The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.
The 2024 marketing campaign — notably the one for president — has been notably imprecise on coverage. However well being points, particularly these surrounding abortion and different reproductive well being care, have nonetheless performed a key position. And whereas the Reasonably priced Care Act has not been the main focus of debate the best way it was over the earlier three presidential campaigns, who turns into the following president may have a significant influence on the destiny of the 2010 well being legislation.
The panelists for this week’s particular election preview, taped earlier than a dwell viewers at KFF’s workplaces in Washington, are Julie Rovner of KFF Well being Information, Tamara Keith of NPR, Alice Miranda Ollstein of Politico, and Cynthia Cox and Ashley Kirzinger of KFF.
Panelists
Ashley Kirzinger
KFF
Cynthia Cox
KFF
Alice Miranda Ollstein
Politico
Tamara Keith
NPR
Learn and take heed to Tamara’s tales.
Among the many takeaways from this week’s episode:
- As Election Day nears, who will emerge victorious from the presidential race is anybody’s guess. Enthusiasm amongst Democratic ladies has grown with the elevation of Vice President Kamala Harris to the highest of the ticket, with extra saying they’re prone to prove to vote. However broadly, polling reveals a margin-of-error race — too near name.
- A number of states have abortion measures on the poll. Proponents of abortion rights are striving to border the problem as nonpartisan, acknowledging that current measures have handed thanks partly to Republican help. For some voters, resisting authorities management of ladies’s well being is a conservative worth. Many are prepared to separate their votes, supporting each an abortion rights measure and in addition candidates who oppose abortion rights.
- Whereas coverage debates have been noticeably missing from this presidential election, the way forward for Medicaid and the Reasonably priced Care Act hinges on its consequence. Republicans need to undermine the federal funding behind Medicaid enlargement, and former President Donald Trump has a document of opposition to the ACA. Probably on the chopping block are the federal subsidies expiring subsequent yr which have reworked the ACA by boosting enrollment and decreasing premium prices.
- And as misinformation and disinformation proliferate, one space of concern is the “malleable center”: people who find themselves unsure of whom or what to belief and subsequently particularly prone to deceptive or downright false data. Might a second Trump administration embed misinformation in federal coverage? The push to melt and even eradicate college vaccination mandates reveals the general public well being penalties of falsehood creep.
Additionally talked about on this week’s podcast:
click on to open the transcript
Transcript: LIVE From KFF: Well being Care and the 2024 Election
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Emmarie Huetteman: Please put your fingers collectively and be part of me in welcoming our panel and our host, Julie Rovner.
Julie Rovner: Howdy, good morning, and welcome again to “What the Well being?” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by among the perfect and smartest well being reporters in Washington, together with some very particular visitors in the present day. We’re taping this particular election episode on Thursday, October seventeenth, at 11:30 a.m., in entrance of a dwell viewers on the Barbara Jordan Convention Middle right here at KFF in downtown D.C. Say hello, viewers.
As at all times, information occurs quick and issues might need modified by the point you hear this. So, right here we go.
So I’m tremendous fortunate to work at and have labored at some fairly nice locations and with some fairly nice, sensible individuals. And once I began to consider who I wished to assist us break down what this yr’s elections may imply for well being coverage, it was fairly simple to assemble an all-star forged. So first, my former colleague from NPR, senior White Home correspondent Tamara Keith. Tam, thanks for becoming a member of us.
Tamara Keith: Thanks for having me.
Rovner: Subsequent, our common “What the Well being?” podcast panelist and my proper hand all yr on reproductive well being points, Alice Ollstein of Politico.
Alice Miranda Ollstein: Hello Julie.
Rovner: Lastly, two of my unbelievable KFF colleagues. Cynthia Cox is a KFF vice chairman and director of this system on the ACA [Affordable Care Act] and one of many nation’s very high specialists on what we all know as Obamacare. Thanks, Cynthia.
Cynthia Cox: Nice to be right here.
Rovner: And at last, Ashley Kirzinger is director of survey methodology and affiliate director of our KFF Public Opinion and Survey Analysis Program, and my favourite explainer of all issues polling.
Ashley Kirzinger: Thanks for having me.
Rovner: So, welcome to all of you. Thanks once more for being right here. We’re going to talk amongst ourselves for a half hour or so, after which we’ll open the ground to questions. So be prepared right here within the room. Tam, I need to begin with the large image. What’s the state of the race as of October seventeenth, each for president and for Congress?
Keith: Effectively, let’s begin with the race for President. That’s what I cowl most carefully. That is what you’ll name a margin-of-error race, and it has been a margin-of-error race just about the complete time, regardless of some actually dramatic occasions, like an entire new candidate and two assassination makes an attempt and issues that we don’t anticipate to see in our lifetimes and but they’ve occurred. And but it’s an extremely shut race. What I’d say is that at this actual second, there appears to have been a slight shift within the common of polls within the route of former President [Donald] Trump. He’s in a barely higher place than he was earlier than and is in a considerably extra comfy place than Vice President [Kamala] Harris.
She has been operating as an underdog the entire time, although there was a time the place she didn’t really feel like an underdog, and proper now she can also be operating like an underdog and the vibes have shifted, if you’ll. There’s been a extra dramatic shift within the vibes than there was within the polls. And the factor that we don’t know and we gained’t know till Election Day is in 2016 and 2020, the polls underestimated Trump’s help. So at this second, Harris seems to be to be in a weaker place in opposition to Trump than both [Hillary] Clinton or [Joe] Biden . It seems that the polls have been underestimating Trump each of these years. However in 2022 after the Dobbs choice, the polls overestimated Republican help and underestimated Democratic help.
So what’s taking place now? We don’t know. So there you go. That’s my overview, I believe, of the presidential race. The campaigning has actually intensified within the final week or so, like actually intensified, and it’s solely going to get extra intense. I believe Harris has gotten a bit darker in her language and descriptions. The joyful warrior has been changed considerably by the particular person warning of dire penalties for democracy. And by way of the Home and the Senate, which can matter quite a bit, quite a bit quite a bit, whether or not Trump wins or Harris wins, if Harris wins and Democrats lose the Senate, Harris might not even be capable of get Cupboard members confirmed.
So it issues quite a bit, and the traditional knowledge — which is as helpful as it’s and typically shouldn’t be all that helpful — the traditional knowledge is that one thing form of uncommon might occur, which is that the Home might flip to Democrats and the Senate might flip to Republicans, and often these items don’t transfer in reverse instructions in the identical yr.
Rovner: And often the presidential candidate has coattails, however we’re probably not seeing that both, are we?
Keith: Proper. Actually, it’s the reverse. A number of of the Senate candidates in key swing states, the Democratic candidates are polling a lot better than the Republican candidates in these races and polling with larger energy than Harris has in these states. Is that this a polling error, or is that this the return of split-ticket voting? I don’t know.
Rovner: Effectively, leads us to our polling skilled. Ashley, what are the most recent polls telling us, and what ought to we take into accout in regards to the limitations of polling? I really feel like yearly individuals rely quite a bit on the polls and yearly we are saying, Don’t rely an excessive amount of on the polls.
Kirzinger: Effectively, can I simply steal Tamara’s line and say I don’t know? So in actually shut elections, when turnout goes to matter quite a bit, what the polls are actually good at is telling us what’s motivating voters to prove and why. And so what the polls have been telling us for some time is that the economic system is high of thoughts for voters. Now, well being care prices — we’re at KFF. So well being care performs an enormous position in how individuals take into consideration the economic system, in actually two massive methods. The primary is sudden prices. So sudden medical payments, well being care prices, are topping the listing of the general public’s monetary worries, issues that they’re anxious about, what may occur to them or their relations. And laying aside care. What we’re seeing is a few quarter of the general public nowadays are laying aside care as a result of they are saying they will’t afford the price of getting that wanted care.
So that basically reveals the best way that the monetary burdens are enjoying closely on the voters. What we’ve seen in current polling is Harris is doing higher on the family bills than Biden did and is best than the Democratic Get together largely. And that’s actually necessary, particularly amongst Black ladies and Latina voters. We’re seeing some motion amongst these two teams of the voters saying that Harris is doing a greater job and so they belief her extra on these points. However traditionally, if the election is in regards to the economic system, Republican candidates do higher. The social gathering does higher on financial points among the many voters.
What we haven’t talked about but is abortion, and that is the primary presidential election since post-Dobbs, within the post-Dobbs period, and we don’t know the way abortion coverage will play in a presidential election. It hasn’t occurred earlier than, in order that’s one thing that we’re additionally keeping track of. We all know that Harris is campaigning round reproductive rights, is working amongst a key group of the voters, particularly youthful ladies voters. She is seen as a real candidate who can discuss these points and an advocate for reproductive rights. We’re seeing abortion rise in significance as a voting difficulty amongst younger ladies voters, and she or he’s seen as extra genuine on this difficulty than Biden was.
Rovner: Speak about final week’s ballot about younger ladies voters.
Kirzinger: Yeah, one of many nice issues that we are able to do in polling is, after we see massive modifications within the marketing campaign, is we are able to return to our polls and respondents and ask how issues have modified to them. So we labored on a ballot of ladies voters again in June. Heaps have modified since June, so we went again to them in September to see how issues have been altering for this one group, proper? So we went again to the identical individuals and we noticed elevated motivation to prove, particularly amongst Democratic ladies. Republican ladies have been about the identical degree of motivation. They’re extra enthusiastic and happy about their candidate, and so they’re extra prone to say abortion is a significant motive why they’re going to be turning out. However we nonetheless don’t know the way that may play throughout the voters in all of the states.
As a result of for many voters, a candidate’s stance on abortion coverage is only one of many elements that they’re weighing relating to turnout. And so these are one of many issues that we’re as effectively. I’ll say that I’m not a forecaster, thank goodness. I’m a pollster, and polls usually are not good at forecasts, proper? So polls are excellent at giving a snapshot of the voters at a second in time. So two weeks out, that’s what I do know from the polls. What’s going to occur within the subsequent two weeks, I’m unsure.
Rovner: Effectively, Alice, simply to select up on that, abortion, reproductive well being writ giant are by far the most important well being points on this marketing campaign. What influence is it having on the presidential race and the congressional races and the poll points? It’s all form of a muddle, isn’t it?
Ollstein: Yeah, effectively, I simply actually need to stress what Ashley mentioned about this being uncharted territory. So we are able to collect some clues from the previous few years the place we’ve seen these abortion rights poll measures win decisively in very purple states, in very blue states, in very purple states. However presidential election years simply have a distinct voters. And so, sure, it did encourage extra individuals to prove in these midterm and off-year elections, however that’s simply not the identical group of parents and it’s not the identical teams the candidates want this time, essentially. And likewise we all know that each time abortion has been on the poll, it has gained, however the influence and the way that spills over into partisan races has been an actual blended bag.
So we noticed in Michigan in 2022, it actually helped Democrats. It helped Governor Gretchen Whitmer. It helped Michigan Democrats take again management of the Statehouse for the primary time in many years. However that didn’t work for Democrats in all states. My colleagues and I did an evaluation of a bunch of various states that had these poll measures, and these poll measures largely succeeded due to Republican voters who voted for the poll initiative and voted for Republican candidates. And that may appear contradictory. You’re voting for an abortion rights measure, and also you’re voting for very anti-abortion candidates. We noticed that in Kentucky, for instance, the place lots of people voted for (Sen.) Rand Paul, who may be very anti-abortion, and for the abortion rights aspect of the poll measure.
I’ve been on the street the previous few months, and I believe you’re going to see plenty of that once more. I simply obtained again from Arizona, and lots of people are planning to vote for the abortion rights measure there and for candidates who’ve a document of opposing abortion rights. A part of that’s Donald Trump’s considerably current line of: I gained’t do any form of nationwide ban. I’ll depart it to the states. Lots of people are believing that, though Democrats are like: Don’t imagine him. It’s not true. But additionally, like Ashley mentioned, of us are simply prioritizing different points. And so, sure, while you take a look at sure slices of the voters, like younger ladies, abortion is a high motivating difficulty. However while you take a look at the complete voters, it’s, like, a distant fourth after the economic system and immigration and a number of other different issues.
I discovered the KFF polling actually illuminating in that, sure, most individuals mentioned that abortion is both simply one in all many elements in deciding their vote on the candidates or not an element in any respect. And most of the people mentioned that they might be prepared to vote for a candidate who doesn’t share their views on abortion. So I believe that’s actually key right here. And these abortion rights poll measures, the campaigns behind them are being actually deliberate about remaining utterly nonpartisan. They should attraction to Republicans, Democrats, independents with a purpose to move, however that additionally … So their motivation is to attraction to everybody. Democrats’ motivation is to say: It’s important to vote for us, too. Abortion rights gained’t be protected should you simply move the poll measure. You additionally must vote for Democrats up and down the poll. As a result of, they argue, Trump might pursue a nationwide ban that might override the state protections.
Rovner: We’ve seen previously — and that is for each of you — poll measures as a part of partisan methods. Within the early 2000s, there have been anti-gay-marriage poll measures that have been meant to drag out Republicans, that have been meant to drive turnout. That’s not precisely what’s taking place this time, is it?
Keith: So I used to be a reporter within the nice state of Ohio in 2004, and there was an anti-gay-rights poll measure on the poll there, and it was a key a part of George W. Bush’s reelection plan. And it labored. He gained the state considerably narrowly. We didn’t get the outcomes till 5 a.m. the following day, however that’s higher than we’ll possible have this time. And that was a essential a part of driving Republican turnout. It’s outstanding how a lot has modified since then by way of public views. It wouldn’t work in the identical approach this time.
The fascinating factor in Arizona, as an example, is that there’s additionally an anti-immigration poll measure that’s additionally polling rather well that was added by the legislature in kind of a rush to attempt to offset the anticipated Democratic-based turnout due to the abortion measure. However as you say, it’s totally potential that there might be plenty of Trump abortion, immigration and [House Democrat and Senate candidate] Ruben Gallego voters.
Ollstein: Completely. And I met a few of these voters, and one girl instructed me, look, she will get offended when individuals assume that she’s liberal as a result of she recognized as pro-choice. We don’t use that terminology in our reporting, however she recognized as pro-choice, and she or he was saying: Look, to me, it is a very conservative worth. I don’t need the federal government in my private enterprise. I imagine in privateness. And so for her, that doesn’t translate over into, And subsequently I’m a Democrat.
Rovner: I lined two abortion-related poll measures in South Dakota that have been two years, I believe it was 2006 and 2008.
Ollstein: They’ve one other one this yr.
Rovner: Proper. There’s one other one this yr. However what was fascinating, what I found in 2006 and 2008 is precisely what you have been saying, that there’s a libertarian streak, notably within the West, of people that vote Republican however who don’t imagine that the federal government has any kind of enterprise in your private life, not simply on abortion however on any variety of different issues, together with weapons. So that is a kind of points the place there’s kind of plenty of distinction. Cynthia, that is the primary time in nevertheless many elections the Reasonably priced Care Act has not been an enormous difficulty, however there’s an terrible lot at stake for this legislation, relying on who will get elected, proper?
Cox: Yeah, that’s proper. I imply, it’s the primary time in current reminiscence that well being care basically, except for abortion, hasn’t actually been the principle subject of dialog within the race. And a part of that’s that the Reasonably priced Care Act has actually reworked the American well being care system during the last decade or so. The uninsured fee is at a document low, and the ACA marketplaces, which had been actually struggling 10 years in the past, have began to not simply survive however thrive. Perhaps additionally much less to dislike in regards to the ACA, however it’s additionally not as a lot a coverage election as earlier elections had been. However sure, the way forward for the ACA nonetheless hinges on this election.
So beginning with President Trump, I believe as anybody who follows well being coverage is aware of, and even politics or simply turned on the TV in 2016 is aware of that Trump has a really, very clear historical past of opposing the Reasonably priced Care Act, or Obamacare. He supported a lot of efforts in Congress to attempt to repeal and substitute the Reasonably priced Care Act. And when these weren’t profitable, he took a lot of regulatory steps, joined authorized challenges, and proposed in his budgets to slash funding for the Reasonably priced Care Act and for Medicaid. However now in 2024, it’s a bit bit much less clear precisely the place he’s going.
I’d say earlier within the 2024 presidential cycle, he made some very clear feedback about saying Obamacare sucks, for instance, or that Republicans ought to by no means hand over on attempting to repeal and substitute the ACA, that the failure to take action when he was president was a low level for the social gathering. However then he additionally has appeared to form of stroll that again a bit bit. Now he’s saying that he would substitute the ACA with one thing higher or that he would make the ACA itself a lot, a lot better or make it price much less, however he’s not offering specifics. After all, within the debate, he famously mentioned that he had “ideas” of a plan, however there’s no … Nothing actually particular has materialized.
Rovner: We haven’t seen any of these ideas.
Cox: Sure, the idea is … However we are able to take a look at his document. And so we do know that he has a really, very clear document of opposing the ACA and actually taking any steps he might when he was president to attempt to, if not repeal and substitute it, then considerably weaken it or roll it again. Harris, against this, is in favor of the Reasonably priced Care Act. When she was a main candidate in 2020, she had expressed help for more-progressive reforms like “Medicare for All” or “Medicare for Extra.” However since turning into vice chairman, particularly now because the presidential candidate, she’s taken a extra incremental strategy.
She’s speaking about constructing upon the Reasonably priced Care Act. Specifically, a key side of her document and Biden’s is these enhanced subsidies that exist within the Reasonably priced Care Act marketplaces. They have been first, I believe … They actually carefully mirror what Biden had run on as president in 2019, 2020, however they have been handed as a part of covid aid. So that they have been momentary, then they have been prolonged as a part of the Inflation Discount Act however, once more, briefly. And they also’re set to run out subsequent yr, which is establishing a political showdown of kinds for Republicans and Democrats on the Hill about whether or not or to not lengthen them. And Harris wish to make these subsidies everlasting as a result of they’ve been chargeable for actually remodeling the ACA marketplaces.
The variety of individuals signing up for protection has doubled since Biden took workplace. Premium funds have been reduce virtually in half. And so that is, I believe, a key a part of, now, her document, but in addition what she desires to see go ahead. However it’s going to be an uphill battle, I believe, to increase them.
Rovner: Cynthia, to kind of construct on that a bit bit, as we talked about earlier, a Democratic president gained’t be capable of get quite a bit achieved with a Republican Home and/or Senate and a Republican president gained’t be capable of get that a lot completed with a Democratic Home and/or Senate. What are among the issues we would anticipate to see if both aspect wins a trifecta management of the chief department and each homes of Congress?
Cox: So I believe, there … So I suppose I’ll begin with Republicans. So if there’s a trifecta, the important thing factor there to bear in mind is whereas there is probably not plenty of urge for food in Congress to attempt to repeal and substitute the ACA, since that wasn’t actually a profitable difficulty in 2017, and since then public help for the ACA has grown. And I believe additionally it’s value noting that the person mandate penalty being decreased to $0. So primarily there’s no particular person mandate anymore. There’s much less to hate in regards to the legislation.
Rovner: All of the pay-fors are gone, too.
Cox: Yeah the pay-fors are gone, too.
Rovner: So the lobbyists have much less to hate.
Cox: Sure, that too. And so I don’t assume there’s a ton of urge for food for this, though Trump has been saying, nonetheless, some unfavourable feedback in regards to the ACA. That being mentioned, if Republicans need to move tax cuts, then they should discover financial savings someplace. And in order that might be any variety of locations, however I believe it’s possible that sure well being packages and different packages are off-limits. So Medicare most likely wouldn’t be touched, possibly Social Safety, protection, however that leaves Medicaid and the ACA subsidies.
And so in the event that they want financial savings with a purpose to move tax cuts, then I do assume specifically Medicaid is in danger, not simply rolling again the ACA’s Medicaid enlargement but in addition possible block-granting this system or implementing per capita caps or another type of actually proscribing the quantity of federal {dollars} which are going in the direction of Medicaid.
Rovner: And that is form of the place we get into the Mission 2025 that we’ve talked about quite a bit on the podcast over the course of this yr, that, in fact, Donald Trump has disavowed. However apparently [Senate Republican and vice presidential candidate] JD Vance has not, as a result of he retains mentioning items of it.
Ollstein: And so they’re solely … They’re simply one in all a number of teams which have pitched deep cuts to well being security web packages, together with Medicaid. You even have the Paragon group, the place plenty of former Trump officers are placing ahead well being coverage pitches and a number of other others. And so I additionally assume given the uncertainty a few trifecta, it’s additionally value retaining in thoughts what they may do by means of waivers and government actions by way of work necessities.
Rovner: That was my subsequent query. I’ve had hassle explaining this. I’ve completed a bunch of interviews within the final couple of weeks to clarify how far more energy Donald Trump would have, if he was reelected, to do issues through the chief department than a President Harris would have. So I’ve not provide you with a great way to clarify that. Please, one in all you give it a shot.
Keith: Another person.
Rovner: Why is it that President Trump might most likely do much more together with his government energy than a President Harris might do with hers?
Cox: I believe we are able to look again at the previous few years and simply see. What did Trump do together with his government energy? What did Biden do together with his government energy? And so far as the Reasonably priced Care Act is anxious or Medicaid. However Trump, after the failure to repeal and substitute the ACA, took a lot of regulatory steps. For instance, attempting to increase short-term plans, which aren’t ACA-compliant, and subsequently can discriminate in opposition to individuals with preexisting circumstances, or slicing funding for sure issues within the ACA, together with outreach and enrollment help.
And so I believe there have been a quantity — and in addition we’ve talked about Medicaid work necessities within the type of state waivers. And plenty of what Biden did, regulatory actions, have been simply rolling that again, altering that, however it’s arduous to increase protection or to supply a brand new program with out Congress performing to authorize that spending.
Kirzinger: I believe it’s additionally actually necessary to consider the general public’s view of the ACA at this cut-off date. I imply, what the polls aren’t blended about is that the ACA has greater favorability than Harris, Biden, Trump, any politician, proper? So we’ve about two-thirds of the general public.
Rovner: So Nancy Pelosi was proper.
Kirzinger: I gained’t go that far, however about two-thirds of the general public’s now view the legislation favorably, and the provisions are much more standard. So whereas, sure, a Republican trifecta may have plenty of energy, the general public — they’re going to have a tough time rolling again protections for individuals with preexisting circumstances, which have bipartisan help. They’re going to have a tough time making it now not out there for grownup youngsters below the age of 26 to be on their mother and father’ medical health insurance. All of these parts of the ACA are actually standard, and as soon as individuals are given protections, it’s actually arduous to take them away.
Cox: Though I’d say that there are a minimum of 10 methods the ACA protects individuals with preexisting circumstances. I believe on the floor it’s simple to say that you’d shield individuals with preexisting circumstances should you say {that a} well being insurer has to supply protection to somebody with a preexisting situation. However there’s all these different ways in which they are saying additionally protects preexisting circumstances, and it makes protection extra complete, which makes protection dearer.
And in order that’s why the subsidies there are key to make complete protection that protects individuals with preexisting circumstances reasonably priced to people. However should you take these subsidies away, then that protection is out of attain for most individuals.
Rovner: That’s additionally what JD Vance was speaking about with altering danger swimming pools. I imply, which most individuals, it makes your eyes glaze over, however that might be tremendous necessary to the affordability of insurance coverage, proper?
Cox: And his remark about danger swimming pools is — I believe lots of people have been attempting to learn one thing into that as a result of it was fairly imprecise. However what lots of people did take into consideration when he made that remark was that earlier than the Reasonably priced Care Act, it was once that should you have been declined medical health insurance protection, particularly by a number of insurance coverage corporations, should you have been principally uninsurable, then you can apply to what existed in lots of states was a high-risk pool.
However the issue was that these high-risk swimming pools have been persistently underfunded. And in most of these high-risk swimming pools, there have been even ready intervals or exclusions on protection for preexisting circumstances or very excessive premiums or deductibles. So though these have been theoretically an possibility for protection for individuals with preexisting circumstances earlier than the ACA, the shortage of funding or help made it such that that protection didn’t work very effectively for individuals who have been sick.
Ollstein: And one thing conservatives actually need to do in the event that they acquire energy is go after the Medicaid enlargement. They’ve kind of arrange this dichotomy of kind of the deserving and undeserving. They don’t say it in these phrases, however they argue that childless adults who’re able-bodied don’t want this security web the best way, quote-unquote, “conventional” Medicaid enrollees do. And they also need to go after that a part of this system by decreasing the federal match. That’s one thing I’d be careful for. I don’t know in the event that they’ll be capable of try this. That may require Congress, but in addition a number of states have of their legal guidelines that if the federal matches decreased, they might robotically unexpand, and that might imply protection losses for lots of people. That may be very politically unpopular.
It’s value retaining in thoughts that plenty of states, primarily purple states, have expanded Medicaid since Republicans final tried to go after the Reasonably priced Care Act in 2017. And so there’s simply much more buy-in now. So it will be politically more difficult to try this. And it was already very politically difficult. They weren’t in a position to do it again then.
Rovner: So I really feel like one of many causes that Trump may be capable of get extra completed than Harris simply utilizing government authority is the make-up of the judiciary, which has been very conservative, notably on the Supreme Court docket, and we even have some breaking information on this yesterday. Three of the states who intervened in what was initially a Texas lawsuit attempting to revoke the FDA’s [Federal Drug Administration’s] approval of the abortion capsule mifepristone, formally revived that lawsuit, which the Supreme Court docket had dismissed as a result of the medical doctors who filed it initially didn’t have standing, in line with the Supreme Court docket.
The states need the courts to invoke the Comstock Act, an 1873 anti-vice legislation banning the mailing and receiving of, amongst different issues, something utilized in an abortion, to successfully ban the drug. That is a kind of ways in which Trump wouldn’t even must raise a finger to result in an abortion ban, proper? I imply, he’d simply must let it occur.
Ollstein: Proper. I believe a lot of this election cycle has been dominated by, Would you signal a ban? And that’s simply the improper query. I imply, we’ve seen Congress unable to move both abortion restrictions or abortion protections even when one social gathering controls each chambers. It’s simply actually arduous.
Rovner: And going again 60 years.
Ollstein: And so I believe it’s far more necessary to have a look at what might occur administratively or by means of the courts. And so sure, lawsuits like that, that the Supreme Court docket punted on however didn’t completely resolve this time period, might completely come again. A Trump administration might additionally direct the FDA to simply unauthorize abortion capsules, that are the vast majority of abortions that happen throughout the U.S.
And so — or there’s this Comstock Act route. There’s — the Biden administration put out a memo saying, We don’t assume the Comstock Act applies to the mailing of abortion capsules to sufferers. A Trump administration might put out their very own memo and say, We imagine the alternative. So there’s quite a bit that might occur. And so I actually have been pissed off. The entire obsessive concentrate on: Would you signal a ban? Would you veto a ban? As a result of that’s the least possible route that this might occur.
Kirzinger: Effectively, and all of those courtroom instances create an air of confusion among the many public, proper? And so, that can also have an impact in a approach that signing a ban — I imply, if individuals don’t know what’s out there to them of their state primarily based on state coverage or nationwide coverage.
Ollstein: Or they’re afraid of getting arrested.
Kirzinger: Yeah, even when it’s utterly authorized of their state, we’re discovering that individuals aren’t conscious of whether or not — what’s out there to them of their state, what they will entry legally or not. And so having these courtroom instances pending creates this air of confusion among the many public.
Keith: Effectively, simply to amplify the air of confusion, speaking to Democrats who watch focus teams, they noticed plenty of voters blaming President Biden for the Dobbs choice and saying: Effectively, why couldn’t he repair that? He’s president. At a a lot greater degree, there may be confusion about how our legal guidelines work. There’s plenty of confusion about civics, and consequently, you see blame touchdown in kind of sudden locations.
Rovner: That is the vaguest presidential election I’ve ever lined. I’ve been doing this since 1988. We principally have each candidates refusing to reply particular questions — as a method, I imply, it’s not that I don’t assume — I believe they each would have a reasonably good thought of what it’s they might do, and each of them discover it to their political benefit to not say.
Keith: I believe that’s completely proper. I believe that the Harris marketing campaign, which I spend extra time overlaying, has the view that if Trump shouldn’t be going to reply questions instantly and he’s going to speak about “ideas” of a plan, and he’s simply going to kind of, like, Effectively, if I used to be president, this wouldn’t be an issue, so I’m not going to reply your query — which is his reply to virtually each query — then there’s not plenty of upside for them to get into nice specifics about coverage and to have assume tank nerds telling them it gained’t work, as a result of there’s no upside to it.
Cox: We’re proper right here.
Panel: [Laughing]
Rovner: So common listeners to the podcast will know that one in all my largest private frustrations with this marketing campaign is the ever-increasing quantity of mis- and outright disinformation within the well being care realm, as we mentioned at some size on final week’s podcast. You’ll be able to return and pay attention. This has turn out to be firmly established in public well being, clearly pushed alongside by the divide over the covid pandemic. The New York Occasions final week had a fairly scary story by Sheryl Homosexual Stolberg — who’s engaged on a e book about public well being — about how a few of these extra fringe beliefs are getting embedded within the mainstream of the Republican Get together.
It was once that we noticed most of those form of fringe, anti-science, anti-health beliefs have been on the far proper and on the far left, and that’s much less the case. What might we be wanting ahead to on the general public well being entrance if Trump is returned to energy, notably with the assistance of anti-vaccine activist and now Trump endorser R.F.Okay. [Robert F. Kennedy] Jr.?
Kirzinger: Oh, goodness to me. Effectively, so I’m going to speak a few group that I believe is basically necessary for us to concentrate on after we take into consideration misinformation, and I name them the “malleable center.” So it’s that group that after they hear misinformation or disinformation, they’re uncertain of whether or not that’s true or false, proper? So that they’re caught on this uncertainty of what to imagine and who do they belief to get the fitting data. It was once pre-pandemic that they might belief their authorities officers.
We’ve got seen declining belief in CDC [Centers for Disease Control and Prevention], all ranges of public well being officers. Who they nonetheless belief is their main care suppliers. Sadly, the teams which are most prone to misinformation are additionally the teams which are much less prone to have a main care supplier. So we’re not in an awesome situation, the place we’ve a gaggle that’s uncertain of who to belief on data and doesn’t have somebody to go to for good sources of knowledge. I don’t have an answer.
Cox: I additionally don’t have an answer.
Rovner: No, I wasn’t — the query isn’t a few answer. The query is about, what can we anticipate? I imply, we’ve seen the kind of mis- and disinformation. Are we going to really see it embedded in coverage? I imply, we’ve principally not, aside from covid, which clearly now we see the large distinction in some states the place masks bans are banned and vaccine mandates are banned. Are we going to see childhood vaccines made voluntary for college?
Ollstein: Effectively, there’s already a motion to massively broaden who can apply for an exception to these, and that’s already had some scary public well being penalties. I imply, I believe there are individuals who would completely push for that.
Kirzinger: I believe no matter who wins the presidency, I believe that the misinformation and disinformation goes to have an rising position. Whether or not it makes it into coverage will rely upon who’s in workplace and Congress and all of that. However I believe that it’s not one thing that’s going away, and I believe we’re simply going to proceed to must battle it. And that’s the place I’m probably the most nervous.
Keith: And while you discuss in regards to the belief for the media, these of us who’re sitting right here attempting to get the reality on the market, or to fact-check and debunk, belief for us is, like, within the basement, and it simply retains getting worse yr after yr after yr. And the most recent Gallup numbers have us worse than we have been earlier than, which is simply, like, one other establishment that individuals are not turning to. We’re in an period the place some rando on YouTube who mentioned they did their analysis is extra trusted than what we publish.
Rovner: And a few of these randos on YouTube have thousands and thousands of viewers, listeners.
Keith: Sure, completely.
Rovner: Subscribers, no matter you need to name them.
Ollstein: One space the place I’ve actually seen this come ahead, and it might positively turn out to be a part of coverage sooner or later, is there’s simply plenty of mis- and disinformation round transgender well being care. There’s polling that present lots of people imagine what Trump and others have been saying, that, Oh, youngsters can come dwelling from college and have a intercourse change operation. Which is clearly ridiculous. Everybody who has youngsters at school is aware of that they will’t even give them a Tylenol with out parental permission. And it clearly doesn’t occur in a day, however individuals are like, Oh, effectively, I do know it’s not taking place at my college, however it’s certain taking place someplace. And that’s actually resonating, and we’re already seeing plenty of authorized restrictions on that entrance spilling.
Rovner: All proper, effectively, I’m going to open it as much as the viewers. Please wait to ask your query till you will have a microphone, so the individuals who will likely be listening to the podcast will be capable of hear your query. And please inform us who you’re, and please make your query or query.
Madeline: Hello, I’m Madeline. I’m a grad pupil on the Milken Institute of Public Well being at George Washington. My query is relating to polling. And I used to be simply questioning, how has polling methodologies or tendencies to over-sample conservatives had on polls within the race? Are you seeing that as a problem or …?
Kirzinger: OK. You understand who’s much less trusted than the media? It’s pollsters, however you may belief me. So I believe what you’re seeing is there at the moment are extra polls than there have ever been, and I need to discuss authentic scientific polls which are probability-based. They’re not letting individuals decide into taking the survey, and so they’re ensuring their samples are consultant of the complete inhabitants that they’re surveying, whether or not it’s the voters or the American public, relying on that.
I believe what we’ve seen is that there have been some tendencies when individuals don’t just like the ballot outcomes, they take a look at the make-up of that pattern and say, oh, this ballot’s too Democratic, or too conservative, has too many Trump voters. Or no matter it might be. That advantages no pollster to make their pattern not appear like the inhabitants that they’re aiming to characterize. And so, sure, there are many actually, actually unhealthy polls on the market, however the ones which are authentic and scientific are nonetheless striving to intention to guarantee that it’s consultant. The issue with election polls is we don’t know who the voters’s going to be. We don’t know if Democrats are going to prove greater than Republicans. We don’t know if we’re going to see greater shares of rural voters than we noticed in 2022.
We don’t know. And in order that’s the place you actually see the shifts in error occur.
Keith: And if former President Trump’s — an enormous a part of his technique is popping out unlikely voters.
Kirzinger: Yeah. We don’t know who they’re.
Rovner: Effectively, yeah, we noticed in Georgia, their first day of in-person early voting, we had this big upswell of voters, however we don’t know who any of these are, proper? I imply, we don’t know what’s essentially turning them out.
Kirzinger: Precisely. And traditionally, Democrats have been extra prone to vote early and vote by mail, however that has actually shifted for the reason that pandemic. And so that you see these day voting totals now, however that basically doesn’t let you know something at this level within the race.
Rovner: Heaps we nonetheless don’t know. One other query.
Rae Woods: Hello there. Rae Woods. I’m with Advisory Board, which implies that I work with well being leaders who have to implement primarily based on the insurance policies and the politics and the outcomes of the election that’s arising. My query is, exterior among the massive issues that we’ve talked about to date in the present day, are there some extra particular, smaller insurance policies or state-level dynamics that you just assume in the present day’s well being leaders might want to reply to within the subsequent six months, the following eight months? What do well being leaders have to be centered on proper now primarily based on what might change most shortly?
Ollstein: One thing I’ve been attempting to shine a lightweight on are state Supreme Courts, which the make-up of them might change dramatically this November. States have every kind of various methods to … Some elect them on a partisan foundation. Some elect them on a nonpartisan foundation. Some have appointments by the governor, however then they must run in these retention elections. However they’re going to simply have a lot energy over … I imply, I’m most centered on the way it can influence abortion rights, however they simply have a lot energy on so many issues.
And given the excessive chance of divided federal authorities, I believe only a ton of well being coverage goes to occur on the state degree. And so I’d say the voters usually overlooks these races. There’s an enormous drop-off. Lots of people simply vote the highest of the ticket after which simply depart these races clean. However sure, I believe we must always all be paying extra consideration to state Supreme Court docket races.
Rovner: I believe the opposite factor that we didn’t, that no one talked about we have been speaking about, what the following president might do, is the influence of the change to the regulatory atmosphere and what the Supreme Court docket’s choice overturning Chevron goes to have on the following president. And we did a complete episode on this, so I can hyperlink again to that for individuals who don’t know. However principally, the Supreme Court docket has made it tougher for whoever turns into president subsequent time to alter guidelines through their government authority, and put extra onus again on Congress. And we’ll see how that every one performs out, however I believe that’s going to be actually necessary subsequent yr.
Natalie Bercutt: Hello. My title is Natalie Bercutt. I’m additionally a grasp’s pupil at George Washington. I research well being coverage. I wished to know a bit bit extra about, clearly, abortion rights, an enormous difficulty on the poll on this election, however a bit bit extra about IVF [in vitro fertilization], which I really feel like has form of come to the forefront a bit bit extra, each in state races but in addition candidates making feedback on a nationwide degree, particularly of us who’ve been out within the discipline and interacting with voters. Is that one thing that extra individuals are popping out to the poll for, or people who find themselves possibly voting break up ticket however in help of IVF, however for Republican candidate?
Ollstein: That’s been fascinating. And so most people know that this actually exploded into the general public consciousness earlier this yr when the Alabama Supreme Court docket dominated that frozen embryos are individuals legally below the state’s abortion ban. And that disrupted IVF providers briefly till the state legislature swooped in. So Democrats’ argument is that due to these anti-abortion legal guidelines in a number of completely different states that have been made potential by the Dobbs choice, a number of states might turn out to be the following Alabama. Republicans are saying: Oh, that’s ridiculous. Alabama was solved, and no different state’s going to do it. However they may.
Rovner: Alabama might turn out to be the following Alabama.
Ollstein: Alabama might definitely turn out to be the following Alabama. Purchase tons of states have very related language of their legal guidelines that might make that potential. At the same time as you see plenty of Republicans proper now saying: Oh, Republicans are … We’re pro-IVF. We’re pro-family. We’re pro-babies. There are plenty of divisions on the fitting round IVF, together with some who do need to prohibit it and others who need to limit the best way it’s mostly practiced within the U.S., the place extra embryos are created and solely probably the most viable ones are implanted and the others are discarded.
And so I believe this can proceed to be an enormous combat. Loads of activists within the anti-abortion motion are actually upset about how Republican candidates and officers have rushed to defend IVF and promised to not do something to limit it. And so I believe that’s going to proceed to be an enormous combat it doesn’t matter what occurs.
Rovner: Tam, are you seeing dialogue in regards to the threats to contraception? I do know that is one thing that Democratic candidates are pushing, and Republican candidates are saying, Oh, no, that’s foolish.
Keith: Yeah, I believe Democratic candidates are definitely speaking about it. I believe that due to that IVF scenario in Alabama, due to considerations that it might transfer to contraception, I believe Democrats have been in a position to discuss reproductive well being care in a extra expansive approach and in a approach that’s maybe extra comfy than simply speaking about abortion, in a approach that’s extra comfy to voters that they’re speaking to again when Joe Biden was operating for president. Instantly when Dobbs occurred, he was like, And this might have an effect on contraception and it might have an effect on homosexual rights. And Biden appeared far more comfy in that realm. And so—
Rovner: Yeah, Biden, who waited, I believe it was a yr and a half, earlier than he mentioned the phrase “abortion.”
Keith: To say the phrase “abortion.” Sure.
Rovner: There was a web site: Has Biden Mentioned Abortion But?
Keith: Primarily what I’m saying is that there’s this extra expansive dialog about reproductive well being care and reproductive freedom than there had been when Roe was in place and it was actually only a debate about abortion.
Rovner: Ashley, do individuals, notably ladies voters, understand that there’s an actual menace to contraception?
Kirzinger: I believe what Tamara was saying about when Biden was the candidate, I do assume that that was a part of the bigger dialog, that bigger menace. And they also have been extra anxious about IVF and contraception entry throughout that. If you ask voters whether or not they’re anxious about this, they’re not as anxious, however they do give the Democratic Get together and Harris a a lot stronger benefit on these points. And so should you have been to be motivated by that, you’ll be motivated to vote for Harris, however it actually isn’t resonating with ladies voters and the best way now that abortion, abortion entry is resonating for them.
Rovner: Principally, it gained’t be resonating till they take it away.
Kirzinger: Precisely. If, I believe, the Alabama Supreme Court docket ruling occurred yesterday, I believe it will be a a lot larger difficulty within the marketing campaign, however all of that is timing.
Ollstein: Effectively, and other people actually talked a few believability hole across the Dobbs choice, though the activists who have been following it carefully have been screaming that Roe is toast, from the second the Supreme Court docket agreed to listen to the case, and particularly after they heard the case and other people heard the tone of the arguments. After which in fact the choice leaked, and even then there was a believability hole. And till it was really gone, lots of people simply didn’t assume that was potential. And I believe you’re seeing that once more across the thought of a nationwide ban, and also you’re seeing it across the thought of restrictions on contraception and IVF. There’s nonetheless this believability hole regardless of the proof we’ve seen.
Rovner: All proper. I believe we’ve time for another query.
Meg: Hello, my title’s Meg. I’m a contract author, and I wished to ask you about one thing I’m not listening to about this election cycle, and that’s weapons. The place do shootings and faculty shootings and gun violence match into this dialog?
Keith: I believe that we’ve heard a good bit about weapons. It’s a part of a laundry listing, I suppose you can say. Within the Kamala Harris stump speech, she talks about freedom. She talks about reproductive freedom. She talks about freedom from being shot, going to the grocery retailer or at college. That’s the place it matches into her stump speech. And positively by way of Trump, he’s very professional–Second Modification and has at occasions commented on the college shootings in ways in which come throughout as insensitive. However for his base — and he’s solely operating for his base — for his base, being very strongly professional–Second Modification is essential. And I believe there was even a query possibly within the Univision city corridor yesterday to him about weapons.
It isn’t the difficulty on this marketing campaign, however it’s definitely an difficulty if we discuss how a lot politics have modified in a comparatively brief time period. To have a Democratic nominee leaning in on restrictions on weapons is a reasonably large shift. When Hillary Clinton did it, it was like: Oh, gosh. She’s going there. She misplaced. I don’t assume that’s why she misplaced, however definitely the NRA [National Rifle Association] spent some huge cash to assist her lose. Biden, clearly an writer of the assault weapons ban, was very a lot in that realm, and Harris has continued transferring in that route together with him, although additionally hilariously saying she has a Glock and she or he’d be prepared to make use of it
Ollstein: And emphasizing [Minnesota governor and Democratic vice presidential candidate Tim] Walz’s looking.
Keith: Oh, look, Tim Walz, he’s pheasant looking this weekend.
Rovner: And in contrast to John Kerry, he seemed like he’d completed it earlier than. John Kerry reasonably famously went out looking and clearly had not.
Keith: I used to be at a rally in 2004 the place John Kerry was sporting the jacket, the barn jacket, and the senator, the Democratic senator from Ohio fingers him a shotgun, and he’s like … Ehh.
Kirzinger: I used to be shocked when Harris mentioned that she had a Glock. I assumed that was a really fascinating response for a Democratic presidential candidate. I do assume it’s possibly a part of her attraction to impartial voters that, As a gun proprietor, I help Second Modification rights, however with limitations. And I do assume that that a part of attraction, it might work for a extra average voting block on gun rights.
Rovner: We haven’t seen this kind of accountable gun proprietor faction in a very long time. I imply, that was the origin of the NRA.
Keith: However then extra just lately, Giffords has actually taken on that mantle as, We personal weapons, however we wish controls.
Rovner: All proper, effectively, I might go on for some time, however that is on a regular basis we’ve. I need to thanks all for coming and serving to me rejoice my birthday being a well being nerd, as a result of that’s what I do. We do have cake for these of you within the room. For these of you out in podcast land, as at all times, should you benefit from the podcast, you can subscribe wherever you get your podcast.
We’d admire it should you left us a assessment. That helps different individuals discover us, too. Particular thanks as at all times to our technical guru, Francis Ying, and our editor, Emmarie Huetteman, and our live-show coordinator extraordinaire, Stephanie Stapleton, and our whole live-show crew. Thanks quite a bit. This takes much more work than you understand. As at all times, you may e mail us your feedback or questions. We’re at whatthehealth, all one phrase, @KFF.org, or you may nonetheless discover me. I’m at X at @jrovner. Tam, the place are you on social media?
Keith: I’m @tamarakeithNPR.
Rovner: Alice.
Ollstein: @AliceOllstein.
Rovner: Cynthia.
Cox: @cynthiaccox.
Rovner: Ashley.
Kirzinger: @AshleyKirzinger.
Rovner: We will likely be again in your feed subsequent week. Till then, be wholesome.
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