Dan Weissmann
Less than 36 hours earlier than his spouse was scheduled to endure main surgical procedure, New York Times private finance columnist Ron Lieber acquired an unwelcome letter from his household’s insurance coverage plan: It was denying prior authorization for the process.
With no time to lodge an enchantment, Lieber and his spouse determined to proceed and wager on her docs’ potential to reverse the choice post-surgery. They succeeded, however the expertise troubled Lieber. Why had nobody warned them sooner? He got down to discover solutions to help people avoid scrambling to take care of a last-minute denial.
In this episode of An Arm and a Leg, Lieber shares with host Dan Weissmann takeaways from his New York Times collection about how docs and different well being care clinicians can do a greater job of preserving sufferers knowledgeable.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a workers reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on “All Things Considered,” the BBC, “99% Invisible,” and “Reveal,” from the Center for Investigative Reporting.
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Transcript: NYT’s Ron Lieber: ‘These people are not going to win.’
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a software however test the corresponding audio earlier than quoting the podcast.
Dan: Hey there. Let’s meet any person.
Ron Lieber: I’m Ron Lieber. I write the “Your Money” column for the New York Times. I write all kinds of books, and I dwell in Brooklyn, New York.
Dan: Ron’s specialty is thrashing the system: How to not pay greater than you actually need to. His most up-to-date ebook — about paying for school — we’ve virtually worn out our copy round my home.
Now, it’s potential Ron’s not the most distinguished journalist in his family. A significant Hollywood film a couple of years in the past had Zoe Kazan starring as Ron’s spouse, Jodi Kantor.
Zoe Kazan as Jodi Kantor: Hi. We’re from the New York Times. I consider you used to work for Harvey Weinstein.
Dan: She was one of many reporters who uncovered the film producer Harvey Weinstein’s historical past of sexual assault, and helped kick begin the Me Too motion. I imply, that’s exhausting to beat.
In 2024, Jodi was identified with breast most cancers, and he or she acquired scheduled for surgical procedure at Memorial Sloan Kettering on a Monday morning in December.
Ron Lieber: And she was doing all of the stuff you’re presupposed to do to prepare for surgical procedure. She did the meditation for every week and, you already know, she wound down all the things at work she went away for a pair days with buddies.
Dan: So on Saturday, two days earlier than surgical procedure, Jodi is on that journey with buddies. Ron spends the day with their 9-year-old, simply the 2 of them.
Ron Lieber: And we get residence and there’s a pile of mail and I put the 9-year-old to mattress and I begin going by the mail and there’s a fats envelope from United Healthcare.
Dan: Ron says he suspects straight away that it’s dangerous information in regards to the surgical procedure.
Ron Lieber: And positive sufficient it’s, you already know, sort of pages of gobbledygook, but it surely’s clear from the duvet web page, that they’re issuing a partial denial, in impact, and we now have, flunked partially, our prior authorization check.
Dan: Prior authorization. It rings a bell. He does a fast search to get his bearings– and shortly realizes: This is a HUGE phenomenon. It hasn’t hit him personally earlier than, but it surely hits thousands and thousands of individuals yearly.
Ron Lieber: So at this level, an entire bunch of stuff goes by my head.
Dan: First, skilled embarrassment. Ron’s a private finance columnist on the New York Times. And he’s considering: how might he have missed one thing that causes a lot private monetary misery to so many individuals?
Ron Lieber: I had that very same feeling that I did in 2008.
Dan: When the monetary disaster hit and he hadn’t seen it coming.
Ron Lieber: Back in 2008. It was, you already know, Ron, why did you not develop into an knowledgeable on mortgage securitization prior to now?
Dan: This time, it’s prior authorization. Ron manages to forgive himself fairly shortly on that rating– and transfer on to extra urgent considerations.
Ron Lieber: The very first thing I gotta determine is: What am I gonna say to Jodi?
Dan: Is he gonna crash her pre-op mellow she’s labored so exhausting for?
And second: How frightened ought to they be?
Ron Lieber: Should we present up on Monday? What’s the worst factor that may occur? And so I’m beginning to do psychological math, like what’s the rack price for this process anyway, and I’m considering, eh, most likely 150- $200,000. Right?
Dan: Yeah, like actual cash. This is the purpose when lots of people would resolve to reschedule surgical procedure. But Ron digs into the paperwork, and he can see this denial is a mistake. United isn’t even denying the reconstructive a part of Jodi’s surgical procedure — the half a plastic surgeon does. They’re denying the mastectomy itself.
That’s gotta be unsuitable. And Ron decides that’s not going to stay.
Ron Lieber: These persons are not going to win. I’m going to win, as a result of I’m Ron Lieber.
Dan: He’s an expert at beating the system.
Ron Lieber: I’m gonna arise for my spouse.
Dan: And he’s not on this alone.
Ron Lieber: I work for a giant firm. We have wonderful HR folks.
Dan: And he figures the hospital will maintain up their finish on this combat.
Ron Lieber: I think about that there are 10, 15, 20 folks at Memorial Sloan Kettering who do nothing however take care of nonsense, all day lengthy. So a technique or one other, we’re gonna win.
Dan: One factor he says is aware of he WON’T do on this combat: Let on to anyone on the hospital or the insurance coverage firm that they need to give him particular remedy as a result of he, you already know, works for the New York Times.
Ron Lieber: We have the strictest ethics code, most likely on the planet, proper? We get fired for throwing our weight round. The second you open your mouth at 1-800 United Healthcare and say, I work for the New York Times, cease messing round with me, you lose your job. There’s no second possibilities.
Dan: He DOES plan on taking notes. Because finally, this may very well be story.
And I’ll simply inform you proper now. It was. Ron finally put his household’s story within the New York Times, trying to assist different folks keep away from — in any case — getting a scary discover that there’s some drawback with their insurance coverage with no time to do something about it.
Hundreds of readers wrote again with their very own tales, with recommendations, with complaints.
And Ron responded by coming again to the story with a software he hoped folks — really folks’s docs — might use to forestall these sort of scary conditions, not less than a few of them.
I freaking like it.
This is An Arm and a Leg — a present about why well being care prices so freaking a lot, and what we are able to possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of the vital terrifying, enraging, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
Jodi comes residence from her journey with buddies on Sunday. Surgery is scheduled for the following morning, very first thing. Ron tells her the information. She hits the roof.
Ron Lieber: She’s not offended, she’s simply unhappy and he or she’s confused all of the issues that ought to not occur, proper, while you’re going into main surgical procedure.
Dan: Meanwhile, Ron does what he can to get the insurance coverage factor resolved. Which, on a Sunday, isn’t a lot.
Ron Lieber: There’s this silly enchantment kind which you could ship to a supposed emergency fax line. So, you already know, I obtain E-fax for the primary time in 19 years, um, and ship the fax off into the ether. Nothing occurs.
Dan: Next morning, they present up for surgical procedure, and as soon as Jodi’s below anesthesia, Ron figures he’s acquired 6 hours to kill, possibly eight.
So he begins roaming the hospital campus, in search of somebody who might clarify what was up, and what to do.
Ron Lieber: So I used to be simply displaying up at desks saying, Hey, try this love letter I acquired from UnitedHealthcare.
Dan: And the folks at these desks are like, Oh wow– we acquired one among these TODAY?
Because Ron and Jodi’s story was enjoying out towards the backdrop of a a lot larger story, one which had began only a few days earlier than.
Jessica Tisch: In Midtown Manhattan, early this morning, 50-year-old Brian Thompson, the CEO of UnitedHealthcare was shot and killed in what seems at this early stage of our investigation to be a brazen, focused assault.
News announcer: Protestors have focused United Healthcare, which reportedly denies one among each three claims.
News reporter: CBS information additionally confirms regulation enforcement discovered shell casings on the crime scene with the phrases deny, defend, and depose written on them.
Dan: Those phrases – “deny, defend, depose”– they instructed to plenty of folks that points like prior authorization performed a task within the killer’s motivation.
And: Police had been chasing the suspected shooter– later recognized as Luigi Mangione– that very morning. So when Ron exhibits up on the billing workplace together with his UnitedHealthcare denial…
Ron Lieber: People are like, oh, is he nonetheless on the free? They simply, simply couldn’t consider that like this factor, you already know, that Luigi was clearly upset about, proper, was presenting itself in actual time whereas he was nonetheless being chased.
Dan: They additionally shortly reassured Ron about his fast scenario.
Ron Lieber: The good lady within the billing workplace, you already know, clicks a bunch of keys on her keyboard and he or she pulls it up and he or she mentioned, oh yeah. She mentioned, this isn’t gonna be an issue. She mentioned, it could take some time. But don’t fear about it.
Dan: And she mentioned one thing else that will get Ron’s wheels spinning.
Ron Lieber: She mentioned, we acquired discover of this, you already know, seven or eight days in the past. If we had thought that there was gonna be an issue, we’d’ve known as you straight away and instructed you to not come.
Dan: Ron was considering: I positive want you’d have given us a heads-up — and this type of reassurance — prior to now.
Ron Lieber: I’m mad as a result of we didn’t discover out about it till 36 hours forward of time when it was too late to do something ’trigger it was Saturday evening and the surgical procedure was Monday morning. So why didn’t you simply inform me?
Dan: And he’s considering: Ok, what’s my subsequent transfer?
Ron Lieber: There are three voices performed concurrently in my head at a minimal. Number one is I’ve acquired a private scenario on my hand that I gotta remedy, you already know, as cheaply as potential. Number two, this can be a story and I should be taking actually cautious notes, not only for my very own functions, however to be sure that I’ve documented issues appropriately and in order that I can, you already know, make the very best case to the reader and, and the very best case to the entities concerned when it comes time to ask them some questions. And then quantity three. Try to keep away from as finest as I can, compromising the story in any means. Right? So like, don’t lose your mood, don’t lose your persistence. Try to not even utter the phrases the New York Times…
Dan: How do you not blow your cowl?
Ron Lieber: Exactly. Right.
Dan: And there’s one other thought: UnitedHealthcare is just like the day’s high story. It’s popping out that this problem — pre-authorization — appears to be one of many alleged killer’s huge points.
Ron Lieber: So then I’ve a dialog with my editors whereas Jodi continues to be below anesthesia saying, I believe I wanna write about this proper now. Right? So that is like an hour earlier than they catch Luigi. We’re proper on the information right here and I believe that is the factor that he was upset about and we should always simply go together with it. And my editor appropriately mentioned “no.” In order this for this to be, um, a helpful story for the reader and to verify we’re 182% in compliance, you already know, with our moral duties, we gotta let this factor play out to its conclusion by itself.
Dan: Ron went again to specializing in what actually mattered to him proper then. Which was not getting a scoop.
Ron Lieber: I used to be not the primary character right here. My spouse was the primary character, proper? She was sick. We had been making an attempt to repair her. It was a giant deal. and I used to be kind of relieved, you already know, at two within the afternoon when my editor was principally like, hit the pause button on this factor.
Dan: And there was extra aid coming proper up.
Ron Lieber: Jodi does nice. The surgical procedure’s profitable. The surgeons did an incredible job.They had been completely satisfied. Recovery was good. And we really feel actual good and so I’m kind of watching the mail.
Dan: Waiting for a super-high invoice from the hospital. Or some phrase from United. Weeks go by. Nothing.
Ron does one thing that I wouldn’t anticipate — or essentially advise — any regular particular person to do, any civilian: He retains ready.
Partly ‘cause he’s super-confident that this may work out, and as a reporter, he’s gathering knowledge: What would the system do, simply left to its personal units?
Finally, on March 1st — greater than two and a half months after Jodi’s surgical procedure — Ron calls United. He says, ‘Hey, you said in early December that you were denying us, and I faxed you an appeal. I was just wondering: any news?’
Ron Lieber: And they took a glance they usually mentioned, oh yeah. Um, the enchantment on this one simply went at this time to the doctor, uh, who’s going to assessment the enchantment. And I mentioned, you guys waited like two and a half months to do this. And they mentioned, yep. Um, uh, and I assumed, effectively, okay.
Dan: Ron will get off the cellphone. Waits one other few weeks earlier than he lastly calls once more and hears from a United rep: Yep, this appears to be resolved.
Eventually, Ron will get a invoice. It’s affordable. He pays it. And switches to reporter mode.
So Ron the Reporter will get to ask the identical questions Ron the Civilian has been asking all alongside.
Couldn’t somebody have given him and Jodi a heads-up earlier?
Ron: Why did you not simply inform us instantly, not by the United States Mail, you already know, which some folks don’t even open and a few folks don’t get. Why did you not ship up some sort of flare? Send us a textual content. Call us on her cellphone, ship an e mail, um, do all three directly. Like fly a freaking, you already know, banner over Prospect Park saying, ‘Ron and Jodi call UnitedHealthcare right now. You have a problem.’
Dan: There’s an entire HUGE set of inquiries to ask about prior authorization itself — like, why on EARTH would you deny a mastectomy for breast most cancers??
But for this story, Ron’s preserving a slim focus.
Ron Lieber: The dialog I wanna have with UnitedHealthcare just isn’t, you’re horrible. The system is horrible. Prior authorization is horrible. All I needed to know was, provided that we now have to dwell inside this method for now, why didn’t you name us?
Dan: The first phrases of that query– GIVEN THAT WE HAVE TO LIVE WITHIN THIS SYSTEM FOR NOW — rang out so loud for me. Because, God assist us, we do.
And it’s such an affordable query: Isn’t giving folks a heads-up the LEAST you possibly can do? So, Ron requested. On the file.
Ron Lieber: And right here’s what they mentioned. Um, they mentioned, yeah, you already know, we all know extra must be accomplished right here about prior auth, you already know, blabbity, blah, blah. And then they mentioned this: ‘We continue to make our own changes to help members navigate through these types of situations, including by offering the opt-in paperless communications.’
Dan: Opt-in. Like — oh, effectively. You COULDA opted in. Ron was like: Grr. You making an attempt to say it’s my fault, as a result of I didn’t decide in? He says he stored arguing to the United spokesperson — who he says was a complete gentleman — you actually ought to simply go forward and provides folks discover. He says it didn’t take.
Ron Lieber: So I assumed to myself, okay, UnitedHealthcare doesn’t appear that excited to vary their processes 180 levels and do what I’m telling them to do.
Dan: And by the best way, Ron says he has one thought about why they wouldn’t.
Ron Lieber: If they despatched out the sort of notices that I’m suggesting, they would want twice as many cellphone reps and it might value them a ton of cash. And they really don’t need folks calling about this. But then I had one other thought about find out how to work round them.
Dan: And that’s coming proper up.
This episode of An Arm and a Leg is a co-production between Public Road Productions and KFF Health News. KFF Health News is a nonprofit newsroom overlaying well being points in America. Their journalists win all types of awards, yearly. We are honored to work with them.
So Ron has one other thought about how — if we now have to dwell in a system the place insurance coverage corporations problem stupefying, horrifying denials of care to thousands and thousands of individuals — we don’t must get the information on the final potential minute.
And it’s this: Maybe our PROVIDERS might assist us out right here. I imply, they wish to deal with us. They wish to receives a commission. We’re a pure staff.
So there was an apparent query to ask the parents at Memorial Sloan Kettering: the query he’d held again from urgent on the day of Jodi’s surgical procedure.
That’s when the girl from the billing division instructed him they’d recognized about United’s denial for seven or eight days. Why didn’t you give us a heads up?
Ron Lieber: And, um, principally their response went like this, effectively, we simply don’t wanna hassle sufferers with this. We solely wanna hassle them with, uh, what they described as clinically vital data. But right here’s my response to that, proper? Pre-surgery, psychological well being should be a part of the establishment’s concern, proper? You need folks strolling in there with their heads clear, with out an excessive amount of fear, with out an excessive amount of worry.
Dan: And once more: Ron didn’t discover himself persuading Memorial Sloan Kettering to vary their coverage.
So when he wrote all this up in a column — in August, greater than eight months after Jodi’s surgical procedure — he principally had a pair items of recommendation for readers.
One: Yeah, in case your insurance coverage requires you to OPT-IN to get a heads-up, then… OK, decide in.
And two: If you want some sort of remedy, ask your physician’s workplace some questions: Is prior authorization gonna come into play right here? Can you begin requesting it ASAP, so we are able to keep away from some last-minute scramble? And if you happen to hit any roadblocks, can somebody give me a heads-up straight away? And if *I* discover out about an issue, who in your workplace ought to I name?
That column acquired folks’s consideration. More than 500 folks left feedback. Ron says even for the New York Times, that’s loads. A variety of them had been supportive. So much had been from individuals who’d had a lot worse experiences than Jodi and Ron.
Ron Lieber: There had been a number of notes from individuals who mentioned, I used to be despatched residence the morning of surgical procedure as a result of they can not work it out. And there was one one who had already had the anesthesia caught in her arm they usually yanked the needle out and needed to ship her away to return again and take a look at one other day.
Dan: Oh my God.
Ron Lieber: And then there was like a small handful of readers that had been principally like, you’re an fool, proper? How did you not examine the opportunity of an insurance coverage denial forward of time?
Dan: He considered giving that recommendation in a follow-up column: Never flip your again for a minute. Make a number of calls.
But he determined to take a special method.
Ron Lieber: And I assumed, okay, effectively how might this have been averted, um, in our scenario? Oh, they might have simply given us a really plain spoken piece of paper, you already know, upon prognosis or once we scheduled the surgical procedure.
Dan: Something to offer them a heads-up that this type of factor might occur. In his publication, he requested readers for recommendations about what that piece of paper ought to say.
He says he acquired plenty of responses — together with from some offended physicians.
Ron Lieber: Who mentioned to me, who’re you to inform me find out how to run my medical observe? And then, and this was the loudest one. This just isn’t my fault. Why are you placing this on me? And there have been simply as many docs who wrote in who mentioned, hey, in case I miss the story, are you able to ship this to me when it comes out?
Dan: And he acquired plenty of good recommendations. So he printed a column with a template for a be aware docs might use.
Ron Lieber: It mentioned: ‘Hey, um, here’s what prior authorization is, and right here’s the way it works. Um, typically folks run into issues, um, the place the insurance coverage firm says that they’re not gonna pay for stuff. We don’t need you to fret about this. You can name us right here or e mail us right here if you happen to run into these points, and we’ll attempt to care for it. If you’ve any questions on this kind, please name our billing specialist. We perceive that you just don’t wish to take up worthwhile examination time speaking about this with the physician. Frankly, our docs don’t both, however we wanna just remember to learn about this forward of time.’
Dan: Again, plenty of responses. Useful responses.
Ron Lieber: I acquired extremely good crucial suggestions. And I spotted that the be aware might get loads higher.
Dan: For occasion, Ron’s preliminary memo included some grouching about insurance coverage corporations, from a physician’s viewpoint. For occasion:
“Often, a doctor will have to do what’s known as a peer review with someone from the insurance company. We find this burdensome, since the “peer” on the road with us could not have the identical stage of experience as we do. That prolongs the decision, provides to our general working bills and retains us from spending extra time with you, the affected person.”
And though plenty of docs say precisely these issues in plenty of boards, they don’t do it on hospital letterhead.
Ron Lieber: There had been some docs who mentioned, uh, There’s no means I might ever get this by our legal professionals. Um, you already know, good attempt, uh, want I want I might, however ain’t gonna occur over right here. To which I mentioned, ship it to your lawyer and have them name me and we are able to have a dialog about what would cross muster.
Dan: Other readers instructed Ron the language simply wanted to be less complicated. They’d his be aware by software program that analyzes a bit of textual content for studying issue.
Ron Lieber: And then wrote me notes and mentioned, that is written at a twelfth grade stage. And like, my sufferers don’t communicate English at a primary language, or they’re by no means gonna learn this, and you have to write it at a fifth grade stage. And so I, so I assumed, okay, yeah, that’s, that’s fairly good recommendation.
Dan: Ron digested all of the suggestions on the memo he’d printed.
Ron Lieber: And then I printed one other one, which was higher, proper? It was shorter, the language was plainer. I took out the the commentary.
Dan: We’ll have a hyperlink to that second model wherever you’re listening to this. If you’re a well being care employee — or know some well being care employees who would possibly discover it helpful — please test it out, cross it round.
Of all of the feedback on Ron’s tales, one which caught with me was from a reader who made a want that was really like a lament– on behalf of anyone who wanted main medical care. Anyone in that scenario, they wrote, Quote: “ought to be enrolled in a certificates course for find out how to navigate the healthcare system.
Ron Lieber: So that is the factor, Dan, proper? This is why I’ve a job and I’m fairly positive because of this you’ve a job too. And I might like to be put out of enterprise, proper? But the best way wherein I might be put out of enterprise. Is if there have been necessary certificates packages in 25 completely different classes of non-public finance existence, proper. And in order that’s how I might be put outta enterprise. But as a result of no one’s ever gonna require such a certificates in, in any of the areas of non-public finance that we’re compelled, um, to wade by as human beings, I’ve a job and I’m simply making an attempt to do a greater job of it.
Dan: ?I hear that. There is a lot I admire about having my job, however I want it weren’t so vital. Lots of individuals find yourself in a lot worse circumstances than Ron Lieber and Jodi Kantor.
In a ebook known as “Coverage Denied,” popping out this spring, University of Pittsburgh professor Miranda Yaver cites estimates starting from 850 million to three billion denials a 12 months.
She additionally cites knowledge displaying that appeals work extra usually than most of us suppose — about half the time.
But interesting is difficult work. The much less privilege you’ve — like, say if you happen to don’t have a versatile schedule to name and fax and all the things else — the tougher it’s.
She calls the consequence “Rationing by inconvenience.”
And we are able to all use all the assistance we are able to get making life much less annoying and inconvenient. Which is why I’m gonna go away you with Ron Lieber’s reply to my final huge query for him.
Because listening to one a part of his recommendation on how to not get blindsided by an insurance coverage denial led to a different query — one which appeared like one to ask an knowledgeable at beating the system.
I mentioned: Hey, you suggest opting in to emails and texts out of your insurance coverage firm so they could offer you a faster heads-up.
Let’s say I do. How the heck am I supposed to seek out that in my inbox — which retains getting tougher to kind by every single day with issues I don’t need and don’t want to take a look at?
I requested him: How do you, Ron Lieber, handle the inbound? How do you establish what really wants your consideration?
And he had reply:
Ron Lieber: ?Yeah. So I’ve three e mail inboxes. I’ve, you already know, work e mail, I’ve private e mail that’s solely private correspondence and probably the most important different stuff, you already know, youngsters’ faculty, uh, faculty tuition funds. And then I’ve an outdated Yahoo e mail for all the things else. And so, you already know, I learn the final 12 to 24 hours of the Yahoo e mail, you already know, as soon as a day or so. Uh, after which, you already know, as soon as a month, I’ll open the inbox and I gained’t shut it till I’ve unsubscribed to 10 issues. And, and in order that retains it roughly manageable.
Dan: This is such good recommendation. I haven’t had an opportunity to implement it since I talked with Ron — hey, I used to be on deadline for this episode! — however sincere: I’m going to.
Here’s one different factor I’m going to do within the subsequent few weeks: Have surgical procedure myself. A hernia restore, it’s gonna be high-quality, I’m in nice fingers. But it’s taking place a couple of days earlier than our subsequent episode is scheduled to return out.
So, because it occurs, I’ve acquired an excellent story from any person ELSE to share with you then. We’ll have one other new episode of our personal for you after I’m again.
And in the meantime, we’ll hold the First Aid Kit publication coming. If you aren’t subscribed, it’s actually good!
My colleagues Emily and Claire have been serving up need-to-know data: Like, while you get your annual checkup… what’s really coated? A variety of the time, it’s lower than you’d suppose.
Which sucks, however is SO necessary to know. If you’re not signed up, test it out at arm and a leg present dot com, slash, publication.
I’ll catch you quickly. Till then, care for your self.
This episode of An Arm and a Leg was produced me, Dan Weissmann, with assist from Emily Pisacreta — and edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Sessions.
Claire Davenport is our engagement producer.
Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations.
An Arm and a Leg is produced in partnership with KFF Health News. That’s a nationwide newsroom producing in-depth journalism about well being points in America and a core program at KFF, an unbiased supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present.
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