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The Health 202: Congress is moving to lengthen Medicaid coverage for new moms

with Alexandra Ellerbeck

Congressional Democrats have taken on a side project as they push forward President Biden's coronavirus relief bill: nudging states to broaden their Medicaid programs.

That includes lengthening coverage for new moms — a key Medicaid population who, in some states, can still get kicked off the program relatively quickly after giving birth.

Legislation being marked up today says state Medicaid programs can cover new mothers for a full year.

This morning, the House Energy and Commerce Committee will hold a hearing on its piece of the $1.9 trillion relief bill moving through the House. The legislation includes a short provision (it’s only a sentence long) saying states, for a length of five years, can extend Medicaid eligibility to women for 12 months after giving birth. 

The aim is to correct a long-standing problem for low-income moms, particularly in the dozen states that have refused to expand Medicaid under the Affordable Care Act.

According to federal rules, every state Medicaid program must cover women with income up to 138 percent of the federal poverty level (about $30,000 for a family of three) on the basis of pregnancy. As a result, Medicaid covers a sizable share of births in the United States — more than 4 in 10.

But in states that didn’t expand Medicaid — and therefore cover only people at much lower income levels — women can lose their coverage 60 days after giving birth, even though their infants remain covered for a full year. That forces them to move between insurance plans even as they’re recovering from childbirth and caring for an infant. It’s a particularly vulnerable and exhausting time for women, who may face pregnancy-related health complications or need help with breastfeeding or postpartum depression.

The ACA helped remedy the problem but didn’t eliminate it.

Under the 2010 health-care law, most states expanded Medicaid eligibility to people earning up to at least 138 percent of the federal poverty level (and in some places, the threshold is even higher). In these states, new moms are likely to still qualify on the basis of income even after they not longer qualify on the basis of pregnancy.

The uninsured rate for new mothers declined from 20.2 percent in 2011 to 11.3 percent in 2015 and stayed relatively stable through 2018, according to Urban Institute research.

Research has shown that expanding Medicaid resulted in more women having continuous health coverage in the months after giving birth. Medicaid expansion was associated with a 10.1 percentage-point decline in insurance churn compared with non-expansion, in a study published in the journal Health Affairs.

But there are a dozen holdout states that haven’t adopted Medicaid expansion. 

Seven of them are clustered together in the nation’s southeast. There’s also Texas, Wisconsin, Wyoming, Kansas and South Dakota.

Women in these states often lose their Medicaid coverage at the 60-day mark after giving birth. The new legislation would allow states to extend pregnancy-based eligibility for a full year — something they’re not allowed to do currently without applying for special permission from the federal government.

The policy has bipartisan support. 

The House passed by voice vote a similar measure last year from Rep. Robin Kelly (D-Ill.).

“There’s a lot of evidence showing Medicaid coverage can improve pregnancy outcomes,” said Hannah Katch, a senior policy analyst for the Center on Budget and Policy Priorities. “Postpartum health coverage is particularly important because life-threatening conditions after pregnancy are common in the U.S.”

Ahh, oof and ouch

AHH: The Biden administration is urging the Supreme Court to uphold Obamacare.

A top Justice Department lawyer wrote a letter to the court stating that the government had reversed its position in the case and that the previous administration had been wrong to argue that the Affordable Care Act was unconstitutional, Robert Barnes reports. The challenge to the health-care law was argued before the court in November, and a decision has not yet been announced.

“While it is rare for the government to switch its position in a case, this change was expected, and this case could be the first of several before the high court in which Biden’s administration separates itself from positions held by former president Donald Trump,” Robert writes.

“It is likely that the court already has decided the outcome — justices usually vote within days of oral arguments — and that an opinion is being written,” he adds.

The Supreme Court heard oral arguments for the third case considering the legality of the Affordable Care Act on Nov. 10. (Video: The Washington Post)

The issue being considered by the court stems from a 2017 decision by Congress to remove Obamacare’s penalty for not buying insurance. A group of Republican-led states and the Trump administration argued that the elimination of the penalty made not only the mandate, but also the entire law, unconstitutional. 

OOF: Updated CDC guidances urges people to wear two masks or ensure a tighter fit to protect against the coronavirus.

“Two methods substantially boost fit and protection, according to a CDC report and updated guidance on its website. One is wearing a cloth mask over a disposable surgical mask. The second is improving the fit of a single surgical mask by knotting the ear loops and tucking in the sides close to the face to prevent air from leaking out around the edges and to form a closer fit,” Lena H. Sun and Fenit Nirappil report.

As new variants of the coronavirus spread within the United States, health professionals have suggested that Americans wear two masks. (Video: John Farrell/The Washington Post)

Both methods reduced exposure to potentially infectious aerosols by more than 95 percent in a laboratory experiment using dummies, according to the report.

Public health experts say that the key takeaway from the report is that the fit of the mask is crucial, although wearing any type of mask is still better than wearing none at all.

OUCH: Poor countries aren't getting the coronavirus vaccines.

“Months into the global vaccine rollout, the pace remains staggeringly unequal, with wealthy countries leaving poorer ones in the dust. And they aren’t competing in a vacuum: The success of the former has come very much at the expense of the latter,” Adam Taylor reports.

It remains to a large degree a zero-sum game, which means that every dose that goes to the U.S. or the U.K. or an E.U. country is a dose that’s off the shelves,” Andrea Taylor, a researcher at Duke University’s Global Health Innovation Center who tracks vaccines, told The Washington Post. “And the shelves aren’t going to be restocked for a while.”

The delayed introduction of vaccines in poorer countries could mean a higher global death toll and a longer-lasting pandemic, as unmitigated spread leads to the emergence of new variants.

Some international experts have called on wealthy countries to share vaccine doses to help protect those most at risk around the world, even before fully vaccinating at home. But it’s an idea that appears to have gained little currency. Canada alone has acquired deals for 338 million doses — enough to vaccinate its population five times over and more than the World Health Organization-backed program Covax plans to distribute to poorer countries in the entire first half of the year.

The Biden administration told The Post that it would pursue the idea of donating excess vaccine doses once there is sufficient supply in the United States, potentially by working through Covax. But the administration provided little detail on these plans.

More on the coronavirus

  • Several major employers, including Dollar General, McDonald’s and Olive Garden, have announced incentives for workers to get vaccinated, USA Today reports. But Amazon, Target, Walmart and other major employers are not committing to providing any extra pay or ensuring workers get time off to receive a shot. (Jeff Bezos, the executive chairman of the board of Amazon, owns The Post).
  • The Federal Emergency Management Agency will help run three mass vaccination sites in Texas, the Texas Tribune reports. The sites, which are set to open before the end of the month, are considered pilots as part of the nation’s effort to speed up vaccine distribution.
  • The White House announced the 12 members of its covid-19 Health Equity Task Force. The group is charged with analyzing inequities in the nation’s coronavirus response and issuing recommendations to inform the Biden administration, Akilah Johnson and William Wan report. The task force will be chaired by Marcella Nunez-Smith, an associate professor at the Yale School of Medicine. It also includes James Hildreth, the president of Meharry Medical College, a historically Black medical school; Andrew Imparato, a disability rights lawyer and executive director of Disability Rights California; and Vincent Toranzo, a high school student activist from Florida.

Elsewhere in health care

ACA subsidies are likely to increase under coronavirus relief plans.

The plans to expand federal subsidies for ACA health plans is part of a proposal the House Ways and Means Committee is expected to approve by the end of this week.

“Increasing ACA subsidies and widening who can get them would represent a first step by Congress to embrace President Biden’s credo of using the sweeping — and politically polarizing — law as the main tool for improving the nation’s health-care system,” Amy Goldstein reports.

“According to Congress’s Joint Committee on Taxation, the changes would cost $52.6 billion. Another $6.3 billion under the plan would eliminate reimbursements people with ACA health plans ordinarily would be required to pay if they misjudged how much income they expected to earn in a year — and thus were given larger subsidies than they deserved,” Amy writes.

Biden’s nominee to head the Office of Management and Budget faced tough confirmation hearings as lawmakers scrutinize her past tweets.

Neera Tanden, the president of the Center for American Progress, a liberal think tank, and a former senior health adviser for the Department of Health and Human Services under the Obama administration, faced back-to-back hearings with the Senate Homeland Security and Government Affairs Committee on Tuesday and the Senate Budget Committee on Wednesday. If confirmed, she would have significant influence over federal policymaking on health care at the helm of the OMB, a powerful agency that plays a central role in regulatory review and annual budget development.

Tanden, who served as a key architect of the ACA, told lawmakers that she would help Biden lower the Medicare eligibility age from 65 to 60, advance paid family and medical leave, and lower drug prices. 

Sen. John Neely Kennedy (R-La.) on Feb. 10 scolded Neera Tanden, the nominee to lead the Office of Management and Budget, for her Twitter history. (Video: C-SPAN)

But policy issues were largely overshadowed by Tanden’s history of sending caustic tweets, targeting both Republicans and figures on the left, including Senate Budget Committee Chairman Bernie Sanders (I-Vt.)

“You wrote that Susan Collins is the worst, that Tom Cotton is a fraud, that vampires have more heart than Ted Cruz. You called Leader McConnell ‘Moscow Mitch’ and ‘Voldemort,’ and on and on,” Sen. Rob Portman (R-Ohio) said to Tanden during the Senate Homeland Security Committee hearing on Tuesday.

The nation's leading insurers, health providers and employer groups have laid out how they want universal coverage achieved.

The policy recommendations include boosting subsidies provided through the insurance marketplaces, creating a new fund to help subsidize extra-expensive patients and automatically enrolling and renewing coverage for people eligible for Medicaid and fully subsidized marketplace plans.

Members of the coalition include America's Health Insurance Plans, the U.S. Chamber of Commerce, the American Medical Association, and a number of other provider associations and health insurers.

“While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all,” they wrote.

Their recommendations would require more funding from the federal government to subsidize private plans. But the list doesn't include this: a government-backed “public option” plan — a key way Biden has proposed to expand coverage options. That idea is fiercely opposed by most health insurers and medical providers, who dislike the idea of competing directly with the government, given it can unilaterally set lower prices and payments.

Michelle Obama will star in a Netflix food show for kids.

The cooking show, “Waffles + Mochi,” will feature puppets discovering and cooking food from around the world. The former first lady said the show was “in many ways is an extension of my work to support children's health,” Axios reports.

Sugar rush

Europe's oldest person, French nun Sister André, recovered from the coronavirus on Feb. 9, and will celebrate her 117th birthday on Feb. 11. (Video: Reuters)