Well being Applications Are at Threat as Debt Ceiling Cave-In Looms


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 knowledgeable on well being coverage points, Julie is the creator of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.

The partisan battle in Congress over easy methods to elevate the nation’s debt ceiling to stop a default has accelerated, because the U.S. Treasury predicted the borrowing restrict may very well be reached as quickly as June 1. On the desk, probably, are massive cuts to federal spending packages, together with main well being packages.

In the meantime, legislators in two conservative states, South Carolina and Nebraska, narrowly declined to move very strict abortion bans, as some Republicans are apparently getting chilly toes concerning the impression on take care of pregnant ladies of their states.

This week’s panelists are Julie Rovner of KFF Well being Information, Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico, Rachel Cohrs of Stat, and Alice Miranda Ollstein of Politico.


Alice Miranda Ollstein


Learn Alice’s tales

Rachel Cohrs
Stat Information


Learn Rachel’s tales

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


Learn Joanne’s tales

Among the many takeaways from this week’s episode:

  • The US is approaching its debt restrict — a lot prior to anticipated. And it’s unclear how, or if, lawmakers can resolve their variations over the price range earlier than the nation defaults on its money owed. Particulars of the unexpectedly constructed Home Republican proposal are coming to mild, together with apparently inadvertent potential cuts to veterans’ advantages and a scarcity of exemptions defending those that are disabled from shedding Medicaid and vitamin advantages beneath proposed work necessities.
  • A seemingly routine markup of a key Senate drug pricing bundle devolved this week because it turned clear the committee’s management crew, beneath Sen. Bernie Sanders (I-Vt.), had not accomplished its due diligence to make sure members have been knowledgeable and on board with the laws. The Senate Well being, Schooling, Labor and Pensions Committee plans to revisit the bundle subsequent week, hoping to ship it to the complete Senate for a vote.
  • In additional abortion information, Republican lawmakers in North Carolina have agreed on a brand new, 12-week ban, which might additional minimize already bare-bones entry to the process within the South. And federal investigations into two hospitals that refused emergency care to a pregnant lady in misery are elevating the prospect of yet one more abortion-related showdown over states’ rights earlier than the Supreme Courtroom.
  • The variety of deaths from covid-19 continues to dwindle. The general public well being emergency expires subsequent week, and masks mandates are being dropped by well being care amenities. There proceed to be points tallying circumstances and guiding prevention efforts. What’s clear is the coronavirus will not be now and will by no means be gone, however issues are getting higher from a public well being standpoint.
  • The surgeon basic has issued suggestions to fight the rising public well being disaster of loneliness. Structural issues that contribute, like the shortage of paid depart and few communal gathering areas, could also be ripe for presidency intervention. However whereas well being consultants body loneliness as a societal-level drawback, the federal authorities’s recommendation largely targets particular person behaviors.

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

Julie Rovner: The Washington Publish’s “Canine-Strolling Accidents Could Be Extra Widespread Than You Suppose,” by Lindsey Bever.

Joanne Kenen: The Atlantic’s “There Is No Stopping the Allergy Apocalypse,” by Yasmin Tayag.

Rachel Cohrs: ProPublica’s “This Pharmacist Mentioned Prisoners Wouldn’t Really feel Ache Throughout Deadly Injection. Then Some Shook and Gasped for Air,” by Lauren Gill and Daniel Moritz-Rabson.

Alice Miranda Ollstein: The Wall Avenue Journal’s “Sufferers Lose Entry to Free Medicines Amid Spat Between Drugmakers, Well being Plans,” by Peter Loftus and Joseph Walker.

Additionally talked about on this week’s episode:

Click on to open the transcript

Transcript: Well being Applications Are at Threat as Debt Ceiling Cave-In Looms

KFF Well being Information’ ‘What the Well being?’

Episode Title: Well being Applications Are at Threat as Debt Ceiling Cave-In Looms

Episode Quantity: 296

Printed: Could 4, 2023

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]

Julie Rovner: Hey and welcome again to “What the Well being?” I’m Julie Rovner, chief Washington correspondent at 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, Could 4, at 10 a.m. As all the time, information occurs quick and issues might need modified by the point you hear this. So right here we go. We’re joined at the moment through video convention by Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico.

Joanne Kenen: Hey, everyone.

Rovner: Rachel Cohrs of Stat Information.

Rachel Cohrs: Good morning.

Rovner: And Alice Miranda Ollstein of Politico.

Ollstein: Hey.

Rovner: So loads of information this week. We’re going to dive proper in. We’re going to begin once more this week with the nation’s debt restrict, which Treasury Secretary Janet Yellen warned this week may very well be reached as quickly as June 1. That’s lots sooner than I feel most individuals had been banking on. And if Congress doesn’t act to boost it by then, the U.S. may default on its money owed for the primary time in historical past. Do we’ve any really feel but for a way this will get untangled now that we all know — I feel there are, what, eight days left the place each the Home and the Senate will likely be in session?

Ollstein: You mentioned it caught all of us unexpectedly. It appears to have caught lawmakers unexpectedly as properly. They appear to have thought they’d much more time to battle and blow smoke at each other, they usually actually don’t. And there has not been a transparent path ahead. There are efforts to get Mitch McConnell extra concerned. He has form of mentioned, “Ah, you individuals determine this out. You understand, no matter Home Republicans and the White Home can agree on, the Senate will move.” And he’s been attempting to remain out of it. However now each Republicans and Democrats need him to weigh in. He’s seen as perhaps somewhat extra cheap than among the Home Republicans to among the gamers, and so —

Rovner: He could also be one of many few Republicans who understands that it might be very, very unhealthy to default.

Ollstein: Proper. You have got quite a lot of Home Republicans saying it wouldn’t be so unhealthy — the robust drugs for Washington spending, and so forth. So, you understand, if I have been to wager cash, which I wouldn’t, I’d wager on some form of short-term punt; I imply, we’re actually coming as much as the deadline, and that’s what Congress likes to do.

Rovner: Yeah, I do too.

Kenen: I agree with Alice. You understand, I feel if the deadline had been a few months from now — they actually didn’t wish to do a punt. I imply, I feel they needed to stroll as much as the cliff and minimize some form of deal on the final hour. However I feel this caught everyone off guard, together with presumably Janet Yellen. So I feel it’s more likely there’ll be a short-term postponement. I feel the Democrats wish to tie it to the common price range talks for the top of the fiscal 12 months. I’m undecided the Republicans will think about September 30 short-term. It is likely to be shorter than that. In fact, we may have one other one. However I feel Alice’s instincts are proper right here.

Rovner: Yeah, I do too. I imply, the most effective factor Congress does is kick the can down the highway. They do it yearly with every kind of issues. Sorry, Rachel, I interrupted you.

Cohrs: Oh, no, that’s all proper. I used to be simply going to flag that the date to look at subsequent week is Could 9, after I suppose they’re all presupposed to form of get in a room collectively and begin this dialog. So I feel we’ll hopefully have a readout. I don’t know that they’re going to unravel every thing in that assembly, however we’ll not less than get a way of the place everybody’s coming from and simply how acrimonious issues actually are. So, yeah, these will kick off in earnest.

Rovner: Yeah. Properly, one factor the Democrats are speaking about is a discharge petition within the Home, which is a hardly ever profitable however not all that little-used technique to convey a invoice to the ground over the objections of the occasion in cost. Is there any probability that that is going to work this time?

Kenen: That’s one cause the Republicans won’t need an extension, as a result of they in all probability couldn’t do it within the subsequent two or three weeks. There’s a slight probability they may do it in early to mid-June. The Democrats want 5 Republicans to signal on to that. I’d suppose that if any Republicans are prepared to signal on to that, they’re not going to say it in public, so we gained’t know who they’re, however the possibilities of it working enhance if there’s an extension; the possibilities of it working are nonetheless not nice, however I don’t suppose it’s unattainable. I don’t suppose it’s unattainable, as a result of there are Republicans who perceive that defaulting will not be a good suggestion.

Rovner: This has been painted this week as, Oh, it is a secret thought. It’s like, it’s not, however the precise discharge petition, you get to signal it not anonymously, however nobody is aware of who’s signing on. It’s not like co-sponsoring a daily invoice.

Kenen: However stuff will get out. I imply, there’s no such factor as a secret on the Hill.

Rovner: However technically, if you signal it, it’s not an apparent public factor that you just’re supporting it, so we are going to — we’ll should see. Properly, we all know that Republicans are demanding deep, in some circumstances very deep, cuts to federal spending with their invoice to boost the debt ceiling. We’re discovering out simply how deep among the cuts could be. One attainable piece of fallout I feel Republicans didn’t cut price for: They are saying they supposed to exempt veterans from the cuts, however apparently the invoice doesn’t really try this, which has already prompted cries of shock from very highly effective veterans teams. That is the hazard of those actually broadly written payments, proper, is that you could form of really unintentionally find yourself sweeping in belongings you didn’t imply to.

Cohrs: Proper. Properly, this invoice got here collectively in a short time, and Kevin McCarthy was coping with quite a lot of competing factions and attempting to make everybody blissful on points like vitality credit, that form of factor. And clearly this didn’t get consideration earlier than. And I feel that that’s simply form of a symptom that isn’t rare in Washington, the place issues come collectively actually shortly, and typically there are some unintended penalties, however I feel that’s one of many features of form of the information cycle in Washington particularly, is to convey consideration to a few of these issues earlier than they turn into regulation. So the rhetoric has been very fiery, however once more, there’s a risk that it may very well be labored out at a later date if for some cause the ultimate deal finally ends up trying one thing just like the Republican invoice, which isn’t essentially the case.

Rovner: As soon as upon a time — and we’ll discuss this subsequent — we had one thing known as common order, the place payments went by way of the committee course of, there was a committee report, and other people had time to take a look at them earlier than they got here to the ground. And now it’s form of like a fish. When you depart it out too lengthy, it’s going to begin to odor. So you bought to catch it and move it instantly. Properly, earlier than we get to that, one other change that these individuals who wrote the Republican invoice in all probability didn’t intend: The requirement for states to institute work necessities for individuals who get Medicaid and/or meals stamps — one thing that states can not decide out of, we’re informed — doesn’t embrace exemptions for individuals with disabilities. In different phrases, they might be required to work if they’re of the age. Even those that’ve been getting, you understand, incapacity advantages for years must be recertified as quote “unfit to work” by a health care provider, or else they might have their advantages terminated. I’d think about that states could be amongst these becoming a member of the uproar with this. They’ve sufficient to do with redeterminations proper now from individuals who obtained on Medicaid throughout the pandemic. The very last thing they want is to should mainly redetermine each single one who’s already been decided to have a incapacity.

Kenen: And it’s a burden for the disabled too, even when the states are prepared to do it. Bureaucracies are laborious to cope with, and other people would get misplaced within the shuffle. There’s completely no query that disabled individuals would get misplaced within the shuffle given the system they’ve arrange.

Ollstein: Sure, it is a good instance of how individuals fall by way of the cracks, and particularly as a result of quite a lot of the mechanisms that states arrange to do that, we’ve seen, will not be absolutely accessible for individuals with disabilities. A few of them have audio-only choices. A few of them have online-only choices. It’s very laborious for individuals to — even when they learn about it, which they won’t — to navigate this and turn into licensed. And so there’s a truthful quantity of knowledge on the market that the projected financial savings from insurance policies like work necessities don’t come from extra individuals working; they arrive from individuals getting kicked off the rolls who perhaps shouldn’t be, needs to be absolutely eligible for advantages.

Kenen: And it’s not simply bodily incapacity. I imply, there’s all types of developmental disabilities — individuals who actually aren’t going to have the ability to navigate the system. It’s simply — it might not be what they supposed, it might be what they supposed, who is aware of. However it’s not a viable method.

Rovner: Yeah. In the meantime, even when the Democrats may sneak a invoice out of the Home with somewhat little bit of average Republican help, there’s no assure it may get by way of the Senate, the place West Virginia’s Joe Manchin says he helps not less than some price range cuts and work necessities and the place the absence of California’s Dianne Feinstein, who’s 89 and has been away from Washington since February, attempting to get better from a case of shingles, has loomed massive in a physique the place the elected majority solely has 51 votes. Joanne, you wrote concerning the sticky drawback of senators of a complicated age. Feinstein is much from the primary, however is there something that may be accomplished about this when, you understand, considered one of our older senators is out for a very long time?

Kenen: There isn’t any institutional resolution to an incapacitated senator. And along with the journal piece I wrote about this yesterday for Politico Journal, I additionally wrote about final night time in Politico Nightly form of going again to the historical past till the Forties. I imply, there have been individuals, a handful, however individuals out for like three or 4 years. The one software is an expulsion vote, and that’s not used. You want two-thirds vote, and you’ll’t get that. It was used throughout the Civil Struggle, the place there have been I feel it was 14 senators from Accomplice states who didn’t form of get that they have been supposed to go away as soon as the Civil Struggle began, in order that they obtained expelled. Apart from that, there’s solely been one case, and it was for treason, within the 1790s. So that they’re not going to begin expelling senators who’ve strokes or who’ve dementia or who produce other illnesses. That’s simply not going to occur. However which means they’re caught with them. And it’s not simply Feinstein. I imply, there have been different impaired senators, and there will likely be extra impaired senators sooner or later. There’s no equal to the twenty fifth Modification, for which the vice chairman and the cupboard can take away a president. The Senate has no mechanism aside from behind-the-scenes cajoling. And, you understand, we’ve seen Dianne Feinstein — she didn’t even announce she wasn’t operating for reelection till different individuals introduced they have been operating for her seat. However it’s like 50-50 Senate — if it’s 47-53 and one is sick, it doesn’t matter a lot. If it’s 50-50 or 51-49, it issues lots.

Rovner: Yeah, and that’s what I used to be going to say. I imply, you and I keep in mind when Tim Johnson from South Dakota had, what was it, an aneurysm?

Kenen: I feel he had a stroke, proper?

Rovner: Yeah. It took him a 12 months to come back again, which he did ultimately.

Kenen: Properly, we each coated Strom Thurmond, who, you understand, was clearly not —

Rovner: —he was not all there —

Kenen: — situational consciousness for fairly just a few years. I imply, it was very clear, you understand, as I point out on this story, that, you understand, as a substitute of the workers following his orders, he was following the workers’s orders and he was not cognizant of Senate proceedings or what was occurring.

Rovner: Yeah, that’s for certain.

Kenen: However there are also some who’re actually positive. I imply, we all know some who’re 80, 88 — you understand, of their 80s who’re completely alert. And so an age cutoff can be problematic. That doesn’t work both.

Rovner: Proper. Ted Kennedy was, you understand, proper there till he wasn’t. So I’m amazed on the at how a few of these 80-something-year-old senators have extra vitality than I do. Properly, elsewhere on Capitol Hill, we talked concerning the bipartisan drug worth invoice final week within the Senate that was presupposed to be marked up and despatched to the ground this week, which didn’t occur. Rachel, how did what ought to have been a reasonably routine committee vote get so tousled?

Cohrs: Yeah, it was a — it was a meltdown. We haven’t seen one thing like this in fairly a — a few years, I feel, on the Hill, the place Chairman Bernie Sanders’ first main, you understand, well being care markup. And I feel it simply turned clear that they’d not accomplished due diligence down the dais and had buy-in on these payments, but in addition the modification course of, which seems like a procedural criticism nevertheless it actually — there have been some substantive adjustments in these amendments, and it was apparent from the markup that senators have been confused about who supported what and what may get the help of the caucus. And people conversations within the Lamar Alexander, you understand, iteration of this committee occurred earlier than. So I feel it, you understand, was a lesson actually for everybody that there does have to be — I don’t know, it’s laborious to attract the road between form of common order, the place each senator can provide an modification, and what passes. And it’s simply one other symptom of that difficulty in Congress the place even typically standard issues that a person senator may help — they may move on their very own — that throwing off the dynamics of packages that they’re attempting to place collectively. So I feel they’re hoping to present it one other shot subsequent week after a listening to with executives from insulin producers and pharmacy profit managers. However it was fairly embarrassing this week.

Rovner: Yeah. I used to be going to say, I imply usually this stuff are negotiated out behind the scenes so by the point you really — for those who’re going to have a markup; typically markups get canceled on the final minute as a result of they haven’t been in a position to work issues out behind the scenes. Appropriate me if I’m unsuitable, however Bernie Sanders has not been chairman earlier than of a significant legislative committee, proper? He was chairman of the Price range Committee, however they don’t do this sort of take up a invoice and make amendments.

Kenen: I don’t keep in mind, however he was a lead creator of the bipartisan veterans invoice. So he has — it’s in all probability his largest legislative achievement within the Senate. And that was a significant bipartisan invoice. So he does know the way this stuff work.

Rovner: Proper. He is aware of easy methods to negotiate.

Kenen: It simply didn’t work.

Rovner: Yeah, I feel this got here as a shock — a committee like this that’s actually busy with laws and that does laws that often will get amended and adjusted earlier than it goes to the ground. I’m informed he was certainly chairman of Veterans’ Affairs, however they don’t do as a lot laws because the HELP Committee. I feel this was maybe his first outing. Possibly he discovered some necessary classes about how this committee really works and the way it ought to go on. All proper. Rachel, you mentioned that there’s going to be a listening to after which they’re going to do that markup once more. So we’ll see in the event that they get by way of this within the May go interval, as they name it.

Kenen: Possibly they’ll come out holding fingers.

Rovner: I wish to flip to abortion. It appears that evidently perhaps, presumably, the tide in states is popping towards passage of the broadest attainable bans. In the identical day final week we noticed sweeping abortion restrictions turned again, although barely, by lawmakers in each South Carolina and Nebraska. And in North Carolina, the place Republicans simply obtained a supermajority large enough to override the state’s Democratic governor’s veto, lawmakers are actually a 12-week ban somewhat than the six-week or whole ban that was anticipated. Alice, is that this a development or form of an anomaly?

Ollstein: Each state is completely different, and you continue to have people pushing for whole or near-total bans in quite a lot of states. And I’ll say that in North Carolina particularly, a 12-week ban can have a huge impact, as a result of that’s the state the place lots of people all through your entire South are going proper now, in order that they’re getting incoming people from Texas, Oklahoma, Alabama, Louisiana. So it’s one of many form of final havens in your entire southeast space, and so even a restriction to 12 weeks, you understand, we all know that the overwhelming majority of abortions occur earlier than that time, however with fewer and fewer locations for individuals to go, wait instances are longer, individuals are pushed later into being pregnant who wish to terminate a being pregnant sooner. And so it may very well be an enormous deal. This has additionally been form of a loopy saga in North Carolina, with a single lawmaker switching events and that being what’s more likely to allow this to move.

Rovner: Yeah, a Democrat turned Republican for causes that I feel haven’t been made solely clear but, however giving the Republicans this veto-proof majority.

Kenen: They’ve obtained the veto-proof majority. I did learn one report saying there was one vote in query. It is likely to be this lawmaker who turned, whether or not she’s for 12-week or whether or not she’s for 15 or 20 or no matter else. So it’ll actually move. I don’t have firsthand data of this, however I did learn one story that mentioned there’s some query about they is likely to be one wanting the veto-proof majority. So we’ll simply have to attend and see.

Rovner: Yeah, North Carolina is clearly a state that’s persevering with. So my colleague and someday podcast panelist Sarah Varney has a story this week out of Idaho, the place docs who deal with pregnant ladies are leaving the state and hospitals are closing maternity wards as a result of they’ll now not workers them. It’s an excellent story, however what grabbed me most was a line from an Idaho state consultant who voted for the ban, Republican Mark Sauter. He informed Sarah, quote, “he hadn’t thought very a lot concerning the state abortion ban aside from I’m a pro-life man and I ran that method.” He mentioned it wasn’t till he had dinner with the spouse of a hospital emergency room physician that he realized what the ban was doing to docs and hospitals within the state and to pregnant ladies who weren’t attempting to have abortions. Are we beginning to see extra of that, Alice? I’ve seen, you understand, just a few Republicans right here and there saying that — now that they’re seeing what’s enjoying out — they’re not so certain these actually dramatic bans are the way in which to go.

Ollstein: Yeah, I’ll say we’re seeing increasingly more of that. I’ve accomplished some reporting on Tennessee, the place among the Republicans who voted for the state’s near-total ban are expressing remorse and saying that there have been unintended penalties for individuals in obstetric emergency conditions. You understand, they mentioned they didn’t understand how this may be a chilling impact on docs offering care in additional than simply so-called elective abortion conditions. However it does appear that these Republicans who’re talking out in that method are nonetheless within the majority. The occasion total remains to be pushing for these restrictions. They’re additionally accusing medical teams of misinterpreting them. So we’re seeing this play out. As an example, you understand, in Tennessee, there was a push to incorporate extra exceptions within the ban, alter enforcement in order that docs wouldn’t be afraid to carry out care in emergency conditions, and quite a lot of that was rejected. What they ended up passing didn’t go so far as what the medical teams say is required to guard pregnant individuals.

Rovner: It’s necessary to level out that the teams on the opposite aspect, the anti-abortion teams, haven’t backed off. They’re nonetheless — and these are the teams which have supported most of those pro-life Republicans who’re in these state legislatures. So have been they to, you understand, even help extra exemptions that will, you understand, flip them towards necessary supporters that they’ve, so I feel it’s this —

Ollstein: —proper—

Rovner: —form of balancing act occurring.

Ollstein: Plus, we’ve seen even within the states which have exemptions, individuals are not in a position to make use of them in quite a lot of circumstances. That’s why you’ve got quite a lot of pro-abortion rights teams, together with medical teams, saying exemptions might give the looks of being extra compassionate however will not be actually navigable in follow.

Rovner: Proper. I imply, we’ve had all these tales each week of how close to dying does a pregnant lady should be earlier than docs will not be afraid to deal with her as a result of they are going to be dragged into court docket or put in jail?

Ollstein: Proper.

Rovner: So this continues. Properly, the opposite massive story of the week has to do with precisely that. The federal Division of Well being and Human Companies has opened an investigation into two hospitals, one every in Missouri and Kansas, that federal officers say violated the federal emergency medical care regulation by refusing to carry out an abortion on a girl in medical misery. If the hospitals don’t show that they’ll adjust to the regulation, they may face fines or worse, be banned from participation in Medicare and Medicaid. I can’t assist however suppose that is the form of battle that’s going to finish up on the Supreme Courtroom, proper? I imply, this entire, in case you have a state regulation that conflicts with federal regulation, what do you do?

Ollstein: Yeah, we’re seeing that each within the EMTALA house [Emergency Medical Treatment and Labor Act] and within the drug house. We’re seeing quite a lot of state-federal conflicts being examined in court docket, form of for the primary time within the abortion query. So we additionally, along with these new federal actions, you understand, we nonetheless have circumstances enjoying out associated to abortion and emergency care in just a few different states. So I feel this may proceed, and I feel that you just’re actually seeing that precisely the letter of the regulation is one factor, and the chilling impact is one other factor. And the way docs level out if quite a lot of these state abortion bans are structured round what’s known as an affirmative protection, which signifies that docs should cross their fingers and supply the care and know that in the event that they get sued, they’ll mount a protection that, you understand, this was mandatory to save lots of somebody’s life. Now, docs level out that lots of people will not be prepared to do this and lots of people are afraid to do this; they don’t have the assets to do it. Plus, within the medical house, if you apply for licenses or issues sooner or later, it doesn’t simply say, “Have been you ever convicted of one thing?” It says, “Have been you ever charged with one thing?” So even when the costs are dropped, it nonetheless stays on their report ceaselessly.

Rovner: Yeah, they usually have malpractice premiums. I imply, there’s an entire lot of issues that this may impression. Properly, I wish to discuss covid, as a result of we haven’t talked about covid in a few weeks. It’s nonetheless with us. Ask individuals who went to the large CDC convention final week; I feel they’ve had, what, 35 circumstances out of that convention? But the general public well being emergency formally ends on Could 11, which can set off all method of adjustments. We’re already seeing states disenrolling individuals for Medicaid now that they’re allowed to redetermine eligibility once more, together with some individuals who say they’re nonetheless eligible, as we talked about somewhat bit earlier. We’re additionally seeing vaccine mandates lifted. Does this imply that the pandemic is actually over? It clearly is a significant sign, proper, even when covid remains to be round?

Kenen: It means it’s legally over. It doesn’t imply it’s biologically over. However it’s clearly higher. I imply, will we’ve extra surges subsequent winter or over some form of vacation gathering? You understand, it’s not gone and it’s in all probability by no means going to be gone. Nevertheless, we additionally don’t know what number of circumstances there actually are as a result of not everyone checks or they don’t understand that chilly is covid or they take a look at at residence and don’t report it. So the caseload is murky, however we certain notice that the dying toll is the bottom it’s been in two years, and I feel it’s beneath 200 a day — and I’d should double test that — nevertheless it’s actually dropped and it’s persevering with to drop. So regardless that there’s concern about whether or not we nonetheless want a few of these protections, and I personally suppose we do want a few of them in some locations, the underside line is, are individuals dying the way in which they have been dying? No. That’s — you understand, I’ve watched that dying toll drop during the last couple of weeks; it’s constant and it’s vital. And so we must always all be glad about that. However whether or not it stays low with out a few of these measures and entry to testing and entry to pictures and — and individuals are confused, you understand, like, Oh, the pictures aren’t going to be free or they’re going to be free or I don’t want one. I imply, that entire murkiness on the a part of the general public — I imply, I’ve buddies who’re fairly properly conscious of issues. I imply, I’ve buddies who simply obtained covid the opposite day and, you understand, mentioned, “Properly, you understand, I’m not going to — I’m probably not, actually sick, so I don’t want Paxlovid.” And I mentioned, “You understand, you really want to name your physician and discuss that.” So her physician gave her Paxlovid — so she really had a threat issue, so, two threat components. So it’s not over, however we additionally should acknowledge that it’s higher than many individuals thought it might be by Could 2023.

Rovner: Yeah, I do know. I imply, the large complaints I’m seeing are individuals with continual sicknesses who fear that masks are now not required in well being care amenities, and that that appears to upset them.

Kenen: I imply, I feel for those who have been to ask a health care provider, I’d hope that you would ask your physician to placed on a masks in a sure scenario. And that doesn’t work in a hospital the place plenty of individuals round, however the docs I’ve been to not too long ago have additionally worn masks and —

Rovner: Yeah, mine too.

Kenen: Fortunately, we do know now that for those who put on masks, an N95, correctly, it’s not good, however you continue to can shield your self by sporting a masks. You understand, I take public transport and I put on masks in public transport, and I nonetheless keep away from sure settings, and I fear extra concerning the people who find themselves in danger they usually don’t perceive that the pictures are nonetheless free; they don’t know easy methods to get medicine; they don’t — there’s simply quite a lot of stuff on the market that we’ve communicated so poorly. And the shortage of a public well being emergency, with each the assets and the messaging — I fear about that.

Rovner: And as we identified, individuals shedding their medical insurance, whether or not, you understand —

Kenen: That’s an entire different —

Rovner: Yeah, rightly or not. I imply, you understand, whether or not they’re now not eligible.

Kenen: Most are, however they’re nonetheless, you understand — falling by way of the cracks is a significant theme in American well being care.

Rovner: It’s. Properly, lastly this week, the U.S. surgeon basic, Vivek Murthy, desires us to be much less lonely. Actually. The well being results of loneliness have been a signature difficulty for Dr. Murthy. We talked about it at some size in a podcast final summer season. I’ll make sure to add the hyperlink to that within the present notes. However now, as a substitute of simply describing how loneliness is unhealthy on your well being — and belief me, loneliness is unhealthy on your well being — the surgeon basic’s workplace has issued a brand new bulletin with how People could make themselves much less lonely. It’s not precisely rocket science. It recommends spending extra time in particular person with buddies and fewer time on-line. However does highlighting the difficulty make it simpler to cope with? I imply, this isn’t one of many conventional public well being points that we’ve talked about through the years.

Ollstein: I’m very to see the place this dialog goes, as a result of it’s already form of feeling like quite a lot of different public well being conversations within the U.S. in that they describe this big, existential, population-level drawback, however the options pushed are very particular person and really like, it’s important to change your life-style, it’s important to log out, it’s important to be part of extra group teams. And it’s like, if it is a huge societal drawback, shouldn’t there be larger, broader coverage responses?

Kenen: You’ll be able to’t mandate somebody going out for espresso —

Ollstein: —precisely—

Kenen: —thrice every week. I imply, this one —

Ollstein: Precisely. You’ll be able to’t boostrap loneliness.

Kenen: This one, I feel — I feel it validates individuals’s emotions. I imply, I feel people who find themselves feeling remoted —I imply, we had loneliness earlier than the pandemic, however the pandemic has modified how we stay and the way we socialize. And if — I feel it’s form of telling individuals, you understand, for those who’re feeling this manner, it’s actual and it’s widespread, and different individuals are feeling that method, too, so choose up the cellphone. And perhaps these of us who’re extra extroverted will attain out to individuals we all know who’re extra remoted. So, I imply, I’m undecided what HHS or the surgeon basic can do to make individuals spend time with each other.

Ollstein: Properly, there are structural components in loneliness. There are financial components. There may be, you understand, a scarcity of paid day off. There are a scarcity of public areas the place individuals can collect, you understand, in a secure and nice method. You understand, different nations do tons of issues. You understand, there are packages in different nations that encourage teenagers, that finance and help teenagers forming storage bands, in Scandinavian nations. I imply, there are there are coverage responses, and perhaps a few of them are already being tried out at like the town degree in quite a lot of locations. However I’m not listening to lots aside from telling individuals to make particular person life adjustments, which might not be attainable.

Rovner: However though I used to be going to level out that one of many causes that that is changing into an even bigger difficulty is that the variety of People residing alone has gone up. You understand, and once more, Joanne, this was method earlier than the pandemic, nevertheless it’s extra seemingly — individuals are extra ready to be lonely, mainly. I imply, it’s going to have an effect on a bigger a part of the inhabitants, so —

Kenen: And among the issues that Alice urged are insurance policies which might be being labored on due to, you understand, social determinants and different issues: recreation, housing. These issues are occurring at each the state and federal degree. So they might assist loneliness, however I don’t suppose you’re going to see them branded as a loneliness — nationwide loneliness program. However, you understand, the demographics of this nation — you understand, households are scattered. Zoom is nice, you understand, however Zoom isn’t actual life. And there are extra people who find themselves single, there are extra people who find themselves widowed, there are extra individuals who by no means married, there are extra people who find themselves divorced, the aged cohort. Many individuals stay alone, and youths and youngsters have had a tough time within the final couple years. So I feel on one degree it’s simple for individuals to make enjoyable of it as a result of, you understand, we’re popping out of this pandemic and the surgeon basic’s speaking about loneliness. However, there are tens of millions or tens of tens of millions of people who find themselves lonely. And I feel this does form of assist individuals perceive that there are issues to be accomplished about it that — I don’t suppose particular person motion is all the time a foul factor. I imply, encouraging individuals to consider the individuals of their lives who is likely to be lonely might be factor. It’s social cohesion. I imply, Republicans could make that case, proper, that we’ve to, you understand, everyone wants to select up a phone or go for a stroll and knock on a door.

Rovner: Yeah, they do. I imply, Republicans are massive on doing issues on the group degree. That’s the thought, is let’s have authorities on the lowest degree attainable. Properly, this will likely be an attention-grabbing difficulty to look at and see if it catches on extra with the general public well being group. All proper. That’s this week’s information. Now it’s time for our further credit score phase. That’s after we every suggest a narrative we learn this week we predict you need to learn too. As all the time, don’t fear for those who miss it. We are going to publish the hyperlinks on the podcast web page at KFF Well being Information and in our present notes in your cellphone or different cell gadget. Rachel, why don’t you go first this week?

Cohrs: My story is in ProPublica and the headline is “This Pharmacist Mentioned Prisoners Wouldn’t Really feel Ache Throughout Deadly Injection. Then Some Shook and Gasped for Air,” by Lauren Gill and Daniel Moritz-Rabson. And I feel it’s only a story about this ongoing difficulty of knowledgeable testimony in prison justice settings. And clearly these are actually necessary questions on drugs that, you understand, are used for deadly injections and the way they work and simply how, you understand, individuals are responding to them within the second. And I imply, it’s simply such an necessary difficulty that will get neglected within the pharmaceutical house typically. And yeah, I feel it’s simply one thing that may be very sobering, and it’s only a actually necessary learn.

Rovner: Yeah. I imply, there’s been lots about docs and the ethics of collaborating in these. That is the primary time I’ve seen a narrative about pharmacists. Joanne?

Kenen: Properly, I noticed this one in The Atlantic. It’s by Yasmin Tayag, and I couldn’t resist the headline: “There Is No Stopping the Allergy Apocalypse.” Principally, due to local weather change, allergic reactions are getting worse. When you have allergic reactions, you already know that. When you suppose you don’t have allergic reactions, you’re in all probability unsuitable; you’re in all probability about to get them. They take a short time to point out up. So it’s not in a single area; it’s in every single place. So, you understand, we’re all going to be wheezing, coughing, sneezing, sniffling much more than we’re used to, together with if you weren’t beforehand a wheezer, cougher, or sniffler.

Rovner: Oh, I can’t wait. Alice.

Ollstein: So I’ve a chunk from The Wall Avenue Journal known as “Sufferers Lose Entry to Free Medicines Amid Spat Between Drugmakers, Well being Plans,” by Peter Loftus and Joseph Walker. And it’s some actually tragic tales about people who’re seeing their month-to-month prices for drugs they rely on to stay shoot up. In a single occasion within the story, what he has to pay per 30 days shot up from 15 to greater than 12,000. And so you’ve got the drugmakers, the insurance coverage corporations, and the middlemen pointing fingers at one another and saying, you understand, “That is your fault, that is your fault, that is your fault.” And in the meantime, sufferers are struggling. So, actually attention-grabbing story, hope it results in some motion to assist people.

Rovner: I used to be going to say, perhaps the HELP Committee will get its act collectively, as a result of it’s attempting to work on this.

Ollstein: Yeah.

Rovner: Properly, my story is from The Washington Publish, and it’s known as “Canine-Strolling Accidents Could Be Extra Widespread Than You Suppose,” by Lindsey Bever. And it’s a couple of research from Johns Hopkins, together with your colleagues, Joanne, that discovered that just about half one million individuals have been handled in U.S. emergency rooms for an damage sustained whereas strolling a canine on a leash. Not surprisingly, most have been ladies and older adults, who’re most probably to be pulled down by a really sturdy canine. The three most recognized accidents have been finger fractures, traumatic mind accidents, and shoulder accidents. As a part-time canine coach in my different life, listed here are my two largest suggestions, aside from coaching your canine to stroll politely on a leash: Don’t use retractable leashes; they’ll really minimize off a finger if it will get caught in a single. And by no means wrap the leash round your hand or your wrist. So that’s my medical recommendation for this week. And that’s our present. As all the time, for those who benefit from the podcast, you may subscribe wherever you get your podcasts. We’d respect it for those who left us a evaluation; that helps different individuals discover us too. Particular thanks, as all the time, to our ever-patient producer, Francis Ying. Additionally, as all the time, you may e-mail us your feedback or questions. We’re at whatthehealth@kff.org. Or you may tweet me, so long as Twitter’s nonetheless there. I’m @jrovner. Joanne?

Kenen: @JoanneKenen.

Rovner: Alice.

Ollstein: @AliceOllstein.

Rovner: Rachel.

Cohrs: @rachelcohrs.

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


Francis Ying
Audio producer

Emmarie Huetteman

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