Tagged Courts

KHN on the Air This Week

KHN chief Washington correspondent Julie Rovner discussed the impact of the election and the upcoming Supreme Court challenge on the Affordable Care Act with New Hampshire Public Radio’s “The Exchange” and WNYC’s “The Brian Lehrer Show” on Wednesday. Rovner also spoke with Newsy’s “Morning Rush” on Thursday about the roles of health care and COVID-19 in the presidential campaign.


KHN Midwest correspondent Lauren Weber discussed COVID vaccine distribution with “Newsy Reports” on Oct. 16.


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KHN’s ‘What the Health?’: A Little Good News and Some Bad on COVID-19


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For the first time in a long time, there is some good news about the coronavirus pandemic: Although cases continue to climb, fewer people seem to be dying. And there are fewer cases than expected among younger pupils in schools with in-person learning. But the bad news continues as well — including a push for “herd immunity” that could result in the deaths of millions of Americans.

Meanwhile, the Trump administration is doubling down on efforts to allow states to require certain people with low incomes to prove they work, go to school or perform community service in order to keep their Medicaid health benefits. The administration is appealing a federal appeals court ruling to the Supreme Court and just granted Georgia the right to impose a work requirement.

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Paige Winfield Cunningham of The Washington Post and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • Opinions seem to be slowly shifting on opening schools around the country. As fall approached, many people were hesitant to send their children back to school because they feared a resurgence of coronavirus infections, but early experiences seem to show that there has been little transmission among young kids in classrooms.
  • Even with good results in those school districts that have reopened, however, the debate about whether schools should be conducting in-person learning is quite polarized. President Donald Trump repeatedly calls for all schools to resume, while groups, such as unions representing teachers and other employees, are more likely to be calling for continued online learning.
  • California, which had a strong resurgence of the virus during the summer, is seeing signs of success in fighting back. The state has been among the most aggressive in shutting down normal activities to reduce case levels. It devised a county-specific method to determine closures, restrictions and reopenings — and it appears to be working.
  • A proposal by some researchers to move the country toward a “herd immunity” plan, in which officials would expect the virus to spread among the general population while also trying to protect the most vulnerable — such as people living in nursing homes — is gaining support among some of Trump’s advisers. Public health advocates are raising alarms because it would likely lead to hundreds of thousands more deaths. They also fear the administration’s focus on restoring normalcy would by default move in this direction.
  • Federal researchers this week announced that nearly 300,000 excess deaths have been recorded this year and much of it is attributed to COVID-19 or the lack of other health care by people who could not or did not seek treatments because they were frightened by the pandemic.
  • With the Senate poised to confirm Amy Coney Barrett, who opposes abortion, to the Supreme Court within days, the fate of the landmark Roe v. Wade decision is in question. If the court overruled that decision, abortion policies would likely fall back to individual states. A recent report on the effects of such a scenario finds that a huge swath of the South and the Midwest would be left without a local facility offering abortion services.

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

Julie Rovner: Cook’s Illustrated’s “The Best Reusable Face Masks,” by Riddley Gemperlein-Schirm, and The Washington Post’s “Consumer Masks Could Soon Come With Labels Saying How Well They Work,” by Yeganeh Torbati and Jessica Contrera

Margot Sanger-Katz: The Hill’s “Republicans: Supreme Court Won’t Toss ObamaCare,” by Peter Sullivan

Paige Winfield Cunningham: The Wall Street Journal’s “Some California Hospitals Refused Covid-19 Transfers for Financial Reasons, State Emails Show,” by Melanie Evans, Alexandra Berzon and Daniela Hernandez

Alice Miranda Ollstein: ProPublica’s “Inside the Fall of the CDC,” by James Bandler, Patricia Callahan, Sebastian Rotella and Kirsten Berg


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UVA Health Still Squeezing Money From Patients — By Seizing Their Home Equity

Doris Hutchinson wanted to use money from the sale of her late mother’s house to help her grandchildren go to college.

Then she learned the University of Virginia Health System was taking $38,000 of the proceeds because a 13-year-old medical bill owed by her deceased brother had somehow turned into a lien on the property.

“It was a mess,” she said. “There are bills I could pay with that money. I could pay off my car, for one thing.”

Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds.

An ongoing examination by KHN into hospital billing and collections in Virginia shows just how widespread and destructive they can be. KHN reported a year ago that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system temporarily suspended patient lawsuits and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.

Those changes were “a first step” in reforming billing and collection practices, university officials said at the time.

However, UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system examined by KHN. VCU Health pledged in March to stop seizing patients’ wages over unpaid bills and to remove all property liens, which are created after a creditor wins a court judgment.

Working courthouse-by-courthouse, VCU Health now says it has discovered and released 45,000 property liens filed against patients just in Richmond, its home city, some dating to the 1990s. There are an estimated 35,000 more in other parts of the state. Fifteen thousand of those have been canceled and they are working on the rest, officials said. These figures have not been previously reported. The system is part of Virginia Commonwealth University.

VCU Health’s total caseload is “a huge number” but perhaps not astonishing given the energy with which many hospital systems sue their patients, said Carolyn Carter, deputy director of the National Consumer Law Center.

Despite having suspended patient lawsuits, UVA Health has continued to create property liens based on older court cases, court records show. The number of new liens is “small,” said UVA Health spokesperson Eric Swensen.

An advisory council of UVA Health officials and community leaders is expected to deliver new recommendations by the end of October, Swensen said. The council, whose schedule has been slowed by the coronavirus crisis, has discussed property liens, Don Gathers, an activist and council member, said in an interview this summer.

Nobody knows how many old or new UVA Health liens are scattered through scores of Virginia courthouses. The health system, which has sued patients in almost every county and city in the state, has failed to respond to repeated requests over two years to disclose the number and value of its property liens.

But in Albemarle County alone, which surrounds the university’s Charlottesville home, “there are thousands” of UVA Health judgments filed in the land records, which creates a lien, said Circuit Court Clerk Jon Zug.

Not just Virginia homes are at risk. UVA Health lawyers search the nation for property or other assets owned by patients with outstanding bills and have filed liens in Maryland, West Virginia, Ohio and Florida, court records show.

The system put a lien on a Nevada vacation condo owned by Veronica Musie’s family a decade ago over a $30,600 hospital bill, said Musie, who lives in northern Virginia. The family has since paid the debt.

Virginia property liens expire after 20 years. But UVA Health often renews them. Since 2017, just in Albemarle County, it has renewed more than three dozen liens. That means the medical system could seize families’ home equity until 2039 for bills dating to the last century.

UVA Health and other medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking their cut at the settlement table. But with 6% simple interest accumulating year after year after the court judgment, as allowed by Virginia law, the final amount owed can be much more than the original charges.

UVA Health treated Hutchinson’s brother for heart disease in the early 2000s. The unpaid bill was $24,868. The system laid claim to their mother’s home because he was one of her heirs. The claim is up to $38,000 now, she said, because of interest charges. Hutchinson has been disputing it for more than a year.

VCU Health and its MCV Physicians affiliate estimate that eliminating two decades of property liens in courthouses across the state, which they began to do last year after KHN published its reports, won’t be finished until spring.

Richmond was especially problematic. Because releasing 40,000 Richmond liens by hand would have been impractical, VCU Health got a judge’s permission to do it with computer code.

Creditors such as UVA and VCU don’t need addresses to create liens. All they have to do is file a judgment in county or city land records. If debtors own any property there, title companies won’t approve a sale until the debt is paid, often with home equity.

Often owners don’t know debts exist until paralegals unearth them when homes are sold, property pros say. Old debts can create liens on newly acquired real estate.

“It could be your grandmother’s house, and as soon as you’ve inherited it, and you’ve got judgments, those [liens] are now attached,” said Richmond Court Clerk Edward Jewett.

Frequently debtors own no property, so judgments in the land records expire without hospitals or other creditors getting anything.

VCU and MCV had no idea how many liens they had placed across the state until they began investigating last year after KHN’s inquiries, officials said.

“It’s an incredibly manual process” to cancel the claims, partly because computer systems at many courthouses prohibit an easy tech solution, said Melinda Hancock, VCU Health’s chief administrative and financial officer. But it’s worth it to remove a burden on patients, she said, adding, “This is an outdated collections practice whose time has come and gone.”

But many medical systems still do it, consumer debt experts say, noting that obtaining a complete picture of hospital property liens is impossible.

Land and judgment records are held by thousands of local court clerks, often using separate computer systems. Records are difficult or impossible to obtain in bulk.

“There is not a good nationwide study that I know of that looks at how widespread this is, how many consumers are affected, what’s the average size of a lien,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing.

Mike Miller and Kitt Klein are among those hoping UVA Health follows VCU Health in canceling thousands of property liens. They fear a $129,000 judgment won by UVA in 2017 against Miller will cost them the equity in their home in Quicksburg, Virginia.

They make about $25,000 a year. Miller, a house painter, was insured but received out-of-network radiation at UVA that doctors said was necessary to treat his lung cancer.

After KHN wrote about his case a year ago, benefits firm WellRithms analyzed his UVA bill and found that a commercial insurer would have paid a little more than $13,000, not $129,000, for the treatment.

“We know all [health care] providers bill a lot, but usually ‘a lot’ is three to six times what reasonable prices would be,” said Jordan Weintraub, vice president of claims for WellRithms. Trying to collect 10 times as much, she said, “is really out there.”

UVA Health does not comment on individual patient cases, Swensen said.

KHN found last year that UVA frequently sued patients for far more than what the system could have collected from insurance.

Early this year Miller and Klein emailed UVA President James Ryan, asking for help in reducing or eliminating the judgment. His office phoned in February, saying it would review the case.

“I became very emotional, filled with gratitude,” Klein said. “I couldn’t talk.”

Months went by with no contact. Recently a lawyer from the office of Virginia Attorney General Mark Herring offered to settle the case for $120,000, Klein said, reducing the bill by only $9,000. They don’t have the money. Miller’s cancer has returned. Interest is mounting at 6%.

University officials do not comment on legal matters or individual cases, a Ryan spokesperson said. Herring’s office did not respond to requests for comment.

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Al sopesar los temas de salud, la mayoría de los votantes se inclinan hacia Biden

Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado de esta elección, según revela una nueva encuesta.

Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).

Un mes antes de que el tribunal escuche los argumentos de los fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes. La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.

Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.

Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.

La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar. Biden tiene una ventaja de 20 puntos: un 56% prefiere su enfoque, contra un 36% para Trump.

De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera en el cargo, lo que indica que los votantes no están satisfechos con el trabajo del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el enfoque de Biden, del 50% al 43%.

La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%. Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas y producirían una vacuna antes del día de las elecciones.

Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica. El 18% eligió el brote de COVID-19 y el 12% mencionó el cuidado de salud en general. Casi una proporción igual, el 29%, optó por la economía.

La encuesta se realizó del 7 al 12 de octubre, después del primer debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.

(KHN es un programa editorialmente independiente de KFF).

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Majority of Voters Tilt Toward Biden as Health Issues Weigh Heavily

At least half of voters prefer former Vice President Joe Biden’s approach to health care over President Donald Trump’s, suggesting voter concern about lowering costs and managing the pandemic could sway the outcome of this election, a new poll shows.

The findings, from KFF’s monthly tracking poll, signal that voters do not trust assurances from the president that he will protect people with preexisting conditions from being penalized by insurance companies if the Supreme Court overturns the Affordable Care Act. (KHN is an editorially independent program of KFF.)

Coming a month before the court will hear arguments from Republican attorneys general and the Trump administration that the health law should be overturned, the poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.

In addition to leaving about 21 million Americans uninsured, overturning the ACA could allow insurance companies to charge more or deny coverage to individuals because they have preexisting conditions — a common practice before the law was established, and one that a government analysis said in 2017 could affect as many as 133 million Americans.

Nearly 6 in 10 people said they have a family member with a preexisting or chronic condition, such as diabetes or cancer, and about half said they worry about a relative being unable to afford coverage, or lose it outright, if the law is overturned.

The poll reveals a striking preference for Biden over Trump when it comes to protecting preexisting conditions, an issue that 94% of voters said would help decide who they vote for. Biden has a 20-point advantage, with voters preferring his approach 56% to 36% for Trump.

In fact, it shows a preference for Biden on every health care issue posed, including among those age 65 and older and on issues that Trump has said were his priorities while in office — signaling voters are not satisfied with the president’s work to lower health care costs, in particular. Support for Trump’s efforts to lower prescription drug costs has been slipping, with voters now preferring Biden’s approach, 50% to 43%.

A majority of voters said they prefer Biden’s plan for dealing with the COVID-19 outbreak, 55% to 39%, and for developing and distributing a vaccine for COVID-19, 51% to 42%. Trump has largely left it up to state and local officials to manage the outbreak, while promising that scientists would defy expectations and produce a vaccine before Election Day.

Asked which issue is most important to deciding whom to vote for, most pointed to health care issues, with 18% choosing the COVID-19 outbreak and 12% saying health care overall. Nearly an equal share, 29%, selected the economy.

The survey was conducted Oct. 7-12, after the first presidential debate and Trump’s announcement that he had tested positive for COVID-19. The margin of error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters.

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KHN’s ‘What the Health?’: Democrats May Lose on SCOTUS, But Hope to Win on ACA


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Republicans appear to be on track to confirm Judge Amy Coney Barrett to the Supreme Court before Election Day, cementing a 6-3 conservative majority on the high court regardless of what happens Nov. 3. Democrats, meanwhile, lacking the votes to block the nomination, used the high-profile hearings to batter Republicans for trying to overturn the Affordable Care Act.

Meanwhile, a number of scientific journals that typically eschew politics, including the prestigious New England Journal of Medicine, threw their support to Democratic presidential candidate Joe Biden, citing what they call the Trump administration’s bungling of the coronavirus pandemic.

This week’s panelists are Julie Rovner of Kaiser Health News, Mary Ellen McIntire of CQ Roll Call, Shefali Luthra of The 19th and Sarah Karlin-Smith of Pink Sheet.

Among the takeaways from this week’s podcast:

  • The lack of progress on a bipartisan coronavirus relief package is making both Democrats and Republicans nervous as they approach Election Day without something to help voters.
  • During hearings on the nomination of Judge Amy Coney Barrett for the Supreme Court, Democrats were consistently on message, seeking to focus public attention before the election on the threat that Republicans pose to the Affordable Care Act as the law goes before the court next month. Four members of the Senate Judiciary Committee, which will vote on the nomination, are up for reelection. Also on the committee is Sen. Kamala Harris, the Democrats’ vice presidential candidate.
  • The public health optics of the hearing were jarring for some viewers. Although the committee chairman said the room was set up to meet federal health guidelines, Republican senators often did not wear masks, including Sens. Thom Tillis (N.C.) and Mike Lee (Utah), who both were diagnosed with COVID-19 after attending a White House celebration for Barrett.
  • The lack of masks could add to confusion about public health messages. And voters sometimes find it insulting that politicians play down risks that the public is called upon to assume.
  • Barrett’s testimony did not change many perceptions of her. Although she was extremely careful not to reveal her personal views on issues that could come before the court, including the ACA and abortion, both Democrats and Republicans highlighted her strong conservative credentials.
  • Scientific American and the New England Journal of Medicine have published stinging critiques of the current administration’s policies on science and medicine. Although it’s not clear what impact the editorials will have, they are a sign of the further politicization of public health.

This week, Rovner also interviews Dr. Ashish Jha, dean of the Brown University School of Public Health. Jha talked about the challenges public health professionals have faced in trying to deal with the COVID-19 pandemic.

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

Julie Rovner: The Atlantic’s “How to Tell If Socializing Indoors Is Safe,” by Olga Khazan

Shefali Luthra: The New York Times’ “A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise Bills,” by Sarah Kliff

Mary Ellen McIntire: KHN’s “Making Money Off Marks, COVID-Spawned Chain Store Aims to Become Obsolete,” by Markian Hawryluk

Sarah Karlin-Smith: Politico’s “Health Officials Scrambling to Produce Trump’s ‘Last-Minute’ Drug Cards by Election Day,” by Dan Diamond

Also mentioned in this week’s podcast:

Bill of the Month update: KHN’s “Moved by Plight of Young Heart Patient, Stranger Pays His Hospital Bill,” by Laura Ungar

Scientific journal endorsements: The New England Journal of Medicine’s “Dying in a Leadership Vacuum

Scientific American Endorses Joe Biden,” by The Editors


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Outnumbered on High Court Nomination, Democrats Campaign for a Different Vote

Democrats on the Senate Judiciary Committee know that, barring something unexpected, they lack the votes to block President Donald Trump from installing his third justice in four years on the Supreme Court and creating a 6-3 conservative majority.

They also know that, in a normal year, by mid-October Congress would be out of session and members home campaigning. But 2020 is obviously no normal year. So, while the rest of Congress is home, Democratic Judiciary members are trying something very different in the hearings for nominee Amy Coney Barrett. Rather than prosecuting their case against Barrett, currently a federal appeals court judge, they are refighting the war that helped them pick up seats in 2018 — banging on Republicans for trying to eliminate the Affordable Care Act.

Conveniently, the ACA is relevant to the Supreme Court debate because the justices are scheduled to hear a case that could invalidate the law on Nov. 10 — exactly a week after Election Day.

As California Sen. Kamala Harris, a member of the Judiciary Committee and the Democratic vice presidential candidate, put it to Barrett on Tuesday, “Republicans are scrambling to confirm this nominee as fast as possible because they need one more Trump judge on the bench before Nov. 10th to win and strike down the entire Affordable Care Act. This is not hyperbole. This is not hypothetical. This is happening.”

Said Sen. Richard Durbin (D-Ill.), also on Tuesday: “We really believe the Supreme Court’s consideration of that case is going — could literally change America for millions of people.”

To be sure, Republicans too were playing to their electorate during the questioning of Barrett, as they expounded on her conservative credentials on issues such as gun rights.

Nonetheless, Democrats were uniformly disciplined in their assault on her potential vote in the ACA case. They chided both Barrett and the Republicans who are rushing her nomination to the floor literally days before a presidential election. In addition, Democrats criticized Republicans for spending time on a nonemergency nomination while continuing to ignore the need for financial and other relief for the COVID-19 pandemic.

And they raised what in more normal times would be the featured talking point for Democrats: the threat to abortion and other reproductive rights from Barrett, who before her elevation to the federal bench publicly opposed abortion and taught law at Notre Dame, one of the nation’s preeminent Catholic universities.

“For many people, and particularly for women, this is a fundamental question,” said Sen. Dianne Feinstein (D-Calif.), the committee’s top Democrat.

Barrett, like every other Supreme Court nominee for the past three decades, declined to offer positions that could suggest which way she might rule on hot-button issues, including abortion and the ACA.

She repeatedly cited what has come to be called the “Ginsburg rule” — after the justice she would replace, Ruth Bader Ginsburg — saying “no hints, no previews, no forecasts.”

Still, Democrats suggested that she may have tipped her hand on the Affordable Care Act case. In pointing out that the issues in the case, now known as California v. Texas, are different from the previous cases upholding the health law in 2012 and 2015, she said the current case will turn on “severability.”

She was referring to the question of whether, if one portion of a law is found to be unconstitutional, the rest of the law can stand without it. In the current ACA case, a group of Republican attorneys general — and the Trump administration — are arguing that when Congress reduced the ACA’s penalty for not having insurance to zero, the requirement to be covered no longer had a tax attached, and therefore the law is now unconstitutional. They based their argument on Chief Justice John Roberts’ 2012 conclusion that the ACA was valid because that penalty was a constitutionally appropriate tax.

The law’s opponents say the rest of the law cannot be “severed” and must therefore fall, too. A federal district judge in Texas agreed with them.

But merely saying the case turns on severability suggests that Barrett has already prejudged major parts of the case, Democrats said. Sen. Chris Coons (D-Del.) noted, “You don’t get to the question of severability if you haven’t already determined the question of constitutionality.”

Barrett insisted repeatedly that despite an article she wrote in 2017 suggesting that the 2012 case upholding the law was wrongly decided, “I have no animus to nor agenda for the ACA,” as she told Sen. Amy Klobuchar (D-Minn.) on Wednesday.

In their rare show of unity of message, Democrats made clear that their primary audience in these hearings was not their Senate colleagues, but the voting public. While this battle looks lost, they hope to win the War of Nov. 3.

HealthBent, a regular feature of KHN, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

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