KHN’s ‘What the Health?’: The Politics of Vaccine Mandates

Like almost everything else associated with the covid-19 pandemic, partisans are taking sides over whether vaccines should be mandated. Meanwhile, Democrats on Capitol Hill are still struggling to find compromise in their effort to expand health insurance and other social programs. Alice Miranda Ollstein of Politico, Jen Haberkorn of the Los Angeles Times and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews best-selling author Beth Macy about her book “Dopesick,” and the new Hulu miniseries based on it.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Should covid vaccines be mandated? The answer to that question has become predictably partisan, as with almost everything else associated with the pandemic. Even as the federal government prepares to issue rules requiring large employers to ensure their workers are vaccinated, GOP governors are trying to ban such mandates, leaving employers caught in the middle.

Meanwhile, on Capitol Hill, Democrats are still working to reach a consensus on a package of social-spending improvements, the size of which will depend largely on how much they can cut prices for prescription drugs.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Jen Haberkorn of the Los Angeles Times and Mary Ellen McIntire of CQ Roll Call.

Among the takeaways from this week’s episode:

  • Congressional Democrats’ struggle to find a compromise on a $3.5 trillion spending package for health and other social programs looks likely to push them past their self-imposed deadline of the end of October to pass a bill. Leaders are wrestling with what to cut as they meet demands from moderates in the party to bring the spending down.
  • Everything in that package appears vulnerable at this stage in the negotiations. Party leaders are considering a variety of strategies, including throwing out some proposals or setting up the new benefits over a shorter time frame to test whether they work and the public appreciates them.
  • It appears that Democrats’ priorities will include proposals to enhance benefits for children. But the health programs at stake — new benefits for Medicare, providing insurance to low-income residents of states that have not expanded their Medicaid programs, and extending the enhanced premium subsidies for the Affordable Care Act — each have strong constituencies and will be hard for leaders to settle on.
  • The proposal to add billions of dollars to long-term care programs may draw the short straw. However, it does have some strong allies in Congress, including Sens. Ron Wyden (D-Ore.) and Bob Casey (D-Pa.).
  • Democratic leaders hope to fund some of the initiatives in this package by cutting Medicare’s drug spending. A poll by KFF this week showed that is a very popular notion, even among Republicans. But drugmakers are fighting that strategy with major ad campaigns and political donations. They need to pick off only a couple of vulnerable lawmakers to thwart the effort since Democrats have razor-thin majorities in both the House and Senate. House Speaker Nancy Pelosi, however, appears determined to get some sort of provision on drug price negotiations in the bill, even without the full effect of her original plan.
  • The Department of Labor reportedly has sent a proposed rule requiring large employers to have their workforce vaccinated to the Office of Management and Budget for review. That means the rule could be coming soon. But it is bound to run headlong into opposition in conservative states, like Texas, where Republican Gov. Greg Abbott has banned mandates. The issue will likely end up in federal court.
  • The fight over vaccine mandates highlights a divide in the Republican Party between the business-oriented faction that wants to move past the pandemic and the more libertarian wing of the party. Some of the most conservative political leaders lean toward that libertarian wing and see the vaccine mandate as a way to excite the base. The experience of some major companies, however, suggests that businesses and many workers don’t object to mandates. One example is United Airlines, where 99% of workers have been vaccinated.
  • As the federal courts bat the Texas abortion law back and forth, it appears headed for a review by the Supreme Court. Some analysts suggest that the urgency of the issue could push the court to take on the Texas issue before they hear a case in December about a different law seeking to limit abortion in Mississippi. But the Supreme Court generally likes to have cases fully debated in lower courts before coming to the justices, so a decision on the Texas law may have to wait.
  • The issue of abortion is getting a good bit of advertising time in the Virginia gubernatorial race. Democratic candidate Terry McAuliffe is telling voters he will work to keep abortions legal in the state and suggesting his opponent, Glenn Youngkin, will not. It’s a strategy that California Gov. Gavin Newsom used as he successfully fought a recall in an election last month.

Also this week, Rovner interviews Beth Macy, author of the best-selling “Dopesick: Dealers, Doctors and the Drug Company That Addicted America” and an executive producer of a miniseries of the same name now streaming on Hulu.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: KHN’s “6 Months to Live or Die: How Long Should an Alcoholic Liver Disease Patient Wait for a Transplant,” by Aneri Pattani

Jen Haberkorn: The Washington Post’s “Covid and Cancer: A Dangerous Combination, Especially for People of Color,” by Laurie McGinley

Mary Ellen McIntire: NPR’s “Judging ‘Sincerely Held’ Religious Belief Is Tricky for Employers Mandating Vaccines,” by Laurel Wamsley

Alice Miranda Ollstein: The 19th’s “Kansas Has Become a Beacon for Abortion Access. Next Year, That Could Disappear,” by Shefali Luthra

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

KHN’s ‘What the Health?’: Abortion Politics Front and Center

The polarizing abortion issue threatens to tie up Congress, the Supreme Court and the states for the coming year. Meanwhile, Congress kicks the can down the road to December on settling its spending priorities. Joanne Kenen of Politico and the Johns Hopkins School of Public Health, Yasmeen Abutaleb of The Washington Post and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more.
Also this week, Rovner interviews KHN’s Aneri Pattani, who delivered the latest KHN-NPR “Bill of the Month” episode about a covid test that cost as much as a luxury car.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Abortion, an issue that has mostly been simmering under the surface lately, is taking center stage in fights at the Supreme Court, in Congress and in the states, as the fate of legalized abortion in the United States hangs in the balance.

Meanwhile, Congress flirted with disaster as it appeared unlikely to meet deadlines to approve a series of budget bills, including an extension of the federal government’s lending authority. But lawmakers found ways to extend programs long enough to continue negotiating through the fall.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and Johns Hopkins, Yasmeen Abutaleb of The Washington Post and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • As Democratic lawmakers seek to reduce the cost of the president’s $3.5 trillion plan to boost health and other domestic programs, they are wrestling with whether to cut the number of programs they fund but still give them full support or to keep a wider range of initiatives but fund them for fewer years or at lower levels. Supporters of the latter proposal contend that getting the programs started is important and, if they have a constituency, it will be hard for Congress in the future to cut the programs.
  • Sen. Joe Manchin (D-W.Va.), who has been at the center of the negotiations because he was refusing to support the package if it stayed at $3.5 trillion, has called for new initiatives to be means-tested so that benefits don’t go to higher-income Americans. Past experience suggests that can lower the popularity of the programs because it creates more bureaucracy to oversee the benefits and sometimes creates problems with getting voters to buy into the need.
  • As the negotiations drag on, it seems less likely that the Democrats will agree on a plan to rein in prescription drug prices. Leaders haven’t come to terms on how they would like to address the issue, and drugmakers have beefed up their advertising campaign to oppose any action that could threaten their profits.
  • Manchin may also throw a wrench into the negotiations if he goes forward with plans to seek a provision in the legislative package that makes the so-called Hyde Amendment permanent. The Hyde Amendment, which is commonly added to annual health spending legislation, bars most federal dollars from being spent on abortions. Progressive Democrats strongly oppose the Hyde Amendment, and they would like to remove it from the annual spending bill for the Department of Health and Human Services.
  • Pfizer on Thursday announced it is seeking authorization from the Food and Drug Administration for a covid vaccine for children ages 5 to 11. The agency has scheduled an advisory committee meeting already and a decision could come around Halloween. A decision on vaccines for children under 5, however, seems unlikely before the end of the year.
  • The recent controversy over whether the U.S. should authorize so-called vaccine boosters has focused attention on the lack of good national data on covid’s effects. Much of the argument for those additional shots was based on studies from Israel and Britain because U.S. health officials have not been collecting the same level of data about covid cases and outcomes. That is partly a reflection of the decentralization of the U.S. health system.
  • The Biden administration announced this week it is reversing a federal Title X rule that denied funding to organizations that counseled people about abortion or referred them to abortion providers. Planned Parenthood left the program after the Trump administration implemented that rule.
  • Abortion is teeing up to be a big issue before the Supreme Court this term. The justices had already agreed to hear a case opposing a Mississippi law restricting most abortions after 15 weeks, but cases involving a controversial Texas law that denies abortions after six weeks appear bound for the high court soon, too.
  • Abortion opponents are hoping the court will overturn the landmark Roe v. Wade decision legalizing the procedure. But that could also set the court up for a major backlash and complaints about its politicization.
  • Biden has another key health opening in his administration: the director of the National Institutes of Health. But it doesn’t seem likely to be as difficult to fill as the head of the FDA, which the White House has still not offered a nominee for.

Also this week, Rovner interviews KHN’s Aneri Pattani, who reported the latest KHN-NPR “Bill of the Month” feature about two similar jaw surgeries with two very different price tags. If you have an outrageous medical bill, you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The New York Times’ “A ‘Historic Event’: First Malaria Vaccine Approved by W.H.O.,” by Apoorva Mandavilli

Joanne Kenen: Vox.com’s “Why Merck’s Covid-19 Pill Molnupiravir Could Be So Important,” by Umair Irfan

Yasmeen Abutaleb: The Wall Street Journal’s “Why It’s So Hard to Find a Therapist Who Takes Insurance,” by Andrea Petersen

Sarah Karlin-Smith: The Washington Post’s “70 Years Ago, Henrietta Lacks’s Cells Were Taken Without Her Consent. Now, Her Family Wants Justice,” by Emily Davies

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Must-Reads Of The Week From Brianna Labuskes

Newsletter editor Brianna Labuskes wades through hundreds of health care policy stories each week, so you don’t have to.

Happy Friday! Where yours truly has parsed approximately 4,346,276,986 coronavirus stories to bring you the most important ones — such as the fact that 38% of Americans won’t buy Corona beer “under any circumstances” because of the outbreak; that apparently dog masks are now all the rage, despite the fact that health professionals say even healthy humans don’t need them; and that if you need of a cheat sheet on what facial hairstyles are officially called you can head over to the CDC for a nifty graphic. (The “walrus” might be my favorite.)

More seriously, here’s what you need to know about the outbreak dominating global attention, sending stocks plunging and creating a booming demand for hand sanitizer. I can tell you one common thread running through coverage about experts’ advice: Keep calm, carry on and wash your hands.

President Donald Trump cracked jokes about his germophobia and downplayed the severity of the coronavirus outbreak at a press conference this week, in which he put Vice President Mike Pence in charge of the country’s coronavirus response. This raised immediate eyebrows, considering that under Pence’s watch Indiana weathered a major HIV outbreak largely attributed to decisions he made as governor.

By contrast, you have the CDC’s Dr. Nancy Messonnier, who has become a leading player in the crisis, saying it’s not a question of if but when the coronavirus will sweep into the U.S. She also said that she’s been talking with her kids about how to prepare and that “the disruption to everyday life might be severe.”

Not surprisingly, after all that whiplash, the administration decided all information released to the public must first get the OK from Pence.

Politico: Coronavirus Gets a Trumpian Response

The New York Times: Pence Will Control All Coronavirus Messaging From Health Officials

The New York Times: What Has Mike Pence Done in Health?

The New York Times: C.D.C. Officials Warn of Coronavirus Outbreaks in the U.S.

Meanwhile, a new case out of California put a harsh spotlight on the deep flaws of the CDC’s original testing parameters. The patient — who may be the first in the U.S. with no link to traveling abroad — was in the hospital for more than 10 days before the CDC approved a coronavirus test. The delay exposed about 100 health workers to the virus as well as set back any attempts to contain people she’d been in contact with.

Stat: A Single Coronavirus Case Exposes a Bigger Problem: The Scope of Undetected U.S. Spread Is Unknown

ProPublica: Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus

If a whistleblower is to be believed, those testing missteps weren’t the only ones made by the government in the early days of the response: New allegations have come to light that HHS workers who were sent to help with the U.S. evacuees weren’t given proper medical training or gear before being exposed to the patients.

The Washington Post: U.S. Workers Without Protective Gear Assisted Coronavirus Evacuees, HHS Whistleblower Says

Meanwhile, for a president who has tied his fate to the health of the stock markets, the global financial turmoil is more worrisome than ever.

Politico: Trump Faces ‘Black Swan’ Threat to the Economy and Reelection

One of the few good things about the coronavirus is that the vast majority of cases are mild. However, that’s also one of the things that might tip it into a pandemic. For more extreme illnesses (like Ebola), it’s far easier to isolate patients. But for those with symptoms that are essentially presenting as a mild cold, it’s harder to contain the spread.

On that note, it’s hard to tell just how lethal the disease is (and anyone who tells you otherwise, question their motives). Because so many cases are mild, some experts say we’re seeing only the tip of the iceberg, and the mortality rate would drop if we had a better sense of how many people are actually infected. Others argue that there’s no evidence that officials don’t have an accurate count.

Right now, from what’s available, it seems the death rate outside the epicenter in China was 0.7%. That’s still soberingly high, but also a long way away from SARS’ 10%.

The New York Times: Most Coronavirus Cases Are Mild. That’s Good and Bad News.

Stat: New China Coronavirus Data Buttress Fears About High Fatality Rate

As someone who has little kiddos in their life (and who affectionately calls them Typhoid Marys), I can’t help but include this story. Are kids innocent bystanders in this outbreak, getting infected if someone brings the virus into their households? Or are they, in fact, a population that is stealthily driving this epidemic, as they can do with the flu?

Stat: Key Question for Coronavirus Response: What’s Kids’ Role in Spreading It?

Globally, cases are climbing, with patients showing up in Lithuania, the Netherlands, Iran, Kuwait, the United Kingdom … you get the gist. Although we’re not really seeing it yet in Latin or South American countries beyond a Brazilian patient who had traveled to Italy, where cases skyrocketed 45% in one day.

In China, officials are tapping their tried-and-true propaganda playbook, but the anger that has boiled up over the government’s handling of the outbreak may be cracking the party’s stronghold. Meanwhile, authorities, in an ongoing attempt to contain the spread, are offering people more than $1,400 to self-report if they have coronavirus symptoms.

The New York Times: Coronavirus Weakens China’s Powerful Propaganda Machine

Reuters: China City Offers $1,400 Reward for Virus Patients Who Report to Authorities

And South Korea gets a shoutout for implementing a very cool idea to create “drive-thru” testing for potential patients.

Reuters: South Korea Launches ‘Drive-Thru’ Coronavirus Testing Facilities As Demand Soars

Remember, there are plenty more stories were those came from. If you’re interested in the full scope of coronavirus coverage, check out all our Morning Briefings from the week.


Believe it or not, there was other news this week! Democrats held a rowdy debate in South Carolina ahead of Super Tuesday, where Sen. Bernie Sanders (I-Vt.) fielded the inevitable attacks that come with being a front-runner. He was put on the hot spot about topics ranging from the cost of his “Medicare for All” plan to his past stance on guns.

Reuters: At Rowdy Debate, Democratic Rivals Warn Sanders Nomination Would Be ‘Catastrophe’

The New York Times: Fact-Checking the Democratic Debate in South Carolina

Sanders (after releasing a plan on how he was going to pay for his ambitious agenda) said that “‘Medicare for All’ will lower health care costs in this country by $450 billion a year and save the lives of 68,000 people who would otherwise have died.” But experts are skeptical of the findings.

KHN: Sanders Embraces New Study That Lowers ‘Medicare For All’s’ Cost, But Skepticism Abounds


A federal appeals court upheld a Trump administration ban on federally funded family planning centers referring women for abortions, arguing that the rule is slightly less restrictive than a 1988 version upheld by the Supreme Court. What’s interesting to note is that the court was the California-based U.S. Court of Appeals for the 9th Circuit. Trump has now named 10 judges to the 9th Circuit — more than one-third of its active judges — compared with seven appointed by President Barack Obama over eight years.

The Washington Post: Appeals Court Upholds Trump Ban on Abortion Referrals by Family Planning Clinics

Los Angeles Times: Trump Has Flipped the 9th Circuit — and Some New Judges Are Causing a ‘Shock Wave’

WBUR: Looking at Changes Happening Within the Nation’s Largest Federal Appeals Court

Beyond fighting for survival in the courts, abortion clinics are often faced with so many fees and unexpected costs that they can face closure from their financial burdens alone. Among those are: security to protect staff and patients; airfare to get doctors to areas lacking trained physicians willing to perform abortions; higher rates for contractors concerned about protesters and boycotts; more stringent loan terms; insurance that can be canceled unexpectedly; and, for some clinic owners, legal fees for defending the constitutionality of the procedure.

Bloomberg: Abortion Clinics Are the Most Challenging Small Business in America


Vocal opposition continues to pour in about the arcane Medicaid rule change that could reduce Medicaid spending by 6% to 8%, or $37 billion to $49 billion, a year. The Trump administration says the change would increase transparency and prevent abuses that enable states to draw down more federal money than they’re entitled to. But, so far, more than 4,200 organizations or individuals from both parties are sounding alarm bells about it.

Stateline: Medical Groups Slam Trump Medicaid Rule


In the miscellaneous file for the week:

— The Sacklers, under fire over allegations about their role in the opioid crisis, turned to Mike Bloomberg to help them manage their reputation. Will that haunt him in his presidential bid?

ProPublica: When the Billionaire Family Behind the Opioid Crisis Needed PR Help, They Turned to Mike Bloomberg

— Are some people immune to Alzheimer’s? Scientists studying donated brains have identified patients who have all the markers for the debilitating disease but didn’t seem to have any symptoms when alive. The findings offer hope that the seemingly inherent protection could be replicated by a drug.

Stat: They Have ‘Alzheimer’s Brains’ But No Symptoms. Why?

— America is facing an autopsy crisis: Large swaths of the country don’t have a medical examiner. Bodies are even having to be shipped across state lines if an autopsy is needed. At one point the problem was so bad that Oklahoma’s overloaded medical examiner declined to perform autopsies on people over 40 who died of unexplained causes.

The New York Times: Piled Bodies, Overflowing Morgues: Inside America’s Autopsy Crisis

— Colorado is continuing to move forward with plans for its public option, this week unveiling reimbursement rates that officials say would keep hospitals profitable under the system. Hospitals were … uh … a little skeptical of those claims.

The Denver Post: Colorado Consumers Could Save Up to 20% Under State Health Insurance Option, Polis Says

— In this terrifying story, a student died after calling 911 because the responders couldn’t locate him.

The Washington Post: College Student Yeming Shen Died of Flu in Troy, N.Y., After 911 Couldn’t Track His Location.


That’s it from me! Have a great weekend.