The Host Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News weekly health policy news podcast, What the Health? A noted expert on health policy issues, Julie is the author of the critically praised reference book Health Care Politics and Policy A to Z, now in its third edition.
With abortion shaping up as a key issue for the November elections, the movement that united to overturn Roe v. Wade is divided over going further, faster including by punishing those who have abortions and banning contraception or IVF. Politicians who oppose abortion are already experiencing backlash in some states.
Meanwhile, bad actors are bilking the health system in various new ways, from switching peoples insurance plans without their consent to pocket additional commissions, to hacking the records of major health systems and demanding millions of dollars in ransom.
This weeks panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine. Panelists Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's articles. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories.
Among the takeaways from this weeks episode: It appears that abortion opponents are learning its a lot easier to agree on what youre against than for. Now that the constitutional right to an abortion has been overturned, political leaders are contending with vocal groups that want to push further such as by banning access to IVF or contraception. A Louisiana bill designating abortion pills as controlled substances targets people in the state, where abortion is banned, who are finding ways to get the drug. And abortion providers in Kansas are suing over a new law that requires patients to report their reasons for having an abortion. Such state laws have a cumulative chilling effect on abortion access. Some Republican lawmakers seem to be trying to dodge voter dissatisfaction with abortion restrictions in this election year. Sen. Ted Cruz of Texas and Sen. Katie Britt of Alabama introduced legislation to protect IVF by pulling Medicaid funding from states that ban the fertility procedure but it has holes. And Gov. Larry Hogan of Maryland declared he is pro-choice, even though he mostly dodged the issue during his eight years as governor. Former President Donald Trump is in the news again for comments that seemed to leave the door open to restrictions on contraception which may be the case, though he is known to make such vague policy suggestions. Trumps policies as president did restrict access to contraception, and his allies have proposed going further.
Also this week, Rovner interviews Shefali Luthra of The 19th about her new book on abortion in post-Roe America, Undue Burden. Email Sign-Up
Subscribe to KFF Health News' free Morning Briefing. Your Email Address Sign Up
Plus, for extra credit, the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The 19ths What Happens to Clinics After a State Bans Abortion? They Fight To Survive, by Shefali Luthra and Chabeli Carrazana.
Alice Miranda Ollstein: Stats How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations, by Eric Boodman.
Rachel Roubein: The Washington Posts What Science Tells Us About Biden, Trump and Evaluating an Aging Brain, by Joel Achenbach and Mark Johnson.
Joanne Kenen: ProPublicas Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe, by Sharon Lerner; and The Guardians Microplastics Found in Every Human Testicle in Study, by Damian Carrington.
Also mentioned on this weeks podcast: NPRs Republicans Try To Soften Stance on Abortion as Abolitionists Go Farther, by Sarah McCammon. KFF Health News Biden Leans Into Health Care, Asking Voters To Trust Him Over Trump, by Phil Galewitz. KFF Health News Exclusive: Senator Urges Biden Administration To Thwart Fraudulent Obamacare Enrollments, by Julie Appleby. KFF Health News KHNs What the Health?: Un-Trumping the ACA, featuring an interview with journalist Marshall Allen. Click to open the Transcript Transcript: Anti-Abortion Hard-Liners Speak Up [Editors note: This transcript was generated using both transcription software and a humans 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 its not a political ad, but it is a call to action. Im Mila Atmos, and Im passionate about unlocking the power of everyday citizens. On our podcast Future Hindsight, we take big ideas about civic life and democracy and turn them into action items for you and me. Every Thursday, we talk to bold activists and civic innovators to help you understand your power and your power to change the status quo. Find us at futurehindsight.com or wherever you listen to podcasts.
Julie Rovner: Hello, and welcome back to What the Health? Im Julie Rovner, chief Washington correspondent for KFF Health News, and Im joined by some of the best and smartest health reporters in Washington. Were taping this week on Thursday, May 23, at 10 a.m. As always, news happens fast and things mightve changed by the time you hear this. So, here we go. We are joined today via a video conference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hello.
Rovner: Rachel Roubein of The Washington Post.
Rachel Roubein: Hi, thanks for having me.
Rovner: And Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine.
Joanne Kenen: Hi, everybody.
Rovner: Later in this episode, well have my interview with podcast panelist Shefali Luthra of The 19th. Shefalis new book about abortion in the post-Roe [v. Wade] world, called Undue Burden, is out this week. But first, this weeks news. Were going to start with abortion this week with a topic Im calling Abolitionists in Ascendance, and a shoutout here to NPRs Sarah McCammon with a great piece on this that we will link to in the show notes. It seems that while Republican politicians, at least at the federal level, are kind of going to ground on this issue, and well talk more about that in a bit, those who would take the ban to the furthest by prosecuting women, and/or banning IVF and contraception, are raising their voices. How much of a split does this portend for what, until the overturn of Roe, had been a pretty unified movement? I mean they were all unified in Lets overturn Roe, and now that Roe has gone, boy are they dividing.
Ollstein: Yeah, its a lot easier to agree on what youre against than on what youre for. We wrote about the split on IVF specifically a bit ago, and it is really interesting. A lot of anti-abortion advocates are disappointed in the Republican response and the Republican rush to say, No, lets leave IVF totally alone because these groups think, some think it some should be banned, some think that there should be a lot of restrictions on the way its currently practiced. So not a total ban, but things like you can only produce a certain number of embryos, you can only implant a certain number of embryos, you can only create the ones you intend to implant, and so that would completely upend the way IVF is currently practiced in the U.S.
So, we know the anti-abortionmovement is good at playing the long game, and so some of them have told me that they see this kind of like the campaign to overturn Roe v. Wade. They understand that Republicans are reacting for political reasons right now, and they are confident in winning them over for restrictions in the long term.
Rovner: Ive been fascinated by, I would say, by things like Kristan Hawkins of Students for Life [of America] whos been sort of the far-right fringe of the anti-abortion movement looking like shes the moderate now with some of these people, and their discussions of We should charge women with murder and have the death penalty if necessary. Sorry, Rachel, you want to say something?
Roubein: This is something that Republicans, they dont want to be asked about this on the campaign. The more hard-line abolitionist movement is something more mainstream groups have been taking a lot of pains to distance themselves and say that we dont prosecute women, and essentially nobody wants to talk about this ahead of 2024. GOP doesnt want to be seen as that party thats going after that.
Kenen: And the divisions existed when Roe was still the law of the land, and we would all write about the divisions and what they were pushing for, and it was partly strategic. How far do you push? Do you push for legislation? Do you push for the courts? Do you push for 20 weeks for fetal pain? But it was like rape exceptions and under what terms and things like that. So it was sort of much later in pregnancy, and with more restrictions, and the fight was about exactly where do you draw that line. This abolition of all abortion under all circumstances, or personhood, only a couple of years ago, were the fringe. Personhood was sort of like, Oh, theyre out there, no one will go for that. And now I dont think its the dominant voice. I dont think we yet know what their dominant voice is, but its a player in this conversation.
At the same time, on the other side, the pro-abortion rights people, theres polls showing us this many Americans support abortion, but its subtler too. Even if people support abortion rights, it doesnt mean that theyre not, some subset are in favor of some restrictions, or where thats going to settle. Right now, a 15-week ban, which wouldve seemed draconian a year or two ago, now seems like the moderate position. It has not shaken out, and
Rovner: Well, lets talk
Kenen: Its not going to shake out for some time.
Rovner: Lets talk about a few specifics. The Louisiana State Legislature on Tuesday approved a bill that would put the drugs used in medication abortion, mifepristone and misoprostol, on the states list of controlled substances. This has gotten a lot of publicity. Im wondering what the actual effect might be here though since abortion is already banned in Louisiana. Obviously, these drugs are used for other things, but they wouldnt be unavailable. They would just be put in this category of dangerous drugs.
Ollstein: So, officials know that people in banned states, including Louisiana, are obtaining abortion pills from out of state, whether through telehealth from states with shield laws or through these gray-area groups overseas that are mailing pills to anyone no matter what state they live in or what restrictions are in place. So I think because it would be very difficult to actually enforce this law, short of going through peoples homes and their mail, this is just one more layer of a chilling effect and making people afraid to seek out those mail order services.
Rovner: So its more, again, for the appearance of it than the actuality of it.
Ollstein: It also sets up another state versus federal law clash, potentially. Weve seen this playing out in courts in West Virginia and in North Carolina, basically. Can states restrict or even completely ban a medication that the FDA says is safe and effective? And that question is percolating in a few different courts right now.
Rovner: Including sort of the Supreme Court. Were still waiting for their abortion pill decision that we expect now next month. Meanwhile, in Kansas, where voters approved a big abortion rights referendum in 2022 remember, it was the first one of those abortion providers are suing to stop a new state law enacted over the governors veto that would require them to report to the state womens reasons for having an abortion. Now its not that hard to see how that information could be misused by people with other kinds of intents, right?
Ollstein: Well, it also brings up right to free speech issues, compelled speech. I think Ive seen this pop up in abortion lawsuits even before Dobbs [v. Jackson Womens Health Organization], this very issue because there have been instances where either doctors are required to give information that they say that they believe is medically inaccurate. Thats an issue in several states right now. And then this demanding information from patients. A lot of clinics that Ive spoken to are so afraid of subpoenas from officials in-state, from out of state, that they intentionally dont ask patients for certain kinds of data even though it would really help medically or organizationally for them to have that data. But theyre so afraid of it being seized, they figure well, they cant seize it if theyre doesnt exist in the first place. And so I think this kind of law is in direct conflict with that.
Roubein: It also gets at the question of medical privacy that weve been seeing in the Biden administrations efforts over HIPAA and protecting patients records and making it harder for state officials to attempt to seize.
Rovner: Yeah, this is clearly going to be a struggle in a lot of states where voters versus Republican legislatures, and we will sort of see how that all plays out. So even while this is going on in a bunch of the states, a lot of Republicans, including some who have been and remain strongly anti-abortion, are doing what Im calling ducking-and-covering on a lot of these issues. Case in point, Texas Republican Sen. Ted Cruz and Alabama Republican Sen. Katie Britt this week introduced a bill they say would protect IVF, which is kind of ironic given that both of them voted against a bill to protect IVF back in, checking notes, February. Whats the difference here? What are these guys trying to do?
Kenen: Theirs is narrower. They say that the original bill, which was a Democratic bill, was larded with abortion rights kinds of things. I have not read the entire bill, I just read the summary of it. And in this one, if a state restricts someone who had someone feel free to correct me if I am missing something here because I dont have deep knowledge of this bill but if a state does not protect IVF, they would lose their Medicaid payment. And I was not clear whether that meant every penny of Medicaid, including nursing homes, or if its a subsection of Medicaid, because it seems like a big can of worms.
Ollstein: Yeah, so the key difference in these bills is the word ban. The Republican bill says that if states ban IVF, then these penalties kick in for Medicaid, but they say that there can be health and safety regulations, and so that is very open to interpretation. That can include the things we talked about before about you can only produce a certain number of embryos, you can only implant a certain number of embryos, and you cant discard them. And so even what Alabama did was not an outright ban. So even something like that that cut off services for lots of people wouldnt be considered a ban under this Republican bill. So I think theres sort of a semantic game going on here where restrictions would still be allowed if they were short of a blanket ban, whereas the democratic bill would also prevent restrictions.
Rovner: Well, and along those exact same lines, in Maryland, former two-term Republican governor Larry Hogan, whos managed to dodge the abortion issue in his primary run to become the Senate nominee, now that he is the Republican candidate for the open Senate seat, has declared himself, his words, pro-choice, and says he would vote to resore Roe in the Senate if given the opportunity. But as I recall, and I live in Maryland, he vetoed a couple of bills to expand abortion rights in very blue Maryland. Is he going to be able to have this both ways? He seems to be doing the [Sen.] Susan Collins script where he gets to say hes pro-choice, but he doesnt necessarily have to vote for abortion rights bills.
Kenen: Hogan is a very popular moderate Republican governor in a Democratic state. He is a strong Senate candidate. His opponent, a Democrat, Angela Alsobrooks, has a stronger abortion rights record. I dont think thats going to be the decisive issue in Maryland. I think it may help him a little bit, but I think in Maryland, if the Senate was 55-45, a lot of Democrats like Hogan and might want another moderate Republican in the Senate. But given that this is going to be about control of the Senate, abortion will be a factor, I dont think abortion is going to be the dominant factor in this particular race.
If she were to win and theres two black women, I mean that would be the first time that two black women ever served in the Senate at once, and I think they would only be number three and number four in history. So race and Affirmative Action will be factors, but I think that Democrats who might otherwise lean toward him, because he was considered a good governor. He was well-liked. This is a 50-50ish Senate, and thats the deciding thing for anyone who pays attention, which of course is a whole other can of worms because nobody really pays attention. They just do things.
Roubein: I think its also worth noting this tact to the left comes as Maryland voters will be voting on an abortion rights ballot measure in 2024. So that all sort of in context, weve seen whats happened with the other abortion measures, abortion rights have won, so.
Rovner: And Maryland is a really blue state, so one would expect it
Kenen: Theres no question that the Maryland …
Rovner: Yeah.
Kenen: I mean, and all of us would fall flat on our faces if the abortion measure fails in Maryland. But I believe this is the first one on the ballot alongside a presidential election, and some of them have been in special elections. Its unclear the correlation between, you can vote for a Republican candidate and still vote for a pro-abortion rights initiative. We will learn a lot more about how that split happens in November. I mean, is Kansas going to go for Biden? Unlikely. But Kansas went really strong for abortion rights. If youre not a single-issue voter, you can, in fact, have it both ways.
Rovner: Yes, and we are already seeing that in the polls. Well, of course then there is the king of trying to have it both ways: former President Trump. He is either considering restrictions on contraception, as he told an interviewer earlier this week, promising a proposal soon, or he will, all caps, as he put on Truth Social, never advocate imposing restrictions on birth control. So which is it?
Ollstein: So this came out of Trumps verbal tick of saying Well have a plan in a few weeks, which he says about everything. But in this context it made it sound like he was leaving the door open to restrictions on contraception, which very well might be the case. So what my colleague and I wrote about is he says he would never restrict contraception. A lot of things he did in his first administration did restrict access to contraception. It was not a ban. Again, were getting back into the semantics of ban. It was not a ban, but his Title X rule led to a drop in hundreds of thousands of people accessing contraception. He allowed more kinds of employers to refuse to cover their employees contraception on their health plans, and the plans his allies are creating in this Project 2025 blueprint would reimpose those restrictions and go even further in different ways that would have the effect of restricting access to contraception. And so I think this is a good instance of look at what people do, not what they say.
Rovner: So now that were on the subject of campaign 2024, President Bidens campaign launched a $14 million ad buy this week that includes the warning that if Trump becomes president again hell try to repeal the Affordable Care Act. Maybe health care will be an issue in this election after all? I dont have a rooting interest one way or the other. Im just curious to see how much of an issue health will be beyond reproductive rights.
Kenen: Well, as Alice just pointed out, Trumps promised plans often do not materialize, and we are still waiting to see his replacement plan eight years later. I think hes being told to sort of go slow on this. I mean, not that you can control what Trump says, but he didnt run on health care until the end, in 2016. It was a close race, and he ran against Hillary Clinton, and it was the last 10 or so days that he really came down hard because it was right when ACA enrollment was about to begin and premiums came in and they were high. He pivoted. So is this going to be a health care election from day one? And Im putting abortion aside for one second in terms of my definition of health care for this particular segment. Is it going to be a health care election in terms of ACA, Medicare, Medicaid? At this point, probably not. But is it going to emerge at various times by one or the other side in politically opportune ways? I would be surprised if Bidens not raising it. The ACA is thriving under Biden.
Rovner: Well, he is. Thats the whole point. He just took out a $14 million ad buy.
Kenen: Right. But again, we dont know. Is it a health care election or is it a couple ads? We dont know. So yes, its going to be a health care election because all elections are health care elections. How much its defined by health care compared to immigration? No, at this point, thats not what were expecting. Compared to the economy? No, at this point. But is it an issue for some voters? Yes. Is it going to be an issue more prominently depending on how other things play out? Itll have its peaks. We just dont know how consistent itll be.
Roubein: Biden would love to run on the Inflation Reduction Act and politically popular policies like allowing Medicare to negotiate drug prices. One of the problems of that is polls, including from KFF, has shown that the majority of voters dont know about that. And some of these policies, the big ones, have not even gone into effect. CMS [Centers for Medicare & Medicaid Services] is going through the negotiation process, but thats not going to hit peoples pocketbooks until after the election.
Kenen: The cliff for the ACA subsidies, which is in 2025, I mean I would imagine Democrats will be campaigning on, We will extend the subsidies, and again, in some places more than others, but thats a time-sensitive big thing happening next year.
Rovner: But talk about an issue that people have no idea thats coming. Well, meanwhile, for Trump, reproductive health isnt the only issue where hes doing a not-so-delicate dance. Apparently worried about Robert F. Kennedy Jr. stealing anti-vax [vaccine] votes from him, Trump is now calling RFK Jr. a fake anti-vaxxer. Except Im old enough to remember when Trump bragged repeatedly about how fast his administration developed and brought the covid vaccine to market. That used to be one of his big selling points. Now hes trying to be anti-vax, too?
Kenen: Not only did he brag about bringing it to the market. The way he used to talk about it, it was like he was there in his lab coat inventing it. Operation Warp Speed was a success. It got vaccines out in record time, way beyond what many people expected. Democrats gave him credit for that one policy in health care. He got a vaccine out and available in less than a year, and he got vaccinated and boasted about being vaccinated. He was open about it. Now we dont know if hes been boosted. He really backed off. As soon as somebody booed him, and it wasnt a lot of boos, at one rally when he talked about vaccination and he got pushed back, that was the end.
Rovner: So, yeah, so I expect that to sort of continueon this election season, too.
Kenen: But we dont expect RFK to flip.
Rovner: No, we do not. Right. Well, moving on to this weekends Cyber Hacks, a new feature, the fallout continues from the hack of Ascension [health care company]. Thats the Catholic hospital system with facilities in 19 states. In Michigan, patients have been unable to use hospital pharmacies and their doctors have been unable to send electronic prescriptions, so theyre having to write them out by hand. And in Indiana orders for tests and test results are being delayed by as much as a day for hospital patients. Not a great thing.
And just in time, or maybe a little late, the U.S. Department of Health and Human Services, through the newly created ARPA-H [Advanced Research Projects Agency for Health] that we have talked about, this week announced the launch of a new program to help hospitals make security patches and updates to their systems without taking them offline, which is obviously a major reason so many of these systems are so vulnerable to cyberhacking.
Of course, this announcement from HHS is just to solicit ideas for grants to help make that happen. So its going to be a while before we get any of these security changes. Im wondering, how many systems are going to try to build a lot more redundancy into them? In the meantime, are we hearing anything about what they can do in the short term? It feels like the entire health care system is kind of a sitting duck for this group of cyberhackers who think they can get in easily and get ransom.
Kenen: Theres a reason they think that.
Rovner: They can.
Roubein: Thinking about hospitals and doctors using this manually, paper-based system and how thats delaying getting your results and just theres been these stories about patients. Like the anxiety that thats understandably causing patients, and well see sort of whether Congress can grapple with this, and theres not really much legislation thats going to move, so
Kenen: But I was surprised that they were calling on ARPA-H. I mean, thats supposed to be a biotech- curing-diseases thing, and none of the four of us are cybersecurity experts, and none of us really specialize in covering the electronic side of the digital side of health, but it just seems to me, I just thought that was an odd thing. First of all, some of these are just systems that havent been upgraded or individual clinicians who dont upgrade or dont do their double authorization. Some of its sort of cyberhygiene, and some of its obviously like the change thing. Theyre really sophisticated criminals, but its not something that one would think you cant get ahead of, right? Theyre smart, good-guy technology people. Its not like the bad guys are the only ones who understand technology. So why are the smart good guys not doing their job? And also, probably, health care systems have to have some kind of security checks on their own members to make sure they are following all the safety rules and some kind of consequences if youre not, other than being embarrassed.
Rovner: Ive just been sort of bemused by all of this, how both patients and providers complain loudly and frequently about the frustrations of some of these electronic record systems. And of course, in the places that theyre going down and theyve had to go back to paper, people are like, Please give us our electronic systems back. So it doesnt take long to get used to some of these things and be sorry when theyre gone, even if its only temporarily. Its obviously been
Kenen: But like what Rachel said, if youre in the hospital, youre sick, and do your clinicians need your lab results? Yes. I mean some of them are more important than others, and I would hope that hospitals are figuring out how to prioritize. But yeah, this is a crisis. If youre in the hospital and they dont know whats wrong with you and theyre trying to figure out do you have X, Y, or Z, waiting until next week is not really a great idea.
Rovner: But it wasnt that many years ago that their existence
Kenen: Right, no, no, no.
Rovner: … did not involve
Kenen: [inaudible 00:21:28].
Rovner: … electronic medical record.
Kenen: Right. Right.
Rovner: They knew how to get test results back and forth even if it was sending an intern to go fetch them. Finally, this week, we have some updates on some stories that weve talked about in earlier episodes. First, thanks in part to the excellent reporting of my colleague and sometime-pod-panelist Julie Appleby, the Senate Finance Committee Chairman Ron Wyden is demanding that HHS [U.S. Department of Health and Human Services] officials do more to rein in rogue insurance brokers who are reaping extra commissions by switching patients Affordable Care Act plans without their knowledge, often subjecting them to higher out-of-pocket costs and separating them from the providers that theyve chosen. Sen. Wyden said he would introduce legislation to make such schemes a crime, but in the meantime he wants Biden officials to do more, given that they have received more than 90,000 complaints in the first quarter of 2024 alone about unauthorized switches and enrollments. Criminals go where the money is, right? You can either cyberhack or you can become a broker and switch people to ACA plans so you can get more commissions.
Kenen: I would think there could be a bipartisan, I mean its hard to get anything done in Congress. Theres no must-pass bills in the immediate future that are relevant. And the idea that a broker is secretly doing something that you dont want them to do and thats costing you money and making them money. I could see, those 90,000 people are from red and blue states and they vote, its going to affect constituents nationwide. Maybe theyll do something. Maybe the industry can also… There is the National Association I forgot the acronym, but theres a brokers organization, that there are probably things that they can also do to sanction. States can also do some things to brokers, but whether theres a national solution or piecemeal, I dont know, but its so outrageous that its not a right-left issue.
Rovner: Yes, one would think that therell be at least some kind of congressional action built into something
Kenen: Something or other, right.
Rovner: … Congress that manages to do before the end of the year. Well, and in one of those seemingly rare cases where legislation actually does what it was intended to do, the White House this week announced that it has approved more than a million claims under the 2022 PACT Act, which made veterans injured as a result of exposure to burn pits and other toxic substances eligible for VA [Veterans Affairs] disability benefits. On the other hand, the VA is still working its way through another 3 million claims that have been submitted. I feel like even if its not very often, sometimes its worth noting that there are bipartisan things from Washington, D.C., that actually get passed and actually help the people that theyre supposed to help. Its kind of sad that this is notable as an exception of something that happened and is working.
Roubein: In sort of the, I guess, Department of Unintended Side Effects here, my colleague Lisa Rein had a really interesting story out this morning that talked about the PACT Act, but basically that despite a federal law that prohibits charging veterans for help in applying for disability benefits, for-profit companies are making millions. She did a review of up to like a hundred unaccredited for-profit companies who have been charging veterans anywhere from like $5,000 to $20,000 for helping file disability claims because
Rovner: Thats the theme of this week. Anyplace that theres a lot of money in health care, there were people who will want to come in and take whats not theirs. Thats where we will leave the news this week. Now we will play my interview with Shefali Luthra, then well come back with our extra credits.
I am so pleased to welcome back to the podcast my former colleague and current What The Health? panelist Shefali Lutha. You havent heard from her in a while because shes been working on her first book, called Undue Burden, thats out this week. Shefali, great to see you.
Luthra: Thank you so much for having me Julie.
Rovner: So as the title suggests, Undue Burden is about the difficulties for both patients and providers in the wake of the overturn of Roe v. Wade. We talk so much about the politics of this issue, and so little about the real people who are affected. Why did you want to take this particular angle?
Luthra: To me, this is what makes this topic so important. Health care and abortion are really critical political issues. They sway elections. They are likely to be very consequential in this coming presidential election. But this matters to us as reporters and to us as people because of the life-or-death stakes and even beyond the life-or-death stakes, the stakes of how you choose to live your life and what it means to be pregnant and to be a parent. These are really difficult stories to tell because of the resources involved. And I wanted to write a book that just got at all of the different reasons why people pursue abortion and why they provide abortion and how thats changed in the past two years. Because it felt to me like one of the few ways we could really understand just how seismic the implications of overturning Roe has been.
Rovner: And unlike those of us who talk to politicians all the time, you were really on the ground talking to patients and doctors, right?
Luthra: That was really, really important to the book. I spent a lot of time traveling the country, in clinics talking to people who were able to get abortions, who were unable to get abortions, and it was just really compelling for me to see how much access to care had the capacity to change their lives.
Rovner: So what kind of barriers then are we talking about that cropped up? And I guess it wasnt even just the wake of the overturn of Roe. In Texas we had sort of a yearlong dry run.
Luthra: Exactly, and the book starts before Roe is overturned in Texas when the state enacted SB 8, the six-week abortion ban that effectively cut off access. And the first main character readers meet is this young girl named Tiffany, and shes a teenager when she becomes pregnant, and she would love to get an abortion. But she is a minor. She lives very far from any abortion provider. She does not know how to self-manage an abortion. She does not know where to find pills. She has no connections into the health care system. She has no independent income. And she absolutely cannot travel anywhere for care. As a result, she has a child before she turns 18. And what this story highlights is that there are just so many barriers to getting an abortion. Many already existed: The incredible cost for procedure not covered by health insurance, the geographic distance, people already had to travel, the extra restrictions on minors.
But the overturning of Roe has amplified these, it is so expensive to get an abortion. It can be difficult to know youre pregnant, especially if you are not trying to become pregnant. You have a very short time window. You may need to find childcare. You may need to find a car, get time off work, and bring all of these different forces together so that you are able to make a journey that can be days and pay for a trip that can cost thousands of dollars.
Rovner: One of the things that I think surprised me was that states that proclaimed themselves abortion havens actually did so little to help their clinics that predictably got swamped by out-of-state patients. Why do you think that was the case, and is it any better now?
Luthra: I think things have certainly changed. We have seen much more action in states, such as Illinois, where we see more people traveling there for care than anywhere else in the country. But it is worth going back to the summer that Roe was overturned. The governor promised to call a special session and put all these resources into making sure that Illinois could be a sanctuary. He never called that special session. And clinics felt like they were hanging out to dry, just waiting to get some support, and in the meanwhile, doing the absolute best they could.
One thing that I think this book really gets at is we are starting to see more efforts from these bluer states, the Illinois, the Californias, the New Yorks, and they talk a lot about wanting to be abortion havens, in part because its great politics if youre a Democrat, but theres only so much you can do. California has seen also quite a large increase in out-of-state patients. But Ive spoken to so many people who just cannot conceivably go to California. They can barely go to Illinois. Making that journey when you are young, if you dont have a lot of money, if you live in South Texas, if you live in Louisiana, its just not really feasible. And the places that are set up as these access points just cant really fill in the gaps that they say they will.
Rovner: As you point out in the book, a lot of this was completely predictable. Was there something in your reporting that actually did surprise you?
Luthra: Thats a great question, and what did surprise me was in part something that weve begun to see borne out in the reporting, is there are very effective telemedicine strategies. We have begun to see physicians living in blue states, the New Yorks, Massachusetts, Californias, prescribing and mailing abortion pills to people in states with bans. This is pretty powerful. It has expanded access to a lot of people. What was really striking to me, though, even as I reported about the experiences of patients seeking care, is that while that has done so much to expand access in the face of abortion bans, it isnt a solution that everyone can use. There were lots of people I met who did not want a medication abortion, who did not feel safe having pills mailed into their homes, or whose pregnancy complications and questions were just too complex to be solved by a virtual consult and then pills being mailed to them to take in the comfort of their house.
Rovner: Arent these difficulties exactly what the anti-abortion movement wanted? Didnt they want clinics so swamped they couldnt serve everybody who wanted to come, and abortion to be so difficult to get that women would end up carrying their pregnancies to term instead?
Luthra: Yes and no, I would argue. I think you are absolutely right that one of the primary goals of the anti-abortion movement was to make abortion unavailable, to make it harder to acquire, to have more people not get abortions and instead have children. But when I speak to folks in the anti-abortion movement, they are very troubled by how many people are traveling out of state to get care. They see those really long wait times in Kansas, in, until recently, Florida, in Illinois, in New Mexico, as a symptom of something that they need to address, which is that so many people are still finding a way to fight incredible odds to access abortion.
Rovner: Is there one thing that you hope people take away after theyre finished reading this?
Luthra: There are two things that I have spent a lot of time thinking about as Ive reported this book. The first is just who gets abortions and under what circumstances. And so often in the national press, in national politics, we talk about these really extreme life-or-death cases. We talk about people who became septic and needed an abortion because their water broke early, or we talk about children who have been sexually assaulted and become pregnant. But we dont talk about most people who get abortions; who are usually mothers, who are usually people of color, who are in their 20s and just know that they cant be pregnant. I think those are really important stories to tell because theyre the true face of who is most affected by this, and it was important to me that this book include that.
The other thing that I have thought about so often in reporting this and writing this is abortion demands have an unequal impact. That is true if you are poor, if you are a person of color, if you live n a rural area, et cetera. You will in all likelihood see a greater effect. That said, the overturning of Roe v. Wade is so tremendous that it has affected people in every state. It affects you if you can get pregnant. It affects you if you want birth control. It affects you if you require reproductive health care in some form. This is just such a seismic change to our health care system that I really hope people who read this book understand that this is not a niche issue. This is something worthy of our collective attention and concern as journalists and as people.
Rovner: Shefali Luthra, thank you so much for this, and we will see you soon on the panel, right?
Luthra: Absolutely. Thank you, Julie. Im so glad we got to do this.
Rovner: OK, we are back. Its time for our extra-credit segment. Thats when we each recommend a story we read this week we think you should read, too. As always, dont worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Joanne, why dont you go first this week?
Kenen: This was a pair of articles, a long one and a shorter, related one. Theres an amazingly wonderful piece in ProPublica by Sharon Lerner, and its called Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe. Im going to come back and talk about it briefly in a second, but the related story was in The Guardian by Damian Carrington: Microplastics Found in Every Human Testicle in Study. Now, that was a small study, but there may be a link to the declining sperm count because of these forever chemicals.
The ProPublica story, it was a young woman scientist. She worked for 3M. They kept telling her her results was wrong, her machinery was dirty, over and over and over again until she questioned herself and her findings. She was supposed to be looking at the blood of 3M workers who were, it turned out, the company knew all this already and they were hiding it, and she compared the blood of the 3M workers to non-3M workers, and she found these plastic chemicals in everybodys blood everywhere, and she was basically gaslit out of her job. She continued to work for 3M, but in a different capacity.
The articles really scary about the impact for human health. It also has wonderfully interesting little nuggets throughout about how various 3M products were developed, some by accident. Something spilled on somebodys sneaker and it didnt stain it, and thats how we got those sprays for our upholstery. Or somebody needed something to find the pages in their church hymnal, and thats how we got Post-it notes. Its a devastating but very readable, and it makes you angry.
Rovner: Yeah, I feel like theres a lot more were going to have to say about forever chemicals going forward. Alice.
Ollstein: So I have a pretty depressing story from Stats. Its called How Doctors Are Pressuring Sickle Cell Patients Into Unwanted Sterilizations, by Eric Boodman. And it is about people with sickle cell, and that is overwhelmingly black women, and they felt pressured to agree to be permanently sterilized when they were going to give birth because of the higher risks. And the doctors said, because were already doing a C-section and were already doing surgery on you, to not have to do an additional surgery with additional risks, they felt pressured to just sign that they could be sterilized right then and there and came to regret it later and really wanted more children. And so, this is an instance of people feeling coerced, and when people think about pro-choice or the choice debate about reproduction they mostly think about the right to an abortion. But I think that the right to have more children, if you want to, is the other side of that coin.
Rovner: It is. Rachel.
Roubein: My extra credit, its called What Science Tells Us About Biden, Trump and Evaluating an Aging Brain, by Joel Achenbach and Mark Johnson from The Washington Post. And basically, they kind of took a very science-based look at the 2024 election. They basically called it a crash course in gerontology because former President Donald Trump will be 78 years old. President Biden will be a couple weeks away from turning 82. And obviously that is getting a lot of attention on the campaign trail. They talked to medical and scientific experts who were essentially warning that news reports, political punditry about the candidates mental fitness, has essentially been marred by misinformation here about the aging process. One of the things they dived into was these gaffes or what the public sees as senior moments and what experts had told them is, thats not necessarily a sign of dementia or predictive of cognitive decline. There need to be kind of further clinical evaluation for that. But there have been some calls for just how to kind of standardize and require a certain level of transparency for candidates in terms of disclosing their health information.
Rovner: Yes, which weve been talking about for a while, and will continue to. My extra credit this week is from our guest, Shefali Luthra, and her colleague at The 19th Chabeli Carrazana, and its called What Happens to Clinics After a State Bans Abortion? They Fight To Survive. And for all the talk about doctors and other staffers either moving out of or not moving into states with abortion bans, I think less has been written about entire enterprises that often provide far more than just abortion services having to shut down as well. We saw this in Texas in the mid-2010s, when a law that shut down many of the clinics there was struck down by the Supreme Court in 2016. But many of those clinics were unable to reopen. They just could not reassemble, basically, their leases and equipment and staff. The same could well happen in states that this November vote to reverse some of those bans. And its not just abortion, as weve discussed. When these clinics close, it often means less family planning, less STI [sexually transmitted infection] screening and other preventive services as well, so its definitely something to continue to watch.
Before we go this week, I want to note the passing of a health policy journalism giant with the death of Marshall Allen. Marshall, who worked tirelessly, first in Las Vegas and more recently at ProPublica, to expose some of the most unfair and infuriating parts of the U.S. health care system, was on the podcast in 2021 to talk about his book, Never Pay the First Bill, and Other Ways to Fight the Health Care System and Win. I will post a link to the interview in this weeks show notes. Condolences to Marshalls friends and family.
OK, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. Wed 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. Were at whatthehealth@kff.org, or you can still find me at X, @jrovner. Joanne, where are you?
Kenen: Were at Threads @JoanneKenen.
Rovner: Alice.
Ollstein: Still on X @AliceOllstein.
Rovner: Rachel.
Roubein: On X, @rachel_roubein.
Rovner: We will be back in your feed next week. Until then, be healthy. Credits Francis Ying Audio producer Emmarie Huetteman Editor
To hear all our podcasts, click here.
And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts. Related Topics Aging Courts Elections Insurance Medicaid Medicare Multimedia Public Heath States Abortion Contraception Kansas KFF Health News' 'What The Health?' Louisiana Podcasts Pregnancy Reproductive Health Texas Women's Health Contact Us Submit a Story Tip
