The Campaign’s Final Days

The Host

Emmarie Huetteman KFF Health News Emmarie Huetteman, senior editor, oversees a team of Washington reporters, as well as “Bill of the Month” and KFF Health News’ “What the Health?” She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy debates in Washington and on the campaign trail.

With the 2024 election campaign in its final days, House Speaker Mike Johnson this week floated “massive” health care reform if former President Donald Trump wins — changes that are also dependent, of course, on whether Republicans control Congress next year.

Meanwhile, new reporting uncovers more maternal deaths under state abortion bans, plus at least one case in which a woman was jailed after a miscarriage. Plus, other investigations are shining a light on a reality of American health care, regardless of who wins on Tuesday: the consequences of health industry profiteering.

This week’s panelists are Emmarie Huetteman of KFF Health News, Lauren Weber of The Washington Post, Shefali Luthra of The 19th, and Jessie Hellmann of CQ Roll Call.

Panelists

Jessie Hellmann CQ Roll Call @jessiehellmann Read Jessie's stories. Shefali Luthra The 19th @shefalil Read Shefali's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.

Among the takeaways from this week’s episode:

Trump has called for reopening the fight over the Affordable Care Act, and given enough votes in Congress, Johnson suggested this week that he’s ready to back the former president’s play. To be sure, the Jan. 1, 2026, expiration of enhanced ACA premium subsidies will put the health law back on the agenda — though given the law’s popularity, changes may be a hard sell even to some Republicans.
Trump also unveiled his own proposal to address the long-term care crisis: a tax credit for family caregivers. His plan follows Vice President Kamala Harris’ proposal weeks ago to create a new Medicare benefit that pays for home health care.
New reporting is out this week on women suffering miscarriages being denied reproductive health care — or even being charged with manslaughter and incarcerated. While many abortion opponents say they have no intention of harming or punishing women, the consequences of overturning Roe v. Wade are coming into clearer focus.

Also this week, KFF Health News’ Julie Rovner interviews Irving Washington, a senior vice president at KFF and the executive director of its Health Misinformation and Trust Initiative.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Emmarie Huetteman: KFF Health News’ “‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way,” by Julie Appleby.

Lauren Weber: The New York Times’ “What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials,” by Walt Bogdanich and Carson Kessler.

Shefali Luthra: NBC News’ “They’re Middle Class and Insured. Childbirth Still Left Them With Crippling Debt,” by Aria Bendix.

Jessie Hellmann: ProPublica’s “‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care,” by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica.

Also mentioned on this week’s podcast:

KFF Health News’ “Ghosts, Ghouls, and Ghastly Drug Prices in Winning Halloween Haikus.”
ProPublica’s “A Woman Died After Being Told It Would Be a ‘Crime’ To Intervene in Her Miscarriage at a Texas Hospital,” by Cassandra Jaramillo and Kavitha Surana.
The Washington Post’s “She Said She Had a Miscarriage — Then Got Arrested Under an Abortion Law,” by Caroline Kitchener.
The 19th’s “Anti-Abortion Centers Are Stepping Into Electoral Politics,” by Shefali Luthra.
The New York Times’ “How Taxpayers Are Helping Health Insurers Make Even Bigger Profits,” by Chris Hamby.
KFF’s Health Misinformation and Trust Initiative, a program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem.

Click to open the transcript Transcript: The Campaign’s Final Days

[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.]

Emmarie Huetteman: Hello and welcome back to “What the Health?” I’m Emmarie Huetteman, a senior editor for KFF Health News and the regular editor on this podcast. I’m filling in for Julie Rovner this week, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 31, at 10 a.m. Happy Halloween. As always, news happens fast, and things might’ve changed by the time you hear this. So, here we go.

Today, we’re joined via video conference by Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Huetteman: Lauren Weber of The Washington Post.

Lauren Weber: Hello, hello.

Huetteman: And Jessie Hellmann of CQ Roll Call.

Jessie Hellmann: Happy Halloween.

Huetteman: Later in this episode, we’ll have Julie’s interview with Irving Washington. Irving is our KFF colleague who is senior vice president and executive director of the Health Misinformation and Trust initiative, and he joined us this week to talk about the election. We’ll also have the winner of KFF Health News’ Halloween Health Haiku contest. But first, this week’s news. We are this close to the end of campaign 2024 and health care is making a bit of an unexpected resurgence. During a campaign event this week, House Speaker Mike Johnson said that there would be massive health care changes if former President Donald Trump is elected, including “no Obamacare.” Here’s what Johnson said:

“The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.” OK, as a reminder, Trump has called for reopening the ACA fight and he has made no promises to preserve Medicaid, which, by the way, pays medical bills for about 1 in 5 Americans. Now, for the reality check for the Republicans to make big changes, it wouldn’t be enough for Trump to win. Republicans would also need to hold the House and win control of the Senate next week.

Let’s put that aside, though, to talk about appetite here. Do we really think that Republicans would go after the Affordable Care Act again? It worked so well for them.

Hellmann: I don’t know if I envision another repeal-and-replace fiasco, but there is an opening for them in 2025. There are enhanced premium tax credits that expire. Those were done through the Inflation Reduction Act, and I see it very unlikely that Republicans would be willing to go along and extend those again. I think that’s going to be a big fight, but it obviously depends who wins the House and the Senate. Right now, it looks like Democrats might retake the House and Republicans will regain the Senate, so maybe there will be some kind of negotiation there, but it has such a high price tag that it just seems like it would be a really messy fight. But as far as just repealing the ACA, I don’t think they want to open that can of worms again.

Huetteman: Absolutely. I’m wondering has much changed since Sen. [John] McCain’s famous thumbs down in 2017 ended the last effort?

Luthra: People are more used to having the ACA. It has only gotten more and more entrenched in our system. One thing that I was really struck by is, this isn’t the first time in the campaign that a prominent Republican has talked about repealing the ACA. We had that kerfuffle earlier this cycle with JD Vance, who talked about, essentially, getting rid of protections for preexisting conditions, with the change in risk pools, and the backlash was pretty swift, and it just seems, from watching and seeing what the political reality has been, that if it was difficult to get the ACA repealed last time and it did not work, it will only be harder because people have grown just so much more accustomed to these benefits. I personally can’t remember having health care without the ACA, and a lot of people who are younger than a certain age probably feel the same way.

Huetteman: Absolutely. I was noting, actually, in my notes, Mike Johnson himself voted for repeal in 2017, but his office, when he was asked after those comments this week, didn’t elaborate when asked whether he also supports extending the ACA subsidies expiring next year. Seems likely that that’s not on his agenda, if I had to guess, especially based on this sort of talk.

Weber: I think this is a question of are they saying the quiet part out loud or are they walking this back because it doesn’t poll particularly well right before the election happens? To some extent, this is a little bit of a wait-and-see game here.

Huetteman: I think you’re absolutely right, Lauren. Moving on to the next issue, talking about the election coming up next week. A few weeks ago, Vice President Kamala Harris suggested a way to address the long-term care crisis in this country. Her plan would add a new Medicare benefit to pay for home health care. Then this week, Trump countered with his own idea. His proposal is to give a tax credit to family caregivers. Here’s the thing, though: There’s a pretty big difference between having Medicare pay for a home health care worker and cutting a family caregiver’s tax bill. But do these policy differences matter to voters at this point in the race?

Weber: I think you’re having Trump throw something at the wall because Harris tapped into something powerful, which is that there are a lot of Americans that are home health care aides. We have seen so much caregiving that goes on around this country without much notice or favor and that drives a lot of our health care costs. So I think the fact that you had the Trump campaign throw out anything at all speaks to how important this issue is to everyday Americans and remains to be seen which would be a better deal for these folks. Often, home care aides are not working, so their tax bill is different because they’re taking care of family members. But we also have to see what happens if Trump has been thought to potentially cut some forms of Medicaid, which also pays for a lot of home care aides. There’s a lot of unknown there, but there’s a lot of dollars that go into this, and a lot of Americans that feel very strongly about it. So I’m not surprised to see his campaign try to match in some way what Harris had suggested.

Luthra: I think the other point that’s worth noting also is, from a politics perspective, there is a question of voter trust as well, and we know from decades of polling that voters largely do trust Democrats more on issues of health policy because it’s the party that has been more invested in trying to expand benefits and trying to reform the health care system and has really devoted much of its intellectual thought to this area in a way that Republicans really haven’t. Obviously, there’s not a one-to-one between home care specifically … versus other times of types of health care, but I do think that we should take a critical eye and see do voters react to this even in an abstract way with the same kind of credibility that they might to a Democrat just with that history in mind.

Huetteman: That’s a great point. I hate to move on so quickly, but it’s time for Washington’s favorite parlor game. Let’s play “Guess Who?” — as in guess who might fill the key health jobs in the next administration. There’s one we talked about a little bit last week, but if Trump is elected, he says that he has promised Robert F. Kennedy [Jr.] free rein over both health and food policy. Here’s what Trump said about RFK Jr. during his rally at Madison Square Garden this week. “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” Do we know what Trump’s saying here and who else could play a major role in the next Trump administration? Lauren, what do you have to add?

Weber: I think it’s important to note that, just last night Trump’s co-chair of his transition team got on CNN and said some version of vaccines are linked to autism, which is patently false as we all know on this panel. I think it’s important to note that RFK, in any sort of health care rule, would be quite alarming to many public health professionals who call vaccination “the bedrock of public health advancement” over the last couple decades. As we look at what’s brewing in Trump Camp, some names that have come to mind are Casey and Calley Means have been floated out as folks that could be in the Trump administration.

You’re seeing some chatter around a fair variety of folks from before and after. I think some of it remains to be seen, but Trump is blatantly saying that he will give RFK some role in picking these people, and a lot of the people I talk to, the sources I talk to are very alarmed by what that could mean. As I said earlier in this podcast, the Trump campaign is saying the quiet part out loud. They’ve pitched the MAHA [Make America Healthy Again] movement as more about ultra-processed foods and some of these other things. But when you have top campaign officials saying, “Actually, we do have questions about vaccines,” it’s hard to look past RFK’s vast record of anti-vaccine activism.

Huetteman: By MAHA, of course, we mean the “Make America Healthy Again” effort.

Weber: Yes, and I will point out know RFK recently tweeted about MAHA that he would “bring sunshine back to the FDA.” He would promote ivermectin, stem cell research, a variety of things that many members of the medical community are alarmed by.

Huetteman: Including, in fact, Trump’s own surgeon general, who made his own comments this week about RFK potentially being in the next administration, his comments were that RFK’s influence could make people less willing to get vaccines, which could impact “our nation’s health, our nation’s economy, and our global security.” That’s pretty big words from someone who served under the last Trump administration about the next one.

Luthra: I think that gets at something quite interesting when we think about who might be doing health policy under a Trump administration, which is, in the previous administration, that picking those people was a job largely outsourced to Mike Pence. Mike Pence is obviously not on the ticket anymore, so that leaves more of an opening and I don’t think we necessarily know who will be filling that role. Does JD Vance necessarily get a larger role in picking some of the people who might influence health policy? That could have a lot of implications because he’s also quite socially conservative and the Health and Human Services Department does have real power over issues like abortion, family planning, a lot of these areas that have been very influential in shaping how voters feel about this election and where JD Vance has changed his views a number of times.

Huetteman: Those are good points. Absolutely. Moving on now to abortion. Speaking of abortion, in terms of the election, we’re having more stories coming out about the effects of the new abortion environment here in this country. You may remember the outcry in September after ProPublica told the stories of two women who died in Georgia because they couldn’t get care under the state’s abortion ban. ProPublica is back this week with reporting on two deaths out of Texas attributable to its ban, one of which happened just two days after the state’s “heartbeat law” took effect in 2021. These are wrenching stories, but are they having an impact on voters?

Luthra: I don’t know. I think we’ve already seen a pretty meaningful shift in how voters think about abortion in the past couple of years because they have heard so many stories about people suffering devastating health consequences, even short of death. One thing that I was really struck by that ProPublica pointed out in this piece, which is just gutting to read and which we saw reinforced by the reaction from anti-abortion interest groups yesterday, is that there isn’t necessarily a reaction from Republicans and from people who oppose abortion to acknowledge the role that abortion laws play in harming people’s health, and in these cases in people’s deaths. Susan B. Anthony List [Susan B. Anthony Pro-Life America], a prominent anti-abortion group, said that the real problem here is not the laws, but rather that doctors don’t understand how to make use of the exceptions in these laws and that the fault lies with doctors.

ProPublica spoke to many, many doctors across the country. Many of us who cover this have also spoken to many doctors across the country, and it’s just very clear that the exceptions as written in these laws are quite unworkable. There just isn’t enough clarity for people to know that they can provide care until it is too late, and in the case like this, it was too late before people could intervene. But I remain skeptical that without broad sustained outcry, we will see this change how abortion opponents and the Republican Party talk about abortion as a policy issue.

Huetteman: I’d love to talk a little bit more about how anti-abortion folks are talking about this issue. Here’s another story that came out this week from The Washington Post about a woman who suffered a miscarriage and ended up in prison charged with manslaughter. This was in Nevada, which doesn’t even have an abortion ban. Her conviction was set aside by a judge and she was released, but the woman is still in legal jeopardy because the prosecutor hasn’t dropped the charges and hasn’t decided whether he will or not. Many abortion opponents say they have no intention of punishing women who have abortions. We’re talking about doctors being potentially punished for performing abortions, but we’re still seeing women punished as a result of their pregnancy outcomes. Why is that?

Luthra: That prosecution and the story is just phenomenal and absolutely worth reading. That prosecution actually happened before Roe v. Wade was even overturned and it made use of very old anti-abortion laws, and it highlighted something that I think is really important, which is that there has been a history of criminalizing people for pregnancy outcomes, even independently of the abortion bans that have swept the country in the past two years, and that comes from a lot of factors, but it is something that we are seeing become potentially more common in the post-Dobbs landscape, and there’s a real divide in the anti-abortion movement, whether they will eventually go after pregnant people in a more systematic way. The reason they haven’t is because of the politics, because it is just so unpopular to say we are going to specifically go after people who are pregnant as opposed to their doctors.

But I think cases like this Nevada case and cases like others that we have seen arise around the country, including in Texas, underscore that there is some appetite for this in some corners of the anti-abortion movement, and it is something that could gain traction and gain prominence if abortion opponents make a calculus that the political trade-offs are worth it or are no longer as salient as they have been.

Huetteman: Shefali, you’ve done some great reporting on this, and I’d like to talk a little bit more about that, actually. So first off, in last week’s extra-credits segment, Julie talked about anti-abortion crisis pregnancy centers. These centers offer free pregnancy tests, ultrasounds, and counseling while trying to convince people not to have an abortion. Shefali, you have a story out this week about how these centers are getting more involved in electoral politics. Can you tell us more about that?

Luthra: I thought this was very interesting and I looked at these anti-abortion/crisis pregnancy centers in the states where abortion is on the ballot and I saw a good number of them have been making themselves more of a presence on the campaign trail and legally most of them are 501(c)(3) nonprofits, so they can’t endorse a specific candidate, but what they are doing is trying to share what they say is information about how these ballot measures would affect them. But what they’re sharing often contains a good amount of misleading or inflammatory language, arguing the classic Republican talking points, “These abortion measures would allow abortion up until the point of birth and beyond,” which, in most cases, isn’t true because a lot of these measures actually would only protect abortion up until fetal viability.

But what we’re seeing is part of a larger effort. Heartbeat International, one of the big crisis pregnancy/anti-abortion center organizations, actually had a session earlier this year teaching their members how can you become more involved in politics while also maintaining your tax-exempt status. And they’re talking through these organizations what kind of strategies might be appropriate in part because they do see abortion being a continuing political issue, and they want to use these centers as part of their toolbox. They’re something that they think can be very effective because people don’t know what they are necessarily. They might look at them and see, that’s my local pregnancy center. They give free ultrasounds, they give pregnancy tests, and I trust them without realizing that they actually have a very clear political agenda.

Huetteman: Absolutely. In many cases, these are the only options that may be available to you for pregnancy care at this point. Isn’t that right?

Luthra: Exactly. They are very affordable because they provide for pregnancy tests and free ultrasounds, and they are not regulated as medical centers. They vastly outnumber abortion clinics, especially obviously in states with abortion bans. I have spoken to a lot of people who say, “This is my only option because I can’t afford to go to a doctor’s office to find out how far along I am, even if I know I don’t want to be pregnant.” As a result, they’ll go to these places not necessarily knowing what they are or even knowing what they are and are given inaccurate information, can be, in some cases, deliberately misled about their pregnancy outcome and options, and their medical data is at jeopardy as well.

Huetteman: Thanks for your reporting on that. We’ll be talking about that more, I’m sure. Shifting gears, while we’ve all had our eyes on the election, President Joe Biden is still in charge of the executive branch and the Biden administration is still doing health policy things. Just in the past week, the administration put out new rules requiring insurance to pay for the new over-the-counter birth control pill, as well as some forms of prescription contraception. Separately, the administration also put out a plan to help track and ease shortages of cancer drugs for kids.

I know we spend a lot of time talking about things politicians promise to do, but we don’t always take note when they actually follow through on these promises, particularly if they’re not controversial. I wanted to make note of that this week. Now, finally this week, here’s something that’s likely to continue no matter who is elected president or who controls Congress next year. I’m talking about profiteering in health care. This week, we have two more investigations digging into profit-seeking middlemen. The first is from The New York Times about how a data firm called MultiPlan determines how much insurers should pay out-of-network providers while charging fees that sometimes exceed the payments themselves. But the other investigation is from ProPublica about another for-profit company called EviCore. Jessie, this story is your extra credit this week. Why don’t you tell us about it now?

Hellmann: This story [“‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care,” by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica] looks at EviCore by Evernorth, which is hired by insurance companies to process prior authorization requests. As we’re seeing more of in health care, they use an algorithm that’s backed by AI to help make these decisions, and there has just been a lot of complaints from patients and doctors about what they see as unfair denials. But what I thought was really interesting about this story is it takes a peek behind the curtain of how this specific algorithm actually works. It has something called a dial, which they can scale up or scale down depending on how many denials they’re trying to get, which obviously can result in more money for the insurance company.

While this algorithm can’t reject a prior authorization request, it does flag requests that have to be approved by a doctor who works for this company, who can reject those requests. I thought it was just an interesting look at — we talk all the time about prior authorization and how it impacts patients and doctors who are tired of the red tape and all the bureaucratic work that they have to do to get care to patients. But I think in the past few years, we’ve been learning more about how these systems are actually structured. I think this is a really good look at that.

Huetteman: Definitely. The thing these businesses have in common is that they’re in the business of saving someone money, but that someone is rarely the patient. Is anyone looking into what this is doing to our health care system, having such a focus on profit as part of the system that we use to care for people when they’re sick and dying? Is this good for patients?

Weber: I think that’s how you get the name of this podcast, right? I think that’s how you come up with the name of this podcast. I think a lot of reporters out here are looking into that, in general. I think that’s why how policy is a beat that we all like to cover because it crosses so many sectors of both real pain and suffering that people feel, and whether that’s in their pocketbooks or medically when dealing with the health care system.

Huetteman: Absolutely, that’s true. Thank you, Lauren. OK, folks, that’s this week’s news. Now, we’ll play Julie’s interview with KFF’s Irving Washington. Then we’ll come back and do the rest of our extra credits and read this year’s Halloween Haiku winner.

Julie Rovner: I am so pleased to welcome to the podcast Irving Washington, KFF senior vice president and executive director of KFF’s newest program launched this summer, our initiative on Health Misinformation and Trust. Irving, welcome to, “What the Health?”

Irving Washington: Hi. Julie. Glad to be here.

Rovner: So why don’t you start by telling us what the Health Misinformation and Trust initiative is and what you do?

Washington: Sure, happy to. So the Health Misinformation and Trust is a new program that you mentioned at KFF. The short of it is, it’s really designed to help people understand all the complexities and what’s going on with health misinformation and trust. As you know, we’ve always had health misinformation, it’s been around. And KFF has been in the business for health misinformation for quite a while. But this new program will bring all of our work together at KFF. And then we’re also launching new products like the KFF Health Misinformation Monitor, which helps people track what misinformation and narratives are happening within the country.

Rovner: And what are some examples of the kinds of health misinformation that you’re trying to bring to light?

Washington: There’s all kinds of examples. Everything from, we had earlier issues around, if you’ve seen on social media, the miracle cures, those things that you see on TikTok, to issues that are happening right now in the elections, whether that be reproductive health, gender-affirming care, and, of course, vaccines and covid-19.

Rovner: Why are we seeing so very much health misinformation right now, and so little trust in expertise? I mean, this all predates Donald Trump, and it predates covid, and yet it seems to be more than ever.

Washington: It does seem like we do see that more these days. However, I like to remind people, as you just also said, we’ve been in the business, or had health misinformation, for quite a while. Misinformation in general. I like to think of the, remember the tabloids from several years ago or just anything — think about not even written information, but if your family had something that was passed down and this is supposed to cure this. So we’ve had misinformation for a while. Obviously, there’s been a few things that have changed, which makes the appearance of it spreading more and actually spreading more. Social media, for example, spreads misinformation much quicker. It also prioritizes engagement. And then you also mentioned the trust in institutions, organizations, that’s been an ongoing trend that I think we’ve seen over the last decade as well, too. So those two things combined, I think, puts us at the moment that we’re in now.

Rovner: So if former President Trump wins a second term, he’s promised Robert F. Kennedy Jr., who is a longtime purveyor of health misinformation, what he calls free rein in health policy. What could that mean?

Washington: That could mean a lot of things. It could mean that many of the systems and resources that we rely on to make sure we’re getting accurate and proper information may disappear. It also could mean that the things that we consider verifiable, factual information that we see from our public health institutions and government, that might be in jeopardy now, or that may or may not be a trustworthy source.

Rovner: How do you determine what’s misinformation and what’s not? I’m old enough I used to look things up in the encyclopedia. You can’t really do that anymore.

Washington: Well, I will tell you, it is much, much more complex these days. I have used the advice of anyone now, and you almost have to consider yourself a detective when you’re looking at information, particularly on social media. And by that, that just means doing extra checks to make sure that you’re confirming what you’re looking at is correct. There are a number of things people can do, a couple of them, and also how you can sort of see if this is misinformation. One thing to look out for is if data is cherry-picked. So if you see one particular data point, but it leaves out the broader context of, say, a study, that’s usually a signal it might be misinformation. Also look out for sensational language. Anything that plays on an emotional appeal, I like to think, just do a check on if you feel yourself getting agitated by this, and just double-check to make sure that it’s something that is factual information as well.

And then of course, I’d say the last thing is just look at who is sharing that information. Is it an expert? Is it someone who just read something in the book? And even with doctors, you’d have to look at, is this in their expertise? One thing I’ve often said is, do you want your cardiologist to give you brain surgery, even though they’re both doctors, right? So you have to look at all those things.

Rovner: So what’s the role of AI in health misinformation? It can be both good and bad here, right?

Washington: That is certainly true. AI is fascinating, I’ll say at this point. And you’re totally right, it can be good and bad. We’ve looked at that from a couple of angles. Our polling shows that more people are turning to that to get their health information. Not a large number, but it is growing. The other thing that we looked at too, and this wasn’t formal research, we just did one experiment with one staffer, and over a period of eight months, we looked at 10 health misinformation false claims. And we asked the three major chatbots if this was misinformation or not. And Julie, those answers changed over a course of eight months. One instance it said it was, the other instance says it was a developing topic. Sometimes they would quote their resources, like the CDC [Centers for Disease Control and Prevention] or the WHO [World Health Organization], the other times they wouldn’t.

So it was an evolving process as each system got updated as to what the AI chatbot said. So it’s important for people to think about. That might be a first source, like you could Google something in the same way to get an idea of something, but you should always verify with your primary care provider.

Rovner: So what should we tell kids and relatives and people who we sort of see purveying misinformation about how they can perhaps better educate themselves?

Washington: As much as possible. This is a big task to ask, but I do ask this request of folks is, you yourself try to be a trusted messenger. We know that trusted messengers work, so as much as possible, share factual information, no judgment on someone else’s belief or what they’re saying, but share factual information that you know. And I think the other thing that you can do is have productive conversations with people, again, if you personally know them, have those productive conversations with people, if you see that them spreading misinformation. One of the things about misinformation, in particular, sometimes people don’t know they’re spreading misinformation. So you also can just start there by helping to inform people. And then after that, when you know there’s clear misinformation, I think we all have a role in this information ecosystem that we’re in. We all can help put out quality and correct information.

Rovner: We’re coming up on the holiday season, Thanksgiving and Christmas, and times when families who perhaps have different views about things get together. Any good advice for sort of gently explaining to some of your friends and family why some of the information they have might not be exactly correct?

Washington: Well, oddly enough, Julie, that might be my dinner table. I can tell you what I may do this upcoming holiday. One, you want to make sure that you are listening. I think where people sometimes perhaps are too quick to share factual information and they want to get this point across, particularly on family members, you really want to take time to listen and understand where someone is getting their information from, who they are getting it from, and why they are choosing to believe. Once you get that information, I think you can then decide how do you want to approach some of those conversations. They could be, again, providing more factual information to counter that. They could be just getting the person to ask questions about the information that they’re receiving. Some conversations … if you can just end with them questioning somewhat where they’re getting information from, that might be a way to help people understand … better factual information.

Rovner: Last question: If people want to sign up to get the KFF Health Misinformation Monitor, how can they do that?

Washington: They can do that by going to kff.org. You will see our Health Misinformation and Trust landing page, and you can sign up and subscribe at the bottom.

Rovner: Irving Washington, thank you so much for joining us. I hope we can call on you again soon.

Washington: Happy to be here, Julie, and do this. Thank you.

Huetteman: OK. We’re back. And it’s time for our extra-credit segment. That’s where we each recognize a story we read this week that we think you should read too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. All right, Jessie’s already done hers. Shefali, why don’t you go next?

Luthra: Mine’s from NBC News. It is by Aria Bendix, and the headline is “They’re Middle Class and Insured. Childbirth Still Left Them With Crippling Debt.” The story is excellent. It is absolutely worth reading. It follows a couple of families in Illinois who gave birth and ended up with, as the headline would imply, thousands of dollars in medical debt. And the family in the lede, they made too much money to qualify for Medicaid. They had this health care plan that was a grandfathered plan, so had very high out-of-pocket limits, and so as a result, they had this tremendous amount of expenses that they had to pay after she gave birth to twins who were born prematurely, who required NICU care. And, even worse, were born right at the end of the year. Right when her health plan reset, and she suddenly had to go through a new effort to hit her out-of-pocket limit.

The story is really, really smart because it takes a problem that is familiar and makes it feel new. Something that we don’t talk about enough. The loopholes that exist in the Affordable Care Act that can still leave medical debt as such a problem. It puts a real human face to this, and the end, the end is really devastating. You talk to this mother, Jessica, and she is talking about all of the medical expenses that she’s trying to forgo, if she can, whether that is for her own health or for her children’s health because she is just really scared of incurring another medical bill and being surprised yet again by more debt that she and her family really can’t afford. It’s absolutely worth your time, especially as we think so much about what it means to get pregnant and to give birth and the challenges that exist for people who do that in our country.

Huetteman: That’s a great point. It is heartbreaking to think that people who are going through something as routine as childbirth are being subject to things like rationing care in order to make sure they can afford their medical bills. Well, all right. Lauren, how about you go next?

Weber: I have a piece from the New York Times titled “What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials,” written by Walt Bogdanich and Carson Kessler, and it’s pretty horrifying. Basically, there was a drug trial for an Alzheimer’s drug that the volunteers that answered the call to do it had a gene that would make them more predisposed to have Alzheimer’s, but that gene also meant that it could make them more likely to have brain bleeds that interact with this drug. They took a genetic test to see whether they had this gene that would go this way and then the drugmaker didn’t tell them that it could cause a higher risk of brain bleeds for these people.

It’s just a very horrifying story about lack of disclosure and, especially in a field like Alzheimer’s, where often people that feel like they are taking part in these trials maybe are worried about the devastating impacts of the disease. Many of us, I’m sure on this podcast and all those listening, have had personal experiences with how devastating that can be. Holding that over someone but not giving them the full knowledge of what they could be signing up for, there was at least one patient that died, many others that had brain hemorrhages that were preventable with the proper disclosure. Great reporting by The New York Times.

Huetteman: Absolutely. Thanks for talking about it for us. My story this week is from KFF Health News and it’s by Julie Appleby. The headline is “‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way.” ACA open enrollment season opens Nov. 1 and, for the first time, so-called Dreamers will be eligible to enroll. As a reminder, the term Dreamers refers to people who were brought to the United States without immigration paperwork when they were kids and who have since qualified for federal protections because they meet certain requirements. Those include that they were in school or had graduated or that they had served in the military. Anyway, a Biden administration rule that came out earlier this year says that Dreamers, as “lawfully present individuals,” are eligible for ACA coverage, and, potentially, the premium subsidies to pay for it. But 19 states are challenging the rule in federal court.

Those states say the rule will put more strain on the system and it’ll encourage people to remain in the United States without permanent legal authorization. A ruling could come at any time with several possible outcomes, including a potential hold on the Biden administration’s rule. We’ll be keeping an eye on this one.

Before we go, I have the privilege of reading the winner of this year’s Halloween Health Haiku contest. The winning entry was written by Crystal Decker, and it goes like this.

Vampires don’t scare me.

Empty blood shelves, now that’s fear.

Roll up, save a life.

You can find the winner and the runners-up and some fabulous illustrations by my KFF Health News colleague Oona Zenda on our website at kffhealthnews.org, and we’ll post the link in our show notes. That’s all the time we have this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and to Stephanie Stapleton, our editor this week. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, and you can still find me lurking on X. I’m @emmarieDC. Jessie?

Hellmann: I am on Twitter @jessiehellmann.

Huetteman: Shefali?

Luthra: I am @shefalil.

Huetteman: And Lauren?

Luthra: I’m @LaurenWeberHP.

Huetteman: Julie will be back next week. Until then, be healthy.

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<h1>KFF Health News' 'What the Health?': The Campaign’s Final Days</h1>
<div>		<time class="posted-on" datetime="2024-10-31T15:10:00-04:00">
			October 31, 2024		</time>
		</div>
<h3>		The Host	</h3>															Emmarie Huetteman	KFF Health News								Emmarie Huetteman, senior editor, oversees a team of Washington reporters, as well as “Bill of the Month” and KFF Health News’ “What the Health?” She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy debates in Washington and on the campaign trail. 				With the 2024 election campaign in its final days, House Speaker Mike Johnson this week floated “massive” health care reform if former President Donald Trump wins — changes that are also dependent, of course, on whether Republicans control Congress next year.Meanwhile, new reporting uncovers more maternal deaths under state abortion bans, plus at least one case in which a woman was jailed after a miscarriage. Plus, other investigations are shining a light on a reality of American health care, regardless of who wins on Tuesday: the consequences of health industry profiteering.This week’s panelists are Emmarie Huetteman of KFF Health News, Lauren Weber of The Washington Post, Shefali Luthra of The 19th, and Jessie Hellmann of CQ Roll Call.		<h3>		Panelists	</h3>															Jessie Hellmann	CQ Roll Call						<a href="https://twitter.com/jessiehellmann">				@jessiehellmann			</a>										<a href="https://rollcall.com/author/jessie-hellmann/"> 				Read Jessie's stories.			</a>																							Shefali Luthra	The 19th						<a href="https://twitter.com/shefalil">				@shefalil			</a>										<a href="https://19thnews.org/author/shefali-luthra/"> 				Read Shefali's stories.			</a>																							Lauren Weber	The Washington Post						<a href="https://twitter.com/LaurenWeberHP">				@LaurenWeberHP			</a>										<a href="https://www.washingtonpost.com/people/lauren-weber/"> 				Read Lauren's stories.			</a>												Among the takeaways from this week’s episode:<ul><li>Trump has called for reopening the fight over the Affordable Care Act, and given enough votes in Congress, Johnson suggested this week that he’s ready to back the former president’s play. To be sure, the Jan. 1, 2026, expiration of enhanced ACA premium subsidies will put the health law back on the agenda — though given the law’s popularity, changes may be a hard sell even to some Republicans.</li><li>Trump also unveiled his own proposal to address the long-term care crisis: a tax credit for family caregivers. His plan follows Vice President Kamala Harris’ proposal weeks ago to create a new Medicare benefit that pays for home health care.</li><li>New reporting is out this week on women suffering miscarriages being denied reproductive health care — or even being charged with manslaughter and incarcerated. While many abortion opponents say they have no intention of harming or punishing women, the consequences of overturning Roe v. Wade are coming into clearer focus.</li></ul>Also this week, KFF Health News’ Julie Rovner interviews Irving Washington, a senior vice president at KFF and the executive director of its Health Misinformation and Trust Initiative.Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:Emmarie Huetteman: KFF Health News’ “<a href="https://kffhealthnews.org/news/article/daca-dreamers-aca-affordable-care-act-obamacare-lawsuit/">‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way</a>,” by Julie Appleby.Lauren Weber: The New York Times’ “<a href="https://www.nytimes.com/2024/10/23/health/alzheimers-drug-brain-bleeding.html">What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials</a>,” by Walt Bogdanich and Carson Kessler.Shefali Luthra: NBC News’ “<a href="https://www.nbcnews.com/health/health-care/childbirth-medical-debt-middle-class-insured-rcna170224">They’re Middle Class and Insured. Childbirth Still Left Them With Crippling Debt</a>,” by Aria Bendix.Jessie Hellmann: ProPublica’s “<a href="https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations">‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care</a>,” by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica.Also mentioned on this week’s podcast:<ul><li>KFF Health News’ “<a href="https://kffhealthnews.org/news/article/winning-halloween-haikus-2024-contest/">Ghosts, Ghouls, and Ghastly Drug Prices in Winning Halloween Haikus</a>.”</li><li>ProPublica’s “<a href="https://www.propublica.org/article/josseli-barnica-death-miscarriage-texas-abortion-ban">A Woman Died After Being Told It Would Be a ‘Crime’ To Intervene in Her Miscarriage at a Texas Hospital</a>,” by Cassandra Jaramillo and Kavitha Surana.</li><li>The Washington Post’s “<a href="https://www.washingtonpost.com/investigations/interactive/2024/abortion-law-nevada-arrest-miscarriage/?utm">She Said She Had a Miscarriage — Then Got Arrested Under an Abortion Law</a>,” by Caroline Kitchener.</li><li>The 19th’s “<a href="https://19thnews.org/2024/10/anti-abortion-centers-are-stepping-into-electoral-politics/">Anti-Abortion Centers Are Stepping Into Electoral Politics</a>,” by Shefali Luthra.</li><li>The New York Times’ “<a href="https://www.nytimes.com/2024/10/28/us/healthcare-taxpayer-money-insurance.html">How Taxpayers Are Helping Health Insurers Make Even Bigger Profits</a>,” by Chris Hamby.</li><li>KFF’s <a href="https://www.kff.org/health-misinformation-and-trust/">Health Misinformation and Trust Initiative</a>, a program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem.</li></ul>																	Click to open the transcript																				Transcript: The Campaign’s Final Days																[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.] Emmarie Huetteman: Hello and welcome back to “What the Health?” I’m Emmarie Huetteman, a senior editor for KFF Health News and the regular editor on this podcast. I’m filling in for Julie Rovner this week, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 31, at 10 a.m. Happy Halloween. As always, news happens fast, and things might’ve changed by the time you hear this. So, here we go. Today, we’re joined via video conference by Shefali Luthra of The 19th. Shefali Luthra: Hello. Huetteman: Lauren Weber of The Washington Post. Lauren Weber: Hello, hello. Huetteman: And Jessie Hellmann of CQ Roll Call. Jessie Hellmann: Happy Halloween. Huetteman: Later in this episode, we’ll have Julie’s interview with Irving Washington. Irving is our KFF colleague who is senior vice president and executive director of the Health Misinformation and Trust initiative, and he joined us this week to talk about the election. We’ll also have the winner of KFF Health News’ Halloween Health Haiku contest. But first, this week’s news. We are this close to the end of campaign 2024 and health care is making a bit of an unexpected resurgence. During a campaign event this week, House Speaker Mike Johnson said that there would be massive health care changes if former President Donald Trump is elected, including “no Obamacare.” Here’s what Johnson said: “The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.” OK, as a reminder, Trump has called for reopening the ACA fight and he has made no promises to preserve Medicaid, which, by the way, pays medical bills for about 1 in 5 Americans. Now, for the reality check for the Republicans to make big changes, it wouldn’t be enough for Trump to win. Republicans would also need to hold the House and win control of the Senate next week. Let’s put that aside, though, to talk about appetite here. Do we really think that Republicans would go after the Affordable Care Act again? It worked so well for them. Hellmann: I don’t know if I envision another repeal-and-replace fiasco, but there is an opening for them in 2025. There are enhanced premium tax credits that expire. Those were done through the Inflation Reduction Act, and I see it very unlikely that Republicans would be willing to go along and extend those again. I think that’s going to be a big fight, but it obviously depends who wins the House and the Senate. Right now, it looks like Democrats might retake the House and Republicans will regain the Senate, so maybe there will be some kind of negotiation there, but it has such a high price tag that it just seems like it would be a really messy fight. But as far as just repealing the ACA, I don’t think they want to open that can of worms again. Huetteman: Absolutely. I’m wondering has much changed since Sen. [John] McCain’s famous thumbs down in 2017 ended the last effort? Luthra: People are more used to having the ACA. It has only gotten more and more entrenched in our system. One thing that I was really struck by is, this isn’t the first time in the campaign that a prominent Republican has talked about repealing the ACA. We had that kerfuffle earlier this cycle with JD Vance, who talked about, essentially, getting rid of protections for preexisting conditions, with the change in risk pools, and the backlash was pretty swift, and it just seems, from watching and seeing what the political reality has been, that if it was difficult to get the ACA repealed last time and it did not work, it will only be harder because people have grown just so much more accustomed to these benefits. I personally can’t remember having health care without the ACA, and a lot of people who are younger than a certain age probably feel the same way. Huetteman: Absolutely. I was noting, actually, in my notes, Mike Johnson himself voted for repeal in 2017, but his office, when he was asked after those comments this week, didn’t elaborate when asked whether he also supports extending the ACA subsidies expiring next year. Seems likely that that’s not on his agenda, if I had to guess, especially based on this sort of talk. Weber: I think this is a question of are they saying the quiet part out loud or are they walking this back because it doesn’t poll particularly well right before the election happens? To some extent, this is a little bit of a wait-and-see game here. Huetteman: I think you’re absolutely right, Lauren. Moving on to the next issue, talking about the election coming up next week. A few weeks ago, Vice President Kamala Harris suggested a way to address the long-term care crisis in this country. Her plan would add a new Medicare benefit to pay for home health care. Then this week, Trump countered with his own idea. His proposal is to give a tax credit to family caregivers. Here’s the thing, though: There’s a pretty big difference between having Medicare pay for a home health care worker and cutting a family caregiver’s tax bill. But do these policy differences matter to voters at this point in the race? Weber: I think you’re having Trump throw something at the wall because Harris tapped into something powerful, which is that there are a lot of Americans that are home health care aides. We have seen so much caregiving that goes on around this country without much notice or favor and that drives a lot of our health care costs. So I think the fact that you had the Trump campaign throw out anything at all speaks to how important this issue is to everyday Americans and remains to be seen which would be a better deal for these folks. Often, home care aides are not working, so their tax bill is different because they’re taking care of family members. But we also have to see what happens if Trump has been thought to potentially cut some forms of Medicaid, which also pays for a lot of home care aides. There’s a lot of unknown there, but there’s a lot of dollars that go into this, and a lot of Americans that feel very strongly about it. So I’m not surprised to see his campaign try to match in some way what Harris had suggested. Luthra: I think the other point that’s worth noting also is, from a politics perspective, there is a question of voter trust as well, and we know from decades of polling that voters largely do trust Democrats more on issues of health policy because it’s the party that has been more invested in trying to expand benefits and trying to reform the health care system and has really devoted much of its intellectual thought to this area in a way that Republicans really haven’t. Obviously, there’s not a one-to-one between home care specifically … versus other times of types of health care, but I do think that we should take a critical eye and see do voters react to this even in an abstract way with the same kind of credibility that they might to a Democrat just with that history in mind. Huetteman: That’s a great point. I hate to move on so quickly, but it’s time for Washington’s favorite parlor game. Let’s play “Guess Who?” — as in guess who might fill the key health jobs in the next administration. There’s one we talked about a little bit last week, but if Trump is elected, he says that he has promised Robert F. Kennedy [Jr.] free rein over both health and food policy. Here’s what Trump said about RFK Jr. during his rally at Madison Square Garden this week. “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” Do we know what Trump’s saying here and who else could play a major role in the next Trump administration? Lauren, what do you have to add? Weber: I think it’s important to note that, just last night Trump’s co-chair of his transition team got on CNN and said some version of vaccines are linked to autism, which is patently false as we all know on this panel. I think it’s important to note that RFK, in any sort of health care rule, would be quite alarming to many public health professionals who call vaccination “the bedrock of public health advancement” over the last couple decades. As we look at what’s brewing in Trump Camp, some names that have come to mind are Casey and Calley Means have been floated out as folks that could be in the Trump administration. You’re seeing some chatter around a fair variety of folks from before and after. I think some of it remains to be seen, but Trump is blatantly saying that he will give RFK some role in picking these people, and a lot of the people I talk to, the sources I talk to are very alarmed by what that could mean. As I said earlier in this podcast, the Trump campaign is saying the quiet part out loud. They’ve pitched the MAHA [Make America Healthy Again] movement as more about ultra-processed foods and some of these other things. But when you have top campaign officials saying, “Actually, we do have questions about vaccines,” it’s hard to look past RFK’s vast record of anti-vaccine activism. Huetteman: By MAHA, of course, we mean the “Make America Healthy Again” effort. Weber: Yes, and I will point out know RFK recently tweeted about MAHA that he would “bring sunshine back to the FDA.” He would promote ivermectin, stem cell research, a variety of things that many members of the medical community are alarmed by. Huetteman: Including, in fact, Trump’s own surgeon general, who made his own comments this week about RFK potentially being in the next administration, his comments were that RFK’s influence could make people less willing to get vaccines, which could impact “our nation’s health, our nation’s economy, and our global security.” That’s pretty big words from someone who served under the last Trump administration about the next one. Luthra: I think that gets at something quite interesting when we think about who might be doing health policy under a Trump administration, which is, in the previous administration, that picking those people was a job largely outsourced to Mike Pence. Mike Pence is obviously not on the ticket anymore, so that leaves more of an opening and I don’t think we necessarily know who will be filling that role. Does JD Vance necessarily get a larger role in picking some of the people who might influence health policy? That could have a lot of implications because he’s also quite socially conservative and the Health and Human Services Department does have real power over issues like abortion, family planning, a lot of these areas that have been very influential in shaping how voters feel about this election and where JD Vance has changed his views a number of times. Huetteman: Those are good points. Absolutely. Moving on now to abortion. Speaking of abortion, in terms of the election, we’re having more stories coming out about the effects of the new abortion environment here in this country. You may remember the outcry in September after ProPublica told the stories of two women who died in Georgia because they couldn’t get care under the state’s abortion ban. ProPublica is back this week with <a href="https://www.propublica.org/article/josseli-barnica-death-miscarriage-texas-abortion-ban">reporting on two deaths</a> out of Texas attributable to its ban, one of which happened just two days after the state’s “heartbeat law” took effect in 2021. These are wrenching stories, but are they having an impact on voters? Luthra: I don’t know. I think we’ve already seen a pretty meaningful shift in how voters think about abortion in the past couple of years because they have heard so many stories about people suffering devastating health consequences, even short of death. One thing that I was really struck by that ProPublica pointed out in this piece, which is just gutting to read and which we saw reinforced by the reaction from anti-abortion interest groups yesterday, is that there isn’t necessarily a reaction from Republicans and from people who oppose abortion to acknowledge the role that abortion laws play in harming people’s health, and in these cases in people’s deaths. Susan B. Anthony List [Susan B. Anthony Pro-Life America], a prominent anti-abortion group, said that the real problem here is not the laws, but rather that doctors don’t understand how to make use of the exceptions in these laws and that the fault lies with doctors. ProPublica spoke to many, many doctors across the country. Many of us who cover this have also spoken to many doctors across the country, and it’s just very clear that the exceptions as written in these laws are quite unworkable. There just isn’t enough clarity for people to know that they can provide care until it is too late, and in the case like this, it was too late before people could intervene. But I remain skeptical that without broad sustained outcry, we will see this change how abortion opponents and the Republican Party talk about abortion as a policy issue. Huetteman: I’d love to talk a little bit more about how anti-abortion folks are talking about this issue. Here’s <a href="https://www.washingtonpost.com/investigations/interactive/2024/abortion-law-nevada-arrest-miscarriage/?utm">another story</a> that came out this week from The Washington Post about a woman who suffered a miscarriage and ended up in prison charged with manslaughter. This was in Nevada, which doesn’t even have an abortion ban. Her conviction was set aside by a judge and she was released, but the woman is still in legal jeopardy because the prosecutor hasn’t dropped the charges and hasn’t decided whether he will or not. Many abortion opponents say they have no intention of punishing women who have abortions. We’re talking about doctors being potentially punished for performing abortions, but we’re still seeing women punished as a result of their pregnancy outcomes. Why is that? Luthra: That prosecution and the story is just phenomenal and absolutely worth reading. That prosecution actually happened before Roe v. Wade was even overturned and it made use of very old anti-abortion laws, and it highlighted something that I think is really important, which is that there has been a history of criminalizing people for pregnancy outcomes, even independently of the abortion bans that have swept the country in the past two years, and that comes from a lot of factors, but it is something that we are seeing become potentially more common in the post-Dobbs landscape, and there’s a real divide in the anti-abortion movement, whether they will eventually go after pregnant people in a more systematic way. The reason they haven’t is because of the politics, because it is just so unpopular to say we are going to specifically go after people who are pregnant as opposed to their doctors. But I think cases like this Nevada case and cases like others that we have seen arise around the country, including in Texas, underscore that there is some appetite for this in some corners of the anti-abortion movement, and it is something that could gain traction and gain prominence if abortion opponents make a calculus that the political trade-offs are worth it or are no longer as salient as they have been. Huetteman: Shefali, you’ve done some great reporting on this, and I’d like to talk a little bit more about that, actually. So first off, in last week’s extra-credits segment, Julie talked about anti-abortion crisis pregnancy centers. These centers offer free pregnancy tests, ultrasounds, and counseling while trying to convince people not to have an abortion. Shefali, you have a <a href="https://19thnews.org/2024/10/anti-abortion-centers-are-stepping-into-electoral-politics/">story out this week</a> about how these centers are getting more involved in electoral politics. Can you tell us more about that? Luthra: I thought this was very interesting and I looked at these anti-abortion/crisis pregnancy centers in the states where abortion is on the ballot and I saw a good number of them have been making themselves more of a presence on the campaign trail and legally most of them are 501(c)(3) nonprofits, so they can’t endorse a specific candidate, but what they are doing is trying to share what they say is information about how these ballot measures would affect them. But what they’re sharing often contains a good amount of misleading or inflammatory language, arguing the classic Republican talking points, “These abortion measures would allow abortion up until the point of birth and beyond,” which, in most cases, isn’t true because a lot of these measures actually would only protect abortion up until fetal viability. But what we’re seeing is part of a larger effort. Heartbeat International, one of the big crisis pregnancy/anti-abortion center organizations, actually had a session earlier this year teaching their members how can you become more involved in politics while also maintaining your tax-exempt status. And they’re talking through these organizations what kind of strategies might be appropriate in part because they do see abortion being a continuing political issue, and they want to use these centers as part of their toolbox. They’re something that they think can be very effective because people don’t know what they are necessarily. They might look at them and see, that’s my local pregnancy center. They give free ultrasounds, they give pregnancy tests, and I trust them without realizing that they actually have a very clear political agenda. Huetteman: Absolutely. In many cases, these are the only options that may be available to you for pregnancy care at this point. Isn’t that right? Luthra: Exactly. They are very affordable because they provide for pregnancy tests and free ultrasounds, and they are not regulated as medical centers. They vastly outnumber abortion clinics, especially obviously in states with abortion bans. I have spoken to a lot of people who say, “This is my only option because I can’t afford to go to a doctor’s office to find out how far along I am, even if I know I don’t want to be pregnant.” As a result, they’ll go to these places not necessarily knowing what they are or even knowing what they are and are given inaccurate information, can be, in some cases, deliberately misled about their pregnancy outcome and options, and their medical data is at jeopardy as well. Huetteman: Thanks for your reporting on that. We’ll be talking about that more, I’m sure. Shifting gears, while we’ve all had our eyes on the election, President Joe Biden is still in charge of the executive branch and the Biden administration is still doing health policy things. Just in the past week, the administration put out new rules requiring insurance to pay for the new over-the-counter birth control pill, as well as some forms of prescription contraception. Separately, the administration also put out a plan to help track and ease shortages of cancer drugs for kids. I know we spend a lot of time talking about things politicians promise to do, but we don’t always take note when they actually follow through on these promises, particularly if they’re not controversial. I wanted to make note of that this week. Now, finally this week, here’s something that’s likely to continue no matter who is elected president or who controls Congress next year. I’m talking about profiteering in health care. This week, we have two more investigations digging into profit-seeking middlemen. The first is <a href="https://www.nytimes.com/2024/10/28/us/healthcare-taxpayer-money-insurance.html">from The New York Times</a> about how a data firm called MultiPlan determines how much insurers should pay out-of-network providers while charging fees that sometimes exceed the payments themselves. But the other investigation is <a href="https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations">from ProPublica</a> about another for-profit company called EviCore. Jessie, this story is your extra credit this week. Why don’t you tell us about it now? Hellmann: This story [“<a href="https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations">‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care</a>,” by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica] looks at EviCore by Evernorth, which is hired by insurance companies to process prior authorization requests. As we’re seeing more of in health care, they use an algorithm that’s backed by AI to help make these decisions, and there has just been a lot of complaints from patients and doctors about what they see as unfair denials. But what I thought was really interesting about this story is it takes a peek behind the curtain of how this specific algorithm actually works. It has something called a dial, which they can scale up or scale down depending on how many denials they’re trying to get, which obviously can result in more money for the insurance company. While this algorithm can’t reject a prior authorization request, it does flag requests that have to be approved by a doctor who works for this company, who can reject those requests. I thought it was just an interesting look at — we talk all the time about prior authorization and how it impacts patients and doctors who are tired of the red tape and all the bureaucratic work that they have to do to get care to patients. But I think in the past few years, we’ve been learning more about how these systems are actually structured. I think this is a really good look at that. Huetteman: Definitely. The thing these businesses have in common is that they’re in the business of saving someone money, but that someone is rarely the patient. Is anyone looking into what this is doing to our health care system, having such a focus on profit as part of the system that we use to care for people when they’re sick and dying? Is this good for patients? Weber: I think that’s how you get the name of this podcast, right? I think that’s how you come up with the name of this podcast. I think a lot of reporters out here are looking into that, in general. I think that’s why how policy is a beat that we all like to cover because it crosses so many sectors of both real pain and suffering that people feel, and whether that’s in their pocketbooks or medically when dealing with the health care system. Huetteman: Absolutely, that’s true. Thank you, Lauren. OK, folks, that’s this week’s news. Now, we’ll play Julie’s interview with KFF’s Irving Washington. Then we’ll come back and do the rest of our extra credits and read this year’s Halloween Haiku winner. Julie Rovner: I am so pleased to welcome to the podcast Irving Washington, KFF senior vice president and executive director of KFF’s newest program launched this summer, our initiative on Health Misinformation and Trust. Irving, welcome to, “What the Health?” Irving Washington: Hi. Julie. Glad to be here. Rovner: So why don’t you start by telling us what the Health Misinformation and Trust initiative is and what you do? Washington: Sure, happy to. So the Health Misinformation and Trust is a new program that you mentioned at KFF. The short of it is, it’s really designed to help people understand all the complexities and what’s going on with health misinformation and trust. As you know, we’ve always had health misinformation, it’s been around. And KFF has been in the business for health misinformation for quite a while. But this new program will bring all of our work together at KFF. And then we’re also launching new products like the KFF Health Misinformation Monitor, which helps people track what misinformation and narratives are happening within the country. Rovner: And what are some examples of the kinds of health misinformation that you’re trying to bring to light? Washington: There’s all kinds of examples. Everything from, we had earlier issues around, if you’ve seen on social media, the miracle cures, those things that you see on TikTok, to issues that are happening right now in the elections, whether that be reproductive health, gender-affirming care, and, of course, vaccines and covid-19. Rovner: Why are we seeing so very much health misinformation right now, and so little trust in expertise? I mean, this all predates Donald Trump, and it predates covid, and yet it seems to be more than ever. Washington: It does seem like we do see that more these days. However, I like to remind people, as you just also said, we’ve been in the business, or had health misinformation, for quite a while. Misinformation in general. I like to think of the, remember the tabloids from several years ago or just anything — think about not even written information, but if your family had something that was passed down and this is supposed to cure this. So we’ve had misinformation for a while. Obviously, there’s been a few things that have changed, which makes the appearance of it spreading more and actually spreading more. Social media, for example, spreads misinformation much quicker. It also prioritizes engagement. And then you also mentioned the trust in institutions, organizations, that’s been an ongoing trend that I think we’ve seen over the last decade as well, too. So those two things combined, I think, puts us at the moment that we’re in now. Rovner: So if former President Trump wins a second term, he’s promised Robert F. Kennedy Jr., who is a longtime purveyor of health misinformation, what he calls free rein in health policy. What could that mean? Washington: That could mean a lot of things. It could mean that many of the systems and resources that we rely on to make sure we’re getting accurate and proper information may disappear. It also could mean that the things that we consider verifiable, factual information that we see from our public health institutions and government, that might be in jeopardy now, or that may or may not be a trustworthy source. Rovner: How do you determine what’s misinformation and what’s not? I’m old enough I used to look things up in the encyclopedia. You can’t really do that anymore. Washington: Well, I will tell you, it is much, much more complex these days. I have used the advice of anyone now, and you almost have to consider yourself a detective when you’re looking at information, particularly on social media. And by that, that just means doing extra checks to make sure that you’re confirming what you’re looking at is correct. There are a number of things people can do, a couple of them, and also how you can sort of see if this is misinformation. One thing to look out for is if data is cherry-picked. So if you see one particular data point, but it leaves out the broader context of, say, a study, that’s usually a signal it might be misinformation. Also look out for sensational language. Anything that plays on an emotional appeal, I like to think, just do a check on if you feel yourself getting agitated by this, and just double-check to make sure that it’s something that is factual information as well. And then of course, I’d say the last thing is just look at who is sharing that information. Is it an expert? Is it someone who just read something in the book? And even with doctors, you’d have to look at, is this in their expertise? One thing I’ve often said is, do you want your cardiologist to give you brain surgery, even though they’re both doctors, right? So you have to look at all those things. Rovner: So what’s the role of AI in health misinformation? It can be both good and bad here, right? Washington: That is certainly true. AI is fascinating, I’ll say at this point. And you’re totally right, it can be good and bad. We’ve looked at that from a couple of angles. Our polling shows that more people are turning to that to get their health information. Not a large number, but it is growing. The other thing that we looked at too, and this wasn’t formal research, we just did one experiment with one staffer, and over a period of eight months, we looked at 10 health misinformation false claims. And we asked the three major chatbots if this was misinformation or not. And Julie, those answers changed over a course of eight months. One instance it said it was, the other instance says it was a developing topic. Sometimes they would quote their resources, like the CDC [Centers for Disease Control and Prevention] or the WHO [World Health Organization], the other times they wouldn’t. So it was an evolving process as each system got updated as to what the AI chatbot said. So it’s important for people to think about. That might be a first source, like you could Google something in the same way to get an idea of something, but you should always verify with your primary care provider. Rovner: So what should we tell kids and relatives and people who we sort of see purveying misinformation about how they can perhaps better educate themselves? Washington: As much as possible. This is a big task to ask, but I do ask this request of folks is, you yourself try to be a trusted messenger. We know that trusted messengers work, so as much as possible, share factual information, no judgment on someone else’s belief or what they’re saying, but share factual information that you know. And I think the other thing that you can do is have productive conversations with people, again, if you personally know them, have those productive conversations with people, if you see that them spreading misinformation. One of the things about misinformation, in particular, sometimes people don’t know they’re spreading misinformation. So you also can just start there by helping to inform people. And then after that, when you know there’s clear misinformation, I think we all have a role in this information ecosystem that we’re in. We all can help put out quality and correct information. Rovner: We’re coming up on the holiday season, Thanksgiving and Christmas, and times when families who perhaps have different views about things get together. Any good advice for sort of gently explaining to some of your friends and family why some of the information they have might not be exactly correct? Washington: Well, oddly enough, Julie, that might be my dinner table. I can tell you what I may do this upcoming holiday. One, you want to make sure that you are listening. I think where people sometimes perhaps are too quick to share factual information and they want to get this point across, particularly on family members, you really want to take time to listen and understand where someone is getting their information from, who they are getting it from, and why they are choosing to believe. Once you get that information, I think you can then decide how do you want to approach some of those conversations. They could be, again, providing more factual information to counter that. They could be just getting the person to ask questions about the information that they’re receiving. Some conversations … if you can just end with them questioning somewhat where they’re getting information from, that might be a way to help people understand … better factual information. Rovner: Last question: If people want to sign up to get the KFF Health Misinformation Monitor, how can they do that? Washington: They can do that by going to kff.org. You will see our Health Misinformation and Trust landing page, and you can sign up and subscribe at the bottom. Rovner: Irving Washington, thank you so much for joining us. I hope we can call on you again soon. Washington: Happy to be here, Julie, and do this. Thank you. Huetteman: OK. We’re back. And it’s time for our extra-credit segment. That’s where we each recognize a story we read this week that we think you should read too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. All right, Jessie’s already done hers. Shefali, why don’t you go next? Luthra: Mine’s from NBC News. It is by Aria Bendix, and the headline is “<a href="https://www.nbcnews.com/health/health-care/childbirth-medical-debt-middle-class-insured-rcna170224">They’re Middle Class and Insured. Childbirth Still Left Them With Crippling Debt</a>.” The story is excellent. It is absolutely worth reading. It follows a couple of families in Illinois who gave birth and ended up with, as the headline would imply, thousands of dollars in medical debt. And the family in the lede, they made too much money to qualify for Medicaid. They had this health care plan that was a grandfathered plan, so had very high out-of-pocket limits, and so as a result, they had this tremendous amount of expenses that they had to pay after she gave birth to twins who were born prematurely, who required NICU care. And, even worse, were born right at the end of the year. Right when her health plan reset, and she suddenly had to go through a new effort to hit her out-of-pocket limit. The story is really, really smart because it takes a problem that is familiar and makes it feel new. Something that we don’t talk about enough. The loopholes that exist in the Affordable Care Act that can still leave medical debt as such a problem. It puts a real human face to this, and the end, the end is really devastating. You talk to this mother, Jessica, and she is talking about all of the medical expenses that she’s trying to forgo, if she can, whether that is for her own health or for her children’s health because she is just really scared of incurring another medical bill and being surprised yet again by more debt that she and her family really can’t afford. It’s absolutely worth your time, especially as we think so much about what it means to get pregnant and to give birth and the challenges that exist for people who do that in our country. Huetteman: That’s a great point. It is heartbreaking to think that people who are going through something as routine as childbirth are being subject to things like rationing care in order to make sure they can afford their medical bills. Well, all right. Lauren, how about you go next? Weber: I have a piece from the New York Times titled “<a href="https://www.nytimes.com/2024/10/23/health/alzheimers-drug-brain-bleeding.html">What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials</a>,” written by Walt Bogdanich and Carson Kessler, and it’s pretty horrifying. Basically, there was a drug trial for an Alzheimer’s drug that the volunteers that answered the call to do it had a gene that would make them more predisposed to have Alzheimer’s, but that gene also meant that it could make them more likely to have brain bleeds that interact with this drug. They took a genetic test to see whether they had this gene that would go this way and then the drugmaker didn’t tell them that it could cause a higher risk of brain bleeds for these people. It’s just a very horrifying story about lack of disclosure and, especially in a field like Alzheimer’s, where often people that feel like they are taking part in these trials maybe are worried about the devastating impacts of the disease. Many of us, I’m sure on this podcast and all those listening, have had personal experiences with how devastating that can be. Holding that over someone but not giving them the full knowledge of what they could be signing up for, there was at least one patient that died, many others that had brain hemorrhages that were preventable with the proper disclosure. Great reporting by The New York Times. Huetteman: Absolutely. Thanks for talking about it for us. My story this week is from KFF Health News and it’s by Julie Appleby. The headline is “<a href="https://kffhealthnews.org/news/article/daca-dreamers-aca-affordable-care-act-obamacare-lawsuit/">‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way</a>.” ACA open enrollment season opens Nov. 1 and, for the first time, so-called Dreamers will be eligible to enroll. As a reminder, the term Dreamers refers to people who were brought to the United States without immigration paperwork when they were kids and who have since qualified for federal protections because they meet certain requirements. Those include that they were in school or had graduated or that they had served in the military. Anyway, a Biden administration rule that came out earlier this year says that Dreamers, as “lawfully present individuals,” are eligible for ACA coverage, and, potentially, the premium subsidies to pay for it. But 19 states are challenging the rule in federal court. Those states say the rule will put more strain on the system and it’ll encourage people to remain in the United States without permanent legal authorization. A ruling could come at any time with several possible outcomes, including a potential hold on the Biden administration’s rule. We’ll be keeping an eye on this one. Before we go, I have the privilege of reading the winner of this year’s <a href="https://kffhealthnews.org/news/article/winning-halloween-haikus-2024-contest/">Halloween Health Haiku contest</a>. The winning entry was written by Crystal Decker, and it goes like this. Vampires don’t scare me.  Empty blood shelves, now that’s fear.  Roll up, save a life. You can find the winner and the runners-up and some fabulous illustrations by my KFF Health News colleague Oona Zenda on our website at kffhealthnews.org, and we’ll post the link in our show notes. That’s all the time we have this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and to Stephanie Stapleton, our editor this week. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, and you can still find me lurking on X. I’m <a href="https://twitter.com/emmarieDC">@emmarieDC</a>. Jessie? Hellmann: I am on Twitter <a href="https://twitter.com/jessiehellmann">@jessiehellmann</a>. Huetteman: Shefali? Luthra: I am <a href="https://twitter.com/shefalil">@shefalil</a>. Huetteman: And Lauren? Luthra: I’m <a href="https://twitter.com/laurenweberhp">@LaurenWeberHP</a>. Huetteman: Julie will be back next week. Until then, be healthy. 					<h3>		Credits	</h3>							Francis Ying	Audio producer															Stephanie Stapleton	Editor 												To hear all our podcasts, <a href="https://kffhealthnews.org/news/tag/podcast/">click here</a>.And subscribe to KFF Health News’ “What the Health?” on <a href="https://open.spotify.com/show/32EdsB662C3oyIrqLMmBXI?si=TQhRjzzLTgWtK3crfbOFtA">Spotify</a>, <a href="https://podcasts.apple.com/us/podcast/what-the-health/id1253607372?mt=2">Apple Podcasts</a>, <a href="https://play.pocketcasts.com/web/podcasts/a379e280-3f57-0135-9028-63f4b61a9224">Pocket Casts</a>, or wherever you listen to podcasts.<a href="https://kffhealthnews.org/about-us">KFF Health News</a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about <a href="https://www.kff.org/about-us">KFF</a>.<a href="https://kffhealthnews.org/morning-briefing/">Subscribe</a> to KFF Health News' free Morning Briefing.This <a target="_blank" href="https://kffhealthnews.org/news/podcast/what-the-health-370-aca-mike-johnson-abortion-miscarriage-october-31-2024/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a Creative Commons license.<img src="https://kffhealthnews.org/wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;"><img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=1935550&amp;ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

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