{"id":2538,"date":"2024-03-28T05:09:42","date_gmt":"2024-03-28T05:09:42","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2538"},"modified":"2024-03-28T05:09:42","modified_gmt":"2024-03-28T05:09:42","slug":"the-aca-turns-14-kff-health-news","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2538","title":{"rendered":"The ACA Turns 14 – KFF Health News"},"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
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\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
The Affordable Care Act was signed into law 14 years ago this week, and Health and Human Services Secretary Xavier Becerra joined KFF Health News\u2019 Julie Rovner on this week\u2019s \u201cWhat the Health?\u201d podcast to discuss its accomplishments so far \u2014 and the challenges that remain for the health law.<\/p>\n
Meanwhile, Congress appears on its way to, finally, finishing the fiscal 2024 spending bills, including funding for HHS \u2014 without many of the reproductive or gender-affirming health care restrictions Republicans had sought.<\/p>\n
This week\u2019s panelists are Julie Rovner of KFF Health News, Mary Agnes Carey of KFF Health News, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.<\/p>\n

\n\t\tPanelists\t<\/h3>\n
\tMary Agnes Carey
\n\tKFF Health News<\/p>\n
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\n\t\t\t\t@maryagnescarey\t\t\t<\/a><\/p>\n
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\n\t\t\t\tRead Mary Agnes’ stories.\t\t\t<\/a><\/p>\n
\tTami Luhby
\n\tCNN<\/p>\n
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\n\t\t\t\t@Luhby\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Tami’s stories.\t\t\t<\/a><\/p>\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
Among the takeaways from this week\u2019s episode:<\/p>\n
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The Supreme Court will hear oral arguments next week in a case that could decide whether the abortion pill mifepristone will remain easily accessible. The case itself deals with national restrictions rather than an outright ban. But, depending on how the court rules, it could have far-reaching results \u2014 for instance, preventing people from getting the pills in the mail and limiting how far into pregnancy the treatment can be used.<\/li>\n
The case is about more than abortion. Drug companies and medical groups are concerned about the precedent it would set for courts to substitute their judgment for that of the FDA regarding drug approvals.<\/li>\n
Abortion-related ballot questions are in play in several states. The total number ultimately depends on the success of citizen-led efforts to collect signatures to gain a spot. Such efforts face opposition from anti-abortion groups and elected officials who don\u2019t want the questions to reach the ballot box. Their fear, based on precedents, is that abortion protections tend to pass.<\/li>\n
The Biden administration issued an executive order this week to improve research on women\u2019s health across the federal government. It has multiple components, including provisions intended to increase research on illnesses and diseases associated with postmenopausal women. It also aims to increase the number of women participating in clinical trials.<\/li>\n
This Week in Medical Misinformation: The Supreme Court heard oral arguments in the case Murthy v. Missouri<\/em>. At issue is whether Biden administration officials overstepped their authority when asking companies like Meta, Google, and X to remove or downgrade content flagged as covid-19 misinformation.<\/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> The Washington Post\u2019s \u201cArizona Lawmaker Tells Her Abortion Story to Show \u2018Reality\u2019 of Restrictions<\/a>,\u201d by Praveena Somasundaram. (Full speech here<\/a>.)<\/p>\n
Alice Miranda Ollstein:<\/strong> CNN\u2019s \u201cWhy Your Doctor\u2019s Office Is Spamming You With Appointment Reminders<\/a>,\u201d by Nathaniel Meyersohn.<\/p>\n
Tami Luhby:<\/strong> KFF Health News\u2019 \u201cGeorgia\u2019s Medicaid Work Requirement Costing Taxpayers Millions Despite Low Enrollment<\/a>,\u201d by Andy Miller and Renuka Rayasam.<\/p>\n
Mary Agnes Carey:<\/strong> The New York Times\u2019 \u201cWhen Medicaid Comes After the Family Home<\/a>,\u201d by Paula Span, and The AP\u2019s \u201c State Medicaid Offices Target Dead People\u2019s Homes to Recoup Their Health Care Costs<\/a>,\u201d by Amanda Seitz.<\/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: The ACA Turns 14<\/strong>\t\t\t\t<\/p>\n
[Editor\u2019s note:<\/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, March 21, 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 Ollstein<\/strong>: Hello.<\/p>\n
Rovner<\/strong>: Tami Luhby of CNN.<\/p>\n
Tami Luhby<\/strong>: Hello.<\/p>\n
Rovner<\/strong>: And my KFF Health News colleague Mary Agnes Carey.<\/p>\n
Mary Agnes Carey<\/strong>: It\u2019s great to be here.<\/p>\n
Rovner<\/strong>: Later in this episode to mark the 14th anniversary of the Affordable Care Act, we\u2019ll have my interview with Health and Human Services Secretary Xavier Becerra, but first, this week\u2019s news. So it appears our long national nightmare following the progress of the fiscal 2024 spending bill for the Department of Health and Human Services is nearly over, nearly halfway through the fiscal year. The White House, House, and Senate have, as far as we can tell, reached a compromise on the last tranche of spending bills, which is a good thing because the latest temporary spending bill runs out at midnight Friday. Funding for the Department of Health and Human Services, from what I\u2019ve seen so far, is basically flat, which is a win for the Democrats because the Republicans had fought for a cut of something in the neighborhood of 22%.<\/p>\n
Now, assuming this all happens, the House is scheduled to vote, as we speak now, on Friday at 11 a.m., leaving the Senate not very much time to avert a possible partial shutdown. Democrats seem also to have avoided adding all manner of new restrictions on reproductive and gender-affirming health care to the HHS part of the bill. It\u2019s the last big train leaving the station likely until after the election. So Alice, we\u2019ll get to the add-ons in a minute, but have you seen anything in the HHS funding worthy of note or did they manage to fend off everything that would\u2019ve been significantly newsworthy?<\/p>\n
Ollstein<\/strong>: Like you said, it is basically flat. It\u2019s a small increase, less than 1% overall for HHS, and then a lot of individual programs are just completely flat, which advocacy groups argue is really a cut when you factor in inflation. The cost of providing services and buying medications and running programs and whatnot goes up. So flat funding is a cut in practice. I\u2019m hearing that particularly from the Title X family planning folks that have had flat funding for a decade now even as demand for services and costs have gone up.<\/p>\n
So I think that in the current environment, Democrats are ready to vote for this. They don\u2019t want to see a shutdown. And in the House, the bill passage will depend on those Democratic votes because they are likely to lose a lot of Republicans. Republicans are mad that there weren\u2019t deeper cuts to spending and, as you alluded to, they\u2019re mad that they didn\u2019t get these policy rider wins they were banking on.<\/p>\n
Rovner<\/strong>: As I\u2019ve mentioned, since this is a must-pass bill, there are always the efforts to add non-spending things to it. And on health care, apparently, the effort to add the PBM, pharmacy benefit regulation bill we\u2019ve talked about so much failed, but lawmakers did finally get a one-year deal to extend PEPFAR, the international AIDS\/HIV program. Alice, you\u2019ve been dutifully following this since it expired last year. Remind us why it got held up and what they finally get.<\/p>\n
Ollstein<\/strong>: What happened in the end is it is a one-year reauthorization that\u2019s a so-called clean reauthorization, meaning they are not adding new anti-abortion restrictions and provisions that the Republicans wanted. So what we reported this week is, like any compromise, no one\u2019s happy. So Republicans are upset that they didn\u2019t get the anti-abortion restrictions they wanted, and I\u2019ll explain more on that in a second, and Democrats are upset that this is just a one-year reauthorization. It\u2019s the first reauthorization that\u2019s this sort of short-term stopgap length. In the program\u2019s decades of history, it\u2019s always been a full five-year reauthorization up until now. But the fight over abortion and accusations that program funds were flowing to abortion providers really split Congress on this.<\/p>\n
Even though you had mainstream leadership Republicans who were saying, \u201cLook, we just want to reauthorize this as-is,\u201d you had a small but very vocal contingent of hard-line anti-abortion lawmakers backed by some really influential groups like the Heritage Foundation and SBA [Susan B. Anthony Pro-Life America] who were saying, \u201cNo, we have to insist on a shorter-term reauthorization,\u201d so that they hope Trump will be in office next year and can impose these exact same anti-abortion restrictions through executive action. So they\u2019re basically trying to punt control of the program into what they hope is a more favorable environment, where either they\u2019ll have the votes in Congress to make these changes and restrictions to the program or they can do it through the White House.<\/p>\n
Rovner<\/strong>: So basically, the fight over PEPFAR, not over. So as I already mentioned, Saturday is the 14th anniversary of the Affordable Care Act, which you\u2019ll hear more about in my interview with HHS Secretary Becerra, but I wanted to pose to you guys one of the questions that I posed to him. As Nancy Pelosi famously predicted, at least according to public opinion polls, the more people learned about the health law, indeed, the more they are liking it. But it still lacks the popularity and branding of big government health programs, like Medicare and Medicaid, and I think lots of people still don\u2019t know that lots of the provisions that they like, things like letting your adult children stay on your health plan until they\u2019re 26 or banning preexisting condition exclusions, those were things that came from the Affordable Care Act. Any theories as to why it is still so polarizing? Republicans didn\u2019t love Medicare and Medicaid at the beginning either, so I don\u2019t think it\u2019s just that Republicans still talk about it.<\/p>\n
Luhby<\/strong>: Part of it I think is because there are so many provisions and they\u2019re not labeled the Affordable Care Act like Medicare is. Actually to some extent, Medicaid may not be as well known in some states because states have different Medicaid programs and different names and so do the ACA exchanges. So that\u2019s part of it, but also, things like why do you get a free mammogram and why you get to go for a routine checkup every year; that\u2019s not labeled as an Affordable Care Act provision, that\u2019s just the preventive services. So I think that it would be difficult now after 14 years to bring all of that into the everyday branding by doctors and health providers. But that\u2019s certainly what the administration and advocates are trying to do by sending out a lot of messages that list all of the benefits of the ACA.<\/p>\n
Rovner<\/strong>: I will say this is the biggest full-court press I\u2019ve seen an administration do on the ACA in quite a while. Obviously, it\u2019s a presidential election year and it\u2019s something that the Biden administration is proud of, but at least I would think that maybe just all the publicity might be part of their strategy. Mac, you wanted to say something.<\/p>\n
Carey<\/strong>: No, absolutely. It\u2019s going to be part of the Biden reelection campaign. They\u2019re going to be pushing it, talking a lot about it. We have to remember we\u2019ve had this ringside seat to all the Republican opposition to the Affordable Care Act. All the conversation about we\u2019re going to repeal it and put something better in, former President Trump is still sending that message out to the electorate. I don\u2019t know how much confusion, if any confusion, it creates, but to Tami\u2019s point, you\u2019ve got millions of people that have gotten coverage under the Affordable Care Act but millions more have benefited by all these provisions we\u2019re talking about: the preventive care provisions, leaving adult kids up to 26 on your health insurance plan, that kind of thing.<\/p>\n
Also, give it time. Fourteen years is a long time, but it\u2019s not the time of Medicare, which was created in 1965, and Medicaid. So I think over time, the Affordable Care Act is part of the fabric and it will continue to be. But absolutely, for sure, President Biden is going to run on this, like you said, Julie, full-court press, talk extensively about it in the reelection campaign.<\/p>\n
Ollstein<\/strong>: It makes sense that they\u2019re leaning really hard on Obamacare as a message because, even if everyone isn\u2019t familiar with it, a lot more people are familiar with it and like it than, polling shows, on the Biden administration\u2019s other big health care accomplishment, which is drug price negotiation, which polling shows that most people, and even most seniors, who are the ones who are set to benefit the most, aren\u2019t aware that it exists. And that makes sense because they\u2019re not feeling the impact of the lower prices yet because this whole thing just started and it won\u2019t be until 2026 that they\u2019ll really actually experience cheaper medications. But people are already feeling the direct impact of Obamacare on their lives, and so it does make sense that they\u2019re going to lean really hard on this.<\/p>\n
Rovner<\/strong>: Of course, we went through the same thing with Obamacare, which also didn\u2019t take full effect until, really, this is really the 10th anniversary of the full effect of the Affordable Care Act because it didn\u2019t take effect until 2014. Tami, you wanted to add something.<\/p>\n
Luhby<\/strong>: No, I was going to say it\u2019s also the seventh anniversary of the Trump administration and congressional Republicans trying to tear apart the Affordable Care Act and repeal and replace it, which is the messaging that you\u2019re seeing now is very similar to what you saw in 2017. It\u2019s just surprising to me that with very intensive messaging on both sides at that time about what the Republicans saying what the problems are and the Democrats saying what all of the benefits are, \u2014 including the protections for people with preexisting conditions and the other things we\u2019ve mentioned \u2014 that more people don\u2019t associate those provisions with the ACA now. But the Biden administration is trying to revive all of that and remind people, as they did in 2018 in the successful midterm elections for the Democrats, that the ACA does provide a lot of the benefits that they are taking advantage of and appreciate.<\/p>\n
Rovner<\/strong>: I think, in some ways, the 2017 fight was one of the best things that ever happened to the ACA in terms of helping people understand what actually was in it, because the Democrats managed to frighten people about things that they liked being taken away. Here we go again. All right, let us turn to abortion. There\u2019s a new report out from the Guttmacher Institute that finds a dramatic jump in the use of medication abortion in 2023, the first full year since the Supreme Court reversed the nationwide right to abortion in the Dobbs<\/em> [v. Jackson Women\u2019s Health Organization<\/em>] case, more than 60% of abortions use medication rather than a procedure last year. This news comes as the Supreme Court next week prepares to hear oral arguments in a case that could dramatically restrict availability of the abortion pill mifepristone. Alice, remind us what\u2019s at stake in this case. It\u2019s no longer whether they\u2019re going to just outright cancel the approval.<\/p>\n
Ollstein<\/strong>: That\u2019s right. So the Supreme Court is taking up the narrowed version of this from the 5th Circuit. So what\u2019s at stake are national restrictions on abortion pills, but not a national outright ban like you mentioned. But those restrictions could be really sweeping and really impactful. It would prevent people from getting the pills through the mail like they currently do. It would prevent people from potentially getting them in any other way other than directly from a doctor. So this would apply to red states and blue states alike. It would override abortion rights provisions in blue states that have done a lot to increase access to the pills. And it would also restrict their use back to the first seven weeks of pregnancy instead of 10, which is a big deal because people don\u2019t often find out they\u2019re pregnant until getting close to that line or beyond.<\/p>\n
So this is a really big deal, and I think you can really see, especially from the flurry of amicus briefs have been filed, that anxiety about this case in the medical community and the pharmaceutical community, the scientific community, it goes way beyond the impact just on abortion. People are really worried about setting a precedent where the FDA\u2019s scientific judgment is second-guessed by courts, and they worry that a win for the anti-abortion groups in this case would open the door to people challenging all kinds of other medications that they have an issue with: contraception, covid vaccines, HIV drugs, the list goes on and on, gender-affirming care medications, all sorts of things. So there are the bucket of potential impacts on abortion specifically, which are certainly significant, and then there\u2019s the bigger slippery slope fears as well.<\/p>\n
Rovner<\/strong>: Also, this is obviously still way political. More than just the abortion pill. It\u2019s been a while since we\u2019ve talked about state ballot measures. We, I think, feel like we spent all of last year talking about abortion state ballot measures. Alice, catch us up real quick on where we are. How many states have them? And what is this campaign against, by the anti-abortion people, to try to prevent them from getting on the ballot?<\/p>\n
Ollstein<\/strong>: Check me if I\u2019m wrong, but I don\u2019t believe we know for sure about, especially the states that have citizen-led ballot initiatives where people are gathering signatures. So Florida had one of the earliest deadlines and they did meet their signature threshold. But they are now waiting on the state Supreme Court to say whether or not they have a green light to go forward this fall. A lot of other states are still collecting signatures. I think the only states we know for sure are the ones where the state legislature is the one that is ordering it to be put on the ballot, not regular citizens gathering signatures.<\/p>\n
We still don\u2019t know, but things are moving forward. I was just in Arizona reporting on their efforts. Things are moving forward there. Things are moving forward in Montana. They just got a court ruling in their favor to put something on the ballot. And things are moving forward in Missouri, a lot of places. So this could be really huge. Of course, like you mentioned, anti-abortion groups and anti-abortion elected officials are doing a lot of different things to try to prevent this from going on the ballot.<\/p>\n
It\u2019s interesting, you heard arguments over the last couple years against this being more along the lines of, \u201cOh, this is allowing these out-of-state big-money groups to swoop in and mislead and tell us what to do,\u201d and those were the anti-abortion arguments against allowing people to vote on this directly. Now, you\u2019re hearing, I\u2019m hearing, more arguments along the lines of, \u201cThis shouldn\u2019t be something subject to a popular vote at all. We shouldn\u2019t put this up for a vote at all.\u201d They consider this a human rights issue, and so I think that\u2019s a really interesting evolution as well, particularly when the fall of Roe <\/em>[v. Wade<\/em>] was celebrated for returning the question of abortion access to the people, but maybe not these people specifically.<\/p>\n
Rovner<\/strong>: I\u2019ve been interested in seeing some of these anti-abortion groups trying to launch campaigns to get people not to put signatures on petitions. That\u2019s moving it back a step I don\u2019t think I\u2019d ever seen. I don\u2019t think I\u2019ve ever seen a campaign to say, \u201cDon\u2019t sign the petition that would put this on the ballot to let people vote on it.\u201d But that\u2019s what we\u2019re seeing, right?<\/p>\n
Ollstein<\/strong>: Well, that\u2019s what I went to Arizona to see firsthand is how that\u2019s working, and it\u2019s fascinating. They really worry that if it gets on the ballot, it\u2019ll pass. It has in every state so far, so it\u2019s reasonable for them to assume that. So they\u2019re trying to prevent it from getting on the ballot. The way they\u2019re doing that is they\u2019re tracking the locations of signature gatherers and trying to go where they are and trying to intervene and hold up signs. I saw this firsthand. I saw it at a street fair. People were gathering signatures and several anti-abortion demonstrators were standing right in front of them with big signs and trying to argue with people and deter them from signing. It was not working, from what I observed. And from the overall signature count statewide, it was not working in Arizona. But it\u2019s fascinating that they\u2019re trying this.<\/p>\n
Carey<\/strong>: I was going to say just our reporting from our KFF Health News colleagues found that 13 states are weighing abortion-related ballot measures, most of which would protect abortion rights. To your point, the scope is pretty extensive. And for all the reasons Alice just discussed, it\u2019s quite the issue.<\/p>\n
Rovner<\/strong>: Yeah, and we will obviously talk more about this as the election gets closer. I know we talk about Texas a lot on this podcast, but this week, I want to highlight a study from next door in Louisiana<\/a>, also a very strong anti-abortion state. A new report from three groups, all of which support abortion rights, charges that, as in Texas, women with pregnancy complications are being forced to wait for care until their conditions become critical. And in some cases, women with nonviable pregnancies are being forced to have C-section surgery because their doctors don\u2019t dare use medication or other less-risky procedures in case they could be accused of performing an abortion.<\/p>\n
At some point, you have to think that somebody is going to have a malpractice case. Having a C-section because your doctor is afraid to terminate a nonviable pregnancy seems like pretty dangerous and rather aggressive way to go. This is the first I\u2019ve ever heard of this. Alice, have you heard anything about this?<\/p>\n
Ollstein<\/strong>: Not the C-section statistics specifically, but definitely the delays in care and some of the other impacts described in that report have absolutely been reported in other states and in legal challenges that have come up in Texas, in Oklahoma, in Tennessee, in Idaho by people who were denied abortions and experienced medical harms because of it. So I think that fits into the broader pattern. And it\u2019s just more evidence about how this is having a chilling effect on doctors. And the exact letter of the law may be one thing, and you have elected officials pointing to exemptions and provisions in the law, but the chilling effect, the fear and the confusion in the medical community, is something in addition to that.<\/p>\n
Rovner<\/strong>: As we put it out before, doctors have legitimate fears even if they don\u2019t want to get dragged into court and have to hire lawyers and take time off \u2014 even if they\u2019re innocent, even if they have what they consider to be pretty strong evidence that whatever it was that they did was legitimate under the law in terms of taking care of pregnant women. A lot of them, they don\u2019t want to come under scrutiny, let\u2019s put it that way, and it is hard to blame them about that.<\/p>\n
Meanwhile, the backlash over the Alabama Supreme Court decision that fertilized embryos for IVF have legal rights is continuing as blue states that made themselves safe spaces for those seeking abortion are now trying to welcome those seeking IVF. Anybody think this is going to be as big a voting issue as abortion this fall? It\u2019s certainly looking like those who support IVF, including some Republicans, are trying to push it.<\/p>\n
Carey<\/strong>: I would think yes, it absolutely will be because it has been brought into the abortion debate. The actual Alabama issue is about an Alabama law and whether or not this particular, the litigants who sued were \u2026 it was germane and covered by the law, but it\u2019s been brought into the abortion issue. The whole IVF thing is so compelling, about storage of the embryos and what people have to pay and all the restrictions around it and some of the choices they\u2019re making. I guess that you could say more people have been touched by IVF perhaps than the actual abortion issue. So now, it\u2019s very personal to them and it\u2019s been elevated, and Republicans have tried to get around it by saying they support it, but then there\u2019s arguments that whether or not that\u2019s a toothless protection of IVF. It came out of nowhere I think for a lot of politicians and they\u2019ve been scrambling and trying to figure it out. But to your point, Julie, I do wonder if it will be elevated in the election. And it was something they didn\u2019t think they\u2019d have to contend with, rather, and now they do.<\/p>\n
Rovner<\/strong>: Obviously, it\u2019s an issue that splits the anti-abortion community because now we\u2019ve had all these very strong pro-lifers like Mike Pence saying, \u201cI created my family using IVF.\u201d Nikki Haley. There are a lot of very strong anti-abortion Republicans who have used IVF. So you\u2019ve got some on the far \u2026 saying, \u201cNo, no, no, you can\u2019t create embryos and then destroy them,\u201d and then you\u2019ve got those who are saying, \u201cBut we need to make sure that IVF is still available to people. If we\u2019re going to call ourselves pro-life, we should be in favor of people getting pregnant and having babies, which is what IVF is for.\u201d Alice, I see you nodding your head.<\/p>\n
Ollstein<\/strong>: Yeah. So we\u2019re having sort of a frustrating discourse around this right now because Democrats are saying, \u201cRepublicans want to ban IVF.\u201d And Republicans are saying, \u201cNo, we don\u2019t. We support IVF. We love IVF. IVF is awesome.\u201d And neither is totally accurate. It\u2019s just missing a lot of nuance. Republicans who say they support IVF also support a lot of different kinds of restrictions on the way it\u2019s currently practiced. So they might correctly argue that they don\u2019t want to ban it entirely, but they do want it practiced in a different way than it is now, such as the production of many embryos, some of which are discarded<\/a>. So I think people are just not being asked the right questions right now. I think you got to get beyond, \u201cDo you support IVF?\u201d That gives people a way to dodge. I think you really have to drill into, \u201cOK. How specifically do you want this regulated and what would that mean for people?\u201d<\/p>\n
Carey<\/strong>: Right, and the whole debate with some of the abortion rights opponents, some of them want the federal government to regulate it. Mike Johnson, speaker of the House, has come out and said, \u201cNo, no, that can be done at the state level.\u201d So they\u2019ve got this whole split internally in the party that is, again, a fight they didn\u2019t anticipate.<\/p>\n
Rovner<\/strong>: Well, Mac, something that you alluded to that I was struck by was a piece in The Washington Post this week about couples facing increasing costs to store their IVF embryos, often hundreds of dollars a year, which is forcing them to choose between letting the embryos go or losing a chance to possibly have another child. It\u2019s obviously a big issue. I\u2019m wondering what the anti-IVF forces think about that. As we\u2019ve seen in Alabama, it\u2019s not like you can just pick your embryos up in a cooler and move them someplace else. Moving them is actually a very big deal.<\/p>\n
I don\u2019t wish to minimize this, but I remember you have storage units for things, not obviously for embryos. One of the ways that they make money is that they just keep raising the cost because they think you won\u2019t bother to move your things, so that you\u2019ll just keep paying the increased cost. It feels like that\u2019s a little bit of what\u2019s happening here with these stored embryos, and at some point, it just gets prohibitively expensive for people to keep them in storage. I didn\u2019t realize how expensive it was.<\/p>\n
Carey<\/strong>: They\u2019re all over the place. In preparing for this discussion, I\u2019ve read things about people are paying $600 a year, other people are paying $1,200 a year. There\u2019s big jumps from year to year. It can be an extremely expensive proposition. Oh, my goodness.<\/p>\n
Rovner<\/strong>: IVF itself, I think as we\u2019ve mentioned, is also extremely expensive and time-consuming, and emotionally expensive. It is not something that people enter into lightly. So I think we will definitely see more as we go. There\u2019s also women\u2019s health news this week that doesn\u2019t have to do with reproduction. That\u2019s new. Earlier this week, President Biden issued an executive order attempting to ensure that women are better represented in medical research. Tami, what does this order do and why was it needed?<\/p>\n
Luhby<\/strong>: Well, it\u2019s another attempt by the Biden administration, as we\u2019ve discussed, to focus on reproductive health and reproductive rights. During the State of the Union address earlier this month, Biden asked Congress to invest $12 billion in new funding for women\u2019s health research. And there are actually multiple components to the executive order, but the big ones are that it calls for supporting research into health and diseases that are more likely to occur midlife for women after menopause, such as rheumatoid arthritis, heart attacks, osteoporosis, and as well as ways to improve the management of menopause-related issues.<\/p>\n
We are definitely seeing that menopause care is of increasing focus in a multitude of areas including employer health insurance, but the executive order also aims to increase the number of women participating in clinical trials since they\u2019re poorly represented now. We know that certain medications and certain treatments have different effects on women than men, but we don\u2019t really know that that well because they\u2019re not as represented in these clinical trials. Then it also directs agencies to develop and strengthen research and data standards on women\u2019s health across all of the relevant research and funding opportunities in the government.<\/p>\n
Rovner<\/strong>: I\u2019ll say that this is an issue I have very strong feelings about because I covered the debate in 1992 about including women in medical research. At the time, doctors didn\u2019t want to have women in clinical trials because they were worried about hormones, and they might get pregnant, and we wouldn\u2019t really know what that meant for whatever it was that we were testing. Someone suggested that \u201cIf you\u2019re going to use these treatments and drugs on women, maybe you should test them on women too.\u201d Then I won an award in 2015 for a story about how they still weren\u2019t doing it, even though it was required by laws.<\/p>\n
Carey<\/strong>: And here we are, 2024.<\/p>\n
Rovner<\/strong>: Yeah, here we are. It just continues, but at least they\u2019re trying. All right, finally, this week in medical misinformation, we travel to the Supreme Court, where the justices heard oral arguments in a case brought by two Republican state attorneys general charging that the Biden administration, quote, \u201ccoerced\u201d social media platforms, Google, Meta, and X, into downgrading or taking down what public health officials deemed covid disinformation. I didn\u2019t listen to the arguments, but all the coverage I saw suggested that the justices were not buying what the attorneys general were selling.<\/p>\n
Yet another public-health-adjacent case to watch for a decision later this spring, but I think this is really going to be an important one in terms of what public officials can and cannot do using their authority as public health officials. We\u2019re obviously in a bit of a public health trust crisis, so we will see how that goes.<\/p>\n
All right, that is the news for this week. Now, we will play my interview with HHS Secretary Xavier Becerra, then we will be back with our extra credits.<\/p>\n
I am so pleased to welcome back to the podcast Health and Human Services Secretary Xavier Becerra. I\u2019ve asked him to join us to talk about the Affordable Care Act, which was signed into law 14 years ago this weekend. Mr. Secretary, thanks so much for coming back.<\/p>\n
Xavier Becerra<\/strong>: Julie, great to be with you on a great week.<\/p>\n
Rovner<\/strong>: So the Affordable Care Act has come a long way, not just in the 14 years since President Obama signed it into law, but in the 10 years since the healthcare.gov website so spectacularly failed to launch, but this year\u2019s enrollment setting a record, right?<\/p>\n
Becerra<\/strong>: That\u2019s right, and you should have said, \u201cYou\u2019ve come a long way, baby.\u201d<\/p>\n
Rovner<\/strong>: So what do we know about this year\u2019s enrollment numbers?<\/p>\n
Becerra<\/strong>: Another record breaker. Julie, every year that President Biden has been in office, we have broken records. Today, more Americans have health insurance than ever in the history of the country. More than 300 million people can now go to a doctor, leave their child in a hospital and know they won\u2019t go bankrupt because they have their own health insurance. That\u2019s the kind of peace of mind you can\u2019t buy. Some 21.5 million Americans today look to the marketplace on the Affordable Care Act to get their coverage. By the way, the Affordable Care Act overall, some 45 million Americans today count on the ACA for their health care insurance, whether it\u2019s through the marketplace, through Medicaid, or some of these basic plans that were also permitted under the ACA.<\/p>\n
Rovner<\/strong>: Obviously, one of the reasons for such a big uptake is the expanded subsidies that were extended by the Inflation Reduction Act in 2022, but those expire at the end of next year, the end of 2025. What do you think would happen to enrollment if they\u2019re not renewed?<\/p>\n
Becerra<\/strong>: Well, and that\u2019s the big question. The fact that the president made health care affordable was the big news. Because having the Affordable Care Act was great, but if people still felt it was unaffordable, they wouldn\u2019t sign on. They now know that this is the best deal in town and people are signing up. When you can get health insurance coverage for $10 or less a month in your premiums, that\u2019s a great deal. You can\u2019t even go see a movie at a theater today for under $10. Now, you can get health care coverage for a full month, Julie. Again, as I always tell people, that doesn\u2019t even include the popcorn and the refreshment at the movie theater, and so it\u2019s a big deal. But without the subsidies, some people would still say, \u201cAh, it\u2019s still too expensive.\u201d So that\u2019s why the president in his budget calls for extending those subsidies permanently.<\/p>\n
Rovner<\/strong>: So there are still 10 states that haven\u2019t taken up the federal government\u2019s offer to pay 90% of the costs to expand Medicaid to all low-income adults in their states. I know Mississippi is considering a bill right now. Are there other states that you expect could join them sometime in the near future? Or are any of those 10 states likely to join the other 40?<\/p>\n
Becerra<\/strong>: We\u2019re hoping that the other 10 states join the 40 that have come on board where millions of Americans today have coverage. They are forsaking quite a bit of money. I was in North Carolina recently where Gov. [Roy] Cooper successfully navigated the passage of expansion for Medicaid. Not only was he able to help some 600,000-plus North Carolinians get health coverage, but he also got a check for $1.6 billion as a bonus. Not bad.<\/p>\n
Rovner<\/strong>: No, not bad at all. So many years into this law, I feel like people now understand a lot of what it did: let adult children stay on their parents\u2019 health plans until the age of 26; banning most preexisting condition exclusions in health coverage. Yet most people still don\u2019t know that those provisions that they support were actually created by Obamacare or even that Obamacare and the Affordable Care Act are the same thing. Medicare has had such great branding success over the years. Why hasn\u2019t the ACA?<\/p>\n
Becerra<\/strong>: Actually, Julie, I think that\u2019s changing. Today, about two-thirds of Americans tell you that they support the marketplaces in the Affordable Care Act. I think we\u2019re actually now beginning an era where it\u2019s no longer the big three, where you had Social Security, Medicare, and Medicaid and everyone protects those. Today, I think it\u2019s the big four, the cleanup hitter being marketplace. Today, you would find tens of millions of Americans who would say, \u201cKeep your dirty, stinking hands off of my marketplace.\u201d<\/p>\n
Rovner<\/strong>: Well, we will see as that goes forward. Obviously, President Biden was heavily involved in the development of the Affordable Care Act as vice president, as were you as a member of the House Ways and Means Committee at the time. What do you hope is this administration\u2019s biggest legacy to leave to the health law?<\/p>\n
Becerra<\/strong>: Julie, I think it\u2019s making it affordable. The president made a commitment when he was first running to be president. He said on health care he was going to make it more affordable for more Americans with better benefits, and that\u2019s what he\u2019s done. The ACA is perfect proof. And Americans are signing up and signaling they agree by the millions. To go from 12 million people on the Affordable Care Act marketplace to 21.5 million in three years, that\u2019s big news.<\/p>\n
Rovner<\/strong>: So if I may, one question on another topic. Next week, the Supreme Court\u2019s oral arguments occur in the case it could substantially restrict the availability of the abortion pill mifepristone. Obviously, this is something that\u2019s being handled by the Justice Department, but what is it about this case that worries you most as HHS secretary, about the potential impact if the court rolls back FDA approval to the 2016 regulations?<\/p>\n
Becerra<\/strong>: Well, Julie, as you well know from your years of covering health care, today there are Americans who have less protection, fewer rights, than many of us growing up. My daughters, my three daughters today, have fewer protections and access to health care than my wife had when she was their age. That\u2019s not the America most of us know. To see another case where, now, medication abortion, which is used by millions of Americans \u2014 in fact, it\u2019s the most common form of care that is received by a woman who needs to have abortion services \u2014 that is now at stake. But we believe that if the Supreme Court believes in science and it believes in the facts, because mifepristone has been used safely and effectively publicly for more than 20 years, that we\u2019re going to be fine.<\/p>\n
The thing that worries me as much, not just in the reduction of access to care for women in America, is the fact that mifepristone went through a process at the FDA similar to scores and scores of other medications that Americans rely on, that have nothing to do with abortion. And if the process is shut down by the Supreme Court for mifepristone, then it\u2019s probably now at risk for all those other drugs, and therefore those other drugs that Americans rely on for diabetes, for cancer, who knows what, might also be challenged as not having gone through the right process.<\/p>\n
Rovner<\/strong>: I know the drug industry is very, very worried about this case and watching it closely, and so will we. Mr. Secretary, thank you so much for joining us.<\/p>\n
Becerra<\/strong>: Always good to be with you, Julie.<\/p>\n
Rovner<\/strong>: OK, we are back. It\u2019s 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. Tami, why don\u2019t you go first this week?<\/p>\n
Luhby<\/strong>: OK, my extra credit this week is an article about Georgia\u2019s unique Medicaid program from KFF Health News\u2019 Andy Miller and Renuka Rayasam. It\u2019s titled \u201cGeorgia\u2019s Medicaid Work Requirement Costing Taxpayers Millions Despite Low Enrollment<\/a>.\u201d And I\u2019m really glad they did this story. I and many others wrote about Georgia launching this program initially but haven\u2019t done follow-up. So I was very happy to see this story.<\/p>\n
As many of our listeners probably know, the Trump administration allowed multiple states to impose work requirements in Medicaid for the first time in the program\u2019s history in 2018. But the efforts were eventually stopped by the courts in all states except Georgia. Georgia was allowed to proceed with adding its work requirement to Medicaid because it was actually going to expand coverage to allowing adults with incomes up to 100% of the poverty line to qualify. So the Georgia Pathways to Coverage initiative began last June.<\/p>\n
Andy and Renuka took a look at how it\u2019s faring, and the answer is actually not so well. Only about 3,500 people have signed up, far short of the 25,000 that the state projected for the first year. What\u2019s more, the program has cost taxpayers at least $26 million so far, with more than 90% of that going towards administrative and consulting costs rather than actual medical care for low-income people.<\/p>\n
By contrast, expanding Medicaid under the Affordable Care Act to people with 138% of the poverty line would make at least 359,000 uninsured Georgia residents newly eligible for coverage and reduce state spending by $710 million over two years. That\u2019s what the advocates are pushing. So we\u2019ll see what happens in coming months. One thing that\u2019s also noted in the story is that about 45% of Pathways applications were still waiting to be processed.<\/p>\n
Rovner<\/strong>: I will point out that we did talk a couple of weeks ago about the low enrollment in the Georgia program. What we had not seen was how much it\u2019s actually costing the states per enrollee. So it is really good story. Alice, why don\u2019t you go next?<\/p>\n
Ollstein<\/strong>: Yeah, so I have some very relatable news from CNN. It\u2019s called \u201cWhy Your Doctor\u2019s Office Is Spamming You With Appointment Reminders<\/a>.\u201d It\u2019s about why we all get so many obnoxious repeat reminders for every medical appointment. It both explains why medical practices that operate on such a tiny profit margin are so anxious about no-shows and last-minute cancellations, and so that\u2019s part of it. But also part of it is that there are all these different systems that don\u2019t communicate with one another. So the prescription drug system and the electronic medical records system and the doctor\u2019s office\u2019s own system are all operating in parallel and not coordinating with one another, and that\u2019s why you get all these annoying multiple reminders. The medical community is becoming aware that it\u2019s backfiring because the more you get, the more you start tuning them out and you don\u2019t pay attention to which ones might be important. So they are working on it. So a somewhat hopeful piece of news.<\/p>\n
Rovner<\/strong>: Raise your hand if you have multiple patient portals that you have to deal with for your multiple \u2026<\/p>\n
Ollstein<\/strong>: Oh, my God, yes.<\/p>\n
Rovner<\/strong>: I will note that everybody\u2019s hands go up. Mac?<\/p>\n
Carey<\/strong>: I have not one but two stories on a very important issue: Medicaid estate recovery. The first is from Paula Span at The New York Times. The headline says it all, \u201cWhen Medicaid Comes After the Family Home<\/a>.\u201d And the second story is an AP piece by Amanda Seitz, and that\u2019s titled \u201c State Medicaid Offices Target Dead People\u2019s Homes to Recoup Their Health Care Costs<\/a>.\u201d Now, these stories are both about a program that\u2019s been around since 1993. That\u2019s when Congress mandated Medicaid beneficiaries over the age of 55 that have used long-term care services, and I\u2019m talking about nursing homes or home care, that states must try to recover those expenses from the beneficiaries\u2019 estates after their deaths.<\/p>\n
As you can imagine, this might be a problem for the beneficiaries. They might have to sell a family home, try to find other ways to pay a big bill from Medicaid. Rep. Jan Schakowsky, she\u2019s a Democrat of Illinois, has reintroduced her bill. It\u2019s called the Stop Unfair Medicaid Recoveries Act. She\u2019s trying to end the practice. She thinks it\u2019s cruel and harmful, and her argument is, in fact, the federal and state governments spend way more than what they collect, and these collections often go after low-income families that can\u2019t afford the bill anyway.<\/p>\n
So even though it\u2019s been around, it\u2019s important to read up on this. A critical point in the stories was do states properly warn people that assets were going to be recovered if they enroll a loved one in Medicaid for long-term care and so on. So great reading, people should bone up on that.<\/p>\n
Rovner<\/strong>: This is one of those issues that just keeps resurfacing and doesn\u2019t ever seem to get dealt with. Well, my story this week is from The Washington Post, although I will say it was covered widely in dozens of outlets. It\u2019s called \u201cArizona Lawmaker Tells Her Abortion Story to Show \u2018Reality\u2019 of Restrictions<\/a>.\u201d On Monday, Arizona State Sen. Eva Birch stood up on the Senate floor and gave a speech unlike anything I have ever seen. She\u2019s a former nurse at a women\u2019s health clinic. She\u2019s also had fertility issues of her own for at least a decade, having both had a miscarriage and an abortion for a nonviable pregnancy in between successfully delivering her two sons.<\/p>\n
Now, she\u2019s pregnant again, but with another nonviable pregnancy, which she plans to terminate. Her point in telling her story in public on the Senate floor, she said, was to underscore how cruel \u2014 her words \u2014 Arizona\u2019s abortion restrictions are. She\u2019s been subject to a waiting period, required to undergo an invasive transvaginal ultrasound to obtain information she and her doctor already knew about her pregnancy, and to listen to a lecture on abortion, quote, \u201calternatives,\u201d like adoption, which clearly don\u2019t apply in her case.<\/p>\n
While she gave the speech on the floor, several of her Democratic colleagues stood in the camera shot behind her, while many of the Republicans reportedly walked out of the chamber. I will link to the story, but I will also link to the entire speech<\/a> for those who want to hear it.<\/p>\n
OK, 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 our fill-in editor for today, Stephanie Stapleton. 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. Mary Agnes, where are you hanging out these days?<\/p>\n
Carey<\/strong>: I\u2019m hanging out on X, @MaryAgnesCarey<\/a>.<\/p>\n
Rovner<\/strong>: Alice?<\/p>\n
Ollstein<\/strong>: @AliceOllstein<\/a> on X, and @alicemiranda<\/a> on Bluesky.<\/p>\n
Rovner<\/strong>: Tami?<\/p>\n
Luhby<\/strong>: The best place to find me is at cnn.com<\/a>.<\/p>\n
Rovner<\/strong>: There you go. We will be back in your feed next week. Until then, be healthy.<\/p>\n
\n\t\tCredits\t<\/h3>\n
\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