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Sen. Sanders Shows Fire, but Seeks Modest Goals, in His Debut Drug Hearing as Health Chair

Sen. Bernie Sanders, who rose to national prominence criticizing big business in general and the pharmaceutical industry in particular, claimed the spotlight Wednesday on what might at first seem a powerful new stage from which to advance his agenda: chairmanship of the Senate health committee.

But the hearing Sanders used to excoriate a billionaire pharmaceutical executive for raising the price of a covid-19 vaccine showed the challenges the Vermont independent faces.

Though its formal name is the Committee on Health, Education, Labor, and Pensions (HELP), the panel Sanders chairs has little if any authority over drug prices. In the Senate, most of that leverage lies with the Finance Committee, which oversees Medicaid, Medicare, and Obamacare.

As far as drug prices go, the platform Sanders commands is essentially a bully pulpit. So Sanders was left to bully his way toward results. And while some committee Republicans sympathized with his complaints, others bristled at his approach.

By the end of the hearing, seeming to acknowledge the limits of his power, the former presidential candidate was pleading with Moderna chief executive Stéphane Bancel for a relatively modest concession on vaccine pricing.

The CEO made no promises. Then again, pulpit proclamations can lead to corporate action, even if delayed and informal; in the weeks following President Joe Biden’s State of the Union call for cheaper insulin, the companies that make it drastically cut their prices.

Sanders began Wednesday’s hearing with his usual fire and brimstone.

“All over this country people are getting sicker, and in some cases dying, because they can’t afford the outrageous cost of prescription drugs, while companies make huge profits and executives become billionaires,” Sanders thundered.

Bancel had won his place in the witness chair with federal assistance. Moderna, which was founded in 2010 and had not brought a drug to market before the pandemic, received billions in government funds for research, guaranteed purchases, and expert advice to help develop and produce its successful covid vaccine. The payoff has been handsome. As of March 8, Bancel held $3 billion in Moderna stock. He also held options to buy millions of additional shares.

Government research and support are foundational to many of the expensive drugs and vaccines in use today. But Bancel made himself the perfect foil for Sanders when he announced in January that Moderna planned to increase the price of its latest covid shot from about $26 to $110 — or as much as $130.

Denouncing greed, Sanders expounded on his dream of a system in which the government fully funds drug development — and in exchange controls drug prices. “Is there another model out there where, when a lifesaving drug is made, it becomes accessible to all those who need it?” he asked. “What am I missing in thinking that it’s cruel to make a medicine that people can’t afford?’”

Sanders’ overt moralizing and harsh attacks on big business make him an outlier in the Senate, even in his own party. Yet distaste for soaring drug prices extends across the aisle. On the HELP Committee, at least, Republican politicians seem about evenly split between populist and pro-business takes on the problem, showing both the possibilities and the pitfalls that Sanders faces.

Sen. Mike Braun (R-Ind.) expressed disgust with the lack of transparency in the health care system and called Moderna’s planned price hike “preposterous.” Sen. Roger Marshall (R-Kan.) called it “outrageous.”

Sen. Rand Paul (R-Ky.), who often bucks mainstream GOP views and has expressed rancor for the biomedical establishment, claimed Bancel was downplaying vaccine injuries to make money. (Paul vastly exaggerated those risks.)

Ranking member Bill Cassidy (R-La.), who has pledged to work with Sanders, responded to the chairman’s opening remarks with both a hedge and a warning. “I’m not defending salaries or profits,” Cassidy said, but he added that he hoped the hearing’s goal wasn’t to “demonize capitalism.”

Only Sen. Mitt Romney (R-Utah), a former private equity executive, came heartily to Bancel’s defense. “If I’m an investor, I have to expect that if a product I’m backing works, I get to make an awful lot of money,” he said. “I’ve heard people say, ‘That’s corporate greed.’ Yeah, that’s how it works.”

Sanders’ idealized vision of the pharmaceutical industry is, in any case, moot. Even the Biden administration, which successfully browbeat insulin makers into drastically lowering prices in March, revealed this week it would not use “march-in” rights to lower the price of a cancer drug, Xtandi, developed with government-licensed patents.

March-in rights were established in the 1980 Bayh-Dole Act, which enabled companies to license federally funded research and use it to develop drugs. But federal courts and administrations have consistently said the government can seize a product only if the license holder has failed to make it available — not because the price is too high. The administration did, however, announce a review of whether price might be considered in future march-in decisions.

Sanders said before the hearing that he was “extremely disappointed” with the Xtandi decision. But he was ultimately realist enough to aim his bully pulpit at a lower target. Late in Wednesday’s hearing, Sanders pushed for a minimal gimme from Moderna. “Will you reconsider your decision to quadruple the price of your vaccine to the U.S. government and its agents?” he asked politely.

Bancel dodged, saying pricing was more complex now that Moderna faced an uncertain market, had to fill separate syringes with its vaccine, and needed to sell and distribute the vaccine to thousands of pharmacies, where previously the government did all that work. Later, he left open the possibility that negotiations could drive down the price paid by some government agencies or private insurers.

For all the theatrics of such hearings and the mix of opinions among the senators, interrogations of figures like Bancel may help inspire a shift in how the National Institutes of Health “does business in giving away its science to the private sector,” said Tahir Amin, co-executive director of I-MAK, a nonprofit that advocates for equitable access to medicines.

“You have to prosecute it so you at least get these public comments on record,” Amin said. Eventually, he said, this type of hearing could lead to a recognition that, ‘Hey, we need to do this.’”

Despite the HELP Committee’s lack of direct jurisdiction over drug prices, said John McDonough, a Harvard professor who was senior adviser for health reform on the HELP Committee from 2008 to 2010, Sanders “uses his position of authority and influence to draw attention to this in a way that has been helpful.”

KHN correspondent Rachana Pradhan contributed to this report.

The Policy, and Politics, of Medicare Advantage

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Medicare Advantage, the private-sector alternative to original Medicare, now enrolls nearly half of all Medicare beneficiaries. But it remains controversial because — while most of its subscribers like the extra benefits many plans provide — the program frequently costs the federal government more than if those seniors remained in the fully public program. That controversy is becoming political, as the Biden administration tries to rein in some of those payments without being accused of “cutting” Medicare.

Meanwhile, President Joe Biden has signed a bill to declassify U.S. intelligence about the possible origin of covid-19 in China. And new evidence has emerged potentially linking the virus to raccoon dogs at an animal market in Wuhan, where the virus reportedly first took hold.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.

Among the takeaways from this week’s episode:

  • The Biden administration recently changed the formula used to calculate how much the federal government pays private Medicare Advantage plans to care for patients with serious conditions, amid allegations that many of the health plans overcharge or even defraud the government. Major insurers are making no secret about how lucrative the program can be: Humana recently said it would leave the commercial insurance market and focus on government-funded programs, like its booming Medicare Advantage plans.
  • The formula change is intended to rein in excess spending on Medicare — a huge, costly program at risk of insolvency — yet it has triggered a lobbying blitz, including a vigorous letter-writing campaign in support of the popular Medicare Advantage program. On Capitol Hill, though, party leaders have not stepped up to defend private insurers as aggressively as they have in the past. But the 2024 campaign season could hear the parties trading accusations over whether Biden cut Medicare or, conversely, protected it.
  • The latest maternal mortality rates released by the Centers for Disease Control and Prevention show the problem continued to worsen during the pandemic. Many states have extended Medicaid coverage for a full year after women give birth, in an effort to improve care during that higher-risk period. But other problems limit access to postpartum care. During the pandemic, some women did not get prenatal care. And after the fall of Roe v. Wade, some states are having trouble securing providers — including one rural Idaho hospital, which announced it will stop delivering babies.
  • The federal government will soon declassify intelligence related to the origins of the covid pandemic. In the United States, the fight over what started the pandemic has largely morphed into an issue of political identity, with Republicans favoring the notion that a Chinese lab leak started the global health crisis that killed millions, while Democrats are more likely to believe it was animal transmission tied to a wet market.
  • And in drug price news, Sanofi has become the third major insulin maker (of three) to announce it will reduce the price on some of its insulin products ahead of a U.S. government policy change next year that could have cost the company.

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

Julie Rovner: Vice News’ “Inside the Private Group Where Parents Give Ivermectin to Kids With Autism,” by David Gilbert

Jessie Hellmann: The Washington Post’s “Senior Care Is Crushingly Expensive. Boomers Aren’t Ready,” by Christopher Rowland

Joanne Kenen: The New Yorker’s “Will the Ozempic Era Change How We Think About Being Fat and Being Thin?” by Jia Tolentino

Margot Sanger-Katz: Slate’s “You Know What? I’m Not Doing This Anymore,” by Sophie Novack

Also mentioned on this week’s podcast:

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Some Roadblocks to Lifesaving Addiction Treatment Are Gone. Now What?

For two decades — as opioid overdose deaths rose steadily — the federal government limited access to buprenorphine, a medication that addiction experts consider the gold standard for treating patients with opioid use disorder. Study after study shows it helps people continue addiction treatment while reducing the risk of overdose and death.

Clinicians who wanted to prescribe the medicine had to complete an eight-hour training. They could treat only a limited number of patients and had to keep special records. They were given a Drug Enforcement Administration registration number starting with X, a designation many doctors say made them a target for drug-enforcement audits.

“Just the process associated with taking care of our patients with a substance use disorder made us feel like, ‘Boy, this is dangerous stuff,’” said Dr. Bobby Mukkamala, who chairs an American Medical Association task force addressing substance use disorder.

“The science doesn’t support that but the rigamarole suggested that.”

That rigamarole is mostly gone. Congress eliminated what became known as the “X-waiver” in legislation President Joe Biden signed late last year. Now begins what some addiction experts are calling a “truth serum moment.”

Were the X-waiver and the burdens that came with it the real reason only about 7% of clinicians in the U.S. were cleared to prescribe buprenorphine? Or were they an excuse that masked hesitation about treating addiction, if not outright disdain for these patients?

There’s great optimism among some leaders in the field that getting rid of the X-waiver will expand access to buprenorphine and reduce overdoses. One study from 2021 shows taking buprenorphine or methadone, another opioid agonist treatment, reduces the mortality risk for people with opioid dependence by 50%. The medication is an opioid that produces much weaker effects than heroin or fentanyl and reduces cravings for those deadlier drugs.

The nation’s drug czar, Dr. Rahul Gupta, said getting rid of the X-waiver would ultimately prevent millions of deaths.

“The impact of this will be felt for years to come,” Gupta said. “It is a true historic change that, frankly, I could only dream of being possible.”

Gupta and others envision obstetricians prescribing buprenorphine to their pregnant patients, infectious disease doctors adding it to their medical toolbox, and lots more patients starting buprenorphine when they come to emergency rooms, primary care clinics, and rehabilitation facilities.

We are “transforming the way we think to make every moment an opportunity to start this treatment and save someone’s life,” said Dr. Sarah Wakeman, the medical director for substance use disorder at Mass General Brigham in Boston.

Wakeman said clinicians she has been contacting for the past decade are finally willing to consider treating patients with buprenorphine. Still, she knows stigma and discrimination could undermine efforts to help those who aren’t being served. In 2021, a national survey showed just 22% of people with opioid use disorder received medications such as buprenorphine and methadone.

The test of whether clinicians will step up and if prescribing will become more widespread is underway in hospitals and clinics across the country as patients struggling with addiction queue up for treatment. A woman named Kim, 65, is among them.

Kim’s recent visit to the Greater New Bedford Community Health Center in southern Massachusetts began in an exam room with Jamie Simmons, a registered nurse who runs the center’s addiction treatment program but doesn’t have prescribing powers. KHN agreed to use only Kim’s first name to limit potential discrimination linked to her drug use.

Kim told Simmons that buprenorphine had helped her stay off heroin and avoid an overdose for nearly 20 years. Kim takes a medication called Suboxone, a combination of buprenorphine and naloxone, which comes in the form of thin, filmlike strips she dissolves under her tongue.

“It’s the best thing they could have ever come out with,” Kim said. “I don’t think I ever even had a desire to use heroin since I’ve been taking them.”

Buprenorphine can produce mild euphoria and slow breathing but there’s a ceiling on the effects. Patients like Kim may develop a tolerance and not experience any effects.

“I don’t get high on Suboxones,” Kim said. “They just keep me normal.”

Still, many clinicians have been hesitant to use buprenorphine — known as a partial opioid agonist — to treat an addiction to more deadly forms of the drug.

Kim’s primary care doctor at the health center never applied for an X-waiver. So for years Kim bounced from one treatment program to another, seeking a prescription. During lapses in her access to buprenorphine, the cravings returned — an especially scary prospect after the powerful opioid fentanyl largely replaced heroin on the streets of Massachusetts, where Kim lives.

“I’ve seen so many people fall out in the last month,” Kim said, using a slang term for overdosing. “That stuff is so strong that within a couple minutes, boom.”

Because fentanyl can kill so quickly, the benefits of taking buprenorphine and other medications to treat opioid use disorder have increased as deaths linked to even stronger types of fentanyl rise.

Buprenorphine is present in a small percentage of overdose deaths nationwide, 2.6%. Of those, 93% involved a mix of one or more other drugs, often benzodiazepines. Fentanyl is in 94% of overdose deaths in Massachusetts.

“Bottom line is, fentanyl kills people, buprenorphine doesn’t,” Simmons said.

That reality added urgency to Kim’s health center visit because Kim took her last Suboxone before arriving; her latest prescription had run out.

Cravings for heroin could have returned in about a day if she didn’t get more Suboxone. Simmons confirmed the dose and told Kim that her primary care doctor might be willing to renew the prescription now that the X-waiver is not required. But Dr. Than Win had some concerns after reviewing Kim’s most recent urine test. It showed traces of cocaine, fentanyl, marijuana, and Xanax, and Win said she was worried about how the street drugs might interact with buprenorphine.

“I don’t want my patients to die from an overdose,” Win said. “But I’m not comfortable with the fentanyl and a lot of narcotics in the system.”

Kim was adamant that she did not intentionally ingest fentanyl, saying it might have been in the cocaine she said her roommate shares occasionally. Kim said she takes the Xanax to sleep. Her drug use presents complications that many primary care doctors don’t have experience managing. Some clinicians are apprehensive about using an opioid to treat an addiction to opioids, despite compelling evidence that doing so can save patients’ lives.

Win was worried about writing her first prescription for Suboxone. But she agreed to help Kim stay on the medication.

“I wanted to start with someone a little bit easier,” Win said. “It’s hard for me; that’s the reality and truth.”

About half of the providers at the Greater New Bedford health center had an X-waiver when it was still required. Attributing some of the resistance to having the waiver to stigma or misunderstanding about addiction, Simmons urged doctors to treat addiction as they would any other disease.

“You wouldn’t not treat a diabetic; you wouldn’t not treat a patient who is hypertensive,” Simmons said. “People can’t control that they formed an addiction to an opiate, alcohol, or a benzo.”

Searching for Solutions to Soften Stigma

Although the restrictions on buprenorphine prescribing are no longer in place, Mukkamala said the perception created by the X-waiver lingers.

“That legacy of elevating this to a level of scrutiny and caution —that needs to be sort of walked back,” Mukkamala said. “That’s going to come from education.”

Mukkamala sees promise in the next generation of doctors, nurse practitioners, and physician assistants coming out of schools that have added addiction training. The AMA and the American Society of Addiction Medicine have online resources for clinicians who want to learn on their own.

Some of these resources may help fulfill a new training requirement for clinicians who prescribe buprenorphine and other controlled narcotics. It will take effect in June. The DEA has not issued details about the training.

But training alone may not shift behavior, as Rhode Island’s experience shows.

The number of Rhode Island practitioners approved to prescribe buprenorphine increased roughly threefold from 2016 to 2022 after the state said physicians in training should obtain an X-waiver. Still, having the option to prescribe buprenorphine “didn’t open the floodgates” for patients in need of treatment, said Dr. Jody Rich, an addiction specialist who teaches at Brown University. From 2016 to 2022, when the number of qualified prescribers increased, the number of patients taking buprenorphine also increased, but by a much smaller percentage.

“It all comes back to stigma,” Rich said.

He said long-standing resistance among some providers to treating addiction is shifting as younger people enter medicine. But tackling the opioid crisis can’t wait for a generational change, he said. To expand buprenorphine access now, states could use pharmacists, partnered with doctors, to help manage the care of more patients with opioid use disorder, Rich’s research shows.

Wakeman, at Mass General Brigham, said it might be time to hold clinicians who don’t provide addiction care accountable through quality measures tied to payments.

“We’re expected to care for patients with diabetes or to care for patients with heart attack in a certain way and the same should be true for patients with an opioid use disorder,” Wakeman said.

One quality measure to track could be how often prescribers start and continue buprenorphine treatment. Wakeman said it would help also if insurers reimbursed clinics for the cost of staff who aren’t traditional clinicians but are critical in addiction care, like recovery coaches and case managers.

Will Ending the X-Waiver Close Racial Gaps?

Wakeman and others are paying especially close attention to whether eliminating the X-waiver helps narrow racial gaps in buprenorphine treatment. The medication is much more commonly prescribed to white patients with private insurance or who can pay cash. But there are also stark differences by race at some health centers where most patients are on Medicaid and would seem to have equal access to the addiction treatment.

At the New Bedford health center, Black patients represent 15% of all patients but only 6% of those taking buprenorphine. For Hispanics, it is 30% to 23%. Most of the health center patients prescribed buprenorphine, 61%, are white, though white patients make up just 36% of patients overall.

Dr. Helena Hansen, who co-authored a book on race in the opioid epidemic, said access to buprenorphine doesn’t guarantee that patients will benefit from it.

“People are not able to stay on a lifesaving medication unless the immense instability in housing, employment, social supports — the very fabric of their communities — is addressed,” Hansen said. “That’s where we fall incredibly short in the United States.”

Hansen said expanding access to buprenorphine has helped reduce overdose deaths dramatically among all drug users in France, including those with low incomes and immigrants. There, patients with opioid use disorder are seen in their communities and offered a wide range of social services.

“Removing the X-waiver,” Hansen said, “is not in itself going to revolutionize the opioid overdose crisis in our country. We would need to do much more.”

This article is part of a partnership that includes WBURNPR, and KHN.

Judge Signals He Could Rule to Halt Sales of Common Abortion Pill

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During a four-hour hearing last week that could eliminate nationwide access to a common and widely used abortion pill, federal Judge Matthew Kacsmaryk, of the Northern District of Texas, signaled his conservative Christian beliefs early and often.

Speaking from the bench in a courtroom in Amarillo, Texas, Kacsmaryk repeatedly used language that mimicked the vocabulary of anti-abortion activists. It also reflected the wording of the lawyers seeking to overturn the FDA’s two-decade-old approval of mifepristone, one of the drugs in the two-pill regimen approved for early pregnancy termination.

Each time a lawyer from the Department of Justice, representing the FDA, referred to “medication abortion,” Kacsmaryk returned to the language of conservative Christian activists, using monikers like “chemical abortion” and “mail-in abortion,” phrases at odds with conventional medical terminology.

The stakes in the case, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, are high: Abortion rights advocates fear that Kacsmaryk, an appointee of then-President Donald Trump and a former lawyer at the First Liberty Institute, a conservative Christian legal group, could rule within days to force manufacturers to pull mifepristone from the market nationwide. If that happens, clinics and obstetricians and gynecologists across the country will be able to prescribe only misoprostol, the second drug in the two-pill regimen, for miscarriages and early abortion care. Misoprostol is still extremely safe but less effective and comes with more side effects.

The ruling would be unprecedented in the history of approved drugs and could affect the health care of millions of women, even those in states where abortion is still legal.

“One conservative judge is impacting the rights of women in California and New York,” said Greer Donley, an associate professor of law at the University of Pittsburgh Law School and expert on reproductive health law. “The endgame is to stop as many abortions as possible by any means necessary.”

When the conservative majority on the Supreme Court eliminated the federal right to abortion, Justice Brett Kavanaugh, a Catholic, wrote that the court was not outlawing abortion throughout the United States. “On the contrary,” Kavanaugh wrote, “the Court’s decision properly leaves the question of abortion for the people and their elected representatives in the democratic process.”

But in the nine months since the announcement of the decision in Dobbs v. Jackson Women’s Health Organization, Christian legal groups have made their strategy clear: eliminate abortion nationwide by filing lawsuits in federal courts that make scientific claims, unsupported by mainstream medical organizations, to raise doubts about the safety of abortion pills and contraception.

These legal decisions, which conservatives might once have decried as “judicial activism,” are partially necessary because abortion rights continually poll positively, with voters even in solidly conservative states like Kansas and Kentucky refusing to enact bans.

“After Dobbs, there have been more and more efforts to move things away from the popular majority and into the hands of judges like Kacsmaryk,” said Mary Ziegler, a law professor and abortion historian at the University of California-Davis School of Law. “Because voters are not sold on fetal rights and because the only way to a national ban on abortion is likely to come from the conservative courts,” she said.

Ziegler added of anti-abortion campaigners, “They don’t want solutions that work only in Tennessee and Texas.”

The strategy of casting doubt on established and accepted science is not new in conservative circles, nor is it limited to abortion.

For decades, conservative Christian legal groups have introduced scientific uncertainty where there had been none: Claims that abortion causes breast cancer or infertility are unsupported by medical and scientific research but nevertheless made their way into state laws, requiring physicians in certain states to tell patients about risks from abortion that do not exist.

And in a recent opinion that ended birth control access for teens without parental consent in Texas, the same judge as in the mifepristone case — Kacsmaryk — exaggerated the health risks of prescription birth control in his decision, asserting that states have an interest in protecting the health of girls.

“Several popular methods of birth control carry serious side effects,” Kacsmaryk wrote, later quoting from Planned Parenthood educational material that read, “Complications are rare, but they can be serious. In very rare cases, they can lead to death.”

That case, Deanda v. Becerra, was filed by a Christian father who cited religious objections to a federal family planning program. And in the mifepristone case, fundamentalist Christian groups have argued that the drug is unsafe, despite ample research and decades of use testifying to the contrary.

Alliance Defending Freedom, which describes itself as the world’s largest legal organization committed to protecting “God’s design for marriage and family,” is pushing to outlaw abortion pills. Erik Baptist, an attorney for the group, said in a statement following the March 15 hearing that the “the FDA’s approval of chemical abortion drugs over 20 years ago has always stood on shaky legal and moral ground.”

He added, “It’s time for the government to do what it’s legally required to do: protect the health and safety of vulnerable women and girls.”

Conservative legal groups like ADF have been savvy about exploiting small wins in the courts and building on them, such as the 2007 decision Gonzales v. Carhart, which upheld a federal ban on a rarely used method of abortion.

The decision had minimal practical impact, as the procedure in question was rarely performed, but it established an important legal principle: When scientific uncertainty arises in legal disputes — is a medical procedure, device, or medication safe or not? — legislatures get to decide.

“The court said when there is scientific uncertainty the tiebreaker goes to the legislature,” said Ziegler.

But there is little question that mifepristone is safe: More than 5.6 million women have successfully used medication abortion since 2000, according to the FDA. In 2008, the Government Accountability Office investigated the FDA’s approval of mifepristone and concluded the process was consistent with FDA regulations.

In the courtroom, Baptist acknowledged that no court had ever ordered the FDA to remove a drug from the market over the agency’s objections, and legal observers say there remains a huge question whether the court can order the secretary of the Department of Health and Human Services, who oversees the FDA, to do so.

But Laurie Sobel, an associate director for women’s health policy at KFF, who listened to the hearing in a Dallas courtroom, said anti-abortion attorneys argued that the mailing of abortion medications strips states of their ability to protect women and children. (The hearing, which Kacsmaryk did not, initially, publicly announce, was not streamed to the public, and the court has yet to release a transcript.)

But Jessica Ellsworth, an attorney representing Danco Laboratories, a manufacturer of mifepristone, told the court that abortion remained legal in all states because it was allowed for preventing a patient’s death or serious bodily injury. Using mifepristone is the safest method of abortion, she argued, noting the judge’s decision in the case could ban it in every state.

“If Kavanaugh said, ‘We’re going to send it back to the states to be decided by their elected representatives,’ this is the exact opposite,” said Donley.

Kacsmaryk appeared ready to grant a preliminary injunction in favor of anti-abortion groups, asking ADF’s Baptist what kind of remedy he was seeking.

Baptist responded, “The court has an interest in preventing dangerous drugs from entering the marketplace.” He added, “Any relief you grant must be complete. The harm of chemical drugs knows no bound.”

Judging the Abortion Pill

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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:

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.

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Wrestling With a Giant: How to Dispute a Hospital Bill

When Sandeep Swami received a $1,339 bill for a quick and uneventful emergency room visit for his 11-year-old daughter, he pushed back. 

The charge was a “facility fee” for the hospital, though the treatment entailed only a six- to seven-minute consultation with a doctor. Because Swami had a high-deductible health plan and had not yet met his deductible for the year, he was on the hook for the entire amount. 

Swami’s attempt to dispute the charge led him to battle the hospital, then his insurer, a bill-mediation service provided by his employer, and finally the debt collector. He didn’t win, but learned valuable lessons about advocating for hospital discounts. 

“An Arm and a Leg” host Dan Weissmann speaks with Swami about the experience. He also interviews Kaelyn Globig, head of advocacy for the Rescu Foundation, about how to find out what Medicare pays for a given procedure, and April Kuehnhoff, an attorney with the National Consumer Law Center, for advice on filing a dispute with a debt collector. 

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there–

You know, sometimes experiments fail. And when we’re lucky,

  • Nothing life-changingly awful happens, and
  • We learn stuff.

That’s the kind of story we’ve got today. It starts with a note from a listener named Sandeep Swami, who was in a fighting spirit.

Sandeep: the facilities are doing nothing but taking advantage of a vulnerable situation, right, which the patient is already in.

Dan: He was fighting a medical bill. And he had a question I didn’t know the answer to. But I WANTED to know. And I knew exactly who I wanted to ask. It wasn’t an academic researcher, or a lawyer, or whatever. It was somebody whose credentials were a lot more … informal. One of my favorite people I’ve ever talked with for this show. I wanted to put her together with Sandeep. In the end, Sandeep’s experiment didn’t work out the way he’d hoped. He was disappointed, but he’ll be OK. Meanwhile,  we did get the answer to that question, we had a great conversation with that expert… and we learned some useful lessons.

This is An Arm and a Leg– a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life, and bring you something entertaining, empowering, and useful.

Sandeep lives in the Bay Area, works in software, came to this country from India fourteen years ago.

Sandeep: I’m basically an immigrant. And so the whole system over here was kind of completely new to me.

Dan: He was used to something a little more basic, but adequate– and way more affordable. The last few years, he’s had a high deductible insurance plan, and it’s gotten him VERY interested in learning more about how to avoid getting ripped off.

Sandeep: you start seeing those big numbers being billed to you and you kind of get uncomfortable paying those large amount.

Dan: He’s been listening to our show, and he’s been reading a book we’ve talked about here: Never Pay the First Bill, by reporter Marshall Allen. I wouldn’t say it had all left him itching for a fight, but…

Sandeep: I had this in mind that, hey, the next time I have a situation where I had to walk into a facility, uh, I’m kind of better prepared

Dan: Then, last spring his daughter wasn’t feeling well — she was eleven at the time. Just a cold, a cough at first. But her usual medicine– an inhaler– wasn’t working like it usually did. And the cough– it was keeping her awake

Sandeep: about four or five in the morning. She was still not able to sleep with coughing

Dan: It got to be like 4 or 5 in the morning, and Sandeep was like, OK. I guess we better get her seen. Now. The trip to the ER was uneventful, and short.

Sandeep: the whole consultation lasted probably about six, seven minutes.

Dan: The doc said, she’s gonna be OK. Maybe up the frequency with the inhaler. That was it. Sandeep’s daughter gets better.

A few weeks later he gets a bill: One thousand three hundred thirty-nine dollars. And this bill doesn’t include the doctor’s services. That was a separate bill– maybe sixty bucks, which he says he paid right away.

This is from the hospital. And what did they do for him, exactly?

Sandeep: there was no IV, no injection, nothing. There was nothing which was given to us from the emergency facility. And the only recommendation we got, hey, use over the counter medication.

Dan: So, Sandeep’s like, OK, I’m gonna fight this.

Sandeep: I think I can afford to pay this amount. There’s no questions that I, I won’t be able to but I think it’s more like a principle thing

Dan: I’m not gonna go through all the work Sandeep had already done before we talked. But it was a LOT.

First, he checked:  Was this charge even correct?

He got an itemized bill, looked up the billing codes, found out he was being charged a “facility fee” — like a cover charge just for walking into the ER.

It’s legal.

In fact, hospitals will tell you:  This is how they keep the lights on. And all the life-saving machinery running. And how they keep the nurses and other staff paid. All the people and equipment they need to keep at the ready for WHATEVER walks through the door.

In any case, Sandeep was like, thirteen hundred bucks?

He made all the phone calls: to the hospital, to his insurance, to a bill-mediation service from his employer.

They all told him the same thing:

Sorry, man. 13 hundred bucks is the amount your insurer pays for that code. 

Sandeep: you haven’t met your deductible. You had to pay, and this is the amount.

Dan: He was like, yeah but it’s ridiculous.

Sandeep: I said, even if I rent a hotel for a day, with all the facilities, it’s not going to come to this price at all.

Dan: So even if there’s no error, he wants to put up a fight. He goes looking for ammo: data that could show the price he’s being charged is unfair.

And because Sandeep has really been following stuff, he knows:  A federal order that went into effect last year requires hospitals to lay out a lot of pricing information for certain services.

Like, what they actually charge different insurers.  And what they charge people who don’t have insurance.

He finds the file. And it’s a good thing for him that he’s a software engineer. Because this file?

Sandeep:  it’s not in a readable format. It’s like the binary

Dan: Yeah, it’s a binary file– pure code. Readable by machines, but not people. And yes, it’s legal for them to post it in that format.

Sandeep puts his work skills to use, decodes the file. And he learns this hospital charges people who don’t have insurance about a thousand dollars less than what they want from him.

And he wrote to me because he wanted to know: How could he find out what they accept from Medicare?

And I was like, ooh, wait. I actually don’t exactly know. I know you CAN. And I know it’s a really good thing to do: If you’re negotiating a medical bill, that could be a good data point to have.

It’s a price the other side definitely accepts, that’s gonna be a lot lower than what they’re charging you.

Medicare prices are set by the government, and they tend to be a lot lower than the rates hospitals and other providers negotiate with insurance companies. Because with Medicare, they don’t get to negotiate.

The government does its studies, decides on what it thinks is reasonable, and says: Here, take it or leave it. Actually, take it or leave Medicare.

Now, hospitals sometimes say they get screwed on Medicare rates … but they all accept them.

They might not accept that rate from you, but if you’re gonna try to negotiate a bill — or fight it– it seems like a data point you might want.

So I wanted to know how to find it too.

And it seemed like an opportunity to re-connect with one of my favorite sources ever.

That’s the behind the scenes star of one of the first stories I ever did for this show — and its’ a story I especially enjoyed making. Partly because I got to report it at a Renaissance Fair.

Rennie 1: Have you gotten the chance to speak with Robin Hood yet? Robin, come forward.

Dan: That’s right after this.

This episode of An Arm and a Leg is a co-production with Kaiser Health News–

That’s a nonprofit newsroom covering health care in America.

KHN is not affiliated with the giant health care outfit, Kaiser Permanente.

We’ll have more information about KHN at the end of this episode.

OK, this very early Arm and a Leg story starts with me at the Renaissance Fair.

Robin Hood: And you’re having fun

Dan: for sure.

Yeah, I’m talking to Robinhood.

Robin Hood: Awesome. Yes

Dan: If you’ve heard the story, you may remember: The people who work at these fairs, Rennies, have developed a kind of hand-crafted medical-bill safety net.

They need one. They don’t all earn a lot of money. The gig doesn’t come with insurance. And they’re handling swords and flaming torches, and what-not.

Part of the Rennie system is, they pitch into a kitty to help cover each other’s medical bills. Like half a million bucks over a five year period.

But the other part of their system is what’s really impressive. Because in that same five-year period, they made more than two million dollars worth of medical bills disappear.

The wizard responsible for that trick is Kaelyn Globig. She’s a former Rennie herself, and she does all this part time — she also works as a real estate agent.

My first interview with Kaelyn may be the single most educational, influential conversation I’ve ever had in reporting for this show. This especially stuck with me.

Kaelyn Globig: I love this job because I am so appalled at the way it, they try to work our medical system. Um, I like to be on this side of it. The one that’s kind of fighting for the, you know, for the little guy.

Dan: That’s it right there, the direction our whole show has taken. Kaelyn’s the person who introduced me to the whole idea of using negotiation, and advocacy, and our wits to defend ourselves– and others — against wild medical bills.

Including by getting an itemized bill, with billing codes. In fact, here’s what she said:

Kaelyn Globig: I look up those codes and I see how much Medicare will pay for those.

Dan: This, I think, is what gave Sandeep the idea to call me. So I was EXTREMELY PLEASED to introduce them. I got the three of us together on Zoom, and Sandeep told his whole story.

Kaelyn definitely loved meeting him.

Kaelyn Globig: well first of all, give them held Sandeep. I am so happy to hear, that you have tried to exhaust every avenue.

Dan: And she was ready to show us how to find out what Medicare pays

Kaelyn had sent us a cheat sheet ahead of time. Including a link to a special page on CMS dot gov– that the site for the Centers for Medicare and Medicaid Services.

It was like she led us to a secret door. Now it was time to go through it.

Kaelyn Globig: So what you wanna do is scroll down, um, in the first page here,

Dan: I am not gonna make you listen to our whole journey.

Kaelyn Globig: Just scroll down and click


or read it if you’d like. I’ve never read that.

Dan: I am going to refer you to Kaelyn’s cheat-sheet– a how-to document. We’ll post that wherever you’re listening, and to arm and a leg show dot com.

For now, I’ll just tell you: about four and a half minutes after we found that secret door, we landed here.

Kaelyn Globig: Yeah. So as you see that $1,339 service , our government has deemed a fair price for the service that you received is,



Dan: it

Kaelyn Globig: did it say? 45

Dan: $45 and 91 cents?

Kaelyn Globig: That’s it. Yep.

Dan: Holy

Kaelyn Globig: They are charging you two to 10 times more usually than the fair price.

So this is our

Dan: This is more like, more like 20 or 30 times more.

Kaelyn Globig: right? Right. Yeah. I mean, just astronomical.

SANDEEP:  It’s so crazy.

Dan: Sandeep said seeing this did strengthen his resolve to fight

Sandeep: I mean, you look at the Medicare price , it’s not even two times, not even three times.

It’s like several times the amount. So it just not right.

Kaelyn Globig: Nope, you’re right.

Dan: Now, a hospital might say:  That 46 dollar medicare rate is the REASON we demand such high rates from insurance companies like Sandeep. We’re getting killed, and we’ve gotta make it up somehow.  It’s an argument I hear a lot. Kaelyn has a different caution.

Kaelyn Globig: I Love what a hard time you’re giving them. Sandeep. This is so great. Um, unfortunately you are wrestling with a giant,

Kaelyn says, that’s not something she tends to take on. When she looks up Medicare prices, it’s not for fighting with a hospital, arguing that their rate is too high.  

She uses Medicare prices when she’s advocating for someone who doesn’t have insurance.  It’s a way of making an offer of something they can pay, even though they can’t pay the amount on the bill.

Kaelyn:  I write them a letter and just let them know  I cannot afford to pay this amount. I’ll ask them to please consider accepting Medicaid prices from me.

Dan: Actually, Kaelyn means Medicare, government insurance primarily for folks age 65 and up. Medicaid is government insurance for low-income folks.

It pays even LESS than Medicare — — and a lot of providers don’t take Medicaid at all.

So Kaelyn asks them if they’ll consider taking Medicare prices, for someone who just doesn’t have insurance. She writes a letter, asking please.

Kaelyn:  And a lot of times they’ll say yes.

Dan: And usually, she’s not approaching big hospitals this way.

Kaelyn: Um, these are smaller, you know, this is the doctor’s offices, the radiologists, you know, the smaller businesses, and service providers, hospitals a little more difficult and every hospital’s different.

Um, but it’s worth trying. I mean, I, I’d still write a letter and send it to somebody who I hope would look at it , yeah, my, my experience, it’s, it would be difficult to get them to agree to negotiate lower prices,

 (Sandeep laughs)

Dan: Sandeep was not exactly sure what would happen next, or what he was gonna do.

Sandeep: time is running out for me, so I think I still have maybe about two weeks time before it goes to collections.

Dan: That was a few months ago. About a week after we talked, Sandeep heard from the hospital. They were offering him half off. He said he’d think about it.

And he did. A week later, he was just about ready to say yes. And then he got a letter from a collection agency, demanding the whole thing. 

Sandeep: I was really upset. I was thinking about, okay, let me get over this. Let settle this amount. , and then the next day I see this letter I was totally kind of pissed off uh, by looking at it,

He sent them back a very firmly worded letter, told them he was disputing the debt. Demanded a bunch of information from them, before he would consider paying, the details of their state license as a debt collector.

Sandeep: , provide the date of the license, the name on the license, the license number,

Dan: He sent it certified mail, called to confirm that they had it.

That was two months ago. And that’s it so far. He hasn’t heard from them, or from the hospital.

Sandeep: nothing. Zero. Zero letter. Zero communication.

Dan: He wondered: Where does that leave me?

I mean, I have to say, I wondered for a minute: Is he off the hook?

And I called another great pal of the show, who happens to be an expert.

April Kuenhoff: my name is April Koff and I’m a staff attorney at the National Consumer Law Center.

Dan: She said, basically, Sandeep’s not really in the clear.

For one thing, the law doesn’t say he’s entitled to all the information his letter demands, and that if he doesn’t get it, the debt’s not valid.

April Kuenhoff: and, you know, just because somebody stops contacting you doesn’t mean that the issue has gone away, unfortunately.

Dan: Saying you dispute a debt doesn’t mean you win.

Which, April says, doesn’t mean you shouldn’t do it! Especially when the other side might actually be in error.

April Kuenhoff: there’s so many reasons you could have. Questions about whether you owe the money is this the right amount? Should my insurance have covered more? You know, was I billed the wrong rate? Was I billed for services not received? and, if you have those questions, then absolutely file a dispute.

Dan: We’re on to a whole nother topic: Dealing with debt collectors. But I’ll note: NCLC has sample letters –editable templates — that you can use. We’ll link to them from wherever you’re listening to this.

Meanwhile, Sandeep’s in a kind of limbo, after all his fighting.

Sandeep: it didn’t turn out the way I wanted. Not to even a minimum, uh, degree,

Dan: He may go back to the hospital and see about settling for half. And if he could do it all over again, he probably wouldn’t do it the same way.

Sandeep: it’s a lot of time, effort. Um, it’s unnecessary stress, I should say.

Dan: Yeah.

So, I’m saying: Sandeep’s experiment — just duking it out when a bill struck him as ridiculous — did not pan out. But he’ll be …OK.

And he says did take a lesson from the experience — he calls it a silver lining: If or when he has to go to the ER again for something that’s not huge and life-threatening:

SANDEEP: I wouldn’t share my info, uh, insurance information. I would insist on the cash pricing.

DAN:  That seems worth considering, as long as you’re sure you COULD give them insurance later, like if they say, “Actually we need to check you into the hospital right now.” 

… because they need to treat you for something where the charges might blow way past what you could pay cash for– and way past your deductible.

And because Sandeep shared his story with us, we learned a few things.

We learned about the limits of just duking it out— of trying to wrestle with a giant.

We learned a little about certain tools — finding the Medicare price, sending a dispute letter to a debt collector— about where they are and aren’t likely to be useful.

And we pulled in tools and guides for when they ARE handy:

Kaelyn Globig’s cheat-sheet for finding out what Medicare pays for something, plus those sample letters from April’s organization.

And, we reconnected with Kaelyn, who was awesome.

On the way out, I’ll share a couple of bonus tips from her that could come in handy next time you’re calling somebody about a stupid medical bill.

The first one? We’ve heard it Ph abefore, but it’s worth repeating: If the person you’re talking to is a total pill, just end the call, and try getting someone else.

Kaelyn Globig: I’ve gotten the most unhelpful, rude. um, just stonewalled people. Um, and I just, I, I politely hang up and call back, uh, because there a good chance that there are more than one operator manning that, um, that department.

And sometimes it’s just the biggest difference is just getting the right person, um, that’s willing to help and listen.

And Kaelyn’s second bonus tip, I especially loved: Bring an advocate with you to the call. It can be anyone. Here’s how it came up.

Kaelyn Globig: somehow even just being, you know, I say I’m a patient advocate, um, and just saying that sometimes they like straighten up a little bit.

Dan: I wonder if it would be a good tactic to kind of try in general. You know, to be each other’s ad to kind of recruit somebody to play that role…

Kaelyn Globig: it’s me and my patient advocate’s on the phone right now, and

Dan: yeah. Right. Which, you know, my patient advocate could be like my spouse. Um, they don’t have to know that

Kaelyn Globig: yeah. , your friend, your neighbor,

Dan: Ya know what I mean? I’m definitely taking that one with me.

Meanwhile, I’m headed to Houston, to meet Dr. Ricardo Nuila. He says we talk about how, what if we had a medical system that didn’t revolve around money, around billing?

And he says, actually we have one. It’s just not evenly distributed. But that’s where he works.

He practices at Ben Taub Hospital — a publicly-funded safety net hospital in Houston. He says it’s not perfect, but it’s where he wants to work. And he’s just written a book about it, called The People’s Hospital. 

That’s next time, on An Arm and a Leg. 

Till then, take care of yourself.

“An Arm and a Leg” is a co-production of KHN and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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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.

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Watch: Walgreens Stops Sale of Abortion Pill in 21 States Under GOP Threat of Legal Action

[embedded content]

Walgreens has announced it will stop dispensing the abortion pill mifepristone in 21 states where Republican attorneys general threatened legal action against the company, which is the nation’s second-largest pharmacy chain.

KHN senior correspondent Sarah Varney joined PBS NewsHour co-anchor Amna Nawaz in a report on the move and its ramifications for women in those states, many of which have outlawed or severely restricted abortion. In four — Alaska, Iowa, Kansas, and Montana — Walgreens could legally sell the pills but has said it will not. 

Other pharmacies such as CVS, Rite Aid, Costco, Walmart, and Kroger also face legal action.

To otherwise obtain the medication, Varney said, women could seek “a telehealth appointment with someone outside of the state” or “you could order from an online pharmacy.” 

But, she noted, the move by Walgreens restricts access to the drug for “women in what is typically a very time-sensitive situation.”

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:

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