On today's episode of the 5 Things podcast: Rep. Mike Johnson, R-La. has won the House speaker race. Israeli troops briefly enter Gaza, while President Joe Biden addresses the Israel-Hamas war. USA TODAY National Political Correspondent David Jackson breaks down Donald Trump's push to expand presidential power. At least 16 people were killed Wednesday night in a Maine mass shooting. USA TODAY Senior Investigative Reporter Emily Le Coz looks at why pharmacists have been walking off the job this year, and what their complaints might mean for patient safety.

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Hit play on the player above to hear the podcast and follow along with the transcript below. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

Taylor Wilson:

Good morning. I'm Taylor Wilson, and this is 5 Things you need to know, Thursday the 26th October, 2023. Today the House finally has a speaker. Plus, how Trump is proposing new rules expanding presidential power. And we take a look at a broken pharmacy system.

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After three grueling weeks, the GOP-led House has a speaker. It's Congressman Mike Johnson from Louisiana. After four nomination votes, GOP lawmakers finally rallied around Johnson. He was a political dark horse just a day before ascending to the highest position in the lower chamber. He noted his rapid rise to the speakership saying that his wife could not book a flight to Washington fast enough to be there for his election. While the House was without a speaker, lawmakers could not take up crucial legislation, including spending measures to avoid a catastrophic government shutdown and legislative decisions around the Israel-Hamas war.

The Israeli military said its troops briefly entered Northern Gaza last night, hitting several military targets as a wider ground attack looms. Israeli airstrikes have devastated parts of the Gaza Strip, including destroying residential buildings and hospitals. The UN warns that it's running dangerously low on fuel in Gaza, curbing its efforts to bring relief to the Palestinian territory. The UN Security Council failed again yesterday to address the Israel-Hamas War and rejected rival US and Russian resolutions. Meanwhile, President Joe Biden during a joint press conference with Australian Prime Minister Anthony Albanese at the White House yesterday questioned the death toll numbers Hamas has reported from Gaza.

President Joe Biden:

Innocents have been killed and it's a price of waging a war. But I have no confidence in the number that the Palestinians are using.

Taylor Wilson:

Biden also expressed alarm about extremist settlers attacking Palestinians in the West Bank.

President Joe Biden:

This was the deal. The deal was made and they're attacking Palestinians in places that they're entitled to be and it has to stop. They have to be held accountable and it has to stop now.

Taylor Wilson:

You can stay up on updates from the Israel-Hamas war with our live updates page on usatoday.com.

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Former President Donald Trump and his 2024 campaign have proposed new rules that would give the president more power. I spoke with USA Today national political correspondent, David Jackson for more. David, thanks for hopping on.

David Jackson:

Hey, thanks for having me.

Taylor Wilson:

So Trump and his campaign have proposed new rules that would give presidents more power. David, what does he want specifically when it comes to the president's authority to hire and fire people?

David Jackson:

Well, he wants a lot of things. The most basic things is he wants the criminal prosecutions of him to go away. I think that's his top priority for all of these changes. And he also wants the power to investigate his political opponents because he's suggested on more than few occasions that what's good for the goose is good for the gander and that he's going to respond to the investigations of him by investigating other people such as Joe Biden and Hunter Biden. But in the general sense, what he is asking for is basically to give presidents the power to hire and fire more government officials.

Right now, major parts of the government like the FCC or the Environmental Protection Agency, they're supposed to be independent. They're supposed to be beyond politics. They're supposed to make the decision based on the evidence and the facts and the science and all that stuff. What Trump wants to do is to put more of those people under the thumb of the presidency so that these decisions would be more political in nature than traditional in nature.

Taylor Wilson:

And what do experts say about the potential implications from this push to expand presidential powers like this if he were to succeed?

David Jackson:

Well, it would encourage a lot of big businesses and corporations to give more money to politicians because they could use the presidency to get rid of a lot of regulations on them, particularly environmental regulations. So a lot of people would love it. Basically, it would just give the president more power to determine what the government is going to pursue and what they're not going to pursue. And that's just an immense amount of power. A lot of it would come at the expense of Congress and of the courts, so it'd be a lot of lawsuits about it.

Taylor Wilson:

And David Trump hasn't won the ticket yet. Is this conversation growing among some of his Republican challengers? Is Biden weighing in from the other side on this at all?

David Jackson:

It's funny it hasn't been talked about much because some of his Republican rivals kind of like some of the things he suggested. They're not too crazy about his idea of investigating rivals. But there hasn't been much talk about Trump's proposal to enhance the power of the presidency on the Republican campaign trail because a lot of his opponents frankly agree with them. They do want the president to have more power so that they can do more of the things they want to do. They want to try to cut the budget and end regulations and all this stuff. Right now, the courts and Congress have been an impediment to that. Many Republicans want to try to look for ways to avoid those impediments.

But I think it'll become a very big issue in the fall because Joe Biden and the Democrats have made a big issue about this. They say basically that Trump is on the edge of fascism, that basically he wants to acquire as much power as he possibly can and be a quasi dictator. President Biden made these Trump proposals the centerpiece of a big speech he gave on democracy back in September in Arizona, and he has served notice that this is going to be a big part of his reelection campaign if Trump is in fact nominated.

Taylor Wilson:

David Jackson, great insight as always. Thank you, David.

David Jackson:

Thank you, sir.

Taylor Wilson:

Meanwhile, Trump was fined $10,000 yesterday after the judge in his New York real estate fraud trial ruled that he violated a gag order for a second time. Judge Arthur Engoron said Trump made disparaging remarks to the press about his clerk being partisan.

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At least 16 people were killed and dozens injured after a gunman opened fire last night in a bowling alley and a bar in Lewiston, Maine, and the gunman remains at large as of this morning. Police have warned people to be on alert and stay off the streets in Lewiston, Maine's second-largest city. Late last night, Lewiston Police posted on its Facebook page the photo of a person of interest, Robert Card. Such a designation usually is made for a person wanted for questioning and is not considered officially as a suspect. But the post read that Card is armed and dangerous. The Associated Press, citing a state police bulletin, reported that card is a firearms instructor trained by the military and was recently committed to a mental health facility. The White House said in a statement that President Joe Biden spoke by phone with Maine Governor, Janet Mills and several lawmakers from Maine offering full federal support in the wake of the attack.

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Pharmacists at major national chains have been walking off the job this year complaining of dangerous working conditions that put patients at risk. I spoke with USA Today's senior investigative reporter, Emily Le Coz, to learn more. Emily, thanks for hopping on 5 Things.

Emily Le Coz:

Thanks so much for having me.

Taylor Wilson:

So there have been deteriorating working conditions inside the nation's largest pharmacy chains, and we saw major walkouts at chains in recent months. Emily, what led to this boiling point?

Emily Le Coz:

Yeah, it has been going on for a while. Even before the pandemic pharmacists at the nation's largest retail chains, including CVS, Walgreens, Walmart, Rite Aid, have been complaining about their working conditions, their repeated cutbacks on staff hours, additional demands placed upon them, such as vaccinations, making these patient consultation calls. So the combination of reduction in staff and additional duties placed upon those who are still there has created a sort of a pressure cooker environment where they feel like they are doing too much with too little time, and that really creates a scenario where errors are made. And of course, medication errors, some of them might not be that bad, others can be deadly.

Taylor Wilson:

Yeah, and Emily, amid all that, pharmacists say it's nearly impossible to meet certain goals without cutting corners. That's a frightening thing to hear. What exactly are we talking about here and how concerned should patients be?

Emily Le Coz:

Patients should be concerned. When you pick up a prescription from the pharmacy, many pharmacists told me this, really, it's incumbent upon you to do a little double check yourself. Make sure that the prescription you are picking up has your name on it. Make sure that the medication in the bottle is the medication that you were expecting to receive. It's even more important if this is a brand new prescription that you are dealing with that you've never taken before, maybe go online and Google what is this medication supposed to look like? Does that match what is in the bottle?

Taylor Wilson:

And Emily, you wrote that retail pharmacy wasn't always this bleak. So how did we get to this point of overworked pharmacists and some of these complaints that we've been talking about?

Emily Le Coz:

Yeah, well, there's obviously a lot of factors that have contributed to the current situation, but none that is more powerful than the role of pharmacy benefit managers, which are these third party administrators of the prescription drug part of your health plan. And they are sort of the middleman. They negotiate with drug manufacturers, with your insurance company, with pharmacies, so they're the ones who set reimbursement rates for pharmacies. And those reimbursement rates have just continually shrunk over the years to the point where pharmacies are now losing money on quite a bit of the prescriptions that they're dispensing. And that has had them not only cutting staff but also scrambling for these alternative sources of revenue. Since selling prescriptions alone isn't going to cut it, they're now doing vaccinations. That's a big money maker for pharmacies. So you see a big push for pharmacists to vaccinate patients. They're also making these patient consultation calls and encouraging patients to stay on their drugs or to upgrade to a 90 day prescription if it's available or to do ScriptSyncs.

There's a lot of different ways in which pharmacies are trying to get more revenue, which is another problem that pharmacists, especially at the chains, have expressed as there are lots of internal targets that they are now being asked and pressured to meet, such as the number of prescriptions that are converted to 90 days, the number of vaccinations that they're giving. All of these are really moneymaking programs, if you will, that the pharmacies are trying to institute in order to stay afloat. And unfortunately, a lot of the demand has fallen on the pharmacists to make those ends meet.

Taylor Wilson:

And broadly speaking, who can be tasked with solutions here? Is this an issue for Congress to figure out? Is it something that the state level needs to address? And what are the solutions being thrown around?

Emily Le Coz:

The pharmacy benefit manager situation is probably the biggest one. Several states are trying to deal with those issues under their particular purviews with their state Medicaid programs, for example. But that is an issue that I think a lot of folks have looked to Congress to solve, are hoping Congress gets involved in. The FTC now is investigating the practices of PBMs, as they're called, and what role that is having on pharmacies able to stay afloat. But obviously, state boards of pharmacy are now starting to get involved in passing regulations that mandate minimum staffing requirements, are eliminating the use of metrics and those types of pressures on employees.

The pharmacy associations are trying to take a more active role now in addressing these issues head on. And then certainly the companies themselves, right? We understand that they're dealing with these financial situations, but independent pharmacies, those that have not closed as a result of these financial impacts, have certainly managed to, for the most part in my interviews, maintained safe levels of staffing and are not placing the same pressures on their staff. So it can be done and it should be done. So the responsibility falls on many different entities to fix these problems.

Taylor Wilson:

Emily Le Coz, great work on this story and thanks for coming on and discussing it with us. Really appreciate it.

Emily Le Coz:

Taylor, I appreciate you.

♦

Taylor Wilson:

Be sure to stay tuned to this channel for another special edition of 5 Things coming out this afternoon at 4:00 PM Eastern Time. My colleague Dana Taylor will be looking into the shortage of sexual assault nurses and what that means for victims. You can listen right here on this feed. Thanks for listening to 5 Things. You can find us every day of the week right here, wherever you get your audio. If you have any comments, you can reach us at podcasts@usatoday.com. I'm back tomorrow with more of 5 Things from USA Today.

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