Health Care on the Ballot: What’s at Stake Nov. 8?

Healthcare on the Ballot

M arianne O’Hare : Welcome to Conversations on Health Care . This week , we welcome
Sheryl Gay Stolberg of the New York Times , and Victoria Knight of
Axios, two veteran health policy reporters on Health Care Issues on
the Ballot this November.

Sheryl Gay Stolb e rg: If Republicans win control of the Senate, it is quite possible that we’ll
see Senator Rand Paul, Dr. Fauci’s biggest n emesis on Capitol Hill, take
control of the Senate Health Committee.

Marianne O’Hare: Lori Robertson joins us from F act C heck.org , and we end with a bright
idea improving health and wellbeing in everyday lives. Now, here are
your hosts , Mark Ma s selli and Margaret Flinter.

[Music]

Mark Masselli: Americans will soon have their opportunity to weigh in on the
direction of the country. The mi dt erm elections are about one month
away , and many experts say h ealth care is on the b allot . They mean
that voters will choose candidates who will ultimately make vital
policy decisions about who will get care , who will receive it , and how
it's paid for.

M argar et Flinter: Two distinguished journalists are joining us to discuss H ealthcare on
the Ballot . Sheryl Gay Stolberg is a New York Times Washington
c orrespondent covering health policy in over two decades at the time .
She's also covered the White House, Congr ess and National Politics .
And also with us , is Victoria Knight, Health Care Policy Reporter for
Axios. She was previously with Kaiser Health News.

Mark Masselli: Well, we want to thank both of you for being here on Conversations
on Health Care today.

Shery l Gay Stolberg: Thank you.

Mark Masselli: Sheryl, let's start by asking you to give us your take on a recent NPR
poll found that the top issue for all voters is inflation, but also that
three quarters of Democrats said that Supreme Court's decision t o
over turn Roe v. Wade makes them more likely to vote. This midterm
is being described as a clash between inflation and health care. I'm
wondering how you see it. Is this going to be a health care election?

Sheryl Gay Stolberg: Well, I think it will certai nly be a n abortion election, a Roe v. Wade
election . I think that we've seen that the Supreme Court's decision in
the Dobbs case , has really up ended what a lot of people thought was
going to be a Republican, if not a route, certainly Republican victories
i n both t he House and the Senate , and now that's looking less so .
Democrats are really energized to go to the polls, and they are angry
and mad about this ruling , and they want Congress to do something
about it . And we're going to see President Biden in fac t talk ab out it.
He's emphasizing this as a factor in the midterm . So I do think

Healthcare on the Ballot

abortion will play a role , and to a lesser extent, health care writ large,
because health care is always an issue. It's so important to so many
Americans. So , even when inflat ion is top o f mind, health care is going
to be on the ballot as well.

Margaret Flinter: Well Victoria, you've reported that voters in California, Michigan and
Vermont will be deciding on constitutional amendments to protect
abortion access. Kentucky and Mo ntana voters will be voting on
further restricting abortion rights and conferring legal rights on
fetuses. How do you think all these ballot questions are playi ng out
right now in the se s tates?

Victoria Knight: Well, I mean we saw a great indicator in Kans as . They had a
referendum on the ballot about abortion, whether to restrict it in the
State of Kansas . That is a traditionally conservative state . Voters
overwhelmingly rejected that , said, “ No, we do not want to further
restrict abortion access , or add th at as a constitut ional amendment . ”
And there was a huge surge in women voters registering to vote in
Kansas. And so I think that at least Democrats are hoping that that is
going to -- a trend that's going to continue. So , as you said, there are -
- in sever al states it's to increas e access to abortion , or further protect
it, and in two states it's to further restrict it. And so the thing that's a
little different is for ballot referendums sometimes you need certain
percentages of the population to vote for s omething and it kind of
differ s by state. So , it's a little different because it's not attached to a
candidate , and so I think that's perhaps why we saw what we saw in
Kansas, which was they rejected that amendment.

Mark Masselli: Sheryl , you reported on t he Democrats passing the Inflat ion
Reduction Act and how it will let Medicare directly negotiate the cost
of prescription drugs and how this will ultimately result in cost
savings. But , I'm wondering if there are enough Americans aware of
this development . Is there enough time? Is this m essage breaking
through?

Sheryl Gay Stolberg: Well, that's a good question. Before we get to it, I actually just want
to jump in and say one more thing about abortion in the
Congressional races. We're already seeing it play out in two very key
races in Vir ginia. Those of Elaine Luria and Abigail Spanberger , two
endangered incumbents who are emphasizing abortion, both are --
abortion rights . Both are running against women who oppose
abortion rights . So that'll be kind of a goo d test in a swing state. As for
th e Inflation Reduction Act, a lot of Americans are actually aware of it.
They're aware of the issue of lower drug prices. The Biden
Administration has just announced that Medicare premiums will go
down. So a lot of the seni ors who we know vote in large numbers , will
be feeling that in their pocketbooks . And people, you know, who take
medicines that are expensive are following this. I do think that it's not

Healthcare on the Ballot

as much time frankly as the Democrats would have liked. But the fact
that they got this law passed, and they took on the pharmaceutical
companies who are, you know, kind of boogeyman in the public mind ,
is something that they're going to be talking a lot about on the
campaign trai l and already are talking about.

Margaret Fl inter: Well , Victoria , may be continuing in this area for a moment , you've
written about the House Republicans ’ agenda called the Commitment
to America , sounds vaguely reminiscent of the 1990s. But it includes
wording about personalized health care, and low er prices through
transparency, choice, and competition, all of which sounds like words
and phrases very carefully chosen . What are the Republicans trying to
communicate about their philosophy with this and what might we see
coming as a result of that?

Vic toria Knight: Yeah, the Commitment to Ameri ca was released a couple weeks ago .
Honestly , it ’ s kind of vague on health policy priorities , and I think
that's perhaps purposeful. I think that Republicans , I have talked to
them in the House of Congress , asked them, House Republicans, what
they want to do about the IRA, and they say they want to amend it or
overturn it, they do not like it. They do not like these drug pricing
provisions. They say, which is a classic argument, they often say , “ It
reduces innovati on, and that competition is the best way to reduce
dr ug prices. ” But the Commitment to America does not explicitly say
that overturning the IRA or amending the IRA is a priority , and I think
that's because Medicare negotiat ing drug prices has strong bipart isan
support. If you look at the polling of the America n public, consistently
over time, both Democrats and Republicans support this . And so I
think they do not want to advertise this as a priority right before the
midterms when it's overwhelmingly pretty p opular with the American
people. But we do know that it's something that they are thinking
about. I know they're strategizing about it already , and so it's
definitely something to watch if the Republicans do take over the
House and potentially the Senate.

Mark Masselli: You know, we recognize that COVID was such a big issue two years
ago in the Presidential election, but now it's barely getting political
coverage. Sheryl, you did write about President Biden ’ s statement
that the pandemic is over, but you not ed it received lots of pushback
from victims ’ families and public health officials. But , from a policy
perspective , is COVID over? Do you expect you'll be reporting on it as
much as you have been in the past?

Sheryl Gay Stolberg: So , first of all, yes, his comments did rankle a lot of family members
and people w ho are grieving. But also , yes, they did ring true with a
lot of members of the public who have just gone on and who feel as if
the pandemic is over . And for the vast majority of the public who are
n ot immunocompromised , or suffering from a disease , are quite

Healthcare on the Ballot

elderly and otherwise vulnerable , you know, they are pretty much
go ing about their lives . I do think we'll be covering COVID for a long
time, maybe not as intensely as we have over the past few y ears , but
the fallout from this pandemic is going to be very long term and it's
going to be with us for a while . We have people who are suffering
from Long COVID. We have children who have lost parents . We've got
issues of pandemic preparedness and future debates on Capitol Hill
about , you know, how to prepare for f uture pandemics. So , from a
policy perspective, this pandemic is not over . And we also don't know
what's coming around the bend, right ? We can't predict the future.
Lot of experts think that ther e i s a fall surge coming. I think it is on
voters ’ minds, but maybe not top of mind the way it was say a year
ago.

Mark Masselli: Yeah.

Margaret Flinter: Victoria, so I want to go back to Medicare for a moment . Th e New
Hampshire Senate candidate has actual ly advocated privatizing
Medicare, and the President and others in his party are using this a n d
some other statements to say that the Republicans will put the
program on the chopping block if they gain power . Is this political
rhetoric , or a real possibili ty? What's your thoughts on that?

Victoria Knight: I think it's more so a convenie nt political attack at the moment . As far
as I know, from talking to most Republicans and Republican
strategist s , it's not a mainstream view within the party. It's some
outsk irts that are saying things like that , Senator Ron Johnson . But I
think Republican s know that it's really embedded in the system , and
it's popular ; people like Medicare. So I think they're more focused on
maybe like expanding Medicare Advantage options , or that's
something they really like, which are private plans within Medica re. I
don't see that as too much of a reality. But I think for the most part
that is political rhetoric, but I do think that in this next however many
days we have left, like they're going to try to get people on the record
in these certain areas of is this something you would vote for , a nd is
this going to be a policy priority? I think it's less likely that privatizing
Medicare is an actual -- going to be an actual Republican policy
p riority. But I think it ’ s [i naudible 00:10:42] popular with seniors , and I
t hink they know that would not be popular.

Sheryl Gay Stolberg: It's long been said that Medicare is the third rail of American politics ,
and that's for a reason that nobody wants t o touch it.

Mark Masselli: That's right. But Sheryl , you know Congress so well . And most voters
probably overlook the fact that the leadership of important health
committees will change if the majority party changes . And the
Republicans are promising inves tigations of Dr. Anthony Fauci, NIH , if
they control the gavel . What are they saying they want to accomplish
if they get the power? And what do you think they'll achieve if the

Healthcare on the Ballot

gavel s change?

Sheryl Gay Stolberg: So , Dr. Fauci, as I have written has become really a lightning rod for
Republican --

Mark Masselli: He’s retir ing .

Sh eryl Gay Stolberg: He's retir ing , but he's not go ing away, trust me . And you know, just
because he's retiring doesn't mean that if Republicans win control of
Congress that they can't subpoena him to come testify . And I would
be surprised if a longtime public servant like Dr. Fauci ignored a
Congressional subpoena. They say they want to investigate a lot of
things . They are particularly honing in on the origins of the pandemic.
They've honed in on Dr. Fauci 's finances . I should say that there
seems to be noth ing amiss about Dr. Fauci’s finances. Senator Roger
Marshall, a Republican from Kansas , helpfully made Dr. Fauci’s
portfolio public by putting it on the Internet , and there doesn't seem
to be anything wrong with it. They want to investigate grants that his
institute gave to an i nstitute in Wuhan, China, where the virus began.
But mostly, I think they want to make a lot of political hay, frankly, out
of Dr. Fauci . And if Republicans w in control of the Senate, it is quite
possible that we will see Senator Rand Pa ul, Dr. Fauci’s biggest
n emesis on Capitol Hill, take control of the Senate Health Committee .
And I can only imagine what that is going to look like, because the two
of them hav e just gone at it , and there is no love lost between them.

And on the House si de, I'm not sure who would take over the
subcommittee, but it's possible that Representative Jim Jordan would
be in a position . And he has really also gone after Dr. Fauci, and h as
said, basically, you know, we're going to investigate. And if you look
on, you kn ow, Republican leaning, like social media sites , or, you
know, go out with Republican candidates, they have been talking
about Dr. Fauci. At least, they certainly were ear lier in the year when
the Omicron variant was racing through the country, and lots of
people were getting sick . But we will see a big change in health policy
discussions , needless to say, if Republicans take charge.

Margaret Flinter: Well , a question to bo th of you r eally if we can stay with this for a
minute . When we all wake up on Novem ber 9, do you think we'll have
kind of a clear picture of where the country is headed on health care
policy issues? Or , do you think we will see that the country remains
qu ite split with very different opinions in different states and regions?

Sheryl Gay Stolberg : I'd put a period in the middle of that sentence and ask when we wake
up, are we going to have a clear picture of where the country is
headed . I think we have to wo rry about, frankly, a lot of things beyond
health policy . We're going to hav e to worry about whether or not
people accept the results of the election. If people do accept the
results of the election, and there's a clear cut outcome, I suppose we'll

Healthcare on the Ballot

have som e sense, although as Victoria mentioned, Republicans don't
really have a s trong proposal for say replacing Obamacare , or
reducing prescription drug costs. They've been kind of vague about it.
In terms of abortion , you know, I think it will be really intere sting to
see how these ballot initiatives that Victoria has written about will
play ou t , and maybe we'll know more then.

Victoria Knight: Yeah, I think Sheryl is absolutely right. I think that it also really
depends on what happens with the makeup of both chambers of
Congress. What i f we have a split Congress, you know, what if we
hav e both Republican majority chambers, but then Biden ha s
obviously still two years left in his administration , and so are they just
going to be sending things to his desk that h e won't sign? Just so
much is up in the air that I'm not sure we can say. But yeah, for the
Republican side, if they do take over at least in the house, there's
going to be investigations, there's going to be the IRA. But past that,
I'm not sure there's mu ch specifics. For the Democrat side, I've heard
some about wanting to make the ACA subsidies permanent. I'm not
sure how much appetite there is for that. But I know it's something
that like the Ways and Means Committee is definitely thinking about .
And the n pas t that , I think, like, implementing the IRA and seeing can
they go farther with drug pricing , I'm hearing, you know, I've been
trying to talk like what are you guys planning for the future ? A nd it
feels like they're all just kind of waiting to see wha t happens , so .

Mark Masselli: Let me pull the thread on that beca use two months ago, nobody
thought the Democrats had a chance at all . Right ? The President
notched a number of wins, as you look at it right now. But your best
sense of how this is going to t urn out, gas prices were high , now
they're low or lower. Is there anything that you see on the horizon
that might cause either party something to worry about?

Sheryl Gay Stolberg: Well, I'm not going to go there and predict . I'd refer to the political
repo rt , just Google it and see what they predict . But in terms of
unknowns on the Horizon , you know, Ebola is an unknown on the
Horizon. There's an Ebola outbreak in Uganda. It's a strain. I don't
want to scare people, but it's a strain that is not responsive to
vaccines . If that comes over here, especially coupled with t he
monkey p ox outbreak, which we haven't talked about, which seems to
be kind of in a steady state now, not out of hand, you know, if
something crazy like that happens, you know, then all eyes w ill be on
the Biden Administration and Democrats for how they respond to it
and we might not be talking so much about other things.

Victoria Knight: I think a little on the other side. I mean, we saw something came out
about Georgia Republican Senate Candi date, Herschel Walker, about
alleging that he paid for an abo rtion for someone that he had a
relationship with , even though he has said that he is strictly anti -

Healthcare on the Ballot

abortion . We're just a couple of days into October , and that was
October s urprise I think . I th ink there potentially could be more that
push ed these r eally close races one way or the other. Some of these
races are just so tight in the Senate, especially the ones that S heryl
talked about earlier in the House as well , and so we just need to see
what h appens in the next month what else might come out .

Marg aret Flinter: Well, we will continue to read your wisdom. But I just have one more
question , I guess, as we head towards that November 9, and beyond
health care, the whole issue of climate change and y outh and new
people coming into voting and exercising th eir right to vote because
of an issue like climate change, which may with young people
especially cross the Republican - Democratic lines, are you seeing this
as a major galvanizing force in the electio ns this year?

Sheryl Gay Stolberg: That's a good quest ion. You know, we don't often see a huge turnout
among young people in a midterm election . You more often see
young people galvanized in a Presidential year . Certainly when Barack
Obama ran for Presiden t , we saw lots and lots of young people
coming to the polls . But climate change is a galvanizing issue for
young people. It's something that they are really passionate about .
And I think it is bringing more and more of them into electoral politics,
and lot of them are worried that the world won't be around, you
know, by the time they get older. So , I do think going forward, we're
going to see a real force of young people talking about climate
change, getting politically involved because of it. I'm not sure it'll be
that big a factor in these elections nex t month though.

Victoria Knight: Yeah . I was just pulling up the polling right before we were chatting ,
and climate change is one of the issues that's much lower down if you
look at the top issues for voters in this coming midterms. It's below
the economy. It 's below abortion. I'm not sure it's as much of a
motivator, though I do wonder if Hurricane Ian could push it a little
more to the forefront . Just because if you look at these photos of
Florida, you know , it's devastating , and it's pretty clear that climate
change contributed to how bad this storm was. It's something that
the State of Florida is going to still be dealing with and some of these
other states that were hit as well , and so perhaps it could pl ay some
role but –

Mark Masselli: Maybe you can share with us sort of the last question of what are you
incubating as a story , m aybe not between now and the election, but
what's on your mind as you sort of think about news and things that
you're particular ly focused in on?

Sheryl Gay Stolberg: Well, I 'm interested certainly in the infectious disease threats that we
have before us . So , i s COVID going to make a resurgence? What's the
administration going to do given that Congress hasn't given it any
money to fight the pandemic and it's not going to ? You k now, will

Healthcare on the Ballot

monkey pox be steady stasis? Will we have this outbreak spread from
Uganda ? And again, the abortion rights issue is more than an election
issue. It's an issue of people's lives. And you know, I've wri tten about
a doctor who helped a 10 - year - old girl who was raped and got
pregnant by her rape, this doctor helped her get an abortion and is
now under investigation in Indiana. So, you know, we're going to see
things playing out , the consequences of these a nd other decisions
playing out in people's li ves. That's what I'm interested in watching.

Victoria Knight: Yeah . I think it'll be really interesting to see, you know, depending on
what happens with these referendums on the ballot, it's just going to
contri bute more to this patchwork of abortion polic ies across the U . S.
and what does that mean for us as a country , w hat does that mean
for people in those states . It ’ s just w e're so early in this post - Do b bs
climate , and I think there's so much more to be seen. Something else
I'm also really interested in, is the data privacy aspect around
abortion . Data from your phone could be used to prosecute you for
an abortion if you're in a state where abortion is illegal. We've seen
some cases where those messages or data from your period tracking
app could be used against yo u. And I think we're just going to see
more, more of these cases like Sheryl was saying , of different aspects
of the ramifications of Dobbs. Of course, I am curious about what the
policy priorities wil l be for this new Congress depending on what
happens with the midterm , as well as the leadership who will take
charge of these key health committees and how will that play into
what the priorities are .

Margaret Flinter: We're going to have some long nights in November as all this plays
out. Shery l Gay Stolberg with the New York Times , and Victoria Knight
with Axios , we want to thank you so much for being with us and for
your insights. And thank you to our audience for joining us. You can
learn more about Co nversations on Health Care , and sign up fo r more
information at www.chcradio.com . Thank you both so much for the
work tha t you do and for being with us.

Sheryl Gay Stolberg: Thank you.

Victoria Knight: Yeah. Thank you for having me.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and Managing
Editor of FactC heck.org, a nonpartisan, nonprofit consumer advo cate
for voters that aim to reduce the level of deception in U .S. politics.
Lori, what have you got for us this week?

Lori Robertson: In a 60 m inutes interview, President Joe Biden said the COVID - 19

Healthcare on the Ballot

pandemic is over . “ We still have a problem with COVID. We're still
doing a lot of work on it. But the pandemic is over. ” Biden said in the
interview, which aired on September 18. Epidemiologists say there's
no single agreed upon definition for what constitutes the end of a
pandemic . And some say we're not there yet. For instance, around
400 people a day have died of COVID - 19 in the U .S. during the first
half of September according to the Centers for Disease Control and
Prevention. As recently as August , the CDC spec ifically said that the
pandemic was not over. Epi demiologists agree that the pandemic is
no longer as dire as it once was. There are life - saving vaccines and
improved treatments, and the public in large measure has already
been infected at least once. But the death toll is still relatively high
and the f uture is unknown. The U .S. and the WHO continue to classify
COVID - 19 as a public health emergency, and it has been renewed nine
times since early 2020.

David Dowdy , an epidemiologist at Johns Hopkins Bloomb erg School
of Public Health, told us that he did not think there was a consensus
on this question, since there was no consensus on a definition of
pandemic. Still, he said that he thought it was premature to say the
pandemic has concluded , and said there w as uncertainty about what
will happen over the w inter. Multiple experts said they did not
consider the pandemic over , and some said Biden was wrong . But
others agreed with the President. Dr. Thomas Frieden, a Former
Director of the CDC, told NPR that while COVID - 19 was still a health
risk that was still taking lives, “ The pandemic as a phenomenon that
ruled our lives for two years , that's pas sed .” Scientists have long
known that the Coronavirus will not go away entirely and will remain
an ongoing concern fo r a long time .

And that's my fact check for this wee k. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Publ ic Policy
Center at the University of Pennsylvania. I f you have a fact that you’d
like check ed , email us at www.chc radio.com . We’ll have
FactCheck.org’s Lori Robertson check it out for you here on Conversations on He alth Care.

[Music]

Margaret Flinter: Each week , Conver sations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. According to
Michigan organic farmer Michel l e Lutz, health care spends too much
time and money t rying to fix the problems that are caused by a poor
die t, that the powers that be at the Henry Ford West Bloomfield
Hospital agree with her. For years, she had offered organic food
growing and cooking demonstrations at the health care facility just

Healthcare on the Ballot

outside of Detroit. But when officials drew up plans to renovat e the
hospital three years ago, they decided to take it to the next level. And
thanks to an anonymous donor, a million dollars certified organic
hydroponic greenhouse and garden were built and Lutz wa s hired
away from her farm to run the operation.

Michell e Lutz: We really wanted to change the way that food culture was done in a
health care setting. When you have the opportunity to heal someone,
it is very important that what they're eating becomes par t of that
plan.

Margaret Flinter: And what is believed to be the first of its kind on - site greenhouse at a
hospital in this country , t he facility now provides most of the
nutritional organic greens, vegetables, fruits and herbs used in the
food that is pre pared there .

Michelle Lutz: The layout was very important so that we could have a very complex ,
diverse variety of herbs and produce for the kitchen to use. It's rather
seasonal . In the wintertime , and in the fall , we change to more of a
cold tolerant crop . Our temperature is never set above 70 degrees in
that gr eenhouse. And then in the summertime, we're picking cherry
tomatoes and we have sweet peppers and things like that that we will
be supplying for the kitchen.

Margaret Flinter: Lutz says there's an e ducational component to the program that's
ongoing and mul tigenerational.

Michelle Lutz: Right now , we are averaging 3 , 000 students per academic school year
that go to our Healthy Habit Program . We have a demonstration
kitchen inside of our hospital. And t hen we have the greenhouse right
behind the hospital to mak e sure that we impress upon, especially our
youth in our community, what does it take to have the foundation of
healthy habits .

Margaret Flinter: And hospital chefs work to incorporate more super g reens and
medicinal herbs into their recipes, reducing the reliance on sugar and
salt for flavors.

Michelle Lutz: You know, when the weather is nice , and our employees are often
walking around , we know that our health care employees are
sometimes -- their priority is to take care of themselves because
they 're so used to taking care of others. So it is not uncommon for a
nice day for us to have a nice stream of doctors and nurses out there
just to be in a beautiful setting and how therapeutic that can be , b u t
to also have them ask questions about what it is that we're growing
and how is that being used .

Margaret Flinter: The nation's first hospital - based year - round certified organic
hydroponic greenhouse, one that provides fresh fruits and vegetables
to patie nts who are healing and the clinicians w orking to heal them,

Healthcare on the Ballot
improving health and wellbeing for the system community - wide , and
teaching the next generation about the benefits of organic produce
for a healthier diet --
Michelle Lutz: The idea of being just a hospital doesn't work anymore. You have t o
be a community center for wellness .
Margaret Flinter: N ow that's a bright idea.
[Music]
Mark Masselli: I'm Mark Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and h ealth .
[Music]
Maria nne O’Hare: Conversations on Health Care i s recorded in the Knowledge and
Technology Center Studios in Middletown, Connecticut, and is
brought to you by the Community Health Center , now celebrating 50
years of providing quality care to the underserved wher e health care
is a right not a privilege . www.chc1.com and www.chcradio.com .
[Music]