\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 As Vice President Kamala Harris appears poised to become the Democratic Party\u2019s presidential nominee, health policy in general and reproductive health issues in particular are likely to have a higher profile. Harris has long been the Biden administration\u2019s point person on abortion rights and reproductive health and was active on other health issues while serving as California\u2019s attorney general.<\/p>\n Meanwhile, Congress is back for a brief session between presidential conventions, but efforts in the GOP-led House to pass the annual spending bills, due by Oct. 1, have run into the usual roadblocks over abortion-related issues.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Stephanie Armour of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico. <\/p>\n \t\t\t \tStephanie Armour \t\t\t \t\t\t \t\t\t \tRachel Cohrs Zhang \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Wright spent the past two decades in California, working with, among others, now-Vice President Kamala Harris on various health issues.<\/p>\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> NPR\u2019s \u201cA Study Finds That Dogs Can Smell Your Stress \u2014 And Make Decisions Accordingly<\/a>,\u201d by Rachel Treisman.\u00a0\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Stat\u2019s \u201cA Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges<\/a>,\u201d by Ed Silverman, and Politico\u2019s \u201cFederal HIV Program Set To Wind Down<\/a>,\u201d by Alice Miranda Ollstein and David Lim.\u00a0<\/p>\n Stephanie Armour:<\/strong> Vox\u2019s \u201cFree Medical School Won\u2019t Solve the Doctor Shortage<\/a>,\u201d by Dylan Scott.\u00a0\u00a0<\/p>\n Rachel Cohrs Zhang:<\/strong> Stat\u2019s \u201cHow UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients<\/a>,\u201d by Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence.\u00a0<\/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: Harris in the Spotlight\t\t\t\t<\/p>\n KFF Health News\u2019 \u2018What the Health?\u2019<\/strong>Episode Title:<\/strong> \u2018Harris in the Spotlight\u2019<\/strong>Episode Number:<\/strong> 357Published:<\/strong> July 25, 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 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, July 25, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this, so here we go. We are joined today via video conference by Alice Miranda Ollstein of Politico.<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.<\/p>\n Rovner:<\/strong> Rachel Cohrs Zhang of Stat News.<\/p>\n Rachel Cohrs Zhang:<\/strong> Hi, everybody.<\/p>\n Rovner:<\/strong> And we welcome back to the podcast one of our original panelists, Stephanie Armour, who I am pleased to say has now officially joined us here at KFF Health News. Stephanie, so great to have you back.<\/p>\n Stephanie Armour:<\/strong> Great to be back.<\/p>\n Rovner:<\/strong> Later in this episode, we will have my interview with Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Anthony previously spent two decades working on health issues in California so he\u2019s pretty familiar with the health work of the current vice president and soon-to-be Democratic presidential nominee, Kamala Harris, and he\u2019ll share some of that knowledge with us. But first, this week\u2019s news.<\/p>\n So it\u2019s safe to say a lot has changed since the last time we met. In fact, it may be fair to say that just about everything has changed. President Joe Biden announced he would not seek reelection after all, he endorsed his vice president, Kamala Harris, and she proceeded to all but lock up the nomination in less than 48 hours. Obviously, this will be a huge deal for the fight over abortion and reproductive health care, which we will get to in a moment. But how is this going to impact health care, in general, as a campaign issue?<\/p>\n Ollstein:<\/strong> Yeah, it\u2019s interesting because Kamala Harris has been a public figure for a while and has held a bunch of different offices, and so we can glean some clues as to where she is on various health care issues. But she\u2019s been a bit hard to pin down. And when my colleagues and I were talking to a lot of folks throughout the health care industry over the past week, there were a lot of question marks on their end, so we know a few things. We know that she used the powers of the AG [attorney general] office to go after monopolies and consolidation and anticompetitive practices in California.<\/p>\n She did that in the insurance space, in the provider space, in the drug space, and so people are expecting that she would be maybe more aggressive on that front. We know that she did co-sponsor [Sen. Bernie Sanders\u2019] \u201cMedicare for All\u201d bill, but then she also introduced her own, arguably more moderate, one that preserved private health insurance. And then, of course, abortion rights. She\u2019s been very vocal on that front, but since becoming the presumptive nominee, she hasn\u2019t really laid out what, if anything, she would do differently than Joe Biden. So like I said, a lot of question marks.<\/p>\n Rovner:<\/strong> Stephanie, you led our coverage of Harris\u2019 health record. What did you learn?<\/p>\n Armour:<\/strong> Well, I think a number of the people that I\u2019ve talked with really expect that she\u2019ll be a standard-bearer to what Biden has already done, and I think that\u2019s probably true. I don\u2019t think she\u2019s going to go back stumping for Medicare for All right now, for example. What I did find really interesting is, yes, she\u2019s very much made abortion and reproductive rights a cornerstone of her vice presidency and, I assume, will be of her campaign. But based on where abortion is polling right now, a number of the strategists I spoke to said she really needs to do something pretty major on it in order to get a real uptick in terms of galvanizing voters, just because economy and immigration are so high. They\u2019re saying that she really needs to do something like say that she\u2019ll bring back legislation to restore Roe v. Wade<\/em>, for example, to really make a difference. So I think it\u2019ll be interesting to see how much that can really motivate voters when there\u2019s so much competing for interest right now.<\/p>\n Cohrs Zhang:<\/strong> Oh, there is one other issue that I wanted to bring up. And I think especially from her time in the Senate, she didn\u2019t sit on health care committees, but she did go out of her way to take ownership over concerns about maternal mortality. She was lead Senate sponsor of the Momnibus Act, which included a whole slew of different policies and programs that could help support mothers, especially Black mothers. And I think she has continued that interest in the White House and really championed health equity, which does, again, just draw a very stark contrast. So we haven\u2019t seen a lot of passion or interest in the traditional health policy sense from her outside of abortion, but that is one issue she really has owned.<\/p>\n Rovner:<\/strong> Yeah, I mean, it has not been part of her quote-unquote \u201cportfolio\u201d as vice president, anything except, as I mentioned, reproductive rights, which will obviously be the biggest change from Biden to Harris. The president, as we all know, does not even like to say the word \u201cabortion.\u201d She, on the other hand, has been all over the issue since well before Roe<\/em> got overturned and obviously particularly since then. Alice, how are advocates on both sides of this issue reacting to this switch at the top of the ticket?<\/p>\n Ollstein:<\/strong> Yeah, honestly, it\u2019s been this interesting convergence because the pro-abortion-rights side is really jazzed. They\u2019ve basically all rushed to endorse her and talk about how they\u2019ve been working with her for years and really know her and trust her, and they believe she\u2019ll be more aggressive than Biden was. But you also have the anti-abortion side being excited to have her as the villain, basically. They\u2019ve had a hard time portraying Biden as extreme on this issue and they think they\u2019ll have an easier time portraying Kamala Harris as extreme on abortion rights. One other thing from her record and background is her fight with the conservatives who recorded sting videos at Planned Parenthood that the anti-abortion movement still brings that up a lot. So yeah, it\u2019ll be really interesting to see for which side this really lights a fire more because we\u2019re hearing claims from both that it will fuel them.<\/p>\n Rovner:<\/strong> And, actually, I think it will actually fuel both sides of this. I would think that the abortion-rights groups were very \u2014 I mean everybody was pretty quick to endorse her \u2014 but the abortion-rights groups were right there right away, as were the anti-abortion groups saying she is extreme on abortion, which in some ways will fuel the abortion-right side. It\u2019s like, \u201cOh good. The more the antis don\u2019t like her, the stronger that means she is for us.\u201d I mean, I literally could see this fueling both sides of this issue and \u2026<\/p>\n Armour:<\/strong> Whereas you see Republicans backing away increasingly from abortion like the RNC [Republican National Committee] platform. And so it\u2019s turning out to be still very much a hot-button issue and difficult issue for Republicans.<\/p>\n Rovner:<\/strong> So they say that the vice presidency is not very good for much, and I definitely agree with that. I mean, everybody always says, \u201cThe vice president hasn\u2019t done anything.\u201d Because the vice president doesn\u2019t really have a job to do anything. Often the only time the vice president is on TV is when he or she sits behind the president at the State of the Union. But I feel like, in Harris\u2019 case, it\u2019s made her a much more confident and natural and comfortable campaigner. I watched her a lot when she was running for president in 2019 and 2020, and she was, to be kind, a little bit awkward; I mean she was just not one of those natural, had-that-rapport with a crowd, and I feel like that has changed a lot having watched her crisscross the country, particularly on reproductive health. Am I the only one that feels that way? I feel like people are going to see a very different vice president than they think they saw, while she was doing her due diligence as vice president.<\/p>\n Ollstein:<\/strong> Definitely, and I\u2019ve found it interesting that it\u2019s only been a few days since all of this went down, but I have noticed that while she has brought up abortion rights in pretty much every speech and appearance she\u2019s given, she has not given specifics. She has not indicated if she is in the Biden camp of let\u2019s restore Roe v. Wade,<\/em> or with a lot of the rest of the movement that says Roe<\/em> was never good enough, we need to aim for something much more expansive. So we didn\u2019t know where she is on that. I mean, largely she\u2019s been just saying, \u201cOh, I will stop Donald Trump from banning abortion nationally.\u201d And using him as the foil and pledging to stop him. And so we haven\u2019t really seen her make an affirmative case of what she would do on this front.<\/p>\n Rovner:<\/strong> Well, I think that would probably be as difficult for her as it is for the Republicans to try and figure out how far they want to go banning. Because yeah, as you mentioned, I mean, there\u2019s a lot of the abortion-rights movement that think that restoring Roe<\/em>, even if they could, is not enough because obviously under Roe<\/em>, many, many types of restrictions were allowed and were in place. That is obviously not where the abortion-rights side wants to end up. And on the other side, as we\u2019ve talked about ad nauseum, do anti-abortion forces, are they OK with state-by-state bans? Do they want a national ban? If so, what would it look like? So that will obviously continue.<\/p>\n Now that we have, relatively, mostly settled who\u2019s going to be at the top of the ticket, we are once again, back to the \u201cWho will be the VP pick?\u201d sweepstakes. Now that we\u2019ve finished the Republican side, we\u2019re back to the Democratic side of the short list. We\u2019ve all been hearing Kentucky Gov. Andy Beshear, North Carolina Gov. Roy Cooper, Arizona Sen. Mark Kelly, and Pennsylvania Gov. Josh Shapiro. They all have significant health records, but mostly on different issues. Who do you think of the people who are being mentioned would make the biggest splash on the health care scene?<\/p>\n Ollstein:<\/strong> I\u2019ve been hearing a lot of people talk about Gov. Beshear\u2019s record on Medicaid expansion and pushing back against work requirements, and also opposing legislation to restrict trans care. And so there\u2019s definitely a lot there. Really, a lot of them have something there, but I\u2019ve been hearing the most about him.<\/p>\n Rovner:<\/strong> And Mark Kelly, of course, is married to Gabrielle Giffords, who was shot at a campaign event and is now a leading voice in the gun control movement. So they all seem to have slightly different major health issues. Roy Cooper in North Carolina got North Carolina to expand Medicaid, which was a very, very, very big deal with a very, very, very Republican legislature. I\u2019m not going to ask anybody to guess who it\u2019s going to be because I can\u2019t imagine that any of us have any major insight into this. Whoever it turns out to be, and I imagine we\u2019ll know in the next week or two, we will go in and examine their health care record. One of the advantages that Vice President Harris will have on the campaign trail is she gets to campaign on the Biden administration\u2019s record, which is fairly accomplished on the health care front without the drag of being in her 80s. Somebody remind us of all the health policies the Biden administration has gotten done. Start with the Inflation Reduction Act.<\/p>\n Cohrs Zhang:<\/strong> The name of the legislation is very general, but I think President Biden, in his goodbye speech last night, did mention the drug pricing portion of that bill. He\u2019s described it as beating Big Pharma. And I think that\u2019s definitely something that he talked about in his State of the Union, that he wanted to expand some of those pricing mechanisms to more people, not just people in Medicare, but people in commercial health plans, too. So I think that\u2019s been something that he has really felt passionate about and Vice President Harris now could certainly use on the campaign trail. It\u2019s a really popular issue and, again, not a huge policy departure, but, certainly, there\u2019s more work to be done there on Democrats\u2019 side.<\/p>\n Armour:<\/strong> And also I think the ACA [Affordable Care Act] extensions in terms of how many more people have been eligible for coverage is something that will definitely be part of Biden\u2019s legacy as well. And the record-low uninsurance that we saw is something I bet that will be remembered, too.<\/p>\n Rovner:<\/strong> Yeah, I mean I\u2019ve been personally surprised at some of the things that he\u2019s gotten done in a Congress with virtually minuscule majority. I mean, one vote in the Senate and, when the Democrats were controlling the House, it was, what, four votes in the House. That takes, I think, a certain kind of legislator to get things passed. I know people walk around and say, \u201cOh, the Biden administration hasn\u2019t done anything.\u201d And you want to pull your hair out because that\u2019s all we\u2019ve spent the last six years talking about, things that have actually gotten done and not gotten done.<\/p>\n Cohrs Zhang:<\/strong> Right. Well, I mean doing things and communicating well about doing things are different issues, and I think that\u2019s going to be Vice President Harris\u2019 challenge over the next few months.<\/p>\n Rovner:<\/strong> Yeah, and so we\u2019ve seen, and I think the Biden administration has prevented a lot of things from happening, which is always very hard to campaign on. It\u2019s like, \u201cWell, if we hadn\u2019t done this, then this might\u2019ve happened.\u201d I mean, I think that\u2019s true about the pandemic. Things could have gone much, much worse and didn\u2019t and that\u2019s tricky to say, \u201cHey, we prevented things from getting even more terrible than they were.\u201d<\/p>\n Ollstein:<\/strong> And on the drug pricing front, I mean it just always reminds me of the Affordable Care Act where the payoff is years down the road, and so selling it to voters in the moment when they\u2019re not feeling the effects yet is really hard. So it makes sense that people aren\u2019t aware that they got this major legal change that\u2019s been decades in the making over the finish line because the drugs aren\u2019t cheaper yet for a lot of people.<\/p>\n Rovner:<\/strong> That\u2019s true. And the caps on spending haven\u2019t really kicked in yet. It is a lot like the Affordable Care Act, which took four years from the time of passage to the time it was fully implemented.<\/p>\n Well, in other news, and there is some other news, Congress is back after a break for the Republican [National] Convention, although they\u2019re about to leave again. At the top of the House\u2019s list was passing the spending bills that they didn\u2019t manage to pass last year. So how\u2019s that all going, Rachel?<\/p>\n Cohrs Zhang:<\/strong> I think they\u2019ve just thrown in the towel this week, given up a bit. I think there\u2019s been an attitude of just apathy on the Hill and especially on health care issues that the sense has been, \u201cWe\u2019ll return to this in December when we all have a little bit more information about the dynamics going to the lame-duck session.\u201d And I think that clearly has bled over into any will that remains to pass appropriations bills before August recess. I think they\u2019re ready to get out there, ready to be on the campaign trail and put this on the back burner.<\/p>\n Rovner:<\/strong> Yeah, and in an election year, you basically have the six months leading up to the first convention and then almost nothing until they come back after the election. They were going gangbusters on some of these spending bills. They were getting them out of committee even though they were obviously not in the kind of shape that they were going to become law. We talked at some length about all of the riders and all of the funding cuts that the Republicans have put in some of these bills, but they couldn\u2019t even get them through the floor. I mean, Alice we\u2019re hung up on abortion, again!<\/p>\n Ollstein:<\/strong> Oh, as always. And it\u2019s the exact same policy fights as last time. The fight\u2019s going to happen in the ag[riculture] bill, around FDA [Food and Drug Administration] regulation of abortion pills. There\u2019s going to be fights about the provisions helping veterans and active-duty service members access abortion, knowing that these appropriations bills are the only real legislation that has any chance of going anywhere. People are putting all of their policy priorities in as riders. And last round of this, there were anti-abortion provisions tacked onto basically every single spending bill, and almost all of them got stripped out in the end and did not become law. Obviously, they kept long-standing things like the Hyde Amendment, but they didn\u2019t add the new restrictions Republicans wanted to add. That is likely to happen again. We\u2019ll see. This could drag past the election potentially. So the dynamics, depending on the outcome of the election, could be really different than they are today.<\/p>\n Rovner:<\/strong> Yeah, I mean, I guess the House is going out and they won\u2019t be back until September. It used to be there would be an August recess in an election year, and they would come back in September, and they would actually work until the beginning or even the middle of October. And even that seems to have gone away. Now, once they\u2019re gone for the quote-unquote \u201cAugust recess,\u201d it\u2019s like, bye-bye getting much of anything done.<\/p>\n Well, there\u2019s also some more news on the abortion front: The on-again off-again, on-again, off-again, six-week abortion ban in Iowa appears to be on again, possibly to start as soon as next week. Alice, I think we\u2019ve mentioned this before, but this is going to affect a lot more than just people in Iowa.<\/p>\n Ollstein:<\/strong> Yeah, definitely. I mean, we\u2019re seeing a big erosion of access across the Midwest Great Plains, like that whole area, that whole swath, the Dakotas, et cetera. And there\u2019s already a lot of pressure on Illinois as the destination and clinics there are already overwhelmed with folks coming in from all over. And so this will add to that. As we\u2019ve seen when this has happened in other states, wait times can go up, shortages of providers needed to care for everyone. Telemedicine does relieve some of that, and there are these groups that mail abortion pills into any state regardless of restrictions. But not everyone is comfortable doing that or knows how to do that or wants to do that or can afford to do that. And so this is said to have a big impact, and we\u2019ll have to see what happens.<\/p>\n Rovner:<\/strong> There were two other pieces about abortion that caught my eye this week, and they\u2019re both about things that we\u2019ve talked about before. One is the push by anti-abortion doctors to change medical practice. In Louisiana, the abortion drugs mifepristone and misoprostol, both of which are used for many more things than just abortion, are now on the state\u2019s list of controlled substances<\/a>. And then from States Newsroom, there\u2019s a piece about how anti-abortion OB-GYNs are trying to get medically necessary abortions<\/a> that happen later in pregnancy, switched instead to C-sections or having the pregnant person go through and induce labor and delivery. I\u2019ve been covering this issue, as I like to say, for nearly 40 years. This is the most intense effort I\u2019ve ever seen from inside the medical profession to actually change how medicine is practiced in terms of what\u2019s considered the standard of care, both for things like \u2014 not even so much mifepristone the abortion pill, but misoprostol, which is used for a lot of things other than abortion.<\/p>\n Armour:<\/strong> Was it initially an ulcer medication?<\/p>\n Rovner:<\/strong> Yes, yes, misoprostol.<\/p>\n Armour:<\/strong> That\u2019s what I thought. Yeah.<\/p>\n Rovner:<\/strong> Cytotec. It was for a long time one of the go-to ulcer medicine. And in fact, the only reason it stopped becoming the go-to ulcer medicine because, if you were pregnant and wanted to be, it could help end your pregnancy. It is known to have that as a side effect, but yes, it\u2019s an ulcer medication.<\/p>\n Armour:<\/strong> Yeah, this is the first I had seen anywhere, and I could be wrong, but of a real push to try and change the management of late-term medical miscarriages to how it would actually be carried out, which was just very interesting and to see what they were recommending instead.<\/p>\n Rovner:<\/strong> ACOG, the American College of Obstetricians and Gynecologists, has put out guidelines \u2014 forever, that\u2019s what they do \u2014 about how to handle pregnancy problems later in pregnancy. Generally using the least invasive procedure is considered the safest and, therefore, best for the patient. And that\u2019s not necessarily having a C-section, which is major surgery, or going through labor and delivery. People forget that it\u2019s really dangerous to be pregnant. I mean, it\u2019s amazing that we have all of these kids and happy parents because if you go back and look in history, a lot of women used to die in childbirth. They still do. It\u2019s obviously not as bad as it used to be, but it is not everything-goes-fine-99%-of-the-time thing that I think a lot of people think it is.<\/p>\n Armour:<\/strong> That\u2019s right. Yeah.<\/p>\n Rovner:<\/strong> All right, well, meanwhile, before we bid Congress goodbye for the rest of the summer, the House Oversight Committee, which is usually as partisan a place as there is in this Congress, held a hearing this week on PBMs [pharmacy benefit managers] and there seems to be pretty bipartisan support that something needs to be done. Rachel, I keep asking this question: It seems that just about everybody on Capitol Hill wants to do something to rein in PBM drug price abuse, and yet no one ever does. So are we getting closer yet?<\/p>\n Cohrs Zhang:<\/strong> We are getting closer, I think, as we approach December. My understanding was that lawmakers were pretty close on a deal on PBMs back in March. But I think it was just a symptom of \u201cAppropriations Bill Has to Move.\u201d They want it to be clean. If they add one committee\u2019s extra stuff, they have to let other committees add extra stuff, too, and it gets too complicated on deadline. But it\u2019s wild to me that we\u2019re still seeing new PBM reform bills at this point. But there\u2019s just a huge, huge pile of bills at this point, everyone wants their name on it. And so I really do believe that we\u2019re going to see something in December. I think the big question is how far some of these reforms will reach: whether they\u2019ll be limited to the Medicare program or whether some of these will start to touch private insurance as well. I think that\u2019s what the larger industry is waiting to see. But I think there\u2019s a lot of appetite. I mean with congresswoman Cathy McMorris Rodgers retiring, she\u2019s led a package on this issue \u2026<\/p>\n Rovner:<\/strong> She\u2019s chairman of the House Energy and Commerce Committee, which obviously has the main jurisdiction over this in the House.<\/p>\n Cohrs Zhang:<\/strong> Right. So if we\u2019re thinking about legacy, getting some of these things across the finish line, it does depend how dynamics change in the lame duck. But I think there is a very good chance that we\u2019re going to see some sort of action here.<\/p>\n Rovner:<\/strong> Congressman Jamie Raskin, at that hearing, had maybe my favorite line ever about PBMs, which is, he said, \u201cThe more I hear about this, the less I understand it.\u201d It\u2019s like you could put that on a T-shirt.<\/p>\n Ollstein:<\/strong> That\u2019s great. Yeah.<\/p>\n Cohrs Zhang:<\/strong> Yes.<\/p>\n Rovner:<\/strong> The PBM debate in one sentence. All right. Finally, this week we have some Medicaid news, a new report from the GAO [Government Accountability Office] finds pretty much what we already knew: that states have been wrongly kicking eligible people off of their Medicaid coverage as they were, quote, \u201cunwinding from the public health emergency.\u201d According to the report, more than 400,000 people lost coverage because the state looked at the household\u2019s eligibility instead of individual eligibility. Even though Medicaid income thresholds are much higher for many people, like children and pregnant women. So if the household wasn\u2019t eligible, possibly, even probably, the children still were. It\u2019s a pretty scathing report. Is anybody going to do anything about it? I mean, the GAO\u2019s recommendation was that the administration act a little more strongly and the administration says, \u201cWe already are.\u201d<\/p>\n Cohrs Zhang:<\/strong> Yeah, I actually had the chance to talk with a White House official about this dynamic, and just, I think there\u2019s only so far that they\u2019re willing to go, and I think might talk about, in a while. I think there\u2019s been clashes between the Biden administration and conservative states, especially on Medicaid programs, and there\u2019s really only so much influence they can exert. And I think without provoking an all-out war, I\u2019m personally expecting them to get much more aggressive in the last six months of their administration, if they weren\u2019t going to do it before, when they really could have potentially made a difference and really made it a calling card in some of these states. So I\u2019m not expecting much change from the White House on this issue.<\/p>\n Rovner:<\/strong> Yeah, I remember the administration was so sensitive about this that when we were first learning about how states were cutting people off who they shouldn\u2019t have been, the administration said, \u201cWe\u2019re working with the states.\u201d And we all said, \u201cWhich states?\u201d And they said, \u201cWe\u2019re not going to tell you.\u201d I mean, that\u2019s literally how sensitive it was. They would not give us the list of the states who they said were incorrectly knocking people off the roll. So yeah, clearly this has been politically sensitive for the administration, but I\u2019m \u2026<\/p>\n Armour:<\/strong> And the Medicaid directors, too. They really pushed back, especially initially, about not wanting it to be too adversarial. I think the administration really took that to heart. Whether that was the right call or not remains to be seen, but there was a lot of tension around that from the get-go.<\/p>\n Rovner:<\/strong> Yeah. Well, also this week, The New York Times has a deep dive into the one remaining Medicaid work requirement in the country, Georgia\u2019s Pathways to Coverage<\/a>. In case you don\u2019t remember, this was the program that Georgia said would enroll up to 100,000 people, except, so far it\u2019s only managed to sign up about 4,500. It feels relevant again though, because the Heritage Foundation\u2019s Project 2025, which is now all over the campaign trail, would go even further than previous Republican efforts to rein in Medicaid by possibly imposing lifetime caps on coverage. Cutting Medicaid didn\u2019t go very well in 2017 when the Republicans tried to repeal and replace the Affordable Care Act. What makes them think an even bigger cutback would be more popular now?<\/p>\n Armour:<\/strong> Well, the study\u2019s authors say to me that if they\u2019re not cutting Medicaid, which goes back to the original debate back when they were talking about \u2026<\/p>\n Rovner:<\/strong> The Project 2025 authors.<\/p>\n Armour:<\/strong> Yes, authors. Right. And that goes back to the original debate of how do you define it? A little bit of sleight of hand. And the other thing is that would definitely bring back the Medicaid work requirements and some premiums for some, which also turned out not to be super-popular as well. So it does dive right into an issue. But it\u2019s also an issue that conservatives have been, boy, working on for years and years now to try and get this accomplished.<\/p>\n Rovner:<\/strong> Oh yeah, block-granting Medicaid goes back decades.<\/p>\n Armour:<\/strong> Exactly. Yeah.<\/p>\n Rovner:<\/strong> And there\u2019ve been various ways to do it. And then work requirements, obviously Alice, you were the queen of our work requirement coverage in Arkansas because they put in a work requirement and it didn\u2019t go well. Remind us.<\/p>\n Ollstein:<\/strong> Yeah. So this is what a lot of experts and advocates predicted, which is that we know from years of data that pretty much everybody on Medicaid who can work is already working and those who aren\u2019t working are not working because they are a student or they have to care for a relative or they have a disability or there are all these reasons. And so when these work requirements actually went into effect, just a lot of people who should have been eligible fell through the cracks. It was hard to navigate the bureaucracy of it all. And so even people who were working struggled to prove it and to get their benefits. And so people really point to that as a cautionary tale for other states. But this is something conservatives really believe in ideologically, and so I don\u2019t expect it to be going away anytime soon.<\/p>\n Rovner:<\/strong> To swing back to where we started. I imagine we will see more talk about health care on the presidential campaign trail as we go forward.<\/p>\n All right, well that\u2019s as much news for this week as we can fit in. Now we will play my interview with Families USA\u2019s Anthony Wright, and then we\u2019ll come back and do our extra credits.<\/p>\n I am so pleased to welcome to the podcast Anthony Wright, the brand-new executive director of Families USA, one of the nation\u2019s leading consumer health advocacy groups. And a big part of why we even have the ACA. Anthony is no stranger to health care battles. He spent more than 20 years heading up the group Health Access California, where he worked on a variety of health issues, large and small, and encountered someone who is suddenly very much in the news: Vice President Kamala Harris. Anthony Wright, welcome to \u201cWhat the Health?\u201d<\/p>\n Anthony Wright:<\/strong> Thank you so much for having me. I\u2019m a longtime listener, but first-time caller.<\/p>\n Rovner:<\/strong> Awesome. So, for those who are not familiar with Families USA, tell us about the group and tell us what your immediate priorities are.<\/p>\n Wright:<\/strong> So, Families USA has been a longtime voice for health care consumers in Congress, at the administration, working nationally for the goal of quality, affordable, equitable health care for all Americans. I\u2019m pleased to take on that legacy and to try to uplift those goals. I\u2019m also particularly interested in continuing to uplift and amplify the voices of patients in the public in health policy debates. It\u2019s opaque to try to figure out how normal people engage in the federal health policy discussions so that health reforms actually matter to them. I would like families to do more to provide pathways so that they have an effective voice in those policy discussion tables. There\u2019s so many policy debates where it\u2019s the fight between various parts of the industry, when, in fact, the point of the health care system is patients, is the public, and they should be at the center of these discussions.<\/p>\n Rovner:<\/strong> Yes, and I\u2019m embarrassed to admit that we spend an enormous amount of time talking about the players in the health care debate that are not patients. They are basically the people who stand to make money from it. What\u2019s your biggest priority for this year and next?<\/p>\n Wright:<\/strong> Yeah, I want to take some of the lessons that I\u2019ve learned over the 22 years of working in California, where we had the biggest drop of the uninsured rate of all 50 states, mostly working to implement and improve the Affordable Care Act. And I recognize that some of those lessons will have to be adopted and changed for the different context of [Washington,] D.C., or the 49 other states. But there is work that we can do, and we should do, moving forward. There are things on the plate right now. For example, in the next year, the additional affordability assistance that people have in the exchanges is set to expire. And so we can either have a system where everybody has a guarantee that their premiums are capped at 8.5% of their income or less on a sliding scale, or we can let those enhanced tax credits expire and to have premiums go up by hundreds, or for many people, thousands of dollars literally in the next year or so.<\/p>\n So that\u2019s a very important thing that will be on the ballot this fall, along with a number of other issues and we want to highlight that. But frankly, I\u2019m also interested in the work around expanding coverage, including in those 10 states that haven\u2019t expanded Medicaid yet. In California, we\u2019ve done a lot of work on health equity dealing with racial and ethnic disparities and just meeting the specific needs of specific communities. That was an imperative in California with the diversity and the size and scale of that state. But there\u2019s more we can do both in California, but nationally, with regard to that. And then I think there\u2019s more to work on costs with regard to just how darn expensive health care is and how do we fix the market failures that lead to, not just high, but irrational and inflated health prices.<\/p>\n Rovner:<\/strong> So obviously a big part of what you will or won\u2019t be able to do next year depends on who occupies the White House and who controls Congress. You\u2019re from California and so is Vice President Harris. Tell us about her record on health care.<\/p>\n Wright:<\/strong> Yeah, she actually has a significant record, mostly from her time as attorney general of California. She didn\u2019t have much of a portfolio as district attorney, but when she did become the attorney general \u2014 attorney generals have choices about where they focus their time and she made a point to focus more on health care and start an evolution of the attorney general being more involved in health care issues \u2014 on issues like reviewing mergers of hospitals and putting conditions to make sure that emergency rooms stayed open, that hospitals continued their commitments to charity care. She worked on broader issues of consolidation, for example, joining the [U.S.] Justice Department in opposing the merger of Anthem and Cigna.<\/p>\n And she took on, whether it\u2019s the insurers or the drug companies or the hospital chains, on issues of pricing and anticompetitive practices, whether it was Bayer and Cipro and other drug companies with regard to pay-for-delay practices, basically schemes to keep the price of drugs inflated. Or on the issue of high hospital prices. She began the investigations that led to a landmark Sutter settlement where that hospital chain paid $575 million in fines, but also agreed to a series of conditions with regard to no longer engaging in anticompetitive contracting practices. And that kind of work is something that we worked on with her, and I think is really relevant to the moment we\u2019re in now where we really do see that consolidation is one of the major drivers of why health care prices are so high. And that kind of experience that she could talk about as she talks about health care costs broadly, medical debt, and some of the issues that are on the campaign trail today.<\/p>\n Rovner:<\/strong> So, obviously, with the exception of reproductive health, health in general has not been a big part of the campaign this year. Do you think it\u2019s going to get bigger now that Harris is at the head of the ticket?<\/p>\n Wright:<\/strong> One of the things that I\u2019m happy with is that, after several weeks where the conversation has much been about the campaign processes, we can maybe focus back on policy and the very real issues that are at stake. Our health care is on the ballot, whether it is reproductive health and abortion care, but also there\u2019s a very easy leap to also talk about the threats, not just to reproductive health, but also to the Affordable Care Act, to Medicaid, to Medicare. There\u2019s very different visions and records of the last two administrations with regard to the Affordable Care Act, whether to repeal it or build upon it, on Medicaid and whether to bolster it or to block-grant it. And even on the question of something like prescription drug negotiation, whether we took some important steps under the Inflation Reduction Act. Do we now expand that authority to cover more drugs for more discounts for more people? Or do we give up that authority to negotiate for the best possible price?<\/p>\n Those are very key issues that are at stake in this election. We are a nonpartisan, non-endorsing organization, but we do want to make sure that health care issues are on people\u2019s minds, and also, frankly, policymakers to make some commitments, including on something like what I was talking about earlier with those enhanced tax credits. Again, at a time when people are screaming about affordability, but we know that they\u2019ve been actually screaming about health care affordability for not just years but decades. And that\u2019s a very specific, concrete thing that literally means hundreds or thousands of dollars in people\u2019s pockets.<\/p>\n Rovner:<\/strong> So then-presidential candidate Kamala Harris was a supporter of Medicare for All in 2020 when she ran. Do you expect that that may have changed, as she\u2019s learned how hard it is even to make incremental change? I haven\u2019t seen anybody ask her yet what her feeling is on systemic health reform.<\/p>\n Wright:<\/strong> I mean, she had a modified proposal that I think was trying to both take seriously the question of how do we get to universal coverage while also recognizing the politics and procedural barriers that exist. And so I think there\u2019s a practical streak of how do we get the most help to the most people and help change, frankly, the financial incentives in our system, which are right now just to get bigger, not to get better. And so I think that there\u2019s some very practical questions on the table right now, like these tax credits, this cap on how much a percentage of your income should go for premium. That\u2019s something that\u2019s front of mind because it literally expires next year. So it\u2019s something that maybe gets dealt with in a lame duck, but hopefully early in the next year, since rates need to be decided early. And so those are the immediate things.<\/p>\n But I do think she\u2019s also, in her record \u2014 I\u2019m not going to talk about what may be \u2014 but in her record, she\u2019s been supportive of the Affordable Care Act. I mean our biggest actual engagement with then-U.S. Sen. Harris was at a time when we all thought that the Affordable Care Act was a goner. It would be repealed and replaced. She was willing to be loud and proud at our rallies, in front of a thousand people, in front of a Los Angeles public hospital, talking about the need to defend the Affordable Care Act and protections for people with preexisting conditions. And she came again in July and just at a time where we needed that forceful defense of the Affordable Care Act. She was there and we very much appreciated that. I think she would continue to do that as well as want to work to build upon that financing and framework to make additional gains forward.<\/p>\n Rovner:<\/strong> This being Washington, everybody\u2019s favorite parlor game this week is handicapping the vice presidential sweepstakes. And who about-to-be-candidate Harris is going to choose to be her running mate. Are any of the big names in contention more or less important in terms of their health care backgrounds?<\/p>\n Wright:<\/strong> I have my credentials to talk about the Californian on the ticket. I probably have less there. I do know that some of those governors and others have their own records of trying to take the framework of the ACA and adapt it to their state. And I think that would be a useful thing to continue to move forward on the trail. I\u2019m not in a position, again, as a non-endorsing organization, we\u2019re focused on the issues.<\/p>\n Rovner:<\/strong> You\u2019re agnostic about the vice presidential candidate.<\/p>\n Wright:<\/strong> You\u2019re right, I think the point is how can we make sure that people recognize what is at stake for the health care that they depend on and, frankly, the financial piece of it. Affordability has been something that has been talked about a lot and there is no greater source of economic anxiety and insecurity than the health care bill. A hospital bill is the biggest bill that anybody will get in their entire life. So how do you deal with it? And whether it\u2019s a conversation about medical debt and how you deal with it, or what kind of tax credits we can provide to provide some security that you don\u2019t pay more than the percentage of your income. Or how do you deal with the root causes of the market failures in our health care system, whether it\u2019s consolidations and mergers or anticompetitive practices. Those are the things that I think we should have a bigger conversation in this campaign cycle about.<\/p>\n Rovner:<\/strong> Hopefully we\u2019ll be able to do this again as it happens. Anthony Wright, thank you so much.<\/p>\n Wright:<\/strong> Thank you.<\/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. Rachel, why don\u2019t you go first this week?<\/p>\n Cohrs Zhang:<\/strong> Sure. There\u2019s a lot of good health journalism out there, but I have to highlight a new project from my colleagues. Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence are looking into UnitedHealth\u2019s business practices, and there\u2019s been a lot of buzz about UnitedHealthcare on the Hill, and the first part of their investigation is headlined \u201cHow UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients<\/a>.\u201d It focuses on the trend that UnitedHealth has been acquiring so many physician practices and looks at the incentives of what actually happens when an insurer owns a physician practice.<\/p>\n What pressures are they putting on? What\u2019s the patient experience? What\u2019s the physician experience? Their physicians on the record were telling them about their experiences: having to turn through patients; feeling pressure to make patients look sicker on paper so UnitedHealth could get more money from the federal government to pay for them. And just, I mean, the documentation here is just really superb reporting. It\u2019s part one of a series. And I think reporting like this really helps inform Washington about how these things are actually playing out and what\u2019s next in terms of whether action should be taken to rein these practices in.<\/p>\n Rovner:<\/strong> I feel like the behemoth that is UnitedHealthcare is going to keep a lot of health reporters busy for a very long time to come. Alice.<\/p>\n Ollstein:<\/strong> Yeah. So there\u2019s been a lot of news on the PrEP front recently. That\u2019s the drug that prevents transmission of HIV. And so basically two steps forward, one step back. I chose this piece from Stat News [\u201cA Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges<\/a>\u201d], about a new form of PrEP that is an injection that you get just twice a year that has proven wildly effective in clinical trials. And so folks are really excited about that, and I think it could really make a difference because, as with birth control and as with lots of other medication, the effectiveness rate is only if you use it perfectly, which, you know, we\u2019re humans. And humans don\u2019t always adhere perfectly. And so something like just a couple injections a year that you could get from your doctor would go a long way towards compliance and making sure people are safe with their medications.<\/p>\n But my colleague and I also scooped this week that HHS [the Department of Health and Human Services] is ending one of its big PrEP distribution programs [\u201cFederal HIV Program Set To Wind Down<\/a>\u201d]. It\u2019s called Ready, Set, PrEP. It debuted under the Trump administration in 2019. And the reason given by HHS for it ending \u2014 which, by the way, they were very quiet about and didn\u2019t even tell a lot of providers that it was ending \u2014 they said it was because there are all these other ways people can get PrEP now, that didn\u2019t exist back then, like generic versions. And while that\u2019s true, we also heard from a lot of advocates who said the program was just really flawed from the start and didn\u2019t reach even a fraction of the people it should have reached. And so we\u2019ll continue to dig on that front.<\/p>\n Rovner:<\/strong> Good stories. Stephanie.<\/p>\n Armour:<\/strong> Yes. I picked the story by Dylan Scott on Vox about \u201cFree Medical School Won\u2019t Solve the Doctor Shortage<\/a>.\u201d And it looks at Michael Bloomberg, who is donating a billion dollars to Johns Hopkins to try to pay for medical school for students there. The idea being that, \u201cLook, there\u2019s this doctor shortage and what can we do to help?\u201d And what\u2019s really interesting about the story is it goes beyond just the donation to look at the fact that it\u2019s not really that there\u2019s a doctor shortage, it\u2019s that we don\u2019t have the right kind of doctors and it\u2019s the distribution. Where you don\u2019t have nearly what we need when it comes to psychiatrists, for example. And there\u2019s a real dearth of physicians in areas that are rural or in the Midwest. So I think what it raises is what resources do we want to spend and where? What other steps can we do that would really help drive doctors to where they\u2019re most needed? So it\u2019s a good story. It\u2019s worth a read.<\/p>\n Rovner:<\/strong> Yeah, it is a good story. It is a continuing problem that I continue to harp on. But we now have quote-unquote \u201cfree medical school,\u201d mostly in really urban, really expensive places.<\/p>\n Armour:<\/strong> Yes.<\/p>\n Rovner:<\/strong> New York, Los Angeles, Baltimore. That\u2019s nice for the doctors who will now graduate without $200,000 in medical debt. But yeah, as Dylan points out, it\u2019s not exactly solving the problem that we have. Well, I went cute this week. My extra credit this week is from NPR. It\u2019s called \u201cA Study Finds That Dogs Can Smell Your Stress \u2014 And Make Decisions Accordingly<\/a>,\u201d by Rachel Treisman. Now, we\u2019ve known for a fairly long time that dogs\u2019 sensitive noses can detect physical changes in their humans. That\u2019s how alert dogs for epilepsy and diabetes and other ailments actually work.<\/p>\n But what we didn\u2019t know until now is that if a dog smells a person\u2019s stress, it can change the dog\u2019s emotional reaction. It was a complicated experiment that you can read about if you want, but as somebody who competes with my dogs, and who knows how differently they act when I am nervous, this study explains a lot.<\/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 editor, Emmarie Huetteman. As always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org, or you can still find me at X, @jrovner<\/a>. Alice, where are you?<\/p>\n Ollstein:<\/strong> @AliceOllstein<\/a> on X.<\/p>\n Rovner:<\/strong> Rachel.<\/p>\n Cohrs Zhang:<\/strong> @rachelcohrs<\/a> on X.<\/p>\n Rovner:<\/strong> Stephanie.<\/p>\n Armour:<\/strong> @StephArmour1<\/a>.<\/p>\n Rovner:<\/strong> We will be back in your feed next week. Until then, be healthy.<\/p>\n \tFrancis Ying
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