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A Killing Touches Off Backlash Against Health Insurers

A Killing Touches Off Backlash Against Health Insurers

Released Thursday, 12th December 2024
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A Killing Touches Off Backlash Against Health Insurers

A Killing Touches Off Backlash Against Health Insurers

A Killing Touches Off Backlash Against Health Insurers

A Killing Touches Off Backlash Against Health Insurers

Thursday, 12th December 2024
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Episode Transcript

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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.

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