{"id":2429,"date":"2024-02-20T23:37:45","date_gmt":"2024-02-20T23:37:45","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2429"},"modified":"2024-02-20T23:37:46","modified_gmt":"2024-02-20T23:37:46","slug":"biden-wins-early-court-test-for-medicare-drug-negotiations","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2429","title":{"rendered":"Biden Wins Early Court Test for Medicare Drug Negotiations"},"content":{"rendered":"

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\n\t\tThe Host\t<\/h3>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n
\t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n
A federal judge in Texas has turned back the first challenge to the nascent Medicare prescription-drug negotiation program. But the case turned on a technicality, and drugmakers have many more lawsuits in the pipeline.<\/p>\n
Meanwhile, Congress is approaching yet another funding deadline, and doctors hope the next funding bill will cancel the Medicare pay cut that took effect in January.<\/p>\n
This week\u2019s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Lauren Weber of The Washington Post.<\/p>\n

\n\t\tPanelists\t<\/h3>\n
\tAlice Miranda Ollstein
\n\tPolitico<\/p>\n
\t\t\t
\n\t\t\t\t@AliceOllstein\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Alice’s stories.\t\t\t<\/a><\/p>\n
\tRachel Cohrs
\n\tStat News<\/p>\n
\t\t\t
\n\t\t\t\t@rachelcohrs\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Rachel’s stories.\t\t\t<\/a><\/p>\n
\tLauren Weber
\n\tThe Washington Post<\/p>\n
\t\t\t
\n\t\t\t\t@LaurenWeberHP\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Lauren’s stories.\t\t\t<\/a><\/p>\n
Among the takeaways from this week\u2019s episode:<\/p>\n
\n
Rep. Cathy McMorris Rodgers (R-Wash.), chair of the powerful House Energy and Commerce Committee, announced she would retire at the end of the congressional session, setting off a scramble to chair a panel with significant oversight of Medicare, Medicaid, and the U.S. Public Health Service. McMorris Rodgers is one of several Republicans with significant health expertise to announce their departures.<\/li>\n
As Congress\u2019 next spending bill deadline approaches, lobbyists for hospitals are feverishly trying to prevent a Medicare provision on \u201csite-neutral\u201d payments from being attached.<\/li>\n
In abortion news, anti-abortion groups are joining the call for states to better outline when life and health exceptions to abortion bans can be legally permissible.<\/li>\n
Senate Finance Chairman Ron Wyden (D-Ore.) is asking the Federal Trade Commission and the Securities and Exchange Commission to investigate a company that collected location data from patients at 600 Planned Parenthood sites and sold it to anti-abortion groups.<\/li>\n
And in \u201cThis Week in Health Misinformation\u201d: Lawmakers in Wyoming<\/a> and Montana<\/a> float bills to let people avoid getting blood transfusions from donors who have been vaccinated against covid-19.<\/li>\n<\/ul>\n
Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n
Julie Rovner:<\/strong> Stateline\u2019s \u201cGovernment Can Erase Your Medical Debt for Pennies on the Dollar \u2014 And Some Are<\/a>,\u201d by Anna Claire Vollers.<\/p>\n
Alice Miranda Ollstein: <\/strong>Politico\u2019s \u201c\u2018There Was a Lot of Anxiety\u2019: Florida\u2019s Immigration Crackdown Is Causing Patients to Skip Care<\/a>,\u201d by Arek Sarkissian.<\/p>\n
Rachel Cohrs:<\/strong> Stat\u2019s \u201cFTC Doubles Down in Welsh Carson Anesthesia Case to Limit Private Equity\u2019s Physician Buyouts<\/a>,\u201d by Bob Herman. And Modern Healthcare\u2019s \u201c Private Equity Medicare Advantage Investment Slumps: Report<\/a>,\u201d by Nona Tepper.<\/p>\n
Lauren Weber:<\/strong> The Wall Street Journal\u2019s \u201cClimate Change Has Hit Home Insurance. Is Health Insurance Next?<\/a>\u201d by Yusuf Khan.<\/p>\n
Also mentioned on this week\u2019s podcast:<\/p>\n
\t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript: Biden Wins Early Court Test for Medicare Drug Negotiations\t\t\t\t<\/p>\n
KFF Health News\u2019 \u2018What the Health?\u2019<\/strong>Episode Title:<\/strong> Biden Wins Early Court Test for Medicare Drug NegotiationsEpisode Number:<\/strong> 334Published:<\/strong> Feb. 15, 2024<\/p>\n
[Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em><\/p>\n
Julie Rovner:<\/strong> Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, Feb. 15, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.<\/p>\n
We are joined today via video conference by Alice Miranda Ollstein of Politico.<\/p>\n
Alice Miranda<\/strong> Ollstein:<\/strong> Good morning.<\/p>\n
Rovner:<\/strong> Lauren Weber of The Washington Post.<\/p>\n
Lauren Weber:<\/strong> Hello, hello.<\/p>\n
Rovner:<\/strong> And Rachel Cohrs of Stat News.<\/p>\n
Rachel Cohrs:<\/strong> Hi everyone.<\/p>\n
Rovner:<\/strong> No interview this week, but we do have a special Valentine\u2019s Day surprise. But first, the news. We\u2019re going to start this week in federal district court, where the drug industry has lost its first legal challenge to the Biden administration\u2019s Medicare drug price negotiation program, although on a technicality. Rachel, which case was this, and now what happens?<\/p>\n
Cohrs:<\/strong> This was the capital \u201cP\u201d PhRMA trade association. And this case was a little bit of a stretch, anyways, because they were trying to find some way to get a judge in Texas to hear it. Because the broader strategy is for companies and trade groups to spread out across the country and try to get conflicting decisions from these lower courts.<\/p>\n
Rovner:<\/strong> Which would force the Supreme Court to take it?<\/p>\n
Cohrs:<\/strong> Exactly, yes. Or make it more likely. So PhRMA, in this case, they had recruited, there\u2019s a national group that represents infusion centers and that was headquartered in Texas. The judge ultimately ended up ruling that this association didn\u2019t follow the right procedure to qualify for judicial review and threw them off the case. And then they were like, well, if you throw them off the case, then there\u2019s nobody in Texas, you can\u2019t hear this here. So that was the ultimate decision there, but this could come back up. It was dismissed without prejudice. So this isn\u2019t the end of the road for this lawsuit.<\/p>\n
And it\u2019s important to keep in mind that this wasn\u2019t a ruling on any of the substance of the arguments. And trade groups generally are going to have less of an argument for standing, or it\u2019s going to be a harder argument than the companies themselves that actually have drugs up for negotiation.<\/p>\n
Rovner:<\/strong> And they\u2019re suing too, the drug companies?<\/p>\n
Cohrs:<\/strong> They are suing too. Yeah, just for everybody to keep on your calendars, there\u2019s a judge in New Jersey who is hoping to have a quadruple oral argument on four of these cases, so stay tuned. That could be coming early next month. But these are very much moving. I think we are going to get insight on some of these arguments pretty soon, but this case is not quite that test case yet.<\/p>\n
Rovner:<\/strong> All right, well, we\u2019ll get to it eventually. Well, moving on to Capitol Hill. When we were taping last week, Sen. Bernie Sanders was holding his much-publicized hearing to grill drug company CEOs about their too-high prices. Rachel, you were there. Did anything significant happen?<\/p>\n
Cohrs:<\/strong> I think it was kind of expected. I don\u2019t think we were trying to find any innovative legislative solutions here. Honestly, it seemed, just from a candid take, that a lot of these lawmakers were not very well-prepared for questioning. There were a couple of notable exceptions, but we didn\u2019t learn a whole lot new about why drug prices are high in the United States, how our system works differently from other countries.<\/p>\n
I did find some useful nuggets in the CEO\u2019s testimony about how low the net prices are for some of their medications, that they\u2019re already offering a 70% discount, a 90% discount, which to me just kind of put into perspective some of the discounts we could be hearing in the Medicare negotiation program. That oh, even if it\u2019s a 90% discount, that might not even be different from what they\u2019re paying now. So just interesting to file a way for the future, but I think it was mostly a non-event for the CEOs who, for some reason, had to, under the threat of subpoena, come make these arguments. So it seemed like much ado about not a whole lot of substance.<\/p>\n
Rovner:<\/strong> That was sort of my theory going in, but you always have to watch just in case. Well, also on Capitol Hill, the chairman of the powerful House Energy and Commerce Committee announced she will retire at the end of the Congress. Cathy McMorris Rodgers, who\u2019s a Republican from Washington, was in her first term as chair of the committee that oversees parts of Medicare, all of Medicaid, as well as the entire U.S. Public Health Service.<\/p>\n
I imagine this is going to set off a good bit of jockeying to take her place. And why would somebody step down early from such a powerful position? Do we have any idea?<\/p>\n
Cohrs:<\/strong> Have you seen \u2026? Oh, go ahead.<\/p>\n
Ollstein:<\/strong> Facing Congress is what you say? Yes. This is part of a wave of retirements we\u2019ve been seeing recently, including from some other committee chairs who could have theoretically continued to be powerful committee chairs for several years to come. People are taking this as part of the bad sign for Republicans. Either a sign that they don\u2019t believe they\u2019re going to hold the majority after this November\u2019s election, or they\u2019re just so fed up with the struggles they\u2019ve had governing over the last few years and the inability to get anything done. And people are thinking, well, maybe I can get something done in a different role, not in Congress, because certainly, we\u2019re not doing too much here to be proud of.<\/p>\n
Rovner:<\/strong> Yeah, I feel like Cathy McMorris Rodgers is kind of this poster child for a very conservative Republican who\u2019s not the far-right-wing MAGA type, who actually wants to do legislation. She just wants to do Republican legislation, and that seems to be getting harder in the House.<\/p>\n
Ollstein:<\/strong> Right, right. And there\u2019s a concern that, particularly on the right within Republicans, that we\u2019re losing a health policy brain trust. We\u2019re losing the people that have been really integral to a lot of the nitty-gritty policy work over the years, and they\u2019re not being replaced with people who have that interest. They\u2019re being replaced with people who are more focused on culture wars and other things. And so there\u2019s concern in the future about the ability to cobble together things like Medicare reimbursement rates, or these technical things that aren\u2019t really part of the culture wars.<\/p>\n
Rovner:<\/strong> Yeah, I think we mentioned at some point that Mike Burgess is also retiring, also high up on the Energy and Commerce Committee. And he\u2019s a doctor who\u2019s really had his hands into some of this really nerdy stuff, like on Medicare physician reimbursement. And that will be obviously just a big loss of institutional memory there.<\/p>\n
Cohrs:<\/strong> For the future of the committee, I know congressman Brett Guthrie has kind of thrown his hat in the ring to succeed her. Unclear who exactly is going to win this race, but he is the chairman of the health subcommittee, does bring some health expertise. So the E&C committee deals with a lot of different priorities, but if he were to succeed her, then I think we would see, at least at the top of the committee, some of the expertise remain.<\/p>\n
Rovner:<\/strong> Well, meanwhile, in all of this jockeying, the next round of temporary government funding bills expires on March 1 and March 8, respectively, which is getting pretty close. And that brings back efforts to cancel the 3.4% pay cut that doctors got for Medicare patients in January. Where are we on funding, and are any of these health issues that people are out lobbying on going to make it into this next round? Is there going to be a next round?<\/p>\n
Cohrs:<\/strong> Yeah, we don\u2019t know if there\u2019s going to be a next round, I don\u2019t think. But at least the sources I\u2019ve talked to have said that a full cancellation of the 3.4% cut for Medicare or payments to doctors is off the table at this point. They are hoping to do some sort of partial relief. They haven\u2019t decided on percentages for that yet. And it\u2019s unclear how much money will be available from pay-fors. It is still very much squishy, not finalized, two, three weeks out from the deadline, but I think \u2026<\/p>\n
Rovner:<\/strong> Two weeks.<\/p>\n
Cohrs:<\/strong> There is some agreement on some relief, which has not been the case thus far for doctors. So I think that\u2019s a positive sign.<\/p>\n
Ollstein:<\/strong> Yeah. Overall, the chatter is about the need for yet another CR [continuing resolution] because the work is not getting done in time to meet these deadlines. That seems to be where we\u2019re headed. Obviously, that will piss off a lot of members on the right who don\u2019t want another CR, who didn\u2019t want the last couple CRs. And so once again, we are staring down a possible shutdown.<\/p>\n
Rovner:<\/strong> And I had forgotten, somebody reminded me, that even if they get another temporary funding bill, starting in April, there are automatic cuts if they\u2019re not finished with this year\u2019s funding bills. Which, I don\u2019t know, is there any indication that they\u2019re going to be finished with them by April either? I have not seen a lot of progress here. They\u2019ve been fighting over other things, which is fine to fight over other things, but I\u2019m not noticing a lot happening on the spending bills.<\/p>\n
I\u2019m seeing a lot of shaking heads. I guess nobody else is noticing either. Well, we will obviously keep watching that<\/em> space because next week, we will only be one week away.<\/p>\n
Well, another Medicare policy that supporters are hoping to get into one or another of these spending bills is creating something called more site-neutral payments in Medicare. Currently, Medicare pays hospitals and hospital outpatient departments, and sometimes even hospital-owned physician practices, more than it pays non-hospital affiliated providers for the exact same service.<\/p>\n
The theory is that hospitals need higher payments because they have higher fixed costs, like keeping emergency rooms open 24\/7. But it costs Medicare many billions of taxpayer dollars for this differential in payments. And this has become quite the lobbying frenzy for the hospital industry, yes?<\/p>\n
Cohrs:<\/strong> Yes. I think it\u2019s something that they can all get on board with hating, and I think they view it similarly to the drug pricing debate as a slippery slope. The policy Congress really is looking at now is a $3 billion, very small slice of all the services that could potentially be subjected to site-neutral payments. But the whole pie here is $150 billion potentially for Medicare.<\/p>\n
We\u2019re talking hundreds of billions of dollars for commercial payments. So I think they are really pushing to get to lawmakers, especially, from what I\u2019ve talked to Senate Republicans, they are just not on board with it, they\u2019re worried about the rural hospitals. And if they can connect to those things, which they have been successful in doing so far, they\u2019re just not going to get very far.<\/p>\n
I mean, if you look at the Senate Finance Committee, you have Mike Crapo from Idaho, Republican leadership. You have [John] Barrasso from Wyoming. There\u2019s really just so many rural states that even Chuck Grassley, who is a moderate on a lot of health policy issues, talked about his rural hospitals in Iowa as soon as I asked him about this. So they\u2019re not there yet right now, but I think hospitals are trying to keep it that way.<\/p>\n
Rovner:<\/strong> And it was ever thus that the Senate is much more rural-focused than the House because pretty much every single senator has at least part of a rural area that they represent. Lauren, you wanted to add something?<\/p>\n
Weber:<\/strong> Yeah, I just wanted to say, I always find it funny when rural hospitals come up as a cudgel by the big hospital associations, who don\u2019t seem to look out for them the vast majority of the time when they\u2019re closing. But as you pointed out, the Senate is much more rural-focused. So I do agree with all of you all, that I question whether or not this will have much ground to gain.<\/p>\n
Rovner:<\/strong> Yeah. And the other thing that I keep wanting to point out is that there\u2019s all this talk on Capitol Hill among Republicans of cutting the spending bills, the appropriations, and we\u2019re going to balance the budget. Well, there\u2019s just not enough money in the appropriation bills to do anything to the deficit. The money is in things like Medicare. I mean, that\u2019s where, if you really want to make a dent in the deficit, you\u2019re going to do it. And, as we\u2019re seeing with this particular fight, every time they want to do something that\u2019s going to save money, it\u2019s going to hurt somebody. And I mean, there are obviously legitimate concerns about rural hospitals that are in trouble, particularly in states that haven\u2019t expanded Medicaid, but that\u2019s one of the reasons. It\u2019s not so much the spending bills that make it hard to do anything about the deficit. It\u2019s fights like these.<\/p>\n
Meanwhile, for better or worse, another reason that Medicare costs so much is that it\u2019s subject to a lot of fraud. Lauren, I have seen a lot of Medicare fraud stories over the years, but you\u2019ve got one that was discovered in a pretty novel way. So tell us about it.<\/p>\n
Weber:<\/strong> Yeah, my colleagues Dan Diamond, Dan Keating, and I found out early last week \u2014 we got a tip from the National Association of ACOs [Accountable Care Organizations] saying that they had seen this massive spike in catheter billing. When we did some digging into the companies they had identified \u2014 and to be clear, that spike of catheter billing was worth an alleged $2 billion in billings to Medicare. So when we talk about site-neutral payments, that\u2019s almost what you would get for site-neutral payments: the $2 billion in Medicare fraud, but regardless.<\/p>\n
So my colleagues and I dug in<\/a>. So Dan, Dan, and I called around, and we found links between the seven companies that were charging Medicare for catheters that folks never received. I want to point out, I spoke to this lovely woman in Ponta Vedra Beach, Florida. She\u2019s 74, Aileen Hatcher, who spotted this diligently going through her Medicare form, but as she said, she went to her \u2014 literally, these are her words \u2014 she\u2019s like, \u201cI went to my old lady luncheon and told them all this was on my Medicare statement.\u201d And they said, \u201cOh, we don\u2019t read those because we don\u2019t pay Medicare the money. So we don\u2019t read the explanation of benefits to see what we\u2019ve been charged.\u201d<\/p>\n
And, unfortunately, I think that is what happens a lot of times with Medicare fraud. It goes unnoticed because folks aren\u2019t the ones paying the dollars. But the bottom line is this was so large and so many people called into Medicare that Dan and I discovered that there is an ongoing federal investigation. Three of the companies, former owners that I called, confirmed to me that FBI had interviewed them or was talking to them about these folks that had taken over the companies and started charging Medicare this much money. And Dan also got some sources on that front as well.<\/p>\n
So, I mean, it\u2019s a pretty massive Medicare fraud scheme. I\u2019ll give a call-out here. If anyone here has been affected by catheter and Medicare fraud, please give me an email. We\u2019d love to hear more. I think it speaks to the fact that Medicare fraud \u2014 we all know this because we cover this \u2014 Medicare fraud is as old as time. It continues to happen, especially durable medical equipment Medicare fraud. But this is so much money. And it is wild that even though we talked to so many people that called Medicare over and over and over again, these folks were able to get away with billing for a very long time.<\/p>\n
Rovner:<\/strong> What I found really fascinating about the story, though, is that it was the doctors in the ACOs that spotted it because \u2014 we\u2019ve talked about these accountable care organizations \u2014 they\u2019re accountable for how much it costs to take care of their patients.<\/p>\n
The patients aren\u2019t paying for it, as they point out, but these doctors, it\u2019s coming right out of their bonuses and what they\u2019re charged and how much they get for Medicare. So there\u2019s finally somebody with a real incentive to spot this kind of fraud, because, basically, it was taking money from them. Right?<\/p>\n
Weber:<\/strong> That\u2019s exactly right. I think that\u2019s why they were so hot to have some movement on this because, as they pointed out, they could lose millions of dollars in bonuses for better taking care of their patients.<\/p>\n
It\u2019s wild that it gets to this point. Like I said, we had all these people that called in to Medicare and many fraud lawyers we talked to said, \u201cLook, why aren\u2019t the NPIs [National Provider Identifiers] turned off?\u201d Great question.<\/p>\n
Rovner:<\/strong> Yeah. Anyway, I was fascinated by this story, and as I told Lauren earlier, I\u2019m not a big fan of Medicare fraud stories just because there are so many of them. But this one is like, oh, maybe we finally have somebody \u2026 the ACOs can become bounty hunters for Medicare fraud, which would not be a bad thing.<\/p>\n
All right, well, moving on to abortion this week, we have spent a lot of time talking about how doctors who perform abortions and patients who need them in emergencies have been trying to get state officials to spell out when the exceptions to state bans apply. Well, now it seems that it\u2019s the other side looking for clarification.<\/p>\n
Stat News reports that several anti-abortion groups have joined doctors and patients in urging the Texas Medical Board to spell out which conditions would qualify for the exception to the ban, and not subject doctors who guess wrong to potential prison terms and loss of their medical licenses.<\/p>\n
Meanwhile, legislation moving through the House in South Dakota, endorsed by multiple anti-abortion groups, would require the state to make a video explaining how its ban works and under what circumstances. Alice, what\u2019s going on here?<\/p>\n
Ollstein:<\/strong> I think it\u2019s this interesting confluence and it\u2019s an interesting development because, at first, anti-abortion groups were insisting that the laws were perfectly clear. And that doctors were either willfully or mistakenly misinterpreting them. As more and more stories came forward of women being turned away while experiencing a medical emergency and suffering harm as a result, a lot of those women are part of lawsuits now.<\/p>\n
They were saying the law is fine. In some cases, these anti-abortion groups wrote the laws themselves or advised on them saying, your interpretation is what\u2019s wrong. The law is fine. But I think as so many of these stories are coming out, that\u2019s not proving enough. And now they\u2019re going back and saying, OK, well, maybe there do need to be some clarifications. They don\u2019t want changes. There\u2019s different camps because some people do want changes. Some people say, OK, we need more exceptions. We need more carve-outs to avoid these painful stories. Whereas other anti-abortion forces and elected officials say, no, we don\u2019t need to change the law. We just need to clarify it and explain it. And so I think that\u2019s going to be an ongoing tension.<\/p>\n
Rovner:<\/strong> Yeah, I know one of the big themes earlier in this whole fight \u2014 I won\u2019t say earlier this year, it was mostly last year \u2014 was redefining things as not abortions. That if you\u2019re terminating an ectopic pregnancy, that\u2019s not an abortion. Well, that is<\/em> an abortion.<\/p>\n
Ollstein:<\/strong> Medically, yes.<\/p>\n
Rovner:<\/strong> So apparently, the \u2026 right. The renaming has not worked so far. So now I guess they\u2019re trying to clarify things. Lauren, you wanted to add something?<\/p>\n
Weber:<\/strong> Yeah, I just wanted to say, when you kick things to the medical board, I think people see that as an unbiased unpolitical organization. But medical boards are often appointed by the governor. So, in this case, Gov. [Greg] Abbott. And also take Ohio, for example: I believe that one of their medical board leaders is the head of the right-to-life movement.<\/p>\n
I haven\u2019t looked at Texas\u2019. But kicking it to the medical board to make a decision \u2014 putting aside the fact that most medical boards are incredibly inadequate at their actual job, which is disciplining doctors, they\u2019re not necessarily known for their competence \u2014 is that you also deal with some of the politics involved in this as well.<\/p>\n
Rovner:<\/strong> So in South Dakota, it would kick this to the South Dakota Department of Health, which, of course, is controlled by the governor, who\u2019s a Republican and pro-lifer. And so it\u2019s hard to imagine what sort of doing a video explaining this is going to do to clarify things any further than they already think the law has gone. But at least \u2026 I\u2019m fascinated by the effort here, that this is going on in multiple states. Speaking of state legislators, in Missouri, they\u2019re working on a bill to create an abortion ban exception for children 12 and under \u2014 obviously thinking of the 10-year-old in Ohio in 2022 [who] had to go to Indiana to get a pregnancy terminated. But one Republican state senator complained that \u201ca 1-year-old could get an abortion under this.\u201d This is a serious question: Should legislators have to pass a basic biology test to make laws about reproductive health? As we know, 1-year-olds cannot get pregnant.<\/p>\n
Ollstein:<\/strong> I mean, this was a more glaring example. We see this over and over in a lot more subtle ways, too, where doctors and medical societies are pointing out that these laws are drafted using language that is not medically accurate at all. And it can be small things in terms of when someone should qualify for a medical exemption to an abortion ban. Some states have language around if it would cause \u201cirreversible damage.\u201d That\u2019s not a term doctors use in that circumstance, things like that. Or a major bodily function would be impaired if they don\u2019t get an abortion. Well, what is a major bodily function? That\u2019s not defined. And so, yes, this was an almost laughable example of this, but I think that it\u2019s a sign of something more pervasive and maybe less obvious.<\/p>\n
Rovner:<\/strong> Yeah, I mean, I have listened to a lot of state debates with a lot of legislators saying things that are, as I say, kind of laughably inaccurate. Sorry, Lauren.<\/p>\n
Weber:<\/strong> Oh, I would just say as a Missourian and as someone who lived in Missouri until a year ago, this gentleman, in particular, it does seem like has a history of making somewhat inflammatory statements that he knows will be picked up by the media. I mean, I think he brought a flamethrower to an event. I mean, I think that\u2019s part of the shtick. But welcome to Missouri politics. You never know what you\u2019re going to get.<\/p>\n
Ollstein:<\/strong> And of course, we have the famous assertion that people can\u2019t get pregnant as a result of rape because the body knows how to shut it down, which is obviously not \u2026<\/p>\n
Rovner:<\/strong> Which happened in a Missouri Senate race.<\/p>\n
Ollstein:<\/strong> Yes. Yep. Exactly. So Missouri, once again, covering itself in glory.<\/p>\n
Rovner:<\/strong> All right, well, something we haven\u2019t talked about a lot recently are crisis pregnancy centers, which are usually storefronts for anti-abortion organizations that often lure women seeking abortions by offering free pregnancy tests and ultrasounds so that they can then talk them into carrying their pregnancies to term. The centers are getting more and more public support from states. One estimate is that government support totaled some $344 million in fiscal 2022. So that was a couple of years back. And increasingly as abortion clinics close in states with bans, crisis pregnancy centers, which typically don\u2019t have medical professionals on staff and aren\u2019t technically medical facilities, may be the only resource available to pregnant women. It seems that could have some pretty serious ramifications. Yes?<\/p>\n
Ollstein:<\/strong> I mean, I think people don\u2019t realize just how vast the network of these centers are. They outnumber abortion clinics by a lot in a lot of states, including states that support abortion rights. They\u2019re very, very pervasive. And this is becoming a huge focus for the anti-abortion movement. It was basically the theme of this year\u2019s March for Life, was these sort of resources. In part, it is an attempt to show a kinder face of the movement and change public opinion. Obviously, like we discussed, there are all these painful stories coming out about people being denied care. And so promoting these stories of places that provide some form of something, some services, it\u2019s not necessarily medical care, but \u2026<\/p>\n
Rovner:<\/strong> They provide diapers and strollers and car seats. I mean, they do actually \u2026 many of them actually provide services for babies once they\u2019re born.<\/p>\n
Ollstein:<\/strong> Right. Right, right, right. And so I think there is going to be a huge focus on this in the policy space, both in terms of directing more taxpayer funding to these centers, which progressives vehemently oppose.<\/p>\n
And so I think this is going to be a big focus going forward. It already has in Texas. Texas has directed a lot of money towards what they call alternatives to abortion, which include these centers. And so I think it\u2019s going to be a big focus going forward.<\/p>\n
Rovner:<\/strong> Well, one other thing about crisis pregnancy centers, because they are not medical facilities, they are not subject to HIPAA medical privacy rules. And it turns out that is important. According to an investigation by Senate Finance Committee Chairman Ron Wyden, a company gathered and sold location data for people whose phones were in or around 600 separate Planned Parenthood locations, without the patients\u2019 consent, to use an anti-abortion advertising.<\/p>\n
Wyden is asking the SEC and the FTC to investigate the company, but this raises broader questions about information privacy, particularly in the reproductive health space. I remember right after Roe v. Wade<\/em> was overturned, there were lots of warnings to women who were using period-tracking apps and other things about the concern about people who you may not want to know your private medical situation being able to find out your private medical situations. Is there any indication that there\u2019s any way from the federal government point of view to crack down on this?<\/p>\n
Ollstein:<\/strong> So I don\u2019t know about that specifically, but there is a bigger effort on privacy and digital privacy and how it relates to abortion. We\u2019re still waiting on the release of the final HIPAA rule from the Biden administration, which will extend more protections around abortion data, I think. But, because it\u2019s HIPAA, it does only apply to certain entities and these centers are not among them. Another area I\u2019ve been hearing concern about is research. A researcher at a university who is studying people who have abortions or don\u2019t have abortions, their data is not protected. And so they are very stressed out about that, and that\u2019s compromising medical research right now. So there\u2019s a lot of these different areas of concern. And as we so often see, technology evolves a hell of a lot faster than government evolves to regulate it and address it. And that is just an ongoing concern.<\/p>\n
Rovner:<\/strong> Yes, it is. And at some point, we\u2019ll talk about artificial intelligence, but not today. Actually, right now, I want to turn to the Super Bowl. Yes, the Super Bowl. In between all the ads for blockbuster movies, beer, cars, and snack foods, and, right, a football game, there were three ads aimed directly at health policy issues.<\/p>\n
In one, the nonprofit price transparency advocacy group Power to the Patients<\/a> got musicians Jelly Roll, Lainey Wilson, and Valerie June to basically call hospitals and insurance companies greedy. It\u2019s not clear to me if this was a free PSA or if this group paid for it, but I suspect the latter.<\/p>\n
Does anybody know who this group is? They seem to have lots of access to big names for what seems to be a kind of obscure health issue. I mean, everybody\u2019s for transparency, but I don\u2019t think I\u2019ve ever seen a Super Bowl ad about it.<\/p>\n
Cohrs:<\/strong> This is not their first Super Bowl. It\u2019s backed by Cynthia Fisher who is married to the CEO of Sam Adams, parent company. And he\u2019s also a member of the Koch family. But she has been passionate about health care price transparency for years. I mean, was in President [Donald] Trump\u2019s ear, has made the legal argument that the authority existed under the Affordable Care Act. Lobbied to get these regulations passed. And she has definitely employed unusual or unorthodox techniques, like Super Bowl ads, like painting murals, like hosting parties and concerts for health staff and health policy people in D.C. And I think she\u2019s also lobbying for the codification of these transparency regulations.<\/p>\n
And it is a little wonky, but I think her frustration is that she lobbied so hard to get these price transparency regulations and everyday people don\u2019t even know that it should be available for them. And obviously academics disagree over how useful that information is for everyday people. But I think she has just taken it upon herself to do the PR campaign for these regulations that she believes could help people make more educated decisions about care that isn\u2019t necessarily emergency care, like MRIs, that kind of thing. So she\u2019s been around for years and has been very active.<\/p>\n
I think Fat Joe is another celebrity that she\u2019s brought onto the case. Jelly Roll \u2014 I hadn\u2019t seen him do an event with her before or an ad. But I think there\u2019s an ever-expanding cast of celebrities where this is just \u2026 it seems like a pretty noncontroversial issue. So I mean, Busta Rhymes, like French Montana, there\u2019s been a lot of people involved in this campaign and I expect it to be ongoing.<\/p>\n
Rovner:<\/strong> I feel like she\u2019s kind of the Mark Cuban of price transparency, where Mark Cuban is all into drug prices. Alice, you want to add something?<\/p>\n
Ollstein:<\/strong> Well, it\u2019s just funny to me because, as we\u2019ve discussed many, many times on this podcast, transparency goes not very far in helping actual patients. And so it\u2019s funny that a group called Power to the Patients is going all in on this issue when, as we know, the vast majority of health care people need they cannot shop around for and, even when they can, it\u2019s not something people are always able or willing to do.<\/p>\n
And so transparency gets a lot of bipartisan support and sounds good in theory, but we\u2019ve seen in terms of what\u2019s been implemented so far in terms of hospital prices, et cetera, that it doesn\u2019t do that much to bring down prices or empower people.<\/p>\n
Rovner:<\/strong> Although, I don\u2019t know, getting famous people to care about health policy can\u2019t be a terrible thing. Lauren, did you want to add something too?<\/p>\n
Weber:<\/strong> No, I just wanted to say, I mean, I will say as much as we\u2019re all clear on price transparency, what this all means, the Super Bowl is a new audience. So, I mean, if you\u2019re going to spend your money, at least you\u2019re spending it \u2014 and that was the most watched TV program, I believe, of all time \u2014 so you\u2019re spending it in a way that you\u2019re getting some eyeballs on it.<\/p>\n
Rovner:<\/strong> All right, well, that was not the only ad. Next, a company that clearly did pay for its ad was Pfizer<\/a>, which used a soundtrack by Queen and talking paintings and statues to celebrate science and declare war on cancer. This is also one I don\u2019t think I had seen before. I mean, what is Pfizer up to here? I mean, obviously, Pfizer can afford a Super Bowl ad. There\u2019s no question about that, but why would they want to?<\/p>\n
Cohrs:<\/strong> I mean, Pfizer has not been performing great financially lately. And I think they pulled out of the lobbying organization biome and chose to spend money on a Super Bowl ad, which I think is a really interesting choice. I mean, I don\u2019t know what the dues are, but a Super Bowl ad is an expensive thing.<\/p>\n
And I think there has been this attack on science, as a whole, and I think there\u2019s an outstanding question of how to rebuild trust. And I think that this was Pfizer\u2019s unorthodox tactic of trying to equate themselves with more credible, historical scientists who are less controversial. Yeah, my colleague did a good story on it.<\/p>\n
Rovner:<\/strong> Yeah, like Einstein.<\/p>\n
Cohrs:<\/strong> Right.<\/p>\n
Rovner:<\/strong> Well, we\u2019ll link to all of these ads. If you haven\u2019t seen them there, they\u2019re definitely worth watching. Well, finally, and in keeping with the occasional politics that does creep into Super Bowl ads, the super PAC supporting the presidential candidacy of independent anti-vaxxer Robert F. Kennedy Jr. paid $7 million for an ad<\/a> that was basically a remake of the 1960 ad for his uncle John F. Kennedy, when he was running for president, which provoked an outcry from several of his Kennedy cousins who have repeatedly disavowed RFK Jr.\u2019s candidacy and his causes.<\/p>\n
For his part, the candidate apologized to his family members and said he didn\u2019t have anything to do with the ad directly, because it was the super PAC. But then he pinned it to his Twitter profile, where he has more than 2\u00bd followers. I can\u2019t help but wonder if they\u2019re going after football fans who actually believe the whole Taylor Swift-Travis Kelsey thing is a conspiracy.<\/p>\n
No comment on Robert F. Kennedy Jr. and pissing off his entire family? We will move ahead then.<\/p>\n
Speaking of conspiracy theories, in \u201cThis Week in Health Misinformation,\u201d we have \u2014 drum roll \u2014 blood transfusions. Seems that there are a significant number of people who believe that getting blood from someone who has been vaccinated against covid, using the mRNA vaccines, will somehow change their DNA or otherwise harm them. And state legislators are listening.<\/p>\n
In Wyoming, a state representative has introduced a bill that would require the labeling of blood from a covid-vaccinated donor. So prospective recipients could refuse it, at least in nonemergency situations. And in Montana, there\u2019s a bill that would go even further, banning blood donations from the covid-vaccinated. That one appears to not be going anywhere, but this could have serious implications. It would create blood shortages, I imagine, even in rural areas where fewer people are vaccinated than in some of the urban areas. But I mean, this strikes me as not an insignificant kind of movement.<\/p>\n
Ollstein:<\/strong> Well, it seems troubling on two fronts. One, we already have blood shortages and we already have dangerously low vaccination rates and not just covid vaccination rates. The hesitancy and anti-vax sentiment is spilling over into routine childhood vaccinations and all kinds of things.<\/p>\n
And so I think anything that appears to give that sort of stigma and conspiracy a veneer of credibility, like state law for instance, threatens to further entrench those trends.<\/p>\n
Rovner:<\/strong> All right, well, that is this week\u2019s news. We will do our extra credits in a minute, but first, as promised, we have the winners of the KFF Health News \u201cHealth Policy Valentines\u201d contest. This year\u2019s winner, and we will post the link to the poem<\/a> and its accompanying illustration, is from Jennifer Reck.<\/p>\n
It goes, \u201cDarling, this Valentine\u2019s Day, let\u2019s grab our passports and fly away to someplace where the same drugs cost a fraction of what they do in the States.<\/em>\u201d I have asked the panel to each choose a finalist of their own to read. So, Lauren, why don\u2019t you start?<\/p>\n
Weber:<\/strong> \u201cThe paperwork flirts with my affections, a dance of denials, full of rejections. My heart yearns for you, my sweet medication, but insurance insists on prior authorization<\/em>.\u201d<\/p>\n
Rovner:<\/strong> And who\u2019s that from?<\/p>\n
Weber:<\/strong> That\u2019s from Sally Nix. Excellent work, Sally.<\/p>\n
Rovner:<\/strong> Alice.<\/p>\n
Ollstein:<\/strong> OK, I have one from Kara Gavin. It\u2019s \u201cMy love for you, darling, is blinding \/ Like a clinical trial pre-findings \/ But I fear we shall part \/ And I\u2019ll lose my heart\/ Because of Medicaid unwinding!<\/em>\u201d Very topical.<\/p>\n
Rovner:<\/strong> Very. Rachel.<\/p>\n
Cohrs:<\/strong> OK, this is from Andrea Ferguson. \u201cParental love is beautiful and guess what makes it stronger? A paid parental leave policy to stay with baby longer.<\/em>\u201d<\/p>\n
Rovner:<\/strong> Very nice. Thank you all who entered. And we\u2019ll do this again next year. All right, now it is time for our extra credit segment. That\u2019s when we each recommend a story we read this week we think you should read, too. As always, don\u2019t worry if you miss it. We will post the links on the podcast page<\/a> at kffhealthnews.org<\/a> and in our show notes on your phone or other mobile device. Alice, why don\u2019t you go first this week?<\/p>\n
Ollstein:<\/strong> I have a piece from my colleague Arek Sarkissian, down in Florida, and it is about how the state\u2019s immigration law is deterring immigrants from seeking health care<\/a>. And one of the areas they\u2019re most concerned about is maternal health care. We already are in a maternal health crisis and the law requires hospitals that receive Medicaid funding to ask people about their immigration status when they come in for care. What a lot of people don\u2019t know is that they don\u2019t have to answer, but this fear of being asked and potentially being flagged for deportation enforcement, et cetera, is making people avoid care. And so there\u2019s just a lot of concern about this and a lot of attempts to educate folks in the immigrant community. Obviously, Florida has a very large immigrant community. And it just reminded me of the fears that were happening early in the pandemic when the public charge rule under Trump was in effect and it was deterring immigrants from seeking care.<\/p>\n
And in the middle of a pandemic, when we\u2019re dealing with an infectious disease that doesn\u2019t care if you have citizenship or not, having a large segment of the population avoid care is dangerous for everyone.<\/p>\n
Rovner:<\/strong> Indeed. Lauren.<\/p>\n
Weber:<\/strong> So I chose an article titled \u201cClimate Change Has Hit Home Insurance. Is Health Insurance Next?<\/a>\u201d by Yusuf Khan in The Wall Street Journal. And, I mean, look, the insurers are \u2014 they\u2019re looking out for their bottom line. And the bottom line is that climate change does have health impacts. So the question is, will that start to hit premiums? The sad answer, in part of this article, is that, unfortunately, the people often most affected by climate change don\u2019t have health insurance. So that may not affect premiums as much as we expect, but I think this is a really fascinating test case of how when climate change comes for your money, you\u2019ll start to see it validated more. So I\u2019ll be curious to see how this plays out with the various health insurers.<\/p>\n
Rovner:<\/strong> Yeah, obviously, we\u2019re already seeing people not being able to get home insurance in places like Florida and California because of increasing fires and increasing hurricanes and increasing flooding in some places. Rachel?<\/p>\n
Cohrs:<\/strong> So mine is a package deal. It\u2019s two stories related to private equity investment in health care. The first is a piece in Modern Healthcare by Nona Tepper<\/a> on a Medicare Advantage report by the Private Equity Stakeholder Project. And it just kind of highlighted the downturn in investment in Medicare Advantage, like marketing companies and brokers, consultants.<\/p>\n
And I thought it was an interesting take because, I think so often, we see reporting about how private equity is expanding its investment in a certain sector. But this, I think, was an interesting indicator where, oh, it\u2019s turning downward so dramatically. And I think that it\u2019s interesting to track the tail end of more regulation or whatever rule comes out. How does that impact investment? And we talk a lot about that in the pharmaceutical space. But I thought this was a great interesting creative take on the Medicare Advantage side of things.<\/p>\n
And also just highlighting some reporting from my colleague Bob Herman about the FTC doubling down<\/a> on the Welsh Carson\u2019s anesthesia case to limit private equity\u2019s physician buyouts. So the FTC is taking on Welsh Carson, a powerful private equity firm, and other private equity firms asked for the case to be dismissed. And Bob does a great job breaking down these really complicated arguments by the FTC as to why they\u2019re not backing down. They\u2019re not going to cut a deal, they want this case to go forward.<\/p>\n
So it will be interesting to watch as this develops, but I think Bob makes a great argument. There are applications for other cases as well and for the FTC and being able to attack these complex corporate arrangements where they\u2019re using subsidiaries to drive prices up for physician services and other things. So definitely worth a read from Bob.<\/p>\n
Rovner:<\/strong> Yes, another theme of the Federal Trade Commission getting more and more involved in health care in general and private equity in health care in particular. My extra credit this week is from Stateline by Anna Claire Vollers, and it\u2019s called \u201cGovernment Can Erase Your Medical Debt for Pennies on the Dollar \u2014 And Some Are<\/a>.\u201d It\u2019s about how a growing number of states and cities are buying up and forgiving medical debt for their residents. Backers of the plans point out that medical debt is a societal problem that deserves a societal solution. And that relieving people\u2019s debt burdens can actually add to economic growth. So it\u2019s a good return on a small investment. It\u2019s obviously not going to solve the medical debt problem, but it may well buy some government goodwill for some of the people of these states and cities.<\/p>\n
All right, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d 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 to Stephanie Stapleton, filling in this week as our editor. As always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org, or you can still find me at X, @jrovner<\/a>, or @julierovner<\/a> at Bluesky and @julie.rovner<\/a> at Threads. Lauren, where are you these days?<\/p>\n
Weber:<\/strong> Still just on Twitter @LaurenWeberHP<\/a>, or X, I guess.<\/p>\n
Rovner:<\/strong> Alice.<\/p>\n
Ollstein:<\/strong> On X @AliceOllstein<\/a> and on Bluesky @alicemiranda<\/a>.<\/p>\n
Rovner:<\/strong> Rachel.<\/p>\n
Cohrs:<\/strong> I\u2019m @rachelcohrs<\/a> on X and also getting more engaged on LinkedIn lately. So feel free to follow me<\/a> there.<\/p>\n
Rovner:<\/strong> We will be back in your feed next week. Until then, be healthy.<\/p>\n
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\tFrancis Ying
\n\tAudio producer<\/p>\n
\tStephanie Stapleton
\n\tEditor <\/p>\n
To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n
And subscribe to KFF Health News\u2019 \u201cWhat the Health?\u201d on\u00a0Spotify<\/a>,\u00a0 Apple Podcasts<\/a>,\u00a0 Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n<\/div>\n