Reporters’ Roundtable: Why Health Care Will Impact the Election—But to Whose Advantage?

240401_Conversations_Reporters_01.mp3

Speaker 1 [00:00:04] We're about seven months from Election Day, and while the battle
lines may seem drawn, there's a lot that still happens between now and November 5th.
We're talking with reporters covering the health care policy stories that are making news.

Speaker 2 [00:00:17] I want to jump on the abortion issue because I think that is really
going to be huge. We've seen in states where abortion has been on the ballot, it's really
played out. People turned out to vote, and it's been a lot in the Democrats favor. So I'm
sure that the Republicans are watching that and figuring out how they can spin the issue.

Speaker 3 [00:00:40] We read their coverage and respect their knowledge. Now we're
going to learn more about their analysis and their insights.

Speaker 2 [00:00:47] It's hard to say with Trump whether anything he says is actually
going to happen one way or the other. But he seems interested. At least he's saying he
seems interested in a 15 minute ban or a 16 week ban. He seems to sort of want to, as he
says, essentially, just like, please everybody.

Speaker 3 [00:01:09] This is conversations on health care.

Speaker 1 [00:01:19] Well, we welcome our guests to conversations on health care. It's
good to see you all. You know, there are distinguished, journalists like yourself, who are
known for great reporting. And we so appreciate you making the time. We have Joyce
Frieden, who oversees Medpage today's coverage of Washington and health policy. Ben
Leonard is a health care reporter at Politico and focuses on policy and politics in
Congress. And Nathaniel Wexler is the health policy reporter for The Hill. And what if we
could start out with a topic for all of you to address the presidential elections? President
Biden, of course, will be the nominee for the Democrats and former President Donald
Trump for the Republicans. Biden has called for extending a subsidy boost under the
Affordable Care Act that's set to end after 2025. And president former President Trump is
again an opponent to the ACA. There's also the Dobbs decision that overturned a
constitutional right to an abortion. I'm wondering, do you see this playing out as a health
care election? And will health care be a defining issue for who wins in November? Who
would like to take that?

Speaker 2 [00:02:30] I can start just I want to jump on the abortion issue, because I think
that is really going to be huge. We've seen in states where abortion has been on the ballot,
it's really played out. People have turned out to vote, and it's been a lot in the Democrats
favor. So I'm sure that the Republicans are watching that and figuring out how they can
spin the issue. And there are just so many other abortion, health care related issues on the
ballot. There's, not necessarily scuse me on the ballot, but health care generally, I think,
goes on people's minds, access to health care and the high price of prescription drugs,
which the Biden administration has taken some actions on. So I don't know, it'll be the top
thing on everybody's mind, but I think it'll be there.

Speaker 4 [00:03:23] And I think it really depends on who you're asking, you know, in
terms of, you know, Republican voters, health care isn't, you know, nearly as high as this
for Democrats. You know, top offices for Republicans are things like the economy,
immigration, where for Democrats, issues like health care, abortion are, you know,
significantly higher. And I think it'll be interesting to watch on the on the abortion issue, like
you mentioned, Joyce, you know, in a lot of these state referendums, we've seen Andrews

turn out, but then, you know, a lot of them have been very successful, but it hasn't
necessarily translated down the ballot as much. So it'll be interesting to see if Democrats
will be able to sort of change that trend going forward.

Speaker 2 [00:04:02] Yeah. I mean, to sort of add in on that, there's been a lot of polling
that shows, you know, health care generally issues like abortion and specifically they drive
Democratic change. But for some of the swing voters, for Republican voters, you know,
and health care, abortion isn't necessarily going to be the driver. So it could help bring out
the base, but it might not necessarily work so well on some of the swing voters. But to that
end, like the Biden administration has been sort of trying to paint health care as a
pocketbook issue, to win over some of these sort of the swing voters who care about cost.
So, you know, they're trying to highlight they're lowering the cost of prescription drugs,
they're lowering the cost of insulin. They're, you know, doing things to just make it clear
that that health care is more than just this abstract thing. It's really about how much you're
paying out of pocket.

Speaker 1 [00:05:02] That's great. And IVF, does that change the equation as well? Sort
of shifting away from abortion, thinking about that issue?

Speaker 2 [00:05:11] Yeah, I do think so. I think that, recent election win in Alabama, I
think a lot of people were watching that. And it was sort of I think that IVF thing was all
about the unintended consequences of, both abortion laws and judicial decisions.

Speaker 3 [00:05:31] Well, before we leave the topic, I think I just want to ask the
question. We've been, hearing, through some reporting from the Hill and others that it was,
you know, very possible that the president would propose the former President Trump
would propose a 15 week national abortion ban, going into the election. And I think what
I'm hearing from you all is maybe yes, maybe no. Anyone want to just take that one as a
very specific, headline grabbing? I would say, kind of, proposal if it happened. Anyone
think that's going to happen?

Speaker 2 [00:06:06] It's hard to say with Trump whether anything he says is actually
going to happen one way or the other. But he he seems interested, at least. He's saying
he seems interested in a 15 week ban or 16 week ban. He seems to sort of want to, as he
says, essentially, just like, please everybody, you know, I'm going to propose something to
make everybody happy, which you can't actually do. On abortion. So in that sort of
remains to be seen, a lot of the people that I've talked to with sort of would not seem like
smart politics for him to stake out a position in advance of the election, because, yeah, no
matter what he says, it's going to be used against him, either by Democrats or even by
some of the more rightwing anti-abortion groups.

Speaker 1 [00:07:01] You know, Ben, you reported the Supreme Court seemed quite
skeptical of the lawsuit challenging the FDA's decision that loosened access to abortion
pills. While we await the court's decision, tell us what you know about the anti-abortion,
abortion movement trying new approaches.

Speaker 4 [00:07:21] Yeah. So just, you know, one part of this court case is just one part
of a larger strategy to try to restrict access to abortion. You know, one of the prongs that
we reported on was, you know, they're planning a lot of protests, trying to, you know, get
things going in the grassroots, preparing potential executive orders first, for a second
Trump administration, if that comes up, including one that would direct the FDA to pull its
approval for me if I pressed on, you know, the Comstock Comstock Act, which some

justices mentioned, you know, is also a potential route, although, you know, maybe maybe
not as likely, but, you know, it's something that's being looked at. You know, a lot of these
groups, these anti-abortion groups are looking at model legislation in the states to, you
know, try to further restrict access. So, it's, you know, beyond this court case, there are a
lot of other things going on, but these activists are working on.

Speaker 3 [00:08:16] Well, Nathaniel, let me turn to you. Congress finally passed, it
seems like forever a $1.2 million federal budget. I'm sorry, did I say million? 1.2 trillion
federal budget? Little mistake there. The US Department of Health and Human Services,
received basically, kind of flat funding. We were glad to see Congress extend a far
program to combat HIV and Aids in other countries. That was something we had talked to
Doctor Fauci about on the show just a few months ago. Yes. I'd like to ask you, Nathaniel,
were there any winners in this budget in the in the fighting and, dealing that went on,
perhaps be, behind the scenes? Were there any winners that emerged?

Speaker 2 [00:08:56] I think you can say the fact that there was essentially flat funding, if
not even a slight boost, makes all of healthcare, all of HHS sort of a winner. Because there
was also a very real possibility that there would have been an across the board cut. So the
fact that Congress was able to come to some sort of agreement to not just pass, you
know, continuing resolution after a continuing resolution, but to come to some sort of
agreement. I mean, I think you can argue that sort of makes the entire health care industry
health care, you know, as a whole, we're sort of the winner. But, you know, FFR was
extended for, you know, one year, which is not what a lot of the the advocacy groups are
looking for. But, you know, again, one year is better than New Year's. I think they're going
to probably count that as a win.

Speaker 1 [00:09:50] And then you also reported that Congress held off on making
controversial health changes to the pharmacy benefit manager industry. What is some
want to see fixed and when could it happen?

Speaker 2 [00:10:02] Yeah, really, it sort of boils down to just the business practices of
PBMs. A lot of the the anti PBM movement is sort of talking about how PBMs are taking
over the small, pharmacies, the mom and pop pharmacies, and they're really just sort of
making it much more difficult. They're talking about the fees that PBMs make and sort of
just how PBMs can come between, patients and their medicines. So there's a lot of
changes that that people are looking for. And part of the problem, I think, is that there were
too many changes across too many different committees in Congress and sort of what it,
what it's boiled down to. So lots of changes across lots of different committees. It's
possible that some of these changes do get worked out towards the end of the year, but as
you mentioned, it did not pass this time.

Speaker 3 [00:10:56] Well, then I wonder if you'd, you'd answer this maybe, theoretical
question. Is there any way to get over these annual budget delays? They cause so much
uncertainty. They really wreak a lot of havoc. In planning in the health care sector, the next
federal fiscal year starts October 1st. And are there any proposals on the table to maybe
structurally deal with these annual delays?

Speaker 4 [00:11:21] Yeah. I mean, we're closing in on another one, you know, just in less
than six months. So, you know, I, I think they're not unless they're wholesale, wholesale
fundamental changes to the American system. You know, other countries have have other
ways of doing this, you know, where essentially the government is forced to resign if they
don't pass a budget. And, you know, I don't see anything like that happening anytime soon

than the US system, that just a, you know, it's the way that it works. I think a lot of it will
just depend on, you know, the composition of Congress and, going forward and even with,
you know, there's been a fair amount of inter-party conflict, particularly in the Republican
Party in this Congress. So, you know, even a larger majority in May not, you know,
necessarily and, you know, lessen the likelihood of a shutdown and, you know, depending
on the situation.

Speaker 1 [00:12:08] You know, Ben, we read with interest your story about health care
sectors use of artificial intelligence as a clinical tool, which raises a new question. Who's
liable if the system makes a mistake? I'm wondering if you could tell us about it.

Speaker 4 [00:12:24] Yeah, that's a really, you know, controversial topic right now that a
lot of the health care sector is trying to, still figure out, yeah. The American Medical
Association is saying that it's already seeing eye come up in liability cases. And they're
asking for, you know, doctors are asking for protection against liability. If I go to a case
that, you know, ends up getting, you know, them in trouble, and they have, some allies in
Congress who have been, pushing the FDA for some sort of safe harbor for, doctors, and
software makers, if they have issues. On the other side of the equation, tech companies
and some, some hospitals have sort of a different view of this where, you know, they say
doctors are making the final calls and are ultimately responsible, even if the software
pushes them in the wrong direction. In some, some groups, are calling for, you know,
another sort of idea of shared responsibility within the health care system, depending on,
you know, how much the provider knows or what abilities they have. So it's really it's sort
of an open question going forward, how this is going to play out. A lot of proposals and not
really any consensus right now.

Speaker 1 [00:13:34] Oh, you did a nice job of covering the areas. Certainly radiology is
one that's already benefited not necessarily from AI but machine learning. But everything's
nowadays grouped under AI. Almost every story has an AI component to it. Whether or
whether it's true or not, people have connected, but it was it was a great article. Thanks so
much.

Speaker 3 [00:13:54] Well, then we'll just continue on this AI question, for a moment. And,
Joyce, you, had a great interview about, NIH, the National Institute of Health, using AI, to
develop potential treatments. Tell us what you learned from Joanie Rudder of the National
Center for Advancing Translational Sciences.

Speaker 2 [00:14:13] Oh, sure. Yeah, I'd be happy to. That was a fun interview. And, just
mentioning about AI. I was talking to a coworker this morning about whether we should call
it augmented intelligence or artificial intelligence, because people seem to have two
different definitions for the same abbreviation. But, Joni, one of the things she was talking
about that she seemed most excited about was this thing called the biomedical data
translator. It's actually in beta mode, and you can go online and find it and ask it a
question. But what it does is it it's a compilation of about 150 databases, everything from
genetic information to everything in PubMed to any other medical database you can
imagine. And using artificial intelligence, they've put together a way for researchers to ask
it questions about potential treatments. And the example that she gave that kind of floored
me was, and I, I hate to say I hope nobody's eating lunch. It was a patient with sick, like,
vomiting syndrome, which is a rare disorder, but very disabling. And these researchers
had this woman who just couldn't keep weight on and had all sorts of problems. And so
they asked the translator what might be a possible treatment for this. And it's a it was a
complicated answer with gene upregulation. But basically the answer came back isopropyl

alcohol not to ingest. But they put a isopropyl alcohol on a cotton swab and had this
woman sniff it whenever she felt like she was going to get sick. And it worked. And so it
was the kind of thing that, you know, answer. You wouldn't expect a.

Speaker 3 [00:16:00] System to shrink at a cost of about a 100th of a penny, right?

Speaker 2 [00:16:05] Exactly. Yeah. It was amazing. Well.

Speaker 1 [00:16:08] Speaking of people who would be lined up to, ask it questions are
certainly the group that you covered at a rally of long Covid patients on the steps of the
Lincoln Memorial, and they're upset that there's no FDA approved medications and there's
no treatment. But it is really accurate for, these patients to get the government focused
back in on long Covid. And we've heard from so many people that we've interviewed over
a long period of time, that, the government really is not doing the making the type of
expenditures that it did initially. With the launch, of the, the vaccine. What can you tell us
about what's happening, with long Covid and the hopeful investments that people are
waiting to be, made in this area?

Speaker 2 [00:17:05] Well, yeah, I can tell you, I did cover this rally, which was in front of
the Lincoln Memorial a couple of weeks ago. And these long Covid patients are really
frustrated, as you said, no cure available, nothing on the horizon. And so they've
developed a whole list of. Goals and things they want to see the federal government do,
such as declaring long Covid a national emergency and implementing the same kind of
emergency use authorization that they did for Covid vaccines for any kind of long Covid
treatment or trials. They want establishment of funding for annual funding for long Covid
treatment programs. They want to have more public tracking of SARS-CoV-2 in
wastewater, because that's something that's kind of gone by the wayside is the tracking of
the illness. And they want, regular communication from the white House. They just feel
ignored. I asked how many people they estimate are there with long Covid, and the figure
they keep hearing is 18 million. But they think it's a vast underestimate because people
don't always know when they have it and it's underreported.

Speaker 1 [00:18:22] We should let our audience know that we've had, a number of guest
on one who was heading up, and then, a longitudinal study on long Covid at, I believe
Margaret NYU, was the lead on that. I think they had up to 15,000 people under it. But we
need more of those happening. And there's just not enough Joyce to pick up anything in
the budget around long Covid this cycle.

Speaker 2 [00:18:47] I actually didn't, and I need to delve deeper into that and find out
what they are planning to do with it. Perfect.

Speaker 3 [00:18:54] Well, Joyce, let me just stick with you for a moment more because I
know that you're covering news from Washington, but you're also keeping your eye on
activity in the States. Certainly Alabama and the IVF controversy. But also Texas, which is
in the news pretty regularly on, issues of, health and health related things. You've been
following, the controversy or the the advocates calling for the Texas Medical Board, to
provide more clarification around medical exceptions to the Texas abortion ban. What's
happening in Texas, currently. And how much of a quandary is it causing for people and
health care providers?

Speaker 2 [00:19:32] Yeah, it is so interesting. So, Texas, as you probably know, has this
six week abortion ban. No exceptions for rape or incest. But there's an exception to save

the life of the mother. And this, of course, came up in this recent court case of a woman
who was 20 weeks pregnant, found out that her fetus had a terrible anomaly. The doctor
recommended abortion, especially because it was going to put her life at risk if she carried
the pregnancy to term. And, the court actually turned her down. She ended up going to
she sued to to get permission, but the court said no. And she ended up going to another
state. But in his decision, the judge suggested that it would help if the Texas Medical
Board could better clarify what constitutes an abortion to save the life of the mother. So the
medical board put out a set of proposed regulations, very recently. And I interviewed the
president and he said, you know, people are mad at me because I didn't say in this
medical situation with this particular disease, then you can do, you know, an abortion to
save the life because it depends on so many things, including where you are
geographically. If you don't have this at all, machinery, because you're in a rural area, you
know, you may need to do one thing. Whereas if you're in an urban area, you may need to
do something else. So doctors should be glad that we didn't make it more specific. Right.
But these are proposed, guidelines, and they're waiting for people to weigh in. So people
have like a month or more to comment on them.

Speaker 1 [00:21:13] Then I watched your interview with, Representative Brad, when
struck by a Republican from Ohio, previously had a long career as a doctor. He's
supporting a bill that would expand Medicare coverage to include the new weight, loss
drugs. I'm wondering, tell us, what the bill would do and how does his endorsement as a
doctor help it in the halls of Congress?

Speaker 4 [00:21:38] Yeah, it was great conversation with them. It's a doll that's been
gaining a lot of money. That's. Since Congress has been banned or Congress banned
Medicare from covering obesity drugs, 2003. The treatments, the types of treatment just
weren't as good back then as we're seeing now where it is promising. Some of the results
are saying for some of these drugs. You know, I think the biggest obstacle for it is the cost.
There has been there have been a lot of, you know, people on both sides of the aisle,
including Bill Cassidy, who's, member on the health committee. We've gotten a lot of
strong bipartisan support, but I think the cost was.

Speaker 1 [00:22:14] Yeah, he was talking about ways to count other savings in that, too.
I, I think, from the preventative side was which was an interesting. Yeah, yeah. Approach
on the Republican side.

Speaker 4 [00:22:26] Yeah. Total and the bipartisan push to reform sort of how the severe
looks at preventing, addiction. Care to it. House, I believe unanimously, to expand the
budget window to 30 years instead of ten require that CBO further out, which I think could
also be a boost there. It'll be interesting to see, you know, the impact of if Congress does
lift ban on, you know, the cost of the health care system generally. The CBO said it would
raise premiums. And, but, you know, it's also said that, the drug could be subject to
Medicare negotiation within the next couple of years. Which, you know, makes sense
given, the price and the amount of spending that's already we're seeing on these drugs.
One of them's in the top ten and, gross spending obviously. And that to continue to rise,
given the recent approval of CMS guidance, saying that, it can be covered, in some
circumstances. So, I think we're just in for more, you know, momentum for this sort of
legislation or more, you know, patients who access these drugs better.

Speaker 3 [00:23:32] Well, it's certainly, going to have huge ripple effects through the
country in terms of, just regular employee insurance and everything that affects health
care, based on what they decide about that. So we'll we'll keep a close eye on it. And,

Joyce, I want to come back to you for a minute. It looks like you're as intrigued as we are
with the new arpa h initiative. Not so new, anymore, but you've, reported on things as
diverse as how it's aiming to change, how, we deliver health care in rural areas to
perfecting whole life, transplants. How are they picking their initiatives? And how broad is
their reach? Does it encompass everything in both delivery and in clinical practice? Tell us
more about what they're up to.

Speaker 2 [00:24:16] Yeah, this is a pretty broad reach. I'm glad you specifically
mentioned those two programs, because I think it gives us a sense of of what it is they're
doing. The, paradigm program that you mentioned with the rural health clinics, you know,
you think about people doing the little mobile vans to go places and give vaccines or
mammograms, but they are talking big. They are talking about basically like a whole
mobile hospital unit that would come to people. And so you could have a virtual visit, or
you could have an in-person visit and you could get your MRI and your CT scan. And so
they are looking for big proposals from people, on that and similar, as you mentioned, to
the whole AI, transplants, you know, they that, that one, I guess when people normally
donate their eyes, you know, the doctors take a piece, they take a cornea and they'll
transplant that. But but they haven't been looking at the whole life, as a transplant vehicle.
And they, they seem to be kind of searching for those whole big ideas. I, I, I'm still in the
process of delving into what, what other areas they're there at, but it is a very wide
spectrum.

Speaker 1 [00:25:32] First, let me close with a question for whomever wants to jump in.
And first of all, let me just preface it by saying you all are doing a great job of educating
Americans. But, I guess the question is, why do so few Americans really understand
what's happening with health care? An issue that they say they care a lot about? Kaiser
Foundation health tracking poll found that only one third of Americans know about the
Affordable Care Act's impact on lowering the rate of uninsured, and only one third realize
the AC has hit an all time high rate of enrollees during the recent open enrollment period.
I'm wondering from your vantage point, as folks who are illuminating, shining that important
light on the issue, how can we all help more Americans understand, health care issues?

Speaker 2 [00:26:24] Well, if I could jump in, I would like to say that, I think it is a matter of
personalization. I can think of more than one member of Congress, for example, who
became interested in an issue and advocated for it. If it had to do with something that
happened in their own family. And I think, that we need to do a lot of this personalizing of
stories, like when you're talking about a prescription drug shortage, instead of starting out
with numbers, you start out with the patient, the cancer patient sitting there with their
oncologist, and they both know what the best treatment is, but the person can't get it. And I
just feel like that seems to go a long way toward at least getting people started on an
issue.

Speaker 4 [00:27:11] Yeah, I think getting people, you know, involved and feeling like they
have a stake in it, too. And, you know, there's obviously a complicated system. And, you
know, a lot of people might ask, what's in it for me, you know, and, you know, why should I
care? So I think, you know, getting ways to having, you know, and coverage, emphasizing,
you know, how it is a pocket, how certain issues are pocketbook issues, I think has
resonated at least in our coverage and has garnered more interest. So I think, you know,
and you see, you see that in political messaging as well. You know, the Biden
administration likes to talk about a lot of the cost of living issues. You know, in terms of
health care and like insulin caps, things like that. So that way that the people that.

Speaker 2 [00:27:53] Yeah. And I think, you know, the Affordable Care Act is sort of this
big, all encompassing idea that, you know, a lot of people don't quite understand what it
actually is. So if you can say like, oh, you know, there's this policy about lowering
prescription drug costs or there's this, you know, sort of breaking it down into individual
sort of messaging rights, right? Like, I think people might not know what the Affordable
Care Act is or they might not know what it does, but, you know, they might know, oh, you
know, I can't be discriminated against for preexisting conditions, or I know that the cost of
my insulin is going down, but they might not understand why. So I think also, you know,
personalization, but also, you know, making sure we really explicitly like, connect the dots.
And a lot of those things can go a long way to help people.

Speaker 3 [00:28:46] Okay. Well, I want to thank each of you for joining us. We know that
the next seven months will go quickly, and we will be following, following your writing.
Thanks to our audience for being here. Be sure to subscribe to our videos on YouTube
and find us on Facebook and X with our account named CHC radio. As always, you can
go online to CHC Radio.com, sign up for email updates, and please, always feel free to
share your thoughts and comments about this program. Thank you so much for being with
us today.

Speaker 4 [00:29:16] Thanks for having.

Speaker 1 [00:29:17] Us. Yeah, I've been a fan. Neil Joyce, really good to see you all.
Thanks for all the great work.

Speaker 3 [00:29:26] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
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