\n<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.\t\t<\/p>\n Recent polling finds that health costs are a top worry for much of the American public, while Republicans in Congress are considering still more cuts to federal health spending on programs such as Medicaid and the Affordable Care Act.<\/p>\n Meanwhile, the Supreme Court ruled that Colorado cannot ban mental health professionals from using \u201cconversion therapy\u201d to treat LGBTQ+ minors, a decision that\u2019s likely to affect other states with similar laws.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Sandhya Raman of Bloomberg Law.<\/p>\n \tJessie Hellmann \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \tSandhya Raman \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF Health News\u2019 Elisabeth Rosenthal, who wrote the last<\/a> two<\/a> KFF Health News \u201cBill of the Month\u201d stories. If you have a medical bill that\u2019s outrageous, infuriating, or just inscrutable, you can submit it to us here<\/a>.<\/p>\n Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> New York Magazine\u2019s \u201cThe Dog Owners Taking Their Injured Corgis and Doodles to Tijuana: Mexico Is to Pet MRIs What Turkey Has Become for Hair Transplants<\/a>,\u201d by Helaine Olen.\u00a0\u00a0<\/p>\n Jessie Hellmann:<\/strong> The Texas Tribune\u2019s \u201c\u2018Don\u2019t\u00a0Take Me to the Hospital\u2019: Undocumented Immigrants in Texas Are Delaying Medical Care<\/a>,\u201d by Colleen DeGuzman, Stephen Simpson, Terri Langford, and Dan Keemahill.\u00a0<\/p>\n Sandhya Raman:<\/strong> Science\u2019s \u201cSupporters Push To Revive Moribund Agency Studying Patient Care<\/a>,\u201d by Jocelyn Kaiser.\u00a0\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> The New York Times\u2019 \u201cCuban Patients Are Dying Because of U.S. Blockade, Doctors Say<\/a>,\u201d by Ed Augustin and Jack Nicas.\u00a0\u00a0<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: GOP Mulls More Health Cuts\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong>\u00a0This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong>\u00a0Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to\u00a0What the Health?<\/em>\u00a0I\u2019m\u00a0Julie Rovner, chief Washington correspondent for KFF Health News, and\u00a0I\u2019m\u00a0joined by some of the best and smartest\u00a0health\u00a0reporters covering Washington.\u00a0We\u2019re\u00a0taping this week on Thursday,\u00a0April 2, at 10\u00a0a.m.\u00a0As always, news happens fast, and things might have changed by the time you hear this. So here we go.\u00a0<\/p>\n Today, we are joined\u00a0via\u00a0video conference by Alice Miranda\u00a0Ollstein\u00a0of Politico.\u00a0<\/p>\n Alice Miranda\u00a0Ollstein:<\/strong>\u00a0Hello.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Jessie Hellmann\u00a0of CQ\u00a0Roll Call.\u00a0<\/p>\n Jessie Hellmann:<\/strong>\u00a0Thanks for having me.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And Sandhya\u00a0Raman,\u00a0now at Bloomberg Law.\u00a0<\/p>\n Sandhya Raman:<\/strong>\u00a0Hello, everyone.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Later in this episode,\u00a0we\u2019ll\u00a0have my interview with\u00a0KFF Health News\u2019\u00a0Elisabeth Rosenthal, who reported and wrote the last\u00a0two<\/em>\u00a0KFF Health News\u00a0\u201cBills of the\u00a0Month.\u201d\u00a0One is about a patient who got caught in the crossfire over prices between insurers and drug companies. The other is about a woman who, and this is not an April Fools\u2019\u00a0joke, got her insurance canceled for\u00a0failing to pay\u00a0a bill for\u00a01\u00a0cent. But first,\u00a0this week\u2019s news.\u00a0<\/p>\n So\u00a0Congress is on spring break, but when they come back,\u00a0health\u00a0policy will be waiting. A new Gallup poll out this week found 61% of those surveyed said they worry about the availability and affordability of health care, quote,\u00a0\u201ca great deal.\u201d\u00a0That was 10 percentage points more than the economy,\u00a0inflation,\u00a0and the federal budget deficit, and it topped a list of 15 domestic concerns. And while we are still waiting for final enrollment numbers for Affordable Care Act plans, we do know that the share of people paying more than $500 a month for their coverage doubled from last year to 2026.\u00a0Yet Axios this week is reporting that Republicans are considering still more cuts to the Affordable Care Act to potentially pay for a\u00a0$200 billion\u00a0war supplemental. What exactly are they thinking? And\u00a0it\u2019s\u00a0looking more like Republicans are going to try for another budget reconciliation bill this spring. Isn\u2019t that, right,\u00a0Jessie?\u00a0<\/p>\n Hellmann:<\/strong>\u00a0House\u00a0Budget\u00a0chair Jodey Arrington has kind of been pushing this idea\u00a0really hard\u00a0of going after what he says is fraud\u00a0in\u00a0mandatory programs like Medicare and Medicaid.\u00a0He\u2019s\u00a0also talked about funding\u00a0cost-sharing\u00a0reductions, which is an idea that slipped out of the last reconciliation bill, and\u00a0it\u2019s\u00a0a wonky kind of idea\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0But\u00a0I think the best way to explain\u00a0it\u00a0is that it will raise premiums for many people.\u00a0That\u2019s\u00a0how\u00a0I\u2019ve\u00a0just been doing it.\u00a0\u00a0<\/p>\n Hellmann:<\/strong>\u00a0Yeah, exactly.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Let\u2019s\u00a0not get into the details.\u00a0<\/p>\n Hellmann:\u00a0<\/strong>It would\u00a0reduce spending for the federal government but\u00a0wouldn\u2019t\u00a0really help people who buy insurance\u00a0on\u00a0the marketplace. He\u00a0hasn\u2019t\u00a0been\u00a0very specific.\u00a0He\u2019s\u00a0also talked about,\u00a0like,\u00a0site-neutral\u00a0policies\u00a0in\u00a0Medicare, but\u00a0it\u2019s\u00a0hard to see how all of this could make a serious\u00a0dent in\u00a0a\u00a0$200 billion\u00a0Iran supplemental.\u00a0There\u2019s\u00a0also a new development.\u00a0I think President\u00a0[Donald]\u00a0Trump threw a wrench in things yesterday when he said he wanted the reconciliation bill to focus on border spending and immigration spending to cover a three-year period, and now Senate Majority Leader John Thune is saying that there\u2019s probably not room for much else in the bill. So,\u00a0unclear what the path forward is for all of that.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, and of course, that was part of the deal to free up the Department of Homeland Security\u2019s budget in the appropriation.\u00a0It\u2019s\u00a0all one sort of big, tied-up mess at this point.\u00a0Alice, I see\u00a0you\u2019re\u00a0nodding.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Yeah.\u00a0I mean, what often happens with these reconciliation bills is it starts out with a tight focus and everyone\u2019s unified, and then, because it can often be the only legislative train leaving the station,\u00a0everybody gets desperate to get their pet issue on board, and then the more and more things get piled onto it, then they start losing votes, and people start disagreeing more. And\u00a0so\u00a0I think even though this is still in the ideas phase,\u00a0you\u2019re\u00a0already seeing some signs of that happening. And when it comes to health care, it can be particularly fraught. And of course, you have lawmakers, especially in the\u00a0House, with wildly\u00a0different needs. Some of them need to fend off a primary from the right, and so they want to be as conservative as possible. Some are fighting to hang on in swing districts, and so they want to be more moderate. And these things are in conflict. And\u00a0so\u00a0these proposals to cut health spending, even more than the massive amount that was cut last year,\u00a0are already, you know, raising some red flags among some moderate Republican members.\u00a0And\u00a0it\u2019s\u00a0very possible the whole thing falls apart.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, along those lines,\u00a0we\u2019re\u00a0supposed to get the\u00a0president\u2019s budget on Friday, which is only two months late. It was due in February.\u00a0And while I\u00a0haven\u2019t\u00a0seen much on it, Jessie, your colleagues at\u00a0Roll\u00a0Call\u00a0are reporting that the budget will seek a 20% cut to the National Institutes of Health.\u00a0That\u2019s\u00a0only half the cut that the administration proposed last year. But given that Congress actually boosted the\u00a0agency\u2019s\u00a0budget slightly this year, that feels kind of unlikely.\u00a0<\/p>\n Hellmann:\u00a0<\/strong>Yeah, I\u00a0don\u2019t\u00a0think that the appropriators are likely to\u00a0go along with this.\u00a0They have really strong advocates, and Sen.\u00a0Susan Collins, who\u2019s chair of the Senate Appropriations Committee.\u00a0And,\u00a0like\u00a0you\u00a0said, they rejected cuts last year.\u00a0Kind of surprised.\u00a0Twenty percent\u00a0is not as deep as the Trump administration went last year.\u00a0I was actually kind of surprised it wasn\u2019t\u00a0a\u00a0bigger proposed cut.\u00a0But either way, I\u00a0don\u2019t\u00a0think Congress is going to go along with that.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Meanwhile, I saw\u00a0a late headline that FDA is looking to hire back people after\u00a0DOGE [Department of Government Efficiency]\u00a0cut\u00a0thousands\u00a0of people last year. Sandhya,\u00a0HHS\u00a0[Department of Health and Human Services]\u00a0is just in this sort of personnel churn at this point, isn\u2019t it?\u00a0<\/p>\n Raman:<\/strong>\u00a0Yeah, I think that HHS is kind of getting\u00a0bit\u00a0in the foot from, you know, we\u2019ve had so many of these layoffs, and we\u2019ve also had a lot of people just flee the various agencies over the past year because of some of this instability and all of these changes. And as\u00a0we\u2019re\u00a0getting\u00a0closer and closer\u00a0to, you know, deadlines of things that they need to get done,\u00a0they\u2019re\u00a0realizing that they do need more personnel to get some of those things done,\u00a0as\u00a0we\u2019ve\u00a0been passing deadlines.\u00a0So\u00a0I\u00a0don\u2019t\u00a0think\u00a0it\u2019s\u00a0something\u00a0that\u2019s\u00a0unique to just FDA.\u00a0But I think the way to solve this\u00a0\u2014\u00a0it\u2019s\u00a0not an overnight thing for the federal government to staff up.\u00a0It\u2019s\u00a0a longer process, but\u00a0it\u2019s\u00a0really showing in a lot of areas right now.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, I would say this is not like TSA\u00a0[Transportation Security\u00a0Administration], where you can, you know, hire new\u00a0people\u00a0and train them up in a couple of months. These are\u00a0\u2026\u00a0many of them scientists\u00a0who\u2019ve\u00a0got years and years of training and experience at doing some of these jobs that,\u00a0you know,\u00a0the federal government is ordered to do by legislation.\u00a0<\/p>\n Raman:<\/strong>\u00a0Yeah, those\u00a0statutes are things that,\u00a0you know, if they\u00a0don\u2019t\u00a0meet those\u00a0deadlines,\u00a0those\u00a0are things that are\u00a0going to be challenged, and just further tie things up in litigation.\u00a0And we already see so many of those right now that are making things more complicated.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, in news that is not from Congress or the administration, the Supreme Court this week said Colorado could not ban licensed mental health professionals from using so-called\u00a0conversion therapy aimed at LGBTQ individuals, at least not on minors.\u00a0What\u2019s\u00a0the practical impact here? It goes well beyond Colorado,\u00a0I\u00a0would think.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Interesting,\u00a0because a lot of people think of this as regulating health care, restricting providers from providing health care that is not helpful and\u00a0maybe actively\u00a0harmful to the health of the patients.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And that\u2019s\u00a0\u2026\u00a0I would say\u00a0that\u2019s\u00a0been a state\u00a0\u2026\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Power.\u00a0<\/p>\n Rovner:<\/strong>\u00a0\u2026 power.\u00a0For generations.\u00a0\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Absolutely.\u00a0Right,\u00a0I mean, you don\u2019t want people selling sketchy snake oil pills on the street, etc. So many people view this as akin to that.\u00a0But it has morphed in the hands of conservative courts into a free speech issue, and that, you know, these laws are restricting the speech of mental health workers who are against people transitioning. And so, yes, it\u00a0definitely has\u00a0national implications. And of course, we are in a national wave right now of both state and federal entities, you know, moving in the direction of rolling back trans rights in the health care space and beyond.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah. In related news,\u00a0regarding\u00a0Colorado and minors and gender,\u00a0The Colorado Sun reports<\/a>\u00a0that Children\u2019s Hospital Colorado has not yet resumed providing gender-affirming care for transgender youth.\u00a0That\u2019s\u00a0despite a federal judge in Oregon having struck down an HHS declaration that would have punished hospitals for providing such services.\u00a0Apparently, the\u00a0hospital in Colorado is concerned that the\u00a0judge\u2019s\u00a0ruling\u00a0doesn\u2019t\u00a0provide it with enough legal cover for them to resume that care.\u00a0I\u2019m\u00a0wondering, is this the administration\u2019s strategy here to get organizations to do what they want, even if they might lack the legal authority to do it?\u00a0Just by making them worry that they might come after them?\u00a0<\/p>\n Raman<\/strong>:\u00a0I think the chilling effect is definitely a big part of this broader issue.\u00a0I mean, we\u2019ve seen it in other issues in the past, but just that if there is this worry that it\u2019s a)\u00a0going to stop on the provider side, new folks taking part in providing care, and also just it\u2019s going to make patients, even if there are opportunities,\u00a0even less likely to want to go because of the fears there. I mean, it goes broader than that.\u00a0We\u2019ve\u00a0had FTC\u00a0[Federal Trade Commission]\u00a0complaints,\u00a0where they have gone and investigated\u00a0different places\u00a0that provide gender-affirming care or endorse it.\u00a0So\u00a0I think\u00a0it\u2019s\u00a0broader than this, and really part of that chilling effect.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>And Alice, as you were saying, I mean, the subject of transgender rights, or lack thereof,\u00a0remains\u00a0a political hot topic. The Idaho\u00a0Legislature this week passed a bill that now goes to the governor that would require teachers and doctors to out transgender minors to their parents. Parents could sue teachers, doctors,\u00a0and\u00a0child care\u00a0providers who, quote,\u00a0\u201cfacilitate the social transformation of the minor student.\u201d\u00a0That includes using pronouns or titles that\u00a0don\u2019t\u00a0align with their sex at birth.\u00a0I don\u2019t know about teachers, but that definitely seems to violate patient privacy when it comes to\u00a0doctors, right?\u00a0<\/p>\n Ollstein:\u00a0<\/strong>There\u2019s definitely patient privacy issues there. I also think, you know,\u00a0it\u2019s\u00a0interesting that\u00a0this kind of nonmedical\u00a0transitioning\u00a0is now coming under attack. Because, you know, you would think that there would be some support for letting a kid, you know, go by a different name for a few weeks, test it out, see how it feels.\u00a0Maybe it\u2019s a phase, then they discover that they don\u2019t want to actually pursue taking medications and going through a medical transition.\u00a0But this is sort of shutting down that avenue as well.\u00a0You\u00a0can\u2019t\u00a0even change your appearance, change how you present in the world, at a time when kids are really trying to figure out who they are.\u00a0So\u00a0I think the broad acceptance of hostility to medical transitioning for youth is now spilling over into this kind of social transitioning, and I wonder if\u00a0we\u2019re\u00a0going to see more of that in the future.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, I feel like we started with\u00a0minors\u00a0shouldn\u2019t\u00a0have surgery<\/em>.\u00a0They\u00a0shouldn\u2019t\u00a0do anything\u00a0that\u2019s\u00a0not easily reversible.\u00a0<\/em>And now\u00a0we\u2019ve\u00a0gotten down to,\u00a0in\u00a0the Idaho\u00a0law,\u00a0there\u2019s\u00a0actually mention\u00a0of nicknames. You\u00a0can\u2019t\u00a0\u2026 a\u00a0kid\u00a0can\u2019t\u00a0change his or her nickname. It feels like we\u2019ve\u00a0sort of\u00a0reduced\u00a0this way, way, way down.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>And I think\u00a0we\u2019ve\u00a0seen these\u00a0laws,\u00a0laws related to bathrooms.\u00a0We\u2019ve\u00a0seen these have negative impacts on people who are not trans at all, people who just are a tomboy or not looking like people\u2019s stereotypes of what different genders may look like. And\u00a0so\u00a0there\u2019s\u00a0a lot of policing of people who are not trans in any way. You know, there\u2019s media reports of people being confronted by law enforcement for going into a bathroom that does align with their biological sex. And\u00a0so\u00a0it\u2019s\u00a0important to keep in mind that these laws have an effect\u00a0that\u2019s\u00a0much broader than just the\u00a0very small\u00a0percentage of people who do consider themselves trans.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah,\u00a0it\u2019s\u00a0kind of the\u00a0opposite of not being\u00a0woke. All\u00a0right,\u00a0we\u2019re\u00a0going to take a quick break. We will be right back.\u00a0\u00a0<\/p>\n So\u00a0while\u00a0we\u2019ve\u00a0had lots of news out of the Department of Health and Human Services the past few weeks,\u00a0it\u2019s\u00a0been mostly public\u00a0health-related.\u00a0But\u00a0there\u2019s\u00a0a lot going on in the Medicare and Medicaid programs too. Item\u00a0A:\u00a0Stat News\u00a0is reporting\u00a0that HHS is studying whether to make the private Medicare Advantage program the default for seniors when they qualify for Medicare. Right now, you get the traditional fee-for-service plan that allows you to go to any doctor or hospital that accepts Medicare, which is most of them.\u00a0You have to affirmatively opt into Medicare Advantage, which often provides extra benefits but also much narrower networks.\u00a0What would it mean to make Medicare Advantage the default,\u00a0that people would go into private plans instead of the\u00a0government\u00a0plan, unless they affirmatively opted for the traditional fee-for-service?\u00a0<\/p>\n Hellmann:\u00a0<\/strong>Someone\u2019s experience with\u00a0\u2026\u00a0can vary\u00a0greatly between\u00a0being on traditional Medicare and Medicare Advantage. If\u00a0you\u2019re\u00a0in Medicare Advantage, you could be exposed to narrow networks. You can only see certain doctors that are covered by your plan. You can be exposed to higher cost sharing. A lot of people are\u00a0kind of fine\u00a0with their plans until they have a medical issue and need to go to the hospital or they need skilled nursing care.\u00a0So\u00a0making this the default could definitely be a challenge for some people, especially people that have complex health needs. Some people on the early side of their Medicare eligibility are fine with Medicare Advantage, and then they get\u00a0older\u00a0and\u00a0they\u2019re\u00a0not fine with it anymore.\u00a0So\u00a0it\u2019s\u00a0interesting that the administration would\u00a0kind of float\u00a0this\u00a0idea\u00a0because\u00a0they\u2019ve\u00a0been critical\u00a0of Medicare Advantage.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Thank you.\u00a0That\u2019s\u00a0exactly what I was thinking.\u00a0<\/p>\n Hellmann:\u00a0<\/strong>Yeah,\u00a0they\u2019ve\u00a0talked about the federal government\u00a0pays\u00a0these plans too much, and\u00a0it\u2019s\u00a0not for better quality in a lot of cases, and\u00a0they\u2019ve\u00a0talked about reforms in that area.\u00a0So\u00a0I was a little\u00a0surprised to see that.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know,\u00a0sort of redid\u00a0the program in 2003.\u00a0And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because\u00a0we\u2019re\u00a0overpaying them. And now the Republicans seem to have joined a lot of their\u00a0\u2014\u00a0at least some Republicans\u00a0\u2014\u00a0seem to have joined a lot of the Democrats in saying,\u00a0Yes,\u00a0we\u2019re\u00a0overpaying them.\u00a0We\u2019re\u00a0paying\u00a0them too much<\/em>. And you know, they talk about the big, powerful insurance companies, and yet\u00a0they\u2019re\u00a0now\u00a0floating\u00a0this idea to make Medicare Advantage the default.\u00a0So\u00a0pick a side, guys.\u00a0<\/p>\n All right, well, in other Medicare news, the Electronic Frontier Foundation is suing Medicare officials to learn more about the pilot program\u00a0that\u2019s\u00a0using artificial intelligence to oversee prior authorization requests in the traditional Medicare\u00a0fee-for-service\u00a0program.\u00a0The idea here is to cut down on,\u00a0quote,\u00a0\u201clow-value services,\u201d\u00a0things that doctors might be prescribing that aren\u2019t either particularly necessary or shown to actually work.\u00a0But the fear, of course, is that needed care for patients will be delayed or denied, which is what\u00a0we\u2019ve\u00a0seen with prior authorization in Medicare Advantage. This is the perennial push-pull of our health care system, right? If you do everything that doctors say,\u00a0it\u2019s\u00a0going to be too expensive, and if you second-guess them,\u00a0it\u2019s\u00a0going to be,\u00a0you know, it\u00a0might turn out to be too constraining.\u00a0<\/p>\n Hellmann:\u00a0<\/strong>Well, I was just going to say\u00a0this\u00a0is another issue that was\u00a0kind of a\u00a0little surprising to me, because\u00a0there\u2019s\u00a0been so much criticism of the use of prior authorization and Medicare Advantage. And CMS\u00a0[Centers for Medicare & Medicaid Services]\u00a0looked at that and said,\u00a0Oh, what if we did it in traditional Medicare?<\/em>\u00a0Like it was never going to go over well politically,\u00a0and\u00a0I think there\u00a0are even some Republican members of Congress who are not in support of this, but they\u00a0haven\u2019t\u00a0really made a huge stink about it.\u00a0Yeah, this\u00a0wasn\u2019t\u00a0something I really expected\u00a0to see.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah,\u00a0we\u2019ll\u00a0see how\u00a0this one plays\u00a0out too.\u00a0Well, meanwhile,\u00a0regarding\u00a0Medicaid, two\u00a0really good\u00a0stories this week from my\u00a0KFF Health News colleagues Phil\u00a0Galewitz, Rachana Pradhan,\u00a0and Samantha Liss.\u00a0Phil\u2019s story<\/a>\u00a0found that efforts in multiple states to find enrollees who were not eligible for the program due to their immigration status turned up very few violators. While\u00a0Samantha and\u00a0Rachana\u00a0detailed<\/a>\u00a0the hundreds of millions of dollars states and the federal government are spending to set up computer programs to track\u00a0Medicaid\u2019s new work requirement, despite the fact that we already know that most people on Medicaid either already work or they are exempt from the requirements under the new law. Is it just me, or are we spending lots of time and effort on\u00a0both of these\u00a0policies that are going to\u00a0have not\u00a0a very big\u00a0return?\u00a0\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Well,\u00a0that\u2019s\u00a0what\u00a0we\u2019ve\u00a0seen in the few states that have gone ahead and\u00a0attempted\u00a0this before,\u00a0that it costs a lot, and you insure fewer people. And\u00a0that\u2019s\u00a0not because those people got great jobs with great health\u00a0care. You insure fewer people, and the level of employment does not meaningfully change.\u00a0<\/p>\n Rovner:\u00a0<\/strong>I would\u00a0say you insure fewer people who may well still be eligible. They just get caught in the bureaucratic red tape of all\u00a0of this.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Exactly.\u00a0These tech systems that are being set up are challenging to navigate, if people even have a means to do it, if they even have a smartphone or a computer or access to Wi-Fi.\u00a0There are not that many physical offices they can\u00a0go\u00a0to\u00a0to\u00a0work it out if they need to. And some of those are\u00a0very far\u00a0from where they live. And\u00a0so\u00a0you see some of these tech vendors,\u00a0you know, are set to make off very well out of this system, and people who need the care not so much. And then, of course, you know,\u00a0it\u2019s\u00a0not just the patients who will feel the impact. You have these hospitals around the country that are on the brink of closure. And if they have people who used to be insured\u00a0\u2014\u00a0they used to be able to bill and get reimbursed for their services, suddenly they\u2019re uninsured\u00a0\u2014\u00a0and they\u2019re coming in for emergency care that they can\u2019t pay for, that the hospital has to throw out-of-pocket for, that puts the strain that some of these facilities can barely cope with.\u00a0And\u00a0so\u00a0you\u2019re\u00a0seeing a lot of state hospital associations\u00a0sounding\u00a0the alarm as well.\u00a0<\/p>\n Raman:\u00a0<\/strong>I would also say the timing is interesting. You know, we spent so much time and energy last year going through the reconciliation process to tighten these areas, to get in the work requirements, to reduce immigrant eligibility for Medicaid. And then, you know, as they\u2019re gearing up to possibly do this again, to defer their crackdown on health care as part of that, instead of it saving money\u00a0\u2014\u00a0that it\u2019s not having as much of an effect and costing so much, in the case of the work requirements, where we\u2019re not expected to see the return of it.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, that may be, although\u00a0I guess the return\u00a0is that people will not have insurance anymore, and so the federal government,\u00a0the states,\u00a0won\u2019t\u00a0be spending money\u00a0for\u00a0their medical care.\u00a0They\u2019ll\u00a0be spending money on other things. All right, of course,\u00a0there\u2019s\u00a0more news from HHS than just Medicare and Medicaid\u00a0this week.\u00a0We also have a lot of news about the Make America\u00a0Healthy\u00a0Again movement, which is a sentence\u00a0that 2023\u00a0me\u00a0would\u00a0definitely not\u00a0recognize.\u00a0Alice, you have a cool story this week<\/a>\u00a0about a new poll that finds the MAHA vote\u00a0isn\u2019t\u00a0necessarily locked in with Republicans. Tell us about it.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>Yeah,\u00a0that\u2019s\u00a0right.\u00a0So\u00a0Politico did our own polling on this, because we\u00a0hadn\u2019t\u00a0really seen good data out there on who identifies as MAHA\u00a0and what do they even believe about the different parties and about different issues. And\u00a0so\u00a0we found that,\u00a0OK, yes, most people associate MAHA\u00a0with the Republican Party\u00a0\u2014\u00a0most, but not all. But a lot of voters who identify as MAHA, and a lot of voters who voted for Trump in 2024\u00a0don\u2019t\u00a0think that the Trump administration has done\u00a0a good job\u00a0making America healthy again.\u00a0And they rank the Democratic Party above the Republican Party on a lot of their top priority issues, like standing up to influence from the food industry and the pharmaceutical industry. They rank Democrats as caring more about health. So, you know, we found this very fascinating, and it supports what we\u2019ve been hearing anecdotally, where Democratic candidates, a handful of them, and\u00a0Democratic electoral groups, are really seeing a lot of opportunity to go after MAHA\u00a0voters and win them over for this November. And you know, we should remember that even if you\u00a0don\u2019t\u00a0see\u00a0a big swing of people\u00a0voting for Democrats, even if MAHA\u00a0voters are disillusioned and stay home, that alone could decide races. You know, midterms are decided by very narrow margins.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, two other really interesting MAHA\u00a0takes this week.\u00a0One is from\u00a0NOTUS<\/a>.\u00a0It\u2019s\u00a0about the tension in and among medical groups, about how to deal with HHS Secretary\u00a0[Robert\u00a0F.]\u00a0Kennedy\u00a0[Jr.]\u00a0and the MAHA movement. The American Medical Association seems to be trying to play nice, at least on things it agrees with the\u00a0secretary about, lest it risk things like its giant contract to supply the CPT billing codes to Medicare. On the other hand, the American Academy of Pediatrics and the American College of Physicians have been more confrontational to the point of going to court.\u00a0The other story,\u00a0from\u00a0The New York Times Magazine,\u00a0profiles teen girl influencers<\/a>\u00a0pushing MAHA.\u00a0One thing I noticed is that\u00a0all of\u00a0the teens in the story seem to suffer from physical problems that are not well understood by the mainstream medical community, and so they turned online to seek advice instead, which is understandable in each individual case. But then they turn around and try to influence others. And you can see how easily misinformation can spread. It makes me not so much wonder\u00a0\u2014\u00a0it makes me see how, oh, this is how this stuff sort of gets out there, because you see so much\u00a0\u2026 and Alice, this\u00a0goes back to what you were saying about MAHA\u00a0is not a movement that\u2019s allied with one particular political party.\u00a0It\u2019s\u00a0more of sort\u00a0of a mindset that\u00a0doesn\u2019t\u00a0trust\u00a0expertise.\u00a0<\/p>\n Ollstein:\u00a0<\/strong>I think it\u00a0spans people who identify as Democrats, identify as Republicans. And, you know,\u00a0we\u2019re\u00a0not really interested in politics until the rise of Robert F Kennedy Jr., and so I think it does show a lot of malleability. And there is a fight for this, for this cohort right now, on the airwaves, on the internet, etc.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>And,\u00a0as\u00a0The New York Times pointed out, you know,\u00a0we\u2019ve\u00a0thought of this as being\u00a0sort of a\u00a0young men cohort.\u00a0It\u2019s\u00a0now also a young woman cohort,\u00a0too.\u00a0So\u00a0there\u2019s\u00a0lots of people out there to\u00a0go and get,\u00a0for these people who are pursuing votes.\u00a0\u00a0<\/p>\n Well, turning to reproductive health, we have a couple of follow-ups to things we covered earlier. The big one is\u00a0Title\u00a0X, the federal family planning program, whose grants were set to end as of April 1. Sandhya, it looks like the federal government is going to fund the program after all?\u00a0<\/p>\n Raman:<\/strong>\u00a0Yeah, the family planning grantees in this space have been on edge for so long, you know, waiting to see would they finally just issue the grant applications.\u00a0And then it was such a short timeline for them to get them done. And then everyone that I talked to in the\u00a0lead-up\u00a0was expecting some sort of delay, just because it was such a short\u00a0timeframe\u00a0before they were set to run out of money. And\u00a0so\u00a0I think that they\u00a0were all pleasantly surprised that HHS was able to turn things around when they confirmed that the money\u00a0is\u00a0going to go out the day before the deadline. It does take a couple\u00a0of\u00a0days to go through the process and get that done. But I think the new worry now is also that in the statements that the White House and HHS have made is just that they are still at work on getting\u00a0Title\u00a0X\u00a0rulemaking out so that a lot of these groups would be ineligible if they also\u00a0provide\u00a0abortions.\u00a0Or we also\u00a0don\u2019t\u00a0know what will be in the rule\u00a0\u2014\u00a0if it will be broader than what was under the last\u00a0Trump administration, if it encompasses other restrictions.\u00a0So\u00a0a little bit of both there.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah. And I also was\u00a0gonna\u00a0say, I mean, we know that anti-abortion groups are unhappy with the administration, so this would be one place where they could\u00a0presumably throw\u00a0them a bone, yes?\u00a0<\/p>\n Ollstein:\u00a0<\/strong>So\u00a0people on both sides have been a little mystified why we\u00a0haven\u2019t\u00a0seen a new\u00a0Title\u00a0X\u00a0rule yet.\u00a0They were expecting that near the beginning of last year, especially if the administration was just planning to reimpose his 2019 version, that would be pretty straightforward and simple.\u00a0And yet, here we are, more than a year into the administration, and we\u00a0haven\u2019t\u00a0really seen this yet. The administration did confirm to me\u00a0\u2014\u00a0we put this in our newsletter\u00a0\u2014\u00a0that a new rule is coming.\u00a0And they said it will\u00a0align with pro-life values. And the White House\u2019s comments to some conservative media outlets were very explicit that this will be the last time Planned Parenthood can get funding. Now I wonder if that statement will come back to bite them in court, because the rule previously was\u00a0very careful\u00a0not to name Planned Parenthood or name any specific organization. It just imposed criteria that applied to a lot of Planned Parenthood facilities, and\u00a0in order to\u00a0make them ineligible for\u00a0Title\u00a0X\u00a0funding. And\u00a0so\u00a0I wonder if that will help Planned Parenthood\u00a0sue\u00a0later on.\u00a0But\u00a0we\u2019ll\u00a0put a pin in that and come back to it.\u00a0But we have confirmed that some sort of new rule is coming, but we don\u2019t know when, and we don\u2019t know what it would entail.\u00a0There\u2019s\u00a0a lot of speculation that this could go way beyond an attempt to kick Planned Parenthood out. There\u2019s speculation it could involve restrictions on\u00a0particular forms\u00a0of birth control. There\u2019s speculation that it could entail restrictions on gender-affirming care. There\u2019s speculation that it could involve rules around parental consent, stricter parental consent requirements, which are currently something that\u2019s not part of\u00a0Title\u00a0X. And\u00a0so\u00a0we just\u00a0don\u2019t\u00a0know, you know,\u00a0in order to\u00a0mollify the anti-abortion groups that are upset, they are saying,\u00a0Don\u2019t\u00a0worry, new rule is coming<\/em>.\u00a0But again, we don\u2019t know when, and we don\u2019t know what\u2019s going to be in it.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well,\u00a0we\u2019ll\u00a0be here when it happens. Another topic\u00a0we\u2019ve\u00a0talked about at some length is crisis pregnancy centers, which are anti-abortion organizations that sometimes offer some medical services.\u00a0This week, we learned about a Texas woman<\/a>\u00a0who was told after an ultrasound at a crisis pregnancy center that she had a normal pregnancy, and three days later, ended up in emergency surgery because the pregnancy was not normal, but rather ectopic\u00a0\u2014\u00a0in other words, implanted in her fallopian tube rather than her uterus, which could have been fatal if not caught. This is not the first such case, but it again raises this question of whether these centers should be treated as medical facilities, which\u00a0we\u2019ve\u00a0talked about many states\u00a0do.\u00a0\u00a0<\/p>\n Raman:<\/strong>\u00a0And I think a lot of the rationale that people have for trying to do some of these\u00a0mandatory ultrasounds, you know, encouraging people to go to this is because the talking point is that\u00a0you don\u2019t know if you have an ectopic pregnancy, you don\u2019t have another complication, so you should go here to instead of just taking a medication abortion. So\u00a0\u2026\u00a0we\u2019re\u00a0coming full circle here, where this is also not helping the\u00a0case, if\u00a0you\u2019re\u00a0not finding the full information there.\u00a0So\u00a0I think that\u00a0was an interesting point to me\u00a0\u2026\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah,\u00a0it\u2019s\u00a0going on both\u00a0sides\u00a0basically.\u00a0It is fraught, and we will continue to cover it.\u00a0<\/p>\n All right, that is this week\u2019s news. Now\u00a0we\u2019ll\u00a0play my interview with Elisabeth Rosenthal at\u00a0KFF Health News, and then we will come back and do\u00a0our\u00a0extra credits.\u00a0<\/p>\n I am pleased to welcome back to the podcast\u00a0KFF Health News\u2019\u00a0Elisabeth Rosenthal, who reported and wrote the last\u00a0two<\/em>\u00a0\u201cBills of the\u00a0Month.\u201d\u00a0Libby, thanks for coming back.\u00a0<\/p>\n Elisabeth Rosenthal:<\/strong>\u00a0Thanks for having me.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0So\u00a0let\u2019s\u00a0start with our drug copay card patient.\u00a0Before we get into the particulars,\u00a0what\u2019s\u00a0a\u00a0drug copay card?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Well, copay cards, or\u00a0copayment programs, are things that the drug companies give patients. You know,\u00a0when it says you could pay as little as $0,\u00a0where they\u00a0pay\u00a0your copayment, which is usually\u00a0pretty big\u00a0\u2014\u00a0when you see a copay card, it means\u00a0the\u00a0price is big, and\u00a0they\u2019ll\u00a0bill your insurance for the rest.\u00a0So\u00a0for patients, it sounds like a good deal, and it is a good deal when they work.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0tell us about this patient, and what drug did he need that cost so much that he\u00a0required\u00a0a copay card?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Well, the funny thing is\u00a0\u2014\u00a0his name is Jayant Mishra, and he has\u00a0a psoriatic\u00a0arthritis. And the doctor told him, you know,\u00a0there\u2019s\u00a0this drug called Otezla that would really help you<\/em>.\u00a0And he was, he was a little cautious, because he knew it could be expensive, so he did wait a few months, and his symptoms, his joint pain, in particular, got worse.\u00a0He was like,\u00a0OK,\u00a0I\u2019ll\u00a0start it<\/em>.\u00a0So\u00a0he started it the first month, and it worked\u00a0really well.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>\u201cIt\u201d\u00a0the drug, or\u00a0\u201cit\u201d\u00a0the copay card, or both?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Both seemed to work very well.\u00a0So\u00a0the copay card covered his copay of over $5,000 and he was like,\u00a0Oh, this is great<\/em>. And then what happened was, the next month, he tried to fill\u00a0it,\u00a0and it was like,\u00a0Wait, the copay card\u00a0didn\u2019t\u00a0work<\/em>!\u00a0And really what happens is copay\u00a0cards,\u00a0they are often limited in time and in the amount of money that\u2019s on them.\u00a0So\u00a0depending on how much the copay is,\u00a0they can run out,\u00a0basically expire. You used all the money, and you have a drug that\u00a0you\u2019ve\u00a0used that is working\u00a0really well\u00a0for you, and then suddenly\u00a0you\u2019re\u00a0hit with a big bill.\u00a0So\u00a0they\u00a0kind of get\u00a0people addicted to drugs,\u00a0which they then\u00a0can\u2019t\u00a0afford.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>And what happened\u00a0in this case was the insurance company charged more than expected, right?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Well, Otezla, you know,\u00a0there\u2019s\u00a0so many things about this, and many\u00a0\u201cBill of the\u00a0Month\u201d\u00a0stories that,\u00a0you know,\u00a0are eye-rollers. Otezla\u00a0\u2014\u00a0there are biosimilars that were approved by the FDA in\u00a0\u2026\u00a02021?\u00a0\u2026\u00a0which\u00a0everyone\u2019s\u00a0talking about, faster approval of biosimilars. Well, this was approved, but the drugmaker filed multiple suits and patent infringement, and so in the U.S., it\u00a0won\u2019t\u00a0be on the market, the\u00a0biosimilar,\u00a0until 2028,\u00a0so\u00a0that\u2019s\u00a0a problem too.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0if you want this drug,\u00a0it\u2019s\u00a0going to be expensive.\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>It\u2019s\u00a0going to be expensive. And the other problem is copay cards. Insurers used to say,\u00a0OK, that will count towards your deductible, right?\u00a0So\u00a0you\u00a0didn\u2019t\u00a0really feel it,\u00a0right?\u00a0Because you got a $5,000 copay card,\u00a0and you had a $5,000 deductible if you had a high-deductible plan.\u00a0And everything was good. Now, insurers\u00a0kind of said,\u00a0Whoa,\u00a0we\u2019re\u00a0not sure we like these things<\/em>.\u00a0So\u00a0yeah, you can use them, but it\u00a0won\u2019t\u00a0count towards your deductibles.\u00a0So\u00a0they\u2019re\u00a0not\u00a0nearly as\u00a0useful as they might have been in the past. But patients are really stuck, because these are\u00a0really expensive\u00a0drugs that most people\u00a0couldn\u2019t\u00a0afford without copay cards.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0what eventually happened to this patient, and how can other people avoid falling into the copay card trap?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>So basically, because he had used up the amount on the copay card, which was\u00a0$9,400 for the year,\u00a0by the second month, he tried for the third month to kind of ration his drugs to take half as much, and his symptoms came back. And then the lucky thing for him was then it was January,\u00a0right,\u00a0copay cards\u00a0are usually done for the year.\u00a0So\u00a0he got a new copay card for another $9,400 and he was good for January, and he paid with his health savings account for the first month\u2019s\u00a0copay,\u00a0with the copay card the second month, with the copay card and his health savings account. And when this went to press, he\u00a0wasn\u2019t\u00a0sure how he was going to pay for the rest of the year. And for him,\u00a0it\u2019s\u00a0not a huge problem, because he has a very\u00a0well-funded\u00a0health savings account, which few of us do, but he was\u00a0really up\u00a0in the air for the rest of the year when we wrote about this.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0sort of moral of this story, be careful if you want to take an expensive drug, and the theory that when the drugmaker promises,\u00a0Oh, you can have this for as little as\u00a0$0\u00a0copay<\/em>.\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Well, I\u00a0think it\u2019s\u00a0you have to understand what a particular card does.\u00a0You have to understand what\u2019s the limit on how much is on the copay card.\u00a0You have to understand how many months it\u2019s good for.\u00a0You\u00a0have to\u00a0understand, from your insurer\u2019s point of view,\u00a0if\u00a0that will count as your deductible or not. And then, man, you know,\u00a0you\u2019re\u00a0kind of on\u00a0your own,\u00a0right?\u00a0Sometimes your copay card will work great for you, and at other times it will work for a shorter amount of time. And you\u00a0got\u00a0to figure out what to do. I think the third,\u00a0bigger lesson is getting biosimilars, which are these\u00a0very expensive\u00a0drugs approved,\u00a0is not really the big problem in our country. The problem is the patent thickets that surround so many of these drugs that prevent them from getting to the patients who need them.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>In other words,\u00a0you can make a copy of this drug, but you might not be able to get it onto the market.\u00a0\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Right.\u00a0<\/strong>You can make a\u00a0copy\u00a0this drug\u00a0\u2014\u00a0it\u00a0[a generic]\u00a0was approved in 2021\u00a0\u2014\u00a0but that won\u2019t help patients until 2028,\u00a0which is really terrible. You know,\u00a0it\u2019s\u00a0available in other countries, but not here.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0moving\u00a0on,\u00a0our March patient had insurance through the Affordable Care Act exchange and was\u00a0benefiting\u00a0from one of those zero-premium plans until she got caught in a\u00a0literally Kafkaesque\u00a0mess over a\u00a01-cent bill that turned into a\u00a05-cent bill. Who is she and what happened here?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Yeah, her name in this wonderful, terrible story is\u00a0Lorena Alvarado Hill. And what happened here is she was on one of these $0 insurance plans through the Obamacare exchanges with that great subsidy, the Biden-era subsidy, and she and her mother were on the same plan, and her mother went on to Medicare,\u00a0turned 65.\u00a0So\u00a0Lorena\u00a0didn\u2019t\u00a0need\u00a0the family\u00a0coverage and told the insurer that. And the insurance, of course, automatically recalculates your subsidy, and her premium went from being zero to\u00a01\u00a0cent. Now,\u00a0no human would make that, you know, would say,\u00a0Oh, that makes sense<\/em>. And to Lorena, it\u00a0didn\u2019t\u00a0really make sense either. She was like,\u00a0I\u2019m\u00a0not sure how to pay\u00a01\u00a0cent, like, will it work on my credit card? And some of the bills said, you\u00a0know,\u00a0you understand that this could\u00a0impact\u00a0the continuation of your insurance, but, you know, she was like,\u00a01\u00a0cent,\u00a0I\u00a0don\u2019t\u00a0think so<\/em>. And then she kept going to doctors, and the insurance still worked, and then at some point, four months later, she\u00a0got\u00a0a letter in November saying,\u00a0Oh, your insurance was canceled in July, and you owe money for all these bills<\/em>.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And what happened with this case?\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Well, you know, like many of our\u00a0\u201cBill of the\u00a0Month\u201d\u00a0patients, I celebrate them for being real fighters, because her bill, since her premium was\u00a01\u00a0cent a month, went from\u00a01\u00a0cent to\u00a02\u00a0cents to\u00a03\u00a0cents to\u00a04\u00a0cents to\u00a05\u00a0cents,\u00a0when they sent her the note saying your insurance has been canceled for the last four months.\u00a0And what turns out, which is really interesting,\u00a0is this is a known glitch in the way the subsidies were calculated, were administered.\u00a0There\u2019s\u00a0a recalculation of subsidies every time\u00a0there\u2019s\u00a0a life event, a kid goes off the plan, you change jobs, get married, you\u00a0get divorced.\u00a0So\u00a0the recalculation\u00a0happens automatically.\u00a0And the Biden administration, understanding that this glitch could exist, they gave the insurers the\u00a0option\u00a0not to cancel insurance if the amount owed was less than $10.\u00a0And there were\u00a0apparently 180,000\u00a0people caught in this situation where their insurance could have been canceled for under $10\u00a0of a\u00a0recalculated premium. The Trump administration revoked that rule because their feeling was, you owe something, you pay something.\u00a0So\u00a0it\u2019s\u00a0part of their\u00a0\u201cstamp out fraud and abuse,\u201d\u00a0and this was, in their view, abuse of a system when people\u00a0didn\u2019t\u00a0pay what they owed.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0One cent.\u00a0<\/p>\n Rosenthal:<\/strong>\u00a0One cent,\u00a0right.\u00a0So\u00a0what happened\u00a0with\u00a0her is, you know,\u00a0a\u00a0good bill-paying\u00a0citizen sending her daughter to college with loans. She wrote her insurers, she wrote to the state, she wrote to everyone. And as a last resort, of course, someone said,\u00a0Well,\u00a0there\u2019s\u00a0this thing called\u00a0Bill of the\u00a0Month you could write to<\/em>.\u00a0So\u00a0when we\u00a0looked into\u00a0this,\u00a0at first\u00a0HealthFirst, which was her insurer in Florida, said,\u00a0Oh,\u00a0she\u2019s\u00a0not insured through us<\/em>.\u00a0And I was like,\u00a0Yeah, because you canceled her insurance<\/em>. And then I gave them her insurance number, and they said,\u00a0Well, yes, according to law, we did the right thing.\u00a0She\u00a0didn\u2019t\u00a0pay,\u00a0so it was canceled<\/em>. Somehow, through all of this,\u00a0word got back to the hospital and the insurer,\u00a0and they worked together, and her bills were suddenly zero on her portal. So\u00a0that\u2019s\u00a0the good news for Lorena Alvarado\u00a0Hill. It\u00a0doesn\u2019t\u00a0really help all those other people whose insurance may have been canceled for premiums that were under $10.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So,\u00a0basically, if you get a bill for\u00a05\u00a0cents, you should pay it.\u00a0<\/p>\n Rosenthal:\u00a0<\/strong>Yeah, you know, it was funny when this story went up, many\u00a0people were sympathetic, but other commenters said,\u00a0Well, she should have just paid $1 because you can pay that<\/em>.\u00a0And\u00a0maybe there\u00a0was a way to pay\u00a01\u00a0cent. And\u00a0I\u2019m\u00a0kind of with\u00a0her, like, if I got a bill for\u00a01\u00a0cent, life is busy. This is a woman who is a teacher\u2019s aide and works on weekends at a store to help pay for her daughter\u2019s college. Life is busy. You just\u00a0can\u2019t\u00a0sweat over\u00a01-cent bills and spend a lot of time figuring out how to pay them. And\u00a0I guess the lesson\u00a0is,\u00a0what\u2019s\u00a0the worst that can happen in a very dysfunctional system where so much is automated\u00a0now?\u00a0The\u00a0worst\u00a0that can happen is always really bad. Your insurance could be canceled.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So basically, stay\u00a0on top of it, I guess,\u00a0is the message for\u00a0both of these\u00a0stories this month. Elisabeth Rosenthal, thank you so much.\u00a0<\/p>\n Rosenthal:<\/strong>\u00a0Thanks,\u00a0Julie,\u00a0for having me.\u00a0<\/p>\n Rovner:\u00a0<\/strong>OK, we\u00a0are back.\u00a0It\u2019s\u00a0time for our\u00a0extra-credit\u00a0segment.\u00a0That\u2019s\u00a0where we each recognize a story we read this\u00a0week\u00a0we think you should read,\u00a0too.\u00a0Don\u2019t\u00a0worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Jessie, why don\u2019t you go\u00a0first this week?\u00a0<\/p>\n Hellmann:\u00a0<\/strong>My story is from\u00a0The Texas Tribune, from a group of reporters who I\u00a0can\u2019t\u00a0name individually.\u00a0There\u2019s\u00a0too many of them. But it is\u00a0about how undocumented immigrants are avoiding medical care<\/a>\u00a0in Texas after the governor issued an executive order a few years ago requiring that hospitals check patients\u2019\u00a0citizenship.\u00a0So\u00a0the story found that hospital visits by undocumented people dropped by about a third, and the story also got into how this is bleeding into other types of health care at other facilities, free vaccine clinics are not being attended as widely anymore. People\u00a0aren\u2019t\u00a0attending their preventive care appointments,\u00a0like cancer screenings or prenatal care checkups. Some of these other health facilities\u00a0are required to\u00a0check citizenship status, but\u00a0it\u2019s\u00a0definitely a\u00a0chilling effect over the broader health\u00a0care landscape in Texas.\u00a0<\/p>\n
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n\n\t\tPanelists\t<\/h3>\n
\n\tCQ Roll Call<\/p>\n
\n\t\t\t\t@jessiehellmann\t\t\t<\/a><\/p>\n
\n\t\t\t\t@jessiehellmann.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Jessie’s stories.\t\t\t<\/a><\/p>\n
\n\tPolitico<\/p>\n
\n\t\t\t\t@AliceOllstein\t\t\t<\/a><\/p>\n
\n\t\t\t\t@alicemiranda.bsky.social\t\t\t<\/a><\/p>\n
\n\t\t\t\tRead Alice’s stories.\t\t\t<\/a><\/p>\n
\n\tBloomberg Law<\/p>\n
\n\t\t\t\t@SandhyaWrites\t\t\t<\/a><\/p>\n
\n\t\t\t\t@sandhyawrites.bsky.social\t\t\t<\/a><\/p>\n\n
\n