Tag: Medicare

Mental Health Care by Video Fills Gaps in Rural Nursing Homes

KNOXVILLE, Iowa ― Bette Helm was glad to have someone to talk with about her insomnia.

Helm lives in a nursing home in this central Iowa town of about 7,500 people, where mental health services are sparse. On a recent morning, she had an appointment with a psychiatric nurse practitioner about 800 miles away in Austin, Texas. They spoke via video, with Helm using an iPad she held on her lap while sitting in her bed.

Video visits are an increasingly common way for residents of small-town nursing homes to receive mental health care. Patients don’t have to travel to a clinic. They don’t even have to get cleaned up and leave their bedrooms, which can be daunting for people with depression or anxiety. Online care providers face fewer appointment cancellations, and they often can work from home. While use of some other telehealth services may dwindle as the covid-19 pandemic winds down, providers predict demand for remote mental health services will continue to increase in rural nursing homes.

“Are you anxious when you try to fall asleep? Is your mind racing?” asked the nurse practitioner, Ayesha Macon.

“Yeah, that’s sort of my time to think,” Helm said. Her thoughts can keep her up past 3 a.m., she said.

They discussed the anxiety Helm sometimes feels during the day and her routine of watching the TV news at 10 p.m. Macon suggested the news might wind Helm up, and she wondered if the 71-year-old patient could ease stress by skipping the news before going to bed.

“No,” Helm said. “I find it interesting. I want to know what’s going on in the world. I’ve always been a bit of a newshound.”

Macon smiled and said she understood. So they talked about other approaches, including using online meditation programs and spending quiet time reading the dozens of novels Helm keeps stacked in her room. “If I couldn’t read, I think I would go absolutely bananas,” she told Macon, who agreed it was a good habit.

Telemedicine visits became much more common throughout the American health care system during the pandemic, as guidelines on “social distancing” curtailed in-person appointments and insurers eased restrictions on what they would cover. The number of telehealth visits paid for by Medicare jumped tenfold in the last nine months of 2020 compared with the same period a year before.

Supporters of online treatment say it’s a good match for mental health care, especially in settings where in-person services have been hard to arrange. They cite small-town nursing homes as prime examples. The company that arranged Helm’s recent appointment, Encounter Telehealth, serves more than 200 nursing homes and assisted living centers, mostly in the Midwest. About 95% of those facilities are in rural areas, said Jen Amis, president of the company, which is based in Omaha, Nebraska.

Encounter Telehealth uses about 20 mental health professionals, many of whom are psychiatric nurse practitioners living in cities. The practitioners read the patients’ electronic medical records through a secure computer system, and they review symptoms and medications with nursing home staff members before each appointment. They complete up to 2,000 visits a month.

It’s important for seniors to have expert support as they face stress and uncertainty in aging, Amis said. “We’re all going to be there at some point,” she said. “Don’t you want that last chapter to be peaceful?”

The company saw demand for its services surge in care facilities when the pandemic hit. Nursing homes were closed to visitors for months at a time while the coronavirus caused thousands of illnesses and deaths among residents and employees. The stress could be overwhelming for everyone involved. “Oh, my gosh, the isolation and fear,” Amis said.

Amis said several developments have made her company’s services possible. Electronic medical records and video systems are crucial. Also, she said, many states have given more independent authority to nurse practitioners and other nonphysicians, and it has become easier to bill public and private insurance plans for mental health treatment.

The federal government could tighten rules for some kinds of telehealth care as the pandemic wanes. But Medicare paid for many remote mental health visits to rural areas before covid, and Amis expects the support to continue.

Jonathan Neufeld, program director of the Great Plains Telehealth Resource and Assistance Center at the University of Minnesota, said in-person mental health care can be hard to arrange in rural care facilities.

“You’ve got a double or even triple whammy going right now,” said Neufeld, a psychologist whose center is supported by federal grants.

He noted the number of mental health professionals nationally has been insufficient for many years, even before the pandemic. And all kinds of rural employers, including nursing homes, face critical staffing shortages.

Neufeld said telehealth visits can be a challenge for some care-facility residents, including those with dementia, who might not understand how a video feed works. But he said it also can be difficult to treat people with dementia in person. Either way, a staff member or relative needs to accompany them during appointments and the mental health professional generally consults with facility staff about a patient’s treatment.

Before telemedicine was available, more residents of rural nursing homes needed to be driven to a clinic in another town to see a mental health professional. That could eat up hours of staff time and add stress to the patients’ lives.

Seleta Stewart, a certified nursing assistant at the Accura HealthCare nursing home where Helm lives, said the facility’s need for the telehealth service is increasing, partly because the facility is home to several younger residents with mental illnesses. In the past, she said, many such Iowans would have been served by specialized facilities, such as two state mental hospitals that closed in 2015. But more now live in nursing homes.

“Iowa is just not a great state for mental health,” Stewart said.

A photo of a nursing home worker speaking to a mental health worker via video call.
Before visiting with patients in their rooms, psychiatric nurse practitioner Ayesha Macon, on video screen, consults with Shaina Flesher (right), a certified nursing assistant at the Accura HealthCare nursing home in Knoxville, Iowa. The two discuss how residents of the nursing home have been faring and what medications they’ve been taking.(Tony Leys / KHN)

Neufeld said that, even with telemedicine’s efficiencies, staffing can be a challenge for companies providing the service in nursing homes. Many mental health professionals already have more patients than they can handle, and they might not have time to pitch in online. He added that Medicare, which insures most seniors, pays lower rates than private insurers or patients paying on their own.

Amis, Encounter Telehealth’s president, said Medicare pays about $172 for an initial appointment and about $107 for a follow-up appointment; care providers collect roughly 30% to 75% more from patients who use private insurance or pay their own bills, she said. She added that nursing homes pay a fee to Encounter for the convenience of having mental health professionals visit by video.

Several patients and care providers said the shift to video appointments is usually smooth, despite seniors’ reputation for being uncomfortable with new technology.

Dr. Terry Rabinowitz, a psychiatrist and professor at the University of Vermont, has been providing telemedicine services to a rural nursing home in upstate New York since 2002. He said many patients quickly adjust to video visits, even if it’s not their initial preference.

“I think most people, if they had their druthers, would rather see me in person,” he said. “And if I had my druthers, I’d rather see them in person.” Online visits can have special challenges, including for patients who don’t hear or see well, he said. But those complications can be addressed.

Nancy Bennett, another resident of Helm’s Iowa nursing home, can attest to the benefits. Bennett had a video appointment with Macon on a recent morning. She told the nurse practitioner she’d been feeling stressed. “I’m 72, I’m in a nursing home, I’ve got no family around, so yeah, I’m a little depressed,” she said. “I do get sad sometimes.”

“That’s normal,” Macon assured her.

Bennett said she dislikes taking a lot of pills. Macon said she could taper some of Bennett’s medication.

In an interview afterward, Bennett said she’d gone to a clinic for mental health care in the past. That was before physical issues forced her into the nursing home, where she spends much of her time sitting in a blue recliner in her room.

If she’d had to get dressed and travel for her appointment with Macon, she said, she probably would have canceled. “There are days when I don’t want to be bothered,” she said.

But on this day, the mental health professional came to her on an iPad ― and helped Bennett feel a little better.

Judging the Abortion Pill

The Host

This week, the eyes of the nation are on Texas, where a federal judge who formerly worked for a conservative Christian advocacy group is set to decide whether the abortion pill mifepristone can stay on the market. Mifepristone is half of a two-pill regimen that now accounts for more than half of the abortions in the United States.

Meanwhile, Novo Nordisk, another of the three large drug companies that dominate the market for diabetes treatments, has announced it will cut the price of many of its insulin products. Eli Lilly announced its cuts early this month. But the push for more affordable insulin from activists and members of Congress is not the only reason for the change: Because of quirks in the way the drug market works, cutting prices could actually save the companies money in the long run.

This week’s panelists are Julie Rovner of KHN, Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s episode:

  • The federal judge examining the decades-old approval of mifepristone could issue a decision at any time after a hearing largely behind closed doors, during which he appeared open to restricting access to the drug.
  • Democratic governors seek to counter the chill of Republican states’ warnings to pharmacies about distributing mifepristone, and a separate lawsuit in Texas seeks to set a precedent for punishing people who aren’t medical providers for assisting someone in obtaining an abortion.
  • In pandemic news, Congress is moving forward with legislation that would force the Biden administration to declassify intelligence related to the origins of covid-19, while the editor of Cochrane Reviews posted a clarification of its recently published masking study, noting it is “inaccurate” to say it found that masks are not effective.
  • Top federal health officials sent an unusual letter to Florida’s surgeon general, warning that his embrace of vaccination misinformation is harmful, even deadly, to Americans. While covid vaccines come with some risk of negative health effects, contracting covid carries a higher risk of poor outcomes.
  • Novo Nordisk’s announcement that it will cut insulin prices puts pressure on Sanofi, the remaining insulin maker that has yet to adjust its prices.
  • The Veterans Health Administration will cover Leqembi, a new Alzheimer’s drug. The decision comes as Medicare considers whether it will also cover the drug. Experts caution that new drugs shaking up the weight-loss market could prove costly for Medicare.
  • Washington is eyeing changes to federal rules that would affect the practice of medicine. One change would force health plans to speed up “prior authorization” decisions by health insurers and increase transparency around denials, which supporters say would help patients better access needed care. Another proposal would ban noncompete clauses in contracts, including in health care. Arguments for and against the change both cite the issue of physician burnout — though they disagree on whether the ban would make the problem better or worse.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: “Tradeoffs” podcast’s “The Conservative Clash Over Abortion Bans,” by Alice Miranda Ollstein and Dan Gorenstein

Alice Miranda Ollstein: Politico’s “Sharpton Dodges the Spotlight on Latest Push to Ban Menthol Cigarettes,” by Julia Marsh

Sarah Karlin-Smith: Allure’s “With New Legislation, You Can Expect More Recalls to Hit the Beauty Industry,” by Elizabeth Siegel and Deanna Pai

Jessie Hellmann: The New York Times’ “Opioid Settlement Hinders Patients’ Access to a Wide Array of Drugs,” by Christina Jewett and Ellen Gabler

Also mentioned in this week’s podcast:


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Biden Budget Touches All the Bases

The Host

President Joe Biden’s fiscal 2024 budget proposal includes new policies and funding boosts for many of the Democratic Party’s important constituencies, including advocates for people with disabilities and reproductive rights. It also proposes ways to shore up Medicare’s dwindling Hospital Insurance Trust Fund without cutting benefits, basically daring Republicans to match him on the politically potent issue.

Meanwhile, five women in Texas who were denied abortions when their pregnancies threatened their lives or the viability of the fetuses they were carrying are suing the state. They charge that the language of Texas’ abortion ban makes it impossible for doctors to provide needed care without fear of enormous fines or prison sentences.

This week’s panelists are Julie Rovner of KHN, Shefali Luthra of The 19th, Victoria Knight of Axios, and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s episode:

  • Biden’s budget manages to toe the line between preserving Medicare and keeping the Medicare trust fund solvent while advancing progressive policies. Republicans have yet to propose a budget, but it seems likely any GOP plan would lean heavily on cuts to Medicaid and subsidies provided under the Affordable Care Act. Democrats will fight both of those.
  • Even though the president’s budget includes something of a Democratic “wish list” of social policy priorities, the proposals are less sweeping than those made last year. Rather, many — such as extending to private insurance the $35 monthly Medicare cost cap for insulin — build on achievements already realized. That puts new focus on things the president has accomplished.
  • Walgreens, the nation’s second-largest pharmacy chain, is caught up in the abortion wars. In January, the chain said it would apply for certification from the FDA to sell the abortion pill mifepristone in states where abortion is legal. However, last week, under threats from Republican attorneys general in states where abortion is still legal, the chain wavered on whether it would seek to sell the pill there or not, which caused a backlash from both abortion rights proponents and opponents.
  • The five women suing Texas after being denied abortions amid dangerous pregnancy complications are not asking for the state’s ban to be lifted. Rather, they’re seeking clarification about who qualifies for exceptions to the ban, so doctors and hospitals can provide needed care without fear of prosecution.
  • Although anti-abortion groups have for decades insisted that those who have abortions should not be prosecuted, bills introduced in several state legislatures would do exactly that. In South Carolina, those who have abortions could even be subject to the death penalty. So far none of these bills have passed, but the wave of measures could herald a major policy change.

Also this week, Rovner interviews Harris Meyer, who reported and wrote the two latest KHN-NPR “Bill of the Month” features. Both were about families facing unexpected bills after childbirth. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: KHN’s “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected,” by Sarah Varney

Shefali Luthra: The 19th’s “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say,” by Jennifer Gerson

Victoria Knight: KHN’s “After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates,” by Tony Leys

Margot Sanger-Katz: ProPublica’s “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Grab,” by J. David McSwane and Ryan Gabrielson

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

Biden Budget Touches All the Bases

The Host

President Joe Biden’s fiscal 2024 budget proposal includes new policies and funding boosts for many of the Democratic Party’s important constituencies, including advocates for people with disabilities and reproductive rights. It also proposes ways to shore up Medicare’s dwindling Hospital Insurance Trust Fund without cutting benefits, basically daring Republicans to match him on the politically potent issue.

Meanwhile, five women in Texas who were denied abortions when their pregnancies threatened their lives or the viability of the fetuses they were carrying are suing the state. They charge that the language of Texas’ abortion ban makes it impossible for doctors to provide needed care without fear of enormous fines or prison sentences.

This week’s panelists are Julie Rovner of KHN, Shefali Luthra of The 19th, Victoria Knight of Axios, and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s episode:

  • Biden’s budget manages to toe the line between preserving Medicare and keeping the Medicare trust fund solvent while advancing progressive policies. Republicans have yet to propose a budget, but it seems likely any GOP plan would lean heavily on cuts to Medicaid and subsidies provided under the Affordable Care Act. Democrats will fight both of those.
  • Even though the president’s budget includes something of a Democratic “wish list” of social policy priorities, the proposals are less sweeping than those made last year. Rather, many — such as extending to private insurance the $35 monthly Medicare cost cap for insulin — build on achievements already realized. That puts new focus on things the president has accomplished.
  • Walgreens, the nation’s second-largest pharmacy chain, is caught up in the abortion wars. In January, the chain said it would apply for certification from the FDA to sell the abortion pill mifepristone in states where abortion is legal. However, last week, under threats from Republican attorneys general in states where abortion is still legal, the chain wavered on whether it would seek to sell the pill there or not, which caused a backlash from both abortion rights proponents and opponents.
  • The five women suing Texas after being denied abortions amid dangerous pregnancy complications are not asking for the state’s ban to be lifted. Rather, they’re seeking clarification about who qualifies for exceptions to the ban, so doctors and hospitals can provide needed care without fear of prosecution.
  • Although anti-abortion groups have for decades insisted that those who have abortions should not be prosecuted, bills introduced in several state legislatures would do exactly that. In South Carolina, those who have abortions could even be subject to the death penalty. So far none of these bills have passed, but the wave of measures could herald a major policy change.

Also this week, Rovner interviews Harris Meyer, who reported and wrote the two latest KHN-NPR “Bill of the Month” features. Both were about families facing unexpected bills after childbirth. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: KHN’s “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected,” by Sarah Varney

Shefali Luthra: The 19th’s “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say,” by Jennifer Gerson

Victoria Knight: KHN’s “After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates,” by Tony Leys

Margot Sanger-Katz: ProPublica’s “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Grab,” by J. David McSwane and Ryan Gabrielson

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

March Medicaid Madness

The Host

With Medicare and Social Security apparently off the table for federal budget cuts, the focus has turned to Medicaid, the federal-state health program for those with low incomes. President Joe Biden has made it clear he wants to protect the program, along with the Affordable Care Act, but Republicans will likely propose cuts to both when they present a proposed budget in the next several weeks.

Meanwhile, confusion over abortion restrictions continues, particularly at the FDA. One lawsuit in Texas calls for a federal judge to temporarily halt distribution of the abortion pill mifepristone. A separate suit, though, asks a different federal judge to temporarily make the drug easier to get, by removing some of the FDA’s safety restrictions.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT News, and Lauren Weber of The Washington Post.

Among the takeaways from this week’s episode:

  • States are working to review Medicaid eligibility for millions of people as pandemic-era coverage rules lapse at the end of March, amid fears that many Americans kicked off Medicaid who are eligible for free or near-free coverage under the ACA won’t know their options and will go uninsured.
  • Biden promised this week to stop Republicans from “gutting” Medicaid and the ACA. But not all Republicans are on board with cuts to Medicaid. Between the party’s narrow majority in the House and the fact that Medicaid pays for nursing homes for many seniors, cutting the program is a politically dicey move.
  • A national group that pushed the use of ivermectin to treat covid-19 is now hyping the drug as a treatment for flu and RSV — despite a lack of clinical evidence to support their claims that it is effective against any of those illnesses. Nonetheless, there is a movement of people, many of them doctors, who believe ivermectin works.
  • In reproductive health news, a federal judge recently ruled that a Texas law cannot be used to prosecute groups that help women travel out of state to obtain abortions. And the abortion issue has highlighted the role of attorneys general around the country — politicizing a formerly nonpartisan state post. –And Eli Lilly announced plans to cut the price of some insulin products and cap out-of-pocket costs, though their reasons may not be completely altruistic: An expert pointed out that a change to Medicaid rebates next year means drugmakers soon will have to pay the government every time a patient fills a prescription for insulin, meaning Eli Lilly’s plan could save the company money.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New York Times’ “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins.

Alice Miranda Ollstein: The New York Times’ “Alone and Exploited, Migrant Children Work Brutal Jobs Across the U.S.,” by Hannah Dreier.

Rachel Cohrs: STAT News’ “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why,” by Sanjay Kishore and Suhas Gondi.

Lauren Weber: KHN and CBS News’ “This Dental Device Was Sold to Fix Patients’ Jaws. Lawsuits Claim It Wrecked Their Teeth,” by Brett Kelman and Anna Werner.

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

Readers and Tweeters Urgently Plea for a Proper ‘Role’ Call in the ER

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


How Physician Assistants and Nurse Practitioners Enhance Health Care

The story of one patient’s ER experience does not at all capture the complexities of an emergency department serving the needs of a stochastic patient population.

Given the reach of KHN, it is disappointing to read stories that inch closer to tabloid-level reporting (“Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs,” Feb. 13).

Having spent most of my career working in and operationalizing emergency departments, I can assure you that there are plenty of opportunities to optimize the delivery of care and reduce unnecessary waste and cost while maintaining excellent outcomes. The salient point that you make “it’s all about the money” is too simplistic given the complexities.

Advanced practice providers (APPs) collectively describe nurse practitioners (NPs), physician assistants (PAs), certified registered nurse anesthetists (CRNAs), and certified nurse midwives (CNMs). The term “midlevel practitioner” is outdated.

The archaic paternalistic approach to health care has long been overdue for change. Post-pandemic, it is critical to pivot from “the way it has always been done,” and that includes embracing new models of care.

Physicians and APPs provide excellent care to their patients and operate with different scopes of practice, training, and licensure. Therefore, most of us find working together in team-based models to be highly effective in ensuring that patients see the right care provider for the right health problem.

I found this reporting to be superficial and even offensive to nurse practitioners, like myself, who provide just as high quality care to patients as our physician colleagues.

I welcome the opportunity for dialogue about the value of nurse practitioners and physician assistants.

— Cindi Warburton, Spokane, Washington


— Mark Williams, Sacramento, California


I heard your NPR-partnered story on emergency rooms being managed by private equity and using fewer doctors and more nurse practitioners and physician assistants as midlevel practitioners.

But I prefer midlevel practitioners and medical residents, if their skills are relevant to me. They tend to be more careful in telling me what I should know and in entering records.

The professionally senior doctors (by years of experience and specialty, but I don’t know about board certification) tend to use record-keeping to support higher insurance reimbursement and then they don’t seem to believe what anyone else writes in the records, or don’t bother looking. Furthermore, they’re less likely to tell me what circumstances should prompt me to seek out a doctor or an ER, but if anything goes so wrong or becomes so advanced that I need even more care, they’re happy to provide it.

Doctors often categorically object to nurse practitioners, and state regulations reflect that.

— Nick Levinson, Brooklyn, New York



The recent KHN article “Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs” failed to address a critical consideration in the complexities of health care delivery today: the challenge of providing care to patients when they need it at a time when demand for care is on the rise, and the health care workforce is experiencing staggering levels of decline.

Today, 99 million Americans lack adequate access to primary care. By 2026, there will be a shortage of up to 3.2 million health care workers. As a physician associate/physician assistant for more than 20 years, I am kept up at night because of this perfect storm on the horizon — worried for my patients and their ability to access the care they need. Timely access to a trusted and qualified health care provider is never more pressing than during an emergency, when patients are at their most vulnerable, and delay in care can be a matter of life or death.

There is no easy answer to this impending workforce crisis, but one thing is clear: We can meet patient needs only if every member of today’s health care team is respected for the contributions they bring and can practice to the fullest extent of their education and training.

The fact is, without PAs, patients’ access to care would suffer. PAs account for more than 500 million patient visits each year. For many patients, PAs serve as primary care providers. And in some communities, PAs are the only health care providers. Let’s not lose sight of the countless stories we have all read in the media about community hospitals and clinics closing.

This article failed to take into account any research that shows the value and quality of PA-delivered care. For example, a 2021 study published by PLOS ONE looked at 39 studies across North America, Europe, and Africa between 1977 and 2021. In 33 of the 39 studies, researchers found care provided by a PA was comparable or better than care delivered by a physician. In 74% of the studies, resource and labor costs were lower when care was delivered by a PA versus a physician.

The quality of PA-delivered care can also be seen when looking at the ratio of liability claims. The ratio of claims to PAs averaged one claim for every 550 PAs. Compare this to the physician ratio, which averaged 1 claim for every 80 physicians.

Hiring PAs to practice in emergency medicine is not about “replacing” physicians, nor does it diminish the quality of care. Utilizing PAs in emergency medicine is about equipping health care teams with a wide range of highly educated and trained clinicians who can work together to ensure patients get the safe, high-quality care they need.

Let us stay focused on the reason why PAs, nurse practitioners, and physicians went into medicine in the first place: to care for people! Patient-centered, team-based care is about every single one of us contributing our knowledge, experience, and expertise to ensure the best outcomes for patients.

— Jennifer M. Orozco, American Academy of Physician Associates president and board chair, Chicago


— Whitney Schmucker, New York City


KHN should not be using the term “midlevel providers.” It’s a derogatory term used by doctors to belittle advanced practice providers (nurse practitioners and physician associates).

— Danielle Franklin, Minneapolis


— Gregg Gonsalves, New Haven, Connecticut


Nurse practitioners are essential providers in our nation’s current and future health care system. In an effort to highlight concerns related to health facility ownership models, the recent article “Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs” incorrectly represents the care provided by NPs in emergency rooms.

In fact, a recent study examining advanced practice providers (APPs), including NPs, in the ER found increasing APP coverage had no impact on flow, safety, or patient experiences in the emergency department. Additional research concluded that after controlling for patient severity and complexity, APPs diagnostic testing and hospitalization rates did not differ from physicians in patients presenting to the emergency department with chest and abdominal pain.

Prepared at the master’s or doctoral level, NPs provide primary, acute, chronic, and specialty care to patients of all ages and backgrounds. NPs practice in nearly every health care setting including hospitals, clinics, Veterans Health Administration and Indian Health Service facilities, emergency rooms, urgent care sites, private physician or NP practices, skilled nursing facilities and nursing facilities, schools, colleges and universities, retail clinics, public health departments, nurse-managed clinics, homeless clinics, and home health care settings. Collectively, NPs deliver high-quality care in more than 1 billion patient visits each year.

Grounded in 50 years of research and evidence-based practice, NPs deliver high-quality care, consistent with their physician counterparts. Results from a study of over 800,000 patients at 530 Veterans Affairs facilities found that patients assigned to NP primary care providers were less likely to utilize additional services, had no difference in costs, and experienced similar chronic disease management compared with physician-assigned patients. Furthermore, a comprehensive summary of studies examining NP quality of care from the American Enterprise Institute underscores the benefits of NP-led care.

Today, NPs represent 355,000 solutions to our nation’s health care needs. Patients deserve access to these high-quality health care providers wherever they seek care.

— April N. Kapu, president of the American Association of Nurse Practitioners, Austin, Texas


— Dr. Sarabeth Broder-Fingert, Boston


Ophthalmologists and Optometrists Aren’t Interchangeable

Increasing Americans’ access to care is critical. However, loosening the scope of practice for certain types of care can be counterproductive and potentially risky for patients (“Montana Considers Allowing Physician Assistants to Practice Independently,” Feb.10).

A small handful of states, for example, have loosened scope-of-practice laws for laser eye surgery, which, if done incorrectly, could lead to serious complications that can damage a person’s vision. Over the course of their medical school education, internships, and residencies, ophthalmologists must complete thousands of hours of training before being allowed to perform laser eye surgeries on their own.

Unfortunately, some states permit optometrists, who are not medical doctors, to perform laser eye surgeries as long as they complete a 16- to 32-hour course. As one might expect, the likelihood of a patient needing additional surgery is significantly higher — more than double — when initial surgeries are performed by an optometrist instead of an ophthalmologist. It is little wonder, then, why states like California have successfully blocked efforts to loosen the scope of practice for laser eye surgery.

Despite the potential risks, and no evidence of documented access issues, the Department of Veterans Affairs updated its community care guidelines last year to allow optometrists in this small number of states to perform laser eye surgery on veterans in community care settings. Worse still, the VA is developing its National Standards of Practice, which many fear would let optometrists in VA facilities nationwide perform laser eye surgery on America’s veterans. To defend our veterans and prevent them from suffering adverse outcomes, it is critical for the VA to maintain patient protections that ensure only medical doctors with the requisite education and training can perform invasive eye surgeries.

Ophthalmologists and optometrists both play important roles in a patient’s collaborative care team, but their duties and skill sets are not interchangeable. Loosening the scope of practice for laser eye surgeries will not serve patients well. Our veterans defended us; now the VA must protect them.

— Dr. Daniel J. Briceland, president of the American Academy of Ophthalmology, Sun City West, Arizona


— David Johnson, Chicago


We were disappointed that the article by Keely Larson about Montana’s consideration of a change in physician assistant regulation failed to note that the vast majority of research on the quality of care provided by physician assistants and nurse practitioners demonstrates that they have similar quality of care to physicians when practicing in their area of expertise. There are numerous literature reviews published in peer-reviewed journals on this topic, which should have been noted in the story. The author selected a single working paper that focuses on quality of care in emergency departments in a single health system (the Department of Veterans Affairs) that is not representative of the settings in which most physician assistants and nurse practitioners work. The individual cited, Dr. Yiqun Chen, extrapolated her working paper to the entire profession of physician assistants (who were not included in her study), which is a significant overreach.

We are accustomed to KHN stories being well researched and balanced. This story missed the mark and does not reflect well on the quality KHN aims to achieve.

— Joanne Spetz, Janet Coffman, and Ulrike Muench, the University of California-San Francisco


— Dr. Mehmet Oz, Bryn Athyn, Pennsylvania


At the Crux of Nursing Home Staffing Crunch: Compensation

I doubt it is possible to staff nursing facilities with qualified and caring staff when the compensation is quite poor and the work environment is very challenging (“Wave of Rural Nursing Home Closures Grows Amid Staffing Crunch,” Jan. 25). It is more a system problem than a staffing problem and will not get “fixed” without some serious changes.

— Dr. Jack Page, Durham, North Carolina


— Benjy Renton, Washington, D.C.


Participating in the Mental Illness Stigma

I wonder what is behind the pressure to persuade us to say there is a stigma to mental health issues (“Public Health Agencies Turn to Locals to Extend Reach Into Immigrant Communities,” Feb. 10)? I wonder why we so easily comply?

— Harold A. Maio, retired mental health editor, Fort Myers, Florida


— Andrzej Klimczuk, Bialystok, Poland


Remote Fitness Must Not Replace the Value of Physical Therapy

If we’ve learned anything in recent years, it’s how vital technology is in allowing us to stay connected virtually, especially when it comes to health care. However, the online world cannot safely and adequately replace everything.

The recent article “Rural Seniors Benefit From Pandemic-Driven Remote Fitness Boom” (Jan.17) details how many older Americans living in rural areas rely on virtual fitness classes to remain physically active. While this is an important and effective option for some seniors, remote fitness classes cannot and should not replace clinically directed physical therapy.

Physical therapy helps patients remain strong and independent by managing pain, preventing injury, and improving mobility, flexibility, and balance under the supervision of a professionally trained physical therapist. It’s especially important at a time when senior deaths from falls are on the rise. Evidence shows that when seniors underwent an exercise intervention from a trained health care professional, it lowered their risk of a fall by 31%.

Not only is it effective in rehabilitating patients, but it is also an affordable, lower-cost alternative to invasive surgeries and pharmacological treatments, saving our health care system millions. And now, with the emergence of remote therapeutic monitoring, physical therapists can more easily reach patients in rural communities to ensure they are reaching their clinical goals through safe, at-home therapy exercises.

Physical therapists undergo years of education and training to provide the best, safest care for their patients. And while I applaud seniors for embracing online fitness classes and staying active, I also encourage them to recognize when clinically supervised physical therapy is needed to protect their safety and health.

— Nikesh Patel, executive director of the Alliance for Physical Therapy Quality and Innovation (APTQI), Washington, D.C.


— Eric Weinhandl, Victoria, Minnesota


Tallying Bad Pennies

Did Your Health Plan Rip Off Medicare?” (Jan. 27) was a highly misleading article. On a per-enrollee per-year basis, over- and under-payments amounted to literally pennies. If you must pile on, focus on the few bad apples.

— Jon M. Kingsdale, Boston


— Inger Burnett-Zeigler, Chicago


How Much Did They Know and When Did They Know It?

Great story by Harris Meyer about Prentice and Lurie hospitals (“A Baby Spent 36 Days in an In-Network NICU. Why Did the Hospital Next Door Send a Bill?” Jan. 30). I was practicing as an anesthesiologist in Illinois in 2011 when the bill became law banning out-of-network balance billing for hospital-based docs. Of course we knew about the advent of the law: We had to enter into contracts to be in network, contracts that materially reduced all our doctors’ incomes!

It is impossible for me to believe that a professional operating a billing service in 2020 for Ann & Robert H. Lurie Children’s Hospital of Chicago didn’t know about this 2011 law. I don’t believe them for a moment.

Thanks for the great article.

— Ron Meyer, Wilmette, Illinois


— Regina Phelps, San Francisco


Leaving a Bad Taste in My Mouth

In every article I’ve read about Paxlovid, including yours (“What Older Americans Need to Know About Taking Paxlovid,” Dec. 18), not one mentions the horrible metallic taste these pills have. I was prescribed Paxlovid after contracting covid-19. I’m 71 years old. It’s beyond my reasoning that in this day and age a pharmaceutical manufacturer can’t put a neutral coating on the pills. This awful taste stays with you day and night for the five days of use. I even had a friend who had to stop taking them as she was losing sleep over the horrible taste. My reference to friends is: “It’s like sucking on a wrench.” I’m sure this issue isn’t confined to us seniors, but it would be nice to read some recognition of a problem with this medication.

By the way, my workaround, which definitely helps but is hardly a solution, is to swallow the pills down with a swig of cranberry juice.

— Don Dugan, Brookfield, Wisconsin


— Olav Mitchell Underdal, Irvine, California


Admiration for Abortion Doulas

I admire and respect individuals willing to provide aid and comfort to others who are going through either the traditional birth process or a hard decision to end a pregnancy (“In North Carolina, More People Are Training to Support Patients Through an Abortion,” Jan. 5). Kudos to news groups for increasing awareness of individuals and organizations providing valuable services for their fellow citizens.

— Michael Walker, Black Mountain, North Carolina


— Dr. Darrell Gray II, Owings Mills, Maryland


Thinking Outside the Traditional Medicine Box

Katheryn Houghton missed out on sharing info on traditional methods, especially acupuncture (“Why People Who Experience Severe Nausea During Pregnancy Often Go Untreated,” Jan. 13). Also ginger, as in ginger tea, and peppermint. Peppermint oil (sniffed) or tea. I am an advocate for people with cancer.

— Ann Fonfa, founder of the Annie Appleseed Project, Delray Beach, Florida


— Catherine Arnst, New York City


A Cartoon Blooper?

The “Gender reveal?” political cartoon (Feb. 14) was confusing, unfunny, and inaccurate. How is this “political”? (It isn’t.) What makes gender reveals funny? (They’re not.) Most importantly, such reveals — an anachronistic cultural tradition that should be done away with anyway — are “sex reveals,” not “gender reveals.” (Biology is based on anatomy at birth, while gender is self-determined later in life and is fluid over time.) Even sex reveals are problematic, as they assume two biological sexes. (Some estimates indicate nearly 2% of individuals are born intersex, with their sexual anatomy not fitting into categories of either female or male.)

With anti-trans and anti-drag queen legislation being proposed and codified seemingly daily, now is not the time to poke fun at, nor inaccurately represent, the construct of gender. (It’s never the time.)

— Steff Du Bois, licensed clinical psychologist, Chicago



Keeping Marijuana Candy Away From Children

As an emergency room doctor, I was disappointed by the recent “KHN Health Minute” story trivializing a growing public health risk by suggesting parents “lock up their marijuana gummies” to avoid poisoning their children (“Listen to the Latest ‘KHN Health Minute,’” Feb. 16).

For background on why I, and other doctors, are concerned, I encourage you to read “Marijuana Candy: Poisoning and Lack of Protection for Children.”

— Dr. Roneet Lev, San Diego


— Halee Fischer-Wright, Denver


A Suggestion for Extra-Credit Reading

In response to the recent “What the Health?” podcast episode “As US Bumps Against Debt Ceiling, Medicare Becomes a Bargaining Chip” (Jan. 19), please have Julie Rovner read Stephanie Kelton’s book “The Deficit Myth.” She needs to understand why taxes pay for nothing. I consider Kelton’s book the most important on economics and how government budgets and financing work in the modern world.

— Mark Schaffer, Las Vegas


— Iqbal Atcha, Hanover Park, Illinois


Investing in ‘Practice-Ready’ Nurses to Bolster Workforce

The Connecticut Center for Nursing Workforce Inc. has created a best-practice plan to address these issues (“Senators Say Health Worker Shortages Ripe for Bipartisan Compromise,” Feb. 17). As nursing is the largest health care workforce role and a critical infrastructure within the state, nurses are a significant contributor to the fiscal, physical, and mental health of Connecticut, and a profession that can provide economic stability to its workers and families. Over 10,000 qualified nursing students were denied admission to registered nursing programs in 2021 due to full-time and part-time faculty shortages, lack of student clinical placements, and capacity of capstone experiences in specialty areas.

To produce “practice-ready” nurses, investment needs to be made in increasing the number of nursing faculty lines, both full-time (classroom) and part-time (clinical) experiences, simulation capacity and expertise, operations staff, and transition to practice resources.

Today, this is more challenging than ever, due to the impact of covid-19 on our nursing workforce, the natural attrition of our older nurses, early departure of new nurses causing a severe nursing shortage in the state, and the cost of “travel” nurses that is crippling the budgets of our health care facilities and not sustainable over the long term.

Nursing schools are competing for the same nursing human capital as our practice settings yet offer 30% less compensation for faculty roles as compared to clinical practice roles.

As a solution, it is critical to:

  1. Engage nursing schools to identify the demand for full-time and part-time faculty lines and staff.
  2. Develop a nurse faculty marketing campaign for associate, baccalaureate, accelerated registered nurse programs, and master’s degree in nursing programs for both full-time and part-time roles.
  3. Capitalize on the expertise of clinical nurses for the role of part-time clinical nurse faculty.
  4. Engage health care facilities to determine current nurse vacancies, future staffing needs, and onboarding/“transition to practice” gaps to best inform educational institutions as to the programs needed to be continued, expanded, or dissolved; thereby, maximizing education capacity, resources, faculty, and staff.

— Marcia Proto, executive director for the Connecticut Center for Nursing Workforce Inc., North Haven, Connecticut


— RJ Connelly III, Pawtucket, Rhode Island


Missing Pieces in the Covid Data Puzzle

It is misinformation to state that covid-19 deaths were counted when the opposite was true, and deaths were underreported due to political reasons, and reasons of expediency (“FDA Experts Are Still Puzzled Over Who Should Get Which Covid Shots and When,”) Jan. 27. For example, my father-in-law tested positive for covid before entering the hospital, and then repeatedly tested positive for covid while in the hospital so that he could not be released, and he died in the hospital, and covid was not listed as a cause of death on his death certificate. I have reason to believe that my own father died of covid in May 2020, during an election year, and covid was not listed as a cause of death on his death certificate. These men were not merely statistics, but left behind families who are still in turmoil and grief.

In public, people should wear masks all the time regardless of vaccination status, but, at the same time, be updated on vaccinations and boosters, and, at the same time, socially distance, and, at the same time, wash hands frequently and thoroughly. While all these measures should be taken simultaneously, everyone wearing masks is the easiest way to monitor compliance, and eliminates problems in determining someone else’s vaccination status, or determining whether the efficacy of their vaccines may have waned, or in determining whether they tested positive for covid, and failed to quarantine.

When, previously, the science was that vaccines and booster efficacy waned after three to six months, it should not be touted now to get the vaccine or booster only once a year.

The goal post should never have been moved to merely keeping people out of the hospital, but the goal should be to prevent people contracting covid, and to eradicate this scourge once and for all.

— Edward H. Bonacci Jr., Apex, North Carolina

Senators Have Mental Health Crises, Too

The Host

Both Republicans and Democrats in Congress reacted with compassion to the news that Sen. John Fetterman (D-Pa.) has checked himself into Walter Reed National Military Medical Center for treatment of clinical depression. The reaction is a far cry from what it would have been 20 or even 10 years ago, as more politicians from both parties are willing to admit they are humans with human frailties.

Meanwhile, former South Carolina governor and GOP presidential candidate Nikki Haley is pushing “competency” tests for politicians over age 75. She has not specified, however, who would determine what the test should include and who would decide if politicians pass or fail.

This week’s panelists are Julie Rovner of KHN, Sarah Karlin-Smith of the Pink Sheet, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachel Roubein of The Washington Post.

Among the takeaways from this week’s episode:

  • Acknowledging a mental health disorder could spell doom for a politician’s career in the past, but rather than raising questions about his fitness to serve, Sen. John Fetterman’s decision to make his depression diagnosis and treatment public raises the possibility that personal experiences with the health system could make lawmakers better representatives.
  • In Medicare news, Sen. Rick Scott (R-Fla.) dropped Medicare and Social Security from his proposal to require that every federal program be specifically renewed every five years. Scott’s plan has been hammered by Democrats after President Joe Biden criticized it this month in his State of the Union address.
  • Medicare is not politically “untouchable,” though. Two Biden administration proposals seek to rein in the high cost of the popular Medicare Advantage program. Those are already proving controversial as well, particularly among Medicare beneficiaries who like the additional benefits that often come with the private-sector plans.
  • New studies on the effectiveness of ivermectin and mask use are drawing attention to pandemic preparedness. The study of ivermectin revealed that the drug is not effective against the covid-19 virus even in higher doses, raising the question about how far researchers must go to convince skeptics fed misinformation about using the drug to treat covid. Also, a new analysis of studies on mask use leaned on pre-pandemic studies, potentially undermining mask recommendations for future health crises.
  • On the abortion front, abortion rights supporters in Ohio are pushing for a ballot measure enshrining access to the procedure in its state constitution, while a lawyer in Florida is making an unusual “personhood” argument to advocate for a pregnant woman to be released from jail.

Plus for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat’s “Current Treatments for Cramps Aren’t Cutting It. Why Aren’t There Better Options,” by Calli McMurray

Joanne Kenen: The Atlantic’s “Eagles Are Falling, Bears Are Going Blind,” by Katherine J. Wu

Rachel Roubein: The Washington Post’s “Her Baby Has a Deadly Diagnosis. Her Florida Doctors Refused an Abortion,” by Frances Stead Sellers

Sarah Karlin-Smith: DCist’s “Locals Who Don’t Speak English Need Medical Translators, but Some Say They Don’t Always Get the Service,” by Amanda Michelle Gomez and Hector Alejandro Arzate

Also mentioned in this week’s podcast:


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A Health-Heavy State of the Union

The Host

Health care was a recurring theme throughout President Joe Biden’s 2023 State of the Union address on Capitol Hill this week. He took a victory lap on recent accomplishments like capping prescription drug costs for seniors on Medicare. He urged Congress to do more, including making permanent the boosted insurance premium subsidies added to the Affordable Care Act during the pandemic. And he sparred with Republicans in the audience — who jeered and called him a liar — over GOP proposals that would cut Medicare and Social Security.

Meanwhile, abortion rights advocates and opponents are anxiously awaiting a federal court decision out of Texas that could result in a nationwide ban on mifepristone, one of two drugs used in medication abortion.

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

Among the takeaways from this week’s episode:

  • President Joe Biden’s State of the Union address emphasized recent victories against high health care costs, like Medicare coverage caps on insulin and out-of-pocket caps on prescription drug spending. Biden’s lively, informal exchange with lawmakers over potential cuts to Medicare and Social Security seemed to steal the show, though the political fight over cutting costs in those entitlement programs is rooted in a key question: What constitutes a “cut”?
  • Biden’s calls for bipartisanship to extend health programs like pandemic-era subsidies for Affordable Care Act health plans are expected to clash with conservative demands to slash federal government spending. And last year’s Senate fights demonstrate that sometimes the opposition comes from within the Democratic Party.
  • While some abortion advocates praised Biden for vowing to veto a federal abortion ban, others felt he did not talk enough about the looming challenges to abortion access in the courts. A decision is expected soon in a Texas court case challenging the future use of mifepristone. The Trump-appointed judge’s decision could ban the drug nationwide, meaning it would be barred even in states where abortion continues to be legal.
  • The FDA is at the center of the abortion pill case, which challenges its approval of the drug decades ago and could set a precedent for legal challenges to the approval of other drugs. In other FDA news, the agency recently changed policy to allow gay men to donate blood; announced new food safety leadership in response to the baby formula crisis; and kicked back to Congress a question of how to regulate CBD, or cannabidiol, products.
  • In drug pricing, the top-selling pharmaceutical, Humira, will soon reach the end of its patent, which will offer a telling look at how competition influences the price of biosimilars — and the problems that remain for lawmakers to resolve.

Also this week, Rovner interviews Kate Baicker of the University of Chicago about a new paper providing a possible middle ground in the effort to establish universal health insurance coverage in the U.S.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too:

Julie Rovner: The New York Times’ “Don’t Let Republican ‘Judge Shoppers’ Thwart the Will of Voters,” by Stephen I. Vladeck

Alice Miranda Ollstein: Politico’s “Mpox Is Simmering South of the Border, Threatening a Resurgence,” by Carmen Paun

Sarah Karlin-Smith: KHN’s “Decisions by CVS and Optum Panicked Thousands of Their Sickest Patients,” by Arthur Allen

Rachel Cohrs: ProPublica’s “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings,” by David Armstrong, Patrick Rucker, and Maya Miller

Also mentioned in this week’s podcast:


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And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

The Medicine Is a Miracle, but Only if You Can Afford It

A wave of new treatments have cured devastating diseases. When the costs are too much, even for the insured, patients hunt for other ways to pay.

Au Revoir, Public Health Emergency

The Host

The public health emergency in effect since the start of the covid-19 pandemic will end on May 11, the Biden administration announced this week. The end of the so-called PHE will bring about a raft of policy changes affecting patients, health care providers, and states. But Republicans in Congress, along with some Democrats, have been agitating for an end to the “emergency” designation for months.

Meanwhile, despite Republicans’ less-than-stellar showing in the 2022 midterm elections and broad public support for preserving abortion access, anti-abortion groups are pushing for even stronger restrictions on the procedure, arguing that Republicans did poorly because they were not strident enough on abortion issues.

This week’s panelists are Julie Rovner of KHN, Victoria Knight of Axios, Rachel Roubein of The Washington Post, and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s episode:

  • This week the Biden administration announced the covid public health emergency will end in May, terminating many flexibilities the government afforded health care providers during the pandemic to ease the challenges of caring for patients.
  • Some of the biggest covid-era changes, like the expansion of telehealth and Medicare coverage for the antiviral medication Paxlovid, have already been extended by Congress. Lawmakers have also set a separate timetable for the end of the Medicaid coverage requirement. Meanwhile, the White House is pushing back on reports that the end of the public health emergency will also mean the end of free vaccines, testing, and treatments.
  • A new KFF poll shows widespread public confusion over medication abortion, with many respondents saying they are unsure whether the abortion pill is legal in their state and how to access it. Advocates say medication abortion, which accounts for about half of abortions nationwide, is the procedure’s future, and state laws regarding its use are changing often.
  • On abortion politics, the Republican National Committee passed a resolution urging candidates to “go on the offense” in 2024 and push stricter abortion laws. Abortion opponents were unhappy that Republican congressional leaders did not push through a federal gestational limit on abortion last year, and the party is signaling a desire to appeal to its conservative base in the presidential election year.
  • This week, the federal government announced it will audit Medicare Advantage plans for overbilling. But according to a KHN scoop, the government will limit its clawbacks to recent years, allowing many plans to keep the money it overpaid them. Medicare Advantage is poised to enroll the majority of seniors this year.

Also this week, Rovner interviews Hannah Wesolowski of the National Alliance on Mental Illness about how the rollout of the new 988 suicide prevention hotline is going.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Axios’ “Republicans Break With Another Historical Ally: Doctors,” by Caitlin Owens and Victoria Knight

Margot Sanger-Katz: The New York Times’ “Most Abortion Bans Include Exceptions. In Practice, Few Are Granted,” by Amy Schoenfeld Walker

Rachel Roubein: The Washington Post’s “I Wrote About High-Priced Drugs for Years. Then My Toddler Needed One,” by Carolyn Y. Johnson

Victoria Knight: The New York Times’ “Emailing Your Doctor May Carry a Fee,” by Benjamin Ryan

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.