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KFF Health News' 'What the Health?': LIVE From KFF: Health Care and the 2024 Election

Thu, 17 Oct 2024 19:40:00 +0000

The Host

Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ 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.

The 2024 campaign — particularly the one for president — has been notably vague on policy. But health issues, especially those surrounding abortion and other reproductive health care, have nonetheless played a key role. And while the Affordable Care Act has not been the focus of debate the way it was over the previous three presidential campaigns, who becomes the next president will have a major impact on the fate of the 2010 health law.

The panelists for this week’s special election preview, taped before a live audience at KFF’s offices in Washington, are Julie Rovner of KFF Health News, Tamara Keith of NPR, Alice Miranda Ollstein of Politico, and Cynthia Cox and Ashley Kirzinger of KFF.

Panelists

Ashley Kirzinger KFF @AshleyKirzinger Read Ashley's bio. Cynthia Cox KFF @cynthiaccox Read Cynthia's bio. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Tamara Keith NPR @tamarakeithNPR Read and listen to Tamara's stories.

Among the takeaways from this week’s episode:

As Election Day nears, who will emerge victorious from the presidential race is anyone’s guess. Enthusiasm among Democratic women has grown with the elevation of Vice President Kamala Harris to the top of the ticket, with more saying they are likely to turn out to vote. But broadly, polling reveals a margin-of-error race — too close to call.
Several states have abortion measures on the ballot. Proponents of abortion rights are striving to frame the issue as nonpartisan, acknowledging that recent measures have passed thanks in part to Republican support. For some voters, resisting government control of women’s health is a conservative value. Many are willing to split their votes, supporting both an abortion rights measure and also candidates who oppose abortion rights.
While policy debates have been noticeably lacking from this presidential election, the future of Medicaid and the Affordable Care Act hinges on its outcome. Republicans want to undermine the federal funding behind Medicaid expansion, and former President Donald Trump has a record of opposition to the ACA. Potentially on the chopping block are the federal subsidies expiring next year that have transformed the ACA by boosting enrollment and lowering premium costs.
And as misinformation and disinformation proliferate, one area of concern is the “malleable middle”: people who are uncertain of whom or what to trust and therefore especially susceptible to misleading or downright false information. Could a second Trump administration embed misinformation in federal policy? The push to soften or even eliminate school vaccination mandates shows the public health consequences of falsehood creep.

Also mentioned on this week’s podcast:

The New York Times’ “Resistance to Public Health, No Longer Fringe, Gains Foothold in G.O.P. Politics,” by Sheryl Gay Stolberg.
KFF Health News’ “‘What the Health?’: SCOTUS Ruling Strips Power From Federal Health Agencies.”
KFF’s Health Misinformation and Trust Initiative, a program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem.

click to open the transcript Transcript: LIVE From KFF: Health Care and the 2024 Election

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

Emmarie Huetteman: Please put your hands together and join me in welcoming our panel and our host, Julie Rovner.

Julie Rovner: Hello, good morning, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the very best and smartest health reporters in Washington, along with some very special guests today. We’re taping this special election episode on Thursday, October 17th, at 11:30 a.m., in front of a live audience at the Barbara Jordan Conference Center here at KFF in downtown D.C. Say hi, audience.

As always, news happens fast and things might have changed by the time you hear this. So, here we go.

So I am super lucky to work at and have worked at some pretty great places and with some pretty great, smart people. And when I started to think about who I wanted to help us break down what this year’s elections might mean for health policy, it was pretty easy to assemble an all-star cast. So first, my former colleague from NPR, senior White House correspondent Tamara Keith. Tam, thanks for joining us.

Tamara Keith: Thank you for having me.

Rovner: Next, our regular “What the Health?” podcast panelist and my right hand all year on reproductive health issues, Alice Ollstein of Politico.

Alice Miranda Ollstein: Hi Julie.

Rovner: Finally, two of my incredible KFF colleagues. Cynthia Cox is a KFF vice president and director of the program on the ACA [Affordable Care Act] and one of the nation’s very top experts on what we know as Obamacare. Thank you, Cynthia.

Cynthia Cox: Great to be here.

Rovner: And finally, Ashley Kirzinger is director of survey methodology and associate director of our KFF Public Opinion and Survey Research Program, and my favorite explainer of all things polling.

Ashley Kirzinger: Thanks for having me.

Rovner: So, welcome to all of you. Thanks again for being here. We’re going to chat amongst ourselves for a half hour or so, and then we will open the floor to questions. So be ready here in the room. Tam, I want to start with the big picture. What’s the state of the race as of October 17th, both for president and for Congress?

Keith: Well, let’s start with the race for President. That’s what I cover most closely. This is what you would call a margin-of-error race, and it has been a margin-of-error race pretty much the entire time, despite some really dramatic events, like a whole new candidate and two assassination attempts and things that we don’t expect to see in our lifetimes and yet they’ve happened. And yet it is an incredibly close race. What I would say is that at this exact moment, there seems to have been a slight shift in the average of polls in the direction of former President [Donald] Trump. He is in a slightly better position than he was before and is in a somewhat more comfortable position than Vice President [Kamala] Harris.

She has been running as an underdog the whole time, though there was a time where she didn’t feel like an underdog, and right now she is also running like an underdog and the vibes have shifted, if you will. There’s been a more dramatic shift in the vibes than there has been in the polls. And the thing that we don’t know and we won’t know until Election Day is in 2016 and 2020, the polls underestimated Trump’s support. So at this moment, Harris looks to be in a weaker position against Trump than either [Hillary] Clinton or [Joe] Biden looked to be. It turns out that the polls were underestimating Trump both of those years. But in 2022 after the Dobbs decision, the polls overestimated Republican support and underestimated Democratic support.

So what’s happening now? We don’t know. So there you go. That is my overview, I think, of the presidential race. The campaigning has really intensified in the last week or so, like really intensified, and it’s only going to get more intense. I think Harris has gotten a bit darker in her language and descriptions. The joyful warrior has been replaced somewhat by the person warning of dire consequences for democracy. And in terms of the House and the Senate, which will matter a lot, a lot a lot, whether Trump wins or Harris wins, if Harris wins and Democrats lose the Senate, Harris may not even be able to get Cabinet members confirmed.

So it matters a lot, and the conventional wisdom — which is as useful as it is and sometimes is not all that useful — the conventional wisdom is that something kind of unusual could happen, which is that the House could flip to Democrats and the Senate could flip to Republicans, and usually these things don’t move in opposite directions in the same year.

Rovner: And usually the presidential candidate has coattails, but we’re not really seeing that either, are we?

Keith: Right. In fact, it’s the reverse. Several of the Senate candidates in key swing states, the Democratic candidates are polling much better than the Republican candidates in those races and polling with greater strength than Harris has in those states. Is this a polling error, or is this the return of split-ticket voting? I don’t know.

Rovner: Well, leads us to our polling expert. Ashley, what are the latest polls telling us, and what should we keep in mind about the limitations of polling? I feel like every year people depend a lot on the polls and every year we say, Don’t depend too much on the polls.

Kirzinger: Well, can I just steal Tamara’s line and say I don’t know? So in really close elections, when turnout is going to matter a lot, what the polls are really good at is telling us what is motivating voters to turn out and why. And so what the polls have been telling us for a while is that the economy is top of mind for voters. Now, health care costs — we’re at KFF. So health care plays a big role in how people think about the economy, in really two big ways. The first is unexpected costs. So unexpected medical bills, health care costs, are topping the list of the public’s financial worries, things that they’re worried about, what might happen to them or their family members. And putting off care. What we’re seeing is about a quarter of the public these days are putting off care because they say they can’t afford the cost of getting that needed care.

So that really shows the way that the financial burdens are playing heavily on the electorate. What we have seen in recent polling is Harris is doing better on the household expenses than Biden did and is better than the Democratic Party largely. And that’s really important, especially among Black women and Latina voters. We are seeing some movement among those two groups of the electorate saying that Harris is doing a better job and they trust her more on those issues. But historically, if the election is about the economy, Republican candidates do better. The party does better on economic issues among the electorate.

What we haven’t mentioned yet is abortion, and this is the first presidential election since post-Dobbs, in the post-Dobbs era, and we don’t know how abortion policy will play in a presidential election. It hasn’t happened before, so that’s something that we’re also keeping an eye on. We know that Harris is campaigning around reproductive rights, is working among a key group of the electorate, especially younger women voters. She is seen as a genuine candidate who can talk about these issues and an advocate for reproductive rights. We’re seeing abortion rise in importance as a voting issue among young women voters, and she’s seen as more authentic on this issue than Biden was.

Rovner: Talk about last week’s poll about young women voters.

Kirzinger: Yeah, one of the great things that we can do in polling is, when we see big changes in the campaign, is we can go back to our polls and respondents and ask how things have changed to them. So we worked on a poll of women voters back in June. Lots have changed since June, so we went back to them in September to see how things were changing for this one group, right? So we went back to the same people and we saw increased motivation to turn out, especially among Democratic women. Republican women were about the same level of motivation. They’re more enthusiastic and satisfied about their candidate, and they’re more likely to say abortion is a major reason why they’re going to be turning out. But we still don’t know how that will play across the electorate in all the states.

Because for most voters, a candidate’s stance on abortion policy is just one of many factors that they’re weighing when it comes to turnout. And so those are one of the things that we’re looking at as well. I will say that I’m not a forecaster, thank goodness. I’m a pollster, and polls are not good at forecasts, right? So polls are very good at giving a snapshot of the electorate at a moment in time. So two weeks out, that’s what I know from the polls. What will happen in the next two weeks, I’m not sure.

Rovner: Well, Alice, just to pick up on that, abortion, reproductive health writ large are by far the biggest health issues in this campaign. What impact is it having on the presidential race and the congressional races and the ballot issues? It’s all kind of a clutter, isn’t it?

Ollstein: Yeah, well, I just really want to stress what Ashley said about this being uncharted territory. So we can gather some clues from the past few years where we’ve seen these abortion rights ballot measures win decisively in very red states, in very blue states, in very purple states. But presidential election years just have a different electorate. And so, yes, it did motivate more people to turn out in those midterm and off-year elections, but that’s just not the same group of folks and it’s not the same groups the candidates need this time, necessarily. And also we know that every time abortion has been on the ballot, it has won, but the impact and how that spills over into partisan races has been a real mixed bag.

So we saw in Michigan in 2022, it really helped Democrats. It helped Governor Gretchen Whitmer. It helped Michigan Democrats take back control of the Statehouse for the first time in decades. But that didn’t work for Democrats in all states. My colleagues and I did an analysis of a bunch of different states that had these ballot measures, and these ballot measures largely succeeded because of Republican voters who voted for the ballot initiative and voted for Republican candidates. And that might seem contradictory. You’re voting for an abortion rights measure, and you’re voting for very anti-abortion candidates. We saw that in Kentucky, for example, where a lot of people voted for (Sen.) Rand Paul, who is very anti-abortion, and for the abortion rights side of the ballot measure.

I’ve been on the road the last few months, and I think you’re going to see a lot of that again. I just got back from Arizona, and a lot of people are planning to vote for the abortion rights measure there and for candidates who have a record of opposing abortion rights. Part of that is Donald Trump’s somewhat recent line of: I won’t do any kind of national ban. I’ll leave it to the states. A lot of people are believing that, even though Democrats are like: Don’t believe him. It’s not true. But also, like Ashley said, folks are just prioritizing other issues. And so, yes, when you look at certain slices of the electorate, like young women, abortion is a top motivating issue. But when you look at the entire electorate, it’s, like, a distant fourth after the economy and immigration and several other things.

I found the KFF polling really illuminating in that, yes, most people said that abortion is either just one of many factors in deciding their vote on the candidates or not a factor at all. And most people said that they would be willing to vote for a candidate who does not share their views on abortion. So I think that’s really key here. And these abortion rights ballot measures, the campaigns behind them are being really deliberate about remaining completely nonpartisan. They need to appeal to Republicans, Democrats, independents in order to pass, but that also … So their motivation is to appeal to everyone. Democrats’ motivation is to say: You have to vote for us, too. Abortion rights won’t be protected if you just pass the ballot measure. You also have to vote for Democrats up and down the ballot. Because, they argue, Trump could pursue a national ban that would override the state protections.

Rovner: We’ve seen in the past — and this is for both of you — ballot measures as part of partisan strategies. In the early 2000s, there were anti-gay-marriage ballot measures that were intended to pull out Republicans, that were intended to drive turnout. That’s not exactly what’s happening this time, is it?

Keith: So I was a reporter in the great state of Ohio in 2004, and there was an anti-gay-rights ballot measure on the ballot there, and it was a key part of George W. Bush’s reelection plan. And it worked. He won the state somewhat narrowly. We didn’t get the results until 5 a.m. the next day, but that’s better than we’ll likely have this time. And that was a critical part of driving Republican turnout. It’s remarkable how much has changed since then in terms of public views. It wouldn’t work in the same way this time.

The interesting thing in Arizona, for instance, is that there’s also an anti-immigration ballot measure that’s also polling really well that was added by the legislature in sort of a rush to try to offset the expected Democratic-based turnout because of the abortion measure. But as you say, it is entirely possible that there could be a lot of Trump abortion, immigration and [House Democrat and Senate candidate] Ruben Gallego voters.

Ollstein: Absolutely. And I met some of those voters, and one woman told me, look, she gets offended when people assume that she’s liberal because she identified as pro-choice. We don’t use that terminology in our reporting, but she identified as pro-choice, and she was saying: Look, to me, this is a very conservative value. I don’t want the government in my personal business. I believe in privacy. And so for her, that doesn’t translate over into, And therefore I am a Democrat.

Rovner: I covered two abortion-related ballot measures in South Dakota that were two years, I think it was 2006 and 2008.

Ollstein: They have another one this year.

Rovner: Right. There is another one this year. But what was interesting, what I discovered in 2006 and 2008 is exactly what you were saying, that there’s a libertarian streak, particularly in the West, of people who vote Republican but who don’t believe that the government has any sort of business in your personal life, not just on abortion but on any number of other things, including guns. So this is one of those issues where there’s sort of a lot of distinction. Cynthia, this is the first time in however many elections the Affordable Care Act has not been a huge issue, but there’s an awful lot at stake for this law, depending on who gets elected, right?

Cox: Yeah, that’s right. I mean, it’s the first time in recent memory that health care in general, aside from abortion, hasn’t really been the main topic of conversation in the race. And part of that is that the Affordable Care Act has really transformed the American health care system over the last decade or so. The uninsured rate is at a record low, and the ACA marketplaces, which had been really struggling 10 years ago, have started to not just survive but thrive. Maybe also less to dislike about the ACA, but it’s also not as much a policy election as previous elections had been. But yes, the future of the ACA still hinges on this election.

So starting with President Trump, I think as anyone who follows health policy knows, or even politics or just turned on the TV in 2016 knows that Trump has a very, very clear history of opposing the Affordable Care Act, or Obamacare. He supported a number of efforts in Congress to try to repeal and replace the Affordable Care Act. And when those weren’t successful, he took a number of regulatory steps, joined legal challenges, and proposed in his budgets to slash funding for the Affordable Care Act and for Medicaid. But now in 2024, it’s a little bit less clear exactly where he’s going.

I would say earlier in the 2024 presidential cycle, he made some very clear comments about saying Obamacare sucks, for example, or that Republicans should never give up on trying to repeal and replace the ACA, that the failure to do so when he was president was a low point for the party. But then he also has seemed to kind of walk that back a little bit. Now he’s saying that he would replace the ACA with something better or that he would make the ACA itself much, much better or make it cost less, but he’s not providing specifics. Of course, in the debate, he famously said that he had “concepts” of a plan, but there’s no … Nothing really specific has materialized.

Rovner: We haven’t seen any of those concepts.

Cox: Yes, the concept is … But we can look at his record. And so we do know that he has a very, very clear record of opposing the ACA and really taking any steps he could when he was president to try to, if not repeal and replace it, then significantly weaken it or roll it back. Harris, by contrast, is in favor of the Affordable Care Act. When she was a primary candidate in 2020, she had expressed support for more-progressive reforms like “Medicare for All” or “Medicare for More.” But since becoming vice president, especially now as the presidential candidate, she’s taken a more incremental approach.

She’s talking about building upon the Affordable Care Act. In particular, a key aspect of her record and Biden’s is these enhanced subsidies that exist in the Affordable Care Act marketplaces. They were first, I think … They really closely mirror what Biden had run on as president in 2019, 2020, but they were passed as part of covid relief. So they were temporary, then they were extended as part of the Inflation Reduction Act but, again, temporarily. And so they’re set to expire next year, which is setting up a political showdown of sorts for Republicans and Democrats on the Hill about whether or not to extend them. And Harris would like to make these subsidies permanent because they have been responsible for really transforming the ACA marketplaces.

The number of people signing up for coverage has doubled since Biden took office. Premium payments were cut almost in half. And so this is, I think, a key part of, now, her record, but also what she wants to see go forward. But it’s going to be an uphill battle, I think, to extend them.

Rovner: Cynthia, to sort of build on that a little bit, as we mentioned earlier, a Democratic president won’t be able to get a lot accomplished with a Republican House and/or Senate and a Republican president won’t be able to get that much done with a Democratic House and/or Senate. What are some of the things we might expect to see if either side wins a trifecta control of the executive branch and both houses of Congress?

Cox: So I think, there … So I guess I’ll start with Republicans. So if there is a trifecta, the key thing there to keep in mind is while there may not be a lot of appetite in Congress to try to repeal and replace the ACA, since that wasn’t really a winning issue in 2017, and since then public support for the ACA has grown. And I think also it’s worth noting that the individual mandate penalty being reduced to $0. So essentially there’s no individual mandate anymore. There’s less to hate about the law.

Rovner: All the pay-fors are gone, too.

Cox: Yeah the pay-fors are gone, too.

Rovner: So the lobbyists have less to hate.

Cox: Yes, that too. And so I don’t think there’s a ton of appetite for this, even though Trump has been saying, still, some negative comments about the ACA. That being said, if Republicans want to pass tax cuts, then they need to find savings somewhere. And so that could be any number of places, but I think it’s likely that certain health programs and other programs are off-limits. So Medicare probably wouldn’t be touched, maybe Social Security, defense, but that leaves Medicaid and the ACA subsidies.

And so if they need savings in order to pass tax cuts, then I do think in particular Medicaid is at risk, not just rolling back the ACA’s Medicaid expansion but also likely block-granting the program or implementing per capita caps or some other form of really restricting the amount of federal dollars that are going towards Medicaid.

Rovner: And this is kind of where we get into the Project 2025 that we’ve talked about a lot on the podcast over the course of this year, that, of course, Donald Trump has disavowed. But apparently [Senate Republican and vice presidential candidate] JD Vance has not, because he keeps mentioning pieces of it.

Ollstein: And they’re only … They’re just one of several groups that have pitched deep cuts to health safety net programs, including Medicaid. You also have the Paragon group, where a lot of former Trump officials are putting forward health policy pitches and several others. And so I also think given the uncertainty about a trifecta, it’s also worth keeping in mind what they could do through waivers and executive actions in terms of work requirements.

Rovner: That was my next question. I’ve had trouble explaining this. I’ve done a bunch of interviews in the last couple of weeks to explain how much more power Donald Trump would have, if he was reelected, to do things via the executive branch than a President Harris would have. So I have not come up with a good way to explain that. Please, one of you give it a shot.

Keith: Someone else.

Rovner: Why is it that President Trump could probably do a lot more with his executive power than a President Harris could do with hers?

Cox: I think we can look back at the last few years and just see. What did Trump do with his executive power? What did Biden do with his executive power? And as far as the Affordable Care Act is concerned or Medicaid. But Trump, after the failure to repeal and replace the ACA, took a number of regulatory steps. For example, trying to expand short-term plans, which are not ACA-compliant, and therefore can discriminate against people with preexisting conditions, or cutting funding for certain things in the ACA, including outreach and enrollment assistance.

And so I think there were a number — and also we’ve talked about Medicaid work requirements in the form of state waivers. And a lot of what Biden did, regulatory actions, were just rolling that back, changing that, but it’s hard to expand coverage or to provide a new program without Congress acting to authorize that spending.

Kirzinger: I think it’s also really important to think about the public’s view of the ACA at this point in time. I mean, what the polls aren’t mixed about is that the ACA has higher favorability than Harris, Biden, Trump, any politician, right? So we have about two-thirds of the public.

Rovner: So Nancy Pelosi was right.

Kirzinger: I won’t go that far, but about two-thirds of the public’s now view the law favorably, and the provisions are even more popular. So while, yes, a Republican trifecta will have a lot of power, the public — they’re going to have a hard time rolling back protections for people with preexisting conditions, which have bipartisan support. They’re going to have a hard time making it no longer available for adult children under the age of 26 to be on their parents’ health insurance. All of those components of the ACA are really popular, and once people are given protections, it’s really hard to take them away.

Cox: Although I would say that there are at least 10 ways the ACA protects people with preexisting conditions. I think on the surface it’s easy to say that you would protect people with preexisting conditions if you say that a health insurer has to offer coverage to someone with a preexisting condition. But there’s all those other ways that they say also protects preexisting conditions, and it makes coverage more comprehensive, which makes coverage more expensive.

And so that’s why the subsidies there are key to make comprehensive coverage that protects people with preexisting conditions affordable to individuals. But if you take those subsidies away, then that coverage is out of reach for most people.

Rovner: That’s also what JD Vance was talking about with changing risk pools. I mean, which most people, it makes your eyes glaze over, but that would be super important to the affordability of insurance, right?

Cox: And his comment about risk pools is — I think a lot of people were trying to read something into that because it was pretty vague. But what a lot of people did think about when he made that comment was that before the Affordable Care Act, it used to be that if you were declined health insurance coverage, especially by multiple insurance companies, if you were basically uninsurable, then you could apply to what existed in many states was a high-risk pool.

But the problem was that these high-risk pools were consistently underfunded. And in most of those high-risk pools, there were even waiting periods or exclusions on coverage for preexisting conditions or very high premiums or deductibles. So even though these were theoretically an option for coverage for people with preexisting conditions before the ACA, the lack of funding or support made it such that that coverage didn’t work very well for people who were sick.

Ollstein: And something conservatives really want to do if they gain power is go after the Medicaid expansion. They’ve sort of set up this dichotomy of sort of the deserving and undeserving. They don’t say it in those words, but they argue that childless adults who are able-bodied don’t need this safety net the way, quote-unquote, “traditional” Medicaid enrollees do. And so they want to go after that part of the program by reducing the federal match. That’s something I would watch out for. I don’t know if they’ll be able to do that. That would require Congress, but also several states have in their laws that if the federal matches decreased, they would automatically unexpand, and that would mean coverage losses for a lot of people. That would be very politically unpopular.

It’s worth keeping in mind that a lot of states, mainly red states, have expanded Medicaid since Republicans last tried to go after the Affordable Care Act in 2017. And so there’s just a lot more buy-in now. So it would be politically more challenging to do that. And it was already very politically challenging. They weren’t able to do it back then.

Rovner: So I feel like one of the reasons that Trump might be able to get more done than Harris just using executive authority is the makeup of the judiciary, which has been very conservative, particularly at the Supreme Court, and we actually have some breaking news on this yesterday. Three of the states who intervened in what was originally a Texas lawsuit trying to revoke the FDA’s [Federal Drug Administration’s] approval of the abortion pill mifepristone, officially revived that lawsuit, which the Supreme Court had dismissed because the doctors who filed it initially didn’t have standing, according to the Supreme Court.

The states want the courts to invoke the Comstock Act, an 1873 anti-vice law banning the mailing and receiving of, among other things, anything used in an abortion, to effectively ban the drug. This is one of those ways that Trump wouldn’t even have to lift a finger to bring about an abortion ban, right? I mean, he’d just have to let it happen.

Ollstein: Right. I think so much of this election cycle has been dominated by, Would you sign a ban? And that’s just the wrong question. I mean, we’ve seen Congress unable to pass either abortion restrictions or abortion protections even when one party controls both chambers. It’s just really hard.

Rovner: And going back 60 years.

Ollstein: And so I think it’s way more important to look at what could happen administratively or through the courts. And so yes, lawsuits like that, that the Supreme Court punted on but didn’t totally resolve this term, could absolutely come back. A Trump administration could also direct the FDA to just unauthorize abortion pills, which are the majority of abortions that take place within the U.S.

And so — or there’s this Comstock Act route. There’s — the Biden administration put out a memo saying, We do not think the Comstock Act applies to the mailing of abortion pills to patients. A Trump administration could put out their own memo and say, We believe the opposite. So there’s a lot that could happen. And so I really have been frustrated. All of the obsessive focus on: Would you sign a ban? Would you veto a ban? Because that is the least likely route that this would happen.

Kirzinger: Well, and all of these court cases create an air of confusion among the public, right? And so, that also can have an effect in a way that signing a ban — I mean, if people don’t know what’s available to them in their state based on state policy or national policy.

Ollstein: Or they’re afraid of getting arrested.

Kirzinger: Yeah, even if it’s completely legal in their state, we’re finding that people aren’t aware of whether — what’s available to them in their state, what they can access legally or not. And so having those court cases pending creates this air of confusion among the public.

Keith: Well, just to amplify the air of confusion, talking to Democrats who watch focus groups, they saw a lot of voters blaming President Biden for the Dobbs decision and saying: Well, why couldn’t he fix that? He’s president. At a much higher level, there is confusion about how our laws work. There’s a lot of confusion about civics, and as a result, you see blame landing in sort of unexpected places.

Rovner: This is the vaguest presidential election I have ever covered. I’ve been doing this since 1988. We basically have both candidates refusing to answer specific questions — as a strategy, I mean, it’s not that I don’t think — I think they both would have a pretty good idea of what it is they would do, and both of them find it to their political advantage not to say.

Keith: I think that’s absolutely right. I think that the Harris campaign, which I spend more time covering, has the view that if Trump is not going to answer questions directly and he is going to talk about “concepts” of a plan, and he’s just going to sort of, like, Well, if I was president, this wouldn’t be a problem, so I’m not going to answer your question — which is his answer to almost every question — then there’s not a lot of upside for them to get into great specifics about policy and to have think tank nerds telling them it won’t work, because there’s no upside to it.

Cox: We’re right here.

Panel: [Laughing]

Rovner: So regular listeners to the podcast will know that one of my biggest personal frustrations with this campaign is the ever-increasing amount of mis- and outright disinformation in the health care realm, as we discussed at some length on last week’s podcast. You can go back and listen. This has become firmly established in public health, obviously pushed along by the divide over the covid pandemic. The New York Times last week had a pretty scary story by Sheryl Gay Stolberg — who’s working on a book about public health — about how some of these more fringe beliefs are getting embedded in the mainstream of the Republican Party.

It used to be that we saw most of these kind of fringe, anti-science, anti-health beliefs were on the far right and on the far left, and that’s less the case. What could we be looking forward to on the public health front if Trump is returned to power, particularly with the help of anti-vaccine activist and now Trump endorser R.F.K. [Robert F. Kennedy] Jr.?

Kirzinger: Oh, goodness to me. Well, so I’m going to talk about a group that I think is really important for us to focus on when we think about misinformation, and I call them the “malleable middle.” So it’s that group that once they hear misinformation or disinformation, they are unsure of whether that is true or false, right? So they’re stuck in this uncertainty of what to believe and who do they trust to get the right information. It used to be pre-pandemic that they would trust their government officials.

We have seen declining trust in CDC [Centers for Disease Control and Prevention], all levels of public health officials. Who they still trust is their primary care providers. Unfortunately, the groups that are most susceptible to misinformation are also the groups that are less likely to have a primary care provider. So we’re not in a great scenario, where we have a group that is unsure of who to trust on information and doesn’t have someone to go to for good sources of information. I don’t have a solution.

Cox: I also don’t have a solution.

Rovner: No, I wasn’t — the question isn’t about a solution. The question is about, what can we expect? I mean, we’ve seen the sort of mis- and disinformation. Are we going to actually see it embedded in policy? I mean, we’ve mostly not, other than covid, which obviously now we see the big difference in some states where mask bans are banned and vaccine mandates are banned. Are we going to see childhood vaccines made voluntary for school?

Ollstein: Well, there’s already a movement to massively broaden who can apply for an exception to those, and that’s already had some scary public health consequences. I mean, I think there are people who would absolutely push for that.

Kirzinger: I think regardless of who wins the presidency, I think that the misinformation and disinformation is going to have an increasing role. Whether it makes it into policy will depend on who is in office and Congress and all of that. But I think that it is not something that’s going away, and I think we’re just going to continue to have to battle it. And that’s where I’m the most nervous.

Keith: And when you talk about the trust for the media, those of us who are sitting here trying to get the truth out there, or to fact-check and debunk, trust for us is, like, in the basement, and it just keeps getting worse year after year after year. And the latest Gallup numbers have us worse than we were before, which is just, like, another institution that people are not turning to. We are in an era where some rando on YouTube who said they did their research is more trusted than what we publish.

Rovner: And some of those randos on YouTube have millions of viewers, listeners.

Keith: Yes, absolutely.

Rovner: Subscribers, whatever you want to call them.

Ollstein: One area where I’ve really seen this come forward, and it could definitely become part of policy in the future, is there’s just a lot of mis- and disinformation around transgender health care. There’s polling that show a lot of people believe what Trump and others have been saying, that, Oh, kids can come home from school and have a sex change operation. Which is obviously ridiculous. Everyone who has kids in school knows that they can’t even give them a Tylenol without parental permission. And it obviously doesn’t happen in a day, but people are like, Oh, well, I know it’s not happening at my school, but it’s sure happening somewhere. And that’s really resonating, and we’re already seeing a lot of legal restrictions on that front spilling.

Rovner: All right, well, I’m going to open it up to the audience. Please wait to ask your question until you have a microphone, so the people who will be listening to the podcast will be able to hear your question. And please tell us who you are, and please make your question or question.

Madeline: Hi, I’m Madeline. I am a grad student at the Milken Institute of Public Health at George Washington. My question is regarding polling. And I was just wondering, how has polling methodologies or tendencies to over-sample conservatives had on polls in the race? Are you seeing that as an issue or …?

Kirzinger: OK. You know who’s less trusted than the media? It’s pollsters, but you can trust me. So I think what you’re seeing is there are now more polls than there have ever been, and I want to talk about legitimate scientific polls that are probability-based. They’re not letting people opt into taking the survey, and they’re making sure their samples are representative of the entire population that they’re surveying, whether it be the electorate or the American public, depending on that.

I think what we have seen is that there have been some tendencies when people don’t like the poll results, they look at the makeup of that sample and say, oh, this poll’s too Democratic, or too conservative, has too many Trump voters. Or whatever it may be. That benefits no pollster to make their sample not look like the population that they’re aiming to represent. And so, yes, there are lots of really, really bad polls out there, but the ones that are legitimate and scientific are still striving to aim to make sure that it’s representative. The problem with election polls is we don’t know who the electorate’s going to be. We don’t know if Democrats are going to turn out more than Republicans. We don’t know if we’re going to see higher shares of rural voters than we saw in 2022.

We don’t know. And so that’s where you really see the shifts in error happen.

Keith: And if former President Trump’s — a big part of his strategy is turning out unlikely voters.

Kirzinger: Yeah. We have no idea who they are.

Rovner: Well, yeah, we saw in Georgia, their first day of in-person early voting, we had this huge upswell of voters, but we have no idea who any of those are, right? I mean, we don’t know what is necessarily turning them out.

Kirzinger: Exactly. And historically, Democrats have been more likely to vote early and vote by mail, but that has really shifted since the pandemic. And so you see these day voting totals now, but that really doesn’t tell you anything at this point in the race.

Rovner: Lots we still don’t know. Another question.

Rae Woods: Hi there. Rae Woods. I’m with Advisory Board, which means that I work with health leaders who need to implement based on the policies and the politics and the results of the election that’s coming up. My question is, outside some of the big things that we’ve talked about so far today, are there some more specific, smaller policies or state-level dynamics that you think today’s health leaders will need to respond to in the next six months, the next eight months? What do health leaders need to be focused on right now based on what could change most quickly?

Ollstein: Something I’ve been trying to shine a light on are state Supreme Courts, which the makeup of them could change dramatically this November. States have all kinds of different ways to … Some elect them on a partisan basis. Some elect them on a nonpartisan basis. Some have appointments by the governor, but then they have to run in these retention elections. But they are going to just have so much power over … I mean, I am most focused on how it can impact abortion rights, but they just have so much power on so many things.

And given the high likelihood of divided federal government, I think just a ton of health policy is going to happen at the state level. And so I would say the electorate often overlooks those races. There’s a huge drop-off. A lot of people just vote the top of the ticket and then just leave those races blank. But yes, I think we should all be paying more attention to state Supreme Court races.

Rovner: I think the other thing that we didn’t, that nobody mentioned we were talking about, what the next president could do, is the impact of the change to the regulatory environment and what the Supreme Court’s decision overturning Chevron is going to have on the next president. And we did a whole episode on this, so I can link back to that for those who don’t know. But basically, the Supreme Court has made it more difficult for whoever becomes president next time to change rules via their executive authority, and put more onus back on Congress. And we will see how that all plays out, but I think that’s going to be really important next year.

Natalie Bercutt: Hi. My name is Natalie Bercutt. I’m also a master’s student at George Washington. I study health policy. I wanted to know a little bit more about, obviously, abortion rights, a huge issue on the ballot in this election, but a little bit more about IVF [in vitro fertilization], which I feel like has kind of come to the forefront a little bit more, both in state races but also candidates making comments on a national level, especially folks who have been out in the field and interacting with voters. Is that something that more people are coming out to the ballot for, or people who are maybe voting split ticket but in support of IVF, but for Republican candidate?

Ollstein: That’s been fascinating. And so most folks know that this really exploded into the public consciousness earlier this year when the Alabama Supreme Court ruled that frozen embryos are people legally under the state’s abortion ban. And that disrupted IVF services temporarily until the state legislature swooped in. So Democrats’ argument is that because of these anti-abortion laws in lots of different states that were made possible by the Dobbs decision, lots of states could become the next Alabama. Republicans are saying: Oh, that’s ridiculous. Alabama was solved, and no other state’s going to do it. But they could.

Rovner: Alabama could become the next Alabama.

Ollstein: Alabama could certainly become the next Alabama. Buy tons of states have very similar language in their laws that would make that possible. Even as you see a lot of Republicans right now saying: Oh, Republicans are … We’re pro-IVF. We’re pro-family. We’re pro-babies. There are a lot of divisions on the right around IVF, including some who do want to prohibit it and others who want to restrict the way it’s most commonly practiced in the U.S., where excess embryos are created and only the most viable ones are implanted and the others are discarded.

And so I think this will continue to be a huge fight. A lot of activists in the anti-abortion movement are really upset about how Republican candidates and officials have rushed to defend IVF and promised not to do anything to restrict it. And so I think that’s going to continue to be a huge fight no matter what happens.

Rovner: Tam, are you seeing discussion about the threats to contraception? I know this is something that Democratic candidates are pushing, and Republican candidates are saying, Oh, no, that’s silly.

Keith: Yeah, I think Democratic candidates are certainly talking about it. I think that because of that IVF situation in Alabama, because of concerns that it could move to contraception, I think Democrats have been able to talk about reproductive health care in a more expansive way and in a way that is perhaps more comfortable than just talking about abortion, in a way that’s more comfortable to voters that they’re talking to back when Joe Biden was running for president. Immediately when Dobbs happened, he was like, And this could affect contraception and it could affect gay rights. And Biden seemed much more comfortable in that realm. And so—

Rovner: Yeah, Biden, who waited, I think it was a year and a half, before he said the word “abortion.”

Keith: To say the word “abortion.” Yes.

Rovner: There was a website: Has Biden Said Abortion Yet?

Keith: Essentially what I’m saying is that there is this more expansive conversation about reproductive health care and reproductive freedom than there had been when Roe was in place and it was really just a debate about abortion.

Rovner: Ashley, do people, particularly women voters, perceive that there’s a real threat to contraception?

Kirzinger: I think what Tamara was saying about when Biden was the candidate, I do think that that was part of the larger conversation, that larger threat. And so they were more worried about IVF and contraception access during that. When you ask voters whether they’re worried about this, they’re not as worried, but they do give the Democratic Party and Harris a much stronger advantage on these issues. And so if you were to be motivated by that, you would be motivated to vote for Harris, but it really isn’t resonating with women voters and the way now that abortion, abortion access is resonating for them.

Rovner: Basically, it won’t be resonating until they take it away.

Kirzinger: Exactly. If, I think, the Alabama Supreme Court ruling happened yesterday, I think it would be a much bigger issue in the campaign, but all of this is timing.

Ollstein: Well, and people really talked about a believability gap around the Dobbs decision, even though the activists who were following it closely were screaming that Roe is toast, from the moment the Supreme Court agreed to hear the case, and especially after they heard the case and people heard the tone of the arguments. And then of course the decision leaked, and even then there was a believability gap. And until it was actually gone, a lot of people just didn’t think that was possible. And I think you’re seeing that again around the idea of a national ban, and you’re seeing it around the idea of restrictions on contraception and IVF. There’s still this believability gap despite the evidence we’ve seen.

Rovner: All right. I think we have time for one more question.

Meg: Hi, my name’s Meg. I’m a freelance writer, and I wanted to ask you about something I’m not hearing about this election cycle, and that’s guns. Where do shootings and school shootings and gun violence fit into this conversation?

Keith: I think that we have heard a fair bit about guns. It’s part of a laundry list, I guess you could say. In the Kamala Harris stump speech, she talks about freedom. She talks about reproductive freedom. She talks about freedom from being shot, going to the grocery store or at school. That’s where it fits into her stump speech. And certainly in terms of Trump, he is very pro–Second Amendment and has at times commented on the school shootings in ways that come across as insensitive. But for his base — and he is only running for his base — for his base, being very strongly pro–Second Amendment is critical. And I think there was even a question maybe in the Univision town hall yesterday to him about guns.

It is not the issue in this campaign, but it is certainly an issue if we talk about how much politics have changed in a relatively short period of time. To have a Democratic nominee leaning in on restrictions on guns is a pretty big shift. When Hillary Clinton did it, it was like: Oh, gosh. She’s going there. She lost. I don’t think that’s why she lost, but certainly the NRA [National Rifle Association] spent a lot of money to help her lose. Biden, obviously an author of the assault weapons ban, was very much in that realm, and Harris has continued moving in that direction along with him, though also hilariously saying she has a Glock and she’d be willing to use it

Ollstein: And emphasizing [Minnesota governor and Democratic vice presidential candidate Tim] Walz’s hunting.

Keith: Oh, look, Tim Walz, he’s pheasant hunting this weekend.

Rovner: And unlike John Kerry, he looked like he’d done it before. John Kerry rather famously went out hunting and clearly had not.

Keith: I was at a rally in 2004 where John Kerry was wearing the jacket, the barn jacket, and the senator, the Democratic senator from Ohio hands him a shotgun, and he’s like … Ehh.

Kirzinger: I was taken aback when Harris said that she had a Glock. I thought that was a very interesting response for a Democratic presidential candidate. I do think it is maybe part of her appeal to independent voters that, As a gun owner, I support Second Amendment rights, but with limitations. And I do think that that part of appeal, it could work for a more moderate voting block on gun rights.

Rovner: We haven’t seen this sort of responsible gun owner faction in a long time. I mean, that was the origin of the NRA.

Keith: But then more recently, Giffords has really taken on that mantle as, We own guns, but we want controls.

Rovner: All right, well, I could go on for a while, but this is all the time we have. I want to thank you all for coming and helping me celebrate my birthday being a health nerd, because that’s what I do. We do have cake for those of you in the room. For those of you out in podcast land, as always, if you enjoy the podcast, you could subscribe wherever you get your podcast.

We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman, and our live-show coordinator extraordinaire, Stephanie Stapleton, and our entire live-show team. Thanks a lot. This takes a lot more work than you realize. As always, you can email us your comments or questions. We’re at whatthehealth, all one word, @KFF.org, or you can still find me. I’m at X at @jrovner. Tam, where are you on social media?

Keith: I’m @tamarakeithNPR.

Rovner: Alice.

Ollstein: @AliceOllstein.

Rovner: Cynthia.

Cox: @cynthiaccox.

Rovner: Ashley.

Kirzinger: @AshleyKirzinger.

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

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KFF Health News' 'What the Health?': Yet Another Promise for Long-Term Care Coverage

Thu, 10 Oct 2024 18:05:00 +0000

The Host

As part of a media blitz aimed at women voters, Vice President Kamala Harris this week rolled out a plan for Medicare to provide in-home long-term care services. It’s popular, particularly for families struggling to care for both young children and older relatives, but its enormous expense has prevented similar plans from being implemented for decades.

Meanwhile, President Joe Biden called out former President Donald Trump by name for having “led the onslaught of lies” about the federal efforts to help people affected by hurricanes Helene and Milton. Even some Republican officials say the misinformation about hurricane relief efforts is threatening public health.

This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico.

Panelists

Jessie Hellmann CQ Roll Call @jessiehellmann Read Jessie's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Shefali Luthra The 19th @shefalil Read Shefali's stories.

Among the takeaways from this week’s episode:

Vice President Kamala Harris’ plan to expand Medicare to cover more long-term care is popular but not new, and in the past has proved prohibitively expensive.
Former President Donald Trump has abandoned support for a drug price policy he pursued during his first term. The idea, which would lower drug prices in the U.S. to their levels in other industrialized countries, is vehemently opposed by the drug industry, raising the question of whether Trump is softening his hard line on the issue.
Abortion continues to be the biggest health policy issue of 2024, as Republican candidates — in what seems to be a replay of 2022 — try to distance themselves from their support of abortion bans and other limits. Voters continue to favor reproductive rights, which creates a brand problem for the GOP. Trump’s going back and forth on his abortion positions is an exception to the tack other candidates have taken.
The Supreme Court returned from its summer break and immediately declined to hear two abortion-related cases. One case pits Texas’ near-total abortion ban against a federal law that requires emergency abortions to be performed in certain cases. The other challenges a ruling earlier this year from the Alabama Supreme Court finding that embryos frozen for in vitro fertilization have the same legal rights as born humans.
The 2024 KFF annual employer health benefits survey, released this week, showed a roughly 7% increase in premiums, with average family premiums now topping $25,000 per year. And that’s with most employers not covering two popular but expensive medical interventions: GLP-1 drugs for weight loss and IVF.

Also this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris campaign about health care issues.

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

Julie Rovner: KFF Health News’ “A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly.

Shefali Luthra: The 19th’s “Arizona’s Ballot Measure Could Shift the Narrative on Latinas and Abortion,” by Mel Leonor Barclay.

Jessie Hellmann: The Assembly’s “Helene Left Some NC Elder-Care Homes Without Power,” by Carli Brosseau.

Joanne Kenen: The New York Times’ “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It,” by Kate Morgan.

Also mentioned on this week’s podcast:

The New York Times’ “Biden Accuses Trump of ‘Outright Lies’ About Hurricane Response,” by Michael D. Shear.
The Miami Herald’s “Florida Threatens To Prosecute TV Stations Over Abortion Ad. FCC Head Calls It ‘Dangerous,’” by Claire Healy and Ana Ceballos.
KFF’s “2024 Employer Health Benefits Survey.”

Click to open the Transcript Transcript: Yet Another Promise for Long-Term Care Coverage

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

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

Today we are joined via teleconference by Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Rovner: Jesse Hellmann of CQ Roll Call.

Jessie Hellmann: Hi there.

Rovner: And Joanne Kenen of the Johns Hopkins Schools of Public Health and Nursing and Politico magazine.

Joanne Kenen: Hi everybody.

Rovner: Later in this episode, we’ll have some excerpts from the Newsmaker lunch we had here at KFF this week with Mark Cuban — “Shark Tank” star, part-owner of the Dallas Mavericks NBA team, and, for the purposes of our discussion, co-founder of the industry-disrupting pharmaceutical company Cost Plus Drugs. But first, this week’s news.

We’re going to start this week with Vice President [Kamala] Harris, who’s been making the media rounds on women-focused podcasts and TV shows like “The View.” To go along with that, she’s released a proposal to expand Medicare to include home-based long-term care, to be paid for in part by expanding the number of drugs whose price Medicare can negotiate. Sounds simple and really popular. Why has no one else ever proposed something like that? she asks, knowing full well the answer. Joanne, tell us!

Kenen: As the one full-fledged member of the sandwich generation here, who has lived the experience of being a family caregiver while raising children and working full time, long-term care is the unfulfillable, extremely expensive, but incredibly important missing link in our health care system. We do not have a system for long-term care, and people do not realize that. Many people think Medicare will, in fact, cover it, where Medicare covers it in a very limited, short-term basis. So the estimates of what families spend both in terms of lost work hours and what they put out-of-pockets is in, I think it’s something like $400 billion. It’s extraordinarily high. But the reason it’s been hard to fix is it’s extraordinarily expensive. And although Harris put out a plan to pay for this, that plan is going to have to be vetted by economists and budget scorers and skeptical Republicans. And probably some skeptical Democrats. It’s really expensive. It’s really hard to do. Julie has covered this for years, too. It’s just—

Rovner: I would say this is where I get to say one of my favorite things, which is that I started covering health care in 1986, and in 1986 my first big feature was: Why don’t we have a long-term care policy in this country? Thirty-eight years later, and we still don’t, and not that people have not tried. There, in fact, was a long-term-care-in-the-home piece of the Affordable Care Act that passed Congress, and HHS [the Department of Health and Human Services] discovered that they could not implement it in the way it was written, because only the people who would’ve needed it would’ve signed up for it. It would’ve been too expensive. And there it went. So this is the continuing promise of something that everybody agrees that we need and nobody has ever been able to figure out how to do. Shefali, I see you nodding here.

Luthra: I mean, I’m just thinking again about the pay-fors in here, which are largely the savings from Medicare negotiating drug prices. And what Harris says in her plan is that they’re going to get more savings by expanding the list of drugs that get lower prices. But that also feels very politically suspect when we have already heard congressional Republicans say that they would like to weaken some of those drug negotiation price provisions. And we also know that Democrats, even if they win the presidency, are not likely to have Congress. It really takes me back to 2020, when we are just talking about ideas that Democrats would love to do if they had full power of Congress, while all of us in Washington kind of know that that is just not going to happen.

Rovner: Yes, I love that one of the pay-fors for this is cutting Medicare fraud. It’s like, where have we heard that before? Oh, yes. In every Medicare proposal for the last 45 years.

Kenen: And it also involves closing some kind of international tax loopholes, and that also sounds easy on paper, and nothing with taxes is ever easy. The Democrats probably are not going to have the Senate. Nobody really knows about the House. It looks like the Democrats may have a narrow edge in that, but we’re going to have more years of gridlock unless something really changes politically, like something extraordinary changes politically. The Republicans are not going to give a President Harris, if she is in fact President Harris, her wish list on a golden platter. On the other hand there’s need for this.

Rovner: But in fairness, this is what the campaign is for.

Kenen: Right. There is a need for something on long-term care.

Rovner: And everybody’s complaining: Well, what would she do? What would she do if she was elected? Well, here’s something she said she would do if she could, if she was elected. Well, meanwhile, former President [Donald] Trump has apparently abandoned a proposal that he made during his first term to require drugmakers to lower their prices for Medicare to no more than they charge in other developed countries where their prices are government-regulated. Is Trump going soft on the drug industry? Trump has been, what, the Republican, I think, who’s been most hostile towards the drug industry until now.

Hellmann: I would say maybe. I think the “most favored nation” proposal is something that the pharmaceutical industry has feared even more than the Democrats’ Medicare negotiation program. And it’s something that Trump really pursued in his first term but wasn’t able to get done. In such a tight race, I think he’s really worried about angering pharmaceutical companies, especially after they were just kind of dealt this loss with Medicare price negotiation. And if he does win reelection, he’s going to be kind of limited in his ability to weaken that program. It’s going to be hard to repeal it. It’s extremely popular, and he may be able to weaken it.

Rovner: “It” meaning price negotiation, not the “most favored nations” prices.

Hellmann: Yeah. It’s going to be really hard to repeal that, and he may be able to weaken it through the negotiation process with drug companies. It’s definitely an interesting turn.

Rovner: Joanne, you want to add something?

Kenen: Trump rhetorically was very harsh on the drug companies right around the time of his inauguration. I think it was the week before, if I remember correctly. Said a lot of very tough stuff on drugs. Put out a list of something like dozens of potential steps. The drug companies have lots of allies in both parties, and more in one than the other, but they have allies on the Hill, and nothing revolutionary happened on drug pricing under Trump.

Rovner: And his HHS secretary was a former drug company executive.

Kenen: Yes, Eli Lilly. So we also pointed out here that former President Trump is not consistent in policy proposals. He says one thing, and then he says another thing, and it’s very hard to know where he’s going to come down. So Trump and drug pricing is an open question.

Rovner: Yes, we will see. All right, well, moving on. Drug prices and Medicare aside, the biggest health issue of Campaign 2024 continues to be abortion and other reproductive health issues. And it’s not just Trump trying to back away from his anti-abortion record. We’ve had a spate of stories over the past week or so of Republicans running for the House, the Senate, and governorships who are trying to literally reinvent themselves as, if not actually supportive of abortion rights, at least anti abortion bans. And that includes Republicans who have not just voted for and advocated for bans but who have been outspokenly supportive of the anti-abortion effort, people like North Carolina Republican gubernatorial candidate Mark Robinson, New Hampshire Republican gubernatorial candidate and former U.S. Senator Kelly Ayotte, along with former Michigan Republican representative and now Senate candidate Mike Rogers. Donald Trump has gotten away repeatedly, as Joanne just said, with changing his positions, even on hot-button issues like abortion. Are these candidates going to be able to get away with doing the same thing, Shefali?

Luthra: I think it’s just so much tougher when your name is not Donald Trump. And that’s because we know from focus group after focus group, and survey after survey, that voters kind of give Trump more leeway on abortion. Especially independent voters will look at him and say, Well, I don’t think he actually opposes abortion, because I’m sure he’s paid for them. And they don’t have that same grace that they give to Republican lawmakers and Republican candidates, because the party has a bad brand on abortion at large, and Trump is seen as this kind of maverick figure. But voters know that Republicans have a history of opposing abortion, of supporting restrictions.

When you look at surveys, when you talk to voters, what they say is, Well, I don’t trust Republicans to represent my interests on this issue, because they largely support access. And one thing that I do think is really interesting is, once again, what we’re seeing is kind of a repeat of the 2022 elections when we saw some very brazen efforts by Republican candidates for the House and Senate try and scrub references to abortion and to fetal personhood from their websites. And it didn’t work, because people have eyes and people have memories, and, also, campaigns have access to the internet archive and are able to show people that, even a few weeks ago, Republican candidates were saying something very different from what they are saying now. I don’t think Mark Robinson can really escape from his relatively recent and very public comments about abortion.

Rovner: Well, on the other hand, there’s some things that don’t change. Republican vice presidential candidate JD Vance told RealClearPolitics last week that if Trump is elected again, their administration would cut off funding to Planned Parenthood because, he said, and I quote, “We don’t think that taxpayers should fund late-term abortions.” Notwithstanding, of course, that even before the overturn of Roe, less than half of all Planned Parenthoods even performed abortions and almost none of those who did perform them later in pregnancy. Is it fair to say that Vance’s anti-abortion slip is showing?

Luthra: I think it might be. And I will say, Julie, when I saw that he said that, I could hear you in my head just yelling about the Hyde Amendment, because we know that Planned Parenthood does not use taxpayer money to pay for abortions. But we also know that JD Vance has seen that he and his ticket are kind of in a tough corner talking about abortion. He has said many times, We need to rebrand — he’s very honest about that, at least — and trying to focus instead on this nonmedical term of “late term” abortions.

It’s a gamble. It’s hoping that voters will be more sympathetic to that because they’ll think, Oh, well, that sounds very extreme. And they’re trying to shift back who is seen as credible and who is not, by focusing on something that historically was less popular. But again, it’s again tricky because when we look at the polling, voters’ understanding of abortion has shifted and they are now more likely to understand that when you have an abortion later in pregnancy, it is often for very medically complex reasons. And someone very high-profile who recently said that is Melania Trump in her new memoir, talking about how she supports abortion at all stages of pregnancy because often these are very heart-wrenching cases and not sort of the murder that Republicans have tried to characterize them as.

Rovner: I think you’re right. I think this is the continuation of the 2022 campaign, except that we’ve had so many more women come forward. We’ve seen actual cases. It used to be anti-abortion forces would say, Oh, well, this never happened. I mean, these are wrenching, awful things that happened to a lot of these patients with pregnancy complications late in pregnancy. And it is, I know, because I’ve talked to them. It’s very hard to get them to talk publicly, because then they get trolled. Why should they step forward?

Well, now we’ve seen a lot of these women stepping forward. So we now see a public that knows that this happens, because they’re hearing from the people that it’s happened to and they’re hearing from their doctors. I do know also from the polling that there are people who are going to vote in these 10 states where abortion is on the ballot. Many of them are going to vote for abortion access and then turn around and vote for Republicans who support restrictions, because they’re Republicans. It may or may not be their most important issue, but I still think it’s a big question mark where that happens and how it shakes out. Joanne, did you want to add something?

Kenen: You’re seeing two competing things at the same time. You have a number of Republicans trying to moderate their stance or at least sound like they’re moderating their stance. At the same time, you also have the whole, where the Republican Party is on abortion has shifted to the right. They are talking about personhood at the moment of conception, the embryo — which is, scientifically put, a small ball of cells still at that point — that they actually have the same legal rights as any other post-birth person.

So that’s become a fairly common view in the Republican Party, as opposed to something that just five or six years ago was seen as the fringe. And Trump is going around saying that Democrats allow babies to be executed after birth, which is not true. And they’re particularly saying this is true in Minnesota because of [Gov.] Tim Walz, and some voters must believe it, right? Because they keep saying it. So you have this trend that Shefali just described and that you’ve described, Julie, about this sort of attempting to win back trust, as Vance said. And it sounded more moderate, and at the same time as you’re hearing this rhetoric about personhood and execution. So I don’t think the Republicans have yet solved their own whiplash post-Roe.

Rovner: Meanwhile, the abortion debate is getting mired in the free-speech debate. In Florida, Republican governor Ron DeSantis is threatening legal action against TV stations airing an ad in support of the ballot measure that would overturn the state’s six-week abortion ban. That has in turn triggered a rebuke from the head of the Federal Communications Commission warning that political speech is still protected here in the United States. Shefali, this is really kind of out there, isn’t it?

Luthra: It’s just so fascinating, and it’s really part of a bigger effort by Ron DeSantis to try and leverage anything that he can politically or, frankly, in his capacity as head of the state to try and weaken the campaign for the ballot measure. They have used the health department in other ways to try and send out material suggesting that the campaign’s talking points, which are largely focused on the futility of exceptions to the abortion ban, they’re trying to argue that that is misinformation, and that’s not true. And they’re using the state health department to make that argument, which is something we don’t really see very often, because usually health departments are supposed to be nonpartisan. And what I will say is, in this case, at least to your point, Julie, the FCC has weighed in and said: You can’t do this. You can’t stop a TV station from airing a political ad that was bought and paid for. And the ads haven’t stopped showing at this point. I just heard from family yesterday in Florida who are seeing the ads in question on their TV, and it’s still—

Rovner: And I will post a link to the ad just so you can see it. It’s about a woman who’s pregnant and had cancer and needed cancer treatment and needed to terminate the pregnancy in order to get the cancer treatment. It said that the exception would not allow her to, which the state says isn’t true and which is clearly one of these things that is debatable. That’s why we’re having a political debate.

Luthra: Exactly. And one thing that I think is worth adding in here is, I mean, this really intense effort from Governor DeSantis and his administration comes at a time when already this ballot measure faces probably the toughest fight of any abortion rights measure. And we have seen abortion rights win again and again at the ballot, but in Florida you need 60% to pass. And if you look across the country at every abortion rights measure that has been voted on since Roe v. Wade was overturned, only two have cleared 60, and they are in California and they are in Vermont. So these more conservative-leaning states, and Florida is one of them, it’s just, it’s really, really hard to see how you get to that number. And we even saw this week there’s polling that suggests that the campaign has a lot of work to do if they’re hoping to clear that threshold.

Rovner: And, of course, now they have two hurricanes to deal with, which we will deal with in a few minutes. But first, the Supreme Court is back in session here in Washington, and even though there’s no big abortion case on its official docket as of now this term, the court quickly declined to hear two cases on its first day back, one involving whether the abortion ban in Texas can override the federal emergency treatment law that’s supposed to guarantee abortion access in medical emergencies threatening the pregnant woman’s life or health. The court also declined to overrule the Alabama Supreme Court’s ruling that frozen embryos can be considered legally as unborn children. That’s what Joanne was just talking about. Where do these two decisions leave us? Neither one actually resolved either of these questions, right?

Luthra: I mean, the EMTALA [Emergency Medical Treatment and Labor Act] question is still ongoing, not because of the Texas case but because of the Idaho case that is asking very similar questions that we’ve talked about previously on this podcast. And the end of last term, the court kicked that back down to the lower courts to continue making its way through. We anticipate it will eventually come back to the Supreme Court. So this is a question that we will, in fact, be hearing on at some point.

Rovner: Although, the irony here is that in Idaho, the ban is on hold because there was a court stay. And in Texas, the ban is not on hold, even though we’re talking about exactly the same question: Does the federal law overrule the state’s ban?

Luthra: And what that kind of highlights — right? — is just how much access to abortion, even under states with similar laws or legislatures, really does depend on so many factors, including what circuit court you fall into or the makeup of your state Supreme Court and how judges are appointed or whether they are elected. There is just so much at play that makes access so variable. And I think the other thing that one could speculate that maybe the court didn’t want headlines around reproductive health so soon into an election, but it’s not as if this is an issue that they’re going to be avoiding in the medium- or long-term future. These are questions that are just too pressing, and they will be coming back to the Supreme Court in some form.

Rovner: Yes, I would say in the IVF [in vitro fertilization] case, they simply basically said, Go away for now. Right?

Luthra: Yeah. And, I mean, right now in Alabama, people are largely able to get IVF because of the state law that was passed, even if it didn’t touch the substance of that state court’s ruling. This is something, for now, people can sort of think is maybe uninterrupted, even as we all know that the ideological and political groundwork is being laid for a much longer and more intense fight over this.

Rovner: Well, remember back last week when we predicted that the judge’s decision overturning Georgia’s six-week ban was unlikely to be the last word? Well, sure enough, the Georgia Supreme Court this week overturned the immediate overturning of the ban, which officially went back into effect on Monday. Like these other cases, this one continues, right?

Luthra: Yes, this continues. The Georgia case continued for a while, and it just sort of underscores again what we’ve been talking about, just how much access really changes back and forth. And I was talking to an abortion clinic provider who has clinics in North Carolina and Georgia. She literally found out about the decision both times and changed her plans for the next day because I texted her asking her for comment. And providers and patients are being tasked with keeping up with so much. And it’s just very, very difficult, because Georgia also has a 24-hour waiting period for abortions, which means that every time the decision around access has changed — and we know it very well could change again as this case progresses — people will have to scramble very quickly. And in Georgia, they have also been trying to do that on top of navigating the fallout of a hurricane.

Rovner: Yeah. And as we pointed out a couple of weeks ago when the court overturned the North Dakota ban, there are no abortion providers left in North Dakota. Now that there’s no ban, it’s only in theory that abortion is now once again allowed in North Dakota. Well, before we leave abortion for this week, we have two new studies showing how abortion bans are impacting the health care workforce. In one survey, more than half of oncologists, cancer doctors, who were completing their fellowships, so people ready to go into practice, said they would consider the impact of abortion restrictions in their decisions about where to set up their practice. And a third said abortion restrictions hindered their ability to provide care.

Meanwhile, a survey of OBGYNs in Texas by the consulting group Manatt Health found “a significant majority of practicing OB/GYN physicians … believe that the Texas abortion laws have inhibited their ability to provide highest-quality and medically necessary care to their patients,” and that many have already made or are considering making changes to their practice that would “reduce the availability of OB/GYN care in the state.” What’s the anti-abortion reaction to this growing body of evidence that abortion bans are having deleterious effects on the availability of other kinds of health care, too? I mean, I was particularly taken by the oncologists, the idea that you might not be able to get cancer care because cancer doctors are worried about treating pregnant women with cancer.

Luthra: They’re blaming the doctors. And we saw this in Texas when the Zurawski case was argued and women patients and doctors in the state said that they had not been able to get essential, lifesaving medical care because of the state’s abortion ban and lack of clarity around what was actually permitted. And the state argued, and we have heard this talking point again and again, that actually the doctors are just not willing to do the hard work of practicing medicine and trying to interpret, Well, obviously this qualifies. That’s something we’ve seen in the Florida arguments. They say: Our exceptions are so clear, and if you aren’t able to navigate these exceptions, well, that’s your problem, because you are being risk-averse, and patients should really take this up with their doctors, who are just irresponsible.

Rovner: Yes, this is obviously an issue that’s going to continue. Well, moving on. The cost of health care continues to grow, which is not really news, but this week we have more hard evidence, courtesy of my KFF colleagues via the annual 2024 Employer Health Benefit Survey, which finds the average family premium rose 7% this year to $25,572, with workers contributing an average of $6,296 towards that cost. And that’s with a distinct minority of firms covering two very popular but very expensive medical interventions, GLP-1 [glucagon-like peptide-1] drugs for obesity and IVF, which we’ve just been talking about. Anything else in this survey jump out at anybody?

Hellmann: I mean, that’s just a massive amount of money. And the employer is really paying the majority of that, but that doesn’t mean it doesn’t have an impact on people. That means it’s going to limit how much your wages go up. And something I thought of when I read this study is these lawsuits that we’re beginning to see, accusing employers of not doing enough to make sure that they’re limiting health care costs. They’re not playing enough of a role in what their benefits look like. They’re kind of outsourcing this to consultants. And so when you look at this data and you see $25,000 they’re spending per year per family on health care premiums, you wonder, what are they doing?

Health care, yes, it’s obviously very expensive, but you just kind of question, what role are employers actually playing in trying to drive down health care costs? Are they just taking what they get from consultants? And another thing that kind of stood out to me from this is, I think it’s said in there, employers are having a hard time lately of passing these costs on to employees, which is really interesting. It’s because of the tight labor market. But obviously health care is still very expensive for employees — $6,000 a year in premiums for family coverage is not a small amount of money. So employers are just continuing to absorb that, and it does really impact everyone.

Rovner: It’s funny. Before the Affordable Care Act, it was employers who were sort of driving the, You must do something about the cost of health care, because inflation was so fast. And then, of course, we saw health care inflation, at least, slow down for several years. Now it’s picking up again. Are we going to see employers sort of getting back into this jumping up and down and saying, “We’ve got to do something about health care costs”?

Hellmann: I feel like we are seeing more of that. You’re beginning to hear more from employers about it. I don’t know. It’s just such a hard issue to solve, and I’ve seen more and more interest from Congress about this, but they really struggle to regulate the commercial market. So …

Rovner: Yes, as we talk about at length every week. But it’s still important, and they will still go for it. Well, finally, this week in health misinformation. Let us talk about hurricanes — the public health misinformation that’s being spread both about Hurricane Helene that hit the Southeast two weeks ago, and Hurricane Milton that’s exiting Florida even as we are taping this morning. President [Joe] Biden addressed the press yesterday from the White House, calling out former President Trump by name along with Georgia Republican congresswoman Marjorie Taylor Greene for spreading deliberate misinformation that’s not just undermining efforts at storm relief but actually putting people in more danger. Now, I remember Hurricane Katrina and all the criticism that was heaped, mostly deservedly, on George W. Bush and his administration, but I don’t remember deliberate misinformation like this. I mean, Joanne, have you ever seen anything like this? You lived in Florida for a while.

Kenen: I went through Andrew, and there’s always a certain — there’s confusion and chaos after a big storm. But there’s a difference between stuff being wrong that can be corrected and stuff being intentionally said that then in this sort of divided, suspicious, two-realities world we’re now living in, that’s being repeated and perpetuated and amplified. It damages public health. It damages people economically trying to recover from this disastrous storm or in some cases storms. I don’t know how many people actually believe that Marjorie Taylor asserted that the Democrats are controlling the weather and sending storms to suppress Republican voters. She still has a following, right? But other things …

Rovner: She still gets reelected.

Kenen: … being told that if you go to FEMA [the Federal Emergency Management Agency] for help, your property will be confiscated and taken away from you. I mean, that’s all over the place, and it’s not true. Even a number of Republican lawmakers in the affected states have been on social media and making statements on local TV and whatever, saying: This is not true. Please, FEMA is there to help you. Let’s get through this. Stop the lies. A number of Republicans have actually been quite blunt about the misinformation coming from their colleagues and urging their constituents to seek and take the help that’s available.

This is the public health crisis. We don’t know how many people have been killed. I don’t think we have an accurate total final count from Helene, and we sure don’t have from Milton. I mean, the people did seem to take this storm seriously and evacuated, but it also spawned something like three dozen tornadoes in places where people hadn’t been told, there’s normally no need to evacuate. There’s flooding. It’s a devastating storm. So when people are flooding, power outages, electricity, hard to get access to health care, you can’t refrigerate your insulin. All these—

Rovner: Toxic floodwaters, I mean, the one thing …

Kenen: Toxic, yeah.

Rovner: … we know about hurricanes is that they’re more dangerous in the aftermath than during the actual storm in terms of public health.

Kenen: Right. This is a life-threatening public health emergency to really millions of people. And misinformation, not just getting something wrong and then trying to correct it, but intentional disinformation, is something we haven’t seen before in a natural disaster. And we’re only going to have more natural disasters. And it was really — I mean, Julie, you already pointed this out — but it was really unusual how precise Biden was yesterday in calling out Trump by name, and I believe at two different times yesterday. So I heard one, but I think I read about what I think was the second one really saying, laying it at his feet that this is harming people.

Rovner: Yeah, like I said, I remember Katrina vividly, and that was obviously a really devastating storm. I do also remember Democrats and Republicans, even while they were criticizing the federal government reaction to it, not spreading things that were obviously untrue. All right. Well, that is the news for this week. Now we will play a segment from our Newsmaker interview with Mark Cuban, and then we will be back with our extra credits.

On Tuesday, October 8th, Mark Cuban met with a group of reporters for a Newsmaker lunch at KFF’s offices in Washington, D.C. Cuban, a billionaire best known as a panelist on the ABC TV show “Shark Tank,” has taken an interest in health policy in the past several years. He’s been consulting with the campaign of Vice President Harris, although he says he’s definitely not interested in a government post if she wins. Cuban started out talking about how, as he sees it, the biggest problem with drug prices in the U.S. is that no one knows what anyone else is paying.

Mark Cuban: I mean, when I talk to corporations and I’ve tried to explain to them how they’re getting ripped off, the biggest of the biggest said, Well, so-and-so PBM [pharmacy benefit manager] is passing through all of their rebates to us.

And I’m like: Does that include the subsidiary in Scotland or Japan? Is that where the other one is?

I don’t know.

And it doesn’t. By definition, you’re passing through all the rebates with the company you contracted with, but they’re not passing through all the rebates that they get or that they’re keeping in their subsidiary. And so, yeah, I truly, truly believe from there everybody can argue about the best way. Where do you use artificial intelligence? Where do you do this? What’s the EHR [electronic health record? What’s this? We can all argue about best practices there. But without a foundation of information that’s available to everybody, the market’s not efficient and there’s no place to go.

Rovner: He says his online generic drug marketplace, costplusdrugs.com, is already addressing that problem.

Cuban: The crazy thing about costplusdrugs.com, the greatest impact we had wasn’t the markup we chose or the way we approach it. It’s publishing our price list. That changed the game more than anything. So when you saw the FTC [Federal Trade Commission] go after the PBMs, they used a lot of our pricing for all the non-insulin stuff. When you saw these articles written by the Times and others, or even better yet, there was research from Vanderbilt, I think it was, that says nine oncology drugs, if they were purchased by Medicare through Cost Plus, would save $3.6 billion. These 15, whatever drugs would save six-point-whatever billion. All because we published our price list, people are starting to realize that things are really out of whack. And so that’s why I put the emphasis on transparency, because whether it’s inside of government or inside companies that self-insure, in particular, they’re going to be able to see. The number one rule of health care contracts, particularly PBM contracts, is you can’t talk about PBM contracts.

Rovner: Cuban also says that more transparency can address problems in the rest of the health care system, not just for drug prices. Here’s how he responded to a question I asked describing his next big plan for health care.

We’ve had, obviously, issues with the system being run by the government not very efficiently and being run by the private sector not very efficiently.

Cuban: Very efficiently, yeah.

Rovner: And right now we seem to have this sort of working at cross-purposes. If you could design a system from the ground up, which would you let do it? The government or—

Cuban: I don’t think that’s really the issue. I think the issue is a lack of transparency. And you see that in any organization. The more communication and the more the culture is open and transparent, the more people hold each other responsible. And I think you get fiefdoms in private industry and you get fiefdoms in government, as well, because they know that if no one can see the results of their work, it doesn’t matter. I can say my deal was the best and I did the best and our outcomes are the best, but there’s no way to question it. And so talking to the Harris campaign, it’s like if you introduce transparency, even to the point of requiring PBMs and insurers to publish their contracts publicly, then you start to introduce an efficient market. And once you have an efficient market, then people are better able to make decisions and then you can hold them more accountable.

And I think that’s going to spill over beyond pharm. We’re working on — it’s not a company — but we’re working on something called Cost Plus Wellness, where we’re eating our own dog food. And it’s not a company that’s going to be a for-profit or even a nonprofit, for that matter, just for the lives that I cover for my companies, that we self-insure. We’re doing direct contracting with providers, and we’re going to publish those contracts. And part and parcel to that is going through the — and I apologize if I’m stumbling here. I haven’t slept in two days, so bear with me. But going through the hierarchy of care and following the money, if you think about when we talk to CFOs and CEOs of providers, one of the things that was stunning to me that I never imagined is the relationship between deductibles for self-insured companies and payers, and the risk associated with collecting those deductibles to providers.

And I think people don’t really realize the connection there. So whoever does Ann’s care [KFF Chief Communications Officer Ann DeFabio, who was present] — well, Kaiser’s a little bit different, but let’s just say you’re employed at The Washington Post or whoever and you have a $2,500 deductible. And something happens. Your kid breaks their leg and goes to the hospital, and you’re out of market, and it’s out of network. Well, whatever hospital you go to there, you might give your insurance card, but you’re responsible for that first $2,500. And that provider, depending on where it’s located, might have collection — bad debt, rather — of 50% or more.

So what does that mean in terms of how they have to set their pricing? Obviously, that pricing goes up. So there’s literally a relationship between, particularly on pharmacy, if my company takes a bigger rebate, which in turn means I have a higher deductible because there’s less responsibility for the PBM-slash-insurance company. My higher deductible also means that my sickest employees are the ones paying that deductible, because they’re the ones that have to use it. And my older employees who have ongoing health issues and have chronic illnesses and need medication, they’re paying higher copays. But when they have to go to the hospital with that same deductible, because I took more of a rebate, the hospital is taking more of a credit risk for me. That’s insane. That makes absolutely no sense.

And so what I’ve said is as part of our wellness program and what we’re doing to — Project Alpo is what we call it, eating our own dog food. What I’ve said is, we’ve gone to the providers and said: Look, we know you’re taking this deductible risk. We’ll pay you cash to eliminate that. But wait, there’s more. We also know that when you go through a typical insurer, even if it’s a self-insured employer using that insurer and you’re just using the insurance company not for insurance services but as a TPA [third-party administrator], the TPA still plays games with the provider, and they underpay them all the time.

And so what happens as a result of the underpayment is that provider has to have offices and offices full of administrative assistants and lawyers, and they have to not only pay for those people, but they have the associated overhead and burden and the time. And then talking to them, to a big hospital system, they said that’s about 2% of their revenue. So because of that, that’s 2%. Then, wait, there’s more. You have the pre-ops, and you have the TPAs who fight you on the pre-ops. But the downstream economic impacts are enormous because, first, the doctor has to ask for the pre-op. That’s eating doctor’s time, and so they see fewer patients. And then not only does the doctor have to deal with them, they go to HR at the company who self-insures and says, Wait, my employee can’t come to work, because their child is sick, and you won’t approve this process or, whatever, this procedure, because it has to go through this pre-op.

Or if it’s on medications, it’s you want to go through the step-up process or you want to go through a different utilization because you get more rebates. All these pieces are intertwined, and we don’t look at it holistically. And so what we’re saying with Cost Plus Wellness is, we’re going to do this all in a cash basis. We’re going to trust doctors so that we’re not going to go through a pre-op. Now we’ll trust but verify. So as we go through our population and we look at all of our claims, because we’ll own all of our claims, we’re going to look to see if there are repetitive issues with somebody who’s just trying to —there’s lots of back surgeries or there’s lots of this or there’s lots of that — to see if somebody’s abusing us. And because there’s no deductible, we pay it, and we pay it right when the procedure happens or right when the medication is prescribed. Because of all that, we want Medicare pricing. Nobody’s saying no. And in some cases I’m getting lower than Medicare pricing for primary care stuff.

Rovner: OK, we are back. Now it’s time for our extra credits. That’s when we each recommend a story we read this week we think you should read too. Don’t worry if you miss the details. We will include the links to all these stories in our show notes on your phone or other device. Joanne, why don’t you go first this week.

Kenen: There was a fascinating story in The New York Times by Kate Morgan. The headline was “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It.” So I knew nothing about this, and it was so interesting. Placentas have amazing healing properties for wound care, burns, infections, pain control, regenerating skin tissue, just many, many things. And it’s been well known for years, and it’s not widely used. This is a story specifically about a really severe burn victim in a gas explosion and how her face was totally restored. We don’t use this, partly because placenta — every childbirth, there’s a placenta. There are lots of them around. There’s I think three and a half million births a year, or that’s the estimate I read in the Times. One of the reasons they weren’t being used is, during the AIDS crisis, there was some development toward using them, and then the AIDS crisis, there was a fear of contamination and spreading the virus, and it stopped decades later.

We have a lot more ways of detecting, controlling, figuring out whether something’s contaminated by AIDS or whether a patient has been exposed. It is being used again on a limited basis after C-sections, but it seems to have pretty astonishing — think about all the wound care for just diabetes. I’m not a scientist, but I just looked at the story and said, it seems like a lot of people could be healed quicker and more safely and earlier if this was developed. They’re thrown away now. They’re sent to hospital waste incinerators and biohazard waste. They’re garbage, and they’re actually medicine.

Rovner: Definitely a scientist’s cool story. Shefali.

Luthra: My story is from my brilliant colleague Mel Leonor Barclay. The headline is “Arizona’s Ballot Measure Could Shift the Narrative on Latinas and Abortion,” and as part of this really tremendous series that she has running this week, looking at how Latinas as a much more influential and growingly influential voter group could shape gun violence, abortion rights, and housing. And in this story, which I really love, she went to Arizona and spent time talking to folks on all sides of the issue to better understand how Latinas are affected by abortion rights and also how they’ll be voting on this.

And she really challenges the narrative that has existed for so long, which is that Latinas are largely Catholic, largely more conservative on abortion. And she finds something much more complex, which is that actually polls really show that a large share of Latina voters in Arizona and similar states support abortion rights and will be voting in favor of measures like the Arizona constitutional amendment. But at the same time, there are real divides within the community, and people talk about their faith in a different way and how it connects their stance on abortion. They talk about their relationships with family in different ways, and I think it just underscores how rarely Latina voters are treated with real nuance and care and thoughtfulness when talking about something as complex as abortion and abortion politics. And I really love the way that she approaches this piece.

Rovner: It was a super-interesting story. Jesse.

Hellmann: My story is from The Assembly. It’s an outlet in North Carolina. It’s called “Helene Left Some North Carolina Elder-Care Homes Without Power.” Some assisted living facilities have been without power and water since the hurricane hit. Several facilities had to evacuate residents, and the story just kind of gets into how North Carolina has more lax rules around emergency preparedness. While they do require nursing homes be prepared to provide backup power, the same requirements don’t apply to assisted living facilities. And it’s because there’s been industry pushback against that because of the cost. But as we see some more of these extreme weather events, it seems like something has to be done. We cannot just allow vulnerable people living in these facilities to go hours and hours without power and water. And I saw that there was a facility where they evacuated dozens of people who had dementia, and that’s just something that’s really upsetting and traumatizing for people.

Rovner: Yeah, once again, now we are seeing these extreme weather events in places that, unlike Florida and Texas, are not set up and used to extreme weather events. And it is something I think that a lot of people are starting to think about. Well, my story this week is from our KFF Health News public health project called Health Beat, and it’s called “A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly. And it’s one of those stories you never really think about until it’s pointed out that in areas, particularly those that had been redlined, in particular, the lack of safety infrastructure that most of us take for granted — crosswalks, sidewalks, traffic lights are not really there. And that’s a public health crisis of its own, and it’s one that rarely gets addressed, and it’s a really infuriating but a really good story.

All right, that is our show. Next week, for my birthday, we’re doing a live election preview show here at KFF in D.C., because I have a slightly warped idea of fun. And you’re all invited to join us. I will put a link to the RSVP in the show notes. I am promised there will be cake.

As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us, too. Thanks as always to our technical guru, Francis Ying, and our fill-in editor this week, Stephanie Stapleton. Also, as always, you can email us your comments or questions. We’re at whatthehealth, all one word, @kff.org, or you can still find me for the moment at X. I’m @jrovner. Joanne, where are you?

Kenen: @JoanneKenen sometimes on Twitter and @joannekenen1 on Threads.

Rovner: Jessie.

Hellmann: @jessiehellmann on Twitter.

Rovner: Shefali.

Luthra: @shefalil on Twitter.

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

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Francis Ying Audio producer Stephanie Stapleton Editor

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An Arm and a Leg: ‘Baby Steps’ in the Fight Against Facility Fees

Dan Weissmann — Wed, 09 Oct 2024 09:00:00 +0000

An $88 “observation room” fee for a checkup didn’t sit right with Kari Greene, an “Arm and a Leg” listener from Oregon. When the price went up to $99 the next year, Kari complained to her benefits representative, who thought it was weird, too — but couldn’t do anything about it.

In states like Connecticut and Indiana, legislators have passed bills restricting these so-called “facility fees.”

In this episode of “An Arm and a Leg,” host Dan Weissmann takes a close look at Kari’s bill, alongside Christine Monahan, an attorney and assistant research professor focused on facility fees and state efforts to limit them.

Dan Weissmann @danweissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

Credits

Emily Pisacreta Producer Claire Davenport Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: ‘Baby Steps’ in the Fight Against Facility Fees

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there–

Kari Greene lives in Portland. She’s got a couple of auto-immune disorders– mostly under control these days. She sees her rheumatologist a couple times a year — just to check in.

And last year she noticed a charge on top of the $40 copay she was used to.

$88 for an “observation room fee.”

She says she called her insurance.

Kari Greene: And the person I spoke with was like, this seems weird.

Dan: She says they promised to investigate, but Kari never heard back. Eventually, she paid the bill and moved on with her life.

After Kari’s appointment at the start of this year, the fee was there again. But instead of $88, now it was $99. Kari was pissed. She still is.

Kari Greene: I’m like, how? How dare you? it’s such a slap in the face where you’re like, I already paid my copay

Dan: Now they want a hundred bucks on top of that. For no reason Kari can see. And Kari’s pretty sure it’s not just her.

Kari Greene: That’s the part that galls me it’s like, there’s this Scrooge McDuck back there going, Oh, we’ve got this doctor who works her little tushy off and she sees, five patients an hour.

And, we can add this charge on to every single one of these office visits.

Dan: Kari’s definitely right that this isn’t just her. We haven’t found Scrooge McDuck and his swimming pool full of currency — yet.

But researchers and advocates have been talking for years about these kinds of extra charges — called “facility fees.”

They can get tacked onto office visits by hospitals, when the hospital owns the doctor’s office.

And with hospitals buying more and more doctors’ offices, those researchers say these fees keep popping up more and more often.

So we asked: Would anybody who had gotten a bill for one please share it with us? Kari was one of a bunch of people who responded.

And took time to talk with us.

Teresa: oh, it made me so mad, so mad.

Anne Gaffney: I mean, it’s a 10 minute appointment for a prescription. Amanda: I don’t understand any of it.

where did this number come from?

Dan: We dug a little deeper with Kari’s story, partly because it fit so closely with what we’d been hearing about: A fee that wasn’t there one year, and the next it was. For a brief office visit — Kari thinks maybe ten minutes– in a normal setting.

Kari Greene: It’s a regular doctor’s office room. it’s got the little bed with the paper on it, you know. And it’s got the like blood pressure cuff thing on the wall, there’s nothing that makes it special,

Dan: Except, when it comes time to bill, for the fact that a hospital owns it.

And our first question, of course, was: Can they really freaking DO that?!? How is that even allowed?

The “how” is long and complicated and honestly boring. But by and large, it’s legal. They can do that.

Except, as far as we can tell — for the most part — in a few states. Especially Connecticut.

Legislators and policy-makers there have been working on this issue for a decade. And bit by bit, they’ve worked to outlaw charges like the ones on Kari’s bills.

And other states have started working on following Connecticut’s lead. We talked with someone who’s been tracking those efforts.

Christine Monahan: My name is Christine Monahan. I’m an assistant research professor at the Center on Health Insurance Reforms, which is part of Georgetown University’s McCourt School of Public Policy.

Dan: Christine and her colleagues issued a report over the summer looking at efforts to restrict facility fees like these across all fifty states.

And she has some good news:

Christine Monahan: there’s bipartisan interest in this issue. We are seeing these reforms bubble up across the states.

Dan: The less-good news: It could take other states a lot of years to catch up. And they’re hitting opposition every step of the way.

We’ll have a progress report. But first we’ll go deeper with Kari’s story, which turns out to have a twist.

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you a show that’s entertaining, empowering, and useful.

Kari’s in her mid-fifties, works in public health. For a long time, she’d had problems that no doctor ever found a cause for: Joint pain, migraines, fatigue.

Then in 2020, she got COVID, and things took a turn. Weird sores. She says her fingers swelled up like sausages.

Kari Greene: when these like Sores were showing up and like I couldn’t move my hands and they were super fat that was at least something that I could be like, see, it’s not just the joint pain. It’s not just the fatigue. It’s not just the migraines. It’s not just the, like, look at my hand. This is not normal. Right.

Dan: Friends helped her find her rheumatologist.

Kari Greene: She was able to figure out what was going on. And, she’s, I, I mean, I will get weepy talking about her because she is just, rheumatologists are like detective doctors, you know, they are amazing diagnosticians, they’re incredible listeners

Dan: After a bunch of listening, a bunch of labs, this doctor got Kari a diagnosis — diagnoses — and some meds that help a lot. So, Kari is pretty devoted to this doctor.

Kari Greene: Anytime I consider switching, you know, when open enrollment comes around, I’m like, Okay, I see that I could spend a lot less money on a different plan, but there’s no way I’m giving her up.

Dan: These extra fees aren’t enough to send her away either. But Kari is doing what she can to avoid charges like this with another specialist she sees.

Kari Greene: My, my neurologist is in the same building and last year he was like, we can switch to telehealth. You don’t have to come in.

Dan: But Kari says the rheumatology consult is different. More hands-on.

Kari Greene: Rheumatologists really need to be able to touch your joints and manipulate. To be able to, see, disease progression or even just be able to do, like, diagnostics.

Dan: So Kari’s back at that office every six months, paying that extra fee.

She says she’s lucky it’s more of an annoyance than a real financial hardship for her, but when she’s in the waiting room, she worries about the other folks she sees there.

Kari Greene: these are not young, healthy people who are like out in the workforce, like just live in their best lives.

Dan: After her January visit this year, when the “observation room fee” went up from $88 to $99, Kari called her insurance again, looped in the benefits person from her work.

The upshot: The insurer didn’t have a problem with the charge. They said the hospital had the right to bill for it.

Kari Greene: But just because you have the right to do it, does that mean you should be able to do it?

Dan: And actually, here’s the thing: Maybe the hospital DIDN’T have the right to do it, either.

Christine Monahan — the Georgetown researcher who’s been tracking efforts to clamp down on these kinds of fees?

She’s also an attorney — and she’s a bulldog. She helped us really dig into Kari’s bills and insurance paperwork. We waded deep into the alphabet soup.

Christine Monahan: She has a um, E/M CPT code on her EOB. Hospital’s billing a G 0 4 6 3

Dan: I’ll spare you more of that. But here’s where Christine patiently led us: Based on written policies from Kari’s insurance company, Christine thinks Kari probably never should have gotten charged for anything beyond that 40 dollar copay.

Christine Monahan: I think there’s a good argument to kind of question why she should be paying more

Dan: Mmhmm. Dang.

Dan: Now, our producer Emily Pisacreta was on the call with Christine too — to help make sure I didn’t get lost.

And then it was time for Emily and me to test how well we’d followed Christine through that strong argument: By summing it up and running it by Kari’s insurance company and the hospital.

We went back to documents Christine had dug up.

Emily: This is…

Dan: This is the, uh, this is the reimbursement policy manual.

Emily: The reimbursement policy manual.

Dan: YEP. That one. It’s a section from the insurer’s REIMBURSEMENT POLICY MANUAL– which spells out what they do and don’t pay for.

Christine had grabbed policy number 0h-Six-one: Clinic Services in the Outpatient Setting. Like Kari’s doctor’s office.

And it turned out to tell basically the whole story. Emily and I got excited, talking over each other.

Dan: Now that we’re looking at it.

Emily: And they’re like not allowed to this.

Dan: I mean, like I got confused even talking through it with Christine, but this seems crystal clear. They’re like not allowed to do this.

Emily: Mmhmm.

Dan: Here’s what it says:

“For clinic visits and services performed in the hospital outpatient setting, we do not allow split-billing”

And a couple sentences down that gets spelled out even more clearly:

“Do not split-bill clinic-based services, billing part of the service as a facility charge, and part of the service as a professional charge”

That sure looks like it means: Don’t double-dip with a professional charge– a bill for the doctor’s service — AND a facility fee.

We reached out to Kari’s insurance company and the hospital that sent the bills. Asking them: Are we missing something here?

We haven’t heard back.

Which leads me to think somebody may owe Kari some kind of refund. Which feels very satisfying to know. But it’s not exactly satisfactory.

Because as Christine said when we talked with her: This is not the sort of thing a regular person could be expected to run down, on their own time.

Christine Monahan: Most consumers are not going to know to look up the reimbursement policy.

Dan: Or how to interpret it. I mean, Emily and I look at this kid of stuff as part of our jobs. We’re not brand new at it. But even with Christine leading us every step of the way, it took us some time to follow it all.

Christine Monahan: I think it, really just highlights how opaque all of this is and there may well be some insurers that are not paying these facility fees, or at least that say on paper that they are not going to, but it’s a whole mishmash of different policies and they’re not always followed. And the consumer is really left in the dark.

Dan: Which is why legislators in states from Connecticut to Colorado have started saying: Hey, maybe this shouldn’t be a fight that individual people have to get into.

Maybe there should be RULES about fees like this.

Maybe there should be rules against them.

That’s next.

This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News. That’s a national newsroom that produces in-depth journalism about health issues. Their reporters do incredible work, and I’m honored to work with them.

Before we start talking about efforts to regulate facility fees, we wanted to hear the case FOR them. We asked the American Hospital Association to make that case.

They sent us a statement from Molly Smith, their group vice president for policy, and she recorded it as a voice memo. Here’s the bulk of it:

Molly Smith: The cost of care delivered in hospitals and health systems and any associated sites of care operated by the hospital takes into account the many unique services that only they provide to their communities. This includes the cost of maintaining standby capacity for traumatic events and delivering 24/7 care to all who come through the emergency department, regardless of ability to pay or insurance status.

They provide access to critical healthcare services that may not be otherwise available, especially in low income, rural, and other medically underserved communities. Hospital facilities also treat patients who are sicker and have more chronic conditions than non hospital facilities, which requires a greater use of resources.

In addition, hospital facilities must comply with a much more comprehensive scope of licensing, accreditation, and other regulatory requirements than do other sites of care. Facility fees are one way that hospitals may bill for overhead costs to maintain all of the essential services they provide to their patients and communities

Dan: Molly Smith also takes a long swipe at insurers, including Medicare, for not paying enough.

And I think it’s fair to sum this up as: Operating a hospital is expensive. Facility fees are one way we try to get money to meet those expenses.

Which, according to Christine Monahan from Georgetown, is what hospitals tell state legislators when facility-fee regulations get proposed.

Christine Monahan: Hospitals will come in and tell horror stories about how devastating it will be to their finances if we were to do even the itsy bitsiest of reforms, and it can be hard for advocates and policy makers to go in and fact check those statements by the hospitals.

An Arm and a Leg Season 12, Episode 4 September 26, 2024 p.9

Dan: Because they don’t have the data. Hospitals have it, but there’s a lot they’re not required to share.

Christine Monahan: The hospitals continue to have all of that information kind of in a black box about like exactly how much revenue are they getting, where are the facility fee revenues going, how much are going to profits, how much are going to cost, and if so, what are the costs,

Dan: That’s a LOT of unknowns.

Christine Monahan: It can be scary to policymakers when a hospital industry comes in and says, this is going to ruin us and they don’t have the data to come back and say, well, no, it really won’t. Even if they may be very skeptical that that what the hospitals are saying is accurate.

Dan: Mm. That is super interesting. There’s like this information asymmetry.

Christine Monahan: Yes. Yeah, we’ve been calling it an information monopoly .

Dan: Look, here’s just one example: How often are hospitals charging facility fees for visits to doctors offices? Like actual offices that aren’t anywhere near the hospital, but that the hospital now owns?

Where could you find that out, if you were a state official? Well, a lot of states have databases with all insurance claims that got paid. Maybe you could look at insurance claims that included facility fees.

But how would you know where a particular appointment happened? The claim has a provider number. But a hospital doesn’t have to use a new provider number for every location, every doctor’s office.

Christine Monahan: Often they will be using a single identifier number for all their claims, or maybe a single health system might have a handful of identifier numbers. And they’ll put those identifier numbers on the claims forms. And they might use the same identifier for if you’re at the hospital, or if you’re out 20 miles away in a physician’s practice that they’ve recently acquired.

Dan: So to start with, policy-makers may have no way of knowing where these fees are even being charged.

So when Connecticut started passing laws in 2014, the first ones were really just about information. Requiring hospitals to post signs about them. And commissioning a study.

The next year, Connecticut passed a much bigger bill. It prohibited a lot of facility fees for regular office visits — what’s called “evaluation and management” services on insurance forms. And required hospitals to make annual reports on facility fees.

And in a separate law, Connecticut banned facility fees for telehealth. That’s a step Christine says a lot of other states have followed.

Christine Monahan: I mean, how egregious is it to get a facility charge for a telehealth visit where you did not leave your home?

Um, that just does not make any sense. And so that’s really easy pickings as far as hospital reforms go for regulated policymakers to look at and say, this, this doesn’t make sense

Dan: Since then, Connecticut has passed a dozen more laws– requiring new disclosures here, tightening loopholes there.

And the state still may not have closed them all. We heard from a listener in Connecticut who was trying — and failing — to find a place he could get a stress test that wouldn’t charge him a facility fee.

But even if more loopholes get closed, there’s a problem. One economist we talked with said: Outlawing fees like this, it’s like squeezing part of a balloon. Other parts of it just get bigger.

Christine Monahan agreed.

Christine Monahan: hospitals, particularly those with more market power, are best able to then, you know, shift their revenue somewhere else. If you say you can’t impose a facility fee for XYZ services, okay, we’re going to start imposing facility fees on these other services, or maybe we’re just going to increase rates overall. And so it may not necessarily contain total system costs because of the balloon effect.

Dan: the, if I’m running a hospital, I’m like, well, my costs are this. Like, I’m gonna like, my, my, my, my revenue goal is this. Like, you’re telling me I can’t charge that. What else can I charge? How else am I gonna get that money?

Christine Monahan: Yeah.

Dan: And as Christine alluded to in that exchange: not all hospitals are created equal. Some are big and rich, running surpluses — profits — in the hundreds of millions of dollars a year. Others — smaller hospitals, rural hospitals — struggle to keep their doors open. Some do close every year.

Christine and her colleagues found, the big ones can use their poorer counterparts as political shields.

Christine Monahan: We spoke with a few hospital executives as part of our research last year. And, you know, one hospital executive we spoke with, he, represents kind of a smaller, less market powerful hospital, and he expressly acknowledged they carry the water for other hospitals in their state before the state legislature.

Dan: So, when a state like Indiana passed restrictions on facility fees in 2023, the law only applied to the state’s biggest hospitals.

Indiana’s story illustrates Christine’s point that this isn’t a partisan issue — where Democrats hold majorities in Connecticut, Indiana is solidly Republican. The Employers Forum of Indiana has led the charge there.

Their story also illustrates Christine’s point that change happens slowly.

Gloria Sachdev is executive director of the Employers Forum of Indiana. When she started the job in 2015, she went around to meet with employers..

Gloria Sachdev: I asked them, what is your biggest pain point? And all of them said, healthcare costs, they’re not sustainable. They’ve been going up, you know, four or five, six, seven, 8 percent every year.

Dan: The group spent years conducting studies. Among their finidngs: Indiana hospitals charged more than hospitals in other states. And more than independent medical practices that offered some of the same services. Oh, also: Hospitals were buying up those practices, and jacking up prices.

Gloria Sachdev: And nothing was changing about the service. It was just that they owned it now and were able to tack on a hospital facility fee.

Dan: In 2020, the Employers Forum started lobbying for changes. Restricting facility fees was one of several issues. And it got maybe the most pushback.

Gloria Sachdev: the Indiana Hospital Association was fairly masterful at, uh, bringing forward Physicians from all across the state, they had school nurses showing up.

Dan: School nurses who were employed by local hospitals.

Gloria Sachdev: They said, Oh my gosh, you know, the, we’d have to shut down the school nurse program.

Dan: The Employers Forum lost that round. Getting a win took three years. And the bill that passed was narrowly tailored. It wouldn’t apply to smaller, financial-strapped hospitals: Just the state’s five largest hospital systems. And it only applied to “off-campus” locations — like a doctors office the hospital just happened to own.

Gloria Sachdev: So if they’re in a strip mall, you know, 20 miles away. They can’t charge a hospital facility fee.

Dan: According to this year’s report from Christine Monahan’s team at Georgetown, Indiana is now one of nine states with some restrictions on facility fees.

Another dozen states have passed other laws, including ones that require hospitals to disclose data. Data that may help advocates and policy-makers chip away at the information monopoly– the one that Christine calls an obstacle to change.

Christine Monahan: we are making baby steps, um, in a very difficult environment. And so I count that as progress.

Dan: We’ll have links to Christine Monahan’s reports in our newsletter. You can check to see what steps your state has taken so far. We’ll also link to reports on facility fees from the Public Interest Research group, which has also been pushing for reforms.

We’ll also highlight some other stories we’re watching right now. I’m telling you: Our newsletter is pretty good. You might want to sign up! You can do that at arm and a leg show dot com, slash, newsletters.

Thank you for sharing your stories, and your bills, with us for this series. We’ve learned more from you than we’ve been able to share so far. We’ll keep looking for ways to bring that to you.

We’ll have a new episode for you in a few weeks right here.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta and Claire Davenport — and edited by Ellen Weiss.

Big thanks to the many experts who talked with us about facility fees, especially Patricia Kelmar of the Public Interest Research Group and medical-bill coding expert Shelley Safian.

Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Gabrielle Healy is our managing editor for audience. Bea Bosco is our consulting director of operations.

Sarah Ballama, who has been our operations manager since early 2022, just left to take a very cool full-time job in another state. Sarah, we’ll miss you so much!

Lucky for us, the amazing Lynne Johnson has come aboard to run the operations side for us. Welcome, Lynne! And thanks so much for joining us.

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor. They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially. You can join in any time at arm and a leg show, dot com https://armandalegshow.com/support/. Thank you so much for pitching in if you can — and, thanks for listening.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to its newsletters. You can also follow the show on Facebook and the social platform X. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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Silence in Sikeston: Is There a Cure for Racism?

Cara Anthony — Tue, 08 Oct 2024 09:00:00 +0000

SIKESTON, Mo. — In the summer of 2021, Sikeston residents organized the biggest Juneteenth party in the city’s history. Sikeston police officers came too, both to provide security for the event and to try to build bridges with the community. But after decades of mistrust, some residents questioned their motives.

In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police.

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things.

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.”

Host

Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher Public health leader and health equity expert click to open the transcript Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.]

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood.

Emory: Today is Juneteenth, baby.

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing.

Cara Anthony: [Laughter] Are you enjoying the water?

Cara Anthony: People are lining up for barbecue.

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic.

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free.

Cara Anthony: I’m a journalist.

Community Health Worker: Ooooh! Hi! Hi!

Cara Anthony: The ladies working the booth are excited I’m there to report on the event.

Cara Anthony: OK, and I’m a health journalist.

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter]

[Dramatic instrumental music plays.]

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor.

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston.

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob.

Both were killed before they got their day in court.

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston.

[Dramatic instrumental ends.]

Rosemary Owens: Being Black in the Bootheel can get you killed at any age.

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri.

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes.

Rosemary has her doubts about why they came today.

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about?

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people.

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri.

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago.

[Slow, minor, instrumental music plays softly.]

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them.

Rosemary had gotten her new car for Mother’s Day.

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving.

Cara Anthony: Someone nearby saw the boys …

Rosemary Owens: … called and told the police that two Black men were robbing cars.

When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth.

[Slow, minor, instrumental music ends.]

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick.

The public health experts say it’s going to take systemwide, institutional change.

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start.

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.”

Episode 4 is our final episode: “Is There a Cure for Racism?”

[“Silence in Sikeston” theme song ends.]

James McMillen: How you doing?

Juneteenth celebration attendee: Good. Good.

James McMillen: Good to see you, man.

Juneteenth celebration attendee: What’s up? How are you?

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this.

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too.

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why.

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing.

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents.

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes.

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening.

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names.

Lauren: My name is Lauren.

Michaiahes: My name is Michaiahes.

Cara Anthony: Yeah. And what are you all … ?

James McMillen: I saw you over there.

Cara Anthony: So, what do you think about all of this?

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um …

Cara Anthony: As she starts to trail off, I encourage her to keep going.

Cara Anthony: He’s right here. He’s in charge of all of those people.

Michaiahes: Well, in my opinion, y’all should start caring about the community more.

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing?

James McMillen: Well, you know what? I agree with everything she said there.

Cara Anthony: She’s confident now, looking the chief in the eye.

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community.

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know.

[Subtle propulsive music begins playing.]

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you.

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few.

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few.

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals.

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions.

And he told me about other things he wants to do …

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community.

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part.

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction.

Except … here’s something else the chief says he wants …

[Subtle propulsive music ends with a flourish.]

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer.

Cara Anthony: That phrase is chilling to me.

[Quiet, dark music starts playing.]

When I hear “just comply” … a litany of names cross my mind.

Philando Castile.

Sonya Massey.

Tyre Nichols.

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next.

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement.

James McMillen: Well, I mean, I think that’s, that’s a good idea to do.

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement.

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police.

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not.

[Quiet, dark music ends.]

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston.

[Sparse electronic music starts playing.]

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism.

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.]

Gail Christopher: If you don’t mind, Dr. Christopher is good.

Cara Anthony: OK. All right. That sounds good. I’m glad I asked.

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change.

She says the way to think about starting to fix structural racism … is to think about the future.

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right?

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy.

Cara Anthony: But I wonder if that future is even possible.

[Sparse electronic music ends.]

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure?

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country.

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system.

[Hopeful instrumental music plays.]

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs.

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating.

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on.

We can’t solve a problem if we don’t admit that it exists.

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world.

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people.

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units.

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color.

Cara Anthony: So, Brigham and Women’s launched a pilot program.

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care.

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that.

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference.

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results.

[Hopeful instrumental music ends.]

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now.

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals.

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired.

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work.

[Warm, optimistic instrumental music plays.]

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves.

Cara Anthony: Rest when you need to, she says, but keep going.

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change.

Cara Anthony: Yep. Heard. It’s all of our work.

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them.

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it.

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 … Justice for Denzel!

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched.

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community.

Cara Anthony: And Sunset did not burn.

[Warm, optimistic instrumental music begins fading out.]

[Piano starts warming up.]

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community.

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright.

[Piano plays along with Pershard singing.]

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky …

[Pershard singing and piano accompaniment fade out.]

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens.

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son.

Pershard Owens: Yeah, I definitely remember that.

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old.

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn?

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him.

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down.

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020.

The group is called Police and Community Together, or PACT for short.

  [Sparse, tentative music begins playing.]

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be.

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor.

PACT is not a citizens’ accountability board. The police don’t have to answer to it.

The committee met every month. For a while. But they haven’t met in over a year now.

Pershard Owens: We would have steps forward and then we would have three steps back.

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston.

Pershard Owens: And people were like, bro, like, how can you work with these people?

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that.

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough.

[Sparse, tentative music ends.]

Cara Anthony: But Pershard says something important changed because he started working with PACT.

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not.

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up.

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation.

[Slow instrumental music begins playing.]

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it.

But Pershard says … it could be meaningful.

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets.

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs.

The more people do that, the more systems can change.

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?”

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it.

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight.

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible.

[Slow instrumental music ends.]

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been.

[“Silence in Sikeston” theme music plays.]

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives.

A world you might not be able to imagine yet, but one that could exist for the next generation.

[“Silence in Sikeston” theme music ends.]

[Upbeat instrumental music plays.]

Cara Anthony: Thanks for listening to “Silence in Sikeston.”

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.

If you made it this far, thank you. Let me know how you’re feeling.

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366.

And thanks to everyone in Sikeston for sharing your stories with us.

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.

This audio series was reported and hosted by me, Cara Anthony.

Audio production by me, Zach Dyer. And me, Taylor Cook.

Editing by me, Simone Popperl.

And me, managing editor Taunya English.

Sound design, mixing, and original music by me, Lonnie Ro.

Podcast art design by Colin Mahoney and Tania Castro-Daunais.

Tarena Lofton and Hannah Norman are engagement and social media producers for the show.

Oona Zenda and Lydia Zuraw are the landing page designers.

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas.

Thank you to vocal coach Viki Merrick.

And thank you to my parents for all their support over the four years of this project.

Music in this episode is from Epidemic Sound and Blue Dot Sessions.

Some of the audio you heard across the podcast is also in the film.

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin.

Kyra Darnton is executive producer at Retro Report.

I was a producer on the film.

Jill Rosenbaum directed the documentary.

Kytja Weir is national editor at KFF Health News.

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast.

Thank you! It makes a difference.

Oh yeah! And tell your friends in real life too!

[Upbeat instrumental music ends.]

Credits
Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer @lonnielibrary Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.
Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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KFF Health News' 'What the Health?': The Health of the Campaign

Fri, 04 Oct 2024 19:20:00 +0000

The Host
Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ 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.
When it comes to health care, this year’s presidential campaign is increasingly a matter of which candidate voters choose to believe. Democrats, led by Vice President Kamala Harris, say Republicans want to further restrict reproductive rights and repeal the Affordable Care Act, pointing to their previous actions and claims. Meanwhile, Republicans, led by former President Donald Trump, insist they have no such plans.

Meanwhile, with open enrollment approaching for Medicare, the Biden administration dodges a political bullet, avoiding a sharp spike next year in Medicare prescription drug plan premiums.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Anna Edney of Bloomberg News.

Panelists
Anna Edney Bloomberg @annaedney Read Anna's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Sandhya Raman CQ Roll Call @SandhyaWrites Read Sandhya's stories.
Among the takeaways from this week’s episode:

This week, Sen. JD Vance of Ohio muddled his ticket’s stances on health policy during the vice presidential debate, including by downplaying the possibility of a national abortion ban. And Melania Trump, the former president’s wife, spoke out in support of abortion rights. Their comments seem designed to soothe voter concerns that former President Donald Trump could take actions to further block abortion access.

Vance raised eyebrows with his debate-night claim that Trump “salvaged” the Affordable Care Act — when, in fact, the former president vowed to repeal the law and championed the GOP’s efforts to deliver on that promise. Meanwhile, Trump deflected questions from AARP about his plans for Medicare, replying, “What we have to do is make our country successful again.”

On the Democratic side, Vice President Kamala Harris is campaigning on health, in particular by pushing out new ads highlighting the benefits of the ACA and Trump’s efforts to restrict abortion. Polls show health is a winning issue for Democrats and that the ACA is popular, especially its protections for those with preexisting conditions.

Also in the news, the Centers for Medicare & Medicaid Services reported a slight dip in average Medicare drug plan premiums for next year. Coming in an annual report — out shortly before Election Day — it looks as though government subsidies cushioned changes to the system, sparing seniors from potentially paying in premiums what they may save under the new $2,000 annual out-of-pocket drug cost cap, for instance.

And in abortion news, a judge struck down Georgia’s six-week abortion ban — but many providers have already left the state. And a new California law protects coverage for in vitro fertilization, including for LGBTQ+ couples.

Also this week, Rovner interviews KFF Health News’ Lauren Sausser, who reported and wrote the latest KFF Health News-Washington Post “Bill of the Month,” about a teen athlete whose needed surgery lacked a billing code. Do you have a confusing or outrageous medical bill you want to share? Tell us about it.

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

Julie Rovner: KFF Health News’ “Doctors Urging Conference Boycotts Over Abortion Bans Face Uphill Battle,” by Ronnie Cohen.

Anna Edney: Bloomberg News’ “A Free Drug Experiment Bypasses the US Health System’s Secret Fees,” by John Tozzi.

Alice Miranda Ollstein: The Wall Street Journal’s “Hospitals Hit With IV Fluid Shortage After Hurricane Helene,” by Joseph Walker and Peter Loftus.

Sandhya Raman: The Asheville Citizen Times’ “Without Water After Helene, Residents at Asheville Public Housing Complex Fear for Their Health,” by Jacob Biba.

Also mentioned on this week’s podcast:

SisterSong v. State of Georgia: Superior Court of Fulton County decision.

Click to open the transcript Transcript: The Health of the Campaign
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Friday, October 4th, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.

Rovner: Today we are joined via teleconference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Sandhya Raman of CQ Roll Call.

Raman: Hello, everyone.

Rovner: And Anna Edney of Bloomberg News.

Anna Edney: Hi there.

Rovner: Later in this episode, we’ll have my “Bill of the Month” interview with my KFF Health News colleague Lauren Sausser. This month’s patient is a high school athlete whose problem got fixed, but his bill did not. But first, the news.

We’re going to start this week with the campaign. It is October. I don’t know how that happened. On Tuesday, vice-presidential candidates Senator JD Vance of Ohio and Governor Tim Walz of Minnesota held their first and only debate. It felt very Midwestern nice, with Walz playing his usual Aw shucks self and Vance trying very hard to seem, for want of a better word, likable. Did we learn anything new from either candidate?

Edney: I don’t think I heard anything new, no — not that I can remember.

Rovner: I know, obviously, they exchanged some views on abortion. Vance tried very hard to distance himself from his own hard-line views on the subject, including denying that he’d ever supported a national abortion ban, which he did, by the way. Meanwhile, during the debate, former President [Donald] Trump announced on social media that he would veto a national abortion ban, something he’d not said in those exact words before. Alice, you’ve got a pretty provocative story out this week suggesting that this all might actually be working on a skeptical public. Is it?

Ollstein: Yes. This has been a theme I’ve been tracking for a little bit. It was part of the reporting I was doing in Michigan a couple weeks ago. One, what I thought was interesting about that night was Trump and Vance have been talking past each other on abortion and contradicting each other, and now …

Rovner: Oh, yeah.

Ollstein: … it finally seems that they are on the same page, in terms of trying to convince the public: Nothing to see here. We won’t do a national ban. Don’t worry about it. Democrats and abortion rights groups are running around screaming: They’re lying. Look at their record. Look at what their allies have proposed in things like Project 2025. But the Republican message on this front does seem to be working. Polls show that even people who care about abortion rights and support abortion rights in some of these key battleground states still plan to vote for Trump. It’s a continuation of a pattern we’ve seen over the past few years where a decent chunk of people vote for these state ballot initiatives to protect abortion but then also vote for anti-abortion politicians.

Voters contain multitudes. We don’t know exactly if it’s because they are not worried that Trump and Vance will pursue national restrictions. We don’t know if it’s because just other issues are more important to them. But I think it’s really worth keeping an eye on in terms of a pattern. And KFF has done some really interesting polling showing that people in states where the ballot initiatives have already passed sort of view it as, Oh, we took care of that, it’s settled, and they don’t see the urgency and the threat of a national ban in the way that Democrats and abortion rights groups want them to.

Rovner: Which we’ll talk about separately in a minute. In late breaking news, Melania Trump this week came out and said that she supports abortion rights. Is this part of the continuing muddle where everybody can see what it is that they want to see, or is this going to have any impact at all?

Ollstein: Can I say one more thing about the debate first?

Rovner: Sure.

Ollstein: OK. So what really struck me about what Vance said about abortion at the debate is he really portrayed two arguments that I’ve seen sort of trickle up from the grass roots of the anti-abortion movement. So one, there were some semantics quibbles around what is a ban. There’s really been an effort in the anti-abortion movement to say that only a total ban throughout pregnancy with no exceptions, only that they call a ban. Everything else, they don’t consider it a ban.

Rovner: It’s a national standard.

Ollstein: Yeah, minimum standard, federal standard. There’s a lot of different words they use — “limit,” “restriction.” But what they’re describing is what others call a ban. It’s not a different policy, and so we saw that on full display on the debate stage. We also saw this argument sort of that these government programs and funding and support are the answer to abortion, so, basically, promoting the idea that with enough child care supports and health care supports, fewer people would have abortions — which the data is mixed on that, I will say, from the U.S. and from other countries. But financial hardship is just one of many reasons people have abortions, so that would impact some people and not others. It also goes against a lot of the sort of traditional small-government, cut-government-spending Republican ethos, and so it is this really interesting sort of pro-natalist direction that some of the party wants to go in and some of the activist movement wants to go in. But there’s definitely some tension around that. And, of course, we’ve seen Republicans vote against those programs and funding at the state and federal level.

Rovner: Things like paid family leave have been a Democratic priority much, much longer than it’s been a Republican priority, if it ever was and if it is now.

Ollstein: But it’s interesting that he was promoting that to sort of show a kinder, gentler face to the anti-abortion movement, which has been a trend we’ve been seeing.

Rovner: Yes. Yes, not just from JD Vance but from lots of Republicans on the anti-abortion side. And Melania—

Ollstein: Sorry, back to Melania.

Rovner: Is there any impact from this?

Edney: Oh, it’s certainly worked for the Trump campaign to muddy the waters on any subject. If you think about immigration, certainly that worked before, and I think you can see where they’re realizing that. And they are coming together, like Alice mentioned, with JD Vance and Trump talking on the same page now a bit better but using sort of a, I don’t want to say “underling,” but like a second …

Rovner: A surrogate.

Edney: Yeah, a surrogate, a secondary character to say, I support abortion rights. And she has Trump’s ear, and that could really be a solid salve to a lot of people.

Rovner: I was fascinated because she’s been pretty much invisible all year. I think this is the first time we have actually heard her voice, the first time I have heard her voice in 2024.

Raman: I would add that it’s not unprecedented for a first lady on the Republican side to come out in favor of abortion rights. I think what makes it so interesting is, A, how close we are to the election and that we are actively in a campaign. When we look at the remarks that Laura Bush made several years ago, it was after [former President George W.] Bush had left office for a few years. And so this, I think, is just what really makes it, if the book is going to come out about a month or so before the election that …

Rovner: Melania’s book.

Raman: Yeah, Melania’s book, yes.

Rovner: So yes, we will see. All right. Well, abortion was not the only health issue that came up during the debate. So did the Affordable Care Act. JD Vance went as far to claim that Donald Trump is actually the one that saved the Affordable Care Act. That’s not exactly how I remember things happening. You’re shaking your head.

Raman: I think this was one of the most striking parts of the debate for me, just because he made several comments about how this was a bipartisan process and Trump was trying to salvage the ACA. And for those of us that were reporting in 2017, he was kind of ringleading the effort to repeal and replace the Affordable Care Act. And I guess there were just numerous claims within the few statements he made that were just all incorrect. He was talking about how Trump had divided risk pools, and that was not something that happened. I think that we assume that he was referring to the reinsurance waivers, but those were also created under the Obama administration, so it wasn’t like a Trump invention. We just had some approved under Trump. And he’d mentioned that enrollment was reaching record heights. Health enrollment grew more under the Biden administration than it did under Trump.

Rovner: Yeah, I went back and actually looked up those numbers because I was so, like, “What are you talking about?” Actually, it was the moderator question: Didn’t enrollment go up during the Trump administration? No, it went down every year.

Ollstein: The number of uninsured went up, in fact, during the Trump administration.

Rovner: That’s right.

Ollstein: But, I mean, this is, again, part of a long pattern. Trump has routinely taken credit for things that were the decisions of other administrations, both before and after him.

Rovner: And things that he tried to do and failed to do.

Ollstein: Right.

Rovner: Like lowering drug prices.

Ollstein: Right. Right, right, right. Exactly. Exactly. Like Anna said, there was very little new that was revealed in this exchange.

Rovner: Well, elsewhere on the campaign trail, the Harris campaign is working hard to elevate health care as an issue, including rolling out not just a 60-second ad warning of what repealing the Affordable Care Act could mean, but also issuing a 43-page white paper theorizing what Trump and Vance are likely to have in mind with their, quote, “concepts” of a health care plan based on what they’ve said and done in the past. They must be seeing something in the polls suggesting this could have some legs, don’t you think? I’m a little surprised, because everybody keeps saying: Not a health care election. This is not a health care election. But I don’t know. The Harris campaign sure keeps behaving like it might be.

Raman: Hammering in on the preexisting conditions and protecting those, just because that is such a popular part of the ACA across the board, is probably a good strategy for them, just because that is something that is not the most wonky with that and that people can understand in a campaign ad and kind of distill down.

Edney: Yeah, that was what I was thinking as well, is it’s a popular issue for, certainly, to be talking about, but also just the idea that he’s talking about it in a way that people think, Oh, we don’t have to worry. And Alice has made this point on abortion before. There’s a lot that he can do through executive order and things like that, and did do like taking away money for the navigators and things to help people enroll. So even if they don’t think it’s maybe going to be about health care fully, it makes sense to try to counter some of that. And you can’t do that on a debate stage most of the time, not in an effective way, but certainly putting out this paper, I mean, it did get some press and things like that, and if you really wanted to go read it, you could.

Rovner: Even I didn’t want to read all 43 pages.

Edney: Yeah.

Rovner: Well, as Anna previewed, the AARP released what’s normally a pretty routine interview with both candidates about issues important to Americans over age 50, things like Medicare, Social Security, and caregiving. But I think it’s fair to say that, at least, former President Trump’s answers were anything but routine. Asked how he would protect Medicare from cuts and improve the program, he said, and I quote: “What we have to do is make our country successful again. This has to do with Medicare and Social Security and other things. We have to let our country become successful, make our country successful again, and we’ll be able to do that.” How do you even respond to things like that? Or is this campaign now so completely divorced from the issues that literally nothing matters?

Edney: Well, I kind of noticed a trend in between that answer and one JD Vance gave when he was talking about abortion, and he said: We just need to make women trust us. They need to trust us again. We need to make them trust us. I was like, I don’t understand how that even connects. But also, how are you going to do that? And I think that this is the same thing. You’re just saying these words over and over again in relation. So in somebody’s mind, Medicare and success is Trump’s word, and trust and abortion as JD Vance’s thing, and you’re connecting these in their minds. And I was seeing this as a trend. It just felt familiar to me after listening to the vice-presidential debate. They’re not going to talk about any policy or anything, but repeating these words over and over again like you were listening to morning affirmations or something was going to really get that through in a voter’s mind is maybe what they’re going for.

Rovner: And I have to say, I mean, when candidates start to talk about actual policy ideas, it gets really wonky really fast. Sort of going back to the debate, JD Vance was talking about visas and immigration, and I think it’s an app that he was talking about. I know this stuff pretty well. I had no idea what he was talking about. I mean, maybe it does work better when Trump says, I’m not going to cut Medicare or Social Security, and leave it at that.

Ollstein: Well, right, because when you talk specific policies, that opens it up to critique. And when you just talk total platitudes, then it’s harder to pick apart and criticize, even though it’s clearly not an answer to the questions they’re asking. And it was even a little bit funny to me for the AARP interview, because I believe they sent in written responses, and so they had the ability—

Rovner: I think they also talked on the phone.

Ollstein: Oh, OK.

Rovner: So I think it was a little bit of both.

Ollstein: Right. Right, right, right. It wasn’t the sort of live televised interview. They could have looked up — it was an open-book test.

Rovner: It was.

Ollstein: And yet all of the responses from Trump were just like, We’re going to do something and it’s going to be great and awesome and it’ll fix everything, and it was completely devoid of policy specifics, which again may be smarter politically than actually saying what you plan to do, which as we’ve seen in Project 2025, generates a lot of backlash. But it is also a little bit dangerous to go into the election not knowing the specifics of what someone wants to do on health care.

Rovner: Yeah, I know. I find when I listen to some of these focus groups with undecided voters, we want to know what exactly they’re going to do, except they don’t really want to know what exactly they’re going to do. They think they do, but it appears that that is not necessarily the case. One thing that we know does matter, at least to people on Medicare, is the premiums they pay for their coverage. And unfortunately, for every administration, that announcement comes just weeks before Election Day every year. So this year, the Biden administration was worried about big jumps in premiums for Medicare Part D drug coverage, mostly thanks to the new caps on spending that will save consumers money but will cost insurers more. That didn’t happen, though. And in fact, average premiums will actually fall slightly next year.

Now, I’m not sure I understand exactly what the administration did to avoid this, but they used existing demonstration authority to boost payments to insurers. And, not surprisingly, Republicans are pretty furious. On the other hand, Republicans used pretty much this same authority to avoid Medicare premium spikes in the past. Anna, is this just political manipulation or good governing, or a little bit of both?

Edney: Yeah, it is certainly very timely and probably necessary also because the IRA, the Inflation Reduction Act, kept the seniors’ out-of-pocket pay at $2,000 a year. And so that was going to skyrocket premiums, and they did not want to face that, particularly in an election year. And as you mentioned, this all happens around that time. And so they did this demonstration, and I have read a few things trying to figure out exactly what it does, and I can’t.

Rovner: So it’s not just me. It’s complicated.

Edney: It’s not just you. It’s really complicated, and it has to do with payments that usually come at the end that insurers are now going to get upfront. And that’s the best I can tell you. But they’ll be getting some subsidies upfront, and it’s to try to spread these premium increases to help mitigate those so that seniors don’t have to then pay on that end instead of for their drugs out-of-pocket. So I think that they need to do something. I mean, already, the premiums were able to go up. I think it’s $35 a month, and some plans did elect to do that and others have them staying even. And you even have some with them going down a little bit. So I guess the moral of the story is for consumers to shop around this year, certainly.

Rovner: That’s right, and we will talk more about Medicare open enrollment, which opens in a couple of weeks, because it’s October, and all of these things happen at once. Moving back to abortion, a judge in Georgia struck down, at least for now, the state’s six-week abortion ban, quoting from “The Handmaid’s Tale” about how the law requires women to serve as human incubators. And I’ll put a link to the decision, because that’s quite the decision. But Alice, this is far from the last word on this, right?

Ollstein: Yes. It’s just so fascinating what a slow burn these lawsuits are. I mean, this, the one in North Dakota recently that restored access, these just sort of simmer under the radar for months or even years, and then a decision can have a major impact. And so access has been restored in some of these states. Some interesting things that came to mind were, one, it could be reversed again and pingpong back and forth, and all of that is very challenging for doctors and patients to manage.

But also — and I’m thinking more of North Dakota, because Georgia is sort of a medical powerhouse with a lot of providers and hospitals and facilities and stuff — but in North Dakota, the state’s only abortion clinic moved out of state, and they do not plan to move back as a result of this decision. This isn’t a switch you can flip back and forth. And so when access is restored on paper in the law, that doesn’t mean it’s going to be restored in practice. You need doctors willing to work in these states and provide the procedure. And even with the court rulings, they may not feel comfortable doing so, or the logistics are just too daunting to move back. So I would urge people to keep that in mind.

Rovner: Yeah, and the state’s already said that it’s going to appeal to the next-higher court. So we will see this continue, but I think it was definitely worth mentioning. We’ve talked a lot this year about women experiencing pregnancy complications not being able to get care in states with abortion bans and restrictions. Well, it’s happening in states where abortion is supposed to be widely available, too.

In California, the state’s attorney general filed suit this week against a Catholic hospital in the rural northern part of the state that refused to terminate the doomed pregnancy of a woman carrying twins after her water broke at 15 weeks, because they said one of the twins still had a heartbeat. She eventually was driven to the only other hospital within a hundred miles of the labor and delivery unit, where she did get the care that she needed, although she was hemorrhaging, but not until after a nurse at the Catholic hospital gave her a bucket of towels, quote, “in case something happens in the car.” Meanwhile, the labor and delivery unit at the hospital she was taken to is itself scheduled to close. Are women starting to get the idea that this is about more than just selective abortions and that no matter where they live, that being pregnant could be more dangerous than it has been in the past?

Raman: I was going to say this is something that abortion rights advocates have been saying for years now, that it’s not just abortion, that they point to things like the whole ordeal that we’ve been having with IVF [in vitro fertilization] and birth control and so many other things. Even in the last couple years, people trying to get other medications that have nothing to do with pregnancy and not being able to get those because they might have an effect or cause miscarriage or things like that. So I think in one way, yes. But at the same time, when you look at something like what we saw happen with the two deaths in Georgia, right? The messaging from the anti-abortion crowd has been that this was not because of the abortion ban but because of the regulations that allowed these people to get a medication abortion and that’s what’s driving the death.

So we think that, in some ways, there’s certain camps that are just going to be focused on a different side of how the emergency might not be related to abortion at all, or the branding is that this is not an abortion in certain cases versus an abortion, it’s just semantics. So I don’t know how many minds it’s changing at this point.

Ollstein: Like Sandhya said, the awareness that this is not just for so-called elective abortions. Obviously, that term is disputed and there’s gray area of what that means. I think the overwhelming focus in messaging — from Democrats, anyway — has been about these wanted pregnancies that suffer medical complications and people can’t get care, and so the spillover effect on miscarriage care. But I think the piece that’s new that this could emphasize is that it’s not a strict red-state-blue-state divide, that Catholic hospitals and other facilities in states with protections, like California — it could happen there, too. So I think that’s what this case may be contributing in a new way to people’s understanding.

Rovner: And, of course, this was happening long before Dobbs — I mean, with Catholic hospitals, particularly Catholic hospitals in areas where there are not a lot of hospitals, denying care according to Catholic teachings and women having basically no place, at least nearby, to go. So I think people are seeing it in a new light now that it seems to be happening in many, many places at the same time. Well, while we are visiting California, Governor Gavin Newsom this week signed legislation requiring large group health insurance plans to cover IVF and other fertility treatments starting next year. California is far from the first state to do this. I think it’s now up to over a dozen. But it’s by far the most populous state to do this. Do we expect to see more of this, particularly given, as you were saying, Sandhya, the attention that IVF is suddenly getting?

Raman: I think we could. We’ve had a lot of states do different variations of those so far, and they haven’t necessarily been blue versus red. I think one thing that was interesting about the California law in particular was that it included LGBTQ people within the infertility definition, which we’ve been having IVF laws for over 20 years at this point and I don’t know that that has been necessarily there in other ones. So I would be watching for more things like that and seeing how widespread that would be in some of the bills coming up in the next legislative cycle.

Rovner: Yes, and another issue that I suspect will continue to simmer beyond this election. Well, finally this week, two big business-of-health-related stories: Over the summer, we talked about how the CEO of Steward Health Care, which is a chain of hospitals bought out by private equity and basically run into bankruptcy, refused to show up to testify before the Senate Health, Education, Labor and Pensions Committee. Well, in the last two weeks, the committee, followed by the full Senate, voted to hold CEO Ralph de la Torre in criminal contempt. And as of last week, he is now ex-CEO Ralph de la Torre, and now he is suing the Senate over that contempt vote. If nothing else, I guess this raises the stakes in Congress to continue to look at the impact of private equity in health care?

Edney: Yeah, I think it’s interesting, because when you look at [Sen.] Bernie Sanders calling in pharmaceutical CEOs, they typically show up and they take their hits and they go home. And in this case, it probably kind of heightens that idea that private equity is the evil person. And I’m not saying everyone thinks pharma is not, but they do understand Washington. And there’s a chance that a lot of New York–focused, Wall Street–focused private equity folks may not get that quite in the same way or just may not view it as important. But now, that may be changing.

Rovner: I was surprised by how bipartisan this was.

Edney: Yeah.

Rovner: I mean, beating up on pharma tends to be a Democratic thing, but this was bipartisan in the committee and bipartisan in the Senate. I mean, it’s also important to remember that Steward Health Care is a chain of hospitals in a whole bunch of states, so there are a lot of senators who are seeing hospitals in, now, dire straits through this whole private equity thing, who I imagine are not very happy about it. And their constituents are not very happy about it. But I think the bipartisanship of it is what sort of stuck out to me.

Raman: I was just going to say hospitals are such a big employer for so many districts that I think that, but I would say this was the first time in 50 years they’ve sent a contemptor to the DOJ [Department of Justice]. And especially doing that in a unanimous fashion is just very striking to me, and I’m curious if DOJ kind of goes forth and does, takes penalty and action with it.

Rovner: Yeah, this is a real under-the-radar story that I think could explode in a big way at some point. Well, the other big, evolving business story this week involves Medicare Advantage, the private sector alternative that gives enrollees extra benefits and makes insurance shareholders rich, mostly at taxpayer expense. Well, the party is, if not ending, then at least slowly closing down. Humana’s stock price dropped dramatically this week after the company reported the new way Medicare officials are calculating quality scores from Medicare Advantage. They get stars. The more stars, the better. The new way that Humana appears to be getting its stars could effectively deprive it of its entire operating profit.

In separate news, UnitedHealthcare is suing Medicare over its Medicare Advantage payments in one of those single-judge conservative districts in Texas, of course. Democrats have been working to at least somewhat rein in these excess payments to Medicare Advantage for the past, I don’t know, two decades or so, but I assume this will all likely be reversed if Trump wins. And Medicare Advantage has been a troublesome issue because it’s really popular with beneficiaries, but it’s really expensive, because it’s really popular, because they get extra money, and some of that extra money goes to give extra benefits. Talk about things that are hard to explain to people. It’s great that you get all these extra benefits, but it’s costing the government more than it should.

Edney: Yeah.

Raman: I guess I do wonder if people, how much attention they’re paying. Are they going to switch plans if it’s dropping that many stars? If you’re on a Humana plan and a huge number of them got demoted to a lower rating, the next time you’re looking for a plan, are you going to switch to something else? And how often people are doing that and just if that would move the needle, because it’s just a longer process than overnight.

Rovner: Although, I think it isn’t just that people have to switch. If people stay in those plans with fewer stars, the company gets less money.

Raman: Yeah.

Rovner: Because they get bonuses when people are in the, quote-unquote, “higher quality” plan. So even if their four-star plan is now a three-star plan and they stay in it, the company’s going to lose money, which I think is why the stock price took such a quick and dramatic bath.

Edney: Yeah, I was surprised. It’s such a seemingly wonky issue, but it did really hit Humana very hard in the stock price. Technically, I think — correct me if I’m wrong — the stars aren’t even out yet. This is people doing searches to see if they can find some of them that have been changed at all, and so they’re coming out soon, but Humana particularly is very Medicare-focused out of all of the insurers. They rely on that for a large part of their revenue, so it is a big deal for them. I don’t know how much, but certainly Wall Street was. And as you mentioned with Trump, the Republicans typically really have supported Medicare Advantage because it is private insurers offering this instead of being just government-run Medicare. So that could have an effect.

It’s hard to tell why their stars went down currently. With UnitedHealth, you at least get a little insight. They’re suing because, last year, their star rating went down for some plans, they said, because of one bad customer service phone call. So someone from Medicare calls and does a test thing, and UnitedHealth says they didn’t ask the right question, so the person never got a chance to answer it correctly, and then their star ratings went down. So, it does feel like it could happen at any point for any reason, so I don’t know how conducive that is, how much that actually plays into people who might have a Humana plan that think, “Oh, I haven’t had any issues, so why would I change?”

Rovner: Yeah. All these under-the-hood things, as you point out, we have all looked at and don’t quite understand is worth billions and billions and billions of dollars. It’s one of the reasons why health care is so expensive and such a big part of the economy. All right. Well, we will continue to watch that space, too. That is the news for the week. Now we will play my “Bill of the Month” interview with Lauren Sausser, and then we will come back with our extra credits.

I am pleased to welcome to the podcast my KFF Health News colleague Lauren Sausser, who reported and wrote the latest KFF Health News “Bill of the Month.” Lauren, thanks for joining us.

Lauren Sausser: Thanks for having me.

Rovner: So tell us about this month’s patient, who he is, and what kind of medical care he needed.

Sausser: This month’s patient is a young man named Preston Nafz. He’s 17. He’s a senior in high school. He lives in Hoover, Alabama, which is right outside of Birmingham. And he played youth sports his whole life and recently is focused on lacrosse, but like many kids in this country, he has sort of cycled through a bunch of different sports, and ended up injured last year.

Rovner: And what happened?

Sausser: He had really debilitating pain in his hip, and the pain was progressive. And, obviously, they tried some treatments on one end of the spectrum, but it kept growing worse and worse. And at one point last year, he ended up limping off of the lacrosse field. He couldn’t do really simple things like turning over in bed or getting in and out of a car. These things were really painful for him. So he ended up as a patient at a sports medicine clinic, and providers at that clinic recommended surgery.

Rovner: And to cut to the chase, the story, at least medically, has a happy ending, right? The surgery worked? He’s better?

Sausser: Yes, the surgery worked. He ended up getting something late last year, a procedure called a sports hernia repair, which is a little bit of a misnomer because he didn’t actually have a hernia. But it’s kind of a catchall phrase that orthopedic surgeons use to talk about a procedure to relieve this type of pain that he was having in his pelvis, groin area. And the recovery was longer than he was anticipating, but yes, it medically does have a happy ending. He was able to play lacrosse again, although the last time I spoke to him, he had another sports-related injury. But the sports hernia repair did do what it was supposed to do, so that’s the good news.

Rovner: So it sounded like it should have been routine. Kid growing up, gets hurt playing sports, family has health insurance, goes to sports medicine, doctor fixes problem. Except for the bill, right?

Sausser: Yeah. So the interesting thing about this story, and this is really why we pursued it, is because there is no CPT [Current Procedural Terminology] code for a sports hernia repair. CPT codes, your listeners are probably familiar with, but they’re the medical codes that providers and insurers use to figure out how things get paid for. And it can become more complicated when there’s no code for a procedure, which was the case here. So Preston’s dad was told before the surgery that he was going to have to pay upfront because his insurance company, which was Blue Cross Blue Shield of Alabama, likely wasn’t going to pay for it.

Rovner: And how much was it upfront?

Sausser: It was just over $7,000. So the surgery itself was $6,000. There was, I think, almost $500 for anesthesia, a little over $600 for the facility fee. And Preston’s dad paid for it on a few different credit cards.

Rovner: So kid has the surgery, is in rehab, and Dad is now trying to recoup this money that he has paid for upfront. And what happened then?

Sausser: Yeah. Before the surgery even happened, Preston’s dad tried to call his insurance company and say: Can I get this covered? My son’s doctor says this is medically necessary. And initially, he got good news. His insurer said: It sounds like this is something that should be covered. If this is something that’s medically necessary, your insurance plan generally covers those things. As the date of the surgery grew closer and closer, he found that the people he was talking to at the insurance company weren’t being as definitive with their answers. And so before the surgery, he got a no. He said he got a no from his insurer saying that they were not going to cover this. Now, on the back end of the surgery, after he’d paid the bill with those credit cards, he tried to appeal that decision by filing a lot of paperwork. And he did end up getting a few hundred dollars reimbursed, but when the insurer sent him that check, it was unclear exactly what they were covering. And, obviously, that didn’t come close to the $7,000-plus that they had paid for it.

Rovner: So that’s what eventually happened with the bill, right? He ended up getting stuck with almost all of it?

Sausser: Yeah.

Rovner: Is there anything he could have done differently that might’ve helped this get reimbursed?

Sausser: That’s the tricky thing about this story, because they did do almost everything right. But it’s almost a cautionary tale for people who are faced with this prospect in the future. So if your provider is recommending something that doesn’t have a CPT code, it is going to be harder to get reimbursed from your insurer. You should assume that. That’s not to say it’s impossible, but it’s going to take more work on your end. It’s going to take more paperwork, it may take more work on your doctor’s end, and you should be prepared to get some pushback, if that makes sense.

Rovner: And has he just sort of written this off?

Sausser: I mean, he paid off the surgery using the credit cards. And the last I spoke to this family, they were still getting some confusing communication from their insurer. I don’t know that they’ve gotten the final, final no yet. I think that he still is invested in getting reimbursed if he can. But at this point, we’re approaching almost the one-year anniversary of the surgery, so it’s looking less likely.

Rovner: Well, we will keep following it. Lauren Sausser, thank you so much.

Sausser: Thanks for having me.

Rovner: OK, we’re back. Now it’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read too. Don’t worry if you miss the details. We’ll include links to all these stories in our show notes on your phone or other mobile device. We have two hurricane-related extra credits this week. Sandhya, why don’t you go first?

Raman: My extra credit this week is called “Without Water After Helene: Residents at Asheville Public Housing Complex Fear for Their Health,” and it is from the Asheville [North Carolina] Citizen Times, by Jacob Biba. And the story just looks at the residents of a specific complex in Asheville that have been hit really hard by the hurricane. And, when this was written, they’d been without water for two days and it might not come back for weeks, and just some of the public health impacts they were facing. One person couldn’t clean their nebulizer or their tracheostomy tube. Others were worrying about sanitation from not being able to flush toilets. I think it’s a good one to check out.

Rovner: Yeah. We think about so many things with hurricanes. We think about being without power. We don’t tend to think about being without water. Alice, you have a related story.

Ollstein: Yeah, and this is more of a supply chain story but really shows that these hurricanes and natural disasters can have really widespread impacts outside the region that they’re in. And so this is from The Wall Street Journal. It’s called “Hospitals Hit With IV Fluid Shortage After Hurricane Helene.” It’s by Joseph Walker and Peter Loftus, and it’s about a facility in North Carolina that produces, like I said, IV bag fluids that hospitals around the country depend on. And yeah, we’ve talked before about just how vulnerable our medical supply chains are and we don’t spread the risk around maybe as much as we need to in this age of climate instability. And so, yeah, hospitals, they’re not rationing the fluids, but they are taking steps to conserve. And so they’re thinking, OK, certain patients can take fluids orally instead of intravenously in order to conserve. And so that’s happening now. Hopefully, it doesn’t become rationing down the road. But, yeah, with the long recovery the region is expecting, it’s a bit scary.

Rovner: Anna.

Edney: I did one from a colleague of mine at Bloomberg, John Tozzi. It’s “A Free Drug Experiment Bypasses the US Health System’s Secret Fees.” So he looked at this Blue Shield of California plan that is deciding to just bypass the pharmacy benefit managers and go directly to a drugmaker to get a biosimilar of Humira, the rheumatoid arthritis and many other ailments drug. And they’re going to be getting it for $525 a month for this drug that a lot of the PBMs are offering for more than a thousand dollars. And so the PBMs mentioned to him, We give rebates, and it’s less than a thousand dollars. But they didn’t say if it was as low as $525. And Blue Shield of California seems to think that this is a really good deal and that they’re basically going to give it for free just to show that it can reach Americans affordably. And so I thought it was a good look at this plan and at maybe a trend, I don’t know, that plans might start going outside of the PBM network.

Rovner: We shall see. Well, I chose a story from KFF Health News this week from Ronnie Cohen, and it’s called “Doctors Urging Conference Boycotts Over Abortion Bans Face Uphill Battle,” and it’s a really thoughtful piece about how to best protest things you disagree with. In this case, some doctors want medical groups to move professional conferences out of states with abortion bans, in order to exert financial pressure and to make a point. But there are those who worry that that amounts to punishing the victims and that it won’t do much anyway, frankly, unless you’re the Super Bowl or the baseball All-Star Game. It’s not like your conference is going to make or break some city’s annual budget. But it’s a microcosm of a bigger debate that’s going on in medicine that I’ve been covering. How do doctors balance their duty to serve patients with their duty to themselves and their own families? There are obviously pregnant medical professionals who do not wish to travel to states with abortion bans lest something bad happens. It’s a struggle that is obviously going to continue. It’s a really interesting story.

OK. That is our show. Before we go this week, it is October and we want your scariest Halloween haikus. The winner will get their haiku illustrated by our award-winning in-house artists, and I will read it on the podcast that we tape on Halloween. We will have a link to the entry page in our show notes.

As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. Also, as always, you can email us your comments or questions. We’re at whatthehealth, all one word, @kff.org, or you can still find me at X. I’m @jrovner. Sandhya?

Raman: @SandhyaWrites.

Rovner: Anna?

Edney: @annaedney.

Rovner: Alice.

Ollstein: @AliceOllstein.

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

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Silence in Sikeston: Trauma Lives in the Body

Cara Anthony — Tue, 01 Oct 2024 09:00:00 +0000

SIKESTON, Mo. — At age 79, Nannetta Forrest, whose father, Cleo Wright, was lynched in Sikeston, Missouri, before she was born, wonders how the decades-long silence that surrounded his death in 1942 influenced her life.

In 2020, Sikeston police killed another young Black man, 23-year-old Denzel Taylor. Taylor’s shooting death immediately made local headlines, but then the cycle of silence in Sikeston repeated itself.

Host Cara Anthony and pediatrician Rhea Boyd draw health parallels between the loss experienced by two families nearly 80 years apart. In both cases, young daughters were left behind to grapple with unanswered questions and devastating loss.

“Regardless of the age, children experience longing,” Boyd said. “They miss people when they don’t see them again; even babies can experience that.”

[Editor’s note: A swear word is bleeped out in this episode.]

Host
Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.
In Conversation With …
Rhea Boyd Pediatrician and public health scholar click to open the transcript Transcript: Trauma Lives in the Body
Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

[Solemn instrumental music begins playing softly.]

Cara Anthony: When Nannetta Forrest was growing up, a lot went unsaid in her family.

Nannetta Forrest: You know, people didn’t do a lot of talking back then. And it was almost like trying to pull teeth out of a hen.

Cara Anthony: She lived nearly her whole life in Indiana, but Nannetta’s story — the secrets and the silence — all started in Sikeston, Missouri.

Nannetta was born there in 1942. Several months earlier, while her mother was pregnant, Nannetta’s father was lynched.

His name … was Cleo Wright.

Nannetta Forrest: He was taken away before I got here!

Cara Anthony: Taken from a jail cell. Taken and dragged through the streets by a white mob. Taken to Sunset Addition, the center of Black life in Sikeston, and lynched. Taken from his family.

Nannetta’s mother kept quiet. She never wanted her daughter to know what happened to her father.

But one day, Nannetta was with her grandfather. A game show that aired on CBS in the 1950s was on TV. It was called “Strike it Rich.”

[Clip from “Strike it Rich” begins playing.]

“Strike It Rich” clip: Mr. “Strike It Rich” himself, Warren Hull. [Applause]

Nannetta Forrest: Celebrities would go on, and they’d try to win money for, like, underprivileged people.

“Strike It Rich” clip: Thanks a lot!

Nannetta Forrest: And that’s when Grandpa told me, he said, “You can go on there, Nan.” And I said, “Go on there with what?” And that’s when he went in his wallet and pulled out this yellow piece of paper.

[Solemn instrumental music plays.]

Cara Anthony: It was a newspaper clipping about the lynching of her father.

Nannetta Forrest: And that was my first time ever becoming aware of it.

Cara Anthony: It was around 1955. Nannetta was 13 or 14 at the time.

Nannetta Forrest: I did wanna know the story behind it, what happened, but nobody seemed to wanna talk about it.

Cara Anthony: Over the years, she pieced together bits of what happened. But there was always one nagging question that didn’t have an answer:

What would her life have been like if that mob hadn’t lynched her dad?

Nannetta Forrest: Now, I do often wonder that. Had he been alive when I was born and been in my life, what type of person would I have been? Would I have been the same person? Would I have been a different person? And this is something I’ll never know.

Cara Anthony: I’m Cara Anthony. I’m a health reporter.

I’ve traveled to Sikeston, Missouri, for years, asking people about the killing of Cleo Wright — and the silence that surrounds his death.

Nearly eight decades after the killing, that silence was still stifling. Like generations of stuffed-down fear and anger.

At nearly every turn, locals refused to talk to me. In fact, many people felt they could not talk to me. Until I met … Mikela Jackson.

[Solemn instrumental music fades out.]

Mikela Jackson: It’s … it’s … it’s no healing from grief. It’s an everyday thing for me.

Cara Anthony: Mikela goes by Keke. She’s in her mid-20s. But she’s heard about the lynching back in 1942.

Cara Anthony: Talk to me a little bit about that. Have you ever heard of Cleo Wright?

Mikela Jackson: Denzel brung that up to me. Denzel brung it up to me because we used to live on Sunset Street, and he was telling me, like, they dragged him through Sunset.

Cara Anthony: “Denzel” is Denzel Taylor, Keke’s fiancé.

Sikeston police shot him at least 18 times — and killed Denzel in April 2020. He was 23 years old.

That year, everyone was talking about new research that found that a Black man had a 1-in-1,000 chance of being killed by police.

Denzel Taylor became that 1 in a thousand.

[Sparse, minor music plays quietly.]

Right in the middle of her grief, Keke refused to be quiet.

Mikela Jackson: The Bootheel knows what happened to him. The world, they have no idea who Denzel Taylor is.

Cara Anthony: The Bootheel is where Sikeston sits — in the far southeast corner of Missouri.

Mikela Jackson: So that’s why I want his story … I wanna make him proud, actually. ’Cuz I want him to know, look, Babe, they going to hear this one way or another.

Cara Anthony: I made a film about the deaths of Denzel and Cleo — two Black men killed decades apart — in the same community.

For the documentary, we explored questions about the impact of racial trauma and the persistent harm it causes.

Here, for the podcast, we’re exploring another layer. How does systemic racial violence impact health? The health of Black people, in particular?

[“Silence in Sikeston” theme begins playing.]

Denzel’s story reminds me so much of Cleo’s. So many things about their lives — and their deaths — are similar.

They both left behind a daughter they never got to meet.

They both were killed by a public health threat of their time.

A threat to Black men of their time.

For Cleo, that was lynching.

For Denzel, it was police violence.

Neither of them got their day in court.

In this episode, we’re looking at what happened to Denzel Taylor.

We’re exploring police violence as a public health problem. One that’s making us sick and cutting lives short.

From WORLD Channel and KFF Health News, and distributed by PRX, this is “Silence in Sikeston,” the podcast about finding the words to say the things that go unsaid.

Episode 3: “Trauma Lives in the Body.”

[“Silence in Sikeston” theme ends.]

[Gentle, bright instrumental music plays.]

Cara Anthony: Denzel was from Chicago. Growing up, he spent time in southeastern Missouri with his dad’s family.

Denzel and Keke met in Sikeston. And Keke says they fell in love immediately.

Mikela Jackson: It was a butterfly feeling, like you could just tell it was love. It was the best energy ever.

Cara Anthony: They started their family. De’nia was born first. Denzel used to call her “Cupcake.”

Denzel Taylor: Hey, Cupcake. Say hey, y’all. I love you, princess. [Baby babbles.]

Cara Anthony: Aiyana came next. In 2020, Keke was pregnant with their third daughter, Brookelynn.

Mikela Jackson: He said he wanted seven kids. I said, Denzel, what? He wanted seven kids. That’s a basketball team. I can’t handle that.

Cara Anthony: They were planning to get married after Brookelynn was born.

Mikela Jackson: I really wanted a big family with Denzel. I wanted to get married. I wanted to go to D- … We was planning on moving to Dallas and everything and it’s just like, my whole world is just like, it just blew up on me.

Cara Anthony: Remember 2020? It felt like the news was full of stories about Black people getting killed by police.

Videos from body cameras were all over social media. Around that same time, Keke remembers Denzel getting pulled over by police more and more.

And, Keke says, he started to become convinced that someday he might be killed by police too.

Mikela Jackson: He said if he was to ever get in any type of interaction with the police, he would let them kill him just to show how America is.

He would bring it up, like, outta nowhere. And he would say it, and I would wonder, like, why is you constantly saying it? And I kind of will get irritated because it’s, like, that’s not a way that I will want you to go out. Like, we’re supposed to grow old together.

Cara Anthony: On April 29 that year, Denzel’s premonition came true.

Police body cameras captured what happened the night Denzel was killed.

You’re about to hear a retelling of what happened the night Denzel died — based on interviews with his family and audio pulled from those body cam videos.

When I first got the videos, I stared at the attachments in my email for a long time. I didn’t want to look.

[Soft droning music fades in.]

But I think it’s important that we do look at what happened. It’s part of what I have to do to examine police killings as a public health threat.

Denzel was staying with his father and his stepmom.

[Rain sounds play.]

It was raining that night. Denzel and his dad, Milton Taylor, were stuck in the house together.

They got into an argument. Things escalated.

Denzel’s mom, Jean Kelly, was asleep in Chicago some 400 miles away. In the early hours of the morning, Denzel’s sister ran into her room yelling.

Jean Kelly: “Mom, wake up.” I said, “What happened?” She said, “Denzel just shot Daddy.” I said, “What? Denzel just shot Daddy? That doesn’t make any sense at all.”

EMS audio: 49-year-old. Male. Gunshot wound. Two to three shots to the chest. Five officers on scene.

Cara Anthony: By the time police arrived at Milton’s home, Denzel had left. EMTs stabilized Milton and took him to the hospital.

EMS audio: We’re running hot. St. Francis. One patient.

Cara Anthony: Meanwhile, up in Chicago, Jean is trying to figure out what’s going on. She calls Milton’s wife, Denzel’s stepmom.

Jean Kelly: She said she had a couple of family members out looking for Denzel, you know, because she was saying, “I want them to find him before the police finds him.”

Cara Anthony: Police are speaking with Denzel’s stepmom when he appears.

The body-camera video shows the scene from an officer’s perspective.

[Music fades out.]

Cara Anthony: By now, it’s stopped raining. A streetlamp lights up the end of the block. Police had wrapped the area in yellow police tape. The camera shows Denzel standing in the near distance on the other side of the yellow tape. He’s wearing a hoodie.

Officers: Show me your hands now! Take your hand out of your pocket!

Denzel Taylor: Just kill me, bro.

Jean Kelly: They were saying, uh, “Put your hands up” or whatever the, the, they said to him, and there was some words exchanged. And, uh, it sounded like he said, “Well, shoot me, bro. Just go ahead, shoot me.”

Cara Anthony: The officers fire their guns.

Jean Kelly: They hit my son one time, I believe, if not two, and my son fell. He went, he dropped to his knees and fell face down.

Cara Anthony: There’s a pause. It’s just a moment or two, but as I watch it, it feels longer.

And then, the police fire again, sending bullets into his body on the ground. They keep shooting. You can hear dozens of shots.

Police body cam video: We got shots fired. We need EMS. We got one subject down, shots fired! Hands now! Hands! Hands!

Cara Anthony: One officer walks up — and uses his foot to roll Denzel the rest of the way onto his stomach. Denzel groans as the officer pins his arms behind his back and handcuffs him.

[Handcuffs click]

Cara Anthony: They search his body.

Police body cam video: Goddamn it.

Cara Anthony: Police don’t find a gun. Or any weapon. Just a piece of wood in his hoodie pocket.

Police body cam video: Are you [expletive] serious? He had a [expletive] stick of wood.

Cara Anthony: Police call for an ambulance.

EMS audio: … EMS respond to one subject shot. Time of page, 02 36.

Cara Anthony: On the body camera video, one officer points a flashlight in Denzel’s face.

Police body cam video: Why didn’t you just take your hand out of your pocket, man?

Cara Anthony: Minutes tick by. Red and blue police lights flash off the wet pavement. Denzel is still in the street, motionless.

[Ambulance sirens]

Cara Anthony: EMS arrive, but it’s too late. Denzel is dead.

Over the radio, the dispatcher calls for the coroner.

EMS audio: That’s yes, ma’am. Contact coroner. Ten-four.

[Somber instrumental music plays softly.]

Cara Anthony: Keke had been out of town. She got the call as she was driving back to Sikeston. The police had killed Denzel.

Mikela Jackson: And I said, “No, they did not. No, they did not.” I couldn’t believe it. It was heartbreaking.

Cara Anthony: A special prosecutor declined to file charges against the police officers who killed Denzel. The officers did not comment for this project. Sikeston Chief of Public Safety James McMillen says the officers believed Denzel was armed and that they were in fear for their life.

Denzel’s family sued the city of Sikeston. The city and the family reached a wrongful death settlement for $2 million. Close to half of it went to legal fees. Most of the rest of it will go to Denzel’s daughters.

Keke thinks a lot about how life goes on for the officers who killed Denzel.

Mikela Jackson: They still get to see their family every single day of their life. They still get to call their daughters. They still get to go home and tuck their kids into bed. Denzel can never do that ever, ever again.

I’m a forced single parent. I have to push through every single day.

Keke watched the body cam video over and over. But Denzel’s death just wouldn’t sink in. And she’s worried about their daughters.

Mikela Jackson: I hope they never see the video ’cause that’s traumatizing. ’Cause that’s their dad.

Cara Anthony: Eventually, Keke left Sikeston. She says there are too many memories of Denzel and what happened to him there.

On the day I visited her new home, it was just over a year after Denzel’s death.

[Cara and Keke laugh together in the background.]

Two-year-old Aiyana is napping in the next room. Keke has the youngest, Brookelynn, on her lap. And the oldest, De’nia, is … everywhere.

Right now, she’s zooming through the dining room on a scooter.

Cara Anthony: She just did, like, a trick, like a BMX. She’s BMXing in this apartment right now. Is she a daredevil?

Mikela Jackson: She do that all the time. [Laughter] Too much. No. No bike.

Cara Anthony: Eventually, De’nia parked her wheels and talked to me.

Cara Anthony: Let’s just get this started. Tell me your name again and how old you are.

De’nia: Four.

Cara Anthony: And what is your name?

De’nia: De’nia.

Cara Anthony: In my time as a health reporter, I’ve written a lot about the impact gun violence has on kids. I’ve gotten some training in how to talk to them about it on their level — without retraumatizing them.

Cara Anthony: Your mommy’s sitting here, and she said I have permission to ask you about your daddy.

De’nia: Daddy?

Cara Anthony: Do you miss your daddy?

De’nia: Yes.

Cara Anthony: Yeah? Where’s your daddy?

De’nia: I don’t know.

Cara Anthony: Yeah.

De’nia: He’s sleeping.

Cara Anthony: Hmm?

De’nia: He’s sleeping.

Cara Anthony: You said he’s sleeping?

De’nia: Yes.

Mikela Jackson: That’s what she say. She said, “My daddy’s sleeping.”

Cara Anthony: De’nia is trying to make sense of why her dad isn’t with them anymore. And Keke doesn’t know what to tell her.

Mikela Jackson: Like last night she actually woke up out of her sleep and she was crying and she was like, Mama, my daddy. And I didn’t know what to tell her because it’s, like, what do you tell a 4-year-old that they’re never ever going to see their dad again?

[Subtle instrumental music plays.]

Cara Anthony: I called a pediatrician, Rhea Boyd, to talk about what losing a parent to police violence could mean for kids like De’nia, Aiyana, and Brookelynn.

Rhea Boyd: Regardless of the age, children experience longing. They miss people when they don’t see them again, even babies can experience that.

Cara Anthony: Losing a parent — especially to violence — can have a major impact on a child’s future health.

Rhea Boyd: Certain experiences, including the death of a parent, increases a child’s risk for certain physical health ailments, like heart disease, um, kind of neurologic ailments, like increased risk for Alzheimer’s. Mental health impairments, like increased risk for depression. And these are increased risks as they move into adulthood.

Cara Anthony: Study after study show the link, even though we don’t totally understand all the mechanisms.

Rhea Boyd: It’s not just innate to our biology. It’s because of the conditions in which Black folks have been forced to live.

Cara Anthony: Black people in the United States carry more stress throughout their lives than white people. That doesn’t change, even when they make more money.

Researchers have tied that stress to the racism we deal with in everyday interactions — and to the institutional racism that makes it harder for us to take care of ourselves and our families.

Black people age faster, get sicker, and die sooner than our white peers — and carrying chronic stress is a factor.

Rhea says police violence contributes to this, too.

Rhea Boyd: Police are a public institution. And when they disproportionately take the lives of Black folks, or disproportionately police Black neighborhoods, that has direct impacts on our lives, on our well-being.

Cara Anthony: Keke says, back when she was living in Sikeston, she felt anxious every time she saw police lights in her rearview mirror.

[Subtle instrumental music ends.]

Mikela Jackson: Now, it’s like, OK, here it go again. I’m getting pulled over. Because it, I’m, it’s, I’m used to it at this point. I’m used to it.

Cara Anthony: Used to it, maybe. But not numb to it.

Mikela Jackson: I can’t tell my kids, “Hey, don’t be scared when you get pulled over.” I can’t tell them that. ’Cause I’m still scared myself, even a year later. I’m still scared.

Cara Anthony: Rhea calls this “anticipatory stress.”

Rhea Boyd: Anticipatory stress means you carry a level of vigilance and worry and concern about things that might happen to you or your kids.

Cara Anthony: Children can pick up on what’s going on in these situations and can end up carrying that toxic stress, too.

Denzel Taylor’s mother, Jean Kelly, told me about the worry that comes with having a Black son in America. The fear that he could become that 1 in 1,000 Black men killed by police.

[Grand, angelic music plays in the background.]

Jean Kelly: [Singing] Lord, have mercy on me …

Cara Anthony: Jean says before Denzel’s death, her spirit was on alert, like she was bracing for something bad. And a tune kept playing over and over in her mind.

Jean Kelly: [Singing] Lord, have mercy on me. I said, Lord, have mercy on me.

I just needed his, I needed his mercy and his grace and strength and everything to prepare me for what was to be … whatever it was to be, I was going to need his mercy.

[Grand, angelic music fades out]

Cara Anthony: I know what Black people are dealing with today. But I can only imagine what it would have been like in 1942, when Cleo Wright was lynched.

Rhea Boyd: The type of control people had their kids and their body under constantly so that they weren’t the victim of that type of violence, I think, physiologically, it was likely so enormous that the intergenerational effects of that type of terror still live in our bodies as descendants of those who experienced it.

Cara Anthony: Research is starting to explore how living with this kind of terror could go beyond behaviors to something deeper: changing how our genes work.

[Bouncy instrumental music plays.]

Some of this research comes out of a field called “epigenetics.” It’s the idea that something you experience can change how the genes in your body are expressed.

And that can have huge impacts on your health: It could make you age quicker or be more prone to developing a disease like cancer.

And epigenetic research is looking into how things your ancestors experienced could also affect your health today.

A police shooting and a lynching.

Two Black men killed in the same town — nearly 80 years apart.

As I reported their stories, many people have asked why we’re examining the deaths of Cleo Wright and Denzel Taylor side by side.

After years of reporting on these deaths, I’ve decided, as a health reporter, I want to focus on is this: the trauma that remains after the violence against these men — the possible health effects for their families and their communities.

I want to better understand what the loss could mean for Cleo and Denzel’s daughters. Little girls growing up without their dad.

Cleo’s daughter, Nannetta Forrest, wasn’t born yet when her father was killed. When we last spoke a few years before she died, she was 78 years old. And she said she was still asking herself that question that had nagged at her, her whole life: Who would she have been?

Nannetta Forrest: Would I have been the same person? Would I have been a different person?

Cara Anthony: And Denzel’s girls: De’nia and Aiyana. And Brookelynn, who wasn’t born yet. Brookelynn might ask herself the same thing as she grows.

Mikela Jackson: She has no memories. She’s never seen him a day in her life. So it’s like, she’ll never know him, like, as a person. [Den’ia playing in the background]

Cara Anthony: Just like Nannetta, Denzel’s girls are facing higher risks of psychological and mental health problems … and the possibility that losing their father this way could change how their genes work.

[“Silence in Sikeston” theme begins playing.]

In the face of those risks and possibilities, Keke’s looking for ways to protect her daughters.

She’s moved them away from Sikeston to a city where she hopes they’ll have more peace.

She wants them to know all about their dad, and how much he loved them.

She wants them to know his voice.

Denzel Taylor: Hey, Cupcake!

Cara Anthony: It’s the opposite of silence. She wants them to be able to heal out loud.

On the next episode, we’re in Sikeston, where people are looking for ways to heal and move forward after the deaths of Cleo Wright and Denzel Taylor.

Pershard Owens: We got to look in the mirror and say, am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt? That’s what we have to start doing.

Cara Anthony: Including the possibility for big changes — community-level, systemwide changes.

James McMillen: I get frustrated and I’m trying to direct that frustration into something that could actually work.

Cara Anthony: That’s next time, on the final episode of “Silence in Sikeston.”

[“Silence in Sikeston” theme ends.]

[Upbeat instrumental music plays.]

Cara Anthony: Thanks for listening to “Silence in Sikeston.”

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.

The audio series was reported and hosted by me, Cara Anthony.

Zach Dyer and Taylor Cook are the producers.

Editing by Simone Popperl.

Taunya English is managing editor of the podcast.

Sound design, mixing, and original music by Lonnie Ro.

Podcast art design by Colin Mahoney and Tania Castro-Daunais.

Oona Zenda and Lydia Zuraw are the landing page designers.

Have you seen the amazing Sikeston photography? It’s from Michael B. Thomas.

And Lynne Shallcross is the photo editor.

Thank you to my vocal coach, Viki Merrick.

Music in this episode is from Epidemic Sound and BlueDot Sessions.

Additional audio from the CBS TV show “Strike It Rich” and Denzel Taylor’s family.

Some of the audio you’ll hear across the podcast is also in the film.

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin.

Kyra Darnton is executive producer at Retro Report.

I was a producer on the film.

Jill Rosenbaum directed the documentary.

Kytja Weir is national editor at KFF Health News.

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.

We’re keeping this conversation going on Instagram and X.

Tarena Lofton and Hannah Norman are engagement and social media producers for the show.

Help us get the word out about “Silence in Sikeston.”

Write a review or give us a quick rating wherever you listen to this podcast.

Thank you. It makes a difference.

Oh, yeah. And tell your friends in real life, too.

[Upbeat instrumental music ends.]

Credits
Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer @lonnielibrary Lonnie Ro is an audio engineer and composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.
Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This story can be republished for free (details).

KFF Health News' 'What the Health?': Congress Punts to a Looming Lame-Duck Session

Thu, 26 Sep 2024 18:20:00 +0000

The Host
Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ 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.
Congress has left Washington for the campaign trail, but after the Nov. 5 general election lawmakers will have to complete work on the annual spending bills for the fiscal year that starts Oct. 1. While the GOP had hoped to push spending decisions into 2025, Democrats forced a short-term spending patch that’s set to expire before Christmas.

Meanwhile, on the campaign trail, abortion continues to be among the hottest issues. Democrats are pressing their advantage with women voters while Republicans struggle — with apparently mixed effects — to neutralize it.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins schools of nursing and public health, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists
Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.
Among the takeaways from this week’s episode:

When Congress returns after the election, there’s a chance lawmakers could then make progress on government spending and more consensus health priorities, like expanding telehealth access. After all, after the midterm elections in 2022, Congress passed federal patient protections against surprise medical billing.

As Election Day approaches, Democrats are banging the drum on health care — which polls show is a winning issue for the party with voters. This week, Democrats made a last push to extend Affordable Care Act subsidies expanded during the pandemic — an issue that will likely drag into next year in the face of Republican opposition.

The outcry over the first reported deaths tied to state abortion bans seems to be resonating on the campaign trail. With some states offering the chance to weigh in on abortion access via ballot measures, advocates are telling voters: These tragedies are examples of what happens when you leave abortion access to the states.

And Sen. Bernie Sanders of Vermont summoned the chief executive of Novo Nordisk before the health committee he chairs this week to demand accountability for high drug prices. Despite centering on a campaign issue, the hearing — like other examples of pharmaceutical executives being thrust into the congressional hot seat — yielded no concessions.

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

Julie Rovner: KFF Health News’ “How North Carolina Made Its Hospitals Do Something About Medical Debt,” by Noam N. Levey and Ames Alexander, The Charlotte Observer.

Lauren Weber: Stat’s “How the Next President Should Reform Medicare,” by Paul Ginsburg and Steve Lieberman.

Joanne Kenen: The Atlantic’s “The Woo-Woo Caucus Meets,” by Elaine Godfrey.

Alice Miranda Ollstein: Stat’s “How Special Olympics Kickstarted the Push for Better Disability Data,” by Timmy Broderick.

Also mentioned on this week’s podcast:

KFF Health News’ “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation,” by Arthur Allen, Daniel Chang, and Sam Whitehead.

KFF Health News’ “Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition,” by Fred Schulte.

KFF Health News’ “Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges,” by Fred Schulte and Holly K. Hacker.

KFF Health News’ “ACA Plans Are Being Switched Without Enrollees’ OK,” by Julie Appleby.

KFF Health News’ “Biden Administration Tightens Broker Access to Healthcare.gov To Thwart Rogue Sign-Ups,” by Julie Appleby.

click to open the transcript Transcript: Congress Punts to a Looming Lame-Duck Session
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, September 26th, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.

Today we are joined via teleconference by Lauren Weber of The Washington Post.

Lauren Weber: Hello hello.

Rovner: Alice Ollstein of Politico.

Alice Miranda Ollstein: Good morning.

Rovner: And Joanne Kenen of the Johns Hopkins Schools of Public Health and Nursing, and Politico.

Joanne Kenen: Hi, everybody.

Rovner: Big props to Emmarie for hosting last week while I was in Ann Arbor at the Michigan Daily reunion. I had a great time, but I brought back an unwelcome souvenir in the form of my first confirmed case of covid. So apologies in advance for the state of my voice. Now, let us get to the news.

To steal a headline from Politico earlier this week, Congress lined up in punt formation, passing a continuing resolution that will require them to come back after the election for what could be a busy lame-duck session. Somebody remind us who wanted this outcome — the Let’s only do the CR through December — and who wanted it to go into next year? Come on, easy question.

Ollstein: Well, the kicking it to right before Christmas, which sets up the stage for what we’ve seen so many times before where it just gets jammed through and people who have objections, generally conservatives who want to slash spending and add on a bunch of policy riders, which they tried and failed to do this time, will have a weaker base to operate from, given that everybody wants to go home for the holidays.

And so once again, we’re seeing people mad at Speaker Mike Johnson, who, again and again, even though he is fully from the hard right of the party, is not catering to their priorities as much as they would like. And so obviously his speakership depends on which party wins control of the House in November. But I think even if Republicans win control, I’m already starting to hear rumblings of throwing him overboard and replacing with someone who they think will cater to them more.

Rovner: It was so déjà vu all over again, which is, last year, as we approached October 1st and the Republican House could not pass any kind of a continuing resolution with just Republican votes, that eventually Kevin McCarthy had to turn to Democrats, and that’s how he lost his job.

And yet that’s exactly what happened here, which is the Republicans wanted to go until March, I guess on the theory that they were betting that they would be in full power in March and would have a chance to do a lot more of what they wanted in terms of spending bills than if they just wait and do it in the lame duck. And yet the speaker doesn’t seem to be paying the same price that Kevin McCarthy did. Is that just acknowledgment on the part of the right wing that they can’t do anything with their teeny tiny majority?

Kenen: I mean, yes, it’s pretty stalemate-y up there right now, and nobody is certain who’s going to control the House, and at this point it is likely to still be a narrow majority, whoever wins it. I mean, they’re six weeks out. Things can change. This has been an insane year. Nobody’s making predictions, but it looks like pretty divided.

Rovner: Whoever wins isn’t going to win by much.

Kenen: We have a pretty divided country, and the likelihood is we’re going to have a pretty divided House. So the dynamic will change depending on who’s in charge, but the Republicans are more fractious and divided right now than the Democrats, although that’s really easy to change, and even the Democrats have gone through their rambunctious divided phases, too.

Everybody just doesn’t know what’s next, because the top of the ticket is going to change things. So the more months you push out, the less money you’re spending. If you control the CR, if you make the CR, the continuing resolution, meaning current spending levels for six months, it’s a win for the Republicans in many ways because they’re keeping — they’re preventing increases. But in terms of policy, both sides get some of the things they want extended.

I don’t know if you can call it a productive stalemate. That’s sort of a contradiction in terms. But I mean, for the Republicans, longer, it would’ve been better.

Rovner: So now that we know that Congress has to come back after the election, there’s obviously things that they are able to do other than just the spending bills. And I’m thinking of a lot of unfinished health legislation like the telehealth extensions and the constant, Are we going to do something about pharmacy benefit managers? which has been this bipartisan issue that they never seem to solve.

I would remind the listeners that in 2022 after the election, that’s when they finally did the surprise-bills legislation. So doing big things in the lame duck is not unheard of. Is there anything any of you are particularly looking toward this time that might actually happen?

Kenen: It’s something like telehealth because it’s not that controversial. I mean, it’s easiest to get something through in — in lame duck, you want to get some things off the plate that are either overdue and need to be taken care of or that you don’t want hanging over you next year. So telehealth, which is, there are questions about does it save money, et cetera, and what form it should take and how some of it should be regulated, so forth, but the basic idea, telehealth is popular. Something like that, yes.

PBMs [pharmacy benefit managers] is a lot harder, where there is some agreement on the need to do something but there’s less agreement about what that something should look like. So although I’m not personally covering that day-to-day basis, in any sense, that’s harder. The more consensus there is and the fewer moving parts, the easier it is to do, as a rule. I mean, sometimes they do get something big done in lame duck, but a lot of it gets kicked.

And also there’s a huge, huge, huge tax fight next year, and it’s going to require a lot of wheeling and dealing no matter what shape it takes, because it’s expiring and things have to be either renewed or allowed to die. So that’s just going to be mega-enormous, and a lot of this stuff become bargaining chips in that larger debate, and that becomes the dominant domestic policy vehicle next year.

Rovner: Well, even before we get to the lame duck, we have to finish the campaign, which is only a month and a half away. And we are still talking about the Affordable Care Act in an election where it was not going to be a campaign issue, everybody said.

I know that you talked last week about all the specifics of the ways former President [Donald] Trump actually tried to sabotage rather than save the ACA and all the ways what [Sen.] JD Vance was talking about on “Meet the Press,” dividing up risk pools once again so sicker people would no longer be subsidized by the less sick, would turn the clock back to the individual insurance market as it existed before 2014.

Now the Democrats in the Senate are taking one last shot at the ACA with a bill — that will fail — to renew the expanded marketplace subsidies, so it will expire unless Congress acts by the end of next year. Might this last effort have some impact in the swing states, or is it just a lot more campaign noise?

Weber: I think this is a lot of campaign noise, to some extent. I mean, I think Democrats are clear in polling shows that the average American voter does trust Democrats more than Republicans on ACA and health issues and health insurance. So I do think this is a messaging push in part by the Dems to speak to voters. As we all know, this is a turnout election, so I think anything that they feel like voters care about, which often has to do with their pocketbook, I think they’re going to lead the drum on.

I do think it’s interesting again that JD Vance really is reiterating a talking point that Donald Trump used in the debate, which is that he said he had improved the ACA and many experts would say it was very much the opposite. Again, I think I did this on the last podcast, but let me reread this because I think it’s important as a fact check. Most of the Trump administration’s ACA-related actions included cutting the program.

So they reduced millions of dollars of funding for marketing and enrollment, and he repeatedly tried to overturn the law. So I think some of the messaging around this is getting convoluted, in part because it’s an election year, to your point.

Rovner: And because it’s popular. Because Nancy Pelosi was right. When people found out what was in it, it got popular.

Kenen: I think there are two things. I mean, I agree with what Lauren just said, but the Democrats came out in favor of extending the subsidies yesterday, which not only changed the eligibility criteria — more people, more higher up the middle-income chain could get subsidized — but also everybody in it had extra benefits for it, including people who were already covered. But it’s better for them.

The idea that Republicans are going to try to take that benefit away from people six weeks before an election — they were probably not. How they handle it next year? I was really surprised by the silence yesterday. The Democrats rolled out their plans for renewing this, and I didn’t see a lot of Republican pushback. So they were really quiet about it.

The other thing that struck me is that JD Vance went on on this risk pool thing last week on “Meet the Press” and in Raleigh, in North Carolina, and then there was pushback. And on that particular point, there’s been silence for the last week. I don’t think he stuck his neck out on that one again. Who knows what next week will bring, but it didn’t continue, and nor did I hear other Republicans saying, “Yeah, let’s go do that.”

So if that was a trial balloon, it was somewhat leaden. So I think that we really don’t know how the subsidy fight is going to play —how or when the subsidy fight will play out. It’s really, you know, we’ve all said many times before, once you give people the benefit, it’s really hard to take it away. And—

Rovner: Although we did that with the Child Tax Credit. We gave everybody the Child Tax Credit and then took it away.

Kenen: We did, and other things that were temporary during the pandemic, and we’ll just see how many of those temporary things do in fact go away. I mean, does it come back next year? I mean, now SALT [state and local taxes], right? I mean, Trump backed backing what’s called SALT. It’s a limit based on mortgage and state taxes. And now he’s talking about he’s going to rescue that like it wasn’t him who … So it all comes around again.

Ollstein: Yeah, and I think what you’re seeing is both sides drawing the battle lines for next year and signaling what the core arguments are going to be. And so you had Democrats come out with their bill this year, and you are hearing a lot of Republicans in hearings and speeches sprinkled around talking about claiming that there is a huge amount of fraud in the ACA marketplaces and linking that to the subsidies and saying, Why would we continue to subsidize something where there’s all this fraud?

I think that is going to be a big argument on that side next year for not extending the subsidies. So I would urge people to keep listening for that.

Kenen: And that came from a conservative think tank consulting firm in which they blame — I actually happened to read it this week, so it’s fresh in my mind. They’re blaming the fraud actually on brokers rather than individuals. They’re saying that people are—

Rovner: That was an investigation uncovered by my colleague Julie Appleby here at KFF Health News.

Kenen: Right. And they ran with that, and they were talking about the low end of the income bracket. And I’m waiting for the sequel in which the people at the upper end of the income bracket, which is the law that’s expiring that we’re talking about, it’s pretty — I’m waiting for the sequel Paragon paper saying, See, it’s even worse at the upper end, and that’s easy to get rid of because it’ll expire. That’s the argument of the day, but there’s so many flavors of anti-ACA arguments that we’ve just scratched the beginning of this round.

Rovner: Exactly. It’ll come back. All right, well, let us move on to abortion. Vice President [Kamala] Harris said in an interview this week that she would support ending the filibuster in the Senate in order to restore abortion rights with 51 rather than 60 votes, which has apparently cost her the endorsement of retiring West Virginia Democratic senator Joe Manchin. Was Manchin’s endorsement even that valuable to her? It’s not like West Virginia was going to vote Democratic anytime soon.

Ollstein: The Harris campaign has really leaned into emphasizing endorsements she’s been getting from across the ideological spectrum, from as far right as Dick Cheney to more centrist types and economists and national security people. And so she’s clearly trying to brandish her centrist credentials. So I guess in that sense. But like you said, Democrats are not going to win West Virginia, and so I think also he was getting upset about something, a position she’s been voicing for years now. This is not new, this question of the filibuster. So I doubt it’ll have much of an impact.

Kenen: It’s a real careful-what-you-wish for, because if the Senate goes Republican, which at the moment looks like it’s going to be a narrow Republican majority. We don’t know until November. There’s always a surprise. There’s always a surprise.

Rovner: You’re right. It’s more likely that it’ll be 51-49 Republican than it’ll be 51-49 Democrat.

Kenen: Right. So if the filibuster is going to be abolished, it would be to advance Republican conservative goals. So it’s sort of dangerous territory to walk into right now. The Democrats have played with abolishing the filibuster. They wanted to do it for voting rights issues, and they decided not to go there on legislation. They did modify it a number of years ago on judicial appointments and other Cabinet appointments and so forth.

But legislative, the filibuster still exists. It’s very, very, very heavily used, much more than historically, by both parties, whoever is in power. So changing it would be a really radical change in how things move or don’t move. So it could have a long tail, that remark.

Rovner: Meanwhile, Senate Democrats, who don’t have the votes now, as we know, to abolish the filibuster, because Manchin is among their one-vote margin, are continuing to press Republicans on reproductive rights issues that they think work in their favor. Earlier this week, the Senate Finance Committee had a hearing on EMTALA, the Emergency Medical Treatment and Labor Act.

It’s a federal law that’s supposed to guarantee women access to abortion in medical emergencies. But in practice, it has not. Last week we talked about the ProPublica stories on women whose pregnancy complications actually did lead to their death. Is this something that’s breaking through as a campaign issue? I do feel like we’ve seen so much more on pregnancy complications and the health impacts of those rather than just, straight, women who want to end pregnancies.

Ollstein: I just got back from Michigan, and I would say it is having a big impact. I was really interested in how Democrats were trying to campaign on abortion in Michigan, even now that the state does have protections. And I heard over and over from voters and candidates that Trump’s leave-it-to-the-states stance, they really are still energized by that.

They’re not mollified by that, because they are pointing to stories like the ones that just came out in Georgia and saying: See? That’s what happens when you leave it to the states. We may be fine, but we care about more than just ourselves. We’re going to vote based on our concern for women in other states as well. I found that really interesting to be hearing out in the field.

Rovner: Lauren, you want to add something?

Weber: Yeah, I just was going to add, I mean, Harris obviously highlighted this effectively in the debate, and I think that has helped bring it to more of a crescendo, but there’s obviously been a lot of reporting for months on this. I mean, the AP has talked about — I think they did a count. It’s over 100 women, at least, have been denied emergency care due to laws like this.

I’d be curious — and it sounds like Alice has this, for voters that are in swing states, that it’s breaking through to — I’d be curious how much this has siloed to people that are outraged by this, and so we’re hearing it and how much it’s skidding down to those that — the Republican talking points have been that these are rare, they don’t really happen, it’s a liberal push to get against this. I’d be curious how much it’s breaking through to folks of all stripes.

Rovner: I watched a big chunk of the Finance Committee hearing, and the anti-abortion witnesses were saying this is not how it worked, that ectopic pregnancies, pregnancy complications do not qualify as abortions, and basically just denying that it happened. They’re sitting here. They’re sitting at the witness table with the woman to whom this happened and saying that this does not happen. So it was a little bit difficult, shall we say. Go ahead.

Ollstein: Well, and the pushback I’ve been hearing from the anti-abortion side is less that it’s not happening and more that it’s not the fault of the laws, it’s the fault of the doctors. They are claiming that doctors are either intentionally withholding care or are wrong in their interpretation of the law and are withholding care for that reason. They’re pointing to the letter of the law and saying, Oh no, it doesn’t say let women bleed out and die, so clearly it’s fine. They’re not really grappling with the chilling effect it’s having.

Rovner: Although we do know that in Texas when, I think it was Amanda Zurawski, there was — no, it was Kate Cox who actually got a judge to say she should be allowed to have an abortion. Ken Paxton, the Texas attorney general, then threatened the hospital, said, If you do this, I will come after you. On the one hand, they say, Well, that’s not what the law says. On the other hand, there are people saying, Yeah, that’s what the law says.

Turning to the Republicans, Donald Trump had some more things to say about abortion this week, including that he is women’s protector and that women will, and I quote, “be happy, healthy, confident, and free. You will no longer be thinking about abortion.”

If that wasn’t enough, in Ohio, Bernie Moreno, who’s the Republican running against Senator Sherrod Brown in the otherwise very red state, said the other night that he doesn’t understand why women over 50 would even care about abortion, since, he suggested, they can no longer get pregnant, which isn’t correct, by the way. But who exactly are the voters that Trump and Moreno are going after here?

Kenen: Moreno is already lagging in the polls. Sherrod Brown is a pretty liberal Democrat in an increasingly conservative state, and he’s also very popular. And it looks like he’s on a glide path to win, and this probably made it easier for him to win. And there are men who support abortion rights, and there are women who oppose.

I mean, this country’s divided on abortion, but it’s not age-related. It’s not like if you’re under 50 and female, you care about abortion and nobody else does. I mean, that’s really not the way it works. Fifty-year-old and older women, some of whom had abortions when they were younger, would want that right for younger women, including their daughters. It’s not a quadrant. It’s not like, oh, only this segment cares.

Ollstein: It’s interesting that it comes amid Democrats really working to broaden who they consider an abortion voter, like I said, trying to encourage people in states where abortion is protected to vote for people in states where abortion is not protected and doing more outreach to men and saying this is a family issue, not just a women’s issue, and this affects everybody.

So as you see Democrats trying to broaden their outreach and get more people to care, you have Bernie Moreno saying the opposite, saying, I don’t understand why people care when it doesn’t affect their own particular life and situation.

Rovner: Although I will say, having listened to a bunch of interviews with undecided voters in the last couple of weeks, I do hear more and more voters saying: Well, such and such candidate, and this is on both sides, is not speaking to me. It’s almost like this election is about them individually and not about society writ large.

And I do hear that on both sides, and it’s kind of a surprise. And I don’t know, is that maybe where Moreno is coming from? Maybe that’s what he’s hearing, too, from his pollsters? It’s only that people are most interested in their own self-interest and not about others? Lauren, you wanted to add to that?

Weber: I mean, I would just say I think that’s a kind interpretation, Julie. I think that more likely than not, he was just speaking out of turn. And in some prior reporting I did this year on misinformation around birth control and contraception, I spoke to a bunch of women legislators, I believe it was in Idaho, who found that in speaking with their male legislator friends, that a lot of them were uncomfortable talking about abortion, birth control, et cetera, which led to a lot of these misconceptions. And I wonder if we’re seeing that here.

Ollstein: Just quickly, I think it’s also reflective of a particular conservative mind-set. I mean, it reminds me of when I was covering the Obamacare fight in Congress and you had Republican lawmakers making jokes about, Oh, well, wouldn’t want to lose coverage for my mammograms. And just what we were just talking about, about the separate risk pools and saying, Oh, I’m healthy. Why should I subsidize a sick person? when that’s literally how insurance works.

But I think just the very individualistic go-it-alone, rugged-individual mind-set is coming out here in different ways. And so it seems like he did not want this particular comment to be scrutinized as it is getting now, but I think we hear versions of this from conservative lawmakers all the time in terms of, Why should I have to care about, pay for, subsidize, et cetera, other people in society?

Rovner: Yeah, there’s a lot of that. Well, finally this week in reproductive health issues that never seem to go away, a federal judge in North Dakota this week slapped an injunction on the Equal Employment Opportunity Commission’s enforcement of some provisions of the 2022 Pregnant Workers Fairness Act, ruling that Catholic employers, including for-profit Catholic-owned entities, don’t have to provide workers with time off for abortions or fertility treatments that violate the church’s teachings.

Now, lest you think this only applies to North Dakota, it does not. There’s a long way to go before this ruling is made permanent, but it’s kind of awkward timing for Republicans when they’re trying to convince voters of their strong support of IVF [in vitro fertilization], and yet here we have a large Catholic entity saying, We don’t even want to give our workers time off for IVF.

Ollstein: Yeah, I think you’ve been hearing a lot of Republicans scoffing at the idea that anyone would oppose IVF, when there are many, many conservatives who do either oppose it in its entirety or oppose certain ways that it is currently commonly practiced. You had the Southern Baptist Convention vote earlier this year in opposition to IVF. You have these Catholic groups who are suing over it.

And so I think there needs to be a real reckoning with the level of opposition there is on the right, and I think that’s why you’re seeing an interesting response to Trump’s promise for free IVF for all and whether or not that is feasible. I think this shows that it would get a lot of pushback from groups on the right if they were ever to pursue that.

Rovner: Yeah, I will also note that this was a Trump-appointed judge, which is pretty … The EEOC, when they were doing these final regulations, acknowledged that there will be cases of religious employers and that they will look at those on a case-by-case basis. But this is a pretty sweeping ruling that basically says, we’re back to the Hobby Lobby Supreme Court case: If you don’t believe in something, you don’t have to do it.

I mean, that’s essentially where we are with this, and we will see as this moves forward. Well, moving on to another big election issue, drug prices, the CEO of Novo Nordisk, makers of the blockbuster obesity and diabetes drugs Ozempic and Wegovy, appeared at the Senate Health, Education, Labor and Pensions Committee on Tuesday in front of Senator Bernie Sanders, who has been one of their top critics.

And maybe it’s just my covid-addled brain, but I watched this hearing and I couldn’t make heads or tails of how Lars Jørgensen, the CEO, tried to explain why either the differences between prices in the U.S. and other countries for these drugs weren’t really that big, or how the prices here are actually the fault of PBMs, not his company. Was anybody able to follow this? It was super confusing, I will say, that he tried to …

First he says that, well, 80% of the people with insurance coverage can get these drugs for $25 a month or less, which I’m pretty sure only applies to people who are using it for diabetes, not for obesity, because I think most insurers aren’t covering it for obesity. And there was much backing and forthing about how much it costs and how much we pay and how much it would cost the country to actually allow people, everybody who’s eligible for these drugs, to use them. And no real response. I mean, this is a big-deal campaign issue, and yet I feel like this hearing was something of a bust.

Weber: I mean, do we really expect a CEO of a highly profitable drug to promise to reduce it immediately on the spot? I mean, I guess I’m not surprised that the hearing was a back-and-forth. From what I understand of what happened, I mean, most hearings with folks that have highly lucrative drugs, they’re not looking to give away pieces of the lucrative drugs. So I think to some extent we come back to that.

But I did think what was interesting about the hearing itself was that Sanders did confront him with promises from PBMs that they would be able to offer these drugs and not short the American consumer, which was actually a fascinating tactic on Sanders part. But again, what did we really walk away with? I’m not sure that we know.

Rovner: Yeah, I mean, even if you were interested in this issue — and I’m interested in this issue and I know this issue better than the average person, as I said —I literally could not follow it. I found it super frustrating. I mean, I know what Sanders was going for here. I just don’t feel like he got what he was hoping to. I don’t know. Maybe he was hoping to get the CEO to say, “We’ve been awful, and so many people need this drug, and we’re going to cut the price tomorrow.” And yes, you point out, Lauren, that did not happen. But we shall see.

Well, speaking of PBMs, the Federal Trade Commission late last week filed an administrative complaint against the nation’s three largest PBMs, accusing them of inflating insulin prices and steering patients toward higher-cost products so they, the PBMs, can make more money, which is, of course, the big problem with PBMs, which is that they get a piece of the action. So the more expensive the drug, the bigger the piece of the action that they get.

I was most interested in the fact that the FTC’s three Democratic appointees voted in favor of the legal action. Its two Republican appointees didn’t vote but actually recused themselves. This whole PBM issue is kind of awkward for Republicans who say they want to fight high drug prices, isn’t it? I feel like the whole PBM issue, which, as we said, is something that Congress in theory wants to get to during the lame-duck session, is tricky.

I mean, it’s less tricky for Democrats who can just demagogue it and a little bit more tricky for Republicans who tend to have more support from both the drug industry and the insurance industry and the PBM industry. How much can they say they want to fight high drug prices without irritating the people with whom they are allied?

Kenen: And the PBMs themselves are owned by insurers. The pharmaceutical drug pricing, it’s really, really, really confusing, right?

Rovner: Nobody understands it.

Kenen: The four of us, none of us cover pharma full time, but the four of us are all pretty sophisticated health care reporters. And if we had to take a final exam on the drug industry, none of us would probably get an A-plus. So I’d be surprised if they figure this out in lame duck. I mean, they could —there’s always the possibility that when they look at the outcome of things, they decide: We do need to cut a deal and get this off the plate. This is the best we’re going to get. We’re going to be in a worse position next month. And they do it.

But it just seems really sticky and complicated, and it doesn’t feel like it’s totally jelled yet to the point that they can move it. I would expect this to spill into next year. If a deal comes through, if a big budget deal comes through at the end of the year, it does have a lot of trade-offs and moving parts, and this could, in fact, get wrapped into it.

If I had to guess, I would say it’s more likely to spill into the following year, but maybe they’ve decided they’ve had enough and want to tie the bow on it and move on. And then it’ll go to court and we’ll spend the next year talking about the court fight against the PBM law. So it’s not going to be gone one way or another, and nor are high drug prices going to be gone one way or another.

Rovner: The issue that keeps on giving. Well, finally this week, a new entry in out This Week in Health Misinformation segment from, surprise, Florida. This is a story from my KFF Health News colleagues Arthur Allen, Daniel Chang, and Sam Whitehead. And the headline kind of says it all: “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation.”

This is the continuing saga involving the state surgeon general, Joseph Ladapo, who’s been talking down the mRNA covid vaccine for several years now and is recommending that people at high risk from covid not get the latest booster. What surprised me about this story, though, was how reluctant other health leaders in Florida, including the Florida Medical Association, have been to call the surgeon general out on this.

I guess to avoid angering his boss, Republican governor Ron DeSantis, who’s known to respond to criticism with retribution. Anybody else surprised by the lack of pushback to this there in Florida? Lauren?

Weber: No, I’m not really surprised. I mean, we’ve seen the same thing over and over and over again. I mean, this is the man who really didn’t make a push to vaccinate against measles when there was an outbreak. He has previously stated that seniors over 65 should not get an mRNA vaccine, with misinformation about DNA fragments. We’ve seen this pattern over and over again.

He is a bit of a rogue state public health officer in a crew that usually everyone else is on pretty much the same page, whether or not they’re red- or blue-state public health officers. And I think what’s interesting about this story and what continues to be interesting is as we see RFK [Robert F. Kennedy Jr.] gaining influence, obviously, in Trump’s potential health picks, you do wonder if this is a bit of a tryout. Although Ladapo is tied to DeSantis, who Trump obviously has feelings about. So who knows there. But it very clearly is the politicization of public health writ large.

Kenen: And DeSantis, during the beginning of the pandemic, he disagreed with the CDC [Centers for Disease Control and Prevention] guidelines about who should get vaccinated, but he did push them for older people. And I think that was his cutoff. If you’re 15 up, you should have them. He was quite negative from the start on under. Florida’s vaccination rates for the older population back when they rolled out in late 2020, early 2021, were not — they were fairly high. And there’s been a change of tone. As the political base became more anti-vax, so did the Florida state government.

Rovner: And obviously, Florida, full of older people who vote. So, I mean, super-important constituency there. Well, we will watch that space. All right, that is this week’s news. Now it is time for our extra credits. That’s when we each recommend a story we read this week we think you should read, too. Don’t worry if you miss the details. We will include links to all these stories in our show notes on your phone or other device. Joanne, why don’t you go first this week?

Kenen: Elaine Godfrey in the Atlantic has a story called “The Woo-Woo Caucus Meets,” and it’s about a four-hour summit on the Hill with RFK Jr., moderated by Senator Ron Johnson of Wisconsin, who also has some unconventional ideas about vaccination and public health. The writer called it the “crunch-ificiation of conservatism.”

It was the merging of the anti-vax pharma-skeptic left and the Trump right and RFK Jr. talking about MAHA, Making America Healthy Again, and his priorities for what he expects to be a leading figure in some capacity in a Trump administration fixing our health. It was a really fun — just a little bit of sarcasm in that story, but it was a good read.

Rovner: Yeah, and I would point out that this goes, I mean, back more than two decades, which is that the anti-vax movement has always been this combination of the far left and the far right.

Kenen: But it’s changed now. I mean, the medical liberty movement, medical freedom movement and the libertarian streak has changed. It started changing before covid, but it’s not the same as it was a few years ago. It’s much more conservative-dominated, or conservative-slash-libertarian-dominated.

Rovner: Alice.

Ollstein: I have an interesting story from Stat. It’s called “How Special Olympics Kickstarted the Push for Better Disability Data.” It’s about how the Special Olympics, which just happened, over the years have helped shine a light on just how many people with developmental and intellectual disabilities just aren’t getting the health care that they need and aren’t even getting recognized as having those disabilities.

And the data we’re using today comes from the Clinton administration still. It’s way out of date. So there have been improvements because of these programs like Healthy Athletes that have been launched around this, but it’s still nowhere near good enough. And so this was a really fascinating story on that front and on a population that’s really falling through the cracks.

Rovner: It really was. Lauren.

Weber: I actually picked an opinion piece in Stat that’s called, quote, “How the Next President Should Reform Medicare,” by Paul Ginsburg and Steve Lieberman. And I want to give a shoutout to my former colleague Fred Schulte, who basically has single-handedly revealed — and now, obviously, there’s been a lot of fall-on coverage — but he was really beating this drum first, how much Medicare Advantage is overbilling the government.

And Fred, through a lot of FOIAs [Freedom of Information Act requests] — and KFF has sued to get access to these documents — has shown that, through government audits, the government’s being charged billions and billions of dollars more than it should be to pay for Medicare Advantage, which was billed as better than Medicare and a free-market solution and so on. But the reality is …

Rovner: It was billed as cheaper than Medicare.

Weber: And billed as cheaper.

Rovner: Which it’s not.

Weber: It’s not. And this opinion piece is really fascinating because it says, look, no presidential candidate wants to talk about changing Medicare, because all the folks that want to vote usually have Medicare. But something that you really could do to reduce Medicare costs is getting a handle around these Medicare Advantage astronomical sums. And I just want to shout out Fred, because I really think this kind of opinion piece is possible due to his tireless coverage to really dig into what’s some really wonky stuff that reveals a lot of money.

Rovner: Yes, I feel like we don’t talk about Medicare Advantage enough, and we will change that at some point in the not-too-distant future. All right, well, my story is from KFF Health News from my colleague Noam Levey, along with Ames Alexander of the Charlotte Observer. It’s called “How North Carolina Made Its Hospitals Do Something About Medical Debt.”

Those of you who are regular listeners may remember back in August when we talked about the federal government approving North Carolina’s unique new program to have hospitals forgive medical debt in exchange for higher Medicaid payments. It turns out that getting that deal with the state hospitals was a lot harder than it looked, and this piece tells the story in pretty vivid detail about how it all eventually got done. It is quite the tale and well worth your time.

OK, that is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X. I’m @jrovner. Lauren, where are you?

Weber: I’m still on X @LaurenWeberHP.

Rovner: Alice?

Ollstein: On X at @AliceOllstein.

Rovner: Joanne?

Kenen: X @JoanneKenen and Threads @JoanneKenen1.

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

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KFF Health News' 'What the Health?': American Health Under Trump — Past, Present, and Future

Thu, 19 Sep 2024 18:50:00 +0000

The Host
Emmarie Huetteman KFF Health News @emmarieDC Emmarie Huetteman, senior editor, oversees a team of Washington reporters, as well as “Bill of the Month” and KFF Health News’ “What the Health?” She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy debates in Washington and on the campaign trail.
Recent comments from former President Donald Trump and Republican lawmakers preview potential health policy pursuits under a second Trump administration. Trump is yet again eyeing changes to the Affordable Care Act, while key lawmakers want to repeal Medicare drug price negotiations.

Also, this week brought news of the first publicly reported death attributed to delayed care under a state abortion ban. Vice President Kamala Harris said the death shows the consequences of Trump’s actions to block abortion access.

This week’s panelists are Emmarie Huetteman of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins University’s schools of nursing and public health, Tami Luhby of CNN, and Shefali Luthra of The 19th.

Panelists
Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Tami Luhby CNN @Luhby Read Tami's stories. Shefali Luthra The 19th @shefalil Read Shefali's stories.
Among the takeaways from this week’s episode:

Sen. JD Vance (R-Ohio), Trump’s running mate, says Trump is interested in loosening ACA rules to make cheaper policies available. While the campaign has said little about what Trump would do or how it would work, the changes could include eliminating protections against higher premiums for those with preexisting conditions. Republicans would also likely let enhanced subsidies for ACA premiums expire.

Key Republican lawmakers said this week that they’re interested in repealing the Inflation Reduction Act’s provisions enabling Medicare drug pricing negotiations. Should Trump win, that stance could create intraparty tensions with the former president, who has vowed to “take on Big Pharma.”

A state review board in Georgia ruled that the death in 2022 of a 28-year-old mother, after her doctors delayed performing a dilatation and curettage procedure, was preventable. Harris tied the death to Trump’s efforts to overturn Roe v. Wade, which included appointing three Supreme Court justices who voted to eliminate the constitutional right to an abortion.

And in health tech news, the FDA has separately green-lighted two new Apple product functions: an Apple Watch feature that assesses the wearer’s risk of sleep apnea, and an AirPods feature that turns the earbuds into hearing aids.

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

Emmarie Huetteman: The Washington Post’s “What Warning Labels Could Look Like on Your Favorite Foods,” by Lauren Weber and Rachel Roubein.

Shefali Luthra: KFF Health News’ “At Catholic Hospitals, a Mission of Charity Runs Up Against High Care Costs for Patients,” by Rachana Pradhan.

Tami Luhby: Politico Magazine’s “Doctors Are Leaving Conservative States To Learn To Perform Abortions. We Followed One,” by Alice Miranda Ollstein.

Joanne Kenen: The New York Times’ “This Chatbot Pulls People Away From Conspiracy Theories,” by Teddy Rosenbluth, and The Atlantic’s “When Fact-Checks Backfire,” by Jerusalem Demsas.

Also mentioned on this week’s podcast:

ProPublica’s “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable,” by Kavitha Surana.
Click to Open the Transcript Transcript: American Health Under Trump — Past, Present, and Future
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

Emmarie Huetteman: Hello, and welcome back to “What The Health?” I’m Emmarie Huetteman, a senior editor for KFF Health News and the regular editor on this podcast. I’m filling in for Julie this week, joined by some of the best and smartest health reporters in Washington. We’re taping on Thursday, September 19th, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go.

We’re joined today, by videoconference, by Tami Luhby of CNN.

Tami Luhby: Good morning.

Huetteman: Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Huetteman: And Joanne Kenan of Politico and Johns Hopkins University Schools of Nursing and Public Health.

Joanne Kenan: Hi everybody.

Huetteman: No interview this week, so let’s get right to the news, shall we? It’s big, it’s popular, and if Donald Trump reclaims the presidency, it could be on the chopping block again. Yes, I’m talking, of course, about the Affordable Care Act. Over the weekend, Senator JD Vance claimed that Trump had “protected Americans” insured under the ACA from “losing their health coverage.” Trump himself made a similar claim during the recent debate, where he also said he has the “concepts of a plan” for health reform. Vance, who is Trump’s running mate, suggested the GOP could loosen regulations to make cheaper policies available. But otherwise, the Trump campaign has not said much about what his administration might change.

Meanwhile, Vice President Kamala Harris has backed off her own plan to change the ACA. You may remember that when she was running for president in 2019, Harris embraced a “Medicare for All” plan. Now, Harris says she plans to build on the existing health system rather than replace it. So let’s talk about what Trump might do as president. What sort of changes could Trump implement to make policies cheaper, as Vance has suggested?

Luhby: Well, one of the things that Vance has talked about, when he talks about deregulating the market, giving people more choice of plans, it’s actually separating people, the healthier people and the sicker enrollees, into separate, different risk pools, which is what existed before the ACA. And that may be, actually, better for the healthy people. That might lower their premiums. But it would cause a lot of problems for sicker enrollees, those with chronic health conditions or serious illnesses, because they would see their premium skyrocket. And this is one of the reasons why health care was so unaffordable for many people prior to the ACA. So Vance says that he wants to protect people with preexisting conditions. That’s what everyone says. It’s a very popular and well-known provision of the ACA. But by separating people into different risk pools, it would actually hurt people with preexisting conditions, because it may make their health insurance unaffordable.

Kenan: The difference between pre-ACA and post-ACA is it might actually even be as bad or possibly worse for people with preexisting conditions. Right now, everybody’s in one unified risk pool, right? Whether you’re sick or healthy, your costs, more or less, get averaged out, and that’s how premiums are calculated. Before ACA, people with preexisting conditions just couldn’t get covered necessarily, or if they got covered, it was sky-high, the premiums. By doing what Tami just described, the people, presumably, in the riskiest pool, the sickest people, the insurers would have to offer them coverage. They couldn’t say, “No, you’re sick, you can’t have it,” because there’s guaranteed coverage. But it would be sky-high. So it would be de facto no insurance for most of those people unless the government were to subsidize them to a really high extent, which I didn’t hear JD Vance mention the other day.

Luthra: Right.

Luhby: And one of the other things that they talked about, more choice. I mean, one of the issues that a lot of people complained about in the ACA, early on, was that they didn’t want substance abuse coverage. There’s 10 health-essential benefits which every insurer has to cover — pregnancy, maternal care, et cetera. And 60-year-old men or even 60-year-old women said: Why am I paying for this? This is making my plan more expensive. But again, as Joanne said, it’s evening out the costs among everyone so that it’s making health care more affordable for everyone. And if you allow people to start picking and choosing what benefits they want covered, it’s going to make the plans more expensive for those who need the higher-cost care.

Luthra: Tami alluded to something that is really important, which is that these conditions we’re talking about are very common. A lot of people get pregnant, for example. A lot of people have chronic health conditions. We are not the healthiest country in the world. And so when you think about who would be affected by this, it’s quite a large number of Americans who would no longer be able to get affordable health coverage and a small group of people who probably would. Because, I mean, one thing that’s worth noting —right? — is even if you are healthy for a time, that’s a transient state. And you can be healthy when you are young and get older and suddenly have knee problems, and then things look very different.

Huetteman: It seems like if they use the exact words, “preexisting-condition protections,” and said they were trying to roll them back in order to make policies cheaper, that might be just a bad political move all around. Preexisting-condition protections are pretty popular, right?

Luhby: Yes, they certainly are. But that’s why they’re saying they’re going to continue it. But what’s also popular is choice. And that’s been one of the knocks against the Affordable Care Act, is that, while there are a lot of plans out there, they do have to conform to certain requirements, and therefore that gives people less choice. I mean, and remember, one of the things that we started by talking about, what a second Trump administration might look like for health care. One of the things the first Trump administration did is loosen the rules on short-term plans, which don’t have to conform to the ACA. And prior, they were available for a short time as a bridge between policies, but the Trump administration lengthened them to up to three years. And the goal of the Trump administration was that people would have more choice. They could pick skinnier plans that they felt would cover them. But they didn’t always realize that if they got into a car accident, if they were diagnosed with cancer, if something bad happened, they did not have all of the protections that ACA plans have.

Huetteman: Joanne, you have something to add.

Kenan: So the first thing is that they spent years and a lot of political capital trying and failing to repeal the ACA or to make major changes in the ACA. The reason it failed is because even then, when the ACA was sort of quasi-popular and there was a lot of controversy still, the preexisting-condition part was extremely popular. Since then, the ACA has become even more popular. What [former President Barack] Obama said when he was speaking to the Democratic National Committee convention the other night — remember that aside where he said, Hey, they don’t call it Obamacare anymore now that it’s popular. It is popular. You’ve even had Republican senators going on record saying it’s here to stay.

So major overhaul of it is, politically, not going to be popular. Plus, the Republicans, even if they capture the Senate, which is what most of the prognosticators are saying right now, it would be a small majority. If the Republicans have 51, 52, none of us know exactly what’s going to happen, because we’re in a rather rapidly changing political environment. But say the Republicans capture the Senate and say Trump is in the White House. They’re not going to have 60 votes. They’re not going to have anywhere near 60 votes. I’m not even sure if there was a way to do this under reconciliation, which would require 51. I’m not sure they have 51 votes. So and then if they do it through some kind of regulatory approach — which I think is harder to do, something this massive, but people find a way — then it ends up in court.

So I think it’s politically unfeasible, and I think it’s practically unfeasible. I think there are smaller things they could do to weaken it. I mean, they did last time, and coverage dropped under Trump, last time. I mean, they could not promote it. They could not market it. They could not have navigators helping people. There’s lots of things they could do to shrink it and damage it, but there’s a difference between denting something and having a frontal collision. And we’ve all seen Vance have to roll back other things that he’s predicted Trump would do, so this is very TBD.

Huetteman: One of the bigger issues with the ACA going into next year is these enhanced subsidies that Joe Biden implemented under the pandemic, that helped a lot of people pay for their premiums, will expire at the end of 2025. And depending on which party has control after this election, that could decide the fate of the subsidies. Joanne, you had something to add on this.

Kenan: That’s the big vulnerability. And it’s not so much, are they going to repeal it or define their concept of a plan? I mean, the subsidies are vulnerable because they expire without action, and they’re part of a larger debate that’s going to happen no matter who wins the presidency and no matter who wins Congress. It’s that a lot of the tax cuts expire in 2025. The subsidies are part of that tax, but many aspects of the tax bill are going to be a huge issue no matter who’s in charge.

The subsidies are vulnerable, right? Republicans think that they went too high. Basically those subsidies let more middle-class people with a higher income get ACA subsidies, so insurance is more affordable. And quite a few million people — Tami might remember how many, because I don’t — are getting subsidized this way. It’s not free. They don’t get the biggest subsidies as somebody who’s lower-income, but they are getting enough subsidies that we saw ACA enrollment go up. That is where the big political battle over the ACA is inevitable. I mean, that is going to happen no matter what else happens around aspects of repealing or redesigning or anything else. This is inevitable. They expire unless there’s action. There will be a fight.

Luhby: Yeah, these—

Kenan: And I don’t know how it’ll turn out, right?

Luhby: These subsidies were created as part of the American Rescue Plan in 2021 and were extended for two years as part of the Inflation Reduction Act, which the Republicans don’t like. And they have, as Joanne said, they’ve allowed more middle-class people to come in, and also, they’re more generous subsidies than in the past. Plus they’ve made policies free for a lot of lower-income people. Folks can get these policies without premiums. So enrollment has skyrocketed, in large part because of these subsidies. Now there are more than 20 million people enrolled. It’s a record. So the Biden administration would like to keep that intact, especially if Harris wins the presidency. But it will be a big fight in Congress next year, as part of the overall Tax Cuts and Jobs Act negotiations, and we’ll see what the Democrats might have to give up in order to retain the subsidies. The—

Kenan: It’s going to be, yeah.

Luhby: Enhanced subsidies.

Kenan: There are deals to be had with tax cuts versus subsidies, because these are large, sprawling bills with many moving parts. But it’s way too early to know if Republicans are willing to deal on this and what a deal would look like. We’re nowhere near there. But yeah, if you talk about ACA battles in 2025, that’s number one.

Huetteman: Well, speaking of health policies that are on the GOP agenda, some high-ranking Republican lawmakers are saying they want to repeal the Inflation Reduction Act if the party wins big in November, particularly the part that enables Medicare drug negotiations. You may recall their objections from when Congress passed the law two years ago. Republicans argue the negotiations harm innovation and amount to government price controls. But on the other hand, drug prices are an issue where Trump kind of sort of agrees with Democrats. He has promised to “take on Big Pharma.” Does this mean we could see a Republican Congress fighting with Trump over drug price negotiations?

Luhby: Well, he did have a lot of executive orders and a lot of efforts that were very un-Republican-like. One was called Most Favored Nation. He didn’t say that we should do negotiations. We were just going to piggyback on the negotiations done in other countries and get their lower prices. He didn’t really get very far in a lot of those measures, so it didn’t come to a fight with the Republican Congress. But he may leave the negotiation process alone, the next set of drugs, that’ll be 15 drugs, that, we’ll find out next year, that will be negotiated. So he could leave that alone. If he tries to expand it, yeah, he may have some problems with the Republican Congress. But as we’ve also seen, a Republican Congress has acquiesced to his demands in the past.

Huetteman: And Congress certainly has no shortage of battles teed up for 2025, of course. Speaking of, here we are again. Yesterday, in the House of Representatives, Democrats and Republicans joined together to defeat a stopgap spending bill that would’ve kept the government open. To be sure they didn’t have the same objections, Democrats opposed a Republican amendment that would impose new voter registration requirements about proving citizenship. And hard-right Republicans objected to the size of the temporary spending bill, $1.6 trillion. Trump weighed in on social media, calling on Republicans to oppose any government spending bill at all, unless it comes with a citizenship measure.

Now, Senate Republican leaders, in particular, are not thrilled about this. Here are the words of [Senate minority Leader] Mitch McConnell, who said it better than I can: “It would be politically beyond stupid for us to do that right before the election, because certainly, we’d get the blame” for that government shutdown. What happens now?

Kenan: Last-minute agreement, like, I feel. I used to cover the Hill full time. I no longer do, but it was, like, late nights standing in the hallway for a last-minute reprieve. At some point, they’re going to probably keep the government open, but with Trump’s demands and the citizenship proof of a life for voters and all that, it’s going to be really messy. Mike Johnson became speaker after a whole bunch of other speakers failed to keep the government open.

Huetteman: That’s right.

Kenan: Probation spell, we went through chaos, he has a small majority. He survived because the Democrats intervened on his behalf once, because of Ukraine. We have no idea the dynamics of — do the Democrats want to see complete chaos so the Republicans get blamed? Who knows? I don’t think it’s going to be a handshake tomorrow and Let’s do a deal. What they usually do is continue current spending levels and what they call a continuing resolution. So you keep status quo for one month, two months, three months, sometimes 10 months. The odds are, the government will stay open at some kind of a last-minute patchwork deal that nobody particularly likes, but that’s likely. I wouldn’t say that certain. Republicans have backed off shutting the government down for a while now, a couple of years.

Huetteman: It’s worth noting, though, that even this bill that they just voted down would’ve only kicked the can down to March. So we are still talking about something that the new Congress would have to deal with pretty quickly, even if we can get something done short-term. But we’ve got a lot of news today. So moving on to reproductive health news.

This week, Senate Republicans, again, blocked a bill that would’ve guaranteed access to in vitro fertilization nationwide. That federal bill would, of course, have overridden state laws that restrict access to the procedure. You may recall that Republicans also blocked that bill earlier this summer, describing it as a political show vote. And indeed, Democrats are trying to get Republicans on the record, opposing IVF, in order to draw contrast with the GOP before voters go to the polls. What do we think? Did Democrats succeed here in showing voters their lawmakers really think about IVF?

Luthra: I mean, realistically, yes, I think this is a very effective strategy for Democrats. If they could talk about abortion and IVF every day, all day, they would. We can look at Taylor Swift’s endorsement of Kamala Harris and [Minnesota Gov.] Tim Walz. She specifically mentions reproductive rights, and she mentions IVF in particular, noting that she thinks that these are the candidates who will support access to that fertility regimen. IVF is very popular, and it is obviously going to be a major battle, because it is the next frontier for the anti-abortion movement, and the Republican Party is allied very closely to this movement. Even if there have been more fractures emerging lately, I just don’t see how Republicans can find a way to make this a political winner for them, unless they figure out a way to change their tune, at least temporarily, without alienating that ally they have.

Huetteman: Absolutely. And meanwhile, speaking of the consequences of these actions on abortion lately, this week we learned of the first publicly reported death from delayed care under a state abortion ban. ProPublica reported the heart-wrenching story of a 28-year-old mother in Georgia who died in 2022 after her doctors held off on performing a D&C [dilation and curettage procedure]. Performing a D&C in Georgia is a felony, with a few exceptions. Sorry, this is difficult to talk about, especially if you or someone you know has needed a D&C, and that may be a lot of us, whether we know it or not.

Her name was Amber Thurman. Amber needed the D&C because she was suffering from a rare complication after taking the abortion pill. She developed a serious infection, and she died on the operating table. Georgia’s Maternal Mortality Review Committee determined that Amber Thurman’s death was preventable. ProPublica says at least one other woman has died from being unable to access illegal abortions and timely medical care. And as the story said, “There are almost certainly others.” On Tuesday, Vice President Harris said Amber’s death shows the consequences of Trump’s actions to block abortion access. How does this affect the national conversation about abortion? Does it change anything?

Luthra: I mean, it should, and I don’t think it’s that simple. And it’s tough, because, I mean, these stories are incredible pieces of journalism, and what they show us are that two women are dead because of abortion bans — and that there are almost certainly many more, because these deaths were in 2022, very soon after the Dobbs decision. And what has been really striking, at the same time, is that the anti-abortion movement has very clear talking points on these deaths. And they’re doing what we have seen them do, in so many cases, where women have almost lost their lives, and now, in these cases where they have, which is they blame the doctors. And they have been going out of their way to argue that, actually, the exceptions that exist in these laws are very clear, even though doctor after doctor will tell you they are not, and that it is the doctor’s fault for not providing care when there is very obviously an exception.

They are also arguing that this is further proof that medication abortion, which is responsible for the vast majority of abortions in this country, is unsafe, even though, as you noted and as these stories noted, the complications these women experienced are very rare and could be addressed and treated for and do not have to be fatal if you have access to health care and doctors who are not handcuffed by your state’s abortion laws. And so what I think happens then is this is something that should matter and that should change our conversation. And there are people talking about this and making clear that this is because of the reproductive health world that we live in, but I don’t think it will necessarily change the course of where we are headed, despite the fact that what abortion opponents are saying is not true and despite the fact that these abortion bans remain very unpopular.

Kenan: I think you can, and she said it really well, but I think in terms of, does it change minds? Think about the two bumper stickers, right? One is “Abortion bans kill,” and the other one is “The abortion pill kills.” And both of these women had medication abortions. Those side effects are very, very, very unusual, that dangerous side effects, are extremely unusual. There’s years of data, there’s like no drug on Earth that is a hundred percent, a thousand percent, a hundred thousand percent safe. So these were tragedies in which the women did develop severe life-threatening side effects, didn’t get the proper treatment. But think about your bumper stickers. I don’t think this changes a lot of minds.

Huetteman: All right. Well, unfortunately we will keep watching for this and more news on this subject. But in state news, Nevada will become the 18th state to use its Medicaid funds to cover abortions after a recent court ruling. While federal funds are generally barred from paying for abortions, states do have more flexibility to use their own Medicaid funds to cover the procedure. And, North Dakota’s abortion ban has been overturned, after a judge ruled that the state’s constitution protects a woman’s right to an abortion until the fetus is viable. But there’s a bigger challenge: The state has no abortion clinics left. We’ve talked a lot on this podcast about how overturning Roe has effectively created new, largely geographical classes of haves and have-nots, people who can access abortion care and people who can’t. It seems like the lesson out of North Dakota right now is that evening that playing field isn’t as simple as changing the law, yes?

Luthra: Absolutely. And this is something that we have seen even before Roe was overturned. I mean, an example that I think about a lot is Texas, which had had this very big abortion law passed in 2013, and it was litigated in the courts, was in and out of effect before it went to the Supreme Court and was largely struck down. But clinics closed in the meantime. And what that tells us is that when clinics close, they largely don’t reopen. It is very, very hard to open an abortion clinic. It is expensive. It can be dangerous because of harassment. You need to find providers. You need to build up a medical infrastructure that doesn’t exist. And we are seeing several states with ballot measures to try to undo abortion bans in their states — Florida, Missouri, Nebraska with their 12-week ban. We are seeing efforts across the country to try and restore access to these states.

But the question is exactly what you pointed out, which is there is a right in name and there is a right in practice. And for all the difficulties of creating a right in name, creating a right in practice is even harder. And there is just so much more that we will need to be following as journalists, and also as people who consume health care, to fully see what it takes for people to be able to get reproductive health care, including abortion, after they have lost it.

Huetteman: All right. And with fewer than 50 days left until Election Day and way fewer before early voting begins, a court in Nebraska has ruled that competing abortion rights measures can appear on the ballot there this fall. Two measures, one that would expand access and one that would restrict it, qualified for the ballot. Nebraska will be the first state to ask residents to vote on two opposing abortion ballot measures. Currently, the state bans abortion in most cases, starting at 12 weeks. There are at least nine other states with ballot measures to protect abortion rights this fall, but this one’s pretty unusual. What do we think? Will this be confusing to Nebraska voters?

Luthra: I mean, I imagine if I were a voter, I would be confused. Most people don’t follow the ins and outs of what’s on their ballot until you get close to Election Day and you are bombarded with advertisements. And I think this is really striking, because it is just part of, I guess, maybe not long, because this only happened two years ago, but part of a repeated pattern of abortion opponents trying to find different ways to get around the fact that ballot measures restoring abortion rights or protecting abortion rights largely win. And so how do you find a way around that? You can try and create confusion. You can try and raise the threshold for approval like they tried and failed to do in Ohio. You can, maybe in Nebraska this is more effective, put multiple measures on the ballot. You can try, as they tried and failed to do in Missouri, try and stop something from appearing on the ballot.

And I think this is just something that we need to watch and see. Is this the thing that finally sticks? Does this finally undercut efforts to use direct voting to restore abortion rights? Which we should also note is a strategy with an expiration date of sorts, because not every state allows for this direct democracy approach. And we’re actually hitting the end of the list of states very soon where this is a viable strategy.

Huetteman: And as we know, every state where a ballot measure has addressed this issue since Roe was overturned has fallen on the side of abortion rights, ultimately. It’ll be curious to see what happens here, where voters have both choices right before them.

Well, let’s wrap up with tech news this week. Are you wearing an Apple Watch right now? Or maybe you’re listening to us on AirPods? Well, that watch could soon tell you if you might have sleep apnea. Or, if you have trouble hearing, those earbuds could soon help you hear better. The FDA has given separate green lights to two new Apple product functions. One is an Apple Watch change that assesses the wearer’s risk of sleep apnea. And the FDA also authorized Apple AirPods as the first over-the-counter hearing-aid software, to assist those with mild to moderate hearing loss. Hearing aids can be pretty expensive, and some resist wearing them due to stigma or stubbornness. What does this mean for people with these conditions, and also about the possibilities for health tech?

Kenan: I mean, none of us are covering the FDA’s tech division full time or even much at all. So basically there’s been a trend toward sort of overlap with consumer and health products. Many of us have something on our wrists or something in our phone that is monitoring something or other, and there’s been some controversy about how accurate some of them are. My understanding with the sleep apnea thing, that it doesn’t actually diagnose it. It tracks your sleep patterns, and if it sees some red flags, it says: You might have sleep apnea. You should go see a doctor. That’s what I think that does.

Huetteman: That’s right.

Kenan: You’re asleep when you’re having sleep apnea. You don’t necessarily know what’s happening. So it’s arguably a useful thing that you have kind of an alert system. The hearing aids, it’s not just these. The FDA, a few months ago, authorized more over-the-counter hearing aids of various types, which have made them much cheaper and much more accessible. This is an advance, another category, another type to have people wearing earbuds anyway. I know people who have the over-the-counter hearing aids, and they are small and cheap, so that industry has really been disrupted by tech. So we are seeing not necessarily some of the sky-in-the-pie promises of health and tech from a few years ago but some useful things for consumers to either make things more accessible or affordable, like the earbuds — although I would lose them — or just a useful tool or a potentially useful tool, I don’t know how great the data is, saying ask your doctor about this. Sleep apnea is dangerous.

So my mom is about to turn 90, and we have a fall monitor on her watch that we actually pay for, an extra service, that they alert emergency. I was with her once when she fell. They called her and said, Are you okay? And she said, Yes, my daughter’s here and et cetera. Except, at 90, she still plays pingpong, doubles pingpong, not a lot of movement for 90 year olds, and it does get the fall monitor very confused. I think it’s been trained. So yeah, I mean, it’s not that expensive, and it’s great peace of mind. People would much rather have it on their watch, because young cool people wear smartwatches, than those buttons around their neck. I would’ve never gotten my mother to wear a button around her neck. So it’s part of a larger trend of tech becoming a health tool, and it’s not a panacea, but the affordability for over-the-counter hearing aids is a big deal.

Huetteman: Right, right. This is expanded access. If you’ve got this consumer product already in your pocket, on your wrist, in your ears, why not have it help with your health? We’ve already kind of adjusted, in many ways, to health tech. We had Fitbits. We’ve had things that have tracked our heart rates and that sort of thing, or even our phones can do that at this point. But hearing aids, in many cases for people who have mild or moderate hearing loss, they don’t even go for a hearing aid, because they don’t want to be stigmatized as being maybe a little older and being unable to hear, even if they might just muddle through. But if you’ve already got those AirPods in, because you’re going to take a call later, I mean, that’s pretty below the radar. You don’t have to feel too self-conscious about that one, so …

Kenan: Yeah, my mom would look cool, but she actually doesn’t need them, so that’s OK.

Huetteman: If she’s playing pingpong at her age, she already looks cool.

Kenan: She plays pingpong very slowly. I hope I’m doing the equivalent when I’m 90. I hope I’m 90, you know?

Huetteman: Hear, hear.

Kenan: You know.

Huetteman: OK, that’s this week’s news. Now it’s time for our extra credit segment. That’s when we each recommend a story we read this week that we think you should read, too. As always, don’t worry if you miss it. We’ll post the links in the podcast page at kffhealthnews.org and in our show notes, on your phone or other mobile device. Shefali, why don’t you go first this week?

Luthra: All right. My story is from KFF Health News by the great Rachana Pradhan. The headline is, “At Catholic Hospitals, a Mission of Charity Runs Up Against High Care Costs for Patients.” The story is one of my favorite genres of stories, which is stories about how everyone loves their hospital and their hospital is a business. And Rachana does a great job looking at the history of Catholic hospitals and the extent to which they were founded as these beacons of charitable care meant to improve the community. But actually, when you look at where Catholic hospitals are now — and Catholic hospitals have really proliferated in the past several years — they look a lot like businesses and a lot less like charities. There’s some fascinating patient stories and also analyses in here, showing that Catholic hospitals are less likely than other nonprofit hospitals to treat Medicaid patients. They are great at going after patients for unpaid medical bills, including suing them, garnishing wages, reporting them to credit bureaus. It’s really great. It’s the exact kind of journalism that I think we need more of, and I love this story, and I hope others do, too.

Huetteman: Excellent. It is a great piece of journalism. We hope everyone will take some time to read it. Tami, why don’t you go?

Luhby: OK. My extra credit is an in-depth piece by one of our very own, Alice Miranda Ollstein of Politico, and it’s titled, “Doctors Are Leaving Conservative States to Perform Abortions. We Followed One.” So Alice followed a doctor who spent a month in Delaware learning how to perform abortions, because she couldn’t obtain that training in her home state, across the country. Alice notes that Politico granted the doctor anonymity due to her fear of professional repercussions and the threat of physical violence for seeking abortion training, which is concerning to hear. While many stories have written about states’ abortion bans, Alice’s piece provides a different perspective. She writes about the lengths the doctors must go to obtain training in the procedure and the negative effects that the overturning of Roe has had on medical education.

The doctor she profiled spent nearly two years searching for a position where she could obtain this training, before landing at Delaware’s Planned Parenthood. It cost nearly $8,000. The doctor had to pull together grants and scholarships in order to cover the costs. Alice walked readers through the doctor’s training in both surgical and medical abortions and through her ethical and medical thoughts after seeing — and this is one thing that stuck with me in the story — what’s called the “products of conception” on a little tray. So the story is very moving, and it’s well worth your time.

Huetteman: Absolutely. And the more detail we can get about what these sorts of procedures and this training looks like for doctors, the better we understand what we’re actually talking about when we’re talking about these abortion bans and other restrictions on reproductive health. Joanne, why don’t you talk to us about your extra credit this week?

Luthra: OK. There’s a piece in the New York Times by Teddy Rosenbluth called “This Chatbot Pulls People Away from Conspiracy Theories.” And there’s also a related podcast at the Atlantic called, by Jerusalem Demsas, “When Fact-Checks Backfire.” They’re both about the same piece of research that appeared in Science. Basically, debunking, or fact-checking, has not really worked very well in pulling people away from misinformation and conspiracy theories. There had been some research suggesting that if you try to debunk something, it was the backfire effect, that you actually made it stick more. That doesn’t always happen. There’s sort of some people that it does and some people it doesn’t — that’s beginning to be understood more.

And what this study, the Times reported on and the Atlantic podcast discussed, is using AI, because we all think that AI is going to be generating more disinformation, but AI is also going to be fighting disinformation. And this is an example of it, where the people in this study had a dialogue, a written, typed-in dialogue, where the chatbot that gave a bespoke response to conspiracy beliefs, including vaccines and other public health things. And that these individually tailored, back-and-forth dialogue, with an AI bot, actually made about 20% of the people, which is, in this field, a lot, drop their or modify their beliefs or drop their conspiracy beliefs. And that it stuck. It wasn’t just because some of these fact-checks work for like a week or two. These, they checked in with people two months later and the changes in their thinking had stuck. So it’s not a solution to disinformation and conspiracy belief, but it is a fairly significant arrow to new techniques and more research to how to debunk it better without a backfire effect.

Huetteman: That’s great. Thanks for sharing those. All right. My extra credit this week comes from two of our podcast pals at The Washington Post, Lauren Weber and Rachel Roubein. The headline is, “What Warning Labels Could Look Like on Your Favorite Foods.” They report that the FDA is considering labeling food to identify when they have a high saturated fat content, sodium, sugar, those sorts of things that we should all be paying attention to on nutrition labels. But their proposal falls short, critics say. It’s not quite as good, they say, at identifying the health risk factors of certain amounts of sodium and sugar in our food, especially compared to other countries.

They do an extensive study on Chile’s food labeling, in fact. And if you’re like me and you buy a lot of your groceries for your household and you try to look at the nutrition labels, you might be surprised by some of the items the article identifies as being particularly high in sodium, like Cheerios. Bad news for my family this morning.

All right, that’s our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review. That helps other people find us, too. Special thanks, as always, to our amazing engineer, Francis Ying. And as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you could try tweeting me. I’m lurking on X, @emmarieDC. Shefali.

Luthra: I’m @shefalil.

Huetteman: Joanne.

Kenan: @JoanneKenen on Twitter, @joanneKenen1 on Threads.

Huetteman: And Tami.

Luhby: Best place to find me is cnn.com.

Huetteman: We’ll be back in your feed next week. Until then, be healthy.

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Silence in Sikeston: Hush, Fix Your Face

Cara Anthony — Tue, 17 Sep 2024 09:00:00 +0000

SIKESTON, Mo. — For residents of Sikeston, as for Black Americans around the country, speaking openly about experiences with racial violence can be taboo and, in some cases, forbidden.

As a child, Larry McClellon’s mother told him not to ask too many questions about the 1942 lynching of Cleo Wright in their hometown of Sikeston. McClellon, now an outspoken activist, wants his community to acknowledge the city’s painful past, as well as the racism and violence.

“They do not want to talk about that subject,” McClellon said. “That’s a hush-hush.”

Also in this episode, host Cara Anthony uncovers details of a police killing in her own family. Anthony unpacks her family’s story with Aiesha Lee, a licensed professional counselor and an assistant professor at Penn State.

“This pain has compounded over generations,” Lee said. “We’re going to have to deconstruct it or heal it over generations.”

Host
Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.
In Conversation With …
Aiesha Lee Assistant professor of counselor education, Penn State click to open the transcript Transcript: Hush, Fix Your Face
Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Cara Anthony: A lynching isn’t an isolated, singular act.

The violence — and the silence around it — was a deliberate, community-wide lesson meant to be passed on.

And passed down.

[BEAT]

Cara Anthony: In Sikeston, Missouri, a 25-year-old soon-to-be father named Cleo Wright was lynched by a white mob.

It happened in 1942. But you didn’t have to be there, or even born yet, to get the message.

Larry McClellon: I grew up here in Sikeston, Missouri. My age … 77.

Cara Anthony: That’s community elder Larry McClellon.

He was born two years after Cleo Wright’s body was dragged across the railroad tracks to the Black side of town.

Larry McClellon: Back in the old days, when dark comes, you don’t want to be caught over here after 6 o’clock. You want to be on this side of the tracks.

I didn’t cross the line. Because I knew what was waiting. I knew what time it was here in Sikeston, Missouri.

[BEAT]

Cara Anthony: I’m Cara Anthony. I’m a journalist. I’ve been visiting Sikeston for years to work on a documentary film and podcast about the lynching of Cleo Wright.

And the police killing in 2020 of another young, Black father, Denzel Taylor.

Larry McClellon: All these Black men are getting shot down, losing their life.

Cara Anthony: Cleo and Denzel, killed some 80 years apart. In the same city.

Larry McClellon: They do not want to talk about that subject. That’s a hush-hush.

Cara Anthony: In this episode of the podcast, we’re exploring how that “hush” hurts the community. And the way it hurts people’s health.

Here’s an example: Larry says it’s hard to feel safe in your hometown when Black men are killed and nearly everyone looks the other way.

Growing up, Larry had a lot of questions about Cleo.

Larry McClellon: I used to ask Mom. You know, “What is this with this man that supposedly, uh, got lynched?” And she told me, “Hey, you stay away from that. … Don’t you be asking no questions about Cleo Wright because that was just a no-no.”

Cara Anthony: Why was that a no-no?

Larry McClellon: Because she’s afraid for me that they would probably take me out and do something to me. Maybe bodily harm or something like that.

Cara Anthony: “They” being white neighbors.

Despite those lessons, Larry became an outspoken activist for racial justice and police reform in Sikeston. He founded an organization here called And Justice for All.

Being vocal has come at a price, he says.

Larry McClellon: Somebody called me and said, “Uh, Mr. Larry, your building is on fire.”

So, I didn’t even really hang the phone up real good. I just jumped up and come up the highway.

Cara Anthony: It was April 2019 — Larry rushed to the headquarters of And Justice for All.

Larry McClellon: I could see the flame was high as anything in Sikeston, might as well say. So, I gets up there and, uh, fire burning. So, all the fire department get out there pouring water and everything.

Cara Anthony: The building was a total loss.

Larry McClellon: The building was set on fire. That’s what, that’s what happened.

Who would come in and destroy something like that?

Cara Anthony: The police report says it was arson, but nothing really came of the investigation. Larry suspects it was a targeted attack — retaliation for his activism, for speaking out. Retaliation that could continue.

Larry McClellon: I got 4 acres over there. A lot of trees and so forth. And some of my own people, they make jokes out of it sometime, like, “Man, you going to be hanging from one of those trees down there, or somebody’s going to set over in those bushes with a high-powered rifle and going to shoot you when you walk out the door or shoot you when you pull up.”

Cara Anthony: And still, Larry’s decided he’s not going to hold his tongue.

Because keeping quiet causes its own trouble, its own hurt and pain.

This is “Silence in Sikeston.” The podcast all about finding the words to say the things that go unsaid.

From WORLD Channel and KFF Health News and distributed by PRX.

Episode 2: “Hush, Fix Your Face.”

[BEAT]

Cara Anthony: Larry’s keeping on with his work in Sikeston. But all those warnings from his mother decades ago to keep quiet about Cleo’s lynching left a mark.

I called up Aiesha Lee to talk about this. She’s a licensed mental health professional and also an assistant professor at Penn State.

One of the first things she wanted me to know is that silence has been used as a tool of systemic oppression in America for a very long time.

Aiesha Lee says lynching — and the community terror it caused — was part of a wider effort to impose white supremacy.

Aiesha Lee: This is a design. Let me be clear, this is, it was very much designed for us to be these subservient, submissive people who do not ask questions, who do not say anything, and just do as they’re told.

Cara Anthony: One of Aiesha’s areas of expertise is how racism can impact physical and mental health — across generations. She sees signs of it in her clients every day.

Aiesha Lee: No one actually comes in and says, “Hey, I’m dealing with intergenerational trauma. Can you help me?” Right?

Cara Anthony: I will have to admit, I’ve been very skeptical about that term, what that means, because, in my family, it was always this thing of like, “We’re good over here. Everything’s OK.”

Aiesha Lee: I love what you just said. And, and for me, as a mental [health] professional, I get really cautious when using, even using the word “trauma.”

Part of the, the generational legacy of Black families is we don’t talk about our problems, we just kind of roll through them, we deal with them, we’re strong, and we just keep it moving forward, right?

It’s protection. It is “Let me teach you the ways of the world according to us” or for us, right? And for us, we need to keep our mouth shut. We can’t ask any questions. We can’t make any noise, because if we do, you’re going to get the same, or worse than, you know, others.

Cara Anthony: My parents. Grandparents. My great-grandparents. Their experiences with racial violence — and what they had to do to stay safe — shaped me.

Stuffing down injustice and pain is a tried-and-true way to cope. But Aiesha says holding hurt in hurts.

Aiesha Lee: It’s almost like every time we’re silent, it’s like a little pinprick that we, we do to our bodies internally.

Cara Anthony: She says over time those wounds add up.

Aiesha Lee: After so long, um, those little pinpricks turn up as heart disease, as cancer, as, you know, all these other ailments.

Cara Anthony: Feeling unsafe, being that vigilant all the time. What can that do to someone’s body?

Aiesha Lee: Imagine every time you walk out of the door, you’re tightening your body, you’re tensing up your body, right? And you’re holding on to it for the entire day until you come home at night. What do we think would happen to our bodies as a result?

Cara Anthony: A study from UCLA found experiences with racism and discrimination correlated with higher levels of inflammation in the bodies of Black and Hispanic people. It affected their immune system, their gut.

Aiesha says always being on edge can rewire how the brain deals with stress.

Aiesha Lee: That’s what that hypervigilance does. That hypervigilance causes our bodies to tense up so that we can’t fully breathe.

Cara Anthony: Yeah, that’s exhausting. And as you were talking about it, like, I even feel my body just being tight as you are speaking about these things.

Cara Anthony: If you don’t deal with the emotional stuff, Aiesha says, it can live in your body.

Aiesha Lee: Arthritis, fibromyalgia, high blood pressure …

Cara Anthony: … and ripple through families as intergenerational trauma.

That makes me wonder about my dad’s high blood pressure.

My mom’s chronic pain.

About my own trouble sleeping.

[BEAT]

Cara Anthony: Despite endless conversations with my parents about this work — somehow, I was months and months into reporting on racial violence in Sikeston before I learned new details about a death in my own family.

Wilbon Anthony: I enjoy reading about history where, you know, my people come from.

Cara Anthony: My dad, Wilbon Anthony, knew the story for nearly a decade, but kept it to himself.

Really, I shouldn’t have been surprised. My whole life I was taught in big and small ways that usually it’s better to stay silent.

There’s a risk — to self — when you speak out.

I’m 37 years old — plenty grown now — but it feels like the “adults” have always tiptoed around the story of Leemon Anthony, my great-uncle on my father’s side.

Leemon served in the military during World War II. Family members remember him as fun-loving and outgoing.

I was told that Leemon died in a wagon-and-mule accident in 1946. But at family reunions, sometimes I’d overhear details that were different.

Wilbon Anthony: There was a hint there was something to do with it about the police, but it wasn’t much.

Cara Anthony: My dad knew that the stories he’d heard about Uncle Leemon’s death were incomplete. That missing piece left him feeling undone.

Wilbon Anthony: Later in life, I started researching it. I just thought about it one day and, uh, just said, “Oh, see if it was something about this.”

Cara Anthony: He called up family members, dug through newspaper archives online, and searched ancestry websites. Eventually, he found Leemon’s death certificate.

To show me what he found, Dad and I sat in his home office. He pulled up the death certificate on his computer. Leemon was 29.

Wilbon Anthony: It says, “Shot by police, resisting arrest.”

Well, no one ever, I never heard this in my, uh, whole life.

Then item 21, it lists the causes of death: accident or suicide or homicide, and the list says that item is homicide.

Cara Anthony: OK, OK, um, that’s a lot. I need to pause.

[BEAT]

Cara Anthony: Shot by police.

Even now, I only have bits and pieces of the story, mostly from whispers from my family.

There was a wagon accident.

One of my older cousins says a local white woman saw it and called the police. An article published in The Jackson Sun quoted Leemon’s father saying that Leemon had been “restless” and “all out of shape” since he returned home from the war.

What we do know is that the police showed up. And they killed Leemon.

[BEAT]

Cara Anthony: When I learned about my Uncle Leemon’s death, when I got slammed by that grief and anger, I called my Aunt B — my dad’s sister Bernice Spann — and told her what my dad had found.

Cara Anthony: OK, I just sent you the death certificate, um, just so you can …

Bernice Spann: What does it say, his death, how he died?

Cara Anthony: It says homicide, and that he was shot by the police.

Bernice Spann: Wow.

Cara Anthony: Yeah. Yeah.

Bernice Spann: And they said “homicide”?

Cara Anthony: Right.

Bernice Spann: And nobody was charged?

Cara Anthony: No charges.

So, what are you thinking right now?

Bernice Spann: I’m heartbroken.

Cara Anthony: Yeah. Yeah.

Bernice Spann: I mean, that’s close. That is not … it’s an uncle.

Cara Anthony: That’s your uncle. That’s my great-uncle. That’s your uncle. Yeah.

Bernice Spann: Well, that’s my uncle. And he died and nobody fought.

Cara Anthony: Yeah.

Bernice Spann: Nobody fought for a resolution ’cause nobody … everybody felt powerless.

Cara Anthony: Even now there’s so much silence in our family around Leemon’s death.

Bernice Spann: I think there’s something in our DNA that still makes us scared to talk about it. I need for us to look at it. I don’t know. Does it make sense? And maybe you’re the one who, it’s time for you to look at it.

Cara Anthony: So, that’s what I’m doing.

[BEAT]

Cara Anthony: This storytelling — this journalism — is about what’s at stake for our health, and our community, and loved ones when we’re silent in the face of racial violence — and the systemic racism that allows it to exist.

So on one reporting trip to Sikeston, I asked my family to take the ride with me.

We loaded into a van.

[Cara’s mom hums in the background.]

And during the drive from Illinois to southeastern Missouri, my mom hummed hymns, while my daughter, Lily, napped and inhaled snacks.

Cotton is still king in Sikeston. It’s a huge part of the town’s economy, and culture, and history. So just before we got to town, we stopped at a cotton field.

[Car door shuts.]

Cara Anthony: OK, Lily, come here.

Cara Anthony: Lily was just 5 back then.

Cara Anthony: What is this? What are we looking at right now?

Lily: Cotton.

Cara Anthony: Lily was excited, but when I turned around, my dad, Wilbon, looked watchful.

Wary.

As for lots of Black Americans, cotton’s a part of our family’s history.

Cara Anthony: OK, Dad. Come over here. So, Dad, Lily just said that cotton looks like cotton candy and potatoes ’cause it looks fluffy. When you look out at this field, what do you see?

Wilbon Anthony: Well, I see. First, I see a lot of memories. I remember … picking cotton as a kid. Actually, I can remember waiting on my parents while they were in the fields picking cotton. And then I remember a lot of days of hard work.

So, yeah, I … yeah, I have a lot, a lot of memories about cotton.

Cara Anthony: My mom has memories, too. As a little girl in Tennessee, around Lily’s age, my mom was already working in a field like this.

Days and days hunched over. Carrying heavy bales, working until her hands were sore.

My mom’s still in grief about the violence and punishing labor — and lost opportunity — so tightly woven into all this cotton.

As a child, she hid that pain. She’d lie face down in the dirt when the school bus drove past, hoping the other kids wouldn’t see.

[BEAT]

Cara Anthony: Standing in that cotton — three generations together — I worried I was dredging up old wounds or causing new hurt.

Still, I want to try to have these conversations without passing the pain and stress down to the next generation — to my daughter.

Cara Anthony: Why did we come down here to Sikeston?

Lily: Because there’s important work here.

Cara Anthony: Yeah, there is important work here.

[BEAT]

Cara Anthony: Someday I need to tell Lily about lynching in America. About Cleo Wright and our Uncle Leemon. I want her to know their names. I need to tell Lily about her personal risk of encountering that kind of violence.

But, truthfully, I’m not quite ready yet.

Here’s some advice I got from Aiesha Lee.

Aiesha Lee: This pain has compounded over generations, and so we’re going to have to deconstruct it or heal it over generations, right? And so, you know, our generation and the generations that come behind us will have little pieces of the work to do.

[BEAT]

As we put mental health more so at the forefront, and as we start to communicate more and more within our families, that’s how we engage in, in this healing.

Cara Anthony: I was told to keep quiet a lot when I was a kid, but I want to nurture Lily’s curiosity and teach her what she needs to know to stay safe.

My parents did what they thought was best. Now it’s my turn to try to find that balance.

Sometimes when Lily’s jumpy and restless, having a hard time falling asleep, we’ll sing together.

Cara Anthony and Lily [singing]: Hush. Hush, hush, somebody’s calling my name. Hush, hush, somebody’s calling my name.

Cara Anthony: At first listen, that might sound like a message to stay silent.

Actually, it’s a song enslaved people sang as they worked in cotton fields. As they dreamed and planned. It’s a call to be acknowledged. Named. And counted.

Lily has grown up a lot since we visited that cotton field in Sikeston. She’s 7 now. I want her to know that she can speak out more freely than her ancestors could.

More than I have.

Cara Anthony: Sit over, come over here. Come over here. Seriously. Do you remember a couple of weeks ago when you were crying? And I told you to fix your what?

Lily: Face.

Cara Anthony: That wasn’t very nice. I want you to know that we can talk about things. Because when we talk about things, we often feel better, right?

Lily: Yes.

Cara Anthony: Can we keep talking to each other while you grow up in life about stuff? Even hard stuff?

Lily: Like doing 100 math facts?

Cara Anthony: Sure. That’s the biggest thing in your life right now. But yes, all of that. We’re just going to keep talking to each other. So, can we make a promise?

Lily: Yeah.

Cara Anthony: All right, cool.

Cara Anthony: Talking just might help us start to heal.

[BEAT]

Cara Anthony: Next time on “Silence in Sikeston” …

Mikela Jackson: The Bootheel knows what happened to him. The world — they have no idea who Denzel Taylor is.

CREDITS

Cara Anthony: Thanks for listening to “Silence in Sikeston.”

Next, go watch the documentary. It’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.

The audio series was reported and hosted by me, Cara Anthony.

Zach Dyer and Taylor Cook are the producers.

Editing by Simone Popperl.

Taunya English is the managing editor of the podcast.

Sound design, mixing, and original music by Lonnie Ro.

Podcast art design by Colin Mahoney and Tania Castro-Daunais.

Oona Zenda was the lead on the landing page design.

Julio Ricardo Varela consulted on the script.

Sending a shoutout to my vocal coach, Viki Merrick, for helping me tap into my voice.

Music in this episode is from BlueDot Sessions and Epidemic Sound.

Some of the audio you’ll hear across the podcast is also in the film.

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin, who worked with us and colleagues from Retro Report.

Kyra Darnton is executive producer at Retro Report.

I was a producer on the film.

Jill Rosenbaum directed the documentary.

Kytja Weir is national editor at KFF Health News.

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.

If “Silence in Sikeston” has been meaningful to you, help us get the word out!

Write a review or give us a quick rating on Apple, Spotify, Amazon Music, iHeart, or wherever you listen to this podcast. It shows the powers that be that this is the kind of journalism you want.

Thank you. It makes a difference.

Oh, yeah, and tell your friends in real life, too!

Credits
Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer @lonnielibrary Lonnie Ro is an audio engineer and composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.
Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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No One Wants To Talk About Racial Trauma. Why My Family Broke Our Silence.

Cara Anthony — Fri, 13 Sep 2024 09:00:00 +0000

SIKESTON, Mo. — I wasn’t sure if visiting a cotton field was a good idea. Almost everyone in my family was antsy when we pulled up to the sea of white.

The cotton was beautiful but soggy. An autumn rain had drenched the dirt before we arrived, our shoes sinking into the ground with each step. I felt like a stranger to the soil.

My daughter, Lily, then 5, happily touched a cotton boll for the first time. She said it looked like mashed potatoes. My dad posed for a few photos while I tried to take it all in. We were standing there — three generations strong — on the edge of a cotton field 150 miles away from home and decades removed from our own past. I hoped this was an opportunity for us to understand our story.

As a journalist, I cover the ways racism — including the violence that can come with it — can impact our health. For the past few years, I’ve been working on a documentary film and podcast called “Silence in Sikeston.” The project is about two killings that happened decades apart in this Missouri city: a lynching in 1942 of a young Black man named Cleo Wright and a 2020 police shooting of another young Black man, Denzel Taylor. My reporting explored the trauma that festered in the silence around their killings.

While I interviewed Black families to learn more about the effect of these violent acts on this rural community of 16,000, I couldn’t stop thinking about my own family. Yet I didn’t know just how much of our story, and the silence surrounding it, echoed Sikeston’s trauma. My father revealed our family’s secret only after I delved into this reporting.

My daughter was too young to understand our family’s past. I was still trying to understand it, too. Instead of trying to explain it right away, I took everyone to a cotton field.

Cotton is complicated. White people got rich off cotton while my ancestors received nothing for their enslaved labor. My grandparents then worked hard in those fields for little money so we wouldn’t have to do the same. But my dad still smiled when he posed for a picture that day in the field.

“I see a lot of memories,” he said.

I’m the first generation to never live on a farm. Many Black Americans share that experience, having fled the South during the Great Migration of the last century. Our family left rural Tennessee for cities in the Midwest, but we rarely talked about it. Most of my cousins had seen cotton fields only in movies, never in real life. Our parents worked hard to keep things that way.

At the field that day, my mom never left the van. She didn’t need to see the cotton up close. She was around Lily’s age when her grandfather taught her how to pick cotton. He had a third-grade education and owned more than 100 acres in western Tennessee. Sometimes she had to stay home from school to help work that land while her peers were in class. She would watch the school bus pass by the field.

“I would just hide, lying underneath the cotton stalks, laying as close to the ground as I could, trying to make sure that no one would see me,” my mom said. “It was very embarrassing.”

She didn’t talk to me about that part of her life until we traveled to Sikeston. Our trip to the cotton field opened the door to a conversation that wasn’t easy but was necessary. My reporting sparked similar hard conversations with my dad.

As a child, I overheard adults in my family as they discussed racism and the art of holding their tongues when a white person mistreated them. On my mother’s side of the family, when we’d gather for the holidays, aunts and uncles discussed cross-burnings in the South and in the Midwest. Even in the 1990s, someone placed a burning cross outside a school in Dubuque, Iowa, where one of my relatives served as the city’s first Black principal.

On my father’s side of the family, I heard stories about a relative who died young, my great-uncle Leemon Anthony. For most of my dad’s life, people had said my great-uncle died in a wagon-and-mule accident.

“There was a hint there was something to do with it about the police,” my dad told me recently. “But it wasn’t much.”

So, years ago, my dad decided to investigate.

He called up family members, dug through online newspaper archives, and searched ancestry websites. Eventually, he found Leemon’s death certificate. But for more than a decade, he kept what he found to himself — until I started telling him about the stories from Sikeston.

“It says ‘shot by police,’ ‘resisting arrest,’” my dad explained to me in his home office as we looked at the death certificate. “I never heard this in my whole life. I thought he died in an accident.”

Leemon’s death in 1946 was listed as a homicide and the officers involved weren’t charged with any crime. Every detail mirrored modern-day police shootings and lynchings from the past.

This young Black man — whom my family remembered as fun-loving, outgoing, and handsome — was killed without any court trial, as Taylor was when police shot him and Wright was when a mob lynched him in Sikeston. Even if the men were guilty of the crimes that prompted the confrontations, those allegations would not have triggered the death penalty.

At a hearing in 1946, a police officer said that he shot my uncle in self-defense after Leemon took the officer’s gun away from him three times during a fight, according to a Jackson Sun newspaper article my dad found. In the article, my great-grandfather said that Leemon had been “restless,” “absent minded,” and “all out of shape” since he returned home from serving overseas in the Army during World War II.

Before I could ask any questions, my dad’s phone rang. While he looked to see who was calling, I tried to gather my thoughts. I was overwhelmed by the details.

My dad later gently reminded me that Leemon’s story wasn’t unique. “A lot of us have had these incidents in our families,” he said.

Our conversation took place when activists around the world were speaking out about racial violence, shouting names, and protesting for change. But no one had done that for my uncle. A painful piece of my family’s story had been filed away, silenced. My dad seemed to be the only one holding space for my great-uncle Leemon — a name that was no longer spoken. Yet my dad was doing it alone.

It seems like something we should have discussed as a family. I wondered how it shaped his view of the world and whether he saw himself in Leemon. I felt a sense of grief that was hard to process.

So, as part of my reporting on Sikeston, I spoke to Aiesha Lee, a licensed counselor and Penn State University assistant professor who studies intergenerational trauma.

“This pain has compounded over generations,” Lee said. “We’re going to have to deconstruct it or heal it over generations.”

Lee said that when Black families like mine and those in Sikeston talk about our wounds, it represents the first step toward healing. Not doing so, she said, can lead to mental and physical health problems.

In my family, breaking our silence feels scary. As a society, we’re still learning how to talk about the anxiety, stress, shame, and fear that come from the heavy burden of systemic racism. We all have a responsibility to confront it — not just Black families. I wish we didn’t have to deal with racism, but, in the meantime, my family has decided not to suffer in silence.

On that same trip to the cotton field, I introduced my dad to the families I’d interviewed in Sikeston. They talked to him about Cleo and Denzel. He talked to them about Leemon, too.

I wasn’t thinking about my great-uncle when I first packed my bags for rural Missouri to tell the stories about other Black families. But my dad was holding on to Leemon’s story. By keeping the file — and finally sharing it with me — he was making sure his uncle was remembered. Now I say each of their names: Cleo Wright. Denzel Taylor. Leemon Anthony.

The “Silence in Sikeston” podcast from KFF Health News and GBH’s WORLD is available on all major streaming platforms. A documentary film from KFF Health News, Retro Report, and GBH’s WORLD will air at 8 p.m. ET on Sept. 16 on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app. Preview the trailer for the film and the podcast. More details about “Silence in Sikeston.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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