The Host
Julie Rovner
KFF Well being Information
Learn Julie’s tales.
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.
The Inexpensive Care Act was signed into legislation 14 years in the past this week, and Well being and Human Providers Secretary Xavier Becerra joined KFF Well being Information’ Julie Rovner on this week’s “What the Well being?” podcast to debate its accomplishments to this point — and the challenges that stay for the well being legislation.
In the meantime, Congress seems on its strategy to, lastly, ending the fiscal 2024 spending payments, together with funding for HHS — with out most of the reproductive or gender-affirming well being care restrictions Republicans had sought.
This week’s panelists are Julie Rovner of KFF Well being Information, Mary Agnes Carey of KFF Well being Information, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.
Panelists
Mary Agnes Carey
KFF Well being Information
Learn Mary Agnes’ tales.
Tami Luhby
CNN
Learn Tami’s tales.
Alice Miranda Ollstein
Politico
Learn Alice’s tales.
Among the many takeaways from this week’s episode:
- The Supreme Court docket will hear oral arguments subsequent week in a case that would determine whether or not the abortion capsule mifepristone will stay simply accessible. The case itself offers with nationwide restrictions fairly than an outright ban. However, relying on how the court docket guidelines, it might have far-reaching outcomes — as an example, stopping folks from getting the tablets within the mail and limiting how far into being pregnant the remedy can be utilized.
- The case is about greater than abortion. Drug corporations and medical teams are involved in regards to the precedent it might set for courts to substitute their judgment for that of the FDA concerning drug approvals.
- Abortion-related poll questions are in play in a number of states. The entire quantity in the end relies on the success of citizen-led efforts to gather signatures to realize a spot. Such efforts face opposition from anti-abortion teams and elected officers who don’t need the questions to succeed in the poll field. Their worry, based mostly on precedents, is that abortion protections are likely to cross.
- The Biden administration issued an govt order this week to enhance analysis on girls’s well being throughout the federal authorities. It has a number of elements, together with provisions meant to extend analysis on sicknesses and illnesses related to postmenopausal girls. It additionally goals to extend the variety of girls collaborating in medical trials.
- This Week in Medical Misinformation: The Supreme Court docket heard oral arguments within the case Murthy v. Missouri. At concern is whether or not Biden administration officers overstepped their authority when asking corporations like Meta, Google, and X to take away or downgrade content material flagged as covid-19 misinformation.
Plus, for “further credit score,” the panelists recommend well being coverage tales they learn this week that they assume it’s best to learn, too:
Julie Rovner: The Washington Submit’s “Arizona Lawmaker Tells Her Abortion Story to Present ‘Actuality’ of Restrictions,” by Praveena Somasundaram. (Full speech right here.)
Alice Miranda Ollstein: CNN’s “Why Your Physician’s Workplace Is Spamming You With Appointment Reminders,” by Nathaniel Meyersohn.
Tami Luhby: KFF Well being Information’ “Georgia’s Medicaid Work Requirement Costing Taxpayers Hundreds of thousands Regardless of Low Enrollment,” by Andy Miller and Renuka Rayasam.
Mary Agnes Carey: The New York Instances’ “When Medicaid Comes After the Household Residence,” by Paula Span, and The AP’s “State Medicaid Places of work Goal Lifeless Folks’s Properties to Recoup Their Well being Care Prices,” by Amanda Seitz.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: The ACA Turns 14
[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: Howdy, 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 greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, March 21, 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.
We’re joined right this moment by way of video convention by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Howdy.
Rovner: Tami Luhby of CNN.
Tami Luhby: Howdy.
Rovner: And my KFF Well being Information colleague Mary Agnes Carey.
Mary Agnes Carey: It’s nice to be right here.
Rovner: Later on this episode to mark the 14th anniversary of the Inexpensive Care Act, we’ll have my interview with Well being and Human Providers Secretary Xavier Becerra, however first, this week’s information. So it seems our lengthy nationwide nightmare following the progress of the fiscal 2024 spending invoice for the Division of Well being and Human Providers is almost over, almost midway via the fiscal yr. The White Home, Home, and Senate have, so far as we are able to inform, reached a compromise on the final tranche of spending payments, which is an efficient factor as a result of the newest non permanent spending invoice runs out at midnight Friday. Funding for the Division of Well being and Human Providers, from what I’ve seen to this point, is mainly flat, which is a win for the Democrats as a result of the Republicans had fought for a reduce of one thing within the neighborhood of twenty-two%.
Now, assuming this all occurs, the Home is scheduled to vote, as we communicate now, on Friday at 11 a.m., leaving the Senate not very a lot time to avert a potential partial shutdown. Democrats appear additionally to have averted including all method of latest restrictions on reproductive and gender-affirming well being care to the HHS a part of the invoice. It’s the final huge practice leaving the station probably till after the election. So Alice, we’ll get to the add-ons in a minute, however have you ever seen something within the HHS funding worthy of observe or did they handle to fend off all the things that might’ve been considerably newsworthy?
Ollstein: Such as you stated, it’s mainly flat. It’s a small improve, lower than 1% total for HHS, after which a variety of particular person packages are simply fully flat, which advocacy teams argue can be a reduce once you think about inflation. The price of offering providers and shopping for medicines and working packages and whatnot goes up. So flat funding is a reduce in follow. I’m listening to that notably from the Title X household planning people which have had flat funding for a decade now whilst demand for providers and prices have gone up.
So I feel that within the present setting, Democrats are able to vote for this. They don’t need to see a shutdown. And within the Home, the invoice passage will depend upon these Democratic votes as a result of they’re more likely to lose a variety of Republicans. Republicans are mad that there weren’t deeper cuts to spending and, as you alluded to, they’re mad that they didn’t get these coverage rider wins they have been banking on.
Rovner: As I’ve talked about, since this can be a must-pass invoice, there are all the time the efforts so as to add non-spending issues to it. And on well being care, apparently, the hassle so as to add the PBM, pharmacy profit regulation invoice we’ve talked about a lot failed, however lawmakers did lastly get a one-year deal to increase PEPFAR, the worldwide AIDS/HIV program. Alice, you’ve been dutifully following this because it expired final yr. Remind us why it acquired held up and what they lastly get.
Ollstein: What occurred in the long run is it’s a one-year reauthorization that’s a so-called clear reauthorization, which means they aren’t including new anti-abortion restrictions and provisions that the Republicans needed. So what we reported this week is, like every compromise, nobody’s pleased. So Republicans are upset that they didn’t get the anti-abortion restrictions they needed, and I’ll clarify extra on that in a second, and Democrats are upset that that is only a one-year reauthorization. It’s the primary reauthorization that’s this form of short-term stopgap size. In this system’s a long time of historical past, it’s all the time been a full five-year reauthorization up till now. However the struggle over abortion and accusations that program funds have been flowing to abortion suppliers actually break up Congress on this.
Regardless that you had mainstream management Republicans who have been saying, “Look, we simply need to reauthorize this as-is,” you had a small however very vocal contingent of hard-line anti-abortion lawmakers backed by some actually influential teams just like the Heritage Basis and SBA [Susan B. Anthony Pro-Life America] who have been saying, “No, we have now to insist on a shorter-term reauthorization,” in order that they hope Trump shall be in workplace subsequent yr and may impose these very same anti-abortion restrictions via govt motion. So that they’re mainly attempting to punt management of this system into what they hope is a extra favorable setting, the place both they’ll have the votes in Congress to make these modifications and restrictions to this system or they will do it via the White Home.
Rovner: So mainly, the struggle over PEPFAR, not over. In order I already talked about, Saturday is the 14th anniversary of the Inexpensive Care Act, which you’ll hear extra about in my interview with HHS Secretary Becerra, however I needed to pose to you guys one of many questions that I posed to him. As Nancy Pelosi famously predicted, a minimum of in keeping with public opinion polls, the extra folks realized in regards to the well being legislation, certainly, the extra they’re liking it. Nevertheless it nonetheless lacks the recognition and branding of massive authorities well being packages, like Medicare and Medicaid, and I feel a lot of folks nonetheless don’t know that a lot of the provisions that they like, issues like letting your grownup kids keep in your well being plan till they’re 26 or banning preexisting situation exclusions, these have been issues that got here from the Inexpensive Care Act. Any theories as to why it’s nonetheless so polarizing? Republicans didn’t love Medicare and Medicaid initially both, so I don’t assume it’s simply that Republicans nonetheless speak about it.
Luhby: A part of it I feel is as a result of there are such a lot of provisions they usually’re not labeled the Inexpensive Care Act like Medicare is. Truly to some extent, Medicaid might not be as well-known in some states as a result of states have totally different Medicaid packages and totally different names and so do the ACA exchanges. In order that’s a part of it, but additionally, issues like why do you get a free mammogram and why you get to go for a routine checkup yearly; that’s not labeled as an Inexpensive Care Act provision, that’s simply the preventive providers. So I feel that it might be troublesome now after 14 years to carry all of that into the on a regular basis branding by medical doctors and well being suppliers. However that’s actually what the administration and advocates are attempting to do by sending out a variety of messages that checklist all the advantages of the ACA.
Rovner: I’ll say that is the most important full-court press I’ve seen an administration do on the ACA in fairly some time. Clearly, it’s a presidential election yr and it’s one thing that the Biden administration is happy with, however a minimum of I’d assume that possibly simply all of the publicity is likely to be a part of their technique. Mac, you needed to say one thing.
Carey: No, completely. It’s going to be a part of the Biden reelection marketing campaign. They’re going to be pushing it, speaking rather a lot about it. We’ve got to recollect we’ve had this ringside seat to all of the Republican opposition to the Inexpensive Care Act. All of the dialog about we’re going to repeal it and put one thing higher in, former President Trump remains to be sending that message out to the voters. I don’t know the way a lot confusion, if any confusion, it creates, however to Tami’s level, you’ve acquired tens of millions of those that have gotten protection underneath the Inexpensive Care Act however tens of millions extra have benefited by all these provisions we’re speaking about: the preventive care provisions, leaving grownup children as much as 26 in your medical health insurance plan, that type of factor.
Additionally, give it time. Fourteen years is a very long time, nevertheless it’s not the time of Medicare, which was created in 1965, and Medicaid. So I feel over time, the Inexpensive Care Act is a part of the material and it’ll proceed to be. However completely, for positive, President Biden goes to run on this, such as you stated, Julie, full-court press, discuss extensively about it within the reelection marketing campaign.
Ollstein: It is smart that they’re leaning actually onerous on Obamacare as a message as a result of, even when everybody isn’t conversant in it, much more persons are conversant in it and prefer it than, polling reveals, on the Biden administration’s different huge well being care accomplishment, which is drug value negotiation, which polling reveals that most individuals, and even most seniors, who’re those who’re set to learn essentially the most, aren’t conscious that it exists. And that is smart as a result of they’re not feeling the influence of the decrease costs but as a result of this complete factor simply began and it received’t be till 2026 that they’ll actually really expertise cheaper medicines. However persons are already feeling the direct influence of Obamacare on their lives, and so it does make sense that they’re going to lean actually onerous on this.
Rovner: After all, we went via the identical factor with Obamacare, which additionally didn’t take full impact till, actually, that is actually the tenth anniversary of the complete impact of the Inexpensive Care Act as a result of it didn’t take impact till 2014. Tami, you needed so as to add one thing.
Luhby: No, I used to be going to say it’s additionally the seventh anniversary of the Trump administration and congressional Republicans attempting to tear aside the Inexpensive Care Act and repeal and change it, which is the messaging that you simply’re seeing now could be similar to what you noticed in 2017. It’s simply stunning to me that with very intensive messaging on either side at the moment about what the Republicans saying what the issues are and the Democrats saying what all the advantages are, — together with the protections for folks with preexisting situations and the opposite issues we’ve talked about — that extra folks don’t affiliate these provisions with the ACA now. However the Biden administration is attempting to revive all of that and remind folks, as they did in 2018 within the profitable midterm elections for the Democrats, that the ACA does present a variety of the advantages that they’re benefiting from and respect.
Rovner: I feel, in some methods, the 2017 struggle was among the finest issues that ever occurred to the ACA by way of serving to folks perceive what really was in it, as a result of the Democrats managed to frighten folks about issues that they preferred being taken away. Right here we go once more. All proper, allow us to flip to abortion. There’s a brand new report out from the Guttmacher Institute that finds a dramatic leap in the usage of medicine abortion in 2023, the primary full yr for the reason that Supreme Court docket reversed the nationwide proper to abortion within the Dobbs [v. Jackson Women’s Health Organization] case, greater than 60% of abortions use medicine fairly than a process final yr. This information comes because the Supreme Court docket subsequent week prepares to listen to oral arguments in a case that would dramatically prohibit availability of the abortion capsule mifepristone. Alice, remind us what’s at stake on this case. It’s not whether or not they’re going to only outright cancel the approval.
Ollstein: That’s proper. So the Supreme Court docket is taking on the narrowed model of this from the fifth Circuit. So what’s at stake are nationwide restrictions on abortion tablets, however not a nationwide outright ban such as you talked about. However these restrictions might be actually sweeping and actually impactful. It will forestall folks from getting the tablets via the mail like they presently do. It will forestall folks from probably getting them in every other manner aside from immediately from a physician. So this could apply to purple states and blue states alike. It will override abortion rights provisions in blue states which have performed rather a lot to extend entry to the tablets. And it might additionally prohibit their use again to the primary seven weeks of being pregnant as a substitute of 10, which is an enormous deal as a result of folks don’t typically discover out they’re pregnant till getting near that line or past.
So this can be a actually huge deal, and I feel you may actually see, particularly from the flurry of amicus briefs have been filed, that anxiousness about this case within the medical group and the pharmaceutical group, the scientific group, it goes manner past the influence simply on abortion. Persons are actually apprehensive about setting a precedent the place the FDA’s scientific judgment is second-guessed by courts, they usually fear {that a} win for the anti-abortion teams on this case would open the door to folks difficult every kind of different medicines that they’ve a problem with: contraception, covid vaccines, HIV medicine, the checklist goes on and on, gender-affirming care medicines, all types of issues. So there are the bucket of potential impacts on abortion particularly, that are actually vital, after which there’s the larger slippery slope fears as properly.
Rovner: Additionally, that is clearly nonetheless manner political. Extra than simply the abortion capsule. It’s been some time since we’ve talked about state poll measures. We, I feel, really feel like we spent all of final yr speaking about abortion state poll measures. Alice, catch us up actual fast on the place we’re. What number of states have them? And what’s this marketing campaign in opposition to, by the anti-abortion folks, to attempt to forestall them from getting on the poll?
Ollstein: Test me if I’m flawed, however I don’t consider we all know for positive about, particularly the states which have citizen-led poll initiatives the place persons are gathering signatures. So Florida had one of many earliest deadlines they usually did meet their signature threshold. However they’re now ready on the state Supreme Court docket to say whether or not or not they’ve a inexperienced mild to go ahead this fall. Numerous different states are nonetheless accumulating signatures. I feel the one states we all know for positive are those the place the state legislature is the one that’s ordering it to be placed on the poll, not common residents gathering signatures.
We nonetheless don’t know, however issues are shifting ahead. I used to be simply in Arizona reporting on their efforts. Issues are shifting ahead there. Issues are shifting ahead in Montana. They simply acquired a court docket ruling of their favor to place one thing on the poll. And issues are shifting ahead in Missouri, a variety of locations. So this might be actually enormous. After all, such as you talked about, anti-abortion teams and anti-abortion elected officers are doing a variety of various things to attempt to forestall this from occurring the poll.
It’s attention-grabbing, you heard arguments during the last couple years in opposition to this being extra alongside the strains of, “Oh, that is permitting these out-of-state big-money teams to swoop in and mislead and inform us what to do,” and people have been the anti-abortion arguments in opposition to permitting folks to vote on this immediately. Now, you’re listening to, I’m listening to, extra arguments alongside the strains of, “This shouldn’t be one thing topic to a preferred vote in any respect. We shouldn’t put this up for a vote in any respect.” They contemplate this a human rights concern, and so I feel that’s a very attention-grabbing evolution as properly, notably when the autumn of Roe [v. Wade] was celebrated for returning the query of abortion entry to the folks, however possibly not these folks particularly.
Rovner: I’ve been considering seeing a few of these anti-abortion teams attempting to launch campaigns to get folks to not put signatures on petitions. That’s shifting it again a step I don’t assume I’d ever seen. I don’t assume I’ve ever seen a marketing campaign to say, “Don’t signal the petition that might put this on the poll to let folks vote on it.” However that’s what we’re seeing, proper?
Ollstein: Effectively, that’s what I went to Arizona to see firsthand is how that’s working, and it’s fascinating. They actually fear that if it will get on the poll, it’ll cross. It has in each state to this point, so it’s affordable for them to imagine that. So that they’re attempting to stop it from getting on the poll. The way in which they’re doing that’s they’re monitoring the areas of signature gatherers and attempting to go the place they’re and attempting to intervene and maintain up indicators. I noticed this firsthand. I noticed it at a road honest. Folks have been gathering signatures and several other anti-abortion demonstrators have been standing proper in entrance of them with huge indicators and attempting to argue with folks and deter them from signing. It was not working, from what I noticed. And from the general signature depend statewide, it was not working in Arizona. Nevertheless it’s fascinating that they’re attempting this.
Carey: I used to be going to say simply our reporting from our KFF Well being Information colleagues discovered that 13 states are weighing abortion-related poll measures, most of which might defend abortion rights. To your level, the scope is fairly intensive. And for all the explanations Alice simply mentioned, it’s fairly the problem.
Rovner: Yeah, and we are going to clearly discuss extra about this because the election will get nearer. I do know we speak about Texas rather a lot on this podcast, however this week, I need to spotlight a examine from subsequent door in Louisiana, additionally a really sturdy anti-abortion state. A brand new report from three teams, all of which assist abortion rights, prices that, as in Texas, girls with being pregnant problems are being compelled to attend for care till their situations grow to be important. And in some circumstances, girls with nonviable pregnancies are being compelled to have C-section surgical procedure as a result of their medical doctors don’t dare use medicine or different less-risky procedures in case they might be accused of performing an abortion.
In some unspecified time in the future, it’s a must to assume that any individual goes to have a malpractice case. Having a C-section as a result of your physician is afraid to terminate a nonviable being pregnant looks like fairly harmful and fairly aggressive strategy to go. That is the primary I’ve ever heard of this. Alice, have you ever heard something about this?
Ollstein: Not the C-section statistics particularly, however positively the delays in care and among the different impacts described in that report have completely been reported in different states and in authorized challenges which have come up in Texas, in Oklahoma, in Tennessee, in Idaho by individuals who have been denied abortions and skilled medical harms due to it. So I feel that matches into the broader sample. And it’s simply extra proof about how that is having a chilling impact on medical doctors. And the precise letter of the legislation could also be one factor, and you’ve got elected officers pointing to exemptions and provisions within the legislation, however the chilling impact, the worry and the confusion within the medical group, is one thing along with that.
Rovner: As we put it out earlier than, medical doctors have authentic fears even when they don’t need to get dragged into court docket and have to rent legal professionals and take time without work — even when they’re harmless, even when they’ve what they contemplate to be fairly sturdy proof that no matter it was that they did was authentic underneath the legislation by way of taking good care of pregnant girls. Numerous them, they don’t need to come underneath scrutiny, let’s put it that manner, and it’s onerous guilty them about that.
In the meantime, the backlash over the Alabama Supreme Court docket choice that fertilized embryos for IVF have authorized rights is constant as blue states that made themselves secure areas for these looking for abortion are actually attempting to welcome these looking for IVF. Anyone assume that is going to be as huge a voting concern as abortion this fall? It’s actually trying like those that assist IVF, together with some Republicans, are attempting to push it.
Carey: I’d assume sure, it completely shall be as a result of it has been introduced into the abortion debate. The precise Alabama concern is about an Alabama legislation and whether or not or not this explicit, the litigants who sued have been … it was germane and lined by the legislation, nevertheless it’s been introduced into the abortion concern. The entire IVF factor is so compelling, about storage of the embryos and what folks need to pay and all of the restrictions round it and among the decisions they’re making. I assume that you could possibly say extra folks have been touched by IVF maybe than the precise abortion concern. So now, it’s very private to them and it’s been elevated, and Republicans have tried to get round it by saying they assist it, however then there’s arguments that whether or not or not that’s a toothless safety of IVF. It got here out of nowhere I feel for lots of politicians they usually’ve been scrambling and attempting to determine it out. However to your level, Julie, I do surprise if will probably be elevated within the election. And it was one thing they didn’t assume they’d need to take care of, fairly, and now they do.
Rovner: Clearly, it’s a problem that splits the anti-abortion group as a result of now we’ve had all these very sturdy pro-lifers like Mike Pence saying, “I created my household utilizing IVF.” Nikki Haley. There are a variety of very sturdy anti-abortion Republicans who’ve used IVF. So that you’ve acquired some on the far … saying, “No, no, no, you may’t create embryos after which destroy them,” and you then’ve acquired those that are saying, “However we have to ensure that IVF remains to be accessible to folks. If we’re going to name ourselves pro-life, we ought to be in favor of individuals getting pregnant and having infants, which is what IVF is for.” Alice, I see you nodding your head.
Ollstein: Yeah. So we’re having form of a irritating discourse round this proper now as a result of Democrats are saying, “Republicans need to ban IVF.” And Republicans are saying, “No, we don’t. We assist IVF. We love IVF. IVF is superior.” And neither is completely correct. It’s simply lacking a variety of nuance. Republicans who say they assist IVF additionally assist a variety of totally different sorts of restrictions on the best way it’s presently practiced. So they could appropriately argue that they don’t need to ban it solely, however they do need it practiced differently than it’s now, such because the manufacturing of many embryos, a few of that are discarded. So I feel persons are simply not being requested the fitting questions proper now. I feel you bought to get past, “Do you assist IVF?” That offers folks a strategy to dodge. I feel you actually need to drill into, “OK. How particularly would you like this regulated and what would that imply for folks?”
Carey: Proper, and the entire debate with among the abortion rights opponents, a few of them need the federal authorities to control it. Mike Johnson, speaker of the Home, has come out and stated, “No, no, that may be performed on the state degree.” So that they’ve acquired this complete break up internally within the get together that’s, once more, a struggle they didn’t anticipate.
Rovner: Effectively, Mac, one thing that you simply alluded to that I used to be struck by was a chunk in The Washington Submit this week about {couples} dealing with growing prices to retailer their IVF embryos, typically a whole lot of {dollars} a yr, which is forcing them to decide on between letting the embryos go or dropping an opportunity to presumably have one other baby. It’s clearly an enormous concern. I’m questioning what the anti-IVF forces take into consideration that. As we’ve seen in Alabama, it’s not like you may simply decide your embryos up in a cooler and transfer them someplace else. Shifting them is definitely a really huge deal.
I don’t want to decrease this, however I bear in mind you might have storage models for issues, not clearly for embryos. One of many ways in which they make cash is that they simply maintain elevating the fee as a result of they assume you received’t trouble to maneuver your issues, so that you simply’ll simply maintain paying the elevated price. It looks like that’s a little bit little bit of what’s taking place right here with these saved embryos, and in some unspecified time in the future, it simply will get prohibitively costly for folks to maintain them in storage. I didn’t understand how costly it was.
Carey: They’re all over. In making ready for this dialogue, I’ve learn issues about persons are paying $600 a yr, different persons are paying $1,200 a yr. There’s huge jumps from yr to yr. It may be an especially costly proposition. Oh, my goodness.
Rovner: IVF itself, I feel as we’ve talked about, can be extraordinarily costly and time-consuming, and emotionally costly. It’s not one thing that folks enter into evenly. So I feel we will certainly see extra as we go. There’s additionally girls’s well being information this week that doesn’t need to do with replica. That’s new. Earlier this week, President Biden issued an govt order making an attempt to make sure that girls are higher represented in medical analysis. Tami, what does this order do and why was it wanted?
Luhby: Effectively, it’s one other try by the Biden administration, as we’ve mentioned, to deal with reproductive well being and reproductive rights. In the course of the State of the Union tackle earlier this month, Biden requested Congress to take a position $12 billion in new funding for ladies’s well being analysis. And there are literally a number of elements to the chief order, however the huge ones are that it requires supporting analysis into well being and illnesses which might be extra more likely to happen midlife for ladies after menopause, equivalent to rheumatoid arthritis, coronary heart assaults, osteoporosis, and in addition to methods to enhance the administration of menopause-related points.
We’re positively seeing that menopause care is of accelerating focus in a mess of areas together with employer medical health insurance, however the govt order additionally goals to extend the variety of girls collaborating in medical trials since they’re poorly represented now. We all know that sure medicines and sure remedies have totally different results on girls than males, however we don’t actually know that that properly as a result of they’re not as represented in these medical trials. Then it additionally directs businesses to develop and strengthen analysis and knowledge requirements on girls’s well being throughout all the related analysis and funding alternatives within the authorities.
Rovner: I’ll say that this is a matter I’ve very sturdy emotions about as a result of I lined the talk in 1992 about together with girls in medical analysis. On the time, medical doctors didn’t need to have girls in medical trials as a result of they have been apprehensive about hormones, they usually would possibly get pregnant, and we wouldn’t actually know what that meant for no matter it was that we have been testing. Somebody steered that “In case you’re going to make use of these remedies and medicines on girls, possibly it’s best to check them on girls too.” Then I received an award in 2015 for a narrative about how they nonetheless weren’t doing it, although it was required by legal guidelines.
Carey: And right here we’re, 2024.
Rovner: Yeah, right here we’re. It simply continues, however a minimum of they’re attempting. All proper, lastly, this week in medical misinformation, we journey to the Supreme Court docket, the place the justices heard oral arguments in a case introduced by two Republican state attorneys common charging that the Biden administration, quote, “coerced” social media platforms, Google, Meta, and X, into downgrading or taking down what public well being officers deemed covid disinformation. I didn’t take heed to the arguments, however all of the protection I noticed steered that the justices weren’t shopping for what the attorneys common have been promoting.
One more public-health-adjacent case to look at for a call later this spring, however I feel that is actually going to be an vital one by way of what public officers can and can’t do utilizing their authority as public well being officers. We’re clearly in a little bit of a public well being belief disaster, so we are going to see how that goes.
All proper, that’s the information for this week. Now, we are going to play my interview with HHS Secretary Xavier Becerra, then we shall be again with our further credit.
I’m so happy to welcome again to the podcast Well being and Human Providers Secretary Xavier Becerra. I’ve requested him to hitch us to speak in regards to the Inexpensive Care Act, which was signed into legislation 14 years in the past this weekend. Mr. Secretary, thanks a lot for coming again.
Xavier Becerra: Julie, nice to be with you on an important week.
Rovner: So the Inexpensive Care Act has come a good distance, not simply within the 14 years since President Obama signed it into legislation, however within the 10 years for the reason that healthcare.gov web site so spectacularly didn’t launch, however this yr’s enrollment setting a report, proper?
Becerra: That’s proper, and it’s best to have stated, “You’ve come a good distance, child.”
Rovner: So what will we learn about this yr’s enrollment numbers?
Becerra: One other report breaker. Julie, yearly that President Biden has been in workplace, we have now damaged information. As we speak, extra Individuals have medical health insurance than ever within the historical past of the nation. Greater than 300 million folks can now go to a physician, depart their baby in a hospital and know they received’t go bankrupt as a result of they’ve their very own medical health insurance. That’s the type of peace of thoughts you may’t purchase. Some 21.5 million Individuals right this moment look to {the marketplace} on the Inexpensive Care Act to get their protection. By the best way, the Inexpensive Care Act total, some 45 million Individuals right this moment depend on the ACA for his or her well being care insurance coverage, whether or not it’s via {the marketplace}, via Medicaid, or a few of these primary plans that have been additionally permitted underneath the ACA.
Rovner: Clearly, one of many causes for such an enormous uptake is the expanded subsidies that have been prolonged by the Inflation Discount Act in 2022, however these expire on the finish of subsequent yr, the top of 2025. What do you assume would occur to enrollment in the event that they’re not renewed?
Becerra: Effectively, and that’s the massive query. The truth that the president made well being care reasonably priced was the massive information. As a result of having the Inexpensive Care Act was nice, but when folks nonetheless felt it was unaffordable, they wouldn’t signal on. They now know that that is the most effective deal on the town and persons are signing up. When you may get medical health insurance protection for $10 or much less a month in your premiums, that’s an important deal. You may’t even go see a film at a theater right this moment for underneath $10. Now, you may get well being care protection for a full month, Julie. Once more, as I all the time inform folks, that doesn’t even embody the popcorn and the refreshment on the movie show, and so it’s an enormous deal. However with out the subsidies, some folks would nonetheless say, “Ah, it’s nonetheless too costly.” In order that’s why the president in his price range requires extending these subsidies completely.
Rovner: So there are nonetheless 10 states that haven’t taken up the federal authorities’s supply to pay 90% of the prices to increase Medicaid to all low-income adults of their states. I do know Mississippi is contemplating a invoice proper now. Are there different states that you simply count on might be part of them someday within the close to future? Or are any of these 10 states more likely to be part of the opposite 40?
Becerra: We’re hoping that the opposite 10 states be part of the 40 which have come on board the place tens of millions of Individuals right this moment have protection. They’re forsaking fairly a bit of cash. I used to be in North Carolina lately the place Gov. [Roy] Cooper efficiently navigated the passage of growth for Medicaid. Not solely was he capable of assist some 600,000-plus North Carolinians get well being protection, however he additionally acquired a verify for $1.6 billion as a bonus. Not dangerous.
Rovner: No, not dangerous in any respect. So a few years into this legislation, I really feel like folks now perceive a variety of what it did: let grownup kids keep on their mother and father’ well being plans till the age of 26; banning most preexisting situation exclusions in well being protection. But most individuals nonetheless don’t know that these provisions that they assist have been really created by Obamacare and even that Obamacare and the Inexpensive Care Act are the identical factor. Medicare has had such nice branding success through the years. Why hasn’t the ACA?
Becerra: Truly, Julie, I feel that’s altering. As we speak, about two-thirds of Individuals inform you that they assist the marketplaces within the Inexpensive Care Act. I feel we’re really now starting an period the place it’s not the massive three, the place you had Social Safety, Medicare, and Medicaid and everybody protects these. As we speak, I feel it’s the massive 4, the cleanup hitter being market. As we speak, you’d discover tens of tens of millions of Individuals who would say, “Hold your soiled, stinking arms off of my market.”
Rovner: Effectively, we are going to see as that goes ahead. Clearly, President Biden was closely concerned within the growth of the Inexpensive Care Act as vp, as have been you as a member of the Home Methods and Means Committee on the time. What do you hope is that this administration’s greatest legacy to depart to the well being legislation?
Becerra: Julie, I feel it’s making it reasonably priced. The president made a dedication when he was first working to be president. He stated on well being care he was going to make it extra reasonably priced for extra Individuals with higher advantages, and that’s what he’s performed. The ACA is ideal proof. And Individuals are signing up and signaling they agree by the tens of millions. To go from 12 million folks on the Inexpensive Care Act market to 21.5 million in three years, that’s huge information.
Rovner: So if I could, one query on one other matter. Subsequent week, the Supreme Court docket’s oral arguments happen within the case it might considerably prohibit the provision of the abortion capsule mifepristone. Clearly, that is one thing that’s being dealt with by the Justice Division, however what’s it about this case that worries you most as HHS secretary, in regards to the potential influence if the court docket rolls again FDA approval to the 2016 rules?
Becerra: Effectively, Julie, as you properly know out of your years of overlaying well being care, right this moment there are Individuals who’ve much less safety, fewer rights, than many people rising up. My daughters, my three daughters right this moment, have fewer protections and entry to well being care than my spouse had when she was their age. That’s not the America most of us know. To see one other case the place, now, medicine abortion, which is utilized by tens of millions of Individuals — in truth, it’s the commonest type of care that’s obtained by a lady who must have abortion providers — that’s now at stake. However we consider that if the Supreme Court docket believes in science and it believes within the info, as a result of mifepristone has been used safely and successfully publicly for greater than 20 years, that we’re going to be superb.
The factor that worries me as a lot, not simply within the discount of entry to care for ladies in America, is the truth that mifepristone went via a course of on the FDA just like scores and scores of different medicines that Individuals depend on, that don’t have anything to do with abortion. And if the method is shut down by the Supreme Court docket for mifepristone, then it’s most likely now in danger for all these different medicine, and subsequently these different medicine that Individuals depend on for diabetes, for most cancers, who is aware of what, may additionally be challenged as not having gone via the fitting course of.
Rovner: I do know the drug trade could be very, very apprehensive about this case and watching it intently, and so will we. Mr. Secretary, thanks a lot for becoming a member of us.
Becerra: All the time good to be with you, Julie.
Rovner: OK, we’re again. It’s time for our extra-credit phase. That’s after we every advocate a narrative we learn this week we predict it’s best to learn, too. As all the time, don’t fear in case you miss it. We’ll put up the hyperlinks on the podcast web page at kffhealthnews.org and in our present notes in your cellphone or different cellular machine. Tami, why don’t you go first this week?
Luhby: OK, my further credit score this week is an article about Georgia’s distinctive Medicaid program from KFF Well being Information’ Andy Miller and Renuka Rayasam. It’s titled “Georgia’s Medicaid Work Requirement Costing Taxpayers Hundreds of thousands Regardless of Low Enrollment.” And I’m actually glad they did this story. I and lots of others wrote about Georgia launching this program initially however haven’t performed follow-up. So I used to be very pleased to see this story.
As a lot of our listeners most likely know, the Trump administration allowed a number of states to impose work necessities in Medicaid for the primary time in this system’s historical past in 2018. However the efforts have been ultimately stopped by the courts in all states besides Georgia. Georgia was allowed to proceed with including its work requirement to Medicaid as a result of it was really going to increase protection to permitting adults with incomes as much as 100% of the poverty line to qualify. So the Georgia Pathways to Protection initiative started final June.
Andy and Renuka took a have a look at the way it’s faring, and the reply is definitely not so properly. Solely about 3,500 folks have signed up, far wanting the 25,000 that the state projected for the primary yr. What’s extra, this system has price taxpayers a minimum of $26 million to this point, with greater than 90% of that going in direction of administrative and consulting prices fairly than precise medical take care of low-income folks.
Against this, increasing Medicaid underneath the Inexpensive Care Act to folks with 138% of the poverty line would make a minimum of 359,000 uninsured Georgia residents newly eligible for protection and scale back state spending by $710 million over two years. That’s what the advocates are pushing. So we’ll see what occurs in coming months. One factor that’s additionally famous within the story is that about 45% of Pathways purposes have been nonetheless ready to be processed.
Rovner: I’ll level out that we did discuss a few weeks in the past in regards to the low enrollment within the Georgia program. What we had not seen was how a lot it’s really costing the states per enrollee. So it’s actually good story. Alice, why don’t you go subsequent?
Ollstein: Yeah, so I’ve some very relatable information from CNN. It’s referred to as “Why Your Physician’s Workplace Is Spamming You With Appointment Reminders.” It’s about why all of us get so many obnoxious repeat reminders for each medical appointment. It each explains why medical practices that function on such a tiny revenue margin are so anxious about no-shows and last-minute cancellations, and in order that’s a part of it. But additionally a part of it’s that there are all these totally different methods that don’t talk with each other. So the prescription drug system and the digital medical information system and the physician’s workplace’s personal system are all working in parallel and never coordinating with each other, and that’s why you get all these annoying a number of reminders. The medical group is turning into conscious that it’s backfiring as a result of the extra you get, the extra you begin tuning them out and also you don’t take note of which of them is likely to be vital. So they’re engaged on it. So a considerably hopeful piece of stories.
Rovner: Elevate your hand in case you have a number of affected person portals that it’s a must to take care of in your a number of …
Ollstein: Oh, my God, sure.
Rovner: I’ll observe that everyone’s arms go up. Mac?
Carey: I’ve not one however two tales on an important concern: Medicaid property restoration. The primary is from Paula Span at The New York Instances. The headline says all of it, “When Medicaid Comes After the Household Residence.” And the second story is an AP piece by Amanda Seitz, and that’s titled “State Medicaid Places of work Goal Lifeless Folks’s Properties to Recoup Their Well being Care Prices.” Now, these tales are each a few program that’s been round since 1993. That’s when Congress mandated Medicaid beneficiaries over the age of 55 which have used long-term care providers, and I’m speaking about nursing properties or residence care, that states should attempt to recuperate these bills from the beneficiaries’ estates after their deaths.
As you may think about, this is likely to be an issue for the beneficiaries. They could need to promote a household residence, attempt to discover different methods to pay an enormous invoice from Medicaid. Rep. Jan Schakowsky, she’s a Democrat of Illinois, has reintroduced her invoice. It’s referred to as the Cease Unfair Medicaid Recoveries Act. She’s attempting to finish the follow. She thinks it’s merciless and dangerous, and her argument is, in truth, the federal and state governments spend far more than what they accumulate, and these collections typically go after low-income households that may’t afford the invoice anyway.
So although it’s been round, it’s vital to learn up on this. A important level within the tales was do states correctly warn those that property have been going to be recovered in the event that they enroll a liked one in Medicaid for long-term care and so forth. So nice studying, folks ought to bone up on that.
Rovner: That is a kind of points that simply retains resurfacing and doesn’t ever appear to get handled. Effectively, my story this week is from The Washington Submit, though I’ll say it was lined extensively in dozens of retailers. It’s referred to as “Arizona Lawmaker Tells Her Abortion Story to Present ‘Actuality’ of Restrictions.” On Monday, Arizona State Sen. Eva Birch stood up on the Senate ground and gave a speech not like something I’ve ever seen. She’s a former nurse at a girls’s well being clinic. She’s additionally had fertility problems with her personal for a minimum of a decade, having each had a miscarriage and an abortion for a nonviable being pregnant in between efficiently delivering her two sons.
Now, she’s pregnant once more, however with one other nonviable being pregnant, which she plans to terminate. Her level in telling her story in public on the Senate ground, she stated, was to underscore how merciless — her phrases — Arizona’s abortion restrictions are. She’s been topic to a ready interval, required to endure an invasive transvaginal ultrasound to acquire info she and her physician already knew about her being pregnant, and to take heed to a lecture on abortion, quote, “options,” like adoption, which clearly don’t apply in her case.
Whereas she gave the speech on the ground, a number of of her Democratic colleagues stood within the digicam shot behind her, whereas most of the Republicans reportedly walked out of the chamber. I’ll hyperlink to the story, however I can even hyperlink to all the speech for many who need to hear it.
OK, that’s our present. As all the time, in case you benefit from the podcast, you may subscribe wherever you get your podcasts. We’d respect it in case you left us a assessment; that helps different folks discover us, too. Particular thanks as all the time to our technical guru, Francis Ying, and our fill-in editor for right this moment, Stephanie Stapleton. As all the time, you may e-mail us your feedback or questions. We’re at whatthehealth@kff.org, or you may nonetheless discover me at X, @jrovner, or @julierovner at Bluesky and @julie.rovner at Threads. Mary Agnes, the place are you hanging out lately?
Carey: I’m hanging out on X, @MaryAgnesCarey.
Rovner: Alice?
Ollstein: @AliceOllstein on X, and @alicemiranda on Bluesky.
Rovner: Tami?
Luhby: The perfect place to seek out me is at cnn.com.
Rovner: There you go. We shall be again in your feed subsequent week. Till then, be wholesome.
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