Loading summary
Transcript45 lines
- [00:00]
Julie Rovner
Foreignada.
- [00:14]
Soojin Pak
Hey, everyone, it's Soojin Pak here, the host of Uncared For. And today we have a special bonus episode for you. With the 2024 election just days away, we thought it would be a good idea to really unpack what are the most important issues we need to around healthcare, like really drill down to the essentials, from abortion to maternal health, medical debt, long term care. What should we know before election day? To do this, we're chatting with longtime health policy journalist and author Julie Rovner. Julie is currently chief Washington correspondent for KFF Health News, where she hosts a weekly health policy podcast, what the Health. And before that, she covered health policy for NPR for 16 years and cited, essentially, Julie is the person to talk to when it comes to healthcare and the election. So let's dig in. Welcome, Julie. Thank you so much for taking time out. I know it is crazy busy season.
- [01:19]
Julie Rovner
This is my fourth podcast this week, not including my own.
- [01:23]
Soojin Pak
Yeah, yeah, no, I know. So thank you so much for sitting with us. Okay, let's get right into this. I mean, you have been covering healthcare and Capitol Hill for a very long time.
- [01:33]
Julie Rovner
38 years.
- [01:34]
Soojin Pak
38 years. Okay, kids, kiddos, let's listen to that. Okay? When we talk about expert, this is what we mean. So when people start to talk about health policy, it's complicated. People make it even more complicated, sometimes on purpose. And I think the majority of us just sort of tune out on that part.
- [01:59]
Unknown
You know what I mean?
- [02:00]
Soojin Pak
If the average person listening to this takes nothing else from this conversation but this, like, what do you want the average person to understand about this issue? What do you want them to take away from this conversation?
- [02:14]
Julie Rovner
That we're not gonna be able to fix the healthcare system unless more people plug into the problems? I hear everybody complaining and everybody should complain. Our healthcare system is a mess, but there's no way to fix it unless we actually engage and work with each other and spend a little bit of time and effort on something that's really important. People don't realize it's important until they need it, and then sometimes it's too late. So it would be nice. I realize that people are busy living their lives and worrying about everything, but this is something that we really need to care about and do something about.
- [02:49]
Soojin Pak
Yeah, I think this particular topic is so intimately interwoven into the fabric of our lives that, like, it is both daunting and yet possibly the most important thing that we deal with. So let's turn to this election. What do you see as the most pressing issues that will be impacted by this election.
- [03:10]
Julie Rovner
Well, obviously, reproductive health and the future of reproductive health care is the biggest electoral issue this time around, which is, you know, I had been sort of jumping up and down yelling, if you care about this, you should really look into it and vote for about the last six elections. And everybody was like, no, not a voting issue. And now suddenly everybody's like, how did Roe get overturned? It's like, because people weren't paying attention while the people who wanted to get Roe overturned were busy doing it. And as I think I've spent the last three years pointing out, this goes way beyond abortion. We can see that it's impacting the health of not just not even pregnant people, but the health of everyone. I just this week saw a survey from oncologists suggesting that they are reluctant to start pract in states with abortion restrictions because they're afraid that they won't be able to treat patients who come to them who are pregnant and have cancer. We're seeing obgyns and others who treat pregnant patients leaving states with abortion bans. They're worried about perhaps ending up in jail for treating their patients. So we're looking at shortages of health professionals and the geographic distribution of health professionals. So you don't have to be a woman of reproductive age in order for this to affect you. Obviously, we now have a debate going over IVF and fertility treatment. There are a lot of implications to. And that's why I talk about not just abortion, but abortion and other reproductive health care. So that is a huge, huge issue, probably the foremost voting issue, because depending on who is elected president and who is in control of Congress, things could go in very different directions.
- [05:00]
Soojin Pak
Wow. I think it's so important that you brought up that example because I think that when people see the headline abortion, that's kind of like it begins and ends there, you know, and it doesn't, because like all healthcare issues, it has this crazy trickle effect. And when we talk about even health care providers being very reluctant to go into states that have these really restrictive bans, you know, we already have what people call, you know, sort of maternity care deserts where it's already so difficult to get maternity care and, and just care in general. So I already love the way that you're breaking this down, so I appreciate it. I want to talk about how this election will affect access to abortion and other reproductive health care services. How this particular election is going to change that landscape. What's at stakeholders?
- [05:57]
Julie Rovner
Well, of course, it depends which side you're on. If you are anti abortion and former President Trump is returned to office. There are many things that he can do using his executive power that could make abortion and as I say, other reproductive health care less available. There are things like the Comstock act, which is an 1873 anti vice law that's still on the books that Congress never got rid of because when Roe v. Wade was in effect, it was basically a dead letter. It made it illegal to send anything that could be used for an abortion through the mail. We're not just talking about the abortion pill. We're talking about all the kinds of medical equipment that passes from state to state that all could stop moving and that could basically make abortion unavailable even in states where it's technically legal. A new commissioner of the Food and Drug Administration could rescind the approval of the abortion pill, which is something that Mr. Trump has said he wouldn't do. But we don't. You know, he has said lots of things that he wouldn't do and wouldn't do any changes his mind fairly frequently. So it's hard to know. But certainly the people who are supporting him, the anti abortion forces who are supporting him would like to see that happen. J.D. vance, the Vice presidential candidate, just said that if they're returned to office, they would eliminate funding for Planned Parenthood. Again, Planned Parenthood has never used federal money for abortion. They've never been allowed to. But they do provide many other types of health and reproductive health services. So that could exacerbate some of the care deserts that we were just talking about. On the other hand, if Vice President Harris is elected, there's less that she can do to restore abortion rights in states where it's now banned. That would take an act of Congress. In order for that to get through, the Senate would likely have to eliminate the filibuster, which might or might happen. Otherwise they would need 60 votes, which there has never been 60 votes either for or against abortion in the Senate. So both sides have been kind of at a standstill in terms of legislation over the last 52 years. And many of the things that could be done administratively by a president have already been done by President Biden. So there wouldn't be that much more that a President Harris could do.
- [08:17]
Soojin Pak
Well, that's so interesting. I mean, because I think to the average person, they're like, okay, if we elect the person that I think stands with me on this issue, then that person is going to make it yes or no. But it's not that simple, right? That it's not just a abortion yes or no?
- [08:34]
Julie Rovner
I think it's fair to say she would have fewer tools to make reproductive health services more available than Trump would have to make them less available.
- [08:42]
Soojin Pak
Okay, we have in this election 10 states with abortion initiatives on the ballot. Do you have predictions of what will happen in some of those states?
- [08:52]
Julie Rovner
Well, we know, we do know that in the seven states that have voted so far, the pro abortion rights side has won every single one. That may or may not happen this time. One of the interesting things on, one of the things that I'll be looking for is that people who are so conflicted on this issue, we have seen this in some of these past elections that they will vote for the abortion rights ballot questions, and then they'll turn around and they'll vote for Republican candidates who are against abortion rights because they support them for other reasons. I mean, so that's something I'll be watching for. In a couple of these states. There are some obviously key Senate elections as well as these abortion ballot issues. You know, and then we have places like Florida where it needs 60% to pass so it could get a majority, but then it could not pass. So it's, it is really hard to say at this point. And everything that I've seen says that the, you know, top of the ballot election is so close. But, you know, I do know that there are a lot of people who have been mobilized by this and who will come out to vote, who might not have voted before. All the times when they were told, people who support abortion rights, abortion rights is on the ballot, and they were like, no, it's not. And guess what? It was this last time or two times ago, it was really in 2016 that this was all set in motion.
- [10:13]
Soojin Pak
We're going to take a quick break, but we'll be right back with more on Uncared for Foreign. Let's be real. Without the black press, who's covering how black Americans are really treated in the healthcare system? Mainstream media barely scratches the surface. But word in black goes deep because lives depend on it. They're reporting the truth about medical racism, black maternal mortality, breast cancer in black women, mental health stigma, all of it. Want to stay informed and empowered? Subscribe to their weekly health newsletter and get the stories that actually put black health first. Go to wordinblack.com that's wordinblack.com and sign up, because being informed is how we protect each other.
- [11:06]
Unknown
Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple Podcasts. You'll get ad free episodes and exclusive bonus content from shows like Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, the Sarah Silverman Podcast, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show, feed on Apple Podcasts and hit subscribe Make Life Suck Less with fewer ads with Lemonada Premium.
- [11:43]
Soojin Pak
Vice President Harris just proposed earlier this month expanding Medicare to cover the cost of even long term care. This could be a game changer for so many millions of Americans. She talked about an issue that we talk about a lot here on Uncared for, which is the Sandwich Generation. Right. These people like myself who are both raising a young family and then taking care of my elder parents. What do you think about what she's proposed? What do you think the impact of that is going to be? I would love to get your thoughts on that.
- [12:19]
Julie Rovner
Well, this is the third sandwich generation since I have been covering this issue. I wrote my first story about the US lack of a long term care policy in 1986 that oh my goodness, what are we going to do when the baby boomers start to retire and they start to need care and they don't know that Medicare doesn't pay for long term care and the only program that does pay for long term care is Medicaid. But you have to spend down all of your money and you know things that have not changed in 38 years. Not that there have not been runs at this, there have been efforts to do things about long term care. We actually got a program similar to what Vice President Harris is proposing that was passed as part of the Affordable care Act in 2010. It was the late Senator Ted Kennedy's literally his dying wish to have this program included in the Affordable Care Act. It was and then the Department of Health and Human Services could not make it work in the way that it was passed because it was supposed to be self supporting. And one thing we've discovered about long term care is that it's so expensive it's impossible to make it self supporting. At some point during these previous 38 years we had a private long term care insurance market that worked for a little while. I was super lucky that I convinced my mom to buy long term care insurance and she used it and it did support her in her assisted living home for the last seven or eight years of her life, for which I am eternally grateful. But I don't have long Term care insurance because the market went away, because the people like my mom who bought it used it and it got too expensive. We have not yet figured out what to do about this. So we know that it's a problem. We know that everybody wants it. Could it be paid for the way she suggests by more Medicare price negotiation of drugs? You know, I'll be interested to see what the Congressional Budget Office says. But this is one of these continuing problems that I won't say. Everybody knows it's there. If everybody knew it was there, maybe we could do something about it. But a lot of people and certainly policymakers know that it's there and it simply thwarted any solution over these years.
- [14:27]
Soojin Pak
So currently, as the system stands now, then how do Americans pay for long term care then? Most Americans, they don't.
- [14:36]
Julie Rovner
They provide it themselves as family caregivers. We know how, you know, that's what you were saying, the sandwich generation, that usually the mom who's raising the kids and taking care of the aging parents or the aging parents spend themselves into poverty, at which point they qualify for Medicaid. Those are basically what you have. I mean, we have a few people left who have private long term care insurance, but not that many. And most people can't buy it anymore. So it's, you know, those are pretty much your options or you hope that you don't need long term care. I mean, there are a lot of that, you know, I'm being overbroad. There are a lot of wonderful sort of smaller programs. There are community villages, there are programs that are you naturally occurring retirement communities, places where people are basically helping each other. But most of this care, you can either afford it yourself or you can have somebody do it for free, or you can hope that you have someone who can help you.
- [15:36]
Soojin Pak
And what do you think is sort of public opinion on this Medicare? How do you think most people feel about it? Do they support the expansion of it? Do they understand it like, you know, what's the argument for the other side who say, no, we have to cut back on all of these programs?
- [15:55]
Julie Rovner
I think Donald Trump is doing us no favors in this campaign by saying he won't touch Medicare or Social Security because Medicare and Social Security both need to be touched. They need to be adjusted and recalibrated every few years. And it's really not enough to just leave them in auto drive because we know that neither program is fully funded into the future and needs to be addressed. If we were going to add something really expensive like long term care, that would require a New source of funding. Republicans in general are not hugely supportive of government funded health care. They would rather have private health care. And we have lots of private health care now involved in Medicare. And lo and behold, it's more expensive rather than less expensive because they're providing the health care and taking a profit. So I mean, it's a very serious debate that we need to have as a country. And we're really not having.
- [16:51]
Soojin Pak
Okay, so let's get to this topic of medical debt because I think it's so related to what we just talked about. You have a podcast called what the health. And in it you have this reoccurring segment called Bill of the Month. Okay, tell me, tell everyone what this is about. Why you do it. Break this down because it's so great.
- [17:15]
Julie Rovner
Well, we started this, I think more than five years ago now with npr and it was a joint project and we had people send us their medical bills. I think the description was did you get a medical bill that was outrageous or baffling or inscrutable? And basically we run down what happened here. Why did this person who had perfectly good health insurance and had a heart attack end up in the hospital with $110,000 hospital bill? Why did person who got pre authorization for this procedure end up with a multi thousand dollar bill anyway? You know, sort of where did these people stumble in the system? Part of this bill of the month is if you're faced with a similar situation, what could you do? Or where did this patient go wrong? There's so many ways to end up just caught in the maw of the health care system. I will say most of these bills are not the patient's fault. The patients usually did not make any kind of a mistake. Often they did everything and they still got caught up because that's what a mess our healthcare system is. One of the things we can do is at least bill by bill. Usually when a reporter calls all of a sudden they say, oh, that was a mistake, we'll take care of it. After a year of these people trying to get these things straightened out. And I hope we help teach people to know what to ask. I mean, sort of the new mantra is never pay the first bill. It's hard to imagine anything in society where when you get a bill, you shouldn't pay it. And yet that's where we are with healthcare.
- [18:51]
Soojin Pak
I'm just sitting with that for a moment because every person listening, I mean, and most of us just pay it. I'm just trying to tabulate in my mind where I'M like, I don't have the Energy to fight $134. Is there a particular bill or a story that has stuck with you over the years that you've been doing this?
- [19:11]
Julie Rovner
I still think the one the poor soul who had in Texas, and we did get his bill forgiven, who had insurance, had a heart attack. He was a teacher, was taken to the hospital, was treated, and they tried to charge him over $100,000. Why? Because it was out of network. You can't get prior. You can't call in advance and say, I'm having a heart attack and the nearest hospital is not in my network. And yet these are the things that happen. This last bill of the month we did was a teenager with a sports injury who needed surgery. And the surgical procedure didn' have a code. And because it didn't have a code, it wasn't experimental. It wasn't something that the surgeon had invented, him or herself. It just, it was new enough that it didn't have its own code. And therefore they had a huge fight over, I think it was like $7,000. And I think in the end, they had to pay.
- [20:11]
Soojin Pak
You know, medical debt, this is an issue that affects so many millions of people in this country, that bankrupt so many people in this country and just bleed them dry. What do you think in terms of the election? Is there anything here that can really affect how people are dealing with and accruing medical debt and out of pocket costs that can make a difference in our lives?
- [20:39]
Julie Rovner
Well, this has been a priority for the Biden administration to do things like no longer allow medical debt to be used on your credit report, because the fact that you got sick or you had an accident and you were taken to a place that charged a lot and you couldn't pay, it doesn't suggest your ability to pay back other bills, like when you take out a car loan and can't make your car payment. So that has changed. Some states we're seeing basically get hospitals to forgive patients medical debts in exchange for getting higher Medicaid payments. Basically help them sort of even that out. So there's a lot of work that's going on on the medical debt side. I have not heard Republicans talking a lot about this, although medical debt is a bipartisan issue, so it is something that both parties are aware of.
- [21:30]
Soojin Pak
Okay, hold tight, everyone. We're gonna take one more quick break, and we'll be back with more on Uncared For.
- [21:43]
Joelle Brevelt
Hello, I'm Joelle Brevelt, medical mythbuster and host of the Dose A health policy podcast from the Commonwealth Fund. Each season, I sit down with a leading health policy expert and medical professionals to have real conversations about the issues that keep them up at night. We talk about breakthroughs in their research and their new ideas to make our healthcare system work better for all Americans.
- [22:07]
Julie Rovner
This idea of equity needs to be taken up by everyone. And wherever you are in your work, whatever sector that you're in, we need to have conversations about what tomorrow looks like.
- [22:22]
Joelle Brevelt
I hope you'll check out the Dose and enjoy listening to our interviews. You can find us at thedose show or by searching your podcast app for the Dose from the Commonwealth Fund.
- [22:39]
David Duchovny
Hi everyone. I'm David Duchovny. Join me on my podcast Fail Better, where we use failure as a lens to reflect on the past and analyze the current moment. I speak with makers and performers like Rob Lowe, Rosie o' Donnell, and Kenya Barris, as well as thinkers like Kara Swisher and Nate Silver to understand how both personal setbacks and larger forces impact our world. Listen to Fail Better wherever you get your podcasts.
- [23:11]
Soojin Pak
So looking at these two presidential candidates, how are they with how health policy, like what. What are you hearing as a journalist who's been covering this for decades, are there promises realistic. Let's kind of break it down in black and white between these two candidates?
- [23:29]
Julie Rovner
Well, I think it's fair to say that, you know, the Vice President Harris has the. The record of the Biden administration to run on and knows about health care and can talk at length about health care. I mean, understands what the issues are, whether or not she can solve them, as I say, has has as much to do with who's in and what the administration happens in terms of the regulatory agenda and what the courts will have to say about that. Former President Trump doesn't really talk about health care in any kind of specifics. All he said is that, you know, he has concepts of a health plan that could replace the Affordable Care act or he's not going to touch Medicare. It's really hard to compare these things. I mean, we certainly do know that when Trump was president the first time, that it was a pretty doctrinaire Republican, with the exception of drug price, for which he was kind of a populist and wanted to go after the drug industry. And we don't know what he would do, whether that would continue. It was a pretty traditional Republican, let's push private industry over government involvement. Quite anti abortion, anti federal family planning. It was more sort of the traditional conservative view of healthcare. But as I say, we have no idea what he would do if he was elected again because he just hasn't.
- [24:48]
Soojin Pak
Said, like we said, you've been covering this for 38 years. I want to ask two final questions as we wrap up. My first question is are you seeing something different this time around? Is there something that's happening? Is there an issue, is there a trend, a feeling that feels different this time around than the others? Or is this sort of like you're like, here we go again, like this is the loop I've been talking about.
- [25:16]
Julie Rovner
Yes and no. I mean, it's been a very strange campaign because on the one side we have Vice President Harris who's a pretty traditional Democratic candidate. She's got some specifics. Does she have as many specifics as some people would want? No. But does any presidential candidate ever have as many specifics as everybody wants? No. And also presidents can't do a lot of things on their own. But we know where she's coming from, that she's a lot like Biden. She's sort of liberal, but not single payer liberal. On health care, we've got a pretty good bead on what it is that she would do. We have no idea what Donald Trump would do on healthcare if he was elected. None. We know what's in Project 2025, but he said that he's not part of that and he doesn't support it. We know what he did when he was president the first time, but again that was mostly not him. And then we had Covid and so a lot of that got interrupted. So it's sort of what we know that would be sort of traditional Democratic priorities and this big vacuum of what we don't know at all. And that is super different from any presidential campaign that I have covered before.
- [26:24]
Soojin Pak
Okay, and my last question, and I gotta ask it, is there hope? Help us, help us please find the light at the end of this never ending tunnel.
- [26:39]
Julie Rovner
Well, that's what I'm looking for. I wanna find the light. You know, I feel like we've tried an awful lot of things haven't worked. We can't obviously can't afford to stop trying. At some point there's going to be, you know, another crisis, whether it's for Medicare or Medicaid or, you know, at some point when it gets bad enough, we're going to have to do something. We're going to have to try something else. Other countries have figured this out. I assume that we can too. I just don't know how long it's going to take.
- [27:06]
Soojin Pak
Yeah, well Julie, I know that you are probably on your way to an another interview, so I'm not going to.
- [27:12]
Julie Rovner
Take no, actually going to see my horse for the first time in a week and a half. Good.
- [27:16]
Soojin Pak
I I think that that's probably the great balance you need, but it was so wonderful to pick your brain and thank you for really kind of breaking it down to some of the essentials and clearing things up. You can find Julie's work@kff healthnews.org as we've just heard, when it comes to your health and the health health of your friends and family, a lot is riding on this election. So make sure you go out and vote. Uncared for is a production of Lemonada Media. I'm your host, Sujin Pak. Muna Danish is our senior producer. Lisa Fu is our producer. Bobby Woody is our audio engineer. Music is by Andrea Kristen's daughter Jackie Danziger is our VP of Partners, Partnerships and Production Executive. Producers are Stephanie Whittles Wax and Jessica Cordova Kramer. This season of Uncared for is presented by the Commonwealth Fund, a non profit foundation making grants to promote an equitable, high performing healthcare system. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram Pak and Lemonada at Le Monana Lemonada Media across all social platforms. Follow Uncared for wherever you get your podcasts and listen. Ad free on Amazon Music with your prime membership.