Episode Transcript
Transcripts are displayed as originally observed. Some content, including advertisements may have changed.
Use Ctrl + F to search
0:09
Hello and welcome back back to
0:11
What the I'm I'm Julie Rovner, Chief Washington
0:13
correspondent for KFF Health joined by
0:15
some of the best and smartest the
0:17
reporters in Washington. health We're taping this week
0:19
on Thursday, December this week at 10 a
0:21
.m. 12th always, news happens fast and things
0:23
might have changed by the time you
0:25
hear changed by the time you hear here we go.
0:27
we go. Today
0:36
we are joined by a
0:38
video conference by Alice Miranda Miranda Olstein
0:40
of Politico. Hello. Rachel Korg News. of
0:43
Stat News. Hi And Sandia Roman
0:45
of CQ Roll Call. Good morning. Later
0:47
in this episode, we'll have my
0:49
interview with Francis Collins, former director of
0:51
the National Institutes of Health, an
0:53
agency expected to be even more in
0:55
the news than usual in 2025. than
0:58
But first, this week's this week's news.
1:00
Obviously, the biggest news of
1:02
the week is the building
1:04
backlash over the shocking shocking Manhattan
1:06
shooting last week of United
1:08
of United Healthcare CEO Brian who was
1:10
on his way to United's to
1:12
investor meeting. There is still
1:14
a lot to be uncovered,
1:16
be but we now know know.
1:18
New York authorities have charged
1:20
26 -year -old Mangione, an Ivy Ivy League
1:22
educated native of Baltimore, Maryland
1:24
with the the murder. Mangione, who
1:26
was arrested after being spotted
1:28
Altoona, Pennsylvania McDonald's, was found. a with a
1:31
3D ghost gun gun that New York
1:33
detectives have linked to the murder
1:35
weapon. and what some have described
1:37
as a manifesto, but was really
1:39
more of a memo detailing his his
1:41
about the nation's healthcare system in
1:43
general and general and particular. Care He
1:45
was reportedly a chronic pain a chronic pain
1:47
recently had back surgery. back Now,
1:50
we have spent a lot of
1:52
time on this podcast talking about
1:54
how big has become. Thompson was actually
1:56
only the CEO of the insurance
1:58
company, not the behemoth United Health Group. also includes
2:00
Optum, which made headlines earlier this year
2:02
as the owner of the claims processor
2:04
whose hack shut down much of the
2:06
health care system for a month or
2:08
two. But this particular act of violence
2:11
appears to have touched a nerve in
2:13
the public at large who have been
2:15
moved to tell their own all too
2:17
common stories of mistreatment at the hands
2:19
of the health care system. Is this
2:21
going to be a blip or is
2:23
this maybe the start of a broader
2:25
conversation this nation really needs to have
2:27
about kind of the sorry state of
2:29
our health system that obviously can't be
2:31
fixed by individuals shooting executives on the
2:33
streets of New York City? I
2:35
think this does open up kind
2:37
of a larger conversation. I mean,
2:40
you know, even just last week,
2:42
we had a lot of backlash
2:44
when, you know, Anthem had decided
2:46
to limit some of their anesthesia
2:48
coverage for surgeries and there's a
2:51
lot of backlash and they kind
2:53
of reversed course on that. Yeah,
2:55
we'll talk about that in a
2:57
second. This kind of builds on
2:59
just the general. I think people
3:01
are upset with the state of
3:04
insurance, whether it's the price or
3:06
the coverage or, you know, who
3:08
has it, who doesn't. And, you
3:10
know, it's not something that I've
3:12
seen before that people are just
3:15
this reactive over something like this
3:17
when it's, you know, someone in
3:19
business and in health versus something
3:21
much more political or related to
3:23
war or something where I've seen
3:25
kind of similar reactions. So this
3:28
both seems unique, but seems like
3:30
it's kind of unleashed something in
3:32
people that they're having a lot
3:34
of thoughts and that it could
3:36
open something up bigger for the
3:39
future. Yeah, I think the narrative
3:41
from Democrats for a very long
3:43
time has been, look at how
3:45
many people are insured. And I
3:47
think this really kind of brought
3:49
out the sentiment that we have
3:52
known has existed that insurance doesn't
3:54
make health care affordable for people
3:56
necessarily. Or even accessible. Right, right.
3:58
And so I think. not
4:01
to say that insurance isn't important or
4:03
better than not having insurance, but I
4:05
think just the way plans are structured
4:07
and I think we're kind of looping
4:10
back to the idea that maybe just
4:12
getting everyone quote unquote check the box
4:14
insured isn't going to fix things. So
4:17
I'm the I am the person here
4:19
who covered the first big managed care
4:21
backlash in the 1990s, which was, I
4:23
will have to say, a simpler time
4:26
because at that point, it really was
4:28
the insurance companies who were kind of
4:30
the bad guys in the narratives. They
4:32
were, you know, it's sort of the
4:35
beginning of bringing for-profit insurance to health
4:37
care and there was a lot of
4:39
sort of, you know, rather crude denials
4:41
ways to restrict people from getting care
4:44
that they were particularly not used to
4:46
i think people are more used to
4:48
it now and there was a really
4:51
big backlash and it still took until
4:53
twenty ten when the Affordable Care Act
4:55
passed that we got what would you
4:57
know the so-called patient bill of rights
5:00
the requirement for insurers to cover people
5:02
with pre-existing conditions which had not existed
5:04
before so i mean even when things
5:06
were even more difficult. It was a
5:09
very, very, very long fight. Now, I
5:11
think, you know, Rachel, as you were
5:13
suggesting, it's a lot more complicated. Sometimes
5:15
insurers are the good guys in this.
5:18
Sandia, you mentioned the Anthem Blue Cross,
5:20
sort of brief episode last week where
5:22
anesthesiologist publicized the fact that Anthem had
5:24
wanted to. cut off payment for surgeries
5:27
that ran long, basically, that they would
5:29
only pay for a certain amount of
5:31
anesthesia for each procedure. And of course,
5:34
immediately there was a backlash and patients
5:36
thought that, well, if, you know, if
5:38
they're not going to pay for the
5:40
anesthesia, then we're going to have to
5:43
pay for it when in fact, what
5:45
Anthem was trying to do was cut
5:47
back on how much anesthesiologist were being
5:49
paid because they thought they were sometimes
5:52
patting their bills. insurance company trying to
5:54
save patients money, but it wasn't taken
5:56
that way, and Anthem immediately walked it
5:58
back, which brings me to my, how
6:01
hard is all of this going to
6:03
be to explain to the public who
6:05
is rightfully angry about the mess that
6:08
the health care system is, that it's
6:10
a lot more complicated than just yelling
6:12
at the insurance companies. I think it's
6:14
a really difficult thing to kind of
6:17
parse down to folks. I mean, what
6:19
people see on a day-to-day is, you
6:21
know, how much am I paying for
6:23
my premiums, for my family, or for
6:26
myself, and those have been going up.
6:28
They've been going up more than inflation.
6:30
And so that is what, you know,
6:32
people get their paychecks and they see.
6:35
And, you know, the top cause of
6:37
bankruptcy right now is health-related debt. Like,
6:39
these are the things that I think
6:42
people are thinking people are thinking about
6:44
on a day-to-to-to-to-to-to-to-to-to-to-to-to-to-to- basis rather than thinking
6:46
about thinking about you know a little
6:48
bit more into the weeds of you
6:51
know if you have employer-based insurance did
6:53
they negotiate these things to be covered
6:55
under this plan because plans are so
6:57
different depending on where you get insurance.
7:00
So I think that explaining a lot
7:02
of that down for books is going
7:04
to be difficult because the pocketbook thing
7:06
is really going to be what's up
7:09
front for folks that are thinking about
7:11
something like this. I think access is
7:13
an issue too though. I mean, I'm
7:15
finding that, you know, I'm starting to
7:18
hear more than anecdotally that people that
7:20
just cannot find mental health providers, primary
7:22
care providers. It takes months to get
7:25
an appointment with a specialist. I mean,
7:27
you know, One of the big arguments
7:29
against Medicare for All or any kind
7:31
of sort of government run health care
7:34
is that they end up rationing care.
7:36
Well, we seem to have the worst
7:38
of both worlds, where we're having rationed
7:40
care and profit-making in health care, that
7:43
those things are not going together very
7:45
well. Right. I was absolutely going to
7:47
agree. We have the long waits and
7:49
bureaucracy of a single-payer system, but we
7:52
have the crazy high prices and exclusions
7:54
of know, a fully private system. And
7:56
so it's really no wonder that there
7:59
is a lot of outpouring of frustration,
8:01
you know, in the wake of this
8:03
violence and people saying that they understand,
8:05
you know, where it's coming from because
8:08
of their own experiences. Well, hopefully this
8:10
might move to a more productive conversation
8:12
that, as I say, needs to be
8:14
had. Well, given all of the news,
8:17
you would be forgiven for not realizing
8:19
that Congress has been back in town
8:21
for the last two weeks and now
8:23
has checks notes, eight days until the
8:26
government shuts down, unless lawmakers agree on
8:28
a temporary spending bill, and 20 days
8:30
until the whole raft of health-related programs
8:33
lose their authority and or funding. Sandy,
8:35
what's the latest on this very lame,
8:37
lame duck Congress? So we're still at
8:39
a very similar place to probably the
8:42
last time that I've talked about this
8:44
and that we have so much to
8:46
do and a limited number of days.
8:48
The big thing is still funding the
8:51
government, which, you know, we're tied to
8:53
December 20th for getting, you know, a
8:55
CR or something longer and it's looking
8:57
very much like at this point, we're
9:00
going to get another sort of continuing
9:02
resolution temporary funding until next year, you
9:04
know, after the new administration, everything takes
9:07
effect. I think what's still kind of
9:09
up in the air is just kind
9:11
of what little things will be tied
9:13
to that. And you know, you talk
9:16
to members of Congress over the last
9:18
few days, a lot of that is
9:20
still in flux. There's a lot of
9:22
health care things that they'd like to
9:25
get added, depending on who you talk
9:27
to, House or Senate, Republican or Democrat.
9:29
And it's looking a lot likely that
9:31
anything big is going to be added
9:34
to that rather than a lot of
9:36
the things that we see year after
9:38
year, and kinds of things like that
9:40
rather than getting some of the bigger
9:43
stuff that they wanted to do across
9:45
the finish line. On getting all these
9:47
emails about telehealth authority, one presumes that
9:50
will find its way into something that's
9:52
popular, right? I think so. really with
9:54
telehealth, it is so popular, you know,
9:56
both sides. I don't feel like telehealth
9:59
won't get included in some way. It's
10:01
more just how long just because of
10:03
the the price tag of it. One
10:05
of the big things that have been
10:08
struggling with right now is finding offsets
10:10
for all the things that they want
10:12
to pay for. and telehealth is expensive,
10:14
so doing a longer term telehealth extension
10:17
just requires agreement on finding ways to
10:19
pay for it, and that's more of
10:21
the issue. I think it's an issue,
10:24
honestly, with a lot of these programs
10:26
where they are bipartisan popular things they
10:28
want to extend for longer amounts of
10:30
time, they just have to find the
10:33
money to pay for it, and that's
10:35
where, you know, kind of the heads
10:37
are budding. But I think in order
10:39
to get things done by the 20th,
10:42
we should be seeing, you know, something
10:44
coming in the next few days in
10:46
order to get it through both chambers.
10:48
But one of the must-pass bills before
10:51
the end of the Congress is the
10:53
National Defense Authorization Act, which usually does
10:55
not involve very many health issues, but
10:58
now is apparently a limbo over a
11:00
provision regarding medical care for transgender minors.
11:02
How is that part of the DOD
11:04
bill? So the NDAA, the
11:07
House passed the compromise version yesterday and
11:09
that has caused some some friction because
11:11
they a cut some of the IDF
11:13
coverage things through tri-care that were included
11:16
in the Senate and House Armed Services
11:18
bills. which is kind of an issue
11:20
because it would mean federal civilian employees
11:23
get eligible for IDF, but not the
11:25
military, but also it includes a provision
11:27
banning coverage of gender framing a care
11:30
for minors. And it passed, but there
11:32
has been a lot of Democrat opposition
11:34
to this. They're not okay with this,
11:36
even though this is the compromise bill.
11:39
And while it did get through the
11:41
house, I think it's going to be
11:43
interesting to see how kind of this
11:46
plays out, because this has been such
11:48
a hot button issue. And it's one
11:50
of the things that would really have
11:52
to get done this year. It would
11:55
be pretty unprecedented to not get that.
11:57
just to clarify, these are minor children
11:59
of people covered by DOD health care.
12:02
Yes. Which is a lot of people.
12:04
Yeah. All right. Well, turning briefly to
12:06
the next Congress, which starts in just
12:09
a couple of weeks, Congressman Brett Guthrie
12:11
of Kentucky will become the next chairman
12:13
of the Powerful House Energy and Commerce.
12:15
Committee, which oversees in the House Medicaid
12:18
part of Medicare and all of the
12:20
Public Health Service. Guthrie's currently chair of
12:22
the panel's health subcommittee, so his elevation
12:25
will open up that position as well.
12:27
What are Guthrie's health priorities and who's
12:29
likely replacement subcommittee? I mean, the time
12:31
that he has been the health committee
12:34
chairman or when he was the ranking
12:36
member before, he's been pretty active on
12:38
like COVID oversight, you know, health care
12:41
costs, opioids, things like that. And he's
12:43
said that some of these and just
12:45
kind of looking at ways to cut
12:48
costs. are things that he's kind of
12:50
like looking forward to next year. Since
12:52
he's been elevated to that, he gets
12:54
to pick who the subcommittee chairs will
12:57
be. And so far, we've had representatives
12:59
Buddy Carter, Gus Bill Arachas, and Morgan
13:01
Griffith express that they're interested in being
13:04
health subcommittee chairs. They're all already subcommittee
13:06
chairs of other subcommittees. So we're going
13:08
to have a shuffle regardless depending on
13:10
who he picks. then he can pick
13:13
at any time. Yeah, I would add
13:15
that Guthrie's been a pretty big supporter
13:17
of Medicare Advantage as well, which I
13:20
think will just be important to note
13:22
as we kind of like move forward
13:24
and think about how they're probably can
13:27
party is shifting on those issues. Yeah,
13:29
and obviously, you know, Medicare Advantage and
13:31
private running of public programs, I think,
13:33
will be a continuing issue over the
13:36
next year. Well, moving on to Trump
13:38
2.0, the President-elect gave a lengthy interview
13:40
to NBC's meet the press host Kristen
13:43
Welker last week that covered a wide
13:45
range of issues on health care. Trump
13:47
continued to wander all over the map,
13:49
repeating that his administration has, quote, concepts
13:52
of a plan to replace the Affordable
13:54
Care Act, which he said it stinks
13:56
and it's lousy and it's lousy. but
13:59
he also insisted that he
14:01
saved the ACA rather than the fact
14:03
that he tried to repeal and then
14:06
weaken it. Do we have any clue
14:08
what he might like to do? He
14:10
did say that, quote, we have the
14:13
biggest health care companies looking at his
14:15
concepts of a plan as if that's
14:17
reassuring to people right now? I think
14:19
it's pretty clear and it's been clear
14:22
through the campaign that this is not
14:24
a priority for him. His priorities are
14:26
immigration, trade, tariffs, those kinds of things.
14:29
You know, law enforcement, this is so
14:31
far down on the list, so it
14:33
makes sense that there's not a fully
14:36
fleshed out plan. although, of course, you
14:38
know, the health of millions of people
14:40
depend on it. And so I would
14:42
expect that the most important thing for
14:45
determining what actually happens is who are
14:47
appointed to maybe these mid-level positions, who
14:49
actually get into the nuts and bolts
14:52
of these health care programs. Yeah, and
14:54
we'll talk about RFK Jr. in a
14:56
minute, but we have talked about it.
14:59
Sometimes it's not even sort of the
15:01
heads of these underling agencies, but you're
15:03
right, the people who end up sort
15:06
of running each individual program who sort
15:08
of determine how big this is going
15:10
to be. Yeah, certainly. I think what
15:12
we've seen so far in the selection
15:15
of some of these higher level officials
15:17
is like a test of loyalty and
15:19
like how they perform on TV, not
15:22
any sort of cohesive policy agenda. So
15:24
I think we definitely could see some
15:26
similar disagreements. We're already seeing disagreements bubble
15:29
to the surface among advisors and people
15:31
who've been appointed. So I think who've
15:33
been appointed. So I think that as
15:36
we saw kind of enduring Trump one,
15:38
there will be this kind of power
15:40
struggle to figure out who has influenced
15:42
who has the president's ear who can
15:45
make friends in the White House. But
15:47
I just think it's way too early
15:49
for us to figure out like kind
15:52
of which ideology will win out here.
15:54
I mean, even even people who have
15:56
expressed strong views of what should happen
15:59
like RFK Jr., you know, a lot
16:01
of the things he's calling for are
16:03
things that already are happening, like studying
16:06
vaccine safety, that already Other things he's
16:08
calling for aren't under the purview of
16:10
HHS at all. They're under the purview
16:12
of USDA or other agencies and so
16:15
even people like him who do somewhat
16:17
have an agenda that has been made
16:19
public it's not clear what they would
16:22
be able to actually do within the
16:24
job they could or could not actually
16:26
have and that leaves all of the
16:29
other folks who don't have as defined
16:31
an agenda so it's a real question
16:33
mark for all of us. Say on
16:36
this Trump interview, because there was a
16:38
lot there. President-elect also had some provocative
16:40
things to say about reproductive health on
16:42
IVF, which he kept calling just fertilization.
16:45
He described completely incorrectly what happened in
16:47
Alabama, and then suggested that, quote, ideally
16:49
the insurance companies would pay for it,
16:52
the fertilization, talking about IVF, like that
16:54
wouldn't have any impact on cost for
16:56
anyone. On abortion, he seemed to say
16:59
that he would not restrict the availability
17:01
of abortion pills. He seemed pretty firm
17:03
about that. What do we think about
17:06
either of these suggestions? Well, and I
17:08
want to compare it also to, he
17:10
did a big interview with Time magazine
17:12
that's out on Thursday for being named
17:15
Time Person of the Year. And again,
17:17
in that he had a long back
17:19
and forth about abortion pill availability. But
17:22
like classic Trump vary all over the
17:24
place, you know, noncommittal, saying, I promise
17:26
to not restrict the availability, but then
17:29
saying, we'll see, we'll take a look
17:31
at it, you know, some of these
17:33
sort of verbal ticks that he often
17:36
has that. leave a lot of doors
17:38
open to things in the future. And
17:40
so I think both this and the
17:42
TV sit-down interview don't give a lot
17:45
of confidence to either side. You know,
17:47
I'm hearing from the anti-abortion world, you
17:49
know, not a lot of strong confidence
17:52
that he'll do what they want and
17:54
obviously the progressives have no confidence in
17:56
his abortion rights plans or records. So
17:59
I think just again, a lot of
18:01
murky area here. awful lot of wait
18:03
and see. Well, meanwhile, Alice, you have
18:06
a story about how the incoming administration
18:08
has still not officially started the transition
18:10
process at HHS. Why is that important
18:12
here in almost mid-December? So it's the
18:15
combination of they've nominated a bunch
18:17
of people with no government experience
18:19
and you know even those who
18:21
have government experience in Congress don't
18:23
have executive branch experience which is
18:25
totally different. You know the HHS
18:27
is this huge complicated bureaucracy and
18:29
even people who have worked in
18:31
it for years tell me they're
18:33
always like discovering new protocols and
18:36
hoops they have to jump through
18:38
and stuff and so it's a
18:40
combination of Trump has nominated a
18:42
bunch of people who don't know
18:44
the landscape and they're not using
18:46
this period to get to know
18:48
the landscape, which is what traditionally
18:50
happens during the transition. Traditionally, very
18:52
soon after the election, the incoming
18:54
administration sends what's known as landing
18:56
teams to the different agencies to
18:58
start talking to the career officials
19:01
and get to know the budget
19:03
and the workforce and what's where
19:05
and who they have to talk
19:07
to to to do what and
19:09
what rules are in the middle
19:11
of. you know, being crafted and
19:13
what deadlines are on the horizon,
19:15
what crises they might have to
19:17
inherit and deal with, and all
19:19
of that work happens before inauguration
19:21
day, so that the new administration
19:23
can come in and hit the
19:25
ground running. None of that is
19:28
happening. They have not sent the
19:30
landing teams yet. They have not
19:32
started this work yet. And the
19:34
transition is going to be half
19:36
over soon. And so that has
19:38
some health experts really concerned about
19:40
things like handling bird flu and
19:42
being able to know how to
19:44
monitor that and keep the American
19:46
people safe. I mean, that's just
19:48
one of many, many examples. Speaking
19:50
of people who might end up
19:53
running the department, apparently there are
19:55
even more doubts that are being
19:57
raised about Robert F. Kennedy, Jr.
19:59
Trump's pick for HHS. that Republican
20:01
senators are likely to care very
20:03
much, but 75 Nobel laureates have
20:05
written a letter urging senators to
20:07
vote no on the pick, writing
20:09
that RFK Jr. would quote, put
20:11
the public's health in jeopardy and
20:13
undermine America's global leadership in the
20:15
health sciences. What are you guys
20:18
hearing about this nomination in trouble
20:20
or not? You know, the headlines
20:22
are. still about the Department of
20:24
Defense nominee and Tulsi Gabbard for,
20:26
you know, head of national intelligence.
20:28
Where is RFK Jr. on this
20:30
list of senators who are concerned?
20:32
I mean, he's expected to come
20:34
to the Senate to meet with
20:36
various folks next week, and I
20:38
think that will also provide some
20:40
answers that we're kind of looking
20:42
for, giving all of them, you
20:45
know, a chance to meet with
20:47
him, ask some of their specific
20:49
concerns. I do think that, you
20:51
know, with him and with a
20:53
lot of the question marks that
20:55
we have and just gaps in,
20:57
you know, traditional experience kinds of
20:59
things that Alice has kind of
21:01
outlined is we will see a
21:03
lot more during the confirmation hearings
21:05
when you know even if one
21:07
person doesn't ask it the other
21:10
one does so even you know
21:12
I think that there have been
21:14
some Republicans that have been wanting
21:16
clarity on him in his stance
21:18
on abortion because he's been you
21:20
know, a little back and forth
21:22
on some of that. So regardless
21:24
if a Democrat asks it in
21:26
one sense or if a Republican
21:28
asks another sense, that kind of
21:30
puts that issue directly on the
21:32
table for them to look at.
21:35
So I think some of that
21:37
will be really crucial in looking
21:39
at that next year, but even
21:41
just next week when we have
21:43
him meeting with the various senators
21:45
to get more concrete details. And
21:47
I think it is it's happening
21:49
in a broader context like you
21:51
said with these other nominees and
21:53
I think we have seen a
21:55
shift this week with the Trump
21:57
transition where they have taken a
21:59
much more aggressive stance with the
22:02
Senate that they're not going to
22:04
be backing down. And I think
22:06
it becomes less about any individual
22:08
candidate and more about like this
22:10
big picture power struggle over who
22:12
going to have influence in this
22:14
Republican kind of led Washington. So
22:16
I think the details of any
22:18
policy issue could matter less than
22:20
this larger our struggle. Yeah, I
22:22
think you're probably right. Well, in
22:24
other news this week, a Trump
22:27
appointed federal district court judge in
22:29
North Dakota has temporarily blocked so-called
22:31
DACA recipient. those undocumented now young
22:33
adults who were brought to the
22:35
U.S. by their parents as children
22:37
from signing up for coverage under
22:39
the Affordable Care Act, at least
22:41
in the 19 red states whose
22:43
attorneys general signed on to this
22:45
lawsuit. The DACA population, which is
22:47
about half a million people, have
22:49
lived legally, but under a cloud
22:52
since the Obama administration. This year,
22:54
under a new rule from the
22:56
Biden administration, they were made eligible
22:58
for ACA coverage and between 100,
23:00
and 150,000 of them were expected
23:02
to sign up. according to my
23:04
colleague Julie Appleby. It's not clear
23:06
if those who have already signed
23:08
up will lose that coverage, which
23:10
of course doesn't start until January,
23:12
and it's also not clear what
23:14
happens now. Would you anticipate that
23:16
the Trump administration would continue this
23:19
lawsuit to try to keep these
23:21
people eligible? Trump did say in
23:23
his Meet the Press interview that
23:25
he wants to do something for
23:27
the DACA population. They seem to
23:29
be sort of the one group
23:31
of undocumented people that he seems
23:33
sympathetic to. Again, I think that
23:35
who Trump appoints to various agency
23:37
positions will determine policy much more
23:39
than himself and his ever shifting
23:41
ideology on so many things. You
23:44
know, we know that he has
23:46
nominated a bunch of really hardline
23:48
anti-immigrant folks to these various positions,
23:50
folks who, you know, not only
23:52
want to very aggressively go after
23:54
the undocumented population, but even our
23:56
questioning birthright citizenship are talking about
23:58
mixed status families and what should
24:00
happen to them in a very
24:02
punitive way. So I would imagine,
24:04
you know, not a lot. interest
24:06
in helping this population from those
24:09
officials. Of course, anything could happen.
24:11
Yeah, and I should point out,
24:13
even though this is an Affordable
24:15
Care Act issue, the decisions are
24:17
going to be made by those
24:19
who oversee DACA and those who
24:21
oversee lawsuits and I mean, it's
24:23
going to be elsewhere, I think,
24:25
in the administration about sort of
24:27
what happens to this. subject of
24:29
lawsuits this week, let's turn to
24:31
abortion. Remember that abortion case out
24:33
of Idaho that the Supreme Court
24:36
kicked back to the lower court
24:38
last summer saying they shouldn't have
24:40
taken it yet? Well, it got
24:42
a hearing at that lower court
24:44
this week. Alice, remind us what
24:46
this case is about and what
24:48
if anything we learned from this
24:50
week's activity. So this case involving
24:52
the Biden administration challenging Idaho for
24:54
violating a Reagan-era patient protection law
24:56
known as MTALA, which basically requires
24:58
any hospital that receives Medicare funding
25:01
to treat whoever comes to their
25:03
doors in a crisis in an
25:05
emergency, give them whatever stabilizing treatment
25:07
is needed and not turn them
25:09
away because of... their lack of
25:11
insurance or who they are or
25:13
anything like that. So the Biden
25:15
administration has said that Idaho's near
25:17
total abortion ban, which it has
25:19
been enforcing even in emergency circumstances
25:21
and turning patients away, flying patients
25:23
out of state, they said that
25:26
that violates this law. Idaho says,
25:28
no it doesn't, you're trying to
25:30
turn this law into an abortion
25:32
mandate. And so this went all
25:34
the way up to the Supreme
25:36
Court earlier this year. The Supreme
25:38
Court said, actually, we shouldn't get
25:40
involved yet. Sorry, sorry for taking
25:42
the case. Our bad, send it
25:44
back and try again later. Improvedently
25:46
granted is the phrase that gets
25:48
used, the Supreme Court used, I
25:50
love that. Yeah, dig, dismissism probably
25:53
granted. And so, you know, this
25:55
went back down to the district
25:57
court level. Now it's back at
25:59
the circuit court level. It very
26:01
well could. to the Supreme Court
26:03
level. But I think the most
26:05
important thing is that there's going
26:07
to be a new administration before
26:09
that happens. And so the expectation
26:11
is that this will not continue
26:13
as it is now with the
26:15
administration arguing. against Idaho's practices. So
26:18
there's just a lot of ways
26:20
this could go. The Trump administration
26:22
could settle with Idaho and say,
26:24
it's fine what you're doing. They
26:26
could change their MTELA guidance and
26:28
then argue in court that the
26:30
lawsuit is moot because of that
26:32
change in guidance, or they could
26:34
just drop the case because it's
26:36
a case brought by the Justice
26:38
Department. They could just say, no,
26:40
we're dropping out. Now, it's also
26:43
likely that some other entity could
26:45
try to intervene to keep this
26:47
alive. And one of the hospitals
26:49
in Idaho got time to argue
26:51
in the case this week and
26:53
basically said as much, said that
26:55
they could and would explore becoming
26:57
the challenger in this case if
26:59
the federal government switched sides or
27:01
decided to bow out. you know
27:03
this hospital is obviously impacted by
27:05
this clash between state and federal
27:07
policy. Yeah I expect there's going
27:10
to be a lot of lawsuit
27:12
musical chairs coming in the first
27:14
months of 2025 which we will
27:16
keep an eye on. All right
27:18
that is the news for this
27:20
week now we will play my
27:22
interview with Francis Collins and we'll
27:24
come back and do our extra
27:26
credits. I
27:33
am so pleased to welcome to the
27:35
podcast Dr. Francis Collins, former director of
27:37
the National Institutes of Health and former
27:39
White House Science Advisor, and former director
27:42
of the National Human Genome Institute, who
27:44
led the effort to map the Human
27:46
Genome. He also has a new book
27:48
out this holiday season called The Road
27:50
to Wisdom on Truth, Science, Faith, and
27:53
Trust. Dr. Collins, it's so great to
27:55
have you here. Hey, Julia, it's great
27:57
to be with you. We go way
27:59
back on a lot of interesting topics
28:01
in health and medical research. let's get
28:04
into it here. I want to start
28:06
with some very basics because we have
28:08
lots of student listeners and people who
28:10
know a lot about health policy, but
28:12
less about science. So what is the
28:14
NIH and how does it work? It
28:17
is the largest supporter of biomedical research
28:19
in the world. The National Institutes of
28:21
Health supported by the taxpayers with money
28:23
that's allocated every year by the Congress.
28:25
is the main way in which in
28:28
the United States we support basic medical
28:30
research, trying to understand the details about
28:32
how life works and how sometimes things
28:34
go wrong and disease happens, and then
28:36
carries those discoveries forward to what you
28:39
might call the translational part, take those
28:41
basic findings and try to see how
28:43
could they actually improve human health in
28:45
the clinic. And then working with industry,
28:47
make sure if there's an idea then
28:49
for an intervention of some sort, that
28:52
it gets tested rigorously in clinical trials.
28:54
And if it works, then it's available
28:56
to everybody. So when you look at
28:58
what's happened over the course of many
29:00
decades in terms of advances in human
29:03
health, like the fact that, you know,
29:05
reductions in heart attacks and strokes have
29:07
happened rather dramatically, that cancer death rates
29:09
are falling every year. Where does that
29:11
come from? An awful lot of that
29:13
is because of the NIH and the
29:16
thousands and thousands of people who work
29:18
on this area supported by those dollars
29:20
that come from NIH, both. a little
29:22
bit in our own location in Bethesda,
29:24
Maryland, but most of the money goes
29:27
out to all those universities and institutes
29:29
across the country and some outside the
29:31
country. 85% of the dollars are given
29:33
out. Two people who write grant applications
29:35
with their best and brightest and boldest
29:38
ideas and they get sent and reviewed
29:40
by peers who have scientific expertise to
29:42
be able to assess what's most likely
29:44
to make real progress happen. And then
29:46
if you get the award, you have
29:48
three to five years of funding to
29:51
pursue that idea and see what you've
29:53
been learned. Unfortunately, even though the budget
29:55
for NIH has been reasonably well treated,
29:57
especially in the last eight or nine
29:59
years, it's still the case that most
30:02
applications that come in to NIH get
30:04
rejected. Only about 20% of them can
30:06
be actually paid for with the current
30:08
budget we have. So, sad to say,
30:10
a lot of good ideas are left
30:13
on the table. And yet, for more
30:15
than three decades now, the NIH has
30:17
been kind of a bipartisan darling with
30:19
strong financial support from Democrats and Republicans
30:21
in both the White House and in
30:23
Congress. Now we have an administration coming
30:26
in that's calling for some big changes.
30:28
Could NIH honestly use some reimagining? It's
30:30
been a while. Oh sure. I mean
30:32
I was privileged to be the NIH
30:34
director for 12 years. I did some
30:37
reimagining myself in that space. One of
30:39
the first things I did when I
30:41
got started was to create a whole
30:43
new part of NIH called NCATS, the
30:45
National Center for Advancing Translational Science because
30:47
it seemed that some of these really
30:50
exciting basic science discoveries just sort of
30:52
landed with a thud instead of moving
30:54
forward into clinical applications. NCATS has done
30:56
a lot to try to try to
30:58
change that. So yeah, there's always been
31:01
this sense of this is the crown
31:03
jewel of the federal government, but it
31:05
could even be better. So let's try
31:07
to work on that. I hope that's
31:09
what's going to happen in this next
31:12
iteration. Find things to fix. If it's
31:14
more an idea of let's just blow
31:16
the whole thing up and start over,
31:18
then I'm opposed because I think The
31:20
rest of the world just has this
31:22
great admiration for NIH. Many of them
31:25
would say this is the most amazing
31:27
engine for medical discovery that the world
31:29
has ever known. Let's certainly optimize it
31:31
if we need to, but my goodness,
31:33
the track record is phenomenal. And the
31:36
track record is both about advances in
31:38
health, and it's also about economic growth,
31:40
which people are rightly concerned about as
31:42
well. Every dollar that NIH gives out
31:44
in a grant returns $8.38 cents. and
31:47
that return on investment to the economy
31:49
within a few years. So if you
31:51
to just say, well, let's just try
31:53
to grow the economy and didn't even
31:55
care about health, NIH would still be
31:57
one of your best bets. So one
32:00
of the things that Robert F. Kennedy
32:02
Jr., whose Trump's pick to lead HHS,
32:04
has talked about is taking a break
32:06
from the federal government researching infectious diseases
32:08
and concentrating on chronic diseases instead. Do
32:11
you think that's a good idea for
32:13
the NIH? Well, NIH does a lot
32:15
on chronic diseases. Let's be clear about
32:17
that. Infectious disease has certainly gotten a
32:19
lot of attention because of COVID and
32:22
the controversies around that. Although let me
32:24
also step back and say, What was
32:26
done during COVID, the development of a
32:28
vaccine in 11 months that is estimated
32:30
to have saved 3.2 million lives in
32:32
the US alone is one of the
32:35
most amazing scientific achievements ever. and shouldn't
32:37
be somehow pushed aside as if that
32:39
wasn't a big deal. That was a
32:41
huge deal. But infectious diseases are still
32:43
out there and with everything that we
32:46
see now with things like H5N1, there's
32:48
a lot of work that needs to
32:50
be done. Sure, chronic diseases deserve a
32:52
lot of attention, but let's look at
32:54
what's happening there with cancer, with Alzheimer's
32:56
disease, with diabetes, with heart disease. Those
32:59
are huge current investments at NIH. Could
33:01
we look at them closely and ask,
33:03
are they being absolutely optimally spent. That's
33:05
always an appropriate question to ask, but
33:07
it's not as if this has been
33:10
sort of ignored. Look at the project
33:12
that I had something that it was
33:14
starting called All of Us, which is
33:16
an effort to look at all kinds
33:18
of illnesses in a million people, a
33:21
very diverse group, and figure out how
33:23
not to just do a better job
33:25
of treating chronic disease, but how to
33:27
prevent it. That's an incredibly powerful resource
33:29
that's now beginning to build a lot
33:31
of momentum. And there's a place where
33:34
maybe even a little bit more attention
33:36
to all of us could be helpful
33:38
because we could go faster. So it's
33:40
not just either or? No, it shouldn't
33:42
be either or. And I mean, look
33:45
around your own family and the people
33:47
you care about, what are the diseases
33:49
that still answers. There's plenty of them
33:51
and they're not all in one category
33:53
or another. This is what NIH has
33:56
always been charged to do. I'll look
33:58
across the entire landscape. Rare diseases as
34:00
well as common diseases, infectious diseases, as
34:02
well as things that are maybe caused
34:04
by environment or diet. All of that
34:06
has to be the purview. Otherwise, we're
34:09
not really serving all the people. Dr.
34:11
Francis Collins, thank you so much for
34:13
joining us. I hope we can call
34:15
on you again. Please do, Julie. It's
34:17
always great to talk to you. Thanks
34:20
for everything you're doing to spread the
34:22
word about what we can do about
34:24
health care. We can do a lot.
34:26
I hope so. Thank you. Okay. We're
34:28
back. And now it's time for our
34:31
extra credit segment. That's where we each
34:33
recognize a story. We read this week.
34:35
We think you should read too. Don't
34:37
worry. Sure, so my piece is in
34:39
pro-publica. The headline is Eat What You
34:41
Kill by Jay David McSwain. And I
34:44
love his reporting. I was an intern
34:46
at the Austin American Statesman when he
34:48
was doing some of his investigations there
34:50
on Medicaid. And it's been just so
34:52
cool to watch his career grow up
34:55
in publica. And I think this story
34:57
was the perfect example of how to
34:59
take just a terrifying example of a
35:01
doctor who truly just doesn't have patients
35:03
best interest at heart and you know
35:05
is kind of the caricature of the
35:08
money hungry specialist kind of doctor who's
35:10
really doing harm to patients and making
35:12
that more general because I think as
35:14
reporters we all hear stories that are
35:16
so tragic and terrible but don't kind
35:19
of tell that larger story but I
35:21
think he did a great job explaining
35:23
how when rural hospitals close and there's
35:25
fewer and fewer options for patients that
35:27
an individual facility can become the only
35:30
option for people in Montana in this
35:32
case and when facilities are struggling and
35:34
they're not financially supported. you have quote
35:36
unquote high performers who bring in a
35:38
lot of income, who have disproportionate power.
35:40
We see that in all sorts of
35:43
organizations, university, like any organization where high
35:45
performers I think get away with way
35:47
more than kind of your average doctor
35:49
or person or. employee, but I think
35:51
in this case, he just did such
35:54
a great job explaining how all of
35:56
these financial incentives like created this opportunity
35:58
for this one doctor to just do
36:00
so much harm to patients. So I
36:02
thought it was really well done. It's
36:05
also, yeah, really well-written, quite the riveting
36:07
story. Sandia. So my pick this week
36:09
is spending less living longer, what the
36:11
US can learn from Portugal's innovative health
36:13
system, and it's by Ushah Lee McFarling
36:15
at Stott. And she did a really
36:18
fascinating dispatch from Lisbon about how Portugal
36:20
and the US had really different life
36:22
expectancies in, you know, 1960. The US
36:24
had 10 years on Portugal and now
36:26
Portugal leads by four, but they've been
36:29
spending a lot less money on their
36:31
health care. And so she has a
36:33
great look at some of the complicated
36:35
factors as to why that's happening, you
36:37
know, how they're approaching prevention and emphasis
36:39
on public health and primary care and
36:42
home health. And it's a good read.
36:44
Alice. I have a from CNN which
36:46
is off of a new CDC report
36:48
the title is most women in the
36:50
in the US aren't accessing family planning
36:53
services even as abortion restrictions grow and
36:55
the new data show that in 2022
36:57
and 2023 so the first years where
36:59
these state abortion bans across the country
37:01
were going into place Just over a
37:04
third of women of reproductive age received
37:06
any family planning services at all over
37:08
the previous 12 months Which is sort
37:10
of staggering because there have been so
37:12
many reports of you know a surge
37:14
in interest in birth control and a
37:17
surge of orders and people seeking services
37:19
anecdotally in the wake of these restrictions
37:21
going into place or in anticipation of
37:23
the restrictions going into place and I
37:25
know you know this covers 22 and
37:28
23 so I'd be really curious about
37:30
24 because we also heard there was
37:32
another surge of interest around the election,
37:34
so would be interested to see that.
37:36
But I, you know, I think this
37:39
really shows that access is really, really
37:41
bad out there for a lot of
37:43
reasons. And the article walks through some
37:45
of them, including, you know, states that
37:47
have an expanded Medicaid, and so people
37:49
can't, you know, pay for birth control
37:52
with insurance. and you know additionally there
37:54
are just these provider deserts that are
37:56
getting worse and worse in a lot
37:58
of parts of the country clinics that
38:00
used to do abortions and other services
38:03
in these red states can't keep their
38:05
doors open have shut down and so
38:07
these patients in these areas are left
38:09
with very little access to any reproductive
38:11
health care services in in the wake
38:14
of these abortion bans and so something
38:16
definitely to keep an eye on. And
38:18
of course as I have talked about
38:20
providers leaving some of these states too,
38:22
so even it's not just the clinics,
38:24
there's actually no one there to work
38:27
in the clinics. My extra credit this
38:29
week is a policy brief from my
38:31
colleagues here on the analysis side of
38:33
KFF, it's called the very exciting, Medicare
38:35
spending was 27% more for people who
38:38
disenrolled from Medicare Advantage than for similar
38:40
people in traditional Medicare, in traditional Medicare,
38:42
by Gini Fugelsten Binienbini, And while President-elect
38:44
Trump has vowed on the one hand
38:46
not to quote cut Medicare, what this
38:48
shows us again is that one reason
38:51
Medicare Advantage seems cheaper is that it
38:53
tends to attract healthier people who need
38:55
less care and that when those people
38:57
get sick and need care and chafe
38:59
at their limited provider options in Medicare
39:02
Advantage, they tend to switch back. to
39:04
traditional fee-for-service Medicare and end up costing
39:06
more. So the government is overpaying for
39:08
them while they're in Medicare Advantage and
39:10
then paying even more when they switch
39:13
back than it would have if they
39:15
in traditional Medicare
39:17
all along. This This
39:19
is just one of
39:21
a lot of
39:23
things about Medicare that
39:26
could put the
39:28
program on a better
39:30
a better financial footing
39:32
if it got addressed.
39:34
So will see if
39:37
Congress actually wants
39:39
to talk about Medicare
39:41
next year. year. right.
39:43
That is this
39:45
week's show. As always,
39:48
if you enjoy
39:50
the podcast, you can
39:52
subscribe wherever you
39:54
get your get your We'd
39:56
appreciate it if
39:58
you left us a
40:01
review. That helps
40:03
other people find us
40:05
people find thanks again
40:07
this week to our
40:09
temporary production team,
40:12
Taylor Cook and team, Taylor
40:14
Cook, as our Rowe, as
40:16
well as our editor, Emery As
40:18
always, you can
40:20
email us your comments
40:22
or questions or questions. We're
40:25
at What the Health, all .org
40:27
or you can still
40:29
find me find me at
40:31
and at Robner and julie
40:33
rovner dot at dot
40:36
social. at Julie are
40:38
you guys these dot Luskei
40:40
dot social. Where are you guys these
40:42
still on x I'm
40:44
on Blue Sky at Alice Miranda and
40:47
on X at Alice Holstein. Sandia.
40:49
I'm social and on
40:51
Sundier Rights. Rachel. I'm on I'm
40:53
on Rachel Corps and on LinkedIn
40:55
as well. See you well. find
40:57
when I'm there. We
41:00
We will be
41:02
back in your feet
41:04
next week. Until
41:06
then, be healthy. healthy.
Podchaser is the ultimate destination for podcast data, search, and discovery. Learn More