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The Open Enrollment Mixing Bowl

The Host

Julie Rovner
KFF Well being Information


Learn Julie’s tales.

Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous professional on well being coverage points, Julie is the writer of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.

Autumn is for pumpkins and raking leaves — and open enrollment for well being plans. Medicare’s annual open enrollment started Oct. 1 and runs via Dec. 7. Will probably be adopted shortly by the Inexpensive Care Act’s annual open enrollment, which begins Nov. 1 and runs till Jan. 15 in most states. However what was a reasonably easy annual job — renewing an current well being plan or selecting a brand new one — has develop into a complicated, time-consuming mess for a lot of, as a consequence of our convoluted well being care system.

In the meantime, Ohio would be the subsequent state the place voters will resolve whether or not to guard abortion rights. These on each side of the controversy are gearing up for the November vote, with anti-abortion forces hoping to interrupt a dropping streak of state poll measures associated to abortion because the 2022 overturn of Roe v. Wade.

This week’s panelists are Julie Rovner of KFF Well being Information, Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Put up.


Joanne Kenen
Johns Hopkins Bloomberg College of Public Well being and Politico


Learn Joanne’s tales

Alice Miranda Ollstein


Learn Alice’s tales

Lauren Weber
The Washington Put up


Learn Lauren’s tales

Among the many takeaways from this week’s episode:

  • The U.S. Home of Representatives has been with out an elected speaker since Oct. 4. Which means lawmakers can’t conduct any legislative enterprise, with a number of necessary well being payments pending — together with renewal of the favored worldwide HIV/AIDS program, PEPFAR.
  • Open enrollment is not only for folks seeking to change medical health insurance plans. Plans themselves change, and those that do nothing danger persevering with in a plan that not meets their wants.
  • A brand new spherical of lawsuits has sprung up associated to “abortion reversals,” a controversial observe during which a affected person, having taken the primary dose of a two-dose abortion treatment routine, takes a excessive dose of the hormone progesterone quite than the second treatment that completes the abortion. In Colorado, a Catholic-affiliated well being clinic says a state regulation banning the observe violates its non secular rights, whereas in California, the state legal professional normal is suing two faith-based chains that function being pregnant “disaster facilities,” alleging that by promoting the process they’re making “fraudulent and deceptive” claims.
  • The most recent survey of employer medical health insurance by KFF reveals annual household premiums are once more escalating quickly — up a mean of seven% from 2022 to 2023, with even bigger will increase anticipated for 2024. It’s not clear whether or not the already excessive value of offering insurance coverage to employees — an annual household coverage now averages slightly below $24,000 — will dampen corporations’ enthusiasm for offering the profit.

Additionally this week, Rovner interviews KFF Well being Information’ Arielle Zionts, who reported and wrote the newest KFF Well being Information-NPR “Invoice of the Month” characteristic concerning the extensive value variation of chemotherapy from state to state. You probably have an outrageous or inscrutable medical you’d prefer to ship us, you are able to do that right here.

Plus, for “further credit score,” the panelists recommend well being coverage tales they learn this week they assume you need to learn, too:

Julie Rovner: NPR’s “How Fuel Utilities Used Tobacco Ways to Keep away from Fuel Range Rules,” by Jeff Brady.

Lauren Weber: KFF Well being Information’ “Medical doctors Abandon a Analysis Used to Justify Police Custody Deaths. It Would possibly Reside On, Anyway,” by Markian Hawryluk and Renuka Rayasam.

Joanne Kenen: The Washington Put up’s “How Lunchables Ended Up on College Lunch Trays,” by Lenny Bernstein, Lauren Weber, and Dan Keating.

Alice Miranda Ollstein: KFF Well being Information’ “Pregnant and Addicted: Homeless Ladies See Hope in Road Drugs,” by Angela Hart.

Additionally talked about on this week’s episode:

Click on to open the transcript

Transcript: The Open Enrollment Mixing Bowl

KFF Well being Information’ ‘What the Well being?’Episode Title: The Open Enrollment Mixing BowlEpisode Quantity: 319Printed: Oct. 19, 2023

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]

Julie Rovner: Good day, and welcome again to “What the Well being?” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by among the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, Oct. 19, at 10 a.m. As all the time, information occurs quick, and issues may need modified by the point you hear this. So right here we go. As we speak, we’re joined through video convention by Alice Ollstein of Politico.

Alice Miranda Ollstein: Good morning,

Rovner: Lauren Weber of The Washington Put up.

Lauren Weber: Good day, whats up.

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico.

Joanne Kenen: Hello, everyone.

Rovner: Later on this episode, we’ll have my interview with Arielle Zionts, who reported and wrote the newest KFF Well being Information-NPR “Invoice of the Month” about how chemotherapy can value 5 occasions extra in a single state than in one other. However first this week’s information. So, it’s Oct. 19, the Home of Representatives remains to be with no speaker. That’s 2½ weeks now. Which means laws can’t transfer. Are there well being care gadgets which might be beginning to stack up? And what would it not imply if the Home finally ends up with an anti-federal authorities conservative like Rep. Jim Jordan, who, at the very least as of this second, isn’t but the speaker and doesn’t but appear to be he has the votes?

Ollstein: So when it comes to unfinished well being care enterprise, the three huge issues we’re monitoring are issues that really lapsed on the finish of September. Congress did handle to maintain the federal government open, however they allowed three huge well being care issues to fall by the wayside, and people are PEPFAR, the worldwide HIV/AIDS program, the SUPPORT Act, the applications for opioids and habit, and PAHPA, the general public well being, pandemics, biohazards huge invoice. And so these …

Rovner: I believe a type of P’s stands for “preparedness,” proper?

Ollstein: Precisely, sure. But it surely’s associated to pandemics, and you’d assume in spite of everything we simply went via that that might be extra of a precedence, however right here we’re. The reauthorization of all three of these is simply dangling on the market and it’s unclear if and when Congress can act on them. There may be some degree of bipartisan help for all of them, however that’s what is stacking up, and nothing is absolutely taking place on these fronts, in response to my conversations with sources on the Hill as a result of every little thing has simply floor to a halt due to the speaker mess.

Rovner: And, after all, we’re lower than a month away from the present persevering with decision operating out once more, and we might undergo — who is aware of? They might get a brand new speaker after which he might lose his job or her job as soon as they attempt to hold the federal government open in November. It’s a multitude. I’ve by no means seen something like this …

Kenen: Additionally, along with these three very political … even public well being and pandemics at the moment are politics … that Alice appropriately identified, these three enormous ideological, how are we going to get them reauthorized within the subsequent 30 days? However there’s additionally extra routine issues that aren’t controversial however are caught up on this corresponding to neighborhood well being middle funding, which has bipartisan help, however they want their apropos and all that stuff. So along with these kind of red-blue fights, there’s simply, how can we hold the doorways open for individuals who want entry to well being care? That’s not the one program. There are a lot of day-to-day applications that like every little thing else within the authorities are up within the air.

Rovner: I imply, we should always level out that is unprecedented. The one different time the Home has been with no speaker this lengthy was one 12 months after they didn’t are available in initially of the Congress till later in January. It’s actually the one time. There’s by no means been a mid-session speakerless Home. So every little thing that occurs from right here is unprecedented. Effectively, in the meantime, in case you have turned on a TV up to now week, you already know this, however Medicare open enrollment started final Sunday, Oct. 15. To be clear, once you first develop into eligible for Medicare, you may enroll anytime within the three months earlier than or after your birthday. However in case you enroll in a non-public Medicare Benefit plan or a non-public prescription drug plan, and most of the people are in a single or the opposite or each, open enrollment is when you may add or change protection. This was fairly easy, however it’s solely gotten extra complicated as non-public plans have proliferated. This 12 months the Biden administration is attempting to combat again in opposition to among the deceptive advertising efforts. Politico reviews that the federal government has rejected some 300 completely different adverts. Is that sufficient to quell the confusion? I’m already seeing adverts and form of take a look at it, like, “I don’t assume that claims what it means to say.”

Weber: Yeah, we see this yearly. It’s a ton of adverts. It’s a barrage of adverts that each one say, “Hey, this plan goes to get you X, Y, Z, and that’s higher than conventional Medicare.” However you bought to learn the effective print, and I believe that’s the huge factor for all the parents which might be taking a look at this each time. Open enrollment could be very complicated, and a variety of occasions persons are attempting to promote you issues that aren’t what they seem. So it does seem that there was extra motion to crack down on these adverts. However look, the members of the family I talked to are nonetheless confused, so I don’t know the way a lot that’s proliferating down fairly but.

Kenen: And even when the adverts had been sincere, our well being system is so complicated. Even in case you’re at an employer well being system. All of us are employed, all of us get insurance coverage at work, and none of us actually know we have now made the only option. I imply, you want a crystal ball to know what sickness you and your relations are going to get that 12 months, and what the copays and deductibles for that particular situation. I’ve by no means been certain. I’ve three selections. They’re all respectable, whether or not it’s the perfect for me and my household, with all that I learn about well being care, I nonetheless don’t know I made the only option ’trigger I don’t have a crystal ball or not one which works.

Rovner: Proper. I even have selections, and I did my mother’s Medicare for years, as Joanne remembers …

Kenen: You probably did an awesome piece on that one.

Rovner: … that is the way in which I keep in mind it. I did do a chunk on that. Very long time in the past, after they had been first beginning the prescription drug profit and also you needed to kind of enroll through a pc, and in 2006, not that many seniors knew learn how to use computer systems. At the very least we’re kind of over that, however there’s nonetheless complaints concerning the official web site, which does a reasonably good job. It’s simply acquired an terrible lot of steps. It’s a type of issues, it’s like, “OK, put aside two hours,” and that’s if you already know what you’re doing to do that. So in the meantime, if this isn’t all complicated sufficient, open enrollment for the Inexpensive Care Act opens in two weeks, and whereas Medicare open enrollment ends Dec. 7, ACA enrollment goes via Jan. 15 in most, however not each, state. In each circumstances, in case you get your insurance coverage via Medicare or via the ACA, you need to look to see what modifications your plan is perhaps making. I ought to say additionally, if it’s open enrollment in your employer insurance coverage, plans make modifications just about yearly. So you might find yourself, even in case you’re in the identical plan, with a plan that you just don’t like or a plan that you just don’t like as a lot as you prefer it now. That is insanely sophisticated, as you level out, for everyone with insurance coverage. Is there any solution to make it simpler?

Kenen: There’s no politically palatable solution to make it simpler. After which issues they’ve completed to attempt to make it simpler, like constant claims varieties, which most of us don’t need to fill out anymore. Most of that’s completed on-line, however they’re not utilizing constant declare varieties and there’s nothing easy and there’s nothing that’s getting easier. And we’re all savvy …

Rovner: It’s what retains our “Invoice of the Month” venture in enterprise.

Kenen: Proper. We’re all fairly savvy and none of us are sensible sufficient to resolve each well being care downside of us and our household.

Rovner: It’s a type of issues the place compromise truly makes for complexity. When policymakers can’t do one thing they actually wish to do, they do one thing smaller and extra incremental. And so what you find yourself with is that this constructed on, in each which approach, form of well being care system that no one is aware of the way it works.

Kenen: Just like the 12 months I damage each a finger and a toe. And I had a deductible for the finger, however not for the toe. Clarify that!

Rovner: I assume it was out and in of community or not even.

Kenen: No. They had been each in community. All of my digits are in community.

Weber: I simply acquired a covid check invoice from 2020 that I had beforehand knocked down by calling, however they rebilled me once more. And since I’m a savvy well being care reporter, I used to be like, “I’m not paying this. I do know that I don’t need to pay this.” But it surely took most likely 10 hours to resolve, I imply, and that’s not even choosing insurance coverage. So I’m simply saying it’s an extremely advanced market. Shout-out to Vox who had a very nice sequence that attempted to make it simpler for folks to know the variations between Medicare and Medicare Benefit, open enrollment, what that each one means. For those who haven’t seen that and also you’re confused about your insurance coverage choices, I’d extremely suggest it.

Rovner: And I’ll hyperlink to the Vox sequence, which is absolutely good, however it was form of taking a look at it. I imply, they needed to write six completely different tales. It’s like that’s how complicated issues are, which is absolutely form of unhappy right here, however we are going to transfer on as a result of we’re not going to resolve this one at present. So talking of issues which might be sophisticated and getting extra so, let’s flip to reproductive well being. Alice, the large occasion that individuals on each side are ready for — a type of occasions, at the very least — is a poll measure in Ohio that might set up a state constitutional proper to abortion. To date, each state poll measure we’ve seen has gone in favor of the abortions rights aspect. How are abortion opponents attempting to flip the script right here?

Ollstein: So I used to be in Ohio a few weeks in the past and was actually targeted on that very query, simply what are they doing in a different way? How are they studying classes from the entire losses final 12 months? And why do they assume Ohio might be any completely different? I’ll say, since my piece got here out, there was the primary ballot I’ve seen of how persons are approaching the November referendum, and it confirmed overwhelming help for the abortion rights aspect, similar to in each different state. So have that coloration, what I’m about to say subsequent, which is that the anti-abortion aspect thinks they will win as a result of they’ve a variety of structural components working of their favor. They’ve the governor of Ohio actually actively campaigning in opposition to the modification. In order that’s in distinction to [Gov. Gretchen] Whitmer in Michigan final 12 months, campaigning actively for it. When you might have a reasonably widespread governor, that does have an effect, they’re a recognized trusted voice to many. Additionally …

Rovner: And the governor of Ohio can also be a former senator and I imply a extremely well-known man.

Ollstein: Yeah. Yeah, precisely. You simply have your complete state construction working to defeat this modification. They tried in a particular election in August to alter the foundations. That didn’t work. Now, you simply have all of those prime officers utilizing their bully pulpit and their platforms to attempt to steer the vote within the anti-abortion path. Additionally, the precise marketing campaign itself is attempting to study classes from final 12 months and doing a couple of issues in a different way. They’re going actually aggressively after the African American vote, notably via Black church buildings. And in order that’s not one thing I noticed within the states I reported on final 12 months, and so they’re actually aggressively going after the scholar vote. And I went to a pupil campus occasion at Ohio State that the anti-abortion aspect was holding, and it appeared fairly efficient. There was a ton of confusion among the many college students. Lots of the scholars are like, “Wait, didn’t we simply vote on this?” referring to the August particular. They stated, “Wait a minute, which aspect means sure, and which aspect means no?” There was simply rampant confusion, and it wasn’t helped … I noticed the anti-abortion aspect, telling folks some deceptive issues about what the modification would and wouldn’t do. And so all of that might positively have an effect. However like I stated, since my story got here out, a ballot got here out displaying actually sturdy help for the abortion rights modification, which might block the state’s six-week ban, which is now held up in court docket, however the court docket leans fairly far to the fitting. This could block that from going again into impact doubtlessly.

Rovner: Ohio, the last word swing state, most likely the reddest swing state within the nation. However Ohio isn’t the one state having an off-year election subsequent month. Virginia doesn’t have an abortion measure on the poll, however its total state Home and Senate are up for reelection. And from virtually each advert I’ve seen from Democrats, it mentions abortion, and there’s a variety of adverts right here within the Washington, D.C., space for among the Virginia elections. Republican Gov. Glenn Youngkin, who’s not on the poll this 12 months, thinks he has a approach of speaking about abortion which may give his aspect the sting. What are we going to have the ability to inform from the last word make-up of the very narrowly divided Virginia Legislature when that is all stated and completed?

Kenen: It gained’t be veto-proof. Not like North Carolina now, even when it’s the Democrats maintain the one chamber they’ve or win each of them, and it’s actually shut. These are very intently divided, so we actually don’t know the way it’s going to prove. However I imply he …

Rovner: One 12 months it was so shut that they actually had to attract rocks out of a bowl.

Kenen: Yeah, proper. There’s extremely unlikely that there might be a state of affairs the place there’s a extremely strongly Democratic legislature with a Republican governor. That’s not going. What’s probably is a really narrowly divided, and we don’t know who has the sting during which chamber. So the governor can’t simply do issues unilaterally, however the way it performs out. And Youngkin’s backing a 15-week ban with some exceptions after that for all times and well being. A 12 months in the past, that might’ve appeared like an excessive measure. And now it appears average, I imply in comparison with zero weeks and no exceptions. So Virginia’s a pink state, it’s swung blue. It’s now reddish once more, I imply, it’s not a swing state a lot in presidential, however on the bottom, it’s a swing state. And …

Rovner: However I assume that’s what I used to be getting at was Youngkin’s attempting to kind of paint his help as one thing average …

Kenen: That’s how he’s been attempting to string this needle ’trigger he comes throughout as average after which he comes throughout as extra conservative. And on abortion, what’s average now? I imply, within the present panorama amongst Republican governors, you possibly can say his is average, however Alice follows the politics extra intently, however half the nation doesn’t assume that’s average.

Rovner: If the Democrats retain or win each homes of the legislature, I imply, will that ship us a message about abortion or is that simply going to ship us a message about Virginia being a really narrowly divided state?

Ollstein: I believe each. I believe Joanne is true in that the polling and the voting report during the last 12 months replicate that lots of people aren’t shopping for the concept 15 weeks is average. And a variety of polls present that when introduced the selection between a complete ban and complete protections, even people who find themselves uncomfortable with the thought of abortions later in being pregnant go for complete protections. And so that you’ve seen that play out. On the similar time, there’s lots of people on the fitting who appropriately argue that the overwhelming majority of abortions occur earlier than 15 weeks, and so 15 weeks isn’t going far sufficient. They usually’re not in favor of that as so-called compromise or average coverage. And so …

Rovner: There are not any compromises in abortion.

Ollstein: Actually, actually.

Rovner: If we’ve realized something, we’ve realized that.

Ollstein: And once you attempt to please everybody, typically you please nobody, as we’ve seen with each candidates and insurance policies that attempt to thread this needle. And so I believe it will likely be a extremely attention-grabbing check as a result of sure, proper now the legislature is kind of the firewall between what the governor needs to do on abortion, and whether or not that can proceed to be true is a extremely attention-grabbing query.

Rovner: In the meantime, we have now dueling abortion reversal lawsuits occurring in each Colorado and California. Abortion reversal, for many who don’t comply with all of the jargon, is the idea of interrupting the two-medication regime for abortion by capsule. And as an alternative of taking the second treatment, the pregnant particular person takes giant doses of the hormone progesterone. The American School of Obstetricians and Gynecologists says there isn’t a proof that this works to reverse a medicine abortion and that it’s unethical for medical doctors to prescribe it. However in Colorado, a Christian well being clinic is charging {that a} state regulation that bans the observe providing abortion reversal violates their freedom of faith. In California, it’s truly the alternative. The state legal professional normal is suing a being pregnant disaster middle for false promoting, selling the observe. Alice, how huge a deal might this combat over abortion reversal develop into? And that’s assuming that the capsule stays broadly accessible, which goes to be determined by yet one more lawsuit.

Ollstein: Yeah, completely. Though it’ll be a very long time earlier than we all know whether or not mifepristone is legally accessible on a federal foundation. However I’ve been watching this bubble up for years, however it’s up until now been extra of a rhetorical combat when it comes to: “Abortion reversal is a factor.” “No, it’s not.” “Sure, it’s.” “No, it’s not.” “Right here’s my professional saying it’s.” “Right here’s my professional saying it’s not.” However that is actually transferring it right into a extra kind of concrete, authorized realm, and never simply rhetoric. And so it’s an escalation, and it will likely be attention-grabbing to see. Mainstream well being care organizations don’t help this observe. There was a scientific trial of it occurring that was truly referred to as off due to the potential risks concerned and dangers to members …

Rovner: Of doing the abortion reversal methodology …

Ollstein: Precisely. Sure.

Rovner: … of attempting to interrupt a medicine abortion.

Ollstein: Sure. That is actually on the chopping fringe of the place drugs and politics are clashing proper now.

Rovner: Yeah, we’ll see the way it, and, after all, in the event that they find yourself somewhere else, this might be one thing else that leads to entrance of the Supreme Courtroom. And that is, I believe, much less of an argument about non secular freedom than an argument concerning the capacity of medical organizations to find out what’s or isn’t customary of observe primarily based on proof. I imply, I assume in some methods it turns into the identical factor because the broader mifepristone case, the place it’s like, do you belief the FDA to find out what’s secure? And now, it’s like, do you belief ACOG and the AMA [American Medical Association] and different organizations of medical doctors to resolve what ought to be allowed?

Kenen: I imply, progesterone has medical functions, it’s used to forestall miscarriages, however it’s off-label. It goes into these different questions, which all of us have written about — ivermectin, and who will get authorized substances, and the way do you employ them correctly, and what’s the hazard? And there’s a bunch of them.

Weber: I believe the combat over customary of care has actually develop into the following frontier in medical lawsuits. I imply, we’ve all written about this, however ivermectin, clearly, misinformation, prescribing hydroxychloroquine, all of these items at the moment are moving into the authorized area. Is that the usual of care? What’s the customary of care and the way does that play out? So I agree with you. I believe that is going to finish up by the Supreme Courtroom and I believe it has a lot broader implications than simply for mifepristone and abortion medicine too.

Rovner: Yeah, I do too. Effectively, lastly, in an replace I didn’t have on my post-Roe Bingo card, it seems that vasectomies are up in some states, together with Oregon, the place abortion remains to be authorized, and Oklahoma, the place it’s not very broadly accessible. Are males lastly taking extra duty for not getting the ladies they’ve intercourse with pregnant? That may be a giant sea change.

Ollstein: Yeah, we’ve been listening to anecdotally that this has been the case positively since Dobbs and even earlier than that as abortion restrictions had been mounting. Politico Journal did a pleasant piece on this final 12 months profiling vasectomy [in] a cell van. And it’s additionally simply fascinating and lots of people have been highlighting simply how few restrictions on vasectomies there are in comparison with extra everlasting sterilization for ladies: no ready durations, no combating about it. And so it does present an attention-grabbing distinction there.

Rovner: I do know there have been tales over time about how the demand for vasectomies goes up proper earlier than the NCAA event in March and April as a result of males determine that they will simply recuperate whereas watching basketball.

Ollstein: I believed that was a delusion then I appeared it up and it’s completely true.

Rovner: It’s completely true.

Kenen: I imply, it additionally appears to be extra widespread amongst older males who’ve had a household and since it’s everlasting, I imply normally everlasting. It’s normally everlasting and proper, it’s one factor to resolve after a sure level in your life once you’ve already had your youngsters. I imply, it’s not going to be an possibility for youthful males who haven’t had youngsters.

Rovner: It’s additionally dependable, it’s a type of issues that you just don’t have to fret about.

Kenen: Although I appeared up the figures as soon as, it’s a really, very low failure fee, however it’s not zero.

Rovner: True. We’re transferring on to what I name this week in declining life expectancy. I’m glad that Lauren is again with us as a result of The Washington Put up has revealed the following items of its deep dive into the U.S. inhabitants’s declining life expectancy. And we’re going to begin with a narrative that was co-written by Lauren, however that’s Joanne’s further credit score this week. So Joanne, you begin, after which Lauren, you may chime in.

Kenen: OK. It’s “How Lunchables Ended Up on College Lunch Trays.” For these of you who’ve by no means been in a grocery store or who’ve closed your eyes in sure aisles, Lunchables are closely processed, encased in plastic, small lunchboxes of a — it’s not even a lot of a meal or small — which you should purchase within the grocery store. And now two of them have been modified in order that they’re allowed in faculties as wholesome sufficient …

Rovner: They’re quote, unquote, “balanced” as a result of it’s just a little piece of meat and just a little piece of cheese.

Kenen: They’ve to this point only a turkey cheese possibility that qualifies for faculties and a pizza that qualifies for faculties. Not a complete pizza, just a little … however the child within the story, the second grader within the story, didn’t even understand it was turkey. It has 14 substances. He thought it was ham. So I imply, that simply kind of says it, however it’s past the shortage of diet, it began out kind of like what is that this youngster placing in his mouth and why is it referred to as college lunch? However the story was deeper as a result of it was a really lengthy investigation by Lauren and Dan Keating on the connection between the meals trade, the commerce group, and the federal government regulation. And simply say, it leaves loads to be desired. And you need to all learn the story solely as a result of you may click on on the story of the outsized Cheez-It.

I imply, it’s a faux one, however the duplicate of this as huge because the planet Mars. I imply, it’s simply this enormous Cheez-It. And it’s a extremely good story as a result of it’s overprocessed meals is absolutely dangerous for us. And I imply, scientists have matched the rise of this overprocessed stuff that started as meals and the rise of weight problems in America. And it’s not simply taking the salt out of it, which they’re doing, the sodium out of or including just a little calcium or one thing to those processed meals. They’re ultra-processed meals, and that’s not what our physique wants.

Rovner: So, Lauren, I imply, how does this relate to the remainder of this declining life expectancy venture and what else is there to return?

Weber: That is our huge tranche of tales. I imply, we should always have some follows, however that’s it. And properly, Joanne, thanks for the sort phrases on it. We actually respect that. However I imply, I believe the purpose that she made that I wish to spotlight for this usually is what was wild in investigating this story is pizza sauce is a vegetable within the U.S. with regards to college lunch and french fries are additionally a vegetable. And that’s actually all it’s essential sum up how the trade affect in Congress has resulted in what youngsters are having for his or her college lunch at present. One of many issues we acquired to do for the story is go to the nationwide College Vitamin Affiliation convention, which is the place we noticed the large Cheez-It. And it’s this huge commerce honest of all these corporations the place they throw events for the college diet personnel to strive all of the completely different meals. And it’s wild to see in actual life. And what Joanne made a superb level of about ultra-processed meals and what the foundations do proper now’s they don’t contemplate the integrity of the meals. They set limits on energy and sodium, however they don’t contemplate what youngsters are literally consuming. And so you find yourself with these ultra-processed meals that rising physique of analysis suggests actually have some unfavorable well being penalties for you. And so, as Joanne talked about, and as our sequence will get into, weight problems is an actual downside on this nation, and weight problems has enormous, long-lasting, life-shortening impacts. One of many of us we talked to for the piece, Michael Moss, stated, he worries that processed meals is the brand new tobacco as a result of he seems like smoking’s happening, however weight problems’s going up. And one thing he stated to me that didn’t make the piece, however I believed was actually attention-grabbing is that in some unspecified time in the future he thinks there’ll be some kind of class-action lawsuit in opposition to ultra-processed meals, very like a cigarette lawsuit-

Rovner: Like with tobacco.

Weber: Like a tobacco lawsuit, like an opioid lawsuit. I believe that’s form of attention-grabbing to consider, however this was simply one of many many life expectancy tales. I wish to shout out my colleague Frances Stead Sellers’ story, which talked about the way it in contrast is sensible. It in contrast two sisters with rheumatoid arthritis, one who lives within the U.S. and one who lives in Portugal. They’re each from Portugal. The one in Portugal has all this fabulous main well being care. The medical doctors even name her on Christmas and so they’re like, “We’re frightened you’re going to have chocolate cherries with brandy that might work together along with your drugs.” Whereas the one within the U.S. has to go to the ER on a regular basis as a result of she doesn’t have regular well being care and she will be able to’t appear to make it work, ends meet. She doesn’t have a main well being care system. She’s a disjointed physician system. And the tip of the story is the sister within the U.S. who has this extreme well being downside is transferring to Portugal as a result of it’s simply so a lot better there for main care. And I believe that will get at a variety of what our tales on life expectancy have talked about, which is that main care, preventative care within the U.S. isn’t a precedence and it ends in a variety of downstream penalties which might be shortening America’s life expectancy.

Rovner: Effectively, I hope when this venture is all revealed that you just put all of the tales collectively and ship them to each college of public well being in the USA. That may be pretty helpful. I guess public well being professors would respect it.

Weber: Thanks.

Rovner: So it’s mid-October, meaning it’s time for the annual KFF survey of employer medical health insurance. And for the primary time because the pandemic, most premiums are up markedly, a mean of seven% from 2022 to 2023 with indications of even bigger will increase coming for 2024. Now, to folks like me and Joanne, who’ve been doing this for a very long time, lived via years of double-digit will increase within the early 2000s, 7% doesn’t appear that huge, however at present, the typical household medical health insurance premium is about the identical as the price of a small automobile. So is there a breaking level for the employer well being system? I imply, one of many issues — to return to what we had been speaking about initially — one of many compromised methods we’ve stored the system practical is by permitting these items to stay in items. Employers have needed to supply medical health insurance. It’s an necessary fringe profit to assist entice employees. However you’re paying $25,000 a 12 months for a household plan, until you’re a extremely huge firm. And even if you’re a extremely huge firm, that’s an terrible lot of cash.

Kenen: One of many issues that struck me is, we’re at some extent once we’ve had a variety of strikes and reactivated labor motion, however 20 years in the past, the fights had been about the price of well being care. The well-known Verizon strike. They had been huge strikes that had been about well being care, the price. And proper now, I’m not likely listening to that an excessive amount of. I’m certain it’s a part of the dialog, however it’s not the highest. It’s not the headline of what these strikes are about. They’re about salaries principally and dealing circumstances with nurses and ratios and issues like that. I’m not listening to well being care prices, however I kind of assume we are going to as a result of, sure, we’re being sponsored by our employers, most of us. However you stated, “What’s the breaking level?” Effectively, apparently there isn’t one. We’ve requested ourselves that each single 12 months. And when can we cease doing it? Nobody has a superb reply for that. And associated is to what Lauren was simply speaking about, life expectancy. The dearth of main care on this nation, along with bettering our well being, it might most likely deliver down value. We used to spend 6 cents on the greenback on main care, 6 cents. Different nations spend much more. Now, we’re all the way down to 4.5 cents. So the stuff that retains you properly and spots issues and has anyone who acknowledges when one thing’s going mistaken in you since you’re their affected person versus … there’s nothing. I don’t imply that pressing care doesn’t have a spot. It does, however it’s not the identical factor as anyone who offers you continuity of care. So these are all associated. I’ll cease. It’s a multitude. Another person can say it’s a multitude now.

Rovner: It’s positively a multitude and we’re not going to repair it at present, however we’ll hold attempting.

Kenen: Possibly subsequent week.

Rovner: All proper. Yeah, possibly subsequent week. That’s this week’s information. Now, we are going to play my “Invoice of the Month” interview with Arielle Zionts. After which we are going to come again and do our further credit.

I’m happy to welcome to the podcast my KFF Well being Information colleague Arielle Zionts who reported and wrote the newest KFF Well being Information-NPR “Invoice of the Month” installment. Arielle, welcome to the podcast.

Arielle Zionts: Thanks for having me.

Rovner: So this month’s affected person is grappling with a grave most cancers prognosis, a toddler, and a few inexplicable payments from hospitals in two completely different states. Inform us just a little bit about her.

Zionts: Positive. So Emily Gebel is from Alaska and has a husband and two younger youngsters. She home-schools them. She actually likes the outside, studying, foraging, and he or she was recognized with breast most cancers. Simply one thing that makes me so unhappy is she discovered when she was mainly breastfeeding as a result of she felt a lump. After which when she was recognized, her child was asleep in her arms when she acquired that decision. So it simply actually reveals what it’s prefer to be a mother and to have most cancers. She was dwelling in Juneau on the time. Her pals who’ve had most cancers advised [they] needed to go to a much bigger metropolis. Whether or not it’s true or not, the thought was, OK, larger cities are going to have larger care. Juneau isn’t a giant metropolis, and you can not drive there. You must take a ferry or it’s important to fly in, and that is the capital of Alaska. So which may …

Rovner: Sure, I’ve been there. It’s very picturesque and really small and really exhausting to get to.

Zionts: Yeah, in order that is perhaps shocking for some folks. The closest main American metropolis is Seattle. So she went there for her surgical procedure after which she determined to have chemo, and he or she opted for this particular kind of chemo that makes use of decrease dose, however extra frequent doses. The thought is that it creates much less of the unintended effects, and he or she went to this standalone clinic in Seattle, flying there each week. It’s not a fast flight. It will possibly take as much as two hours and 45 minutes. And that simply acquired actually tiring. I imply, bodily …

Rovner: And he or she’s acquired youngsters at dwelling.

Zionts: Sure, bodily and mentally and simply taking over time. So she determined to change to the native hospital in Juneau. So they’d payments from the primary clinic in Seattle, after which they acquired some estimates from the one in Juneau after which lastly acquired a invoice from there as properly.

Rovner: Sure, as we are saying, “Then the invoice got here.” And, boy, there was a giant distinction between the identical chemotherapy in Seattle and in Juneau, Alaska, proper?

Zionts: I in contrast two of Emily’s therapies that used the same combine of medicine and likewise had overlapping non-drug fees, corresponding to how a lot it prices for the primary hour of therapy, subsequent hours. And within the Seattle clinic, one spherical value about $1,600. After which in Juneau it value greater than $5,000, so greater than 3 times increased. And we had been ready to have a look at particular fees. In order that first hour of chemo was $1,000 in Juneau, which is greater than twice the speed within the Seattle clinic. There was a drug that value greater than 3 times the worth on the clinic. After which even the cheaper fees had been costlier. So the hospital charged $19.15 for Benadryl, which is about 22 occasions the worth on the clinic, which was 87 cents.

Rovner: Now to be clear, the Gebel household appears to have fairly complete insurance coverage. So this case wasn’t as a lot about their out-of-pocket prices as among the different Payments of the Month that we’ve lined, however they did wish to know why there was such a giant distinction, and what did they, and we discover out?

Zionts: Yeah. So we began the story for NPR, we mainly began saying, “Hey, it is a little completely different than the opposite ones as a result of the household has met their most out-of-pocket.”

Rovner: For the 12 months?

Zionts: Sure. When you pay a sure sum of money for the 12 months, your insurance coverage will cowl every little thing, and that may be a excessive quantity. However in case you have most cancers, most cancers’s costly, so you’ll most likely hit it in some unspecified time in the future. By the point she switched her therapy to Juneau, she had met that, so she wouldn’t truly owe something.

Rovner: However what did they discover out nonetheless, about why it prices that rather more in Juneau than it did in Seattle?

Zionts: Sure. So Jered, her husband, he’s considerably of a self-taught medical billing professional. He gained this information by listening to “Invoice of the Month” after which studying some books about this. I imply, at first, he thought possibly they might owe cash, however then he realized they wouldn’t. However he nonetheless didn’t assume it was honest. I imply, he didn’t assume it was honest for the insurance coverage corporations. And he did catch two errors. Considered one of them, an estimate, was mistaken. The hospital stated, “Oh, it seems to be like there was a pc error,” and that was lowered. After which when it got here for the precise invoice, there was a coding error. It made one of many medicine not lined when it ought to have been. So that might’ve truly left them out-of-pocket prices. So he was capable of decrease an estimate, decrease the invoice. However once more, even with these modifications, it was nonetheless a lot costlier. And that’s once I referred to as some specialists and somebody’s intestine response or preliminary speculation is perhaps, “Effectively, after all, it’s costlier in Alaska. Alaska is small, it’s distant. I imply, it’s simply going to value extra to ship issues there. It’s worthwhile to pay medical doctors extra to entice them to reside there.”

Rovner: And it prices extra for medical doctors to reside there anyway, proper?

Zionts: Sure.

Rovner: The price of dwelling is excessive in Alaska.

Zionts: Sure. The professional I spoke with, an economist who has studied this problem. He stated, “Sure, that’s a part of it.” Such as you stated, every little thing is costlier in Alaska, however even when accounting for that, the costs are even increased. So the expansion of value within the well being care sector in Alaska is increased than the expansion of general value. And he listed some insurance policies or tendencies which may clarify that. There’s one that basically stood out, which is one thing referred to as the “eightieth percentile rule,” however it was meant to comprise value for once you’re seen by out-of-network suppliers. And evidently it might have truly backfired, and the state is contemplating repealing that. However as Elisabeth Rosenthal, considered one of our editors at KFF Well being Information, and he or she’s written a whole e book about this, as she stated, “That is how our well being system works. There’s no regulation saying, that is how a lot you may upcharge for some intrinsic worth of a medication or of a service. So hospitals can do what they need.” So …

Rovner: And we should always level out, I imply, this isn’t a for-profit hospital, proper? It’s owned by the town.

Zionts: Sure. It is a nonprofit hospital owned by the town, and so they don’t get a ton of cash from the town or state, which is attention-grabbing although. So that they’re actually getting their funding from the companies they supply. And the hospital stated they attempt to make it honest by evaluating it to wholesale prices, what different hospitals within the area are charging. However in addition they stated, “Sure, we do have to account for the upper prices.”

Rovner: So what’s the takeaway right here? I imply, mainly what it prices goes to rely on the place you reside?

Zionts: Mainly, what we’ve realized from all these Invoice of the Months is that it’s going to differ relying on what facility you go to. And that might be inside one metropolis, the costs might differ. And then you definately may see some extra variation between states and particularly in states the place the price of dwelling is increased or it’s extra distant.

Rovner: Of which Alaska is each.

Zionts: Sure. And truly, one thing so as to add is that the sum of money that this hospital has to spend to fly in medical doctors and nurses and likewise simply workers, even nonmedical workers, they spent almost $11 million final 12 months to move them and pay them as a result of they don’t have sufficient native folks. And the opposite takeaway, although, is that sure, this may be defined, but additionally, it’s unexplainable within the sense that our well being care system doesn’t have some magic components or some exhausting guidelines about what’s, quote, “honest.”

Rovner: Sure, at the very least with regards to Medicare, Congress has been attempting to try this for, oh, I don’t know, about 50 years now. Nonetheless engaged on it. Arielle Zionts, thanks very a lot for becoming a member of us.

Zionts: Thanks for having me.

Rovner: OK. We’re again, and it’s time for our extra-credit section. That’s once we every suggest a narrative we learn this week we expect you need to learn, too. As all the time, don’t fear in case you miss it. We’ll put up the hyperlinks on the podcast web page at and in our present notes in your cellphone or different cell machine. Joanne, you’ve already completed yours. Alice, why don’t you go subsequent?

Ollstein: I did a chunk by my former colleague Angela Hart for KFF Well being Information, and it’s about road drugs. So groups of medical doctors working with unhoused folks, and that is profiling primarily in Northern California, however it’s kind of discussing this throughout the nation. And along with the actually very transferring private tales that she present in her reporting, she additionally talked about among the structural stuff that’s supporting the enlargement of this sort of well being care. And so California was already placing some huge cash into well being care companies for the homeless, however in hospitals and in clinics, they had been discovering that individuals simply aren’t capable of are available in. Whether or not it’s as a result of they don’t wish to go away all of their earthly possessions unguarded or as a result of they will’t get the transportation or no matter. And so that cash’s now being redirected into having the medical doctors go to them, which appears to be profitable in some methods, however the depth of well being care issues is simply so deep. And …

Rovner: But in addition, actually the significance of main care.

Ollstein: Completely. And so what they’re discovering is simply a variety of pregnancies and issues with being pregnant within the homeless inhabitants. And they also’re doing extra companies round that and extra providing contraception and prenatal look after the people who find themselves already pregnant. It’s very unhappy, however considerably hopeful. And the opposite extra structural factor is altering guidelines in order that medical doctors can get reimbursed at a good fee for offering road drugs versus in brick-and-mortar services.

Rovner: Thanks. Lauren?

Weber: So I even have a KFF particular from my former colleagues, Markian [Hawryluk] and Renu [Rayasam]. It’s only a nice piece. It’s referred to as “Medical doctors Abandon a Analysis Used to Justify Police Custody Deaths. It Would possibly Reside On, Anyway.” So what the piece does is it interviews the physician who helped debunk what excited delirium is for his medical group, however it reveals that that won’t assist when it comes to court docket circumstances which have already been determined and when it comes to science usually. And I believe it’s so fascinating as a result of what this piece does is it will get at what occurs when flawed science then is used for lawsuits and consequential issues for a lot of, a few years to return. I believe we’ve seen a variety of tales this 12 months about flawed science and what the precise ramifications are after, and that is clearly horrible ramifications right here. And it’s simply form of a captivating query of how does that ever get made proper and the way do issues slowly or ever return to what they need to be after flawed science is revealed? So actually, actually nice work from the workforce.

Rovner: Yeah, it’s actually good piece. Effectively, maintaining with the theme of selecting tales by our former colleagues. Mine is from a former colleague at NPR, Jeff Brady, and it’s “How Fuel Utilities Used Tobacco Ways to Keep away from Fuel Range Rules.” And in case you don’t know what that refers to, I’ve a e book or a number of for you concerning the enormous sums of cash that the tobacco trade paid over many many years to have captive, scientific, quote-unquote, “specialists” counterclaims that smoking is dangerous in your well being. It seems that the fuel range trade likewise knew that fuel stoves had been worse in your well being than electrical ones, and that these vent hoods don’t actually handle all the issues of the issues that fuel stoves emit. And that it additionally paid for research supposed to muddy the waters and confuse each prospects and regulators. It’s a reasonably damning story, and I say that as somebody who could be very a lot connected to my fuel range however am now having second ideas.

OK, that’s our present for this week. As all the time, in case you benefit from the podcast, you may subscribe wherever you get your podcasts. We’d respect it in case you left us a evaluation; that helps different folks discover us too. Particular thanks as all the time to our wonderful and affected person engineer, Francis Ying. Additionally, as all the time, you may electronic mail us your feedback or questions. We’re at, or you may nonetheless discover me holding down the fort at X, I’m @jrovner or @julierovner at Bluesky and Threads. Joanne, the place are you today?

Kenen: I’m extra on Threads, @joannekenen1. I nonetheless have a Twitter account, @JoanneKenen, the place I’m not very lively.

Rovner: Alice?

Ollstein: I’m @AliceOllstein on X and @alicemiranda on Bluesky.

Rovner: Lauren?

Weber: I’m @LaurenWeberHP on X, the HP stands for well being coverage, as I like to inform folks.

Rovner: We might be again in your feed subsequent week. Till then, be wholesome.


Francis Ying
Audio producer

Stephanie Stapleton

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