Maybe you could just tell us, how are Democrats framing these changes as they go out there this election season?

Well, mostly just sort of stating what they are.

I mean, you know, the Republicans tried to backload these changes so that most of them wouldn't take place before these midterms, that they would sort of start in 2027 and in 2028.

But what, of course, we've seen is that in anticipation of the cuts that they know are coming, we've seen lots of cutbacks by states and by, you know, doctors and hospitals and anybody, you know, in the healthcare industry realizes that these cuts are coming, so they have started to, to pull back already.

And so people are feeling these cuts already.

The bulk of the cuts have not started yet.

Um, but Democrats really don't have to work that hard to be able to point and say, "Here's where these cuts are actually hurting people." Um, they're hurting hospitals, they're hurting employment.

Uh, so we ask, if we end up with divided government, your viewpoint is that that doesn't always mean gridlock, right? Tell us about that.

Clinton was attempting to introduce that September day before Congress.

I mean, this was part of the problem, is that their program was so complicated.

If you're an employer and you aren't insuring your workers at all, you'll have to pay more.

Even today, I'm not sure I can explain it.

And it made it easy for people to demonize it.

Call today.

One of the things that I already knew from covering health care is that people didn't like the health care system in general, but they mostly were OK with their own health care.

And in 1993, unless you were a nerd like me and could see that the costs were going up and the number of people without insurance was going up, it wasn't necessarily top of mind.

What are they saying precisely?

Well, there are sort of gradations of Medicare for all, if you will.

You know, in the last time we went through this in 2019 and 2020, there was something called Medicare for more, which meant you could sign up for Medicare if you wanted to.

This was sort of a phrase to talk about the public option, which, of course, is what President Biden ultimately supported and Congress couldn't quite pass.

So there would be a sort of competing public option on the Affordable Care Act exchanges to go with the private insurance.

You could have something like what Senator Kim is talking about, which is let's get to universal coverage gradually.

Let's enroll kids who are pretty cheap.

Could they do Medicare for all? that doesn't force people off private insurance that they like, or is that just the public option?

What are they saying precisely?

Well, there are sort of gradations of Medicare for all, if you will.

You know, in the last time we went through this in 2019 and 2020, there was something called Medicare for more, which meant you could sign up for Medicare if you wanted to.

This was sort of a phrase to talk about the public option, which, of course, is what President Biden ultimately supported and Congress couldn't quite pass.

So there would be a sort of competing public option on the Affordable Care Act exchanges to go with the private insurance.

You could have something like what Senator Kim is talking about, which is let's get to universal coverage gradually.

Let's enroll kids who are pretty cheap.

Could they do Medicare for all? that doesn't force people off private insurance that they like, or is that just the public option?

What are they saying precisely?

Well, there are sort of gradations of Medicare for all, if you will.

You know, in the last time we went through this in 2019 and 2020, there was something called Medicare for more, which meant you could sign up for Medicare if you wanted to.

This was sort of a phrase to talk about the public option, which, of course, is what President Biden ultimately supported and Congress couldn't quite pass.

So there would be a sort of competing public option on the Affordable Care Act exchanges to go with the private insurance.

You could have something like what Senator Kim is talking about, which is let's get to universal coverage gradually.

Let's enroll kids who are pretty cheap.

Could they do Medicare for all? that doesn't force people off private insurance that they like, or is that just the public option?

So, Julie, do they promote the measles vaccine? Do they promote it and cast shade on it at the same time? How would you describe them on that spectrum, given the answer by RFK and the premise by Senator Bennett that in the past promoting it has not been his position?

Yeah, I like that phrase, promote it and cast shade on it at the same time.

That seems to be where RFK Jr. has landed.

Of course, he spent much of his career suing the vaccine industry, you know, charging that basically vaccines cause various problems.

And there are, it's not to say the vaccines are 100% safe.

There are side effects from some vaccines.

Some people have, you know, pretty dramatic reactions to those side effects.

But then we hear something like, well, There can be some extreme reactions in some cases, but we don't hear those stats like we hear the spread of measles stats.

Why does it worry you anyway?

It's funny, at the beginning of this, uh, presidential term, I used to sort of shrug off executive orders.

It's like, yeah, they don't have any force of law.

But what we've seen is that they, what executive orders do is they order other executive agencies to do things that they can do, and what we've seen is that this is an administration where the people who work for President Trump tend to do what he says.

One of the really sort of ominous things about this particular executive order is that it orders our new attorney general to go after states that don't allow parents to say, "I don't want my kid to get this vaccine." Now, there are already exceptions in most states.

There are religious exceptions.

There are medical exceptions in every state.

Uh, but, but we just have to say it out loud, right?

Why does it worry you anyway?

It's funny.

At the beginning of this presidential term, I used to sort of shrug off executive orders.

It's like, yeah, they don't have any force of law.

But what we've seen is that they what executive orders do is they order other executive agencies to do things that they can do.

And what we've seen is that this is an administration where the people who work for President Trump tend to do what he says.

One of the really sort of ominous things about this particular executive order is that it orders everything.

Is the Trump administration running out of doctors who will vouch for them? We'll see.

Why does it worry you anyway?

It's funny.

At the beginning of this, uh, presidential term, I used to sort of shrug off executive orders, and it's like, yeah, they don't have any force of law.

But what we've seen is that they, what executive orders do is they order other executive agencies to do things that they can do, and what we've seen is that this is an administration where the people who work for President Trump tend to do what he says.

One of the really sort of ominous things about this particular executive order is that it orders our new attorney general to go after states that don't allow parents to say, "I don't want my kid to get this vaccine." Now, there are already exceptions in most states.

There are religious exceptions.

There are medical exceptions in every state.

Uh, but, but we just have to say it out loud, right?

What are you seeing on the political landscape, and why did you decide to have this public conversation at this moment? Was it just because of this sort of real push by what we're seeing by a lot of progressive Democrats, or is it because of the consequences of our current healthcare system? Anyway, welcome to the program.

Thank you.

Um, you know, I think it's all of the above.

Obviously, this was, you know...

It, it was newsy this week because of the primary election in Michigan.

Obviously, you know, um, Abdul El-Sayed, who's been running, who is a doctor, who's been running on a Medicare for All platform for a while now.

Um, but also, um, you know, as part of our podcast, we're, uh, in the midst of a project called How Would You Fix It?, where we're having basically everybody in to say, "Okay, if you could fix the healthcare system, what would you do?" So Democrats, Republicans, Medicare for All, um, you know, going all private, uh, you know, everybody's sort of ideas are welcome because I do think we're heading for another big debate about healthcare.

How is it possible for them to point to the private marketplace as the solution when you realize their goal is not your health, their goal is making money? How do they balance that justification?

Why?

Well, this particular parasite, cyclospora, does tend to flourish in the summer.

And of course, we had a, a bagged spinach outbreak a c- few years ago, so it's not just bagged lettuce.

Some of it is that it's coming from lots of different places, and it's very hard to figure out where.

If, you know, if there's contaminated lettuce that's coming from a farmers market, that's gonna be isolated to the people who eat that lettuce from probably that farm.

Bagged lettuce comes from so many different places.

And of course, this particular parasite, cyclospora, doesn't come off when you just wash the vegetables.

And correlation is not causation, but I have to wonder, do those cuts have anything to do with the size and scale of this outbreak?

And now I'm wondering, like, are we seeing something that's, like, effectively kind of a slow motion repeal of the ACA by other means?

Oh, absolutely.

No question about it.

Most of the Affordable Care Act has been dismantled over, you know, th- this was, several people have written this story.

It's like, you know, Republicans failed on their repeal and replace when they called it repeal.

But basically, over the last 10 years, look at all the things we've taken away.

All of the taxes that supported [laughs] the, the financing of this have gone away.

Hmm.

What could unfold and what would it look like? It seems like it'd be a massive logjam.

It would.

I mean, if you can just imagine, you know, science is not a straight line.

These are often grants that, you know, go, that string on for many, many years.

A lot of really important scientific achievements have taken years, if not decades, to make.

So if you have administrations changing and then One, you know, one money stream is going to stop and another one's going to start every four years or even every eight years.

That's not really how science is best done.

Do you think that's an actual shift in priorities or do you think that's responding to what they think will work going into the midterms?

Um, but who would qualify?

qualify?That's right.

Well, there are already people who are getting these drugs because they have, they're not just overweight and/or obese, but they have other health problems that qualify them for the drug.

So those people, nothing changes.

But there are somewhere in the neighborhood of three, four, five million Medicare beneficiaries who would like to take these drugs purely for weight loss.

That's something that Medicare has banned since the beginning of its drug benefit in 2003.

And for the first time, they will be able to get these drugs, as Dr. Oz says, for $50 a month.

Uh, and I guess one of the things I'm trying to figure out is because there are other health benefits to GLP-1s, which we're only really coming to understand now, could this bring down the cost of healthcare in a population of people that have a lot of health issues?

Yes

... spearheaded by Bill Frist.

You know, again, a lot of these things were completely bipartisan, and this administration came in and said, "We don't know what this is, so we're getting rid of it." And in my 40 years, this is like nothing I've ever seen before.

You know, as I say, administrations come and go, parties change, parties take over Congress, parties take over the administration, priorities change.

You know, what you're working on changes.

But this wholesale, let's just toss it all out, and it's not even a matter of toss it all out and start over.

It's just, let's just toss it all out, is what a lot of this seems to be.

Do we know how the current policy instability has led to any changes in healthcare professionals that are willing to enter this business, enroll in nursing school, enroll in medical school? What have we seen there?

What happened once that decision came down?

Well, I think it's safe to say there was mass confusion.

Uh, medication abortion today accounts for more than 60% of all abortions in the US, most of them using this drug.

Mifepristone is also used to treat miscarriage.

It's not just an abortion drug.

And this order attempted to roll back its availability dramatically.

Doctors, patients, and drug makers all had no idea what it meant on the ground.

Now, does this affect the political landscape ahead of the midterms?

Julie, what should we keep in mind when we're using this kind of data to try to understand what's happening in the healthcare system right now?

Well, you know, data is not always, uh... data is usually not up to date.

I mean, it's always lagging by at least a year.

I'm pretty sure this report used, um, twenty, uh, twenty-twenty-three and twenty-twenty-four data.

Um, and of course they would-- they didn't say that these hospitals are likely to close.

They're just, it calculated how much they rely on Medicaid compared to what the data suggested they were looking like financially at that point.

So some of these hospitals are gonna be able to survive.

H-How might that compound the strain we're seeing on the, the landscape of obstetrics care in the U.S. right now?

Can you, can you explain, uh, in a little more detail what you were measuring?

Yes.

It actually comes from my colleagues at KFF, um, we're the, we're the journalism arm, they're the analysis arm, and they're the ones that do these very complicated, um, analyses.

But basically, what, what they have found is that overall premiums are going up about 18%, um, and premiums are going up across, you know, the spectrum.

Employer premiums are going up, uh, Medicare premiums are going up.

So you know, healthcare is more expensive, which for a variety of reasons, which we can talk about.

Um, so premiums in the Affordable Care Act exchanges are going up.

"Give money to people, not insurance companies." Do you understand what difference he's talking about?

Julie, you know we are going to you first on this, okay? Is there any hope for keeping these subsidies going at this point? And please explain to us what happens when they expire.

Well, they're going to expire on December 31st.

It's pretty clear that Congress is not going to be able to do anything in time for that.

Even if one of these discharge petitions in the House ended up with 218 signatures, uh, it wouldn't become ripe for a vote until after the first of the year.

So, what happens when these, uh, uh, extra subsidies expire? The underlying subsidies that were in the original Affordable Care Act as it passed in 2010 will remain.

What happened was in 2021, Congress made the subsidies much larger and more generous, um, helped m- helped people at the bottom much more, helped people at the top for the first time, people who earned more than about $60,000 a year.

Um, if they expire, we go back to the original subsidies, and the CBO estimates that about four million people will no longer be able to afford their insurance and will likely drop it.

Julie, can you give us a little more information what they actually look like?

How are those going to get to a vote without Speaker Johnson's support?

Well, there is, (laughs) something called the discharge petition, which is of course how the Epstein files bill got to a vote without the Speaker's support, and apparently there are a couple of discharge petitions that enough Republicans have signed onto that if all the Democrats in the House sign onto also, they would have to have a vote on.

That's how frantic I think some of these more moderate Republicans in the House are.

They are terrified that their voters are gonna see these huge increases in what they are being charged for their health insurance.

Some of them are gonna have to drop insurance 'cause it's gonna get so expensive.

And they've heard from President Trump's pollster that, you know, instead of being down three points in the generic ballot, they're gonna be down 15 points in the generic ballot, and unlikely to, to maintain their seats.

And remember, every member of the House, unlike the Senate, is up for re-election next year.

If Congress can't reach a deal and the enhanced ACA subsidies expire at the end of the year, what can we expect to see in the ACA marketplace and private health insurance plans in the coming months?

Like, what was some of the reasoning for that? Like, how did the cost go down?

It was a big jump.

For a lot of people, health insurance became free.

I mean, they still needed to pay co-pays and deductibles, many of them, but they had zero premium plans.

And these were people at the lower end of the income scale.

So it was really a no-brainer for them.

It's like, hey, want free health insurance? And a lot of them said, yeah, please.

So your insurance may not pay that much, but you have this little account that can help you get through when you need to.

Like, what was some of the reasoning for that? Like, how did the cost go down?

It was a big jump.

For a lot of people, health insurance became free.

I mean, they still needed to pay co-pays and deductibles, many of them, but they had zero premium plans.

And these were people at the lower end of the income scale.

So it was really a no-brainer for them.

It's like, hey, want free health insurance? And a lot of them said, yeah, please.

So your insurance may not pay that much, but you have this little account that can help you get through when you need to.

Like, what was some of the reasoning for that? Like, how did the cost go down?

It was a big jump.

For a lot of people, health insurance became free.

I mean, they still needed to pay co-pays and deductibles, many of them, but they had zero premium plans.

And these were people at the lower end of the income scale.

So it was really a no-brainer for them.

It's like, hey, want free health insurance? And a lot of them said, yeah, please.

So your insurance may not pay that much, but you have this little account that can help you get through when you need to.

Can you talk about how that works and, and what happens if an infant is exposed to hepatitis B?

Yeah.

First of all, I mean, it's important to say a couple of things.

Uh, this vaccine has been, uh, given since the 1990s.

It has reduced, uh, chronic, uh, hepatitis B, which can cause cancer and other liver- serious liver diseases, um, by 99%.

It's one of the amazingly successful public health interventions.

Uh, and also, you know, what the- these anti-vaccine activists are saying is, you know, "Why are we giving a vaccine for a sexually transmitted disease to a baby who's one day old?" Well, as you suggest, the answer is that sexual transmission is not the only way that hepatitis B can be transmitted.

Who are the appointees voting on these recommendations?

I, I would just love your response.

Well, one of the things I will say from my colleagues on the analysis side at, at KFF, uh, is that the vast majority of people who are on Medicaid either work or can't work or are caregiving.

Um, it's not, it's not people who are sitting around watching TV.

Um, sometimes it's people who can't find jobs.

I think the difference between...

And I covered the 1988 Welfare Bill and the 1996 Welfare Bill.

So, I understand sort of what that work requirement was, and that was about h- getting people training mostly, so they could get better paying jobs so they wouldn't need assistance like housing assistance and food assistance and healthcare assistance.

Go ahead.