On Abortion Rights, Ohio Is the New Kansas


The Host

Julie Rovner
KFF Well being Information


Learn Julie’s tales.

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 creator of the critically praised reference e-book “Well being Care Politics and Coverage A to Z,” now in its third version.

Ohio voters — in a uncommon August election — turned out in unexpectedly excessive numbers to defeat a poll measure that will have made it more durable to go an abortion-rights constitutional modification on the poll in November. The election was virtually a 12 months to the day after Kansas voters additionally shocked observers by supporting abortion rights in a poll measure.

In the meantime, the proportion of People with out medical health insurance dropped to an all-time low of seven.7% in early 2023, reported the Division of Well being and Human Providers. However that’s not more likely to proceed, as states boot from the Medicaid program thousands and thousands of people that acquired protection underneath particular eligibility guidelines throughout the pandemic.

This week’s panelists are Julie Rovner of KFF Well being Information, Emmarie Huetteman of KFF Well being Information, Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico, and Rachel Roubein of The Washington Submit.


Emmarie Huetteman
KFF Well being Information


Learn Emmarie’s tales

Joanne Kenen
Johns Hopkins Bloomberg College of Public Well being and Politico


Learn Joanne’s tales

Rachel Roubein
The Washington Submit


Learn Rachel’s tales

Among the many takeaways from this week’s episode:

  • It shouldn’t have come as a lot of a shock that Ohio voters sided with abortion-rights advocates. Abortion rights up to now have prevailed in each state that has thought of a associated poll measure for the reason that Supreme Courtroom overturned Roe v. Wade, together with in politically conservative states like Kentucky and Montana.
  • Reasonable Republicans and independents joined Democrats in defeating the Ohio poll query. Opponents of the measure — which might have elevated the edge of votes wanted to approve state constitutional amendments to 60% from a easy majority — had not solely cited its ramifications for the upcoming vote on statewide abortion entry, but additionally for different points, like elevating the minimal wage.
  • A Texas case about exceptions underneath the state’s abortion ban awaits the enter of the state’s Supreme Courtroom. However the painful private experiences shared by the plaintiffs — notable partly as a result of such personal tales had been as soon as scarce in public discourse — pressed abortion opponents to handle the results for ladies, not fetuses.
  • The uninsured price hit a file low earlier this 12 months, a milestone that has since been washed away by states’ efforts to strip newly ineligible Medicaid beneficiaries from their rolls because the covid-19 public well being emergency ended.
  • The promise of diabetes medicine to help in weight reduction has attracted loads of consideration, but with their excessive worth tags and protection points, one thorny impediment to entry stays: How might we, individually and as a society, afford this?
  • Lawmakers are asking extra questions concerning the nature of nonprofit, or tax-exempt, hospitals and the care they supply to their communities. However they nonetheless face an uphill battle in difficult the highly effective hospital business.

Additionally this week, Rovner interviews Kate McEvoy, government director of the Nationwide Affiliation of Medicaid Administrators, about how the “Medicaid unwinding” goes as thousands and thousands have their eligibility for protection rechecked.

Plus, for “further credit score” the panelists counsel well being coverage tales they learn this week that they assume you must learn, too:

Julie Rovner: KFF Well being Information’ “How the Texas Trial Modified the Story of Abortion Rights in America,” by Sarah Varney.

Joanne Kenen: Fox Information’ “Male Well being Care Leaders Full ‘Simulated Breastfeeding Problem’ at Texas Hospital: ‘Large Eye-Opener’,” by Melissa Rudy.

Rachel Roubein: Stat’s “From Home windows to Wall Artwork, Hospitals Use Digital Actuality to Design Extra Inclusive Rooms for Youngsters,” by Mohana Ravindranath.

Emmarie Huetteman: KFF Well being Information’ “The NIH Ices a Analysis Mission. Is It Self-Censorship?” by Darius Tahir.

Additionally talked about on this week’s episode:

click on to open the transcript

Transcript: On Abortion Rights, Ohio Is the New Kansas

KFF Well being Information’ ‘What the Well being?’Episode Title: On Abortion Rights, Ohio Is the New KansasEpisode Quantity: 309Revealed: Aug. 10, 2023

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]

Julie Rovner: Hi there 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 number of the greatest and smartest well being reporters in Washington. We’re taping a day early this week, on Wednesday, Aug. 9, at 3:30 p.m. As all the time, information occurs quick, and issues might need modified by the point you hear this. So right here we go. We’re joined as we speak through video convention by Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico.

Joanne Kenen: Hey, everyone.

Rovner: Rachel Roubein of The Washington Submit.

Rachel Roubein: Hello, everyone.

Rovner: And my colleague and editor right here at KFF Well being Information Emmarie Huetteman.

Emmarie Huetteman: Hey, everybody. Glad to be right here.

Rovner: So later on this episode, we’ll have my interview with Kate McEvoy, government director of the Nationwide Affiliation of Medicaid Administrators. She’s acquired her pulse on how that large post-public well being emergency “Medicaid unwinding” goes. And she or he’ll share a few of that with us. However first, this week’s information. I suppose the largest information of the week is out of Ohio, which, in virtually a rerun of what occurred in Kansas virtually precisely a 12 months in the past, voters soundly defeated a poll concern that will have made it more durable for different voters this fall to reverse the legislature’s strict abortion ban. When you’re having hassle following that, so did they in Ohio. [laughs] This time, the truth that the abortion rights aspect received wasn’t as a lot of a shock as a result of each statewide abortion poll query has gone for the abortion rights aspect since Roe v. Wade was overturned final 12 months. What will we take away from Ohio? Apart from it appeared so much like … the break up appeared so much like Kansas. It was virtually 60-40.

Kenen: It exhibits that there’s a coalition round this concern that’s larger than Democrat or Republican. Ohio was the basic swing state that has was a conservative Republican-voting state — not on this concern. This was clearly independents, average Republicans joined Democrats to … 60-40, roughly, is a fairly large win. Sure, we’ve seen it in different states. It’s nonetheless a fairly large win.

Roubein: I agree. And I believe one in all my colleagues, Patrick Marley, and I spent a while simply driving round and touring Ohio in July. And one of many issues that we did discover is that — this poll measure to extend the edge for constitutional amendments is 60% — it had in some, in lots of, methods was a proxy battle over abortion. However, in some methods, each side additionally didn’t speak about abortion once they had been, , canvassing totally different voters. You already know, they use totally different instruments within the toolbox. I used to be following round somebody from Ohio Proper to Life and, , he very a lot mentioned, “Abortion is the most important concern to me.” However, , they tried to sort of carry collectively the aspect that supported this. Different points like legalizing marijuana and elevating the minimal wage, and, , the abortion rights aspect was very a lot part of, , the opposition right here. However when some canvassers went out — my colleague Patrick had traveled and adopted some, and a few, , sort of targeted on different points like, , voters having a voice in coverage and retaining a easy majority rule.

Rovner: Yeah, I believe it’s necessary — for many who haven’t been following this as intently as we’ve — what the poll measure was was to make future poll measures — they usually mentioned they weren’t going to have them in August anymore, which, this was the final one — with the intention to amend the structure by referendum, you would wish a 60% majority quite than a 50% majority. And simply coincidentally, there’s an abortion poll measure on Ohio’s poll for November, and it’s polling at about 58%. However, sure, this might have utilized to all the things, and it was defeated.

Kenen: And it’s half of a bigger development. It started earlier than the overturning of Roe v. Wade. Over the past couple of years, you’ve seen conservative states transfer to tighten these guidelines for poll initiatives. And that’s as a result of extra liberal positions have been profitable. I imply, Medicaid, the Medicaid enlargement on the poll, has received, and received large. Just one was even shut …

Rovner: In very pink states!

Kenen: They usually received very large in quite a few very, very conservative states, locations like Idaho and Nebraska. So, , there’s all the time been … the traditional knowledge is that, , the political events are extra excessive than many citizens, that the Democratic Celebration is for the left and the Republican Celebration is for the fitting. And there are lots of people who establish with one get together or the opposite however aren’t … who’re extra average or, on this case, extra liberal on Medicaid. And Medicaid … what was it, seven states? I believe it’s seven. Seven actually conservative states. After which the abortion has received in each single state. And there’s a little bit little bit of dialog and it’s … very early. And I don’t know if it’s going to go wherever, but when I’ve heard it and written a bit about it, conservative lawmakers have heard about it, too, which is there are teams all for attempting to get some gun security initiatives on ballots. In order that’s difficult. And it could not occur. However they’re seeing, I imply, that’s the basic instance of each a prison justice and a public well being concern — so we will speak about it — a basic instance the place the nation is way more within the heart.

Rovner: Properly, allow us to transfer to Texas, as a result of that’s the place we all the time find yourself once we speak about abortion. Chances are you’ll do not forget that lawsuit the place a number of ladies who practically died from being pregnant issues sued the state to make clear when medical personnel are capable of intercede with out being subjected to fines and/or jail sentences. Properly, the ladies received, at the least for a few days. A Texas district choose who heard the case dominated of their favor, briefly blocking the Texas ban for ladies with being pregnant issues. However then the state appealed, and a Texas appeals courtroom blocked the lower-court choose’s blocking of a part of the ban. When you didn’t observe that, it simply signifies that legally nothing has modified in Texas. And now the case goes to the Texas Supreme Courtroom, which has a conservative majority. So we just about know what’s going to occur. However whether or not these ladies finally win or lose their case might not be a very powerful factor. And, to elucidate why I’m going to do my further credit score early this week. It’s by my KFF Well being Information colleague Sarah Varney. It’s referred to as “How the Texas Trial Modified the Story of Abortion Rights in America.” She writes that this trial was significantly important as a result of it put abortion foes on the defensive by graphically depicting hurt to ladies of abortion bans — quite than to fetuses. And it’s additionally concerning the energy of individuals publicly telling their tales. I’ve performed a whole lot of tales over time about ladies whose very needed pregnancies went very flawed, very late. And, I’ve to inform you, it’s been laborious to seek out these ladies. And if you discover them, it’s been actually laborious to get them to speak to a journalist. So, the truth that we’re seeing an increasing number of folks truly come out publicly, , might do for this concern what, , maybe what homosexual rights, , what folks popping out as homosexual did for homosexual marriage? I don’t know. What do you guys assume?

Kenen: Properly, I believe these tales have been actually compelling, however they’re additionally, they’re probably the most dramatic and possibly best to push again. However it’s, , there’s an entire lot of different causes ladies need abortions. And the main target — and it’s life and demise, so the main target, fairly rightfully, needs to be on these actually excessive instances. However that’s not … it’s nonetheless in some methods shifting consideration from the bigger political dialogue about selection and rights. However, clearly, a few of these states, we’ve seen so many tales of ladies who, their lives are at stake, their docs understand it, they usually simply don’t assume they’ve the authorized energy; they’re afraid of the results in the event that they’re second-guessed. There are large monetary and imprisonment [risks] for a health care provider who’s deemed to have performed an pointless abortion. And this concept that’s taken maintain … amongst some conservatives is that there’s by no means a necessity for a medical abortion. And that’s simply not true.

Rovner: And but, I imply, what this trial and a whole lot of issues in Sarah’s piece too level out is that that line between miscarriage and abortion is admittedly sort of fuzzy in a whole lot of instances. You already know, for those who go to the hospital with a miscarriage they usually’re going to say, “Properly, did you provoke this miscarriage?” And we’ve seen ladies thrown in jail earlier than for dropping pregnancies, with them saying, “You already know, you threw your self down the steps to finish this being pregnant.” That truly occurred, I believe it was in Indiana. So that is —

Kenen: And miscarriage is quite common.

Rovner: That was what I used to be saying.

Kenen: Early miscarriage is quite common. Very, quite common.

Huetteman: One of many issues that’s so hanging concerning the previous 12 months, since Dobbs overturned Roe v. Wade ,is that we’ve seen this type of nationwide schooling about what being pregnant is and the way harmful it may be and the way care wants to actually be versatile to satisfy these kinds of challenges. And this truly acquired me fascinated about one thing that one other acquainted voice on this podcast, Alice Miranda Ollstein, and a few colleagues wrote this morning concerning the Ohio consequence, which is that they identified that the anti-abortion motion actually hasn’t developed when it comes to the arguments that they’re making prior to now 12 months about why abortion ought to proceed to be much less and fewer accessible. In the meantime, we’ve acquired these, like, actually unimaginable, actually emotional, transferring tales from ladies who’ve skilled this firsthand. And that’s a tough message to beat if you’re attempting to achieve voters particularly.

Rovner: And it’s fascinating; each side wish to take — , all of them go to the toughest instances. So, for years and years, the anti-abortion aspect has, , has gone to the toughest instances. And that’s why they speak about abortion within the ninth month up until beginning, which isn’t a factor, however they speak about it. And , now the abortion rights aspect has some laborious instances now that abortions are more durable to get. Properly, whereas we’re as regards to Texas lawsuits, States Newsroom — and thanks for sending this my method, Joanne — has a narrative reporting that the writer of the scientific paper that each the decrease courtroom choose and the appeals courtroom judges used to conclude that the abortion drug mifepristone causes frequent issues — it doesn’t — is being reviewed for potential scientific misconduct. The paper comes from the Charlotte Lozier Institute, which is the analysis arm of the anti-abortion group the Susan B. Anthony Listing. Sage, which is the writer of the journal that the paper appeared in, has posted one thing referred to as an expression of concern, saying that the writer and editor, quote, “had been alerted to potential points relating to the illustration of knowledge within the article and creator conflicts of curiosity. SAGE has contacted the authors of this text and an investigation is underway.” This was type of a whistleblower by a pharmacist who appeared on the method the information on this paper was put collectively and says, “No, that’s actually very deceptive.” I don’t assume I’ve ever seen this, although; I’ve by no means seen a scientific paper that’s now being questioned for its political bent, a peer-reviewed scientific paper. I imply, this might change a whole lot of issues, couldn’t it?

Kenen: Properly, not if folks resolve that they nonetheless assume it’s true. I imply, take a look at — , the vaccine autism paper was retracted. That wasn’t initially political. It’s grow to be extra political over time; it wasn’t political on the time. That was retracted. And other people have been leaping up and down screaming, “It was retracted! It was retracted!” And, , thousands and thousands of individuals nonetheless consider it. So, I imply, legally, I’m unsure how a lot it adjustments. I imply, I believed we had all heard that there have been flaws on this research. This text was good as a result of I hadn’t been conscious of how deeply flawed and in all the various methods it was flawed. And in addition the whistleblower yarn was fascinating. I’m unsure how a lot it adjustments something.

Rovner: Properly, I’m pondering not when it comes to this case. And by the way in which, I believe we didn’t say this, that the research was of emergency room visits by ladies who’d had both surgical or medical abortions. And the rivalry was that medical abortions had been extra harmful than surgical abortions as a result of extra ladies ended up within the emergency room. However as a number of folks have identified, extra folks ended up within the emergency room after medical abortions as a result of there have been so many extra medical abortions over time. I imply, you don’t truly should be an information scientist to see a number of the issues.

Kenen: Proper. And a few of them additionally weren’t that — actually, had been nervous, they usually didn’t know what was regular they usually went to the ER as a result of they had been scared they usually actually had been protected. They weren’t — they didn’t want — , they simply weren’t certain how a lot ache and discomfort or bleeding you’re purported to have. They usually went they usually had been reassured and had been despatched dwelling. So it’s not even that they actually had a medical emergency or that they had been harmed.

Rovner: Or that that they had a complication.

Kenen: Proper. There have been many flaws identified with this analysis.

Rovner: However my broader query is, I imply, if individuals are going to begin questioning the politics of scientific papers, I imply, I might see the opposite aspect going after this.

Kenen: Properly, there’s local weather science, too, that’s unhealthy. I imply, I don’t assume that is truly distinctive. I believe it’s egregious. However there have been research minimizing the chance of smoking, which was additionally a political enterprise, business. Local weather is actually political. I imply, I believe that is type of probably the most politicized and most acute instance, however I don’t assume it’s the one one.

Roubein: And I believe, Julie, as you’d talked about, I believe when [U.S. District Judge] Matthew Kacsmaryk in Texas got here down along with his resolution — , for example, there are media shops — that my colleagues on the Submit did a narrative simply sort of unpacking a number of the sort of flaws and a number of the research that had been used to make, , a courtroom resolution.

Rovner: Yeah, to offer the choose what he assumes to be proof that it is a harmful drug. So it’s — yeah.

Kenen: Which he got here in believing, we all know, from the profiles of him and his background.

Rovner: Proper. All proper, effectively, allow us to transfer on. The official Census Bureau estimate of how many individuals lack medical health insurance received’t be out till subsequent month. However the Division of Well being and Human Providers is out with a report based mostly on that different large federal inhabitants survey that exhibits the uninsured price early this 12 months was at its lowest degree since information began being stored, which I believe was within the Eighties: 7.7%. Now, that’s clearly going to be the excessive level for the fewest variety of folks uninsured, at the least for some time, as a result of clearly not all the thousands and thousands of people who find themselves dropping or about to lose their Medicaid protection are going to finish up with different insurance coverage. However I keep in mind — Joanne, you’ll, too — when the speed was nearer to 18% … was an enormous information story, and the factor that triggered the entire well being reform debate within the first place. I’m stunned that there’s been so little consideration paid to this.

Kenen: As a result of, … [unintelligible] … it’s so yesterday. And in addition, as you alluded to, , we’re in the midst of the Medicaid unwinding. So the numbers are going up once more now. And we don’t know. We all know that it’s a few million folks. I believe 3 million could be the final —

Rovner: I believe it’s 4 [million], it’s as much as 4.

Kenen: 4, OK. And a few of them will get coated once more and a few of them will discover different sources of protection. However proper now, there’s an uptick, not a downtick.

Roubein: And I believe if you take a look at simply, like, estimates of what the insured and the uninsured charges can be in 2030, like, the CMS’ [Centers for Medicare & Medicaid Services] evaluation, one of many different questions is, , whether or not the improved Obamacare subsidies proceed previous 2025. So there’s Medicaid after which there’s additionally another sort of query marks and cliffs arising on how and whether or not it’ll fluctuate.

Rovner: No, it’s price watching. And keep in mind, when the census numbers come out, these shall be for 2022. Properly, transferring on, we’ve two tales this week wanting on the potential price of these breakthrough weight problems medicine, however by two very totally different lenses. One is from my KFF Well being Information colleague Rachana Pradhan, particulars how the makers of the present “it” drug, Ozempic, which is Novo Nordisk, in an effort to get the votes to raise the Medicare cost ban on weight reduction medicine, is quietly contributing massive quantities of cash to teams just like the Congressional Black Caucus Basis and the Congressional Hispanic Caucus Institute. It’s type of a backdoor lobbying that’s fairly age-old, however that doesn’t imply it doesn’t work. The opposite story, by Elaine Chen at Stat, appears at how well being insurers are pushing again laborious towards the off-label use of diabetes medicines that additionally work to assist folks drop some pounds. They’re doing issues like permitting the costlier weight reduction medicine provided that folks have tried and failed different strategies or disallowing them if the opposite strategies had been barely profitable. So, for those who take a lesser drug and also you lose sufficient weight, they received’t allow you to take the higher drug as a result of, look, you misplaced weight on the opposite drug. We’ve talked about this, clearly, earlier than: These medicine, on the one hand, have the potential to make lots of people each more healthy and happier. There’s a research out this week that exhibits that Mounjaro, the Eli Lilly drug, truly reduces coronary heart illness by 20%.

Kenen: In individuals who have coronary heart illness.

Rovner: Proper, in individuals who have coronary heart illness.

Kenen: It’s not reducing everyone’s threat.

Rovner: However nonetheless, I imply, everyone’s — effectively, I imply, there are medical indications for utilizing these medicine for weight reduction. But when everyone who desires them might get them, it will actually break the financial institution. No person can afford to offer everyone who’s eligible for these medicine these medicine. Is the winner right here going to be the aspect with the simplest lobbying, or is that too cynical?

Huetteman: Isn’t that all the time the winner? Talking of cynical.

Rovner: Yeah, in well being care.

Kenen: Properly, I imply, I additionally assume there’s questions on, like, these medicine clearly are actually great for individuals who they had been designed for; you don’t should be on insulin. They’re having not simply weight reduction and diabetes. There are apparently cardiac and different — , these are most likely actually good medicine. However there are lots of people who shouldn’t have diabetes or coronary heart illness who need them as a result of they wish to lose 20 kilos. And a few of them are being advised you need to take it for the remainder of your life. I imply, I simply know this anecdotally, and I’m certain everyone knows it anecdotally.

Rovner: Proper. It’s like statins.

Kenen: Sure.

Rovner: Or blood stress remedy. When you cease taking your blood stress remedy, your blood stress goes again up.

Kenen: Proper. So, I imply, ought to the purpose for the burden loss be, “OK, that is going that will help you take off that weight and then you definately’re going to have to keep up it by weight loss program and train and wholesome life-style,” blah, blah, blah, which is tough for folks. We all know that. Or are we placing wholesome folks on a very costly drug that adjustments an terrible lot of issues about their physique indefinitely? We don’t have security information for lifelong use in in any other case wholesome folks. So, , I’m all the time a little bit nervous as a result of even the very best scientific trial is small in comparison with the whole — it’s small and it’s time-limited. And possibly these medicine are going to become completely phenomenal and we’re going to all dwell one other 20 wholesome years. However possibly not, . Or possibly they’re going to be actually nice for a sure subpopulation, however, , we’re not going to wish to put it within the water provide. So, I nonetheless assume that there’s this type of pell-mell rush. And I believe it’s partly as a result of there’s some huge cash at stake. And it’s additionally, like, most people who find themselves obese have tried to lose it, and it’s very troublesome to lose and preserve weight. So, , folks need a better method to do it. And I believe the opposite factor is true now it’s an injection. There are unwanted effects for some folks on discomfort. There most likely shall be an oral model, a capsule, someday pretty quickly, which can open — , there are individuals who don’t wish to take a shot who would take a capsule. It additionally means you may be capable to inform — I imply, I don’t know the science of the drugs, however it will make sense to me that you might take a decrease dose, , possibly ease into it with out the unwanted effects, or might you keep on it longer with fewer issues? I imply, we’re simply the very starting of this, however it’s an enormous amount of cash.

Rovner: Yeah. You might see — I imply, my large query, although, is why can’t we pressure the drugmakers to decrease the value? That may, if not clear up the issue, make it so much higher. I imply, actually, we’re going to have to attend till there’s generic competitors?

Kenen: It’s not simply this.

Rovner: Yeah.

Kenen: I imply, it’s all kinds of most cancers remedies and it’s hepatitis remedies. And it’s, I imply, there’s a whole lot of costly medicine on the market. So, this one simply has a whole lot of demand as a result of it makes you skinny.

Rovner: Properly, that was the factor. We went by this with the hepatitis C medicine, which had been actually tremendous costly. It’s way more like that.

Kenen: Properly, they appeared tremendous costly on the time —

Rovner: Not a lot anymore.

Kenen: — however possibly for a thousand {dollars}, on reflection.

Rovner: All proper. Properly, let’s transfer on. So, talking of highly effective lobbies, let’s speak about hospitals. Iowa Republican Sen. Chuck Grassley and Massachusetts Democrat Elizabeth Warren — now, there’s an unlikely couple — are amongst these asking the IRS to extra fastidiously study tax-exempt hospitals to ensure they’re truly benefiting the neighborhood in change for not paying taxes, which is meant to be the deal. Now, Sen. Grassley has been on this explicit hobbyhorse for a lot of, a few years, I believe most likely greater than 20, however not a lot ever appears to return of this. I can’t inform you what number of workshops I’ve been to on, , tips on how to measure neighborhood advantages that tax-exempt hospitals are offering. Any inkling that this time goes to be any totally different?

Roubein: Properly, hospitals don’t are usually type of the losers. They attempt to sort of body themselves as, like, “We’re your type of pleasant neighborhood hospital,” and each — I imply, each congressman, most congressmen have, , hospitals of their district. In order that they they get lobbied so much, although, — I imply, it is a totally different concern, however significantly on the Home aspect, hospitals are going through site-neutral funds, which if that truly went by Congress can be a loss. So yeah, however lawmakers have discovered it typically laborious to tackle the hospital business.

Rovner: Yeah, very a lot so.

Kenen: Yeah. I imply, I believe that we consider nonprofits and for-profits as, they’re totally different, however they’re not as totally different as we expect they’re, in that, , nonprofits are getting a tax break they usually should reinvest their earnings. However it doesn’t imply they’re not making some huge cash. A few of them are. I imply, a few of them have, , we’ve all walked into fancy nonprofits with, , fancy artwork and marble flooring and so forth and so forth. And we’ve all been in nonprofits which might be barely retaining their doorways open. So it’s your tax standing. It’s not likely, , your moral standing or the standard of care. I imply, there’s good nonprofits, there’s good for-profits. You already know, this entire factor is like, if I had been a hospital, I’d be getting this enormous tax break, and what am I doing to deserve it? And that’s the query.

Rovner: And I believe the argument is, , that the 7.7% uninsured we had been speaking about, that hospitals are purported to be offering care as a part of their neighborhood profit that the federal authorities now’s ending up paying for. I believe that’s type of the frustration. If nonprofit hospitals had been doing what they had been purported to do, it will price federal and state governments much less cash, which all the time surprises me as a result of this isn’t gone after extra. I imply, Grassley has spent his entire profession engaged on numerous varieties of authorities fraud. So that is completely in line for him. However it’s by no means simply appeared to be an enormous precedence for any administration.

Huetteman: There’s a little bit little bit of an X issue right here. Take a look at the truth that Grassley and Warren are speaking about this publicly now. Possibly I’m simply actually optimistic from all of the journalism we’ve been doing about initiatives like “Invoice of the Month.” However the actuality is that lots of people are actually seeing reporting that’s exhibiting to them what nonprofit hospitals are literally doing in terms of pursuing sufferers who don’t pay payments. And what it means to have neighborhood profit comes into query so much if you speak about wage garnishment, suing sufferers who’re low-income for his or her medical debt. These are issues that journalists have uncovered time and again, taking place at — ding, ding, ding — nonprofit hospitals. It’s more durable to argue that hospitals are simply doing their greatest for folks when you might have these tales of poor people who find themselves dropping their properties over unpaid medical payments, for example. And I believe that proper now, once we’re on this political second the place well being care prices are so, so potent to folks and so necessary, I imply, might we see that it will truly be more practical, that we’re heading in direction of one thing that’s more practical? Possibly.

Rovner: Properly, repeats the journalist, as all of us are, the facility of storytelling. Positively the general public is primed. I think about that’s why they’re doing it now. We’ll see what comes of it.

Kenen: assume the general public is primed for unhealthy practices. I’m unsure what number of sufferers perceive if the hospital they go to is a nonprofit or a for-profit. I believe the general public understands that all the things in well being care prices an excessive amount of and that there are unhealthy actors and greed. There’s a distinction between revenue and greed, and I believe many individuals would say that we’re now in an period of greed. And never everyone within the well being care sector — earlier than anyone calls us up and shouts, “Not everyone who offers care is grasping” — however we’ve seen, , it’s clearly on the market. You already know, you had Zeke Emanuel on a few weeks in the past. Keep in mind what he mentioned, that, , 10 years in the past, some folks nonetheless preferred their well being care and now no person likes their well being care, wealthy or poor.

Rovner: Yeah, he’s proper. All proper. Properly, that’s this week’s information. Now, we’ll play my interview with Kate McEvoy of the Nationwide Affiliation of Medicaid Administrators about how the Medicaid unwinding goes. And one notice earlier than you pay attention: Kate ceaselessly refers back to the federal CMCS, which isn’t a misspeak; it stands for the Heart for Medicaid and CHIP Providers, which is the department of CMS, the Facilities for Medicare & Medicaid Providers, that offers with Medicaid. So, right here’s the interview:

I’m happy to welcome to the podcast Kate McEvoy, government director of the Nationwide Affiliation of Medicaid Administrators, which is just about precisely what the title says, a gaggle the place state Medicaid officers can share info and concepts. Kate, welcome to “What the Well being?”

Kate McEvoy: Good afternoon. Thanks for having me.

Rovner: Clearly, the Medicaid unwinding, which we’ve talked about so much on the podcast, is Subject A on your members proper now. Remind us once more which Medicaid recipients are having their protection eligibility rechecked? It’s not simply these within the enlargement group from the Inexpensive Care Act, proper?

McEvoy: It’s not, no. Every particular person served by the nation nationwide needs to be reevaluated from an eligibility standpoint this 12 months.

Rovner: What will we learn about the way it’s going? We’re seeing a number of stories that counsel the overwhelming majority of individuals dropping protection are for paperwork causes, not as a result of they’ve been discovered to be not eligible. I do know you latterly surveyed your members. What are they telling you about this?

McEvoy: So, I first wish to say that is an unprecedented job and it’s clearly traditionally important for everybody served by this system. The quantity of the work, and likewise the complexity, makes it a difficult job for all states and territories. However what we’re seeing to this point is just a few issues. First, we’ve seen an unimaginable effort on the a part of states and territories to saturate actually each technique of speaking with their membership, actually getting out that message round connecting with the packages, particularly if a person has moved throughout the interval of the pandemic, which may be very typical for folks served by Medicaid. In order that saturation of messaging and use of latest technique of connecting with folks, like texting, actually does characterize an incredible advance for the Medicaid program that has historically relied on a whole lot of complicated, formal, authorized notices to folks. In order that looks as if a really optimistic factor. What we’re seeing, and this isn’t sudden, is that, , for causes associated to complicated life circumstances and competing concerns, many individuals aren’t responding to these notices, regardless of how we’re transmitting these messages. And so that could be a piece that’s of nice curiosity and concern to all of us, notably Medicaid administrators eager to guarantee that eligible of us don’t lose protection just because they aren’t attentive to the requests for extra info. So we’re at some extent the place we’re past that preliminary push round messaging and now are actually targeted on technique of defending individuals who stay eligible, both by automated assessment of their eligibility — the ex parte course of — or by restoring them by such means as reconsideration. That’s actually the principle focus proper now.

Rovner: And there’s that 90-day reconsideration window. Is that … how does that work?

McEvoy: So the federal regulation provides this era of 90 days to households and youngsters inside which they are often renewed with little or no effort, primarily eradicating the duty to finish a brand new software. We even have long-standing assist to folks referred to as “presumptive eligibility.” So if somebody goes to a federally certified well being heart or, extra sadly, goes to the hospital, a lot of these varieties of suppliers can restore somebody’s eligibility. So these are necessary protecting items. We additionally know from the survey that you simply talked about of our membership that many states and territories are extending these reconsideration protections to all protection teams — additionally together with older adults and folks with disabilities.

Rovner: So are there any states which might be doing something that’s totally different and progressive? I keep in mind when CHIP [the federal Children’s Health Insurance Program] was being stood up — and boy, that was a very long time in the past, like 1999 — South Carolina put flyers in pizza packing containers, and another state put flyers in sneaker packing containers for back-to-school stuff. Are there higher methods to possibly get ahold of those folks?

McEvoy: So I believe the reply is: a whole lot of totally different channels. Our colleagues in Louisiana have a partnership with Household Greenback shops to primarily characteristic this info on receipts. There’s a whole lot of work at pharmacy counters. Among the large chain pharmacies have QR codes and different technique of prompting folks round their Medicaid eligibility. There’s going to be an enormous push for the back-to-school effort. And I believe CMS and states are actually , significantly in guaranteeing that youngsters don’t lose protection even when their dad and mom have regained employment they usually’re not eligible. One other factor that’s occurring is a whole lot of innovation within the technique of enabling entry to info. So many states have put in place private apps by which individuals can monitor their very own eligibility. There’s curiosity and a few uptake of the so-called pizza-tracker operate — so you possibly can sort of see the place you’re located in that pipeline — and likewise a whole lot of use of automation to assist name folks again in the event that they’re attempting to get to state name facilities. So actually, all of these varieties of methods … we’re seeing an enormous quantity of effort throughout the nation.

Rovner: How’s the cooperation going with the Division of Well being and Human Providers? I do know that … they appear to be not pleased with some states. Are they being useful, typically?

McEvoy: They’re being terribly useful. I’d say that we frequently speak about Medicaid representing a federal-state fairness partnership, and we’ve seen that manifest from the start of the primary discover of the knowledge across the begin of the unwinding. CMCS has constantly supplied steering to states. They work with states utilizing a mitigation method versus transferring quickly to compliance. We really feel mitigation is the easiest way of primarily understanding the methods which might be going to greatest shield persevering with eligibility for folks on the state degree. And we actually recognize CMS’ efforts on that. We perceive they do have to make sure accountability throughout the nation, and we’re mutually dedicated to that.

Rovner: You higher clarify mitigation methods.

McEvoy: Yeah, so it is a 12 months the place we’re calling the query on eligibility requirements that assist make sure that the pathway to Medicaid protection is a clean one, and likewise that there’s continuity of protection. So, for any state that wasn’t but assembly all these requirements, CMCS primarily entered into an settlement with the state or territory to say, right here is how you’ll get there. And that would have concerned some technique of enhancing the automated renewals for Medicaid. It might have meant counting on an built-in eligibility processes. There are a whole lot of totally different instruments and methods that had been put in place, however primarily that could be a path to each state and territory coming into full compliance.

Rovner: Is there something sudden that’s taking place? I do know a lot of this was predicted, and it was predicted that the states that went first that, , had been actually in a rush to get further folks off of their rolls appear to be doing simply that: getting further folks off of their rolls. Are you stunned on the variations amongst states?

McEvoy: I believe that there have undoubtedly been variations amongst states when it comes to the instruments they’ve used from a system standpoint, however I don’t see any variations when it comes to retention of eligible folks. That continues to be a shared purpose throughout the whole nation. And once more, it is a watershed level the place we’ve the chance to carry everybody to the identical requirements, ongoing, in order that we assist to stop a number of the heartache of the eligibility course of for people ongoing.

Rovner: Anything I didn’t ask?

McEvoy: Properly, I believe that piece across the reconsideration interval is especially necessary. We’re struck by there being most likely much less literacy round that choice, and that’s one thing we wish to proceed to advertise. The opposite piece I’d wind up by saying is that the Medicaid program is all the time accessible for people who find themselves eligible. So within the worst-case state of affairs through which an in any other case eligible particular person loses protection, they will all the time come again and be coated. That is in distinction to non-public insurance coverage that will have an annual open enrollment interval. Medicaid, as , is offered on a rolling foundation, and we wish to preserve reinforcing that theme in order that nobody goes with a spot in protection.

Rovner: Kate McEvoy, thanks very a lot. And I hope we will name you again in a few months.

McEvoy: I’d be very glad to listen to from you.

Rovner: OK. We’re again and it’s time for our further credit score phase. That’s once we every advocate a narrative we learn this week we expect you must learn too. As all the time, don’t fear for those who miss it. We’ll put up the hyperlinks on the podcast web page at kffhealthnews.org and in our present notes in your cellphone or different cellular gadget. I did mine already. Emmarie, why don’t you go subsequent?

Huetteman: My story this week comes from KFF Well being Information, my colleague Darius Tahir. He has a narrative referred to as “The NIH Ices a Analysis Mission. Is It Self-Censorship?” Now, the story talks about the truth that the previous head of NIH Francis Collins, was, as he was leaving, asserting an effort to check well being communications. And we’re speaking about not simply doctor-to-patient communications, however truly additionally how mass communications influence American well being. However as Darius came upon, the performing director quietly ended this system as NIH was making ready to open its grant functions. And officers who spoke with us mentioned that they assume political stress over misinformation is guilty. Now, we don’t should look too far for examples of conservative stress over misinformation and data today. Specifically, there’s a notable one from simply final month out of a Louisiana courtroom, the federal courtroom resolution that blocked authorities officers from speaking with social media firms. You actually don’t should look too far to see that there’s a chilling impact on info. And we’re speaking concerning the NIH was going to check or quite fund research into communication and data. Not misinformation, info: how folks get details about their well being. So it’s a fairly fascinating instance and a very nice story price your learn.

Rovner: And I’ve performed nothing however preach about public well being communication for 3 years now.

Kenen: It’s an excellent story.

Rovner: Yeah, it was a very good story. Rachel, you’re subsequent.

Roubein: All proper. This story is named “From Home windows to Wall Artwork, Hospitals Use Digital Actuality to Design Extra Inclusive Rooms for Youngsters,” by Stat Information, by Mohana Ravindranath. And I believed this story was actually fascinating as a result of she sort of dived into what Mohana referred to as “a budding motion to make structure extra inclusive” for the folks and sufferers who’re spending so much, a whole lot of time in hospital partitions. And what some researchers are doing is utilizing digital actuality to primarily gauge how snug youngsters who’re sufferers are in hospital rooms. And she or he talked to researchers at Berkeley who had been utilizing these, like, digital actuality headsets to sort of research and discover mocked-up hospital rooms. And, I didn’t know a ton about this discipline. I imply, apparently it’s not new, however it’s this type of rising type of motion to make sufferers extra snug within the house that they’re inhabiting for maybe lengthy intervals of time.

Rovner: I went to a convention on structure, hospital structure, making it extra patient-centered, 10 years in the past. However my favourite factor that I nonetheless keep in mind from that’s they talked about placing artwork on the ceiling as a result of individuals are both in mattress or they’re in gurneys. They’re wanting up on the ceiling so much. And ceilings are scary in hospitals. In order that was one of many issues that I took away from that. OK, Joanne, now it’s your flip.

Kenen: OK. That is from Fox Information. And sure, you probably did hear that proper. It’s by Melissa Rudy, and the headline is “Male Well being Care Leaders Full ‘Simulated Breastfeeding Problem’ at Texas Hospital: ‘Large Eye-Opener’.” So at Covenant Well being, that they had a bunch of high-level guys in fits faux they had been nursing and/or pumping moms, they usually needed to nurse each three hours for 20 minutes at a time. They usually discovered it was fairly troublesome and fairly cumbersome they usually didn’t have sufficient privateness. And as one in all them mentioned, “There was no method to multitask.” However belief me, when you have two children, you need to determine that out, too. So it was a very good story.

Rovner: A few of these issues that we really feel like must be required in all places, however it was an awesome learn; it was a very good story. OK, that’s our present for this week. As all the time, for those who benefit from the podcast, you possibly can subscribe wherever you get your podcasts. We’d recognize it for those who left us a assessment; that helps different folks discover us too. Particular thanks this week to Zach Dyer, sitting in for the indefatigable Francis Ying. And as all the time, you possibly can e mail us your feedback or questions. We’re at [email protected]. Or you possibly can tweet me or X me or no matter; I’m @jrovner. And in addition on Bluesky and Threads. Rachel?

Roubein: @rachel_roubein — that’s on Twitter.

Rovner: Joanne.

Kenen: In most locations I’m @JoanneKenen. On Threads, I’m @joannekenen1.

Rovner: Emmarie.

Huetteman: And I’m @emmarieDC.

Rovner: We shall be again in your feed subsequent week. Till then, be wholesome.


Zach Dyer
Senior Audio Producer

Emmarie Huetteman

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