Tag: U.S. Congress

KFF Health News’ ‘What the Health?’: Trump Puts Obamacare Repeal Back on Agenda

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Former president and current 2024 Republican front-runner Donald Trump is aiming to put a repeal of the Affordable Care Act back on the political agenda, much to the delight of Democrats, who point to the health law’s growing popularity.

Meanwhile, in Texas, the all-Republican state Supreme Court this week took up a lawsuit filed by more than two dozen women who said their lives were endangered when they experienced pregnancy complications due to the vague wording of the state’s near-total abortion ban.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Johns Hopkins University and Politico Magazine, Victoria Knight of Axios, and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • The FDA recently approved another promising weight loss drug, offering another option to meet the huge demand for such drugs that promise notable health benefits. But Medicare and private insurers remain wary of paying the tab for these very expensive drugs.
  • Speaking of expensive drugs, the courts are weighing in on the use of so-called copay accumulators offered by drug companies and others to reduce the cost of pricey pharmaceuticals for patients. The latest ruling called the federal government’s rules on the subject inconsistent and tied the use of copay accumulators to the availability of cheaper, generic alternatives.
  • Congress will revisit government spending in January, but that isn’t soon enough to address the end-of-the-year policy changes for some health programs, such as pending cuts to Medicare payments for doctors.
  • “This Week in Medical Misinformation” highlights a guide by the staff of Stat to help lay people decipher whether clinical study results truly represent a “breakthrough” or not.

Also this week, Rovner interviews KFF Health News’ Rachana Pradhan, who reported and wrote the latest “Bill of the Month” feature, about a woman who visited a hospital lab for basic prenatal tests and ended up owing almost $2,400. If you have an outrageous or baffling medical bill you’d like to share with us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: KFF Health News’ “Medicaid ‘Unwinding’ Makes Other Public Assistance Harder to Get,” by Katheryn Houghton, Rachana Pradhan, and Samantha Liss.

Joanne Kenen: KFF Health News’ “She Once Advised the President on Aging Issues. Now, She’s Battling Serious Disability and Depression,” by Judith Graham.  

Victoria Knight: Business Insider’s “Washington’s Secret Weapon Is a Beloved Gen Z Energy Drink With More Caffeine Than God,” by Lauren Vespoli.

Sarah Karlin-Smith: ProPublica’s “Insurance Executives Refused to Pay for the Cancer Treatment That Could Have Saved Him. This Is How They Did It,” by Maya Miller and Robin Fields.

Also mentioned in this week’s episode:

To hear all our podcasts, click here.

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In Congress, Calls Mount for Social Security to Address Clawbacks

An investigation by KFF Health News and Cox Media Group gained further traction on Capitol Hill this week as additional members of Congress formally demanded answers from the Social Security Administration about billions of dollars it mistakenly paid to beneficiaries — and then ordered they repay.

Two members of a Senate panel that oversees Social Security sent a letter to the agency’s acting commissioner, Kilolo Kijakazi, urging her to do more to prevent overpayments and “limit harm to vulnerable beneficiaries” when trying to recover the money.

As KFF Health News and Cox Media Group television stations jointly reported in September, the Social Security Administration routinely sends notices to beneficiaries saying they received benefits to which they weren’t entitled — and demanding they pay the government back, often within 30 days.

In the 2022 federal fiscal year, for example, the agency sent overpayment notices to more than 1 million people, Kijakazi told Congress in mid-October.

Alleged overpayments can continue for years before the government notifies a recipient and seeks repayment. By then, the amount a beneficiary allegedly owes the government can reach tens of thousands of dollars or more. People living check to check likely would have spent the money.

To recoup money owed, the government can reduce or stop people’s monthly benefit checks.

“[W]e have been deeply concerned by stories from our constituents and recent reports of the extreme financial hardship placed upon beneficiaries who are asked to quickly repay in full or whose payments are halted, reduced, or reclaimed as the agency attempts to correct improper payments, many of which occurred due to agency error,” Sens. Maggie Hassan (D-N.H.) and Bill Cassidy (R-La.) wrote in a Nov. 28 letter to Kijakazi.

Citing the news organizations’ reporting, the senators asked what Kijakazi is doing to prevent harm to beneficiaries and what Congress can do.

Hassan and Cassidy are on the Senate Finance Committee’s Subcommittee on Social Security, Pensions, and Family Policy.

Meanwhile, Sen. Rick Scott (R-Fla.) sent Kijakazi a letter on Nov. 17 calling the agency’s actions “unacceptable.”

“If anyone intentionally defrauded the system or lied to receive payments at other taxpayers’ expense, they should absolutely be held accountable and repay this debt to taxpayers,” Scott wrote. “But it’s completely wrong for the federal government to go after well-intentioned Americans who did all the right things and trusted that their government was doing the right thing, too.”

Many of the people affected are disabled, low-income, or both and are enrolled in the Social Security Administration’s Disability Insurance or Supplemental Security Income programs.

In the 2022 fiscal year, the agency issued an estimated $4.6 billion in SSI overpayments, which represented 8% of payments in that program, according to the agency’s latest annual financial report.

Kijakazi recently told a House subcommittee the 8% was “a small percentage.”

In other programs administered by the agency, there were an estimated $6.5 billion in overpayments in fiscal 2022, which amounted to one-half of 1%. Kijakazi called that overpayment rate “extremely low.”

During the 2023 fiscal year, which ended on Sept. 30, the agency recovered $4.9 billion in overpayments, according to a recent statement by Social Security’s inspector general. At the end of that period, an additional $23 billion of accumulated overpayments remained uncollected, the statement said.

Since KFF Health News and Cox Media Group TV stations published and broadcast news reports on overpayment clawbacks in September, several members of the House and Senate have written to the Social Security Administration calling for change or answers.

“Many of these overpayment notices come as a complete surprise to SSA beneficiaries, leaving them confused, shocked, and scared that they cannot pay what SSA says they owe,” Rep. Ruben Gallego, an Arizona Democrat and Senate candidate, said in a Sept. 29 letter. “And, because of an indefinite ‘look-back period’, SSA can collect funds from a recipient for an error going back decades,” he added.

Asked about the latest letters from lawmakers, Social Security spokesperson Nicole Tiggemann said the agency “will respond directly to the requestors.”

Kijakazi said in October that she ordered a “top-to-bottom” review of how the agency handles overpayments.

Under federal law, the agency must seek recovery of overpaid amounts unless circumstances warrant waiving the debts, Kijakazi said in recent testimony to Congress. There’s no time limit on efforts to collect the debts, she said.

In their letter to the acting commissioner, Cassidy and Hassan asked what the agency is doing to make it less burdensome for beneficiaries to appeal or seek a waiver when an overpayment is the government’s fault.

In response to questions for this article, Tiggemann, the Social Security spokesperson, said, “We will examine our policies and procedures — including our regulations — to determine where administrative updates to the overpayment recovery and waiver process may reduce the complexity and burden for the people we serve.”

Scott, the Florida Republican, asked if the review Kijakazi announced in October would be disclosed to the public. In a written response to questions for this article, the Social Security spokesperson didn’t say.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

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US Military Says National Security Depends on ‘Forever Chemicals’

The Department of Defense relies on hundreds, if not thousands, of weapons and products such as uniforms, batteries, and microelectronics that contain PFAS, a family of chemicals linked to serious health conditions.

Now, as regulators propose restrictions on their use or manufacturing, Pentagon officials have told Congress that eliminating the chemicals would undermine military readiness.

PFAS, known as “forever chemicals” because they don’t break down in the environment and can build up in the human body, have been associated with such health problems as cancer. In July, a new federal study showed a direct link between testicular cancer and PFOS, a PFAS chemical that has been found in the blood of thousands of military personnel.

Congress has pressured the Defense Department to clean up U.S. military sites and take health concerns more seriously. Under the fiscal 2023 James M. Inhofe National Defense Authorization Act, the Pentagon was required to assess the ubiquity of per- and polyfluoroalkyl substances, or PFAS, in products and equipment used by the military.

In a report delivered to Congress in August, Defense Department officials pushed back against health concerns raised by environmental groups and regulators. “DoD is reliant on the critically important chemical and physical properties of PFAS to provide required performance for the technologies and consumable items and articles which enable military readiness and sustainment,” the authors said.

Further, they wrote: “Losing access to PFAS due to overly broad regulations or severe market contractions would greatly impact national security and DoD’s ability to fulfill its mission.”

According to the report, most major weapons systems, their components, microelectronic chips, lithium-ion batteries, and other products contain PFAS chemicals. These include helicopters, airplanes, submarines, missiles, torpedoes, tanks, and assault vehicles; munitions; semiconductors and microelectronics; and metalworking, cooling, and fire suppression systems — the latter especially aboard Navy ships.

PFAS are also present in textiles such as uniforms, footwear, tents, and duffel bags, for which the chemicals help repel water and oil and increase durability, as well as nuclear, chemical, and biological warfare protective gear, the report says.

The Pentagon’s report to Congress was released last month by the American Chemistry Council.

Defending a Tradition of Defense

Military officials’ defense of PFAS use comes as concerns mount over the health risks associated with the chemicals. Beyond cancer, some types of PFAS have been linked to low birth weight, developmental delays in children, thyroid dysfunction, and reduced response to immunizations. Health concerns grew with the release of the study definitively linking testicular cancer in military firefighters to a foam retardant containing PFAS.

But that wasn’t the first time U.S. military officials were warned about the potential health threat. In the 1970s, Air Force researchers found that firefighting foam containing PFAS was poisonous to fish and, by the 1980s, to mice.

In 1991, the U.S. Army Corps of Engineers told Fort Carson, Colorado, to stop using firefighting retardants containing PFAS because they were “considered hazardous material in a number of states.”

The Environmental Protection Agency has struggled to determine whether there are acceptable levels of PFAS in drinking water supplies, given the existence of hundreds of varieties of these chemicals. But in March, the EPA did propose federal limits on the levels of PFAS in drinking water supplies.

The regulation would dramatically reduce limits on six types of the chemicals, with caps on the most common compounds, known as PFOA and PFOS, at 4 parts per trillion. Currently, the Defense Department’s threshold for drinking water is 70 parts per trillion based on a 2016 EPA advisory. As part of a widespread testing program, if levels are found on installations or in communities above that amount, the military furnishes alternative drinking water supplies.

The Defense Department has used PFAS-laced firefighting foam along with other products containing the chemicals for more than a half-century, leading to the contamination of at least 359 military sites or nearby communities, with an additional 248 under investigation, according to the department.

In its report, however, the Department of Defense did not address the health concerns and noted that there is “no consensus definition of PFAS as a chemical class.” Further, it said that the broad term, which addresses thousands of man-made chemical chains, “does not inform whether a compound is harmful or not.”

Researchers with the Environmental Working Group, an advocacy group that focuses on PFAS contamination nationwide, said the report lacked acknowledgment of the health risks or concerns posed by PFAS and ignored the availability of PFAS-free replacements for material, tents, and duffel bags.

The military report also did not address possible solutions or research on non-PFAS alternatives or address replacement costs, noted EWG’s Jared Hayes, a senior policy analyst, and David Andrews, a senior scientist.

“It’s kind of like that report you turn in at school,” Andrews said, “when you get a comment back that you did the minimum amount possible.”

Andrews added that the report fell short in effort and scope.

The Defense Department announced this year it would stop buying firefighting foam containing PFAS by year’s end and phase it out altogether in 2024. It stopped using the foam for training in 2020, by order of Congress.

The report noted, however, that while new Navy ships are being designed with alternative fire suppression systems such as water mists, “limited use of [PFAS-containing systems] remains for those spaces where the alternatives are not appropriate,” such as existing ships where there is no alternative foam that could be swapped into current systems.

According to the report, “the safety and survivability of naval ships and crew” from fires on ships depends on current PFAS-based firefighting foams and their use will continue until a capable alternative is found.

Pervasive Yet Elusive

Commercially, PFAS chemicals are used in food packaging, nonstick cookware, stain repellents, cosmetics, and other consumer products.

The fiscal 2023 National Defense Authorization Act also required the Defense Department to identify consumer products containing PFAS and stop purchasing them, including nonstick cookware and utensils in dining facilities and ship galleys as well as stain-repellent upholstered furniture, carpeting, and rugs.

But in a briefing to Congress in August accompanying the report on essential uses, Pentagon officials said they couldn’t comply with the law’s deadline of April 1, 2023, because manufacturers don’t usually disclose the levels of PFAS in their products and no federal laws require them to do so.

Come Jan. 1, however, makers of these chemicals and products containing them will be required to identify these chemicals and notify “downstream” manufacturers of other products of the levels of PFAS contained in such products and ingredients, even in low concentrations, according to a federal rule published Oct. 31 by the EPA.

This would include household items like shampoo, dental floss, and food containers.

Officials reiterated that the Defense Department is committed to phasing out nonessential and noncritical products containing PFAS, including those named above as well as food packaging and personal protective firefighting equipment.

And it is “developing an approach” to remove items containing PFAS from military stores, known as exchanges, also required by the fiscal 2023 NDAA.

Risk-Benefit Assessments

In terms of “mission critical PFAS uses,” however, the Pentagon said the chemicals provide “significant benefits to the framework of U.S. critical infrastructure and national and economic security.”

Andrews of EWG noted that the industry is stepping up production of the chemicals due to market demand and added that the federal government has not proposed banning PFAS chemicals, as the Defense Department alluded to when it emphasized the critical role these substances play in national security and warned against “overly broad regulations.”

“The statements are completely unsubstantiated, and it’s almost a fear-mongering statement,” Andrews said. “I think the statement is really going beyond anything that’s even being considered in the regulatory space.”

“There haven’t been realistic proposals policy-wise of a complete ban on PFAS,” his colleague Hayes added. “What people have been pushing for and talking about are certain categories of products where there are viable alternatives, where there is a PFAS-free option. But to ban it outright? I haven’t really seen that as a realistic policy proposal.”

Kevin Fay, executive director of the Sustainable PFAS Action Network, a coalition of corporations, industry advocates, and researchers who support the use and management of PFAS compounds, said the Defense Department has a point and it is up to federal regulators to “responsibly manage” these chemicals and their use to strike a balance among environmental, health, and industrial needs.

“The U.S. Department of Defense’s report on critical PFAS uses is crystal clear: regulating PFAS through a one-size fits all approach will gravely harm national security and economic competitiveness,” Fay wrote in an email to KFF Health News.

Adding that not all PFAS compounds are the same and arguing that not all are harmful to human health, Fay said risk-based categorization and control is vital to the continued use of the chemicals.

But, he added, in locations where the chemicals pose a risk to human health, the government should act.

“The federal government should implement plans to identify and remediate contaminated sites, properly identify risk profiles of the many types of PFAS compounds, and encourage innovation by clearing the regulatory path for viable alternatives to specific dangerous compounds,” Fay wrote.

Assessments are completed or underway at 714 active and former military installations, National Guard facilities, and other former defense sites to determine the extent of contamination in groundwater, soil, and the water supply to these locations and nearby communities.

Last year, the Pentagon issued a temporary moratorium on burning materials containing PFAS. Studies have shown that the practice can release toxic gases. But on July 11, the Defense Department lifted the moratorium on incineration, along with interim guidance on PFAS disposal.

Military personnel who were exposed to PFAS — including through firefighting foam — say they live in fear that they or their family members will develop cancer as a result of their service.

“I’ve got more of some of those materials in my system than 90-plus percent of those on the planet. This is bad. It doesn’t go away,” said Christian Jacobs, who served in the Army for four years and worked as a civilian Defense Department firefighter for nearly three decades. “It keeps me up at night.”

KFF Health News visual reporter Hannah Norman contributed to this report.

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New Social Security Report Shows Growing Overpayment Problem Tops $23B

A new financial report released by the Social Security Administration this week shows that the scope of the agency’s overpayment problem has continued to grow.

As of Oct. 1, the SSA had an uncollected balance of $23 billion in overpayments — money the agency had determined it mistakenly paid to beneficiaries across the country but had not been able to claw back, despite repeated attempts to do so.

In September, a series of investigative reports by KFF Health News and Cox Media Group television stations first revealed the magnitude of the problem and shared the experiences of dozens of people who’ve received letters from the federal agency demanding repayment, sometimes in the tens of thousands of dollars. At the beginning of fiscal year 2023, the agency’s uncollected balance of overpayments was $21.6 billion.

Its latest “Agency Financial Report” also revealed that the SSA made approximately $11.1 billion in new overpayments to beneficiaries during federal fiscal year 2022, the most recent year of data available. That figure represents more than a 65% increase from overpayments made the previous year. For the past several years, the agency routinely distributed between $6 billion and $7 billion in new overpayments each year.

The report shows the majority of the 2022 overpayments occurred within the Old-Age, Survivors, and Disability Insurance (OASDI) programs, an estimated $6.5 billion. Those programs provide retirement and survivors’ benefits to qualified workers and their families, or support workers who become disabled and their families.

In prior years, most of the overpayments occurred within the Supplemental Security Income program, which provides financial support to aged, blind, and disabled adults and children who have limited income and resources. In 2022, overpayments within the SSI program topped $4.6 billion, which is similar to previous years.

The SSA had not yet responded to a request for an explanation of the significant increase in overpayments within OASDI.

(WHIO-TV)

The report said $1.6 billion of the OASDI overpayments and $287 million of the SSI overpayments were within the agency’s control, meaning they weren’t the beneficiaries’ fault.

In recent weeks, beneficiaries have told KFF Health News-CMG reporters they had no idea they were receiving too much money in their monthly checks until they received a letter from Social Security demanding repayment, often within 30 days.

“I almost threw up when I opened that letter,” said Lori, a Florida woman who didn’t want to publicly disclose her last name. She received a notice saying she owed $121,000, a debt she said was later erased following a multiyear fight with the SSA.

The notices often arrive years after the alleged overpayments occur and, by that time, the money owed can balloon to dollar amounts impossible for beneficiaries to repay.

“It’s just scary to my husband and me. Where are we supposed to come up with this money?” Ohio resident Tammy Eichler told WHIO-TV.

When beneficiaries can’t repay the money, the agency may lower their monthly benefit checks, even when the overpayments were the government’s fault. 

“Taking that benefit away from me will make me homeless,” Florida resident Jesse Greatorex told WFTV-TV.

SSA spokesperson Nicole Tiggemann said the SSA is required by law to attempt to recover overpayments once they are detected.

“We will be doing a top-to-bottom review to see how we can further reduce the error rate,” said SSA acting Commissioner Kilolo Kijakazi, who directed an agency-wide review of overpayment policies and procedures following the reporting by KFF Health News and CMG in September.

Members of the Social Security Subcommittee of the House Ways and Means Committee held a hearing in October, citing the joint reporting and demanding answers from Kijakazi regarding the number of people affected by overpayments and what the agency plans to do to address the problem.

A group of senators also wrote to Kijakazi asking about overpayments caused by government-issued stimulus checks during the covid-19 pandemic. KFF Health News and Cox Media Group TV stations profiled beneficiaries who believe the agency erroneously counted those payments against their asset limit, in violation of SSA policy.

Sen. Sherrod Brown (D-Ohio) and other members of Congress are considering several legislative changes that could make it easier for people to avoid overpayments: for example, raising the cap on how much money they’re allowed to save.

“I want [the legislation] to fix the people that it’s already happened to. I want it to stop it from happening in the future,” Brown told WHIO-TV.

Ohio resident Addie Arnold, who cares for her disabled niece and received a letter saying they owed the government more than $60,000, wrote to the SSA saying, “I truly do hope and pray that she is allowed to stay on SSI … because she has to continue to live and without it, she will be in a very bad place.”

“Social Security should be to help people, not to destroy them,” Arnold said.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

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Senators Have Mental Health Crises, Too

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Both Republicans and Democrats in Congress reacted with compassion to the news that Sen. John Fetterman (D-Pa.) has checked himself into Walter Reed National Military Medical Center for treatment of clinical depression. The reaction is a far cry from what it would have been 20 or even 10 years ago, as more politicians from both parties are willing to admit they are humans with human frailties.

Meanwhile, former South Carolina governor and GOP presidential candidate Nikki Haley is pushing “competency” tests for politicians over age 75. She has not specified, however, who would determine what the test should include and who would decide if politicians pass or fail.

This week’s panelists are Julie Rovner of KHN, Sarah Karlin-Smith of the Pink Sheet, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachel Roubein of The Washington Post.

Among the takeaways from this week’s episode:

  • Acknowledging a mental health disorder could spell doom for a politician’s career in the past, but rather than raising questions about his fitness to serve, Sen. John Fetterman’s decision to make his depression diagnosis and treatment public raises the possibility that personal experiences with the health system could make lawmakers better representatives.
  • In Medicare news, Sen. Rick Scott (R-Fla.) dropped Medicare and Social Security from his proposal to require that every federal program be specifically renewed every five years. Scott’s plan has been hammered by Democrats after President Joe Biden criticized it this month in his State of the Union address.
  • Medicare is not politically “untouchable,” though. Two Biden administration proposals seek to rein in the high cost of the popular Medicare Advantage program. Those are already proving controversial as well, particularly among Medicare beneficiaries who like the additional benefits that often come with the private-sector plans.
  • New studies on the effectiveness of ivermectin and mask use are drawing attention to pandemic preparedness. The study of ivermectin revealed that the drug is not effective against the covid-19 virus even in higher doses, raising the question about how far researchers must go to convince skeptics fed misinformation about using the drug to treat covid. Also, a new analysis of studies on mask use leaned on pre-pandemic studies, potentially undermining mask recommendations for future health crises.
  • On the abortion front, abortion rights supporters in Ohio are pushing for a ballot measure enshrining access to the procedure in its state constitution, while a lawyer in Florida is making an unusual “personhood” argument to advocate for a pregnant woman to be released from jail.

Plus for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat’s “Current Treatments for Cramps Aren’t Cutting It. Why Aren’t There Better Options,” by Calli McMurray

Joanne Kenen: The Atlantic’s “Eagles Are Falling, Bears Are Going Blind,” by Katherine J. Wu

Rachel Roubein: The Washington Post’s “Her Baby Has a Deadly Diagnosis. Her Florida Doctors Refused an Abortion,” by Frances Stead Sellers

Sarah Karlin-Smith: DCist’s “Locals Who Don’t Speak English Need Medical Translators, but Some Say They Don’t Always Get the Service,” by Amanda Michelle Gomez and Hector Alejandro Arzate

Also mentioned in this week’s podcast:

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A Health-Heavy State of the Union

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Health care was a recurring theme throughout President Joe Biden’s 2023 State of the Union address on Capitol Hill this week. He took a victory lap on recent accomplishments like capping prescription drug costs for seniors on Medicare. He urged Congress to do more, including making permanent the boosted insurance premium subsidies added to the Affordable Care Act during the pandemic. And he sparred with Republicans in the audience — who jeered and called him a liar — over GOP proposals that would cut Medicare and Social Security.

Meanwhile, abortion rights advocates and opponents are anxiously awaiting a federal court decision out of Texas that could result in a nationwide ban on mifepristone, one of two drugs used in medication abortion.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • President Joe Biden’s State of the Union address emphasized recent victories against high health care costs, like Medicare coverage caps on insulin and out-of-pocket caps on prescription drug spending. Biden’s lively, informal exchange with lawmakers over potential cuts to Medicare and Social Security seemed to steal the show, though the political fight over cutting costs in those entitlement programs is rooted in a key question: What constitutes a “cut”?
  • Biden’s calls for bipartisanship to extend health programs like pandemic-era subsidies for Affordable Care Act health plans are expected to clash with conservative demands to slash federal government spending. And last year’s Senate fights demonstrate that sometimes the opposition comes from within the Democratic Party.
  • While some abortion advocates praised Biden for vowing to veto a federal abortion ban, others felt he did not talk enough about the looming challenges to abortion access in the courts. A decision is expected soon in a Texas court case challenging the future use of mifepristone. The Trump-appointed judge’s decision could ban the drug nationwide, meaning it would be barred even in states where abortion continues to be legal.
  • The FDA is at the center of the abortion pill case, which challenges its approval of the drug decades ago and could set a precedent for legal challenges to the approval of other drugs. In other FDA news, the agency recently changed policy to allow gay men to donate blood; announced new food safety leadership in response to the baby formula crisis; and kicked back to Congress a question of how to regulate CBD, or cannabidiol, products.
  • In drug pricing, the top-selling pharmaceutical, Humira, will soon reach the end of its patent, which will offer a telling look at how competition influences the price of biosimilars — and the problems that remain for lawmakers to resolve.

Also this week, Rovner interviews Kate Baicker of the University of Chicago about a new paper providing a possible middle ground in the effort to establish universal health insurance coverage in the U.S.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too:

Julie Rovner: The New York Times’ “Don’t Let Republican ‘Judge Shoppers’ Thwart the Will of Voters,” by Stephen I. Vladeck

Alice Miranda Ollstein: Politico’s “Mpox Is Simmering South of the Border, Threatening a Resurgence,” by Carmen Paun

Sarah Karlin-Smith: KHN’s “Decisions by CVS and Optum Panicked Thousands of Their Sickest Patients,” by Arthur Allen

Rachel Cohrs: ProPublica’s “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings,” by David Armstrong, Patrick Rucker, and Maya Miller

Also mentioned in this week’s podcast:

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Abortion Debate Ramps Up in States as Congress Deadlocks

Anti-abortion advocates are pressing for expanded abortion bans and tighter restrictions since the Supreme Court overturned the national right to abortion. But with the debate mostly deadlocked in Washington, the focus is shifting to states convening their first full legislative sessions since Roe v. Wade was overturned.

Although some state GOP lawmakers have filed bills to ban abortion pills or make it more difficult for women to travel out of state for an abortion, others seem split about what their next steps should be. Some are even considering measures to ease their states’ existing bans somewhat, particularly after Republicans’ less-than-stellar showing in the 2022 midterm elections and voters’ widespread support for abortion on state ballot measures.

Meanwhile, Democratic-led states are looking to shore up abortion protections, including Minnesota and Michigan, where Democrats sewed up legislative majorities in the November elections.

Anti-abortion groups said their goal in overturning Roe v. Wade was to turn the decision back to the states, but now they are making clear that what they want is an encompassing national abortion ban.

“Legislation at the state and federal levels should provide the most generous protections possible to life in the womb,” says the “Post-Roe Blueprint” of the anti-abortion group Students for Life.

The new Republican-led House showed its anti-abortion bona fides on its first day of formal legislating, Jan. 11, passing two pieces of anti-abortion legislation that are unlikely to become law with a Senate still controlled by Democrats and President Joe Biden in the White House.

So at the federal level, the fight is taking shape in the courts over the abortion pill mifepristone, which has been used as part of a two-drug regimen for more than two decades, and recently became the way a majority of abortions in the U.S. are conducted.

The Biden administration has moved to make mifepristone more widely available by allowing it to be distributed by pharmacies, as well as clarifying that it is legal to distribute the pills via the U.S. mail. But the conservative legal group Alliance Defending Freedom, on behalf of several anti-abortion groups, filed a federal lawsuit in Texas in November, charging that the FDA never had the authority to approve the drug in the first place.

In Texas, some lawmakers are exploring new ways to chip away at Texans’ remaining sliver of access to abortions. For example, one proposal would prevent local governments from using tax dollars to help people access abortion services out of state, while another would prohibit tax subsidies for businesses that help their local employees obtain abortions out of state.

Those measures could get lost in the shuffle of the state’s frantic 140-day, every-other-year session, if legislative leaders don’t consider them a priority. The state’s trigger law banning almost all abortions that went into effect last year “appears to be working very well,” said Joe Pojman, founder and executive director of Texas Alliance for Life, an anti-abortion group. In August 2022, three abortions were documented in the state, down from more 5,700 reported during the same month a year earlier, according to the most recent state data.

The top state House Republican said his priority is boosting support for new moms, for example, by extending postpartum Medicaid coverage to 12 months.

It’s “an opportunity for the Texas House to focus more than ever on supporting mothers and children,” said Republican House Speaker Dade Phelan.

South Dakota Gov. Kristi Noem, a Republican, struck a similar theme in a Jan. 10 speech, saying she will introduce bills to expand a program for nurses to visit new mothers at home and help state employees pay for adoptions. Previously, Noem said South Dakota needs to focus “on taking care of mothers in crisis and getting them the resources that they need for both them and their child to be successful.”

Some Texas GOP lawmakers indicated they may be open to carving out exceptions to the abortion ban in cases of rape and incest. And a Republican lawmaker plans to attempt to modify South Dakota’s ban, which allows abortions only for life-threatening pregnancies, to clarify when abortions are medically necessary.

“Part of the issue right now is that doctors and providers just don’t know what that line is,” said state Rep. Taylor Rehfeldt, a nurse who has experienced miscarriages and high-risk pregnancies herself.

Rehfeldt wants to reinstate a former law that allows abortions for pregnancies that could cause serious, irreversible physical harm to a “major bodily function.” Rehfeldt said she is also working on bills to allow abortions for people carrying non-viable fetuses, or who became pregnant after rape or incest.

Some anti-abortion activists in Georgia are pushing lawmakers to go further than the state’s ban on most abortions at about six weeks of pregnancy. They want a law to ban telehealth prescriptions of abortion pills and a state constitutional amendment declaring that an embryo or a fetus has all the legal rights of a person at any stage of development.

“Roe is out of the way,” said Zemmie Fleck, executive director of Georgia Right to Life. “There’s no more roadblock to what we can do in our state.”

Republican leaders, however, are biding their time while Georgia’s high court weighs a legal challenge of the six-week ban. “Our focus remains on the case before the Georgia Supreme Court and seeing it across the finish line,” said Andrew Isenhour, spokesperson for Republican Gov. Brian Kemp.

Abortion rights lawmakers and advocates have few options to advance their initiatives in these Republican-controlled statehouses.

A Georgia Democrat filed a bill that would make the state compensate women who are unable to terminate pregnancies because of the state’s abortion ban. State Rep. Dar’shun Kendrick acknowledged her bill likely won’t go far, but she said she hopes it keeps attention on the issue and forces GOP lawmakers to “put their money where their mouth is” in supporting families.

In Missouri, where nearly all abortions are now banned, abortion rights advocates are mulling the idea of circumventing the state’s Republican-dominated legislature by asking voters in 2024 to enshrine the right to an abortion in the state’s constitution.

But those efforts could be upended by a slew of bills filed by Republican lawmakers seeking to make it more difficult to place constitutional initiatives on the ballot, and for those measures that do make it on the ballot, by requiring the approval of at least 60% of voters for passage.

Democrats in Michigan and Minnesota are likely to use their newfound control of both legislative chambers and the governors’ office to protect abortion access. While Michigan voters already passed a ballot measure in November that enshrines the right to abortions in the state constitution, Democrats are trying to repeal a 1931 abortion law from the books.

In Illinois, Democrats in control of the legislature recently bolstered abortion protections amid increased demand from out-of-state residents. New York lawmakers this year may send voters a proposed state constitutional amendment to protect abortion, while New Jersey lawmakers decided against a similar proposal.

The November elections brought divided government to Arizona and Nevada, with Arizona now having a Democratic governor and Nevada having a Republican one. Any abortion-related bills that pass the legislatures in those states could be vetoed.

Some Republican-controlled legislatures, including those in Montana, Florida, and Alaska, also are limited in passing sweeping abortion bans because of court rulings that tie abortion access to right-to-privacy provisions in those states’ constitutions.

In Montana, a state judge blocked three anti-abortion laws passed in 2021 on that basis. State government attorneys have asked the Montana Supreme Court to reverse the precedent, and a decision is pending.

In the meantime, Republican state Sen. Keith Regier has filed a bill there seeking to exclude abortion from the state’s definition of a right to privacy. Regier said he believes an individual’s right to privacy should not apply to abortion because an unborn child also is involved.

Democratic leaders said Republicans are out of sync with the people they represent on this issue. In November, Montana voters rejected a “born alive” ballot initiative that would have required doctors to apply medical care to newborns who draw breath or have a heartbeat after a failed abortion or any other birth.

“Montanans said so clearly that they do not want government overreach in their health care decisions,” said Democratic state Rep. Alice Buckley.

KHN correspondents Renuka Rayasam and Sam Whitehead in Atlanta; Arielle Zionts in Rapid City, South Dakota; Bram Sable-Smith in St. Louis; and Katheryn Houghton in Missoula, Montana, contributed to this report.

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GOP House Opens With Abortion Agenda

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Having spent its entire first week choosing a speaker, the Republican-led U.S. House finally got down to legislative business, including passing two bills backed by anti-abortion groups. Neither is likely to become law, because they won’t pass the Senate nor be signed by President Joe Biden. But the move highlights how abortion is sure to remain a high-visibility issue in the nation’s capital.

Meanwhile, as open enrollment for the Affordable Care Act nears its Jan. 15 close, a record number of people have signed up, taking advantage of renewed subsidies and other help with medical costs.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • The House now has a speaker after 15 rounds of full-chamber roll call votes. That paved the way for members to be sworn in, committee assignments to be made, and new committee chairs to be named. Cathy McMorris Rodgers (R-Wash.) and Jason Smith (R-Mo.) will be taking the helm of major health committees.
  • McMorris Rodgers will lead the House Energy and Commerce Committee; Smith will be the chairman of Ways and Means. Unlike McMorris Rodgers, Smith has little background in health issues and has mostly focused on tax issues in his public talking points. But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees.
  • One thing is certain: The new GOP-controlled House will do a lot of investigations. Republicans have already reconstituted a committee to investigate covid-19, although, unlike the Democrats’ panel, this one is likely to spend time trying to find the origin of the virus and track where federal dollars may have been misspent.
  • The House this week began considering a series of abortion-related bills — “statement” or “messaging” bills — that are unlikely to see the light of day in the Senate. However, some in the caucus question the wisdom of holding votes on issues like these that could make their more moderate members more vulnerable. So far, bills have had mostly unanimous support from the GOP. Divisions are more likely to emerge on topics like a national abortion ban. Meanwhile, the Title X program, which pays for things like contraception and testing for sexually transmitted infections, is becoming a hot topic at the state level and in some lawsuits. A case in Texas would restrict contraception availability for minors through this program.
  • It’s increasingly clear that abortion pills are going to become an even bigger part of the abortion debate. On one hand, the FDA has relaxed some of the risk evaluation and mitigation strategies (REMS) from the prescribing rules surrounding abortion pills. The FDA puts these extra restrictions or safeguards in place for certain drugs to add additional protection. Some advocates say these pills simply do not bring that level or risk.
  • Anti-abortion groups are planning protests in early February at large pharmacies such as CVS and Walgreens to try to get them to walk back plans to distribute abortion pills in states where they are legal.
  • A growing number of states are pressuring the Department of Health and Human Services to allow them to import cheaper prescription drugs from Canada — or, more accurately, importing Canada’s price controls. While this has long been a bipartisan issue, it has also long been controversial. Officials at the FDA remain concerned about breaking the closed supply chain between drugs being manufactured and delivered to approved U.S. buyers. The policy is popular, however, because it promises lower prices on at least some drugs.
  • Also in the news from the FDA: The agency granted accelerated approval for Leqembi for the treatment of Alzheimer’s disease. Leqembi is another expensive drug that appears to work, but also carries big risks. However, it is generally viewed as an improvement over the even more controversial Alzheimer’s drug Aduhelm. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug.
  • As the Affordable Care Act enrolls a record number of Americans, it is notable that repealing the law has not been mentioned as a priority for the new GOP majority in the House. Rather, the top health issue is likely to be how to reduce the price of Medicare and other health “entitlement” programs.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week that they think you should read, too:

Julie Rovner: The Washington Post’s “Social Security Denies Disability Benefits Based on List With Jobs From 1977,” by Lisa Rein

Margot Sanger-Katz: Roll Call’s “Providers Say Medicare Advantage Hinders New Methadone Benefit,” by Jessie Hellmann

Alice Miranda Ollstein: The New York Times’ “Grant Wahl Was a Loving Husband. I Will Always Protect His Legacy.” By Céline Gounder

Sarah Karlin-Smith: KHN’s “Hospitals’ Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say,” by Lauren Sausser

Also mentioned in this week’s podcast:

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KHN’s ‘What the Health?’: Year-End Bill Holds Big Health Changes

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Julie Rovner photo

The year-end government spending bill includes a lot of changes to federal health programs, including changes to Medicare payments and some structure for states to begin to disenroll people on Medicaid whose eligibility has been maintained through the pandemic.

Separately, the Biden administration took several steps to expand the availability of the abortion pill, which in combination with another drug can end a pregnancy within about 10 weeks of gestation. Anti-abortion forces have launched their own campaign to limit the reach of the abortion pill.

This week’s panelists are Julie Rovner of KHN, Rachel Cohrs of Stat, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachel Roubein of The Washington Post.

Among the takeaways from this week’s episode:

  • Congress ended the year by passing a nearly $1.7 trillion government spending package. The legislation included smaller-than-scheduled cuts to Medicare payments for physicians, extended telehealth flexibilities, and funding boosts for programs like the Indian Health Service and the federal 988 mental health hotline.
  • But lawmakers left out many priorities, such as more money in response to the covid-19 emergency, and included a change to Medicaid eligibility that could result in millions of Americans losing their health insurance.
  • The Biden administration took perhaps its biggest stand on abortion rights since the Supreme Court overturned Roe v. Wade last year, with the FDA announcing that retail pharmacies will be permitted to dispense abortion pills for the first time, and the Justice Department confirming that it is legal to send the pills through the U.S. Postal Service.
  • A new congressional report on Aduhelm, the controversial Alzheimer’s drug, reveals its manufacturer, Biogen, knew the impact its pricing could have on the Medicare program — and priced it high anyway. The report also raises big questions about the FDA’s decision-making in approving the drug and what some officials were willing to do to make it happen.
  • And in price transparency news, insurers are now required to provide patients with cost-estimating tools designed to make more than 500 nonemergency services “shoppable.” But it is unclear whether insurance companies are prepared to help consumers access and use that information.

Also this week, Rovner interviews Mark Kreidler, who wrote the latest NPR-KHN “Bill of the Month” feature, about two patients with the same name and a mistaken bill. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The New York Times’ “The F.D.A. Now Says It Plainly: Morning-After Pills Are Not Abortion Pills,” by Pam Belluck

Joanne Kenen: Politico Magazine’s “Racist Doctors and Organ Thieves: Why So Many Black People Distrust the Health Care System,” by Joanne Kenen and Elaine Batchlor

Rachel Cohrs: The New York Times’ “‘Major Trustee, Please Prioritize’: How NYU’s E.R. Favors the Rich,” by Sarah Kliff and Jessica Silver-Greenberg

Rachel Roubien: KHN’s “Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?” by Noam N. Levey

Also mentioned in this week’s podcast:

Stat’s “’Rife With Irregularities’: Congressional Investigation Reveals FDA’s Approval of Aduhelm Marked by Secret Discussions, Breaches of Protocol,” by Rachel Cohrs

KHN’s “Want a Clue on Health Care Costs in Advance? New Tools Take a Crack at it,” by Julie Appleby

Stat’s “Congress Reaches Major Health Policy Deal on Medicare, Medicaid, and Pandemic Preparedness,” by Rachel Cohrs and Sarah Owermohle

USA Today’s “Half of Ambulance Rides Yield Surprise Medical Bills. What’s Being Done to Protect People?” by Ken Alltucker

To hear all our podcasts, click here.

And subscribe to KHN’s “What the Health?” on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.

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KHN’s ‘What the Health?’: Health Spending? Only Congress Knows

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Congress has a tentative framework for government spending through this fiscal year. Now, lawmakers must fill in the blanks, including on key health care provisions, and get it passed. The Biden administration will send more free covid-19 home tests to Americans after initial fears the program was running out of money.

And there’s plenty of news coming in from the states, where this week a Texas judge tossed out a lawsuit based on the state’s so-called vigilante abortion law, and the governor of Florida is asking for a grand jury investigation into harm caused by covid vaccines.

This week’s panelists are Mary Agnes Carey of KHN, Rachel Cohrs of Stat, Alice Miranda Ollstein of Politico, and Rebecca Adams of KHN.

Among the takeaways from this week’s episode:

  • Congressional appropriators have settled on an omnibus framework that would set government spending through next fall and hope to pass it by the end of next week. But lawmakers still have details to iron out. While health measures like extended flexibilities for telehealth are likely to get approved — and others, like more money for pandemic response, are not — the outcome is less clear for some key provisions. Will lawmakers relax or even nix Medicare pay cuts for doctors scheduled for next year?
  • Pharmacy chains CVS and Walgreens announced a major settlement this week in lawsuits alleging they mishandled opioid prescriptions. Most of the settlement money awarded in ongoing opioid epidemic litigation is earmarked to pay for opioid-related treatment, and families of victims are also asking for compensation for the harm opioids have caused. Meanwhile, federal lawmakers have shown little urgency to respond to the country’s epidemic of opioid-related overdoses.
  • Abortion fights continued to play out in the states this week, including in Iowa, where a judge blocked an effort to ban most abortions in the state. In Texas, a judge dealt a blow to the state’s so-called vigilante law, ruling that an individual who is not directly affected by an abortion may not sue for violations of the state’s ban. Watch for the legal challenges to continue, especially as some state legislatures return to session in January for the first time since the Supreme Court overturned Roe v. Wade.
  • In pandemic news, the Biden administration plans to reopen its program allowing Americans to request free covid home tests through the U.S. Postal Service. And the House of Representatives select committee investigating the pandemic wrapped up its work this week, with Democrats and Republicans coming to different conclusions and issuing recommendations unlikely to come to pass — a reflection of partisan tensions and a loss of public interest in the pandemic.
  • And Gov. Ron DeSantis of Florida, a Republican who is considered a possible 2024 presidential candidate, has called for a grand jury to examine alleged “crimes and wrongdoing” related to the covid vaccines.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Mary Agnes Carey: Scientific American’s “Kindness Can Have Unexpectedly Positive Consequences,” by Amit Kumar

Rachel Cohrs: The Washington Post’s “From Heart Disease to IUDs: How Doctors Dismiss Women’s Pain,” by Lindsey Bever

Alice Miranda Ollstein: Stat’s “Watch: With Little More Than a Typewriter, an Idaho Man Overturns the Entire State’s Policy on Hepatitis C Treatment in Prison,” by Nicholas Florko

Rebecca Adams: KHN’s “Mass Shootings Reopen the Debate Over Whether Crime Scene Photos Prompt Change or Trauma,” by Lauren Sausser

Also mentioned in this week’s podcast:

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.

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