| Good Monday morning. Apparently some foods taste better the next day. We love a good leftover dish. Send tips and recipes to rachel.roubein@washpost.com. Was this forwarded to you? Sign up here. Today's edition: Some lawmakers are seeking to make methadone, an opioid use disorder treatment, more accessible. Utah's Republican governor says he'll sign legislation that would effectively ban abortion clinics. But first … | Democrats want Biden to restrict plans they call 'junk' as millions could lose their Medicaid coverage |  President Biden speaks at Kempsville Recreation Center this week in Virginia Beach to frame Republicans as a threat to the Affordable Care Act and Medicaid. (Carlos Bernate/Bloomberg News) | | | In a speech in Virginia Beach last week, President Biden pledged to protect the Affordable Care Act from threats from MAGA Republicans. But Biden has some unfinished Obamacare business of his own. Democrats in Congress and some advocacy groups are once again ramping up pressure on the administration to end former president Donald Trump's expansion of short-term plans. Democrats — and even Biden himself — have derided such coverage as "junk plans" since they aren't required to comply with the ACA's consumer protections. They repeatedly harped on these plans during the 2020 campaign. Roughly a week into Biden's presidency, he directed federal departments to review Trump-era policies that Democrats believe undermine the ACA. The nation's health department has repeatedly indicated its intent to further limit the length of time people are allowed to enroll in short-term plans, but it hasn't yet released its proposal to reverse the Trump-era rules. Now, key congressional Democrats are upping the ante, urging the administration to get the process moving before the unwinding of pandemic-era Medicaid rules begins in April, with millions expected to lose their safety net program in the coming months. In separate letters to the administration, Democratic lawmakers in both chambers recently expressed concern that some Americans could unknowingly sign up for plans that don't cover preexisting conditions or sidestep covering services like maternity care and mental health treatment. | - "It's time to act — it's actually long past due for them to act," said Rep. Kathy Castor (Fla.), the top Democrat on the House Energy and Commerce oversight subcommittee who has long been vocal on the topic.
| | Rep. Frank Pallone Jr. (N.J.), the top Democrat on the House Energy and Commerce Committee: |  | | | | | If all this sounds familiar, it does to us, too. We wrote a piece last April about efforts from congressional Democrats and patient advocacy groups to press the Biden administration on short-term plans. | | | | | | | Current law allows Medicare patients to be overcharged for routine health care services at certain locations. Site-neutral payment policies could save Americans $471 billion over 10 years. Learn how. | | | |  | | | | | How we got here: Short-term plans were originally intended to fill brief gaps in people's coverage, and the Obama administration imposed a three-month limit on the plans. But in 2018, Trump's health department significantly extended that time frame, allowing people to stay on those plans for nearly a year. Consumers could then ask to get their coverage renewed and keep their plan for a total of up to three years. Supporters and drafters of Trump's rule argue the plans — which historically consist of skimpier, cheaper coverage — represent an important option for affordable coverage. But opponents are now using the spring deadline for states to begin redetermining who is still eligible for Medicaid to put new pressure on the Biden administration. In a statement, the federal Medicare and Medicaid agency says it has "indicated its intention to consider rulemaking" on this type of coverage. In a recent rulemaking agenda, the federal health department said it intended to issue a proposal by next month. (But remember: That agenda is a nonbinding list of the administration's regulatory priorities.) | - The administration is "committed to protecting Americans from insufficient health insurance coverage and remains concerned about the long-term use of short term, limited-duration insurance (STLDI) in place of comprehensive coverage," a spokesperson for the Centers for Medicare and Medicaid Services said in a statement.
| | It's hard to pin down how many people are enrolled in short-term plans. Data is spotty, and there isn't one comprehensive source. A House Energy and Commerce Democratic staff report in 2020 estimated at least 3 million people had this type of coverage in 2019. The concern from some Democrats is that those who get kicked off Medicaid may fall prey to deceptive marketing or otherwise unknowingly sign up for these plans. Even if a proposal to limit short-term plans was released soon, it'd take at least several months, if not longer, before it was finalized — meaning Medicaid redeterminations will begin occurring before new restrictions on the insurance option kick in. Is the risk overblown? "I am sure that some people will leave Medicaid and end up enrolled in a short-term plan," Matthew Fiedler, a senior fellow with the USC-Brookings Schaeffer Initiative for Health Policy, wrote in an email, adding, "the harder question is how many people we are talking about. My bet is that the number of people in this situation will be relatively small, but there is real uncertainty here." There's now one big difference than in years past that could move more people toward the Obamacare marketplace. Some who lose Medicaid will be eligible for more heavily discounted ACA plans, which would likely be cheaper than signing up for a short-term plan. That's because Democrats beefed up the health law's financial aid in 2021 — and then later extended the enhanced subsidies through 2025. But this also depends on how the Medicaid unwinding process goes. State Medicaid officials and the Biden administration have been preparing for months, worried that the nation's record-low uninsured rate could begin to rise. In the statement, CMS said it has a "comprehensive plan" to either help people maintain their Medicaid coverage, or if they're no longer eligible, help move them to other coverage such as in the Obamacare marketplace. | | |  | Public health watch | | As drug deaths rise, experts urge easing of strict methadone rules |  Studies show methadone works, but draconian regulations make it hard to get. (Thomas Simonetti/The Washington Post) | | | Several lawmakers in both parties are pushing to ease regulations on methadone that critics say erect barriers to one of the few effective treatments for opioid use disorder, The Post's David Ovalle reports. Late last week, bipartisan bills were reintroduced in both chambers to allow patients to get methadone at local pharmacies with a prescription from a doctor specializing in addiction, in addition to federally regulated clinics. This comes as strict rules on methadone had already begun loosening during the pandemic, offering a real-world experiment. Beforehand, patients often had to visit clinics daily to receive the medication, which patients say disrupt their lives. But during the pandemic, the federal government gave clinics the flexibility to give patients deemed "stable" up to 28 days' worth of doses, or up to 14 take-home doses for those with less time in treatment. Apart from the proposed legislation, the federal government is moving to make permanent the relaxation of such rules. | | Sen. Ed Markey (D-Mass.): |  | | | | A mile-long line for free food offers a warning as covid benefits end | | In Kentucky, residents are waiting on mile-long lines for free food after the state slashed its pandemic-era benefit to help buy groceries. | | That may foreshadow what could be in store for millions of Americans as the federal government ends the remaining pandemic-era increase in monthly food stamps benefits, The Post's Tim Craig reports. Over the past year, 18 states, such as Kentucky, rescinded the covid food benefit. Now, the benefit will sunset in the rest of the states, D.C., and two territories. The average Supplemental Nutrition Assistance Program benefit is expected to be cut by about $90 per month, according to the left-leaning Center on Budget and Policy Priorities. The move could mark a setback to Biden's efforts to slash poverty while building a healthier middle class. | | |  | Reproductive wars | | Utah governor plans to sign abortion clinic ban |  Utah Gov. Spencer Cox (R) plans to sign antiabortion legislation passed by the state's GOP-led legislature. (Elizabeth Frantz for The Washington Post) | | | Utah Gov. Spencer Cox (R) said he is planning to sign legislation that would effectively ban abortion clinics from operating in the state, since the procedure could soon only be performed in hospitals, the Associated Press reports. The state's Republican-led legislature sent the bill to Cox's desk Friday. Specifically, the measure would require both medication and surgical abortions be provided in hospitals because it wouldn't let new clinics be licensed after May 2 and wouldn't allow any clinics to operate once their licenses expire, the AP's Sam Metz writes. It would affect the four clinics that provide abortions in the state. Abortion is prohibited in Utah after 18 weeks, and a near-total ban on abortion has been blocked by the courts. The legislation Cox is expected to sign also seeks to clarify the definition of abortion to address legal liability concerns from providers about how exceptions were worded in state law. | | Wyoming's Republican-led legislature approved two measures Thursday that would make it nearly impossible to terminate most pregnancies in the state, including prohibiting abortions with narrow exceptions and legislation criminalizing the use of medication abortion, The Post's Joanna Slater reports. The bills now head to the desk of Gov. Mark Gordon (R), who has approved antiabortion legislation in the past. The measures are part of a push by Wyoming lawmakers to close gaps and eliminate legal weaknesses in a previous abortion ban, which was temporarily blocked last year while the courts decide whether it violates the state constitution. | | Kristan Hawkins, president of Students for Life Action: |  | | | | | Planned Parenthood of the Rocky Mountains: |  | | | | | |  | In other health news | | - New this a.m.: Former president Jimmy Carter's recovery from advanced melanoma almost eight years ago electrified the public and the oncology world, putting a spotlight on a revolutionary class of drugs that would go on to transform cancer care, our colleague Laurie McGinley reports.
- Florida Gov. Ron DeSantis (R) gave a speech at the Ronald Reagan Presidential Library yesterday in California, where he accused leaders in blue states of being "lockdown politicians," The Post's Maeve Reston reports. This comes as the Republican moves toward entering the 2024 presidential race.
- President Biden had a cancerous skin lesion removed from his chest last month, his longtime doctor Kevin C. O'Connor wrote in a letter Friday. All cancerous tissue was successfully removed, and no further treatment is needed, our colleague Mariana Alfaro reports.
| | |  | Daybook | | | 📅 It's another busy week in Washington. Here's what we're keeping our eye on: On Tuesday: A Senate Appropriations subcommittee will receive a briefing on the Department of Defense Health Program; a House Veterans Affairs subcommittee will hold a hearing to examine the VA's electronic health record system; the House Rules Committee will consider a Senate-passed bill that would compel the director of national intelligence to declassify information related to the origins of covid-19, among other measures. On Wednesday: The House select subcommittee on the coronavirus pandemic will hold its first hearing investigating the pandemic's origin. On Thursday: Biden is slated to release his annual budget and will give remarks on the proposal in Philadelphia. Also on Thursday: The Senate Committee on Environment and Public Works will meet to consider ways to protect public health after a train carrying toxic chemicals went off the tracks in East Palestine, Ohio; the Senate Special Committee on Aging will hold a hearing on supporting communities of care for older adults. | | |  | Health reads | | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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