The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.
As a part of a media blitz aimed toward ladies voters, Vice President Kamala Harris this week rolled out a plan for Medicare to offer in-home long-term care providers. It’s standard, significantly for households struggling to take care of each younger kids and older family, however its monumental expense has prevented related plans from being carried out for many years.
In the meantime, President Joe Biden known as out former President Donald Trump by title for having “led the onslaught of lies” in regards to the federal efforts to assist individuals affected by hurricanes Helene and Milton. Even some Republican officers say the misinformation about hurricane aid efforts is threatening public well being.
This week’s panelists are Julie Rovner of KFF Well being Information, Shefali Luthra of The nineteenth, Jessie Hellmann of CQ Roll Name, and Joanne Kenen of the Johns Hopkins colleges of public well being and nursing and Politico.
Panelists
Jessie Hellmann
CQ Roll Name
Joanne Kenen
Johns Hopkins College and Politico
Shefali Luthra
The nineteenth
Among the many takeaways from this week’s episode:
- Vice President Kamala Harris’ plan to increase Medicare to cowl extra long-term care is standard however not new, and up to now has proved prohibitively costly.
- Former President Donald Trump has deserted assist for a drug value coverage he pursued throughout his first time period. The concept, which might decrease drug costs within the U.S. to their ranges in different industrialized nations, is vehemently opposed by the drug {industry}, elevating the query of whether or not Trump is softening his laborious line on the problem.
- Abortion continues to be the largest well being coverage situation of 2024, as Republican candidates — in what appears to be a replay of 2022 — attempt to distance themselves from their assist of abortion bans and different limits. Voters proceed to favor reproductive rights, which creates a model downside for the GOP. Trump’s going forwards and backwards on his abortion positions is an exception to the tack different candidates have taken.
- The Supreme Court docket returned from its summer season break and instantly declined to listen to two abortion-related instances. One case pits Texas’ near-total abortion ban in opposition to a federal regulation that requires emergency abortions to be carried out in sure instances. The opposite challenges a ruling earlier this 12 months from the Alabama Supreme Court docket discovering that embryos frozen for in vitro fertilization have the identical authorized rights as born people.
- The 2024 KFF annual employer well being advantages survey, launched this week, confirmed a roughly 7% improve in premiums, with common household premiums now topping $25,000 per 12 months. And that’s with most employers not overlaying two standard however costly medical interventions: GLP-1 medicine for weight reduction and IVF.
Additionally this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris marketing campaign about well being care points.
Plus, for “further credit score,” the panelists recommend well being coverage tales they learn this week they suppose it is best to learn, too:
Julie Rovner: KFF Well being Information’ “A Boy’s Bicycling Demise Haunts a Black Neighborhood. 35 Years Later, There’s Nonetheless No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly.
Shefali Luthra: The nineteenth’s “Arizona’s Poll Measure Might Shift the Narrative on Latinas and Abortion,” by Mel Leonor Barclay.
Jessie Hellmann: The Meeting’s “Helene Left Some NC Elder-Care Houses With out Energy,” by Carli Brosseau.
Joanne Kenen: The New York Occasions’ “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It,” by Kate Morgan.
Additionally talked about on this week’s podcast:
Click on to open the Transcript
Transcript: But One other Promise for Lengthy-Time period Care Protection
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Whats up, and welcome again to “What the Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information. And I’m joined by a few of the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, October tenth, at 10 a.m. As at all times, information occurs quick, and issues may’ve modified by the point you hear this. So, right here we go.
As we speak we’re joined by way of teleconference by Shefali Luthra of The nineteenth.
Shefali Luthra: Whats up.
Rovner: Jesse Hellmann of CQ Roll Name.
Jessie Hellmann: Hello there.
Rovner: And Joanne Kenen of the Johns Hopkins Colleges of Public Well being and Nursing and Politico journal.
Joanne Kenen: Hello all people.
Rovner: Later on this episode, we’ll have some excerpts from the Newsmaker lunch we had right here at KFF this week with Mark Cuban — “Shark Tank” star, part-owner of the Dallas Mavericks NBA workforce, and, for the needs of our dialogue, co-founder of the industry-disrupting pharmaceutical firm Price Plus Medicine. However first, this week’s information.
We’re going to start out this week with Vice President [Kamala] Harris, who’s been making the media rounds on women-focused podcasts and TV reveals like “The View.” To associate with that, she’s launched a proposal to increase Medicare to incorporate home-based long-term care, to be paid for partially by increasing the variety of medicine whose value Medicare can negotiate. Sounds easy and actually standard. Why has nobody else ever proposed one thing like that? she asks, figuring out full nicely the reply. Joanne, inform us!
Kenen: Because the one full-fledged member of the sandwich technology right here, who has lived the expertise of being a household caregiver whereas elevating kids and dealing full time, long-term care is the unfulfillable, extraordinarily costly, however extremely vital lacking hyperlink in our well being care system. We wouldn’t have a system for long-term care, and other people don’t understand that. Many individuals suppose Medicare will, in actual fact, cowl it, the place Medicare covers it in a really restricted, short-term foundation. So the estimates of what households spend each when it comes to misplaced work hours and what they put out-of-pockets is in, I believe it’s one thing like $400 billion. It’s terribly excessive. However the motive it’s been laborious to repair is it’s terribly costly. And though Harris put out a plan to pay for this, that plan goes to need to be vetted by economists and funds scorers and skeptical Republicans. And possibly some skeptical Democrats. It’s actually costly. It’s actually laborious to do. Julie has coated this for years, too. It’s simply—
Rovner: I might say that is the place I get to say one among my favourite issues, which is that I began overlaying well being care in 1986, and in 1986 my first huge function was: Why don’t we now have a long-term care coverage on this nation? Thirty-eight years later, and we nonetheless don’t, and never that folks haven’t tried. There, in actual fact, was a long-term-care-in-the-home piece of the Reasonably priced Care Act that handed Congress, and HHS [the Department of Health and Human Services] found that they might not implement it in the way in which it was written, as a result of solely the individuals who would’ve wanted it will’ve signed up for it. It will’ve been too costly. And there it went. So that is the persevering with promise of one thing that everyone agrees that we’d like and no person has ever been ready to determine tips on how to do. Shefali, I see you nodding right here.
Luthra: I imply, I’m simply pondering once more in regards to the pay-fors in right here, that are largely the financial savings from Medicare negotiating drug costs. And what Harris says in her plan is that they’re going to get extra financial savings by increasing the checklist of medication that get decrease costs. However that additionally feels very politically suspect when we now have already heard congressional Republicans say that they wish to weaken a few of these drug negotiation value provisions. And we additionally know that Democrats, even when they win the presidency, will not be more likely to have Congress. It actually takes me again to 2020, after we are simply speaking about concepts that Democrats would like to do if they’d full energy of Congress, whereas all of us in Washington form of know that that’s simply not going to occur.
Rovner: Sure, I really like that one of many pay-fors for that is slicing Medicare fraud. It’s like, the place have we heard that earlier than? Oh, sure. In each Medicare proposal for the final 45 years.
Kenen: And it additionally includes closing some form of worldwide tax loopholes, and that additionally sounds straightforward on paper, and nothing with taxes is ever straightforward. The Democrats in all probability will not be going to have the Senate. No person actually is aware of in regards to the Home. It appears to be like just like the Democrats might have a slim edge in that, however we’re going to have extra years of gridlock except one thing actually adjustments politically, like one thing extraordinary adjustments politically. The Republicans will not be going to offer a President Harris, if she is in actual fact President Harris, her want checklist on a golden platter. Alternatively there’s want for this.
Rovner: However in equity, that is what the marketing campaign is for.
Kenen: Proper. There’s a want for one thing on long-term care.
Rovner: And all people’s complaining: Effectively, what would she do? What would she do if she was elected? Effectively, right here’s one thing she stated she would do if she might, if she was elected. Effectively, in the meantime, former President [Donald] Trump has apparently deserted a proposal that he made throughout his first time period to require drugmakers to decrease their costs for Medicare to not more than they cost in different developed nations the place their costs are government-regulated. Is Trump going smooth on the drug {industry}? Trump has been, what, the Republican, I believe, who’s been most hostile in the direction of the drug {industry} till now.
Hellmann: I might say possibly. I believe the “most favored nation” proposal is one thing that the pharmaceutical {industry} has feared much more than the Democrats’ Medicare negotiation program. And it’s one thing that Trump actually pursued in his first time period however wasn’t in a position to get finished. In such a decent race, I believe he’s actually fearful about angering pharmaceutical firms, particularly after they have been simply form of dealt this loss with Medicare value negotiation. And if he does win reelection, he’s going to be form of restricted in his capability to weaken that program. It’s going to be laborious to repeal it. It’s extraordinarily standard, and he could possibly weaken it.
Rovner: “It” that means value negotiation, not the “most favored nations” costs.
Hellmann: Yeah. It’s going to be actually laborious to repeal that, and he could possibly weaken it via the negotiation course of with drug firms. It’s positively an attention-grabbing flip.
Rovner: Joanne, you wish to add one thing?
Kenen: Trump rhetorically was very harsh on the drug firms proper across the time of his inauguration. I believe it was the week earlier than, if I bear in mind accurately. Stated loads of very robust stuff on medicine. Put out a listing of one thing like dozens of potential steps. The drug firms have a number of allies in each events, and extra in a single than the opposite, however they’ve allies on the Hill, and nothing revolutionary occurred on drug pricing below Trump.
Rovner: And his HHS secretary was a former drug firm govt.
Kenen: Sure, Eli Lilly. So we additionally identified right here that former President Trump is just not constant in coverage proposals. He says one factor, after which he says one other factor, and it’s very laborious to know the place he’s going to come back down. So Trump and drug pricing is an open query.
Rovner: Sure, we’ll see. All proper, nicely, shifting on. Drug costs and Medicare apart, the largest well being situation of Marketing campaign 2024 continues to be abortion and different reproductive well being points. And it’s not simply Trump attempting to again away from his anti-abortion document. We’ve had a spate of tales over the previous week or so of Republicans working for the Home, the Senate, and governorships who’re attempting to actually reinvent themselves as, if not truly supportive of abortion rights, a minimum of anti abortion bans. And that features Republicans who haven’t simply voted for and advocated for bans however who’ve been outspokenly supportive of the anti-abortion effort, individuals like North Carolina Republican gubernatorial candidate Mark Robinson, New Hampshire Republican gubernatorial candidate and former U.S. Senator Kelly Ayotte, together with former Michigan Republican consultant and now Senate candidate Mike Rogers. Donald Trump has gotten away repeatedly, as Joanne simply stated, with altering his positions, even on hot-button points like abortion. Are these candidates going to have the ability to get away with doing the identical factor, Shefali?
Luthra: I believe it’s simply a lot more durable when your title is just not Donald Trump. And that’s as a result of we all know from focus group after focus group, and survey after survey, that voters form of give Trump extra leeway on abortion. Particularly impartial voters will have a look at him and say, Effectively, I don’t suppose he truly opposes abortion, as a result of I’m certain he’s paid for them. And so they don’t have that very same grace that they provide to Republican lawmakers and Republican candidates, as a result of the get together has a foul model on abortion at giant, and Trump is seen as this type of maverick determine. However voters know that Republicans have a historical past of opposing abortion, of supporting restrictions.
Whenever you have a look at surveys, whenever you speak to voters, what they are saying is, Effectively, I don’t belief Republicans to signify my pursuits on this situation, as a result of they largely assist entry. And one factor that I do suppose is de facto attention-grabbing is, as soon as once more, what we’re seeing is form of a repeat of the 2022 elections after we noticed some very brazen efforts by Republican candidates for the Home and Senate attempt to scrub references to abortion and to fetal personhood from their web sites. And it didn’t work, as a result of individuals have eyes and other people have reminiscences, and, additionally, campaigns have entry to the web archive and are in a position to present folks that, even a couple of weeks in the past, Republican candidates have been saying one thing very totally different from what they’re saying now. I don’t suppose Mark Robinson can actually escape from his comparatively current and really public feedback about abortion.
Rovner: Effectively, alternatively, there’s some issues that don’t change. Republican vice presidential candidate JD Vance advised RealClearPolitics final week that if Trump is elected once more, their administration would lower off funding to Deliberate Parenthood as a result of, he stated, and I quote, “We don’t suppose that taxpayers ought to fund late-term abortions.” However, in fact, that even earlier than the overturn of Roe, lower than half of all Deliberate Parenthoods even carried out abortions and nearly none of those that did carry out them later in being pregnant. Is it truthful to say that Vance’s anti-abortion slip is exhibiting?
Luthra: I believe it is likely to be. And I’ll say, Julie, once I noticed that he stated that, I might hear you in my head simply yelling in regards to the Hyde Modification, as a result of we all know that Deliberate Parenthood doesn’t use taxpayer cash to pay for abortions. However we additionally know that JD Vance has seen that he and his ticket are form of in a tricky nook speaking about abortion. He has stated many occasions, We have to rebrand — he’s very sincere about that, a minimum of — and attempting to focus as a substitute on this nonmedical time period of “late time period” abortions.
It’s of venture. It’s hoping that voters can be extra sympathetic to that as a result of they’ll suppose, Oh, nicely, that sounds very excessive. And so they’re attempting to shift again who’s seen as credible and who is just not, by specializing in one thing that traditionally was much less standard. However once more, it’s once more difficult as a result of after we have a look at the polling, voters’ understanding of abortion has shifted and they’re now extra more likely to perceive that when you have got an abortion later in being pregnant, it’s typically for very medically complicated causes. And somebody very high-profile who just lately stated that’s Melania Trump in her new memoir, speaking about how she helps abortion in any respect phases of being pregnant as a result of typically these are very heart-wrenching instances and never form of the homicide that Republicans have tried to characterize them as.
Rovner: I believe you’re proper. I believe that is the continuation of the 2022 marketing campaign, besides that we’ve had so many extra ladies come ahead. We’ve seen precise instances. It was once anti-abortion forces would say, Oh, nicely, this by no means occurred. I imply, these are wrenching, terrible issues that occurred to loads of these sufferers with being pregnant problems late in being pregnant. And it’s, I do know, as a result of I’ve talked to them. It’s very laborious to get them to speak publicly, as a result of then they get trolled. Why ought to they step ahead?
Effectively, now we’ve seen loads of these ladies stepping ahead. So we now see a public that is aware of that this occurs, as a result of they’re listening to from the folks that it’s occurred to they usually’re listening to from their medical doctors. I do know additionally from the polling that there are people who find themselves going to vote in these 10 states the place abortion is on the poll. A lot of them are going to vote for abortion entry after which flip round and vote for Republicans who assist restrictions, as a result of they’re Republicans. It might or might not be their most vital situation, however I nonetheless suppose it’s a giant query mark the place that occurs and the way it shakes out. Joanne, did you wish to add one thing?
Kenen: You’re seeing two competing issues on the similar time. You have got various Republicans attempting to average their stance or a minimum of sound like they’re moderating their stance. On the similar time, you even have the entire, the place the Republican Get together is on abortion has shifted to the best. They’re speaking about personhood in the meanwhile of conception, the embryo — which is, scientifically put, a small ball of cells nonetheless at that time — that they really have the identical authorized rights as another post-birth individual.
In order that’s develop into a reasonably widespread view within the Republican Get together, versus one thing that simply 5 or 6 years in the past was seen as the perimeter. And Trump goes round saying that Democrats enable infants to be executed after delivery, which isn’t true. And so they’re significantly saying that is true in Minnesota due to [Gov.] Tim Walz, and a few voters should imagine it, proper? As a result of they hold saying it. So you have got this development that Shefali simply described and that you simply’ve described, Julie, about this form of making an attempt to win again belief, as Vance stated. And it sounded extra average, and similtaneously you’re listening to this rhetoric about personhood and execution. So I don’t suppose the Republicans have but solved their very own whiplash post-Roe.
Rovner: In the meantime, the abortion debate is getting mired within the free-speech debate. In Florida, Republican governor Ron DeSantis is threatening authorized motion in opposition to TV stations airing an advert in assist of the poll measure that may overturn the state’s six-week abortion ban. That has in flip triggered a rebuke from the pinnacle of the Federal Communications Fee warning that political speech remains to be protected right here in the US. Shefali, that is actually form of on the market, isn’t it?
Luthra: It’s simply so fascinating, and it’s actually a part of an even bigger effort by Ron DeSantis to attempt to leverage something that he can politically or, frankly, in his capability as head of the state to attempt to weaken the marketing campaign for the poll measure. They’ve used the well being division in different methods to attempt to ship out materials suggesting that the marketing campaign’s speaking factors, that are largely centered on the futility of exceptions to the abortion ban, they’re attempting to argue that that’s misinformation, and that’s not true. And so they’re utilizing the state well being division to make that argument, which is one thing we don’t actually see fairly often, as a result of normally well being departments are presupposed to be nonpartisan. And what I’ll say is, on this case, a minimum of to your level, Julie, the FCC has weighed in and stated: You’ll be able to’t do that. You’ll be able to’t cease a TV station from airing a political advert that was purchased and paid for. And the advertisements haven’t stopped exhibiting at this level. I simply heard from household yesterday in Florida who’re seeing the advertisements in query on their TV, and it’s nonetheless—
Rovner: And I’ll put up a hyperlink to the advert simply so you’ll be able to see it. It’s a few girl who’s pregnant and had most cancers and wanted most cancers therapy and wanted to terminate the being pregnant to be able to get the most cancers therapy. It stated that the exception wouldn’t enable her to, which the state says isn’t true and which is clearly one among these items that’s debatable. That’s why we’re having a political debate.
Luthra: Precisely. And one factor that I believe is price including in right here is, I imply, this actually intense effort from Governor DeSantis and his administration comes at a time when already this poll measure faces in all probability the hardest combat of any abortion rights measure. And we now have seen abortion rights win repeatedly on the poll, however in Florida you want 60% to move. And should you look throughout the nation at each abortion rights measure that has been voted on since Roe v. Wade was overturned, solely two have cleared 60, and they’re in California and they’re in Vermont. So these extra conservative-leaning states, and Florida is one among them, it’s simply, it’s actually, actually laborious to see the way you get to that quantity. And we even noticed this week there’s polling that implies that the marketing campaign has loads of work to do in the event that they’re hoping to clear that threshold.
Rovner: And, in fact, now they’ve two hurricanes to cope with, which we’ll cope with in a couple of minutes. However first, the Supreme Court docket is again in session right here in Washington, and despite the fact that there’s no huge abortion case on its official docket as of now this time period, the court docket shortly declined to listen to two instances on its first day again, one involving whether or not the abortion ban in Texas can override the federal emergency therapy regulation that’s supposed to ensure abortion entry in medical emergencies threatening the pregnant girl’s life or well being. The court docket additionally declined to overrule the Alabama Supreme Court docket’s ruling that frozen embryos could be thought of legally as unborn kids. That’s what Joanne was simply speaking about. The place do these two choices depart us? Neither one truly resolved both of those questions, proper?
Luthra: I imply, the EMTALA [Emergency Medical Treatment and Labor Act] query remains to be ongoing, not due to the Texas case however due to the Idaho case that’s asking very related questions that we’ve talked about beforehand on this podcast. And the top of final time period, the court docket kicked that again all the way down to the decrease courts to proceed making its means via. We anticipate it should ultimately come again to the Supreme Court docket. So it is a query that we’ll, in actual fact, be listening to on sooner or later.
Rovner: Though, the irony right here is that in Idaho, the ban is on maintain as a result of there was a court docket keep. And in Texas, the ban is just not on maintain, despite the fact that we’re speaking about precisely the identical query: Does the federal regulation overrule the state’s ban?
Luthra: And what that form of highlights — proper? — is simply how a lot entry to abortion, even below states with related legal guidelines or legislatures, actually does rely on so many components, together with what circuit court docket you fall into or the make-up of your state Supreme Court docket and the way judges are appointed or whether or not they’re elected. There’s simply a lot at play that makes entry so variable. And I believe the opposite factor that one might speculate that possibly the court docket didn’t need headlines round reproductive well being so quickly into an election, but it surely’s not as if this is a matter that they’re going to be avoiding within the medium- or long-term future. These are questions which are simply too urgent, and they are going to be coming again to the Supreme Court docket in some kind.
Rovner: Sure, I might say within the IVF [in vitro fertilization] case, they merely principally stated, Go away for now. Proper?
Luthra: Yeah. And, I imply, proper now in Alabama, individuals are largely in a position to get IVF due to the state regulation that was handed, even when it didn’t contact the substance of that state court docket’s ruling. That is one thing, for now, individuals can form of suppose is possibly uninterrupted, whilst everyone knows that the ideological and political groundwork is being laid for a for much longer and extra intense combat over this.
Rovner: Effectively, bear in mind again final week after we predicted that the decide’s resolution overturning Georgia’s six-week ban was unlikely to be the final phrase? Effectively, certain sufficient, the Georgia Supreme Court docket this week overturned the instant overturning of the ban, which formally went again into impact on Monday. Like these different instances, this one continues, proper?
Luthra: Sure, this continues. The Georgia case continued for some time, and it simply form of underscores once more what we’ve been speaking about, simply how a lot entry actually adjustments forwards and backwards. And I used to be speaking to an abortion clinic supplier who has clinics in North Carolina and Georgia. She actually came upon in regards to the resolution each occasions and adjusted her plans for the following day as a result of I texted her asking her for remark. And suppliers and sufferers are being tasked with maintaining with a lot. And it’s simply very, very tough, as a result of Georgia additionally has a 24-hour ready interval for abortions, which signifies that each time the choice round entry has modified — and we all know it very nicely might change once more as this case progresses — individuals must scramble in a short time. And in Georgia, they’ve additionally been attempting to do this on high of navigating the fallout of a hurricane.
Rovner: Yeah. And as we identified a few weeks in the past when the court docket overturned the North Dakota ban, there aren’t any abortion suppliers left in North Dakota. Now that there’s no ban, it’s solely in idea that abortion is now as soon as once more allowed in North Dakota. Effectively, earlier than we depart abortion for this week, we now have two new research exhibiting how abortion bans are impacting the well being care workforce. In a single survey, greater than half of oncologists, most cancers medical doctors, who have been finishing their fellowships, so individuals prepared to enter observe, stated they might contemplate the influence of abortion restrictions of their choices about the place to arrange their observe. And a 3rd stated abortion restrictions hindered their capability to offer care.
In the meantime, a survey of OBGYNs in Texas by the consulting group Manatt Well being discovered “a major majority of practising OB/GYN physicians … imagine that the Texas abortion legal guidelines have inhibited their capability to offer highest-quality and medically obligatory care to their sufferers,” and that many have already made or are contemplating making adjustments to their observe that may “cut back the provision of OB/GYN care within the state.” What’s the anti-abortion response to this rising physique of proof that abortion bans are having deleterious results on the provision of other forms of well being care, too? I imply, I used to be significantly taken by the oncologists, the concept that you won’t have the ability to get most cancers care as a result of most cancers medical doctors are fearful about treating pregnant ladies with most cancers.
Luthra: They’re blaming the medical doctors. And we noticed this in Texas when the Zurawski case was argued and girls sufferers and medical doctors within the state stated that they’d not been in a position to get important, lifesaving medical care due to the state’s abortion ban and lack of readability round what was truly permitted. And the state argued, and we now have heard this speaking level repeatedly, that truly the medical doctors are simply not prepared to do the laborious work of practising drugs and attempting to interpret, Effectively, clearly this qualifies. That’s one thing we’ve seen within the Florida arguments. They are saying: Our exceptions are so clear, and should you aren’t in a position to navigate these exceptions, nicely, that’s your downside, since you are being risk-averse, and sufferers ought to actually take this up with their medical doctors, who’re simply irresponsible.
Rovner: Sure, that is clearly a problem that’s going to proceed. Effectively, shifting on. The price of well being care continues to develop, which isn’t actually information, however this week we now have extra laborious proof, courtesy of my KFF colleagues by way of the annual 2024 Employer Well being Profit Survey, which finds the common household premium rose 7% this 12 months to $25,572, with employees contributing a mean of $6,296 in the direction of that value. And that’s with a definite minority of corporations overlaying two very talked-about however very costly medical interventions, GLP-1 [glucagon-like peptide-1] medicine for weight problems and IVF, which we’ve simply been speaking about. Anything on this survey bounce out at anyone?
Hellmann: I imply, that’s only a huge amount of cash. And the employer is de facto paying the vast majority of that, however that doesn’t imply it doesn’t have an effect on individuals. Meaning it’s going to restrict how a lot your wages go up. And one thing I considered once I learn this research is these lawsuits that we’re starting to see, accusing employers of not doing sufficient to ensure that they’re limiting well being care prices. They’re not taking part in sufficient of a job in what their advantages appear to be. They’re form of outsourcing this to consultants. And so whenever you have a look at this information and also you see $25,000 they’re spending per 12 months per household on well being care premiums, you surprise, what are they doing?
Well being care, sure, it’s clearly very costly, however you simply form of query, what position are employers truly taking part in in attempting to drive down well being care prices? Are they simply taking what they get from consultants? And one other factor that form of stood out to me from that is, I believe it’s stated in there, employers are having a tough time currently of passing these prices on to staff, which is de facto attention-grabbing. It’s due to the tight labor market. However clearly well being care remains to be very costly for workers — $6,000 a 12 months in premiums for household protection is just not a small amount of cash. So employers are simply persevering with to soak up that, and it does actually influence everybody.
Rovner: It’s humorous. Earlier than the Reasonably priced Care Act, it was employers who have been form of driving the, You need to do one thing about the price of well being care, as a result of inflation was so quick. After which, in fact, we noticed well being care inflation, a minimum of, decelerate for a number of years. Now it’s choosing up once more. Are we going to see employers form of getting again into this leaping up and down and saying, “We’ve obtained to do one thing about well being care prices”?
Hellmann: I really feel like we’re seeing extra of that. You’re starting to listen to extra from employers about it. I don’t know. It’s simply such a tough situation to resolve, and I’ve seen increasingly curiosity from Congress about this, however they actually wrestle to control the business market. So …
Rovner: Sure, as we discuss at size each week. But it surely’s nonetheless vital, and they’re going to nonetheless go for it. Effectively, lastly, this week in well being misinformation. Allow us to discuss hurricanes — the general public well being misinformation that’s being unfold each about Hurricane Helene that hit the Southeast two weeks in the past, and Hurricane Milton that’s exiting Florida whilst we’re taping this morning. President [Joe] Biden addressed the press yesterday from the White Home, calling out former President Trump by title together with Georgia Republican congresswoman Marjorie Taylor Greene for spreading deliberate misinformation that’s not simply undermining efforts at storm aid however truly placing individuals in additional hazard. Now, I bear in mind Hurricane Katrina and all of the criticism that was heaped, largely deservedly, on George W. Bush and his administration, however I don’t bear in mind deliberate misinformation like this. I imply, Joanne, have you ever ever seen something like this? You lived in Florida for some time.
Kenen: I went via Andrew, and there’s at all times a sure — there’s confusion and chaos after a giant storm. However there’s a distinction between stuff being mistaken that may be corrected and stuff being deliberately stated that then on this form of divided, suspicious, two-realities world we’re now residing in, that’s being repeated and perpetuated and amplified. It damages public well being. It damages individuals economically attempting to recuperate from this disastrous storm or in some instances storms. I don’t know the way many individuals truly imagine that Marjorie Taylor asserted that the Democrats are controlling the climate and sending storms to suppress Republican voters. She nonetheless has a following, proper? However different issues …
Rovner: She nonetheless will get reelected.
Kenen: … being advised that should you go to FEMA [the Federal Emergency Management Agency] for assist, your property can be confiscated and brought away from you. I imply, that’s far and wide, and it’s not true. Even various Republican lawmakers within the affected states have been on social media and making statements on native TV and no matter, saying: This isn’t true. Please, FEMA is there that can assist you. Let’s get via this. Cease the lies. Plenty of Republicans have truly been fairly blunt in regards to the misinformation coming from their colleagues and urging their constituents to hunt and take the assistance that’s obtainable.
That is the general public well being disaster. We don’t know the way many individuals have been killed. I don’t suppose we now have an correct complete last depend from Helene, and we certain don’t have from Milton. I imply, the individuals did appear to take this storm severely and evacuated, but it surely additionally spawned one thing like three dozen tornadoes in locations the place individuals hadn’t been advised, there’s usually no have to evacuate. There’s flooding. It’s a devastating storm. So when individuals are flooding, energy outages, electrical energy, laborious to get entry to well being care, you’ll be able to’t refrigerate your insulin. All these—
Rovner: Poisonous floodwaters, I imply, the one factor …
Kenen: Poisonous, yeah.
Rovner: … we find out about hurricanes is that they’re extra harmful within the aftermath than in the course of the precise storm when it comes to public well being.
Kenen: Proper. It is a life-threatening public well being emergency to actually tens of millions of individuals. And misinformation, not simply getting one thing mistaken after which attempting to right it, however intentional disinformation, is one thing we haven’t seen earlier than in a pure catastrophe. And we’re solely going to have extra pure disasters. And it was actually — I imply, Julie, you already pointed this out — but it surely was actually uncommon how exact Biden was yesterday in calling out Trump by title, and I imagine at two totally different occasions yesterday. So I heard one, however I believe I examine what I believe was the second actually saying, laying it at his ft that that is harming individuals.
Rovner: Yeah, like I stated, I bear in mind Katrina vividly, and that was clearly a extremely devastating storm. I do additionally bear in mind Democrats and Republicans, even whereas they have been criticizing the federal authorities response to it, not spreading issues that have been clearly unfaithful. All proper. Effectively, that’s the information for this week. Now we’ll play a section from our Newsmaker interview with Mark Cuban, after which we can be again with our further credit.
On Tuesday, October eighth, Mark Cuban met with a gaggle of reporters for a Newsmaker lunch at KFF’s places of work in Washington, D.C. Cuban, a billionaire finest often known as a panelist on the ABC TV present “Shark Tank,” has taken an curiosity in well being coverage up to now a number of years. He’s been consulting with the marketing campaign of Vice President Harris, though he says he’s positively not curious about a authorities put up if she wins. Cuban began out speaking about how, as he sees it, the largest downside with drug costs within the U.S. is that nobody is aware of what anybody else is paying.
Mark Cuban: I imply, once I speak to companies and I’ve tried to elucidate to them how they’re getting ripped off, the largest of the largest stated, Effectively, so-and-so PBM [pharmacy benefit manager] is passing via all of their rebates to us.
And I’m like: Does that embrace the subsidiary in Scotland or Japan? Is that the place the opposite one is?
I don’t know.
And it doesn’t. By definition, you’re passing via all of the rebates with the corporate you contracted with, however they’re not passing via all of the rebates that they get or that they’re maintaining of their subsidiary. And so, yeah, I really, actually imagine from there all people can argue about the easiest way. The place do you utilize synthetic intelligence? The place do you do that? What’s the EHR [electronic health record? What’s this? We can all argue about best practices there. But without a foundation of information that’s available to everybody, the market’s not efficient and there’s no place to go.
Rovner: He says his online generic drug marketplace, costplusdrugs.com, is already addressing that problem.
Cuban: The crazy thing about costplusdrugs.com, the greatest impact we had wasn’t the markup we chose or the way we approach it. It’s publishing our price list. That changed the game more than anything. So when you saw the FTC [Federal Trade Commission] go after the PBMs, they used loads of our pricing for all of the non-insulin stuff. Whenever you noticed these articles written by the Occasions and others, and even higher but, there was analysis from Vanderbilt, I believe it was, that claims 9 oncology medicine, in the event that they have been bought by Medicare via Price Plus, would save $3.6 billion. These 15, no matter medicine would save six-point-whatever billion. All as a result of we printed our value checklist, individuals are beginning to understand that issues are actually out of whack. And in order that’s why I put the emphasis on transparency, as a result of whether or not it’s inside of presidency or inside firms that self-insure, particularly, they’re going to have the ability to see. The primary rule of well being care contracts, significantly PBM contracts, is you’ll be able to’t discuss PBM contracts.
Rovner: Cuban additionally says that extra transparency can handle issues in the remainder of the well being care system, not only for drug costs. Right here’s how he responded to a query I requested describing his subsequent huge plan for well being care.
We’ve had, clearly, points with the system being run by the federal government not very effectively and being run by the personal sector not very effectively.
Cuban: Very effectively, yeah.
Rovner: And proper now we appear to have this form of working at cross-purposes. In the event you might design a system from the bottom up, which might you let do it? The federal government or—
Cuban: I don’t suppose that’s actually the problem. I believe the problem is a scarcity of transparency. And also you see that in any group. The extra communication and the extra the tradition is open and clear, the extra individuals maintain one another accountable. And I believe you get fiefdoms in personal {industry} and also you get fiefdoms in authorities, as nicely, as a result of they know that if nobody can see the outcomes of their work, it doesn’t matter. I can say my deal was one of the best and I did one of the best and our outcomes are one of the best, however there’s no technique to query it. And so speaking to the Harris marketing campaign, it’s like should you introduce transparency, even to the purpose of requiring PBMs and insurers to publish their contracts publicly, then you definately begin to introduce an environment friendly market. And upon getting an environment friendly market, then individuals are higher in a position to make choices after which you’ll be able to maintain them extra accountable.
And I believe that’s going to spill over past pharm. We’re engaged on — it’s not an organization — however we’re engaged on one thing known as Price Plus Wellness, the place we’re consuming our personal pet food. And it’s not an organization that’s going to be a for-profit or perhaps a nonprofit, for that matter, only for the lives that I cowl for my firms, that we self-insure. We’re doing direct contracting with suppliers, and we’re going to publish these contracts. And half and parcel to that’s going via the — and I apologize if I’m stumbling right here. I haven’t slept in two days, so bear with me. However going via the hierarchy of care and following the cash, if you consider after we speak to CFOs and CEOs of suppliers, one of many issues that was gorgeous to me that I by no means imagined is the connection between deductibles for self-insured firms and payers, and the chance related to accumulating these deductibles to suppliers.
And I believe individuals don’t actually understand the connection there. So whoever does Ann’s care [KFF Chief Communications Officer Ann DeFabio, who was present] — nicely, Kaiser’s a bit bit totally different, however let’s simply say you’re employed at The Washington Publish or whoever and you’ve got a $2,500 deductible. And one thing occurs. Your child breaks their leg and goes to the hospital, and also you’re out of market, and it’s out of community. Effectively, no matter hospital you go to there, you may give your insurance coverage card, however you’re chargeable for that first $2,500. And that supplier, relying on the place it’s situated, might need assortment — unhealthy debt, quite — of fifty% or extra.
So what does that imply when it comes to how they need to set their pricing? Clearly, that pricing goes up. So there’s actually a relationship between, significantly on pharmacy, if my firm takes an even bigger rebate, which in flip means I’ve the next deductible as a result of there’s much less accountability for the PBM-slash-insurance firm. My increased deductible additionally signifies that my sickest staff are those paying that deductible, as a result of they’re those which have to make use of it. And my older staff who’ve ongoing well being points and have persistent diseases and wish medicine, they’re paying increased copays. However once they need to go to the hospital with that very same deductible, as a result of I took extra of a rebate, the hospital is taking extra of a credit score danger for me. That’s insane. That makes completely no sense.
And so what I’ve stated is as a part of our wellness program and what we’re doing to — Challenge Alpo is what we name it, consuming our personal pet food. What I’ve stated is, we’ve gone to the suppliers and stated: Look, we all know you’re taking this deductible danger. We’ll pay you money to eradicate that. However wait, there’s extra. We additionally know that whenever you undergo a typical insurer, even when it’s a self-insured employer utilizing that insurer and also you’re simply utilizing the insurance coverage firm not for insurance coverage providers however as a TPA [third-party administrator], the TPA nonetheless performs video games with the supplier, they usually underpay them on a regular basis.
And so what occurs on account of the underpayment is that supplier has to have places of work and places of work filled with administrative assistants and attorneys, they usually need to not solely pay for these individuals, however they’ve the related overhead and burden and the time. After which speaking to them, to a giant hospital system, they stated that’s about 2% of their income. So due to that, that’s 2%. Then, wait, there’s extra. You have got the pre-ops, and you’ve got the TPAs who combat you on the pre-ops. However the downstream financial impacts are monumental as a result of, first, the physician has to ask for the pre-op. That’s consuming physician’s time, and they also see fewer sufferers. After which not solely does the physician need to cope with them, they go to HR on the firm who self-insures and says, Wait, my worker can’t come to work, as a result of their youngster is sick, and also you received’t approve this course of or, no matter, this process, as a result of it has to undergo this pre-op.
Or if it’s on medicines, it’s you wish to undergo the step-up course of otherwise you wish to undergo a special utilization since you get extra rebates. All these items are intertwined, and we don’t have a look at it holistically. And so what we’re saying with Price Plus Wellness is, we’re going to do that all in a money foundation. We’re going to belief medical doctors in order that we’re not going to undergo a pre-op. Now we’ll belief however confirm. In order we undergo our inhabitants and we have a look at all of our claims, as a result of we’ll personal all of our claims, we’re going to look to see if there are repetitive points with any individual who’s simply attempting to —there’s a number of again surgical procedures or there’s a number of this or there’s a number of that — to see if any individual’s abusing us. And since there’s no deductible, we pay it, and we pay it proper when the process occurs or proper when the medicine is prescribed. Due to all that, we wish Medicare pricing. No person’s saying no. And in some instances I’m getting decrease than Medicare pricing for major care stuff.
Rovner: OK, we’re again. Now it’s time for our further credit. That’s after we every suggest a narrative we learn this week we predict it is best to learn too. Don’t fear should you miss the main points. We’ll embrace the hyperlinks to all these tales in our present notes in your telephone or different gadget. Joanne, why don’t you go first this week.
Kenen: There was an enchanting story in The New York Occasions by Kate Morgan. The headline was “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It.” So I knew nothing about this, and it was so attention-grabbing. Placentas have superb therapeutic properties for wound care, burns, infections, ache management, regenerating pores and skin tissue, simply many, many issues. And it’s been well-known for years, and it’s not broadly used. It is a story particularly a few actually extreme burn sufferer in a fuel explosion and the way her face was completely restored. We don’t use this, partly as a result of placenta — each childbirth, there’s a placenta. There are many them round. There’s I believe three and a half million births a 12 months, or that’s the estimate I learn within the Occasions. One of many causes they weren’t getting used is, in the course of the AIDS disaster, there was some growth towards utilizing them, after which the AIDS disaster, there was a worry of contamination and spreading the virus, and it stopped a long time later.
We have now much more methods of detecting, controlling, determining whether or not one thing’s contaminated by AIDS or whether or not a affected person has been uncovered. It’s getting used once more on a restricted foundation after C-sections, but it surely appears to have fairly astonishing — take into consideration all of the wound take care of simply diabetes. I’m not a scientist, however I simply appeared on the story and stated, it looks like lots of people might be healed faster and extra safely and earlier if this was developed. They’re thrown away now. They’re despatched to hospital waste incinerators and biohazard waste. They’re rubbish, they usually’re truly drugs.
Rovner: Positively a scientist’s cool story. Shefali.
Luthra: My story is from my good colleague Mel Leonor Barclay. The headline is “Arizona’s Poll Measure Might Shift the Narrative on Latinas and Abortion,” and as a part of this actually large collection that she has working this week, taking a look at how Latinas as a way more influential and growingly influential voter group might form gun violence, abortion rights, and housing. And on this story, which I actually love, she went to Arizona and hung out speaking to of us on all sides of the problem to higher perceive how Latinas are affected by abortion rights and likewise how they’ll be voting on this.
And he or she actually challenges the narrative that has existed for therefore lengthy, which is that Latinas are largely Catholic, largely extra conservative on abortion. And he or she finds one thing way more complicated, which is that truly polls actually present that a big share of Latina voters in Arizona and related states assist abortion rights and can be voting in favor of measures just like the Arizona constitutional modification. However on the similar time, there are actual divides inside the group, and other people discuss their religion otherwise and the way it connects their stance on abortion. They discuss their relationships with household in numerous methods, and I believe it simply underscores how hardly ever Latina voters are handled with actual nuance and care and thoughtfulness when speaking about one thing as complicated as abortion and abortion politics. And I actually love the way in which that she approaches this piece.
Rovner: It was a super-interesting story. Jesse.
Hellmann: My story is from The Meeting. It’s an outlet in North Carolina. It’s known as “Helene Left Some North Carolina Elder-Care Houses With out Energy.” Some assisted residing amenities have been with out energy and water for the reason that hurricane hit. A number of amenities needed to evacuate residents, and the story simply form of will get into how North Carolina has extra lax guidelines round emergency preparedness. Whereas they do require nursing properties be ready to offer backup energy, the identical necessities don’t apply to assisted residing amenities. And it’s as a result of there’s been {industry} pushback in opposition to that due to the price. However as we see some extra of those excessive climate occasions, it looks like one thing needs to be finished. We can’t simply enable weak individuals residing in these amenities to go hours and hours with out energy and water. And I noticed that there was a facility the place they evacuated dozens of people that had dementia, and that’s simply one thing that’s actually upsetting and traumatizing for individuals.
Rovner: Yeah, as soon as once more, now we’re seeing these excessive climate occasions in locations that, not like Florida and Texas, will not be arrange and used to excessive climate occasions. And it’s one thing I believe that lots of people are beginning to consider. Effectively, my story this week is from our KFF Well being Information public well being undertaking known as Well being Beat, and it’s known as “A Boy’s Bicycling Demise Haunts a Black Neighborhood. 35 Years Later, There’s Nonetheless No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly. And it’s a kind of tales you by no means actually take into consideration till it’s identified that in areas, significantly those who had been redlined, particularly, the dearth of security infrastructure that the majority of us take without any consideration — crosswalks, sidewalks, site visitors lights will not be actually there. And that’s a public well being disaster of its personal, and it’s one which hardly ever will get addressed, and it’s a extremely infuriating however a extremely good story.
All proper, that’s our present. Subsequent week, for my birthday, we’re doing a stay election preview present right here at KFF in D.C., as a result of I’ve a barely warped thought of enjoyable. And also you’re all invited to hitch us. I’ll put a hyperlink to the RSVP within the present notes. I’m promised there can be cake.
As at all times, should you benefit from the podcast, you’ll be able to subscribe wherever you get your podcast. We’d admire it should you left us a assessment. That helps different individuals discover us, too. Thanks as at all times to our technical guru, Francis Ying, and our fill-in editor this week, Stephanie Stapleton. Additionally, as at all times, you’ll be able to e mail us your feedback or questions. We’re at whatthehealth, all one phrase, @kff.org, or you’ll be able to nonetheless discover me for the second at X. I’m @jrovner. Joanne, the place are you?
Kenen: @JoanneKenen generally on Twitter and @joannekenen1 on Threads.
Rovner: Jessie.
Hellmann: @jessiehellmann on Twitter.
Rovner: Shefali.
Luthra: @shefalil on Twitter.
Rovner: We can be again in your feed subsequent week. Till then, be wholesome.
Credit
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Stephanie Stapleton
Editor
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