\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 Congress has left Washington for the campaign trail, but after the Nov. 5 general election lawmakers will have to complete work on the annual spending bills for the fiscal year that starts Oct. 1. While the GOP had hoped to push spending decisions into 2025, Democrats forced a short-term spending patch that\u2019s set to expire before Christmas.<\/p>\n Meanwhile, on the campaign trail, abortion continues to be among the hottest issues. Democrats are pressing their advantage with women voters while Republicans struggle \u2014 with apparently mixed effects \u2014 to neutralize it.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins schools of nursing and public health, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.<\/p>\n \t\t\t \tJoanne Kenen \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \tLauren Weber \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/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> KFF Health News\u2019 \u201cHow North Carolina Made Its Hospitals Do Something About Medical Debt<\/a>,\u201d by Noam N. Levey and Ames Alexander, The Charlotte Observer.<\/p>\n Lauren Weber:<\/strong> Stat\u2019s \u201cHow the Next President Should Reform Medicare<\/a>,\u201d by Paul Ginsburg and Steve Lieberman.\u00a0<\/p>\n Joanne Kenen:<\/strong> The Atlantic\u2019s \u201cThe Woo-Woo Caucus Meets<\/a>,\u201d by Elaine Godfrey.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Stat\u2019s \u201cHow Special Olympics Kickstarted the Push for Better Disability Data<\/a>,\u201d by Timmy Broderick.<\/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: Congress Punts to a Looming Lame-Duck Session\t\t\t\t<\/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, September 26th, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via teleconference by Lauren Weber of The Washington Post.\u00a0<\/p>\n Lauren Weber:<\/strong> Hello hello.\u00a0<\/p>\n Rovner:<\/strong> Alice Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Good morning.\u00a0<\/p>\n Rovner:<\/strong> And Joanne Kenen of the Johns Hopkins Schools of Public Health and Nursing, and Politico.\u00a0<\/p>\n Joanne Kenen:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Big props to Emmarie for hosting last week while I was in Ann Arbor at the Michigan Daily reunion. I had a great time, but I brought back an unwelcome souvenir in the form of my first confirmed case of covid. So apologies in advance for the state of my voice. Now, let us get to the news.\u00a0<\/p>\n To steal a headline from Politico earlier this week, Congress lined up in punt formation, passing a continuing resolution that will require them to come back after the election for what could be a busy lame-duck session. Somebody remind us who wanted this outcome \u2014 the Let\u2019s only do the CR through December<\/em> \u2014 and who wanted it to go into next year? Come on, easy question.\u00a0<\/p>\n Ollstein:<\/strong> Well, the kicking it to right before Christmas, which sets up the stage for what we\u2019ve seen so many times before where it just gets jammed through and people who have objections, generally conservatives who want to slash spending and add on a bunch of policy riders, which they tried and failed to do this time, will have a weaker base to operate from, given that everybody wants to go home for the holidays.\u00a0<\/p>\n And so once again, we\u2019re seeing people mad at Speaker Mike Johnson, who, again and again, even though he is fully from the hard right of the party, is not catering to their priorities as much as they would like. And so obviously his speakership depends on which party wins control of the House in November. But I think even if Republicans win control, I\u2019m already starting to hear rumblings of throwing him overboard and replacing with someone who they think will cater to them more.\u00a0<\/p>\n Rovner:<\/strong> It was so d\u00e9j\u00e0 vu all over again, which is, last year, as we approached October 1st and the Republican House could not pass any kind of a continuing resolution with just Republican votes, that eventually Kevin McCarthy had to turn to Democrats, and that\u2019s how he lost his job.\u00a0<\/p>\n And yet that\u2019s exactly what happened here, which is the Republicans wanted to go until March, I guess on the theory that they were betting that they would be in full power in March and would have a chance to do a lot more of what they wanted in terms of spending bills than if they just wait and do it in the lame duck. And yet the speaker doesn\u2019t seem to be paying the same price that Kevin McCarthy did. Is that just acknowledgment on the part of the right wing that they can\u2019t do anything with their teeny tiny majority?\u00a0<\/p>\n Kenen:<\/strong> I mean, yes, it\u2019s pretty stalemate-y up there right now, and nobody is certain who\u2019s going to control the House, and at this point it is likely to still be a narrow majority, whoever wins it. I mean, they\u2019re six weeks out. Things can change. This has been an insane year. Nobody\u2019s making predictions, but it looks like pretty divided.\u00a0<\/p>\n Rovner:<\/strong> Whoever wins isn\u2019t going to win by much.\u00a0<\/p>\n Kenen:<\/strong> We have a pretty divided country, and the likelihood is we\u2019re going to have a pretty divided House. So the dynamic will change depending on who\u2019s in charge, but the Republicans are more fractious and divided right now than the Democrats, although that\u2019s really easy to change, and even the Democrats have gone through their rambunctious divided phases, too.\u00a0<\/p>\n Everybody just doesn\u2019t know what\u2019s next, because the top of the ticket is going to change things. So the more months you push out, the less money you\u2019re spending. If you control the CR, if you make the CR, the continuing resolution, meaning current spending levels for six months, it\u2019s a win for the Republicans in many ways because they\u2019re keeping \u2014 they\u2019re preventing increases. But in terms of policy, both sides get some of the things they want extended.\u00a0<\/p>\n I don\u2019t know if you can call it a productive stalemate. That\u2019s sort of a contradiction in terms. But I mean, for the Republicans, longer, it would\u2019ve been better.\u00a0<\/p>\n Rovner:<\/strong> So now that we know that Congress has to come back after the election, there\u2019s obviously things that they are able to do other than just the spending bills. And I\u2019m thinking of a lot of unfinished health legislation like the telehealth extensions and the constant, Are we going to do something about pharmacy benefit managers?<\/em> which has been this bipartisan issue that they never seem to solve.\u00a0<\/p>\n I would remind the listeners that in 2022 after the election, that\u2019s when they finally did the surprise-bills legislation. So doing big things in the lame duck is not unheard of. Is there anything any of you are particularly looking toward this time that might actually happen?\u00a0<\/p>\n Kenen:<\/strong> It\u2019s something like telehealth because it\u2019s not that controversial. I mean, it\u2019s easiest to get something through in \u2014 in lame duck, you want to get some things off the plate that are either overdue and need to be taken care of or that you don\u2019t want hanging over you next year. So telehealth, which is, there are questions about does it save money, et cetera, and what form it should take and how some of it should be regulated, so forth, but the basic idea, telehealth is popular. Something like that, yes.\u00a0<\/p>\n PBMs [pharmacy benefit managers] is a lot harder, where there is some agreement on the need to do something but there\u2019s less agreement about what that something should look like. So although I\u2019m not personally covering that day-to-day basis, in any sense, that\u2019s harder. The more consensus there is and the fewer moving parts, the easier it is to do, as a rule. I mean, sometimes they do get something big done in lame duck, but a lot of it gets kicked.\u00a0<\/p>\n And also there\u2019s a huge, huge, huge tax fight next year, and it\u2019s going to require a lot of wheeling and dealing no matter what shape it takes, because it\u2019s expiring and things have to be either renewed or allowed to die. So that\u2019s just going to be mega-enormous, and a lot of this stuff become bargaining chips in that larger debate, and that becomes the dominant domestic policy vehicle next year.\u00a0<\/p>\n Rovner:<\/strong> Well, even before we get to the lame duck, we have to finish the campaign, which is only a month and a half away. And we are still talking about the Affordable Care Act in an election where it was not going to be a campaign issue, everybody said.\u00a0<\/p>\n I know that you talked last week about all the specifics of the ways former President [Donald] Trump actually tried to sabotage rather than save the ACA and all the ways what [Sen.] JD Vance was talking about on \u201cMeet the Press,\u201d dividing up risk pools once again so sicker people would no longer be subsidized by the less sick, would turn the clock back to the individual insurance market as it existed before 2014.\u00a0<\/p>\n Now the Democrats in the Senate are taking one last shot at the ACA with a bill \u2014 that will fail \u2014 to renew the expanded marketplace subsidies, so it will expire unless Congress acts by the end of next year. Might this last effort have some impact in the swing states, or is it just a lot more campaign noise?\u00a0<\/p>\n Weber:<\/strong> I think this is a lot of campaign noise, to some extent. I mean, I think Democrats are clear in polling shows that the average American voter does trust Democrats more than Republicans on ACA and health issues and health insurance. So I do think this is a messaging push in part by the Dems to speak to voters. As we all know, this is a turnout election, so I think anything that they feel like voters care about, which often has to do with their pocketbook, I think they\u2019re going to lead the drum on.\u00a0<\/p>\n I do think it\u2019s interesting again that JD Vance really is reiterating a talking point that Donald Trump used in the debate, which is that he said he had improved the ACA and many experts would say it was very much the opposite. Again, I think I did this on the last podcast, but let me reread this because I think it\u2019s important as a fact check. Most of the Trump administration\u2019s ACA-related actions included cutting the program.\u00a0<\/p>\n So they reduced millions of dollars of funding for marketing and enrollment, and he repeatedly tried to overturn the law. So I think some of the messaging around this is getting convoluted, in part because it\u2019s an election year, to your point.\u00a0<\/p>\n Rovner:<\/strong> And because it\u2019s popular. Because Nancy Pelosi was right. When people found out what was in it, it got popular.\u00a0<\/p>\n Kenen:<\/strong> I think there are two things. I mean, I agree with what Lauren just said, but the Democrats came out in favor of extending the subsidies yesterday, which not only changed the eligibility criteria \u2014 more people, more higher up the middle-income chain could get subsidized \u2014 but also everybody in it had extra benefits for it, including people who were already covered. But it\u2019s better for them.\u00a0<\/p>\n The idea that Republicans are going to try to take that benefit away from people six weeks before an election \u2014 they were probably not. How they handle it next year? I was really surprised by the silence yesterday. The Democrats rolled out their plans for renewing this, and I didn\u2019t see a lot of Republican pushback. So they were really quiet about it.\u00a0<\/p>\n The other thing that struck me is that JD Vance went on on this risk pool thing last week on \u201cMeet the Press\u201d and in Raleigh, in North Carolina, and then there was pushback. And on that particular point, there\u2019s been silence for the last week. I don\u2019t think he stuck his neck out on that one again. Who knows what next week will bring, but it didn\u2019t continue, and nor did I hear other Republicans saying, \u201cYeah, let\u2019s go do that.\u201d\u00a0<\/p>\n So if that was a trial balloon, it was somewhat leaden. So I think that we really don\u2019t know how the subsidy fight is going to play \u2014how or when the subsidy fight will play out. It\u2019s really, you know, we\u2019ve all said many times before, once you give people the benefit, it\u2019s really hard to take it away. And\u2014\u00a0<\/p>\n Rovner:<\/strong> Although we did that with the Child Tax Credit. We gave everybody the Child Tax Credit and then took it away.\u00a0<\/p>\n Kenen:<\/strong> We did, and other things that were temporary during the pandemic, and we\u2019ll just see how many of those temporary things do in fact go away. I mean, does it come back next year? I mean, now SALT [state and local taxes], right? I mean, Trump backed backing what\u2019s called SALT. It\u2019s a limit based on mortgage and state taxes. And now he\u2019s talking about he\u2019s going to rescue that like it wasn\u2019t him who \u2026 So it all comes around again.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, and I think what you\u2019re seeing is both sides drawing the battle lines for next year and signaling what the core arguments are going to be. And so you had Democrats come out with their bill this year, and you are hearing a lot of Republicans in hearings and speeches sprinkled around talking about claiming that there is a huge amount of fraud in the ACA marketplaces and linking that to the subsidies and saying, Why would we continue to subsidize something where there\u2019s all this fraud?<\/em>\u00a0<\/p>\n I think that is going to be a big argument on that side next year for not extending the subsidies. So I would urge people to keep listening for that.\u00a0<\/p>\n Kenen:<\/strong> And that came from a conservative think tank consulting firm in which they blame \u2014 I actually happened to read it this week, so it\u2019s fresh in my mind. They\u2019re blaming the fraud actually on brokers rather than individuals. They\u2019re saying that people are\u2014\u00a0<\/p>\n Rovner:<\/strong> That was an investigation uncovered by my colleague Julie Appleby here at KFF Health News<\/a>.\u00a0<\/p>\n Kenen:<\/strong> Right. And they ran with that, and they were talking about the low end of the income bracket. And I\u2019m waiting for the sequel in which the people at the upper end of the income bracket, which is the law that\u2019s expiring that we\u2019re talking about, it\u2019s pretty \u2014 I\u2019m waiting for the sequel Paragon paper saying, See, it\u2019s even worse at the upper end, and that\u2019s easy to get rid of because it\u2019ll expire<\/em>. That\u2019s the argument of the day, but there\u2019s so many flavors of anti-ACA arguments that we\u2019ve just scratched the beginning of this round.\u00a0<\/p>\n Rovner:<\/strong> Exactly. It\u2019ll come back. All right, well, let us move on to abortion. Vice President [Kamala] Harris said in an interview this week that she would support ending the filibuster in the Senate in order to restore abortion rights with 51 rather than 60 votes, which has apparently cost her the endorsement of retiring West Virginia Democratic senator Joe Manchin. Was Manchin\u2019s endorsement even that valuable to her? It\u2019s not like West Virginia was going to vote Democratic anytime soon.\u00a0<\/p>\n Ollstein:<\/strong> The Harris campaign has really leaned into emphasizing endorsements she\u2019s been getting from across the ideological spectrum, from as far right as Dick Cheney to more centrist types and economists and national security people. And so she\u2019s clearly trying to brandish her centrist credentials. So I guess in that sense. But like you said, Democrats are not going to win West Virginia, and so I think also he was getting upset about something, a position she\u2019s been voicing for years now. This is not new, this question of the filibuster. So I doubt it\u2019ll have much of an impact.\u00a0<\/p>\n Kenen:<\/strong> It\u2019s a real careful-what-you-wish for, because if the Senate goes Republican, which at the moment looks like it\u2019s going to be a narrow Republican majority. We don\u2019t know until November. There\u2019s always a surprise. There\u2019s always a surprise.\u00a0<\/p>\n Rovner:<\/strong> You\u2019re right. It\u2019s more likely that it\u2019ll be 51-49 Republican than it\u2019ll be 51-49 Democrat.\u00a0<\/p>\n Kenen:<\/strong> Right. So if the filibuster is going to be abolished, it would be to advance Republican conservative goals. So it\u2019s sort of dangerous territory to walk into right now. The Democrats have played with abolishing the filibuster. They wanted to do it for voting rights issues, and they decided not to go there on legislation. They did modify it a number of years ago on judicial appointments and other Cabinet appointments and so forth.\u00a0<\/p>\n But legislative, the filibuster still exists. It\u2019s very, very, very heavily used, much more than historically, by both parties, whoever is in power. So changing it would be a really radical change in how things move or don\u2019t move. So it could have a long tail, that remark.\u00a0<\/p>\n Rovner:<\/strong> Meanwhile, Senate Democrats, who don\u2019t have the votes now, as we know, to abolish the filibuster, because Manchin is among their one-vote margin, are continuing to press Republicans on reproductive rights issues that they think work in their favor. Earlier this week, the Senate Finance Committee had a hearing on EMTALA, the Emergency Medical Treatment and Labor Act.\u00a0<\/p>\n It\u2019s a federal law that\u2019s supposed to guarantee women access to abortion in medical emergencies. But in practice, it has not. Last week we talked about the ProPublica stories<\/a> on women whose pregnancy complications actually did lead to their death. Is this something that\u2019s breaking through as a campaign issue? I do feel like we\u2019ve seen so much more on pregnancy complications and the health impacts of those rather than just, straight, women who want to end pregnancies.\u00a0<\/p>\n Ollstein:<\/strong> I just got back from Michigan, and I would say it is having a big impact. I was really interested in how Democrats were trying to campaign on abortion in Michigan, even now that the state does have protections. And I heard over and over from voters and candidates that Trump\u2019s leave-it-to-the-states stance, they really are still energized by that.\u00a0<\/p>\n They\u2019re not mollified by that, because they are pointing to stories like the ones that just came out in Georgia and saying: See? That\u2019s what happens when you leave it to the states. We may be fine, but we care about more than just ourselves. We\u2019re going to vote based on our concern for women in other states as well.<\/em> I found that really interesting to be hearing out in the field.\u00a0<\/p>\n Rovner:<\/strong> Lauren, you want to add something?\u00a0<\/p>\n Weber:<\/strong> Yeah, I just was going to add, I mean, Harris obviously highlighted this effectively in the debate, and I think that has helped bring it to more of a crescendo, but there\u2019s obviously been a lot of reporting for months on this. I mean, the AP has talked about \u2014 I think they did a count. It\u2019s over 100 women, at least, have been denied emergency care due to laws like this.\u00a0<\/p>\n I\u2019d be curious \u2014 and it sounds like Alice has this, for voters that are in swing states, that it\u2019s breaking through to \u2014 I\u2019d be curious how much this has siloed to people that are outraged by this, and so we\u2019re hearing it and how much it\u2019s skidding down to those that \u2014 the Republican talking points have been that these are rare, they don\u2019t really happen, it\u2019s a liberal push to get against this. I\u2019d be curious how much it\u2019s breaking through to folks of all stripes.\u00a0<\/p>\n Rovner:<\/strong> I watched a big chunk of the Finance Committee hearing, and the anti-abortion witnesses were saying this is not how it worked, <\/em>that ectopic pregnancies, pregnancy complications do not qualify as abortions, and basically just denying that it happened. They\u2019re sitting here. They\u2019re sitting at the witness table with the woman to whom this happened and saying that this does not happen. So it was a little bit difficult, shall we say. Go ahead.\u00a0<\/p>\n Ollstein:<\/strong> Well, and the pushback I\u2019ve been hearing from the anti-abortion side is less that it\u2019s not happening and more that it\u2019s not the fault of the laws, it\u2019s the fault of the doctors. They are claiming that doctors are either intentionally withholding care or are wrong in their interpretation of the law and are withholding care for that reason. They\u2019re pointing to the letter of the law and saying, Oh no, it doesn\u2019t say let women bleed out and die, so clearly it\u2019s fine.<\/em> They\u2019re not really grappling with the chilling effect it\u2019s having.\u00a0<\/p>\n Rovner:<\/strong> Although we do know that in Texas when, I think it was Amanda Zurawski, there was \u2014 no, it was Kate Cox who actually got a judge to say she should be allowed to have an abortion. Ken Paxton, the Texas attorney general, then threatened the hospital, said, If you do this, I will come after you.<\/em> On the one hand, they say, Well, that\u2019s not what the law says.<\/em> On the other hand, there are people saying, Yeah, that\u2019s what the law says.<\/em>\u00a0<\/p>\n Turning to the Republicans, Donald Trump had some more things to say about abortion this week, including that he is women\u2019s protector and that women will, and I quote, \u201cbe happy, healthy, confident, and free. You will no longer be thinking about abortion.\u201d\u00a0<\/p>\n If that wasn\u2019t enough, in Ohio, Bernie Moreno, who\u2019s the Republican running against Senator Sherrod Brown in the otherwise very red state, said the other night that he doesn\u2019t understand why women over 50 would even care about abortion, since, he suggested, they can no longer get pregnant, which isn\u2019t correct, by the way. But who exactly are the voters that Trump and Moreno are going after here?\u00a0<\/p>\n Kenen:<\/strong> Moreno is already lagging in the polls. Sherrod Brown is a pretty liberal Democrat in an increasingly conservative state, and he\u2019s also very popular. And it looks like he\u2019s on a glide path to win, and this probably made it easier for him to win. And there are men who support abortion rights, and there are women who oppose.\u00a0<\/p>\n I mean, this country\u2019s divided on abortion, but it\u2019s not age-related. It\u2019s not like if you\u2019re under 50 and female, you care about abortion and nobody else does. I mean, that\u2019s really not the way it works. Fifty-year-old and older women, some of whom had abortions when they were younger, would want that right for younger women, including their daughters. It\u2019s not a quadrant. It\u2019s not like, oh, only this segment cares.\u00a0<\/p>\n Ollstein:<\/strong> It\u2019s interesting that it comes amid Democrats really working to broaden who they consider an abortion voter, like I said, trying to encourage people in states where abortion is protected to vote for people in states where abortion is not protected and doing more outreach to men and saying this is a family issue, not just a women\u2019s issue, and this affects everybody.\u00a0<\/p>\n So as you see Democrats trying to broaden their outreach and get more people to care, you have Bernie Moreno saying the opposite, saying, I don\u2019t understand why people care when it doesn\u2019t affect their own particular life and situation.<\/em>\u00a0<\/p>\n Rovner:<\/strong> Although I will say, having listened to a bunch of interviews with undecided voters in the last couple of weeks, I do hear more and more voters saying: Well, such and such candidate, <\/em>and this is on both sides, is not speaking to me. <\/em>It\u2019s almost like this election is about them individually and not about society writ large.\u00a0<\/p>\n And I do hear that on both sides, and it\u2019s kind of a surprise. And I don\u2019t know, is that maybe where Moreno is coming from? Maybe that\u2019s what he\u2019s hearing, too, from his pollsters? It\u2019s only that people are most interested in their own self-interest and not about others? Lauren, you wanted to add to that?\u00a0<\/p>\n Weber:<\/strong> I mean, I would just say I think that\u2019s a kind interpretation, Julie. I think that more likely than not, he was just speaking out of turn. And in some prior reporting I did this year on misinformation around birth control and contraception, I spoke to a bunch of women legislators, I believe it was in Idaho, who found that in speaking with their male legislator friends, that a lot of them were uncomfortable talking about abortion, birth control, et cetera, which led to a lot of these misconceptions. And I wonder if we\u2019re seeing that here.\u00a0<\/p>\n Ollstein:<\/strong> Just quickly, I think it\u2019s also reflective of a particular conservative mind-set. I mean, it reminds me of when I was covering the Obamacare fight in Congress and you had Republican lawmakers making jokes about, Oh, well, wouldn\u2019t want to lose coverage for my mammograms.<\/em> And just what we were just talking about, about the separate risk pools and saying, Oh, I\u2019m healthy. Why should I subsidize a sick person?<\/em> when that\u2019s literally how insurance works.\u00a0<\/p>\n But I think just the very individualistic go-it-alone, rugged-individual mind-set is coming out here in different ways. And so it seems like he did not want this particular comment to be scrutinized as it is getting now, but I think we hear versions of this from conservative lawmakers all the time in terms of, Why should I have to care about, pay for, subsidize, et cetera, other people in society?<\/em>\u00a0<\/p>\n Rovner:<\/strong> Yeah, there\u2019s a lot of that. Well, finally this week in reproductive health issues that never seem to go away, a federal judge in North Dakota this week slapped an injunction on the Equal Employment Opportunity Commission\u2019s enforcement of some provisions of the 2022 Pregnant Workers Fairness Act, ruling that Catholic employers, including for-profit Catholic-owned entities, don\u2019t have to provide workers with time off for abortions or fertility treatments that violate the church\u2019s teachings.\u00a0<\/p>\n Now, lest you think this only applies to North Dakota, it does not. There\u2019s a long way to go before this ruling is made permanent, but it\u2019s kind of awkward timing for Republicans when they\u2019re trying to convince voters of their strong support of IVF [in vitro fertilization], and yet here we have a large Catholic entity saying, We don\u2019t even want to give our workers time off for IVF<\/em>.\u00a0<\/p>\n Ollstein:<\/strong> Yeah, I think you\u2019ve been hearing a lot of Republicans scoffing at the idea that anyone would oppose IVF, when there are many, many conservatives who do either oppose it in its entirety or oppose certain ways that it is currently commonly practiced. You had the Southern Baptist Convention vote earlier this year in opposition to IVF. You have these Catholic groups who are suing over it.\u00a0<\/p>\n And so I think there needs to be a real reckoning with the level of opposition there is on the right, and I think that\u2019s why you\u2019re seeing an interesting response to Trump\u2019s promise for free IVF for all and whether or not that is feasible. I think this shows that it would get a lot of pushback from groups on the right if they were ever to pursue that.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I will also note that this was a Trump-appointed judge, which is pretty \u2026 The EEOC, when they were doing these final regulations, acknowledged that there will be cases of religious employers and that they will look at those on a case-by-case basis. But this is a pretty sweeping ruling that basically says, we\u2019re back to the Hobby Lobby Supreme Court case: If you don\u2019t believe in something, you don\u2019t have to do it.\u00a0<\/p>\n I mean, that\u2019s essentially where we are with this, and we will see as this moves forward. Well, moving on to another big election issue, drug prices, the CEO of Novo Nordisk, makers of the blockbuster obesity and diabetes drugs Ozempic and Wegovy, appeared at the Senate Health, Education, Labor and Pensions Committee on Tuesday in front of Senator Bernie Sanders, who has been one of their top critics.\u00a0<\/p>\n And maybe it\u2019s just my covid-addled brain, but I watched this hearing and I couldn\u2019t make heads or tails of how Lars J\u00f8rgensen, the CEO, tried to explain why either the differences between prices in the U.S. and other countries for these drugs weren\u2019t really that big, or how the prices here are actually the fault of PBMs, not his company. Was anybody able to follow this? It was super confusing, I will say, that he tried to \u2026\u00a0<\/p>\n First he says that, well, 80% of the people with insurance coverage can get these drugs for $25 a month or less, which I\u2019m pretty sure only applies to people who are using it for diabetes, not for obesity, because I think most insurers aren\u2019t covering it for obesity. And there was much backing and forthing about how much it costs and how much we pay and how much it would cost the country to actually allow people, everybody who\u2019s eligible for these drugs, to use them. And no real response. I mean, this is a big-deal campaign issue, and yet I feel like this hearing was something of a bust.\u00a0<\/p>\n Weber:<\/strong> I mean, do we really expect a CEO of a highly profitable drug to promise to reduce it immediately on the spot? I mean, I guess I\u2019m not surprised that the hearing was a back-and-forth. From what I understand of what happened, I mean, most hearings with folks that have highly lucrative drugs, they\u2019re not looking to give away pieces of the lucrative drugs. So I think to some extent we come back to that.\u00a0<\/p>\n But I did think what was interesting about the hearing itself was that Sanders did confront him with promises from PBMs that they would be able to offer these drugs and not short the American consumer, which was actually a fascinating tactic on Sanders part. But again, what did we really walk away with? I\u2019m not sure that we know.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I mean, even if you were interested in this issue \u2014 and I\u2019m interested in this issue and I know this issue better than the average person, as I said \u2014I literally could not follow it. I found it super frustrating. I mean, I know what Sanders was going for here. I just don\u2019t feel like he got what he was hoping to. I don\u2019t know. Maybe he was hoping to get the CEO to say, \u201cWe\u2019ve been awful, and so many people need this drug, and we\u2019re going to cut the price tomorrow.\u201d And yes, you point out, Lauren, that did not happen. But we shall see.\u00a0<\/p>\n Well, speaking of PBMs, the Federal Trade Commission late last week filed an administrative complaint against the nation\u2019s three largest PBMs, accusing them of inflating insulin prices and steering patients toward higher-cost products so they, the PBMs, can make more money, which is, of course, the big problem with PBMs, which is that they get a piece of the action. So the more expensive the drug, the bigger the piece of the action that they get.\u00a0<\/p>\n I was most interested in the fact that the FTC\u2019s three Democratic appointees voted in favor of the legal action. Its two Republican appointees didn\u2019t vote but actually recused themselves. This whole PBM issue is kind of awkward for Republicans who say they want to fight high drug prices, isn\u2019t it? I feel like the whole PBM issue, which, as we said, is something that Congress in theory wants to get to during the lame-duck session, is tricky.\u00a0<\/p>\n I mean, it\u2019s less tricky for Democrats who can just demagogue it and a little bit more tricky for Republicans who tend to have more support from both the drug industry and the insurance industry and the PBM industry. How much can they say they want to fight high drug prices without irritating the people with whom they are allied?\u00a0<\/p>\n Kenen:<\/strong> And the PBMs themselves are owned by insurers. The pharmaceutical drug pricing, it\u2019s really, really, really confusing, right?\u00a0<\/p>\n Rovner:<\/strong> Nobody understands it.\u00a0<\/p>\n Kenen:<\/strong> The four of us, none of us cover pharma full time, but the four of us are all pretty sophisticated health care reporters. And if we had to take a final exam on the drug industry, none of us would probably get an A-plus. So I\u2019d be surprised if they figure this out in lame duck. I mean, they could \u2014there\u2019s always the possibility that when they look at the outcome of things, they decide: We do need to cut a deal and get this off the plate. This is the best we\u2019re going to get. We\u2019re going to be in a worse position next month<\/em>. And they do it.\u00a0<\/p>\n But it just seems really sticky and complicated, and it doesn\u2019t feel like it\u2019s totally jelled yet to the point that they can move it. I would expect this to spill into next year. If a deal comes through, if a big budget deal comes through at the end of the year, it does have a lot of trade-offs and moving parts, and this could, in fact, get wrapped into it.\u00a0<\/p>\n If I had to guess, I would say it\u2019s more likely to spill into the following year, but maybe they\u2019ve decided they\u2019ve had enough and want to tie the bow on it and move on. And then it\u2019ll go to court and we\u2019ll spend the next year talking about the court fight against the PBM law. So it\u2019s not going to be gone one way or another, and nor are high drug prices going to be gone one way or another.\u00a0<\/p>\n Rovner:<\/strong> The issue that keeps on giving. Well, finally this week, a new entry in out This Week in Health Misinformation segment from, surprise, Florida. This is a story from my KFF Health News colleagues Arthur Allen, Daniel Chang, and Sam Whitehead. And the headline kind of says it all: \u201cFlorida\u2019s New Covid Booster Guidance Is Straight-Up Misinformation<\/a>.\u201d\u00a0<\/p>\n This is the continuing saga involving the state surgeon general, Joseph Ladapo, who\u2019s been talking down the mRNA covid vaccine for several years now and is recommending that people at high risk from covid not get the latest booster. What surprised me about this story, though, was how reluctant other health leaders in Florida, including the Florida Medical Association, have been to call the surgeon general out on this.\u00a0<\/p>\n I guess to avoid angering his boss, Republican governor Ron DeSantis, who\u2019s known to respond to criticism with retribution. Anybody else surprised by the lack of pushback to this there in Florida? Lauren?\u00a0<\/p>\n Weber:<\/strong> No, I\u2019m not really surprised. I mean, we\u2019ve seen the same thing over and over and over again. I mean, this is the man who really didn\u2019t make a push to vaccinate against measles when there was an outbreak. He has previously stated that seniors over 65 should not get an mRNA vaccine, with misinformation about DNA fragments. We\u2019ve seen this pattern over and over again.\u00a0<\/p>\n He is a bit of a rogue state public health officer in a crew that usually everyone else is on pretty much the same page, whether or not they\u2019re red- or blue-state public health officers. And I think what\u2019s interesting about this story and what continues to be interesting is as we see RFK [Robert F. Kennedy Jr.] gaining influence, obviously, in Trump\u2019s potential health picks, you do wonder if this is a bit of a tryout. Although Ladapo is tied to DeSantis, who Trump obviously has feelings about. So who knows there. But it very clearly is the politicization of public health writ large.\u00a0<\/p>\n Kenen:<\/strong> And DeSantis, during the beginning of the pandemic, he disagreed with the CDC [Centers for Disease Control and Prevention] guidelines about who should get vaccinated, but he did push them for older people. And I think that was his cutoff. If you\u2019re 15 up, you should have them. He was quite negative from the start on under. Florida\u2019s vaccination rates for the older population back when they rolled out in late 2020, early 2021, were not \u2014 they were fairly high. And there\u2019s been a change of tone. As the political base became more anti-vax, so did the Florida state government.\u00a0<\/p>\n Rovner:<\/strong> And obviously, Florida, full of older people who vote. So, I mean, super-important constituency there. Well, we will watch that space. All right, that is this week\u2019s news. Now it is time for our extra credits. That\u2019s when we each recommend a story we read this week we think you should read, too. Don\u2019t worry if you miss the details. We will include links to all these stories in our show notes on your phone or other device. Joanne, why don\u2019t you go first this week?\u00a0<\/p>\n Kenen:<\/strong> Elaine Godfrey in the Atlantic has a story called \u201cThe Woo-Woo Caucus Meets<\/a>,\u201d and it\u2019s about a four-hour summit on the Hill with RFK Jr., moderated by Senator Ron Johnson of Wisconsin, who also has some unconventional ideas about vaccination and public health. The writer called it the \u201ccrunch-ificiation of conservatism.\u201d\u00a0<\/p>\n It was the merging of the anti-vax pharma-skeptic left and the Trump right and RFK Jr. talking about MAHA, Making America Healthy Again, and his priorities for what he expects to be a leading figure in some capacity in a Trump administration fixing our health. It was a really fun \u2014 just a little bit of sarcasm in that story, but it was a good read.\u00a0<\/p>\n Rovner:<\/strong> Yeah, and I would point out that this goes, I mean, back more than two decades, which is that the anti-vax movement has always been this combination of the far left and the far right.\u00a0<\/p>\n Kenen:<\/strong> But it\u2019s changed now. I mean, the medical liberty movement, medical freedom movement and the libertarian streak has changed. It started changing before covid, but it\u2019s not the same as it was a few years ago. It\u2019s much more conservative-dominated, or conservative-slash-libertarian-dominated.\u00a0<\/p>\n Rovner:<\/strong> Alice.\u00a0<\/p>\n Ollstein:<\/strong> I have an interesting story from Stat. It\u2019s called \u201cHow Special Olympics Kickstarted the Push for Better Disability Data<\/a>.\u201d It\u2019s about how the Special Olympics, which just happened, over the years have helped shine a light on just how many people with developmental and intellectual disabilities just aren\u2019t getting the health care that they need and aren\u2019t even getting recognized as having those disabilities.\u00a0<\/p>\n And the data we\u2019re using today comes from the Clinton administration still. It\u2019s way out of date. So there have been improvements because of these programs like Healthy Athletes that have been launched around this, but it\u2019s still nowhere near good enough. And so this was a really fascinating story on that front and on a population that\u2019s really falling through the cracks.\u00a0<\/p>\n Rovner:<\/strong> It really was. Lauren.\u00a0<\/p>\n Weber:<\/strong> I actually picked an opinion piece in Stat that\u2019s called, quote, \u201cHow the Next President Should Reform Medicare<\/a>,\u201d by Paul Ginsburg and Steve Lieberman. And I want to give a shoutout to my former colleague Fred Schulte, who basically has single-handedly revealed \u2014 and now, obviously, there\u2019s been a lot of fall-on coverage \u2014 but he was really beating this drum first, how much Medicare Advantage is overbilling the government<\/a>.\u00a0<\/p>\n And Fred, through a lot of FOIAs [Freedom of Information Act requests] \u2014 and KFF has sued to get access to these documents \u2014 has shown that, through government audits, the government\u2019s being charged billions and billions of dollars more than it should be to pay for Medicare Advantage, which was billed as better than Medicare and a free-market solution and so on. But the reality is \u2026\u00a0<\/p>\n Rovner:<\/strong> It was billed as cheaper than Medicare.\u00a0<\/p>\n Weber:<\/strong> And billed as cheaper.\u00a0<\/p>\n Rovner:<\/strong> Which it\u2019s not.\u00a0<\/p>\n Weber:<\/strong> It\u2019s not. And this opinion piece is really fascinating because it says, look, no presidential candidate wants to talk about changing Medicare, because all the folks that want to vote usually have Medicare. But something that you really could do to reduce Medicare costs is getting a handle around these Medicare Advantage astronomical sums. And I just want to shout out Fred, because I really think this kind of opinion piece is possible due to his tireless coverage to really dig into what\u2019s some really wonky stuff that reveals a lot of money.\u00a0<\/p>\n Rovner:<\/strong> Yes, I feel like we don\u2019t talk about Medicare Advantage enough, and we will change that at some point in the not-too-distant future. All right, well, my story is from KFF Health News from my colleague Noam Levey, along with Ames Alexander of the Charlotte Observer. It\u2019s called \u201cHow North Carolina Made Its Hospitals Do Something About Medical Debt.<\/a>\u201d\u00a0<\/p>\n Those of you who are regular listeners may remember back in August when we talked about the federal government approving North Carolina\u2019s unique new program to have hospitals forgive medical debt in exchange for higher Medicaid payments. It turns out that getting that deal with the state hospitals was a lot harder than it looked, and this piece tells the story in pretty vivid detail about how it all eventually got done. It is quite the tale and well worth your time.\u00a0<\/p>\n OK, that is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. 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. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org, or you can still find me at X. I\u2019m @jrovner. Lauren, where are you?\u00a0<\/p>\n Weber:<\/strong> I\u2019m still on X @LaurenWeberHP.\u00a0<\/p>\n Rovner:<\/strong> Alice?\u00a0<\/p>\n Ollstein:<\/strong> On X at @AliceOllstein.\u00a0<\/p>\n Rovner:<\/strong> Joanne?\u00a0<\/p>\n Kenen:<\/strong> X @JoanneKenen and Threads @JoanneKenen1.\u00a0<\/p>\n Rovner:<\/strong> We will be back in your feed next week. Until then, be healthy.\u00a0<\/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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