\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n After narrowly passing in the House in May, President Donald Trump\u2019s \u201cOne Big Beautiful Bill\u201d has now arrived in the Senate, where Republicans are struggling to decide whether to pass it, change it, or \u2014 as Elon Musk, who recently stepped back from advising Trump, is demanding \u2014 kill it.\u00a0<\/p>\n Adding fuel to the fire, the Congressional Budget Office estimates the bill as written would increase the number of Americans without health insurance by nearly 11 million over the next decade. That number would grow to approximately 16 million should Republicans also not extend additional subsidies for the Affordable Care Act, which expire at year\u2019s end.\u00a0<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.<\/p>\n \t\t\t \tJessie Hellmann \t\t\t \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t \t\t\t \tLauren Weber \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF Health News\u2019 Arielle Zionts, who reported and wrote the latest \u201cBill of the Month<\/a>\u201d feature, about a Medicaid patient who had an emergency in another state and the big bill he got for his troubles. If you have an infuriating, outrageous, or baffling medical bill you\u2019d like to share with us, you can do that here<\/a>.<\/p>\n\n Plus, for \u201cextra credit,\u201d the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> KFF Health News\u2019 \u201cNative Americans Hurt by Federal Health Cuts, Despite RFK Jr.\u2019s Promises of Protection<\/a>,\u201d by Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts.<\/p>\n Alice Miranda Ollstein:<\/strong> Politico\u2019s \u201c\u2018They\u2019re the Backbone\u2019: Trump\u2019s Targeting of Legal Immigrants Threatens Health Sector<\/a>,\u201d by Alice Miranda Ollstein.<\/p>\n Lauren Weber:<\/strong> The New York Times\u2019 \u201cTake the Quiz: Could You Manage as a Poor American?<\/a>\u201d by Emily Badger and Margot Sanger-Katz.<\/p>\n Jessie Hellmann:<\/strong> The New York Times\u2019 \u201cA DNA Technique Is Finding Women Who Left Their Babies for Dead<\/a>,\u201d by Isabelle Taft.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Trump\u2019s \u2018One Big Beautiful Bill\u2019 Lands in Senate. Our 400th Episode!\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, June 5, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> Lauren Weber of The Washington Post.\u00a0<\/p>\n Lauren Weber:<\/strong> Hello, hello.\u00a0<\/p>\n Rovner:<\/strong> And Jessie Hellmann of CQ Roll Call.\u00a0<\/p>\n Jessie Hellmann:<\/strong> Hi there.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode we\u2019ll have my interview with my colleague Arielle Zionts, who reported and wrote the KFF Health News \u201cBill of the Month,\u201d about a Medicaid patient who had a medical emergency out of state and got a really big bill to boot. But first the news. And buckle up \u2014 there is a lot of it.\u00a0<\/p>\n We\u2019ll start on Capitol Hill, where the Senate is back this week and turning its attention to that \u201cBig Beautiful\u201d budget reconciliation bill passed by the House last month, and we\u2019ll get to the fights over it in a moment. But first, the Congressional Budget Office on Wednesday finished its analysis of the House-passed bill, and the final verdict is in. It would reduce federal health care spending by more than a trillion dollars, with a T, over the next decade. That\u2019s largely from Medicaid but also significantly from the Affordable Care Act. And in a separate letter from CBO Wednesday afternoon, analysts projected that 10.9 million more people would be uninsured over the next decade as a result of the bill\u2019s provisions.\u00a0<\/p>\n Additionally, 5.1 million more people would lose ACA coverage as a result of the bill, in combination with letting the Biden-era enhanced subsidies expire, for a grand total of 16 million more people uninsured as a result of Congress\u2019 action and inaction. I don\u2019t expect that number is going to help this bill get passed in the Senate, will it?\u00a0<\/p>\n Ollstein:<\/strong> We\u2019re seeing a lot of what we saw during the Obamacare repeal fight in that, even before this report came out, Republicans were working to discredit the CBO in the eyes of the public and sow the seeds of mistrust ahead of time so that these pretty damaging numbers wouldn\u2019t derail the effort. They did in that case, among other things. And so they could now, despite their protestations.\u00a0<\/p>\n But I think they\u2019re saying a combination of true things about the CBO, like it\u2019s based on guesses and estimates and models and you have to predict what human behavior is going to be. Are people going to just drop coverage altogether? Are they going to do this? Are they going to do that? But these are the experts we have. This is the nonpartisan body that Congress has chosen to rely on, so you\u2019re not really seeing them present their own credible sources and data. They\u2019re more just saying, Don\u2019t believe these guys.<\/em>\u00a0<\/p>\n Rovner:<\/strong> Yeah, and some of these things we know. We\u2019ve seen. We\u2019ve talked about the work requirement a million times, that when you have work requirements in Medicaid, the people who lose coverage are not people who refuse to work. It\u2019s people who can\u2019t navigate the bureaucracy. And when premiums go up, which they will for the Affordable Care Act, not just because they\u2019re letting these extra subsidies expire but because they\u2019re going back to the way premiums were calculated before 2017. The more expensive premiums get, the fewer people sign up. So it\u2019s not exactly rocket science figuring out that you\u2019re going to have a lot more people without health insurance as a result of this.\u00a0<\/p>\n Ollstein:<\/strong> Honestly, it seems from the reactions so far that Republicans on the Hill are more impacted by the CBO\u2019s deficit increase estimates than they are by the number of uninsured-people increase estimates.\u00a0<\/p>\n Rovner:<\/strong> And that frankly feels a little more inexplicable to me that the Republicans are just saying, This won\u2019t add to the deficit. <\/em>And the CBO \u2014 it\u2019s arithmetic. It\u2019s not higher math. It\u2019s like if you cut taxes this much so there\u2019s less money coming in, there\u2019s going to be less money and a bigger deficit. I\u2019m not a math person, but I can do that part, at least in my head.\u00a0<\/p>\n Jessie, you\u2019re on the Hill. What are you seeing over in the Senate? We don\u2019t even have really a schedule for how this is going to go yet, right? We don\u2019t know if the committees are going to do work, if they\u2019re just going to plunk the House bill on the floor and amend it. It\u2019s all sort of a big question mark.\u00a0<\/p>\n Hellmann:<\/strong> Yeah, we don\u2019t have text yet from any of the committees that have health jurisdiction. There\u2019s been a few bills from other committees, but obviously Senate Finance has a monumental task ahead of them. They are the ones that have jurisdiction over Medicaid. Their members said that they have met dozens of times already to work out the details. The members of the Finance Committee were at the White House yesterday with President [Donald] Trump to talk about the bill.\u00a0<\/p>\n It doesn\u2019t seem like they got into the nitty-gritty policy details. And the message from the president seemed to mostly be, like, Just pass this bill and don\u2019t make any major changes to it.<\/em> Which is a tall order, I think, for some of the members like [Sens.] Lisa Murkowski of Alaska and Susan Collins of Maine, and even a few others that are starting to come out and raise concerns about some of the changes that the House made, like to the way that states finance their share of Medicaid spending through the provider tax.\u00a0<\/p>\n Lisa Murkowski has raised concerns about how soon the work requirements would take effect, because, she was saying, Alaska doesn\u2019t have the infrastructure right now and that would take a little bit to work out. So there are clearly still a lot of details that need to be worked out.\u00a0<\/p>\n Rovner:<\/strong> Well, I would note that Senate Republicans were already having trouble communicating about this bill even before these latest CBO numbers came out. At a town hall meeting last weekend in Iowa, where nearly 1 in 5 residents are on Medicaid, Republican Sen. Joni Ernst had an unfortunate reaction to a heckler in the audience, and, rather than apologize \u2014 well, here\u2019s what she posted on Instagram.\u00a0<\/p>\n Sen. Joni Ernst:<\/strong> Hello, everyone. I would like to take this opportunity to sincerely apologize for a statement that I made yesterday at my town hall. See, I was in the process of answering a question that had been asked by an audience member when a woman who was extremely distraught screamed out from the back corner of the auditorium, \u201cPeople are going to die!\u201d And I made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth.\u00a0<\/p>\n So I apologize. And I\u2019m really, really glad that I did not have to bring up the subject of the tooth fairy as well. But for those that would like to see eternal and everlasting life, I encourage you to embrace my Lord and Savior, Jesus Christ.\u00a0<\/p>\n Rovner:<\/strong> And what you can\u2019t see, just to add some emphasis, Ernst recorded this message in a cemetery with tombstones visible behind her. I know it is early in this debate, but I feel like we might look back on this moment later like [Sen. John] McCain\u2019s famous thumbs-down in the 2017 repeal-and-replace debate. Or is it too soon? Lauren.\u00a0<\/p>\n Weber:<\/strong> For all the messaging they\u2019ve tried to do around Medicaid cuts, for all the messaging, We\u2019re all going to die<\/em> I cannot imagine was on the list of approved talking points. And at the end of the day, I think it gets at how uncomfortable it is to face the reality of your constituents saying, I no longer have health care.<\/em> This has been true since the beginning of time. Once you roll out an entitlement program, it\u2019s very difficult to roll it back.\u00a0<\/p>\n So I think that this is just a preview of how poorly this will go for elected officials, because there will be plenty of people thrown off of Medicaid who are also Republicans. That could come back to bite them in the midterms and in general, I think, could lead \u2014 combine it with the anti-DOGE [Department of Government Efficiency] fervor\u2014 I think you could have a real recipe for quite the feedback.\u00a0<\/p>\n Rovner:<\/strong> Yes, and we\u2019re going to talk about DOGE in a second. As we all now know, Elon Musk\u2019s time as a government employee has come to an end, and we\u2019ll talk about his legacy in a minute. But on his way out the door, he let loose a barrage of criticism of the bill, calling it, among other things, a, quote \u201cdisgusting abomination\u201d that will saddle Americans with, quote, \u201ccrushingly unsustainable debt.\u201d\u00a0<\/p>\n So basically we have a handful of Republicans threatening to oppose the bill because it adds to the deficit, another handful of Republicans worried about the health cuts \u2014 and then what? Any ideas how this battle plays out. I think in the House they managed to get it through by just saying, Keep the ball rolling and send it to the Senate.<\/em> Now the Senate, it\u2019s going to be harder, I think, for the Senate to say, Oh, we\u2019ll keep the ball rolling and send it back to the House.<\/em>\u00a0<\/p>\n Ollstein:<\/strong> Well, and to jump off Lauren\u2019s point, I think the political blowback is really going to be because this is insult on top of injury in terms of not only are people going to lose Medicaid, Republicans, if this passes, but they\u2019re being told that the only people who are going to lose Medicaid are undocumented immigrants and the undeserving. So not only do you lose Medicaid because of choices made by the people you elected, but then they turn around and imply or directly say you never deserved it in the first place. That\u2019s pretty tough.\u00a0<\/p>\n Rovner:<\/strong> And we\u2019re all going to die.\u00a0<\/p>\n Ollstein:<\/strong> And we\u2019re all going to die.\u00a0<\/p>\n Weber:<\/strong> Just to add onto this, I do think it\u2019s important to note that work requirements poll very popularly among the American people. A majority of Americans here \u201cwork requirements\u201d and say, Gee, that sounds like a commonsense solution.<\/em> What the reality that we\u2019ve talked about in this podcast many, many times is, that it ends up kicking off people for bureaucratic reasons. It\u2019s a way to reduce the rolls. It doesn\u2019t necessarily encourage work.\u00a0<\/p>\n But to the average bear, it sounds great. Yes, absolutely. Why wouldn\u2019t we want more people working? So I do think there is some messaging there, but at the end of the day, like Alice said, like I pointed out, they have not figured out the messaging enough, and it is going to add insult to injury to imply to some of these folks that they did not deserve their health care.\u00a0<\/p>\n Ollstein:<\/strong> And what\u2019s really baffling is they are running around saying that Medicaid is going to people who should never have been on the program in the first place, able-bodied people without children who are not too young and not too old, sort of implying that these people are enrolling against the wishes of the program\u2019s creators.\u00a0<\/p>\n But Congress explicitly voted for these people to be eligible for the program. And then after the Supreme Court made it optional, all of these states, most states, voted either by a direct popular vote or through the legislature to extend Medicaid to this population. And now they\u2019re turning around and saying they were never supposed to be on it in the first place. We didn\u2019t get here by accident or fraud.\u00a0<\/p>\n Rovner:<\/strong> Or by executive order.\u00a0<\/p>\n Ollstein:<\/strong> Exactly.\u00a0<\/p>\n Rovner:<\/strong> Well, even before the Senate digs in, there\u2019s still a lot of stuff that got packed into that House bill, some of it at the last minute that most people still aren\u2019t aware of. And I\u2019m not talking about [Rep.] Marjorie Taylor Greene and AI, although that, too, among other things. And shout out here to our podcast panelist Maya Goldman over at Axios<\/a>. The bill would reduce the amount of money medical students could borrow, threatening the ability of people to train to become doctors, even while the nation is already suffering a doctor shortage.\u00a0<\/p>\n It would also make it harder for medical residents to pay their loans back and do a variety of other things. The idea behind this is apparently to force medical schools to lower their tuition, which would be nice, but this feels like a very indirect way of doing it.\u00a0<\/p>\n Weber:<\/strong> I just don\u2019t think it\u2019s very popular in an era in which we\u2019re constantly talking about physician shortages and encouraging folks that are from minority communities or underserved communities to become primary care physicians or infectious disease physicians, to go to the communities that need them, that reflect them, to then say, Look, we\u2019re going to cut your loans.<\/em> And what that\u2019s going to do \u2014 short of RFK [Robert F. Kennedy Jr.], who has toyed with playing with the code. So who knows? We could see.\u00a0<\/p>\n But as the current structure stands, here\u2019s the deal: You have a lot of medical debt. You are incentivized to go into a more lucrative specialty. That means that you\u2019re not going into primary care. You\u2019re not going into infectious disease care. You\u2019re not going to rural America, because they can\u2019t pay you what it costs to repay all of your loans. So, I do think \u2014 and, it was interesting. I think the Guardian<\/a> spoke to some of the folks from the study that said that this could change it. That study was based off of metrics from 2006, and for some reason they were like, The financial private pay loans are not really going to cut it today.<\/em>\u00a0<\/p>\n I find it hard to believe this won\u2019t get fixed, to be quite honest, just because I think hating on medical students is usually a losing battle in the current system. But who knows?\u00a0<\/p>\n Rovner:<\/strong> And hospitals have a lot of clout.\u00a0<\/p>\n Weber:<\/strong> Yeah.\u00a0<\/p>\n Rovner:<\/strong> Although there\u2019s a lot of things in this bill that they would like to fix. And, I don\u2019t know. Maybe\u2014\u00a0<\/p>\n Weber:<\/strong> Well, and hospitals have a lot of financial incentive, because essentially they make medical residents indentured servants. So, yeah, they also would like them to have less loans.\u00a0<\/p>\n Rovner:<\/strong> As I mentioned earlier, Elon Musk has decamped from DOGE, but in his wake is a lot of disruption at the Department of Health and Human Services and not necessarily a lot of savings. Thousands of federal workers are still in limbo on administrative leave, to possibly be reinstated or possibly not, with no one doing their jobs in the meantime. Those who are still there are finding their hands tied by a raft of new rules, including the need to get a political-appointee sign-off for even the most routine tasks.\u00a0<\/p>\n And around the country, thousands of scientific grants and contracts have been summarily frozen or terminated for no stated cause, as the administration seeks to punish universities for a raft of supposed crimes that have nothing to do with what\u2019s being studied. I know that it just happened, but how is DOGE going to be remembered? I imagine not for all of the efficiencies that it has wrung out of the health care system.\u00a0<\/p>\n Ollstein:<\/strong> Well, one, I wouldn\u2019t be so sure things are over, either between Elon and the Trump administration or what the amorphous blob that is DOGE. I think that the overall slash-and-burn of government is going to continue in some form. They are trying to formalize it by sending a bill to Congress to make these cuts, that they already made without Congress\u2019 permission, official. We\u2019ll see where that goes, but I think that it\u2019s not an ending. It\u2019s just morphing into whatever its next iteration is.\u00a0<\/p>\n Rovner:<\/strong> I would note that the first rescission request that the administration has sent up formally includes getting rid of USAID [the U.S. Agency for International Development] and PEPFAR [the President\u2019s Emergency Plan for AIDS Relief] and public broadcasting, which seems unlikely to garner a majority in both houses.\u00a0<\/p>\n Ollstein:<\/strong> Except, like I said, this is asking them to rubber-stamp something they\u2019re already trying to do without them. Congress doesn\u2019t like its power being infringed on, especially appropriators. They guard that power very jealously. Now, we have seen them a little quieter in this administration than maybe you would\u2019ve thought, but I think there are some who, even if they agree on the substance of the cuts, might object to the process and just being asked to rubber-stamp it after the fact.\u00a0<\/p>\n Rovner:<\/strong> Well, meanwhile, Health and Human Services Secretary Kennedy continues to try to remake what\u2019s left of HHS, although his big reorganization is currently blocked by a federal judge. And it turns out that his big MAHA, \u201cMake America Healthy Again,\u201d report may have been at least in part written by AI, which apparently became obvious when the folks at the news service NOTUS<\/a> decided to do something that was never on my reporting bingo card, which is to check the footnotes in the report to see if they were real, which apparently many are not. Then, Lauren, you and your colleagues took that yet another step<\/a>. So tell us about that.\u00a0<\/p>\n Weber:<\/strong> Yeah. NOTUS did a great job. They went through all the footnotes to find out that several of the studies didn\u2019t exist, and my colleagues and I saw that and said, Hm,<\/em> let\u2019s look a little closer at these footnotes and see.<\/em> And what we were able to do in speaking with AI experts is find telltale signs of AI. It\u2019s basically a sign of artificial intelligence when things are hallucinated \u2014 which is what they call it \u2014 which is when it sounds right but isn\u2019t completely factual, which is one of the dangers of using AI.\u00a0<\/p>\n And it appears that some of AI was used in the footnotes of this MAHA report, again, to, as NOTUS pointed out, create studies that don\u2019t exist. It also kind of garbled some of the science on the other pieces of this. We found something called \u201coaicite,\u201d which is a marker of OpenAI system, throughout the report. And at the end of the day, it casts a lot of questions on the report as a whole and: How exactly did it get made? What is the science behind this report?\u00a0<\/p>\n And even before anyone found any of these footnotes of any of this, a fair amount of these studies that this report cites to back up its thesis are a stretch. Even putting aside the fake studies and the garbled studies, I think it\u2019s important to also note that a lot of the studies the report cites, a lot of what Kennedy does, take it a lot further than what they actually say.\u00a0<\/p>\n Rovner:<\/strong> So, this is all going well. Meanwhile, there is continuing confusion in vaccine land after Secretary Kennedy, flanked by FDA [Food and Drug Administration] Commissioner Marty Makary and NIH [National Institutes of Health] Director Jay Bhattacharya, announced in a video on X that the department would no longer recommend covid vaccines for pregnant women and healthy children, sidestepping the expert advice of the Centers for Disease Control and Prevention and its advisory committee of experts.\u00a0<\/p>\n The HHS officials say people who may still be at risk can discuss whether to get the vaccine with their doctors, but if the vaccines are no longer on the recommended list, then insurance is less likely to cover them and medical facilities are less likely to stock them. Paging Sen. [Bill] Cassidy, who still, as far as I can tell, hasn\u2019t said anything about the secretary\u2019s violation of his promise to the senator during his confirmation hearings that he wouldn\u2019t mess with the vaccine schedule. Have we heard a peep from Sen. Cassidy about any of this?\u00a0<\/p>\n Ollstein:<\/strong> I have not, but a lot of the medical field has been very vocal and very upset. I was actually at the annual conference of the American College of Obstetricians and Gynecologists when this news broke, and they were just so confused and so upset. They had seen pregnant patients die of covid before the vaccines were available, or because there was so much misinformation and mistrust about the vaccines\u2019 safety for pregnant people that a lot of people avoided it, and really suffered the consequences of avoiding it.\u00a0<\/p>\n A lot of the issue was that there were not good studies of the vaccine in pregnant people at the beginning of the rollout. There have since been, and those studies have since shown that it is safe and effective for pregnant people. But it was, in a lot of people\u2019s minds, too late, because they already got it in their head that it was unsafe or untested. So the OB-GYNs at this conference were really, really worried about this.\u00a0<\/p>\n Rovner:<\/strong> And, confusingly, the CDC on its website amended its recommendations to leave children recommended but not pregnant women, which is kind of the opposite of, I think, what most of the medical experts were recommending. Jessie, you were about to add something.\u00a0<\/p>\n Hellmann:<\/strong> I just feel like the confusion is the point. I think Kennedy has made it a pattern now to get out ahead of an official agency decision and kind of set the narrative, even if it is completely opposite of what his agencies are recommending or are stating. He\u2019s done this with a report that the CDC came out with autism, when he said rising autism cases aren\u2019t because of more recognition and the CDC report said it\u2019s a large part because of more recognition.\u00a0<\/p>\n He\u2019s done this with food dyes. He said, We\u2019re banning food dyes.<\/em> And then it turns out they just asked manufacturers to stop putting food dyes into it. So I think it\u2019s part of, he\u2019s this figurehead of the agency and he likes to get out in front of it and just state something as fact, and that is what people are going to remember, not something on a CDC webpage that most people aren\u2019t going to be able to find.\u00a0<\/p>\n Rovner:<\/strong> Yeah, it sounds like President Trump. It\u2019s like, saying it is more important than doing it, in a lot of cases. So of course there\u2019s abortion news this week, too. The Trump administration on Tuesday reversed the Biden administration guidance regarding EMTALA, the Emergency Medical Treatment and Active Labor Act. Biden officials, in the wake of the overturn of Roe v. Wade<\/em> three years ago, had reminded hospitals that take Medicare and Medicaid, which is all of them, basically, that the requirement to provide emergency care includes abortion when warranted, regardless of state bans. Now, Alice, this wasn\u2019t really unexpected. In fact, it\u2019s happening later than I think a lot of people expected it to happen. How much impact is it going to have, beyond a giant barrage of press releases from both sides in the abortion debate?\u00a0<\/p>\n Ollstein:<\/strong> Yeah, so, OK, it\u2019s important for people to remember that what the Biden administration, the guidance they put out was just sort of an interpretation of the underlying law. So the underlying law isn\u2019t changing. The Biden administration was just saying: We are stressing that the underlying law means in the abortion context, in the post-Dobbs context, blah, blah, blah, blah, blah, that hospitals cannot turn away a pregnant woman who\u2019s having a medical crisis. And if the necessary treatment to save her life or stabilize her is an abortion, then that\u2019s what they have to do, regardless of the laws in the state.<\/em>\u00a0<\/p>\n In a sense, nothing\u2019s changed, because EMTALA itself is still in place, but it does send a signal that could make hospitals feel more comfortable turning people away or denying treatment, since the government is signaling that they don\u2019t consider that a violation. Now, I will say, you\u2019re totally right that this was expected. In the big lawsuit over this that is playing out now in Idaho, one of the state\u2019s hospitals intervened as a plaintiff, basically in anticipation of this happening, saying, The Trump administration might not defend EMTALA in the abortion context, so we\u2019re going to do it for them, basically, to keep this case alive.<\/em>\u00a0<\/p>\n Rovner:<\/strong> And I would point out that ProPublica just won a Pulitzer for its series<\/a> detailing the women who were turned away and then died because they were having pregnancy complications. So we do know that this is happening. Interestingly, the day before the administration\u2019s announcement, the American College of Obstetricians and Gynecologists<\/a> put out a new, quote, \u201cpractice advisory\u201d on the treatment of preterm pre-labor rupture of membranes, which is one of the more common late-pregnancy complications that result in abortion, because of the risk of infection to the pregnant person.\u00a0<\/p>\n Reading from that guidance, quote, \u201cthe Practice Advisory affirms that ob-gyns and other clinicians must be able to intervene and, in cases of previable and periviable PPROM\u201d \u2014 that\u2019s the premature rupture of membranes \u2014 \u201cprovide abortion care before the patient becomes critically ill.\u201d Meanwhile, this statement came out Wednesday from the American College of Emergency Physicians<\/a>, quote, ,\u201cRegardless of variances in the regulatory landscape from one administration to another, emergency physicians remain committed not just by law, but by their professional oath, to provide this care.\u201d\u00a0<\/p>\n So on the one hand, professional organizations are speaking out more strongly than I think we\u2019ve seen them do it before, but they\u2019re not the ones that are in the emergency room facing potential jail time for, Do I obey the federal law or do I obey the state ban?<\/em>\u00a0<\/p>\n Ollstein:<\/strong> And when I talk to doctors who are grappling with this, they say that even with the Biden administration\u2019s interpretation of EMTALA, that didn\u2019t solve the problem for them. It was some measure of protection and confidence. But still, exactly like you said, they\u2019re still caught in between seemingly conflicting state and federal law. And really a lot of them, based on what they told me, were saying that the threat of the state law is more severe. It\u2019s more immediate.\u00a0<\/p>\n It means being charged with a felony, being charged with a crime if they do provide the abortion, versus it\u2019s a federal penalty, it\u2019s not on the doctor itself. It\u2019s on the institution. And it may or may not happen at some point. So when you have criminal charges on one side and maybe some federal regulation or an investigation on the other side, what are you going to choose?\u00a0<\/p>\n Rovner:<\/strong> And it\u2019s hard to imagine this administration doing a lot of these investigations. They seem to be turning to other things. Well, we will watch this space, and obviously this is all still playing out in court. All right, that is this week\u2019s news, or at least as much as we could squeeze in. Now we\u2019ll play my \u201cBill of the Month\u201d interview with Arielle Zionts, and then we\u2019ll come back and do our extra credits.\u00a0<\/p>\n I am pleased to welcome back to the podcast KFF Health News\u2019 Arielle Zionts, who reported and wrote the latest KFF Health News \u201cBill of the Month<\/a>.\u201d Arielle, welcome back.\u00a0<\/p>\n Arielle Zionts:<\/strong> Hi. Thanks for having me.\u00a0<\/p>\n Rovner:<\/strong> So this month\u2019s patient has Medicaid as his health insurance, and he left his home state of Florida to visit family in South Dakota for the holidays, where he had a medical emergency. Tell us who he is and what happened that landed him in the hospital.\u00a0<\/p>\n Zionts:<\/strong> Sure. So I spoke with Hans Wirt. He was visiting family in the Black Hills. That\u2019s where Mount Rushmore is and its beautiful outdoors. He was at a water park, following his son up and down the stairs and getting kind of winded. And at first he thought it might just be the elevation difference, because in Florida it\u2019s like 33 feet above sea level. Here it\u2019s above 3,000 in Rapid City.\u00a0<\/p>\n But then they got him back to the hotel room and he was getting a lot worse, his breathing, and then he turned pale. And his 12-year-old son is the one who called 911. And medics were like, Yep, you\u2019re having a heart attack.<\/em> And they took him to the hospital in town, and that is the only place to go. There\u2019s just one hospital with an ER in Rapid City.\u00a0<\/p>\n Rovner:<\/strong> So the good news is that he was ultimately OK, but the bad news is that the hospital tried to stick them with the bill. How big was it?\u00a0<\/p>\n Zionts:<\/strong> It was nearly $78,000.\u00a0<\/p>\n Rovner:<\/strong> Wow. So let\u2019s back up a bit. How did Mr. Wirt come to be on Medicaid?\u00a0<\/p>\n Zionts:<\/strong> Yeah. So it is significant that he is from Florida, because that is one of the 10 states that has not opted in to expand Medicaid. So in Florida, if you\u2019re an adult, you can\u2019t just be low-income. You have to also be disabled or caring for a minor child. And Hans says that\u2019s his case. He works part time at a family business, but he also cares for his 12-year-old son, who is also on Medicaid.\u00a0<\/p>\n Rovner:<\/strong> So Medicaid patients, as we know, are not supposed to be charged even small copays for care in most cases. Is that still the case when they get care in other states?\u00a0<\/p>\n Zionts:<\/strong> So Medicaid will not pay for patient care if they are getting more of an elective or non-medically necessary kind of optional procedure or care in another state. But there are several exceptions, and one of the exceptions is if they have an emergency in another state. So federal law says that state Medicaid programs have to reimburse those hospitals if it was for emergency care.\u00a0<\/p>\n Rovner:<\/strong> And presumably a heart attack is an emergency.\u00a0<\/p>\n Zionts:<\/strong> Yes.\u00a0<\/p>\n Rovner:<\/strong> So why did the hospital try to bill him anyway? They should have billed Florida Medicaid, right?\u00a0<\/p>\n Zionts:<\/strong> So what\u2019s interesting is while there\u2019s a law that says the Medicaid program has to reimburse the hospital, there\u2019s no law saying the hospital has to send the bill to Medicaid. And that was really interesting to learn. In this case, the hospital, it\u2019s called Monument Health, and they said they only bill plans in South Dakota and four of our bordering states. So basically they said for them to bill for the Medicaid, they would have to enroll.\u00a0<\/p>\n And they say they don\u2019t do that in every state, because there is a separate application process for each state. And their spokesperson described it as a burdensome process. So in this case, they billed Hans instead.\u00a0<\/p>\n Rovner:<\/strong> So what eventually happened with this bill? He presumably didn\u2019t have $78,000 to spare.\u00a0<\/p>\n Zionts:<\/strong> Correct. Yeah. And he had told them that, and he said they only offered, Hey, you can set up a payment plan.<\/em> But that would\u2019ve still been really expensive, the monthly payments. So he reached out to KFF Health News, and I had sent my questions to the hospital, and then a few days later I get a text from Hans and he says, Hey, my balance is at zero now.<\/em> He and I both eventually learned that that\u2019s because the hospital paid for his care through a program called Charity Care.\u00a0<\/p>\n All nonprofit hospitals are required to have this program, which provides free or very discounted pricing for patients who are uninsured or very underinsured. And the hospital said that they screen everyone for this program before sending them to collections. But what that meant is that for months, Hans was under the impression that he was getting this bill. And he was, got a notice saying, This is your last warning before we send you to collection.<\/em>\u00a0<\/p>\n Rovner:<\/strong> So, maybe they would\u2019ve done it anyway, or maybe you gave them a nudge.\u00a0<\/p>\n Zionts:<\/strong> They say they would\u2019ve done it anyways.\u00a0<\/p>\n Rovner:<\/strong> OK. So what\u2019s the takeaway here? It can\u2019t be that if you have Medicaid, you can\u2019t travel to another state to visit family at Christmas.\u00a0<\/p>\n Zionts:<\/strong> Right. So Hans made that same joke. He said, quote, \u201cIf I get sick and have a heart attack, I have to be sure that I do that here in Florida now instead of some other state.\u201d Obviously, he\u2019s kidding. You can\u2019t control when you have an emergency. So the takeaway is that you do risk being billed and that if you don\u2019t know how to advocate yourself, you might get sent to collections. But I also learned that there\u2019s things that you can do.\u00a0<\/p>\n So you could file a complaint with your state Medicaid program, and also, if you have a managed-care program, and they might have \u2014 you should ask for a caseworker, like, Hey, can you communicate with the hospital?<\/em> Or you can contact an attorney. There\u2019s free legal-aid ones. An attorney I spoke with said that she would\u2019ve immediately sent a letter to the hospital saying, Look, you need to either register with Florida Medicaid and submit it. If not, you need to offer the Charity Care.<\/em> So that\u2019s the advice.\u00a0<\/p>\n Rovner:<\/strong> So, basically, be ready to advocate for yourself.\u00a0<\/p>\n Zionts:<\/strong> Yes.\u00a0<\/p>\n Rovner:<\/strong> OK. Arielle Zionts, thank you so much.\u00a0<\/p>\n Zionts:<\/strong> Thank you.\u00a0<\/p>\n Rovner:<\/strong> OK. We\u2019re back, and it\u2019s time for our extra-credit segment. That\u2019s where we each recognize the story we read this week we think you should read, too. Don\u2019t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Jessie, why don\u2019t you go first this week?\u00a0<\/p>\n Hellmann:<\/strong> My story is from The New York Times. It\u2019s called \u201cA [DNA] Technique Is Finding Women Who Left Their Babies for Dead<\/a>,\u201d which I don\u2019t know how I feel about that headline, but the story was really interesting. It\u2019s about how police departments are using DNA technology to find the mothers of infants that had been found dead years and years ago. And it gets a little bit into just the complicated situation.\u00a0<\/p>\n Some of these women have gone on to have families. They have successful careers. And now some of them are being charged with murder, and some who have been approached about this have unfortunately died by suicide. And it just gets into the ethics of the issue and what police and doctors, families, should be considering about the context around some of these situations, about what the circumstances were, in some cases, 40 years ago and what should be done with that.\u00a0<\/p>\n Rovner:<\/strong> Really thought-provoking story. Lauren.\u00a0<\/p>\n Weber:<\/strong> With credit to Julie, too, because she brought this up again, was brought back to a classic from The New York Times back in 2020, which is called \u201cTake a Quiz: Could You Manage as a Poor American?<\/a>\u201d And here are the questions: I will read them for the group.\u00a0<\/p>\n Rovner:<\/strong> And I will point out that this is once again relevant. That\u2019s why it was brought back.\u00a0<\/p>\n Weber:<\/strong> It\u2019s once again relevant, and one of them is, \u201cDo you have paper mail you plan to read that has been unopened for more than a week?\u201d Yes. I\u2019m looking at paper mail on my desk. \u201cHave you forgotten to pay a utility bill on time?\u201d If I didn\u2019t set up auto pay, I probably would forget to pay a utility bill on time. \u201cHave you received a government document in the mail that you did not understand?\u201d Many times. \u201cHave you missed a doctor\u2019s appointment because you forgot you scheduled it or something came up?\u201d\u00a0<\/p>\n These are the basic facts that can derail someone from having access to health care or saddle them, because they lose access to health care and don\u2019t realize it, with massive hospital bills. And this is a lot of what we could see in the coming months if some of these Medicaid changes come through. And I just, I think I would challenge a lot of people to think seriously about how much mail they leave unopened and what that could mean for them, especially if you are living in different homes, if you are moving frequently, etc. This paperwork burden is something to definitely be considered.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think we should sort of refloat this every time we have another one of these debates. Alice.\u00a0<\/p>\n Ollstein:<\/strong> So I wanted to recommend something I wrote [\u201c\u2018They\u2019re the Backbone\u2019: Trump\u2019s Targeting of Legal Immigrants Threatens Health Sector<\/a>\u201d]. It was my last story before taking some time off this summer. It is about the intersection of Trump\u2019s immigration policies and our health care system. And so this is jumping off the Supreme Court allowing the Trump administration to strip legal status from hundreds of thousands of immigrants. Again, these are people who came legally through a designated program, and they are being made undocumented by the Trump administration, with the Supreme Court\u2019s blessing. And tens of thousands of them are health care workers.\u00a0<\/p>\n And so I visited an elder care facility in Northern Virginia that was set to lose 65 staff members, and I talked to the residents and the other workers about how this would affect them, and the owner. And it was just a microcosm of the damage this could have on our health sector more broadly. Elder care is especially immigrant-heavy in its workforce, and everyone there was saying there just are not the people to replace these folks.\u00a0<\/p>\n And not only is that the case right now, but as the baby boomer generation ages and requires care, the shortages we see now are going to be nothing compared to what we could see down the road. With the lower birth rates here, we\u2019re just not producing enough workers to do these jobs. The piece also looks into how public health and management of infectious diseases is also being worsened by these immigration raids and crackdowns and deportations. So, would love people to take a look.\u00a0<\/p>\n Rovner:<\/strong> I\u2019m so glad you did this story, because it\u2019s something that I keep running up and down screaming. And you can tell us why you\u2019re taking some time off this summer, Alice.\u00a0<\/p>\n Ollstein:<\/strong> I\u2019m writing a book. Hopefully it will be out next year, and I can\u2019t wait to tell everyone more about it.\u00a0<\/p>\n Rovner:<\/strong> Excellent. All right. My extra credit this week is from my KFF Health News colleagues Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts, who you just heard talking about her \u201cBill of the Month,\u201d and it\u2019s called \u201cNative Americans Hurt by Federal Health Cuts, Despite RFK Jr.\u2019s Promises of Protection<\/a>.\u201d And that sums it up pretty well. The HHS secretary had a splashy photo op earlier this year out west, where he promised to prioritize Native American health. But while he did spare the Indian Health Service from personnel cuts, it turns out that the Native American population is also served by dozens of other HHS programs that were cut, some of them dramatically, everything from home energy assistance to programs that improve access to healthy food, to preventing overdoses. The Native community has been disproportionately hurt by the purging of DEI [diversity, equity, and inclusion] programs, because Native populations have systematically been subjected to unequal treatment over many generations. It\u2019s a really good if somewhat infuriating story.\u00a0<\/p>\n OK. That is this week\u2019s show. Before we go, if you will indulge me for a minute, this is our 400th episode of \u201cWhat the Health?\u201d We launched in 2017 during that year\u2019s repeal-and-replace debate. I want to thank all of my panelists, current and former, for teaching me something new every single week. And everyone here at KFF Health News who makes this podcast possible. That includes not only my chief partners in crime, Francis Ying and Emmarie Huetteman, but also the copy desk and social media and web teams who do all the behind-the-scenes work that brings our podcast to you every week. And of course, big thanks to you, the listeners, who have stuck with us all these years.\u00a0<\/p>\n I won\u2019t promise you 400 more episodes, but I will keep doing this as long as you keep wanting it. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org. Or you can find me on X, @jrovner<\/a>, or on Bluesky, @julierovner<\/a>. Where are you folks these days? Jessie?\u00a0<\/p>\n Hellmann:<\/strong> @jessiehellmann
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