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KFF 国产精品视频 News' 'What the 国产精品视频?': Nursing Home Staffing Rules Prompt Pushback
KFF 国产精品视频 News' 'What the 国产精品视频?'

Nursing Home Staffing Rules Prompt Pushback

Episode 350

The Host

Julie Rovner
KFF 国产精品视频 News
Julie Rovner is chief Washington correspondent and host of KFF 国产精品视频 News鈥 weekly health policy news podcast, 鈥淲hat the 国产精品视频?鈥 A noted expert on health policy issues, Julie is the author of the critically praised reference book 鈥湽肥悠 Care Politics and Policy A to Z,鈥 now in its third edition.

It鈥檚 not surprising that the nursing home industry is filing lawsuits to block new Biden administration rules requiring minimum staffing at facilities that accept federal dollars. What is slightly surprising is the pushback against the rules from members of Congress. Lawmakers don鈥檛 appear to have the votes to disapprove the rule, but they might be able to force a floor vote, which could be embarrassing for the administration.

Meanwhile, Senate Democrats aim to force Republicans who proclaim support for contraceptive access to vote for a bill guaranteeing it, which all but a handful have refused to do.

This week鈥檚 panelists are Julie Rovner of KFF 国产精品视频 News, Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.


Rachel Cohrs Zhang
Stat News
Alice Miranda Ollstein
Sandhya Raman
CQ Roll Call

Among the takeaways from this week鈥檚 episode:

  • In suing to block the Biden administration鈥檚 staffing rules, the nursing home industry is arguing that the Centers for Medicare & Medicaid Services lacks the authority to implement the requirements and that the rules, if enforced, could force many facilities to downsize or close.
  • Anthony Fauci, the retired director of the National Institute of Allergy and Infectious Diseases and the man who advised both Presidents Donald Trump and Joe Biden on the covid-19 pandemic, testified this week before the congressional committee charged with reviewing the government鈥檚 pandemic response. Fauci, the subject of many conspiracy theories, pushed back hard, particularly on the charge that he covered up evidence that the pandemic began because dangerous microbes escaped from a lab in China partly funded by the National Institutes of 国产精品视频.
  • A giant inflatable intrauterine device was positioned near Union Station in Washington, D.C., marking what seemed to be 鈥淐ontraceptive Week鈥 on Capitol Hill. Republican senators blocked an effort by Senate Majority Leader Chuck Schumer to force a vote on consideration of legislation to codify the federal right to contraception. Immediately after, Schumer announced a vote for next week on codifying access to in vitro fertilization services.
  • Hospitals in London appear to be the latest, high-profile cyberattack victims, raising the question of whether it might be time for some sort of international cybercrime-fighting agency. In the United States, health systems and government officials are still in the very early stages of tackling the problem, and it is not clear whether Congress or the administration will take the lead.
  • An FDA advisory panel this week recommended against the formal approval of MDMA, a psychedelic also known as ecstasy, to treat post-traumatic stress disorder. Members of the panel said there was not enough evidence to recommend its use. But the discussion did provide more guidance about what companies need to present in terms of trials and evidence to make their argument for approval more feasible.

Also this week, Rovner interviews KFF 国产精品视频 News鈥 Bram Sable-Smith, who reported and wrote the latest KFF 国产精品视频 News-NPR 鈥Bill of the Month鈥 feature about a free cruise that turned out to be anything but. If you have an outrageous or baffling bill you鈥檇 like to send us, you can do that here.

Plus, for 鈥渆xtra credit,鈥 the panelists suggest health policy stories they read this week that they think you should read, too:

  • Julie Rovner: Abortion, Every Day鈥檚 鈥,鈥 by Jessica Valenti.
  • Alice Miranda Ollstein: The Washington Post鈥檚 鈥,鈥 by Lauren Weber.
  • Rachel Cohrs Zhang: ProPublica鈥檚 鈥,鈥 by Isabelle Taft, Mississippi Today.
  • Sandhya Raman: Air Mail鈥檚 鈥,鈥 by Clara Molot.

[Editor鈥檚 note: This transcript was generated using both transcription software and a human鈥檚 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鈥檚 not a political ad, but it is a call to action. I鈥檓 Mila Atmos, and I鈥檓 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 鈥淲hat the 国产精品视频?鈥 I鈥檓 Julie Rovner, chief Washington correspondent for KFF 国产精品视频 News, and I鈥檓 joined by some of the best and smartest health reporters in Washington. We鈥檙e taping this week on Thursday, June 6, 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: Sandhya Raman of CQ Roll Call.

Sandhya Raman: Good morning.

Rovner: And Rachel Cohrs Zhang of Stat News.

Rachel Cohrs Zhang: Hi, everybody.

Rovner: Later in this episode, we鈥檒l have my interview with KFF 国产精品视频 News鈥 Bram Sable-Smith, who reported and wrote this month鈥檚 KFF 国产精品视频 News/NPR 鈥淏ill of the Month.鈥 It鈥檚 about a free cruise that turned out to be anything but. But first, this week鈥檚 news. We鈥檙e going to start this week with those controversial nursing home staffing rules.

In case you鈥檝e forgotten, back in May, the Biden administration finalized rules that would require nursing homes that receive federal funding, which is basically all of them, to have nurses on duty 24/7/365, as well as impose other minimum staffing requirements.

The nursing home industry, which has been fighting this effort literally for decades, is doing what most big powerful health industry players do when an administration does something it doesn鈥檛 like: filing lawsuits. So what is their problem with the requirement to have sufficient staff to care for patients who, by definition, can鈥檛 care for themselves or they wouldn鈥檛 be in nursing homes?

Cohrs Zhang: Well, I think the groups are arguing that CMS [Centers for Medicare & Medicaid Service] doesn鈥檛 have authority to implement these rules, and that if Congress had wanted these minimum staffing requirements, Congress should have done that and they didn鈥檛. So they鈥檙e arguing that they鈥檙e overstepping their boundaries, and we are seeing this lawsuit again in Texas, which is a popular venue for the health care industry to try to challenge rules or legislation that they don鈥檛 like.

So, I think it isn鈥檛 a surprise that we would see these groups sue, given the financial issues at stake, given the fearmongering about facilities having to close, and just the hiring that could have to happen for a lot of these facilities. So it鈥檚 not necessarily a surprise, but it will certainly be interesting and impactful for facilities and for seniors across the nation as this plays out.

Rovner: I mean, basically one of their arguments is that there just aren鈥檛 enough people to hire, that they can鈥檛 get the number of people that they would need, and that seems to be actually pretty persuasive argument at some point, right?

Cohrs Zhang: I mean, there is controversy about why staffing shortages happen. Certainly there could be issues with the pipeline or with nursing schools, education. But I think there are also arguments that unions or workers鈥 rights groups would make that maybe if facilities paid better, then they would get more people to work for them. Or that people might exit the industry because of working conditions, because of understaffing, and just that makes it harder on the workers who are actually there if their workloads are too much. Or they鈥檙e expected to do more work 鈥 longer hours or overtime 鈥 or their vacation is limited, that kind of thing.

So I think it is a surprisingly controversial issue that doesn鈥檛 have an easy answer, but that鈥檚 the perspectives that we鈥檙e seeing here.

Rovner: I mean, layering onto this, it鈥檚 not just the industry versus the administration. Now Congress is getting into the act, which you rarely see. They鈥檙e talking about using the Congressional Review Act, which is something that Congress can do. But of course, when you鈥檙e in the middle of an administration that鈥檚 done it, it would get vetoed by the president. So they can鈥檛 probably do anything. Sandhya, I see you nodding your head. These members of Congress just want to make a statement here?

Raman: Yeah. So Sen. James Lankford insured the resolution earlier this week to block the rule鈥檚 implementation, and it鈥檚 mostly Republicans that have signed on, but we also have [Sen.] Joe Manchin and [Sen.] Jon Tester. But the way it stands, it doesn鈥檛 have enough folks on board yet, and it would also need to be taken up. It faces an uphill climb like many of these things.

Rovner: Somebody actually asked me yesterday though, can they do this? And the answer is yes, there is the Congressional Review Act. Yes, Congress with just a majority vote and no filibuster in the Senate can overturn an administration rule. But like I said, it usually happens when an administration changes its hands because it does have to be signed by the president and the president can veto it.

If the president vetoes it, then they would need a veto override majority, which they clearly don鈥檛 seem to have in this case. But obviously there is enough concern about this issue. I think there鈥檚 been a Congressional Review Act resolution introduced in the House too, right?

Ollstein: It鈥檚 really tough because, like Rachel said, these jobs are low-paid. They鈥檙e emotionally and physically grueling. It鈥檚 really hard to find people willing to do this work. And at the same time, the current situation seems really untenable for patients. There鈥檚 been so many reports of really horrible patient safety and hygiene issues and all kinds of stuff in part, not entirely the fault of understaffing, but not helped by understaffing certainly.

I think, like, we see on so many fronts in health care, there are attempts to do something about this situation that has become untenable, but any attempt also will piss off someone and be challenged.

Rovner: Yeah, absolutely. And we should point out that nursing homes are staffed primarily not by nurses, but by nurses aides of various training levels. So this is not entirely about a nursing shortage, it is about a shortage of workers who want to do this, as you say, very grueling and usually underpaid work.

Well, speaking of controversial things, Dr. Tony Fauci, the now-retired head of the NIH鈥檚 National Institute of Allergy and Infectious Diseases, and currently the man most conspiracy theorists hold responsible for the entire covid-19 pandemic, testified before the House Select Committee on the pandemic Monday. And not surprisingly, sparks flew. What, if anything, did we learn from this hearing?

Cohrs Zhang: The interesting part of this hearing was watching how Dr. Fauci positioned himself in response to a lot of these criticisms that have been circulating. The committee has been going through different witnesses, and specifically it criticized one of his deputies, essentially, who had some unflattering emails released showing that he appeared to be trying to delete emails or use personal accounts to avoid public records requests from journalists or other organizations 鈥

Rovner: I鈥檓 shocked, shocked that officials would want to keep their information away from prying reporters鈥 eyes.

Cohrs Zhang: It鈥檚 not surprising, but it is surprising to see it in writing. But this is, again, everyone is working from home and channels of communication were changing. But I think we did see Dr. Fauci pretty aggressively distancing himself, downplaying the relationship he had with this individual and saying that they worked on research together, but he wasn鈥檛 necessarily advising agency policy.

So that鈥檚 at least how he was framing the relationship. So he definitely downplayed that. And I think an interesting comment he made 鈥 I鈥檓 curious to see what you think about this, Julie 鈥 was that he didn鈥檛 say that the lab leak theory itself was a conspiracy, but his involvement and a cover-up was a conspiracy. And so it did seem that some of the rhetoric has at least changed. He seemed more open-minded, I guess, to a lab leak theory than I expected.

Rovner: I thought he was pretty careful about that. I think it was the last thing he said, which is that we鈥檙e never really going to know. I mean, it could have been a lab leak. It could have happened. It could have been an animal from the wet market. The Chinese have not been very forthcoming with information. I personally keep wondering why we keep pounding at this.

I mean, it seems unlikely that it was a lab leak and then a conspiracy to cover it up. It clearly was one or the other, and there鈥檚 a lot of differences of opinions. And that was the last thing he said is that it could have been either. We don鈥檛 know. That鈥檚 always struck me as the, 鈥淥K, let鈥檚 talk about something else.鈥 Anyway, let鈥檚 talk about something else.

Raman: I was just going to add, we did see a personal side to him, which I think we didn鈥檛 see as much when he was in his official role when he was talking. It was about the death threats that he and his family have been receiving when responding to a lot of the misinformation going around about that. And I thought that was striking compared to, just juxtaposed, with a lot of the other [indecipherable] with [Rep.] Marjorie Taylor Greene saying, 鈥淥h, you鈥檙e not a real doctor.鈥 There鈥檚 a lot of colorful protesters. And I just thought that stood out, too.

Rovner: Yeah, he did obviously, I think, relish the chance to defend himself from a lot of the charges that have been leveled at him. And I think 鈥 his wife is a prominent scientist in her own right 鈥 obviously can take care of herself 鈥 but I think he was particularly angry that there had been death threats leveled toward his grown daughters, which probably a bit out of line. Alice, you wanted to add something.

Ollstein: Yeah, I think it鈥檚 also been interesting to see the shift among Democrats on the committee over time. I think they鈥檝e gone from an attitude of Republicans are on a total witch hunt, this is completely political, this is muddying the waters and fueling conspiracy theories and will lead to worse public health outcomes. And I think based on some of the revelations, like Rachel said about emails and such, they have come to a position of, oh, there might be some things that need investigating and need accountability in here.

But I think their frustration seems to be what it鈥檚 always been in that how will this lead to making the country better prepared in the future for the next pandemic 鈥 which may or may not already be circulating, but certainly is inevitable at some point. Either way, it鈥檚 all well and good to hold officials accountable for things they may have done, but how does that lead to making the country more prepared, improving pandemic response in the future? That鈥檚 what they feel is the missing piece here.

Rovner: Yeah. I think there was not a lot of that at this hearing, although I feel like they had to go through this maybe to get over to the other side and start thinking about what we can do in the future to avoid similar kinds of problems. And obviously you get a disease that you have no idea what to do about, and people try to muddle through the best they can. All right, now we are going to move on and we鈥檒l talk about abortion where there is always lots of news.

Here in Washington, there is a giant inflatable IUD flying over Union Station Wednesday to highlight what seems to be Contraception Week on Capitol Hill. Not coincidentally, it鈥檚 also the anniversary this week of the Supreme Court鈥檚 1965 ruling Griswold v. Connecticut that created the right to birth control. Alice, what are Democrats, particularly in the Senate where they鈥檙e in charge, doing to try to highlight these potential threats to contraceptive access?

Ollstein: So this vote that happened that was blocked because only two Republicans crossed the aisle to support this Right to Contraception bill 鈥 it鈥檚 the two you expect, it鈥檚 [Sen.] Lisa Murkowski and [Sen.] Susan Collins 鈥 and you鈥檙e already seeing Democrats really make hay of this. Both Democrats and their campaign arms and outside allied groups are planning to just absolutely blitz this in ads. They鈥檙e holding events in swing states related to it, and they鈥檙e going hard against individual Republicans for their votes.

I think the Republicans I talked to who voted no, they had a funny mixed message about why they were voting no on it. They were both saying that the bill was this sinister Trojan horse for forcing religious groups to promote contraception and even abortion and also gender-affirming care somehow. But also, the bill was a pointless stunt that wouldn鈥檛 really do anything because there is no threat to contraception. But also Republicans have their own rival bill to promote access to contraception.

So access to contraception isn鈥檛 a problem, but please support my bill to improve access to contraception. It鈥檚 a tough message. Whereas Democrats鈥 message is a lot simpler. You can argue with it on the merits, but it鈥檚 a lot simpler. They point to the fact that Supreme Court Justice Clarence Thomas has expressed interest and actually called on the court to revisit precedents that protect the right to contraception.

Lots of states have thwarted attempts to enact protections for contraception. And a lot of anti-abortion groups have really made a big push to muddy the waters on medical understanding of what is contraception versus what is abortion, which we can get into later.

Rovner: Yes, which we will. Sandhya, did you want to add something?

Raman: Yeah, and I think that something that I would add to what Alice was saying is just how this is kind of at the same time a little bit different for the Democrats. Something that I wrote about this week was just that after the Dobbs [v. Jackson Women鈥檚 国产精品视频 Organization] decision, we had the then-Democratic House vote on several different bills, but the Democrats have not really been holding this chamber-wide vote on bills related to abortion, contraception for the most part. And so this was the first time that they are stepping into that.

They鈥檝e done the unanimous consent requests on a lot of these bills. And even just a couple months ago when talks are really heating up on IVF, there鈥檚 other things that we have to get to, appropriations and things like that, and this would just get bogged down. And they were shying away from taking floor time to do this. So I think that was an interesting move that they鈥檙e doing this now and that they鈥檙e going to vote on an IVF next week and whatever else next down the line.

Rovner: Yeah, I noticed that as soon as this bill went down, Sen. [Chuck] Schumer teed up the Right to IVF bill for a vote next week. But Alice, as you were alluding to, I mean, where this gets really uncomfortable for Republicans is that fine line between contraception and abortion. Our colleague Lauren Weber has a story about this this week [鈥,鈥漖, which is your extra credit, so why don鈥檛 you tell us about it?

Ollstein: Yeah. So she did a really great job highlighting how, especially at the state level where a lot of these battles are playing out, anti-abortion groups that are very influential are making arguments that certain forms of birth control are abortifacients. This is completely disputed by medical experts and the FDA [Food and Drug Administration] that regulates these products. They say, just to be clear about what we鈥檙e talking about, we鈥檙e talking about some forms of emergency contraception, which is taken after sex to prevent pregnancy. It is not an abortifacient. It won鈥檛 work if you鈥檙e already pregnant. It prevents pregnancy. It does not terminate a pregnancy. They are also saying this about some IUDs, intrauterine devices, and even about some hormonal birth control pills.

So there鈥檚 been pushback that Lauren detailed in her story, including from some Republicans who are trying to correct the record. But this misinformation is getting really entrenched, and I think it鈥檚 something we should all be paying attention to when it crops up, especially in the mouths of people in power.

Rovner: I mean, when I first started writing about it it was not entirely clear. There was thought that one of the ways the morning-after pill worked was by preventing implantation of a fertilized egg, which some people consider, if you consider that fertilization and not implantation, is the beginning of life. According to doctors, implantation is the beginning of pregnancy, among other things, because that鈥檚 when you can test for it.

But those who believe that fertilization is the beginning of life 鈥 and therefore something that prevents implantation is an abortion 鈥 were concerned that IUDs, and mostly progesterone-based birth control that prevented implantation, were abortifacients. Except that in the years since, it鈥檚 been shown that that鈥檚 not the case.

Ollstein: Right.

Rovner: That in fact, both IUDs and the morning-after pill work by preventing ovulation. There is no fertilized egg because there鈥檚 no egg. So they are not abortifacients. On the other hand, the FDA changed the labeling on the morning-after pill because of this. And yet the Hobby Lobby case [Burwell v. Hobby Lobby Stores Inc.] that the decision was written by Justice [Samuel] Alito, basically took that premise, that they were allowed to not offer these forms of contraception because they believed that they were acted as abortifacients, even though science suggests that they didn鈥檛. It鈥檚 not something new, and it鈥檚 not something I don鈥檛 think is going to go away anytime in the near future.

Raman: I would add that it also came up in this week鈥檚 Senate 国产精品视频 [Committee] hearing, that line of questioning about whether or not different parts of birth control were abortifacients. Sen. [Patty] Murray did that line of questioning with Dr. Christina Francis, who鈥檚 the head of the anti-abortion obstetrician-gynecology group and went through on Plan B, IUDs and different things. And there was a back and forth of evading questions, but she did call IUDs as abortifacients, which goes back to the same thing that we鈥檙e saying.

Rovner: Right, which they have done all along.

Ollstein: Yeah. I mean, I think this really spotlights a challenge here, which is that Republicans鈥 response to votes like this week and things that are playing out in the state level, they鈥檙e scoffing and saying, 鈥淚t鈥檚 absolutely ridiculous to suggest that Republicans are trying to ban birth control. This is completely a political concoction by Democrats to scare people into voting for them in November.鈥

What we鈥檙e talking about here are not bans on birth control, but there are policies that have been introduced at both the state and federal level that would make birth control, especially certain forms like we were just talking about, way harder to access. So there are proposals to carve them out of Obamacare鈥檚 contraception mandate, so they鈥檙e not covered by insurance.

That鈥檚 not a ban. You can still go pay out-of-pocket, but I remember all the people who were paying out-of-pocket for IUDs before Obamacare: hundreds and hundreds of dollars for something that is now completely free. And so what we鈥檙e seeing right now are not bans, but I think it鈥檚 important to think about the ways it would still restrict access for a lot of people.

Rovner: Before we leave the nation鈥檚 capital it seems that the Supreme Court鈥檚 upcoming decision on the abortion pill may not be the last word on the case. While it seemed likely from the oral arguments that the justices will agree that the Texas doctors who brought the case don鈥檛 have standing, there were three state attorneys general who sought to become part of the case when it was first considered back in Texas. So it would go back to Judge [Matthew] Kacsmaryk, our original judge who said that the entire abortion pill approval should be overturned. It feels like this is not the end of fighting about the abortion pill鈥檚 approval at the federal level. I mean, I assume that that鈥檚 something that the drug industry, among others, won鈥檛 be happy about.

Ollstein: Courts could find that the states don鈥檛 have standing either, that this policy does not harm them in any real way. In fact, Democratic attorneys general have argued the exact opposite, that the availability of mifepristone helps states: saves a lot of money; it prevents pregnancy; it treats people鈥檚 medical needs. So obviously, Kacsmaryk has a very long anti-abortion record and has sided with these challenges in a lot of cases. But that doesn鈥檛 mean that this would necessarily go anywhere.

But your bigger point that the Supreme Court鈥檚 upcoming ruling on mifepristone is not the end, it certainly is not. There鈥檚 going to be a lot more court challenges, some already in motion. There鈥檚 going to be state-level policy fights. There鈥檚 going to be federal-level policy fights. If Trump is elected, groups want him to do a lot of things through executive order to restrict mifepristone or remove it from the market entirely through the FDA. So yes, this is not going to be over for the foreseeable future.

Rovner: Well, meanwhile, in a case that might be over for the foreseeable future, the Texas Supreme Court last week officially rejected the case brought by 20 women who nearly died when they were unable to get timely care for pregnancy complications. The justices said in their ruling that while the women definitely did suffer, the fault lay with the doctors who declined to treat them rather than the vagueness of the state鈥檚 abortion ban. So where does that leave the debate about medical exceptions?

Ollstein: So anti-abortion groups鈥 response to a lot of the challenges to these abortion bans and stories about women in medical emergencies who are getting denied care and suffering real harm as a result, their response has been that there鈥檚 nothing wrong with the law. The law is perfectly clear, and that doctors are either accidentally or intentionally misinterpreting the law for political reasons. Meanwhile, doctors say it鈥檚 not clear at all. It鈥檚 not clear how honestly close to dead someone has to be in order to receive an abortion.

Rovner: And it鈥檚 not just in Texas. This is true in a bunch of states, right? The doctors don鈥檛 know 鈥

Ollstein: In many states.

Rovner: 鈥 right? 鈥

Ollstein: Exactly.

Rovner: 鈥 when they can intervene.

Ollstein: Right. And so I think the upcoming Supreme Court ruling on EMTALA [Emergency Medical Treatment and Active Labor Law], which we鈥檝e talked about, could give some indication either way of what doctors are and are not able to do, but that won鈥檛 really resolve it either. There is still so much gray area. And so patients and doctors are going to state courts to plead for clarity. They鈥檙e going to their legislatures to plead for clarity. And they鈥檙e going to state medical boards, including in Texas, to plead for clarity. And so far, they have not gotten any.

Most legislatures have been unwilling to revisit their bans and clarify or expand the exceptions even as these stories play out on the ground of doctors who say, 鈥淚 know that providing an abortion for this patient is the right thing medically and ethically to do, but I鈥檓 so afraid of being hit with criminal charges that I put the patient on a plane out of state instead.鈥 Yeah, it鈥檚 just really tough.

And so what we wrote about it is we keep talking about doctors being torn between conflicting state and federal law, and that鈥檚 absolutely true, but what we dug into is that the state law just looms so much larger than the federal laws. So when you鈥檙e weighing, should I maybe violate EMTALA or should I maybe violate my state鈥檚 ban, they鈥檙e not going to want to violate their state鈥檚 ban because that means jail time, that means losing their license, that means having their freedom and their livelihood taken away.

Whereas an EMTALA violation may or may not mean a fine somewhere down the road. The enforcement has not been as aggressive at the federal level from the Biden administration as a lot of doctors would like it to be. And so, in that environment, they鈥檙e really deferring to the state law, and that means some people are not getting care that they maybe need.

Rovner: I say in the meantime, we had yet another jury just last week about a woman who had a miscarriage and could not get a D&C [dilation and curettage procedure] basically. When she went in there was no fetal heartbeat, but she ended up miscarrying at home and almost dying. She was sent away, I believe, from three different facilities. This continues to happen because doctors are concerned about when it is appropriate for them to intervene. And they seem, you鈥檙e right, to be leaning towards the 鈥渓et鈥檚 not get in trouble with the state鈥 law, so let鈥檚 wait to provide care as long as we think we can.

Well, moving on, we have two stories this week about efforts to treat post-traumatic stress disorder, particularly in military veterans. On Tuesday, an FDA advisory committee recommended against approval of the psychedelic MDMA, better known as ecstasy, for the treatment of PTSD. My understanding is that the panel didn鈥檛 reject the idea outright that this could be helpful, only that there isn鈥檛 enough evidence yet to approve it. Was I reading that right? Rachel, you guys covered this pretty closely.

Cohrs Zhang: Yes. Yeah, my colleagues did cover this. Certainly I think what鈥檚 a discouraging sign, I don鈥檛 think there鈥檚 any way around it, for some of these companies that are looking at psychedelics and trying to figure out some sort of approval pathway for conditions like PTSD.

One of my colleagues, Meghana Keshavan, she chatted with a dozen companies yesterday and they were trying to put a positive spin on it, that having some opinion or some discussion of a treatment like this by the advisory committee could lay out more clear standards for what companies would have to present in order to get something approved. So I think obviously they have a vested interest in spinning this positively.

But it is a very innovative space and certainly was a short-term setback. But it certainly isn鈥檛 a long-term issue if some of these companies are able to present stronger evidence or better trial design. I think there were some questions about whether trial participants actually could figure out whether they were placebo or not, which if you鈥檙e taking psychedelic drugs, yeah, that鈥檚 kind of a challenge in terms of trial design.

So I think there are some interesting questions, and I am confident that this鈥檒l be something the FDA and industry is going to have to figure out in a space that鈥檚 new like this.

Rovner: Yeah, it鈥檚 been interesting to follow. Well, in something that does seem to help, one of the first controlled studies of service dogs to treat PTSD has found that man鈥檚 best friend can be a therapist as well. Those veterans who got specially trained dogs showed much more improvement in their symptoms than those who were on the doggy wait list as determined by professionals who didn鈥檛 know who had the dogs and who didn鈥檛. So pet therapy for the win here?

Raman: I mean, this is the biggest study of this kind that we鈥檝e had so far, and it seems promising. I think one thing will be interesting is if there鈥檚 more research, if this would change policy down the line for the VA [Department of Veterans Affairs] or other agencies to be able to get these kinds of service dogs in the hands of more vets.

Rovner: Yeah, I know there鈥檚 a huge demand for these kinds of service dogs. I know a lot of people who basically have started training service dogs for veterans. Obviously they were able to do this study because there was a long wait list. They were able to look at people who were waiting but hadn鈥檛 gotten a dog yet. So at least in the short term, possibly some help for some people.

Finally this week, in a segment I鈥檓 calling 鈥淢isery Loves Company,鈥 it鈥檚 not just the U.S. where big health systems are getting cyberhacked. Across the pond, quoting here from the BBC, major hospitals in London have declared a critical incident after a cyberattack led to operations being canceled and emergency patients being diverted elsewhere. This sounds painfully familiar.

Maybe we need an international cybercrime fighting agency. Is there one? Is there at least, do we know, is there a task force working on this? Obviously the bigger, more centralized your health care system, the bigger problem this becomes, as we saw with Change 国产精品视频care belonging to United[国产精品视频care], and this is now … I guess it鈥檚 a contractor that works for the NHS [National 国产精品视频 Service]. You can see the potential for really bad stuff here.

Cohrs Zhang: That鈥檚 a good question about some international standards, Julie, but I think what we have seen is Sen. Ron Wyden, who leads the Senate Finance Committee, did write to HHS [Department of 国产精品视频 and Human Services] this week and asked HHS to add to multiple-factor authentication as a condition of participation for some of these facilities to try to institute standards that way.

And again, I think there are questions about how much HHS can actually do, but I think it鈥檚 a signal that Congress might not want to do anything or think they can do anything if they鈥檙e asking the administration to do something here. But we鈥檙e still in the very early stages of systems viewing this as worthy of investment and just education about some of the best practices here.

Yeah, certainly it鈥檚 going to be a business opportunity for some consulting firms to help these hospitals increase their cybersecurity measures and certainly will be a global market if we see these attacks continue in other places, too.

Rovner: Maybe our health records will be as protected as our Spotify accounts. It would apparently be a step forward. All right, well, that is the news for this week. Now we will play my 鈥淏ill of the Month鈥 interview with Bram Sable-Smith, and then we will come back and do our extra credits.

I am pleased to welcome back to the podcast my KFF 国产精品视频 News colleague Bram Sable-Smith, who reported and wrote the latest KFF 国产精品视频 News-NPR 鈥淏ill of the Month鈥 about a free cruise that turned out to be anything but. Welcome back to the podcast, Bram.

Bram Sable-Smith: Thanks for having me.

Rovner: So tell us about this month鈥檚 patient, who he is, and what happened to him. This is one of the wilder Bills of the Month, I think.

Sable-Smith: Right. So his name is Vincent Wasney. He lives in Saginaw, Michigan. Never been on an airplane before, neither had his [fianc茅e], Sarah. But when they bought their first house in 2019, their Realtor, as a gift, gifted them tickets for a cruise. My Realtor gave me a tote bag. So, what a Realtor, first of all! What an incredible gift.

Rovner: My Realtor gave me a wine opener, which I do still use.

Sable-Smith: If it sailed to the Caribbean, it鈥檇 be equivalent. So their cruise got delayed because of the pandemic, but they set sail in December 2022. And they were having a great time. One of the highlights of their trip was they went to this private island called CocoCay for Royal Caribbean guests, and it included an excursion to go swimming with pigs.

Rovner: Wild pigs, right?

Sable-Smith: Wild pigs, a big fancy water park, all kinds of food. They were having a great time. But it鈥檚 also on that island that Vincent started feeling off. And so in the past, Vincent has had seizures. About 10 years earlier, he had had a few seizures. They decided he was probably epileptic, and he was on medicine for a while. He went off the medicine because they were worried about liver damage, and he鈥檇 been relatively seizure-free for a long time. It鈥檇 been a long time since he鈥檇 had a seizure.

But when he was on that island having a great time, it鈥檚 when he started to feel off. And when they got back on the cruise ship for the last full day of the cruise, he had a seizure in his room. And he was taken down to the medical center on the cruise ship and he was observed. He was given fluids for a while, and then sent back to his room, where he had a second seizure. Once again, went down to the medical center on the ship, where he had a third seizure. It was time to get him off the boat. He needed to get onto land and go to a hospital. And so they were close enough to land that they were able to do the evacuation by boat instead of having to do something like a helicopter to do a medevac that way. And so a rescue boat came to the ship. He was lowered off the ship. He was in a stretcher and it was lowered down to the rescue boat by a rope.

His fianc茅e, Sarah, climbed down a rope ladder to get into the boat as well to go with them to land. And then he was taken to land in an ambulance ride to the hospital, et cetera. But, before they were allowed to disembark, they were given their bill and told 鈥淚t鈥檚 time to pay this. You have to pay this bill.鈥

Rovner: And how much was it?

Sable-Smith: So the bill for the medical services was $2,500. This was a free cruise. They had budgeted to pay for internet, $150 for internet. They had budgeted to pay for their alcoholic drinks. They had budgeted to pay for their tips. So they had saved up a few hundred dollars, which is what they thought would be their bill at the end of this cruise. Now, that completely exploded into this $2,500 bill just for medical expenses alone.

And as they鈥檙e waiting to evacuate the ship, they鈥檙e like, 鈥淲e can鈥檛 pay this. We don鈥檛 have this money.鈥 So that led to some negotiations. They ended up basically taking all the money out of their bank accounts, including their mortgage payment. They maxed out Vincent鈥檚 credit card, but they were still $1,000 short. And they later learned once they were on land that Vincent鈥檚 credit card had been overdrafted by $1,000 to cover that additional expense.

Rovner: So it turns out that he was uninsured at the time, and we鈥檒l talk about that in a minute. But even if he had had insurance, the cruise ship wasn鈥檛 going to let him off the boat until he paid in full, even though it was an emergency? Did I read that right?

Sable-Smith: That鈥檚 certainly the feeling that they had at the time. When Vincent was short the $1,000, eventually they were let off the ship, but they did end up, as we said, getting that credit card overdrafted. But I think what鈥檚 important to note here is that even though he was uninsured at the time, even if he had had insurance, and even if he had had travel insurance, which he also did not have at the time, which we can talk about, he still would鈥檝e been required to pay upfront and then submit the receipts later to try to get reimbursed for the payments.

And that鈥檚 because on the cruise鈥檚 website, they explain that they do not accept 鈥渓and-based health insurance plans鈥 when they鈥檙e on the vessel.

Rovner: In fact, as you mentioned, a lot of health insurance doesn鈥檛 cover care on a cruise ship or, in fact, anywhere outside the United States. So lots of people buy travel insurance in case they have a medical emergency. Why didn鈥檛 they?

Sable-Smith: So travel insurance is often purchased when you purchase the tickets. You鈥檒l buy a ticket to the cruise and then it will prompt you, say, 鈥淗ey, do you want some travel insurance to protect you while you鈥檙e on this ship?鈥 And that鈥檚 the way that most people are buying travel insurance. Well, remember, this cruise was a gift from their realtors, so they never bought the ticket. So they never got that prompting to say, 鈥淗ey, time to buy some travel insurance to protect yourself on the trip.鈥

And again, these were inexperienced travelers. They鈥檇 never been on an airplane before. The furthest either one of them had been from Michigan was Vincent went to Washington, D.C., one time on a school trip. And so they didn鈥檛 really know what travel insurance was. They knew it existed. But as Vincent explained, he said, 鈥淚 thought this was for lost luggage and trip cancellations. I didn鈥檛 realize that this was something for medical expenses you might incur when you鈥檙e out at sea.鈥

Rovner: And it鈥檚 really both. I mean, it is for lost luggage and cancellation, right?

Sable-Smith: And it is for lost luggage and cancellation. Yeah, that鈥檚 right.

Rovner: So what eventually happened to Vincent and what eventually happened to the bill?

Sable-Smith: Well, once he got taken to the hospital, he got an additional bill, or actually several additional bills, one from the hospital, two from a couple doctors who saw him at the hospital who billed separately, and also one from the ambulance services. As we know, he had already drained his bank account and maxed out his credit card and had it overdrafted to cover the expenses on the ship. So he was working on paying those off. And then for the additional bills he incurred on land, he had set up payment plans, really small ones, $25, $50 a month, but going to four separate entities.

He actually missed a couple payments on his bill to the hospital, and that ended up getting sent to collections. Again, none of these are charging interest, but these are still quite some burdens. And so he was paying them off bit by bit by bit. He set up a GoFundMe campaign, which is something that a lot of people end up doing who never expect to have to cover these kinds of emergency expenses, or reach out publicly for help like that. And they got quite a bit of help from family and friends. Including, Vincent picked up Frisbee golf during the pandemic, and he鈥檚 made quite a lot of good friends that way. And that community really came through for them as well. So with those GoFundMe payments, they were able to make their house payment. It was helpful with some of these bills that they had lingering leftover from the cruise.

Rovner: So what鈥檚 the takeaway here, other than that nothing that seems free is ever really free?

Sable-Smith: Yeah, right. Well, the takeaway is to be informed before you leave about a plan for how are you going to cover medical expenses when you鈥檙e going traveling. I think this is something that a lot of people are going to be doing this summer, going on vacations. I鈥檝e got vacations planned. What鈥檚 your plan for covering medical expenses? And if you鈥檙e leaving the country, if you鈥檙e going on a cruise, someplace where your land-based American health insurance might not cover you, you should consider travel insurance.

And when you鈥檙e considering travel insurance, they come in all sorts of varieties. So you want to make sure that they鈥檙e going to cover your particular cases. So some plans, for example, won鈥檛 cover pre-existing conditions. Some plans won鈥檛 cover care for risky activities like rock climbing. So you want to know what you鈥檙e going to be doing during your trip, and you want to make sure when you鈥檙e purchasing travel insurance to find a plan that鈥檚 going to cover your particular needs.

Rovner: Very well explained. Bram Sable-Smith, thank you very much.

Sable-Smith: Always a pleasure.

Rovner: And now it鈥檚 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.  Alice, you鈥檝e gone already. Sandhya, why don鈥檛 you go next?

Raman: So my extra credit is 鈥,鈥 and it鈥檚 an Air Mail from Clara Molot. And this is a really interesting piece. So at least 16 alumni from the classes of 2011 to 2019 of Roanoke have been diagnosed with cancer since 2010, which is a much higher rate when compared to the rate for 20-somethings in the U.S. and 15-times-higher mortality rate. And so the piece does some looking at some of the work that鈥檚 being done to uncover why this is happening.

Rovner: It鈥檚 quite a scary story. Rachel?

Cohrs Zhang: Yes. So the story I chose, it was co-published by ProPublica in Mississippi Today. The headline is 鈥,鈥 by Isabelle Taft. And I mean, truly such a harrowing story of … obviously we know that there鈥檚 capacity issues with mental health treatment, but the idea that patients would be involuntarily committed, go to a hospital, and then be transferred to a jail having committed no crime, having no recourse.

I mean, some of these detentions happened. It was like two months long where these patients who are already suffering are then thrown out of their comfortable environments into jail as they awaited county facilities to open up spots for them. And I think the story also did a good job of pointing out that other jurisdictions had found other solutions to this other than placing suffering people in jail. So yeah, it just felt like it was a really great classic example of investigative journalism that鈥檒l have an impact.

Rovner: Local investigative journalism 鈥 not just investigative journalism 鈥 which is really rare, yet it was a really good piece. Well, my extra credit this week is from Jessica Valenti, who writes a super-helpful newsletter called Abortion, Every Day. Usually it鈥檚 an aggregation of stories from around the country, but this week she also has her own exclusive [鈥,鈥漖 about how Heartbeat International, which runs the nation鈥檚 largest network of crisis pregnancy centers, is collecting and sharing private health data, including due dates, dates of last menstrual periods, addresses, and even family living arrangements.

Isn鈥檛 this a violation of HIPAA, you may ask? Well, probably not, because HIPAA only applies to health care providers and insurers and the vast majority of crisis pregnancy centers don鈥檛 deliver medical care. You don鈥檛 need a medical license to give a pregnancy test or even do an ultrasound. Among other things, personal health data has been used for training sales staff, and until recently was readily available to anyone on the web without password protection. It鈥檚 a pretty eye-opening story.

All right, 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 fill-in editor this week, Stephanie Stapleton. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, I鈥檓 at . Sandhya?

Raman: .

Rovner: Alice?

Ollstein: .

Rovner: Rachel?

Cohrs Zhang: .

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


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