Why voting could look different for you in 2024

Guests: Axios' Eugene Scott, Tina Reed, and Alex Fitzpatrick

Credits: Axios Today is produced by Niala Boodhoo, Alexandra Botti, Fonda Mwangi, Lydia McMullen-Laird, Robin Linn, and Alex Sugiura. Music is composed by Evan Viola. You can reach us at [email protected]. You can send questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

Transcript

NIALA BOODHOO: Good morning! Welcome to Axios Today! It's Tuesday, September 5. I'm Niala Boodhoo. Today on the show: low-quality health care is costing employers...and workers.

Plus, telemedicine could soon be available in-flight. But first, why voting may look different for you in 2024. That's today's One Big Thing.

There's been a lot of stories about the restriction or attempted restriction of voting rights in the last several years. But as Axios politics reporter Eugene Scott reports, there have been even more state-led moves to expand voting access. He's here to explain – hi, Eugene. Welcome back.

EUGENE SCOTT: Thanks for having me.

NIALA: First, can you remind us where we have seen states make it harder to vote, especially since the midterm elections?

EUGENE: Well, a number of states have changed their voter ID laws in terms of what is acceptable. It's been pretty common for a while for student identification from state universities, which are government institutions, to be accepted. But there are a number of states, including Idaho, that now no longer accept student IDs. And so, that is a way that voting has become more difficult for college students in states where, their only, state-issued ID card may be from their university. Another example of voting rights being restricted is that in the state of Arkansas, there are no more ballot drop boxes and write-in candidates are no longer an option. And so, what it looks like to participate in the voting process in that state is, is very different from what it did in the last presidential election.

NIALA: OK, but then you report that in many states, voting has gotten easier since the midterm elections. What does that look like?

EUGENE: So, in states like New Mexico and Nevada, there's been an effort to make voting easier for people who are indigenous, which has meant like more polling, uh, locations on reservations, and helping even translate voting materials into languages that people speak besides English.

Another example of expansion happened in Michigan where voters passed an amendment that pretty much radically changed what voting looks like in the state. There's a website voters can go to to track their ballot and, early voting has been expanded in the state, which it's quite popular with, you know, a number of voters who prefer not to vote on election day. We've seen even some states pass statewide voting rights acts, which, as you know, on the national level was passed originally in 1965 to make discrimination based on race and color and other identity issues illegal. And that's also happened in Connecticut, in states like North Carolina, where Republicans are really in control of the legislature, their Democratic governor has vetoed a bill that would limit absentee voting. And so, that's one of the ways that voting rights have moved towards being more expansive than restrictive.

NIALA: What do you think we need to know about how these restrictions and expansions will actually affect the voting landscape ahead of the 2024 presidential election?

EUGENE: Well I think it's important that everyone pay attention. No matter what you consider your norm in terms of what voting looks like based on the last election you participated in, there's a good chance that things have changed, especially if you didn't vote in the midterms. But, I think if you're in a battleground state, you know, Arizona, Georgia, North Carolina, Michigan, Wisconsin, Pennsylvania. These are states where we know the presidential election and other elections will be determined. And, making sure that you can participate in the election process, uh, is really important. And it's very possible that new rules could be implemented, even before election day 2024. And so I think there's a lot of interest in what these lawmakers are trying to make legal.

NIALA: Eugene Scott reports on politics for Axios. Thanks, Eugene.

EUGENE: Thanks for having me.

NIALA: In a moment: poor quality health care is costing employers big bucks.

NIALA: Welcome back to Axios Today. I'm Niala Boodhoo.

Employers are spending huge amounts on health care that often turns out to be lower quality than they realized. That means employees don't get the best care and companies get a bad return on a hefty investment.

Axios health care editor Tina Reid has more. Tina, first, can you tell us what researchers found about what's this data that shows this disconnect for employers?

TINA REED: Yes, so provider quality is an issue that can really fall through the cracks, and the issue they're highlighting here is what's called variability. It doesn't sound very sexy, but at its core, it means some doctors aren't following the evidence as well, and others are, and that difference can get pretty expensive. So let's think about something really common like statins. We have known for a while they work, they've been in guideline recommended therapy for years, and among the bottom 10% of performing cardiologists, they found that only 37% of patients with coronary artery disease were actually adhering to the therapy.

On the flip side, if you looked at the 10% top performing cardiologists, 73% of their patients were adhering to this therapy. So there's this really big difference.

NIALA: And are there discrepancies in care that follow gender or socioeconomic lines?

TINA: One of the best examples is probably with C-sections. We know that it's recommended to avoid them when possible. And so they looked at uncomplicated pregnancies and they found that more than 60% of women with uncomplicated pregnancies who were seeing the lowest performing obstetricians delivered their babies through the procedure. And then on the flip side, roughly 14% of people with uncomplicated pregnancies received a C-section if they were seeing those top 10% of performers.

NIALA: So, if I'm understanding this correctly, the highest performing doctors provided the best level of service, which in this case was also not just better for the patients but cheaper?

TINA: That's exactly right.

NIALA: What does the research say about how employers can help empower their workers to get better treatment as patients?

TINA: The researchers were really focused on telling employers what they could do: find ways to put provider quality data in the hands of your plan members and try to support this ecosystem where clinicians themselves can see the data and make improvements. That's something that consistently has been shown, is when doctors can actually see how they stack up against their peers, we do see a really big difference…They also recommended employers work directly with the insurers using provider quality data to create these better networks.

NIALA: Axios health care editor Tina Reid. Thanks, Tina.

TINA: Thank you, Niala.

NIALA: And now an update on health care in the skies. Airlines are upgrading their wifi systems as they look to improve the traveler experience…but that goes beyond just in-flight entertainment. Airlines including Delta now say they have an easier time communicating with medical experts on the ground thanks to on-board wifi and a company called MedAire, which provides on-demand medical advice to flight crews. And next up could be full-fledged airborne telemedicine for patients in the air. I asked Alex Fitzpatrick, editor of Axios' What's Next, to catch us up quick.

ALEX FITZPATRICK: About 11 of every 100,000 flights are diverted because of in-flight medical emergencies, according to one study. And those incidents cost airlines anywhere from $15,000 to almost a million dollars. And also, they're obviously a huge headache for anybody who's traveling. Obviously, you feel for somebody having an emergency, but then you gotta figure out how to get from Des Moines to wherever you're going, right?

And then Dr. Henry Ting, who's an SVP at Delta and their Chief Health Officer. You know, what he told me was that... You can have virtual medicine, you know, with your provider right now. Why can't you do that in the air? Especially given the high-speed wifi coming to planes. And he sees these capabilities and this technology is really a first step in that direction of having true video-based telemedicine available to people on airplanes.

And he said the idea isn't to turn an airplane into a, quote, clinic or emergency room. It's really about, you know, making sure that if there's an in-flight emergency, then we can get the fastest care to somebody. And also the best opinions about whether a plane can continue or needs to land right away to get somebody to a hospital.

NIALA: Alex Fitzpatrick is the editor of Axios What's Next.

And one more health-related headline for you today: Narcan, the nasal-spray version of the opioid overdose reversal drug naloxone, is available over-the-counter for the first time at many stores starting this week.

Public health officials and experts hope this move will make Narcan more widely available in public places and private homes alike, but many say the suggested retail price of $44.99 for a two-dose pack is too high and could keep the drug out of reach of those who need it.

As Axios' Sabrina Moreno reported last week, Naloxone acts in a fraction of the time it takes EMS technicians to arrive, and that's critical since the synthetic opioid fentanyl can render a person unconscious within 90 seconds.

Federal data says nearly 110,000 people died of drug overdoses in 2022 – with more than three-quarters of those involving opioids. If opioid addiction and overdose has affected your life, we'd like to hear about your experience with Narcan – do you keep it on hand? Is it available near you? What do you want others to know about it? You can send me a text or a voice memo to 202-918-4893.

And that's it for us today. I'm Niala Boodhoo. Thanks for listening, stay safe, and we'll see you back here tomorrow morning.