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[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

Julie Rovner: Hello, from �Թϲ����� and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for �Թϲ�����. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: And we welcome back to the podcast Paige Winfield Cunningham, now of the brand-new Washington Sun. 

Paige Winfield Cunningham: Hi, Julie. It’s great to be back. 

Rovner: Later in this episode, we’ll have my interview with Michelle Andrews, who reported and wrote the latest �Թϲ����� “Bill of the Month,” about a patient who got a bill from a hospital emergency room, although she never actually received any treatment there. But first, this week’s news. 

So Election Day is less than a month away, and a finds that healthcare is voters’ top cost concern going into the midterms, and cost concerns are the top voting issue. When asked about their biggest financial concern, health costs topped things like food, utilities, and rent, and tied with the cost of gas. My big boss, Drew Altman, , theorizes that’s not just because individual health costs have spiked of late, but because health costs are so unpredictable and potentially catastrophic. So, is it fair to call these midterms a healthcare election? 

Winfield Cunningham: When is it not a healthcare election? 

Rovner: That may be. 

Winfield Cunningham: I don’t know. I guess I feel it’s not new that Democrats have the advantage on healthcare. Like, they pretty much always have the advantage on healthcare in polls. But what’s sort of interesting to me is that this administration has really tried to score some political wins here and kind of flip the script. I don’t think they’re necessarily being successful, but President [Donald] Trump is going about this in a very President Trump kind of way, right? They passed the [One] Big Beautiful Bill [Act], which was unpopular, and they’re not talking about that at all. But instead, you see Trump trying to, you know, send ACA [Affordable Care Act] checks to ACA customers and checks to Medicare customers. 

Rovner: Yes, we’ll get to that in a second, yes. 

Winfield Cunningham: And then, you know, they’re talking about their deals with drug companies. We know President Trump loves to cut deals. I think in his own way they’re trying to be, like, Hey, we’re good at healthcare, and, like, we are worried about costs, etc. And we’re doing something. But, of course, much of this is a one-time kind of fix, and not even a fix. That’s probably being too generous. But a one-time check that people are getting. So yeah, I don’t think Republicans are being successful in … presenting themselves as the party people can trust on healthcare per se. 

Ollstein: To Paige’s point, I think the sudden rush to mail out checks to a bunch of people who’ve been impacted by Republican healthcare policies is a sign that they’re sweating the impact of those Republican healthcare policies. I don’t think that it is coming from a place of confidence. It is coming from a sweatier place, I believe. And it’s almost an acknowledgment that those folks need that money because their costs are so much higher, and that’s having a political impact. And I also think, you know, you’re seeing Republicans having to spend a lot of money campaigning in states that were previously considered safe red states. And some of those states have been particularly hard hit by rising health costs and a lot of people losing their insurance. I did a reporting trip to Ohio a little bit ago, and I saw so much evidence of that, and I know it’s happening in other states as well. 

Edney: I also think that everything that Paige and Alice just mentioned are really important, and, you know, these efforts to send out checks and talk about this in certain ways is it’s trying to fill this gap that the Trump administration sort of started by saying, Oh, we’re bringing down drug prices by — I don’t know, whatever mathematical impossibility that they said they brought them down in. And that’s not actually what people are seeing in their pocketbooks. So it’s at front of mind for them because I think maybe there was some expectation that something might happen, but that’s not what they’re seeing in their bills. 

Rovner: So another interesting finding from the poll is that support for that amorphous phrase “Medicare for All” is at its highest point in at least a decade. And while, as usual, support drops dramatically when people are told that it could mean higher taxes or longer wait times for care, support didn’t drop as much as usual when people were told Medicare for All could mean eliminating private insurance companies. It was, of course, the threat of losing your own coverage that doomed the Clinton healthcare plan and that almost sunk Obamacare on the launch pad. Are Americans finally ready for a big change, or do they just think they are until they see the specifics? 

Ollstein: Well, the question has sort of always been, like: How bad does it need to get before people are open to a radical alternative? And I think, really, until now, people have been happy enough — I won’t say happy; I’ll say happy enough — with a partially private, partially public, partially regulated, not partially unregulated healthcare system. Enough people were happy enough to keep these proposals at bay, and now you have so many people who can’t afford insurance, who can’t afford care even if they have insurance. There was some new studies out this week about the number of people with private insurance, what’s considered the good stuff, who still have tons of medical debt and are having to put off payments, you know, on other things and cut back in other areas of life to afford their healthcare. That is changing people’s minds and making people more open. Now, we know that what public sentiment is does not always translate into what Congress is willing to vote for. So I won’t say that it is going to be any kind of foregone conclusion, even if Democrats take back the majorities in Congress, but there’s definitely a shift going on. 

Winfield Cunningham: I was just gonna say to Alice’s point, just the fact that Congress just can’t do anything on healthcare, and you even had quite a lot of Republicans that wanted to extend the subsidies. Like, this is really an area that should have been ripe for bipartisan work, right? I mean, this is like the government subsidizing private plans, something, an idea in theory that Republicans should like and have supported in other ways. 

Rovner: It was a Republican idea! 

Winfield Cunningham: Yeah, exactly. And then also, when I’ve talked to Democrats about, like, what’s your biggest regret about the ACA, or what’s the thing that you wish you had done differently? Many have said to me: The cliff, the subsidy cliff, was not well done. You shouldn’t have a situation where people are going from subsidies to zero subsidies, and they’re still kind of like mid-income people. So this should have been an area that was ripe for bipartisan work last year. And we all saw what happened. It fell apart. So, I mean, even at this point, Congress is just so dysfunctional. They can’t even, they can’t even agree to fix pieces of a law, which now people kind of generally like. So that’s where we’re at. 

Rovner: Well, it’s funny. I would say one of the big ironies I’ve noticed is that, you know, you’ve got a lot of sort of more progressive Democrats this year running on Medicare for All, and Republicans, you know, that are saying: This is communism. This is socialism. We can’t have this. On the other hand, for the first time I can remember, Republicans are coming out very loudly about greedy insurance companies, which, even more ironically, isn’t really the biggest problem. It’s not what’s driving up healthcare costs. You know, the cost of care is what’s driving up healthcare costs. It’s not excessive insurer profits. But I wonder if the Republicans’ beating up on big insurance is like feeding this desire for Medicare for All — ironically. I mean, Republicans are terrified about ending up there, and yet I feel like they’re inadvertently pushing us that way. 

Edney: Well, I think they’re also hitting on the zeitgeist of the day. Like, they’re sending this message out because it’s one that’s being well received, and that people are very upset. You know, there was unfortunately the murder of the UnitedHealth[care] CEO Brian Thompson, and I think that that has, like, not abated in the sense that people are really angry, and that any politician who wants to talk about the big, bad insurance companies has free rein to do so. 

Winfield Cunningham: Yeah, I think it’s really easy to get people really riled up about their insurance companies, even though, as you say, Julie, they are not collecting the biggest profits in the healthcare system. But your interaction with the insurer is not personal. You know, you just see this number that you have to pay them every month, and then you see copays you have to pay. Whereas you’re having a personal interaction typically when you’re at the hospital with the doctors and the nurses that are caring for you, and you’re going to see your physician. So there’s much blame to be spread around here in terms of healthcare costs going up, and, like, many villains in this industry. Maybe not. Maybe villains isn’t the right word, but many actors in this industry. But I think it is really easy to get people upset about insurers, in particular. 

Rovner: Yeah, I mean, some of it is that we’ve just invented things that are really cool, like GLP-1 drugs that happen to be really expensive. So that’s not necessarily a villain, but it is definitely one of the things that is driving up, at least at the moment, healthcare costs. 

Well, we need to move on. One of the things that’s pushed healthcare to the top of the concern list, as we’ve mentioned, oh, pretty much every week since the spring, is that while Republicans tried to time the Medicaid and other health spending cuts in their 2025 budget bill to , that message didn’t get to the hospitals, clinics, and state and local governments that are already making cuts in anticipation of lower federal funding to come. Plus, as we’ve said, millions of people saw their Affordable Care Act premiums skyrocket when Republicans declined to continue the expanded premium subsidies. Alice, you managed to see how a lot of this was playing out on the ground on the reporting trip you already referred to. What else did you find out there? 

Ollstein: Yeah, like you said, the effort to put off the more controversial cuts until after the election does not mean that this election will not be about those cuts. Those cuts are coming up in every debate, in every Democratic town hall and speech, and they’re in a lot of ads. And Democrats really see this as one of Republicans’ biggest liabilities going into the election, and they’re really trying to press their advantage there. And polling indicates that it may be working. And, like you said, even though those cuts, a lot of them, aren’t going to hit until 2027, states have to make their budgets now, and so they’re making these deep cuts to services in anticipation of losing all that Medicaid money. Hospitals need to make their budgets now. They are cutting services. They’re closing labor and delivery wards. They’re closing down entire facilities because they see the writing on the wall. And so I thought it was fascinating because I dug up an article my colleagues wrote last year when the bill was being debated and passed, and Democrats were worried that the delayed implementation would make it impossible for them to attack Republicans about it. And, lo and behold, that was not the case. 

Rovner: Yeah. Well, and even though the Medicaid work requirements included in that 2025 bill aren’t required to start until next January, several states have now either started early or started the process of notifying people that their Medicaid coverage will soon be contingent on their proving that they’re working. And — this is my shocked face — people are very confused. I will also post a link to a story from Montana Public Radio about how the rollout there has been, well, pun intended, kind of rocky. I thought AI [artificial intelligence] was going to make this process all smooth compared to the last time. That apparently is not the case. 

Edney: Definitely not. I mean, the article you’re referring to about Montana, I mean, it sounded very confusing. Something that you would think AI could sort of clear up is just getting the dates right when you need to be getting paperwork and stuff in, but even that wasn’t the case. 

Ollstein: And adding fuel on the fire here is that the federal administration has gone beyond what Congress ordered in terms of the harshness of the implementation of these work requirements. Even beyond that, certain states are implementing the work requirements in a harsher way than the federal government is requiring, and they are allowed to do that. And so, some are offering exemptions for certain populations, and some are saying no thanks to that. Some are saying, OK, for the first year you get kind of a grace period if you have a serious illness. We’ll just take your word for it if you testify that you have an illness that prevents you from working, and we won’t require, you know, a doctor note or other proof, just for the first year, and then after that you have to prove. But some states are saying: no one-year grace period. You need your proof now, or we’re kicking you off your insurance. And so I think all of those different layers of harsh enforcement are really hitting a lot of people, and we pretty much only have hard data out of Nebraska so far because they were so early in their implementation, way out in front of any other state. And there, we’ve seen hundreds and hundreds of people lose their insurance, and most of them was for, you know, procedural reasons, not because they were ineligible. And so I think that is a sort of canary in the coal mine of what we could see in other states once implementation becomes mandatory everywhere. 

Rovner: And wait until all these people have to go to their doctor, sort of hat in hand, saying you have to write me a note, or I’m going to lose my insurance. 

Winfield Cunningham: I just tend to think, and I haven’t followed this story quite as closely over the last couple of months, but I tend to think … that a lot of it is going to have to do with the nuts and bolts of what verification looks like, and each state is going to do that differently. And if you believe Dr. [Mehmet] Oz when he talks about this, he makes it sound as though it’s going to be this easy process where people have an app, and they can go into the app, and maybe they have to submit one document one time, but then they can go in and check a box or whatever. But in reality, maybe it’ll look like that in some states. Maybe it won’t look like that in some states. Yeah, if someone just has to go into an app and check something, fine. If someone’s having to log onto a website and get a document from their employer or their educational institution and submit this in a really tedious way, then I do think you’re going to see a lot of people dropping off. So I’m really curious to see what those nuts and bolts look like. 

Rovner: Yeah, I am too. We will clearly see more of this. 

All right, turning to vaccines, because there is always vaccine news. The measles case count in Pennsylvania has now topped 1,000, making it officially the biggest outbreak in 35 years. And some of the complications that doctors are seeing are among people who did not have underlying health conditions, which has been troubling. Even more troubling is a , now at the University of Minnesota’s Center for Infectious Disease Research and Policy. She reminds us that measles causes something called immune amnesia by basically erasing the body’s immunity to other germs, making those who have had measles more susceptible to other infections. So everyone who’s getting measles now is going to be more at risk in the future. And against that backdrop comes a , The New York Times’ Christina Jewett, about Texas Attorney General and Republican Senate candidate Ken Paxton, who is investigating pediatricians in the state for what he claims are potential violations of the state’s deceptive trade practices law. Paxton’s office is demanding reams of paperwork from busy pediatric practices, trying to prove that they are pushing unnecessary vaccines in exchange for financial incentives provided by vaccine makers. Given how little profit is made on vaccines at every level of the distribution chain — so little that many vaccine makers have threatened to get out of the business altogether — this feels like a weird investigation. Do we know what’s behind it? 

Edney: I don’t think that we know for sure by any means, and there’s not even a ton of information on exactly what he’s investigating, but it does seem to fit with things that President Trump has gone after, that Secretary [Robert F.] Kennedy [Jr.] has talked about in the sense that Big Pharma is making money off of these things, pediatricians are being paid off, and we’ve heard this many times from them. You know, that’s a way they’ve tried to go after vaccines, and I think that Ken Paxton would like some backup from the president for other endeavors that he has in life, and so he was looking for some backup. And maybe that’s one of the reasons for this is, you know, to kind of look more aligned with the administration. 

Rovner: Yeah, he may not dress well, but at least he’s pursuing the president’s policies. 

Winfield Cunningham: I don’t have any inside information about it, but it does feel like a play to look quite aligned with an administration that is increasingly not shy about looking vaccine-skeptical. I mean, Trump has been very out there in recent months, signing the executive order, you know, talking about how, I guess, he says for his five kids their shots were spaced out. He has, you know, personal concerns about this. And then the other thing is it seems like this is attractive to Paxton’s base. You know, I mean, there are plenty of MAHA [Make Americans Healthy Again] moms in Texas who have, you know, left traditional pediatrician practices and gone more like the functional health route, where they go to these doctors who are willing to let them space or skip vaccines, so this seems like maybe a good political move for him. I’m not sure. 

Rovner: And I will just say before we leave this: There are lots of places where there’s clearly industry influence over prescribing practices and types of procedures. But I think the one place it’s fair to say that there is not a lot of profit being made is in vaccines. Vaccines are hanging on by a thread. I’ve been doing this for 40 years. I mean, I was there when they passed the Vaccine Injury Compensation Act, and it’s because all of the vaccine makers were threatening to stop making vaccines. It’s just not a place where there is lots of profit. 

All right, we’re going to take a quick break. We’ll be right back. 

Turning to reproductive news, yesterday was the date that the FDA had to report to a federal court in Louisiana how that safety study of the abortion pill mifepristone is going. Alice, what did they say? 

Ollstein: Of course, they waited until, like, 9 p.m. on the deadline, which was very helpful to all of us reporters who were refreshing PACER [Public Access to Court Electronic Records] all day long. But we finally got it. It was not a very fulsome update, I would say. It was just a few pages long. And the main news is that they said we’re going to finish gathering all the data we need by December, but we’re not going to release a report. We’re going to need until March to crunch the numbers and draft our report on whether we deem mifepristone to be safe and effective. Now, I also think it was notable in there that they’re sort of separately studying the drugs’ safety and efficacy and the safety of the telehealth rules around it from 2023 that the Biden administration imposed. And they noted — and I thought this would, you know, maybe additionally piss off the anti-abortion groups who were already pissed off by the punt until March — they said that they will be examining the 2023 rule changes in light of both court challenges, saying that the current rules are too loose, and court rulings saying the current rules are too strict and access to …  

Rovner: Which we rarely talk about! 

Ollstein: Yes, but two different federal courts have ruled that the remaining restrictions on abortion pills are too strict and not justified, and that it would be safe without them. And so you have the FDA acknowledging these competing forces and pressures on it from the courts and from activist groups and from states. And so it really seems like they’re trying to walk this careful line to not piss off anyone, but they’re ending up pissing off everyone. And what I found really notable about the reaction to this filing was you have the pro-abortion rights forces saying, basically, you know, Wake up, sheeple, they’re waiting until right after the midterms and then they’re going to ban everything! And the anti-abortion groups don’t seem to think that’s the case; they do not seem confident that that is what is going to happen. They are blasting the administration not only for not doing more, to date, to impose restrictions on the drugs, but they do not seem to have confidence in this review process at all. So obviously, we don’t know what will happen. They shared very little detail about who’s in charge of this study, exactly what data are they incorporating? So it continues to be somewhat of a black box. 

Rovner: So, what does this all mean for the potential confirmation of Heidi Overton, the White House health policy aide who’s been nominated to head the FDA and had her confirmation hearing, at which she politely declined to answer most of the lawmakers’ questions, and the Senate left town without acting on said nomination? 

Winfield Cunningham: Well, I believe [Sen. Bill] Cassidy has not said yet how he’s going to vote on Overton. I imagine …  

Rovner: Cassidy, the chairman of the relevant committee. 

Winfield Cunningham: The outgoing Sen. Cassidy. Heidi was asked very pointedly, I think, by Sen. [Patty] Murray, “Do you believe this is safe and effective?” She gave a very carefully — you could tell her answers were very, very carefully rehearsed. I’m not sure what’s going to happen there, but I was going to say, as I think about after the election and kind of how all of this unfolds, I really have no idea. I think you could kind of argue it both ways. There are a lot of anti-abortion allies in key places at the Domestic Policy Council in certain offices within HHS. In some ways, this administration looks like a bit of a traditionally Republican administration. A lot of folks in there, when I talk to pro-lifers, they are, like, “We really have allies here.” But on the other hand, I think Trump’s kind of done with this. The White House still says he’s the most pro-life president. This is the pro-life president, they say. But he’s made it very clear that he doesn’t really want federal policymaking here. And then RFK Jr., he’s, like, Catholic, but I don’t think this is a top issue for him as well. So I’m genuinely curious. I do not know how they’re going to handle this. 

Rovner: I did not have on my bingo card Trump going with the anti-vaxxers but throwing the anti-abortion forces under the bus. Which, hey, everything’s a surprise. 

Ollstein: And to that point, you know, Cassidy is very anti-abortion, and so if he votes against Overton, it will not be because of her anti-abortion views. It will be because of vaccines or something else. You know, her general leadership abilities or whatnot, whatever else he’s concerned about. It’s not going to be about abortion. But you have some other people on that panel who could be concerned about her views on abortion that could affect her confirmation going forward. And I think it’s notable that that too is getting punted until after the election, so as not to provide any fodder or controversy for the members who are having to run. But I also think that there’s always another election coming up, and so, yes, they don’t want to rile people up right before the midterms with some sort of big sweeping anti-abortion action. But as soon as this election’s over, they’re going to be thinking about 2028 and not wanting to rock the boat there. And so I think these sort of political pressures are only going to continue. And we have seen in Congress and in the executive branch sort of an effort to tell the anti-abortion forces that are getting more and more and more frustrated: Just wait. Just be patient. You know, we’re going to get to you. We’re going to get to your priorities eventually. And it keeps not happening. So you’ve seen that on the defund Planned Parenthood front. They keep saying, Oh, it’s going to be in the next reconciliation bill. It’s going to be in the next one, the next one, the next one. 2.0, 3.0, 4.0, and it keeps not happening. And so you could see that again on this front as well. But, also, you know, whether as a result of a court ruling or just the FDA on its own, something could happen that really restricts drugs both in states with abortion bans and in states where they’re legally protected. This would affect the whole country. 

Rovner: All right. And sure enough, not only do we have outbreaks here in the U.S. of measles and other vaccine-preventable illnesses, there’s now a scary case out of Russia of a lab worker who died of a so-far-unidentified strain of pneumonia. Oh, and the patient worked at a lab in Siberia studying plague. Russian officials said that they have the situation under control, but I feel like we’ve heard that before somewhere? Um, I don’t know about you guys. I’m kind of watching this one with a wary eye. 

Edney: Yeah, I think that that is the right way to be when we have these very secretive countries, China with covid, and now Russia with the plague. Where these things start doesn’t lead to a lot of information getting out there, so filling the holes is very difficult. It sounds like the U.S. government doesn’t really even know a whole lot, and we’ve had assurances from Russia that everything is under control. But where’s the proof? I guess. It hasn’t really manifested. So I think watching it closely is right. No need to panic. There’s been no verified reports of anyone else dying at that lab, but, you know, certainly something not to turn away from. 

Rovner: Finally this week, we’ve talked in the past about how doctors no longer want to be associated with helping carry out the death penalty by lethal injection. Well, in Tennessee, we saw yet another botched execution with the patient surviving not one, but two injections intended to end her life. Fifty-year-old Christa Pike, who was on death row for her part in the torture and murder of a classmate when she was 18, was awake and talking as of Wednesday after being unconscious for several days. And it’s not clear what will happen to her now. In the meantime, though, Tennessee’s governor has put a moratorium on executions in the state for the rest of the year and ordered an independent review of what happened. This was the second time this year the state has failed to successfully carry out an execution. I will link to a story from Nashville Public Radio’s Catherine Sweeney, who is an official media witness for both unsuccessful executions. I will warn you: It’s really vivid. It also raises the question of whether lethal injection, which was supposed to be a more “humane,” air quotes, alternative to hanging or an electric chair, really is. Particularly given that many doctors and now many drug companies won’t participate on ethical grounds, and states are turning to some pretty questionable and, as we’ve seen, not always successful protocols, are we sort of getting to the end of this? Anna, I see you nodding. 

Edney: Yeah, I think that these botched executions and the most recent one have given a lot for the anti-capital-punishment groups to work with and to make their case about torture and that this isn’t something humane that we should be doing in the United States; we’re one of the few developed countries that does do that. And you brought up the point about medications and how a lot of the pharmaceutical companies don’t even want to give them to the corrections facilities anymore. And the problem is then those facilities need to find the drugs somewhere. They’re maybe going to less reputable places, or keeping them, the ones they do find, on hand for too long past their expiration date. And so it’s clearly not working out, when maybe if you had the perfect protocol and the drug just off the line of a very respectable company, things might work. But that’s not what’s been happening. 

Rovner: Yeah, I think we’re going to watch that space. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Michelle Andrews. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast Michelle Andrews, who reported and wrote the latest �Թϲ����� “Bill of the Month.” Hi, Michelle. It’s been a minute. 

Michelle Andrews: Hi, Julie. It’s great to be here. 

Rovner: So this month’s patient was sent to the emergency room by an urgent care doctor for a particularly severe migraine attack. Tell us who she is, where she’s from, how she ended up at the hospital. 

Andrews: Sure. Her name is Autumn Daniels, and she lives in Champaign, Illinois, and she has a history of severe migraines back to when she was a kid, like a 10-year-old. And so she gets them regularly, more regularly now. And she had had this migraine for seven days, and finally, the urgent care doc said, “If you still are having trouble tomorrow, you need to go to the emergency room.” Because they’d given her some, you know, a shot to help relieve the symptoms, and it hadn’t worked. So she ended up at the emergency room, with her sister, and waited a long time for care. 

Rovner: So once she got there, she got triaged, right — checked by a nurse to see how serious her ailment was compared to others waiting to be seen. Then what happened? 

Andrews: Sure, I just want to say a word about triage because the hospital kind of makes a big deal of that. It’s just checking her temperature, her pulse, and her blood pressure, and asking her, “Do you often get migraines?” So they did this little bit of “care,” in quotes, and then they sent her back out to the waiting room, and she waited, with her sister. And she waited, for four hours, and nothing happened. 

Rovner: So she leaves and goes to another ER where she does get seen and treated, but then she gets a bill from the first ER, too. How much was it, and what did they say it was for? 

Andrews: The bill was for $410, and they said it was for an emergency room Level 1 visit, and they also stuck a procedural code on it that said that it had been an evaluation and management visit, meaning that some medical care had been provided by a healthcare provider. 

Rovner: Which was questionable, right? 

Andrews: Absolutely questionable. 

Rovner: So, is this a new thing? Hospitals billing for patients who don’t get beyond the initial triage? 

Andrews: Well, it’s new for this hospital, which I thought was interesting. Their policy changed, starting in March, I believe it was, where they said, oh, you know: If you come into our hospital, even if you don’t get treated by a provider, we can still bill you because we’re using up our staff time and we have to keep our facility running. And so that’s the justification that they use. Let me just say, I don’t know that other hospitals do it, but I don’t think it’s that rare, from what I understand. 

Rovner: And her insurance company was not buying this, right? 

Andrews: Exactly. They covered her second ER visit, and that was fine, where she got treated. But this whole, you know, You came to the hospital and you left without getting treatment. Sorry, we’re not going to cover that. 

Rovner: Because technically they said she left against medical advice, right? 

Andrews: Exactly, and of course she didn’t actually receive advice. But I did ask some experts in billing about this, and they said, Well, from the insurer’s perspective, what that often means is that, you know, she didn’t get care at the facility by a provider, and so she’s leaving against their advice, basically. 

Rovner: So, what’s the takeaway here? Is there a way to prevent something like this from happening? 

Andrews: I think there is no way to easily prevent it, but you can certainly ask when you arrive at the hospital, at the ER desk, with your throbbing headache, you can say, “Oh, what happens if I wait and I don’t get care?” You can check with your insurance company and ask them. You know, you would do that perhaps if you were someone who often ended up at the ER, but it’s not something most of us are going to think about. And then let me just say, you can, of course, appeal, and you should appeal if you’re not getting the answers or you’re getting billed in a way that you shouldn’t be billed. 

Rovner: Yeah, I love the kicker of your story: If you don’t appeal, the answer is always no. 

Andrews: Always no. Yes, exactly. 

Rovner: But still, I mean, another list of things that you need to do when you’re in an emergency health situation. Awesome. 

Andrews: I know, I know, and I think there was some conversation about well, you know, you signed these papers, and she’s like, Of course I signed the papers. I can’t be held responsible for the papers. I couldn’t — I could barely see. I was vomiting every 10 minutes. 

Rovner: Anyway, thank you for following this. And yet another thing to beware of when you go to the emergency room. Michelle Andrews, thanks for doing this. 

Andrews: Thanks, Julie. 

Rovner: OK, we are back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you go first this week? 

Ollstein: Yeah, I have a story from my colleague Carmen Paun. It’s called “,” and it is how that approach to foreign policy and foreign aid is playing out in the healthcare space, where the CDC [Centers for Disease Control and Prevention] is now closing offices it had in a bunch of other countries that were supporting local health systems there and also helping to monitor for outbreaks of infectious diseases. Nothing bad ever came from overseas, as we know! And so there’s a lot of worry about this. There is a lot of prediction over both the cuts that have come to HIV prevention and a bunch of other things, increased risk of outbreaks, but also just an inability to have early detection going forward. And there’s going to be some big appropriations fights about this that she previews in the story. 

Rovner: Good story. Paige. 

Winfield Cunningham: Yeah, mine is a New York Times story by Reed Abelson and Teddy Rosenbluth called “.” And I thought this was a really, really interesting story. It’s basically talking about how hospitals are running their coding through AI tools, and the AI is basically picking up more complicated conditions and then adding secondary conditions to basically maximize the number of things that they can bill the insurers for. And I had heard rumblings about this, and I remember actually talking to my sister last year, and she was telling me how they haul in the nurses and actually put them through training sessions of how to code for maximal return. And so it’s easy to see how if you’re now just starting to run this stuff through AI, they’re finding ways to just, you know, upcode as much as possible. So something to really watch amid this larger conversation about healthcare costs ballooning. 

Rovner: Indeed. Anna. 

Edney: Mine is from Annie Waldman at ProPublica: “.” Obviously, it’s an awful story about this baby who was given raw milk and contracted a terrible case of E. coli, and she’s going to have lifelong problems from this. It’s not just some simple thing. But I think the really important point that a lot of coverage before I haven’t seen as much of is that this was in California. The state really couldn’t do a whole lot. This farmer had sold potentially contaminated raw milk, and that’s not supposed to be something, even contaminated or not, that is sold. But there really wasn’t a lot that the state could do. When they even went to collect samples, they couldn’t enter the farm. They had to tell her they were coming back tomorrow to collect samples to test the milk. So, I mean, you can imagine all the things you could do to make sure the milk is clean by then. So I think it was an interesting look at why maybe this is proliferating right now. The FDA certainly isn’t doing a whole lot, given the secretary’s support for raw milk, and then it seems to be like the states’ hands are tied as well. 

Rovner: Yeah, it was a really good story. Well, my extra credit this week is an amazing read from Sarah Zhang at The Atlantic. It’s called “,” and it’s about a rare but tragic medical mystery involving mostly young men who fail to wake up normally from anesthesia, even for minor procedures. I won’t spoil the solution to the mystery, but it’s really a testament to smart and persistent moms for figuring out what happened and why, and working to prevent it from happening to more people in the future. You really need to read it. 

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X and on Bluesky . Where are you guys hanging about these days? Alice? 

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Anna. 

Edney: All the places . 

Rovner: Paige. 

Winfield Cunningham: And I’m mostly on X . 

Rovner: We will be back in your feed next week. Until then, be healthy.