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Julie Rovner
KFF Health News

@jrovner

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

The presidential election is less than five months away, and while abortion is the only health policy issue expected to play a leading role, others are likely to be raised in the presidential and down-ballot races. This election could be critical in determining the future of key health care programs, such as Medicaid and the Affordable Care Act.

In this special episode of KFF Health News’ “What the Health?” taped at the Aspen Ideas: Health festival in Aspen, Colorado, Margot Sanger-Katz of The New York Times and Sandhya Raman of CQ Roll Call join Julie Rovner, KFF Health News’ chief Washington correspondent, to discuss what the election season portends for top health issues.

Panelists

Margot Sanger-Katz
The New York Times

@sangerkatz

Read Margot's stories.

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Policies surrounding abortion — and reproductive health issues, in general — likely will dominate in many races, as Democrats try to exploit an issue that is motivating their voters and dividing Republican voters. The topics of contraception and in vitro fertilization are playing a more prominent role in 2024 than they have in past elections.
• High prescription drug prices — which, for frustrated Americans, are a longtime symbol, and symptom, of the nation’s dysfunctional health care system — have been a priority for the Biden administration and, previously, the Trump administration. But the issue is so confusing and progress so incremental that it is hard to say whether either party has an advantage.
• The fate of many major health programs will be determined by who wins the presidency and who controls Congress after this fall’s elections. For example, the temporary subsidies that have made Affordable Care Act health plans more affordable will expire at the end of 2025. If the subsidies are not renewed, millions of Americans will likely be priced out of coverage again.
• Previously hot-button issues like gun violence, opioid addiction, and mental health are not playing a high-profile role in the 2024 races. But that could change case by case.
• Finally, huge health issues that could use public airing and debate — like what to do about the nation’s crumbling long-term care system and the growing shortage of vital health professionals — are not likely to become campaign issues.

click to open the transcript

Transcript: Live From Aspen: Health and the 2024 Elections

KFF Health News’ ‘What the Health?’ Episode Title: ‘Live From Aspen: Health and the 2024 Elections’Episode Number: 352Published: June 21, 2024

[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.] 

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Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent at KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. I am joined tonight by a couple of our regular panelists: Margot Sanger-Katz, The New York Times.

Sanger-Katz: Hey, everybody.

Rovner: And Sandhya Raman of CQ Roll Call.

Raman: Good evening everyone.

Rovner: For those of you who aren’t regular listeners, we have a rotating panel of more than a dozen health policy reporters, all of whom just happen to be women, and every week we recap and analyze the week’s top health news. But tonight we’ve been given a slightly different assignment to talk about how health policy is likely to shape the 2024 elections and, vice versa, how the elections are likely to shape health policy.

So, this is actually my 10th presidential election season as a health reporter, which is terrifying, and I can say with some experience that health is one of those issues that’s always part of the political debate but is relatively rarely mentioned when pollsters ask voters what their top issue is. Of those of you who went to the pollsters session this afternoon might’ve seen that or said we’re not going to… it’s not going to be a health election this year.

This year, though, I think will be slightly different. As you’ll hear, I’ve divided these issues into three different buckets: Those that are likely to be pivotal or very important to how people vote; those that are likely to come up over the next few months in the presidential and/or congressional and Senate races; and finally, a couple of issues that aren’t as likely to come up but probably should. It would be good to have a debate about them.

So we will start with the political elephant in the room: reproductive health. Since the Supreme Court overturned Roe v. Wade two years ago next week, abortion has been front and center in just about every political contest, usually, though not always, with the abortion-right side prevailing. How do you two see abortion playing out both at the presidential and congressional level these next couple of months?

Raman: I see it playing out in kind of two different ways. We see already at the presidential level that President Joe Biden has been really going in, all in, that this is his No. 1 issue, and I think this will continue to play out, especially next week with the anniversary of the Dobbs [v. Jackson Women’s Health Organization] decision.

And a lot of the Democrats in the Senate have kind of been taking lead from that and also really amping up the issue. They’ve been doing kind of messaging votes on things within the reproductive health spectrum and it seems like they’re going to continue that in July. So we’re going to see it really focused on there. On the Republican side, they’ve been not focused on this issue as much.

Rovner: They’ve been ducking this issue.

Raman: Yes, they’ve been ducking this issue, so I think it’ll just be continued to be downplayed. They’ve really been going in on immigration more than any other of the issues that they’ve got this year.

Sanger-Katz: If you look at the public polling, abortion is one of really the only issues where the Democrats and Joe Biden seem to have a real advantage over the Republicans and Donald Trump. And so I think that that tells you that they’re going to have to be hitting it a lot. This is an issue where the voters are with the Democrats. They trust Biden more. They agree more with the policies the Democrats are promoting around reproductive health care. So it’s just impossible for me to imagine a scenario in which we don’t see Democrats kind of up and down the ticket really taking advantage of this issue, running ads on it, talking about it, and trying to really foreground it.

I think for Biden, in particular, it’s a hard issue. I think he has always had some personal ambivalence about abortion. He’s a Catholic. He, early in his career, had opposed certain abortion rights measures that other Democrats had endorsed, and you can kind of see him slowly getting comfortable with this issue. I think he said the word abortion for the first time just in the last six months. I think I would anticipate a real ramping up of discussion of this issue among Democrats. The other dynamic that I think is pretty important is that there are a number of states that have ballot initiatives to try to kind of permanently enshrine abortion rights into state constitutions.

And some of those are in states that are not pivotal to the election, and they will be important in those states, and for those state senate races and governor races and other things, because they may pull in more of these voters who care a lot about reproductive rights. But there are some of these ballot measures that are in pivotal states for the presidential race, the kind of battleground states that we’re all watching. And so there’s a big emphasis on those as well. And I think there’s some interesting tensions with those measures because abortion rights actually are valued by people across the political spectrum.

So I think we tend to think of this as a Democrat-Republican issue where Republicans want to restrict abortion rights, and Democrats want to promote them. But we’re seeing in the public polling now that’s not really true. There are a lot of Republicans that are uncomfortable with the kind of abortion bans that we’re seeing in certain parts of the country now. So it’s this question: Are they going to come out and vote and split their ticket where they’ll vote for constitutional measure to protect abortion rights and still vote for President Trump? Or will the abortion issue mobilize them so much that they will vote across the board as Democrats?

And I think that’s a big question, and I think it’s a big challenge. In fact, for many of the people that are running these campaigns to get these ballot measures passed, how much they want to kind of lean into the Democratic messaging and try to help prop up Democratic candidates in their state. And how much they want to just take a step back and try to get Republicans to support their particular measure, even if it doesn’t help Democratic candidates on the ticket.

Rovner: Well, of course, it’s not just abortion that’s on the ballot, literally and figuratively. There’s a not-insignificant portion of the anti-abortion movement that not only wants to ban abortion nationwide but wants to establish in law something called personhood. The concept that a person with full legal rights is created at fertilization.

That would result in outlawing many forms of contraception, as well as if we have seen rather vividly this spring, IVF. Unlike abortion, contraception and IVF are very widely supported, not nearly as divisive as abortion itself is. Are we potentially looking at a divorce between the Republican Party and its longtime absolutist, anti-abortion backers?

Raman: I think that Republicans have been toeing the line on this issue so far. We’ve seen them not support some of the Democrats’ bills on the state level, the federal level, that are related to IVF, but at the same time, kind of introducing their counterparts or issuing broad statements in support of IVF, in support of contraception. Even just like a couple of weeks ago, we had Sen. Rick Scott of Florida release an IVF-themed full ad.

And so we have a lot of messaging on this, but I think at the same time a lot of these are tiptoeing the line in that they might not add any new protections. They might not codify protections for any of these procedures. They might just issue support or not address some of the other issues there that people have been going back and forth with the personhood issue.

Sanger-Katz: I think this is a big challenge for the Republican Party, not just over the course of this particular election cycle, but I think thinking further into the future. The pro-life movement has been such a pivotal group of activists that have helped elect Republicans and have been so strongly allied with various other Republican interest groups across the last few decades. And you can see that those activists helped overturn Roe after nearly 50 years of having a constitutional right to abortion.

Many of them don’t want to give up there. They really want to abolish abortion. They think it’s a morally abhorrent and something that shouldn’t happen in this country. And they’re concerned that certain types of contraception are similar to abortion in certain ways and that IVF is also morally abhorrent. And we saw recently with the [Southern] Baptist Convention that there was a vote basically to say that they did not support in vitro fertilization and assisted reproductive technologies.

Yet, at the same time, you can see in public polling and in the way that the public responds to these kinds of messages that the activists are way out further than the typical voter and certainly way out further than the typical Republican voter. And there’s this interesting case study that happened a few months ago where the Alabama Supreme Court issued a ruling — the implications of which suggested that IVF might be imperiled in that state — and it was kind of uncertain what the result that would be.

And what happened, in fact, is that Republicans and the Alabama State Legislature and the Republican governor of Alabama, many of whom had sort of longtime pro-life connections and promises, immediately passed a bill to protect in vitro fertilization because they saw that it was something that their voters really cared about and that’s something that could really hurt them politically if they were being seen as being allied with a movement that wanted to ban it.

But the activists in this movement are really important part of the Republican coalition, and they’re very close to leadership. And I think this is going to be a real tension going forward about how does the party accommodate itself to this? Do they win hearts and minds? They figure out a way to get the public on their side? Or do they kind of throw over these people who have helped them for so long, and these ideological commitments that I do think that many Republican politicians really deeply do hold?

Rovner: How much wild card is Donald Trump can be in this? He’s been literally everywhere on this issue, on reproductive rights in general. He is not shy about saying he thinks that abortion is a loser of an issue for Republicans. He wants to just continue to say, “Let the states do whatever they want.”

But then, of course, when the states do things like perhaps ban IVF — that I would think would even make Donald Trump uncomfortable — he seems to get away with being anywhere he wants with these very strong evangelical and pro-life groups who have supported him because, after all, he appointed the two Supreme Court justices that overturned Roe. But I’m wondering if, down-ballot, how all these other candidates are going to cope with the forever sort of changing position of the head of their ticket.

Sanger-Katz: I think it’s pretty interesting. I was talking with a colleague about this recently. It seems like Trump’s strategy is to just have every position. If you look at his statements, he said just about every possible thing that you could possibly say about abortion and where he stands on it. And I think it’s actually quite confusing to voters in a way that may help him because I think if you’re only looking for the thing that you want to hear, you can find it.

If you’re someone who’s really a pro-life activist who cares a lot about restricting abortion, he brags about having been responsible for overturning Roe. And if you’re someone who really cares about protecting IVF, he’s said that he wants that. If you’re someone who want… lives in a state that has… continues to have legal abortion, he said, “We’re going to leave that up to the states.”

If you’re in a state that has banned abortion, that has very extreme bans, he said something that pleases you. And so, I don’t know. I did a story a few weeks ago where I interviewed voters who had been part of a New York Times/Siena poll, and these were voters who, they were asked a question: Who do you find responsible for the Dobbs decision for the overturning of Roe v. Wade? And these were voters who supported abortion rights but thought that Joe Biden was responsible. And there’re like… it’s not a lot of people, but it’s …

Rovner: But it’s like 20%, isn’t it?

Sanger-Katz: Yeah, it’s like 10[%], 15% of voters in battleground states, people whose votes are really going to matter and who support abortion rights. They don’t know who was responsible. They don’t really understand the dynamics of where the candidates are on this issue. And I think for those of us who are very politically engaged and who are following it closely, it’s kind of hard to imagine. But they’re just a lot of people who are not paying close attention.

And so I think that makes Trump being everywhere on the issue, it makes it easier for those people to not really engage with abortion. And I think that’s again why I think we’re going to see the Biden campaign and other Democrats kind of hitting it over and over and over again. “This is Trump’s fault. We are going to protect abortion rights.” Because I think that there are a lot of voters who don’t really know what to make of the candidates and don’t know what to make of Trump on this particular issue.

Rovner: Well, Sandhya, they keep trying to bring it up in Congress, but I don’t think that’s really breaking through as a big news story.

Raman: No, and I think that for Congress, we’ve seen the same thing this year, but we’ve also seen it in previous years where they coalesce around a certain week or a certain time and bring up different bills depending on who’s in control of that chamber to message on an issue. But it hasn’t really moved the needle either way that we get similar tallies, whether it was this year or three years ago or 10 years ago.

One thing that I think activists are really looking at on the pro-life side is just really Trump’s record on these issues. Regardless of what he’s saying this week or last week or in some of these different interviews that’s a little all over the place. They’ve pointed to a lot of things that he’s done, like different things that he’s expanded more than previous Republican presidents. And for them, that might be enough.

That’s if it’s just the dichotomy of Biden versus Trump, that to get to their end goal of more pro-life policies, then Trump is the easy choice. And in the past years, the amount of money that they have poured into these elections to just really support issues… candidates that are really active on these issues, has grown astronomically. So I don’t know that necessarily if he does make some of these statements it’s going to make a huge difference in their support.

Sanger-Katz: And I think it also comes back to Julie’s opening point, which is I think abortion is an issue on which the Democrats have a huge edge, and I do think it is an issue that is very mobilizing for certain types of voters. But I also think that this is an election in which a lot of voters, whatever their commitments are on abortion, may be deciding who to vote for based on another set of issues. Those people that I talked to who were kind of confused about abortion, they really cared a lot about the economy.

They were really concerned about the cost of groceries. And so I think for those people, they may have a preference on abortion. If they could sort of pick each individual issue, they might pick something different. But I think the fact that they supported abortion rights did not necessarily mean that even if they really understood where the candidates were that they were necessarily going to vote for Joe Biden. I think a lot of them were going to vote for Donald Trump anyway because they thought he was better on the issues that were affecting their daily lives more.

Rovner: Well, Margot, to your point about voters not knowing who’s responsible for what, I think another big issue in this campaign is going to be prescription drug prices. As we know, drug prices are kind of the stand-in for everything that’s currently wrong with the nation’s health care system. The system is byzantine. It can threaten people’s health and even their lives if they can’t afford it.

And just about every other country does it better than we do. Interestingly, both President Biden and former President Trump made drug prices a top health priority, and both have receipts to show what they have done, but it’s so confusing that it’s not clear who’s going to get credit for these things that have gotten done.

Trump said that Biden was lying when Biden said that he had done the insulin cap for Medicare, which in fact was done by the Democrats, although Trump had done sort of a precursor to it. So, who wins this point, or do you think it’s going to end up being a draw? Because people are not going to be able to figure out who was responsible for which parts of this. And by the way, we haven’t really fixed it anyway.

Raman: I would say it was a draw for two reasons. I think, one, when we deal with something like drug prices, it takes a while for you to see the effects. When we have the IRA [Inflation Reduction Act] that made it so that we can negotiate the price of some drugs under Medicare, the effects of that are over a long tailwind. And so it’s not as easy to kind of bring that up in political ads and that kind of thing when people aren’t seeing that when they go to the pharmacy counter.

And I think another thing is that for at least on the congressional level, there’s been a little bit of a gap in them being able to pass anything that kind of moves the point along. They made some efforts over the past year but weren’t able to get it over the finish line. I think it’s a lot more difficult to say, “Hey, we tried but didn’t get this done” without a … as a clear campaign message and to get votes on that.

Sanger-Katz: I also think it’s this issue that’s really quite hard because — setting aside $35 insulin, which we should talk about — most people have insurance, and so the price of the drug doesn’t always affect them in a direct way. A lot of times, when people are complaining about the high cost of drugs, they’re really complaining about the way that their insurance covers the drug. And so the price of the drug might, in fact, be astronomical, but it’s the $100 copayment that people are responding to.

And so it could be that the government is taking all these actions, or the companies by themselves, and the price has gone down, but if you’re still paying that $100 copayment, you’re not really experiencing the benefits of that change. So I do think that the Democrats and Joe Biden have done two things that are helpful in that regard. So, one, is this $35 cap on copayments for insulin. So that’s just for people in Medicare, so it’s not everyone. But I do think that is… it’s a great talking point. You can put that on an ad. It’s a real thing.

People are going to go to the pharmacy counter, and they’re not going to pay more than that. It’s easy to understand. The other thing that they did, and I think this is actually harder to understand, is they redesigned the drug benefit for people who have Medicare. So it used to be in Medicare that if you had a really expensive set of drugs that you took, like, say, you had cancer and you were taking one of these newer cancer drugs that cost tens of thousands dollars a year, you could be on the hook for tens of thousands of dollars a year out of your own pocket, on top of what your insurance covered.

If you took less-expensive drugs, your insurance kind of worked the way it works for people in the commercial market where you have some copayments, not that you don’t pay anything, but it wasn’t sort of unlimited. But for really high-cost drugs in Medicare, people in Medicare were on the hook for quite a lot of money, and the Inflation Reduction Act changed that. They changed the Medicare drug benefit, and now these people who have these really expensive health conditions have a limit. They only have to pay a couple of thousand dollars a year.

Rovner: But it doesn’t start until next year.

Sanger-Katz: But it doesn’t start until next year. So I just think a lot of this stuff around drug prices is, people feel this sense of outrage that the drugs are so expensive. And so I think that’s why there’s this huge appetite for, for example, having Medicare negotiate the price of drugs. Which is another thing that the Inflation Reduction Act enabled, but it’s not going to happen in time for the election.

But I don’t think that really hits people at the pharmacy counter. That is more the benefits of that policy are going to affect taxpayers and the government. They’re not going to affect individual people so much. And I think that’s part of why it’s such a hard issue. And I think that President Trump bumped up against this as well.

His administration was trying all of these little techniques deep in the works of the drug pricing and distribution system to try to find ways to lever down the prices of drugs. And some of them worked, and some of them didn’t. And some of them got finalized, and some of them didn’t. But I think very few of them had this obvious consumer impact. And so it was hard for them to go to the voters and say, “We did this thing. It affected your life.”

Rovner: I see some of these ads, “We’ve got to do something about the PBMs [Pharmacy Benefit Managers].” And I’m like, “Who’s this ad even aimed at? I cover this for a living, and I don’t really understand what you’re talking about.” I wonder, though, if some… if candidates really on both sides, I mean, this is a unique election in that we’ve got two candidates, both of whom have records behind them.

I mean, normally, you would have at least one who’s saying, “This is what I will do.” And, of course, when it comes to drug prices, the whipping boy has always been the drug companies. And I’m wondering if we’re not going to see candidates from both parties at all levels just going up against the drug companies because that’s worked in the past.

Raman: I think it’s kind of a difficult thing to do when I think so many candidates, congressional level especially, have good relationships with pharmaceutical companies as some of the top donors for their campaigns. And so there’s always that hesitation to go too hard on them when that is helping keep them in office.

So it’s a little bit more difficult there to see teeth-out going into an ad for something like that. I think when we go back to something like PBMs where it seems like everyone in Congress just has made that kind of the bully of this past couple years, then that might be something that’d be easier to throw into ads saying, “I will go after PBMs.”

Sanger-Katz: I think we’re likely to see, especially in congressional races, a lot of candidates just promising to lower your drug prices without a whole lot of detail under that.

I don’t know that it’s necessarily going to be like the evil pharmaceutical companies, and I don’t think it’s going to be detailed policy proposals for all the reasons I just said: because it’s complicated; doesn’t always affect people directly; it’s hard to understand. But I think it will be a staple promise that we’ll particularly see from Democrats and that I expect we will hear from President Trump as well because it’s something that has been part of his kind of staple of talking points.

Rovner: So let’s move on to some of the issues that are sort of the second-tier issues that I expect will come up, just won’t be as big as immigration and abortion. And I want to start with the Affordable Care Act. I think this is the first time in a presidential election year that it seems that the continuing existence of the ACA is no longer in question. If you disagree, do let me know, but that’s not to suggest …

Sanger-Katz: Maybe last time.

Rovner: Little bit. That’s not to suggest, though, that the fate of the Affordable Care Act is not also on the line in this election. The additional subsidies that the Democrats added in the Inflation Reduction Act, which will sunset at the end of next year unless they are renewed, are responsible in large part for the largest percentage of Americans with health insurance ever measured.

And conversely, the Congressional Budget Office estimates that enrollment would fall by an immediate 20% if the subsidies are allowed to expire. It’s hard to see how this becomes a campaign issue, but it’s obviously going to be really important to what… I mean who is elected is going to be really important to what happens on this issue, and it’s a lot of people.

Raman: Using the subsidies as a campaign point is a difficult thing to do. It’s a complicated issue to put in a digestible kind of ad thing. It’s the same thing with a lot of the prescription drug pricing policies where, to get it down to the average voter, is hard to do.

And I think had we not gotten those subsidies extended, we would’ve seen people more going into that in ads. But when it’s keeping the status quo, people aren’t noticing that anything has changed. So it’s an even more difficult thing to kind of get across.

Sanger-Katz: I think this is one of, in health care, one of the highest-stakes things. That I feel like there’s just a very obvious difference in policy depending on who is elected president. Whereas a lot of the things that we’ve talked about so far, drug prices, abortion, a little harder to predict. But just to get out of the weeds for a second, Congress increased the amount of money that poor and middle-class people can get when they buy their own health insurance on the Obamacare exchanges. And they also made it possible for way more people to get health insurance for free.

So there are a lot of Americans who were uninsured before who now have insurance that they don’t pay a single dollar for. And there are also a lot of Americans that are higher, the kind of people that were disadvantaged in the early years of Obamacare, sort of self-employed people, small business owners who bought their own insurance and used to just have sort of uncapped crazy premiums. People who earn more than $100,000 a year now have financial assistance for the first time ever. And that policy has been in place for several years, and we’ve seen record enrollment.

There’s lots more people with insurance now, and their insurance is more affordable than it’s ever been. And those things are, of course, related. I think it’s almost definitely going to go away if Trump is elected to the presidency and if Republicans take at least one house of Congress because basically it’s on a glide path to expiration. So if nothing is done, that money will go away. What needs to happen is for Congress to pass a new law that spends new money to extend those subsidies and for a president to sign it.

And I just think that the basic ACA, the stuff that passed in 2010, I think is relatively safe, as Julie says. But lots of people are going to face much more expensive insurance and maybe unaffordable insurance. And again, the CBO [Congressional Budget Office] projects that a lot of people will end up giving up their insurance as a result of those changes if these policies are allowed to expire. And so I don’t know. I think we don’t see candidates talking about it very much. But I don’t actually think it’s that hard to message on. You could just say, “If you vote for this guy, your insurance premiums are going to go up by 50% or whatever.”

That doesn’t seem like a terrible message. So I do wonder if we’ll see more of that, particularly as we get closer to the election. Because it does feel like a real pocketbook issue for people. The cost of health care, the cost of health insurance, like the cost of drugs, I think, is something that really weighs on people. And we’ve seen in these last few years that making insurance cheaper has just made it much more appealing, much more accessible for people. There’s lots more Americans who have health insurance now, and that’s at risk of going away.

Rovner: Well, also on the list of things that are likely to come up, probably not in the presidential race, but certainly lower down on the ballot, is gender-affirming care. Republicans are right now are all about parental control over what books their children read and what they’re taught in school, but not apparently about medical care for their children.

They want that to be determined by lawmakers. This is very much a wedge issue, but I’m wondering for which side. I mean, traditionally, it would’ve been the conservatives and the evangelicals sort of pushing on this. But as abortion has sort of flip-flopped in importance among voters, I’m wondering where this kind of falls into that.

Raman: I think that the messaging that I’ve seen so far has still prominently been from Republicans on this issue. Whether or not it’s bills that they’ve been introducing and kind of messaging on in Congress or just even in the ads, there’s still been a lot of parental safeguards and the language related to that with relation to gender-affirming care. I have not actually seen as many Democratic ads going super into this. I think they have been way more focused on abortion.

I’m thinking back to, I saw a statistic that 1 in 4 Democratic ads go into abortion, which is really high compared to previous years. And so I don’t know that it will be as big of an issue. I even see some people kind of playing it down because the more attention it gets, sometimes it rallies people up, and they don’t… It’s kind of the flip of Republicans not wanting to bring attention to the abortion issue. And I think a lot of Democrats are trying to shy away so that some of these things aren’t elevated, that we aren’t talking about some of the talking points and the messaging that Republicans are bringing up on the same thing.

Sanger-Katz: Yeah, it feels to me almost like a mirror image of the abortion issue in the sense that the Democrats have this challenge where their activists are out in front of their voters. There clearly are parts of the Democratic coalition that are really concerned about transgender rights and wanting to protect them and are very opposed to some of the action that we’re seeing at the state and local level, both in terms of what’s happening in schools, but also regulation of medical care. But I think voters I think are less comfortable with transgender rights.

Even Democratic voters, you see sort of there’s more of a generational split on this issue than on some of these other issues where I think older voters are just a little bit less comfortable. And so I do think that it is an issue where — particularly certain parts of it like transgender athletes — that seems to be an area where you see the Republican message really getting more traction among certain subsets of Democratic voters. And I think it’s a hard issue for Democrats except in the places where there’s really broad acceptance.

Rovner: So I want to move on to the things that are less likely to come up, but probably should. We’re going to start with Medicaid. During the pandemic, it grew to cover over 90 million Americans. That’s like a third more than Medicare, which most people still think of as the largest government health program.

But as states pare back their roles after the expiration of the public health emergency, it seems that lots of people — particularly children, who are still eligible — are getting dropped nonetheless. During the fight over repealing the Affordable Care Act in 2017, it was the fate of Medicaid in large part that saved the program.

Suddenly, people realized that their grandmother was getting Medicaid and that one out of every three births, maybe one of every two births, is paid for by Medicaid. But now it seems not so much. Has Medicaid gotten invisible again in national politics?

Raman: I think, in a way, it has. I mean, it doesn’t mean that it’s any less important, but I haven’t seen as big of a push on it, as many people talking about it. And I think it is more of a tricky thing to message on at this point, given that if you look at where the states that have been disenrolling a lot of people, a lot of the ones that are near the top, are blue states.

California is a bigger population, but it’s also the one where they’ve disenrolled the most people. And so messaging on this is going to be difficult. It’s a harder thing to kind of attack your opponent on if this is something that is also being … been difficult in your state. It’s something that states have been grappling with even before we even got to this point.

Sanger-Katz: I think this is another issue where, I think, the stakes of the election are actually quite high. I do think it’s relatively invisible as an issue. I think part of the reason is that we don’t really see the Republicans talking about it, and I think the Democrats don’t really know how to message on it. I think they were really good at, “We’re going to protect you. We’re going to prevent the Republicans from taking this away from you.” But I think they don’t have a good affirmative message about, “How we love this program and we want to support and extend it.”

I don’t think voters are really responding to that. But if you look at what President Trump did in his first administration, he had budgets every single year that proposed savage cuts to Medicaid, big changes to the structure and funding of the program. Those did not get enacted into law. But even after Obamacare repeal was abandoned, you did not see the Trump budgets and the Trump administration, economic officials and health officials, abandoning those plans to make significant cuts to Medicaid.

And I think there are quite a lot of people in the Republican health policy world who think that Medicaid is sort of a bloated and wasteful program that needs to be rethought in a kind of fundamental way, needs to be handed back to the states to give them more fiscal responsibility and also more autonomy to run the program in their own way. I think we will see that again. I also think it’s very hard to know, of course, I feel like anytime… whoever’s in power is always less concerned about the deficit than they are when they are running for election.

But something we haven’t talked about because it’s not a health care issue, is that the expiration of the Trump tax reform bill is going to come up next year, and all of our budget projections that we rely on now assume that those tax cuts are going to expire. I think we all know that most of them probably are not going to expire regardless of who is elected. But I think if Trump and the Republicans take power again, they’re going to want to do certainly a full renewal and maybe additional tax cuts.

And so I think that does put pressure, fiscal pressure on programs like Medicaid because that’s one of the places where there’s a lot of dollars that you could cut if you want to counterbalance some of the revenues that you’re not taking in when you cut taxes. I think Medicaid looks like a pretty ripe target, especially because Trump has been so clear that he does not want to make major cuts to Medicare or to Social Security, which are kind of the other big programs where there’s a lot of money that you could find to offset major tax cuts if you wanted to.

Rovner: Yet, the only big program left that he hasn’t promised not to cut, basically. I guess this is where we have to mention Project 2025, which is this 900-page blueprint for what could happen in a second Trump term that the Trump campaign likes to say, whenever something that’s gets publicized that seems unpopular, saying, “It doesn’t speak for us. That’s not necessarily our position.”

But there’s every suggestion that it would indeed be the position of the Trump administration because one of the pieces of this is that they’re also vetting people who would be put into the government to carry out a lot of these policies. This is another one that’s really hard to communicate to voters but could have an enormous impact, up and down, what happens to health.

Sanger-Katz: And I think this is true across the issue spectrum that I think presidential candidates, certainly congressional candidates and voters, tend to focus on what’s going to happen in Congress. What’s the legislation that you’re going to pass? Are you going to pass a national abortion ban, or are you going to pass a national protect-abortion law? But actually, most of the action in government happens in regulatory agencies. There’s just a ton of power that the executive branch has to tweak this program this way or that.

And so on abortion, I think there’s a whole host of things that are identified in that Project 2025 report that if Trump is elected and if the people who wrote that report get their way, you could see lots of effects on abortion access nationwide that just happened because the federal agencies change the rules about who can get certain drugs or how things are transported across state lines. What happens to members of the military? What kind of funding goes to organizations that provide contraception coverage and other related services?

So, in all of these programs, there’s lots of things that could happen even without legislation. And I think that always tends to get sort of undercovered or underappreciated in elections because sort of hard to explain, and it also feels kind of technical. I think, speaking as a journalist, one thing that’s very hard is that this Project 2025 effort is kind of unprecedented in the sense that we don’t usually have this detailed of a blueprint for what a president would do in all of these very detailed ways. They have, I mean, it’s 100…

Rovner: Nine-hundred …

Sanger-Katz: … 900-page document. It’s like every little thing that they could do they’ve sort of thought about in advance and written down. But it’s very hard to know whether this document actually speaks for Trump and for the people that will be in leadership positions if he’s reelected and to what degree this is sort of the wish casting of the people who wrote this report.

Rovner: We will definitely find out. Well, kind of like Medicaid, the opioid crisis is something that is by no means over, but the public debate appears to have just moved on. Do we have short attention spans, or are people just tired of an issue that they feel like they don’t know how to fix? Or the fact that Congress threw a lot of money at it? Do they feel like it’s been addressed to the extent that it can be?

Raman: I think this is a really difficult one to get at because it’s — at the same time where the problem has been so universal across the country — it has also become a little fragmented in terms of certain places, with different drugs becoming more popular. I think that, in the past, it was just so much that it was the prescription opioids, and then we had heroin and just different things. And now we have issues in certain places with meth and other drugs. And I think that some of that attention span has kind of deviated for folks. Even though we are still seeing over 100,000 drug-related deaths per year; it hasn’t dipped.

And the pandemic, it started going up again after we’d made some progress. And I’m not sure what exactly has shifted the attention, if it’s that people have moved on to one of these other issues or what. But even in Congress, where there have been a lot of people that were very active on changing some of the preventative measures and the treatment and all of that, I think some of those folks have also left. And then when there’s less of the people focused on that issue, it also just slowly trickles as like a less-hyped-up issue in Congress.

Sanger-Katz: I think it continues to be an issue in state and local politics. In certain parts of the country I think this is a very front-of-mind issue, and there’s a lot of state policy happening. There’s a lot also happening at the urban level where you’re seeing prosecutors, mayors, and others really being held accountable for this really terrible problem. And also with the ancillary problems of crime and homelessness associated with people who are addicted to drugs. So, at the federal level, I agree, it’s gotten a little bit sleepy, but I think in certain parts of the country, this is still a very hot issue.

And I do think this is a huge, huge, huge public health crisis that we have so many people who are dying of drug overdoses and some parts of the country where it is just continuing to get worse. I will say that the latest data, which is provisional, it’s not final from the CDC [Centers for Disease Control and Prevention], but it does look like it’s getting a little bit better this year. So it’s getting better from the worst ever by far. But it’s the first time in a long time that overdoses seem to be going down even a little. So I do think there’s a glimmer of hope there.

Raman: Yeah. But then the last time that we had that, it immediately changed again. I feel like everyone is just so hesitant to celebrate too much just because it has deviated so much.

Sanger-Katz: It’s definitely, it’s a difficult issue. And even the small improvements that we’ve seen, it’s a small improvement from a very, very large problem, so.

Rovner: Well, speaking of public health, we should speak of public health. We’re still debating whether or not covid came from a wet market or from a lab leak, and whether Dr. [Anthony] Fauci is a hero or a villain. But there seems to be a growing distrust in public health in general. We’ve seen from President Trump sort of threatened to take federal funds away from schools with vaccine mandates.

The context of what he’s been saying suggests he’s talking about covid vaccines, but we don’t know that. This feels like one of these issues that, if it comes up at all, is going to be from the point of view of do you trust or do you not trust expertise? I mean, it is bigger than public health, right?

Raman: Yeah. I think that… I mean, the things that I’ve seen so far have been largely on the distrust of whether vaccines are just government mandates and just ads that very much are aligning with Trump that I’ve seen so far that have gone into that. But it does, broader than expertise.

I mean, even when you go back to some of the gender-affirming care issues, when we have all of the leading medical organizations that are experts on this issue speaking one way. And then we having to all of the talking points that are very on the opposite spectrum of that. It’s another issue where even if there is expertise saying that this is a helpful thing for a lot of folks that it’s hard to message on that.

Sanger-Katz: And we also have a third-party candidate for the presidency who is, I think, polling around 10% of the electorate — and polling both from Democratic and Republican constituencies — whose kind of main message is an anti-vaccine message, an antipublic health message.

And so I think that reflects deep antipublic health sentiments in this country that I think, in some ways, were made much more prominent and widespread by the covid pandemic. But it’s a tough issue for that reason.

I think there is a lot of distrust of the public health infrastructure, and you just don’t see politicians really rushing into defend public health officials in this moment where there’s not a crisis and there’s not a lot of political upside.

Rovner: Finally, I have a category that I call big-picture stuff. I feel like it would be really refreshing to see broad debates over things like long-term care. How we’re going to take care of the 10,000 people who are becoming seniors every day. The future solvency of Medicare. President Trump has said he won’t cut Medicare, but that’s not going to help fix the financial issues that still ail at end, frankly, the structure of our dysfunctional health care system.

Everything that we’ve talked about in terms of drug prices and some of these other things is just… are all just symptoms of a system that is simply not working very well. Is there a way to raise these issues, or are they just sort of too big? I mean, they’re exactly the kinds of things that candidates should be debating.

Raman: That is something that I have been wondering that when we do see the debate next week, if we already have such a rich background on both of these candidates in terms of they’ve both been president before, they have been matched up before, that if we could explore some of the other issues that we haven’t had yet. I mean, we know the answers to so many questions. But there are certain things like these where it would be more refreshing to hear some of that, but it’s unclear if we would get any new questions there.

Rovner: All right. Well, I have one more topic for the panel, and then I’m going to turn it over to the audience. There are folks with microphones, so if you have questions, be thinking of them and wait until a microphone gets to you.

One thing that we haven’t really talked about very much, but I think it’s becoming increasingly important, is data privacy in health care. We’ve seen all of these big hacks of enormous storages of people’s very personal information. I get the distinct impression that lawmakers don’t even know what to do. I mean, it’s not really an election issue, but boy, it almost should be.

Sanger-Katz: I did some reporting on this issue because there was this very large hack that affected this company called Change Healthcare. And so many things were not working because this one company got hacked. And the impression I got was just that this is just an absolute mess. That, first of all, there are a ton of vulnerabilities both at the level of hospitals and at the level of these big vendors that kind of cut across health care where many of them just don’t have good cybersecurity practices.

And at the level of regulation where I think there just aren’t good standards, there isn’t good oversight. There are a lot of conflicting and non-aligned jurisdictions where this agency takes care of this part, and this agency takes care of that part. And I think that is why it has been hard for the government to respond, that there’s not sort of one person where the buck stops there. And I think the legislative solutions actually will be quite technical and difficult. I do think that both lawmakers and some key administration officials are aware of the magnitude of this problem and are thinking about how to solve it.

It doesn’t mean that they will reach an answer quickly or that something will necessarily pass Congress. But I think this is a big problem, and the sense I got from talking to experts is this is going to be a growing problem. And it’s one that sounds technical but actually has pretty big potential health impacts because when the hospital computer system doesn’t work, hospitals can’t actually do the thing that they do. Everything is computerized now. And so when there’s a ransomware attack on a main computer electronic health record system, that is just a really big problem. That there’s documentation has led to deaths in certain cases because people couldn’t get the care that they need.

Rovner: They couldn’t … I mean, couldn’t get test results, couldn’t do surgeries. I mean, there was just an enormous implications of all this. Although I did see that there was a hack of the national health system in Britain, too. So, at least, that’s one of the things that we’re not alone in.

Sanger-Katz: And it’s not just health care. I mean, it’s like everything is hackable. All it takes is one foolish employee who gives away their password, and you think, often, the hackers can get in.

Raman: Well, that’s one of the tricky parts is that we don’t have nationally, a federal data privacy law like they do in the E.U. and stuff. And so it’s difficult to go and hone in on just health care when we don’t have a baseline for just, broadly … We have different things happening in different states. And that’s kind of made it more difficult to get done when you have different baselines that not everyone wants to come and follow the model that we have in California or some of the other states.

Rovner: But apparently Change Healthcare didn’t even have two-factor authentication, which I have on my social media accounts, that I’m still sort of processing that. All right, so let’s turn it over to you guys. Who has a question for my esteemed panel?

[Audience member]: Private equity and their impact on health care.

Rovner: Funny, one of those things that I had written down but didn’t ask.

Sanger-Katz: I think this is a really interesting issue because we have seen a big growth in the investment of private equity into health care, where we’re seeing private equity investors purchasing more hospitals, in particular, purchasing more doctors’ practices, nursing homes. You kind of see this investment across the health care sector, and we’re just starting to get evidence about what it means. There’s not a lot of transparency currently. It’s actually pretty hard to figure out what private equity has bought and who owns what.

And then we really don’t know. I would say there’s just starting to be a little bit of evidence about quality declines in hospitals that are owned by private equity. But it’s complicated, is what I would say. And I think in the case of medical practices, again, we just don’t have strong evidence about it. So I think policymakers, there are some who are just kind of ideologically opposed to the idea of these big investors getting involved in health care. But I think there are many who are… feel a little hands-off, where they don’t really want to just go after this particular industry until we have stronger evidence that they are in fact bad.

Rovner: Oh, there’ve been some pretty horrendous cases of private equity buying up hospital groups, selling off the underlying real estate. So now that the… now the hospital is paying rent, and then the hospitals are going under. I mean, we’ve now seen this.

Sanger-Katz: Yeah, there’s… No, there’s… There have clearly been some examples of private equity investments in hospitals and in nursing homes that have led to really catastrophic results for those institutions and for patients at those places. But I think the broader question of whether private equity as a structure that owns health care entities is necessarily bad or good, I think that’s what we don’t know about.

Rovner: Yeah, I mean, there’s an argument that you can have the efficiencies of scale, and that there may be, and that they can bring some business acumen to this. There are certainly reasons that it made sense when it started. The question is what the private equity is in it for.

Is it there to try to support the organization? Or is it there to do what a lot of private equity has done, which is just sort of take the parts, pull as much value as you can out of them, and discard the rest, which doesn’t work very well in the health care system.

Sanger-Katz: I also think one thing that’s very hard in this issue — and I think in others that relate to changes in the business structure of health care — is that it’s, like, by the time we really know, it’s almost too late. There’s all of this incredible scholarship looking at the effects of hospital consolidation, that it’s pretty bad that when you have too much hospital concentration; particularly in individual markets, that prices go up, that quality goes down. It’s really clear. But by the time that research was done so many markets were already highly consolidated that there wasn’t a way to go back.

And so I think there’s a risk for private equity investment of something similar happening that when and if we find out that it’s bad, they will have already rolled up so much of medical practice and changed the way that those practices are run that there’s not going to be a rewind button. On the other hand, maybe it will turn out to be OK, or maybe it will turn out to be OK in certain parts of the health care system and not in others. And so there is, I think, a risk of over-regulating in the absence of evidence that it’s a problem.

Raman: Yeah. And I would just echo one thing that you said earlier is that about the exploratory stages. Everything that I can rack my brain and think of that Congress has done on this has been very much like, “Let’s have a discussion. Let’s bring in experts,” rather than like really proposing a lot of new things to change it. I mean, we’ve had some discussion in the past of just changing laws about physician-owned practices and things like that, but it hasn’t really gone anywhere. And some of the proponents of that are also leaving Congress after this election.

Rovner: And, of course, a lot of this is regulated at the state level anyway, which is part of the difficulty.

Sanger-Katz: And there is more action at the state level. There are a bunch of states that have passed laws that are requiring more transparency and oversight of private equity acquisitions in health care. That seems to be happening faster at the state level than at the federal level.

Raman: And so many times, it trickles from the state level to the federal level anyway, too.

Rovner: Maybe the states can figure out what to do.

Sanger-Katz: Yes.

Rovner: More questions.

[Audience member]: Oh, yeah. I have a question about access to health care. It seems that for the past few years, maybe since covid, almost everybody you talked to says, “I can’t get an appointment with a doctor.” They call, and it’s like six months or three months. And I’m curious as to what you think is going on because … in this regard.

Raman: I would say part of it is definitely a workforce issue. We definitely have more and more people that have been leaving due to age or burnout from the pandemic or from other issues. We’ve had more antagonism against different types of providers that there’ve been a slew of reasons that people have been leaving while there’s been a greater need for different types of providers. And so I think that is just part of it.

Rovner: I feel like some of this is the frog in the pot of water. This has been coming for a long time. There have been markets where people have… people unable to get in to see specialists. You break your leg, and they say, “We can see you in November.” And I’m not kidding. I mean, that’s literally what happens. And now we’re seeing it more with primary care.

I mean that the shortages that used to be in what we called underserved areas, that more and more of the country is becoming underserved. And I think because we don’t have a system. Because we’re all sort of looking at these distinct pieces, I think the health care workforce issue is going kind of under the radar when it very much shouldn’t be.

Sanger-Katz: There’s also, I think, quite a lot of regional variation in this problem. So I think there are some places where there’s really no problem at all and certain specialties where there’s no problem at all. And then there are other places where there really are not enough providers to go around. And rural areas have long had a problem attracting and retaining a strong health care workforce across the specialties.

And I think in certain urban areas, in certain neighborhoods, you see these problems, too. But I would say it’s probably not universal. You may be talking to a lot of people in one area or in a couple of areas who are having this problem. But, as Julie said, I think it is a problem. It’s a problem that we need to pay attention to. But I think it’s not a problem absolutely everywhere in the country right now.

Rovner: It is something that Congress… Part of this problem is because Congress, in 1997, when they did the Balanced Budget Act, wanted to do something about Medicare and graduate medical education. Meaning why is Medicare paying for all of the graduate medical education in the United States, which it basically was at that point? And so they put in a placeholder. They capped the number of residences, and they said, “We’re going to come back, and we’re going to put together an all-payer system next year.”

That’s literally what they said in 1997. It’s now 27 years later, and they never did it, and they never raised the cap on residencies. So now we’ve got all these new medical schools, which we definitely need, and we have all of these bright, young graduating M.D.s, and they don’t have residencies to go to because there are more graduating medical school seniors than there are residency slots. So that’s something we’re… that just has not come up really in the past 10 years or so. But that’s something that can only be fixed by Congress.

Raman: And I think even with addressing anything in that bubble we’ve had more difficulty of late when we were… as they were looking at the pediatric residency slots, that whole discussion got derailed over a back-and-forth between members of Congress over gender-affirming care.

And so we’re back again to some of these issues that things that have been easier to do in the past are suddenly much more difficult. And then some of these things are felt down the line, even if we are able to get so many more slots this year. I mean, it’s going to… it takes a while to broaden that pipeline, especially with these various specialized careers.

Rovner: Yeah, we’re on a trajectory for this to get worse before it gets better. There’s a question over here.

[Audience member]: Hi. Thanks so much. I feel like everybody’s talking about mental health in some way or another. And I’m curious, it doesn’t seem to be coming at the forefront in any of the election spaces. I’m curious for your thoughts.

Raman: I think it has come up some, but not as much as maybe in the past. It has been something that Biden has messaged on a lot. Whenever he does his State of the Union, mental health and substance use are always part of his bipartisan plan that he wants to get done with both sides. I think that there has been less of it more recently that I’ve seen that them campaigning on. I mean, we’ve done a little bit when it’s combined with something like gun violence or things like that where it’s tangentially mentioned.

But front and center, it hasn’t come up as much as it has in the past, at least from the top. I think it’s still definitely a huge issue from people from the administration. I mean, we hear from the surgeon general like time and time again, really focusing on youth mental health and social media and some of the things that he’s worried about there. But on the top-line level, I don’t know that it has come up as much there. It is definitely talked about a lot in Congress. But again, it’s one of those things where they bring things up, and it doesn’t always get all the way done, or it’s done piecemeal, and so …

Rovner: Or it gets hung up on a wedge issue.

Raman: Yep.

Sanger-Katz: Although I do think this is an issue where actually there is a fair amount of bipartisan agreement. And for that reason, there actually has been a fair amount of legislation that has passed in the last few cycles. I think it just doesn’t get the same amount of attention because there isn’t this hot fight over it. So you don’t see candidates running on it, or you don’t see people that…

There’s this political science theory called the Invisible Congress, which is that sometimes, actually, you want to have issues that people are not paying attention to because if they’re not as controversial, if they’re not as prominent in the political discourse, you can actually get more done. And infrastructure, I think, is a kind of classic example of that, of something like it’s not that controversial. Everybody wants something in their district. And so we see bipartisan cooperation; we got an infrastructure bill.

And mental health is kind of like that. We got some mental health investments that were part of the pandemic relief packages. There was some mental health investment that was part of the IRA, I believe, and there was a pretty big chunk of mental health legislation and funding that passed as part of the gun bill.

So I do think there’s, of course, more to do it as a huge problem. And I think there are probably more creative solutions even than the things that Congress has done. But I think just because you’re not seeing it in the election space doesn’t mean that there’s not policymaking that’s happening. I think there has been a fair amount.

Rovner: Yeah, it’s funny. This Congress has been sort of remarkably productive considering how dysfunctional it has been in public. But underneath, there actually has been a lot of lawmaking that’s gone on, bipartisan lawmaking. I mean, by definition, because the House is controlled by Republicans and the Senate by Democrats. And I think mental health is one of those issues that there is a lot of bipartisan cooperation on.

But I think there’s also a limit to what the federal government can do. I mean, there’s things that Congress could fix, like residency slots, but mental health is one of those things where they have to just sort of feed money into programs that happen. I think at the state and local level, there’s no federal… Well, there is a federal mental health program, but they’re overseeing grants and whatnot. I think we have time for maybe one more question.

[Audience member]: Hi. To your point of a lot of change happens at the regulatory level. In Medicaid one of the big avenues for that is 1115 waivers. And let’s take aside block granting or anything else for a minute. There’s been big bipartisan progress on, including social care and whole-person care models. This is not just a blue state issue. What might we expect from a Trump administration in terms of the direction of 1115s, which will have a huge effect on the kind of opportunity space in states for Medicaid? And maybe that we don’t know yet, but I’m curious. Maybe that 900-page document says something.

Sanger-Katz: Yeah, I think that’s an example of we don’t know yet because I think the personnel will really matter. From everything that I know about President Trump, I do not think that the details of Medicaid 1115 waiver policy are something that he gets up in the morning and thinks about or really cares that much about. And so I think …

Rovner: I’m not sure it’s even in Project 2025, is it?

Sanger-Katz: I think work requirements are, so that was something that they tried to do the last time. I think it’s possible that we would see those come back. But I think a lot really depends on who is in charge of CMS [Centers for Medicare & Medicaid Services] and Medicaid in the next Trump administration and what are their interests and commitments and what they’re going to say yes and no to from the states. And I don’t know who’s on the shortlist for those jobs, frankly. So I would just put that in a giant question-mark bin — with the possible exception of work requirements, which I think maybe we could see a second go at those.

Raman: I would also just point to his last few months in office when there were a lot of things that could have been changed had he been reelected; where they wanted to change Medicaid drug pricing. And then we had some things with block grants and various things that had we had a second Trump presidency we could have seen some of those waivers come to a fruition. So I could definitely see a push for more flexibility in asking states to come up with something new that could fall for under one of those umbrellas.

Rovner: Well, I know you guys have more questions, but we are out of time. If you enjoyed the podcast tonight, I hope you will subscribe. Listen to “What the Health?” every week. You can get it wherever you get your podcast. So good night and enjoy the rest of the festival. Thanks.

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“We’re flying blind,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. With so few tests run, she said, it’s impossible to know how many farmworkers have been infected, or how serious the disease is. A lack of testing means the country might not notice if the virus begins to spread between people — the gateway to another pandemic.

“We’d like to be doing more testing. There’s no doubt about that,” said Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention. The CDC’s bird flu test is the only one the Food and Drug Administration has authorized for use right now. Shah said the agency has distributed these tests to about 100 public health labs in states. “We’ve got roughly a million available now,” he said, “and expect 1.2 million more in the next two months.”

But Nuzzo and other researchers are concerned because the CDC and public health labs aren’t generally where doctors order tests from. That job tends to be done by major clinical laboratories run by companies and universities, which lack authorization for bird flu testing.

As the outbreak grows — with at least 114 herds infected in 12 states as of June 18 — researchers said the CDC and FDA are not moving fast enough to remove barriers that block clinical labs from testing. In one case, the diagnostics company Neelyx Labs was on hold with a query for more than a month.

“Clinical labs are part of the nation’s public health system,” said Alex Greninger, assistant director of the University of Washington Medicine Clinical Virology Laboratory. “Pull us into the game. We’re stuck on the bench.”

The CDC recognized the need for clinical labs in a June 10 memo. It calls on industry to develop tests for the H5 strain of bird flu virus, the one circulating among dairy cattle. “The limited availability and accessibility of diagnostic tests for Influenza A(H5) poses several pain points,” the CDC wrote. The points include a shortage of tests if demand spikes.

Researchers, including former CDC director Tom Frieden and Anthony Fauci, who led the nation’s response to covid, cite testing failures as a key reason the U.S. fared so poorly with covid. Had covid tests been widely available in early 2020, they say, the U.S. could have detected many cases before they turned into outbreaks that prompted business shutdowns and cost lives.

In an article published this month, Nuzzo and a group of colleagues noted that the problem wasn’t testing capability but a failure to deploy that capability swiftly. The U.S. reported excess mortality eight times as high as other countries with advanced labs and other technological advantages.

A covid test vetted by the WHO was available by mid-January 2020. Rather than use it, the United States stuck to its own multistage process, which took several months. Namely, the CDC develops its own test then sends it to local public health labs. Eventually, the FDA authorizes tests from clinical diagnostic labs that serve hospital systems, which must then scale up their operations. That took time, and people died amid outbreaks at nursing homes and prisons, waiting on test results.

In contrast, South Korea immediately rolled out testing through private sector laboratories, allowing it to keep schools and businesses open. “They said, ‘Gear up, guys; we’re going to need a ton of tests,’” said Frieden, now president of the public health organization Resolve to Save Lives. “You need to get commercials in the game.”

Nuzzo and her colleagues describe a step-by-step strategy for rolling out testing in health emergencies, in response to mistakes made obvious by covid. But in this bird flu outbreak, the U.S. is weeks behind that playbook.

Ample testing is critical for two reasons. First, people need to know if they’re infected so that they can be quickly treated, Nuzzo said. Over the past two decades, roughly half of about 900 people around the globe known to have gotten the bird flu died from it.

Although the three farmworkers diagnosed with the disease this year in the United States had only mild symptoms, like a runny nose and inflamed eyes, others may not be so lucky. The flu treatment Tamiflu works only when given soon after symptoms start.

The CDC and local health departments have tried to boost bird flu testing among farmworkers, asking them to be tested if they feel sick. Farmworker advocates list several reasons why their outreach efforts are failing. The outreach might not be in the languages the farmworkers speak, for example, or address such concerns as a loss of employment.

If people who live and work around farms simply see a doctor when they or their children fall ill, those cases could be missed if the doctors send samples to their usual clinical laboratories. The CDC has asked doctors to send samples from people with flu symptoms who have exposure to livestock or poultry to public health labs. “If you work on a farm with an outbreak and you’re worried about your welfare, you can get tested,” Shah said. But sending samples to public health departments requires knowledge, time, and effort.

“I really worry about a testing scheme in which busy clinicians need to figure this out,” Nuzzo said.

The other reason to involve clinical laboratories is so the nation can ramp up testing if the bird flu is suddenly detected among people who didn’t catch it from cattle. There’s no evidence the virus has started to spread among people, but that could change in coming months as it evolves.

The fastest way to get clinical labs involved, Greninger said, is to allow them to use a test the FDA has already authorized: the CDC’s bird flu test. On April 16 the CDC opened up that possibility by offering royalty-free licenses for components of its bird flu tests to accredited labs.

Several commercial labs asked for licenses. “We want to get prepared before things get crazy,” said Shyam Saladi, chief executive officer of the diagnostics company Neelyx Labs, which offered covid and mpox tests during shortages in those outbreaks. His experience over the past two months reveals the types of barriers that prevent labs from moving swiftly.

In email exchanges with the CDC, shared with KFF Health News, Saladi specifies the labs’ desire for licenses relevant to the CDC’s test, as well as a “right to reference” the CDC’s data in its application for FDA authorization.

That “right to reference” makes it easier for one company to use a test developed by another. It allows the new group to skip certain analyses conducted by the original maker, by telling the FDA to look at data in the original FDA application. This was commonplace with covid tests at the peak of the pandemic.

At first, the CDC appeared eager to cooperate. “A right of reference to the data should be available,” Jonathan Motley, a patent specialist at the CDC, wrote in an email to Saladi on April 24. Over the next few weeks, the CDC sent him information about transferring its licenses to the company, and about the test, which prompted Neelyx’s researchers to buy testing components and try out the CDC’s process on their equipment.

But Saladi grew increasingly anxious about the ability to reference the CDC’s data in the company’s FDA application. “Do you have an update with respect to the right of reference?” he asked the CDC on May 13. “If there are any potential sticking points with respect to this, would you mind letting us know please?”

He asked several more times in the following weeks, as the number of herds infected with the bird flu ticked upward and more cases among farmworkers were announced. “Given that it is May 24 and the outbreak has only expanded, can CDC provide a date by which it plans to respond?” Saladi wrote.

The CDC eventually signed a licensing agreement with Neelyx but informed Saladi that it would not, in fact, provide the reference. Without that, Saladi said, he could not move forward with the CDC’s test — at least not without more material from the agency. “It’s really frustrating,” he said. “We thought they really intended to support the development of these tests in case they are needed.”

Shah, from the CDC, said test manufacturers should generate their own data to prove that they’re using the CDC’s test correctly. “We don’t have a shortage such that we need to cut corners,” he said. “Quality reigns supreme.”

The CDC has given seven companies, including Neelyx, licenses for its tests — although none have been cleared to use them by the FDA. Only one of those companies asked for the right of reference, Shah said. The labs may be assisted by additional material that the agency is developing now, to allow them to complete the analyses — even without the reference.

“This should have happened sooner,” Saladi told KFF Health News when he was told about the CDC’s pending additional material. “There’s been no communication about this.”

Greninger said the delays and confusion are reminiscent of the early months of covid, when federal agencies prioritized caution over speed. Test accuracy is important, he said, but excessive vetting can cause harm in a fast-moving outbreak like this one. “The CDC should be trying to open this up to labs with national reach and a good reputation,” he said. “I fall on the side of allowing labs to get ready — that’s a no-brainer.”

Clinical laboratories have also begun to develop their own tests from scratch. But researchers said they’re moving cautiously because of a recent FDA rule that gives the agency more oversight of lab-developed tests, lengthening the pathway to approval. In an email to KFF Health News, FDA press officer Janell Goodwin said the rule’s enforcement will occur gradually.

However, Susan Van Meter, president of the American Clinical Laboratory Association, a trade group whose members include the nation’s largest commercial diagnostic labs, said companies need more clarity: “It’s slowing things down because it’s adding to the confusion about what is allowable.”

Creating tests for the bird flu is already a risky bet, because demand is uncertain. It’s not clear whether this outbreak in cattle will trigger an epidemic or fizzle out. In addition to issues with the CDC and FDA, clinical laboratories are trying to figure out whether health insurers or the government will pay for bird flu tests.

These wrinkles will be smoothed eventually. Until then, the vanishingly slim numbers of people tested, along with the lack of testing in cattle, may draw criticism from other parts of the world.

“Think about our judgment of China’s transparency at the start of covid,” Nuzzo said. “The current situation undermines America’s standing in the world.”

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Oropouche virus (OROV) is a single-stranded RNA virus that belongs to the Peribunyaviridae family.1 It is considered a public health threat in tropical and subtropical areas of the Americas, as it primarily circulates in Central and South America and the Caribbean.1-3  Oropouche virus causes a dengue-like illness called Oropouche fever. Outbreaks have been reported in […]

The post What is Oropouche virus? appeared first on Medical News Bulletin.

GAINESVILLE, Fla. — En un granero al aire libre en el borde de la Universidad de Florida, el veterinario Juan Campos Krauer examina las pezuñas y las orejas de un armadillo muerto en busca de signos de infección.

Sus garras están apretadas y cubiertas de sangre. Campos Krauer cree que lo golpearon en la cabeza mientras cruzaba una carretera cercana.

Luego, corta con un bisturí la parte inferior del animal y extrae todos los órganos importantes: corazón, hígado, riñones. Coloca las muestras embotelladas en un congelador ultra frío, en su laboratorio de la universidad.

Campos Krauer planea examinar el armadillo para detectar lepra, un antiguo mal también conocido como enfermedad de Hansen que puede provocar daño a los nervios y desfiguración en humanos. Junto con otros científicos están tratando de resolver un misterio médico: por qué Florida central se ha convertido en una zona crítica para las antiguas bacterias que la causan.

La lepra sigue siendo rara en Estados Unidos. Pero Florida, que a menudo informa el mayor número de casos de cualquier estado, ha visto un aumento en pacientes. El epicentro está al este de Orlando. El condado de Brevard informó un asombroso 13% de los 159 casos de lepra del país en 2020, según un análisis del Tampa Bay Times de datos estatales y federales.

Muchas preguntas sobre el fenómeno siguen sin respuesta. Pero expertos en lepra creen que los armadillos juegan un papel en la propagación de la enfermedad a las personas. Para comprender mejor quién está en riesgo y prevenir infecciones, unos 10 científicos se unieron el año pasado para investigar.

El grupo incluye investigadores de la Universidad de Florida, la Universidad Estatal de Colorado y la Universidad de Emory, en Atlanta.

“Realmente no sabemos cómo está ocurriendo esta transmisión”, dijo Ramanuj Lahiri, jefe de la rama de investigación de laboratorio del Programa Nacional de Enfermedad de Hansen, que estudia las bacterias involucradas y cuida a los pacientes con lepra en todo el país.

“Nada encajaba”

Se cree que la lepra es la infección humana más antigua de la historia. Probablemente ha estado enfermando a las personas durante al menos 100,000 años. Es fuertemente estigmatizada: en la Biblia, se describía como un castigo por pecar. En tiempos más modernos, los pacientes eran aislados en “colonias” alrededor del mundo, incluyendo en Hawaii y Louisiana.

En casos leves, las bacterias de crecimiento lento causan algunas lesiones. Si no se trata, pueden paralizar las manos y los pies.

Pero en realidad es difícil enfermarse de lepra, ya que la infección no es muy contagiosa. Los antibióticos pueden curar la enfermedad en uno o dos años. Están disponibles de forma gratuita a través del gobierno federal y de la Organización Mundial de la Salud (OMS), que lanzó una campaña en la década de 1990 para eliminar la lepra como problema de salud pública.

En 2000, los casos reportados en EE.UU. cayeron a su nivel más bajo en décadas, con 77 infecciones. Pero luego aumentaron, promediando alrededor de 180 por año desde 2011 hasta 2020, según datos del Programa Nacional de Enfermedad de Hansen.

Durante ese tiempo, surgió una tendencia curiosa en Florida.

En la primera década del siglo XXI, el estado registró 67 casos. El condado de Miami-Dade tuvo 20 infecciones, la mayoría de cualquier condado de Florida. La gran mayoría de esos casos fueron adquiridos fuera del país, según un análisis del Times de datos del Departamento de Salud de Florida.

Pero durante los siguientes 10 años, los casos registrados en el estado fueron más del doble, 176, y el condado de Brevard tomó el protagonismo.

El condado, cuya población es aproximadamente una quinta parte del tamaño de Miami-Dade, registró 85 infecciones durante ese tiempo, con mucho, la mayoría de cualquier condado en el estado y casi la mitad de todos los casos de Florida. En la década anterior, Brevard solo registró cinco casos.

De manera notable, al menos una cuarta parte de las infecciones de Brevard fueron adquiridas dentro del estado, no mientras los individuos estaban en el extranjero.

India, Brasil e Indonesia diagnostican más casos de lepra que en cualquier otro lugar, reportando más de 135,000 infecciones combinadas solo en 2022.

Las personas se estaban enfermando a pesar de no haber viajado a esas áreas ni haber estado en contacto cercano con pacientes con lepra, dijo Barry Inman, ex epidemiólogo del departamento de salud de Brevard que investigó los casos y se retiró en 2021.

“Nada encajaba”, dijo Inman. Algunos pacientes recordaron haber tocado armadillos, que se sabe que portan las bacterias. Pero la mayoría no, dijo. Muchos pasaron mucho tiempo al aire libre, incluidos trabajadores de jardines y ávidos jardineros. Los casos eran generalmente leves.

Era difícil determinar dónde contrajeron la enfermedad, agregó. Debido a que las bacterias crecen tan lentamente, pueden pasar entre nueve meses y 20 años para que comiencen los síntomas.

¿Amoeba o insectos culpables?

Concientizar sobre la lepra podría desempeñar un papel en el aumento de casos en Brevard. Los médicos deben reportar la lepra al Departamento de Salud. Sin embargo, Inman dijo que muchos en el condado no lo sabían, por lo que trató de educarlos después de notar los casos a fines de la década de 2000.

Pero ese no es el único factor en juego, dijo Inman. “No creo que haya ninguna duda en mi mente de que está ocurriendo algo nuevo”, dijo.

Otras partes en el centro de Florida también han registrado más infecciones. De 2011 a 2020, el condado de Polk registró 12 casos, triplicando su número en comparación con los 10 años anteriores. El condado de Volusia registró 10 casos. No reportó ninguno en la década anterior.

Los científicos se están enfocando en los armadillos. Sospechan que estos animales que son cavadores pueden causar indirectamente infecciones a través de la contaminación del suelo.

Los armadillos, que están protegidos por caparazones duros, sirven como buenos huéspedes para las bacterias, a las que no les gusta el calor y pueden prosperar en los animales cuyos rangos de temperatura corporal son de 86 a 95 grados Fahrenheit.

Los colonos probablemente trajeron la enfermedad al Nuevo Mundo hace cientos de años, y de alguna manera los armadillos se infectaron, dijo Lahiri, el científico del Programa Nacional de Enfermedad de Hansen.

Estos mamíferos nocturnos pueden desarrollar lesiones por la enfermedad igual que los humanos. Hay más de un millón de armadillos en Florida, estimó Campos Krauer, profesor asistente en el Departamento de Ciencias Clínicas de Animales Grandes de la Universidad de Florida.

Cuántos portan lepra no está claro. Un estudio publicado en 2015 con más de 600 armadillos en Alabama, Florida, Georgia y Mississippi encontró que aproximadamente el 16% mostraban evidencia de infección. Expertos en salud pública creen que la lepra anteriormente estaba confinada a los armadillos al oeste del río Mississippi y luego se extendió hacia el este.

Manipular los animales es un peligro conocido. La investigación de laboratorio muestra que las amebas unicelulares, que viven en el suelo, también pueden portar las bacterias.

Los armadillos aman desenterrar y comer lombrices, lo que frustra a los propietarios de viviendas cuyos jardines dañan. Los animales pueden eliminar las bacterias mientras buscan comida, pasándolas a las amebas, que podrían infectar a las personas más tarde.

Los expertos en lepra también se preguntan si los insectos ayudan a propagar la enfermedad. Las garrapatas que chupan sangre también podrían ser culpables, según muestra la investigación de laboratorio.

“Algunas personas que están infectadas tienen poca o ninguna exposición al armadillo”, dijo Norman Beatty, profesor asistente de medicina en la Universidad de Florida. “Probablemente hay otra fuente de transmisión en el medio ambiente”.

Campos Krauer, que ha estado buscando armadillos muertos en las calles de Gainesville, quiere reunir animales infectados y dejarlos descomponer en un área cercada, permitiendo que los restos se empapen en una bandeja con tierra mientras las moscas ponen huevos. Espera examinar la tierra y las larvas para ver si recogen las bacterias.

Agregando intriga hay una cepa de lepra encontrada solo en Florida, según los científicos. En el estudio de 2015, los investigadores descubrieron que siete armadillos del Refugio Nacional de Vida Silvestre de Merritt Island, que está mayormente en Brevard pero cruza a Volusia, portaban una versión del patógeno no vista anteriormente.

Diez pacientes en la región también se vieron afectados por esta cepa. A nivel genético, es similar a otro tipo encontrado en armadillos en el país, dijo Charlotte Avanzi, investigadora de la Universidad Estatal de Colorado que se especializa en lepra. No se sabe si la cepa causa una enfermedad más grave, dijo Lahiri.

Reduciendo el riesgo

El público no debe entrar en pánico por la lepra, ni las personas deben apresurarse a sacrificar armadillos, advierten los investigadores.

Los científicos estiman que más del 95% de la población humana mundial tiene una capacidad natural para resistir la enfermedad. Creen que se necesitan meses de exposición a gotitas respiratorias para que ocurra la transmisión de persona a persona.

Pero cuando ocurren infecciones, pueden ser devastadoras. “Si lo entendemos mejor”, dijo Campos Krauer, “podremos aprender a vivir con él y reducir el riesgo”.

La nueva investigación también puede proporcionar información para otros estados del sur. Los armadillos, que no hibernan, se han estado moviendo hacia el norte, dijo Campos Krauer, alcanzando áreas como Indiana y Virginia.

Podrían ir más lejos debido al cambio climático.

Las personas preocupadas por la lepra pueden tomar precauciones simples, dicen los expertos médicos. Aquellos que trabajan en tierra deben usar guantes y lavarse las manos después. Elevar las camas de jardín o rodearlas con una cerca puede limitar las posibilidades de contaminación del suelo.

Si se desentierra una madriguera de armadillo, es mejor usar una mascarilla, dijo Campos Krauer. No jugar con los animales ni comerlos, agregó John Spencer, científico de la Universidad Estatal de Colorado que estudia la transmisión de la lepra en Brasil. Es legal cazarlos todo el año en Florida sin una licencia.

Hasta ahora, el equipo de Campos Krauer ha examinado 16 armadillos muertos encontrados en carreteras del área de Gainesville, a más de 100 millas del epicentro de la lepra del estado, tratando de obtener una idea preliminar de cuántos portan las bacterias.

Todavía ninguno ha dado positivo.

Este artículo fue producido por una asociación entre KFF Health News y el Tampa Bay Times.

KFF Health News 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 KFF.

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Es el último capítulo de una larga saga que involucra a Magellan Diagnostics, con sede en Massachusetts, que pagará $42 millones en multas, según el Departamento de Justicia (DOJ).

Aunque muchos de los dispositivos propensos a fallas se utilizaron desde 2013 hasta 2017, algunos fueron retirados del mercado recién en 2021. El DOJ dijo que este mal funcionamiento produjo resultados inexactos para “potencialmente decenas de miles” de niños y otros pacientes.

Los médicos no consideran seguro ningún nivel de plomo en sangre, especialmente en niños.

Varias ciudades de Estados Unidos, incluyendo Washington, DC, y Flint, en Michigan, han luchado con una contaminación generalizada de plomo en sus suministros de agua en las últimas dos décadas, lo que hace que las pruebas precisas sean críticas para la salud pública.

Es posible que se hayan utilizado kits defectuosos de Magellan para analizar la exposición al plomo en niños hasta principios de la década de 2020, basándose en el retiro del mercado en 2021.

Esto es lo que los padres deben saber.

¿Cuáles pruebas eran defectuosas?

Los resultados inexactos provinieron de tres dispositivos de Magellan: LeadCare Ultra, LeadCare II y LeadCare Plus. Uno de ellos, el LeadCare II, utiliza principalmente muestras de punción en el dedo y representó más de la mitad de todas las pruebas de plomo en sangre realizadas en el país desde 2013 hasta 2017, según el DOJ.

A menudo se usaba en consultorios médicos para verificar los niveles de plomo en los niños.

Los otros dos también podían usarse extrayendo sangre de una vena y pueden haber sido más comunes en laboratorios que en consultorios médicos. La empresa “se enteró por primera vez de que un mal funcionamiento en su dispositivo LeadCare Ultra podría causar resultados inexactos de pruebas de plomo, específicamente, resultados de pruebas de plomo que eran falsamente bajos” en junio de 2013 mientras buscaba la aprobación regulatoria para vender el producto, dijo el DOJ.

Pero, según el acuerdo, no divulgó esa información y siguió comercializando las pruebas.

La agencia dijo que las pruebas de 2013 indicaron que el mismo defecto afectaba al dispositivo LeadCare II. Un retiro del mercado en 2021 incluyó la mayoría de los tres tipos de kits para pruebas distribuidos desde el 27 de octubre de 2020.

En un comunicado de prensa para anunciar la resolución, la empresa dijo que “los problemas subyacentes que afectaron los resultados de algunos de los productos de Magellan de 2013 a 2018 han sido completa y eficazmente solucionados” y que las pruebas que actualmente venden son seguras.

¿Qué significa un resultado “falsamente bajo”?

A menudo se realiza la prueba a los niños durante las visitas al pediatra al año y nuevamente a los 2 años. Los niveles elevados de plomo pueden poner a los niños en riesgo de retraso en el desarrollo, menor coeficiente intelectual y otros problemas. Y los síntomas, como dolor de estómago, falta de apetito o irritabilidad, pueden no aparecer hasta que se alcancen niveles altos.

Los resultados de pruebas falsamente bajos podrían significar que los padres y los médicos no eran conscientes del problema.

Eso es preocupante porque el tratamiento para la intoxicación por plomo es, al principio, principalmente preventivo. Los resultados que muestran niveles elevados deberían llevar a los padres y a los funcionarios de salud a determinar las fuentes de plomo y tomar medidas para prevenir una ingesta continua de este metal, dijo Janine Kerr, educadora de salud del Programa de Prevención de la Intoxicación por Plomo en la Infancia del Departamento de Salud de Virginia.

Los niños pueden estar expuestos al plomo de diversas maneras, incluyendo el consumo de agua contaminada con plomo de tuberías viejas, como en Flint y Washington; la ingestión de escamas de pintura a base de plomo que a menudo se encuentran en casas antiguas; o, como se informó recientemente, comiendo algunas marcas de puré de manzana con sabor a canela.

¿Qué deben hacer los padres ahora?

“Los padres pueden contactar al pediatra para determinar si su hijo tuvo una prueba de plomo en sangre con un dispositivo LeadCare” y discutir si es necesario repetirla, dijo Maida Galvez, pediatra y profesora en la Escuela de Medicina Icahn en Mount Sinai en Nueva York.

Durante un retiro anterior de algunos dispositivos de Magellan, en 2017, los Centros para el Control y Prevención de Enfermedades (CDC) recomendaron que se les hiciera otra prueba a los pacientes si estaban embarazadas, amamantando o eran niños menores de 6 años y tenían un nivel de plomo en sangre de menos de 10 microgramos por decilitro según lo determinado por un dispositivo Magellan de una extracción de sangre venosa.

El retiro de dispositivos Magellan en 2021 recomendó repetir la prueba a los niños cuyos resultados fueran inferiores al nivel de referencia actual de los CDC de 3.5 microgramos por decilitro. Muchas de esas pruebas eran del tipo de punción en el dedo.

Kerr, del Departamento de Salud de Virginia, dijo que su agencia no ha recibido muchas llamadas sobre ese retiro.

Las pruebas de punción en el dedo “no se utilizan tan ampliamente en Virginia”, explicó Kerr, agregando que “recibimos muchas preguntas sobre el retiro del puré de manzana”.

En cualquier caso, dijo, el “mejor curso de acción para los padres es hablar con un proveedor de atención médica”.

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Los casos de sarampión están aumentando en Estados Unidos. En el primer trimestre de este año, se registró un número de casos 17 veces mayor con respecto al promedio registrado durante el mismo período en los cuatro años anteriores, según los Centros para el Control y Prevención de Enfermedades (CDC). La mitad de las personas infectadas, principalmente niños, han sido hospitalizadas.

Y se espera que las cifras sigan empeorando, en gran medida porque cada vez más padres deciden no vacunar a sus hijos contra el sarampión y otras enfermedades como la polio y la tos ferina.

Este año, el 80% de los casos ha sido en personas no vacunadas o con un estatus de vacunación desconocido. Muchos padres han sido influenciados por una avalancha de desinformación difundida por políticos y personalidades en redes sociales, podcasts, y en la TV, que repiten falsas creencias, erosionando la confianza en la ciencia que respalda las vacunas infantiles de rutina.

A continuación, examinamos algunos mitos frecuentes de la retórica antivacunas y explicamos por qué está equivocada:

“No es para tanto”

Una idea errónea común es que las vacunas no son necesarias porque las enfermedades que previenen no son peligrosas u ocurren con muy poca frecuencia como para ser motivo de preocupación. Aunque se hayan reportado casos de sarampión en 19 estados, los escépticos acusan a funcionarios de salud pública y a los medios de comunicación de sembrar temor sobre la enfermedad sin fundamento.

Por ejemplo, una nota publicada en el sitio web del National Vaccine Information Center, una fuente habitual de desinformación sobre las vacunas, sostuvo que la preocupación creciente por el sarampión “es una exageración al estilo de ‘el cielo se cae'”. El artículo decía que contraer el sarampión, las paperas, la varicela y la gripe (también llamada influenza) era “políticamente incorrecto”.

Según los CDC, el sarampión resulta fatal en aproximadamente 2 de cada 1,000 niños infectados. Si este nivel de riesgo suena aceptable, vale la pena señalar que un número mucho mayor de niños con sarampión requieren hospitalización por neumonía y otras complicaciones serias.

Por cada 10 casos de sarampión, un niño con la enfermedad desarrolla una infección de oído que puede causar la pérdida auditiva permanente. Otro efecto extraño del virus es que puede destruir la inmunidad de una persona, y así afectar su capacidad para recuperarse de la gripe y otras afecciones comunes.

Las vacunas contra el sarampión han evitado la muerte de alrededor de 94 millones de personas, principalmente niños, en los últimos 50 años, según un análisis de abril de la Organización Mundial de la Salud (OMS). Junto con las vacunas contra la polio y otras enfermedades, se estima que las vacunas han salvado 154 millones de vidas en todo el mundo.

Algunos escépticos de las vacunas sostienen que las enfermedades que previenen ya no son una amenaza porque se han vuelto relativamente poco frecuentes en el país. (Lo cual es cierto, gracias a la vacunación). Es el razonamiento que invocó el cirujano general de Florida, Joseph Ladapo, durante un brote de sarampión en febrero, cuando dijo a los padres que sus hijos no vacunados podían seguir yendo a la escuela. “Hay mucha inmunidad”, dijo Ladapo.

A medida que esta actitud relajada hacia las vacunas convence a los padres de no dárselas a sus hijos, la inmunidad colectiva disminuye y los brotes serán cada vez más grandes y se propagarán más rápido.

En 2019, un brote de rápido crecimiento afectó a una comunidad con tasas de vacunación insuficientes en Samoa y mató a 83 personas en cuatro meses. Las tasas persistentemente bajas de vacunación contra el sarampión en la República Democrática del Congo mataron a más de 5,600 personas a causa de la enfermedad en brotes masivos el año pasado.

“Nunca se sabe”

Desde los orígenes de las vacunas, siempre ha existido un grupo que ha desconfiado porque no son naturales, en comparación con las infecciones y plagas que abundan en la naturaleza. Los miedos y dudas sobre las vacunas han ido cambiando a lo largo de las décadas. En el 1800, por ejemplo, los escépticos pensaban que las vacunas contra la viruela hacían que a las personas les salieran cuernos y que se comportaran como bestias.

En tiempos más recientes, los escépticos han vinculado las vacunas con una variedad de afecciones, desde el trastorno por déficit de atención e hiperactividad hasta el autismo y las enfermedades del sistema inmunológico. Los estudios científicos no respaldan estas afirmaciones.

La realidad es que las vacunas están entre las intervenciones médicas más estudiadas. En el siglo pasado, las vacunas han pasado por estudios científicos y ensayos clínicos masivos tanto en las fases de desarrollo como después, durante su uso generalizado.

Más de 12,000 personas participaron en los ensayos clínicos de la última vacuna aprobada para prevenir el sarampión, las paperas y la rubéola. Al probar la vacuna en un gran número de personas, los investigadores pueden detectar riesgos poco comunes, lo cual es importante porque se administran a millones de personas sanas.

Para evaluar los riesgos a largo plazo, los científicos analizan grandes cantidades de datos para identificar señales de daño. Por ejemplo, un grupo danés analizó una base de datos de más de 657,000 niños y encontró que aquellos que fueron vacunados contra el sarampión cuando eran bebés no tenían más probabilidades de ser diagnosticados con autismo que aquellos que no fueron vacunados.

En otro estudio, los investigadores analizaron registros de 805,000 niños nacidos entre 1990 y 2001 y no encontraron ninguna prueba de que las vacunaciones múltiples pudieran afectar el sistema inmune de los niños.

Pero las personas que promueven la desinformación sobre las vacunas, como el candidato a la presidencia Robert F. Kennedy Jr., descartan los estudios masivos respaldados por la ciencia.

Por ejemplo, Kennedy sostiene que los ensayos clínicos para las nuevas vacunas no son confiables porque no se compara a los niños vacunados con un grupo que recibe un placebo, como solución salina u otra sustancia sin efecto. En vez de utilizar un placebo, muchos ensayos modernos comparan las vacunas actualizadas con otras más antiguas. Esto se debe a que se considera no ético poner en peligro a los niños al darles una vacuna falsa cuando se conoce el efecto protector de la inmunización.

En un ensayo clínico de vacunas contra la polio realizado en la década de 1950, 16 niños que recibieron un placebo murieron de polio y 34 quedaron paralizados, dijo Paul Offit, director del Centro de Educación Sobre Vacunas del Hospital de Niños de Philadelphia y autor de un libro sobre la primera vacuna contra la polio.

“Demasiadas y demasiado pronto”

Varios de los libros sobre vacunas más vendidos en Amazon promueven la peligrosa idea de que los padres deberían omitir o retrasar la vacunación de sus hijos. “Puede ser que no todas las vacunas en el calendario de los CDC sean adecuadas para todos los niños en todo momento”, escribe Paul Thomas en su libro más vendido “The Vaccine-Friendly Plan”. Para respaldar su argumento, dice que los niños que han seguido “mi protocolo están entre los más sanos del mundo”.

Desde la publicación del libro, la licencia médica de Thomas fue suspendida temporalmente en Oregon y Washington.

La Junta Médica de Oregon documentó cómo Thomas convenció a los padres a omitir vacunas recomendadas por los CDC e “hizo llorar” a una madre que no estaba de acuerdo. Varios niños bajo su cuidado contrajeron tos ferina y rotavirus, ambas enfermedades que se previenen fácilmente con vacunas, escribió la junta.

Thomas le recetó suplementos de aceite de pescado y homeopatía a un niño que tenía una laceración profunda en el cuero cabelludo en lugar de darle una vacuna de emergencia contra el tétanos. El niño desarrolló un cuadro de tétanos grave y estuvo en el hospital por casi dos meses, donde tuvo que someterse a una intubación, una traqueotomía y una sonda de alimentación para sobrevivir.

El calendario de vacunación recomendado por los CDC se diseñó para proteger a los niños en los momentos más vulnerables de su vida y minimizar los efectos secundarios. Por ejemplo, la vacuna combinada contra el sarampión, las paperas y la rubéola no se administra durante el primer año de vida del bebé porque los anticuerpos que transmite temporalmente la madre pueden interferir con la respuesta inmunitaria. Y como algunos bebés no generan una respuesta inmunitaria fuerte con esa primera dosis, los CDC recomiendan una segunda dosis alrededor del momento en que los niños comiencen el jardín de infantes, ya que el sarampión y otros virus se propagan rápidamente en contextos grupales.

No se recomienda retrasar mucho más las dosis de esta vacuna ya que los datos sugieren que los niños vacunados a los 10 años o más tienen más probabilidades de desarrollar reacciones adversas, como convulsiones o fatiga.

Alrededor de una docena de otras vacunas siguen su propio esquema cronológico, con superposiciones para obtener la mejor respuesta. Los estudios han demostrado que la vacuna contra el sarampión, las paperas y la rubéola se puede administrar de forma segura y eficaz combinada con otras vacunas.

“Ellos no quieren que lo sepas”

En la introducción del nuevo libro de Ladapo sobre cómo superar el miedo en la salud pública, Kennedy compara al cirujano general de Florida con Galileo. Así como la Inquisición católica condenó al famoso astrónomo por promover teorías sobre el universo, sugiere Kennedy, las instituciones científicas reprimen a los disidentes de las vacunas por razones nefastas.

“La persecución de científicos y médicos que se atreven a cuestionar las doctrinas contemporáneas no es nada nuevo”, escribe Kennedy. Su compañera de fórmula, la abogada Nicole Shanahan, ha hecho campaña con la idea de que las conversaciones sobre los peligros de las vacunas se están censurando y que las corporaciones influyen sobre los CDC y otras agencias federales para ocultar datos.

En el podcast más escuchado en Estados Unidos, “The Joe Rogan Experience”, a menudo figuran invitados que desconfían del consenso científico. El año pasado, en el programa, Kennedy repitió el mito muchas veces desmentido de que las vacunas causan autismo.

Lejos de ignorar ese miedo, los epidemiólogos lo han tomado en serio. Han realizado más de una docena de estudios en busca de un vínculo entre las vacunas y el autismo, y no han encontrado ninguno. “Hemos refutado de manera concluyente la teoría de que las vacunas están relacionadas con el autismo”, afirmó Gideon Meyerowitz-Katz, epidemiólogo de la Universidad de Wollongong en Australia. “Es por esto que el sistema de salud pública tiende a cerrar esas conversaciones rápidamente”.

Las agencias federales son transparentes con respecto a las reacciones que pueden causar las vacunas, incluyendo convulsiones y dolor en el brazo. Y el gobierno tiene un programa para compensar a las personas si se determina científicamente que sus lesiones son el resultado de las vacunas. Alrededor de 1 a 3.5 de cada millón de dosis de la vacuna contra el sarampión, las paperas y la rubéola pueden provocar una reacción alérgica potencialmente mortal. Se estima que el riesgo de muerte a causa de un rayo durante toda la vida de una persona es hasta cuatro veces mayor.

“Lo más convincente que puedo decir es que mi hija tiene todas sus vacunas y que todos los pediatras y profesionales de salud pública que conozco han vacunado a sus hijos”, dijo Meyerowitz-Katz. “Nadie haría eso si pensara que existen riesgos graves”.

KFF Health News 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 KFF.

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Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

With abortion shaping up as a key issue for the November elections, the movement that united to overturn Roe v. Wade is divided over going further, faster — including by punishing those who have abortions and banning contraception or IVF. Politicians who oppose abortion are already experiencing backlash in some states.

Meanwhile, bad actors are bilking the health system in various new ways, from switching people’s insurance plans without their consent to pocket additional commissions, to hacking the records of major health systems and demanding millions of dollars in ransom.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine.

Panelists

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories.

Joanne Kenen
Johns Hopkins University and Politico

@JoanneKenen

Read Joanne's articles.

Rachel Roubein
The Washington Post

@rachel_roubein

Read Rachel's stories.

Among the takeaways from this week’s episode:

• It appears that abortion opponents are learning it’s a lot easier to agree on what you’re against than for. Now that the constitutional right to an abortion has been overturned, political leaders are contending with vocal groups that want to push further — such as by banning access to IVF or contraception.
• A Louisiana bill designating abortion pills as controlled substances targets people in the state, where abortion is banned, who are finding ways to get the drug. And abortion providers in Kansas are suing over a new law that requires patients to report their reasons for having an abortion. Such state laws have a cumulative chilling effect on abortion access.
• Some Republican lawmakers seem to be trying to dodge voter dissatisfaction with abortion restrictions in this election year. Sen. Ted Cruz of Texas and Sen. Katie Britt of Alabama introduced legislation to protect IVF by pulling Medicaid funding from states that ban the fertility procedure — but it has holes. And Gov. Larry Hogan of Maryland declared he is pro-choice, even though he mostly dodged the issue during his eight years as governor.
• Former President Donald Trump is in the news again for comments that seemed to leave the door open to restrictions on contraception — which may be the case, though he is known to make such vague policy suggestions. Trump’s policies as president did restrict access to contraception, and his allies have proposed going further.

Also this week, Rovner interviews Shefali Luthra of The 19th about her new book on abortion in post-Roe America, “Undue Burden.”

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

Julie Rovner: The 19th’s “What Happens to Clinics After a State Bans Abortion? They Fight To Survive,” by Shefali Luthra and Chabeli Carrazana. 

Alice Miranda Ollstein: Stat’s “How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations,” by Eric Boodman.  

Rachel Roubein: The Washington Post’s “What Science Tells Us About Biden, Trump and Evaluating an Aging Brain,” by Joel Achenbach and Mark Johnson.  

Joanne Kenen: ProPublica’s “Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe,” by Sharon Lerner; and The Guardian’s “Microplastics Found in Every Human Testicle in Study,” by Damian Carrington. 

Also mentioned on this week’s podcast:

• NPR’s “Republicans Try To Soften Stance on Abortion as ‘Abolitionists’ Go Farther,” by Sarah McCammon.
• KFF Health News’ “Biden Leans Into Health Care, Asking Voters To Trust Him Over Trump,” by Phil Galewitz.
• KFF Health News’ “Exclusive: Senator Urges Biden Administration To Thwart Fraudulent Obamacare Enrollments,” by Julie Appleby.
• KFF Health News’ “KHN’s ‘What the Health?’: Un-Trumping the ACA,” featuring an interview with journalist Marshall Allen.

Click to open the Transcript

Transcript: Anti-Abortion Hard-Liners Speak Up

[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.] 

Mila Atmos: The future of America is in your hands. This is not a movie trailer, and it’s not a political ad, but it is a call to action. I’m Mila Atmos, and I’m passionate about unlocking the power of everyday citizens. On our podcast Future Hindsight, we take big ideas about civic life and democracy and turn them into action items for you and me. Every Thursday, we talk to bold activists and civic innovators to help you understand your power and your power to change the status quo. Find us at futurehindsight.com or wherever you listen to podcasts.

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, May 23, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. We are joined today via a video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Rachel Roubein of The Washington Post.

Rachel Roubein: Hi, thanks for having me.

Rovner: And Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine.

Joanne Kenen: Hi, everybody.

Rovner: Later in this episode, we’ll have my interview with podcast panelist Shefali Luthra of The 19th. Shefali’s new book about abortion in the post-Roe [v. Wade] world, called “Undue Burden,” is out this week. But first, this week’s news. We’re going to start with abortion this week with a topic I’m calling “Abolitionists in Ascendance,” and a shoutout here to NPR’s Sarah McCammon with a great piece on this that we will link to in the show notes. It seems that while Republican politicians, at least at the federal level, are kind of going to ground on this issue, and we’ll talk more about that in a bit, those who would take the ban to the furthest by prosecuting women, and/or banning IVF and contraception, are raising their voices. How much of a split does this portend for what, until the overturn of Roe, had been a pretty unified movement? I mean they were all unified in “Let’s overturn Roe,” and now that Roe has gone, boy are they dividing.

Ollstein: Yeah, it’s a lot easier to agree on what you’re against than on what you’re for. We wrote about the split on IVF specifically a bit ago, and it is really interesting. A lot of anti-abortion advocates are disappointed in the Republican response and the Republican rush to say, “No, let’s leave IVF totally alone” because these groups think, some think it some should be banned, some think that there should be a lot of restrictions on the way it’s currently practiced. So not a total ban, but things like you can only produce a certain number of embryos, you can only implant a certain number of embryos, you can only create the ones you intend to implant, and so that would completely upend the way IVF is currently practiced in the U.S.

So, we know the anti-abortion movement is good at playing the long game, and so some of them have told me that they see this kind of like the campaign to overturn Roe v. Wade. They understand that Republicans are reacting for political reasons right now, and they are confident in winning them over for restrictions in the long term.

Rovner: I’ve been fascinated by, I would say, by things like Kristan Hawkins of Students for Life [of America] who’s been sort of the far-right fringe of the anti-abortion movement looking like she’s the moderate now with some of these people, and their discussions of “We should charge women with murder and have the death penalty if necessary.” Sorry, Rachel, you want to say something?

Roubein: This is something that Republicans, they don’t want to be asked about this on the campaign. The more hard-line abolitionist movement is something more mainstream groups have been taking a lot of pains to distance themselves and say that we don’t prosecute women, and essentially nobody wants to talk about this ahead of 2024. GOP doesn’t want to be seen as that party that’s going after that.

Kenen: And the divisions existed when Roe was still the law of the land, and we would all write about the divisions and what they were pushing for, and it was partly strategic. How far do you push? Do you push for legislation? Do you push for the courts? Do you push for 20 weeks for fetal pain? But it was like rape exceptions and under what terms and things like that. So it was sort of much later in pregnancy, and with more restrictions, and the fight was about exactly where do you draw that line. This abolition of all abortion under all circumstances, or personhood, only a couple of years ago, were the fringe. Personhood was sort of like, “Oh, they’re out there, no one will go for that.” And now I don’t think it’s the dominant voice. I don’t think we yet know what their dominant voice is, but it’s a player in this conversation.

At the same time, on the other side, the pro-abortion rights people, there’s polls showing us this many Americans support abortion, but it’s subtler too. Even if people support abortion rights, it doesn’t mean that they’re not, some subset are in favor of some restrictions, or where that’s going to settle. Right now, a 15-week ban, which would’ve seemed draconian a year or two ago, now seems like the moderate position. It has not shaken out, and …

Rovner: Well, let’s talk …

Kenen: It’s not going to shake out for some time.

Rovner: Let’s talk about a few specifics. The Louisiana State Legislature on Tuesday approved a bill that would put the drugs used in medication abortion, mifepristone and misoprostol, on the state’s list of controlled substances. This has gotten a lot of publicity. I’m wondering what the actual effect might be here though since abortion is already banned in Louisiana. Obviously, these drugs are used for other things, but they wouldn’t be unavailable. They would just be put in this category of dangerous drugs.

Ollstein: So, officials know that people in banned states, including Louisiana, are obtaining abortion pills from out of state, whether through telehealth from states with shield laws or through these gray-area groups overseas that are mailing pills to anyone no matter what state they live in or what restrictions are in place. So I think because it would be very difficult to actually enforce this law, short of going through people’s homes and their mail, this is just one more layer of a chilling effect and making people afraid to seek out those mail order services.

Rovner: So it’s more, again, for the appearance of it than the actuality of it.

Ollstein: It also sets up another state versus federal law clash, potentially. We’ve seen this playing out in courts in West Virginia and in North Carolina, basically. Can states restrict or even completely ban a medication that the FDA says is safe and effective? And that question is percolating in a few different courts right now.

Rovner: Including sort of the Supreme Court. We’re still waiting for their abortion pill decision that we expect now next month. Meanwhile, in Kansas, where voters approved a big abortion rights referendum in 2022 — remember, it was the first one of those — abortion providers are suing to stop a new state law enacted over the governor’s veto that would require them to report to the state women’s reasons for having an abortion. Now it’s not that hard to see how that information could be misused by people with other kinds of intents, right?

Ollstein: Well, it also brings up right to free speech issues, compelled speech. I think I’ve seen this pop up in abortion lawsuits even before Dobbs [v. Jackson Women’s Health Organization], this very issue because there have been instances where either doctors are required to give information that they say that they believe is medically inaccurate. That’s an issue in several states right now. And then this demanding information from patients. A lot of clinics that I’ve spoken to are so afraid of subpoenas from officials in-state, from out of state, that they intentionally don’t ask patients for certain kinds of data even though it would really help medically or organizationally for them to have that data. But they’re so afraid of it being seized, they figure well, they can’t seize it if they’re … doesn’t exist in the first place. And so I think this kind of law is in direct conflict with that.

Roubein: It also gets at the question of medical privacy that we’ve been seeing in the Biden administration’s efforts over HIPAA and protecting patients’ records and making it harder for state officials to attempt to seize.

Rovner: Yeah, this is clearly going to be a struggle in a lot of states where voters versus Republican legislatures, and we will sort of see how that all plays out. So even while this is going on in a bunch of the states, a lot of Republicans, including some who have been and remain strongly anti-abortion, are doing what I’m calling ducking-and-covering on a lot of these issues. Case in point, Texas Republican Sen. Ted Cruz and Alabama Republican Sen. Katie Britt this week introduced a bill they say would protect IVF, which is kind of ironic given that both of them voted against a bill to protect IVF back in, checking notes, February. What’s the difference here? What are these guys trying to do?

Kenen: Theirs is narrower. They say that the original bill, which was a Democratic bill, was larded with abortion rights kinds of things. I have not read the entire bill, I just read the summary of it. And in this one, if a state restricts someone who had — someone feel free to correct me if I am missing something here because I don’t have deep knowledge of this bill — but if a state does not protect IVF, they would lose their Medicaid payment. And I was not clear whether that meant every penny of Medicaid, including nursing homes, or if it’s a subsection of Medicaid, because it seems like a big can of worms.

Ollstein: Yeah, so the key difference in these bills is the word ban. The Republican bill says that if states ban IVF, then these penalties kick in for Medicaid, but they say that there can be “health and safety regulations,” and so that is very open to interpretation. That can include the things we talked about before about you can only produce a certain number of embryos, you can only implant a certain number of embryos, and you can’t discard them. And so even what Alabama did was not an outright ban. So even something like that that cut off services for lots of people wouldn’t be considered a ban under this Republican bill. So I think there’s sort of a semantic game going on here where restrictions would still be allowed if they were short of a blanket ban, whereas the democratic bill would also prevent restrictions.

Rovner: Well, and along those exact same lines, in Maryland, former two-term Republican governor Larry Hogan, who’s managed to dodge the abortion issue in his primary run to become the Senate nominee, now that he is the Republican candidate for the open Senate seat, has declared himself, his words, “pro-choice,” and says he would vote to restore Roe in the Senate if given the opportunity. But as I recall, and I live in Maryland, he vetoed a couple of bills to expand abortion rights in very blue Maryland. Is he going to be able to have this both ways? He seems to be doing the [Sen.] Susan Collins script where he gets to say he’s pro-choice, but he doesn’t necessarily have to vote for abortion rights bills.

Kenen: Hogan is a very popular moderate Republican governor in a Democratic state. He is a strong Senate candidate. His opponent, a Democrat, Angela Alsobrooks, has a stronger abortion rights record. I don’t think that’s going to be the decisive issue in Maryland. I think it may help him a little bit, but I think in Maryland, if the Senate was 55-45, a lot of Democrats like Hogan and might want another moderate Republican in the Senate. But given that this is going to be about control of the Senate, abortion will be a factor, I don’t think abortion is going to be the dominant factor in this particular race.

If she were to win and there’s two black women, I mean that would be the first time that two black women ever served in the Senate at once, and I think they would only be number three and number four in history. So race and Affirmative Action will be factors, but I think that Democrats who might otherwise lean toward him, because he was considered a good governor. He was well-liked. This is a 50-50ish Senate, and that’s the deciding thing for anyone who pays attention, which of course is a whole other can of worms because nobody really pays attention. They just do things.

Roubein: I think it’s also worth noting this tact to the left comes as Maryland voters will be voting on an abortion rights ballot measure in 2024. So that all sort of in context, we’ve seen what’s happened with the other abortion measures, abortion rights have won, so.

Rovner: And Maryland is a really blue state, so one would expect it …

Kenen: There’s no question that the Maryland …

Rovner: Yeah.

Kenen: I mean, and all of us would fall flat on our faces if the abortion measure fails in Maryland. But I believe this is the first one on the ballot alongside a presidential election, and some of them have been in special elections. It’s unclear the correlation between, you can vote for a Republican candidate and still vote for a pro-abortion rights initiative. We will learn a lot more about how that split happens in November. I mean, is Kansas going to go for Biden? Unlikely. But Kansas went really strong for abortion rights. If you’re not a single-issue voter, you can, in fact, have it both ways.

Rovner: Yes, and we are already seeing that in the polls. Well, of course then there is the king of trying to have it both ways: former President Trump. He is either considering restrictions on contraception, as he told an interviewer earlier this week, promising a proposal soon, or he will, all caps, as he put on Truth Social, never advocate imposing restrictions on birth control. So which is it?

Ollstein: So this came out of Trump’s verbal tick of saying “We’ll have a plan in a few weeks,” which he says about everything. But in this context it made it sound like he was leaving the door open to restrictions on contraception, which very well might be the case. So what my colleague and I wrote about is he says he would never restrict contraception. A lot of things he did in his first administration did restrict access to contraception. It was not a ban. Again, we’re getting back into the semantics of ban. It was not a ban, but his Title X rule led to a drop in hundreds of thousands of people accessing contraception. He allowed more kinds of employers to refuse to cover their employees’ contraception on their health plans, and the plans his allies are creating in this Project 2025 blueprint would reimpose those restrictions and go even further in different ways that would have the effect of restricting access to contraception. And so I think this is a good instance of look at what people do, not what they say.

Rovner: So now that we’re on the subject of campaign 2024, President Biden’s campaign launched a $14 million ad buy this week that includes the warning that if Trump becomes president again he’ll try to repeal the Affordable Care Act. Maybe health care will be an issue in this election after all? I don’t have a rooting interest one way or the other. I’m just curious to see how much of an issue health will be beyond reproductive rights.

Kenen: Well, as Alice just pointed out, Trump’s promised plans often do not materialize, and we are still waiting to see his replacement plan eight years later. I think he’s being told to sort of go slow on this. I mean, not that you can control what Trump says, but he didn’t run on health care until the end, in 2016. It was a close race, and he ran against Hillary Clinton, and it was the last 10 or so days that he really came down hard because it was right when ACA enrollment was about to begin and premiums came in and they were high. He pivoted. So is this going to be a health care election from day one? And I’m putting abortion aside for one second in terms of my definition of health care for this particular segment. Is it going to be a health care election in terms of ACA, Medicare, Medicaid? At this point, probably not. But is it going to emerge at various times by one or the other side in politically opportune ways? I would be surprised if Biden’s not raising it. The ACA is thriving under Biden.

Rovner: Well, he is. That’s the whole point. He just took out a $14 million ad buy.

Kenen: Right. But again, we don’t know. Is it a health care election or is it a couple ads? We don’t know. So yes, it’s going to be a health care election because all elections are health care elections. How much it’s defined by health care compared to immigration? No, at this point, that’s not what we’re expecting. Compared to the economy? No, at this point. But is it an issue for some voters? Yes. Is it going to be an issue more prominently depending on how other things play out? It’ll have its peaks. We just don’t know how consistent it’ll be.

Roubein: Biden would love to run on the Inflation Reduction Act and politically popular policies like allowing Medicare to negotiate drug prices. One of the problems of that is polls, including from KFF, has shown that the majority of voters don’t know about that. And some of these policies, the big ones, have not even gone into effect. CMS [Centers for Medicare & Medicaid Services] is going through the negotiation process, but that’s not going to hit people’s pocketbooks until after the election.

Kenen: The cliff for the ACA subsidies, which is in 2025, I mean I would imagine Democrats will be campaigning on, “We will extend the subsidies,” and again, in some places more than others, but that’s a time-sensitive big thing happening next year.

Rovner: But talk about an issue that people have no idea that’s coming. Well, meanwhile, for Trump, reproductive health isn’t the only issue where he’s doing a not-so-delicate dance. Apparently worried about Robert F. Kennedy Jr. stealing anti-vax [vaccine] votes from him, Trump is now calling RFK Jr. a fake anti-vaxxer. Except I’m old enough to remember when Trump bragged repeatedly about how fast his administration developed and brought the covid vaccine to market. That used to be one of his big selling points. Now he’s trying to be anti-vax, too?

Kenen: Not only did he brag about bringing it to the market. The way he used to talk about it, it was like he was there in his lab coat inventing it. Operation Warp Speed was a success. It got vaccines out in record time, way beyond what many people expected. Democrats gave him credit for that one policy in health care. He got a vaccine out and available in less than a year, and he got vaccinated and boasted about being vaccinated. He was open about it. Now we don’t know if he’s been boosted. He really backed off. As soon as somebody booed him, and it wasn’t a lot of boos, at one rally when he talked about vaccination and he got pushed back, that was the end.

Rovner: So, yeah, so I expect that to sort of continue on this election season, too.

Kenen: But we don’t expect RFK to flip.

Rovner: No, we do not. Right. Well, moving on to this weekend’s “Cyber Hacks,” a new feature, the fallout continues from the hack of Ascension [health care company]. That’s the Catholic hospital system with facilities in 19 states. In Michigan, patients have been unable to use hospital pharmacies and their doctors have been unable to send electronic prescriptions, so they’re having to write them out by hand. And in Indiana orders for tests and test results are being delayed by as much as a day for hospital patients. Not a great thing.

And just in time, or maybe a little late, the U.S. Department of Health and Human Services, through the newly created ARPA-H [Advanced Research Projects Agency for Health] that we have talked about, this week announced the launch of a new program to help hospitals make security patches and updates to their systems without taking them offline, which is obviously a major reason so many of these systems are so vulnerable to cyberhacking.

Of course, this announcement from HHS is just to solicit ideas for grants to help make that happen. So it’s going to be a while before we get any of these security changes. I’m wondering, how many systems are going to try to build a lot more redundancy into them? In the meantime, are we hearing anything about what they can do in the short term? It feels like the entire health care system is kind of a sitting duck for this group of cyberhackers who think they can get in easily and get ransom.

Kenen: There’s a reason they think that.

Rovner: They can.

Roubein: Thinking about hospitals and doctors using this manually, paper-based system and how that’s delaying getting your results and just there’s been these stories about patients. Like the anxiety that that’s understandably causing patients, and we’ll see sort of whether Congress can grapple with this, and there’s not really much legislation that’s going to move, so …

Kenen: But I was surprised that they were calling on ARPA-H. I mean, that’s supposed to be a biotech- curing-diseases thing, and none of the four of us are cybersecurity experts, and none of us really specialize in covering the electronic side of the digital side of health, but it just seems to me, I just thought that was an odd thing. First of all, some of these are just systems that haven’t been upgraded or individual clinicians who don’t upgrade or don’t do their double authorization. Some of it’s sort of cyberhygiene, and some of it’s obviously like the change thing. They’re really sophisticated criminals, but it’s not something that one would think you can’t get ahead of, right? They’re smart, good-guy technology people. It’s not like the bad guys are the only ones who understand technology. So why are the smart good guys not doing their job? And also, probably, health care systems have to have some kind of security checks on their own members to make sure they are following all the safety rules and some kind of consequences if you’re not, other than being embarrassed.

Rovner: I’ve just been sort of bemused by all of this, how both patients and providers complain loudly and frequently about the frustrations of some of these electronic record systems. And of course, in the places that they’re going down and they’ve had to go back to paper, people are like, “Please give us our electronic systems back.” So it doesn’t take long to get used to some of these things and be sorry when they’re gone, even if it’s only temporarily. It’s obviously been …

Kenen: But like what Rachel said, if you’re in the hospital, you’re sick, and do your clinicians need your lab results? Yes. I mean some of them are more important than others, and I would hope that hospitals are figuring out how to prioritize. But yeah, this is a crisis. If you’re in the hospital and they don’t know what’s wrong with you and they’re trying to figure out do you have X, Y, or Z, waiting until next week is not really a great idea.

Rovner: But it wasn’t that many years ago that their existence …

Kenen: Right, no, no, no.

Rovner: … did not involve …

Kenen: [inaudible 00:21:28].

Rovner: … electronic medical record.

Kenen: Right. Right.

Rovner: They knew how to get test results back and forth even if it was sending an intern to go fetch them. Finally, this week, we have some updates on some stories that we’ve talked about in earlier episodes. First, thanks in part to the excellent reporting of my colleague and sometime-pod-panelist Julie Appleby, the Senate Finance Committee Chairman Ron Wyden is demanding that HHS [U.S. Department of Health and Human Services] officials do more to rein in rogue insurance brokers who are reaping extra commissions by switching patients’ Affordable Care Act plans without their knowledge, often subjecting them to higher out-of-pocket costs and separating them from the providers that they’ve chosen. Sen. Wyden said he would introduce legislation to make such schemes a crime, but in the meantime he wants Biden officials to do more, given that they have received more than 90,000 complaints in the first quarter of 2024 alone about unauthorized switches and enrollments. Criminals go where the money is, right? You can either cyberhack or you can become a broker and switch people to ACA plans so you can get more commissions.

Kenen: I would think there could be a bipartisan, I mean it’s hard to get anything done in Congress. There’s no must-pass bills in the immediate future that are relevant. And the idea that a broker is secretly doing something that you don’t want them to do and that’s costing you money and making them money. I could see, those 90,000 people are from red and blue states and they vote, it’s going to affect constituents nationwide. Maybe they’ll do something. Maybe the industry can also… There is the National Association … I forgot the acronym, but there’s a broker’s organization, that there are probably things that they can also do to sanction. States can also do some things to brokers, but whether there’s a national solution or piecemeal, I don’t know, but it’s so outrageous that it’s not a right-left issue.

Rovner: Yes, one would think that there’ll be at least some kind of congressional action built into something …

Kenen: Something or other, right.

Rovner: … Congress that manages to do before the end of the year. Well, and in one of those seemingly rare cases where legislation actually does what it was intended to do, the White House this week announced that it has approved more than a million claims under the 2022 PACT Act, which made veterans injured as a result of exposure to burn pits and other toxic substances eligible for VA [Veterans Affairs] disability benefits. On the other hand, the VA is still working its way through another 3 million claims that have been submitted. I feel like even if it’s not very often, sometimes it’s worth noting that there are bipartisan things from Washington, D.C., that actually get passed and actually help the people that they’re supposed to help. It’s kind of sad that this is notable as an exception of something that happened and is working.

Roubein: In sort of the, I guess, Department of Unintended Side Effects here, my colleague Lisa Rein had a really interesting story out this morning that talked about the PACT Act, but basically that despite a federal law that prohibits charging veterans for help in applying for disability benefits, for-profit companies are making millions. She did a review of up to like a hundred unaccredited for-profit companies who have been charging veterans anywhere from like $5,000 to $20,000 for helping file disability claims because …

Rovner: That’s the theme of this week. Anyplace that there’s a lot of money in health care, there were people who will want to come in and take what’s not theirs. That’s where we will leave the news this week. Now we will play my interview with Shefali Luthra, then we’ll come back with our extra credits.

I am so pleased to welcome back to the podcast my former colleague and current “What The Health?” panelist Shefali Luthra. You haven’t heard from her in a while because she’s been working on her first book, called “Undue Burden,” that’s out this week. Shefali, great to see you.

Luthra: Thank you so much for having me Julie.

Rovner: So as the title suggests, “Undue Burden” is about the difficulties for both patients and providers in the wake of the overturn of Roe v. Wade. We talk so much about the politics of this issue, and so little about the real people who are affected. Why did you want to take this particular angle?

Luthra: To me, this is what makes this topic so important. Health care and abortion are really critical political issues. They sway elections. They are likely to be very consequential in this coming presidential election. But this matters to us as reporters and to us as people because of the life-or-death stakes and even beyond the life-or-death stakes, the stakes of how you choose to live your life and what it means to be pregnant and to be a parent. These are really difficult stories to tell because of the resources involved. And I wanted to write a book that just got at all of the different reasons why people pursue abortion and why they provide abortion and how that’s changed in the past two years. Because it felt to me like one of the few ways we could really understand just how seismic the implications of overturning Roe has been.

Rovner: And unlike those of us who talk to politicians all the time, you were really on the ground talking to patients and doctors, right?

Luthra: That was really, really important to the book. I spent a lot of time traveling the country, in clinics talking to people who were able to get abortions, who were unable to get abortions, and it was just really compelling for me to see how much access to care had the capacity to change their lives.

Rovner: So what kind of barriers then are we talking about that cropped up? And I guess it wasn’t even just the wake of the overturn of Roe. In Texas we had sort of a yearlong dry run.

Luthra: Exactly, and the book starts before Roe is overturned in Texas when the state enacted SB 8, the six-week abortion ban that effectively cut off access. And the first main character readers meet is this young girl named Tiffany, and she’s a teenager when she becomes pregnant, and she would love to get an abortion. But she is a minor. She lives very far from any abortion provider. She does not know how to self-manage an abortion. She does not know where to find pills. She has no connections into the health care system. She has no independent income. And she absolutely cannot travel anywhere for care. As a result, she has a child before she turns 18. And what this story highlights is that there are just so many barriers to getting an abortion. Many already existed: The incredible cost for procedure not covered by health insurance, the geographic distance, people already had to travel, the extra restrictions on minors.

But the overturning of Roe has amplified these, it is so expensive to get an abortion. It can be difficult to know you’re pregnant, especially if you are not trying to become pregnant. You have a very short time window. You may need to find childcare. You may need to find a car, get time off work, and bring all of these different forces together so that you are able to make a journey that can be days and pay for a trip that can cost thousands of dollars.

Rovner: One of the things that I think surprised me was that states that proclaimed themselves abortion “havens” actually did so little to help their clinics that predictably got swamped by out-of-state patients. Why do you think that was the case, and is it any better now?

Luthra: I think things have certainly changed. We have seen much more action in states, such as Illinois, where we see more people traveling there for care than anywhere else in the country. But it is worth going back to the summer that Roe was overturned. The governor promised to call a special session and put all these resources into making sure that Illinois could be a sanctuary. He never called that special session. And clinics felt like they were hanging out to dry, just waiting to get some support, and in the meanwhile, doing the absolute best they could.

One thing that I think this book really gets at is we are starting to see more efforts from these bluer states, the Illinois, the Californias, the New Yorks, and they talk a lot about wanting to be abortion havens, in part because it’s great politics if you’re a Democrat, but there’s only so much you can do. California has seen also quite a large increase in out-of-state patients. But I’ve spoken to so many people who just cannot conceivably go to California. They can barely go to Illinois. Making that journey when you are young, if you don’t have a lot of money, if you live in South Texas, if you live in Louisiana, it’s just not really feasible. And the places that are set up as these access points just can’t really fill in the gaps that they say they will.

Rovner: As you point out in the book, a lot of this was completely predictable. Was there something in your reporting that actually did surprise you?

Luthra: That’s a great question, and what did surprise me was in part something that we’ve begun to see borne out in the reporting, is there are very effective telemedicine strategies. We have begun to see physicians living in blue states, the New Yorks, Massachusetts, Californias, prescribing and mailing abortion pills to people in states with bans. This is pretty powerful. It has expanded access to a lot of people. What was really striking to me, though, even as I reported about the experiences of patients seeking care, is that while that has done so much to expand access in the face of abortion bans, it isn’t a solution that everyone can use. There were lots of people I met who did not want a medication abortion, who did not feel safe having pills mailed into their homes, or whose pregnancy complications and questions were just too complex to be solved by a virtual consult and then pills being mailed to them to take in the comfort of their house.

Rovner: Aren’t these difficulties exactly what the anti-abortion movement wanted? Didn’t they want clinics so swamped they couldn’t serve everybody who wanted to come, and abortion to be so difficult to get that women would end up carrying their pregnancies to term instead?

Luthra: Yes and no, I would argue. I think you are absolutely right that one of the primary goals of the anti-abortion movement was to make abortion unavailable, to make it harder to acquire, to have more people not get abortions and instead have children. But when I speak to folks in the anti-abortion movement, they are very troubled by how many people are traveling out of state to get care. They see those really long wait times in Kansas, in, until recently, Florida, in Illinois, in New Mexico, as a symptom of something that they need to address, which is that so many people are still finding a way to fight incredible odds to access abortion.

Rovner: Is there one thing that you hope people take away after they’re finished reading this?

Luthra: There are two things that I have spent a lot of time thinking about as I’ve reported this book. The first is just who gets abortions and under what circumstances. And so often in the national press, in national politics, we talk about these really extreme life-or-death cases. We talk about people who became septic and needed an abortion because their water broke early, or we talk about children who have been sexually assaulted and become pregnant. But we don’t talk about most people who get abortions; who are usually mothers, who are usually people of color, who are in their 20s and just know that they can’t be pregnant. I think those are really important stories to tell because they’re the true face of who is most affected by this, and it was important to me that this book include that.

The other thing that I have thought about so often in reporting this and writing this is abortion demands have an unequal impact. That is true if you are poor, if you are a person of color, if you live in a rural area, et cetera. You will in all likelihood see a greater effect. That said, the overturning of Roe v. Wade is so tremendous that it has affected people in every state. It affects you if you can get pregnant. It affects you if you want birth control. It affects you if you require reproductive health care in some form. This is just such a seismic change to our health care system that I really hope people who read this book understand that this is not a niche issue. This is something worthy of our collective attention and concern as journalists and as people.

Rovner: Shefali Luthra, thank you so much for this, and we will see you soon on the panel, right?

Luthra: Absolutely. Thank you, Julie. I’m so glad we got to do this.

Rovner: OK, we are back. It’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Joanne, why don’t you go first this week?

Kenen: This was a pair of articles, a long one and a shorter, related one. There’s an amazingly wonderful piece in ProPublica by Sharon Lerner, and it’s called “Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe.” I’m going to come back and talk about it briefly in a second, but the related story was in The Guardian by Damian Carrington: “Microplastics Found in Every Human Testicle in Study.” Now, that was a small study, but there may be a link to the declining sperm count because of these forever chemicals.

The ProPublica story, it was a young woman scientist. She worked for 3M. They kept telling her her results was wrong, her machinery was dirty, over and over and over again until she questioned herself and her findings. She was supposed to be looking at the blood of 3M workers who were, it turned out, the company knew all this already and they were hiding it, and she compared the blood of the 3M workers to non-3M workers, and she found these plastic chemicals in everybody’s blood everywhere, and she was basically gaslit out of her job. She continued to work for 3M, but in a different capacity.

The article’s really scary about the impact for human health. It also has wonderfully interesting little nuggets throughout about how various 3M products were developed, some by accident. Something spilled on somebody’s sneaker and it didn’t stain it, and that’s how we got those sprays for our upholstery. Or somebody needed something to find the pages in their church hymnal, and that’s how we got Post-it notes. It’s a devastating but very readable, and it makes you angry.

Rovner: Yeah, I feel like there’s a lot more we’re going to have to say about forever chemicals going forward. Alice.

Ollstein: So I have a pretty depressing story from Stats. It’s called “How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations,” by Eric Boodman. And it is about people with sickle cell, and that is overwhelmingly black women, and they felt pressured to agree to be permanently sterilized when they were going to give birth because of the higher risks. And the doctors said, because we’re already doing a C-section and we’re already doing surgery on you, to not have to do an additional surgery with additional risks, they felt pressured to just sign that they could be sterilized right then and there and came to regret it later and really wanted more children. And so, this is an instance of people feeling coerced, and when people think about pro-choice or the choice debate about reproduction they mostly think about the right to an abortion. But I think that the right to have more children, if you want to, is the other side of that coin.

Rovner: It is. Rachel.

Roubein: My extra credit, it’s called “What Science Tells Us About Biden, Trump and Evaluating an Aging Brain,” by Joel Achenbach and Mark Johnson from The Washington Post. And basically, they kind of took a very science-based look at the 2024 election. They basically called it a crash course in gerontology because former President Donald Trump will be 78 years old. President Biden will be a couple weeks away from turning 82. And obviously that is getting a lot of attention on the campaign trail. They talked to medical and scientific experts who were essentially warning that news reports, political punditry about the candidates’ mental fitness, has essentially been marred by misinformation here about the aging process. One of the things they dived into was these gaffes or what the public sees as senior moments and what experts had told them is, that’s not necessarily a sign of dementia or predictive of cognitive decline. There need to be kind of further clinical evaluation for that. But there have been some calls for just how to kind of standardize and require a certain level of transparency for candidates in terms of disclosing their health information.

Rovner: Yes, which we’ve been talking about for a while, and will continue to. My extra credit this week is from our guest, Shefali Luthra, and her colleague at The 19th Chabeli Carrazana, and it’s called “What Happens to Clinics After a State Bans Abortion? They Fight To Survive.” And for all the talk about doctors and other staffers either moving out of or not moving into states with abortion bans, I think less has been written about entire enterprises that often provide far more than just abortion services having to shut down as well. We saw this in Texas in the mid-2010s, when a law that shut down many of the clinics there was struck down by the Supreme Court in 2016. But many of those clinics were unable to reopen. They just could not reassemble, basically, their leases and equipment and staff. The same could well happen in states that this November vote to reverse some of those bans. And it’s not just abortion, as we’ve discussed. When these clinics close, it often means less family planning, less STI [sexually transmitted infection] screening and other preventive services as well, so it’s definitely something to continue to watch.

Before we go this week, I want to note the passing of a health policy journalism giant with the death of Marshall Allen. Marshall, who worked tirelessly, first in Las Vegas and more recently at ProPublica, to expose some of the most unfair and infuriating parts of the U.S. health care system, was on the podcast in 2021 to talk about his book, “Never Pay the First Bill, and Other Ways to Fight the Health Care System and Win.” I will post a link to the interview in this week’s show notes. Condolences to Marshall’s friends and family.

OK, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner. Joanne, where are you?

Kenen: We’re at Threads @JoanneKenen.

Rovner: Alice.

Ollstein: Still on X @AliceOllstein.

Rovner: Rachel.

Roubein: On X, @rachel_roubein.

Rovner: We will be back in your feed next week. Until then, be healthy.

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En el campamento que habían montado los estudiantes dentro del campus de la Universidad de California en Los Ángeles (UCLA), de repente la ginecóloga y obstetra residente Elaine Chan se sintió como una médica en un campo de batalla.

La policía avanzó hacia el campamento luego de horas de enfrentamiento y tensión.

Chan, de 31 años, voluntaria en el puesto de atención médica, dijo que los manifestantes llegaban con dificultades para caminar y con graves heridas punzantes. Pero, por el caos que reinaba afuera, había pocas posibilidades de trasladarlos a un hospital donde se les pudiera brindar otro tipo de cuidados.

Chan expresó su sospecha de que esas lesiones habían sido causadas por balas de goma u otros proyectiles “menos letales”. Después del desalojo del campamento, la policía confirmó que había usado estos dispositivos.

“Los proyectiles atravesaron la piel y se clavaron profundamente en el cuerpo de las personas”, explicó Chan. “Todos sangraban profusamente. Los médicos que nos especializamos en obstetricia y ginecología no hemos sido capacitados para atender heridos por balas de goma… No podía creer que se permitiera atacar de ese modo a civiles, a estudiantes, que tenían ningún equipo de protección”.

La protesta de la UCLA, que reunió a miles de personas que se oponen a los continuos bombardeos de Israel sobre la Franja de Gaza, comenzó en abril y alcanzó un peligroso crescendo en mayo, cuando manifestantes pro Israel y la policía se enfrentaron a los activistas y a los que los apoyaban.

En entrevistas con KFF Health News, Chan y otros tres médicos voluntarios describieron cómo debieron atender a manifestantes con heridas sangrantes, lesiones en la cabeza y huesos presuntamente fracturados en una clínica improvisada en tiendas de campaña, sin electricidad ni agua corriente.

En los puestos sanitarios del campamento hubo día y noche médicos, enfermeras, estudiantes de medicina, paramédicos y voluntarios sin formación médica formal.

En muchos momentos, la escalada de la violencia fuera de la carpa sanitaria fue de tal magnitud que impedía que los manifestantes heridos llegaran hasta las ambulancias, explicaron los médicos. Esto obligó a que los heridos fueran caminando por sus propios medios hasta algún hospital cercano. A otros los llevaron más allá de los límites de la protesta para trasladarlos a una sala de emergencias.

“Nunca había estado en una situación en la que se nos impidiera ofrecer una atención de mayor nivel”, dijo Chan. “Y eso me aterrorizó”.

Tres de los médicos entrevistados por KFF Health News dijeron que estaban presentes el 2 de mayo, cuando la policía arrasó el campamento, y describieron que debieron ocuparse de múltiples lesiones que parecían haber sido causadas por proyectiles “menos letales”.

Estos proyectiles “menos letales” incluyen balas llenas de perdigones de metales pesados o plomo; y municiones comúnmente conocidas como balas de goma. Los utiliza la policía para controlar a sospechosos o para dispersar multitudes y protestas.

La policía recibió una condena generalizada por haber utilizado estas armas contra las manifestaciones del movimiento Black Lives Matter, que se extendieron por todo el país tras el asesinato de George Floyd en 2020.

Aunque el nombre de estas armas parece minimizar su peligrosidad, los proyectiles menos letales pueden viajar a más de 200 mph y está comprobada su capacidad de herir, mutilar o matar.   

Las entrevistas a los médicos que atendieron en la posta sanitaria contradicen directamente la versión del Departamento de Policía de Los Ángeles (LAPD). Después que los agentes desalojaran el campamento, el jefe de Policía, Dominic Choi, afirmó en una publicación en la plataforma social X que “no hubo heridos graves entre los agentes ni entre los manifestantes” durante el operativo en el hubo más de 200 arrestos.

En las respuestas enviadas por correo electrónico a las preguntas de KFF Health News, tanto el Departamento de Policía de Los Ángeles como la Patrulla de Carreteras de California afirmaron que investigarían cómo habían actuado sus agentes durante la protesta en la UCLA. Esas indagaciones, dijeron, darán lugar a un “informe detallado”.

La declaración de la Patrulla de Carreteras asegura que los oficiales advirtieron previamente a los manifestantes que si no se dispersaban podrían utilizar “municiones no letales”.

Después que algunos manifestantes se convirtieran en una “amenaza inmediata” porque “lanzaban objetos y armas”, algunos oficiales utilizaron “balas cinéticas especiales para protegerse a sí mismos, a otros oficiales y a los miembros del público”. Un agente resultó con heridas leves, según el comunicado.

Las imágenes de un video que circuló por Internet después del desalojo del campamento parecían mostrar a un oficial de la Patrulla de Carreteras disparando con una escopeta estos proyectiles de menor letalidad contra los manifestantes.

“El uso de la fuerza y cualquier incidente que implique el uso de un arma por parte del personal de la CHP es un asunto serio, y la CHP llevará a cabo una investigación justa e imparcial para garantizar que las acciones fueron coherentes con la política y la ley”, respondió la Patrulla de Carreteras en su declaración.

El Departamento de Policía de la UCLA, que también participó en el operativo vinculado a la protesta, no respondió al pedido de testimonio de KFF Health News.

Jack Fukushima, de 28 años, estudiante de medicina de la UCLA y socorrista voluntario, contó que presenció cómo un agente de policía les disparó a por lo menos dos manifestantes con proyectiles de menor letalidad.

Entre ellos, a un hombre que se desplomó tras recibir un impacto “justo en el pecho”. Fukushima explicó que, junto con otros médicos, acompañaron al hombre, aturdido, a la carpa sanitaria. Luego volvieron a la zona de los enfrentamientos para buscar más heridos.

“Realmente lo sentí como una guerra”, aseguró Fukushima. “Encontrarse con semejante brutalidad policial fue muy descorazonador”.

Cuando los médicos estuvieron de regreso en la primera línea, la Policía ya había traspasado los límites del campamento y se encontraba forcejeando directamente con los manifestantes, recordó Fukushima.

En esa situación, el socorrista vio como el mismo policía que antes le había disparado al herido que habían llevado al puesto sanitario ahora le disparaba a otro manifestante en el cuello. El muchacho cayó al suelo. Fukushima supuso lo peor y corrió a su lado.

“Cuando logré acercarme le pregunté: ‘Oye, ¿estás bien?’”, contó Fukushima. “Y él, con una valentía impresionante, me respondió: ‘Sí, no es mi primera vez’. Y volvió de inmediato a la acción”.

Sonia Raghuram, de 27 años, otra estudiante de medicina que colaboró en la carpa sanitaria dijo que durante el operativo policial atendió a un manifestante que tenía una herida punzante abierta en la espalda, a otro con un moretón del tamaño de una moneda en el centro del pecho y a un tercero con un corte que sangraba “a borbotones” sobre el ojo derecho y que probablemente tenía una costilla rota.

Raghuram contó que los pacientes le dijeron que las heridas habían sido causadas por los proyectiles policiales, lo que, según ella, coincidía con la gravedad de sus lesiones.

Los pacientes les advirtieron claramente que los agentes de policía se estaban acercando a la posta sanitaria, dijo Raghuram, pero ella no se movió.

“Nunca abandonaremos a un paciente”, aseguró, aludiendo al mantra de la carpa médica. “No me importa que nos detengan. Si estoy atendiendo a un paciente, eso es lo prioritario”, concluyó.

La protesta de la UCLA es una de las muchas que se han organizado en campus universitarios de todo el país. Los estudiantes que se oponen a la guerra que Israel mantiene en Gaza exigen que la universidad apoye un alto el fuego y que se retiren las inversiones que pueda tener en empresas vinculadas a Israel.

La Policía utilizó la fuerza para desalojar a los manifestantes de campamentos en la Universidad de Columbia, la Universidad de Emory y las universidades de Arizona, Utah y el sur de Florida, entre otras.

En el campus de la UCLA, el 25 de abril los estudiantes que protestaban instalaron tiendas de campaña en una plaza cubierta de césped frente al teatro Royce Hall.

El asentamiento atrajo a miles de simpatizantes, según Los Angeles Times. Días más tarde, una “violenta turba” de manifestantes de signo contrario “atacó el campamento”, informó el Times, e intentó derribar las barricadas que protegían sus límites, arrojando fuegos artificiales contra las carpas que había en su interior.

La noche siguiente, la Policía declaró ilegal la demostración y luego desalojó el campamento en las primeras horas del 2 de mayo. Hubo cientos de arrestos.

La Policía ha sido muy criticada por no haber intervenido durante el enfrentamiento entre los manifestantes que acampaban y los que fueron a atacarlos, una confrontación que se prolongó durante horas.

La red de Universidades de California anunció que había contratado a un consultor independiente en materia policial para que investigara los actos de violencia y para “resolver las preguntas sin respuesta sobre la planificación y los protocolos de la UCLA, así como sobre el trabajo de colaboración interinstitucional”.

Charlotte Austin, de 34 años, residente de cirugía, dijo que cuando los manifestantes opositores atacaron el campamento de protesta, vio a unos 10 agentes de seguridad privada del campus de pie, “con las manos en los bolsillos”, mientras los estudiantes eran golpeados y ensangrentados.

Austin asegura que atendió a pacientes con cortes en la cara y posibles fracturas de cráneo. La posta médica envió al menos a 20 personas al hospital esa noche, agregó.

“Cualquier profesional de la medicina calificaría esas lesiones de graves”, dijo Austin. “Hubo personas que debieron ser internadas, no se limitó solo a una visita a la sala de emergencias, sino que necesitaron una hospitalización real”.

Tácticas policiales: “lícitas pero horribles”

Los manifestantes de la UCLA no son los primeros heridos por proyectiles de menor letalidad, ni mucho menos.

En los últimos años, la policía de todo Estados Unidos ha disparado cientos de veces estas armas contra manifestantes, sin que prácticamente exista una normativa general que regule su uso o su seguridad. Algunos de los heridos nunca han vuelto a ser los mismos y las ciudades han gastado millones para responder a las demandas de los damnificados.

Durante las protestas que se produjeron en todo el país tras la muerte de George Floyd a manos de la policía en 2020, al menos 60 manifestantes sufrieron lesiones graves —incluso ceguera y fractura de mandíbula— por disparos de estos proyectiles, a veces en aparente violación de las políticas de los departamentos de policía, según una investigación conjunta de KFF Health News y USA Today.

En 2004, en Boston, una estudiante universitaria que celebraba la victoria de los Red Sox murió por el impacto de un proyectil lleno de gas pimienta, que le atravesó el ojo y le llegó al cerebro.

“Se llaman ‘menos letales’ por una razón”, sentenció Jim Bueermann, ex jefe de policía de Redlands, en California, que ahora lidera el Future Policing Institute. “Pueden matarte”.

Bueermann, que a petición de KFF Health News revisó las imágenes de video de la intervención de la policía en la UCLA, dijo que muestran a agentes de la Patrulla de Carreteras de California disparando balas de salva con una escopeta.

Bueermann opinó que las imágenes no proporcionaban suficiente contexto como para determinar si los proyectiles se estaban utilizando “razonablemente”, según indica la norma establecida por los tribunales federales, o se estaban disparando “indiscriminadamente”, lo que fue prohibido por una ley de California en 2021.

“Hay un dicho en la Policía — “legal pero horrible”— lo que significa que es razonable bajo los estándares legales, pero se ve terrible”, explicó Bueermann. “Y creo que un policía cargando múltiples balas en una escopeta y disparando contra los manifestantes, no es algo que se vea muy bien”.

KFF Health News 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 KFF.

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Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Public health officials are watching with concern since a strain of bird flu spread to dairy cows in at least nine states, and to at least one dairy worker. But in the wake of covid-19, many farmers are loath to let in health authorities for testing.

Meanwhile, another large health company — the Catholic hospital chain Ascension — has been targeted by a cyberattack, leading to serious problems at some facilities.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

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Rachel Cohrs Zhang
Stat News

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Read Rachel's stories.

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories.

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Stumbles in the early response to bird flu bear an uncomfortable resemblance to the early days of covid, including the troubles protecting workers who could be exposed to the disease. Notably, the Department of Agriculture benefited from millions in covid relief funds designed to strengthen disease surveillance.
• Congress is working to extend coverage of telehealth care; the question is, how to pay for it? Lawmakers appear to have settled on a two-year agreement, though more on the extension — including how much it will cost — remains unknown.
• Speaking of telehealth, a new report shows about 20% of medication abortions are supervised via telehealth care. State-level restrictions are forcing those in need of abortion care to turn to options farther from home.
• And new reporting on Medicaid illuminates the number of people falling through the cracks of the government health system for low-income and disabled Americans — including how insurance companies benefit from individuals’ confusion over whether they have Medicaid coverage at all.

Also this week, Rovner interviews Atul Grover of the Association of American Medical Colleges about its recent analysis showing that graduating medical students are avoiding training in states with abortion bans and major restrictions.

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

Julie Rovner: NPR’s “Why Writing by Hand Beats Typing for Thinking and Learning,” by Jonathan Lambert.  

Alice Miranda Ollstein: Time’s “‘I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured Into Long-Term Birth Control,” by Alana Semuels.  

Rachel Cohrs Zhang: Stat’s “After Decades Fighting Big Tobacco, Cliff Douglas Now Leads a Foundation Funded by His Former Adversaries,” by Nicholas Florko.  

Sandhya Raman: The Baltimore Banner’s “People With Severe Mental Illness Are Stuck in Jail. Montgomery County Is the Epicenter of the Problem,” by Ben Conarck.  

Also mentioned on this week’s podcast:

• Stat’s “My Rendezvous With the Raw Milk Black Market: Quick, Easy, and Unchecked by the FDA,” by Nicholas Florko.
• The Stamford Advocate’s “Dan Haar: Hackers Stole a Disabled CT Couple’s SNAP Food Aid. Now They’re Out $1,373,” by Dan Haar.
• WKRN’s “‘Chaos’: Nurses, Visitors Describe Conditions Inside Ascension Hospitals After Cyberattack,” by Stephanie Langston.
• KFF Health News’ “Medicaid ‘Unwinding’ Decried as Biased Against Disabled People,” by Daniel Chang.
• KFF Health News’ “Why Medicaid’s ‘Undercount’ Problem Counts,” by Phil Galewitz.

Click to open the transcript

Transcript: Bird Flu Lands as the Next Public Health Challenge

[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.]

Mila Atmos: The future of America is in your hands.

This is not a movie trailer and it’s not a political ad, but it is a call to action. I’m Mila Atmos and I’m passionate about unlocking the power of everyday citizens. On our podcast “Future Hindsight,” we take big ideas about civic life and democracy and turn them into action items for you and me. Every Thursday we talk to bold activists and civic innovators to help you understand your power and your power to change the status quo. Find us at futurehindsight.com or wherever you listen to podcasts.

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, May 16, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this, so here we go.

We are joined today via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Rachel Cohrs Zhang of Stat News.

Rachel Cohrs Zhang: Hi, everybody.

Rovner: And we welcome back to the podcast following her sabbatical, Sandhya Raman of CQ Roll Call.

Sandhya Raman: Hi, everyone.

Rovner: Later in this episode we’ll have my interview with Atul Grover of the Association of American Medical Colleges. He’s the co-author of the analysis we talked about on last week’s episode about how graduating medical students are avoiding applying for residencies in states with abortion bans or severe restrictions. But first this week’s news.

Well, I have been trying to avoid it, but I guess we finally have to talk about bird flu, which I think we really need to start calling “cow flu.” I just hope we don’t have to call it the next pandemic. Seriously, scientists say they’ve never seen the H5N1 virus spread quite like this before, including to at least one farmworker, who luckily had a very mild case. And public health officials are, if not actively freaking out, at least expressing very serious concern.

On the one hand, the federal government is providing livestock farmers tens of thousands of dollars each to beef up their protective measures — yes, I did that on purpose — and test for the avian flu virus in their cows, which seems to be spreading rapidly. On the other hand, many farmers are resisting efforts to allow health officials to test their herds, and this is exactly the kind of thing at the federal level that touches off those intra-agency rivalries between FDA [Food and Drug Administration] and USDA [United States Department of Agriculture] and the CDC [Centers for Disease Control and Prevention].

Is this going to be the first test of how weak our public health sector has become in the wake of covid? And how worried should we be both about the bird flu and about the ability of government to do anything about it? Rachel, you wrote about this this week.

Cohrs Zhang: I did, yes. It is kind of wild to see a lot of these patterns play out yet again, as if we’ve learned nothing. We still have a lot of challenges between coordinating with state and local health officials and federal agencies like CDC. We’re still seeing authorities that are exactly the same between USDA and FDA. USDA actually got $300 million from covid relief bills to try to increase their surveillance for these kind of diseases that spread among animals, but people are worried it could all potentially jump to humans.

So I think there was a lot of hope that maybe we would learn some lessons and learn to respond better, but I think we have seen some hiccups and just these jurisdictional issues that have just continued to happen because Congress didn’t really address some of these larger authorities in any meaningful way.

Rovner: I think the thing that worries me the most is looking at the dairy farmers who don’t want to let inspectors onto their farms. That strikes me as something that could seriously hamper efforts to know how widely and how fast this is spreading.

Cohrs Zhang: It could. And USDA does have more authority than they have had in other foodborne disease outbreaks like E. coli or salmonella to get on these farms, according to the experts that I’ve talked to. But we do see sometimes federal agencies don’t always want to use their full statutory authority because then it creates conflict. And obviously USDA has this dual mission of both ensuring food safety and promoting agriculture. And I think that comes into conflict sometimes and USDA just hasn’t been willing to enforce anything mandatory on farms yet. They’ve been kind of trying to use the carrot instead of the stick approach so far. So we’ll see how that goes and how much information they’re able to obtain with the measures they’ve used so far.

Rovner: Alice, you want to add something.

Ollstein: Yeah, I mean, like Rachel said, it’s sort of Groundhog Day for some of the bigger missteps of covid: inadequate testing, inadequate PPE [personal protective equipment]. But it’s also like a scary repeat of some of the specifics of covid, which really hit agricultural workers really hard. And a lot of that wasn’t known at the time, but we know it now. And a lot of workers in these agricultural, meatpacking, and other sectors, were just really devastated and forced to keep working during the outbreak.

This sector in particular has been resistant to public health enforcement and we’re just seeing that repeat once again with a potentially more deadly virus should it make the jump to humans.

Rovner: Basically, from what they can tell, this virus is in a lot of milk. It seems that pasteurization can kill it, but is this maybe what will get people to stop drinking raw milk, which isn’t that safe anyway? And if you need to know why you shouldn’t drink raw milk, I will link to a highly informative and entertaining story by Rachel’s colleague Nick Florko about how easy it is to buy raw milk and how dangerous it can be. This is one of those things where the public looks at the public health and goes, “Yeah, nah.”

Ollstein: Right, yeah. I think, at least anecdotally, the raw milk seller that Nick bought from indicated that business is good for him, business is booming. A lot of the people that maybe weren’t so concerned about covid aren’t so concerned about bird flu, and I think that will continue to drink that. Again, we haven’t seen a lot of data about how exactly that works with bird flu fragments or virus fragments: whether it’s showing up in raw milk?; what happens when people drink it? There’s so many questions we have right now because I think the FDA has been focused on pasteurized milk because that’s what most people drink. But certainly in terms of concern with transitions into humans, I think that’s an area to watch.

Raman: One of the things that struck me was that one of the benefits from what the USDA and HHS [Department of Health and Human Services] were doing was the benefit for workers to get a swab test and do an interview so they can study more and gauge the situation.

If $75 is enough to incentivize people to take off work, to maybe have to do transportation, to do those other things. And if they’ll be able to get some of the data, just as Rachel was saying, to just kind of continue gauging the situation. So I think that’ll be interesting to see.

Because even with when we had covid, there were so many incentives that we did just for vaccines that we hoped would be successful for different populations and money and prizes and all sorts of things that didn’t necessarily move the needle.

Rovner: Although some did. And nice pun there.

All right, well, moving on to less potentially-end-of-the-world health news, Congress is grappling with whether and how to extend coverage of telehealth and, if so, how to pay for it. Telehealth, of course, was practically the only way to get nonemergency health care throughout most of the pandemic, and both patients and providers got used to it and even, dare I say, came to like it. But as a Politico story succinctly put it this week, telehealth “has the potential to reduce expenses but also lead to more visits, driving up costs.”

Rachel, you’ve been watching this also this week. Where are we on these competing telehealth bills?

Cohrs Zhang: Well, we have some news this morning. The [House Committee on] Energy and Commerce Health Subcommittee is planning to mark up their telehealth bill. And the underlying bill will be a permanent extension of some of these Medicare telehealth flexibilities that matter a lot to seniors. But they’re planning to amend it today, so that they’re proposing a two-year extension, which does fall more in line with what the Ways and Means Committee, which is kind of the counterpart that makes policy on health care, marked up …

Rovner: Yes, they shared jurisdiction over Medicare.

Cohrs Zhang: … unanimously passed. They shared, yes, but it is surprising and remarkable for them to come to an agreement this quickly on a two-year extension. Again, I think industry would’ve loved to see a little bit more certainty on this for what these authorities are going to look like, but I think it is just expensive. Again, when these bills pass out of committee, then we’ll actually get formal cost estimates for them, which will be helpful in informing what our end-of-the-year December package is going to look like on health care. But we are seeing some alignment now in the House on a two-year telehealth extension for some of these very impactful measures for Medicare patients.

Rovner: Congress potentially getting things done months before they actually have to! Dare we hope?

Meanwhile, bridging this week’s topics between telehealth and abortion, which we will get to next, a new report from the family planning group WeCount! finds that not only are medication abortions more than half of all abortions being performed these days, but telehealth medication abortions now make up 20% of all medication abortions.

Some of this increase obviously is the pandemic relaxation of in-person medication abortion rules by the FDA, as well as shield laws that attempt to protect providers in states where abortion is still legal, who prescribe the pills for patients in states where abortion is banned.

Still, I imagine this is making anti-abortion activists really, really frustrated because it is certainly compromising their ability to really stop abortions in these states with bans, right?

Ollstein: Well, I think for a while we’ve seen anti-abortion activists really targeting the two main routes for people who live in states with bans to still have an abortion. One is ordering pills and the other is traveling out of state. And so they are exploring different policies to cut off both. Obviously both are very hard to police, both logistically and legally. There’s been a lot of debate about how this would be enforced. You see Louisiana moving to make abortion pills a controlled substance and police it that way. These pills are used for more than just abortions, so there’s some health care implications to going down that route. They’re used in miscarriage management, they’re used for other things as well in health care. And then of course, the enforcement question. Short of going through everyone’s mail, which has obvious constitutional problems, how would you ever know? These pills are sent to people’s homes in discreet packaging.

What we’ve seen so far with anti-abortion laws and their enforcement is that just the chilling effect alone and the fear is often enough to deter people from using different methods. And so that could be the goal. But actually cutting off people from telehealth abortions that, like you said, like the report said, have become very, very widely used, seems challenging.

Raman: And I would say that that really underscores the importance of the case we’d heard this year from the Supreme Court, and that we will get a decision coming up about the regulation of medication abortions. And how the court lands on that could have a huge impact on the next steps for all of these. So it’s in flux regardless of what’s happening here.

Cohrs Zhang: I want to emphasize, too, that mail-order abortion pills have been sort of held up as this silver bullet for getting around bans. And for a lot of people, that seems to be the case. But I really hear from providers and from patients that this is not a solution for everyone. A lot of people don’t have internet access or don’t know how to navigate different websites to find a reliable source for the pills. Or they’re too scared to do so, scared by the threat of law enforcement or scared that they could purchase some sort of counterfeit that isn’t effective or harms them.

Some people, even when they’re eligible for a medication abortion, prefer surgical or procedural because with a medication you take it and then you have to wait a few weeks to find out if it worked. And so some people would rather go into the clinic, make sure it’s done, have that peace of mind and security.

Also, these pills are delivered to people’s homes. Some people, because of a domestic violence situation or because they’re a minor who’s still at home with their parents, they can’t have anything sent to their homes. There’s a lot of reasons why this isn’t a solution for everyone, that I’ve been hearing about, but it is a solution, it seems, for a lot of people.

Rovner: In other abortion news this week, Democrats in the Missouri state Senate this week broke the record for the longest filibuster in history in an effort to block anti-abortion forces from making it harder for voters to amend the state constitution.

Alice, this feels pretty familiar, like it’s just about what happened in Ohio, right? And I guess the filibuster is over, but so far they’ve managed to be successful. What’s happening in Missouri?

Ollstein: So Missouri Democrats, with their filibuster that lasted for days, managed to stop a vote for now on a measure that would’ve made ballot measures harder to pass, including the abortion rights ballot measure that’s expected this fall. It’s not over yet. They sort of kicked it back to committee, but there’s only basically a day left in the legislature session, and so stay tuned over the next day to see what happens.

But what Democrats are trying to do is prevent what happened in Ohio, which is setting up a summer special election on a provision that would make all ballot measures harder to pass in the future. In Ohio, they did hold that summer vote, and voters defeated it and then went on to pass an abortion rights measure. And so even if Republicans push this through, it can still be scuttled later. But there, Democrats are trying to nip it in the bud to make sure that doesn’t happen in the first place.

Rovner: I thought that was very well explained. Thank you very much.

And speaking of misleading ballot measures, next door in Nebraska — and I did have to look at a map to make sure that Nebraska and Missouri do have a border, they do — anti-abortion forces are pushing a ballot measure they’re advertising as enshrining abortion rights in the state constitution, but which would actually enshrine the state’s current 12-week ban.

We’re seeing more and more of this: anti-abortion forces trying to sort of confuse voters about what it is that they’re voting on.

Raman: I mean, I think that that has been something that we have been seeing a little bit more of this. They’ve been trying different tactics to see — the same metaphor of throwing spaghetti at the wall and seeing what sticks. So with Nebraska right now, the proposal is to ban abortions after the first trimester, except in the trio of cases: medical emergencies, rape, incest.

And so that’s definitely different than a lot of the other ballot measures that we’ve seen in the last few years in that it’s being kind of pitched as a little bit of a middle ground and it has the backing of the different anti-abortion groups. But at the same time, it would allow state legislature to put additional bans on top of that. This is just kind of like the mark in the constitution and it would already keep in place the bans that you have in place.

So it’s a little bit more difficult to comprehend, especially if you’re just kind of walking in and checking a box, since there’s more nuance to it than some of the other measures. And I think that a lot of that is definitely more happening in states like that and others.

Rovner: I feel like we’re learning a lot more about ballot measures and how they work. And while we’re in the Great Plains, there’s a wild story out of South Dakota this week about an actual scam related to signatures on petitions for abortion ballot measures. Somebody tease this one apart.

Ollstein: So in South Dakota, they’ve already submitted signatures to put an abortion rights measure on the November ballot. The state is, as happens in most states, going through those signatures to verify it. What’s different than most states is that the state released the names of some of the people who signed the petition, and that enabled these anti-abortion groups to look up all those people and start calling them, and to try to convince them to withdraw their signatures to deny this from going forward.

What happened is that, in doing so, these groups are accused of misrepresenting themselves and impersonating government officials in the way they said, “Hey, we’re the ballot integrity committee of the something, something, something.” And they said it in a way that made it sound like they were with the secretary of state’s office. So the secretary of state put out a press release condemning this and referring it to law enforcement.

The group has admitted to doing this and said it’s done nothing wrong, that technically it didn’t say anything untrue. Of course there’s lying versus misleading versus this versus that. It’s a bit complicated here.

So regardless, I am skeptical that enough people will bother to go through the process of withdrawing their signature to make a difference. It’s a lot more work to withdraw your signature than to sign in the first place. You have to go in person or mail something in. And so I am curious to see if, one, whether this is illegal, and two, whether it makes a difference on the ground.

Rovner: Well, at some point, I think by the end of the summer we’ll be able to make a comprehensive list of where there are going to be ballot measures and what they’re going to be. In the meantime, we shall keep watching.

Let’s move on to another continuing story: health system cyberhacks. This week’s victim is Ascension, a large Catholic system with hospitals in 19 states. And the hack, to quote the AP, “forced some of its 140 hospitals to divert ambulances, caused patients to postpone medical tests, and blocked online access to patient records.”

You would think in the wake of the Change Healthcare hack, big systems like Ascension would’ve taken steps to lock things down more, or is that just me?

Cohrs Zhang: We’re still using fax machines, Julie. What are your expectations here? So cyberattacks have been a theoretical concern of health systems for a long time. I mean, back in 2019, 2020, Congress was kind of sliding provisions into spending bills to help support health systems in upgrading their systems. But again, we’re just seeing the scale. And I think these stories that came out this week really illustrate the human impact of these cyberattacks. And people are waiting longer in an ambulance to get to the hospital.

I mean, that’s a really serious issue. And I’m hoping that health systems will start taking this seriously. But I think it’s just exposing yet another risk that the failure to upgrade these systems isn’t just an inconvenience for people actually using the system. It isn’t just a disservice to all kind of the power of health care data and patients’ information that they could be leveraging better. But it’s also a real medical concern with these attacks. So I am optimistic. We’ll see. Sometimes it takes these sort of events to force change.

Rovner: Well, just before we started to tape this morning, I saw a story out of Tennessee about one of the hospitals that’s being affected. And apparently it is. I believe the word “chaos” was used in the headline and the lead. I mean, these are really serious things. It’s not just what’s going on in the back room, it’s what’s going on with patient care.

In maybe the most depressing hacking story ever, in Connecticut criminals are hacking and stealing the value of people’s electronic food stamp debit card. The Stamford Advocate wrote about one older couple whose card has been now hacked five times and who are out nearly $1,400 they can’t get back because the state can only reimburse people for two hacks. I remember when electronic funds transfers were going to make our lives so much easier. They do seem to be making lives so much easier for criminals.

Finally this week, more on the mess that is the Medicaid unwinding, from two of my colleagues. One story by Daniel Chang is about how people with disabilities, who shouldn’t really have been impacted by the unwinding anyway, are losing critical home care services in all of the administrative confusion. This seems a lot like the cases of eligible children losing coverage because their parents were deemed to have too-high income, even though children have different eligibility criteria.

I know the Biden administration has been trying to soft-pedal its pushes to some of these states. Rachel, you were talking about the USDA trying not to push too hard, but it does seem like in Medicaid a lot of eligible people are falling between the cracks.

Raman: Yeah, I mean states, as we’ve seen, have been really trying to see how fast that they can go to kind of reverify this huge batch of folks because it will be a cost saver for them to have fewer folks on the rolls. But as you’re saying, that a lot of people are falling through the cracks, especially when it’s unintentionally getting pulled from the program like your colleague’s story. And people with a lot of chronic disabilities already qualify for Medicaid, don’t need to be reverified each time because they’re continually qualified for it. And so there are some cases that have been filed already by the National Health Law Program in Colorado, and [Washington,] D.C., and Texas. And so we’ll kind of see as time goes on, how those go and if there’s any changes made to stop that.

Rovner: Also on the Medicaid beat, my colleague Phil Galewitz has a story that’s kind of the opposite. According to a study in the policy journal Health Affairs, a third of those enrolled in Medicaid in 2022, didn’t even know it. That’s 26 million people. And 3 million people actually thought they were uninsured when they in fact had Medicaid. That not only meant lots of people who didn’t get needed health services because they thought they couldn’t afford them because they thought they didn’t have insurance, but also managed-care companies who got paid for these enrollees who never got any care, and conveniently never bothered to inform them that they were covered. Rachel, you had a comment about this?

Cohrs Zhang: I did, yes. One part I really liked about this story is how Phil highlighted that it’s in insurance companies’ best interests for these people not to know that they can get health care services. Because a lot of Medicaid, they’re getting a payment for each member, capitated payments. And so if people aren’t using it, then the insurance companies are making more money. And so I think there has been some more, I think, political conversation about the incentives that capitated payments create especially in the Medicaid population. And so I think that was certainly just a disservice. I mean, these people have been done a disservice by someone. And I think that it’s a really interesting question of who should have been reaching them. And we’ll just, I guess, never know how much care they could have gotten and how their lives could be different had they known.

Rovner: It’s funny, we’ve known for a long time when they do the uninsured statistics that people don’t always know what kind of insurance they have. And they’ll say when they started asking a follow-up question, the Census Bureau started asking a follow-up question about insurance, suddenly the number of uninsured went down. This is the first time I’ve seen a study like this though, where people actually had insurance but didn’t know it. And it’s really interesting. And you’re right, it has real policy ramifications.

All right, well that’s the news for this week. Before we get to our interview, Sandhya, you’ve been gone for the last couple of months on sabbatical. Tell us what you saw in Europe.

Raman: Yeah, so it’s good to be back. I was gone for six weeks mostly to France, improving my French to see how I could get better at that and hopefully use it in my reporting at some point. It was interesting because I was trying to tune out of the news a little bit and stay away from health care. And of course when you try to do that, it comes right back to you. So I would be in my French class and we’d do a practice, let’s read an article or learn a historical thing, and lo and behold, one of the examples was about abortion politics in France over the years.

It was interesting to have to explain to my classmates, “Yes, I’m very familiar with this topic, and how much do you want me to talk about how this is in my country? But let me make sure I know all of those words.” So it pops up even when you think you’re going to sneak away from it.

Rovner: Yes, and we’re very obviously U.S.-centric here, but when you go to another country you realize none of their health systems work that well either. So the frustration continues everywhere.

All right, that is the news for this week. Now we will play my interview with Atul Grover, then we will come back and do our extra credits.

I am so pleased to welcome to the podcast Dr. Atul Grover, executive director of the Association of American [Medical] Colleges’ Research and Action Institute. I bet you have a very long business card.

And I want to offer him a public apology for not having him on sooner. Atul is the co-author of the report we talked about on last week’s episode on how graduating medical students are less likely to apply for residency in states with abortion bans and restrictions. Welcome at last to “What the Health?”

Grover: Better late than never.

Rovner: So there seems to be some confusion, at least in social media land, about some of the numbers here. Tell us what your analysis found.

Grover: First, Julie, is there ever not confusion in social media land? The numbers basically bear out the same thing that we saw last year — making it a very short but real trend — which is that when we look at where new U.S. medical school graduates are applying for residencies, and they apply to any number of programs, what they’re doing, it appears, is selectively avoiding those states in which abortion is either completely banned or severely restricted. And that’s not just in reproductive health-heavy specialties like OB-GYN, but it seems to be across the board.

Rovner: Now, can you explain why all of the numbers seem to be going down? It’s not that the number of applicants are falling, it’s the number of applications.

Grover: There’s about 20,000 people that graduate from U.S. MD [medical degree] schools every year. There are another 15[,000] to 20,000 applicants for residency positions that are DO [doctor of osteopathic medicine] graduates domestically or international graduates. Could be U.S. citizens or foreign citizens.

But what we’ve tried to do for a number of years is encourage applicants to apply to a fewer number of residency programs because we found that they were out-applying, they were over-applying. Where we did some data analyses a couple of years back on diminishing returns where we said, “Look, once you apply to 15, 20, 30 programs, your likelihood of matching, I know you’re nervous, but the likelihood of matching is not going to go up. You’re going to do fine. You don’t need to apply to 60, 70, 80 programs.”

So the good news is we’re actually seeing those numbers come down by about, for U.S. medical grads, about 7% this year, which is really the first time that I can remember in the last 10 years that this has happened. So that is good news.

Rovner: And that was an explicit goal.

Grover: That was an explicit goal. We want to make this cheaper, easier, and more rational for applicants and for programs, as they have to screen people and figure out who really wants to come to their program.

So overall, we were really pleased to see that the average applicant, as they applied to programs, applied to a few less programs, which meant that in many cases they were maybe not applying to one or two states that the average applicant might’ve applied to last year. So on average, each state saw about a 10% decrease in the number of unique applicants. But that decrease was much higher when we looked at those states that had banned abortion or severely limited it.

Rovner: Eventually, all these residency positions fill though, right, because there are more applicants as you point out, more graduating medical students and incoming graduates from other countries than there are slots. So why should we care, if all of these programs are filling?

Grover: So, I think you should always care about the number of residency spots, and I know you have a long history here, as do I, in that that is the bottleneck where we have to deal with why we have physician shortages, or one of the reasons why across the board we just don’t train enough physicians.

We have increased the number of medical school spots. We have people that are graduating from DO schools, as I said, international graduates. More are applying every year than we have space for. Which means that, yes, right now every spot will fill, because if the alternative for somebody applying is, look, I either won’t get in and actually be able to train in my specialty of choice. Or, I may have to go to my third choice or 10th choice or 50th choice or 100th choice. I’d rather go to someplace than no place at all.

So yes, everything is filling, but our look at the U.S. MD seniors was in part because we believe that they are the most competitive applicants, and in some ways the most desirable applicants. They have a 95% success in the match year after year. And so we thought they would be the most sensitive to look at in terms of, hey, I’ve got a little more choice here. Maybe I won’t apply to that state where I don’t feel like I can practice medicine freely for my patients.

And I think that’s a potential problem for a lot of these states and a lot of these programs is, if the people who might’ve been applying if the laws were different, who happened to be a better match for your program, for your specialty and your community, aren’t choosing to apply there, yes, you can fill it, but maybe not with the ideal candidate. And I think that’s going to affect patients and populations and local communities in the years to come.

Rovner: When we saw the beginning of this trend last year most of the talk was about a potential shortage of OB-GYNs going forward, since physicians often stay in practice where it is that they do their residency. But now, as you mentioned, we’re seeing a decrease in applications and specialties across the board. Why would that be?

Grover: So this is an informed opinion as to why people across specialties are choosing not to apply to residencies in these states. We didn’t ask the specific people who are matching this past year, “Why did you choose to apply or not to apply to this state?”

So what we know, though, from asking questions in other surveys is that about 70% of all health professions and health profession students believe that abortion should be legal at some point during a pregnancy. If you look at some specialties like adolescent medicine, that number goes up to 96%. So No. 1, I think it’s a potential violation of what people believe should be some freedom between doctors and patients as to allowing them to have the full range of reproductive health care.

No. 2, I think the potential penalties and the laws are often viewed as being incredibly punitive and somewhat unclear. And as much as doctors hate getting sued, we really don’t want to be indicted. I know some people are fine getting indicted. We really don’t want to be indicted. And that has implications because if we’re indicted, if we’re convicted of any kind of criminal offense, we could lose our license and not be able to care for patients. And we have a long investment in trying to do so.

The third thing that I think is relevant is certainly some of the specialties we’re looking at are heavily populated by women physicians, so OB-GYN, pediatrics. But again, across the board, it’s 50% women. So I think for the women themselves that happen to be applying, there is this issue of, think about their ages, 26, 27, 28 to the mid-30s, for the most part, and there are outliers on either end. But for the most part, they are of reproductive age, and I think they want to have control over their own lives and their own health care, and make sure that all services are available to them and their families if they need it. And I think even if it’s not relevant to you as an individual, it probably is relevant to your spouse or partner or somebody else in your family. And I think that makes a huge difference when people make these choices.

Rovner: So in the end, assuming these trends continue, I mean there really is concern for what the health professional community will look like in some of these states, right?

Grover: Yeah, and I think one of the things that I tried to look at last year in an editorial for JAMA was trying to overlay the states that have already significant challenges in recruiting and retaining physicians. They tend to be a lot of the heavily rural states, Southern states, parts of the Midwest. You overlay that on a map of the 14 states now that have basically banned abortion, and there’s a pretty close match.

So I think it’s critically important for state, local officials, legislatures, governors to think about their own potential impact of passing these laws on something that they may think is critically important, which is recruiting and retaining health professionals. And as you said, about half of people who train in a state will end up staying there to practice.

And for these pipeline programs, I know places like Mississippi and Alabama will really try and recruit individuals from underserved communities, get them through high school, get them into college, get them to stay in the state for med school, stay in the state for residency. They’re 80% likely to stay in those states. You lose them at any point along the way and they’re a lot less likely to come back.

So without even telling these states, I can’t tell you what’s good for you, but you should at least figure out how to collect the data at a local level to understand the implications of your policies on the health of everybody in a state, not just women of reproductive age.

Rovner: And I assume that we’ll be hearing more about this.

Grover: I would think so, yes.

Rovner: And asking more students about it.

Grover: Yes, we will. And we get to administer something called the Graduation Questionnaire every year for all these MD students. One of the questions we just added, and hopefully we’ll have some data, my colleagues will have that by probably August or so, is asking them specifically: What role did laws around some of these social issues have in your choice of where to do your residency? And again, there is some overlap here of states that have restricted reproductive rights, transgender care, and some other issues that are probably all kind of mixed in.

Rovner: Great. We’ll have you back to talk about it then.

Grover: Great. And I’m happy to come back and talk about market consolidation, about life expectancy, the quality of U.S. health, or anything else you want.

Rovner: Atul Grover, thank you so much.

Grover: Thanks for having me.

Rovner: OK, we are back. It’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device.

Sandhya, why don’t you go ahead and go first this week?

Raman: Great. So my story is from Ben Conarck at The Baltimore Banner, and it’s called “People With Severe Mental Illness Are Stuck in Jail. Montgomery County Is the Epicenter of the Problem.”

This is a really sad and impactful story about Montgomery County, Maryland, which is just outside of  D.C., and how they are leading to this problem in this state. And many people are on the wait list for beds and psychiatric facilities, but they’re serving pretty short sentences of 90 days or less, and just a lot of the issues there. And just the problems for criminal defendants waiting in facilities for months on end for treatment.

Rovner: And I would add, because I live there, Montgomery County, Maryland, is one of the wealthiest counties in the country, and it’s kind of embarrassing that there are people who are not where they should be because they don’t have enough beds. Alice.

Ollstein: I have a piece from Time magazine called “‘I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured Into Long-Term Birth Control.” And it’s about something that I’ve been hearing about from providers for a bit now, which is that IUDs are this very effective form of birth control. It’s a device implanted in the uterus, and it was supposed to be this amazing way to help people avoid unwanted pregnancies. But as with many things, it is being used coercively, according to this report.

Because a physician has to implant it and remove it, people say that, one, they were pressured into having one often right after giving birth when they were sort of not in a place to make that kind of big decision. And then people who were given one struggled to have someone remove it when they wanted that done in the future.

And so I think it’s a good reminder that these tools are not inherently good or inherently bad. They can be used unethically or ethically by providers.

Rovner: And all reproductive health care is fraught. Rachel?

Cohrs Zhang: Yes. So Nick has been on quite the tear this week. My colleague Nick Florko at Stat and I wanted to highlight a profile that he wrote. The headline is, “After Decades Fighting Big Tobacco, Cliff Douglas Now Leads a Foundation Funded by His Former Adversaries.”

And I think it just has so much nuance into just a figure who fought Big Tobacco to bring to light what they were doing over decades. And now he’s chosen to take over this organization that had, in the past, been entirely funded by a tobacco company. And so I think it’s this really interesting … what we see all the time in Washington, how people contort themselves to make that transition into the private sector, or what they choose to do with their careers after public service. This is a nontraditional public service, obviously, being an advocate in this way. But I think it will be a really interesting dynamic to watch to see how much he chooses to change the direction of the organization, how long that arrangement lasts, if he chooses to do that.

I learned a lot reading this profile, and I think it’s even more rare to see people sit down for lengthy interviews for an old-fashioned profile. So I really enjoyed the piece.

Rovner: Full disclosure, I’ve known Cliff Douglas since the 1980s when he was just a young advocate starting out on his antismoking career. It really is good piece. I also thought Nick did a really good job.

Well, my story this week is from the NPR Shots blog. It’s by Jonathan Lambert and it’s called “Why Writing by Hand Beats Typing for Thinking and Learning.” And it made me feel much better for often being the only person in a room taking notes by hand in a notebook when everyone else is on their laptop. In fact, I can type as fast as anyone, and I can definitely type faster than I can write in longhand, but I actually find I take better notes if I have to boil down what I’m listening to. And it turns out there’s science that bears that out. Now, if only we could get the schools to go back to teaching cursive, but that’s a whole different issue.

OK, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. And happy birthday today to half of my weekly live audience: Aspen the corgi turns 4 today.

As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X or Twitter, whatever you want to call it, @jrovner. Sandhya, where are you?

Raman: @SandhyaWrites.

Rovner: Alice.

Ollstein: @AliceOllstein.

Rovner: Rachel.

Cohrs Zhang: @rachelcohrs.

Rovner: We will be back in your feed next week. Until then, be healthy.

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In early 2020, with reports of covid-19 outbreaks making dire headlines, Trever Schapers worried about her father’s safety in a nursing home in Queens.

She had delighted in watching her dad, John Schapers, blow out the candles on his 90th birthday cake that February at the West Lawrence Care Center in the New York City borough. Then the home went into lockdown.

Soon her father was dead. The former union painter spiked a fever and was transferred to a hospital, where he tested positive for covid, his daughter said, and after two weeks on a ventilator, he died in May 2020.

But when Trever Schapers sued the nursing home for negligence and wrongful death in 2022, a judge dismissed the case, citing a New York state law hastily passed early in the pandemic. It granted immunity to medical providers for “harm or damages” from an “act or omission” in treating or arranging care for covid. She is appealing the decision.

“I feel that families are being ignored by judges and courts not recognizing that something needs to be done and changed,” said Schapers, 48, who works in the medical field. “There needs to be accountability.”

The nursing home did not return calls seeking comment. In a court filing, the home argued that Schapers offered no evidence that the home was “grossly negligent” in treating her father.

More than four years after covid first raged through many U.S. nursing homes, hundreds of lawsuits blaming patient deaths on negligent care have been tossed out or languished in the courts amid contentious legal battles.

Even some nursing homes that were shut down by health officials for violating safety standards have claimed immunity against such suits, court records show. And some families that allege homes kept them in the dark about the health of their loved ones, even denying there were cases of covid in the building, have had their cases dismissed.

Schapers alleged in a complaint to state health officials that the nursing home failed to advise her that it had admitted covid-positive patients from a nearby hospital in March 2020. In early April, she received a call telling her the facility had some covid-positive residents.

“The call I received was very alarming, and they refused to answer any of my questions,” she said.

About two weeks later, a social worker called to say that her father had a fever, but the staff did not test him to confirm covid, according to Schapers’ complaint.

The industry says federal health officials and lawmakers in most states granted medical providers broad protection from lawsuits for good faith actions during the health emergency. Rachel Reeves, a senior vice president with the American Health Care Association, an industry trade group, called covid “an unprecedented public health crisis brought on by a vicious virus that uniquely targeted our population.”

In scores of lawsuits, however, family members allege that nursing homes failed to secure enough protective gear or tests for staffers or residents, haphazardly mixed covid-positive patients with other residents, failed to follow strict infection control protocols, and brazenly misled frightened families about the severity of covid outbreaks among patients and staff.

“They trusted these facilities to take care of loved ones, and that trust was betrayed,” said Florida attorney Lindsey Gale, who has represented several families suing over covid-related deaths.

“The grieving process people had to go through was horrible,” Gale said.

A Deadly Toll

KFF Health News found that more than 1,100 covid-related lawsuits, most alleging wrongful death or other negligent care, were filed against nursing homes from March 2020 through March of this year.

While there’s no full accounting of the outcomes, court filings show that judges have dismissed some suits outright, citing state or federal immunity provisions, while other cases have been settled under confidential terms. And many cases have stalled due to lengthy and costly arguments and appeals to hash out limits, if any, of immunity protection.

In their defense, nursing homes initially cited the federal Public Readiness and Emergency Preparedness Act, which Congress passed in December 2005. The law grants liability protection from claims for deaths or injuries tied to vaccines or “medical countermeasures” taken to prevent or treat a disease during national emergencies.

The PREP Act steps in once the secretary of Health and Human Services declares a “public health emergency,” which happened with covid on March 17, 2020. The emergency order expired on May 11, 2023.

The law carved out an exception for “willful misconduct,” but proving it occurred can be daunting for families — even when nursing homes have long histories of violating safety standards, including infection controls.

Governors of at least 38 states issued covid executive orders, or their legislatures passed laws, granting medical providers at least some degree of immunity, according to one consumer group’s tally. Just how much legal protection was intended is at the crux of the skirmishes.

Nursing homes answered many negligence lawsuits by getting them removed from state courts into the federal judicial system and asking for dismissal under the PREP Act.

For the most part, that didn’t work because federal judges declined to hear the cases. Some judges ruled that the PREP Act was not intended to shield medical providers from negligence caused by inaction, such as failing to protect patients from the coronavirus. These rulings and appeals sent cases back to state courts, often after long delays that left families in legal limbo.

“These delays have been devastating,” said Jeffrey Guzman, a New York City attorney who represents Schapers and other families. He said the industry has fought “tooth and nail” trying to “fight these people getting their day in court.”

Empire State Epicenter

New York, where covid hit early and hard, is ground zero for court battles over nursing home immunity.

Relatives of residents have filed more than 750 negligence or wrongful death cases in New York counties since the start of the pandemic, according to court data KFF Health News compiled using the judicial reporting service Courthouse News Service. No other area comes close. Chicago’s Cook County, a jurisdiction where private lawyers for years have aggressively sued nursing homes alleging poor infection control, recorded 121 covid-related cases.

Plaintiffs in hundreds of New York cases argue that nursing homes knew early in 2020 that covid would pose a deadly threat but largely failed to gird for its impact. Many suits cite inspection reports detailing chronic violations of infection control standards in the years preceding the pandemic, court records show. Responses to this strategy vary.

“Different judges take different views,” said Joseph Ciaccio, a New York lawyer who has filed hundreds of such cases. “It’s been very mixed.”

Lawyers for nursing homes counter that most lawsuits rely on vague allegations of wrongdoing and “boilerplate” claims that, even if true, don’t demonstrate the kind of gross negligence that would override an immunity claim.

New York lawmakers added another wrinkle by repealing the immunity statute in April 2021 after Attorney General Letitia James noted the law could give nursing homes a free pass to make “financially motivated decisions” to cut costs and put patients at risk.

So far, appeals courts have ruled lawmakers didn’t specify that the repeal should be made retroactive, thus stymying many negligence cases.

“So these cases are all wasting the courts’ time and preventing cases that aren’t barred by immunity statutes from being resolved sooner and clogging up the court system that was already backlogged from COVID,” said attorney Anna Borea, who represents nursing homes.

Troubled Homes Deflect Suits

Some nursing homes that paid hefty fines or were ordered by health officials to shut down at least temporarily because of their inadequate response to covid have claimed immunity against suits, court records show.

Among them is Andover Subacute and Rehabilitation nursing home in New Jersey, which made national headlines when authorities found 17 bodies stacked in a makeshift morgue in April 2020.

Federal health officials fined the facility $220,235 after issuing a critical 36-page report on covid violations and other deficiencies, and the state halted admissions in February 2022.

Yet the home has won court pauses in at least three negligence lawsuits as it appeals lower court rulings denying immunity under the federal PREP Act, court records show. The operators of the home could not be reached for comment. In court filings, they denied any wrongdoing.

In Oregon, health officials suspended operations at Healthcare at Foster Creek, calling the Portland nursing home “a serious danger to the public health and safety.” The May 2020 order cited the home’s “consistent inability to adhere to basic infection control standards.”

Bonnie Richardson, a Portland lawyer, sued the facility on behalf of the family of Judith Jones, 75, who had dementia and died in April 2020. Jones’ was among dozens of covid-related deaths at that home.

“It was a very hard-fought battle,” said Richardson, who has since settled the case under confidential terms. Although the nursing home claimed immunity, her clients “wanted to know what happened and to understand why.” The owners of the nursing home provided no comment.

No Covid Here

Many families believe nursing homes misled them about covid’s relentless spread. They often had to settle for window visits to connect with their loved ones.

Relatives of five patients who died in 2020 at the Sapphire Center for Rehabilitation and Nursing in the Flushing neighborhood in Queens filed lawsuits accusing the home’s operators of keeping them in the dark.

When they phoned to check on elderly parents, they either couldn’t get through or were told there was “no COVID-19 in the building,” according to one court affidavit.

One woman grew alarmed after visiting in February 2020 and seeing nurses wearing masks “below their noses or under their chin,” according to a court affidavit.

The woman was shocked when the home relayed that her mother had died in April 2020 from unknown causes, perhaps “from depression and not eating,” according to her affidavit.

A short time later, news media reported that dozens of Sapphire Center residents had died from the virus — her 85-year-old mother among them, she argued in a lawsuit.

The nursing home denied liability and won dismissal of all five lawsuits after citing the New York immunity law. Several families are appealing. The nursing home’s administrator declined to comment.

Broadening Immunity

Nursing home operators also have cited immunity to foil negligence lawsuits based on falls or other allegations of substandard care, such as bedsores, with little obvious connection to the pandemic, court records show.

The family of Marilyn Kearney, an 89-year-old with a “history of dementia and falls,” sued the Watrous Nursing Center in Madison, Connecticut, for negligence. Days after she was admitted in June 2020, she fell in her room, fracturing her right hip and requiring surgery, according to court filings.

She died at a local hospital on Sept. 16, 2020, from sepsis attributed to dehydration and malnutrition, according to the suit.

Her family argued that the 45-bed nursing home failed to assess her risk of falling and develop a plan to prevent that. But Watrous fired back by citing an April 2020 declaration by Connecticut Gov. Ned Lamont, a Democrat, granting health care professionals or facilities immunity from “any injury or death alleged to have been sustained because of the individual’s or health care facility’s acts or omissions undertaken in good faith while providing health care services in support of the state’s COVID-19 response.”

Watrous denied liability and, in a motion to dismiss the case, cited Lamont’s executive order and affidavits that argued the home did its best in the throes of a “public health crisis, the likes of which had never been seen before.” The operators of the nursing home, which closed in July 2021 because of covid, did not respond to a request for comment. The case is pending.

Attorney Wendi Kowarik, who represents Kearney’s family, said courts are wrestling with how much protection to afford nursing homes.

“We’re just beginning to get some guidelines,” she said.

One pending Connecticut case alleges that an 88-year-old man died in October 2020 after experiencing multiple falls, sustaining bedsores, and dropping more than 30 pounds in the two months he lived at a nursing home, court records state. The nursing home denied liability and contends it is entitled to immunity.

So do the owners of a Connecticut facility that cared for a 75-year-old woman with obesity who required a lift to get out of bed. She fell on April 26, 2020, smashing several teeth and fracturing bones. She later died from her injuries, according to the suit, which is pending.

“I think it is really repugnant that providers are arguing that they should not be held accountable for falls, pressure sores, and other outcomes of gross neglect,” said Richard Mollot, executive director of the Long Term Care Community Coalition, which advocates for patients.

“The government did not declare open season on nursing home residents when it implemented COVID policies,” he said.

Protecting the Vulnerable

Since early 2020, U.S. nursing homes have reported more than 172,000 residents’ deaths, according to Centers for Medicare & Medicaid Services data. That’s about 1 in 7 of all recorded U.S. covid deaths.

As it battles covid lawsuits, the nursing home industry says it is “struggling to recover due to ongoing labor shortages, inflation, and chronic government underfunding,” according to Reeves, the trade association executive.

She said the American Health Care Association has advocated for “reasonable, limited liability protections that defend staff and providers for their good faith efforts” during the pandemic.

“Caregivers were doing everything they could,” Reeves said, “often with limited resources and ever-changing information, in an effort to protect and care for residents.”

But patients’ advocates remain wary of policies that might bar the courthouse door against grieving families.

“I don’t think we want to continue to enact laws that reward nursing homes for bad care,” said Sam Brooks, of the Coalition for the Protection of Residents of Long-Term Care Facilities, a patient advocacy group.

“We need to keep that in mind if, God forbid, we have another pandemic,” Brooks said.

Bill Hammond, a senior fellow at the Empire Center for Public Policy, a nonpartisan New York think tank, said policymakers should focus on better strategies to protect patients from infectious outbreaks, rather than leaving it up to the courts to sort out liability years later.

“There is no serious effort to have that conversation,” Hammond said. “I think that’s crazy.”

KFF Health News 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 KFF.

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