Tag: Podcasts

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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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:

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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

Accept

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,

SANDEEP: Wow.

KAELYN: 40…

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.

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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:

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March Medicaid Madness

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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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Senators Have Mental Health Crises, Too

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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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The Kids Are Not OK

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Teen girls “are experiencing record high levels of violence, sadness, and suicide risk,” according to a new survey from the Centers for Disease Control and Prevention. In 2021, according to the survey, nearly 3 in 5 U.S. teen girls reported feeling “persistently sad or hopeless.”

Meanwhile, a conservative judge in Texas has delayed his ruling in a case that could ban a key drug used in medication abortion. A group of anti-abortion doctors is suing to challenge the FDA’s approval decades ago of the abortion pill mifepristone.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sandhya Raman of CQ Roll Call.

Among the takeaways from this week’s episode:

  • American teenagers reported record rates of sadness in 2021, with especially high levels of depression in girls and teens identifying as LGBTQ+, according to a startling CDC report. Sexual violence, mass shootings, cyberbullying, and climate change are among the intensifying problems plaguing young people.
  • New polling shows more Americans are dissatisfied with abortion policy than ever before, as a U.S. district court judge in Texas makes a last call for arguments on the fate of mifepristone. The case is undermining confidence in continued access to the drug, and many providers are discussing using only misoprostol for medication abortions. Misoprostol is used with mifepristone in the current two-drug regimen but is safe and effective, though slightly less so, when used on its own.
  • There are big holes in federal health privacy protections, and some companies that provide health care, like mental health services, exploit those loopholes to sell personal, identifying information about their customers. And this week, Republican Gov. Glenn Youngkin of Virginia blocked a state law that would have banned search warrants for data collected by menstrual tracking apps.
  • California plans to manufacture insulin, directly taking on high prices for the diabetes drug. While other states have expressed interest in following suit, it will likely be up to wealthy, populous California to prove the concept.

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

Julie Rovner: NPR’s “Is the Deadly Fungi Pandemic in ‘The Last of Us’ Actually Possible?” by Michaeleen Doucleff

Alice Ollstein: The New York Times’ “Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds,” by Claire Cain Miller, Sarah Kliff, and Larry Buchanan; interactive produced by Larry Buchanan and Shannon Lin

Joanne Kenen: NPR’s “In Tennessee, a Medicaid Mix-Up Could Land You on a ‘Most Wanted’ List,” by Blake Farmer

Sandhya Raman: Bloomberg Businessweek’s “Zantac’s Maker Kept Quiet About Cancer Risks for 40 Years,” by Anna Edney, Susan Berfield, and Jef Feeley

Also mentioned in this week’s podcast:

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A Health-Heavy State of the Union

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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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Au Revoir, Public Health Emergency

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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 Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.

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