番茄社区

In this Instagram Live interview, 番茄社区 editor-in-chief Jeremy Faust, MD, and Anand Parekh, MD, MPH, of the Bipartisan Policy Center in Washington, D.C., discuss the upcoming election and what the results could mean for our healthcare system.

The following is a transcript of their remarks:

Faust: Let's actually go right to it and get to probably the most divisive issue which is reproductive care and abortion rights and women's issues. Tell me where the bipartisan light is on that.

Parekh: It's hard. There's not a lot of light, and Vice President Harris wants to ensure, if she's elected, she wants to codify Roe v. Wade through Congress. It's going to be hard to do, but that is her focus.

President Trump wants to -- he's not talking about a national ban anymore, but he certainly seems fine letting the states go at it. And over 40 states have some restrictions on abortion. At least over a dozen have severe restrictions, and so that is absolutely a big divide.

There are also some questions related to what the executive branch could do under a Trump versus Harris administration. There are other ways to restrict access to reproductive health services, such as abortion -- look at mifepristone -- which is the most common medication used for medication abortions, which are about two-thirds of abortions in this country. FDA could change their stances on that and their issues related to family planning clinics.

Then finally, Jeremy, from a state perspective there are 10 states where abortion reproductive health services are on the ballot, including swing states like Arizona and Nevada. Since the Dobbs decision to overturn Roe v. Wade, seven states have had referendums, all seven have enshrined reproductive health choices of abortion in their constitution. So seven out of seven, we'll see how these other 10 states do on Tuesday.

Faust: In terms of one area which I would think would be bipartisan but I'm not sure it is, relates to this which is , that's the Emergency Medicine Treatment and [Labor] Act, a 1984 Reagan administration era law that says that hospitals have to take everybody.

I'm an ER doctor; we have to see everybody and stabilize them, life and limb and pain. But EMTALA sort of has entered the conversation because it's a place where some of these issues come into conflict with one another, right? So you have somebody whose life may be in danger, but you don't know if it's today or tomorrow. And abortion might be definitive care to keep them safe. EMTALA is a law that both sides support, is that correct?

Parekh: It is. It's a federal law. And it's been in the news lately because of a that made it up to the Supreme Court.

The issue here is does EMTALA, as a federal law, trump state laws regarding restrictions on abortion care. And so this is playing out, Jeremy, in states across the country. And I think exactly as you said, as physicians and clinicians we have been trained as morally we believe we need to do everything that we can to take care of the patients in front of us and to save lives.

And so this is playing out in states across the country -- tremendous legal ramifications. And I suspect the courts will continue to take a look at this and maybe it might go back to the Supreme Court, so we're just going to have to wait and see. Traditionally this should absolutely, you're right, be a bipartisan issue.

Faust: One more thing about this issue before we maybe pivot to another direction, which is what you said a moment ago about Vice President Harris' sort of view and agenda on this. She said that she wants to codify Roe into law, and you aptly said 'Good luck,' because that requires legislation in a very, very polarized world. Not only polarized, there are just different views on this. And the Supreme Court has basically made it fair play to talk about.

So she's running on that, but what can she really do? Right? She can't do that. I'm almost certain she can't, and if she can, she'll sign it. But what can she do if she's president to sort of push back against some of the post-Dobbs efforts that have been against what that side wants?

Parekh: Yeah, yeah. Very difficult to do anything in Congress. States will likely continue leading on this, and that's unfortunately somewhat chaotic. The legal system will continue to be involved.

As I said, I think the executive branch regardless of who wins will have influence as to the access of -- mifepristone is one example at FDA, funding of Title 10 family planning clinics is another example. So I think there are executive branch actions that can support choice or further restrict choice, and I think that's where you'll see the differentiation between administrations.

Faust: Okay. And do you think that the Supreme Court is likely to decide these cases on the merits or on the politics?

Parekh: Jeremy, that probably depends on your opinion of the Supreme Court. I think we all want it on the legal merits and want to give the benefit of the doubt to the Supreme Court. I think we've seen the politicization of this issue like many, many other healthcare and public health issues increase. So I think we're just going to have to wait and see.

Faust: Alright, let's talk about healthcare reform and really access to care and affordability. It's interesting to me that the Affordable Care Act [ACA] is now no longer called Obamacare. People like it now, like they call it the Affordable Care Act. I think that's a that maybe the former President [Obama] himself made.

And there are certain things that are very popular. Nobody really wants to threaten this idea of taking away coverage for people with preexisting conditions. But it seems to be in the last Trump administration, they certainly did try.

Famously or infamously, former President Trump said [at a debate] '' Do you have any idea what he would do on this issue on ACA and access in general were he to be reelected?

Parekh: Yeah. Very difficult to predict there, I think you'd have to go back to his first term to see what he did. He certainly didn't support marketing and outreach of the current ACA exchanges. I think his administration looked to try to increase choice and try to make what are called short-term plans or association plans up to 12 months become more prevalent in that. But those plans don't necessarily have to cover preexisting conditions, for example, so they're not as robust.

Faust: Can you say more about that? Because I don't think that people, including myself, really know that nook. And also, why can it actually not cover preexisting conditions?

For more, watch the full video interview above.

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