Trump & Harris Debate IVF: Why It’s an Election Issue

This transcript was exported on Nov 05, 2024 - view latest version here .

Speaker 1 ( 00:00 ):
The following is an Encore presentation of Conversations on Healthcare.
Mark Masselli ( 00:08 ):
The important topics of reproduction and maternal health are in the policy portfolio of Carole Johnson.
She's the administrator of the Health Resources and Service Administration known as HRSA, which is an
important agency at the US Department of Health and Human Services.
Carole Johnson ( 00:24 ):
The bigger picture here is about how we as a nation want to move forward in protecting women's rights
and protecting the autonomy of women's reproductive freedom, and in ensuring that we are growing
and developing a healthcare workforce that can support women's healthcare needs, and that's what we
want to do in this administration is continue to grow that healthcare workforce, continue to make sure
that training opportunities are available to provide the kind of healthcare support that women need
across the country.
Margaret Flinter ( 00:55 ):
With a multi-billion dollar budget, HRSA reaches every part of the country, including Alabama, where
families seeking IVF treatment are reeling from that state's controversial court ruling.
Carole Johnson ( 01:06 ):
It's really important that women have the autonomy and the ability to make informed healthcare
decisions with their healthcare providers, and so that's why the secretary was in Alabama this week.
That is why we as an administration are going to do everything we can to ensure that we sustain and
maintain and grow the autonomy that women have to ensure that their reproductive rights are
protected, and that they have the ability to make the best choices possible. It should not be the case
that young women in this generation have less rights than I did growing up.
Margaret Flinter ( 01:40 ):
This is Conversations on Healthcare.
Mark Masselli ( 01:50 ):
Well, Administrator Carole Johnson, welcome to Conversations on Healthcare.
Carole Johnson ( 01:55 ):
Thank you. Thank you so much for having me.
Mark Masselli ( 01:57 ):
We want to start with the Alabama Supreme Court decision that frozen embryos are children, and
there's a lot of legislative maneuvering going on right now. The Alabama House just passed a bill to
protect providers who engage, and I believe hospitals, in in vitro fertilization, give them immunity. But
on February 28th, a Republican US senator blocked a similar effort in that chamber. Senator Cindy Hyde-
Smith of Mississippi said the bill is vast. And I quote, "Overreach." We wanted to get your reaction to the
entire situation down in Alabama.

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

Carole Johnson ( 02:36 ):
Well, thank you for raising the question, and thank you for putting the focus on the families who are
now in very difficult position of trying to figure out their next steps, trying to ensure that they have
confidence in their family choices. Again, this is about how families plan and make family choices, and
that should be something that women and their doctors are able to do together. We say that across the
board. It's really important that women have the autonomy and the ability to make informed healthcare
decisions with their healthcare providers. And so that's why the secretary was in Alabama this week.
That is why we as an administration are going to do everything we can to ensure that we sustain and
maintain, and grow the autonomy that women have to ensure that their reproductive rights are
protected and that they have the ability to make the best choices possible.
( 03:31 ):
It should not be the case that young women in this generation have less rights than I did growing up,
and we need to change that. And so the other thing that I'll point out, as you note, we at HRSA focus on
the health and wellbeing of moms and babies through our maternal and child health work, but we are
also the home of the healthcare workforce investments across the Department of Health and Human
Services. And we continue to see challenges in making sure that people who go into healthcare
professions are going to go to states where there are restrictive environments about the ways that
physicians can practice medicine. And so we need to make sure that we're not only protecting and
wrapping ourselves around families, and helping women ensure that they have their reproductive health
rights, but also that we're supporting a workforce that can ensure that those opportunities are available
to families in states where there's a more restrictive legislative environment.

Margaret Flinter ( 04:33 ):
Well, Administrator Johnson, I really appreciate those comments. And maybe just clarify for me a little
bit, what can the federal government do to aid families who are in limbo at this time or questioning
what to do? I understand that moving embryos out of the state is not an option. Is that all within the
control of the state? Just help us figure out what the federal government can do in this situation to help
[inaudible 00:04:58]-

Carole Johnson ( 04:57 ):
I think there are a lot of things that are within the jurisdiction of states and a lot of things that states will
make decisions about. As you noted, there are legislators in the state who are taking action in the short
term here. But the bigger picture here is about how we as a nation want to move forward in protecting
women's rights and protecting the autonomy of women's reproductive freedom, and in ensuring that
we are growing and developing a healthcare workforce that can support women's healthcare needs.
And that's what we want to do in this administration is continue to grow that healthcare workforce,
continue to make sure that training opportunities are available to provide the healthcare support that
women need across the country. And so the secretary was there in Alabama earlier this week, and as
part of that said, he would continue to come back and work with all of us across HHS on where there are
opportunities that we can be helpful and supportive. But at the same time, we will continue to lean in as
an administration in supporting women.

Mark Masselli ( 06:03 ):
And it's so important, as you mentioned earlier, trying to figure out where are places that people can go
and feel safe. 2% of live births result from IVF. It's a large number across the country. Where else is the

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

administration focused in on terms of states? As you think about where a workforce should go, are there
other states like Alabama that are considering these changes to their constitution?

Carole Johnson ( 06:32 ):
I don't know that I can speak to what decisions are being made in other states or what is on deck in
other states. I can speak to what we as an administration will continue to lean into, which is having the
backs of women and families across our country.

Margaret Flinter ( 06:46 ):
Well, Administrator Johnson, one area that has been a loud and clear focus of the administration is the
recognition of the rising rates of maternal mortality and morbidity, and the need to do something about
it and to act. HRSA has invested $65 million in community health centers, just last year, to improve
maternal health care access, launched a maternal mental health hotline, has special grants to try
innovations in maternity care. Share with us those efforts, and what are we seeing on the ground that is
innovative? Is it too early to see results? Tell us about that.

Carole Johnson ( 07:27 ):
Yeah. Thanks, Margaret, for the question. Look, starting at the beginning of this administration, the
president and the vice president said it is absolutely unacceptable that the United States has the
maternal mortality rate that we have. That is not something that this administration can abide, and that
we need to pull every possible lever to improve maternal health outcomes for women. And what it turns
out is that 80% of maternal deaths are preventable, and they're preventable because they are caused by
things like mental health conditions, cardiovascular conditions, social determinants of health that we
know is an area of considerable need of attention, not just what happens inside the clinic walls, but
what happens in the community. And that's why across the administration, we have made this a priority.
I got to participate in the first ever cabinet meeting focused on women's health and maternal mortality
where the vice president pulled us all together and said, "This is not just a healthcare issue. It is critically
a healthcare issue, but not just a healthcare issue. This is about the Department of Labor," and the
Secretary of Labor was there.
( 08:31 ):
This is about what happens at the Department of Agriculture when it comes to food and nutrition
services. It's about transportation and the VA. And I sat next to the Secretary of Housing. It is about
making sure that we're doing a whole of government response here. Our part at HRSA is, as you
mentioned, really focusing on how we pull levers across all of our funding streams. So we're not just
putting more money into health centers, we're putting more money into training more midwives. We're
putting more money into training more community-based doulas who reflect the communities they
serve and can be a voice for women who are often not heard in the delivery environment and who know
something is wrong, but don't get the response that they need because the system isn't structured
around them. And too often what we hear from women is, "I did everything right and I still had a bad
outcome."
( 09:20 ):
That is a failure of all of us as a nation. It shouldn't be on the woman to say, "All of this is on you." It
should be us making sure that we've done everything possible for them. That's why we're investing in
making sure that hospitals are prepared for the most common causes of maternal crises in delivery like a
hemorrhage. That's why we're investing in social determinants of health. So we support the Healthy

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

Start Program to make sure they're community supports that can help ensure people get to prenatal
visits and postnatal visits. And that's why this administration is so proud to say that nearly every state
has extended Medicaid to 12 months postpartum.

Mark Masselli ( 10:02 ):
I want to take a little look at your own data, which shows that maternal mortality and other adverse
outcomes associated with pregnancy or childbirth have worsened. The rate in 2021 was 89% higher than
in 2018. The maternal mortality rate among non-Hispanic Black and African-American women was about
two and a half times greater than non-Hispanic White women during these years. And I'm wondering if
you could just focus in on what the role COVID played in these disparities.

Carole Johnson ( 10:34 ):
Yeah. Well, obviously COVID played a considerable part in health outcomes across all of our metrics. I
would also say there's some time lag in that data, but nonetheless, COVID had a big impact, not just on
maternal health, which is a critical priority for us, but on other critical healthcare needs. Again, we are
the home of the Maternal and Child Health Bureau. We care a great deal about children, ensuring that
they're up-to-date on their vaccines. Places like making sure routine vaccines are delivered. Places like
oral health in children, that oral health was one of the areas where the rebound post COVID was the
slowest, and so we are focused on making sure kids are getting their oral healthcare.
( 11:18 ):
But when it comes to maternal mortality, we think that there were obviously issues and challenges
during COVID. We saw a lot of states try to do things, like make sure doulas were allowable in hospitals
during delivery. There was so much restricted access during delivery, but yet we had this known way to
help improve healthcare outcomes, and they weren't always allowed in the delivery room. So all the
kinds of things that are lessons learned from COVID are the kinds of things we're working strategically to
improve and grow going forward.

Margaret Flinter ( 11:51 ):
Well, Administrator, you've focused on recommendations that have gone back many years now and
you're putting them all into place, which is really fantastic in a short period of time. I want to focus
maybe just on the health workforce for a moment. We talked about it earlier with regard to the
Alabama situation, but obviously making sure that there are enough nurses, labor delivery nurses, nurse
midwives, women's health nurse practitioners, OBGYNs in underserved areas as critical. I think for our
audience, maybe share some of the strategies that HRSA has to really bring these critical personnel
through training and get them to the areas where they're most needed. And I'll add community health
workers and health support workers of all kinds to the list. Tell us about the strategies for making this
happen.

Carole Johnson ( 12:41 ):
Well, thanks for the question, and thank you for your thought leadership on this, Margaret. You have
been a real leader in thinking about how to build a community-based health workforce, and that is very
much what we are focused on at HRSA. How do we ensure that we're training people, we incentivize the
creation of training placements in the community where we want people to practice. That's how we're
more likely to get clinicians who reflect the communities that they serve. That's how we're more likely to
build a workforce that will stay in those communities. And so we have a number of strategies to do this,

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

not least of which is our National Health Service Corps Program, which is where we provide scholarships
and loan repayment to primary care clinicians to practice in the highest need areas in the country,
including many urban areas and many rural areas across this country who would not have primary care
providers but for the National Health Service Corps.
( 13:39 ):
I will tell you, thanks to the president, we've had the largest investment in the National Health Service
Corps in the fifty-year history of the program under this administration. But that program expired at the
end of September, and Congress has not yet reauthorized it and provided the funding necessary for us
to continue it. So we are very anxious for this bipartisan's well-supported program to actually get the
resources we need so that we can continue and to sustain and grow this strategy for building a
workforce in the community. Similarly, we are investing in training nurses, including advanced practice
nurses who are primary care providers in so many places across the country, and support investing in
mobile clinics so that nurse practitioners can get into the community and deliver critical primary care
services.
( 14:32 ):
All across the board everywhere we can, we are thinking strategically about how, A, do we get a young
person interested in the healthcare field? How do we support them through health professions training,
with mentoring and other supports? How do we help them with stipends and tuition support, and the
like get through training? How do we encourage them with loan repayment to go to the communities
where we need them the most? And so that continuum is critically important to us and we're investing
all along the way.

Mark Masselli ( 15:01 ):
Well, that investment in training is so important. You're also engaged in cultivating collaboration and
partnership. And I note that HRSA has maternal health grantees from 11 states in the District of
Columbia in this initiative. I'm wondering how you chose those states. And talk to us a little bit of how
you anticipate them learning from each other. That collaborative relationship is so important, and I
know that's one of HRSA's goals.

Carole Johnson ( 15:28 ):
Thanks so much for raising it. We, last month, launched what we're calling our Enhancing Maternal
Health Initiative. And what we are saying here is, look, we know there's a lot of debate in Congress and
we're not done on all of the appropriations bills, and we don't know what our budget's going to look like
this year, but we have a lot of investments and a lot of work and support, and grantees that we've built
up in communities across the country. So let's look at those places where we have a lot of HRSA
resources that have been invested and where the maternal mortality rates are higher than we'd like
them to be, and how do we ensure that all of those grantees are working together in a way that ensures
that the whole is better than the sum of the parts? And so how do we leverage to make sure that the
nurse midwives we're training are available to and know and can train in our health centers where we're
investing in maternal health work?
( 16:21 ):
How do we make sure everyone in our AIM Program where we're focused on what happens in the
hospital, that that relationship with the hospital is also translated into everyone leaving that hospital,
having our maternal mental health hotline number so that we can treat and intervene in maternal
depression as early as possible. Our maternal mental health hotline number is 833-TLC-MAMA. That's

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

our 24/7 text and call way for people to get emotional and mental health support. And we are finding
that pregnant women, new moms, other family members of new moms are calling and getting that kind
of emotional and mental health support and referral when necessary. So we are thinking about how do
we strategically put all of HRSA's grantees together around the table and get the best possible outcome
from that collaboration rather than continuing to fund multiple different grantees doing important work
but not interconnected work.

Mark Masselli ( 17:22 ):
I love that. TLC MAMA. Sounds great.

Margaret Flinter ( 17:26 ):
Absolutely. And Administrator, we're talking about maternal mortality, but I want to talk just for a
moment about infant mortality, and note that HRSA has reported that the infant mortality rate overall,
though we still see some disparities between groups, overall continues to decline and reach even
historic lows, which is just wonderful news. In the past years, you and people in the community had
been promoting messages about taking folic acid supplements, not smoking, getting early prenatal care.
What do you think we can learn from these infant mortality campaigns that can inform maternal
mortality? Are they mirror images or is there something really different about the two groups in terms
of our messaging?

Carole Johnson ( 18:14 ):
It's such a great question. Thanks for the question, Margaret. I think one, as you did, it's very important
to note that the disparities still exist in the infant mortality space as well, and we obviously have more
work to do. But I think you're right that what we've seen here in infant mortality is really a marriage of
well-thought-out public health interventions coupled with clinical interventions, coupled with
community interventions. Unless we're thinking about it in that holistic way, we aren't going to make
meaningful progress. And so lots of investment in community prevention campaigns and community
education campaigns, lots of investment in insurance coverage and in making sure that kids are covered.
And CHIP predates our work in the Affordable Care Act. We knew that kids had to have coverage, and
then making sure that we are thinking about early access to food, early access to school lunch, early
access to all the things, SNAP expansion, all the things that make it possible for families to thrive, and so
there is much to learn there, I think.
( 19:24 ):
And I think one of the critical things that we focus on is, it's been an incredible success to get so many
people covered both through our Medicaid expansion and the numbers of folks who took up Affordable
Care Act coverage this year. But your insurance card needs to get you to a high quality place to get care,
and that's why investments in places like community health centers, in our rural partners, in the ways
that we are trying to build those footprints around the country where primary care is well-supported,
well-funded, and we're recruiting the workforce to deliver that care is so important.

Mark Masselli ( 20:00 ):
Administrator, the US Government Accountability Office recommended some improvements in how HHS
measures its performance regarding maternal health, and HHS agreed to these changes. Can you fill our
audiences in on the role and value of such performance measures?

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

Carole Johnson ( 20:18 ):
We think performance measures are really important, right? It's absolutely critical that we are holding
ourselves accountable. These are taxpayer dollars we are stewards of, and there's a sacred trust with
the community that you invest in the work we're doing, and then we're going to tell you how well it's
going. The one thing I would say that's really important to note though is that we also want to make
sure that new innovation and community strategies are part of the equation too. Too often we hear
from initiatives that have worked on the ground in communities that are sensitive to communities' need
and responsive to the community, they haven't had the resources and capacity to do a study that
documents the evidence to prove that X, Y, or Z happen. But it is clearly making a difference in the
community. And we need to, as we focus on performance measures and accountability, also account for
things that are evidence-informed and places where community interventions are making a meaningful
difference.

Margaret Flinter ( 21:22 ):
Well, Administrator, members of the Black Maternal Health Caucus have highlighted the very important
role of HRSA and their goal to pass the Momnibus Act. That's a great name for a new piece of legislation.
What would this legislation do?

Carole Johnson ( 21:37 ):
Yeah. I actually had the opportunity to, as part of the kickoff of our Enhancing Maternal Health Event
Initiative last month, we started that initiative by first hearing from the voices of women who have had
adverse maternal health outcomes or otherwise had experienced in the clinical system where their
voices weren't heard and their pregnancies were more complicated as a consequence. But then I had
the chance to, at that event, have a dialogue with Congresswoman Lauren Underwood, who is the co-
chair of the Congressional Maternal Mortality Caucus, and who is working on these issues directly, who
spoke eloquently about how important investments in HRSA have been to helping to advance the
overall goals of the caucus.
( 22:32 ):
And that is things like the work we do in Healthy Start, where dollars are going directly to community-
based organizations. Where I had the chance recently to visit one of our Healthy Start grantees with the
secretary, where women talked about how the Healthy Start grantee was their support during
pregnancy, was the way that they got, ensured that someone was following up with them, helping them
figure out how to prepare, what was next, and then once they had their children being able to get on a
pathway to ensuring that they had tenancy preparedness so that they could get apartment, ensuring
that they could get into community college. I mean, that is the way we need to think about these
interventions and the way that we're excited about doing more of going forward.

Mark Masselli ( 23:26 ):
I think all Americans would hope that COVID was in our rearview mirror, but it's still with us quite
prevalent. And you had a catbird seat because you previously served on President Biden's White House
COVID-19 Response team, and your area of focus was testing. Just want to ask you to address, how do
you think HRSA's handled this year's COVID season, and what will you be doing differently when the
vaccine campaign starts up in the fall?

Carole Johnson ( 23:56 ):

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

Yeah. It is really amazing, but in my prior seat on the president's COVID Response team, how often we
turn to HRSA to be able to make sure that there was equitable access to services. And so as I like to say, I
know more about which health centers in America have a loading dock versus not, because we delivered
pallets of tests and masks, and all kinds of things directly to health centers so that, and then they did the
incredible work of packaging it up, wrapping it up with fact sheets in the language of the community and
getting it out to people through their community health workers, through those kind of interventions.
( 24:42 ):
And health centers delivered more than 20 million doses of the vaccine. It is amazing what health
centers and rural health clinics, first time we were ever able to give direct funding to rural health clinics.
Really being able to think about where are trusted people in the community, who are they? How do we
get these resources to those folks? Because that's who people are going to turn to, and we see that
again and again, and we see that now in this RSV season, as we tend to call it, right? Because there's a
lot of stuff out there right now-

Mark Masselli ( 25:16 ):
It's a lot.

Carole Johnson ( 25:17 ):
... and we know that that's going to be important going forward. It's really important, particularly for
older adults who we interact with through, who we deliver care through, either through health centers
or rural clinics, or even in our HIV work, making sure that we leverage all those touch points to get
people up to date on vaccines.

Mark Masselli ( 25:40 ):
Let me just follow up on that, around the financing, the funds that are available. We're at this inflection
point in Washington where a budget hasn't been passed. Tell us about what the budget looks like for
HRSA, hope for, and also maybe how this will flow down. What's the larger picture look like now as we
still have no completed resolution on the budget?

Carole Johnson ( 26:08 ):
Yeah. We're at a critical inflection point at HRSA. We fund 1500 community health centers across the
country that see 30 million people regardless of ability to pay. They're the go-to source for healthcare in
communities all across this country. We fund more than 20,000 people in the National Health Service
Corps who are getting scholarships and loan repayment to practice in those high need communities. We
fund teaching health centers that are training new providers in those communities. All of those
programs have expired. They have to get funded in this new package. They have to be part of the deal in
order for us to continue just to continue keeping the lights on and doing the work we're doing. But the
president said in our budget, we actually should be doubling the investment in health centers. They're a
proven model that works. We know people need access to primary care, and this is a way to do it.
( 27:04 ):
So we have seen some fits and starts on that effort, but we're going to keep at it and lean into what we
need to do to continue to grow those investments so that people can get community... People can get
primary healthcare that is sensitive to their culture, that is responsive to their needs, and that is a place
where we can do all the things that are really priorities in this administration. My goal, our goal, the
president's goal is to get mental health and substance use disorder services delivered in community

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .

health centers. The reality is we're in a moment where everyone in America now understands how
critically important it is to have mental health and substance use disorder treatment services readily
available.
( 27:52 ):
And we have made incredible investments in this administration across the board in growing the
footprint of those services. But if we are not leveraging primary care to help expand access to mental
health and substance use disorder, then we're missing a huge opportunity, both because there is so
much that can be done there, but also because that's a trusted provider that people are willing to talk to
about their behavioral health needs. And if we are not ready to respond, then we're missing an
opportunity. So I firmly believe that behavioral health has to be part of primary care, and whenever
someone raises their hand, we have to be there to be able to meet those needs.

Margaret Flinter ( 28:32 ):
Well, Administrator Carole Johnson, thank you for joining us. Thanks to our audience for being here. Be
sure to subscribe to our videos on YouTube, find us on Facebook and X with our account name
CHCRadio. As always, you can go online to chcradio.com to sign up for email updates, and please share
your thoughts and your comments about this program. Administrator, thank you so much for joining us
today. Thank you for the work that you're doing in the federal government to really improve health and
healthcare for everybody in this country.

Carole Johnson ( 29:03 ):
Well, thank you, Mark and Margaret, and thank you for having me and for the work that you do.

Margaret Flinter ( 29:10 ):
This copyrighted program is produced by Conversations on Healthcare and cannot be reproduced or
retransmitted in whole or in part without the expressed written consent from Community Health Center
Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion of
Conversations on Healthcare or its affiliated entities.

Transcript by Rev.com