As part of a media blitz aimed at women voters, Vice President Kamala Harris this week rolled out a plan for Medicare to provide in-home long-term care services. It’s popular, particularly for families struggling to care for both young children and older relatives, but its enormous expense has prevented similar plans from being implemented for decades.

Meanwhile, President Joe Biden called out former President Donald Trump by name for having “led the onslaught of lies” about the federal efforts to help people affected by hurricanes Helene and Milton. Even some Republican officials say the misinformation about hurricane relief efforts is threatening public health.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Shefali Luthra of The 19th, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico.

Panelists

Among the takeaways from this week’s episode:

• Vice President Kamala Harris’ plan to expand Medicare to cover more long-term care is popular but not new, and in the past has proved prohibitively expensive.
• Former President Donald Trump has abandoned support for a drug price policy he pursued during his first term. The idea, which would lower drug prices in the U.S. to their levels in other industrialized countries, is vehemently opposed by the drug industry, raising the question of whether Trump is softening his hard line on the issue.
• Abortion continues to be the biggest health policy issue of 2024, as Republican candidates — in what seems to be a replay of 2022 — try to distance themselves from their support of abortion bans and other limits. Voters continue to favor reproductive rights, which creates a brand problem for the GOP. Trump’s going back and forth on his abortion positions is an exception to the tack other candidates have taken.
• The Supreme Court returned from its summer break and immediately declined to hear two abortion-related cases. One case pits Texas’ near-total abortion ban against a federal law that requires emergency abortions to be performed in certain cases. The other challenges a ruling earlier this year from the Alabama Supreme Court finding that embryos frozen for in vitro fertilization have the same legal rights as born humans.
• The 2024 KFF annual employer health benefits survey, released this week, showed a roughly 7% increase in premiums, with average family premiums now topping $25,000 per year. And that’s with most employers not covering two popular but expensive medical interventions: GLP-1 drugs for weight loss and IVF.

Also this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris campaign about health care issues.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too:

Julie Rovner: Ñî¹óåú´«Ã½Ò•îl Health News’ “A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly.

Shefali Luthra: The 19th’s “,” by Mel Leonor Barclay.

Jessie Hellmann: The Assembly’s “,” by Carli Brosseau.

Joanne Kenen: The New York Times’ “,” by Kate Morgan.

Also mentioned on this week’s podcast:

• The New York Times’ “,” by Michael D. Shear.
• The Miami Herald’s “” by Claire Healy and Ana Ceballos.
• KFF’s “.”

[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.]Ìý

Julie Rovner: Hello, and welcome back to “What the Health.” I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, October 10th, at 10 a.m. As always, news happens fast, and things might’ve changed by the time you hear this. So, here we go.Ìý

Today we are joined via teleconference by Shefali Luthra of The 19th.Ìý

Shefali Luthra: Hello.Ìý

Rovner: Jesse Hellmann of CQ Roll Call.Ìý

Jessie Hellmann: Hi there.Ìý

Rovner: And Joanne Kenen of the Johns Hopkins Schools of Public Health and Nursing and Politico magazine.Ìý

Joanne Kenen: Hi everybody.Ìý

Rovner: Later in this episode, we’ll have some excerpts from the Newsmaker lunch we had here at KFF this week with Mark Cuban — “Shark Tank” star, part-owner of the Dallas Mavericks NBA team, and, for the purposes of our discussion, co-founder of the industry-disrupting pharmaceutical company Cost Plus Drugs. But first, this week’s news.Ìý

We’re going to start this week with Vice President [Kamala] Harris, who’s been making the media rounds on women-focused podcasts and TV shows like “The View.” To go along with that, she’s released a proposal to expand Medicare to include home-based long-term care, to be paid for in part by expanding the number of drugs whose price Medicare can negotiate. Sounds simple and really popular. Why has no one else ever proposed something like that? she asks, knowing full well the answer. Joanne, tell us!Ìý

Kenen: As the one full-fledged member of the sandwich generation here, who has lived the experience of being a family caregiver while raising children and working full time, long-term care is the unfulfillable, extremely expensive, but incredibly important missing link in our health care system. We do not have a system for long-term care, and people do not realize that. Many people think Medicare will, in fact, cover it, where Medicare covers it in a very limited, short-term basis. So the estimates of what families spend both in terms of lost work hours and what they put out-of-pockets is in, I think it’s something like $400 billion. It’s extraordinarily high. But the reason it’s been hard to fix is it’s extraordinarily expensive. And although Harris put out a plan to pay for this, that plan is going to have to be vetted by economists and budget scorers and skeptical Republicans. And probably some skeptical Democrats. It’s really expensive. It’s really hard to do. Julie has covered this for years, too. It’s just—Ìý

Rovner: I would say this is where I get to say one of my favorite things, which is that I started covering health care in 1986, and in 1986 my first big feature was: Why don’t we have a long-term care policy in this country? Thirty-eight years later, and we still don’t, and not that people have not tried. There, in fact, was a long-term-care-in-the-home piece of the Affordable Care Act that passed Congress, and HHS [the Department of Health and Human Services] discovered that they could not implement it in the way it was written, because only the people who would’ve needed it would’ve signed up for it. It would’ve been too expensive. And there it went. So this is the continuing promise of something that everybody agrees that we need and nobody has ever been able to figure out how to do. Shefali, I see you nodding here.Ìý

Luthra: I mean, I’m just thinking again about the pay-fors in here, which are largely the savings from Medicare negotiating drug prices. And what Harris says in her plan is that they’re going to get more savings by expanding the list of drugs that get lower prices. But that also feels very politically suspect when we have already heard congressional Republicans say that they would like to weaken some of those drug negotiation price provisions. And we also know that Democrats, even if they win the presidency, are not likely to have Congress. It really takes me back to 2020, when we are just talking about ideas that Democrats would love to do if they had full power of Congress, while all of us in Washington kind of know that that is just not going to happen.Ìý

Rovner: Yes, I love that one of the pay-fors for this is cutting Medicare fraud. It’s like, where have we heard that before? Oh, yes. In every Medicare proposal for the last 45 years.Ìý

Kenen: And it also involves closing some kind of international tax loopholes, and that also sounds easy on paper, and nothing with taxes is ever easy. The Democrats probably are not going to have the Senate. Nobody really knows about the House. It looks like the Democrats may have a narrow edge in that, but we’re going to have more years of gridlock unless something really changes politically, like something extraordinary changes politically. The Republicans are not going to give a President Harris, if she is in fact President Harris, her wish list on a golden platter. On the other hand there’s need for this.Ìý

Rovner: But in fairness, this is what the campaign is for.Ìý

Kenen: Right. There is a need for something on long-term care.Ìý

Rovner: And everybody’s complaining: Well, what would she do? What would she do if she was elected? Well, here’s something she said she would do if she could, if she was elected. Well, meanwhile, former President [Donald] Trump has apparently abandoned a proposal that he made during his first term to require drugmakers to lower their prices for Medicare to no more than they charge in other developed countries where their prices are government-regulated. Is Trump going soft on the drug industry? Trump has been, what, the Republican, I think, who’s been most hostile towards the drug industry until now.Ìý

Hellmann: I would say maybe. I think the “most favored nation” proposal is something that the pharmaceutical industry has feared even more than the Democrats’ Medicare negotiation program. And it’s something that Trump really pursued in his first term but wasn’t able to get done. In such a tight race, I think he’s really worried about angering pharmaceutical companies, especially after they were just kind of dealt this loss with Medicare price negotiation. And if he does win reelection, he’s going to be kind of limited in his ability to weaken that program. It’s going to be hard to repeal it. It’s extremely popular, and he may be able to weaken it.Ìý

Rovner: “It” meaning price negotiation, not the “most favored nations” prices.Ìý

Hellmann: Yeah. It’s going to be really hard to repeal that, and he may be able to weaken it through the negotiation process with drug companies. It’s definitely an interesting turn.Ìý

Rovner: Joanne, you want to add something?Ìý

Kenen: Trump rhetorically was very harsh on the drug companies right around the time of his inauguration. I think it was the week before, if I remember correctly. Said a lot of very tough stuff on drugs. Put out a list of something like dozens of potential steps. The drug companies have lots of allies in both parties, and more in one than the other, but they have allies on the Hill, and nothing revolutionary happened on drug pricing under Trump.Ìý

Rovner: And his HHS secretary was a former drug company executive.Ìý

Kenen: Yes, Eli Lilly. So we also pointed out here that former President Trump is not consistent in policy proposals. He says one thing, and then he says another thing, and it’s very hard to know where he’s going to come down. So Trump and drug pricing is an open question.Ìý

Rovner: Yes, we will see. All right, well, moving on. Drug prices and Medicare aside, the biggest health issue of Campaign 2024 continues to be abortion and other reproductive health issues. And it’s not just Trump trying to back away from his anti-abortion record. We’ve had a spate of stories over the past week or so of Republicans running for the House, the Senate, and governorships who are trying to literally reinvent themselves as, if not actually supportive of abortion rights, at least anti abortion bans. And that includes Republicans who have not just voted for and advocated for bans but who have been outspokenly supportive of the anti-abortion effort, people like North Carolina Republican gubernatorial candidate Mark Robinson, New Hampshire Republican gubernatorial candidate and former U.S. Senator Kelly Ayotte, along with former Michigan Republican representative and now Senate candidate Mike Rogers. Donald Trump has gotten away repeatedly, as Joanne just said, with changing his positions, even on hot-button issues like abortion. Are these candidates going to be able to get away with doing the same thing, Shefali?Ìý

Luthra: I think it’s just so much tougher when your name is not Donald Trump. And that’s because we know from focus group after focus group, and survey after survey, that voters kind of give Trump more leeway on abortion. Especially independent voters will look at him and say, Well, I don’t think he actually opposes abortion, because I’m sure he’s paid for them. And they don’t have that same grace that they give to Republican lawmakers and Republican candidates, because the party has a bad brand on abortion at large, and Trump is seen as this kind of maverick figure. But voters know that Republicans have a history of opposing abortion, of supporting restrictions.Ìý

When you look at surveys, when you talk to voters, what they say is, Well, I don’t trust Republicans to represent my interests on this issue, because they largely support access. And one thing that I do think is really interesting is, once again, what we’re seeing is kind of a repeat of the 2022 elections when we saw some very brazen efforts by Republican candidates for the House and Senate try and scrub references to abortion and to fetal personhood from their websites. And it didn’t work, because people have eyes and people have memories, and, also, campaigns have access to the internet archive and are able to show people that, even a few weeks ago, Republican candidates were saying something very different from what they are saying now. I don’t think Mark Robinson can really escape from his relatively recent and very public comments about abortion.Ìý

Rovner: Well, on the other hand, there’s some things that don’t change. Republican vice presidential candidate last week that if Trump is elected again, their administration would cut off funding to Planned Parenthood because, he said, and I quote, “We don’t think that taxpayers should fund late-term abortions.” Notwithstanding, of course, that even before the overturn of Roe, less than half of all Planned Parenthoods even performed abortions and almost none of those who did perform them later in pregnancy. Is it fair to say that Vance’s anti-abortion slip is showing?Ìý

Luthra: I think it might be. And I will say, Julie, when I saw that he said that, I could hear you in my head just yelling about the Hyde Amendment, because we know that Planned Parenthood does not use taxpayer money to pay for abortions. But we also know that JD Vance has seen that he and his ticket are kind of in a tough corner talking about abortion. He has said many times, We need to rebrand — he’s very honest about that, at least — and trying to focus instead on this nonmedical term of “late term” abortions.Ìý

It’s a gamble. It’s hoping that voters will be more sympathetic to that because they’ll think, Oh, well, that sounds very extreme. And they’re trying to shift back who is seen as credible and who is not, by focusing on something that historically was less popular. But again, it’s again tricky because when we look at the polling, voters’ understanding of abortion has shifted and they are now more likely to understand that when you have an abortion later in pregnancy, it is often for very medically complex reasons. And someone very high-profile who recently said that is Melania Trump in her new memoir, talking about how she supports abortion at all stages of pregnancy because often these are very heart-wrenching cases and not sort of the murder that Republicans have tried to characterize them as.Ìý

Rovner: I think you’re right. I think this is the continuation of the 2022 campaign, except that we’ve had so many more women come forward. We’ve seen actual cases. It used to be anti-abortion forces would say, Oh, well, this never happened. I mean, these are wrenching, awful things that happened to a lot of these patients with pregnancy complications late in pregnancy. And it is, I know, because I’ve talked to them. It’s very hard to get them to talk publicly, because then they get trolled. Why should they step forward?Ìý

Well, now we’ve seen a lot of these women stepping forward. So we now see a public that knows that this happens, because they’re hearing from the people that it’s happened to and they’re hearing from their doctors. I do know also from the polling that there are people who are going to vote in these 10 states where abortion is on the ballot. Many of them are going to vote for abortion access and then turn around and vote for Republicans who support restrictions, because they’re Republicans. It may or may not be their most important issue, but I still think it’s a big question mark where that happens and how it shakes out. Joanne, did you want to add something?Ìý

Kenen: You’re seeing two competing things at the same time. You have a number of Republicans trying to moderate their stance or at least sound like they’re moderating their stance. At the same time, you also have the whole, where the Republican Party is on abortion has shifted to the right. They are talking about personhood at the moment of conception, the embryo — which is, scientifically put, a small ball of cells still at that point — that they actually have the same legal rights as any other post-birth person.Ìý

So that’s become a fairly common view in the Republican Party, as opposed to something that just five or six years ago was seen as the fringe. And Trump is going around saying that Democrats allow babies to be executed after birth, which is not true. And they’re particularly saying this is true in Minnesota because of [Gov.] Tim Walz, and some voters must believe it, right? Because they keep saying it. So you have this trend that Shefali just described and that you’ve described, Julie, about this sort of attempting to win back trust, as Vance said. And it sounded more moderate, and at the same time as you’re hearing this rhetoric about personhood and execution. So I don’t think the Republicans have yet solved their own whiplash post-Roe.Ìý

Rovner: Meanwhile, the abortion debate is getting mired in the free-speech debate. In Florida, Republican governor Ron DeSantis against TV stations airing an ad in support of the ballot measure that would overturn the state’s six-week abortion ban. That has in turn triggered a rebuke from the head of the Federal Communications Commission warning that political speech is still protected here in the United States. Shefali, this is really kind of out there, isn’t it?Ìý

Luthra: It’s just so fascinating, and it’s really part of a bigger effort by Ron DeSantis to try and leverage anything that he can politically or, frankly, in his capacity as head of the state to try and weaken the campaign for the ballot measure. They have used the health department in other ways to try and send out material suggesting that the campaign’s talking points, which are largely focused on the futility of exceptions to the abortion ban, they’re trying to argue that that is misinformation, and that’s not true. And they’re using the state health department to make that argument, which is something we don’t really see very often, because usually health departments are supposed to be nonpartisan. And what I will say is, in this case, at least to your point, Julie, the FCC has weighed in and said: You can’t do this. You can’t stop a TV station from airing a political ad that was bought and paid for. And the ads haven’t stopped showing at this point. I just heard from family yesterday in Florida who are seeing the ads in question on their TV, and it’s still—Ìý

Rovner: And I will post a link to the ad just so you can see it. It’s about a woman who’s pregnant and had cancer and needed cancer treatment and needed to terminate the pregnancy in order to get the cancer treatment. It said that the exception would not allow her to, which the state says isn’t true and which is clearly one of these things that is debatable. That’s why we’re having a political debate.Ìý

Luthra: Exactly. And one thing that I think is worth adding in here is, I mean, this really intense effort from Governor DeSantis and his administration comes at a time when already this ballot measure faces probably the toughest fight of any abortion rights measure. And we have seen abortion rights win again and again at the ballot, but in Florida you need 60% to pass. And if you look across the country at every abortion rights measure that has been voted on since Roe v. Wade was overturned, only two have cleared 60, and they are in California and they are in Vermont. So these more conservative-leaning states, and Florida is one of them, it’s just, it’s really, really hard to see how you get to that number. And we even saw this week there’s polling that suggests that the campaign has a lot of work to do if they’re hoping to clear that threshold.Ìý

Rovner: And, of course, now they have two hurricanes to deal with, which we will deal with in a few minutes. But first, the Supreme Court is back in session here in Washington, and even though there’s no big abortion case on its official docket as of now this term, the court quickly declined to hear two cases on its first day back, one involving whether the abortion ban in Texas can override the federal emergency treatment law that’s supposed to guarantee abortion access in medical emergencies threatening the pregnant woman’s life or health. The court also declined to overrule the Alabama Supreme Court’s ruling that frozen embryos can be considered legally as unborn children. That’s what Joanne was just talking about. Where do these two decisions leave us? Neither one actually resolved either of these questions, right?Ìý

Luthra: I mean, the EMTALA [Emergency Medical Treatment and Labor Act] question is still ongoing, not because of the Texas case but because of the Idaho case that is asking very similar questions that we’ve talked about previously on this podcast. And the end of last term, the court kicked that back down to the lower courts to continue making its way through. We anticipate it will eventually come back to the Supreme Court. So this is a question that we will, in fact, be hearing on at some point.Ìý

Rovner: Although, the irony here is that in Idaho, the ban is on hold because there was a court stay. And in Texas, the ban is not on hold, even though we’re talking about exactly the same question: Does the federal law overrule the state’s ban?Ìý

Luthra: And what that kind of highlights — right? — is just how much access to abortion, even under states with similar laws or legislatures, really does depend on so many factors, including what circuit court you fall into or the makeup of your state Supreme Court and how judges are appointed or whether they are elected. There is just so much at play that makes access so variable. And I think the other thing that one could speculate that maybe the court didn’t want headlines around reproductive health so soon into an election, but it’s not as if this is an issue that they’re going to be avoiding in the medium- or long-term future. These are questions that are just too pressing, and they will be coming back to the Supreme Court in some form.Ìý

Rovner: Yes, I would say in the IVF [in vitro fertilization] case, they simply basically said, Go away for now. Right?Ìý

Luthra: Yeah. And, I mean, right now in Alabama, people are largely able to get IVF because of the state law that was passed, even if it didn’t touch the substance of that state court’s ruling. This is something, for now, people can sort of think is maybe uninterrupted, even as we all know that the ideological and political groundwork is being laid for a much longer and more intense fight over this.Ìý

Rovner: Well, remember back last week when we predicted that the judge’s decision overturning Georgia’s six-week ban was unlikely to be the last word? Well, sure enough, the Georgia Supreme Court this week overturned the immediate overturning of the ban, which officially went back into effect on Monday. Like these other cases, this one continues, right?Ìý

Luthra: Yes, this continues. The Georgia case continued for a while, and it just sort of underscores again what we’ve been talking about, just how much access really changes back and forth. And I was talking to an abortion clinic provider who has clinics in North Carolina and Georgia. She literally found out about the decision both times and changed her plans for the next day because I texted her asking her for comment. And providers and patients are being tasked with keeping up with so much. And it’s just very, very difficult, because Georgia also has a 24-hour waiting period for abortions, which means that every time the decision around access has changed — and we know it very well could change again as this case progresses — people will have to scramble very quickly. And in Georgia, they have also been trying to do that on top of navigating the fallout of a hurricane.Ìý

Rovner: Yeah. And as we pointed out a couple of weeks ago when the court overturned the North Dakota ban, there are no abortion providers left in North Dakota. Now that there’s no ban, it’s only in theory that abortion is now once again allowed in North Dakota. Well, before we leave abortion for this week, we have two new studies showing how abortion bans are impacting the health care workforce. In one survey, more than half of oncologists, cancer doctors, who were completing their fellowships, so people ready to go into practice, said they would consider the impact of abortion restrictions in their decisions about where to set up their practice. And a third said abortion restrictions hindered their ability to provide care.Ìý

Meanwhile, in Texas by the consulting group Manatt Health found “a significant majority of practicing OB/GYN physicians … believe that the Texas abortion laws have inhibited their ability to provide highest-quality and medically necessary care to their patients,” and that many have already made or are considering making changes to their practice that would “reduce the availability of OB/GYN care in the state.” What’s the anti-abortion reaction to this growing body of evidence that abortion bans are having deleterious effects on the availability of other kinds of health care, too? I mean, I was particularly taken by the oncologists, the idea that you might not be able to get cancer care because cancer doctors are worried about treating pregnant women with cancer.Ìý

Luthra: They’re blaming the doctors. And we saw this in Texas when the Zurawski case was argued and women patients and doctors in the state said that they had not been able to get essential, lifesaving medical care because of the state’s abortion ban and lack of clarity around what was actually permitted. And the state argued, and we have heard this talking point again and again, that actually the doctors are just not willing to do the hard work of practicing medicine and trying to interpret, Well, obviously this qualifies. That’s something we’ve seen in the Florida arguments. They say: Our exceptions are so clear, and if you aren’t able to navigate these exceptions, well, that’s your problem, because you are being risk-averse, and patients should really take this up with their doctors, who are just irresponsible.Ìý

Rovner: Yes, this is obviously an issue that’s going to continue. Well, moving on. The cost of health care continues to grow, which is not really news, but this week we have more hard evidence, courtesy of my KFF colleagues via the annual , which finds the average family premium rose 7% this year to $25,572, with workers contributing an average of $6,296 towards that cost. And that’s with a distinct minority of firms covering two very popular but very expensive medical interventions, GLP-1 [glucagon-like peptide-1] drugs for obesity and IVF, which we’ve just been talking about. Anything else in this survey jump out at anybody?Ìý

Hellmann: I mean, that’s just a massive amount of money. And the employer is really paying the majority of that, but that doesn’t mean it doesn’t have an impact on people. That means it’s going to limit how much your wages go up. And something I thought of when I read this study is these lawsuits that we’re beginning to see, accusing employers of not doing enough to make sure that they’re limiting health care costs. They’re not playing enough of a role in what their benefits look like. They’re kind of outsourcing this to consultants. And so when you look at this data and you see $25,000 they’re spending per year per family on health care premiums, you wonder, what are they doing?Ìý

Health care, yes, it’s obviously very expensive, but you just kind of question, what role are employers actually playing in trying to drive down health care costs? Are they just taking what they get from consultants? And another thing that kind of stood out to me from this is, I think it’s said in there, employers are having a hard time lately of passing these costs on to employees, which is really interesting. It’s because of the tight labor market. But obviously health care is still very expensive for employees — $6,000 a year in premiums for family coverage is not a small amount of money. So employers are just continuing to absorb that, and it does really impact everyone.Ìý

Rovner: It’s funny. Before the Affordable Care Act, it was employers who were sort of driving the, You must do something about the cost of health care, because inflation was so fast. And then, of course, we saw health care inflation, at least, slow down for several years. Now it’s picking up again. Are we going to see employers sort of getting back into this jumping up and down and saying, “We’ve got to do something about health care costs”?Ìý

Hellmann: I feel like we are seeing more of that. You’re beginning to hear more from employers about it. I don’t know. It’s just such a hard issue to solve, and I’ve seen more and more interest from Congress about this, but they really struggle to regulate the commercial market. So …Ìý

Rovner: Yes, as we talk about at length every week. But it’s still important, and they will still go for it. Well, finally, this week in health misinformation. Let us talk about hurricanes — the public health misinformation that’s being spread both about Hurricane Helene that hit the Southeast two weeks ago, and Hurricane Milton that’s exiting Florida even as we are taping this morning. President [Joe] Biden addressed the press yesterday from the White House, calling out former President Trump by name along with Georgia Republican congresswoman Marjorie Taylor Greene for spreading deliberate misinformation that’s not just undermining efforts at storm relief but actually putting people in more danger. Now, I remember Hurricane Katrina and all the criticism that was heaped, mostly deservedly, on George W. Bush and his administration, but I don’t remember deliberate misinformation like this. I mean, Joanne, have you ever seen anything like this? You lived in Florida for a while.Ìý

Kenen: I went through Andrew, and there’s always a certain — there’s confusion and chaos after a big storm. But there’s a difference between stuff being wrong that can be corrected and stuff being intentionally said that then in this sort of divided, suspicious, two-realities world we’re now living in, that’s being repeated and perpetuated and amplified. It damages public health. It damages people economically trying to recover from this disastrous storm or in some cases storms. I don’t know how many people actually believe that Marjorie Taylor asserted that the Democrats are controlling the weather and sending storms to suppress Republican voters. She still has a following, right? But other things …Ìý

Rovner: She still gets reelected.Ìý

Kenen: … being told that if you go to FEMA [the Federal Emergency Management Agency] for help, your property will be confiscated and taken away from you. I mean, that’s all over the place, and it’s not true. Even a number of Republican lawmakers in the affected states have been on social media and making statements on local TV and whatever, saying: This is not true. Please, FEMA is there to help you. Let’s get through this. Stop the lies. A number of Republicans have actually been quite blunt about the misinformation coming from their colleagues and urging their constituents to seek and take the help that’s available.Ìý

This is the public health crisis. We don’t know how many people have been killed. I don’t think we have an accurate total final count from Helene, and we sure don’t have from Milton. I mean, the people did seem to take this storm seriously and evacuated, but it also spawned something like three dozen tornadoes in places where people hadn’t been told, there’s normally no need to evacuate. There’s flooding. It’s a devastating storm. So when people are flooding, power outages, electricity, hard to get access to health care, you can’t refrigerate your insulin. All these—Ìý

Rovner: Toxic floodwaters, I mean, the one thing …Ìý

Kenen: Toxic, yeah.Ìý

Rovner: … we know about hurricanes is that they’re more dangerous in the aftermath than during the actual storm in terms of public health.Ìý

Kenen: Right. This is a life-threatening public health emergency to really millions of people. And misinformation, not just getting something wrong and then trying to correct it, but intentional disinformation, is something we haven’t seen before in a natural disaster. And we’re only going to have more natural disasters. And it was really — I mean, Julie, you already pointed this out — but it was really unusual how precise Biden was yesterday in , and I believe at two different times yesterday. So I heard one, but I think I read about what I think was the second one really saying, laying it at his feet that this is harming people.Ìý

Rovner: Yeah, like I said, I remember Katrina vividly, and that was obviously a really devastating storm. I do also remember Democrats and Republicans, even while they were criticizing the federal government reaction to it, not spreading things that were obviously untrue. All right. Well, that is the news for this week. Now we will play a segment from our Newsmaker interview with Mark Cuban, and then we will be back with our extra credits.Ìý

On Tuesday, October 8th, Mark Cuban met with a group of reporters for a Newsmaker lunch at KFF’s offices in Washington, D.C. Cuban, a billionaire best known as a panelist on the ABC TV show “Shark Tank,” has taken an interest in health policy in the past several years. He’s been consulting with the campaign of Vice President Harris, although he says he’s definitely not interested in a government post if she wins. Cuban started out talking about how, as he sees it, the biggest problem with drug prices in the U.S. is that no one knows what anyone else is paying.Ìý

Mark Cuban: I mean, when I talk to corporations and I’ve tried to explain to them how they’re getting ripped off, the biggest of the biggest said, Well, so-and-so PBM [pharmacy benefit manager] is passing through all of their rebates to us.Ìý

And I’m like: Does that include the subsidiary in Scotland or Japan? Is that where the other one is?Ìý

I don’t know.Ìý

And it doesn’t. By definition, you’re passing through all the rebates with the company you contracted with, but they’re not passing through all the rebates that they get or that they’re keeping in their subsidiary. And so, yeah, I truly, truly believe from there everybody can argue about the best way. Where do you use artificial intelligence? Where do you do this? What’s the EHR [electronic health record? What’s this? We can all argue about best practices there. But without a foundation of information that’s available to everybody, the market’s not efficient and there’s no place to go.Ìý

Rovner: He says his online generic drug marketplace, costplusdrugs.com, is already addressing that problem.Ìý

Cuban: The crazy thing about costplusdrugs.com, the greatest impact we had wasn’t the markup we chose or the way we approach it. It’s publishing our price list. That changed the game more than anything. So when you saw the FTC [Federal Trade Commission] go after the PBMs, they used a lot of our pricing for all the non-insulin stuff. When you saw these articles written by the Times and others, or even better yet, there was research from Vanderbilt, I think it was, that says nine oncology drugs, if they were purchased by Medicare through Cost Plus, would save $3.6 billion. These 15, whatever drugs would save six-point-whatever billion. All because we published our price list, people are starting to realize that things are really out of whack. And so that’s why I put the emphasis on transparency, because whether it’s inside of government or inside companies that self-insure, in particular, they’re going to be able to see. The number one rule of health care contracts, particularly PBM contracts, is you can’t talk about PBM contracts.Ìý

Rovner: Cuban also says that more transparency can address problems in the rest of the health care system, not just for drug prices. Here’s how he responded to a question I asked describing his next big plan for health care.Ìý

We’ve had, obviously, issues with the system being run by the government not very efficiently and being run by the private sector not very efficiently.Ìý

Cuban: Very efficiently, yeah.Ìý

Rovner: And right now we seem to have this sort of working at cross-purposes. If you could design a system from the ground up, which would you let do it? The government or—Ìý

Cuban: I don’t think that’s really the issue. I think the issue is a lack of transparency. And you see that in any organization. The more communication and the more the culture is open and transparent, the more people hold each other responsible. And I think you get fiefdoms in private industry and you get fiefdoms in government, as well, because they know that if no one can see the results of their work, it doesn’t matter. I can say my deal was the best and I did the best and our outcomes are the best, but there’s no way to question it. And so talking to the Harris campaign, it’s like if you introduce transparency, even to the point of requiring PBMs and insurers to publish their contracts publicly, then you start to introduce an efficient market. And once you have an efficient market, then people are better able to make decisions and then you can hold them more accountable.Ìý

And I think that’s going to spill over beyond pharm. We’re working on — it’s not a company — but we’re working on something called Cost Plus Wellness, where we’re eating our own dog food. And it’s not a company that’s going to be a for-profit or even a nonprofit, for that matter, just for the lives that I cover for my companies, that we self-insure. We’re doing direct contracting with providers, and we’re going to publish those contracts. And part and parcel to that is going through the — and I apologize if I’m stumbling here. I haven’t slept in two days, so bear with me. But going through the hierarchy of care and following the money, if you think about when we talk to CFOs and CEOs of providers, one of the things that was stunning to me that I never imagined is the relationship between deductibles for self-insured companies and payers, and the risk associated with collecting those deductibles to providers.Ìý

And I think people don’t really realize the connection there. So whoever does Ann’s care [KFF Chief Communications Officer Ann DeFabio, who was present] — well, Kaiser’s a little bit different, but let’s just say you’re employed at The Washington Post or whoever and you have a $2,500 deductible. And something happens. Your kid breaks their leg and goes to the hospital, and you’re out of market, and it’s out of network. Well, whatever hospital you go to there, you might give your insurance card, but you’re responsible for that first $2,500. And that provider, depending on where it’s located, might have collection — bad debt, rather — of 50% or more.Ìý

So what does that mean in terms of how they have to set their pricing? Obviously, that pricing goes up. So there’s literally a relationship between, particularly on pharmacy, if my company takes a bigger rebate, which in turn means I have a higher deductible because there’s less responsibility for the PBM-slash-insurance company. My higher deductible also means that my sickest employees are the ones paying that deductible, because they’re the ones that have to use it. And my older employees who have ongoing health issues and have chronic illnesses and need medication, they’re paying higher copays. But when they have to go to the hospital with that same deductible, because I took more of a rebate, the hospital is taking more of a credit risk for me. That’s insane. That makes absolutely no sense.Ìý

And so what I’ve said is as part of our wellness program and what we’re doing to — Project Alpo is what we call it, eating our own dog food. What I’ve said is, we’ve gone to the providers and said: Look, we know you’re taking this deductible risk. We’ll pay you cash to eliminate that. But wait, there’s more. We also know that when you go through a typical insurer, even if it’s a self-insured employer using that insurer and you’re just using the insurance company not for insurance services but as a TPA [third-party administrator], the TPA still plays games with the provider, and they underpay them all the time.Ìý

And so what happens as a result of the underpayment is that provider has to have offices and offices full of administrative assistants and lawyers, and they have to not only pay for those people, but they have the associated overhead and burden and the time. And then talking to them, to a big hospital system, they said that’s about 2% of their revenue. So because of that, that’s 2%. Then, wait, there’s more. You have the pre-ops, and you have the TPAs who fight you on the pre-ops. But the downstream economic impacts are enormous because, first, the doctor has to ask for the pre-op. That’s eating doctor’s time, and so they see fewer patients. And then not only does the doctor have to deal with them, they go to HR at the company who self-insures and says, Wait, my employee can’t come to work, because their child is sick, and you won’t approve this process or, whatever, this procedure, because it has to go through this pre-op.Ìý

Or if it’s on medications, it’s you want to go through the step-up process or you want to go through a different utilization because you get more rebates. All these pieces are intertwined, and we don’t look at it holistically. And so what we’re saying with Cost Plus Wellness is, we’re going to do this all in a cash basis. We’re going to trust doctors so that we’re not going to go through a pre-op. Now we’ll trust but verify. So as we go through our population and we look at all of our claims, because we’ll own all of our claims, we’re going to look to see if there are repetitive issues with somebody who’s just trying to —there’s lots of back surgeries or there’s lots of this or there’s lots of that — to see if somebody’s abusing us. And because there’s no deductible, we pay it, and we pay it right when the procedure happens or right when the medication is prescribed. Because of all that, we want Medicare pricing. Nobody’s saying no. And in some cases I’m getting lower than Medicare pricing for primary care stuff.Ìý

Rovner: OK, we are back. Now it’s time for our extra credits. That’s when we each recommend a story we read this week we think you should read too. Don’t worry if you miss the details. We will include the links to all these stories in our show notes on your phone or other device. Joanne, why don’t you go first this week.Ìý

Kenen: There was a fascinating story in The New York Times by Kate Morgan. The headline was “” So I knew nothing about this, and it was so interesting. Placentas have amazing healing properties for wound care, burns, infections, pain control, regenerating skin tissue, just many, many things. And it’s been well known for years, and it’s not widely used. This is a story specifically about a really severe burn victim in a gas explosion and how her face was totally restored. We don’t use this, partly because placenta — every childbirth, there’s a placenta. There are lots of them around. There’s I think three and a half million births a year, or that’s the estimate I read in the Times. One of the reasons they weren’t being used is, during the AIDS crisis, there was some development toward using them, and then the AIDS crisis, there was a fear of contamination and spreading the virus, and it stopped decades later.Ìý

We have a lot more ways of detecting, controlling, figuring out whether something’s contaminated by AIDS or whether a patient has been exposed. It is being used again on a limited basis after C-sections, but it seems to have pretty astonishing — think about all the wound care for just diabetes. I’m not a scientist, but I just looked at the story and said, it seems like a lot of people could be healed quicker and more safely and earlier if this was developed. They’re thrown away now. They’re sent to hospital waste incinerators and biohazard waste. They’re garbage, and they’re actually medicine.Ìý

Rovner: Definitely a scientist’s cool story. Shefali.Ìý

Luthra: My story is from my brilliant colleague Mel Leonor Barclay. The headline is “,” and as part of this really tremendous series that she has running this week, looking at how Latinas as a much more influential and growingly influential voter group could shape gun violence, abortion rights, and housing. And in this story, which I really love, she went to Arizona and spent time talking to folks on all sides of the issue to better understand how Latinas are affected by abortion rights and also how they’ll be voting on this.Ìý

And she really challenges the narrative that has existed for so long, which is that Latinas are largely Catholic, largely more conservative on abortion. And she finds something much more complex, which is that actually polls really show that a large share of Latina voters in Arizona and similar states support abortion rights and will be voting in favor of measures like the Arizona constitutional amendment. But at the same time, there are real divides within the community, and people talk about their faith in a different way and how it connects their stance on abortion. They talk about their relationships with family in different ways, and I think it just underscores how rarely Latina voters are treated with real nuance and care and thoughtfulness when talking about something as complex as abortion and abortion politics. And I really love the way that she approaches this piece.Ìý

Rovner: It was a super-interesting story. Jesse.Ìý

Hellmann: My story is from The Assembly. It’s an outlet in North Carolina. It’s called “.” Some assisted living facilities have been without power and water since the hurricane hit. Several facilities had to evacuate residents, and the story just kind of gets into how North Carolina has more lax rules around emergency preparedness. While they do require nursing homes be prepared to provide backup power, the same requirements don’t apply to assisted living facilities. And it’s because there’s been industry pushback against that because of the cost. But as we see some more of these extreme weather events, it seems like something has to be done. We cannot just allow vulnerable people living in these facilities to go hours and hours without power and water. And I saw that there was a facility where they evacuated dozens of people who had dementia, and that’s just something that’s really upsetting and traumatizing for people.Ìý

Rovner: Yeah, once again, now we are seeing these extreme weather events in places that, unlike Florida and Texas, are not set up and used to extreme weather events. And it is something I think that a lot of people are starting to think about. Well, my story this week is from our Ñî¹óåú´«Ã½Ò•îl Health News public health project called Health Beat, and it’s called “A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly. And it’s one of those stories you never really think about until it’s pointed out that in areas, particularly those that had been redlined, in particular, the lack of safety infrastructure that most of us take for granted — crosswalks, sidewalks, traffic lights are not really there. And that’s a public health crisis of its own, and it’s one that rarely gets addressed, and it’s a really infuriating but a really good story.Ìý

All right, that is our show. Next week, for my birthday, we’re doing a live election preview show here at KFF in D.C., because I have a slightly warped idea of fun. And you’re all invited to join us. I will put a link to the RSVP in the show notes. I am promised there will be cake.Ìý

As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us, too. Thanks as always to our technical guru, Francis Ying, and our fill-in editor this week, Stephanie Stapleton. Also, as always, you can email us your comments or questions. We’re at whatthehealth, all one word, @kff.org, or you can still find me for the moment at X. I’m . Joanne, where are you?Ìý

Kenen: sometimes on Twitter and on Threads.

Rovner: Jessie.

Hellmann: on Twitter.

Rovner: Shefali.

Luthra: on Twitter.

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

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Guinea worms are spread through contaminated drinking water and eating undercooked fish. The female worms, which can be up to 3 feet long once mature, cause incredibly painful, open blisters usually on the infected person’s lower legs and feet — through which the worms emerge. It can take a toll for weeks or months, and sometimes permanently, leaving some people unable to support a family.

If someone with Guinea worm has contact with water — perhaps to cool the burning pain caused by a worm’s emergence — the worm may release tens of thousands of baby worms, contaminating the whole body of water.

The effort to end this disease did not rely on high-tech methods. “Guinea worm disease has no cure, no vaccination, basically the entire eradication effort is built on behavior change,” said Kelly Callahan, a public health worker who spent years fighting Guinea worm disease in southern Sudan with the Carter Center, the charity the ex-president and his wife created in partnership with Emory University.

That has meant teaching people in vulnerable areas to filter their water and giving them the low-cost tools to do so.

Other strategies include providing access to safe water supplies, better detection of human and animal cases, cleaning and bandaging wounds, preventing infected people and animals from wading into water, and using larvicide to kill the worms.

Because of Carter, the world has come incredibly close to wiping out Guinea worm.

“I would like to see Guinea worm completely eradicated before I die,” Carter said at a press conference in 2015. “I’d like for the last Guinea worm to die before I do. I think right now we have 11 cases. We started out with 3.6 million cases.”

It did look as if the last Guinea worm was going to die before the 39th U.S. president. Then, a few years ago, scientists discovered that the parasite was spreading among stray dogs in Chad — and that baboons in Ethiopia were also carrying the parasite. This long-overlooked reservoir of the worms was a setback for the global eradication program and showed that killing the last Guinea worm would be harder than previously thought.

What’s more, as the number of cases has dwindled, new challenges have emerged. In 2018, Guinea worm disease was , a country not known to have had cases in the past.

As a result, in 2019 the World Health Organization pushed back its expected eradication date for the disease a full decade — from 2020 to 2030.

Researchers are now looking for a treatment for infected dogs, and public health workers have turned to new interventions, like paying people to report infected animals. Nonetheless, Carter’s campaign has been remarkably successful.

In an interview with NPR in 2015, Carter recalled the origins of his crusade. Carter’s former drug czar, Peter Borne, was working on a U.N. initiative called the “Freshwater Decade.” Borne came to the Carter Center to talk about overlooked diseases spread by “drinking bad water.” One of them was Guinea worm.

“The main reason [Borne] came to the Carter Center was because he couldn’t get anyone else to tackle this problem,” Carter recalled. “It’s a despicable disease. And it was in such remote villages that no one wanted to take on the task. So, we decided to take it on.” That was in 1986.

Dr. Paul Farmer, the founder of Partners in Health and a champion of global health causes who died last year, spoke to NPR in 2019 about Carter’s efforts. Farmer said the former president deserves much of the credit for pushing Guinea worm to the brink of extinction.

Smallpox, Farmer said, is “the only human disease [that’s] ever been eradicated. And if … Guinea worm is right behind, that’s going to be thanks to Carter. I mean, there were millions of cases when he got involved … after his presidency in the mid-’80s. And now we are down to fewer than a hundred last year.” In 2022, the Carter Center reported, there were only 13 recorded human cases of the disease, a provisional number that will be officially confirmed, likely this month.

“When you take on a problem like this, like Guinea worm, you have to sweet-talk the ministry officials, the political figures, the nurses, the doctors, the community activists, the farmers, the people who are … most at risk. Carter’s had to sweet-talk all those people. And that’s something that’s been very inspiring to many of us,” Farmer said.

, adjunct professor of medicine at the University of Maryland School of Medicine, agrees that Carter’s advocacy has helped governments and public health agencies around the world stay focused on eradicating Guinea worm disease. , too, investing about $500 million since 1986.

“I think we should be optimistic that it is achievable,” said Plowe. “I think we shouldn’t be overly optimistic about how quick it’s gonna be.”

Guinea worm was just one of the targets of Carter’s war. Onchocerciasis, also known as , has been eliminated from most of the Americas and dramatically reduced in Africa due to the work of Carter and the Carter Center. Major inroads have also been made against other neglected diseases including which causes horrific swelling of the legs and genitals.

Those who know Carter well said it was his upbringing in an impoverished part of the South that left him with a strong sense of self-reliance and self-sacrifice, and a duty to help others.

Born in Plains, Georgia, in 1924, he stayed close to his roots, returning home after his Navy career to run the family’s peanut farm. Church was a central part of his life in Plains — he taught Sunday school there into his 90s — and friends said his Christian faith drove him.

“He did what he did out of a love for mankind,” said , a co-founder of Habitat for Humanity, which has counted Jimmy and Rosalynn Carter among their many volunteers, hammering nails by day and sleeping in bunk beds by night. The Carters worked on Habitat projects in 14 countries.

In February, Carter entered hospice care, forgoing additional medical treatment to extend his life. But his death will not mean the end of his work. In a statement, the Carter Center has pledged to continue the fight to wipe out Guinea worm.

When the disease does come to an end, it will become one of Carter’s signature achievements — an extraordinary accomplishment that reflects a simple yet profound tenet of his personal philosophy: “to try to help one another instead of being willing to go to war with one another.”

This article is from a partnership that includes and KHN.

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Click here for a transcript of the episode.

The federal government finally addressed the infant formula shortage, as a growing number of families found themselves without anything to feed their babies. But it will likely take weeks for any effects of the federal action to be felt, while infants must be fed daily.

Meanwhile, a third of the nation is experiencing covid-19 activity that justifies expanding preventive measures, but public health and elected officials appear loath to ask the public to return to anything that might be deemed inconvenient.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Tami Luhby of CNN, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

• Thousands of parents around the country are reeling as they face a dire shortage of infant formula, and the administration is trying to find workarounds to restore supplies. Even before formula maker Abbott closed a key manufacturing plant in Michigan in February, distribution problems and shortages had been seen in parts of the country. Manufacturing is highly concentrated among a small number of companies.
• Still, only in recent weeks did the administration or Congress take high-profile steps to help families feed their babies. That slow response has brought searing criticism. But, at least on Capitol Hill, the hesitation to react may reflect a demographic that is older, male, well-off, and not likely affected closely by the shortages.
• Covid cases and hospitalizations are on the rise, and some officials are warning that the public needs to return to masking and testing to stay safe. However, a return to mandates does not appear likely despite assurances from public health authorities months ago that if new surges threatened the country, requirements would be reinstituted.
• Despite widespread suspicions that the Biden administration might announce this month that the public health emergency will end in July, no end date has been given. Officials have pledged they will provide a 60-day notice before ending the emergency to allow states to prepare. Some analysts suggest the emergency may continue after the midterm elections and not end until the year is over.
• One of the biggest impacts of a continuing public health emergency is that states receive additional federal Medicaid funds and cannot push any enrollees off the health insurance program for low-income people. Enrollment has swelled during the pandemic, raising state costs for their share of the program. Some conservative states are considering whether they would be better off paring their Medicaid rolls and forsaking those pandemic relief funds from the federal government.
• As the country awaits a final abortion decision from the Supreme Court, abortion-rights groups are looking at possible strategies if the justices overturn the 49-year Roe v. Wade decision that guaranteed access to abortion across the country. They are looking at states that may have protections in their individual constitutions, using arguments in court that limiting abortion impinges on some groups’ religious freedoms, and boosting the number of health care professionals who can provide early abortions.

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

Julie Rovner: Fortune and KHN’s “,” by Michelle Andrews

Alice Miranda Ollstein: JAMA Health Forum’s “,” by David Cutler

Rachel Cohrs: ProPublica’s “,” by Anjeanette Damon

Tami Luhby: KHN’s “States Have Yet to Spend Hundreds of Millions of Federal Dollars to Tackle Covid Health Disparities,” by Phil Galewitz, Lauren Weber, and Sam Whitehead

Also discussed on this week’s podcast:

The New York Times’ “’” by Catherine Pearson

CNN’s “,” by Tami Luhby

Politico’s “,” by Alice Miranda Ollstein and Laura Barrón-López

Politico’s “,” by Alice Miranda Ollstein and Megan Messerly

The Atlantic’s “,” by Ed Yong

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A federal court judge in Florida said the Centers for Disease Control and Prevention had overstepped its authority in requiring masks on public transportation, a mandate that legal experts considered well within the bounds of the agency’s charge to prevent the spread of covid-19 across the nation.

The CDC said late Wednesday that it had asked the Department of Justice to appeal the decision — a move the DOJ left up to the agency. That will put the issue before one of the nation’s most conservative-leaning appellate courts, the 11th U.S. Circuit Court of Appeals.

Public health experts worry the ruling, unless overturned, will hamper the agency’s ability to respond to future outbreaks.

“If CDC can’t impose an unintrusive requirement to wear a mask to prevent a virus from going state to state, then it literally has no power to do anything,” said public health law expert , faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.

The outcome of the appeal will shape what the agency does the next time an outbreak occurs. And the ongoing debate highlights a civics lesson: The U.S. gives most responsibility for public health measures to states. The federal role has been more limited but could be further clarified by Congress.

“Congress has authority to pass a law,” said , executive vice president at the State Policy Network, a coalition of mainly conservative and libertarian groups. “If they think the CDC does not have enough power, give them more. If they think it has too much, they should curtail it.”

But the case also comes as Congress — and the country — remains sharply divided over just about everything having to do with covid, so passing any kind of legislation could prove impossible. That leaves the courts to interpret what is already on the books.

The latest case, filed in Florida by a group opposed to medical mandates, centers on a federal law called the Public Health Service Act of 1944. The law gives federal officials the to prevent the spread of communicable diseases. Those could include “inspection, fumigation, disinfection, sanitation” and other measures that in its “judgment may be necessary.”

Judge Kathryn Kimball Mizelle, a Trump administration appointee to the U.S. District Court for the Middle District of Florida, ruled Monday that the CDC had exceeded its authority under that law. A large section of discusses whether masks meet the definition of a “sanitation” measure.

Federal judges are often called to consider whether a federal administrative action meets statutory requirements. Mizelle’s ruling, while giving a nod to the importance of controlling the covid epidemic, said that wearing a mask “cleans nothing” and at most only “traps virus droplets,” concluding that it “neither ‘sanitizes’ the person wearing the mask nor ‘sanitizes’ the conveyance.”

It isn’t the first time during the pandemic that the CDC has had its authority questioned. The agency suffered a blow last year when the Supreme Court said it by imposing an eviction ban during the pandemic.

, with the conservative American Legislative Exchange Council policy group, sees connections between the eviction and mask mandate cases. “The CDC used its authority or at least argued that its authority should extend to much more broad public health emergency responses than was actually granted,” he said.ÌýThe recent ruling, Hauenschild argued, simply offers further definition of the powers the CDC and local jurisdictions have — even during an emergency.

“What this case does is it kind of establishes a baseline that says, ‘We’re going to keep the public health authorities to their statutory grant of authority,” he said. “That’s an important distinction because state legislatures or even Congress have weighed the policy implications. They’ve realized there’s a balance here.”

Other legal experts say this case is a bit different because the CDC’s authority over interstate travel is more clear-cut than any power it might have over rental units. “The transportation mask mandate was a textbook example of CDC’s mandate and its legitimate powers,” Gostin said.

Meanwhile, the requirement to wear masks on planes, trains, and subways is on hold — and major airlines wasted no time in telling domestic passengers they can take them off.

States, not the federal government’s CDC, have the broadest authority over public health efforts to control disease. Their public health agencies, or elected officials, have a range of authorities, including the ability to require masks in schools or businesses. Governors can issue stay-at-home orders during public health emergencies. And health departments routinely track outbreaks of communicable diseases and inspect restaurants for pathogens or vermin.

But states don’t have authority over interstate commercial flights.

“Public health is primarily governed at the local level, but the minute a disease crosses a state line or crosses our national borders, then the federal government has a role,” said Dr. , executive director of the American Public Health Association.

The pandemic has caused even state authority to be questioned. Backlashes to local mask mandates and other requirements have prompted more than half of states to roll back public health officials’ powers.

“One day there will be a really scary virus that will come to the shores of the U.S. and we will look to the CDC to protect us and what we’ll find is an agency that is frightened to act, gun-shy, and always looking over its shoulder,” Gostin said.

He and other public health experts said it might also be time for Congress to review and clarify the agency’s authority.

“Traditionally, CDC’s got very little power,” said , co-director of the Center for Health and Risk Communication at the University of Georgia. He spent more than a decade working in communications at the CDC, including during the 2009 H1N1 flu pandemic.

“Most of what CDC does really is about, ‘Here’s our recommendation — we strongly urge you to comply,’” he said. “And then it’s up to typically state and local health departments or states in general to figure out how you’re going to achieve high compliance.”

But such recommendations rely on trust in agencies, something that has cratered during the pandemic. And, said Nowak, public health measures at all levels — federal, state, and local — have landed in court, in part because of misperceptions about how willing the American public would be to comply. “A lot of it was based on assumptions about compliance — that there would be high compliance by the public, that they would share the sense of urgency, and would place a high priority on stopping the spread of a virus,” Nowak said.

The American Public Health Association’s Benjamin said there’s little time to waste. He said the reason public health officials need established lines of authority is because public health emergencies — whether that’s the emergence of a new variant of covid-19 or some future pandemic — require quick action.

“We will not have time to fool around with the courts making a decision,” he said.

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