Tag: Capitol Desk

As US Bumps Against Debt Ceiling, Medicare Becomes a Bargaining Chip

The Host

While repealing the Affordable Care Act seems to have fallen off congressional Republicans’ to-do list for 2023, plans to cut Medicare and Medicaid are back. The GOP wants Democrats to agree to cut spending on both programs in exchange for a vote to prevent the government from defaulting on its debts.

Meanwhile, the nation’s health care workers — from nurses to doctors to pharmacists — are feeling the strain of caring not just for the rising number of insured patients seeking care, but also more seriously ill patients who are difficult and sometimes even violent.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Tami Luhby of CNN, and Victoria Knight of Axios.

Among the takeaways from this week’s episode:

  • Conservative House Republicans are hoping to capitalize on their new legislative clout to slash government spending, as the fight over raising the debt ceiling offers a preview of possible debates this year over costly federal entitlement programs like Medicare.
  • House Speaker Kevin McCarthy said Republicans will protect Medicare and Social Security, but the elevation of conservative firebrands — like the new chair of the powerful House Ways and Means Committee — raises questions about what “protecting” those programs means to Republicans.
  • Record numbers of Americans enrolled for insurance coverage this year under the Affordable Care Act. Years after congressional Republicans last attempted to repeal it, the once highly controversial program also known as Obamacare appears to be following the trajectory of other established federal entitlement programs: evolving, growing, and becoming less controversial over time.
  • Recent reports show that while Americans had less trouble paying for health care last year, many still delayed care due to costs. The findings highlight that being insured is not enough to keep care affordable for many Americans.
  • Health care workers are growing louder in their calls for better staffing, with a nursing strike in New York City and recent reports about pharmacist burnout providing some of the latest arguments for how widespread staffing issues may be harming patient care. There is bipartisan agreement in Congress for addressing the nursing shortage, but what they would do is another question.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week that they think you should read, too:

Julie Rovner: Roll Call’s “NIH Missing Top Leadership at Start of a Divided Congress,” by Ariel Cohen

Tami Luhby: CNN’s “ER on the Field: An Inside Look at How NFL Medical Teams Prepare for a Game Day Emergency,” by Nadia Kounang and Amanda Sealy

Joanne Kenen: The Atlantic’s “Don’t Fear the Handshake,” by Katherine J. Wu

Victoria Knight: The Washington Post’s “‘The Last of Us’ Zombie Fungus Is Real, and It’s Found in Health Supplements,” by Mike Hume

Also mentioned in this week’s podcast:

The New York Times’ “As France Moves to Delay Retirement, Older Workers Are in a Quandary,” by Liz Alderman

Stat’s “Congressional Medicare Advisers Warn of Higher Drug Prices, Despite New Price Negotiation,” by John Wilkerson

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KHN’s ‘What the Health?’: Looking Ahead to the Lame-Duck Session

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When the lame-duck Congress returns to Washington after Election Day, it will face a long list of health items needing attention before the end of the year, including setting overall spending for health programs and averting a series of Medicare payment cuts to health care providers.

Meanwhile, in California, Democratic Gov. Gavin Newsom has signed a first-in-the-nation bill aimed at curbing covid-19 misinformation and disinformation by doctors.

This week’s panelists are Julie Rovner of KHN; Sandhya Raman of CQ Roll Call; Jessie Hellmann, also of CQ Roll Call; and Mary Agnes Carey of KHN.

Among the takeaways from this week’s episode:

  • When congressional lawmakers left town last week for a month of campaigning before the midterm elections, they agreed to fund the government — but only until mid-December. The election results may impact whether they reach agreements on funding for the full fiscal year when they come back.
  • Key Democratic members of the House have pledged to jettison the so-called Hyde Amendment from any spending bills, but clearly those efforts don’t have enough support to get through the Senate. The Hyde Amendment, named for Rep. Henry Hyde (R-Ill.), who died in 2007, bans federal funds from being used for most abortions.
  • Among the funding issues still to be settled by lawmakers is whether they will continue certain programs begun during the pandemic, such as allowing Medicare to cover telehealth services and whether enhanced Medicaid will continue for U.S. territories.
  • Also still awaiting a decision by Congress is a bipartisan effort to improve mental health services.
  • In response to some of the unusual treatments and theories that emerged surrounding covid, California has enacted a law that could bring more discipline for doctors who knowingly spread disinformation directly to patients. They can be reprimanded by the state medical board.
  • The issue of abortion is heating up in campaigns around the country, especially among Democrats running for Congress, governor, or attorney general. Republicans, on the other hand, are playing down the issue while they try to emphasize economic and immigration issues.
  • A new report from Ohio officials points to the surprisingly high number of girls and young teens seeking abortions. The state health department reported that among 538 children age 17 and younger who got abortions in Ohio last year, 57 were under 15.

Also this week, Rovner interviews KHN’s Sam Whitehead, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a family who tried to use urgent care to save money but ended up with a big emergency room bill, anyway. If you have an outrageous or enormous medical bill you’d like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: NPR’s “The Ice Bucket Challenge Wasn’t Just for Social Media. It Helped Fund a New ALS Drug,” by Wynne Davis

Sandhya Raman: Mountain State Spotlight’s “As WV Officials Tout Small Reductions in Drug Overdose Deaths, Epidemic Remains at Crisis Levels,” by Allen Siegler

Jessie Hellmann: KHN’s “Severe Sleep Apnea Diagnosis Panics Reporter Until He Finds a Simple, No-Cost Solution,” by Jay Hancock

Mary Agnes Carey: The Washington Post’s “Seniors Are Stuck Home Alone as Health Aides Flee for Higher-Paying Jobs,” by Christopher Rowland

Also mentioned in this week’s episode:

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KHN’s ‘What the Health?’: Graham’s Bill Recenters Abortion Debate

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Sen. Lindsey Graham (R-S.C.) put abortion back on Republicans’ agenda this week with a legislative proposal calling for a national ban on most abortions after 15 weeks of pregnancy. For many in his party, it was an unwelcome intrusion that could add to public unease with the party’s efforts to limit access to abortion as they look toward the midterm elections.

The World Health Organization suggested this week that the end of the covid-19 pandemic is within sight, but that doesn’t mean there’s an end to second-guessing about how public health officials reacted or their plans going forward.

This week’s panelists are Mary Agnes Carey of KHN, Rachel Cohrs of Stat, Sandhya Raman of CQ Roll Call, and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s episode:

  • Graham appeared to be trying to build consensus among conservatives with his bill. Republicans have been startled how the Supreme Court’s decision this summer ending a constitutional right to abortion has energized voters opposed to the move. In some red states, confusion has arisen over how strict a ban lawmakers can support. Graham’s bill would allow states to enact abortion laws that are more restrictive but would cap efforts by more progressive states to keep abortion legal later in pregnancy. He had the backing of several influential anti-abortion groups.
  • That didn’t seem to matter to many Capitol Hill Republicans. Senate Minority Leader Mitch McConnell was dismissive of the proposal, saying the issue needs to be dealt with on a state level, and refused to commit to bringing up the bill if Republicans capture the Senate in the fall elections. Conservatives have long argued that abortion access should be a state decision.
  • Graham’s announcement was inconvenient for Capitol Hill Republicans. Much of the political debate on abortion access had been focused on state races, but his bill allows Democrats to make it an issue in congressional races, too.
  • Groups that oppose abortion say that Graham’s effort is a good first step toward setting policy for the country, especially since states may continue to be more restrictive.
  • In the past, the 15-week gestational ban has been fairly well supported by the public, according to opinion polling. But new surveys suggest Americans’ views may be shifting as they witness the consequences of the Supreme Court decision and tragic stories appear about pregnancies in which fetal anomalies are discovered late or a mother’s health is impaired in late pregnancy.
  • On the covid-19 front, World Health Organization Director-General Tedros Adhanom Ghebreyesus told reporters Wednesday that the covid pandemic is not over but was upbeat about the fight against the virus. “The end is in sight,” he said.
  • His comments came as a group of world health experts, the Lancet Covid-19 Commission, blamed the WHO, the U.S. government, and others for insufficient coordination in fighting the disease. And a report by Politico and the German newspaper Welt looks at four non-governmental health organizations that had an influence on pandemic efforts.
  • Despite Adhanom Ghebreyesus’ comments, public health officials in the U.S. are pushing hard for Americans to get another covid booster this fall. And the situation points out that public health officials may not have a good handle on how to transition from treating covid as an emergency to an ongoing health threat.
  • The outlook is also muddled because the Biden administration has asked for more money from Congress to continue to fund vaccination and testing efforts, but congressional Republicans appear unlikely to support that effort. They believe it is time for the government to move out of that effort and allow the regular health industry to take over.
  • The latest statistics from the Census Bureau show a near-record low in the number of people who are uninsured. But most experts are concerned because once the covid emergency ends, states will again be allowed to recalibrate their Medicaid rolls and many people who have been covered by the federal-state health program during the pandemic could be pushed off government coverage.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Mary Agnes Carey: KHN’s “As State Institutions Close, Families of Longtime Residents Face Agonizing Choices” by Tony Leys

Rachel Cohrs: Politico’s “A New Approach to Domestic Violence” by Joanne Kenen

Sandhya Raman: The Philadelphia Inquirer’s “Philly’s Kids Are Grieving Alone From the Far-Reaching Trauma of Gun Violence, Advocates Say” by Abraham Gutman

Margot Sanger-Katz: The New York Times’ “Despite Their Influence and Extensive Access to Information, Members of Congress Can Buy and Sell Stocks With Few Restrictions”  and “These 97 Members of Congress Reported Trades in Companies Influenced by Their Committees” by Kate Kelly, Adam Playford, and Alicia Parlapiano

Also discussed on this week’s podcast:

Politico and Welt’s “How Bill Gates and Partners Used Their Clout to Control the Global Covid Response — With Little Oversight” by Erin Banco, Ashleigh Furlong, and Lennart Pfahler

The Census Bureau’s “Income, Poverty, and Health Insurance Coverage in the United States: 2021

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KHN’s ‘What the Health?’: A Big Week for Biden

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Health policy was front and center as Congress rushed to pass major legislation before leaving for its summer break. President Joe Biden signed a bill this week providing health benefits to military veterans who were sickened by exposure to toxic burn pits and will likely soon sign a measure allowing Medicare to negotiate the price of prescription drugs and extend enhanced subsidies for those who buy their insurance through the Affordable Care Act’s marketplaces.

Meanwhile, the abortion debate continues to rage around the country, with Indiana becoming the first state to pass a new ban since the Supreme Court overturned Roe v. Wade in June.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • The Senate parliamentarian determines whether provisions in special budget legislation called reconciliation bills meet the requirements to not be subject to a filibuster and are instead eligible to be passed with a simple majority vote. With the Inflation Reduction Act, she forced Democrats last week to drop some of the drug pricing provisions that would have applied to consumers in the private health insurance market. That includes a plan that would have required drugmakers to hold any increases in the price of certain drugs to the rate of inflation.
  • Democrats were also disappointed that the parliamentarian denied their efforts to pass a price cap on insulin patients who are not covered by Medicare and that Republicans failed to support an effort to pass the measure. Several other bills designed to help keep the cost of the lifesaving medicine affordable are languishing in Congress and are unlikely to get a vote in the Senate this year.
  • But the bill still provides key guarantees for Medicare beneficiaries and is a major change in how the government will interact with drugmakers. Getting legislation like this — so strongly opposed by the industry — was an impressive feat for the Democrats in an evenly divided Senate.
  • If the bill passes the House on Friday, as expected, some of the changes to Medicare, including the price negotiations, will not take effect immediately. So consumers will have to wait to realize all the benefits of the new law.
  • Indiana’s new abortion law is set to take effect next month. But the legislative debate exposed tensions among anti-abortion groups over how strict to be about abortion access for those who may have been raped. In the end, Indiana lawmakers opted to leave in exceptions for rape and incest.
  • The new Indiana abortion law, however, prompted a statement by drugmaker Lilly, which is headquartered in the state, saying that the restrictions could hurt the company’s efforts to recruit workers and that the company will provide assistance to employees who need to go out of state for abortion care.
  • The Biden administration last week declared a public health emergency for monkeypox, and Health and Human Services Secretary Xavier Becerra this week gave the FDA authority to grant emergency use authorizations for monkeypox vaccines.
  • Concerns are growing about the large number of people in the U.S. who are afflicted with long-term health problems caused by covid-19. Yet there appears to be little interest on Capitol Hill in funding studies or programs to help this population.

Also, for extra credit, the panelists suggest their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “For Sleep Apnea Patients With Recalled CPAP Machines, Restless Nights,” by Laurie McGinley

Rachel Cohrs: The Washington Post’s “Conservatives Skeptical of Coronavirus Vaccines Battle to Lead a Hospital,” by Tim Craig

Alice Miranda Ollstein: The AP’s “Study Connects Climate Hazards to 58% of Infectious Diseases,” by Seth Borenstein

Sarah Karlin-Smith: The Pink Sheet’s “US FDA Commissioner Califf Takes on Misinformation, Starting With ‘Rumor Control,’” by Sue Sutter

Also mentioned in this week’s episode:

The Washington Post’s “Abortion Bans Complicate Access to Drugs for Cancer, Arthritis, Even Ulcers,” by Katie Shepherd and Frances Stead Sellers

Politico’s “Republicans Turn on Each Other Amid Post-Roe Chaos,” by Megan Messerly and Alice Miranda Ollstein

The Indianapolis Star’s “‘A Slap in the Face’: Some Upset Lilly, Cumming Wait to Criticize Abortion Ban Until Holcomb Signed It,” by Binghui Huang and Lizzie Kane

NBC News’ “Pregnant Women in States With Abortion Bans Face the Reality of a Post-Roe World,” by Lauren Dunn and Kristen Dahlgren

Politico’s “Tim Kaine Has Long Covid. That’s Not Moving Congress to Act,” by Alice Miranda Ollstein

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A GOP Talking Point Suggests Birth Control Is Not at Risk. Evidence Suggests Otherwise.

“In no way, shape, or form is access to contraception limited or at risk of being limited.”

Rep. Kat Cammack (R-Fla.), co-chair, Congressional Pro-Life Caucus on the floor of the U.S. House, July 21, 2022

Republicans who oppose abortion have new talking points — birth control will remain easily available in the wake of the Supreme Court’s decision overturning the federal right to abortion, and when Democrats say otherwise, they are just trying to scare voters.

Variations on this claim were made by a series of Republicans on the House floor July 21 during debate on a bill that would add a right to contraception to federal law. Democrats advanced the bill as a way to ensure the availability of birth control before some abortion opponents have a chance to see whether the Supreme Court will overturn that right, too.

“This bill is completely unnecessary,” said Rep. Kat Cammack (R-Fla.), a co-chair of the Congressional Pro-Life Caucus. “In no way, shape, or form is access to contraception limited or at risk of being limited. The liberal majority is clearly trying to stoke fears and mislead the American people, once again, because in their minds stoking fear is clearly the only way that they can win.”

We reached out to Cammack’s office to inquire about the basis for this statement but did not receive a response.

Similar claims were made in the Senate as it declined to take up the House bill on July 27. “This idea that we ought to spend scarce time here in the Congress, which we have in limited supply, reaffirming rights that already exist is a clear political narrative designed to divert the American people’s attention from things that really are at risk,” said Sen. John Cornyn (R-Texas).

However, a review of documents and current efforts in some states to change laws indicates there is significant evidence that birth control — or at least some forms of it — may be at risk legally. So we dug in.

At the Supreme Court

The cornerstone for this concern can be found in Justice Clarence Thomas’ concurring opinion in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade’s guarantee of access to abortion. Thomas suggested that having found no constitutional right to abortion, the court should next “reconsider all of this court’s substantive due process precedents, including Griswold.” That is a reference to Griswold v. Connecticut, the 1965 case that established a right for married couples to use contraception (single people were granted that right in a separate case in 1972). In Griswold, the court found that the “due process” clause of the 14th Amendment protects the right to privacy.

True, Thomas represents only one vote on the court, and the number of his fellow justices who share his opinion that the birth control case should be reversed is unclear. But the Supreme Court has already allowed some employers to decline to offer their workers contraceptive coverage based on their opposition to abortion. At issue in the 2014 Hobby Lobby case was the religious belief of the owners of the craft store chain that some forms of contraception — including the “morning-after” pill and two types of intrauterine devices — could produce early abortions by preventing the implantation of a fertilized egg. The court decided the government could not force the contraceptive coverage requirement from the Affordable Care Act on employers with those beliefs.

Scientific evidence suggests that neither the morning-after pill (which is a higher dose of a hormone used in regular birth control pills) nor IUDs stop the implantation of a fertilized egg and therefore do not cause abortions. Still, the court ruled that the owners’ religious beliefs trumped the government’s interest in workers getting contraceptive coverage.

“That legal blurring of distinct scientific boundaries between abortion and birth control threatens contraceptive access in the United States,” wrote professors Rachel VanSickle-Ward and Kevin Wallsten in The Washington Post. They predicted that some states “will probably ban some forms of contraception outright, using the discredited idea that contraceptives act as abortifacients.”

State Action

Confusion about how some forms of contraception work has led to efforts in several states to ban certain types of birth control. The most frequently targeted form of birth control is the morning-after pill, which can prevent pregnancy if taken within a few days of unprotected sex but which cannot interrupt an established pregnancy. It is not the same as the abortion pill, a regimen of two other medications that do end a pregnancy up to 10 weeks of gestation.

And even if the birth control methods did prevent a fertilized egg from implanting in a woman’s uterus, that would not be an abortion, at least not according to the medical community. Although many religious groups and abortion opponents argue that human life begins when the egg is fertilized, there is a consensus among doctors, scientists, and legal experts that pregnancy begins at implantation. And, they point out, an abortion is the termination of a pregnancy. Roughly half of all fertilized eggs never implant.

Even before Roe was overturned, lawmakers in Idaho called for hearings to ban emergency contraception, and Missouri lawmakers tried to bar Medicaid from paying for the morning-after pill and IUDs.

Anti-abortion groups are pushing the idea. “Plan B is Capable of Causing an Early Abortion,” said a fact sheet from Students for Life of America, referring to the name of a brand of the morning-after pill. Model legislation from the National Right to Life Committee would ban abortion from the moment of fertilization, not implantation.

The bottom line, wrote professors VanSickle-Ward and Wallsten before the decision overturning Roe was even final, is that “the court doesn’t have to formally end legal protection for contraception use.”

“If it allows plaintiffs to call contraception abortion, and Dobbs ends legal protection for abortion, then contraception is at risk.”

Our Ruling

It is true that, so far, no state has banned forms of contraception. But the threat appears very real. And the absolute nature of Cammack’s statement — saying there’s “no way, shape, or form” that access to contraception is at risk — is not accurate. We rate the statement False.


Congressional Record, July 21, 2022, Pages H6927-H6940

Supreme Court, Dobbs v. Jackson Women’s Health Organization, June 24, 2022

Supreme Court, Burwell v. Hobby Lobby Stores, June 30, 2014

Supreme Court, Griswold v. Connecticut, June 7, 1965

Stateline, “Some States Already Are Targeting Birth Control,” May 19, 2022

The 19th, “With Abortion Rights in Limbo, Conservative Lawmakers Are Eyeing Restrictions on IUDs and Plan B,” May 25, 2022

The Daily Beast, “Why Can’t the FDA Fix Outdated Birth Control Labels,” updated July 12, 2017

Journal of Contraception, “Mechanism of Action of Emergency Contraception,” July 12, 2010

KHN, “FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate,” June 30, 2014

KHN, “Misinformation Clouds America’s Most Popular Emergency Contraception,” June 7, 2022

National Right to Life, “National Right to Life Committee Proposes Legislation to Protect the Unborn Post-Roe,” June 15, 2022

NPR, “Abortion Foes Push To Redefine Personhood,” June 1, 2011

Students for Life, Facts About Plan B, accessed Aug. 1, 2022

The Washington Post, “If the Supreme Court Undermines Roe v. Wade, Contraception Could Be Banned,” updated May 3, 2022