The Health 202: Democrats are working on a 'Plan A' for finally getting full Medicaid expansion

The Energy and Commerce Committee is working on legislation... | Presented by Humana ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

Sign up for this newsletter Read online Your health policy appointment. Presented by Humana       By Paige Winfield Cunningham with Alexandra Ellerbeck  Email Republicans' long effort to ditch Obamacare seems finally in the rearview mirror, now that the Supreme Court has thrice upheld it. The road ahead will look very different for the law, as it enters what many view as a new phase of life. "The 'Repeal and Replace' Era Is Over; The 'ACA Expansion' Era Begins," Chris Condeluci, a health policy consultant, wrote in an email to clients this week. First up: Medicaid expansion. Democrats have been devising several different strategies for getting health insurance to people in the "coverage gap" — a population that would have otherwise been eligible for expanded Medicaid except for the fact that their states refused to expand the program. This includes roughly 4.3 million Americans in a dozen states. Their first approach — incentivizing states to expand by giving them extra federal money to do so — hasn't seemed to work, at least so far. A second approach rolled out by Rep. Lloyd Doggett (D-Tex.) is creative but could be logistically difficult to implement and perhaps even impossible under persistent state resistance (we wrote about Doggett's bill here). Rep. Lloyd Doggett speaks at a rally in Austin. (Sergio Flores/Getty Images) So Democrats are working on a third approach. The legislation — which two health policy experts described to me as Democrats' "Plan A" for Medicaid expansion — is being crafted by staff members on the House Energy and Commerce Committee.  The main thrust of the pending legislation is to circumvent the GOP-led states still refusing to expand Medicaid, and find a way to get the free or low-cost coverage to people in the coverage gap, who typically earn at or below the federal poverty level. The bill could take two basic routes to get there — and it's unclear which one staffers have settled on.  One approach would be to allow the coverage gap population to buy fully subsidized plans on HealthCare.gov or the state-run marketplaces. As Judy Solomon writes at the Center on Budget and Policy Priorities, this would require policymakers to make changes in benefits, cost-sharing and enrollment processes. Another approach would be to set up a federalized Medicaid program. It probably would involve direct contracts between the Centers for Medicare and Medicaid Services and managed-care companies to administer Medicaid benefits to people in the coverage gap. The first method — using the marketplace — could raise some cost concerns, considering it's far more expensive to insure people through private plans than through Medicaid, which pays providers lower rates. There's also a worry that both approaches could incentivize states that already expanded Medicaid to drop the coverage, if the federal government starts fully funding the expansion population through a new route. Democrats are keeping their plans close to the vest. An Energy and Commerce Committee spokesman declined to offer any details about the legislation, offering only a generic statement about the committee's work. "The committee is continuing to work on a comprehensive solution to provide coverage to Americans who are trapped in the Medicaid coverage gap through no fault of their own," the statement said. "Our priority is crafting a policy fix that provides coverage and access to care to everyone in the states that have not expanded and not limited to certain counties." Whatever the bill ends up looking like, Democrats are hoping to include it in any budget reconciliation package Congress tries to pass this year. But those plans are still up in the air, as a bipartisan group of senators tries to negotiate an infrastructure deal with the White House, which would allow Democrats to wait on passing a partisan reconciliation bill until later in the year. The Post's Jeff Stein, who has been covering the negotiations:   ADVERTISEMENT Content from Humana Medicare Advantage: Better health outcomes, lower costs The Medicare program has evolved for over 50 years to meet seniors' needs. Today, Medicare Advantage plans are reducing ER visits and saving enrollees an average of $1,640/year in out-of-pocket costs.   Share The Health 202    Ahh, oof and ouch AHH: The White House said the United States will miss Biden's July 4 vaccination goal. White House coronavirus coordinator Jeff Zients conceded at a press briefing that the country will not meet the president's target of administering at least one dose of a coronavirus vaccine to 70 percent of adults. Zients outlined a new Independence Day goal: ensuring that 70 percent of Americans age 27 and up receive at least one shot by the holiday weekend. Zients said that the United States is also running a few weeks behind another July 4 target laid out by Biden: getting 160 million Americans fully vaccinated. He said that number would be reached by mid-July. About 150 million Americans have been fully vaccinated, and 70 percent of Americans over the age of 30 have received at least one shot. "White House officials' remarks Tuesday are a formal acknowledgment of what had become clear in recent weeks: The United States had fallen behind Biden's goal as vaccinations slowed, particularly in the South and Midwest," The Post's Dan Diamond reports. "Health officials have struggled to persuade younger Americans to get vaccinated despite lotteries, gifts and other promotions." OOF: Sen. Ron Wyden (D-Ore.) outlined new principles for drug pricing reform. "The new framework, which Wyden has discussed for months with members of his influential committee and Democratic leadership, proposes building on the bipartisan plan he and Sen. Chuck Grassley (R-Iowa) offered last Congress that never came up for a floor vote due to GOP leaders' opposition," Politico's Alice Miranda Ollstein reports. Sen. Ron Wyden (D-Ore.) talks with Sen. Chuck Grassley (R-Iowa) during a hearing on Capitol Hill. (Susan Walsh/AP) The plan also contains provisions similar to those in Democrats' signature drug-pricing bill, H.R. 3, that would allow federal government to directly negotiate with drugmakers for lower prices on some pharmaceuticals. "The Wyden plan comes as drug pricing talks in Congress remain uncertain. A group of House Democratic moderates have raised concerns over government negotiations, casting in doubt Speaker Nancy Pelosi's pledge to include her drug pricing bill in infrastructure legislation," Alice writes. OUCH: More than 150 health workers at a Texas hospital system who refused a coronavirus vaccine were fired or resigned. Houston Methodist terminated or accepted the resignations of 153 workers Tuesday, spokeswoman Gale Smith told The Post. The decision comes one week after a federal judge dismissed a lawsuit against the policy brought by one of the employees. Workers at Houston Methodist Baytown Hospital protest the health system's coronavirus vaccination requirement on June 7. (Yi-Chin Lee/Houston Chronicle/AP) The Texas hospital was one of the first health systems to require the coronavirus shots, announcing on April 1 that staffers would be required to get the vaccine to keep their jobs.  "A growing number of health-care organizations have opted to impose vaccine mandates, including the majority of hospitals in D.C. and Maryland," Dan reports. "The University of Pennsylvania Health System last month announced that it would require its roughly 44,000 employees and clinical staffers to be vaccinated by September, crediting Houston Methodist's example."   More in coronavirus news Deaths among Medicare nursing home patients were up by 32 percent last year amid the pandemic, according to a report from the inspector general of the Department of Health and Human Services. The report found that 4 in 10 Medicare patients in nursing homes probably contracted the virus, the Associated Press's Ricardo Alonso-Zaldivar reports.   A coronavirus outbreak in a Florida government building killed at least two people and hospitalized several others, The Post's Timothy Bella reports. Six unvaccinated employees in the Manatee County Administration Building tested positive for the virus within a two-week period. One vaccinated employee in the IT department, where the outbreak was concentrated, was exposed but did not get infected.   The economist Emily Oster has offered data-driven and sometimes counterintuitive advice about parenting, from recommendations that an occasional glass of wine is probably safe during pregnancy to advice that breastfeeding is overrated. Now she's in the spotlight for her repeated calls to reopen schools amid the coronavirus, the New York Times's Dana Goldstein reports. She's drawn on reams of data from a project she launched to track coronavirus cases in classrooms, but she's facing backlash from some teachers, epidemiologists and labor activists who point out that she's not an infectious-disease specialist.   Elsewhere in health care There's a battle brewing over where a new health research agency should be housed. President Biden is set on reviving a former Trump administration proposal: the creation of the Advance Research Projects Agency for Health (ARPA-H). "In the administration's debut budget proposal, the National Institutes of Health received $6.5 billion to launch the new agency modeled after the military's Defense Advanced Research Projects Agency (DARPA)," our Power Up colleague Jacqueline Alemany writes. "ARPA-H would accelerate the development of medical treatments for Alzheimer's disease, cancer, cardiovascular disease, and more." NIH Director Francis Collins holds up a model of the coronavirus as he testifies before a Senate Appropriations Subcommittee in May. (Photo by Sarah Silbiger-Pool/Getty Images) "For Biden, whose son Beau died of brain cancer in 2015, the potential creation of the agency is personal. Biden and his wife Jill founded the Biden Cancer Initiative in 2017 to continue the Obama administration's "cancer moonshot," which Biden led as vice president," she adds." "…But there's a battle brewing over where exactly the agency should be housed — and how it should be structured to have the most impact. Some medical experts and some lawmakers believe that for the agency to successfully innovate, it should be a stand-alone entity within the Department of Health and Human Services, and free of what many experts view as NIH's bureaucratic and time-consuming approach to innovation and research. The FDA released new information on its decision to approve a controversial Alzheimer's drug. "But the new information, included in interviews with agency officials and 83 pages of internal documents, might not quiet a furor over the drug Aduhelm that has drawn in Alzheimer's doctors and patients, members of Congress, Medicare officials, and the agency itself," The Post's Laurie McGinley reports. Agency officials opted against full approval, given conflicting evidence of the drug's benefit to patients. Instead, they opted for an "accelerated approval" based on a judgment that the drug's success in reducing amyloid beta plaque in the brain made it "reasonably likely" to slow cognitive decline. But some scientists say that even a conditional approval is not warranted given numerous studies showing that amyloid-targeting drugs don't help patients. Marc Archambault was one of the first people to receive Aduhelm. (Jessica Rinaldi/Pool/Reuters) Peter Stein, director of the Food and Drug Administration's Office of New Drugs, cited the "substantial and urgent" need for new therapies in a memo explaining why the agency decided to approve a drug whose benefits are uncertain. "FDA has heard the voices of many patients afflicted with [Alzheimer's disease] who express a desperate desire for an effective treatment," Stein said. The stakes of the approval are high, not only for the patients who may receive treatment, but also for the broader health system. At $56,000 a year, the drug is costly, and the potential market numbers in the millions. The New York Times reported that projections estimate Medicare could spend more on Aduhelm than the entire government budget for NASA. Elite American nonprofit hospitals are looking to make money abroad. Cleveland Clinic is launching a $1 billion project to open a hospital in London. The hospital will primarily offer elective surgeries and other profitable treatments, while forgoing less lucrative services, such as emergency care, Kaiser Health News's Jordan Rau reports. And Cleveland Clinic is not alone. It's one of three dozen elite hospitals and health systems seeking patients and insurers overseas who are able to pay high prices. "These foreign forays prompt questions about why American nonprofit health systems, which pay little or no taxes in their hometowns, are indulging in such nakedly commercial ventures overseas," Jordan writes. The majority of U.S. hospitals are exempt from taxes because they provide charity care and benefits to their local communities, but it's not clear that these communities benefit from international expansion.   Sugar rush   We think you'll like this newsletter Check out Post Most for the most popular and interesting stories of the day, from politics to opinions to world news, to keep you in the know. In your inbox, every day. Sign up »

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