Tarsaa[[Editor’s gift: This transcript was generated the usage of each transcription software and a human’s gentle touch. It has been edited for fashion and clarity.]
Julie Rovner: Hiya, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health Information, and I’m joined by some of the finest and smartest health newshounds in Washington. We’re taping this week on Thursday, March 14, at 10 a.m. Happy Pi Day, all individuals. As always, information happens fast and things may have changed by the time you hear this, so here we inch. We are joined today via video conference by Margot Sanger-Katz of The Unusual York Instances.
Margot Sanger-Katz: Good morning, all individuals.
Rovner: Anna Edney of Bloomberg Information.
Anna Edney: Hi there.
Rovner: And Joanne Kenen of the Johns Hopkins College and Politico Magazine.
Joanne Kenen: Howdy, all individuals.
Rovner: Later on this episode we’ll have my interview with Dr. Kelly Henning, head of the public health program at Bloomberg Philanthropies. She’ll give us a preview of the recent four-part documentary series on the history of public health called “The Invisible Protect;” It premieres on PBS March 26. Nevertheless first this week’s information. We’re going to start here in Washington with the annual State of the Union / budget dance, which this year coincides with the formal launch of the general election campaign, with each President Biden and broken-down President Donald Trump having clinched their respective nominations this week.
Despite earlier claims that this year’s campaign would mostly ignore health points, that’s turning out no longer lots to be the case. Biden in his speech highlighted reproductive health, which we’ll talk about in a minute, as properly as prescription drug costs and the Affordable Care Act expansions. His proposed budget released on Monday contains strategies of the way to operationalize some of these proposals, including expanding Medicare’s drug negotiating powers. Did anything in particular in the speech or the budget leap out at any of you? Anything we weren’t awaiting.
Edney: I wouldn’t say there was anything that I wasn’t awaiting. There had been things that I was advised I may tranquil no longer search information from and that I assume like I’ve been proven lawful, and so I’m happy about that, and that was the Medicare drug value negotiation. I believed that that was a gather that he was going to take a lap on at some point of the State of the Union, and certainly he did. And he’s also talking about seeking to expand it, although that seems to face an extremely uphill battle, but it’s a steady talking point.
Rovner: Properly, and obviously the expanded subsidies from the ACA expire at the terminate of subsequent year. I imagine there’s going to be sufficient of a battle apt to maintain these going, lawful?
Edney: Yeah, certainly. I contemplate folks really appreciate the subsidies. If these had been to transfer away, then the uninsured rate may inch up. It’s probably an ordinary place in a way for Republicans, too, who are talking about, again, tranquil in some circles, in some ways, taking out Obamacare. We’re back at that place although I don’t contemplate anyone thinks that’s fully realistic.
Rovner: Oh, you are anticipating my subsequent quiz, which is that broken-down President Trump, who’s identified for being all over the place on a lot of points, has been fairly steadfast all along about maintaining Medicare and Social Safety, but he’s now backing away from even that. In an interview on CNBC this week, Trump said, and I’m quoting, “There is a lot you can accomplish in relation to entitlements in relation to decreasing” — which his staff said was regarding waste and fraud, but which appears to inaugurate that up as a general election campaign converse. Sure, the Biden folks appear to be already jumping on it.
Sanger-Katz: Sure. They may no longer be more wrathful about this. I contemplate this has been an converse that Biden has really wanted to escape on as the protector of these programs for the elderly. He had this confrontation with Congress in the State of the Union last year, as you may bear in mind, whereby he tried to bring together them to promise no longer to touch these programs. And I contemplate his goal of weaponizing this converse has been a great deal hindered by Trump’s reluctance to take it on. I contemplate there are Republicans, certainly in Congress, and I contemplate that we saw at some point of the presidential primary some other candidates for president who had been more drawn to rethinking these programs and concerned about the prolonged-term trajectory of the federal deficit. Trump has historically no longer been one of them. What Trump meant exactly, I contemplate, is manufacture of TBD, but I contemplate it does present this opening. I’m obvious that we’ll contemplate Biden talking about this a lot more as the campaign wears on and it wouldn’t shock me at all to ogle this clip in tv ads and featured again and again.
Kenen: So it’s each, I mean, it’s basically, he’s talked about reopening the repeal battle as Julie apt mentioned, which failed to inch too properly for the Republicans last time, and there’s a lot to carve in Medicare. When you happen to read the complete quote, he does then talk about fraud and abuse and mismanagement, but the soundbite is the soundbite. Those are the phrases that came out of his mouth, whether he meant it that way or no longer, and we are able to contemplate that campaign ad a lot, some version of it.
Rovner: My theory is that he was, and here is something that Trump does, he was on CNBC, he knew he was talking to a industry audience, and he favored to say what he thinks the audience wants to hear without — you may perchance perchance contemplate by now he would know that speaking to one audience doesn’t mean that you’re easiest speaking to that one audience. I contemplate that’s why he’s all over the place on a lot of points because he tends to tailor his remarks to what he thinks the folks he’s speaking immediately to want to hear. Nevertheless meanwhile, Anna, as you mentioned, he’s also raised the specter of the Affordable Care Act repeal again.
Sanger-Katz: I accomplish contemplate the juxtaposition of the Biden budget and State of the Union and these remarks from Trump, who now is officially the presumptive nominee for president, I contemplate it really does spotlight that there are fairly high stakes in health care for this election. I contemplate it’s no longer been a focal point of our discussion of this election so far. Nevertheless Julie, you’ve mentioned the expiration of these subsidies that have made Affordable Care Act plans substantially more affordable for Americans and substantially more appealing, nearly doubling the selection of these that are enrolled in these plans.
That is a coverage that goes to escape out at the terminate of subsequent year. And so that you may imagine a scenario, even supposing Trump did not want to repeal the Affordable Care Act, which he does occasionally continue to make noises about, the place that may apt inch away via pure inertia at the same time as you happen to didn’t have an administration that was actively seeking to increase that coverage and you may contemplate a real retrenchment: increases in costs, folks leaving the market, potentially some instability in the marketplace itself, the place you may contemplate insurers exiting or other forms of problems and a situation far more akin to what we saw in the Trump administration the place these markets had been “OK, but had been a cramped bit rocky and no longer that popular.”
I contemplate similarly for Medicare and Medicaid, these tall federal health programs, Biden has really been committed to, as he says, no longer decreasing them. The Medicare value negotiation for medication has equipped a cramped bit more savings for the program. So it’s on a cramped bit of a larger fiscal trajectory, and he has these additional proposals, again, I contemplate prolonged photographs politically to attempt to shore up Medicare’s finances more. So you contemplate this dedication to these programs and certainly this dedication to — there had been more than one things in the budget to attempt to liberalize and expand Medicaid coverage to make postpartum coverage for ladies after they give start, permanently one year after start, folks would have coverage.
Suitable now, that’s an choice for states, but it’s no longer required for each state. And additionally to attempt to, in an optional basis, make it a cramped easier to maintain adolescents enrolled in Medicaid for longer, to apt allow states to maintain adolescents in for the first six years of life and then three years at a time after that. So again, that’s an choice, but I contemplate you contemplate the Biden administration making a dedication to expand and shore up these programs, and I accomplish contemplate a Trump administration and a Republican Congress will probably be coming at these programs with a bit more of a scalpel.
Rovner: And also, I mean, one of the things we haven’t talked about a great deal since we’re on the discipline of the campaign is that this year Trump is ready in a way that he was no longer, certainly no longer in 2016 and no longer even in 2020. He’s purchased the Heritage Foundation in the back of him with this complete 2025 blueprint, folks with actual expertise in colorful what to flip, what to accomplish, actually, the way to manipulate the bureaucracy in a way that the first Trump administration didn’t have to. So I contemplate we may contemplate, in fact, a lot more on health care that Republicans writ large would favor to accomplish if Trump is reelected. Joanne, you wanted to add something.
Kenen: Yeah, I mean, we all didn’t contemplate this year as a health care election, and I tranquil contemplate that larger existential points about democracy, it’s a reprise. It’s 2020 all over again in many ways, but abortion yes, abortion is a health care converse, and that was tranquil going …
Rovner: We’re attending to that subsequent.
Kenen: I know, but I mean we all knew that was tranquil going to be a ballot driver, a voter driver. Nevertheless Trump, with two remarks, then again, properly, there’s a dissimilarity between the folks at the Heritage Foundation writing detailed coverage plans about how they’re going to dismantle the CDC [Centers for Disease Control and Prevention] as we at the moment understand it versus what Trump says off the cuff. I mean, at the same time as you happen to say to a normal particular person on the avenue, we want to divide the CDC in two, that’s no longer going to trigger anything for a voter. Nevertheless at the same time as you start talking about we want to take away your health care subsidies and carve Medicare, so these are manufacture of, some observers have called them unforced errors, but basically lawful now, yeah, we’re in another health care election. No longer the prime converse — and also reckoning on what else goes on in the world, because it’s a fairly shaky place at the moment. By September, will or no longer it be a prime three converse? None of us know, but lawful now it’s more of a health care election than it was shaping as a lot as be even apt a few weeks ago.
Rovner: Yeah. Properly, one thing, as you said, that we all know will probably be a tall campaign converse this fall is abortion. We saw that in the State of the Union with the gallery corpulent of ladies who’d been denied abortion, IVF products and services, and other forms of reproductive health care and the dozens of Democratic girls on the floor of the Residence wearing white from head to toe as a statement of strengthen for reproductive health care. While Democrats accomplish have some divides over how strongly to embrace abortion rights, a tall one is whether restoring Roe [[v. Wade]is sufficient or they must inch even further in assuring access to basically all manner of reproductive health care.
It’s actually the Republicans who are most on the defensive, particularly over IVF and other state efforts that would restrict start regulate by declaring personhood from the moment of fertilization. Along these lines, one of the more attention-grabbing tales I saw this week instructed that Donald Trump, who has fretted aloud about how unpopular the anti-abortion place is among the public, seems much less liable to make your mind up on a stable pro-lifer as his operating mate this time. Bear in ideas Mike Pence came along with that tall anti-abortion background. What would this mean? It’s no longer like he’s going to make your mind up on Susan Collins or Lisa Murkowski or some Republican that we know actually helps abortion rights. I’m no longer obvious I contemplate what this may accomplish for him and who may fit this category.
Kenen: Properly, I contemplate there’s a steady chance he’ll decide a woman, and we all have names at the tip of our tongues, but we don’t know yet. Nevertheless yeah, I mean they must soften some of these items. Nevertheless Trump’s personal attempt lawful now bragging about appointing the justices that killed Roe, at the same time, he’s apparently talking about a 15-week ban or a 16-week ban, which is amazingly various than zero. So he’s giving a combined message. That’s no longer what his base wants to hear from him, obviously. I mean, Julie, you’ll probably bring together to this, but the IVF thing is also pitting anti-abortion Republican against anti-abortion Republican, with Mike Pence, again, being a very steady example the place Mike Pence’s anti-abortion bona fides are fairly clear, but he has been public about his adolescents are IVF babies? I’m no longer obvious if all of them are, but at least some of them are. So he does no longer contemplate that two cells in a freezer or eight cells or 16 cells is the same to cramped one. In his see, it’s a potential cramped one. So yeah.
Edney: I contemplate you can accomplish a lot with a vice president. We contemplate Biden has his personal points with the abortion converse and, as folks have pointed out, he demurred from saying that phrase in the State of the Union and we contemplate apt it was no longer too prolonged ago announced that Vice President Kamala Harris goes to visit an abortion hospital. So you can appease maybe the other facet, and that will probably be what Trump is looking out to accomplish. I contemplate, as Joanne mentioned, his base wants him to be anti-abortion, but now you’re getting all of these fractures in the Republican Party and you want anyone that maybe can massage that and aid with the crowd that’s been voting on the state level, voting on more of a personal level, to maintain reproductive rights, although his base doesn’t appear to be that that’s what they want. So I assume like he may be looking out to make your mind up on anyone who’s very various or has some differences that he can, no longer acknowledge, but that they can inch out and please the other facet.
Rovner: For certain, the easiest one that really suits that invoice is Nikki Haley, who’s amazingly, very strongly anti-abortion, but at least tried, no longer thoroughly, but tried to say that there are other folks around and they assume other things and we may tranquil embrace them, too. I can’t imagine another Republican with the exception of for Nikki Haley who’s really tried to accomplish that. Margot, you wanted to say something?
Sanger-Katz: Oh, I was apt going to say that if this reporting is lawful, I contemplate it does really assume the political moment that Trump finds himself in. I contemplate when he was operating the last time, I contemplate he really had to persuade the anti-abortion voter, the evangelical voter, to advance back along with him. I contemplate they had reservations about his character, about his dedication to their cause. He was considered as anyone who maybe wasn’t really a steady believer in these points. And so I contemplate he had to accomplish these things, like selecting Mike Pence, selecting anyone who was one of them. Pre-publishing a checklist of judges that he would bear in ideas for the Supreme Court who had been considered as rock stable on abortion. He had to persuade these voters that he was the real deal and that he was going to be on their facet, and I apt don’t contemplate he really has that converse to the same level lawful now.
I contemplate he’s consolidated strengthen among that segment of the electorate and his larger effort going into the general election, and also the primaries are over, and so his larger effort going into the general election is the way to deal with more moderate swing voters, suburban girls, and other teams who I contemplate are a cramped bit concerned about the coarse anti-abortion insurance policies that have been pursued in some of these states. And I contemplate they will probably be reluctant to vote for Trump if they contemplate him as being associated with these insurance policies. So you contemplate him maybe pondering about the way to soften his image on this converse.
Rovner: I may tranquil point out the primaries aren’t actually over, most of states tranquil haven’t had their primaries, but the primaries are successfully over for president because each candidates have now amassed sufficient delegates to have the nomination.
Sanger-Katz: Sure, that’s lawful. And it’s no longer over until the convention, although I contemplate the way that the Republicans have arranged their convention, it’s very hard to imagine anyone other than Trump being president no matter what happens.
Rovner: Sure.
Sanger-Katz: Or no longer being president. Sorry, being the nominee.
Rovner: Being the nominee, yes, indeed. Properly, we are easiest two weeks away from the Supreme Court oral arguments in the abortion capsule case and a cramped over a month from another role of Supreme Court oral arguments surrounding whether doctors have to bring together abortions in medical emergencies. And the cases apt carry on coming in court this week. A three-decide panel from the fifth Circuit Court of Appeals upheld in part a decrease court ruling that held that Texas’ law requiring parents to bring together consent earlier than their teenage daughters may obtain prescription start regulate, Trump’s federal ideas requiring patient confidentiality even for minors at federally funded Title X clinics.
Two things about this case. First, it’s a battle that goes all the way back to the Reagan administration and something called the “Squeal Rule,” which I did not duvet, I easiest read about, but it’s something that the courts have repeatedly dominated against, that Title X is in fact allowed to maintain patient privacy even for teenagers. And the 2d thing is that the decrease court ruling came from Texas federal Mediate Matthew Kacsmaryk, who also wrote the determination attempting to overturn the FDA’s approval of the abortion drug mifepristone. This one, although, we may no longer search information from to bring together to the Supreme Court.
Kenen: Nevertheless we’re usually base on these forms of things.
Rovner: Yeah, that’s steady.
Kenen: I mean, things that seem based on the historical pathway that shouldn’t have gotten to the court are attending to the court and the complete debate has shifted so far to the lawful. An attention-grabbing aside, there is a transfer, and I read this yesterday, but now I’m forgetting the details, so one of you can clarify for me. I can’t bear in mind whether they’re pondering about doing this or the way they’ve actually save into place steps to cease decide-procuring.
Rovner: That’s subsequent.
Kenen: OK, I’m sorry, I’m doing such a steady job of reading your ideas.
Rovner: You are such a steady job, Joanne.
Kenen: Nevertheless I mean so many in these cases inch back to one. If there was a bingo card for reproductive lawsuits, there will probably be one face in it.
Rovner: Two, Mediate [Reed] O’Connor, bear in mind the man with the Affordable Care Act.
Kenen: Suitable. Nevertheless lots of here goes back to make your mind up on-procuring or district-procuring for the decide. So a lot of these things that we thought wouldn’t bring together to the court have gotten to the court.
Rovner: Yeah, properly, no, I was going to say on this case, although, there seems some recommendation that folks who strengthen the confidentiality and the Title X ideas may no longer want to appeal this to the Supreme Court because they’re afraid they’ll lose. That here is the Supreme Court that overturned Roe, it will almost certainly be a Supreme Court that would rule against Title X confidentiality for start regulate, that perhaps they want to apt let this lie. I contemplate as it stands now it easiest applies to the fifth Circuit. So Texas, Louisiana, and I neglect what else is in the fifth Circuit, but it wouldn’t apply around the country and on this case, I assume it’s apt Texas because it’s Texas’ law that conflicts with the ideas.
Kenen: Apart from when one state does something, it doesn’t mean that it’s easiest Texas’ law six months from now.
Rovner: Suitable. What starts in Texas doesn’t necessarily stay in Texas.
Kenen: Suitable, it may inch to Nevada. They may contemplate that they have a shedding case and they want to wait 20 years, but other folks terminate up taking things — I mean, it’s totally unpredictable and a spacious amount of the docket is reproductive health lawful now.
Rovner: I may well say the one thing we know is that Justice Alito, when he said that the Supreme Court was going to cease having to deal with this converse was either disingenuous or apt very base because that is certainly no longer what’s happened. Properly, as Joanne already jumped ahead a cramped bit, I mentioned Mediate Kacsmaryk for a particular reason. Also this week, the Judicial Convention of the United States, which makes ideas for a way the federal courts work, voted to make it harder to make your mind up on-shop by submitting cases in particular places like Amarillo, Texas, the place there’s easiest one sitting federal decide. Here is why Mediate Kacsmaryk has gotten so many of these sizzling-button cases. No longer because kookie stuff happens all the time in Amarillo, but because plaintiffs have specifically filed suit there to bring together their cases in front of him. The change by the judicial conference basically gadgets things back to the way they frail to be, lawful, the place it was at least partly random, which decide to obtain at the same time as you filed a case.
Kenen: Nevertheless there are also some organizations that have intentionally based themselves in Amarillo so that they’re there. I mean, we may also contemplate, if the ideas inch back to the ancient days, we may also tranquil say you have a larger case for submitting in the place you actually operate. So all individuals apt retains hopping around and playing the discipline to their advantage.
Rovner: Yeah. And I imagine in some places there’s easiest a couple of judges, I contemplate it was mostly Texas that had these one-decide districts the place you knew at the same time as you happen to filed there, you had been going to bring together that decide, so — the these that watch these things and who fear about decide-procuring appear to be heartened by this determination by the judicial conference. So I’m no longer anyone who’s an professional in that manufacture of thing, but they appear to contemplate that this may deter it, if no longer cease it fully.
Transferring on, bear in mind a couple of weeks ago after I said that the hack of UnitedHealth [Group] subsidiary Change Healthcare was the most undercovered sage in health? Clearly, I had no idea how steady that was going to transform. That processes 15 billion — with a B — claims each year handles one of each three patient records is tranquil down, meaning hospitals, physician’s offices, nursing homes, and all other manner of health services tranquil mostly aren’t getting paid. Some are being concerned they quickly acquired’t be able to pay their workers. How tall may this complete mess ultimately transform? I don’t contemplate anybody anticipated it’d be as tall as it already is.
Sanger-Katz: I contemplate it’s affecting a selection of federal programs, too, that rely on this data, like quality measurement. And it really is a reflection, first of all, obviously of the consolidation of all of this, which I know that you guys have talked about on the podcast earlier than, but also apt the digitization and interconnectedness of all the things. All of these programs are relying on this billing information, and we exercise that no longer apt to pay folks, but also to evaluate what roughly health care is being delivered, and what quality it’s, and how a lot we may tranquil pay folks in Medicare Advantage, and on all forms of other things. So it’s this really complex, interconnected web of information that has been disrupted by this hack, and I contemplate there’s going to be rather a lot of fallout.
Edney: And the coverage that I’ve read we’re potentially, and no longer in an alarmist way, but weeks away from maybe some patients no longer getting care because of this, particularly at the small services. A few of my colleagues did a sage yesterday on the small cancer services who are really struggling and aren’t obvious how prolonged they’re going to be able to maintain the lights on because they apt aren’t getting paid. And there are programs now that have been role up but maybe aren’t providing sufficient money in these no-interest loans and things like that. So it appears like a really precarious situation for a lot of them. And now we contemplate that HHS [Department of Health and Human Services] is looking out into this other facet of it. They’re going to investigate whether there had been some HIPAA violations. So no longer looking out exactly at the money exchange, but what happened on this hack, which is attention-grabbing because I haven’t considered a lot about that, and I did marvel, “Oh, what happened with these patients’ information that was stolen?” And UnitedHealth has taken a spacious hit. I mean, it’s a spacious company and it’s apt taken a spacious hit to its reputation and I contemplate …
Rovner: And to its stock value.
Edney: And it’s stock value. That is amazingly steady. And they don’t know when they’re actually going to be able to unravel all of this. I mean, it’s apt a spacious mess.
Rovner: And no longer to neglect they paid $22 million in ransom two weeks ago. When I saw that, I assumed that this was going to be almost over because usually I know when a hospital gets hacked, all individuals says, don’t pay ransom, but they pay the ransom, they bring together their material back, they liberate what was locked away. And usually that ends it, although it then encourages other folks to accomplish it because hello, at the same time as you happen to accomplish it, you can bring together paid ransom. Frankly, for UnitedHealthcare, I believed $22 million was a fairly low sum, but it does no longer appear — I contemplate this has transform such a mess that they’re going to have to rebuild the complete operation in reveal to make it work. At least, no longer a computer professional here. Nevertheless that’s the way I understand here is happening.
Kenen: Nevertheless I also contemplate this, I mean none of us are cyber experts, but I’m also wondering if here goes to lead to a couple roughly rethinking about alternative ways of paying folks. If this created such chaos, and no longer apt chaos, damage, real damage, the incentive to accomplish something similar to another, intermediate, even supposing it’s no longer rather this tall. It’s like, “Wait, no one wants to be the subsequent one.” So what roughly push is there going to be, no longer apt for greater cybersecurity, but for Plan B when there is a crisis? And I don’t know if that’s something that the cyberexperts can save together in what roughly timeline — if HHS was to require that or whether the trade apt decides they want it without requirements that here just will not be any longer OK. It’s going to maintain happening if it’s profitable for whoever’s doing it.
Rovner: I bear in mind, ruefully, Joanne and I had been there together maintaining HIPAA when they had been passing it, which obviously had nothing whatsoever to accomplish with medical privacy at the time, but what it did accomplish was give that first tall push to start digitizing medical information. And there was all this talk about how very impartial correct it was going to be after we had all this digitally and researchers may accomplish lots with it, and patients can be able to have all of their records in a single place and …
Kenen: You bring together to have 19 passwords for 19 various boards now.
Rovner: Sure. Nevertheless in 1995 it all appeared like a great, very impartial correct recent world of all the things being way more atmosphere pleasant. And I don’t bear in mind ever hearing anyone talking about hacking this information, although as I point out the part of HIPAA that we all know, the patient medical records privacy, was added on literally at the last minute because anyone said, “Uh-oh, if we’re going to digitize all this information, maybe we larger make obvious that it doesn’t fall into the base hands.” So at least anyone had some idea that we are able to be here. What are we 20, 30 … are we 30 years later? It’s been a very prolonged time. Anyway, that’s my two cents. All lawful, subsequent up, Mississippi is flirting with actually expanding Medicaid beneath the Affordable Care Act. It’s one of easiest 10 remaining states that has no longer prolonged the program to these that have very low incomes but don’t meet the so-called categorical eligibility requirements like being a pregnant woman or cramped one or particular person with a disability.
The Mississippi Residence passed an expansion invoice including a fairly stringent work requirement by a veto-proof majority last week, week earlier than.
Kenen: I contemplate two weeks ago.
Rovner: Nevertheless even supposing it passed the Senate and gets signed by the governor, which is tranquil a fairly tall if, the governor is reportedly lobbying hard against it. The plan would require a waiver from the Biden administration, which is rarely any longer a tall fan of work requirements. On the other hand, even supposing it doesn’t happen, and I may well probably save my money at this point that it’s no longer going to happen this year, does it signal that some of the most strident, holdout states will probably be seeing the attraction of a 90% federal match and some of the pleas of their hospital associations? Anna, I contemplate you nodding.
Edney: Yeah, I mean it was a cramped surprising, but here is also why I really like statehouses. They apt accomplish these unexpected things that maybe make sense for their constituents typically, and it’s no longer all the time. I believed that it appeared like they had advance around to the fact that here is a lot of cash for Mississippi and it can aid a lot of parents. I contemplate I’ve considered numbers like maybe adding 200,000 or so to the rolls, and so that’s a spacious boost for folk residing there. And with the work requirement, is it steady that even supposing the Biden administration rejects it, this plan can tranquil inch into place, lawful?
Kenen: The Residence version.
Edney: The Residence version.
Kenen: Sure.
Edney: Yeah.
Rovner: My wager is that’s why the governor is lobbying so hard against it. Nevertheless yeah.
Kenen: I mean, I contemplate that we had been watching a couple of states, we keep hearing Alabama was one of the states that has been talking about it but no longer doing anything about it. Wyoming, which greatly surprised me when they had a cramped spurt of activity, which I contemplate has subsided. I mean, what we’ve been saying ever since the Supreme Court made this optional for states more than 10 years ago now. Was it 2012? We’ve been saying eventually they’ll all accomplish it. Keeping in ideas that original Medicaid in [19]65, it took until 1982, which neither Julie nor I lined, until the last state, which was Arizona, took regular Medicare, Medicaid, the tall — neglect the ACA stuff. I mean, Medicaid was no longer in all states for almost 20 years. So I contemplate we’ve all said eventually they’re going to accomplish it. I don’t contemplate that we are about to ogle a domino accomplish that North Carolina, which is a red state, they did it a few months ago, maybe a year by now.
There was talk then that, “Oh, all the leisure will accomplish it.” No, all the leisure will probably accomplish it eventually, but no longer day after today. Mississippi is one of the poorest states in the country. It has one of the lowest health statuses of their population, weight problems, diabetes, other power diseases. It has a very small Medicaid program. The eligibility ranges are even for terribly, very, very downhearted childless adults, you can’t bring together on their plan. Nevertheless have we heard rural hospitals pushing for this for a decade? Sure. Have we heard chambers of commerce in some of these states wanting it because communities without hospitals or communities without sturdy health systems are no longer economically attractive? We’ve been hearing the industry neighborhood push for this for a very prolonged time. Nevertheless the holdouts are tranquil holdouts and I accomplish contemplate they will all take it. I don’t contemplate it’s forthcoming.
Rovner: Yeah, I contemplate that’s probably a fair assessment.
Kenen: It makes steady financial sense, I mean, you’re getting all this money from the federal government to duvet downhearted folks and keep your hospitals inaugurate. Nevertheless it’s a political battle. It’s no longer apt a …
Rovner: It’s ideology.
Kenen: Sure, it’s no longer a [inaudible]. And it’s called Obamacare.
Edney: And typically things apt have to fall into place. Mississippi purchased a recent speaker of the Residence in their state government, so that’s his determination to push this as something that the Residence was going to take up. So whether that happens in other places, whether all these cards fall into places can take more time.
Kenen: Properly, the last thing is we also understand it’s popular with voters because we’ve considered it on the ballot in what, seven states, eight states, I forgot. And it acquired, and it acquired fairly tall in really conservative states like Idaho and Utah. So as Julie said, here is ideology, it’s state lawmakers, it’s governors, it’s no longer voters, it’s no longer hospitals, it’s no longer chambers of commerce. It’s no longer particularly rural hospitals. A lot of parents contemplate this makes sense, but their personal governments don’t contemplate it makes sense.
Rovner: Sure. Properly, another of these tales that strikes very, very slowly. Finally, “This Week in Medical Misinformation”: I want to call out folks who are fighting back against folks who are accusing them of spreading false or misleading claims. I know this sounds confusing. Specifically, 16 conservative state attorneys general have called on YouTube to lawful a, quote, “context disclaimer” that it save on videos posted by the anti-abortion Alliance Defending Freedom claiming extreme and scientifically unproven harms that can be caused by the abortion capsule mifepristone.
Unfortunately, for YouTube, their context disclaimer was a cramped clunky and conflated medication and surgical abortion, which tranquil doesn’t make the original ADF videos more accurate, apt means that the disclaimer wasn’t rather lawful. Meanwhile, more anti-abortion states are having legal rather than medical experts attempt to “explain” — and I save explain in air quotes — when an abortion to save the lifetime of a woman is or isn’t legal, which isn’t really helping clarify the situation a lot at the same time as you happen to are a physician terrified about having your license pulled or, at finest, ending up having to protect yourself in court. It appears like misinformation is now being frail as a weapon as properly as a way to mislead folks. Or am I reading this base?
Edney: I mean, I had to read that disclaimer a few instances. Good the complete back-and-forth was confusing sufficient. And so it does feel like we’re entering into this recent era of, at the same time as you happen to say one base thing against the disinformation, that’s going to be frail against you. So all individuals has to be really careful. And the disclaimer, it was ordinary because I believed it said the design is [inaudible]. So that made me contemplate, oh, they’re apt talking about the actual surgical abortion. Nevertheless it was clunky. I contemplate clunky is a steady phrase that you frail for it. So yeah.
Rovner: Yeah, it worries me. I contemplate I contemplate all of this — these that want to place out misinformation. I’m no longer accusing ADF of saying, “We’re going to place out misinformation.” I contemplate here is what they’ve been saying all along, but these that accomplish want to place out misinformation for misinformation’s sake are then going to hit back at the these that point out that it’s misinformation, which obviously there’s no way for the public to then know who the heck is lawful. And it undercuts the idea of seeking to indicate some of this misinformation. Other individuals ask me wherever I inch, “What are we going to accomplish about this misinformation?” My answer is, “I don’t know, but I am hoping anyone thinks of something.”
Kenen: I mean, at the same time as you happen to phrase something poorly, to obtain to fix it. I mean, that’s apt the bottom line. Good like we as journalists have to advance back clean after we make a mistake. And it feels bad to have to jot down a correction, but we accomplish it. So Google has been engaged on — there’s a neighborhood convened by the Institute of Medication [National Academy of Medicine] and the World Health Organization and some others that have advance out with guidelines and credible communicators, like who can you belief? I mean, we talked about the RSV [respiratory syncytial virus] sage I did a few weeks ago, and at the same time as you happen to Google RSV vaccine on and you gawk on YouTube or Google, it’s no longer that there’s zero misinformation, but there’s a lot much less than there frail to be. And what comes up first is the reliable stuff: CDC, Mayo Hospital, things like that. So YouTube has been really engaged on weeding out the disinformation, but again, for their personal credibility, if they want to be considered as clean arbiters of going with credibility, if they bring together something gentle, they’ve purchased to de-mush it at the terminate.
Rovner: And I will say that Twitter of all places — or X, whatever you want to call it, the place that all individuals now is like, “Don’t inch there. It’s apt a mess” — has these neighborhood notes that bring together attached to a couple of the posts that I actually gather fairly valuable and it allows you to rate it.
Kenen: A few of them, I mean overall, there’s actually research on that. We’ll talk about my book when it comes out subsequent year, but we have stuff. I’m in the final stages of co-authoring a book that … it goes into misinformation, which is why I’ve learned a lot about this. Neighborhood Notes has been really uneven and …
Rovner: I assume when it pops up in my feed, I have learned it surprisingly valuable and I believed, “Here just will not be any longer what I search information from to ogle on this space.”
Kenen: And it hasn’t stopped [Elon] Musk himself from tweeting misinformation about medication …
Rovner: That’s certainly steady.
Kenen: … medication he doesn’t like, including the start regulate capsule he tells folks no longer to make exercise of because it promotes suicide. So basically, yeah, Julie, you’re lawful that we want tools to battle it, and none of the tools we at the moment have are particularly efficient yet. And absolutely all the things gets politicized.
Sanger-Katz: And it’s a real challenge I contemplate for these social media platforms. You already know what I mean? They don’t really want to be in the editorial industry. I contemplate they don’t really want to be in the moderation industry in large part. And so that you can contemplate them grappling with the converse of the most egregious forms of misinformation on their platforms, but doing it clumsily and anxiously and maybe making mistakes along the way. I contemplate it’s no longer a natural feature for these companies, and I contemplate it’s no longer a comfortable feature for the folks that escape these companies, who I contemplate are far more committed to free discourse and algorithmic sharing of information and seeking to boost engagement as against seeking to operate the way a newspaper editor will probably be in selecting the Most mighty and steady information and foregrounding that.
Kenen: Yeah, I mean that’s what the Supreme Court has been grappling with too, is another [inaudible] … what are the ideas of the game? What may tranquil be legally enforced? What is their accountability, that the social media company’s tasks, to moderate versus what is apt folks bring together to put up? I mean, Google’s seeking to make exercise of algorithms to promote credible communicators. It’s no longer that nothing base is there, but it’s no longer what you contemplate first.
Rovner: I contemplate it’s positively the converse of the 2020s. It is miles rarely going away anytime quickly.
Kenen: And it’s no longer apt about health.
Rovner: Oh, absolutely. I know. Properly, that is the information for this week. Now, we are able to play my interview with Dr. Kelly Henning of Bloomberg Philanthropies, and then we’ll advance back with our extra credit.
I am so pleased to welcome to the podcast Dr. Kelly Henning, who heads the Bloomberg Philanthropies Public Health program. She’s here to repeat us about a recent documentary series about the past, present, and future of public health called “The Invisible Protect.” It premieres on PBS on March 26. Dr. Henning, thank you lots for becoming a member of us.
Kelly Henning: Thank you for having me.
Rovner: So the tagline for this series is, “Public health saved your life today, and you don’t even understand it.” You’ve worked in public health in a lot of capacities for a lot of years, so have I. Why has public health been so invisible for many of the time?
Henning: It’s a really attention-grabbing phenomenon, and I contemplate, Julie, we all take public health for granted on some level. It is what really protects folks across the country and across the world, but it’s rather invisible. So usually if things are working really properly in public health, you don’t contemplate about it at all. Issues like very impartial correct vaccination programs, clean water, clean air, these are all public health programs. Nevertheless I contemplate most folks don’t really give them a lot of thought each day.
Rovner: Till we want them, and then they bring together fully controversial.
Henning: So that you may perchance that point, covid-19 and the recent pandemic really was a moment when public health was in the spotlight a great deal no longer in the back of an invisible protect, but rather out in front. And so this appeared like a moment after we really wanted to unpack a cramped bit more around public health and talk about how it works, why it’s so important, and what some of the alternatives are to continue to augment it.
Rovner: I assume like even earlier than the pandemic, although, the perceptions of public health had been changing. I assume it had something to accomplish with a general anti-science, anti-authority rising pattern. Had been there warning indicators that public health was about to explode in folks’s consciousness in no longer necessarily a steady way?
Henning: Properly, I contemplate these are all steady facets, but I also contemplate that there are younger generations of students who have transform very drawn to public health. It’s one of the leading undergraduate majors nowadays. Johns Hopkins Bloomberg Faculty of Public Health has more applications than ever earlier than, and that was happening earlier than the pandemic and even more so all via. So I contemplate it’s a bit of a combined situation. I accomplish contemplate public health in the United States has had some really sophisticated instances in relation to life expectancy. So we started to ogle declines in life expectancy way back in 2017. So we have had challenges on the program facet, but I contemplate this movie is an alternative for us to talk more deeply about public health.
Rovner: Remind folks what are some of the things that public health has introduced us besides, we talk about vaccines and clean water and clean air, but there’s a lot more to public health than the tall headlines.
Henning: Yeah, I mean, for example, seat belts. Every day we bring together into our car, we save a seat belt on, but I contemplate most folks don’t realize that was initially extremely controversial and actually no longer so easy to bring together that coverage in place. And yet it saved literally tens of a lot of of thousands of lives across the U.S. and now across the world. So seat belts are something that usually advance to ideas. Similar to that are things like cramped one restraints, what we would call car seats in the U.S. That’s another similar strategy that’s been a great deal promoted and the evidence has been created via public health initiatives. There are other things like window guards. In cities, there are window guards that aid adolescents no longer fall out of windows from high structures. Again, these are public health initiatives that many folks are rather unaware of.
Rovner: How can this documentary aid change the perception of public health? Suitable now I contemplate when folks imagine public health, they imagine folks fighting over mask mandates and folks fighting over covid vaccines.
Henning: Yeah, I really hope that this documentary will give folks some standpoint around all the ways whereby public health has been working in the back of the scenes over decades. Also, I am hoping that this documentary will allow the public to ogle some of these staff and what they face, these public health front-line staff. And these are no longer apt physicians, but scientists, activists, reformers, engineers, government officials, all forms of parents from all disciplines working in public health. It’s a moment to shine a gentle on that. And then lastly, I am hoping it’s hopeful. I am hoping it reveals us that there are alternatives tranquil to advance back in the space of public health and many, many more things we can accomplish together.
Rovner: Longtime listeners to the podcast will know that I’ve been exploring the quiz of why it has been so sophisticated to communicate the advantages of public health to the public, as I’ve talked to a lot of parents, including experts in messaging and communication. What is your solution for a way we can larger communicate to the public all of the things that public health has done for them?
Henning: Properly, Julie, I don’t have one solution, but I accomplish contemplate that public health has to take this converse of communication more severely. So we have to really earn strategies and meet folks the place they are, make obvious that we are bringing these messages to communities, and the messengers are folks that the neighborhood feels are honest and that are really appropriate spokespeople for them. I also contemplate that this converse of communications is evolving. Other individuals are getting their information in various ways, so public health has to transfer with the instances and be prepared for that. And lastly, I contemplate this “Invisible Protect” documentary is an alternative for folk to hear and learn and understand more about the history of public health and the place it’s going.
Rovner: Dr. Kelly Henning, thank you lots for becoming a member of us. I really gawk forward to watching the complete series. OK, we are back. It’s time for our extra-credit segment. That’s after we each advocate a sage we read this week we contemplate you may tranquil read, too. As always, don’t fear at the same time as you happen to miss it. We can put up the hyperlinks on the podcast page at kffhealthnews.org and in our point to notes on your cell phone or other cell software. Joanne, you have all individuals’s favorite sage this week. Why don’t you inch first?
Kenen: I demanded the lawful to accomplish this one, and it’s Olga, I contemplate her last name is pronounced Khazan. I actually know her and I don’t know the way to speak her name, but Olga Khazan, apologies if I’ve purchased it base, from The Atlantic, has a sage that says “Frigid Workplaces May Be Killing Ladies folk’s Productivity.” Properly, from all of us who are cool, I’m no longer obvious I may well want to make exercise of the phrase “frigid,” but of all of us who are cool in the workplace and sitting there with blankets. I frail to have a contraband, very small space heater hidden in the back of a trash basket beneath my desk. We freeze because men like colder temperatures and they’re wearing suits. So we’ve been complaining about being cool, but there’s actually a ogle now that reveals that it actually hurts our actual cognitive performance. And here is one ogle, there’s more to advance back, but it may also be one explanation for why high faculty girls accomplish worse than high faculty boys on math SATs.
Rovner: Did not read that part.
Kenen: It’s no longer apt comfort in the battle over the thermostat, it’s actually how accomplish our brains feature and can we accomplish our finest if we’re really cool?
Rovner: Honest. Anna.
Edney: Here is a departure from my normal doom and gloom. So I’m happy to say here is in Scientific American, “How Hospitals Are Going Inexperienced Below Biden’s Climate Legislation.” I believed it was attention-grabbing. Apparently at the same time as you happen to’re a no longer-for-income, there had been tax credit that you were not able to make exercise of, but the Inflation Slit value Act changed that so that there are some hospitals, and they talked to this Valley Kids’s in California, that there had been rolling blackouts after some fires and things like that, and they wanted to place in a micro-grid and a solar farm. And so they’ve been able to accomplish that.
And health care contributes a decent amount. I contemplate it’s like 8.5% of U.S. greenhouse gas emissions. And Biden had established this Place of job of Climate Change [and Health Equity] a few years ago and inside of the health department. So here is something that they’re seeking to accomplish to battle these things. And I believed that it was apt attention-grabbing that we’re talking about this on the day that the prime sage, Margot, in The Unusual York Instances is, no longer by you, but is about how there’s this spacious surge in energy demand. And so here is a way folks are seeking to accomplish it on their personal and no longer be so reliant on that overpowered grid.
Rovner: KFF Health Information has done a bunch of tales about contribution to climate change from the health sector, which I had no idea, but it’s tall. Margot.
Sanger-Katz: I wanted to concentrate on the 2d sage on this Lev Facher series on treatment for opioid addiction in Stat called “Inflexible Ideas at Methadone Clinics Are Jeopardizing Patients’ Path to Recovery From Opioid Addiction,” which is a nice prolonged title that tells you a lot about what is in the sage. Nevertheless I contemplate methadone treatment is a really evidence-based treatment that can be really valuable for a lot of these that have opioid addiction. And I contemplate what this sage highlights is that the mechanics of how a lot of these programs work are really hard. They’re punitive, they’re sophisticated to navigate, they make it really hard for folk to have normal lives whereas they’re present process methadone treatment and then, in some cases, arbitrarily so. And so I contemplate it apt facets out that there are alternatives to potentially accomplish this larger in a way that larger helps restoration and it helps the lives of these that are in restoration.
Rovner: Yeah, it frail the phrase “liquid handcuffs,” which I had no longer considered earlier than, which was fairly shimmering. For these of you who weren’t listening, the Part One in all this series was an extra credit last week, so I’ll put up hyperlinks to each of them. My sage’s from our friend Dan Diamond at The Washington Put up. It’s called “Navy Demoted Ronnie Jackson After Probe Into White Residence Behavior.” Ronnie Jackson, in case you don’t bear in mind, was the White Residence physician beneath Presidents [Barack] Obama and Trump and a 2021 inspector general’s yarn learned, and I’m reading from the sage here, quote, “that Jackson berated subordinates in the White Residence medical unit, made sexual and denigrating statements about a female subordinate, consumed alcohol inappropriately with subordinates, and consumed the sleep drug Ambien whereas on accountability as the president’s physician.” According to the yarn, the Navy demoted Jackson retroactively — he’s retired —from a rear admiral down to a captain.
Now, why is any of this important? Properly, mainly because Jackson is now a member of Congress and because he tranquil incorrectly refers to himself as a retired admiral. It’s a fairly shimmering sage, you may tranquil really read it.
OK. That is our point to. As always, at the same time as you happen to revel in the podcast, you can subscribe wherever you bring together your podcasts. We’d appreciate it at the same time as you happen to left us a evaluation; that helps other folks gather us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, otherwise you can tranquil gather me at X, @jrovner. Margot, the place are you these days?
Sanger-Katz: I’m at all the places @Sanger-Katz, although no longer particularly active on any of them.
Rovner: Anna.
Edney: On X, it’s @annaedney and on Threads it’s @anna_edneyreports.
Rovner: Joanne.
Kenen: I’m Threads @joannekenen1, and I’ve been the usage of LinkedIn more. I contemplate some of the other panelists have said that folks are starting to treat that as a place to put up, and I contemplate many of us are seeing a cramped bit more traction there.
Rovner: Great. Properly, we are able to be back on your feed subsequent week. Till then, be healthy.
Tarsaa
