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KFF Health News’ ‘What the Health?’: Readying for Republican Rule

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[[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: Hello, and welcome back to “What The Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, November 14th, at 10 a.m. As always, and particularly this week, news happens fast and things might’ve changed by the time you hear this. So, here we go.

Today we are joined via videoconference by Rachel Roubein of The Washington Post.

Rachel Roubein: Hi. Thanks for having me.

Rovner: Anna Edney of Bloomberg News.

Anna Edney: Hello.

Rovner: And Lauren Weber, also The Washington Post.

Lauren Weber: Double trouble today. Thanks for having me.

Rovner: No interview this week but more than enough news to make up for it, so let’s dig right in. So as of yesterday, it’s official. Come January 20th, Republicans will control the presidency, the Senate, and the House, although the final split is still yet to be determined and might be even smaller than the handful it is now. Plus President-elect [Donald] Trump keeps naming House Republicans to his administration, which will complicate things and which we’ll talk about in a moment. But assuming there is a trifecta when Trump puts his hand on the Bible at noon on January 20th, what difference is that going to make to the health agenda than if the House had flipped Democratic, even by a vote or two?

Edney: Well, I think that, as you just mentioned, this majority is likely to be so small. And just thinking to the past, we’ve seen such divisions, even among the Republican Party, on what should be done.

Rovner: It only takes one or two — when you can only afford to lose one or two votes, it only takes one or two people to gum up the works.

Edney: Yeah, and there are a lot of members — and particularly, it seems like, in the GOP — that are very willing to do that. I mean, I think that also the potential is that health care is not top of mind for President Trump, at least. So I know we’ve heard Speaker [Mike] Johnson say that he would like to overturn the ACA [Affordable Care Act] right away, but I don’t know that, like we said, with the small majority, that that will be able to even happen.

Rovner: I feel like that’s a big difference from, I would say from 2017, when we came in and health care, repealing ACA, was right at the top. Not so much now. Lauren.

Weber: I was just going to say: What version of the Trump administration on health care are we going to get? I mean, you have Robert F. Kennedy Jr. out there talking about “Make America Healthy Again,” which also flies in the face of a lot of Republican ideology. I mean, a lot of what he’s talking about seems to be high regulation of ultra-processed foods. He seems to want to limit advertising for pharmaceutical ads. He wants to focus on chronic disease, which is something that a lot of people on the left would love to see more interest in, along with the ultra-processed food. But is that the new Republican Party focus for health? I don’t know. I think we’re going to see, I mean, considering RFK seems poised for a large position in the administration.

Rovner: And we’ll talk more about him in a few minutes. Rachel, you wanted to add something.

Roubein: Yeah. I think of — when I think about Congress and the power structure, I’m thinking a lot about just the government spending bills and how that is used to negotiate. Like, if you look from a few years ago, Democrats negotiated some Medicaid policies that they wanted on maternal health for exchange for what Republicans wanted on unwinding Medicaid. And so Democrats lose their negotiating leverage there. And really one of the big policies in Congress for next year, I think, is the expiration in 2025 of the enhanced Obamacare subsidies. So Democrats don’t really have a chamber there.

Rovner: Which we’ll also get to. But, I mean, the big difference is that if the Democrats had gained a majority even by one or two votes, that would’ve given them control of committees, which now they won’t have. And that is, yes, a big deal. I was going to say, Anna, in a year when health is not necessarily at the top of the sort of big agenda, what happens in committee is often what happens.

Edney: Right, yeah, what they decide to look into or not to look into. One of the places maybe where they could sort of cross paths or agree in a way with RFK Jr., if that’s the way the Trump administration goes, is there’s still a lot of anger on the right about the covid vaccine. So we could see investigations ongoing — I think they’re still happening — but ongoing in that vein, and [Anthony] Fauci could keep getting called before Congress. And that leads to a sort of aversion to pandemic preparedness, which could be concerning because we’re looking down at this bird flu potential problem that keeps getting slightly more concerning all the time.

Rovner: There’s a teenager in Canada in intensive care with bird flu, who was not exposed to anything on a farm. That has public health people concerned.

Edney: Right, right, exactly. And when you think about raw milk and RFK Jr. in support of that — I know we’ll get to him — but it all feels like a perfect storm, potentially. But I think that the way that the Republicans would prefer to go is not dealing with — they’d rather gut pandemic preparedness. They don’t see a place for it, so that those things could become important down the line.

Rovner: So as I mentioned, President-elect Trump is already announcing lots and lots of people to staff the upper levels of his incoming administration. And even with the Senate, with the Republican majority, that seems pretty likely to give him whatever he wants, he’s been curiously suggesting that he wants to use something called recess appointments for his major offices, which would mean his appointees would be temporary, but they would also avoid the normal Senate confirmation process, which involves vetting and hearings and votes and even on an expedited basis can take weeks. Are we starting to get an idea of why he wants that, given some of the folks that he’s already named, like firebrand and ethics-challenged Republican congressman Matt Gaetz to be attorney general?

Edney: Yeah, certainly. We haven’t seen an HHS [Department of Health and Human Services] pick yet, and I can’t even guess who it might be just given what’s already come out was very unexpected. And so I think that you’ve seen agencies like the Food and Drug Administration go through that before, where they’ve just had these temporary people or they’ve kept in place whoever was the deputy at the time, and they become the commissioner for a while and not confirmed. And it really hampers their ability to do a lot, though. There are decisions that a department or an agency can’t make if someone’s not Senate-confirmed.

Rovner: But doesn’t that throw more power back to the White House? Isn’t that kind of the idea here?

Edney: Yeah, true. That’s a good point. If RFK Jr. gets this sort of health czar spot — I’ve been telling people I couldn’t really see him as HHS secretary, because a lot of what he wants to do is under the USDA [Agriculture Department]so that would make no sense. And so if he just kind of has the power he wants in the White House to do what he needs, you make a good point there as well.

Rovner: Yeah, what else are — I would’ve said before yesterday that they would never name RFK Jr. to be HHS secretary. Although after some of the names we got yesterday, maybe that will happen. This could happen while we’re taping this. But what other names are we hearing, if any? I know I have three people here who have been covering the FDA. I mean, obviously during the first Trump administration, the FDA was headed by Scott Gottlieb, who we would consider a traditional Republican, a doctor. He’d worked in the agency before. He’d been in government. That doesn’t seem likely what we’re going to see this time around.

Edney: I think that’s true. I think the one thing is what Trump’s focus will be. If he does let someone else kind of take the reins on this, maybe we would see someone a little more measured. I would say right now, most of the names that I’m hearing for HHS or FDA are very much recycling from last time around. And so I’m really unsure whether people are just batting that around because those are names that have come forward before or whether that’s who we’ll actually see named. I think we will know in short order, because I do think that these are coming out quickly. And I appreciated, Julie, that you corrected everyone that they’re not nominated. There is an intent to nominate by a president-elect, so, but still will—

Rovner: Although, I will say, his statements say that he’s nominating, which is confusing people.

Edney: Yeah. I think they’re less concerned with the specifics.

Rovner: Yes. Well, surprise, surprise. All right, now let’s talk about RFK Jr. Obviously, we don’t know what position he’s going to fill, but we’ve talked a lot about his more Republican-friendly positions, anti-vax stuff and raw milk and sort of anti-public-health. But Rachel and Lauren, you’ve got a story up today about some other positions that Democrats might be a little more sympathetic to. What are some of those?

Roubein: There’s at least two ideas that we had sort of looked at in this story that have found some public support on both the right and the left, such as stripping ultra-processed food from school cafeterias and kind of cracking down on food dyes. And, I mean, one of the things we noted up top is that this is, some of this would be a contradiction from Trump’s first term, where Sonny Perdue, who was Trump’s agriculture secretary, within the first week or two of him being in his position, he vowed to quote-unquote “make school meals great again” and then kind of waged this assault on Michelle Obama’s efforts to make school meals healthier. That’s not to say that Kennedy being a position of power doesn’t alarm federal health officials or public health experts or people in the food industry, because it does. But there are some policies that he could have a [Sen.] Bernie Sanders agree with him on.

Rovner: And while we’re on the subject of ultra-processed food, Lauren, you’re our Lunchables correspondent, and there’s Lunchables news this week. Tell us about it.

Weber: There is Lunchables news this week, and loyal listeners of the pod will remember that I did a story at The Washington Post last year with some of my colleagues that looked at how Lunchables had ended up on school lunch trays for the first time ever. Kraft Heinz had kind of tinkered with the formula, reformulated it, and actually ended up adding more sodium while adding more protein and other things to qualify for the National School Lunch Program. And, obviously, a lot of nutrition experts were appalled because they felt like this is an example of ultra-processed foods that’s being served as free and reduced lunch to kids who don’t necessarily have as much of a choice there on what’s being served to them. And we got news this week that Kraft Heinz didn’t make enough money, that school districts did not purchase their reformulated product, and they had, due to quote “lack of demand,” they’re taking them off the options.

So it’s kind of interesting. RFK’s push against ultra-processed food is coming at a moment not just in school lunches but in the United States, where there has been growing awareness about ultra-processed foods making up 60% of the American’s diet. And for a very, very long time, food industry h as been really successful in Congress at watering down some of the regulations against stuff like ultra-processed food, especially in school lunches, to kind of weaken these regulations, as Rachel talked about, that Michelle Obama had pushed for and other ways, so that they could continue selling their products. And so some of the food industry folks that Rachel and I talked to are quite concerned about a possible RFK role because he’s really pushing against the powers that be there. And it’s really interesting to see that dynamic, because, as Rachel pointed out, the only other person that’s really been doing that recently is Bernie Sanders. So you kind of have this horseshoe of right and left that’s coming to the forefront here.

Edney: I was just going to add, I actually wrote my newsletter on this today. The FDA is doing some things in this vein that are sort of interesting. I said it was kind of an RFK-FDA, very tiny, very small Venn diagram in that the agency is also looking at ultra-processed food. They said — Jim Jones is their deputy commissioner for human foods, and he said recently that they were doing some work trying to figure out how to study whether there’s really causality, but he did say they’ve been working and they have done a lot on certain trans fats, getting them out of food. They’ve done a lot to try to, they’re trying to reduce sodium levels. That’s going to be a stepwise process in food. And they have made consumers a lot more aware, including on the label, of added sugars. And he was like, This is all what we see in processed foods that is a problem.

And so there’s sort of this quiet— they’re quietly going after it, just not calling it that. And then on the dyes, they’re certainly not going as far as RFK Jr. and saying, We want to ban all dyes. But they have had a petition in front of them for a couple years, and Jim Jones said he expected a response from the FDA. I forget exactly the quote, but it was very soon on what they’re going to do on Red Dye Number 3, which is sort of the one that has been studied the most and has links to cancer and potentially hyperactivity in kids.

Roubein: I think it’s also worth noting, in talking about the FDA’s nutrition department, is the day after the election, RFK Jr. was on MSNBC saying that there are entire departments at FDA that have to go, and he specifically said the nutrition department. Again, whether you could just have kind of a mass firing of civil servants is kind of pretty TBD, but that’s how he’s viewing the nutritionists there, and that is alarming to staff. FDA Commissioner Robert Califf the other day said that, called them hardworking people. He was asked about it and had a bit of a defense there.

Weber: Just to add in on that, too, there are some nutrition advocates that wouldn’t be that sad about that. I mean, I know that they feel like the FDA has been too slow, is too influenced by industry. I mean, look at the food label story that we talked about also on this podcast, that Rachel and I did. The Biden administration was supposed to propose potential front-of-pack labels for front of food, and a lot of nutrition advocates thought, even though this proposal has not come out yet, that what they were thinking about was too weak and too deferential to industry. So RFK has certainly tapped into this growing anger, it seems, at the lack of protections for kids or in general about the food supply. I think part of it is is that he and Trump are very good marketers. They have these catchy slogans, “Make America Healthy Again.” I think that’s somewhat at play as well.

Rovner: I think before we leave this sort of next administration segment, though, I do want to broaden it out a little bit, because we’ve been talking about this contradiction that is Donald Trump, which is, on the one hand, he’s got a group of people that wants to strip the federal government of all of its ability to regulate and get rid of regulations and let industry run wild because, as Vivek Ramaswamy says, regulation is a yoke around the neck of innovation. On the other hand, he’s got people like RFK Jr. who want to come in and say: No, let’s get industry out of government. Let government do its job regulating. I mean, the health industry must be — their heads must be spinning, because this obviously is going to affect different portions of the industry different ways, right?

Edney: Yeah, it’s a confusing thing, too, when you think about the pharma industry, for instance. I can say, they are highly regulated in the sense that they pay lots of money to the FDA, millions and millions of dollars to have their new drug applications reviewed. There’s a very strict process of what they get for that, what the FDA will do for that. They don’t want that thrown away, because that gives them a lot of security on, Here’s how things are going to work and we need to know thatversus if you just had somebody up there being like, Yes to that one, no to that one. And there could be other areas. Certainly Big Pharma would not love it if everything was tried to be cured with ivermectin and the hydroxychloroquine. So that would be a problem for all of us. So I think that there’s just a lot of confusion and uncertainty in pharma, at least.

Rovner: And I mean, the one thing we know is that industry hates uncertainty. They would like to be able to plan.

Edney: Yes. Right, yes. They very much need that for themselves, for their researchers, for their shareholders. That’s super important.

Rovner: Yeah, so obviously, everybody in health care is sort of watching eagerly. All right, well, while we’ve all been busy talking about the election, open enrollment began for the Affordable Care Act for 2025, possibly the last year that millions of Americans will remain eligible for expanded subsidies, since a fully Republican Congress and president seem unlikely to extend them beyond December 31st, 2025. What is going to become of the ACA expanded subsidies? Is there any chance they get extended? It would displace millions of people who have gotten health insurance through the ACA.

Edney: Well, I think if we’re talking in ways that Trump may be interested in, the insurance companies wouldn’t like it, because they don’t want to lose all of those patients. So I guess maybe that is the potential glimmer of hope for people who want those expanded subsidies to stay intact.

Rovner: And we still don’t know what the Republicans have in mind for the Affordable Care Act. As I like to point out, they’ve been talking about a replacement since 2010 and we’ve never actually seen one.

Roubein: Trump has concepts of a plan, he says.

Rovner: So we have heard.

Roubein: Remember that in the debate? I mean, we heard that for how many years, right? Years and years.

Rovner: Two weeks. He’s going to have something in two weeks.

Edney: I was going to say, if anyone writes an In two weeks it’s coming story, they have to buy drinks for everyone.

Rovner: Absolutely. Lauren, you wanted to say something.

Weber: I mean, I was just going to say that the first Trump administration was not known for expanding any sort of subsidies for the ACA. So I’m curious. But as Anna pointed out, frankly it’s always hard to take away something that’s popular. You don’t necessarily want those people mad at you. So to be quite honest, let’s wait and see.

Rovner: Yeah, TBD.

Weber: TBD.

Rovner: Well, this is also the first year that DACA [Deferred Action for Childhood Arrivals] recipients, the so-called “Dreamers” who were brought to the U.S. without documentation as children, are eligible themselves for subsidized ACA coverage. That’s estimated to be about 100,000 people. I wouldn’t expect that to last either, though. And I’m wondering, it might not even make it through the year, as it’s the subject of a lawsuit brought by Republican attorneys general that I expect a new Justice Department would just drop?

Roubein: Yeah, I feel like with everything, there’s kind of a road map to look at what Trump did in the first term, just kind of speaking broadly, not just on DACA. But then there are things that they might not do again. So I feel like it’s hard to predict, but yeah, feasibly I feel like that could sort of be the thinking.

Rovner: Trump has been nothing more than unpredictable all the way through. So I’m going to do my extra-credit story early this week because I want us all to talk about it a little bit. It’s from my KFF Health News colleague Phil Galewitz, and it’s called “In Vermont, Where Almost Everyone Has Insurance, Many Can’t Find or Afford Care.” And it’s about a problem that’s kind of been sneaking up on us and is now here for all to see: Having insurance is necessary but not sufficient to get health care.

As Phil points out, Vermont has basically the lowest uninsured rate in the United States, but care there is expensive. Both providers and insurers are having financial difficulties, and growing numbers of patients either can’t find care or can’t pay for it or both. Some of this appears to be demographics. Vermont is, on average, older and more rural than most other states, and some of it is possibly due to health provider consolidation. But I feel like this is kind of the early warning of the same sorts of things happening around the country. At what point do we have to actually take stock of the fact that our health system is not functioning very well? I mean, we’re so busy talking about what industry wants and what government wants and what will help this group and what will help that group. And it’s like, even with an all-time-low uninsured rate, the stories about people being unable to get care are becoming more than anecdotal, right?

Weber: I mean, I think, Julie, go back to the name of this podcast. The podcast is called “What the Health?” I mean, I think you’ve, obviously, and all of us here have been covering this for many years. But Phil’s story was just beautifully done, because it showed how multifaceted the problem is. But that also means there’s not a quick fix. But the bottom-line kicker was these people are paying a ton of money for their health care and are having to wait months and months and months for stuff they feel like is not that great, or they’re forced to go across state lines and pay more somewhere else to get it quicker. And obviously that’s, as you said, not quite a solution. So a fascinating look at, what it seems like, a large number of factors that are causing serious issues with people’s health care delivery.

Rovner: I just feel like it’s a warning to not — I mean, obviously we are health reporters. We look at things in the micro. But sometimes I feel like we’re kind of losing the forest for the trees, and this was a really good reminder. It’s like there’s a forest out there and things are not going great in the forest.

All right, well, let’s turn to abortion. Even though seven out of 10 states with ballot measures voted for the abortion rights position — eight states, if you count Florida, where the measure to overturn the state six-week ban got 57%, but that was short of the 60% it needed to pass — the anti-abortion movement is nonetheless gearing up to undo as much of this as it can.

According to our podcast panelist Alice Ollstein, some of the strategies anti-abortion groups plan to pursue are ones that we have talked about here before, including requiring that abortion pills be labeled as a controlled substance, like they’re doing in Louisiana, or that the remains of medication abortion be handled as medical waste. Other ideas are new or at least new-ish, like trying to cut off funding to colleges and universities that provide abortion pills at campus facilities. The anti-abortion movement is also trying to push state legislation aimed at circumventing the protective amendments that tho se states’ voters just passed. This fight is a long way from being over, right?

Edney: Oh, yeah. And you just mentioned states. That’s where I’m sure that a lot of the focus is, because if Trump holds to his word, and I don’t know if that’s the case, he said it should be up to the states on how they handle all of this stuff. So I imagine now is their moment if they’re going to try some of these more out-of-the-box ways of dealing with it.

Roubein: And I think one thing that emerged, particularly after Republicans took back the House in 2022 and Roe v. Wade was overturned, was that the battleground being states, but also the executive branch. The battleground in terms of Congress, the House didn’t bring up a bill to ban abortion at 15 weeks or anything politically—

Rovner: They couldn’t have gotten the votes with their tiny majority.

Roubein: Yeah, it’s very politically tricky. We’ve seen Republicans back away from those stances. And then you look at the Biden administration, which has said, There are things we can do to sort of do some guidelines, et cetera, like letting the VA [Department of Veterans Affairs] do abortions in certain instances, or they rolled back Trump’s changes on the Title X federal family program that basically forced Planned Parenthood out. So you could sort of see some of those things being rolled back again.

Rovner: Well, one of the things that I haven’t seen noted by anybody, and I absolutely agree with you about: The first thing that the Trump and whoever in the Trump administration to do is reverse the things that [President Joe] Biden did, which in some ways were reversals of things that Trump did the first time around. But we do have a bunch of abortion-related lawsuits still in play that involve the Justice Department. Remember that Supreme Court case where the justices ruled that the anti-abortion doctors who brought the case didn’t have standing to sue? Well, that case is still alive. It’s still in court, because states have stepped in as plaintiffs. Then there are cases challenging the Biden administration’s interpretation of EMTALA, which is the federal law that requires emergency abortions be provided to protect a pregnant woman’s health and says that those override state laws that only allow abortions if the woman’s life is imminently endangered. I would think those cases would go away under Attorney General Matt Gaetz or whoever is going to be in charge of the Justice Department, right?

Edney: I mean, that makes perfect sense to me that they would not continue arguing those by any means unless Trump is more focused on trying to overturn his own convictions. I don’t know what that could look like.

Rovner: Yes, no matter what, the Justice Department will be very busy, but I suspect not very busy arguing the abortion rights side of abortion cases.

Edney: Right.

Rovner: Well, I want to turn to Medicare. Trump insisted during the campaign that he wouldn’t touch Medicare, but that’s not actually possible for a Congress and an administration. The only real question is how Medicare will be touched. Doctors are, once again, facing a Medicare pay cut for next year. This one is just under 3%. And that’s something that the lame-duck Congress, which is just getting back into session this week, may or may not cancel, given how crazy things are right now on Capitol Hill. And The Wall Street Journal has a piece this week about how sicker people are leaving their Medicare Advantage plans to return to traditional Medicare, which makes sense because private Medicare Advantage plans make care harder to access when you’re sick. So that ends up making — when they leave, it ends up making the plans richer because they don’t have to pay for the care, and the taxpayers poorer because now Medicare, traditional Medicare, is paying for the care. So Medicare’s going to have to be on the table in some form. We can’t just ignore Medicare for four years, right?

Edney: Yeah, I think particularly this is the sort of bigger picture. But when you think about if Trump does want to do a bunch of tax cuts and where does the money come from, I’m sure there are ways to do it. There are all kinds of budget tricks that can be done to look like you’re not touching Medicare but you’re touching Medicare, so you can keep that campaign promise. And I don’t know if that’s really on the table for them, but I don’t think we can expect no one to be looking at this, particularly also because of the sort of Republican desire to prop up the Medicare Advantage a little bit more to get … So I don’t know if there’s a way to encourage some people back on those plans or how they’re going to look at that.

Rovner: Yeah, it’s important to remember that the traditional Republican idea on Medicare is to get more people to go into Medicare Advantage, which is happening naturally anyway because people who are aging into Medicare are mostly coming out of managed care plans, so they’re used to being in managed care plans. So it’s easy for them to go into these Medicare Advantage plans that say, Hey, we’re going to offer you extra benefits that Medicare doesn’t. And it’s not until they actually need care and can’t get it that they realize that maybe that wasn’t the best idea. But I certainly expect this entire debate to carry over to the next administration.

Edney: Well, and you also … I don’t know why, but you reminded me that there are still drugs to negotiate under Medicare.

Rovner: That’s right.

Edney: And you somehow have to deal with that, and taking it away would be pretty difficult, seemingly.

Rovner: And cost a lot of money.

Edney: And cost a lot of money. But you could negotiate things differently or — I’m not sure.

Rovner: Yes, we’ll have plenty of Medicare to talk about. All right, well, that is the news, at least up until this moment. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. I’ve already done mine. Anna, why don’t you go next? Yours is so very on brand for you.

Edney: Thank you. So mine is from The Atlantic. It’s called “Throw Out Your Black Plastic Spatula.” Certainly, I grew up in my family and my parents still have all their black cooking utensils. And what this is talking about is how most of our black cooking utensils are made from recycled electronics. And there’s a whole reason for that. It’s really interesting to read about. But the outcome is that there are also a lot of fire retardants in those, so we are getting fire retardants leaching out into our food.

Rovner: Of course, fire retardants are why they had them in the first place, right? Because you’re putting them in very hot things.

Edney: Well, this is more because of the electronics. Like, yeah, when you’re using an electronic, I guess there’s fire retardants in there because you don’t want the battery blowing up or whatever. But if you’re recycling those and making utensils out of them, then you’re going to get some of that in your food.

Rovner: The dark side of recycling.

Edney: Yes.

Rovner: Lauren, why don’t you go next?

Weber: Mine’s actually a study in JAMA that’s titled “Medical Board Discipline of Physicians for Spreading Medical Misinformation.” And the study found that actually the least common reason for medical board discipline was spreading misinformation, which was not actually news to me or some of my colleagues at The Washington Post, as they cite our work in this study. But Lena Sun, Hayden Godfrey, and I last year did a large investigation in which we actually surveyed all 50 medical boards and went through and asked them about whether or not they had disciplined anyone for misinformation.

And then on the boards that did not respond, which was many, we then went through and read every single disciplinary action to see what we could find. And the bottom line is is doctors didn’t get punished. There’s a lot of free-speech protections, and, frankly, it had to be very, very, very egregious for medical boards to step in. In general, medical boards are weak. They are known to be poor at self-regulating their own. It takes a lot to really get punished by a medical board, so it’s not that surprising. But after a lot of clamor during covid and a lot of physicians that really became megaphones for unscientific evidence, it’s still quite striking that not very many of them faced any sort of repercussions for that.

Rovner: Yeah, another issue going forward. Rachel.

Roubein: My extra credit, it’s titled “‘Been a Long Time Since I Felt That Way’: Sexually Transmitted Infection Numbers Provide New Hope,” in Politico by Alice Miranda Ollstein. The story talks about basically how there’s been this drop in sexually transmitted infections, and that has followed years of just skyrocketing cases. So this is from new data from the Centers for Disease Control and Prevention that came out this week. So, for instance, total cases of syphilis increased 1% and congenital syphilis ticked up 3%, but that’s a far slower rate of growth than the spikes of the last few years. So that’s an encouraging note for STD health directors in states. But in the piece, she talks about how there’s some concern from public health experts and other advocates about potentially backsliding under Trump, depending what happens, and also noting that Congress last year clawed back hundreds of millions of dollars in public health funding.

Rovner: That’s right. And obviously the federal Family Planning Program plays a big role in the prevention of sexually transmitted infections, and we have no idea what’s going to become of the federal Family Planning Program under a Republican trifecta. So again, a story that I’m sure we will spend more time talking about.

All right, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks this week to our temporary production team, Taylor Cook and Lonnie Ro, as well as our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth, all one word, @kff.org. Or you can still find me at X @jrovner and increasingly at Bluesky @julierovner.bsky.social. Where are you guys these days? Lauren?

Weber: Still just on X, LaurenWeberHP. The “HP” is for “health policy.”

Rovner: Anna.

Edney: On X. It’s @annaedney. And I am trying out Bluesky as well, but I’m so new that I don’t even remember my name.

Rovner: It’s OK.

Edney: I’ll get that next time.

Rovner: Rachel.

Roubein: Similarly to Lauren, on X, @rachel_roubein.

Rovner: We will be back in your feed next week. Until then, be healthy.

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KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records

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KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to release a range of Medicare Advantage health plan audits and other financial records.

The suit, filed Nov. 12 in U.S. District Court in San Francisco under the Freedom of Information Act, or FOIA, seeks documents from the HHS inspector general’s office, which acts as a watchdog over federal health insurance programs run by the Centers for Medicare & Medicaid Services.

The suit asks for correspondence and other records of contact between HHS officials or their representatives and Medicare Advantage organizations concerning overpayment audit findings and potential financial penalties.

It also seeks records reflecting communication between HHS and CMS officials regarding the government’s policies for recovering overpayments discovered during Medicare Advantage audits, including a controversial decision in January 2023 to limit dollar recoveries for audits dating back a decade or more.

Additionally, the suit seeks copies of government contracts awarded to outside firms that have conducted Medicare Advantage audits, including budgets and performance evaluations, dating to 2020. In these audits, reviewers take a sample of 200 patients from a health plan and determine whether medical records support the diagnoses the government paid health plans to treat.

KFF Health News requested the records in August, but, more than two months later, “no documents, responsive or otherwise, have been produced,” the suit says.

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Sam Cate-Gumpert, an attorney with Davis Wright Tremaine, which is representing KFF Health News pro bono in the case, said the information is “critically important to public oversight of government misspending.”

According to the suit, the inspector general’s office has audited the Medicare Advantage program more than three dozen times since 2019, revealing billions of dollars in overpayments.

But government officials have not recouped the overcharges, according to the suit.

The HHS Office of Inspector General “has left taxpayers footing the bill for billions of dollars in overpayments — even though HHS OIG’s primary purpose is to combat fraud and waste in Medicare and other federally funded health programs,” the suit alleges.

“In fact, taxpayers have been forced to pay for the Medicare Advantage program’s wasteful spending twice — first, because of the program itself, and second, because of the costs of the audits, which the government spends millions of dollars to conduct,” according to the suit.

Medicare Advantage, mostly run by private insurance companies, has enrolled more than 33 million seniors and people with disabilities, more than half of people on Medicare.

But the program has faced criticism that it costs billions of dollars more than it should with research showing that many health plans exaggerate how sick patients are to boost payments.

A FOIA lawsuit filed by KFF Health News in September 2019 prompted CMS to release summaries of 90 Medicare Advantage audits revealing millions of dollars in overpayments. As part of a settlement, CMS paid $63,000 in KFF Health News’ legal fees, though it did not admit to wrongfully withholding the records.

The HHS Office of Inspector General had no immediate comment on the suit.

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KFF Health News’ ‘What the Health?’: Trump 2.0

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The Host

Health care might not have been the biggest issue in the campaign, but the return of Donald Trump to the presidency is likely to have a seismic impact on health policy over the next four years.

Changes to the Affordable Care Act, Medicaid, and the nation’s public health infrastructure are likely on the agenda. But how far Trump goes will depend largely on who staffs key health policy roles and on whether Democrats take a majority in the U.S. House, where several races remain uncalled.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

  • As of Friday morning, it remained unclear which party will control the House next year. A Democratic-controlled House would offer a check against Republican policy changes and some control of key government oversight committees. A Republican House would give the party full control of Congress and the presidency. Either way, the party in control will have a slim majority.
  • Majorities of voters in eight states voted to protect abortion rights — though the ballot measures passed in only seven states. (More than half of voters in Florida voted for the abortion rights measure, but the state requires at least 60% support for ballot measures to pass.)
  • Robert F. Kennedy Jr. — now a key voice in the Trump transition team — is telegraphing big plans for health policy. Who ends up in Trump’s Cabinet will make a difference, as the president-elect is seemingly outsourcing much of his health policy planning in favor of focusing on issues such as the economy, immigration, and trade.
  • And conservative appointees throughout the judicial system are likely to remain friendly to Trump administration causes, which could open the door to more challenges to federal policies. Several important legal challenges are already winding through the courts.

Also this week, Rovner interviews KFF Health News’ Jackie Fortiér, who reported and wrote the latest KFF Health News-Washington Post “Bill of the Month” feature, about a 2-year old who had an expensive run-in with a rattlesnake. Do you have a medical bill that is exorbitant, baffling, infuriating, or all of the above? Tell us about it!

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

Julie Rovner: KFF Health News’ “Dentists Are Pulling ‘Healthy’ and Treatable Teeth to Profit From Implants, Experts Warn,” by Brett Kelman and Anna Werner of CBS News.

Alice Miranda Ollstein: Politico’s “The Election’s Stakes for Global Health,” by Carmen Paun.

Rachel Cohrs Zhang: KFF Health News’ “As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations,” by Samantha Liss.

Also mentioned in this week’s podcast:

  • The New York Times’ “R.F.K. Jr. Lays Out Possible Public Health Changes Under Trump,” by Remy Tumin.
  • KFF Health News’ “Toddler’s Backyard Snakebite Bills Totaled More Than a Quarter Million Dollars,” by Jackie Fortiér.

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To hear all our podcasts,click here.

And subscribe to KFF Health News’ “What the Health?” onSpotify,Apple Podcasts,Pocket Castsor wherever you listen to podcasts.

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KFF Health News’ ‘What the Health?’: The Campaign’s Final Days

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[[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.]

Emmarie Huetteman: Hello and welcome back to “What the Health?” I’m Emmarie Huetteman, a senior editor for KFF Health News and the regular editor on this podcast. I’m filling in for Julie Rovner this week, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 31, at 10 a.m. Happy Halloween. As always, news happens fast, and things might’ve changed by the time you hear this. So, here we go.

Today, we’re joined via video conference by Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Huetteman: Lauren Weber of The Washington Post.

Lauren Weber: Hello, hello.

Huetteman: And Jessie Hellmann of CQ Roll Call.

Jessie Hellmann: Happy Halloween.

Huetteman: Later in this episode, we’ll have Julie’s interview with Irving Washington. Irving is our KFF colleague who is senior vice president and executive director of the Health Misinformation and Trust initiative, and he joined us this week to talk about the election. We’ll also have the winner of KFF Health News’ Halloween Health Haiku contest. But first, this week’s news. We are this close to the end of campaign 2024 and health care is making a bit of an unexpected resurgence. During a campaign event this week, House Speaker Mike Johnson said that there would be massive health care changes if former President Donald Trump is elected, including “no Obamacare.” Here’s what Johnson said:

“The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.” OK, as a reminder, Trump has called for reopening the ACA fight and he has made no promises to preserve Medicaid, which, by the way, pays medical bills for about 1 in 5 Americans. Now, for the reality check for the Republicans to make big changes, it wouldn’t be enough for Trump to win. Republicans would also need to hold the House and win control of the Senate next week.

Let’s put that aside, though, to talk about appetite here. Do we really think that Republicans would go after the Affordable Care Act again? It worked so well for them.

Hellmann: I don’t know if I envision another repeal-and-replace fiasco, but there is an opening for them in 2025. There are enhanced premium tax credits that expire. Those were done through the Inflation Reduction Act, and I see it very unlikely that Republicans would be willing to go along and extend those again. I think that’s going to be a big fight, but it obviously depends who wins the House and the Senate. Right now, it looks like Democrats might retake the House and Republicans will regain the Senate, so maybe there will be some kind of negotiation there, but it has such a high price tag that it just seems like it would be a really messy fight. But as far as just repealing the ACA, I don’t think they want to open that can of worms again.

Huetteman: Absolutely. I’m wondering has much changed since Sen. [John] McCain’s famous thumbs down in 2017 ended the last effort?

Luthra: People are more used to having the ACA. It has only gotten more and more entrenched in our system. One thing that I was really struck by is, this isn’t the first time in the campaign that a prominent Republican has talked about repealing the ACA. We had that kerfuffle earlier this cycle with JD Vance, who talked about, essentially, getting rid of protections for preexisting conditions, with the change in risk pools, and the backlash was pretty swift, and it just seems, from watching and seeing what the political reality has been, that if it was difficult to get the ACA repealed last time and it did not work, it will only be harder because people have grown just so much more accustomed to these benefits. I personally can’t remember having health care without the ACA, and a lot of people who are younger than a certain age probably feel the same way.

Huetteman: Absolutely. I was noting, actually, in my notes, Mike Johnson himself voted for repeal in 2017, but his office, when he was asked after those comments this week, didn’t elaborate when asked whether he also supports extending the ACA subsidies expiring next year. Seems likely that that’s not on his agenda, if I had to guess, especially based on this sort of talk.

Weber: I think this is a question of are they saying the quiet part out loud or are they walking this back because it doesn’t poll particularly well right before the election happens? To some extent, this is a little bit of a wait-and-see game here.

Huetteman: I think you’re absolutely right, Lauren. Moving on to the next issue, talking about the election coming up next week. A few weeks ago, Vice President Kamala Harris suggested a way to address the long-term care crisis in this country. Her plan would add a new Medicare benefit to pay for home health care. Then this week, Trump countered with his own idea. His proposal is to give a tax credit to family caregivers. Here’s the thing, though: There’s a pretty big difference between having Medicare pay for a home health care worker and cutting a family caregiver’s tax bill. But do these policy differences matter to voters at this point in the race?

Weber: I think you’re having Trump throw something at the wall because Harris tapped into something powerful, which is that there are a lot of Americans that are home health care aides. We have seen so much caregiving that goes on around this country without much notice or favor and that drives a lot of our health care costs. So I think the fact that you had the Trump campaign throw out anything at all speaks to how important this issue is to everyday Americans and remains to be seen which would be a better deal for these folks. Often, home care aides are not working, so their tax bill is different because they’re taking care of family members. But we also have to see what happens if Trump has been thought to potentially cut some forms of Medicaid, which also pays for a lot of home care aides. There’s a lot of unknown there, but there’s a lot of dollars that go into this, and a lot of Americans that feel very strongly about it. So I’m not surprised to see his campaign try to match in some way what Harris had suggested.

Luthra: I think the other point that’s worth noting also is, from a politics perspective, there is a question of voter trust as well, and we know from decades of polling that voters largely do trust Democrats more on issues of health policy because it’s the party that has been more invested in trying to expand benefits and trying to reform the health care system and has really devoted much of its intellectual thought to this area in a way that Republicans really haven’t. Obviously, there’s not a one-to-one between home care specifically … versus other times of types of health care, but I do think that we should take a critical eye and see do voters react to this even in an abstract way with the same kind of credibility that they might to a Democrat just with that history in mind.

Huetteman: That’s a great point. I hate to move on so quickly, but it’s time for Washington’s favorite parlor game. Let’s play “Guess Who?” — as in guess who might fill the key health jobs in the next administration. There’s one we talked about a little bit last week, but if Trump is elected, he says that he has promised Robert F. Kennedy [Jr.] free rein over both health and food policy. Here’s what Trump said about RFK Jr. during his rally at Madison Square Garden this week. “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” Do we know what Trump’s saying here and who else could play a major role in the next Trump administration? Lauren, what do you have to add?

Weber: I think it’s important to note that, just last night Trump’s co-chair of his transition team got on CNN and said some version of vaccines are linked to autism, which is patently false as we all know on this panel. I think it’s important to note that RFK, in any sort of health care rule, would be quite alarming to many public health professionals who call vaccination “the bedrock of public health advancement” over the last couple decades. As we look at what’s brewing in Trump Camp, some names that have come to mind are Casey and Calley Means have been floated out as folks that could be in the Trump administration.

You’re seeing some chatter around a fair variety of folks from before and after. I think some of it remains to be seen, but Trump is blatantly saying that he will give RFK some role in picking these people, and a lot of the people I talk to, the sources I talk to are very alarmed by what that could mean. As I said earlier in this podcast, the Trump campaign is saying the quiet part out loud. They’ve pitched the MAHA [Make America Healthy Again] movement as more about ultra-processed foods and some of these other things. But when you have top campaign officials saying, “Actually, we do have questions about vaccines,” it’s hard to look past RFK’s vast record of anti-vaccine activism.

Huetteman: By MAHA, of course, we mean the “Make America Healthy Again” effort.

Weber: Yes, and I will point out know RFK recently tweeted about MAHA that he would “bring sunshine back to the FDA.” He would promote ivermectin, stem cell research, a variety of things that many members of the medical community are alarmed by.

Huetteman: Including, in fact, Trump’s own surgeon general, who made his own comments this week about RFK potentially being in the next administration, his comments were that RFK’s influence could make people less willing to get vaccines, which could impact “our nation’s health, our nation’s economy, and our global security.” That’s pretty big words from someone who served under the last Trump administration about the next one.

Luthra: I think that gets at something quite interesting when we think about who might be doing health policy under a Trump administration, which is, in the previous administration, that picking those people was a job largely outsourced to Mike Pence. Mike Pence is obviously not on the ticket anymore, so that leaves more of an opening and I don’t think we necessarily know who will be filling that role. Does JD Vance necessarily get a larger role in picking some of the people who might influence health policy? That could have a lot of implications because he’s also quite socially conservative and the Health and Human Services Department does have real power over issues like abortion, family planning, a lot of these areas that have been very influential in shaping how voters feel about this election and where JD Vance has changed his views a number of times.

Huetteman: Those are good points. Absolutely. Moving on now to abortion. Speaking of abortion, in terms of the election, we’re having more stories coming out about the effects of the new abortion environment here in this country. You may remember the outcry in September after ProPublica told the stories of two women who died in Georgia because they couldn’t get care under the state’s abortion ban. ProPublica is back this week with reporting on two deaths out of Texas attributable to its ban, one of which happened just two days after the state’s “heartbeat law” took effect in 2021. These are wrenching stories, but are they having an impact on voters?

Luthra: I don’t know. I think we’ve already seen a pretty meaningful shift in how voters think about abortion in the past couple of years because they have heard so many stories about people suffering devastating health consequences, even short of death. One thing that I was really struck by that ProPublica pointed out in this piece, which is just gutting to read and which we saw reinforced by the reaction from anti-abortion intere st groups yesterday, is that there isn’t necessarily a reaction from Republicans and from people who oppose abortion to acknowledge the role that abortion laws play in harming people’s health, and in these cases in people’s deaths. Susan B. Anthony List [Susan B. Anthony Pro-Life America]a prominent anti-abortion group, said that the real problem here is not the laws, but rather that doctors don’t understand how to make use of the exceptions in these laws and that the fault lies with doctors.

ProPublica spoke to many, many doctors across the country. Many of us who cover this have also spoken to many doctors across the country, and it’s just very clear that the exceptions as written in these laws are quite unworkable. There just isn’t enough clarity for people to know that they can provide care until it is too late, and in the case like this, it was too late before people could intervene. But I remain skeptical that without broad sustained outcry, we will see this change how abortion opponents and the Republican Party talk about abortion as a policy issue.

Huetteman: I’d love to talk a little bit more about how anti-abortion folks are talking about this issue. Here’s another story that came out this week from The Washington Post about a woman who suffered a miscarriage and ended up in prison charged with manslaughter. This was in Nevada, which doesn’t even have an abortion ban. Her conviction was set aside by a judge and she was released, but the woman is still in legal jeopardy because the prosecutor hasn’t dropped the charges and hasn’t decided whether he will or not. Many abortion opponents say they have no intention of punishing women who have abortions. We’re talking about doctors being potentially punished for performing abortions, but we’re still seeing women punished as a result of their pregnancy outcomes. Why is that?

Luthra: That prosecution and the story is just phenomenal and absolutely worth reading. That prosecution actually happened before Roe v. Wade was even overturned and it made use of very old anti-abortion laws, and it highlighted something that I think is really important, which is that there has been a history of criminalizing people for pregnancy outcomes, even independently of the abortion bans that have swept the country in the past two years, and that comes from a lot of factors, but it is something that we are seeing become potentially more common in the post-Dobbs landscape, and there’s a real divide in the anti-abortion movement, whether they will eventually go after pregnant people in a more systematic way. The reason they haven’t is because of the politics, because it is just so unpopular to say we are going to specifically go after people who are pregnant as opposed to their doctors.

But I think cases like this Nevada case and cases like others that we have seen arise around the country, including in Texas, underscore that there is some appetite for this in some corners of the anti-abortion movement, and it is something that could gain traction and gain prominence if abortion opponents make a calculus that the political trade-offs are worth it or are no longer as salient as they have been.

Huetteman: Shefali, you’ve done some great reporting on this, and I’d like to talk a little bit more about that, actually. So first off, in last week’s extra-credits segment, Julie talked about anti-abortion crisis pregnancy centers. These centers offer free pregnancy tests, ultrasounds, and counseling while trying to convince people not to have an abortion. Shefali, you have a story out this week about how these centers are getting more involved in electoral politics. Can you tell us more about that?

Luthra: I thought this was very interesting and I looked at these anti-abortion/crisis pregnancy centers in the states where abortion is on the ballot and I saw a good number of them have been making themselves more of a presence on the campaign trail and legally most of them are 501(c)(3) nonprofits, so they can’t endorse a specific candidate, but what they are doing is trying to share what they say is information about how these ballot measures would affect them. But what they’re sharing often contains a good amount of misleading or inflammatory language, arguing the classic Republican talking points, “These abortion measures would allow abortion up until the point of birth and beyond,” which, in most cases, isn’t true because a lot of these measures actually would only protect abortion up until fetal viability.

But what we’re seeing is part of a larger effort. Heartbeat International, one of the big crisis pregnancy/anti-abortion center organizations, actually had a session earlier this year teaching their members how can you become more involved in politics while also maintaining your tax-exempt status. And they’re talking through these organizations what kind of strategies might be appropriate in part because they do see abortion being a continuing political issue, and they want to use these centers as part of their toolbox. They’re something that they think can be very effective because people don’t know what they are necessarily. They might look at them and see, that’s my local pregnancy center. They give free ultrasounds, they give pregnancy tests, and I trust them without realizing that they actually have a very clear political agenda.

Huetteman: Absolutely. In many cases, these are the only options that may be available to you for pregnancy care at this point. Isn’t that right?

Luthra: Exactly. They are very affordable because they provide for pregnancy tests and free ultrasounds, and they are not regulated as medical centers. They vastly outnumber abortion clinics, especially obviously in states with abortion bans. I have spoken to a lot of people who say, “This is my only option because I can’t afford to go to a doctor’s office to find out how far along I am, even if I know I don’t want to be pregnant.” As a result, they’ll go to these places not necessarily knowing what they are or even knowing what they are and are given inaccurate information, can be, in some cases, deliberately misled about their pregnancy outcome and options, and their medical data is at jeopardy as well.

Huetteman: Thanks for your reporting on that. We’ll be talking about that more, I’m sure. Shifting gears, while we’ve all had our eyes on the election, President Joe Biden is still in charge of the executive branch and the Biden administration is still doing health policy things. Just in the past week, the administration put out new rules requiring insurance to pay for the new over-the-counter birth control pill, as well as some forms of prescription contraception. Separately, the administration also put out a plan to help track and ease shortages of cancer drugs for kids.

I know we spend a lot of time talking about things politicians promise to do, but we don’t always take note when they actually follow through on these promises, particularly if they’re not controversial. I wanted to make note of that this week. Now, finally this week, here’s something that’s likely to continue no matter who is elected president or who controls Congress next year. I’m talking about profiteering in health care. This week, we have two more investigations digging into profit-seeking middlemen. The first is from The New York Times about how a data firm called MultiPlan determines how much insurers should pay out-of-network providers while charging fees that sometimes exceed the payments themselves. But the other investigation is from ProPublica about another for-profit company called EviCore. Jessie, this story is your extra credit this week. Why don’t you tell us about it now?

Hellmann: This story [“‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care,” by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica] looks at EviCore by Evernorth, which is hired by insurance companies to process prior authorization requests. As we’re seeing more of in health care, they use an algorithm that’s backed by AI to help make these decisions, and there has just been a lot of complaints from patients and doctors about what they see as unfair denials. But what I thought was really interesting about this story is it takes a peek behind the curtain of how this specific algorithm actually works. It has something called a dial, which they can scale up or scale down depending on how many denials they’re trying to get, which obviously can result in more money for the insurance company.

While this algorithm can’t reject a prior authorization request, it does flag requests that have to be approved by a doctor who works for this company, who can reject those requests. I thought it was just an interesting look at — we talk all the time about prior authorization and how it impacts patients and doctors who are tired of the red tape and all the bureaucratic work that they have to do to get care to patients. But I think in the past few years, we’ve been learning more about how these systems are actually structured. I think this is a really good look at that.

Huetteman: Definitely. The thing these businesses have in common is that they’re in the business of saving someone money, but that someone is rarely the patient. Is anyone looking into what this is doing to our health care system, having such a focus on profit as part of the system that we use to care for people when they’re sick and dying? Is this good for patients?

Weber: I think that’s how you get the name of this podcast, right? I think that’s how you come up with the name of this podcast. I think a lot of reporters out here are looking into that, in general. I think that’s why how policy is a beat that we all like to cover because it crosses so many sectors of both real pain and suffering that people feel, and whether that’s in their pocketbooks or medically when dealing with the health care system.

Huetteman: Absolutely, that’s true. Thank you, Lauren. OK, folks, that’s this week’s news. Now, we’ll play Julie’s interview with KFF’s Irving Washington. Then we’ll come back and do the rest of our extra credits and read this year’s Halloween Haiku winner.

Julie Rovner: I am so pleased to welcome to the podcast Irving Washington, KFF senior vice president and executive director of KFF’s newest program launched this summer, our initiative on Health Misinformation and Trust. Irving, welcome to, “What the Health?”

Irving Washington: Hi. Julie. Glad to be here.

Rovner: So why don’t you start by telling us what the Health Misinformation and Trust initiative is and what you do?

Washington: Sure, happy to. So the Health Misinformation and Trust is a new program that you mentioned at KFF. The short of it is, it’s really designed to help people understand all the complexities and what’s going on with health misinformation and trust. As you know, we’ve always had health misinformation, it’s been around. And KFF has been in the business for health misinformation for quite a while. But this new program will bring all of our work together at KFF. And then we’re also launching new products like the KFF Health Misinformation Monitor, which helps people track what misinformation and narratives are happening within the country.

Rovner: And what are some examples of the kinds of health misinformation that you’re trying to bring to light?

Washington: There’s all kinds of examples. Everything from, we had earlier issues around, if you’ve seen on social media, the miracle cures, those things that you see on TikTok, to issues that are happening right now in the elections, whether that be reproductive health, gender-affirming care, and, of course, vaccines and covid-19.

Rovner: Why are we seeing so very much health misinformation right now, and so little trust in expertise? I mean, this all predates Donald Trump, and it predates covid, and yet it seems to be more than ever.

Washington: It does seem like we do see that more these days. However, I like to remind people, as you just also said, we’ve been in the business, or had health misinformation, for quite a while. Misinformation in general. I like to think of the, remember the tabloids from several years ago or just a nything — think about not even written information, but if your family had something that was passed down and this is supposed to cure this. So we’ve had misinformation for a while. Obviously, there’s been a few things that have changed, which makes the appearance of it spreading more and actually spreading more. Social media, for example, spreads misinformation much quicker. It also prioritizes engagement. And then you also mentioned the trust in institutions, organizations, that’s been an ongoing trend that I think we’ve seen over the last decade as well, too. So those two things combined, I think, puts us at the moment that we’re in now.

Rovner: So if former President Trump wins a second term, he’s promised Robert F. Kennedy Jr., who is a longtime purveyor of health misinformation, what he calls free rein in health policy. What could that mean?

Washington: That could mean a lot of things. It could mean that many of the systems and resources that we rely on to make sure we’re getting accurate and proper information may disappear. It also could mean that the things that we consider verifiable, factual information that we see from our public health institutions and government, that might be in jeopardy now, or that may or may not be a trustworthy source.

Rovner: How do you determine what’s misinformation and what’s not? I’m old enough I used to look things up in the encyclopedia. You can’t really do that anymore.

Washington: Well, I will tell you, it is much, much more complex these days. I have used the advice of anyone now, and you almost have to consider yourself a detective when you’re looking at information, particularly on social media. And by that, that just means doing extra checks to make sure that you’re confirming what you’re looking at is correct. There are a number of things people can do, a couple of them, and also how you can sort of see if this is misinformation. One thing to look out for is if data is cherry-picked. So if you see one particular data point, but it leaves out the broader context of, say, a study, that’s usually a signal it might be misinformation. Also look out for sensational language. Anything that plays on an emotional appeal, I like to think, just do a check on if you feel yourself getting agitated by this, and just double-check to make sure that it’s something that is factual information as well.

And then of course, I’d say the last thing is just look at who is sharing that information. Is it an expert? Is it someone who just read something in the book? And even with doctors, you’d have to look at, is this in their expertise? One thing I’ve often said is, do you want your cardiologist to give you brain surgery, even though they’re both doctors, right? So you have to look at all those things.

Rovner: So what’s the role of AI in health misinformation? It can be both good and bad here, right?

Washington: That is certainly true. AI is fascinating, I’ll say at this point. And you’re totally right, it can be good and bad. We’ve looked at that from a couple of angles. Our polling shows that more people are turning to that to get their health information. Not a large number, but it is growing. The other thing that we looked at too, and this wasn’t formal research, we just did one experiment with one staffer, and over a period of eight months, we looked at 10 health misinformation false claims. And we asked the three major chatbots if this was misinformation or not. And Julie, those answers changed over a course of eight months. One instance it said it was, the other instance says it was a developing topic. Sometimes they would quote their resources, like the CDC [Centers for Disease Control and Prevention] or the WHO [World Health Organization]the other times they wouldn’t.

So it was an evolving process as each system got updated as to what the AI chatbot said. So it’s important for people to think about. That might be a first source, like you could Google something in the same way to get an idea of something, but you should always verify with your primary care provider.

Rovner: So what should we tell kids and relatives and people who we sort of see purveying misinformation about how they can perhaps better educate themselves?

Washington: As much as possible. This is a big task to ask, but I do ask this request of folks is, you yourself try to be a trusted messenger. We know that trusted messengers work, so as much as possible, share factual information, no judgment on someone else’s belief or what they’re saying, but share factual information that you know. And I think the other thing that you can do is have productive conversations with people, again, if you personally know them, have those productive conversations with people, if you see that them spreading misinformation. One of the things about misinformation, in particular, sometimes people don’t know they’re spreading misinformation. So you also can just start there by helping to inform people. And then after that, when you know there’s clear misinformation, I think we all have a role in this information ecosystem that we’re in. We all can help put out quality and correct information.

Rovner: We’re coming up on the holiday season, Thanksgiving and Christmas, and times when families who perhaps have different views about things get together. Any good advice for sort of gently explaining to some of your friends and family why some of the information they have might not be exactly correct?

Washington: Well, oddly enough, Julie, that might be my dinner table. I can tell you what I may do this upcoming holiday. One, you want to make sure that you are listening. I think where people sometimes perhaps are too quick to share factual information and they want to get this point across, particularly on family members, you really want to take time to listen and understand where someone is getting their information from, who they are getting it from, and why they are choosing to believe. Once you get that information, I think you can then decide how do you want to approach some of those conversations. They could be, again, providing more factual information to counter that. They could be just getting the person to ask questions about the information that they’re receiving. Some conversations … if you can just end with them questioning somewhat where they’re getting information from, that might be a way to help people understand … better factual information.

Rovner: Last question: If people want to sign up to get the KFF Health Misinformation Monitor, how can they do that?

Washington: They can do that by going to kff.org. You will see our Health Misinformation and Trust landing page, and you can sign up and subscribe at the bottom.

Rovner: Irving Washington, thank you so much for joining us. I hope we can call on you again soon.

Washington: Happy to be here, Julie, and do this. Thank you.

Huetteman: OK. We’re back. And it’s time for our extra-credit segment. That’s where we each recognize a story we read this week that we think you should read too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. All right, Jessie’s already done hers. Shefali, why don’t you go next?

Luthra: Mine’s from NBC News. It is by Aria Bendix, and the headline is “They’re Middle Class and Insured. Childbirth Still Left Them With Crippling Debt.” The story is excellent. It is absolutely worth reading. It follows a couple of families in Illinois who gave birth and ended up with, as the headline would imply, thousands of dollars in medical debt. And the family in the lede, they made too much money to qualify for Medicaid. They had this health care plan that was a grandfathered plan, so had very high out-of-pocket limits, and so as a result, they had this tremendous amount of expenses that they had to pay after she gave birth to twins who were born prematurely, who required NICU care. And, even worse, were born right at the end of the year. Right when her health plan reset, and she suddenly had to go through a new effort to hit her out-of-pocket limit.

The story is really, really smart because it takes a problem that is familiar and makes it feel new. Something that we don’t talk about enough. The loopholes that exist in the Affordable Care Act that can still leave medical debt as such a problem. It puts a real human face to this, and the end, the end is really devastating. You talk to this mother, Jessica, and she is talking about all of the medical expenses that she’s trying to forgo, if she can, whether that is for her own health or for her children’s health because she is just really scared of incurring another medical bill and being surprised yet again by more debt that she and her family really can’t afford. It’s absolutely worth your time, especially as we think so much about what it means to get pregnant and to give birth and the challenges that exist for people who do that in our country.

Huetteman: That’s a great point. It is heartbreaking to think that people who are going through something as routine as childbirth are being subject to things like rationing care in order to make sure they can afford their medical bills. Well, all right. Lauren, how about you go next?

Weber: I have a piece from the New York Times titled “What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials,” written by Walt Bogdanich and Carson Kessler, and it’s pretty horrifying. Basically, there was a drug trial for an Alzheimer’s drug that the volunteers that answered the call to do it had a gene that would make them more predisposed to have Alzheimer’s, but that gene also meant that it could make them more likely to have brain bleeds that interact with this drug. They took a genetic test to see whether they had this gene that would go this way and then the drugmaker didn’t tell them that it could cause a higher risk of brain bleeds for these people.

It’s just a very horrifying story about lack of disclosure and, especially in a field like Alzheimer’s, where often people that feel like they are taking part in these trials maybe are worried about the devastating impacts of the disease. Many of us, I’m sure on this podcast and all those listening, have had personal experiences with how devastating that can be. Holding that over someone but not giving them the full knowledge of what they could be signing up for, there was at least one patient that died, many others that had brain hemorrhages that were preventable with the proper disclosure. Great reporting by The New York Times.

Huetteman: Absolutely. Thanks for talking about it for us. My story this week is from KFF Health News and it’s by Julie Appleby. The headline is “‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way.” ACA open enrollment season opens Nov. 1 and, for the first time, so-called Dreamers will be eligible to enroll. As a reminder, the term Dreamers refers to people who were brought to the United States without immigration paperwork when they were kids and who have since qualified for federal protections because they meet certain requirements. Those include that they were in school or had graduated or that they had served in the military. Anyway, a Biden administration rule that came out earlier this year says that Dreamers, as “lawfully present individuals,” are eligible for ACA coverage, and, potentially, the premium subsidies to pay for it. But 19 states are challenging the rule in federal court.

Those states say the rule will put more strain on the system and it’ll encourage people to remain in the United States without permanent legal authorization. A ruling could come at any time with several possible outcomes, including a potential hold on the Biden administration’s rule. We’ll be keeping an eye on this one.

Before we go, I have the privilege of reading the winner of this year’s Halloween Health Haiku contest. The winning entry was written by Crystal Decker, and it goes like this.

Vampires don’t scare me.

Empty blood shelves, now that’s fear.

Roll up, save a life.

You can find the winner and the runners-up and some fabulous illustrations by my KFF Health News colleague Oona Zenda on our website at kffhealthnews.org, and we’ll post the link in our show notes. That’s all the time we have this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and to Stephanie Stapleton, our editor this week. As always, you can email us your comments or questions. We’re at [email protected], and you can still find me lurking on X. I’m @emmarieDC. Jessie?

Hellmann: I am on Twitter @jessiehellmann.

Huetteman: Shefali?

Luthra: I am @shefalil.

Huetteman: And Lauren?

Luthra: I’m @LaurenWeberHP.

Huetteman: Julie will be back next week. Until then, be healthy.

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