner: Yeah. They’ve issues like how vast the hallways must be, I imply, guidelines that had been created to discourage them from providing abortions, not as a result of they had been truly wanted for security and well being. 

Raman: Yeah. These guidelines solely apply to the abortion amenities. They’re not parallel within the different varieties of clinics and hospitals. So it’s focused to them. I feel it’s simply one other instance of it being type of an uphill battle for them, as a result of now, I imply, even up to now few years we’ve seen a lot extra consideration on state supreme courtroom races, which I really feel like a couple of years in the past that was not one thing that may get nationwide consideration for one state or one other. 

However, provided that, as they’re type of litigating these and seeing how can we implement the legislation in order that these clinics can open underneath the constitutional modification, it depends on them, and simply how a lot cash that’s being fueled to have the ability to not come down on the opposite facet in order that they’ll type of function. So I feel that’s one thing to positively watch, as a few of these states are type of litigating these items, but it surely’s going to be an extended, drawn-out battle, even when it’s already been a number of months since seven out of 10 states final 12 months voted in favor of abortion rights. 

Rovner: Yeah, this continues, and naturally, we’ll wait and see what occurs on the federal degree, when the Trump administration will get going. Effectively, lastly this week, we’ve got one other entry in our recurring section, “This Week in Medical Misinformation.” I wished to speak about a little-noted story from the medical information web site MedPage At this time in regards to the American Board of Inside Medication pulling the board certification of a Texas heart specialist who made controversial and unfaithful claims about covid and the covid vaccine, together with that vaccine had killed tens of 1000’s of individuals. 

What’s troublesome about this story, although, is that the ABIM wouldn’t touch upon particular person physicians, though it did checklist this explicit physician on his web site as not being licensed. How ought to specialty boards cope with medical doctors who categorical views which might be, let’s assume, not in step with medical proof? And the way clear ought to they be about telling sufferers once they sanction one in every of their very own, which is principally what occurred right here? 

Kenen: Effectively, they did put out a press release, I feel it was the New England Journal of Medication a few 12 months and a half in the past, saying that they had been going to crack down on this. I’m unsure if there’s, for any of the boards, if there’s a mechanism for telling sufferers, as a result of how do you even know who all of the sufferers or potential sufferers are? 

Rovner: However after I say telling sufferers, I imply telling the general public. 

Kenen: Proper. However I don’t know that any of the boards do this in any — it’s an enormous can of worms about decertification and the way occasionally it occurs. 

So ABIM did put out a press release, I feel it was two years in the past now, and there’s been a course of for a couple of, however not lots. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So until the state medical board, which is admittedly the group that pulls a license — that is saying that you just’re not a board-certified no matter your specialty is underneath ABIM. 

However Lauren [Weber of The Washington Post], who is usually on the web site, had a superb piece a few months in the past about how few state boards have acted to sanction medical doctors who say incorrect issues about vaccines. And that goes again method earlier than covid. The medical career doesn’t do numerous self-policing. 

Rovner: Sure, and I’ve been doing this lengthy sufficient to have lined the creation of the Nationwide Practitioner Knowledge Financial institution, when medical doctors who’d had their licenses pulled might simply go to a different state, and there was no method for that state to simply discover out that that physician had had his or her license revoked. 

And that was normally not for saying issues however for doing issues that ended up with having the physician decreed not certified to follow drugs anymore. So, I imply, this is a matter that goes again an extended methods. 

Kenen: And you’d assume they might be the other. You’ll assume that the state boards, when any individual can be a dangerous man or a foul gal, you’d assume they might say, “We cease them!” Like, “We’re defending your well being.” And as an alternative, it’s been very secretive and really rare. 

It’s extra the state licensing board. I imply, certification is vital, however actually the facility to de-license any individual is within the state boards. 

Rovner: Yeah, effectively, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we’ll preserve watching. All proper, that’s the information for this week. Now, we’ll play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our additional credit. 

I’m happy to welcome to the podcast Harris Meyer, who reported and wrote the most recent KFF Well being Information “Bill of the Month.” Harris, welcome to “What the Well being?” 

Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you. 

Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he received. 

Meyer: OK, Julie, it is a story about excessive costs, complicated payments, and lack of value transparency for a quite common process. The affected person is Tom Contos, a 45-year-old well being care guide who lives in Chicago. Final spring, Tom seen blood in his stool. He went to see his household doctor at Northwestern Medication. 

The physician referred him for a diagnostic colonoscopy due to the bleeding and due to his household historical past of significant colon points. Then in June, he went in for a colonoscopy at Northwestern Memorial Hospital, which is an enormous educating hospital in downtown Chicago. 

A Northwestern gastroenterologist carried out the process, which took lower than an hour. He discovered and eliminated two polyps, which a pathologist later discovered weren’t cancerous. The gastroenterologist concluded that Tom’s rectal bleeding was attributable to a big hemorrhoid. 

Rovner: So, simply to be clear, it’s screening colonoscopies, these for folks with no signs, which might be speculated to be free as preventive care underneath the Reasonably priced Care Act. Diagnostic colonoscopies like this one can require a affected person to fulfill deductible and copay necessities, proper? That’s one thing vital for folks to know? 

Meyer: Sure. There’s numerous confusion about this. I received numerous feedback on my Washington Publish article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are completed when there are signs like bleeding or ache. In distinction, screening colonoscopies are really helpful beginning at age 45, even when there are not any signs, to forestall colon most cancers or different severe circumstances. 

The Reasonably priced Care Act requires well being insurers to cowl screening colonoscopies without charge to sufferers. However for a diagnostic colonoscopy, sufferers could need to pay a deductible and copayment, although that process equally can forestall colon most cancers. It doesn’t— 

Rovner: It may be complicated. 

Meyer: It’s complicated, yeah. 

Rovner: So he has a process, which discovered some minor indications that had been taken care of, after which, as we are saying, the invoice got here. How a lot was it? 

Meyer: Yeah, Northwestern’s whole cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated fee with Northwestern of a nonetheless important about $6,000. When he received his insurance coverage rationalization of profit assertion, he noticed that he owed about $4,100, with the insurer paying about $2,000. 

He was bewildered as a result of he had requested Northwestern for an estimate of how a lot he would owe in whole and he was instructed that he would owe about $2,400. My exterior billing professional mentioned $4,100 is kind of a excessive out-of-pocket invoice, although common for educating hospitals. 

Rovner: And he was charged for 2 colonoscopies, proper? 

Meyer: Sure. That was a serious purpose that the invoice was so excessive. Northwestern billed him for 2 colonoscopies, which Tom didn’t perceive, since he had solely obtained one. It seems that suppliers routinely invoice for 2 procedures if the gastroenterologist removes and biopsies two polyps in two other ways throughout the identical process. 

The second process is billed at a reduced fee. Now, this appears unusual to laypeople, however that is how suppliers receives a commission for the additional work of eradicating two polyps moderately than one. 

Rovner: Which, as you identified at the start, it’s not like it is a several-hour surgical procedure. It is a pretty fast process. 

Meyer: That’s proper. It’s at most an hour, usually lower than that. 

Rovner: So what occurred finally with the invoice? 

Meyer: Effectively, Tom appealed the invoice to Northwestern and Aetna and was instructed that it was appropriate. He had already paid about $2,400 of the almost $4,100 he owed, however he instructed Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they might take him to collections. 

Northwestern mentioned that’s what they had been going to do, and Tom determined to now not use Northwestern or its medical doctors sooner or later. 

Rovner: Though I assume he did pay the quantity that they mentioned he owed. 

Meyer: No, he mentioned: Take me to collections. I’m not paying it. My credit score is sweet, and — I received’t repeat among the issues that he mentioned to them. 

Rovner: Thanks. It is a household podcast. How can others keep away from falling into this lure? I imply, he received an estimate. He had an thought of what he was going to be charged, and but he was nonetheless charged significantly greater than that estimate. 

Meyer: Yeah, he’s a well being care guide, however lots of people get confused by this course of, together with him taken unexpectedly. He solely regarded on the estimate after he had had the process however earlier than he received the ultimate invoice. So, like lots of people, he received confused and he didn’t proceed essentially as effectively as he may need. However that’s widespread and never shocking. 

Rovner: Even for any individual who’s principally within the well being care cost enterprise. 

Meyer: Sure, that’s appropriate. 

Rovner: So be vigilant. Is that principally the takeaway? 

Meyer: Effectively, how are you going to keep away from falling in the identical lure? Sadly, not simply. Sufferers needing a diagnostic colonoscopy ought to take a look at freestanding endoscopy facilities or ambulatory surgical procedure facilities that aren’t related to a hospital, as a result of they are often cheaper and so they can present good high quality of care. 

To cost-shop forward of time, sufferers can have a look at the hospital’s value web site and their insurer’s price estimator web site to get a way of how a lot a diagnostic colonoscopy might price. Additionally they can search for a so-called good religion estimate of the money value, which means the process could possibly be cheaper in the event that they pay money, moderately than going by means of insurance coverage. 

Plus, there are free web sites resembling Turquoise Health and Fair Health for checking costs for colonoscopies and different procedures. Now, as soon as they get a value estimate from the supplier, there’s another wrinkle. Sufferers ought to ask whether or not that value contains the additional providers, if the gastroenterologist finds and has to take away and biopsy a number of polyps. At the least 40% of colonoscopies do discover polyps. 

Now, consultants say it’s unlucky that getting a diagnostic colonoscopy will be so costly and complicated billing-wise, however don’t hesitate, as a result of it may be a lifesaving process for many individuals. 

Rovner: All wonderful recommendation. Harris Meyer, thanks a lot. 

Meyer: Thanks, Julie. 

Rovner: OK, we’re again, and it’s time for our extra-credit section. That’s the place we every acknowledge the story we learn this week we expect it’s best to learn, too. Don’t fear. When you miss it, we’ll put the hyperlinks in our present notes in your telephone or different cellular system. Anna, why don’t you go first this week? 

Edney: I wished to speak about one I wrote final month, and the headline is “It’s Not Just Sunscreen. Toxic Products Line the Drugstore Aisles.” I type of wished to place in a single place speaking about numerous these contamination points which have come up, however notably additionally simply present that, whereas the issues with merchandise continue to grow — one in every of them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting type of slower on numerous these items. They’re digging in, and so they’re not making an attempt to speak to the general public in regards to the points which have come up. They’ve had since final March of 2024 considerations delivered to them about benzene and pimples merchandise. 

They’ve mentioned nothing to the general public. They only preserve saying, We’re taking a look at it. And that’s very completely different from when this primary type of began taking place on a bigger scale, the place it was like, growth, recollects. Now it’s simply type of this battle to possibly not have recollects. I don’t know what’s occurring of their head. 

However there are also some points in there with the tampons had been discovered to comprise numerous heavy metals, FDA additionally slow-walking there. So I wished to level out that piece I wrote if anyone missed it. 

Rovner: Sure. Thanks, Anna, on the “every part you thought may be protected is definitely harmful” beat. 

Edney: I’m the life of each social gathering. 

Rovner: There you go. Joanne. 

Kenen: I’m unsure if that is an additional credit score or a public service announcement, however there’s a nice piece in The Atlantic by Daniel Engber. Effectively, everyone knows there’s a ton of abdomen bugs and norovirus going round, and it’s fairly extreme this 12 months. And the headline is “A Secret Way to Fight Off Stomach Bugs,” and the reply is wash your palms with cleaning soap. 

Nevertheless it’s a extremely well-written — it truly makes you snigger about abdomen bugs. It’s a really well-written, good story. And no, for this bug, hand sanitizers don’t work. 

Rovner: Sandhya. 

Raman: My additional credit score this week is known as “New obesity definition sidelines BMI to focus on health,” and it’s by Giorgia Guglielmi for Nature. And it takes a have a look at — we had a revised definition of measuring and diagnosing weight problems within the Lancet Diabetes & Endocrinology this week. 

So, as an alternative of BMI [body mass index], which is weight- and height-linked, they’re suggesting a few options: preclinical weight problems, which is an individual with additional physique fats however their organs are nonetheless functioning usually, and scientific weight problems, so when you’ve that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply other ways clinicians are taking a look at this globally. 

Rovner: Yeah, it’s actually fascinating as a result of, clearly, each physician says that BMI is a silly and imprecise solution to measure this, after which all people makes use of BMI as a result of, in the intervening time, it’s all we’ve got. My additional credit score this week is a KFF Well being Information story from Felice Freyer. It’s referred to as “Can Medical Schools Funnel More Doctors into the Primary Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher. 

Whereas the U.S. has opened numerous new medical faculties over the previous decade and has launched a raft of applications aimed toward getting extra graduating medical doctors to enter main care, method too many are nonetheless pursuing specialty care as an alternative. We have now tried, as a society, free tuition and mortgage compensation applications, but it surely doesn’t appear that medical schooling debt is the most important drawback. 

We’ve additionally tried coaching medical doctors in additional primary-care-centric places, i.e. in neighborhood clinics moderately than in hospitals, however that’s not made an enormous dent, both. Quite, to cite one of many household drugs consultants within the story: “It’s not the medical faculties which might be the issue; it’s the job. The job is simply too poisonous.” 

In different phrases, it’s probably not interesting to see too many sufferers for too little time and do tons of preventing with insurance coverage corporations and digital medical data. Till we as a society begin making main care much more of a satisfying job, it’s not going to matter how a lot it pays. We’re nonetheless going to have a severe scarcity. 

All proper, that’s this week’s present. As all the time, for those who benefit from the podcast, you may subscribe wherever you get your podcasts. We’d respect it for those who left us a evaluation. That helps different folks discover us, too. Particular thanks once more this week to our momentary manufacturing crew, Taylor Prepare dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman. 

As all the time, you may electronic mail us your feedback or questions. We’re at whatthehealth@kff.org, or you may nonetheless discover me sometimes at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out as of late? Anna? 

Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social

Rovner: Joanne. 

Kenen: I’m on Bluesky, @joannekenen.bsky.social, very sometimes on X nonetheless, @JoanneKenen

Rovner: Sandhya. 

Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social

Rovner: We can be again in your feed subsequent week. Till then, be wholesome. 

Credit

Taylor Prepare dinner
Audio producer

Lonnie Ro
Audio producer

Emmarie Huetteman
Editor

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