\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.\t\t<\/p>\n Health programs are feeling the pinch of the ongoing government shutdown. Funding for the Supplemental Nutrition Assistance Program, or SNAP, and the food program for women, infants, and children, WIC, is likely to run out in November, and cuts at the Centers for Disease Control and Prevention are keeping the agency from carrying out some of its primary public health functions.<\/p>\n Meanwhile, the Trump administration’s immigration crackdown is also leading to health consequences, and the Department of Homeland Security is trying to bolster its medical staff to cope with the large number of people in its custody.<\/p>\n This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post.<\/p>\n \t\t\t \tShefali Luthra \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \t\t\t \tRachel Roubein \t\t\t \t\t\t Among the takeaways from this week’s episode:<\/p>\n Also this week, Rovner interviews KFF Health News’ Katheryn Houghton, who wrote the latest “Bill of the Month<\/a>” feature, about a broken elbow and a nearly six-figure bill.<\/p>\n\n Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:\u00a0<\/p>\n Julie Rovner:<\/strong> ProPublica’s “The Shadow President<\/a>,” by Andy Kroll.<\/p>\n Shefali Luthra:<\/strong> The 19th’s “More People Are Freezing Their Eggs \u2014 But Most Will Never Use Them<\/a>,” by Shalini Kathuria Narang, Rewire News Group.<\/p>\n Alice Miranda Ollstein:<\/strong> Brown University’s “New Study: AI Chatbots Systematically Violate Mental Health Ethics Standards<\/a>.”<\/p>\n Rachel Roubein: <\/strong>The Washington Post’s “Errors in New Medicare Plan Portal Mislead Seniors on Coverage<\/a>,” by Dan Diamond and Akilah Johnson.<\/p>\n Also mentioned in this week’s podcast:<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Nutrition Programs Face Their Own Shutdown<\/strong>\t\t\t\t<\/p>\n [<\/em>Editor \u2018s note:<\/em><\/strong> This transcript was generated using both transcription software and a human \u2018s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest reporters in Washington. We’re taping this week on Thursday, Oct. 23, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Shefali Luthra of The 19th.\u00a0<\/p>\n Shefali Luthra:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hi there.\u00a0<\/p>\n Rovner:<\/strong> And Rachel Roubein of The Washington Post.\u00a0<\/p>\n Rachel Roubein:<\/strong> Hi.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we’ll have my interview with my KFF Health News colleague Katheryn Houghton, who reported and wrote the latest “Bill of the Month” about a broken elbow that cost nearly six figures to fix. But first, this week’s news.\u00a0<\/p>\n So, today is Day 23 of the government shutdown, and there is still no discernible end in sight. But even though the Trump administration is playing fast and loose with the law that’s supposed to ban most spending without the consent of Congress, more ramifications to the shutdown are starting to be felt. It appears that both big federal nutrition programs \u2014 food stamps and WIC, which serves pregnant and breastfeeding women and the youngest children \u2014 will soon run out of money, which someone on social media pointed out would mean people going hungry on Thanksgiving, which is not a great look for the government. Yet both Republicans and Democrats still think they’re winning this fight. Really?\u00a0<\/p>\n Ollstein:<\/strong> I feel like every week we’re like: Yep, still shut down.<\/em> Yep, no real meaningful progress on negotiations.<\/em> And we’re just in a “Groundhog Day” time loop here.\u00a0<\/p>\n Rovner:<\/strong> And now the president’s off to Asia in addition to everything else.\u00a0<\/p>\n Ollstein:<\/strong> Yes, but he wasn’t really super engaged on the shutdown and the reopening. Actually, some lawmakers in both parties have been begging him to get involved, saying it’s really the only way for this to work itself out and to strike some sort of deal on the Obamacare subsidies, is for President [Donald] Trump to be the leader of the Republican Party and tell them to get in line, basically. But that has not happened, and without that happening we haven’t seen a ton of real progress.\u00a0<\/p>\n Roubein:<\/strong> I mean, I think one thing we’re all looking for is we’ve obviously started seeing rates in some states go up.\u00a0<\/p>\n Rovner:<\/strong> For the ACA [Affordable Care Act]. Yeah.\u00a0<\/p>\n Roubein:<\/strong> Yes, for the Obamacare exchanges, due to the impending expiration of the subsidies. But\u2014\u00a0<\/p>\n Rovner:<\/strong> And the impending open enrollment that starts Nov. 1.\u00a0<\/p>\n Roubein:<\/strong> Exactly. And so we’ve not yet seen posted on HealthCare.gov, the federal site that some states use, those rates. So I think everyone’s also watching and waiting to see those rates, which are expected to go up.\u00a0<\/p>\n Rovner:<\/strong> Well, we’ll get to the ACA in a minute, but first I want to talk a little bit more about some of the things that are actually happening because the government is shut down. Over at the CDC [Centers for Disease Control and Prevention], where furloughs have been followed by firings that may or may not be legal, remaining staff are unable to attend this week’s big international meetings on infectious diseases, which feels like something you’d want public health professionals to be kind of up to date on.\u00a0<\/p>\n And with the so far temporary stoppage of the CDC’s Morbidity and Mortality Weekly Report, which is kind of the weekly bible of public health, now the New England Journal of Medicine and CIDRAP [the Center for Infectious Disease Research and Policy], the public health institute at the University of Minnesota, announced at that same infectious disease conference that they would begin publishing their own public health alerts to try and fill the void of the MMWR. It’s not clear to me if this is intended to be temporary and will stop if and when MMWR is back up and running. Or is RFK [Health and Human Services Secretary Robert F. Kennedy Jr.] actually succeeding in his quest to dismantle the CDC and leave public health up to states and private funders? Is this sort of the decline and fall of the federal role in public health?\u00a0<\/p>\n Ollstein:<\/strong> I mean, I think it’s a step in a trajectory we’ve been seeing for a few years. It’s not brand-new. I mean, it reminds me of how during the peak of the covid pandemic, outside institutions, academic and otherwise, were setting up their own trackers and other data tools because they did not trust the federal government. And we’re sort of back in that same situation. It’s both a lack of trust in the federal government and the people running it, as well as this new slashing of resources and institutions and a desire to build sort of independent ones that can’t be sort of subject to these political whims in the future.\u00a0<\/p>\n Although the idea was that the MMWR was protected from political whims, but that is maybe no longer the case. And so it’s tough because building these independent outside versions, they just won’t have the same resources. They won’t have the same access to data that the federal ones that they’re trying to replace had. So it’s not like a one-to-one. And again, seeing the splintering of trust. And so there’s a portion of the public that doesn’t trust the federal government right now, but there’s going to be a portion of the public that won’t trust this alternative setup, either. So it’s just very hard to have a gold standard fount of data that everyone can agree on.\u00a0<\/p>\n Roubein:<\/strong> Just in sort of the public health space, we’re seeing this really particularly in vaccine policy. It’s starting to fracture along state and political lines. We’re seeing states in the Northeast and the West with their own coalitions to make shot recommendations. We’re seeing groups trying to, like major medical associations, putting out recommendations and saying that they don’t trust the new ACIP [Advisory Committee on Immunization Practices]. So that’s, I mean, I think a kind of tangible spot there.\u00a0<\/p>\n Rovner:<\/strong> I would say, since I have all three of my abortion experts here, I mean one of the things that we’ve seen since the fall of Roe<\/em> is that every state now has a completely different policy on reproductive health. Are we moving to the point where every state is also going to have a completely different policy on these public health issues?\u00a0<\/p>\n Luthra:<\/strong> I think that’s really plausible, but just thinking about Rachel’s point about vaccines in particular, one of the most important differences there is that vaccines are effective when more people use them. And with abortion, we have seen these sort of patchworks take effect. People can travel. People can get pills mailed to them. And there’s a strain on this system. But if someone doesn’t get an abortion in Texas, that doesn’t necessarily affect the health of someone a few states over. But if we see some people have ready access to vaccines and trust in the system that enables them to get that kind of preventive health care and in other parts of the country we don’t, eventually what happens is that there is broader spread of disease and worse public health consequences for all of us.\u00a0<\/p>\n Rovner:<\/strong> Which is kind of why we have a national public health infrastructure in the first place. We’ll clearly come back to this, but let’s move back to what’s driving this shutdown in the first place, as you mentioned, Rachel, which is the high and growing cost of health care. The Paragon Institute, which is providing what seems to be most of the Republicans’ talking points on health care these days, is pushing a new argument that the expiration of the additional Affordable Care Act tax credits are only a small piece of the increasing premiums for 2026. And that’s true. The CBO [Congressional Budget Office] said in its estimates that insurers are raising premiums slightly to make up for the loss of policyholders who are likely to drop their coverage, which will raise costs for everybody else. But the bigger reasons that premiums are going up are things like tariffs and industry consolidation and the general increase in health care cost.\u00a0<\/p>\n But I’m wondering if that very semantic point, that the subsidy expiration is only a tiny part of the premium increase is going to make much difference to the people who are going to see their out-of-pocket costs double or more, because while the premium might only be going up a few percentage points, the expiring tax credit will dwarf that, because now they’re going to have to pay the whole premium instead of just a portion of the premium. It’s like your employer’s premiums are going up 5%, but your employer is cutting its contribution in half. That doesn’t seem like a very big solace to people who were \u2014 even though the expirations are a little bit of the premium increase, you’re still going to see a bill that says a thousand dollars a month instead of $200 a month, right?\u00a0<\/p>\n Ollstein:<\/strong> I think we’re seeing that realization take hold. I mean, I know we’ve talked on the podcast before about a small handful of Republicans coming out and saying: Look, my kids’ premiums are going up. We really have to do something, people.<\/em> Including some members you might not expect, like [Rep.] Marjorie Taylor Greene, very, very conservative folks who say: Look, I’m no fan of Obamacare, but we have to act. This is really bad.<\/em> Meanwhile, you still have other lawmakers downplaying it, saying, Oh, those subsidies, that was a covid thing and covid’s over, so we don’t need that.<\/em> But I think the more the plans and the costs start to solidify and people start getting these notifications, the political pressure will continue to build, but build towards what we’re not really sure at this point.\u00a0<\/p>\n Rovner:<\/strong> Yeah, we’ve seen, I think we’re starting to actually see these premiums in a dozen states. And Rachel, as you mentioned, we will see the federal premiums soon and that might spur something. Meanwhile, the Democrats have a new talking point as well to counter the Republican complaints that the subsidies for the ACA coverage are exceedingly high. They point out that all other forms of health insurance coverage are also heavily subsidized by the government, Medicare and Medicaid by the federal and state governments and employer coverage by the tax exclusion that makes premiums tax-free for both employers and employees. So why, they say, should the individual market be the only one that is not highly subsidized? Effective or a little bit too complicated for this?\u00a0<\/p>\n Roubein:<\/strong> I mean, I think in general, like at the sort of macro level, we tend to see this in health care. When there’s some benefit or there’s a new policy, it is hard to change that. A lot of things that are supposed to sort of, in Congress they’ll do for a few years, tend to just get extended on and on because it then becomes a pain point.\u00a0<\/p>\n Rovner:<\/strong> So in the end, I mean, do these subsidies get extended or we still have to wait and see how painful this pain point gets?\u00a0<\/p>\n Roubein:<\/strong> Who’s to say? I don’t like to always predict what Congress will do, so\u2014\u00a0<\/p>\n Rovner:<\/strong> Certainly not this year.\u00a0<\/p>\n Luthra:<\/strong> One thing I will add in there is that we did some polling recently at The 19th just looking at broad economic concerns among other issues, and health care costs are a very serious concern for just a huge majority of Americans. It’s not even, I mean, across the board, this is true. It’s even more true for women. We know that the subsidies had and have had a really meaningful impact for a lot of specific demographics. Women are one of those, so are a lot of more conservative-leaning voters. And I just think that we may not know what will happen with the subsidies, but what we can say is that it’s a really big deal to a lot of people who will be affected, and it’s hard not to imagine that affecting how they think about their representation and ultimately whether government is working for them when they look at their health care getting more expensive.\u00a0<\/p>\n Rovner:<\/strong> I don’t carry around a lot of numbers in my head, but the numbers that I carry around include 24 million people who are getting ACA coverage, 90% of whom are getting subsidies. So, it’s a lot of people, as we’ve said many times, in a lot of pretty Republican states. So we’ll see when the yelping really starts. Well, I want to talk a little bit about immigration and health because we have two excellent stories about health care and immigration this week, written or co-written by two of our panelists. How convenient. Alice, tell us about your story<\/a> about ICE [Immigration and Customs Enforcement] hiring more health workers.\u00a0<\/p>\n Ollstein:<\/strong> My co-worker and I noticed that all of these jobs were posted for doctors, nurses, pharmacists, therapists, health care workers to work specifically in ICE detention. And we were interested in, why go on this hiring spree? I mean, we’re in a government shutdown. It’s not exactly hiring season. But once we started looking into it \u2014 well, one, the federal government did not respond to our questions about why they’re hiring and what they hope to achieve. But we saw that the detainee population has exploded to record levels and the number of deaths has gone way up. We are approaching the number of deaths, just in 10 months this year, almost as much as occurred over the four years of the Biden administration. Now, the actual rate isn’t as high because there’s just so many more detainees, but it’s very troubling and people are dying of both sort of acute and chronic factors.\u00a0<\/p>\n And so there’s all these lawsuits right now about medical neglect and poor access to medical care in ICE detention. There are multiple hunger strikes going on in multiple states related to We’re being denied access to health care<\/em>. And so all of this is sort of building to a crisis point. And people are being held in facilities that weren’t meant to hold people, let alone this many people, these sort of tent cities they’re standing up very quickly. Facilities are overcrowded, which makes it hard to control the spread of disease. Just a lot of issues going on. And so we talk to people about what could hiring some new medical personnel, what could that help address and what is it not likely to address in terms of the conditions.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I mean it seems when you have that many people in detention, hiring a couple of dozen of health workers is going to not really solve the problem.\u00a0<\/p>\n Ollstein:<\/strong> Right. So, one, we don’t know if and when these people will be hired, but even so, again, a few dozen compared to they’re trying to grow the population of detainees by tens of thousands. The numbers don’t really add up.\u00a0<\/p>\n Rovner:<\/strong> Well, Shefali, you have a story<\/a> that kind of follows onto that, about women who are pregnant or nursing being taken into immigration custody, which is a change from prior practice, and the sometimes tragic outcomes of that. What did you find?\u00a0<\/p>\n Luthra:<\/strong> So this story came because we just kept seeing individual lawsuits and single reports of someone saying: I was detained while I was pregnant. Here are the conditions I was held in.<\/em> Some people reported miscarriages. Some people just reported really substandard care. And it came to become clear to us that this appeared to be somewhat of a trend, is these women were being detained, sometimes for short periods, sometimes for longer periods, and they were having adverse health consequences.\u00a0<\/p>\n And so we did some digging. We learned that there actually was a policy put in place that said you are not supposed to detain people who are pregnant, who are nursing, who are a year postpartum, unless there are really extenuating circumstances. We looked everywhere to see: Had this been rescinded anywhere? And it hadn’t been. And that was just so striking to us because this policy is technically still in place. ICE is not supposed to be detaining these people, and every doctor you speak to will say: Well, we can’t study. There’s no randomized control trial of being detained versus not and pregnant and what happens to you.<\/em>\u00a0<\/p>\n But we know what is good for pregnancy and what is not, and we can say that the best practices are you shouldn’t detain people where access to prenatal care is sporadic at best, maybe not in the language that you speak. The food will not work for you, especially if you have these strong aversions. You may not be able to talk to someone right away if you suspect you are miscarrying. There’s a lot of psychological and physical stress. And then at the same time, the government has stopped reporting just how many of these cases there are.\u00a0<\/p>\n And so there’s a lot of efforts underway to try and figure out as detention gets broader and broader, they try and, as Alice said, really increase the number of people being detained. We are seeing more women in particular, more pregnant, postpartum nursing women, being detained, and the numbers will just not be able to give us that clear sense of who they are or also what the health consequences can be.\u00a0<\/p>\n Rovner:<\/strong> We’ll try to keep an eye on it there. I will post links obviously to both of your stories. I want to talk about MAHA, Make America Healthy Again. The AP [Associated Press] has a series out this week tracking the organized campaign by those with financial interest in the MAHA movement to, in the words of the story<\/a>, quote, “strip away protections that have been built over a century” in public health. The reporters, including KFF Health News alum Laura Ungar, tracked 420 anti-science bills introduced in 43 state legislatures around the country focusing on vaccines, fluoride, and raw milk. They also tracked back those pushing the legislation to the supplement and wellness product sellers, raw milk farmers, and others who stand to profit from focusing on the MAHA priorities. For all of Secretary Kennedy’s accusations about the health care industry being in the pocket of Big Pharma or Big Food, can’t it also be said that many of his allies are in the pocket of Big Wellness?\u00a0<\/p>\n Ollstein:<\/strong> I think that it has been fascinating that the wellness industry, the supplements industry, these aren’t being seen as the big capitalist forces that they really have become. And they’re far less regulated than the industries that the movement rails against, like food and like the pharmaceutical industry. And yet it sort of has this sheen of virtue that is \u2014 it’s gotten a lot less scrutiny and a lot less questioning. And so I wonder if that changes as this power shift happens at the state and federal level.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I think the raw milk producers I think really probably shocked me the most, maybe because I knew about the other ones, but sort of the power of the burgeoning raw milk industry. By the way, if you don’t pasteurize milk, you can get all kinds of bacteria and viruses and other bad things from drinking raw milk. It’s one of those things, like many of these things, that sounds great until you actually look into it. Rachel, you wanted to add something?\u00a0<\/p>\n Roubein:<\/strong> Oh yeah, I was just going to say that I think in general, this push from the Make America Healthy Again movement, its allies into state legislatures, has been very coordinated. This is a big goal of the MAHA movement. Allies aligned with Kennedy are pushing a range of bills. They’re also pushing bills around food that did pass the state legislatures last year, such as barring SNAP [Supplemental Nutrition Assistance Program] recipients from using their benefits to buy soda or cracking down on artificial dyes in the food supply. But in general, Kennedy has not put sort of sweeping regulations, new regulations, around food, around pesticides, etc. And instead, a lot of allies are seeking to use the states, particularly when it comes to food, to sort of pressure companies and then be able to kind of pressure into a sort of federal, a more kind of national push.\u00a0<\/p>\n Rovner:<\/strong> That’s kind of this administration’s theme, right? It’s: We’re not going to regulate, because we don’t like regulation. We’re just going to do individual deals with individual companies.<\/em> I mean, certainly that’s what Trump’s doing with tariffs and other things, and it looks like that’s what Kennedy’s doing too, right? Seeing nodding.\u00a0<\/p>\n Well, moving on. Like pretty much every week, there is news on the reproductive health front. Late last week, President Trump unveiled his plan to improve access to IVF [in vitro fertilization] for people hoping to get pregnant. During the 2024 campaign, he very specifically promised to make IVF free, either by having the government pay for it or requiring insurers to cover it, quote, “because we want more babies,” he said. But his plan doesn’t really do either of those things, right? It doesn’t make it free. I’m seeing shaking heads. Someone explain what it actually does do.\u00a0<\/p>\n Ollstein:<\/strong> So there’s two pieces of this. One is a voluntary agreement with a pharmaceutical company to lower the cost of one fertility drug. It’s not a drug that every single person who goes through the process uses, but a lot of people do use it. I will also note that out of the total cost of IVF, the cost of these drugs is just like a fraction of it. Less than a quarter is what I was told when I talked to experts. So this doesn’t do anything to lower the cost of the consultations, the egg retrievals, the egg storage, the embryo implantation. All of those costs are unchanged. So there’s the drug crisis \u2014 yeah.\u00a0<\/p>\n Rovner:<\/strong> I would say basically if you don’t have coverage for IVF and you can’t afford it on your own, lowering the cost of the drug is nice but it’s not going to make you able to afford it. Right?\u00a0<\/p>\n Ollstein:<\/strong> Likely not. Likely not. But the other piece of it is we’re still waiting for the exact text of what this guidance and regulation will consist of, but just going off of what they’ve said, they want to make it easier for employers to offer supplemental IVF coverage that’s separate from the regular health plan. Now, I’ve talked to some experts who are really skeptical that that will make a difference. One, employers can already do that. Politico offers supplemental IVF coverage.\u00a0<\/p>\n Rovner:<\/strong> So does KFF Health News.\u00a0<\/p>\n Ollstein:<\/strong> There you go. And so it’s not clear what this guidance, which comes with no funding, no incentives, no mandates, why an employer that didn’t already offer it would choose to offer it now. It’s not totally clear. But also making it this separate supplemental thing, you get into this adverse selection situation where the only people who are going to sign up for it are the people who plan to use it, and that doesn’t spread the cost around and bring it down like regular insurance does.\u00a0<\/p>\n Luthra:<\/strong> And I think it’s worth noting, if we even \u2014 to Alice’s point, we don’t have a lot of details yet about how these plans would work \u2014 but going off of everything they said in their remarks, looking through what documentation has been put out so far, one thing we keep hearing about from administration officials is the flexibility within these plans and the ideas that employers could offer benefits that match their values.\u00a0<\/p>\n Which I think is really interesting because when you talk about fertility benefits, some people do have moral objections to IVF, and when you talk about matching their values, there’s a real question there: Are these plans actually required to cover IVF with multiple embryos, created with embryos discarded? We also heard a lot of chatter about offering benefits that would address the root causes of infertility. And this has become somewhat of an allusion to other forms, regimens, ideas of what fertility treatment can be that conservatives call restorative reproductive medicine.\u00a0<\/p>\n And I think as we get more details, a really important question to see is, how generous do these plans have to be, or are they in practice? Do they actually cover IVF in a way that is meaningful and actually addresses people’s needs? Or do they instead offer limited coverage of something that is less effective, maybe already covered, and certainly already affordable for a lot of Americans?\u00a0<\/p>\n Rovner:<\/strong> So one would assume that this plan is sort of meek because the administration is trying to be sensitive to the portion of the anti-abortion movement that opposes IVF because, as you say, you often create multiple embryos and then don’t end up using them and they end up getting destroyed. So is the politics of this going to satisfy both sides or going to dissatisfy both sides of this fight?\u00a0<\/p>\n Luthra:<\/strong> The anti-abortion movement seems to understand that it could have been worse for them, but they are not thrilled about it, either. You mentioned, when we were discussing this part of the show, the Vox article, which I thought had a really great headline, by Rachel Cohen Booth, which was “Trump Manages To Disappoint Nearly Everyone With His New IVF Plan<\/a>,” which I think is about right. I mean, this is not what people who want broad access to IVF would actually hope for, and this is certainly not what conservatives who oppose IVF would hope for, either, because they want something that is more sweeping in its criticism of IVF as it’s practiced. They want something that more full-throatedly endorses what they support instead. And it’s neither of them. It’s just sort of trying to find something that pleases everyone and, as a result, not necessarily changing that much.\u00a0<\/p>\n Rovner:<\/strong> Politics as usual. Well, meanwhile, Bloomberg has a really provocative story<\/a> this week about the limbo that many Planned Parenthood clinics find themselves in. You may or may not remember that as part of the Republicans’ big budget bill that passed earlier this year, the organization lost all of its federal Medicaid funding for a year. But because of the shutdown, HHS has not yet issued guidance on which Planned Parenthoods \u2014 many of which have stopped providing abortions or never provided abortions in the first place \u2014 are covered by this funding cutoff. Making everybody uncertain and unable to plan appears to be the overall strategy for this HHS, doesn’t it?\u00a0<\/p>\n Ollstein:<\/strong> Well, and on top of that, Planned Parenthood affiliates that were getting Title X family planning money had that withheld, had that frozen, and they’re still waiting to learn the fate of that portion of money. And so it’s just uncertainty piled on top of uncertainty.\u00a0<\/p>\n Rovner:<\/strong> Yeah. This I imagine is not going to impact what sort of the big abortion fight is going forward, which is going to be about abortion pills sent through the mail. But one would assume that it is going to impact people who are looking for services that don’t have anything to do with abortion, that have to do with cancer screenings and STD [sexually transmitted disease] screenings and just regular, routine gynecologic care. I mean, that’s what these Planned Parenthoods are providing using Medicaid funds and using the Title X funds, neither of which can be used for abortion.\u00a0<\/p>\n Ollstein:<\/strong> Right, and a lot of the clinics that have shut down in recent months \u2014 I’m thinking of the ones in Louisiana and Texas and Iowa \u2014 abortion is banned in those places. Those clinics were not providing abortions. So I’ve been seeing a lot of folks on the right celebrating those clinic closures. But again, those clinic closures don’t mean less abortion. Those clinic closures mean less access to these other services.\u00a0<\/p>\n Rovner:<\/strong> All right, well, that is this week’s news, or at least as much as we have time for. Now we will play my “Bill of the Month” interview with Katheryn Houghton, and then we will come back and do our extra credits.\u00a0<\/p>\n I am pleased to welcome back to the podcast KFF Health News’ Katheryn Houghton, who reported and wrote the latest KFF Health News “Bill of the Month<\/a>.” Katheryn, welcome back.\u00a0<\/p>\n Katheryn Houghton:<\/strong> Thank you so much.\u00a0<\/p>\n Rovner:<\/strong> So, this month’s patient had insurance but ended up dropping it because she could no longer afford the premiums, an all too common story, and then two months later slipped and fell and broke her elbow. Tell us who she is, what kind of care she got, and how much she was told it was going to cost.\u00a0<\/p>\n Houghton:<\/strong> Sure. So her name is Deborah Buttgereit. She had fractured her left arm near the joint. So this was a humerus break, and it shattered a bit. So she needed surgery to kind of piece the bones back together, and that’s pretty key to, say, be able to move her arm. So she was told it was going to cost $50,000 or just a little bit more than that, and all of that would be out of pocket because, like you said, she didn’t have health insurance.\u00a0<\/p>\n Rovner:<\/strong> Yikes. So, she had the surgery. Presumably her arm is better. And then the bill came. How much did it end up being?\u00a0<\/p>\n Houghton:<\/strong> A lot more than $50,000. It was more than $97,000. Though it is important to say the hospital applied a self-pay discount, which left her with a $78,000 bill.\u00a0<\/p>\n Rovner:<\/strong> So what was the explanation about why it was so much more expensive than the original estimate?\u00a0<\/p>\n Houghton:<\/strong> The original estimate is just that, and the way that hospitals put it is: It is our best guess of what you are going to have to pay.<\/em> If there’s some sort of complication, it could cost more, and there is a small fine print in any good-faith estimate that says that. So for Deborah’s case, the hospital said there were surprise complications, which means surprise costs. Her doctor said they encountered complications kind of mid-procedure, so her bones shattered into more pieces than they expected. That meant more time in surgery, that meant more skill to fix the break, and that also meant more tools to fix the break. And all of that comes with more costs.\u00a0<\/p>\n Rovner:<\/strong> Yes. So Ms. Buttgereit decided that she did not wish to pay, even though, what, $78,000 that they were hoping that she would, and found that eventually she could appeal the bill under a provision that I didn’t know was included in the federal No Surprises Act, which I thought only applied to people with health insurance. Tell us about this little not well-known piece of the No Surprises Act.\u00a0<\/p>\n Houghton:<\/strong> Yeah, exactly. I mean, fair thought on it being surprising, because a lot of people don’t know this exists. Some of the policy experts I talked to were like, Oh, this exists.<\/em> A little-known fact about this is the No Surprises Act also created a formal dispute process for uninsured patients or those paying completely out-of-pocket for a planned procedure, so even outside of that emergency care situation. And this process, you’re eligible for it if you’re paying out-of-pocket and your final tab is $400 or more than the initial estimate.\u00a0<\/p>\n Rovner:<\/strong> Which this clearly was.\u00a0<\/p>\n Houghton:<\/strong> By quite a bit.\u00a0<\/p>\n Rovner:<\/strong> So in the end, she decided not to use this appeal process. Why?\u00a0<\/p>\n Houghton:<\/strong> So the appeal process, the floor of a process starts at the good-faith estimate, and Deborah had said, more time to think pain-free, she started to question that $50,000 bill and started using online price comparison tools and saying: You know what? This all seems overpriced. I don’t want that to be the floor.<\/em> So she’s been going back and forth and doing negotiations with the hospital. But honestly what I’m hearing from the policy experts that I spoke with for this story was there’s just not a good process or system for patients paying out-of-pocket to fight a big bill. And this dispute process is one of the only options that they see out there.\u00a0<\/p>\n Rovner:<\/strong> And I take it this fight about what she’s eventually going to be required to pay is still ongoing.\u00a0<\/p>\n Houghton:<\/strong> Last I heard it was still ongoing. She was still going back and forth with the hospital, which was standing by their price tag, and she was working on setting up a payment plan no matter what the final tally came to. But if it stays at that final $78,000 range, a payment plan means she would face payments for 60-plus years.\u00a0<\/p>\n Rovner:<\/strong> And she’s already in her 60s, right?\u00a0<\/p>\n Houghton:<\/strong> Yes. Yeah. She would be paying off this for the rest of her life.\u00a0<\/p>\n Rovner:<\/strong> So it’s probably in the hospital’s interest to find a better solution. What’s the takeaway here for other patients who end up with an accident and a big bill and no health insurance?\u00a0<\/p>\n Houghton:<\/strong> The takeaway is if you’re going to push back on a price, starting at the good-faith estimate is key. So once you’ve already gone through the procedure, that’s almost like acceptance of what that floor price would be. And so if you’re going to fight back, fight at the very beginning. That’s hard when you’re going through a, say, painful break and you don’t have a lot of the energy to deal with anything other than trying to be OK with yourself and take care of yourself. The other thing to know is just if you are uninsured, if you are paying out-of-pocket, there is this dispute process if you get to that point.\u00a0<\/p>\n Rovner:<\/strong> Great. Katheryn Houghton, thank you so much.\u00a0<\/p>\n Houghton:<\/strong> Thanks so much.\u00a0<\/p>\n Rovner:<\/strong> OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Shefali, you have a story that’s related to reproductive health and IVF and all of those other good things. Tell us about it.\u00a0<\/p>\n Luthra:<\/strong> Sure. So this was written by Shalini Kathuria Narang, written for Rewire News Group, co-published with the 19thnews.org. The headline is, “More People Are Freezing Their Eggs \u2014 But Most Will Never Use Them<\/a>.” And I thought this was so interesting. It delves into a study that showed that 6% of people who froze their eggs between 2014 and 2021 had actually come back and used them within seven years.\u00a0<\/p>\n There’s a Q&A with the author. But what’s so striking to me about this is, I mean, I definitely felt in the 2010s there was this huge conversation around egg freezing among especially young women who were working, this idea that this is a benefit that is being made available to you, this could actually make it much easier for you to ultimately have children if it’s something you want to do later in life when it gets harder.\u00a0<\/p>\n And I just think this is so fascinating that this was a benefit that was really promoted, an alternative that a lot of people turned to, and that it seems that a lot of people aren’t necessarily using it. I really wonder why. I’m curious how much money has been spent on this and what this means and sort of how it helps us understand people’s reproductive choices moving forward. I just am so excited to see where this research takes us and how we better understand people’s reproductive choices.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it was interesting. I mean, one of the things that I found really interesting about this story was that it’s actually too soon to really know how many of them get used, because we did see this increase in young women having their eggs retrieved and frozen, and those young women, many of them are still young and not yet ready to use them. I mean, they still could, in other words.\u00a0<\/p>\n Luthra:<\/strong> And many of them who froze them may not have to use them, because they froze them thinking, Oh, this is for much later<\/em>, and then it turns out they actually can get pregnant without using them to begin with.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it’s a really provocative story. Alice.\u00a0<\/p>\n Ollstein:<\/strong> Yes. So I chose this new study from Brown University. It’s titled “AI Chatbots Systematically Violate Mental Health Ethics Standards<\/a>.” So the number of people who turn to ChatGPT and these other AI tools for therapy, either just chatting with it or specifically prompting it to provide therapy \u2014 that’s an increasingly common practice.\u00a0<\/p>\n But if you read this study, you might not want to do that. This says that exhibited 15 ethical risks, including failing to refer users to appropriate resources or responding indifferently to crisis situations, including suicidal ideation. The chatbots exhibited gender, cultural, or religious bias. They used what they called deceptive empathy. They created a false bond between the bot and the user. They reinforced negative thoughts and beliefs. So this is yet more evidence that therapy is best provided by a human being who was trained and not a language predictor tool.\u00a0<\/p>\n Rovner:<\/strong> Maybe it’s just that I’m old, but I don’t think I want to take personal advice from anything that learned everything it knows from the internet. That’s just me. Rachel.\u00a0<\/p>\n Roubein:<\/strong> My extra credit this week is a story by my colleagues Dan Diamond and Akilah Johnson at The Washington Post. The headline is “Errors in New Medicare Plan Portal Mislead Seniors on Coverage<\/a>.” So Medicare open enrollment began Oct. 15, and ahead of that, the Trump administration created this directory that was aimed at helping millions of seniors try and look up what doctors and medical providers accept which insurance.\u00a0<\/p>\n But the portal, when it first opened, it was focused just on Medicare Advantage plans, and what my colleagues found is it frequently produced erroneous and conflicting information, and that led to a scramble inside the federal government to try and fix it. Dan and Akilah wrote about the backstory, too, which is that the Trump administration announced these plans for a national directory, but then in August they said it would be a temporary directory limited to just Medicare Advantage or private plans. After Dan and Akilah raised the problems that they were writing about to the Centers for Medicare & Medicaid Services last week, officials said that they were working to address the errors and seek potential solutions.\u00a0<\/p>\n Rovner:<\/strong> People in other countries that have national health insurance must laugh at us about the fact that we can’t even have accurate directories of which providers take which insurance. But this has been a long-standing problem dating back as many years as we’ve had networks of doctors. Someday someone will solve it. I don’t know, maybe AI can do it.\u00a0<\/p>\n My extra credit this week is from ProPublica. It’s called “The Shadow President<\/a>,” by Andy Kroll. It’s about the rise of Russell Vought, whose name most people don’t know unless you listen to podcasts like ours, but who is the head of the White House Office of Management and Budget, the man behind lots of Project 2025, and the person calling most of the shots for the domestic policies of Trump 2.0. Trump actually proudly introduced him this week at a lunch for Republican senators as his personal Darth Vader.\u00a0<\/p>\n What I really like about this story, though, is not just the detail of how Vought came to his beliefs, which is interesting enough, but how OMB is so intricately in charge of just about everything an administration does, which I think most people do not appreciate. This story is part of a year-long investigation with The New Yorker, and it is well worth your time, even though it’s pretty long.\u00a0<\/p>\n All right, that is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org<\/a>. Or you can find me still on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you guys hanging these days? Shefali?\u00a0<\/p>\n Luthra:<\/strong> I’m on Bluesky, @shefali<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Alice.\u00a0<\/p>\n Ollstein:<\/strong> Mainly on Bluesky, @alicemiranda<\/a>.\u00a0<\/p>\n Rovner:<\/strong> Rachel.\u00a0<\/p>\n
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