THE PROGNOSIS

Nearly 28 million Americans lack health insurance despite this fact: About half of them are eligible for either free coverage or government help in buying it.

That’s both a discouraging and heartening reality behind new census data showing the country’s pool of uninsured people grew significantly for the first time since President Obama signed the Affordable Care Act almost a decade ago. In most states, programs are in place for people who need help getting covered. But many aren’t availing themselves of the opportunity.

“There are a significant number of people who are unaware of their eligibility,” said Ron Pollack, a long-time consumer advocate and former president of Families USA. “This actually could easily be fixed through a number of things that are not a heavy lift.”

The new figures show 8.5 percent of Americans lacked coverage in 2018, up from 7.9 percent the year prior. That’s still much lower than before the 2010 health-care law, when the uninsured rate hovered around 15 percent. The uninsured rate plunged for a few years, slowed and then stayed steady between 2016 and 2017 when there was no statistically significant change.

This year’s uptick in uninsured people was mostly due to changes among the low-income population.

“The change was driven primarily by a decrease in public insurance for the poor, with enrollment in Medicaid dropping by 0.7 percent,” my colleagues Amy Goldstein and Heather Long explain.

“The uninsured rate spiked especially among adults who are Hispanic and foreign-born, with the increase in uninsured among both groups three times the national average,” they continue. “Coverage also dwindled among children who are Hispanic and naturalized citizens.”

It doesn’t have to be this way. There are nearly 11 million people eligible for Medicaid who just haven’t enrolled in it, for one reason or another. Just signing up those people would reduce the uninsured population by more than one-third.

And then there are those eligible for federal subsidies on the individual marketplaces who have also decided against signing up – or just aren’t aware they’d qualify. The Kaiser Family Foundation estimates 4.2 million uninsured people nationwide could buy a “bronze” level plan where they wouldn’t have to contribute any premiums.

A majority of uninsured adults don’t even check out their options. In a survey conducted by the Commonwealth Fund, 67 percent hadn’t looked into marketplace coverage. Of those:

  • 36 percent said they didn’t think they’d be able to afford a plan
  • 15 percent said they didn’t think they needed it
  • 8 percent said they didn’t think they’d be eligible
  • 7 percent weren’t aware of the marketplaces.

The higher uninsured numbers drew swift reactions from Democrats and many health-care advocates, who blamed the Trump administration for being less proactive in urging people to sign up for public programs and even taking actions that appear to discourage it.

“Nearly two million more people went without health care law year following President Trump and Republicans’ relentless attacks on families’ health care,” said Sen. Patty Murray (D-Wash.), ranking member of the Health, Education, Labor and Pensions Committee.

House Speaker Nancy Pelosi (D-Calif.): 

Sen. Richard Blumenthal (D-Conn.):

Andy Slavitt, former CMS acting administrator under President Obama:

The Department of Health and Human Services has significantly scaled back outreach around the Obamacare marketplaces, compared to spending by the Obama administration. Last month it announced just $10 million in grants for “navigators,” who help publicize the plans and aid people in enrolling in them, the same lower level of funding it has distributed for several years.

“One thing that has hurt is the cut back in outreach, including advertising and enrollment efforts on the part of the federal government,” Sara Collins, Commonwealth’s vice president of health care coverage, wrote me in an email.

“Research has suggested that outreach and enrollment assistance does make a difference in whether people enroll,” she wrote.

There’s more at play here, too. Another 2 million people would become eligible for Medicaid if all the states agreed to expand it. Instead of encouraging expansion, the Centers for Medicare and Medicaid Services has urged states to seek more requirements for recipients, such as working or volunteering, or contributing to premiums.

“The backsliding almost certainly reflects Trump administration policies to weaken health care coverage,” said Bob Greenstein, president of the Center on Budget and Policy Priorities.

AHH, OOF and OUCH

AHH: HHS Secretary Alex Azar is traveling to the Democratic Republic of Congo along with a group of Trump administration officials amid the ongoing Ebola outbreak.

“The DRC is facing the most complex Ebola outbreak we have ever seen,” Azar told reporters yesterday. “Ending the outbreak will take continued commitment and persistence.” It's his first trip to the region since the outbreak began. 

The HHS secretary will travel to the region along with CDC Director Robert Redfield, who has previously traveled to the outbreak zone, National Institute for Allergy director Anthony Fauci, Tim Ziemer, senior deputy assistant administrator of the U.S. Agency for International Development and staff of the National Security Council, Stat News’s Helen Branswell reports.

“The delegation will meet with officials of the countries and with the director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, who has traveled to the outbreak zone on 10 previous occasions,” she writes. “Among the topics up for discussion will be U.S. support for the outbreak, including the deployment of government employees. A small team of CDC Ebola experts was in the region in late August of 2018, but was ordered out of the outbreak zone within days because of insecurity.”

Since the outbreak started more than a year ago, there have been more 3,080 people infected, including 2,070 who have died.

OOF: A sixth person has died from the mysterious vaping-related illness that have sickened people across the country, our Post colleague Lena H. Sun reports, Health officials in Kansas confirmed the first death there after a resident older than 50 with a history of underlying health issues was hospitalized with “symptoms that progressed rapidly.”

It's not known what type of products the patient used. Federal and state investigators have not yet determined any specific vaping or e-cigarette product linked to all the cases of vaping-related illnesses, but authorities are narrowing the possible culprits to contaminants or counterfeit substances in the products as a likely cause, Lena reports.

— The House Energy and Commerce panel on Oversight and Investigations announced it has scheduled a hearing for later this month on the surge of vaping-related illnesses.

Officials from the CDC and FDA will be asked to testify at the Sept. 25 hearing, says Rep. Diana DeGette (D-Colo.), who chairs the subcommittee that oversees both agencies. The officials will be asked to testify on any link between e-cigarette products and the spate of illnesses.

“This recent surge in vaping-related illnesses shows exactly why more federal regulation of these vaping products is so important,” DeGette said in a statement. “No one who uses these products knows what they are inhaling into their bodies, or how it might affect their health. We can, and must, do more to protect the health of the American people. Our committee is determined to find out exactly what is causing these life-threatening illnesses and what needs to be done to prevent them.”

OUCH: The crackdown on opioid prescriptions means some patients with chronic pain who have relied on opioids for years are being forced to lower their dosage – and it’s leaving some confused and in extreme pain, our Post colleagues Joel Achenbach and Lenny Bernstein report.

“With close to 70,000 people in the U.S. dying every year from drug overdoses, and prescription opioids blamed for helping ignite this national catastrophe, the medical community has grown wary about the use of these painkillers,” they write. "The situation is worse for people forced to cut back their medication too quickly. Even medical experts who advocate a major reduction in the use of opioids for chronic pain have warned that rapid, involuntary tapering could harm patients who are dependent on these drugs.”

One man, 79-year-old Hank Skinner of Alexandria, Va., has a fentanyl patch he replaces every three days to maintain his shoulder pain, and who also takes slow-release fentanyl pills that have hydrocodone. Now that he’s being forced to taper he says: “Why am I being singled out? I took it as prescribed. I didn’t abuse it," he told our colleagues.

Tami Mark, senior director of behavioral health financing and quality measurement for RTI International called it a “national experiment”: ““This national effort at ‘de-prescribing’ is again being undertaken with limited research on how best to taper people off opioid medications,” Mark told our colleagues. “You can’t just cut off the spigot of a highly addictive medication that rewires your brain in complex ways and not anticipate negative public health consequences.”

HEALTH ON THE HILL

— The House will hold a hearing this fall to investigate Veterans Affairs after a report on how the agency failed to stop an Arkansas pathologist who allegedly misdiagnosed 3,000 cases while impaired, our Post colleague Lisa Rein reports.

“I heard about the situation with the pathologist, and I was appalled,” House Veterans’ Affairs Committee Chairman Mark Takano (D-Calif.) said to Rep. Steve Womack (R-Ark.), who went before the committee to call for an investigation into VA’s actions in the case of Robert Morris Levy, who was the chief pathologist at a VA medical center in northwest Arkansas, in Womack’s district, for a dozen years.

“A review of 34,000 tissue and fluid samples he read from 2005 to 2017 found an error rate of nearly 10 percent, 10 times the average rate of mistakes for pathologists, prosecutors found,” Lisa reports, adding many of those errors were harmful to the health of veterans and led to the deaths of at least 15 veterans. VA’s inspector general and federal prosecutors are also looking into 11 suspicious deaths after unnecessary insulin injections at a VA hospital in Clarksburg, W.Va. and a physician at a center in Beckley, W.Va. is under investigation after allegations the physician sexually assaulted numerous veterans.

 “The shocking reports from West Virginia and Arkansas call into question whether VA is equipped to identify clinicians who are negligent, abusive, or commit criminal acts — and prevent them from practicing,” Takano said in a statement.

— A Senate funding bill was enmeshed in partisan disagreements yesterday. Senate Republican leaders yesterday canceled a subcommitte markup of a Labor- Health and Human Services-Education spending bill after Sen. Patty Murray (D-Wash.) said she would introduce an amendment to the HHS measure that would block the Trump administration from implementing its Title X family planning rule.

Murray chided the move that she said was an effort to avoid voting on Trump’s rule:

In a statement, Jacqueline Ayers, vice president for government relations and public policy for Planned Parenthood, called the move a “shocking and disgusting display by Chairman Shelby, Leader McConnell and Republican leaders who are desperate to hide the fact that the Trump administration’s Title X gag rule is deeply unpopular.”

A Senate Republican aide told Politico’s Caitlin Emma that any work on the measure will now be delayed until “sides can hash out what constitutes a ‘poison pill,’” she writes. “The full committee is still scheduled to consider the bill on Thursday.”

— A coalition that includes employer groups and health insurance providers launched a multi-million dollar advertising campaign over surprise medical billing legislation, urging lawmakers to oppose any proposals pushed by medical groups backed by private equity firms. It’s the latest skirmish in an ongoing battle over how lawmakers should tackle surprise medical bills.

The Coalition Against Surprise Medical Billing is pushing to peg the payments for surprise bills to other specific payment rates, a process that would send insurers and providers through an independent review to determine a price. A pair of television ads, part of the group's latest buy, attacks the private equity firms they say are pushing for policy “that would allow them to continue charging patients sky-high prices for medical services.”  

“Ever wonder what’s behind surprise medical bills? It’s a private equity business model: take over medical practices, remove them from networks and overcharge patients,” the narrator of one ad says.

INDUSTRY RX

—Private insurance companies are set to return a record minimum of $1.3 billion in rebates to consumers starting at the end of the month, according to a new analysis from the Kaiser Family Foundation.

The analysis estimates the total rebates that will be distributed to consumers this year include $743.3 million in the individual market, which is a record after the analysis notes a profitable year for individual market insurers in 2018. There will also be $250 million in rebates in the small group market and $284 million in the large group insurance market.

Under the ACA, insurers must spent at least 80 percent of premium revenues on health care claims --  or 85 percent in the case of large group plans – or pay these rebates back to consumers.

“The analysis also finds that millions of dollars in rebates from previous years have gone unclaimed by consumers -- $37.5 million in the individual market, $22.2 million in the small group market and $11.6 million in the large group market,” according to KFF.

— And here are a few more good reads: 

AGENCY ALERT
The Texas oncologist has been dogged by controversy — but has developed a knack for “institutional turnaround experiences,” as an MD Anderson official said.
Stat
Federal health authorities should strongly consider recalling e-cigarettes in the wake of a vaping-linked illness that’s killed at least six people and sickened hundreds, Sen. Mitt Romney (R-Utah) said.
The Hill
TRUMP TEMPERATURE
Business
Administration officials have discussed using the federal government to get homeless people off the streets of Los Angeles and other areas and into new government-backed facilities.
Jeff Stein, Tracy Jan, Josh Dawsey and Ashley Parker
PowerPost
White House aides briefed Republican senators on potential legislative options but gave no indication of what the president is willing to sign into law.
Mike DeBonis and Paul Kane
MEDICAL MISSIVES
Technology
A new report found that some period-tracking apps shared intimate information with Facebook. In some cases, that data included when the user reported last having sex.
Marie C. Baca
STATE SCAN
Local
Officials urged residents to avoid mosquitoes, which spread the disease.
Justin Wm. Moyer
DAYBOOK

Today

  • The House Small Business Committee holds a hearing on barriers to care and burdens on small medical practice.
  • The House Education and Labor Subcommittee on Early Childhood, Elementary and Secondary Education holds a hearing on trauma-informed practices for students impacted by gun violence. 
  • The House Oversight and Reform Subcommittee on Civil Rights and Civil Liberties holds a hearing on “The Administration’s Apparent Revocation of Medical Deferred Action for Critically Ill Children.”
SUGAR RUSH

There was no treatment for their child's rare condition. Now they're trying to create one: