KFF Health News’ ‘What the Health?’
Episode Title: To End School Shootings, Activists Consider a New Culprit: Parents
Episode Number: 333
Published: Feb. 8, 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.]

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, Feb. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this, so here we go. Today, we are joined via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Sarah Karlin-Smith of the Pink Sheet.

Karlin-Smith: Hi, everybody.

Rovner: And my KFF Health News colleague Rachana Pradhan.

Rachana Pradhan: Hi, Julie.

Rovner: No interview today, so we will get straight to the news. We’re going to start in Michigan this week, where a jury convicted the mother of a teenager, who shot 10 of his high school classmates and killed four of them, of involuntary manslaughter. This is the first time the parent of an underage mass school shooter has been successfully prosecuted. The shooter’s father will be tried separately starting next month. Some gun control advocates say this could open the door to lots more cases like this, but others think this may have been a one-off because prosecutors had particularly strong evidence that both parents should have known that their son was both in mental distress and had easy access to their unlocked gun. Is this possibly a whole new avenue to pursue for the whole “What are we going to do about school shooters?” problem?

Ollstein: I mean, it seems like we’re just in an era where people are just trying various different things. I mean, there was ongoing efforts to try to hold gun manufacturers liable. There were efforts on a lot of different fronts. And the goal is to prevent more shootings in the future and prevent more deaths. And so, I think the goal here is to impress upon other parents to be more responsible in terms of weapon storage and also in terms of being aware of their child’s distress.

So, whether or not that happens, I think, remains to be seen, but these shootings have just gone on and on and on and not slowed down. And so, I think there’s just a desperation to try different solutions.

Rovner: Yeah. Apparently in other states they’re starting to look at this, but I guess we talk so much about the chilling effect. That’s actually what they’re going for here, right? As you say, to try and get parents to at least be more careful if they have guns in the house of how they’re storing them, and who has access to them.

Well, we will turn to abortion now. As we noted last week, the Supreme Court will hear the case challenging the FDA’s approval of the abortion drug mifepristone on March 26. We’ll get to some of the amicus briefs that are flooding in, in a minute. But I think the most surprising thing that happened this week is that two of the journal studies that the appeals court relied on in challenging the FDA’s actions were officially retracted this week by the journal’s publisher, Sage.

In a very pointed statement, Sage editors wrote that it had been unaware that the authors, and in one case one of the peer reviewers, were all affiliated with anti-abortion advocacy organizations and that the articles were found by a new set of peer reviewers to have, “fundamental problems with study design and methodology, unjustified or incorrect factual assumptions, material errors in the author’s analysis of the data.” And a lot more problems I won’t get into, but we will post the link to the entire statement in our show notes.

Now, close listeners to the podcast might remember that we talked about this last August, when a pharmacy professor in Georgia alerted the journals to some of the substantive and political problems, and Sage printed something at the time called an expression of concern. Alice, these articles were cited many times in both the lower-court and the appeals-court rulings. What does it mean that they’ve been formally disavowed by their publisher?

Ollstein: It’s really hard to tell what it’s going to mean because we’re in an era where facts don’t always matter in the courts. I mean, we had recently a whole Supreme Court case about a wedding website designer that was based on facts that did not turn out to be true about their standing. The football coach who prayed on the 50-yard line turned out to not be a true story.

And so, it’s really hard to tell. And pro-abortion rights groups have been arguing that evidence cited by the lower court was not scientifically sound. And so, it’s this “flood the zone with competing studies.” And the average person is just confused and throws up their hands. So, in terms of how much it’ll matter, I’m not sure. You already have the groups in question behind the retracted study accusing the publisher of bias. I think this back-and-forth and finger-pointing will continue, and it’s unclear what effect it’ll actually have in court.

Pradhan: I think the thing that I find troubling about it is it’s … and it’s happened with other issues too. It certainly happened during the covid-19 pandemic, where people would say that there would be research or science via press release instead of academic research really undergoing the controls that it is meant to undergo before it’s released and published in a journal. And I hope at the very least that it leads to this, if we’re going to get some amount of good change, it’s that it really does reinforce the need for really rigorous checks, regardless of what the subject of the study is, because clearly these things, it has real consequences.

And frankly, I mean, look at one of the best-known examples of a retracted study which links vaccines to autism. I mean, that happened. It was widely discredited after the fact, and it is still doing harm in society, even though it’s been retracted and the researcher discredited. So, I think it really underscores the importance. I hope that frankly some of these journals get their act together before they publish things that … because it’s too little too late by the time that the damage has been done already.

Rovner: Yeah, I feel like I would say the judicial version of the journalistic “he said, she said.”

Ollstein: I mean, that’s such a good point by Rachana about how the damage is already done in the public understanding of it. But I also am pretty cynical about the ramifications in court specifically, particularly given the fact that the same lower court that cited these studies also cited things that weren’t peer-reviewed or published in medical journals at all. Things that were just these online surveys of self-reported problems with abortion pills. And so, there doesn’t seem to be a clear bar for scientific rigor in the courts.

Karlin-Smith: I was going to say that gets to this fundamental issue in this case, which is: Are judges capable of really assessing the kinds of evidence you need to make these decisions or whether we should trust the FDA and the people we’ve charged with that to do that? Because they know how to look at research papers and the range of research papers out there and evaluate what science is credible, what’s been replicated, look for these problems.

Because if you want to make an argument, you probably can always find one scientific paper or two scientific paper that might seem like it was published in some journal somewhere that can help support your point, but it’s being able to really understand how science works and back it up with that breadth of evidence and the accurate and really reliable evidence.

Rovner: Yeah. I would note that one of the amicus briefs came from a bunch of former heads of the FDA who are very concerned that judges are taking on, basically, the kind of scientific questions that have been ceded to the expertise of the FDA over many, many generations. I don’t remember another amicus brief like this coming from former FDA commissioners banding together. Have you seen this before?

Karlin-Smith: Yeah. I mean, I certainly can’t think of something like it, but I haven’t necessarily scoured the history books to make sure of it, but it is pretty unusual. I did actually note that [former President Donald] Trump’s two FDA commissioners are not among the alive possible FDA commissioners who could have joined in, that didn’t join in on this one, which is interesting.

Ollstein: Oh, I just think that we’re seeing a lot of the medical community that has previously tried to stay above the fray now feeling like this is such a threat to the practice of medicine and regulatory scientific bodies that they feel like they have to get involved, where they didn’t before. And now you’ve reported a lot on how much the AMA [American Medical Association] has changed over time.

But I think seeing these folks in the medical community that aren’t exactly waving a flag at the front of the abortion rights parade really speaking out about this, and it’s a really interesting shift.

Pradhan: It’s certainly a case that challenges the administrative state, if you will, right? Like the one about mifepristone, about FDA’s expertise in science and scientific background in assessing whether a drug should be approved or not.

But as you all know, there’s another case going before the Supreme Court that challenges what’s known as the Chevron doctrine, which is how the agencies are relied upon to interpret federal laws and court rulings, and it’s their expertise that is deferred to, that also is now, I think being questioned and very well could be undermined potentially next year. So, who else? I guess it’s either judges or lawmakers that are supposed to be the ones that truly know how to implement various laws, instead of the folks that are working at these agencies.

Rovner: As you say, this is a lot broader than just the abortion pill. One of the briefs that I didn’t expect to see came from the former secretaries of the Army, Navy, and Air Force who argued that restricting medication abortion would threaten military readiness by hurting recruitment and retainment and the ability for active women service members in states that ban abortion to basically be able to serve. I did not have that particular amicus on my bingo card, but, Alice, this is becoming a bigger issue. Right?

Ollstein: Well, it’s just interesting because I think about the Biden administration policy supporting service members traveling across state lines for an abortion if they’re stationed in a state where it’s now banned. And the administration has been defending that policy from attacks from Capitol Hill, et cetera, and saying, “Look, we’re not backing this policy because it’s some high-minded abortion right priority. We’re backing this because they think it’s good for the military itself.”

And so, I think this amicus brief is making that same case and saying, having tens of thousands of service members lose access to decision-making ability would really hurt the military. So, I think that’s an interesting argument. Again, like these medical groups, you don’t see the military making this kind of case very often and you might not see it under a different administration.

Rovner: Yeah. It’s yet another piece of this that’s flowing out. Well, not everything on abortion is happening in Washington. The states are still skirmishing over whether abortion questions should even appear on ballots this fall. The latest happened in Florida this week, where the Supreme Court there heard arguments about a ballot question that would broadly guarantee abortion rights in the state. Alice, you were watching that, yes?

Ollstein: Yeah. It was an interesting mixed bag because most of the current state Supreme Court was appointed by [Republican Gov.] Ron DeSantis. These are very conservative people, a lot of them are very openly anti-abortion, and were making that clear during the oral arguments, and they were repeating anti-abortion talking points about what the amendment would do. But at the same time, they seemed really skeptical of the state’s argument that they should block it and kill it.

They were saying, “Look, it’s not our job to decide whether this amendment is good or not. It’s our job to decide whether the language is deceptive or not, whether voters who go to vote on it will understand what they’re voting for and against.” And so, they had this whole analogy of, “Is this a wolf in sheep’s clothing or is it just a wolf?” They seem to be leaning towards “it’s just a wolf” and voters can decide for themselves if they think it’s good or bad.

Rovner: Well, my favorite fun fact out of this case yesterday is that one of the five Republican members of the seven-member Florida Supreme Court is Charles Kennedy, who, when he was serving in the House in the 1990s, was the first member of Congress to introduce a bill to ban “partial-birth” abortion. So, he was at the very, very forefront of that very, very heated debate for many years. And now he is on the Florida Supreme Court, and we will see what they say.

Do we have any idea when we’re expecting a decision? Obviously, ballots are going to have to be printed in the not-too-distant future.

Ollstein: Yes. So, the court has to rule before April 1, otherwise the ballot measure will automatically go forward. And so, they can either rule to block it and kill it, they can rule to uphold it, or they can do nothing and then it’ll just go forward on its own.

Pradhan: The thing that — what I keep thinking about too is so, OK, they’ve indicated that they have to rule, right, by April 1. But then we also have this separate pending matter of what is the status of the six-week ban that is still blocked currently? And I just keep wondering, I’m like, how much could change over the course of 2024? We still don’t have a decision on that, even though that’s been pending for much longer. No?

Rovner: Yeah. Where is the Florida six-week ban? It’s not in effect, right?

Ollstein: Yes. There was the hearing on the 15-week ban, and if that gets upheld, the six-week ban automatically goes into effect after a certain period of time. So, we’re waiting on a ruling on the 15-week ban, which will determine the fate of the six-week ban, and then the ballot measure could wipe out both, potentially.

Pradhan: Right. So, it’s very topsy-turvy.

Ollstein: It’s very simple, very simple.

Pradhan: Right. Yeah. I mean, even just the 15-week ban and the six-week ban, to me, at first it was counterintuitive to think, “Oh, so either both of them stand or neither of them do.” So, it seems like we could be in for many, many changes in Florida this year, but I’m very curious about when that is going to happen because it’s been much longer since … rather than the abortion rights ballot measure for this year.

Rovner: And meanwhile, I mean, Florida is a really key state in this whole issue because it’s one of the only states in the South where abortion is still available, right?

Ollstein: Right. And we saw how important it’s become in the data where the number of abortions taking place plummeted in so many states, but in Florida, they’ve actually gone up since Dobbs, even with the 15-week ban in place. A lot of that is people coming from surrounding states. And so, it is really pivotal, and I think that’s why you’re seeing these big national groups like Planned Parenthood really prioritizing it, and there’s so many different ballot measure fights going on, but I think you’re seeing a lot of resources go to Florida, in part for that reason.

Rovner: We will keep an eye on it. Well, we have not talked about Medicaid in a while, and conveniently, my KFF Health News colleague Phil Galewitz has an interesting story this week that halfway through the largest eligibility redetermination in history, Medicaid rolls nationwide are down net about 10 million people or at roughly the number that they were before the pandemic. Rachana, you spend a lot of time looking at Medicaid. Does that surprise you, that the rolls ended up where they were before?

Pradhan: I think, no, not necessarily. Our esteemed KFF colleague Larry Levitt put it really well in the story Phil wrote, which is that the rapid clip at which this is happening is obviously notable, right? It is not normal for how fast enrollment is declining.

I do think the thing that I wish we had, and we only, I think maybe from a state or two know this, but we certainly don’t have nationwide data and won’t for several years, but how many of these people are becoming uninsured? I think at the end of the day, that’s really what big picture-wise matters. Right? But I think certainly, I mean, the unwinding is still occurring. We’re still probably going to have disenrollments that will, I think at least through basically the first half of this year, certain states are still going to take that long. And so, we really won’t know the full picture for obviously a little bit, but I thought that Phil’s piece was really interesting and on point, for sure.

Rovner: Yeah. We talked about how many more people joined the exchanges this year, on now ACA [Affordable Care Act] coverage. Anecdotally, we know that a lot of those came from being disenrolled from Medicaid, and obviously Medicaid is always full of churn. People get jobs and they get job insurance, and they go on, and then other people lose jobs and they lose their job insurance and they qualify for Medicaid. So, there’s always a lot of ups and downs.

But I’m just wondering, the rolls had gotten so swell during the pandemic when states were not allowed to take people off, that I think it will be interesting that when this is all said and done, Medicaid rolls end up where you would’ve expected them to be had there not been a pandemic, right?

Pradhan: Right. I think that what’ll be interesting to see is, I mean, we have some sense of ACA marketplace enrollment, the way it increased this past open enrollment, but again, we don’t know if some of those Medicaid enrollees, how many of them have shifted to job-based plans, if they have at all, or if they’ve just fallen off the rolls entirely.

One of the other things I think about also is the macro-level picture, of course, is important and good, but knowing who has lost their coverage is also … and so, children, I think have been impacted quite a lot by these disenrollments, and so that’s certainly something to keep in mind and keep an eye on. Right?

Rovner: Yeah. And I know, I mean, the federal government obviously has, I think, more data than they’re sharing about this because we know they’ve quietly or not so quietly told some states that they wish they were doing things differently and they should do things differently. But I think they’re trying very hard not to politicize this. And so, I think it’s frustrating for people who are trying to follow it because we know that they know more than we know, and we would like to know some of the things that they know, but I guess we’re not going to find out, at least not right away.

Well, so remember that work requirement that Georgia got permission to put in, as opposed to just expanding Medicaid? Georgia, remember, is one of the 10 states that have yet to expand Medicaid under the Affordable Care Act. Well, now Georgia is suing the Biden administration to try to keep their experiment going, which seems like a lot of trouble for a program that has enrolled only 2,300 of a potential pool of 100,000 people. Why does Georgia think that extending its program is going to increase enrollment substantially? Clearly, this is not going over in a very big way for the work requirements. Alice, you’ve been our work-requirement person. I’ll bet you’re not surprised.

Ollstein: So, the state’s argument is that all of the back-and-forth with the administration before they launched this partial, limited, whatever you want to call it, expansion, they say that that didn’t give them enough time to successfully implement it and that they shouldn’t be judged on the small amount of people they’ve enrolled so far. They should be given more time to really make it a success.

We don’t have a ton of data of what it looks like when states really go all in on these work requirements, but what we have shows that it really limits enrollment and a lot of people who should qualify are falling through the cracks. So, I don’t know if more time would help here, in Georgia and in some other states that haven’t expanded yet. There’s a real tussle right now between the people who just want to take the federal help and just do a real, full expansion like so many other states have done, and those who want to put more of a conservative stamp on the idea and feel like they’re not just wholeheartedly embracing something that they railed against for so many years.

Rovner: Yeah. Just a gentle reminder that the majority of people on Medicaid either are working or cannot work or are taking care of someone who cannot work. And that in the few states that tried to implement work requirements, the problem wasn’t so much that they weren’t working, it’s that they were having trouble reporting their work hours, that that turned out to be a bigger issue than actually whether or not they were … the perception that, I guess, from some of these state leaders that people on Medicaid are just sitting at home and collecting their Medicaid, turns out not to be the case, but that doesn’t mean that people don’t get kicked off the program likely when they shouldn’t.

I mean, that’s what we saw, Alice, you were in … it was Arkansas, right, that tried to do this and it all blew up?

Ollstein: That’s right. And there were other factors there that made it harder for folks to use the program. But I mean, everywhere that’s tried this, it shows that the administrative burdens of having to report hours trip people up and make it so that people who are working still struggle to prove they’re working or to prove they’re working in the right way in order to qualify for insurance that they theoretically should be entitled to.

Rovner: Well, before we leave Medicaid for this week, I want to talk about the newest state trend, which is using Medicaid money to help pay for housing for people who are homeless or at risk of eviction. California is doing it, so are Arizona and Oregon; even Arkansas is joining the club. All of them encouraged by the Biden administration.

The idea is to keep people from ending up in places that are even more expensive for taxpayers, in hospitals or jails or nursing homes, and that so very many health problems cannot be addressed unless patients have a stable place to live. But pouring money earmarked for health services into housing is a really slippery slope, isn’t it? I mean, we obviously have a housing crisis, but it’s hard to feel like Medicaid’s going to be able to plug that hole very effectively.

Karlin-Smith: I feel like that’s where some of the debate is moving next, which is there’s certainly lots of evidence that shows how much being unhoused impacts somebody’s health and their life span and so forth. But state Medicaid programs have to balance their budget and are usually not unlimited. And for me, in following drugs, that’s been a big issue with some of the really new expensive drugs coming on the market is it’s not that Medicaid doesn’t necessarily want to cover it, it’s that if they cover it, they might have to cut some other health service somewhere else, which they also don’t want to cut.

So, I think maybe this evidence of the ability to improve health through housing might have to lead to thinking about, OK, how do we change our budgets or our systems to ensure we’re actually tackling that? But I’m not sure that long-term, unless we really expand the funding of Medicaid, you can really continue doing that and serve all the traditional health needs Medicaid serves.

Pradhan: Yeah, I mean, if you think about Medicaid, I mean, just going back to the bread and butter of reimbursement of providers. I mean, everyone knows that it’s bad, right? It’s too low, it’s lower than Medicare, it’s lower than commercial insurance, and it affects even a Medicaid enrollee’s ability to see a primary care doctor, specialists. I mean, because there are clinicians that will not accept Medicaid as a form of insurance because they lose too much money on it.

And so, I think this is, it’s interesting, I think there’s this big philosophical debate of, is this Medicaid’s problem? Should it be paying for this type of need when there are so many other, you could argue, unmet needs in the program that you could be spending money on? But these states are not necessarily doing that. And so, I think, obviously, I think it would help to have housing stability, but it, for me, raises these broader questions of, but look at all these other things. Like Sarah said, being able to afford drugs that are expensive, but also are quite effective potentially and could really help people. But they’re already scrambling to do those basic things and now they’re moving on to, is it a new shiny toy? Or, something that’s obviously important, but then you’re ignoring some of the other challenges that have existed for a long time.

Rovner: And housing is only one of these social determinants of health that people are trying to address. And it’s absolutely true. I mean, nobody suggests that not having housing and nutrition and lots of other things very much affect your health, and if people have them, they’re very much likely to do better health-wise. But whether that should all fall to the Medicaid program is something that I think is going to have to be sorted out.

Well, back here in Washington, Congress is having some kind of week, mostly not on health care. So, if you’re interested in the gory details, you’re going to have to find them someplace else. But in the midst of the chaos, the House yesterday did manage to pass a bill called the Protecting [Health] Care for [All] Patients Act [of 2022], which certainly sounds benign enough. Its purpose is to ban the use of a measurement called quality-adjusted life years or QALYs, as they’re known. But Sarah, this is way more controversial than it seems, right? Particularly given the bill passed on a party-line vote.

Karlin-Smith: To back up a little bit, quality-adjusted life years, or QALYs, it’s basically a way to figure out cost-effectiveness or what’s a fair price of a product based on the dollar amount that they’re saying it costs per year of quality of your life extended. So, it’s not just taking into account if your life’s extended, but the quality of your life during that time.

And a lot of people have trouble with that metric because they feel like it unfairly penalizes people with disabilities or conditions where the quality of your life might not seem quite the same as somebody who a drug can make you almost perfectly healthy, if that makes sense? And so actually, Democrats are fairly in alignment with Republicans on not being huge fans of the QALY, that particular measure. It’s actually already banned in Medicare, but they are concerned that the way Republicans drafted this bill, it could make it pretty much hard to use any kind of metric that tries to help programs, state agencies, the VA, figure out what’s a fair price to pay for a drug. And then you get into really difficult problems figuring out what to cover, how to negotiate with a drug company for that.

So, Democrats have actually been pushing Republicans to take out some language that might basically narrow the bill or ensure you could use some other measures that are similar to QALYs, but they argue is a bit fairer for the entire populace. So, something that potentially down the road there could be some bipartisan agreement to ban this measure. I think the concern from people who work in the health economist space is that it does make people, I think, uncomfortable thinking about placing this dollar value on life.

But the flip side is, is that again, every drug that saves your life, we can’t spend a billion dollars on it. Right? And so, we have to come up with some way to effectively figure out how to bargain and deal with the drugmakers to figure out what is a fair price for the system. And these are tools to do it, and they’re really not meant to penalize people on an individual basis, because, again, if the drug is priced way too high, regardless of how beneficial it is, the system and you are not going to be able to afford it. It’s a way of figuring out, OK, what is a fair price based on what this does for you? And also then incentivize drug companies to develop drugs that at the price are really a good benefit for the price.

Rovner: It’s so infuriating because I mean, Congress and health policy experts and economists have been talking about cost-effectiveness measures for 30 years, and this was one of the few that there were, and obviously everybody agrees that it is far from perfect and there are a lot of issues. But on the other side, you don’t want to say, “Well, we’re just not going to measure cost-effectiveness in deciding what is allowed.” Which essentially is where we’ve been and what makes our system so expensive, right?

Karlin-Smith: Right. I mean, you can imagine, like, if you thought about other things that are crucial in your life, like I sometimes think about it, it makes it easier if I think about water, OK, everybody needs water to live. If we let the water utilities charge us $100,000 for every jug of water, we would get into problems.

So again, I think the people that use these metrics and try and think about it, they’re not trying to penalize people or put a price on life in the way I think the politicians use it to get out of this. They’re trying to figure out, how do we fairly allocate resources in society in an equitable way? But it can be easily politicized because it is so hard to talk about these issues when you’re thinking about your health care and what you have access to or not.

Rovner: We will watch this as it moves through what I’m calling the chaotic Congress. Turning to “This Week in Health Misinformation,” we have a story from KFF Health News’ Katheryn Houghton for PolitiFact that earned a rare “Pants on Fire!” rating. It seems that a fundraising ad for Republican congressman Matt Rosendale of Montana, who’s about to become Senate candidate Matt Rosendale of Montana, claims that former NIH [National Institutes of Health] official Tony Fauci brought covid to Montana a year before the pandemic. In other forums, Rosendale has charged that an NIH researcher at Rocky Mountain Laboratories infected bats with covid from China. It actually turns out that the laboratory was studying another coronavirus entirely, not the coronavirus that causes covid, the covid that we think of, and that the virus wasn’t actually shipped, but rather its molecular sequence was provided. To quote from this story, “Rosendale’s claim is wrong about when the scientists began their work, what they were studying, and where they got the materials.” But other than that, these kinds of scary claims keep getting used because they work in campaigns. Right?

Karlin-Smith: It taps into this theme that we’ve seen that Republicans on the Hill have certainly been tapping into over the past year or two of whether covid came from a lab and what funding from the U.S. to China contributed to that, and what do people in the U.S., particularly connected to Democrats, know that they’re not saying.

So, even though as you start to dig into this story and you see every level how it’s just not true, the surface of it, people have already been primed to believe that this is occurring, and it’s been how we do this sort of research in this country has already been politicized. So, if you just see a clip, people are easily persuaded.

Rovner: Yes. I think it was Alice, we started out by saying we’ve become a fact-free society. I think this is another example of it. All right, well that is this week’s news.

Now it is 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. Rachana, you got the first one in this week. Why don’t you go first?

Pradhan: Oh, sure. The story I wanted to highlight was from North Carolina Health News. It is focusing on a very large health system known as Atrium Health, which is based in Charlotte, North Carolina. And basically, it’s really interesting, it talks about how Atrium actually operates under a public hospital authority. So, it enjoys certain benefits of being a public or government entity, including they avoid millions in state and federal taxes. They have the power of eminent domain, and they are not subject to antitrust regulations.

And again, this is one of the largest health systems in North Carolina, but it’s playing it both ways. Right? It tries to use the advantages of being a public entity like the ones I just named, but when it comes to other requirements to have checks and balances in government, as we do with various levels of government, like having open public meetings, being able to ask for public comment at these meetings and the like, Atrium does not behave like a government entity at all.

I would also note, as an aside, Atrium was, in the past, one of the most litigious hospital systems in North Carolina. They sued their patients for outstanding medical debt until they ended the practice last year. And so, it’s a really interesting story. So, I enjoyed it.

Rovner: It was a really interesting story. Sarah.

Karlin-Smith: I looked at a piece in the Atlantic from KFF [Health] News editor Elisabeth Rosenthal, “GoFundMe Is a Health-Care Utility Now,” and she tracks the rise of people in the U.S. using GoFundMe to help pay for medical bills, which I think, at first, maybe doesn’t seem so bad if people are having another way to help them pay for medical expenses. But she shows how it’s a band-aid for much bigger problems in an unfair and inequitable system. And, really, also documents how it tends to perpetuate the already existing socioeconomic disparities.

So, if you’re somebody who’s famous or has a lot of friends or just has a lot of friends with money, you’re more likely to actually have your crowdfunding campaign succeed than not. And talking about how health systems are actually directing patients there to fund their medical debt. So, it’s just one of those trends that highlights the state of where the U.S. health system is and that our health insurance system, which is in theory supposed to do what GoFundMe is now an extra band-aid for, which is, you pay money over time so that when you are sick, you’re not hit with these huge bills. But that obviously isn’t the case for many people.

Rovner: Indeed. Alice.

Ollstein: So, I have a piece from Stat’s Usha Lee McFarling, and it’s about the FDA coming under pressure to act more quickly now that they know that pulse oximeters, which were really key during the worst months of the covid pandemic for detecting who needed to be hospitalized, that they don’t work on people of color, they don’t work as well on detecting blood oxygen.

And so, it’s a really fascinating story about, now that we know this, how quickly are regulators going to act and how can they act? But also going forward, this is what happens when there’s not enough diversity in clinical trials. You don’t find out about really troubling racial disparities in efficacy until it’s too late and a lot of people have suffered. So, really curious about what reforms come out of this.

Rovner: Yeah, me too. Well, my extra credit this week is from the Alabama Daily News, and it comes with the very vanilla-sounding headline “Alabama Lawmakers Briefed on New ‘ALL Health’ Insurance Coverage Expansion Plan,” by Alexander Willis. Now, Alabama is also one of the 10 remaining states that have not expanded Medicaid under the Affordable Care Act, much to the chagrin of the state’s hospitals, which would likely have to provide much less free care if more low-income people actually had insurance, even Medicaid, which, as Rachana points out, doesn’t pay that well. The plan put forward by the state hospital association would create a public-private partnership where those who are in the current coverage gap, the ones who earn too much for Medicaid now, but not enough to qualify for Affordable Care Act subsidies, would get full Medicaid benefits delivered through a private insurer. Ironically, this is basically how neighboring Arkansas, another red state, initially expanded Medicaid back in 2013. I did go and look this up when this happened. And it wasn’t even new then. But still, the plan could provide a quarter of a million people in Alabama with insurance at apparently no additional cost to the state for at least the first five years and maybe the first 10. So, another place where we will watch that space.

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 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, or @julierovner at Bluesky and @julie.rovner at Threads. Sarah, where are you these days?

Karlin-Smith: I’m on Twitter a little bit, @SarahKarlin. And Bluesky, I’m @sarahkarlin-smith, other platforms as well.

Rovner: Alice?

Ollstein: @AliceOllstein on X, and @alicemiranda on Bluesky.

Rovner: Rachana?

Pradhan: I’m @rachanadpradhan on X, although my presence lately has been a little lacking.

Rovner: Well, you can definitely find all of us. And we will be back in your feed next week. Until then, be healthy.