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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Biden promised to reverse Trump's health policies. He's done that -- mostly.

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good morning! It's almost the end of the year and we're wondering…have you signed up for our sister newsletter The Climate 202 yet? Subscribe here to add it to your 2022 reading list. 

Below: The Senate voted to repeal Biden's vaccine or test policy for private businesses, and there's a bipartisan effort to keep telehealth benefits around. 

Biden has reversed some but not all Trump-era health policies

President Biden came into office with a goal in mind: Reverse Donald Trump’s health care policies.

Democrats spent four years arguing the Trump administration was sabotaging Obamacare and the social safety net, making the case for how they would change such measures if they were in the White House. In his second week in office, Biden issued executive orders putting to paper his campaign pledges to revoke Trump-era rules. 

Indeed, Biden has killed a significant number of Trump-era measures Democrats despise the most. But there are still some policies the administration hasn’t touched. As the year winds to an end, we’re taking a look at which policies Biden rescinded — and what he hasn’t. We’ll home in on three buckets: the Affordable Care Act, Medicaid and reproductive rights.

Obamacare

There’s a philosophical difference between Biden and Trump that served as the driving force behind each president’s policies. 

  • “There’s the important symbolic change of promoting the ACA rather than trashing it,” said Larry Levitt, an executive vice president of the Kaiser Family Foundation.

A snapshot at what changed: The Biden administration created a special Obamacare enrollment session for the pandemic. It’s moved to give more money to navigator groups who help people sign up for the insurance marketplaces after Trump cut their funding. It rolled back Trump-era measures that let states turn their marketplaces over to private brokers and that relaxed some of the guardrails around approving state plans to change Obamacare.

What’s left on the table: The Biden administration, at least for now, hasn’t changed or rescinded three Trump-era insurance regulations. Democrats had argued the measures could weaken Obamacare by potentially paving the way for poorly regulated plans, while Republicans say it offers consumers more choices.

  • The rule that got the most pushback from Democrats: Trump’s expansion of short-term health plans, which typically don’t cover pre-existing conditions.
  • A regulation expanding so-called association health plans — which allows businesses to band together to buy health coverage — has been stalled in the courts. A federal judge still hasn’t ruled on the measure, despite hearing the case back in 2019, and the Biden administration told the court as recently as this week that the administration is still considering the matter.
  • The last regulation allows for employers to provide subsidies for their workers to buy health coverage on the individual market.

(The Department of Health and Human Services didn’t respond to a question on the status of the rules. But, in general, said “our mission as we head in to 2022 and beyond is to always put health care in reach for hard-working Americans.”)

Medicaid

The Biden administration quickly worked to rescind one of Trump’s signature health policies: Medicaid work rules. 

  • In 2018, the Trump administration issued first-of-its-kind guidance letting states require some enrollees work, volunteer or attend school as a condition of getting health coverage.
  • Starting in February, the Biden administration began unwinding the permission they gave mostly GOP-led states to implement the work rules, though many states had already halted their programs in part due to court rulings. The agency removed the document detailing how states could set up such rules from the Centers for Medicare and Medicaid Services’ website.

Guidance for Medicaid block grants is still online: The Trump administration encouraged states to convert parts of their Medicaid program into a block grant, a longtime goal of conservatives. That guidance hasn’t been removed from the CMS’ website, though it also hasn’t gotten take up from states. 

  • Medicaid advocates have pushed back hard against block grants, which would be a radical change for the over 55-year-old program. The federal government gives open-ended payments to states’ Medicaid programs, and those would instead be converted to a fixed amount.
Abortion and contraception

What’s gone: The Biden administration moved fast to repeal the so-called Mexico City policy, which bars U.S. government funding for groups around the world that provide or refer abortions. And gone is a Trump-era rule banning clinics from receiving federal family planning grants if they refer patients for abortions. 

Possibly on the chopping block: A Trump policy letting employers opt out of covering contraception for religious or moral reasons. In August, the Biden administration said it intended to begin rulemaking within six months to amend the 2018 contraceptive rule.

On the Hill

Senate votes to nullify key Biden vaccine and testing policy

Republicans ratcheted up their anti-mandate sentiment yesterday, adopting a measure in the Senate to unwind the Biden administration’s rule requiring large private businesses to require vaccinations or weekly testing, The Post's Tony Romm reports.

The effort was led by Sen. Mike Braun (R-Ind.). Notably, it gained the backing of two Democrats, Sens. Joe Manchin III (W.Va.) and Jon Tester (Mont.), ultimately passing in a 52-48 vote. 

  • The push hinged on a congressional process which allows lawmakers to review federal agency regulations, clearing the way for Republicans to bring the bill to the floor for a vote despite not controlling the chamber.

The measure is unlikely to go far. A senior Democratic aide told The Health 202 that they didn’t expect the chamber to vote on the measure

Coming soon? Another group of Republican lawmakers is preparing a second measure aimed at scrapping the administration’s mandate for health professionals. Courts have halted the mandate for private businesses, health professionals and federal contractors.

First in The Health 202: Key lawmakers introduce bipartisan telehealth bill

New legislation to be unveiled today will push to make a slew of telehealth services last longer, as demand for such services has skyrocketed amid the pandemic. 

  • Who’s introducing the bill: Rep. Lloyd Doggett (D-Texas), the chair of the House Ways & Means Health Subcommittee; Devin Nunes (R-Calif.), the subcommittee’s top Republican; and panel members Mike Thompson (D-Calif.), Mike Kelly (R-Penn.), and David Schweikert (R-Ariz.).

A glimpse of the bill’s major provisions:

  • Before the pandemic, Medicare generally only reimbursed telehealth visits for rural patients, who were required to go to a health-care setting to make the telehealth call. Under the legislation, patients would be able to make telehealth calls from home and would not be restricted to certain zip codes, even after the end of the public health emergency.
  • The bill also includes a two-year temporary extension of emergency telehealth waivers, such as allowing certain providers like speech language pathologists, occupational therapists and physical therapists to provide telehealth services.

The uninsured are looking to Congress to fill a coverage gap

Our colleague Amy Goldstein dives into the on-the-ground stakes of Democrats’ plan to create a path to health coverage for over 2 million uninsured people in a dozen states that have not expanded Medicaid. Amy recounts the case of one Texas woman for whom the expansion would mean a chance to see a cardiologist about her spiking blood pressure. 

  • But the proposal comes with limits: It would only run through 2025, if passed at all. Its fate is far from certain in the Senate, where the chamber will consider this measure and the rest of Democrats’ spending bill in the weeks ahead.

Coronavirus

Fauci: The definition of full vaccination could change to include a booster

“Right now, I don't see that changing tomorrow or next week,” Anthony Fauci, Biden's chief medical adviser, said on CNN. But, he added that, in his personal opinion, “it’s going to be a matter of when, not if.”

Currently Americans are considered fully vaccinated if they have received one dose of the Johnson & Johnson vaccine or two doses of either Pfizer-BioNTech or Moderna’s shot. The definition of fully vaccinated matters for state vaccine mandates and requirements for travel and businesses.

Schools play a role in encouraging kids to get vaccinated

That’s according to a new Kaiser Family Foundation survey showing that vaccine uptake is higher in schools encouraging children to get vaccinated. 

In schools encouraging vaccination..60 percent of parents say their kid ages 12 to 17 is vaccinated. That rate was 28 percent among parents with kids between ages 5 and 11. 

In schools that don’t encourage vaccination…42 percent of parents say their adolescent is vaccinated, and 8 percent say their younger child has received the shot.

Another takeaway: Many parents of younger children want to “wait and see”

  • Only 16 percent of parents of children between the ages of 5 and 11 say their child has received at least one dose. An additional 13 percent of parents want to get their child vaccinated as soon as possible, while nearly a third say they want to wait and see. Three in 10 say they do not want to get their child vaccinated.

On the move

Mitch Zeller, the director of the FDA’s Center for Tobacco Products, plans to retire in April 2022 after serving in the post since 2013, our colleague Laurie McGinley shares with us. In a letter to staff, acting FDA Commissioner Janet Woodcock praised his work as “invaluable and instrumental” to advancing “numerous historic public health milestones in tobacco regulation.”

Biden intends to nominate January Contreras as assistant secretary for the Administration for Children and Families — a division within HHS that manages the Head Start program for low-income children, welfare and foster-care programs and the refugee office that handles the care of migrant children. Contreras previously oversaw the Arizona Department of Health Services and served as an ombudsman in the Department of Homeland Security under Obama. 

Sugar rush

Thanks for reading! See y'all tomorrow.

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