Latest / Paging America / ICE, Medicaid, and the New Attack on Health Care Privacy

Transcript

ICE, Medicaid, and the New Attack on Health Care Privacy · Paging America

0:14
SPEAKER_01: Hello, everybody.
0:15
SPEAKER_01: Welcome back to Paging America,
0:17
where we explore the power of profit and politics shaping
0:20
American healthcare and
0:20
SPEAKER_01: what you can do about it.
0:21
SPEAKER_01: I'm your host, Myles Baker, along with Dr. Rob Davidson.
0:24
SPEAKER_01: Dr. Rob, how are you doing today?
0:25
SPEAKER_01: Where are you?
0:26
SPEAKER_01: I'm here.
0:26
I'm here in West Michigan,
0:28
sweltering with everybody else here in the Midwest.
0:30
SPEAKER_01: How are you doing today, Myles?
0:31
SPEAKER_01: I'm pretty good.
0:33
SPEAKER_01: I am on the precipice of my summer vacation out in Vancouver,
0:37
SPEAKER_01: British Columbia,
0:38
SPEAKER_01: and it is not nearly as hot.
0:40
SPEAKER_01: As it was in Chicago when I left.
0:42
SPEAKER_01: I left Chicago.
0:43
SPEAKER_01: It was so hot on the way to the airport.
0:44
SPEAKER_01: I thought, is this thing going to even get off the ground?
0:46
SPEAKER_01: Yeah, yeah, yeah.
0:47
SPEAKER_01: But, no, we're out in Vancouver, and it's just quite a bit nicer.
0:53
SPEAKER_01: So excited.
0:54
Any interesting conversations with our friends north of the
0:56
border on what's going
0:57
SPEAKER_02: on here over the last six months?
0:59
SPEAKER_02: Or just kind of, oh, wow.
1:00
SPEAKER_01: You know, I'll tell you the most interesting thing that's happened.
1:04
SPEAKER_01: I've only been here a day.
1:05
SPEAKER_01: But when I go to Canada,
1:07
I get put in a different category of people and I get
1:11
interrogated every time I
1:12
SPEAKER_01: cross the border.
1:13
SPEAKER_01: And that has been true since 2012.
1:15
SPEAKER_01: So this is the sixth time that that has happened.
1:17
SPEAKER_01: Now,
1:18
this is the first time as we were going through immigration
1:20
that I got a little,
1:22
SPEAKER_01: they give you a little printout.
1:24
SPEAKER_01: It's very high tech.
1:24
SPEAKER_01: I mean, very nice airport in Vancouver.
1:27
SPEAKER_01: And everyone's had just a number on it.
1:30
SPEAKER_01: And mine had a big W on it that no one else had.
1:33
SPEAKER_01: And I pointed to my wife.
1:35
SPEAKER_01: I said, I think this W means I'm going to have to go in a different line.
1:38
SPEAKER_01: And as soon as I get up there,
1:40
SPEAKER_01: they look,
1:41
SPEAKER_01: they point at the W and they say,
1:42
SPEAKER_01: you got to go over there.
1:43
SPEAKER_01: So I walk over to the,
1:44
SPEAKER_01: I walk over the immigration enforcement person and they're having nice,
1:48
SPEAKER_01: a lot less sinister on the Canadian side.
1:50
SPEAKER_01: I'll just say it's like aesthetically.
1:53
SPEAKER_01: And I get up there and I say,
1:54
SPEAKER_01: and she goes,
1:55
SPEAKER_01: you know,
1:56
SPEAKER_01: starts asking us the questions that we already answered on the computer.
1:59
And then her last question was,
2:00
have you ever had a problem at customs in Canada?
2:05
and i said well in fact i have in 2012 in the city of detroit i
2:09
took a wrong turn
2:11
which takes you onto the ambassador bridge and sends you to the
2:14
other and you can't
2:15
turn around on the ambassador bridge so it sends you all the
2:18
way to canada and when
2:19
i got to the canadian side they're like where is your passport
2:22
and i said i'm just
2:23
trying to go to work i don't have my passport and they're like
2:26
we're gonna search
2:27
SPEAKER_01: your whole car
2:28
SPEAKER_01: And you worked in Detroit.
2:30
SPEAKER_01: I worked in Detroit, right?
2:31
SPEAKER_01: I was just trying to go across Detroit.
2:32
SPEAKER_01: And so every time I've gone to Canada,
2:34
SPEAKER_01: ever since,
2:34
SPEAKER_01: including yesterday,
2:36
SPEAKER_01: I get put in a different category.
2:38
SPEAKER_01: Now,
2:38
SPEAKER_01: the funniest thing was the letter on the thing was a W.
2:40
SPEAKER_01: I told that whole story to the immigration person on the Canadian side.
2:43
And I said,
2:44
hey,
2:45
can you tell me what the W stands for so I know why I'm
2:48
flagged?
2:48
SPEAKER_01: And she looked at me and she goes...
2:50
SPEAKER_01: Wrong turn.
2:50
SPEAKER_01: She was just making fun of me.
2:54
SPEAKER_02: That's great.
2:55
SPEAKER_02: That's great.
2:56
SPEAKER_02: Well, I tell you what, it's weird.
2:57
SPEAKER_02: I grew up in the Detroit area.
2:58
SPEAKER_02: And so it's very interesting being so close to an international border.
3:02
SPEAKER_02: The only place where you head south to go into Canada from the U.S.
3:06
SPEAKER_02: I don't know, man.
3:06
SPEAKER_02: When I was 19 years old, we used to go to Canada.
3:09
I won't say exactly why a bunch of 19 year olds from from Metro
3:13
Detroit would be
3:13
SPEAKER_02: going to Canada when they're home from college.
3:15
SPEAKER_02: We know.
3:16
But I did have an interesting conversation with Canadian
3:19
immigration at the border
3:21
SPEAKER_02: up in New Brunswick.
3:22
SPEAKER_02: I was doing some local work up in a town,
3:25
SPEAKER_02: Machias,
3:25
SPEAKER_02: Maine,
3:26
SPEAKER_02: about 40 miles from the border of New Brunswick.
3:29
SPEAKER_02: And I just was going across because I'd never been to New Brunswick.
3:32
SPEAKER_02: I had a day off in between shifts.
3:34
SPEAKER_02: And there was a little fast food joint there,
3:37
SPEAKER_02: the pita pit that I said,
3:38
SPEAKER_02: hey,
3:38
SPEAKER_02: that sounds interesting.
3:39
SPEAKER_02: I'm going to get a pita.
3:41
SPEAKER_02: And she asked, so what brings you to New Brunswick?
3:42
SPEAKER_02: I said, well, I'm just going to go to the pita pit.
3:44
SPEAKER_02: She said, well.
3:45
SPEAKER_02: You drove all the way to Canada to do that?
3:47
SPEAKER_02: I said, well, I've never been to New Brunswick.
3:48
SPEAKER_02: I just wanted to check it out.
3:49
SPEAKER_02: And she looks, she says, well, there's not much except for the Peter pit.
3:52
SPEAKER_02: I said, okay, well, then I guess I'll be seeing you in about an hour.
3:55
Sure enough,
3:56
I drove back across the border an hour,
3:57
waved to that same person.
3:59
But I think she just looked at me like,
4:01
is there something more to this guy's story?
4:03
SPEAKER_02: No, just a little jaunt into New Brunswick because I've never been there.
4:06
SPEAKER_02: You want to check it off on your map.
4:07
SPEAKER_02: Yeah.
4:08
SPEAKER_02: Well, good.
4:09
SPEAKER_02: Well, I'm glad you got into Canada.
4:11
SPEAKER_02: Knock on wood.
4:12
The activities of this podcast don't preclude you from coming
4:15
back from Canada.
4:16
SPEAKER_02: I don't think we're quite there yet, but I don't know, Miles.
4:20
SPEAKER_00: I don't know.
4:21
SPEAKER_00: No, no, no.
4:22
SPEAKER_00: We'll see.
4:22
SPEAKER_00: Yeah.
4:23
SPEAKER_01: Well, yeah.
4:23
SPEAKER_01: And then, yeah.
4:25
SPEAKER_01: So we're going to – we'll get into the headlines here.
4:26
SPEAKER_01: We have a great guest.
4:29
SPEAKER_01: Kim Lewis,
4:29
SPEAKER_01: who comes to us from the National Health Law Program,
4:32
to talk to us a little bit about the details and the legal
4:35
frameworks surrounding
4:36
SPEAKER_01: HHS sharing Medicaid data with ICE.
4:39
And so we're going to get into that on the back half of the
4:42
show,
4:42
so stick around for that.
4:43
SPEAKER_02: Absolutely.
4:44
SPEAKER_01: Yeah.
4:44
SPEAKER_01: So, okay, Rob, we got a lot of news today.
4:47
I think the first thing,
4:50
you know,
4:50
every day is new fallout from the One Big Beautiful Bill Act.
4:54
SPEAKER_01: We have a new study published by JAMA Health Forum titled,
4:57
SPEAKER_01: Did Health System and Economic Impacts of 2025 Medicaid Policy Proposes.
5:02
SPEAKER_01: Pretty boring title for a pretty wild outcome.
5:06
SPEAKER_01: Basically,
5:06
it shows there'd be nearly 1,500 unnecessary deaths in the US
5:10
each year because of
5:10
SPEAKER_01: the cuts to Medicaid.
5:12
SPEAKER_01: But it's not just talking about deaths.
5:14
EBO projections suggest 7.6 million individuals would become
5:17
uninsured by 2035 or
5:20
SPEAKER_01: 2034 with 1,484 excess deaths and 94,000 preventable hospitalizations.
5:26
SPEAKER_01: That is the number that just shocks my brain,
5:29
is 94,000 preventable hospitalizations as an outcome of the One
5:34
Big Beautiful Bill
5:35
SPEAKER_01: Act.
5:36
SPEAKER_01: It seems like we're getting,
5:37
SPEAKER_01: Rob,
5:37
SPEAKER_01: it seems like we're getting like all sorts of different numbers,
5:39
which at least kind of says to me that people are like doing
5:43
the best they can with
5:44
imperfect information on what something so large is going to
5:47
have such a wild
5:48
SPEAKER_01: impact on the American healthcare system.
5:49
SPEAKER_01: What are you, how are you thinking about it?
5:51
Yeah,
5:51
I mean,
5:51
they're building these models to predict outcomes over a
5:53
decade,
5:54
right?
5:54
SPEAKER_02: And so if you have a little,
5:55
SPEAKER_02: you know,
5:57
if your vector is off or if you're off by just a few points
5:59
here or there,
6:00
SPEAKER_02: as you get out to 10 years,
6:02
SPEAKER_02: it's a pretty big scatterplot of the impact.
6:04
SPEAKER_02: I think the bottom line is it's a significant impact.
6:07
There is a lot of data going back decades now looking at the
6:12
negative health
6:12
SPEAKER_02: consequences of not having insurance.
6:14
SPEAKER_02: Yeah.
6:15
SPEAKER_02: Right.
6:15
SPEAKER_02: People who have insurance overall have healthier lives.
6:19
If we have a Maha HHS secretary named Maha president making
6:23
America healthy again,
6:24
and then they're all kind of lining up to take health insurance
6:27
away from seven
6:29
SPEAKER_02: million,
6:29
SPEAKER_02: 10 million,
6:30
SPEAKER_02: 15 million.
6:31
I mean,
6:31
with the ACA subsidies at risk,
6:33
you know,
6:33
we're now up to 12 or 14 million.
6:35
SPEAKER_02: Like when we do that, it
6:39
necessarily because the way the system is built,
6:42
there will be worse health outcomes.
6:43
SPEAKER_02: And so at a time when hospitals are overcrowded,
6:47
SPEAKER_02: where ERs are overcrowded,
6:48
SPEAKER_02: we have a hospital about a half hour from us.
6:50
SPEAKER_02: It's in a different county.
6:52
And our year-over-year county numbers are up like 70% because
6:56
this hospital is so crowded.
6:58
They are routinely holding over half of their ER beds are
7:02
patients being held
7:03
SPEAKER_02: waiting for a bed to be opened up in the hospital to get admitted.
7:06
SPEAKER_02: So when patients go there,
7:07
they're actually putting up partitions in their waiting room to
7:12
move people through
7:13
to give the illusion of the fact that patients are getting real
7:16
care when they're
7:17
just being shuttled from partition to partition still in a
7:20
waiting room on average
7:22
SPEAKER_02: five or six hours.
7:23
Now,
7:23
I know people in L.A.,
7:24
people in big cities will say,
7:26
yeah,
7:26
that's been the case.
7:27
And it has been like overcrowding and patients waiting to be
7:30
admitted is a problem,
7:31
SPEAKER_02: has been a problem.
7:32
If you're now adding 100,000 people getting admitted to the
7:35
hospital to the system
7:36
SPEAKER_02: that's already broken,
7:38
SPEAKER_02: and it's a problem that was created,
7:41
SPEAKER_02: right?
7:42
SPEAKER_02: It didn't just happen.
7:43
SPEAKER_02: It didn't just happen because people are – I mean,
7:45
SPEAKER_02: the population is getting older,
7:47
SPEAKER_02: people in general requiring more health care,
7:49
SPEAKER_02: sometimes more inpatient care because of that.
7:51
SPEAKER_02: This is a manufactured problem, right?
7:54
SPEAKER_02: The party, the Republican Party and Donald Trump created the problem.
7:58
SPEAKER_02: And that to me is the most kind of bizarre,
8:00
SPEAKER_02: shocking part of all of this,
8:02
that it isn't just a report on what's happening because this is
8:05
the demographics of
8:06
SPEAKER_02: what's happening in America.
8:08
SPEAKER_02: It's that these guys did this.
8:10
SPEAKER_02: It's crazy.
8:11
And well,
8:11
this all gets me to sort of the bad actors,
8:14
bad players in all of this.
8:15
SPEAKER_02: Certainly the folks voting for these cuts are...
8:20
SPEAKER_02: But the hypocrites,
8:21
SPEAKER_02: and I'm thinking of a guy,
8:22
SPEAKER_02: Missouri Senator Josh Hawley,
8:24
SPEAKER_02: spent a lot of airtime railing against Medicaid cuts.
8:27
SPEAKER_02: And now he was not going to vote for November.
8:29
SPEAKER_02: And he voted for it, right?
8:30
SPEAKER_02: He voted for the Medicaid cuts.
8:31
SPEAKER_02: Now,
8:32
SPEAKER_02: Josh Hawley,
8:33
SPEAKER_02: Senator Hawley,
8:33
SPEAKER_02: has introduced legislation to scale back all those Medicaid cuts.
8:37
SPEAKER_02: It has no path, right?
8:38
SPEAKER_02: It's a press release.
8:39
SPEAKER_02: It's like all of Donald Trump's executive orders with his...
8:42
SPEAKER_02: his signature and the big pomp and circumstance, it's a press release.
8:46
SPEAKER_02: It's a thing for him to say,
8:47
SPEAKER_02: look what I'm trying to do,
8:49
SPEAKER_02: trying to gloss over the fact that the guy just,
8:51
SPEAKER_02: and because it was a 50-50 vote,
8:53
SPEAKER_02: he alone could have stopped that bill,
8:55
SPEAKER_02: right?
8:56
SPEAKER_02: It's amazing to me that they think people are that stupid,
8:59
SPEAKER_02: that they're just going to forget what they did a couple weeks earlier.
9:02
SPEAKER_02: Right.
9:03
SPEAKER_01: It's like for the uninitiated,
9:06
when you propose a piece of legislation that you know has no
9:11
chance in hell of even
9:13
SPEAKER_01: getting a vote,
9:14
SPEAKER_01: it's called a message bill.
9:16
SPEAKER_01: And so when Josh Hawley...
9:17
When Josh Hawley is out there pretending he's trying to modify
9:21
the cuts to Medicaid
9:23
because his state is going to become a failed state where
9:25
they're going to have to
9:26
SPEAKER_01: make choices between closing schools,
9:27
not rebuilding roads because their Medicaid expansion is locked
9:31
into the state
9:31
SPEAKER_01: constitution.
9:36
He's doing this so when your car has its axle snap in half or
9:41
when your kid has to
9:42
SPEAKER_01: get on a different bus and go 45 extra minutes to get to grammar school,
9:46
SPEAKER_01: like Josh Hawley can say,
9:48
SPEAKER_01: like,
9:48
SPEAKER_01: I worked against that.
9:49
SPEAKER_01: Don't believe him.
9:50
Your busted car,
9:51
your shitty school is because Josh Hawley defunded Medicaid.
9:57
SPEAKER_02: Message bills do not help you fix your axle.
10:00
SPEAKER_02: They do not help that.
10:01
SPEAKER_00: Right.
10:02
that's exactly right so kudos to you josh ollie doing doing
10:06
incredible work over
10:07
there um all right uh and what we're gonna and and what our
10:10
guest today is going to
10:11
be talking about and helping us understand um with it more
10:13
depth be the ap trump
10:15
administration has handed over medicaid recipients personal
10:18
data including
10:19
SPEAKER_01: addresses and possibly including hipaa non-compliant like
10:24
SPEAKER_01: categories of care.
10:25
SPEAKER_01: We don't know.
10:26
SPEAKER_01: We haven't seen the file, right?
10:28
SPEAKER_01: But they've handed over Medicaid recipients' personal data over to ICE.
10:32
SPEAKER_01: Just a little background.
10:33
Lawmakers and some CMS officials have challenged the legality
10:36
of deportation
10:37
SPEAKER_01: officials' access to some state's Medicaid enrollee data.
10:40
It's a move first reported by the AP last month that health and
10:43
human services
10:44
officials said was aimed at rooting out people enrolled in the
10:47
programs improperly.
10:49
SPEAKER_01: ICE in the agreement,
10:50
ICE will use CMS data to allow ICE to receive identity and
10:54
location information of,
10:56
SPEAKER_01: and I'm quoting here,
10:57
SPEAKER_01: aliens identified by ICE.
10:59
And we've said this phrase before,
11:00
and I'm just gonna say it as clearly as possible.
11:02
SPEAKER_01: Is this anything,
11:03
can you call this anything other than using Medicaid data to go
11:08
hunting people that
11:09
SPEAKER_01: you want to deport?
11:11
SPEAKER_01: Like that is the project of the HHS today.
11:15
SPEAKER_02: Yeah, I mean, it's a breach of contract, right?
11:20
It's a breach of contract between states and the federal
11:22
government and sharing
11:23
SPEAKER_02: data between patients,
11:25
SPEAKER_02: right?
11:25
Individuals who seek these services who are assured that their
11:29
privacy will be
11:29
SPEAKER_02: maintained,
11:30
SPEAKER_02: that it will only be shared for purposes of determining eligibility,
11:34
SPEAKER_02: right?
11:34
And determining eligibility when you have the cost sharing
11:36
between the federal
11:37
SPEAKER_02: government and the states,
11:38
SPEAKER_02: who pays for what.
11:39
SPEAKER_02: Like, that's what people have been told.
11:41
SPEAKER_02: That's what they sign off on.
11:43
SPEAKER_02: And then when they're handing it over and letting ICE kind of run wild,
11:46
SPEAKER_02: now with ICE being,
11:47
SPEAKER_02: what,
11:48
SPEAKER_02: the third largest budget of any military,
11:50
SPEAKER_02: essentially,
11:51
SPEAKER_02: you know,
11:51
SPEAKER_02: bigger than militaries of all these nations,
11:54
SPEAKER_02: right,
11:54
SPEAKER_02: with the...
11:55
SPEAKER_01: Yeah,
11:56
SPEAKER_01: and it's certainly going to be bigger than the FBI,
11:58
SPEAKER_01: the CIA,
11:58
SPEAKER_01: and the NSA is our understanding that the ICE budget is going to be.
12:03
They talk about – this is the thing that gets me really fired
12:06
up is they can't
12:08
SPEAKER_01: actually – in the current funding of ICE,
12:10
SPEAKER_01: my understanding is they cannot hire that many ICE.
12:12
There's a cap on how many they hire because they just don't get
12:15
enough qualified applicants.
12:17
SPEAKER_01: who can meet all the requirements.
12:19
SPEAKER_01: ICE has this way lower,
12:21
SPEAKER_01: like a way lower threshold than an FBI agent who needs a master's degree,
12:26
SPEAKER_01: like a terminal degree and all this other stuff,
12:28
SPEAKER_01: or a CIA agent.
12:29
You don't have to be nearly as qualified,
12:31
but you do have to meet minimal quality standards.
12:36
SPEAKER_01: If you're scaling up really fast, adding ICE agents there,
12:39
SPEAKER_01: What you're essentially doing is,
12:41
SPEAKER_01: by definition,
12:42
SPEAKER_01: you're taking less qualified people,
12:44
SPEAKER_01: giving them enforcement powers,
12:46
SPEAKER_01: and then handing them healthcare roles and say,
12:48
SPEAKER_01: have at it,
12:49
SPEAKER_01: chief.
12:50
SPEAKER_01: That feels like it could have such a pernicious,
12:54
SPEAKER_01: just bad on the enforcement side and make enforcement worse,
12:57
SPEAKER_01: and then bad on the healthcare side and make healthcare worse.
13:00
SPEAKER_02: Right, right.
13:01
SPEAKER_02: We talked to Kim a little bit about this in the interview,
13:03
SPEAKER_02: but I think it bears some discussion of the chilling effect.
13:07
So when this filters into communities of immigrants here with
13:13
proper documentation,
13:14
SPEAKER_02: here across the board,
13:16
it kind of steers people away from trusting going to the
13:20
doctor's office or the
13:20
SPEAKER_02: clinic or the hospital,
13:22
SPEAKER_02: right?
13:22
SPEAKER_02: Right.
13:22
SPEAKER_02: Rightfully are questioning.
13:24
SPEAKER_02: I don't know if I want to avail myself.
13:26
I mean,
13:26
emergency Medicaid is there for folks who get hospitalized who
13:29
don't have insurance.
13:30
SPEAKER_02: And we don't ask people's immigration status.
13:32
SPEAKER_02: But if they if they get admitted and they have a big,
13:35
SPEAKER_02: you know,
13:35
SPEAKER_02: big bill,
13:35
SPEAKER_02: they have a heart attack,
13:36
SPEAKER_02: they have surgery,
13:37
SPEAKER_02: you know,
13:37
tens of hundreds or hundreds of thousands of dollars that they
13:40
can't afford.
13:40
And now that and now medical debt could be counted against you
13:44
on your credit
13:44
SPEAKER_02: report,
13:45
thanks to a right wing judge in Texas and probably going to be
13:49
upheld by the
13:50
SPEAKER_02: Supreme Court.
13:50
SPEAKER_02: You know, that just makes people stay home.
13:53
SPEAKER_02: And again,
13:53
SPEAKER_02: it's bad enough,
13:54
SPEAKER_02: like they're taking away people's health insurance,
13:56
but then they're also providing these barriers to an entire
13:59
group of people wanting
14:01
SPEAKER_02: to even seek care.
14:02
SPEAKER_02: And to me,
14:03
SPEAKER_02: I mean,
14:03
SPEAKER_02: that's personally offensive as a physician,
14:05
SPEAKER_02: you know,
14:06
SPEAKER_02: because again,
14:06
SPEAKER_02: we take this oath,
14:07
SPEAKER_02: right,
14:07
SPEAKER_02: to do no harm and to take care of the people in our community.
14:11
And when those people are avoiding coming to see us because of
14:15
this breach of trust,
14:17
SPEAKER_02: from our federal government, it's really sad.
14:20
There have been reports that HHS,
14:22
like,
14:23
workers and officials oppose this.
14:25
SPEAKER_02: And then Secretary Kennedy, right?
14:28
SPEAKER_02: The brain worm told him he should do it, and he did it, right?
14:30
SPEAKER_02: The brain worm in charge again.
14:32
SPEAKER_01: The power-hungry brain worm.
14:34
SPEAKER_01: The power-hungry brain worm.
14:38
SPEAKER_01: Yeah, I mean, like, right.
14:39
SPEAKER_01: I mean, this is incredible.
14:40
SPEAKER_01: Like,
14:40
SPEAKER_01: this guy,
14:41
SPEAKER_01: this guy is literally like,
14:42
is like breaking down the integrity of the healthcare system
14:45
because he really
14:46
SPEAKER_01: wants Fanta soda to be like a little lighter orange.
14:49
SPEAKER_01: He obviously has this, like, yeah, it's totally bizarre.
14:53
SPEAKER_01: It's like sometimes,
14:54
SPEAKER_01: you know,
14:54
it's like you got to remind yourself it's about making money
14:56
and it's about power.
14:58
Because if you let the things they say they want to do that are
15:01
obvious lies and
15:02
SPEAKER_01: like trickery for their maha base,
15:04
SPEAKER_01: if you like let that creep into the brain,
15:07
SPEAKER_01: the things they're doing are so not proportional to try to achieve those
15:11
SPEAKER_01: objectives.
15:12
SPEAKER_01: He's doing this to stay in Trump's good graces, right?
15:15
They're breaking down the silos between HHS and ICE so he can
15:20
curry favor with Dear
15:21
SPEAKER_01: Leader to go accomplish the things he wants to accomplish.
15:23
But like that's not getting rid of food dye because that would
15:28
be a preposterous tradeoff.
15:29
SPEAKER_01: Right.
15:30
SPEAKER_02: Right, right, right, right.
15:31
SPEAKER_02: Yeah,
15:32
SPEAKER_02: it defies logic,
15:33
SPEAKER_02: but that's presupposing there's any logical consideration of any of this,
15:37
SPEAKER_02: right?
15:38
SPEAKER_02: This is about power, right?
15:39
SPEAKER_02: It's about having power.
15:40
SPEAKER_02: It's about political power for Trump getting the Maha movement.
15:43
SPEAKER_02: It's about political power for RFK Jr., maybe running for president.
15:46
I saw something about his PAC,
15:49
a PAC that has supported him kind of being active again.
15:52
So is that,
15:53
I don't know,
15:53
is that the next iteration of Naga,
15:56
Maha amalgamation is RFK Jr.?
15:58
?
15:59
I don't think RFK is going to be able to run for president
16:02
because he is like,
16:03
SPEAKER_01: one,
16:03
SPEAKER_01: he's a little bit older.
16:04
SPEAKER_01: And two, I don't know.
16:06
SPEAKER_01: It just seems like he's flying a little too close to the sun,
16:09
a little too early in the Trump presidency to be putting
16:14
serious battlements
16:15
SPEAKER_01: together to go try to run for president.
16:17
It seems like the Trump folks might clip his wings pretty fast
16:20
on that one.
16:21
SPEAKER_01: Yeah.
16:21
SPEAKER_01: Right, right, right.
16:22
SPEAKER_01: Yeah, but I did read the news.
16:23
SPEAKER_01: It would make sense on what the motivations were if he was thinking,
16:28
SPEAKER_01: I'll just position myself to take a run at the president.
16:31
And normally,
16:32
if you want to take back it,
16:33
you'd say,
16:34
oh,
16:34
good,
16:34
bring him on,
16:34
right?
16:35
SPEAKER_02: Bring him on.
16:35
SPEAKER_02: We can take this guy.
16:36
SPEAKER_02: I don't know.
16:38
SPEAKER_02: It would be terrifying to have a guy like him be the nominee and have,
16:42
SPEAKER_02: you know,
16:42
SPEAKER_02: nowadays,
16:43
SPEAKER_02: it's almost like a coin flip,
16:44
SPEAKER_01: right?
16:44
SPEAKER_01: Yeah.
16:45
SPEAKER_01: Yeah.
16:45
SPEAKER_01: Well,
16:45
SPEAKER_01: I don't think,
16:46
SPEAKER_01: you know,
16:46
SPEAKER_01: I wonder,
16:47
SPEAKER_01: you know,
16:47
SPEAKER_01: as we saw,
16:48
SPEAKER_01: almost anything can happen in presidential politics.
16:50
So you just don't want to have the kookiest people of which I
16:53
can consider RFK a
16:54
card-carrying member of anywhere close to the process of
16:57
getting to the presidency.
17:00
SPEAKER_01: That's way too scary.
17:01
SPEAKER_01: We obviously, the current guy's pretty damn scary, though.
17:04
SPEAKER_01: So we'll take this one at a time.
17:05
SPEAKER_02: Yeah, I mean, we've been there, right?
17:07
SPEAKER_02: In 2016, we were all saying that, oh, good, he's the nominee.
17:10
SPEAKER_02: This guy can't win.
17:12
SPEAKER_02: And here we are in 2.0.
17:13
SPEAKER_01: I love the other Hucksters that participate in his Maha Pack events.
17:18
Include Russell Brand,
17:20
like sex pest,
17:22
violent,
17:23
drug addict,
17:24
Russell Brand.
17:25
SPEAKER_01: Here we go.
17:26
SPEAKER_01: And then we got like no quote motivational speaker.
17:29
SPEAKER_01: I would say like Huckster extraordinaire, Tony Robbins.
17:33
These are the guys that are like these people who sort of get
17:36
these niche set of
17:37
SPEAKER_01: followers regardless of their bad or weird behavior.
17:40
SPEAKER_01: And he sort of parades them out.
17:42
SPEAKER_01: It's so weird.
17:43
SPEAKER_01: Maybe we'll go to a – you want to go to a Maha Pack event,
17:47
SPEAKER_01: Rob,
17:47
SPEAKER_01: and just check out the scene and see who's hanging out?
17:50
SPEAKER_02: There is nothing I want to do less, Miles.
17:52
SPEAKER_02: Nothing I want to do less.
17:54
SPEAKER_02: You're welcome to go and report back.
17:56
SPEAKER_02: We can FaceTime or we can get on a Zoom while you're there,
17:59
and then we can see what's up because I don't want to be
18:02
anywhere near that.
18:03
SPEAKER_00: I think it's too bad and weird.
18:05
SPEAKER_02: I kept something.
18:05
SPEAKER_02: You got a bunch of unvaccinated people hanging out.
18:08
SPEAKER_00: Yeah, I'm not going –
18:09
right maybe they'll have a zoom event yeah yeah yeah i would
18:14
not be in that crowd
18:16
that's so funny yeah that that makes a lot of sense i don't
18:19
want to be in that
18:19
crowd either okay so moving on we can move on from the maha
18:23
pack more and more more
18:25
updates on the maha pack as as we learn as we learn about how
18:28
it's positioning
18:29
SPEAKER_01: itself relative to the the midterms and beyond
18:32
SPEAKER_01: So we have an update on sort of the ongoing fights around Mifepristone.
18:37
The Washington Post reports that West Virginia's near-total
18:40
abortion ban will be
18:41
SPEAKER_01: upheld by a federal court.
18:42
A divided federal appeals court on Tuesday allowed West
18:45
Virginia to restrict access
18:46
SPEAKER_01: to Mifepristone,
18:47
SPEAKER_01: the pill used to end pregnancies that has...
18:49
SPEAKER_01: emerged as a focal point of legal battles over abortion.
18:52
The decision marks the first time a federal appeals court has
18:54
allowed a state to
18:55
SPEAKER_01: strictly limit the drug,
18:56
teeing up a key test of state's powers to ban medication that
19:00
is broadly or
19:02
SPEAKER_01: specifically approved by the Food and Drug Administration.
19:04
SPEAKER_01: So this feels like part of a larger right-wing strategy to go,
19:10
SPEAKER_01: you know,
19:10
SPEAKER_01: they've gone after abortion in lots of different forms,
19:14
but then there's a very specific and focused effort to attack
19:17
medication abortions.
19:18
SPEAKER_02: Yeah, I mean, again, it's chilling, right?
19:21
SPEAKER_02: Again, we got to keep saying these are Trump abortion bans, right?
19:25
The Supreme Court,
19:26
when they said,
19:27
leave it to the states,
19:28
and Trump just kept parodying this.
19:30
SPEAKER_02: It's beautiful.
19:31
SPEAKER_02: It's up to the states.
19:32
SPEAKER_02: There's no ban.
19:33
When you leave it up to the states,
19:34
this is what you get in a lot of the states,
19:36
unfortunately.
19:37
SPEAKER_02: I think West Virginia is also the place now they want to not let you have
19:40
SPEAKER_02: mifepristone,
19:41
SPEAKER_02: but I believe it's one of the states,
19:42
or at least they've got legislation introduced to make
19:45
ivermectin over the counter.
19:46
SPEAKER_02: So heaven forbid,
19:47
SPEAKER_02: you know,
19:47
people cannot be without their ivermectin to treat non-diseases
19:51
that don't respond
19:52
SPEAKER_02: to ivermectin.
19:53
SPEAKER_02: But, you know, so anyway, we see where their priorities are.
19:56
Yeah,
19:56
I mean,
19:56
I think we have still a lot of work to do on this extremely
19:59
safe drug.
20:01
And Mifepristone is under attack,
20:03
not just within state abortion bans,
20:05
right?
20:05
SPEAKER_02: The federal government is still coming after Mifepristone.
20:07
And I think all of us as advocates need to be aware and need to
20:12
be ready for that
20:13
SPEAKER_02: fight because that fight's coming.
20:15
SPEAKER_02: Right.
20:16
SPEAKER_01: The thing that scares me about the Memphis Pristone fight,
20:18
SPEAKER_01: because so much of it is under the FDA's purview,
20:20
SPEAKER_01: is that Kennedy,
20:21
SPEAKER_01: especially if Kennedy's thinking about running,
20:23
SPEAKER_01: I don't think Kennedy is going to be able to run for president.
20:26
But if he thinks he's going to be able to run for president,
20:28
that might still motivate him.
20:30
SPEAKER_01: And if Kennedy is going to run for president,
20:32
SPEAKER_01: you could see him trying to take sort of dramatic and showy action.
20:37
Because he was pro-abortion so recently that if he's going to
20:40
run inside the
20:41
SPEAKER_01: Republican Party,
20:42
SPEAKER_01: he's going to have to establish anti-abortion,
20:44
SPEAKER_01: anti-choice,
20:45
SPEAKER_01: bona fides in some way.
20:46
SPEAKER_01: I hope this is not the route.
20:48
That would be – Yeah,
20:49
but he doesn't give a shit about what's good for people or not.
20:52
SPEAKER_02: He just doesn't, right?
20:54
SPEAKER_02: So of course this will be the route.
20:55
SPEAKER_02: He doesn't care.
20:56
He doesn't care what his firmly held beliefs were a year and a
20:59
half ago or a year ago.
21:00
SPEAKER_02: I mean that's –
21:02
SPEAKER_02: It's opportunism.
21:03
SPEAKER_02: It's opportunism.
21:05
SPEAKER_02: They find out the niche they have to.
21:06
SPEAKER_02: I mean, Trump was pro-choice right back in the day.
21:09
SPEAKER_02: And then the guy appointed the Supreme Court that took it all away.
21:12
SPEAKER_02: So these guys don't have any kind of moral compass.
21:14
They just kind of go with wherever they think the base they're
21:17
trying to attract will be.
21:18
And he's trying to have that intersection of,
21:20
you know,
21:21
cane,
21:21
sugar and soda.
21:22
SPEAKER_02: No, no dyes.
21:24
SPEAKER_02: And also no miffy.
21:25
I guess there's a there's a constituency that he thinks is out
21:28
there for that.
21:29
SPEAKER_02: And he's going to unfortunately tap into it.
21:31
Yeah,
21:31
he was also,
21:32
he was recently bragging about how he got rid of the dyes
21:35
already.
21:35
SPEAKER_01: I don't know.
21:35
I've seen bright orange Fanta in store shelves yesterday,
21:39
like at the airport.
21:40
SPEAKER_01: I saw bright orange Fanta.
21:42
SPEAKER_01: The dyes are still there, brother.
21:45
SPEAKER_02: It's so hard, right?
21:46
Because I don't want to sit here and argue on the side of
21:48
artificial dyes.
21:49
SPEAKER_02: Like, sure.
21:50
SPEAKER_02: Fanta could be clear.
21:51
SPEAKER_02: If it tastes the same, it tastes the same.
21:53
SPEAKER_02: Great.
21:53
SPEAKER_01: I don't really get it.
21:55
SPEAKER_01: That's fine.
21:55
SPEAKER_01: It's like cloudy Fanta.
21:56
SPEAKER_01: It's like a cloudy, it's kind of, yeah.
21:59
SPEAKER_00: Yeah.
22:00
SPEAKER_02: It's whatever.
22:00
SPEAKER_02: Anyway, it's whatever.
22:03
SPEAKER_02: To argue that this is somehow going to make people healthy,
22:05
take away health care on one side and then get rid of the dyes
22:08
and somehow that
22:09
SPEAKER_02: balance is going to play out that people will be more healthy.
22:12
SPEAKER_02: It's insane.
22:13
SPEAKER_02: It's insane.
22:14
And that he is allowed to continue to say these things and to
22:18
parrot this without
22:19
SPEAKER_02: being challenged.
22:20
I mean,
22:20
he's obviously just goes in front of press and media that won't
22:24
challenge him.
22:24
SPEAKER_02: So he never has to actually answer for it.
22:26
And Trump doesn't give a shit as long as the Maha voters will
22:29
stay on his side.
22:30
And he's got so much damn trouble with Epstein and losing his
22:33
extreme MAGA base.
22:35
SPEAKER_02: He's got to keep the coalition as much as he can in support of him.
22:38
SPEAKER_02: Someone's got to buy Trump phones,
22:40
SPEAKER_02: you know,
22:40
SPEAKER_02: so they got to keep that coalition together as much as they can.
22:43
SPEAKER_01: All right.
22:44
SPEAKER_01: Well, Rob, what do you think?
22:45
SPEAKER_01: Should we take a little pause and then we'll head over?
22:48
Our guest today is Kim Lewis,
22:50
who works at the National Health Law Program.
22:52
SPEAKER_01: She's going to help us understand Medicaid data at a deeper level.
22:56
SPEAKER_02: Let's get to it.
22:59
SPEAKER_01: All right.
23:00
SPEAKER_01: Welcome back, everybody.
23:01
SPEAKER_01: Today on the show, we want to welcome Kim Lewis.
23:04
Kimberly Lewis is the Managing Director of the California
23:07
Advocacy and Practice
23:08
SPEAKER_01: Area and Managing Director at the National Health Law Program.
23:11
SPEAKER_01: Kim works on state and national health care issues,
23:13
SPEAKER_01: including Medicaid and health reform implementation,
23:16
SPEAKER_01: by engaging in policy and administrative advocacy,
23:18
SPEAKER_01: impact litigation,
23:19
SPEAKER_01: and technical assistance and training to state advocates.
23:23
SPEAKER_01: Kim, welcome to the show.
23:24
SPEAKER_01: Where do we find you today?
23:26
SPEAKER_03: I'm in Los Angeles, California, but it's great to be with you all.
23:29
SPEAKER_01: So can I,
23:30
SPEAKER_01: you know,
23:30
the reason why we wanted to have a have a conversation today is
23:34
we continue to read
23:35
SPEAKER_01: news about the agreement between ICE and CMS,
23:39
SPEAKER_01: where CMS is forking over its data to ICE,
23:42
SPEAKER_01: including identity information.
23:44
So ICE can identify those folks that are on the Medicaid rolls
23:47
potentially to go do
23:49
SPEAKER_01: customs or customs integration enforcement against those folks.
23:53
SPEAKER_01: Do you know anything about the history of this?
23:54
Historically,
23:55
why hasn't HHS shared data with ICE,
23:59
with Customs Enforcement?
24:00
SPEAKER_03: Well, it's a great question.
24:02
So before I answer that,
24:04
I'd love to provide some context for kind of the environment
24:06
we're in.
24:07
This is a part of an overall federal administrative strategy to
24:11
attack the health
24:11
SPEAKER_03: care axis for immigrants in this country.
24:13
SPEAKER_03: many of whom are lawfully present or a critical part of the U.S.
24:17
SPEAKER_03: workforce and pay taxes.
24:18
They're weaponizing personal and private health care
24:21
information and further
24:22
SPEAKER_03: immigration enforcement,
24:23
SPEAKER_03: something we're about to talk about.
24:25
They're rolling back immigrant eligibility for Medicaid and
24:28
Medicare and Affordable
24:30
Care Act coverage in the marketplaces through the recent
24:33
Republican enacted
24:34
SPEAKER_03: reconciliation bill called OBBBA.
24:37
And they're just enacted a federal rule that reinterprets the
24:41
meaning of a
24:42
A 1996 welfare law that makes non-citizens who are not
24:46
qualified immigrants
24:47
SPEAKER_03: ineligible for a broader array of health and human services programs,
24:51
including community health clinics and community behavioral
24:53
health clinics.
24:54
SPEAKER_03: Title 10 family program.
24:56
SPEAKER_03: So this is really an overall,
24:58
SPEAKER_03: I think,
24:59
SPEAKER_03: concern we have about what's happening,
25:01
SPEAKER_03: especially to immigrants today in this environment.
25:04
SPEAKER_03: But it's also important,
25:05
SPEAKER_03: I think,
25:06
SPEAKER_03: to answer the question about this agreement that came to light,
25:09
SPEAKER_03: I think,
25:09
through the AP article in June about the essentially Department
25:14
of Healthcare
25:14
SPEAKER_03: Services,
25:15
which is the department that CMS or Center for Medicare and
25:19
Medicaid Services lives
25:20
SPEAKER_03: within,
25:21
SPEAKER_03: having an agreement to share information with the Department of
25:24
Homeland Security or ICE agencies,
25:26
so they could use this for enforcement.
25:29
SPEAKER_03: But the practice of sharing information between states and CMS has been,
25:33
SPEAKER_03: up until this administration,
25:35
SPEAKER_03: a pretty normal practice.
25:37
SPEAKER_03: All states share data with CMS as longstanding routine practice.
25:41
They submit monthly reports to CMS through what's called the
25:44
Transformed Medicaid
25:46
SPEAKER_03: Statistical Information System,
25:47
SPEAKER_03: or TMSIS.
25:48
SPEAKER_03: These reports include demographic and eligibility information,
25:52
SPEAKER_03: such as names and addresses,
25:54
SPEAKER_03: date of birth,
25:55
SPEAKER_03: social security number provided,
25:57
eligibility status for every Medicaid member enrolled in the
26:00
federally authorized
26:01
SPEAKER_03: program.
26:02
SPEAKER_03: And states routinely provide CMS with reports and data information.
26:07
SPEAKER_03: For federal oversight purposes.
26:09
SPEAKER_03: So,
26:09
SPEAKER_03: for example,
26:09
SPEAKER_03: California submits quarterly expenditure reports and data,
26:13
which is an account of the state's actual recorded expenditures
26:17
and the disposition
26:18
of federal dollars and monthly eligibility determinations and
26:22
enrollment reports
26:23
SPEAKER_03: and data,
26:23
which reflect the state's enrollment activity for all
26:26
populations receiving
26:27
SPEAKER_03: Medicaid benefits.
26:28
as a part of their program performance as well so states
26:32
confirm applicants
26:33
immigrant eligibility via a cms data services hub called save
26:39
or the systemic
26:40
SPEAKER_03: verification of alien entitlement system which is
26:43
DHS is the Department of Homeland Security Central Repository
26:47
for biographic
26:48
citizenship immigration status information for all individuals
26:51
in the U.S.
26:52
And they save response to these verification requests by
26:55
confirming applicants'
26:56
SPEAKER_03: immigrant status.
26:57
SPEAKER_03: This includes whether the applicant's lawfully present,
26:59
SPEAKER_03: qualified citizen,
27:00
SPEAKER_03: or non-naturalized citizen.
27:01
They check the information was saved to ensure that states are
27:04
enrolling eligible
27:05
SPEAKER_03: applicants for full-scope Medicaid,
27:08
SPEAKER_03: which is,
27:09
SPEAKER_03: you know,
27:09
SPEAKER_03: the full Medicaid program.
27:11
SPEAKER_03: that people can be found eligible for.
27:13
So federal law also exempts non-citizens from applying or
27:17
receiving Medicaid for
27:18
SPEAKER_03: treatment for emergency services.
27:20
SPEAKER_03: So if you're seeking emergency Medicaid,
27:22
SPEAKER_03: it's called emergency Medicaid,
27:23
SPEAKER_03: you don't have to provide your social security number or documentation of
27:27
SPEAKER_03: immigration or citizenship status,
27:29
but federal Medicaid dollars are available for that as a
27:33
specifically designed
27:34
to cover medical care for individuals who experience medical
27:38
emergencies or don't
27:39
SPEAKER_03: qualify for regular Medicaid due to immigration status.
27:42
SPEAKER_03: So that includes pregnancy, labor and delivery, et cetera.
27:45
SPEAKER_03: But these have been longstanding agreements to secure the privacy of this
27:50
SPEAKER_03: information between the state and CMS.
27:53
SPEAKER_03: That's pursuant to applicable federal laws and regulations.
27:58
SPEAKER_03: And these agreements have responsibilities on both sides.
28:00
SPEAKER_03: to be able to ensure protection of that information.
28:04
And CMS promises even on its own privacy policy and website
28:07
that information won't
28:08
be used or shared other than for people who need to know and
28:12
that they'll inform
28:13
people before they collect information and that they will use
28:16
it only for that
28:17
SPEAKER_03: purpose.
28:17
SPEAKER_03: So that's really the backdrop of this.
28:20
And states like California have promised the same thing to get
28:24
people to apply.
28:25
SPEAKER_03: We're only using this information
28:27
SPEAKER_03: To protect your privacy and to ensure you get health care.
28:31
SPEAKER_03: That's the purpose.
28:31
SPEAKER_01: So,
28:32
SPEAKER_01: Kim,
28:32
and so in the long time you've been thinking about with the
28:35
sort of federal
28:36
guarantee of not sharing that data and the state guarantee of
28:39
not sharing that
28:40
SPEAKER_01: data,
28:40
there has not been an instance you know of where HHS and a
28:43
previous administration,
28:44
SPEAKER_01: Republican or Democrat,
28:46
SPEAKER_01: has shared that information with customs enforcement.
28:49
SPEAKER_03: No, not that we're aware of.
28:50
SPEAKER_03: I mean, this is really unprecedented.
28:52
SPEAKER_03: Even I think the first Trump administration, this did not occur.
28:55
So this is a very recent kind of change in longstanding policy,
29:00
I would say.
29:01
And so as someone who's sort of thought about the intersection
29:03
of health and law
29:04
SPEAKER_01: for a long time,
29:05
what's the thing that gives you the most pause or you're the
29:08
most worried about the
29:09
SPEAKER_01: precedent that this agreement sets?
29:11
SPEAKER_03: Well,
29:12
SPEAKER_03: I mean,
29:12
most concerning is the privacy of individuals' health
29:16
information and the reliance
29:19
SPEAKER_03: that they have for a longstanding time placed in Medicaid,
29:23
SPEAKER_03: particularly by government health insurance,
29:25
SPEAKER_03: as a way to get health care in this country.
29:28
SPEAKER_03: And that is protected,
29:29
SPEAKER_03: you know,
29:29
that that is the purpose of what this information is for and
29:32
that we are only using
29:34
SPEAKER_03: this information for your benefit to get you health insurance.
29:36
SPEAKER_03: That should be the only purpose.
29:38
SPEAKER_03: And so this really change in approach to
29:41
SPEAKER_03: is going to substantially,
29:43
SPEAKER_03: I think,
29:44
SPEAKER_03: have a chilling effect,
29:45
which we can talk about on exactly what people will feel they
29:50
can access in this
29:51
SPEAKER_03: country when it comes to health care services.
29:53
SPEAKER_03: Are they going to be afraid to sign up for Medicaid or Medicare?
29:56
SPEAKER_03: or the Affordable Care Act marketplace coverage,
29:59
because they don't think now that their information will be
30:02
used simply for health
30:03
SPEAKER_03: care,
30:03
SPEAKER_03: but for other purposes.
30:05
SPEAKER_02: And Kim,
30:05
SPEAKER_02: something you said,
30:07
I've seen discussion online about people's private health care
30:09
information,
30:10
SPEAKER_02: and I've seen HIPAA invoked.
30:11
I don't think HIPAA necessarily applies because these aren't
30:14
people providing care
30:15
SPEAKER_02: to them,
30:15
but is it something akin to HIPAA where there is actual
30:18
personal medical data that
30:20
SPEAKER_02: could potentially be shared?
30:22
Reason for people's visits or when they visited the doctor or
30:24
hospital or what have you?
30:25
SPEAKER_03: No,
30:26
I don't think we know what information was shared with DHS
30:30
other than that they
30:31
SPEAKER_03: could be sharing information.
30:33
SPEAKER_03: I mentioned the TMSIS system,
30:35
which is a data claims reimbursement system that where every
30:39
single service that's
30:41
covered by Medicaid could be submitted to CMS for purposes of
30:45
getting federal
30:46
SPEAKER_03: matching funds and making sure that those
30:49
SPEAKER_03: services are ones that they're obligated to pay for.
30:51
So I think there's a lot of information that is available in
30:55
the system to be exploited.
30:57
SPEAKER_03: I'll say it that way.
30:58
SPEAKER_03: But do we think that that's what was shared with ICE?
31:01
SPEAKER_03: I don't know.
31:02
SPEAKER_03: I think it's information, obviously, to locate people.
31:05
SPEAKER_03: That is primarily the motivation.
31:08
SPEAKER_03: But
31:08
SPEAKER_03: Again,
31:09
SPEAKER_03: I'm not,
31:09
SPEAKER_03: you know,
31:09
SPEAKER_03: the administration,
31:10
so I can't say what they're using it for exactly and who's
31:13
getting access to what
31:14
SPEAKER_03: services.
31:15
But we see that there's a precedent for sharing data in this
31:18
administration.
31:19
So I think it's fair to say there'd be concerns that it
31:22
wouldn't be just limited to
31:23
SPEAKER_03: name and phone number.
31:25
I know in the health care delivery space,
31:27
I mean,
31:28
the guardrails around HIPAA are so tight.
31:31
SPEAKER_02: I mean,
31:31
I've seen fellow staff members and workers at the hospital be
31:35
relieved of their
31:35
duties for sort of even having a monitor facing the wrong way
31:40
where someone could
31:41
SPEAKER_02: actually see someone's.
31:42
SPEAKER_02: information on a chart,
31:43
SPEAKER_02: something like that,
31:44
or posting photos that sort of tangentially in the background
31:47
might have had
31:48
SPEAKER_02: something that could have been just a patient identifier.
31:51
SPEAKER_02: So something like this where massive swaths of data,
31:53
it does worry you if there's really no actual agreement on what
31:57
can or can't be
31:58
SPEAKER_02: shared.
31:59
And then it's just big chunks of data are being transferred
32:02
from one department to the next.
32:03
SPEAKER_02: I think the concerns,
32:04
SPEAKER_02: I think,
32:05
SPEAKER_02: beyond the immigration enforcement piece,
32:07
I think certainly for health care providers and patients alike
32:09
should be a concern.
32:11
SPEAKER_03: Yeah,
32:11
SPEAKER_03: I mean,
32:11
I can talk a little bit about the legal implications and the
32:15
violation potentially
32:16
SPEAKER_03: of Medicaid statutes or privacy laws.
32:18
SPEAKER_03: I think
32:18
SPEAKER_03: That's really what you're getting at.
32:20
SPEAKER_03: And while we haven't filed legal action on this specific,
32:24
SPEAKER_03: what we call data breach,
32:26
SPEAKER_03: the states have.
32:27
There's 20 states,
32:28
including California,
32:29
who filed a lawsuit against HHS over this data breach.
32:31
SPEAKER_03: And they've alleged all types of violations of federal law,
32:35
SPEAKER_03: including HIPAA,
32:36
SPEAKER_03: which you mentioned,
32:37
as well as Medicaid law that has well-established regulations
32:41
that prioritize
32:42
SPEAKER_03: confidentiality and limitations on
32:44
disclosure of this type of data and HHS previously many many
32:48
years ago instructed
32:50
states that releasing this information to a federal immigration
32:53
agency regarding
32:54
the receipt of Medicaid benefits was not connected to the
32:56
administration of the
32:57
Medicaid state plan so they've already long ago instructed
33:00
states they couldn't do
33:01
this so how they could say that they themselves are allowed to
33:04
do it is beyond
33:05
SPEAKER_03: real reason here.
33:06
So privacy laws like HIPAA and other laws that are protecting
33:11
privacy have been
33:13
SPEAKER_03: alleged and are part of a lawsuit that there will be a hearing on,
33:18
SPEAKER_03: I think,
33:19
SPEAKER_03: in August,
33:20
SPEAKER_03: August 28th,
33:21
SPEAKER_03: actually.
33:21
SPEAKER_03: So hopefully we'll get some clarity from the court,
33:24
SPEAKER_03: the federal court on that case when that decision is made.
33:28
Yeah.
33:29
SPEAKER_01: You know,
33:29
SPEAKER_01: one of the things I was reading about,
33:32
it was some reporting from The Atlantic was about how when
33:35
unaccompanied minors
33:36
SPEAKER_01: make it into the United States,
33:38
regardless of their immigration status or if they have an
33:40
immigration status that
33:41
SPEAKER_01: is in question,
33:42
SPEAKER_01: that they are quickly routed into HHS to keep them sort of out of ice,
33:47
that there's a special disposition because the thought was that
33:51
HHS has a very
33:53
SPEAKER_01: different objective,
33:55
SPEAKER_01: like
33:55
SPEAKER_01: First principles objective, HHS is here to help people.
33:58
First principles objective for ICE is customs enforcement or
34:03
immigration enforcement.
34:04
And it just strikes me that those objectives are so far apart
34:07
that the blending of
34:08
SPEAKER_01: those things in any way,
34:09
whether it's data here or if there's sort of a larger project
34:14
of breaking down
34:15
silos between government agencies so everyone becomes a customs
34:19
and immigration
34:20
SPEAKER_01: official,
34:21
SPEAKER_01: That's not just going to have the effect of beefing up ice enforcement,
34:24
but it's going to have a deleterious effect on the basic
34:27
functions of HHS because
34:29
SPEAKER_01: it's creating mission creep.
34:31
SPEAKER_01: I'm wondering if you have any thoughts on sort of that.
34:35
SPEAKER_03: Sure.
34:35
SPEAKER_03: I mean...
34:36
Medicaid was created to ensure access to health care,
34:39
not to help immigration enforcement.
34:40
SPEAKER_03: I mean,
34:41
sharing and rolling data with ICE represents a fundamental
34:44
betrayal of that purpose
34:46
SPEAKER_03: and the promise of privacy to people who rely on it.
34:48
So this agreement really breaks the promise of confidentiality
34:51
that underpins the
34:52
SPEAKER_03: public health programs and federal laws,
34:55
SPEAKER_03: all of them really protect
34:56
personal identifiable health information and sharing it with
34:59
immigration for
35:00
SPEAKER_03: enforcement of immigration laws directly undermines those protections.
35:04
SPEAKER_03: So the trust is the foundation of the health care system.
35:07
SPEAKER_03: And when the trust is broken, families disengage from care.
35:10
Trust in the health care system post-COVID is already low with
35:14
devastating
35:15
SPEAKER_03: consequences,
35:15
SPEAKER_03: largely due to misinformation.
35:17
SPEAKER_03: This simply adds to the mistrust in health care.
35:19
And the administration and ICE's targeted immigrants at work
35:23
and schools and courthouse
35:25
SPEAKER_03: and churches and now in healthcare facilities.
35:27
SPEAKER_03: And these are spaces where people should feel safe.
35:31
So when you weaponize Medicaid data and you further erode that
35:34
safety and trust in
35:35
SPEAKER_03: the federal government,
35:36
SPEAKER_03: it really undermines trust in all federal benefits.
35:39
SPEAKER_03: And that's concerning because people need these benefits to live on.
35:43
SPEAKER_03: So yeah,
35:44
SPEAKER_03: it creates a conflict,
35:46
SPEAKER_03: especially between,
35:47
SPEAKER_03: I think,
35:48
SPEAKER_03: CMS as a healthcare agency and ICE's role as an enforcement agency.
35:52
We obviously believe that the CMS policy staff at CMS at the
35:57
time did not think
35:58
this was legally appropriate to share the data with DHS and
36:01
were opposed to the CMS
36:02
SPEAKER_03: agency being used to undermine trust in the Medicaid program.
36:06
SPEAKER_03: Immigration enforcement is not within their mission or purpose.
36:09
SPEAKER_03: Clearly, the HHS Secretary Kennedy overruled their objections.
36:13
SPEAKER_03: And unfortunately, this mass collection of data
36:16
SPEAKER_03: sharing among all agencies is a dangerous precedent,
36:19
SPEAKER_03: but also a clear practice of the administration,
36:22
SPEAKER_03: starting with Doge,
36:23
SPEAKER_03: you know,
36:23
data mining and multiple media outlets reporting that Doge
36:27
enlisted a company to
36:29
SPEAKER_03: build a massive repository of data,
36:31
SPEAKER_03: pulling from multiple federal agencies,
36:33
SPEAKER_03: including HHS for the purpose of immigration enforcement.
36:36
SPEAKER_03: So unfortunately, this isn't really limited.
36:38
SPEAKER_02: Hey, Kim.
36:39
SPEAKER_02: It's probably too early to know the effects,
36:40
SPEAKER_02: the chilling effects that this has had or is having or will have.
36:44
But was there something even remotely close to this that
36:47
happened in the first
36:48
SPEAKER_02: Trump administration?
36:49
SPEAKER_02: Didn't they talk about using Medicaid rolls for enforcement?
36:52
I think you had mentioned previously or someone on your team
36:55
mentioned that this
36:56
SPEAKER_02: happened and they do have information of what this did.
36:59
SPEAKER_03: Well, I mean, yeah, let's let's talk about the chilling effect.
37:02
SPEAKER_03: I think it is happening already.
37:04
SPEAKER_03: We are hearing people disenrolling from care.
37:07
SPEAKER_03: Even in California, we're hearing people staying away from health care.
37:11
SPEAKER_03: You know,
37:11
ICE has even come to some locations where health care clinics
37:15
where people are
37:16
SPEAKER_03: providing health care,
37:17
SPEAKER_03: looking for people.
37:18
SPEAKER_03: So it's already frightening for them just to go to work and school.
37:22
SPEAKER_03: But it's also going they are now canceling medical appointments.
37:25
I think this is really intended to have a chilling effect and
37:28
it is having a chilling effect.
37:29
SPEAKER_03: And,
37:30
SPEAKER_03: you know,
37:30
we have seen this before past immigration policies in the Trump
37:34
administration,
37:35
really around changing what's called the public charge policy
37:39
that had a deep
37:39
SPEAKER_03: chilling effect where you consider use of certain benefits,
37:43
SPEAKER_03: public benefits as a basis for potentially denying admission to the U.S.
37:48
SPEAKER_03: or adjustment of status.
37:49
SPEAKER_03: basically saying if you have access Medicaid,
37:52
SPEAKER_03: which is not a public charge program,
37:54
SPEAKER_03: that that could impact your ability to get into this country.
37:57
SPEAKER_03: And so that was in the first administration,
38:00
SPEAKER_03: they changed that policy,
38:02
SPEAKER_03: which had that chilling effect,
38:04
SPEAKER_03: causing people to withdraw from essential services,
38:06
SPEAKER_03: including Medicaid and SNAP,
38:08
SPEAKER_03: the Supplemental Nutrition Assistance Program and WIC,
38:11
out of fear of using that using benefits would impact them
38:14
legally or have
38:15
SPEAKER_03: immigration consequences.
38:17
SPEAKER_03: So for sure that has happened.
38:19
SPEAKER_03: And we expect, you know, public charge changes again.
38:22
SPEAKER_03: But I mentioned at the top of the hour,
38:23
SPEAKER_03: you know,
38:23
SPEAKER_03: there's these three things that have happened just so far.
38:26
SPEAKER_03: And this is really early in the administration.
38:28
We've got,
38:29
I hate to say,
38:30
three and a half more years to be watching this.
38:32
SPEAKER_02: I feel like we've been at this longer than a half a year.
38:35
SPEAKER_03: It does feel like a long time.
38:36
SPEAKER_02: Oh, my gosh.
38:37
SPEAKER_03: So these are, you know, I think, avoidable harms.
38:40
SPEAKER_03: You know, people dip and delay care.
38:42
SPEAKER_03: Chronic conditions get worse.
38:43
SPEAKER_03: You're pregnant.
38:44
People miss prenatal care and risking,
38:46
you know,
38:47
the life of the mother,
38:48
infant.
38:48
SPEAKER_03: Children go without vaccines and developmental screens.
38:50
It's really then becomes emergency rooms as the sort of last
38:54
resort or sole place
38:55
that people will end up if they are forced to because they're
38:58
afraid to seek care
38:59
SPEAKER_03: and they won't go for preventative care.
39:02
SPEAKER_03: Okay.
39:03
SPEAKER_02: A question?
39:04
SPEAKER_02: Real quick,
39:05
SPEAKER_02: with until emergency,
39:06
the emergency departments and labor delivery units are required
39:09
to see people
39:10
SPEAKER_02: irrespective of their insurance status.
39:12
SPEAKER_02: But is it then,
39:13
because you had mentioned the emergency Medicaid coverage for
39:16
folks without
39:17
SPEAKER_02: documentation,
39:18
that states have to file with the federal government to get
39:21
that reimbursement,
39:23
SPEAKER_02: is that ubiquitous?
39:24
SPEAKER_02: Is that anytime someone presents, like, is that just a standard fare?
39:28
So as that becomes known,
39:30
do you think that will impact people even seeking emergency?
39:33
SPEAKER_03: Well,
39:33
SPEAKER_03: I mean,
39:34
SPEAKER_03: you know,
39:34
SPEAKER_03: EMTALA is a,
39:36
SPEAKER_03: you know,
39:36
SPEAKER_03: it does require hospitals to pay,
39:38
SPEAKER_03: to provide emergency medical treatment to everyone in need.
39:41
It doesn't matter what their insurance or their ability to pay
39:44
or regardless of
39:45
SPEAKER_03: their citizenship or immigration status.
39:46
So that existing federal law obviously means you don't ask
39:51
people about those
39:52
SPEAKER_03: things when they come in an emergency.
39:54
You know,
39:54
you worry about that afterwards and then you bill them if they
39:57
don't have insurance.
39:58
SPEAKER_03: So, or you get uncompensated care.
40:00
SPEAKER_03: So I think
40:01
SPEAKER_03: This puts further pressure on the hospitals financially, for sure.
40:05
SPEAKER_03: And unless a person gets emergency Medicaid or is on Medicaid,
40:08
then the hospital system probably won't be collecting that
40:11
immigration information.
40:13
SPEAKER_03: They do ask people to sign up for Medicaid.
40:16
SPEAKER_03: It isn't that they can force you to accept Medicaid.
40:19
You know,
40:20
most people who want to have health insurance because it
40:23
actually keeps you healthy.
40:24
SPEAKER_03: And so,
40:25
SPEAKER_03: yes,
40:25
SPEAKER_03: yes,
40:26
for people who've had insurance in Medicaid or go into a
40:30
hospital where they face
40:31
SPEAKER_03: potentially hundreds of thousands of dollars,
40:33
SPEAKER_03: like,
40:33
SPEAKER_03: well,
40:34
SPEAKER_03: this can be free if you have Medicaid.
40:36
SPEAKER_03: And if people would say no to that,
40:38
SPEAKER_03: The potential for worse consequences are bankruptcy,
40:42
SPEAKER_03: medical debt,
40:43
SPEAKER_03: things that take your home if they have one.
40:46
SPEAKER_03: So there's other consequences to saying no to this information.
40:50
SPEAKER_03: So I think, will people refuse emergency room care?
40:53
SPEAKER_03: Some people may.
40:54
SPEAKER_03: Ultimately,
40:54
SPEAKER_03: somebody at some point is going to end up in the hospital,
40:56
SPEAKER_03: though,
40:57
SPEAKER_03: and notwithstanding the fact that they may not want to be there.
41:01
And it is a hard call to advise people not to seek something
41:06
that would actually
41:07
ensure they don't become bankrupt as opposed to worrying about
41:11
whether ICE uses the
41:12
SPEAKER_03: information or misuses it.
41:14
SPEAKER_03: So I don't,
41:15
SPEAKER_03: it's a very hard decision individually,
41:17
SPEAKER_03: but I think,
41:18
SPEAKER_03: you know,
41:18
how you advise people about access to emergency Medicaid when
41:21
they have very
41:22
SPEAKER_03: expensive care is a very complex conversation.
41:25
SPEAKER_03: For sure.
41:25
SPEAKER_01: A question on,
41:26
so the thought of ICE enforcement at whether it's ERs or
41:30
whether it's at like a
41:31
SPEAKER_01: longer stay at a hospital just makes me absolutely sick to my stomach.
41:34
But are there in places where they're in sort of blue states or
41:38
states that want to
41:40
guard against this at the public policy level or at like a
41:43
hospital like practices,
41:46
like when hospitals have agency or are making decisions about
41:49
what they say,
41:50
SPEAKER_01: what they're saying yes or no to?
41:52
SPEAKER_01: Are there any tools in the toolbox where actors who don't want to see ICE
41:55
enforcement happening or have legal tools in the toolbox that
41:59
they could that they
42:00
SPEAKER_01: could deploy?
42:01
SPEAKER_03: Well,
42:01
SPEAKER_03: you know,
42:02
SPEAKER_03: states can certainly object and they can sue,
42:04
SPEAKER_03: which they have done,
42:05
to stop this kind of action and prevent this information being
42:09
further disclosed.
42:10
SPEAKER_03: I think that is one of the key levers that's available to states.
42:14
And we've seen quite a bit of action in this area in terms of
42:18
lawsuits filed by
42:19
SPEAKER_03: states against this administration,
42:21
SPEAKER_03: including HHS in this particular instance.
42:23
SPEAKER_03: So I think that's one of the things that we have,
42:27
SPEAKER_03: as lawyers,
42:28
SPEAKER_03: we often suggest is,
42:29
SPEAKER_03: is there a violation of
42:30
law and should we go to court now is everything going to get
42:33
remedied by court by
42:35
the courts it really depends i mean we're in a situation where
42:38
you know everything
42:38
is being appealed to the supreme court and they haven't had
42:41
quite the same generous
42:42
sense of what the law protects as we might want them to in this
42:46
case so some of
42:46
these are still working through i think the court system and
42:49
we're gonna you know
42:51
ensure they get maximized by enforcement through the courts
42:54
because i think that is
42:55
really the critical lever right now outside of that states
42:58
don't have a lot of
42:59
SPEAKER_03: leverage
42:59
SPEAKER_03: And they depend heavily on Medicaid matching funds.
43:02
I mean,
43:02
these federal dollars are a huge part of the health care
43:05
funding for states.
43:07
And it's part of the federal state partnership that's
43:09
fundamentally built into
43:11
SPEAKER_03: Medicaid and Medicare.
43:12
And so there's,
43:13
you know,
43:13
there have been numerous other lawsuits filed by other
43:15
organizations.
43:16
SPEAKER_03: Again,
43:17
data sharing breaches by Doge and Social Security data and SNAP
43:21
data and IRS
43:22
SPEAKER_03: records and Labor Department records.
43:24
SPEAKER_03: I mean, there have been numerous, numerous cases.
43:26
SPEAKER_03: So this sort of data sharing precedent is kind of exploding, I think.
43:31
SPEAKER_03: And I think we're going to have to see where this ends up in the courts.
43:35
And that's,
43:36
I think,
43:36
really going to be one of the few things that's going to stop.
43:40
SPEAKER_03: This kind of behavior if they follow the courts.
43:42
SPEAKER_03: But,
43:42
SPEAKER_03: you know,
43:43
SPEAKER_03: short of that,
43:43
SPEAKER_03: I feel like,
43:44
SPEAKER_03: you know,
43:45
it's people actually talking to their congresspeople because we
43:49
do we are supposed
43:50
SPEAKER_03: to have separation of powers here.
43:52
SPEAKER_03: And,
43:52
SPEAKER_03: you know,
43:52
the executive and the legislative branch in the courts are
43:55
three different
43:55
SPEAKER_03: branches.
43:56
SPEAKER_03: But.
43:56
What we have seen is that Congress has been absent at this job
44:00
right now in terms
44:01
SPEAKER_03: of checks and balances on the administration.
44:03
And so until that pressure on those elected officials changes
44:06
that impacts federal
44:08
SPEAKER_03: budgeting and policies,
44:09
SPEAKER_03: the real only other option is the courts at this point.
44:12
He can't say I'm in the hospital or someone's at a clinic and
44:15
ice rolls up.
44:16
SPEAKER_02: Right.
44:17
SPEAKER_02: Is there I mean,
44:18
SPEAKER_02: is it basically at that point,
44:19
SPEAKER_02: the burden on the providers,
44:21
SPEAKER_02: you know,
44:21
SPEAKER_02: if they if they would like to enforce,
44:23
SPEAKER_02: say,
44:24
SPEAKER_02: at a clinic?
44:24
SPEAKER_02: I mean,
44:24
we've it's a it's a very interesting and somewhat challenging
44:27
dynamic just with law
44:29
SPEAKER_02: enforcement in an emergency department.
44:31
SPEAKER_02: Because particularly in a rural area,
44:32
SPEAKER_02: we depend on them sometimes when we have patients who become violent.
44:36
SPEAKER_02: Violence in hospitals is at an all-time high.
44:39
And we do need help from law enforcement sometimes to protect
44:43
staff,
44:43
protect patients.
44:44
SPEAKER_02: However, there are also times when law enforcement kind of...
44:49
feels like they teeter on the edge of maybe not working in good
44:54
faith when we're
44:55
SPEAKER_02: trying to take care of patients.
44:56
I've had multiple instances in 20-some years of care where I
45:00
have to really press
45:01
SPEAKER_02: upon the law enforcement officials like,
45:03
SPEAKER_02: hey,
45:04
SPEAKER_02: I need to take care of this person medically.
45:06
SPEAKER_02: You guys can figure out all your legal stuff after.
45:08
SPEAKER_02: So beyond civil disobedience by people providing care,
45:13
is there any legal sort of status that we have or that the
45:16
actual hospital has to
45:17
SPEAKER_02: say,
45:18
SPEAKER_02: like,
45:18
SPEAKER_02: this is
45:19
SPEAKER_02: this area cannot be breached by immigration folks, by customs officials.
45:23
SPEAKER_03: I mean,
45:23
SPEAKER_03: I think hospitals,
45:25
SPEAKER_03: you know,
45:26
SPEAKER_03: and all healthcare agencies have a role in saying no to ICE,
45:31
SPEAKER_03: particularly.
45:31
SPEAKER_03: I mean, law enforcement is a broad group of people, right?
45:34
SPEAKER_03: So I think we know that if ICE shows up in a hospital,
45:37
SPEAKER_03: you don't have to cooperate with immigration enforcement.
45:41
SPEAKER_03: I mean, you know, we say get a warrant.
45:43
And if you don't have anyone's name and you don't have a court
45:46
order or a court warrant,
45:47
They shouldn't just be allowed to walk the halls of the
45:49
hospital or go into the ER
45:50
and check every patient that's sitting there waiting for
45:52
emergency room services.
45:53
I mean,
45:53
that's not something they have that hospitals or healthcare
45:56
clinics have to do.
45:57
And so I think a large part of this is a need to educate
46:00
providers on the right to
46:02
SPEAKER_03: at least to refuse or not cooperate with immigration,
46:05
SPEAKER_03: knowing that it's always hard to say no,
46:07
SPEAKER_03: but it really is like we have to hold the line,
46:09
SPEAKER_03: especially when there isn't a legal right for them to be in there.
46:13
SPEAKER_01: All right, Ken, well, we've covered a lot of ground today.
46:16
SPEAKER_01: Is there anything else that,
46:17
SPEAKER_01: you know,
46:17
SPEAKER_01: for the,
46:18
SPEAKER_01: there's healthcare activists who listen to this,
46:20
SPEAKER_01: there are folks who are interested in health reform,
46:21
and then there's a lot of physicians who are out there doing
46:24
their best to make
46:24
SPEAKER_01: healthcare better.
46:25
Is there anything else you'd want on the top of minds of the
46:27
folks who are
46:28
SPEAKER_01: listening before we wrap up?
46:31
SPEAKER_03: Well,
46:31
SPEAKER_03: you know,
46:31
SPEAKER_03: I mean,
46:32
I think we are trying to do our part to push back on what's
46:37
happening in this
46:37
SPEAKER_03: country.
46:38
SPEAKER_03: I think,
46:38
SPEAKER_03: you know,
46:39
especially when it comes to protecting the rights of low income
46:42
and underserved
46:43
SPEAKER_03: populations.
46:44
SPEAKER_03: I mean,
46:44
SPEAKER_03: our mission is obviously to,
46:46
SPEAKER_03: you know,
46:47
to ensure over the last 55 years that we improve access to
46:50
health care for low
46:51
SPEAKER_03: income and underserved people.
46:52
SPEAKER_03: And that includes defending the integrity of Medicaid and pushing back on
46:56
discriminatory policies and lifting up the rights of immigrant
47:00
communities across
47:01
SPEAKER_03: the countries.
47:01
SPEAKER_03: I mean, this is our mission.
47:03
SPEAKER_03: So,
47:03
SPEAKER_03: you know,
47:04
we're looking to ensure that Medicaid remains a strong and
47:08
viable program and that
47:09
SPEAKER_03: people aren't afraid to use their health care.
47:11
And I'd really want to suggest that people think carefully
47:15
about disenrolling for
47:16
Medicaid or thinking that if I somehow leave the program now or
47:20
I don't seek health
47:21
SPEAKER_03: care,
47:21
SPEAKER_03: they're not going to have my information.
47:23
SPEAKER_03: Again,
47:23
SPEAKER_03: this information,
47:24
SPEAKER_03: as I kind of said earlier,
47:26
SPEAKER_03: is out there and has been routinely provided,
47:29
SPEAKER_03: just not for this purpose.
47:30
SPEAKER_03: So the idea that you can escape from,
47:32
SPEAKER_03: you know,
47:33
health and human services sharing of data versus Social
47:35
Security or work-related
47:38
SPEAKER_03: information,
47:38
SPEAKER_03: I think it sort of keeps people running afraid,
47:42
SPEAKER_03: I feel like,
47:43
SPEAKER_03: in circles.
47:43
SPEAKER_03: I mean, there's no sense of anything being safe anymore.
47:47
And I think it's critical that people think carefully and
47:50
access health care when
47:51
SPEAKER_03: they can,
47:52
SPEAKER_03: knowing that
47:52
SPEAKER_03: We have to stand up for our civil rights as well.
47:54
SPEAKER_03: And,
47:55
SPEAKER_03: you know,
47:55
the sort of principles of the Constitution of having to process
47:58
before people are
47:59
SPEAKER_03: detained and taken and,
48:01
SPEAKER_03: you know,
48:01
SPEAKER_03: sent away in this country.
48:02
SPEAKER_03: So I think that's the kind of message here is,
48:06
SPEAKER_03: you know,
48:06
trying to restore our civil rights and our sense of faith in
48:09
the Constitution.
48:11
SPEAKER_03: Not having this just continue to erode further,
48:13
SPEAKER_03: you know,
48:13
SPEAKER_03: not just beyond immigrants,
48:15
SPEAKER_03: but,
48:15
SPEAKER_03: you know,
48:15
SPEAKER_03: everyone else who's at risk,
48:17
including people who are seeking gender affirming care or
48:19
people wanting to seek
48:20
SPEAKER_03: abortion services.
48:21
SPEAKER_03: These are all under attack.
48:23
And so people are afraid to access these services or providers
48:26
are afraid to provide them.
48:28
And I think we need to really try to bolster the health care
48:31
system to not become a
48:32
SPEAKER_03: place where people run from,
48:34
SPEAKER_03: but actually go to.
48:35
SPEAKER_03: So that's really, I think, an important message to get out there.
48:37
SPEAKER_02: Thank you for that.
48:38
SPEAKER_02: As a provider,
48:39
it's nice to know that you all on the legal side are sort of
48:42
providing cover for us
48:44
SPEAKER_02: when we are trying to do that,
48:46
SPEAKER_02: you know,
48:46
SPEAKER_02: in real time,
48:46
SPEAKER_02: because it can be scary,
48:48
SPEAKER_02: I think,
48:49
SPEAKER_02: for some folks to take on a system that seems like it's against them.
48:53
SPEAKER_02: But to know that you all are on our side, I think, is reassuring.
48:58
SPEAKER_03: Yeah,
48:58
and I think beneficiaries need your support too as providers to
49:02
encourage them and
49:02
SPEAKER_03: just say this really is important for you to get healthcare,
49:05
SPEAKER_03: even telehealth.
49:07
SPEAKER_01: All right,
49:07
SPEAKER_01: for the listeners at home,
49:08
SPEAKER_01: if you want to hear more about the work of Kim's organization,
49:13
you can visit their website at www.healthlaw.org or you can
49:17
find their handle and
49:18
SPEAKER_01: help at Blue Sky.
49:19
SPEAKER_01: Kim Lewis, thank you so much for joining us today.
49:21
SPEAKER_03: Thank you for having me.
49:22
SPEAKER_03: I appreciate it.
49:23
SPEAKER_03: It's an important subject.
49:24
SPEAKER_03: Thank you.
49:28
SPEAKER_01: All right, we're back.
49:28
SPEAKER_01: Rob, that was a great conversation with Kim Lewis.
49:31
SPEAKER_01: I feel like I understand the nuances of that a little bit better now.
49:34
SPEAKER_02: Yeah, absolutely.
49:34
SPEAKER_02: Appreciate her being there.
49:35
SPEAKER_02: And like I said at the end,
49:36
SPEAKER_02: I appreciate having them out there as a provider,
49:40
SPEAKER_02: having them have our backs,
49:42
because I think the defense of our patients is going to have to
49:45
be multi-pronged.
49:46
And I think in this fight,
49:48
the lawyers are going to be the heroes without capes.
49:51
SPEAKER_02: And we're really glad she's there.
49:53
SPEAKER_01: All right.
49:53
Today's episode was written by Chris Savage,
49:55
Dr.
49:55
Rob Davidson,
49:56
and me,
49:56
Miles Baker.
49:57
It was produced by Amelia Dillon-Schneider,
49:59
Azan Ibrahim,
49:59
and Joel Bryson.
50:00
SPEAKER_01: Music by Annette Somerset at Doonflower Productions.
50:03
SPEAKER_01: If you enjoyed today's show,
50:04
SPEAKER_01: please subscribe and leave us a rating on YouTube,
50:06
SPEAKER_01: Spotify,
50:06
SPEAKER_01: Apple Podcasts,
50:07
SPEAKER_01: or wherever you listen.
50:08
SPEAKER_01: Your support helps others discover the podcast.
50:10
SPEAKER_01: Physicians,
50:11
if you want to join the fight for better American healthcare by
50:14
becoming a member
50:14
SPEAKER_01: of the Committee to Protect,
50:16
SPEAKER_01: please visit www.committeetoprotect.org to learn more.
50:19
SPEAKER_01: And it was great having a conversation today, Rob.
50:21
SPEAKER_01: We'll catch you next time.
50:22
SPEAKER_02: All right.
50:22
SPEAKER_02: See you then.
50:23
you