\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n A unanimous Supreme Court turned back a challenge to the FDA\u2019s approval and rules for the abortion pill mifepristone, finding that the anti-abortion doctor group that sued lacked standing to do so. But abortion foes have other ways they intend to curtail availability of the pill, which is commonly used in medication abortions, which now make up nearly two-thirds of abortions in the U.S.<\/p>\n Meanwhile, the Biden administration is proposing regulations that would bar credit agencies from including medical debt on individual credit reports. And former President Donald Trump, signaling that drug prices remain a potent campaign issue, attempts to take credit for the $35-a-month cap on insulin for Medicare beneficiaries \u2014 which was backed and signed into law by Biden.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Rachana Pradhan of KFF Health News, and Emmarie Huetteman of KFF Health News.<\/p>\n \t\t\t \tAnna Edney \t\t\t \t\t\t \t\t\t \tEmmarie Huetteman \t\t\t \t\t\t \t\t\t \tRachana Pradhan \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF president and CEO Drew Altman about KFF\u2019s new \u201cHealth Policy 101\u201d primer. You can learn more about it here<\/a>.<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> HuffPost\u2019s \u201cHow America\u2019s Mental Health Crisis Became This Family\u2019s Worst Nightmare<\/a>,\u201d by Jonathan Cohn.<\/p>\n Anna Edney:<\/strong> Stat News\u2019 \u201cFour Tops Singer\u2019s Lawsuit Says He Visited ER for Chest Pain, Ended Up in Straitjacket<\/a>,\u201d by Tara Bannow.<\/p>\n Rachana Pradhan:<\/strong> The New York Times\u2019 \u201cAbortion Groups Say Tech Companies Suppress Posts and Accounts<\/a>,\u201d by Emily Schmall and Sapna Maheshwari.<\/p>\n Emmarie Huetteman:<\/strong> CBS News\u2019 \u201cAs FDA Urges Crackdown on Bird Flu in Raw Milk, Some States Say Their Hands Are Tied<\/a>,\u201d by Alexander Tin.<\/p>\n Also mentioned on this week\u2019s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: SCOTUS Rejects Abortion Pill Challenge \u2014 For Now\t\t\t\t<\/p>\n KFF Health News\u2019 \u2018What the Health?\u2019<\/strong>\u00a0Episode Title:<\/strong> \u2018SCOTUS Rejects Abortion Pill Challenge \u2014 For Now\u2019<\/strong>Episode Number:<\/strong> 351Published:<\/strong> June 13, 2024<\/p>\n [Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Mila Atmos<\/strong>: The future of America is in your hands. This is not a movie trailer and it\u2019s not a political ad, but it is a call to action. I\u2019m Mila Atmos and I\u2019m passionate about unlocking the power of everyday citizens. On our podcast \u201cFuture Hindsight,\u201d we take big ideas about civic life and democracy and turn them into action items for you and me. Every Thursday we talk to bold activists and civic innovators to help you understand your power and your power to change the status quo. Find us at futurehindsight.com or wherever you listen to podcasts.<\/p>\n Julie Rovner<\/strong>: Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, June 13, at 10:30 a.m. As always, news happens fast and things might have changed by the time you hear this, so here we go.<\/p>\n We are joined today via video conference by Anna Edney of Bloomberg News.<\/p>\n Anna Edney<\/strong>: Hi there.<\/p>\n Rovner<\/strong>: Rachana Pradhan of KFF Health News.<\/p>\n Rachana Pradhan<\/strong>: Hello.<\/p>\n Rovner<\/strong>: And Emmarie Huetteman, also of KFF Health News.<\/p>\n Emmarie Huetteman<\/strong>: Good morning.<\/p>\n Rovner<\/strong>: Later in this episode we\u2019ll have my interview with KFF President and CEO Drew Altman, who I honestly can\u2019t believe hasn\u2019t been on the podcast before. He is here to talk about \u201cHealth Policy 101,\u201d which is KFF\u2019s all-new, all-in-one introductory guide to health policy. But first, this week\u2019s news.<\/p>\n So, as we tape, we have breaking news from the Supreme Court about that case challenging the abortion pill mifepristone. And you know how we always say you can\u2019t predict what the court is going to do by listening to the oral arguments? Well, occasionally you can, and this was one of those times the court watchers were correct. The justices ruled unanimously that the anti-abortion doctors who brought the suit against the pill lack standing to sue. So the suit has been dismissed, wrote Justice [Brett] Kavanaugh, who wrote the unanimous opinion for the court: \u201cA plaintiff\u2019s desire to make a drug less available for others does not establish standing to sue.\u201d So, might anybody have standing? Have we not maybe heard the end of this case?<\/p>\n Edney<\/strong>: Yeah, I think certainly there could be someone else who could decide to do that. I mean, just quickly looking around when this came out, it seems like maybe state AGs [attorneys general] could take this up, so it doesn\u2019t seem like it\u2019s the last of it. I also quickly saw a statement from Sen. [Bill] Cassidy, a Republican, who mentioned this wasn\u2019t a ruling on the merits exactly of the case, but just that these doctors don\u2019t have standing. So it does seem like there would be efforts to bring it back.<\/p>\n Rovner<\/strong>: This is not going to be the last challenge to the abortion pill.<\/p>\n Edney<\/strong>: Yeah.<\/p>\n Pradhan<\/strong>: Just looking in my inbox this morning after the decision, I mean it\u2019s clear the anti-abortion groups are really not done yet. So I think there\u2019s going to be a lot of pressure, of course, from them. It is an election year, so they\u2019re trying to get, notch wins as far as races go, but also to get various AGs to keep going on this.<\/p>\n Rovner<\/strong>: And if you listen to last week\u2019s podcast, there are three AGs who are already part of this case, so they may take it back with the district court judge in Texas. We shall see. Anyway, more Supreme Court decisions to come.<\/p>\n But moving on to campaign 2024 because, and this seems impossible, the first presidential debate is just two weeks away.President [Joe] Biden is still struggling to convince the public that he\u2019s doing things that they support. Along those lines, this week the administration proposed rules that would ban medical debt from being included in calculating people\u2019s credit scores. I thought that had happened already. What would this do that hasn\u2019t already been done?<\/p>\n Huetteman<\/strong>: Well, last year the big credit agencies volunteered to cut medical debt that\u2019s below $500 from people\u2019s credit reports. Of course, there\u2019s a lot of evidence that shows that that\u2019s not really the way that people get hurt with their credit scores, they get hurt when they have big medical bills. So this addresses a major concern that a lot of Americans have with paying for health care in the United States.<\/p>\n I oversee our \u201cBill of the Month\u201d project with NPR and I can say that a lot of Americans will pay their medical bills without question, even for fear of harm to their credit score, even if they think that their bill might be wrong. Also, it\u2019s worth noting also that researchers have found that medical debt does not accurately predict whether an individual is credit-worthy, actually, which is unlike other kinds of debt that you\u2019d find on credit scores.<\/p>\n Rovner<\/strong>: So yeah, not paying your car payment suggests what you might or might not be able to do with a mortgage or a credit card. But not paying your surprise medical bill, maybe not so much?<\/p>\n Huetteman<\/strong>: Yes, exactly. Really, we can all end up in the emergency room with a big bill. You don\u2019t get a big bill just because you have trouble meeting your credit card bills or you have trouble meeting your car payments, for example.<\/p>\n Rovner<\/strong>: We\u2019ll see if this one resonates with the public because a lot of the things that the administration has done have not. Meanwhile, President [Donald] Trump, who presided over one of the most rapid and successful vaccine development projects ever, for the covid vaccine, now seems to be moving more firmly into the anti-vax camp, and it\u2019s not just apparently anti-covid vaccine. Trump said at a rally last month that he would strip federal funding from schools with vaccine mandates \u2014 any vaccines apparently, like measles and mumps and polio \u2014 and he says he would do it by executive order. No legislation required. This feels like it could have some pretty major consequences if he followed through on this. Anna, I see you nodding. You have a toddler.<\/p>\n Edney<\/strong>: Right, right. I was just thinking about that going into kindergarten, what that could mean, and there\u2019s just so many \u2026 I mean, even kids don\u2019t have to get chickenpox nowadays. That seems like a really great thing. I don\u2019t know. I mean, I had chickenpox. I think that it could take us backwards, obviously, into a time that we\u2019re seeing pockets of as measles crops up in certain places and things like that. I\u2019d be curious. What I don\u2019t know is how much federal funding supports a lot of these schools. I know there\u2019s state funding, county funding, how much that\u2019s actually taking away if it would change the minds of certain ones. But I guess if you\u2019re in maybe a state that doesn\u2019t like vaccines in the first place, it\u2019s a free-for-all to go ahead and do that.<\/p>\n Pradhan<\/strong>: One of the questions I have, too, is through the CDC [Centers for Disease Control and Prevention] we have the Vaccines for Children Program, which provides free immunizations to children for a lot of these infectious diseases, for children who are either uninsured or underinsured or low-income. And so that\u2019s been a really long-standing program and I\u2019m very curious as to whether they would try to maybe reduce or eliminate a bunch of the vaccines that are provided through that, which obviously could affect a significant number of children nationwide.<\/p>\n Rovner<\/strong>: Yeah, it\u2019s funny, the anti-vax movement has been around for, I don\u2019t know, 20, 25 years; whenever that Lancet piece that later got rescinded came out that connected vaccines to autism. It seems it\u2019s getting a boost and, yes, that\u2019s an intended pun right now. I guess covid, and the doubts about covid, is pushing onto these other vaccines, too.<\/p>\n Edney<\/strong>: I think that we\u2019ve certainly seen that. Before covid, at least my understanding of a lot of the concerns around the behavioral issues and autism linked to vaccines or things like that was more of the left-wing, maybe crunchier people who were seeing it as not wanting to put, in their words, poison in their bodies. But now we\u2019re seeing this also right-wing opposition to it, and I think that\u2019s certainly linked to covid. Any mandate at this point from the government is pushed back against more so than before.<\/p>\n Rovner<\/strong>: Well, we have lots of news this week on drugs and drug prices. Anna, you have quite the story about how trying to save money by buying generic might not always be the best move<\/a>? As I describe it: the scary story of the week. Tell us about it.<\/p>\n Edney<\/strong>: Yes. Yeah, thank you. Yeah, I did this data dive looking into store-brand medication. So when you go into CVS or Walgreens, for example, you can see the Tylenol brand name there, but next to it you\u2019ve got one that looks a lot like it, but it\u2019s got CVS Health or Walgreens on the name and it costs usually a few dollars less. What I found is that of those store brands, CVS has a lot more recalls than the rest, even though they\u2019re selling these same store-brand drugs. So they have two to three times more recalls than Walgreens and Walmart. And what\u2019s happening is they are more often going to shady contract manufacturers to make their generic products that they\u2019re selling over the counter. I found one that was making kids\u2019 medication with contaminated water. And then the really disturbing one that was nasal sprays for babies on the same machines that this company was using to make pesticides. And just wrote about a whole litany of these kinds of companies that CVS is hiring at a higher rate than the other two \u2014 Walgreens and Walmart \u2014 that I was able to do the data dive on.<\/p>\n And interestingly, these store brands have a loophole, so they\u2019re not responsible for the quality of those medications, even though their name\u2019s on it. They can just walk away and say, \u201cWell, we put it on the shelves. We agree with that, but it\u2019s up to these companies that are making it to verify the quality.\u201d And so, that\u2019s usually not how this works. Even if there\u2019s contract manufacturers, which a lot of drugmakers use, they usually have to also verify the quality. But store brands are considered just distributors, and so there\u2019s this separation of who even owns the responsibility for this drug.<\/p>\n Pradhan<\/strong>: Yeah, I think a collective reaction reading this. I know, how many people did I text your story to Anna, saying, \u201cYikes! \u2026 FYI.\u201d<\/p>\n Rovner<\/strong>: So on the one hand, you get what you pay for. On the other hand, price is not the only problem that we find with drugs. A new study from the University of Utah Drug Information Service just found that pharmacists are reporting the largest number of drugs in shortage since the turn of the century. And my colleague Susan Jaffe has a story on how some shortages are being exacerbated at the pharmacy level by a new Medicare rule that was intended to lower prices for patients at the counter<\/a>.<\/p>\n Anna, how close are we to the point where the drug distribution system is just going to collapse in on itself? It does not seem to be working very well.<\/p>\n Edney<\/strong>: Yeah, it does feel that way because I always think of that example of the long balloon and when you squeeze it at one end the other end gets bigger. Because when you\u2019re trying to help patients at the counter, somebody\u2019s taking that hit, that money isn\u2019t just appearing out of thin air in their pockets. So the pharmacists are saying \u2014 and particularly smaller pharmacies, but also some of the bigger ones \u2014 are saying the way that these drugs are now being reimbursed, how that\u2019s working under this new effort, is they don\u2019t have as much cash on hand, so they\u2019re having trouble getting these big brand-name drugs. It was a really interesting story that Susan wrote. Just shows that you can\u2019t fix one end of it, you need to fix the whole thing somehow. I don\u2019t know how you do that.<\/p>\n And shortages are another issue just of other kinds, whether it\u2019s quality issues or whether it\u2019s the demand is growing for a lot of these drugs, and depending even on the time of year. So I think we\u2019re all seeing it just appear to be disintegrating and hoping that there\u2019s just no tragedy or big disaster where we really need to rely on it.<\/p>\n Rovner<\/strong>: Yeah, like, you know, another pandemic.<\/p>\n Edney<\/strong>: Exactly.<\/p>\n Rovner<\/strong>: There\u2019s also some good news on the drug front. An FDA [Food and Drug Administration] advisory committee this week recommended approval for yet another potential Alzheimer\u2019s drug, donanemab, I think I\u2019m pronouncing that right. I guess we\u2019ll learn more as we go on. The drug appears to have better evidence that it actually slows the progression of the disease without the risks of Aduhelm, the controversial drug approved by the FDA that\u2019s been discontinued by its manufacturer. This would be the second promising drug to be approved following Leqembi last year. When we first started talking about Aduhelm \u2014 what was that, two years ago \u2014 we talked about how it could break Medicare financially because so many people would be eligible for such an expensive drug. So now we\u2019re looking at maybe having two drugs like this and I don\u2019t hear people talking about the potential costs anymore.<\/p>\n Is there a reason why or are we just worried about other things?<\/p>\n Edney<\/strong>: Well, I think there\u2019s a benefit that they seem to have proven more than Aduhelm. But there\u2019s also still a risk of brain swelling and bleeding, and that I\u2019m sure would factor into someone\u2019s decision of whether they want to try this. So maybe people aren\u2019t exactly flocking in the same way to want to get these drugs. As they\u2019re used more, maybe that changes and we see more of \u201cCan you spot the swelling? Can you stop it?\u201d And things like that. But I think that there just seems to be a lot of questions around them. Also, Aduhelm was the biggest one, which obviously Medicare didn\u2019t cover, and then they\u2019re not even trying to sell anymore. But I think that there\u2019s just always questions about how they\u2019re tested, how much benefit really there is. Is a few months worth that risk that you could have a major brain issue?<\/p>\n Rovner<\/strong>: While we are on the subject of drugs and drug prices, we have \u201cThis Week in Misinformation\u201d from former President Trump, who as we all know, likes to take credit for things that are not his and deflect blame from things that are. Now in a post on his Truth Social platform, he says that he is the one who lowered insulin copayments to $35 a month, and that President Biden \u201chad nothing to do with it.\u201d Yes, the Trump administration did offer a voluntary $35 copayment program for Medicare Part D plans, but it was limited. It was time-limited and not all the plans adopted it. President Biden actually didn\u2019t do the $35 copay either, but he did propose and sign the law that Congress passed that did it. It was part of the Inflation Reduction Act. Ironically, President Biden didn\u2019t get all he wanted either. The intent was to limit insulin copayments for all patients, but so far, it\u2019s only for those on Medicare. I would guess that Trump is saying this to try to neutralize one of the few issues that maybe is getting through to the public about something that President Biden did.<\/p>\n Pradhan<\/strong>: Well, I mean, I think even during President Trump\u2019s first term, I mean lowering drug prices, he made it very clear that that was something that was important to him. He certainly wasn\u2019t following the traditional or older Republican Party\u2019s friendliness to the pharmaceutical industry. I mean, he was openly antagonizing them a lot, and so it\u2019s certainly something that I think he understands resonates with people. And it\u2019s a pocketbook issue similar to what\u2019s going on on medical debt that we talked about earlier, right? These new regulations that are being proposed \u2014 they may not be finalized, we\u2019ll have to see about that because of the timing \u2014 but these are things that are, I think at the end of the day, of course, are very relatable to people. Unlike, perhaps, abortion is a big campaign issue, but it\u2019s not necessarily going to resonate with people in the same way and certainly not potentially men and women in the same way. But I think that there\u2019s much more broad-based understanding of having to pay a lot for medications and potentially not being able to afford it. Obviously, insulin is probably the best poster child for a lot of reasons for that. So no surprise he wants to take credit for it, and also perhaps that it\u2019s not really what happened, so \u2026<\/p>\n Rovner<\/strong>: If nothing else, I think it signals that drug prices are still going to be a big issue in this campaign.<\/p>\n Pradhan<\/strong>: For sure. And I mean Joe Biden has made it very clear. I mean the Inflation Reduction Act of course included other measures to lower people\u2019s out-of-pocket costs for drugs, which he\u2019s very eagerly touting on the trail right now to shore up support.<\/p>\n Rovner<\/strong>: Let\u2019s move on from drugs to abortion via the FDA spending bill on Capitol Hill this week. The annual appropriations bills are starting to move in House committees, which is notable itself because this is when they are supposed to start moving if they\u2019re going to get done by Oct. 1, the start of the next fiscal year. We haven\u2019t seen that in a long time. So last year Republicans got hung up because they wanted their leaders to attach all manner of policy riders to the spending bills, most of them aimed at abortion, which can\u2019t get through the Senate. Well in a big shift, Republicans appear to be backing off of that, and the current version of the bill that funds the Department of Agriculture, as well as the FDA, does not include language trying to ban or further restrict the abortion pill mifepristone. Of course, that could still change, but my impression is that the new [House] Appropriations chairman, [Rep.] Tom Cole, who\u2019s very much a pragmatist, wants to get his bills signed into law.<\/p>\n Pradhan<\/strong>: I do wonder, though, if because of the Supreme Court decision that just came out today, whether that will change the calculation, or at the very least, the pressure that he is under to include something in the FDA bill. But as you know, there\u2019s plenty of time for abortion riders to make it in or out. I feel like this is, it\u2019s like Groundhog Day. Usually something related to abortion policy will upend various pieces of legislation. So I\u2019ll be curious to be on the lookout for that, whether it changes anything.<\/p>\n Rovner<\/strong>: Anna, were you surprised that they left it out, at least at the start?<\/p>\n Edney<\/strong>: Yeah, I think you\u2019re just what we\u2019ve seen with all of the rancor around abortion and abortion-related issues, I guess a little surprised. But also maybe it makes sense in just the sense that there are Republicans who are struggling with that issue and don\u2019t want to have to keep talking about it or voting on it in the same way.<\/p>\n Rovner<\/strong>: Well, that leads right to my next subject, which is that the Senate is voting this afternoon, after we tape, on a bill that would guarantee access to IVF. Republicans are expected to block it as they did last week on the bill to guarantee access to contraception. But as of Wednesday, it\u2019s going to be harder for Republicans to say they\u2019re voting against the bill because no one is threatening to block IVF. That\u2019s because the influential Southern Baptist Convention, one of the nation\u2019s largest evangelical groups, voted, if not to ban IVF, at least to restrict the number of embryos that can be created and ban their destruction, which doctors say would make the treatments more expensive and less successful. It sounds like the rift among conservatives over contraception and IVF is a long way from getting settled here.<\/p>\n Huetteman<\/strong>: That certainly seems to be true. It\u2019s also worth noting that there are a lot of influential members of Congress who are Baptist, of course, including House Speaker Mike Johnson. And I was refreshing my memory of the religious background of the current Congress with a Pew report: They say 67 members of this Congress are Baptist. Of course, Southern Baptist is the largest piece of that. And 148 are Catholic, which of course is another denomination that opposes IVF as well. So that\u2019s a pretty big constituency that has their churches telling them that they oppose IVF and should, too.<\/p>\n Rovner<\/strong>: Yeah, everybody says they\u2019re not coming for contraception, they\u2019re not coming for IVF. I think we\u2019re going to see a very spirited and continued debate over both of those things.<\/p>\n Well, speaking of the rift over reproductive health, former President Trump is struggling to please both sides and not really succeeding at it. He made a video address last week to the evangelical group, The Danbury Institute, which is a conservative subset of the aforementioned Southern Baptist Convention, in which former President Trump didn\u2019t use the word abortion and skirted the issue. That prompted some grumbling from some of the attendees, reported Politico. Even as Democrats called him an anti-abortion radical for even speaking to the group, which has labeled abortion \u201cchild sacrifice.\u201d<\/p>\n So far, Trump has gotten away with telling audiences what they want to hear, even if he contradicts himself regularly. But I feel like abortion is maybe the one issue where that\u2019s not going to work.<\/p>\n Pradhan<\/strong>: Well, I think the struggle really is even if people are more forgiving of him saying different things, it puts a lot of down-ballot candidates in a really difficult position. And I know, Julie, you\u2019d wanted to talk about this, but Republican candidates for U.S. Senate, I mean just how they have to thread the needle, and I don\u2019t know that voters will be as forgiving about changes in their position. So I think they say it\u2019s like, it\u2019s not just about you. It\u2019s like when two people get married, they\u2019re like, \u201cIt\u2019s not just about the two of you. It\u2019s like your whole family.\u201d This is like the family is your party and everyone down-ballot who has to now figure out what the best message is, and as we\u2019ve seen, they\u2019ve really struggled with \u201cWe\u2019ve shifted now from being many candidates and Republican officeholders supporting basically near-total abortion bans, if not very early gestational limits, to the 15-week ban being a consensus position.\u201d And now saying, well, Trump\u2019s saying he\u2019s not going to sign a national abortion ban, so let\u2019s leave it to the states. I mean, it keeps changing, and I think obviously underscores the difficulty that they\u2019re all having with this. So I don\u2019t think it helps for him to be saying inconsistent things all the time because then these other candidates for office really struggle, I think, with explaining their positions also.<\/p>\n Rovner<\/strong>: So as I say every week, I\u2019ve been covering abortion for a very long time, and before Roe<\/em> [v. Wade<\/em>] was overturned the general political rule is you could change positions on abortion once. If you were anti-abortion you could become pro-choice, and we\u2019ve seen that among a lot of Democrats, Sen. [Bob] Casey in Pennsylvania, sort of a notable example. And if you supported abortion rights, you could become anti-abortion, which Trump kind of did when he was running the first time. Others have also as, there are \u2026 and again we\u2019re seeing this more among Republicans, but not exclusively.<\/p>\n But people who try to change back usually get hammered. And as I say, Trump has violated every political rule about everything. So not counting him, I\u2019m wondering about, as you say, Rachana, some of these Senate candidates, some of these down-ballot candidates who are struggling to really rationalize their current positions with maybe what they\u2019d said before is something I think that bears watching over the next couple of months.<\/p>\n Huetteman<\/strong>: Absolutely. And we\u2019re seeing candidates who will change their tone within weeks of saying something or practically days at this point. They\u2019re really banking on our attention being pretty low as a public.<\/p>\n Rovner<\/strong>: Yeah. Although they may be right about that part.<\/p>\n Pradhan<\/strong>: Yeah, that\u2019s true. And there\u2019s a lot of time between now and November, but I think even the \u2026 just all the things, even this week of course, between now and November is an eternity. But we just talked about the Southern Baptist Convention stance on IVF. Of course, usually when these things happen, it prompts a lot of questions to lawmakers about whether they support that decision or not, whether they agree with it. And I think these court decisions \u2026 the Supreme Court, of course, will be out by the end of June, and so right now it might be fresh on people\u2019s minds. But it\u2019s hard to know whether September or October is the dominant or very prominent campaign issue in the same way.<\/p>\n Rovner<\/strong>: At the same time, we have a long way to go and a short way to go, so we will actually all be watching.<\/p>\n All right, well that is the news for this week. Now we will play my interview with Drew Altman and then we will come back and do our extra credits.<\/p>\n I am pleased to welcome to the podcast Drew Altman, president and CEO of KFF, and of course my boss. But lest you think that this is going to be a suck-up interview, you will see in a moment it\u2019s also a shameless self-promotion interview. Drew, thank you so much for joining us.<\/p>\n Drew Altman<\/strong>: It\u2019s great to be on \u201cWhat the Health?\u201d Thank you.<\/p>\n Rovner<\/strong>: I asked you here to talk about KFF\u2019s new \u201cHealth Policy 101\u201d project which launched last month, as a resource to help teach the basics of health policy. I know this is something you\u2019ve been thinking about for a while. Tell us what the idea was and who\u2019s the target audience here.<\/p>\n Altman<\/strong>: Well, since the Bronze Era, when I started KFF, faculty and students found their way to our stuff and they found it useful. It might\u2019ve been a fact sheet about Medicaid or a policy brief about Medicare or a bunch of charts that we produced. But they\u2019ve had to hunt and peck to find what they wanted and someone would find something on Medicaid or Medicare or the ACA [Affordable Care Act] or health care costs or women\u2019s health policy or international comparisons or whatever it was. And for a very long time, I have wanted to organize our material about health policy for their world so that it was easy to find. It was one stop, and you could find all the basic materials that you wanted on the core stuff about health policy as a service to faculty and students interested in health policy because we don\u2019t just analyze it and poll about it and report on it. We have a deep commitment. We really care about health policy and health policy education.<\/p>\n Rovner<\/strong>: You said those are the main topics covered. I assume that other topics could be added in the future? I mean, I could see a chapter on AI and health care.<\/p>\n Altman<\/strong>: Yes, and we\u2019re starting with an introduction for me. There\u2019s a chapter by Larry Levitt about challenges ahead. There\u2019s a chapter by somebody named Julie Rovner on Congress and the agencies, who also wrote a book about all of that stuff, which is still available, folks.<\/p>\n Rovner<\/strong>: It desperately needs updating. So I\u2019m pleased to be contributing to this.<\/p>\n Altman<\/strong>: But this is just the first year. And there were 13 chapters on the issues that I ticked off a moment ago and many more issues. And we\u2019re starting the process of adding chapters. So the next chapter will probably be on LGBTQ issues, and then, though it\u2019s not exactly the same thing as health policy, by popular demand, we will have a chapter on the basics of public health and what is the public health system, and spending on public health.<\/p>\n And I will admit, some of this also has origins in my own personal experience because before I was in government or in the nonprofit world or started and ran KFF, I was an academic at MIT [Massachusetts Institute of Technology] and I was fine when it came to big thoughts. And there I was and I\u2019d written a book about health cost regulation. But what I didn\u2019t know much about was how stuff really worked and the basics. And if I really needed to understand what was happening with regulation of private health insurance or the Medicaid program or the Medicare program, I didn\u2019t really have any place to go to get basic information about the history of the program, or the details of the program, or a few charts that would give me the facts that I needed, or what are the current challenges. And when it really sunk in was when I left MIT and I went to work in what is now CMS [Centers for Medicare & Medicaid Services] and then was called the HCFA [Health Care Financing Administration], and boy on the first day did I realize what I did not know. It was only when I entered the real world of health policy that I understood how much I had to learn. So I wanted to bridge the two worlds a little bit by making available this basic \u201cHealth Policy 101.\u201d<\/p>\n Rovner<\/strong>: I confess, I\u2019m a little bit jealous that this hadn\u2019t existed when I started to learn health policy because, like you, I had to ferret it all out, although thankfully KFF was there through most of it and I was able to find most of it along the way.<\/p>\n Altman<\/strong>: Exactly, and I think there\u2019ll be other audiences for this because if you\u2019re working on the Hill \u2014 but you don\u2019t work full time on health \u2014 if you\u2019re working in an association, if you\u2019re working anywhere in the health care system, there\u2019s lots of times when you really just need to understand. I just read about an 1115 waiver. What is that? Or what really is the difference between traditional Medicare and the Medicare Advantage plan? How is it that you get your drugs covered in the Medicare program? It seems to be lots of different ways. And just I\u2019m confused. How does this actually work?<\/p>\n I\u2019ll admit to you, also, I personally have an ulterior motive in all of this. And my ulterior motive is that it is my feeling now, and this has been a slowly creeping problem, that there isn\u2019t enough what I would call health policy in health policy education. So that over time it has become more about what is fashionable now, which is delivery and quality and value.<\/p>\n And I won\u2019t name names, but I spent a couple of days advising a health policy center at a renowned medical school about their curriculum in what they called health policy. And the draft of it had nothing in it that I recognized as health policy. Some of this is understandable. It\u2019s because if you\u2019re faculty with a disciplinary base \u2014 economics, political science, sociology, whatever \u2014 there\u2019s no reason you would know a lot about what we recognize as the core of health policy. There has been a serious decline in faith in government, in young people taking jobs in certainly the federal government, but a little bit in state government as well. So the jobs now are all in the health care industry, they\u2019re in tech, they\u2019re in consulting firms. And so I think there\u2019s just less of an incentive to learn a lot about Medicare, Medicaid, the ACA, the federal agencies, because you\u2019re not going to go work in the federal agencies, at least as frequently as students did in my time. And so just to be blunt about it, I am, in my mind, trying to get more health policy back into health policy education.<\/p>\n Rovner<\/strong>: Well, as you know, I endorse that fully because that\u2019s what we\u2019re trying to do, too. One more question since I have you. I\u2019ve been thinking about this a lot. When I started covering health policy shortly after you left HCFA, the big issue was people without insurance. And then throughout the early 2000s the big issue was spiraling costs. I feel like now the big issue is people who simply cannot navigate the system. The system has become so byzantine and complicated that, well, now there\u2019s a \u201cSouth Park\u201d about it. I mean, it\u2019s really to get even minor things dealt with is a major undertaking. I mean, what do you see as the biggest issue in policy for the next five or 10 years?<\/p>\n Altman<\/strong>: Well, I think the big issue for health care people used to be access to care. Now only about 8% of the population is uninsured. The big issue now is affordability, in my mind, and the struggles Americans are having paying their health care bills. It is an especially acute problem, virtually a crisis, for people with severe illnesses or people who are chronically ill. Fifty[%], 60% of those people really struggle to pay their medical bills. The crisis or the problem that isn\u2019t discussed enough \u2014 because it isn\u2019t a single problem it rears its head in so many ways \u2014 is the one you\u2019re talking about: that is the complexity of the health care system. Just the sheer complexity of it; how difficult it is to navigate and to use for people who have insurance or don\u2019t have insurance. Larry Levitt and I wrote a piece in JAMA about this, and we, all of us at KFF, are trying to focus more attention on that problem. Need to do more work on that problem and the many parts of it. It\u2019s partly why we set up an entire program a couple of years ago on consumer and patient protection, where we intend to focus more on just this issue of the complexity of the system makes it hard to make it work for people. But especially for patients who are people who encounter the system because they need it.<\/p>\n Rovner<\/strong>: Well, we will both continue to try to keep explaining it as it keeps getting more byzantine. Drew Altman, thank you so much for joining us.<\/p>\n Altman<\/strong>: Thank you, Julie, very much.<\/p>\n Rovner<\/strong>: OK, we are back. It\u2019s time for our extra-credit segment. That\u2019s when we each recommend a story we read this week we think you should read, too. As always, don\u2019t worry if you miss it. We will post the links on the podcast page<\/a> at kffhealthnews.org<\/a> and in our show notes on your phone or other mobile device. Emmarie, why don\u2019t you go first this week?<\/p>\n Huetteman<\/strong>: Sure. My story comes from CBS [News]. The headline is \u201cAs FDA Urges Crackdown on Bird Flu in Raw Milk, Some States Say Their Hands Are Tied<\/a>.\u201d So the story says that there are three more states<\/a> that have had their first reported cases of bird flu in the last month. And two of them don\u2019t really have a way to conduct increased oversight of dairy cows and the industry that seems to be particularly having problems here. Wyoming and Iowa are those two states. Basically, these are states where raw milk is unregulated, so there\u2019s no way for them to implement surveillance and restrictions on raw milk that might protect people from the fact that pasteurization appears to kill bird flu. But you don\u2019t have pasteurization with raw milk, of course, that\u2019s the definition.<\/p>\n Actually, this leads me to an extra, extra credit. KFF Health News\u2019 Tony Leys wrote about the raw milk change in Iowa last year, and he was reporting on how Iowa only just changed their law, allowing legal sales of raw milk. And his story<\/a>, among other things, pointed out that pasteurization helped rein in many serious illnesses in the past, including tuberculosis, typhoid, and scarlet fever. So unfortunately, this is a public health issue that\u2019s been going on for a century or more, and we\u2019ve got a method to deal with this, but not if you\u2019re drinking raw milk. So that\u2019s my story this week.<\/p>\n Rovner<\/strong>: Now people are going to drink raw milk and not get childhood vaccines. We\u2019ll see how that goes. Sorry. Anna, you go next.<\/p>\n Edney<\/strong>: Yeah, mine is from Stat and it\u2019s \u201cFour Tops Singer\u2019s Lawsuit Says He Visited ER for Chest Pain, Ended Up in Straitjacket<\/a>.\u201d It\u2019s really scary, and maybe not totally surprising, unfortunately, that this is how an older Black man was treated when he went to the hospital. But this is Alexander Morris, a member of the Motown group The Four Tops. These are in the Rock & Roll Hall of Fame, The Four Tops, and he had chest pain and problems breathing and went to the hospital in Detroit and was immediately just assumed he was mentally ill, and he ended up quickly in a straitjacket. So he is suing this hospital. And I think he brought up in this article he\u2019d seen people talk about driving while Black or walking while Black, and he essentially had become sick while Black. And he was able to prove he was a famous person and they took him out of the straitjacket. But how many other people haven\u2019t had that ability, and just been assumed, because of the color of their skin, to not be having a serious health issue? So I think it\u2019s worth a read.<\/p>\n Rovner<\/strong>: Yeah, it was quite a story. Rachana.<\/p>\n Pradhan<\/strong>: This week, I will take a story from The New York Times that is headlined \u201cAbortion Groups Say Tech Companies Suppress Posts and Accounts<\/a>.\u201d It is basically an examination of how TikTok, Instagram, and others, how they moderate\/remove content about abortion. What\u2019s interesting about this is, so this is being told from the perspective of individuals who support access to abortion services. And it recounts some examples of Instagram suspending one group, it was called Mayday Health, which provides information about abortion pill access. There\u2019s a telemedicine abortion service called Hey Jane, where TikTok briefly suspended them. What I thought was really interesting about this is anti-abortion groups have said for longer, actually, that technology companies have suppressed or censored information about crisis pregnancy centers, for example, that designed to dissuade women from having abortions. But I think it\u2019s concerns about, broadly speaking, just what the policies are of some of these social media companies and how they decide what information is acceptable or not. And it details these examples of, again, women who support abortion access or posting TikToks that maybe spell abortion phonetically. Like \u201ction\u201d is, instead of T-I-O-N, it\u2019s S-H-U-N. Or they\u2019ll put a zero instead of an O, and so it doesn\u2019t get flagged in the same way. So yeah, definitely an interesting read.<\/p>\n Rovner<\/strong>: The fraughtness of social media moderation on this issue and many others. Well, my extra credit this week is from my fellow Michigan fan and sometime podcast guest Jonathan Cohn of HuffPost, and it\u2019s called \u201cHow America\u2019s Mental Health Crisis Became This Family\u2019s Worst Nightmare<\/a>.\u201d And it\u2019s basically the story of the entire mental health system in the United States over the last century, as told through the eyes of one middle-class American family, about one patient whose trip through the system came to a tragic end. Even if you think you know about this country\u2019s failure to adequately treat people with mental illness, even if you do know about this country\u2019s failures on mental health, you really do need to read this story. It is that good.<\/p>\n All right, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our doing-double-duty editor this week, Emmarie Huetteman. As always, you can email us your comments or questions. We\u2019re whatthehealth, all one word, @kff.org. Or you can still find me at X, I\u2019m @jrovner<\/a>. Anna?<\/p>\n Edney<\/strong>: @annaedney<\/a>.<\/p>\n Rovner<\/strong>: Rachana?<\/p>\n Pradhan<\/strong>: I\u2019m @rachanadpradhan<\/a> on X.<\/p>\n Rovner<\/strong>: Emmarie?<\/p>\n Huetteman<\/strong>: I\u2019m lurking on X @EmmarieDC<\/a>.<\/p>\n Rovner<\/strong>: We will be back in your feed next week. Actually, we\u2019ll be coming to you from Aspen next week. But until then, be healthy.<\/p>\n \tFrancis Ying \tEmmarie Huetteman To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n And subscribe to KFF Health News\u2019 \u201cWhat the Health?\u201d on\u00a0Spotify<\/a>,\u00a0Apple Podcasts<\/a>,\u00a0Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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