95 Days to Election ’24: Analyzing the Health Care Issues

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Margaret Flinter ( 00:01 ):
Recorded on location at Aspen Ideas: Health, in Aspen, Colorado.
Mark Masselli ( 00:12 ):
We're on location, Aspen Ideas: Health with Julie Rovner. She's the Chief Washington Correspondent for
KFF Health News and host of its podcast, What the Health?
Julie Rovner ( 00:23 ):
I think this may be the first time that abortion rights drives people out to vote. The anti-abortion
movement has always been sort of the ones that have been able to gin up their base. And the people
who are sort of on the most extreme of the anti-abortion movement are the most devoted, and the
most likely to vote. That's a big reason why Republicans have courted them so assiduously, is because
they show up and they vote.
Margaret Flinter ( 00:47 ):
Decisions made in Washington affect everyone's health care from reproductive rights to the cost of
medication. Julie Rovner is here to provide insights and analysis as we head toward election day.
Julie Rovner ( 00:58 ):
Former President Trump, and I don't mean this in a negative way, I would actually like to ask him if he
knows the difference between Medicare and Medicaid, and whether he feels as strongly about
preserving Medicaid as he has said he does about Medicare? That is honestly, if I had five minutes with
him, that is the question I would ask him.
Margaret Flinter ( 01:17 ):
This is Conversations on Health Care.
Mark Masselli ( 01:27 ):
Well, Julie Rovner, welcome to Conversations on Health Care.
Julie Rovner ( 01:30 ):
Oh, thank you so much for having me.
Mark Masselli ( 01:31 ):
Yeah. Let's start asking you about the Supreme Court. We're just a week away in this recording from
when their final results will come out, final rulings. Tell us what you are watching in terms of the
Supreme Court, and other issues around their thinking about health care?
Julie Rovner ( 01:51 ):
Well, they could go into July by the way, because I think they have 12 or somewhere between 12 and 15
cases left, and occasionally they slide into that next week. But we expect most of the decisions next
week. There are two cases that I'm watching pretty closely. One of them is an abortion case. It's about
the Emergency Medical Treatment and Active Labor Act or EMTALA, which requires hospitals to provide
emergency care to people who present at their emergency rooms, even if they don't have insurance. It

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was passed in 1986 in order to stop patient dumping, to stop them from turning people away at the
emergency room. But if a woman comes in distress, obviously complications of pregnancy and needs an
emergency abortion, the Biden administration has said, "You must do that." And the state of Idaho has
passed a law that said, "Nope, unless the woman is actually dying."
( 02:41 ):
And there is some space between women at risk of losing their fertility, of losing limbs, of moving
towards death, but not quite on death's door. So, we're waiting to see whether the Supreme Court is
going to say that the Federal law overrides the Idaho law, or whether the Idaho law is allowed to stand
while the Federal law stands. So that's sort of the big health-related case that I'm waiting for. The other
case that affects everything is a case about something called Chevron Doctrine, which sounds super
nerdy and is super nerdy. And basically what it says is, when Congress passes a law, the administration,
the agencies of the Federal Government are the experts and generally when they put out regulations to
implement these laws, unless there's something that's egregiously wrong with it, arbitrary and
capricious, that deference should be given to the agency's interpretation.
( 03:37 ):
And there are a lot of people, particularly on the right, who worry about the deep state and all of the
people in the... Career people in the federal bureaucracy that they would like that not to be the case
anymore. And there is a case about herring fishing in Rhode Island, that it's asking the court to actually
overturn Chevron deference. It should be one of the last cases I imagine that we will see out of Supreme
Court before they leave for the summer. So that's kind of the big one [inaudible 00:04:05]-

Mark Masselli ( 04:05 ):
... In the claims, usually they're asked in their nomination about different things. Is Chevron one of those
things that's on the list of-

Julie Rovner ( 04:16 ):
It will be going forward.

Mark Masselli ( 04:17 ):
It will be, all right.

Julie Rovner ( 04:19 ):
I'm trying to remember if... I don't know that it even came up when Amy Coney Barrett was sort of the
last one, who I don't think they would've asked Justice Jackson about Chevron deference. I think they
probably know what she would've said. But I mean, it could tie the hands of the Federal bureaucracy in
many, many ways if the court overrules this assumption basically, that the experts in Federal agencies
know whereof they speak.

Margaret Flinter ( 04:45 ):
Well, both of those situations are caused for a lot of concern. The first in the very real case, and we've
been hearing this, of women who show, present at emergency rooms, not even necessarily at death's
door, but very, very much at risk. So, thank you for flagging that, and also the Chevron doctrine. I want
to talk about another issue that we're all hearing a lot about, the court's decision to preserve the status
quo for Mifepristone, the medication, abortion, as I think the American public has come to learn about

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over these past months. We don't really think this is the end of the debate, do we? Advocates expect to
launch other efforts to restrict it as has been done in Louisiana.

Julie Rovner ( 05:25 ):
Well, actually this effort isn't even dead. What the Supreme Court did was they said that the doctors,
and I think one of them was a dentist, who sued to say that they were somehow injured, even though
they don't prescribe the abortion pill by the existence of the abortion pill. The court said unanimously,
no, you cannot show enough hurt, enough injury from this to have standing. However, and when the
case now goes back to Texas, there are three states where the attorney's general have also sued on
different grounds. And so it could be revived just this case with those states back at the district court
level before Judge Kacsmaryk in Amarillo.

Mark Masselli ( 06:08 ):
Julie, you've written the book on health care coverage here in Washington DC. And I'm wondering if
we're at the high water mark for Congress in getting involved in specific health care decisions. I'm
thinking about the Senate Republicans blocking IVF access bill, which I don't think many Americans really
thought was a controversial issue.

Julie Rovner ( 06:28 ):
No, they didn't. Although I will say back in 2011 and 2012, there was the beginnings of what we call the
personhood movement. Where there were some people who were, I will say, out on the fringe of the
anti-abortion movement, who wanted to have state laws declaring personhood. That when an egg and
sperm come together and fertilized, it is a person with full legal rights. Even at the time, the anti-
abortion, the people who were pushing to overturn Roe v. Wade, were trying to tell these personhood
people-

Mark Masselli ( 06:28 ):
Too much.

Julie Rovner ( 06:58 ):
... yeah, too much, too soon, go away. There were a couple, there was actually a vote in Mississippi and
it went down. There were a couple of votes here in Colorado and it went down. But it's nothing new, it's
nothing that we've seen before. So when this Alabama Supreme Court decision came down on IVF,
basically saying that these embryos now are potentially people, I think that shook a lot of people up.
Because Republicans of course have been saying ever since Roe fell that, we're not coming after your
birth control, we're not coming after IVF. But there are segments of the anti-abortion movement that
are coming after birth control.

Mark Masselli ( 07:34 ):
Why the quick reversal? All politics, all thinking about the presidential election, the reversal-

Julie Rovner ( 07:39 ):
The reversal of the Republicans, or the reversal of the anti-abortion movement?

Mark Masselli ( 07:43 ):

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Anti-abortion.
Julie Rovner ( 07:47 ):
Well, this case had been bubbling up, and it sort of when they won it's like, "Okay, we should go out and
do it now." And it's true that the anti-abortion movement never has viewed the overturn of Roe as the
end of their fight. They've viewed it as the beginning of their fight. They viewed it as what has allowed
them to go into each state and see how far they can push.
Margaret Flinter ( 08:07 ):
Mm-hmm. Well, there's been some interesting and frightening writing about how well organized and
long-standing this campaign was to get to exactly this point. It gives you pause about the talent that got
people to a place that we might be very concerned about. They know with this election year there is so
much that people are going to consider. I think you've noted 15 states will consider abortion related
ballot initiatives, but also funding for mental health services, firearm related taxes, probably firearm
control, which we had a chance to talk with Admiral Levine about today. I'm sorry, with Gregory Jackson
today who we spoke to earlier this morning, financing for long-term care and health care for low-income
families. So those seem like all areas that are worthy of debate. But what are you thinking we're going to
see in terms of this being the issues that drive people out to vote?
Julie Rovner ( 09:01 ):
I think this may be the first time that abortion rights drives people out to vote. The anti-abortion
movement has always been the ones that have been able to gin up their base, and the people who are
sort of on the most extreme of the anti-abortion movement are the most devoted and the most likely to
vote. That's a big reason why Republicans have courted them so assiduously. It's because they show up
and they vote. So a lot of Republicans, and they're saying this publicly, it's like, "Well, I never thought
Roe would get overturned." So it seems safe to say that I would support what they wanted. And now
they're in this box where they see things like IVF with the 80% public popularity. But they have promised
these evangelical and other anti-abortion groups that they would support this, and they're in a real bind.
Mark Masselli ( 09:51 ):
Okay. We're less than a week out from the presidential debate. And-
Julie Rovner ( 09:56 ):
Maybe.
Mark Masselli ( 09:56 ):
... maybe. Well, it's scheduled. CNN is doing a lot of-
Julie Rovner ( 10:00 ):
Thursday night.
Mark Masselli ( 10:00 ):
... promotion on it. And-
Julie Rovner ( 10:02 ):

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I won't believe it until they both walk out on the stage.
Mark Masselli ( 10:06 ):
They may be walking out on different stages. But what would be the one question you'd like to ask
around health policy to former President Trump and President Biden?
Julie Rovner ( 10:18 ):
For former President Trump, and I don't mean this in a negative way, I would actually like to ask him if
he knows the difference between Medicare and Medicaid? And whether he feels as strongly about
preserving Medicaid as he has said he does about Medicare. That is honestly, if I had five minutes with
him, that is the question I would ask him.
Mark Masselli ( 10:38 ):
And how about President Biden?
Julie Rovner ( 10:39 ):
I'd like to ask President Biden how he came to where he is on abortion and reproductive health. It's not
a secret. Obviously, I covered him in the 1980s when he was... He wasn't one of those Democrats who
was strongly, anti-abortion, there have been several of those, but he was never comfortable with it. And
obviously over the years things have changed. There was a website that was sort of deriding him when
he was president. He didn't say the word abortion until a year and a half into his term. He still only said
it a handful of times. It's clearly something he's not particularly comfortable with. But obviously he is
pushing his administration to do things that the abortion rights side would like. And when he talks about
it, I mean, it seems fairly clear that he believes it. So I'd love to know how that sort of rolled out over
many, many years of his thinking about the issue.
Mark Masselli ( 11:27 ):
Right.
Margaret Flinter ( 11:27 ):
Well, I imagine you'll get the life story as well as the adult pivotal events.
Mark Masselli ( 11:32 ):
Oh yeah, always.
Margaret Flinter ( 11:33 ):
The story will be very fascinating. Probably be a long answer, very fascinating. You've studied what a
second Trump presidency would look like for health care. What are the big takeaways for you on that
from your reporting?
Julie Rovner ( 11:44 ):
Well, it's a good question. There is this Project 2025 that's been put together by... Well, it's been
spearheaded by the Heritage Foundation, but a lot of other groups have contributed to it. And it's
basically a Republican wishlist of everything they would like to do on health, I mean, on every issue. But

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there's a big section on health, and work requirements for Medicaid, and I think block granting
Medicaid, and turning Medicare into even more privatized than it is now. So whether if Trump was
elected, he would actually do those things. It's hard to know. I mean, the other part of Project 2025 is
that they are vetting people who would like to come into the administration and do some of these
things. So there's a probably better than 50/50 chance on a lot of these things, but that's certainly
something that we would be looking at.
( 12:35 ):
Trump himself, obviously when he was president, did talk a lot about drug prices. It's something he feels
strongly about. He did talk about preserving Medicare and Social security. Basically, I think he knew
what a hot button issue it was and didn't want to get into it. We'll see if that would still be the same as
we get... At some point Congress has to do something about Social Security and Medicare if we would
like them to still be there. So you can't duck them forever.

Mark Masselli ( 13:01 ):
I'm wondering, I was taking a look at it, and I didn't know who Roger Severino is, who wrote the 50 page
sort of piece on the health care. But it seemed like they were talking a little bit about breaking up the
CDC, Certainly the expanding Medicare advantage as well. They had a number of details in there. I was
kind of surprised that out there, nothing around the safety net, but all around other-

Julie Rovner ( 13:30 ):
Roger Severino was in the first Trump administration. He was the head of the Office of Civil Rights at the
Department of Health and Human Services. He was the person in charge of saying that anyone who does
not believe in abortion should not have to be anywhere near it, or family planning or anything else. And
a lot of people, all of the protections for gay and trans people in the Affordable Care Act, they tried to
water them down, and obviously a lot of that stuff got reversed. Roger Severino's wife is actually a
leader in the anti-abortion movement and has been for a long time. So they are long time conservative
activists.

Mark Masselli ( 14:06 ):
Where are they on the Affordable Care Act? They're sort of dancing around it.

Julie Rovner ( 14:10 ):
Yeah, I think they're dancing around it.

Mark Masselli ( 14:11 ):
Yeah, just keep it on the sidelines.

Margaret Flinter ( 14:13 ):
Smart on their part. We're pretty engaged in public health and community health. And the idea that
Donald Trump has promised to strip funding from schools that have vaccine requirements. Something
that probably just about everybody has had as part of their life, that's certainly something to raise some
concern that would potentially result in breakouts of measles, and mumps and rubella and all sorts of
things that the society has not had to deal with. Is this getting the attention that it deserves? Or is this-

Julie Rovner ( 14:46 ):

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I've given it some attention. It's funny, I've seen him say it. It's a talking point, and what he says is that
he won't a single Federal dollar to any schools that have vaccine mandates or mask mandates, so-

Margaret Flinter ( 14:56 ):
It's 100% of public schools to the best of my knowledge.

Julie Rovner ( 14:59 ):
Right, for vaccine mandates. But in the context of how he's saying it, it seems that he's applying it to
COVID. But he's not actually saying that it only applies to COVID. So, it's kind of a question mark whether
he means all vaccines. But there's certainly more anti-vax feeling than there has been in quite a long
time. Trump, even after he championed the COVID vaccine, and that was a major accomplishment for
the Trump administration, turned that vaccine around in such a short period of time. He immediately
started getting pushback from his base, and he sort of backed off of it. So we're not quite sure what he
means about the anti-vax. That may be another one of these things where it depends who is running the
CDC or who's running HHS.

Mark Masselli ( 15:42 ):
Julie, in our day job, we run a large federally qualified health center. One thing that we keep an eye on
was Medicaid, obviously had an enormous upswing in terms of people who became eligible. But 15
million people lost eligibility in this Medicaid redetermination. Maybe I think 5 or so million got some
form of coverage, and the ACA coverage seems to have gone up. Talk a little bit about that and its
impact. I'm not sure people know how large the combination of Medicaid and Medicare is in this
country as has a profound impact on health.

Julie Rovner ( 16:21 ):
Yeah. Well, Medicaid at its peak had 90 million people enrolled, which is a number every time I see it, it
just kind of boggles my mind. I mean, that's a third bigger than Medicare. And even with 15 million
fewer people, it's still a lot of people. It's still the largest Federal health program, even though it's a
Federal state health program. And I think there's been a fair bit of attention to this Medicaid unwinding,
as they call it. When states finally after the public health emergency ended, got to redetermine eligibility
for the first time in three years. And indeed, many people are no longer eligible. And a lot of those
people did either get employer insurance, or they got Affordable Care Act insurance. But of course, what
we saw is that 75% of the people who lost their coverage lost it for basically paperwork reasons. They
either didn't respond to the emails, or to the phone calls, or they moved.
( 17:15 ):
Many of these people move frequently, or they didn't return the forms in time. So we know that there
are millions of people who are still eligible for Medicaid, who nevertheless lost their Medicaid. But in the
states that did this fairly methodically and seriously, a lot of them would say, "Okay, you're no longer
eligible for Medicaid, but you are eligible for probably free coverage under the Affordable Care Act, and
here's how you can sign up." So we did see that. I mean, I think the big increase in Affordable Care Act
coverage was because of these expanded subsidies that Congress did, that will expire at the end of next
year, unless Congress renews them. Which I should have mentioned is something that is really
important depending on who's the next administration.

Margaret Flinter ( 17:57 ):

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There's a lot coming up at the end of the year. And on that list, and I don't know if this has been on your
radar, but certainly along with so many people having coverage for the first time, people had access to
telehealth and telemedicine throughout the pandemic. It forced all of us who deliver care to get with
the program and make that happen. And patients got used to it pretty readily, telephone, and by video.
But Medicare says some of those enhanced provisions will disappear in December unless something
changes. How much do you think this has really gotten to be a permanent fixture of the American health
care system, including the government programs?

Julie Rovner ( 18:36 ):
Everything I can tell from Capitol Hill is that they would like to renew this, if not permanently, then at
least for another couple of years. It is popular, as you say. One of the issues with telehealth, and it's
been the issue with telehealth all along about not wanting to expand it, is that they're afraid that it
would actually increase cost because it would increase visits. Again, you take out some of that friction of
people actually getting medical care, and they're going to get more medical care. And at some point
they worry about doctors inducing demand. I mean, there's no question that telehealth is amazingly
helpful, particularly for people who have mobility limitations or distance limitations. But there are
indications that it is costing the programs more, and I think that may give some lawmakers a little bit of
pause. Maybe they'll renew it with some more restrictions. I don't know. It comes up on Capitol Hill
every other week, so I mean, I think there will be some legislated resolution to it. I'm not sure I would be
able to guess what it will be.

Mark Masselli ( 19:35 ):
Mm-hmm. We talked a little bit about what a second Trump administration might look like. I should
note that I think in that mandate for leadership, there was a Medicaid work requirement that also may
impose lots of stir the pot in terms of what's happening. But let's talk about President Biden. What do
you think, one, what were his accomplishments in the health care arena, and what do you think the
second term might look like?

Julie Rovner ( 19:59 ):
He's gotten a lot more done than I think he's gotten credit for. As I mentioned, there's millions more
people getting Affordable Care Act coverage because of the subsidies. We're going to see just in a couple
of months, the first 10 negotiated drug prices for Medicare, $35 a month copay cap for insulin for
people with diabetes on Medicare. Next year we'll see a $2000 out-of-pocket cap on Part D prescription
drugs. I mean, those are big things that people have been trying to do for a really long time. There is
something to be said for a president who spent three decades in the Congress. He knows where the
levers are and he knows how to make them work.

Mark Masselli ( 20:38 ):
But the timing on that will be after the election, right? The impact on those?

Julie Rovner ( 20:42 ):
Yes, the impact, yes, the impact on those. Because everything takes a long time. It's health care, it's a big
boat, it takes time time to move it around.

Margaret Flinter ( 20:49 ):

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Everybody ideally would like to get credit for what they accomplished.

Julie Rovner ( 20:51 ):
Right. And of course, what he would do in a second term will depend on who controls Congress. I mean,
it's just so tight. The fact that he's gotten as much accomplished as he has was such a tiny majority,
particularly in the Senate and in the House... Even in the house, when Democrats controlled the house,
it was a very tiny majority. I have to say, of all the presidents I've covered, I think he's gotten the most
accomplished that he wanted to in the most difficult of situations. And that includes passing the
Affordable Care Act. It's 60 votes in the Senate when the Affordable Care Act passed. They should have
been able to pass the Affordable Care Act.

Margaret Flinter ( 21:28 ):
Well, pivoting to a slightly different topic, the Pew Research Center found that about 9 in 10 Americans
say marijuana should be legal for recreational or medicinal use. But the use and possession of marijuana
is still illegal under US Federal law. Do you think we'll see a change in the next four years no matter
who's president? Is there enough momentum for that?

Julie Rovner ( 21:49 ):
I think it's coming. In my home state of Maryland, the governor just basically canceled all of the
sentences for the people who had been convicted of simple marijuana possession. That was a big deal.
We made recreational marijuana legal in Maryland a couple of years ago. I can't remember whether it
was 2020 or 2022, but in the last few years. But that was a big deal. I think it's definitely being thought
about. I mean, they're obviously rescheduling marijuana for the purposes of the Federal Controlled
Substances Act, which is a very big deal. That's been coming for a while. So, I wouldn't be shocked no
matter who's elected if that happens.

Mark Masselli ( 22:28 ):
Julie, one of the things that we're really focused in on is primary health care systems. And one of the
things that we see eroding because of hospital venture-fueled investments that seem to have gone
south in terms of that. Talk about what's happening in the venture world, how it might be undermining
hospital systems, primary care systems, and the like. What's it look like out there?

Julie Rovner ( 22:53 ):
I think you have to distinguish between venture capitalists and private equity.

Mark Masselli ( 22:55 ):
Private equity, yeah.

Julie Rovner ( 22:56 ):
I mean, venture capitalists are people who actually want to come in and help underwrite cool things,
and then make money from the profits of those cool things. Private equity in many cases, as we have
seen in the health care, wants to come in, buy up something, strip it of its valuable parts, and then sort
of leave it for dead on the side of the road, which we have seen in many hospitals.

Mark Masselli ( 23:18 ):

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Prospect and-

Margaret Flinter ( 23:19 ):
Stewart.

Julie Rovner ( 23:19 ):
Yes, yeah. It's a very different thing. We have a segment of the podcast that we do periodically called
this Week in Private Equity in Health care, because there are stories about this almost every week. I
don't know. There's definitely concern among policymakers. I know certainly Lina Khan at the Federal
Trade Commission is concerned about this. But it's hard to know what the Federal Government can
really do. It's something that Congress is looking at and worrying about, but hard to know what it will
do. But actually on our podcast this week, my panelist, Margot Sanger-Katz from the New York Times
pointed out, we're studying this now, but by the time they study it, if they decide that private equity is a
bad thing for health care, it's going to be too late.

Mark Masselli ( 24:05 ):
There are some states that have tougher regulatory hurdles for people, and that may be the model, at
least in the interim, until the Federal situation settles out. And obviously they have a lot of money, the
private equity people who are investing in them. But we are seeing, I think most recently, 21% of the
bankruptcies that happened were those that had private equity in them. But do you make the
distinction between venture, so you're not really seeing venture doing the same thing, let's sell it for its
parts? Or you really think there they're a force for good in terms of the system?

Julie Rovner ( 24:43 ):
I think the concept of venture capital is a force for good. I cannot speak for all venture capitalists, but
certainly the idea. I mean, I know a lot of people from health care policy who've gone into venture
capital, and are doing interesting stuff. Let's try this out and see if it works, and that's what venture
capital is for. Sometimes it works and sometimes it doesn't. Somebody has to try it.

Margaret Flinter ( 25:04 ):
Well, I think you're exactly right on the private equity, it may be too late. But on the other hand, where
so much of health care is a mystery to people, their community hospital is not a mystery. It's an
employer, it's a neighbor, it's where people had their babies, and sat by their loved ones while they died.
So I think this might turn out be more of an election issue too-

Julie Rovner ( 25:23 ):
We'll see, I don't-

Margaret Flinter ( 25:24 ):
... by the time we get there, if people have more experience with it.

Julie Rovner ( 25:27 ):
I don't know that people are making the connection yet. I think those of us in health care know, and see
it and worry. There's a lot of things the public is worried about, but it's mostly prices and taking three
months to get an appointment-

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Margaret Flinter ( 25:41 ):
Primary care shortages.
Julie Rovner ( 25:44 ):
... and being shuttled between... Right. Primary care shortages, being shuttled between specialists.
They're not at the level of who owns this hospital that's the heart of our community. It may be coming.
Mark Masselli ( 25:52 ):
How transformational do you see the GLP-1 drugs being? They're obviously having impact. Every week
we're seeing a new study released that it has a positive impact on a particular area. What's the horizon
look like for that type of...
Julie Rovner ( 26:10 ):
It's funny. I have a contrary view. A lot of people say, "Oh my God, we're all going to go broke because
these drugs are so expensive." It's like, when there's 100 of them, they're not going to be that expensive
anymore. It's like statins. At some point statins cost $10 a month. So I think the prices, the ridiculous
prices will come down pretty fast. And certainly the drug companies will make a lot of money, because a
lot of people are going to be eligible to take these drugs.
Margaret Flinter ( 26:33 ):
For a very long time.
Julie Rovner ( 26:34 ):
They don't have to be charging $1300 a month. But I am told that there are more of these in the
pipeline. Obviously oral medications rather than injectable medications. It's going to be a continuing
evolution. But I don't think that the dramatic, it's going to break Medicare is probably going to happen.
Margaret Flinter ( 26:57 ):
Julie, I know you've been very busy, but you were part of a session about life after 50 focused on putting
supportive public policies in place for what people call the second half of life. What were you all talking
about on your panel? What was interesting to you and what came up?
Julie Rovner ( 27:12 ):
Well, of course I am over 50, so I-
Margaret Flinter ( 27:14 ):
So it's very interesting to you.
Julie Rovner ( 27:15 ):
Yes, I was very interested. It actually was mostly based around a book that's coming out from the head
of policy at the AARP, who posed sort of seven questions for people to think about as they look at the
second half of life. And they include everything from, where will I live? Will I have enough money to
retire to? How will I die? What about longevity? How can I live longer? It was a really fascinating... The
book is fascinating. It comes out in September. But the panel included a geriatrician who treats elderly

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people, someone who basically runs projects to bring the generations together. The author of the book
and the head of the Trust for America's Health, who's looking at data around how we treat the aging
population. And it was really a very interesting discussion about the changing role of aging. Although I
did my first story about our lack of a long-term care policy in this country in 1986. Still nothing has
changed.
Margaret Flinter ( 28:24 ):
Life expectancy, mostly was the higher-
Julie Rovner ( 28:27 ):
Yes, that's true. Life expectancy has gone up. Our ability to-
Margaret Flinter ( 28:30 ):
So we need more public policy.
Julie Rovner ( 28:30 ):
... provide people with long-term care has not.
Mark Masselli ( 28:33 ):
Well, won't aging be solved by AI?
Julie Rovner ( 28:37 ):
Yeah, maybe.
Mark Masselli ( 28:38 ):
No, but what are you seeing in the AI field, and are you keeping an eye on that as you sort of do your
broad view horizon of what's impacting health policy?
Julie Rovner ( 28:49 ):
I'm absolutely keeping an eye eye on AI. But like most people who are not AI experts, I have no idea
what it really means. I mean, I can see the low level advantages, not so low level, doctors could be
talking into their computer rather than having to stare at the screen and write, I mean, and type. We can
have a lot more help for people with various disabilities. They're much better monitoring. But when you
get to some of the big picture things, I mean, I don't think I want to be treated by an AI bot. I'd still
rather be treated by a human being. I think like so much technology, and particularly so much
technology in the health care space, sometimes the technology gets ahead of how useful or how good it
actually is. That concerns me.
Margaret Flinter ( 29:37 ):
Well, Julie, health misinformation has been a big topic here at Aspen, and KFF Health News has a health
misinformation and trust initiative aimed at tracking health information in the US, and analyzing its
impact on people. What are you finding so far?
Julie Rovner ( 29:50 ):

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Actually, it's KFF, not KFF Health News.

Margaret Flinter ( 29:54 ):
All right, thank you.

Julie Rovner ( 29:55 ):
So it's a program alongside of KFF Health News. But it's director sits next to me.

Margaret Flinter ( 30:00 ):
Perfect.

Julie Rovner ( 30:02 ):
This was something that obviously was a huge concern during the COVID pandemic of all of the
information that was going out that was either not right because it was just people made a mistake, or
deliberately misleading people, trying to sell things that we knew didn't work. People trying to deter
people from obvious public health interventions. So basically, KFF is going to start a misinformation and
disinformation dashboard. We're going to keep track of all of this, and keep track of the research that's
going on in the field. I think it's really important for us to get involved in this. It's a big problem in health
care of people. A lot of this information that's responsible for a lot of declining trust in public health, and
in the health care system, it's really a critical issue going forward. So I'm glad we're elevating it.

Mark Masselli ( 30:54 ):
And I think the intersection is that people don't trust science either. And there's a whole group of people
who are trying to work on that to rebuild trust. And that's true in the news media as well, the need to
have trusted partners who are out there. But that's been a big conversation here is that, I think people
are very anxious that we've lost a generation, may have lost a generation of people who are simply
saying, "I won't believe what the scientist says. I'm going to look at my TikTok," or whatever.

Julie Rovner ( 31:23 ):
And it's not just science. They don't trust anyone with expertise. So, everybody is sort of losing out. It's
like, there used to be experts that you could turn to and say, "Well, that's the person who's spent their
career doing this, they should know." And we really don't have that anymore. You're right. Now it's like,
"Oh, well, I'm going to follow the influencer on TikTok."

Margaret Flinter ( 31:41 ):
Right. We'll have another whole show on science literacy, which is another piece of the fundamental
issues that we have. But I want to talk about medical bills for a month, medical debt always a big issue,
and something that does resonate with people insured. uninsured people face the same shock and awe
when they see their medical bills. You have a feature on your podcast called Bill of the Month. What
have you looked at that you found really either interesting, shocking, or provocative that shed light on
health care prices in the US?

Julie Rovner ( 32:14 ):

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Well, this is a joint project with KFF Health News and NPR that we've been doing, I think for five years
now. Definitely it did, I will say, help lead to the surprise billing legislation that went through Congress.
Many of the-

Margaret Flinter ( 32:30 ):
Very important.

Julie Rovner ( 32:30 ):
... yes. Many of the bills that we had, and some of them were just absurdly outrageous, people who go
to in-network providers and end up with these out-of-network bills, or make tiny mistakes and end up
with these enormous bills. And in most cases, as you can find with your local news, sometimes getting a
call from a journalist will suddenly straighten things out. That has not happened in every case, I will tell
you, but it's happened in a lot of cases. And what I think what's been most useful about this project is
not only helping the individuals who were in a bind with these enormous bills that they couldn't possibly
pay, but also giving people actionable information. Sort of, what did this person do that you need to be
careful not to do? Because a lot of this is on individual patients. The system is so hard to navigate, and
when you navigate it wrong, you can end up basically broke. I mean, that's where we are.

Margaret Flinter ( 33:25 ):
The sicker you are, the more you're responsible for navigation, which is very challenging.

Julie Rovner ( 33:28 ):
Yes.

Mark Masselli ( 33:29 ):
One of the more interesting politicians of our time was here, Pennsylvania Senator John Fetterman, who
talked about his struggle with depression. And he was very articulate, I thought, very thoughtful,
seemed like he'd found the seam of bipartisanship in terms of the mental health coalition he's put
together. What do you think his voice will be able to do in terms of public policy?

Julie Rovner ( 33:56 ):
Well, he's obviously a freshman, so he's new to the Senate. But I agree with you. I think he's worked...
Pennsylvania obviously is a very closely divided state. I think they have all Democrats representing them
in the Senate and the Governor now, but it can switch at any moment. And I think he's of the mind to try
to find the things where you can thread that needle, and make policy that you can get things
accomplished even if you can't get the big things that you might want to do accomplished. And I think
that's what... I mean, that's what Biden did as a senator. That's what it takes to be an effective senator,
is to find those pieces where you can establish a big enough coalition to get something passed. I mean,
there's so many people in the Senate now who are just there to yell. And then there are people who are
there to actually do the work. And he's one of those people who is clearly there to do the work.

Margaret Flinter ( 34:46 ):
Well, Julie Rovner, we thank you so much for your important reporting through the years. We're going
to continue to keep learning from your coverage, and we want to thank our audience for being here. Be
sure to subscribe to our videos on YouTube, find us on Facebook and X with our account name, CHC

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Radio. And as always, you can go online to chcradio.com to sign up for email updates. And please, we'd
love to hear your thoughts and comments about this program. Julie, thank you so much for your
incredible work, and for joining us today on Conversations on Health Care.
Julie Rovner ( 35:14 ):
This was fun.
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