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The Health 202: Democrats devise a way to finally expand Medicaid in resistant states

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with Alexandra Ellerbeck

Democrats, now in charge for the first time since Obamacare passed, have been mulling over how to get health insurance to about 4.3 million Americans stuck in the so-called “Medicaid coverage gap.”

Rep. Lloyd Doggett (D-Tex.) says he has a solution. This morning he'll introduce legislation, co-signed by more than 40 House Democrats, that would let cities and counties bypass the states still refusing to expand their Medicaid programs.

“We’ve got a new, homegrown solution to finally get Medicaid to millions of our most vulnerable citizens by empowering local governments to cover their residents and protect their health," Doggett said in a statement provided to The Health 202.

The bill would create, for the first time, a local pathway for expanding the health insurance program for the low-income.

The idea, as Doggett’s office explained to me, is to allow local leaders in the dozen non-expansion states to take matters into their own hands without waiting on their state governor or legislature to act. 

Cities, counties or even hospital districts could get special permission from the Centers for Medicare and Medicaid Services to expand Medicaid within their own jurisdiction. The permission, granted through what are known as “demonstration projects,” would last for five years, with an option to extend for an additional five years. It would provide the same federal assistance provided to states; localities would have all of their expansion costs covered for the first three years, with the federal subsidies phased down to 90 percent of costs by the seventh year.

So, for example, a city like Austin — where liberal political leaders have been champing at the bit to expand Medicaid — could entirely bypass the conservative politicians who lead the state of Texas and are resistant to Medicaid expansion.

Texas is one of a dozen GOP-led states — mostly in the South — which have stuck with their much leaner Medicaid programs.

They’ve long rejected the federal government’s offer to largely cover the costs of expanding the program to people earning up to 138 percent of the federal poverty level.

The result is more than 2 million low-income Americans who can’t get government assistance in buying health insurance. They don’t meet the income threshold to get subsidies on or the other individual marketplaces. And because their state hasn’t expanded Medicaid, they’re not eligible for that either. There's an additional group of people in non-expansion states (around 1.8 million) who do qualify for marketplace subsidies, but would be able to enroll in Medicaid if their state expanded it. 

The issue is a microcosm of the enduring political battles over the 2010 Affordable Care Act. Democrats have fretted over the ACA’s shortcomings in closing the nation’s uninsured gap (which still hovers around 11 percent), while Republicans have spent the last decade trying to resist and undermine the law at every turn.

Consequently, the Biden administration is under pressure to further expand health coverage.

Nearly 30 million Americans are still uninsured. But the environment is so politically toxic that across-the-aisle discussions about improving and expanding health insurance rarely happen these days.

Democrats already took one shot this year at nudging the dozen holdout states toward finally expanding Medicaid, by providing extra incentive funding in their March coronavirus relief bill. But it didn’t seem to work, so lawmakers are searching for other methods.

Thus, the Doggett bill.

All but three of the Democrats from the dozen non-expansion states are co-sponsoring the legislation, dubbed the Cover Now Act, and Doggett’s office said it still hopes to get them on board.

Staffers stressed the coverage gains that could be made possible should the bill ever become law. 

  • For example, Texas’s Harris County (which contains Houston) holds one-fourth of the Texans who would be eligible for expanded Medicaid.
  • If Harris County expanded, along with the state’s second- and fourth-largest counties (Dallas and Bexar), more than half of all Texans in the coverage gap could be covered.

“We cannot continue to allow Republican ideologues to obstruct health care access and deepen health inequities,” Doggett wrote in a letter to colleagues.  

He will announce the bill at 10 a.m. today.

Ahh, oof and ouch

AHH: A federal appeals court ruled North Carolina’s ban on abortion after 20 weeks unconstitutional.

The U.S. Court of Appeals for the 4th Circuit ruled unanimously that a 1973 state law prohibiting almost all abortions after the 20th week of pregnancy was unconstitutional. The law has been blocked since a district judge struck it down in 2019, The Post’s Ann E. Marimow reports.

North Carolina officials attempted to dismiss the lawsuit by arguing that abortion providers did not have standing to challenge the law, because no abortion provider has been prosecuted. The court rejected that argument.

A Supreme Court review of a Mississippi abortion law could pave the way for many other state laws that restrict or ban the procedure. (Video: Joshua Carroll/The Washington Post, Photo: Melina Mara/The Washington Post)

“North Carolina is one of 15 states, including Texas, Ohio and Louisiana, with similar laws. The case comes as many Republican-led state legislatures have proposed or passed measures that make it more difficult for women to access abortion services or place restrictions on medical professionals and clinics where abortions are performed,” Ann writes.

The ruling also comes one month after the Supreme Court announced it will review a case challenging Mississippi’s ban on abortions after the 15th week of pregnancy. Experts think that a more conservative court could use that case to diminish Roe v. Wade.

OOF: CureVac, the latest experimental coronavirus vaccine, proved just 47 percent effective.

Preliminary results from a coronavirus vaccine invented by the German company CureVac were disappointing and may highlight the challenges posed by coronavirus variants.

“The results of the 40,000-person trial, announced by news release Wednesday, mark a setback for a promising vaccine based on messenger RNA technology, the same approach at the core of the Pfizer-BioNTech and Moderna vaccines authorized late last year for use in the United States,” The Post’s Carolyn Y. Johnson reports.

The company is expected to release a final result with more details in a few weeks. It’s unclear whether the disappointing results can be attributed to the spread of new coronavirus variants. Thirteen different variants caused the cases of covid-19 in the trial, with only a single case caused by the original SARS-CoV-2 virus. 

“They’re testing their vaccine much later than all the other vaccines we have were tested, and there are a lot more variants out there that could confound the ability of a vaccine to protect,” said Deborah Fuller, a vaccine scientist at the University of Washington.

OUCH: Device manufacturers are funneling billions to doctors.

“Medical industry payments to orthopedists and neurosurgeons who operate on the spine have risen sharply, despite government accusations that some of these transactions may violate federal anti-kickback laws, drive up health care spending and put patients at risk of serious harm,” Kaiser Health News’s Fred Schulte and Elizabeth Lucas report

More than $3.1 billion flowed to surgeons from manufacturers of spinal implants, artificial knees and hip joints between 2013 and 2019, the Kaiser Health News investigation found. Money came in the form of royalties for helping to design implants, speakers’ fees for promoting devices at medical meetings and stock holdings in exchange for consulting work.

“Health policy experts and regulators have focused for decades on pharmaceutical companies’ payments to doctors — which research has shown can influence which drugs they prescribe. But far less is known about the impact of similar payments from device companies to surgeons. A drug can readily be stopped if deemed harmful, while surgical devices are permanently implanted in the body and often replace native bone that has been removed,” Fred and Elizabeth report.

More in coronavirus news

Pfizer engineers went from total failure to 3 billion vaccine doses.

The first attempt to produce industrial-scale quantities of Pfizer’s coronavirus vaccine resulted in a total failure. Operators conducting a vaccine manufacturing trial run in September 2020 soon realized that the key ingredient in their vaccine was missing by the time it reached a vat at the end of the production run. 

“The company and its vaccine partner BioNTech would ultimately master the job of churning out large batches of mRNA vaccine, making it the clearest winner among drug companies to emerge from the pandemic. The company is producing vaccine in greater quantities than any other company and has secured an advantage in the quest to use next-generation mRNA technology for treatments of other diseases,” The Post’s Christopher Rowland reports.

“But the failed September test shows that success was far from a foregone conclusion. Pfizer’s ambitious production objective ultimately forced the company to accept government help to procure vital supplies, defeating its earlier efforts to avoid a closer partnership with federal health authorities,” Christopher writes.

The company says it expects to make 3 billion doses by in 2021, twice as much as its initial projection. But it has also faced criticism for selling its early doses to wealthy countries, fueling a global disparity in vaccine access.

Experts say waiving patents won’t help poorer nations acquire the technical complexity of manufacturing coronavirus vaccines. (Video: Luis Velarde/The Washington Post)
Nearly 900 people got expired shots in New York.

“The New York City Department of Health and Mental Hygiene is urging the 899 people, who were given Pfizer shots between June 5 and 10 at the former NFL Experience building in Times Square, to get another dose as soon as possible. Experts say the expired doses are not dangerous, but their effectiveness could be in question,” The Post’s Brittany Shammas reports.

A spokesman said that there are no safety concerns with the expired doses but that patients were being encouraged to receive another dose to ensure full protection. The doses are considered expired because they spent too much time in the freezer to meet guidelines for full efficacy. 

On the Hill

Sen. Chuck Grassley met with moderate House Democrats to discuss drug pricing.

Grassley, of Iowa, has been one of the most outspoken Republicans on the issue of lowering drug prices. The meeting, which took place in the office of Rep. Stephanie Murphy (D-Fla.), included some Democratic lawmakers who have expressed concerns about H.R. 3, the sweeping drug pricing reform backed by Democratic leaders, the Hill’s Peter Sullivan reports.

“Any bipartisan approach to drug pricing faces a steep uphill climb to passage, though, given that many Democratic lawmakers, including leadership, are intent on including a provision to allow Medicare to negotiate lower prices, saying it is needed to get meaningful savings. Almost all Republican lawmakers oppose that idea,” Peter writes.

  • Senators have introduced a bill to ban “forever chemicals” from makeup. Sens. Susan Collins (R-Maine) and Richard Blumenthal (D-Conn.) are backing a bill that would require the Food and Drug Administration to ban the addition of a class of chemicals known as PFAS to cosmetic products. These chemicals have been associated with a number of diseases, including cancer, The Post’s Tik Root reports.
  • A bipartisan group of lawmakers has reintroduced legislation aimed at spurring the development of antibiotics to combat drug-resistant bacteria. The bill would provide upfront money to drug developers in exchange for access to new antibiotics, Stat News’s Ed Silverman reports.

Sugar rush