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The Health 202

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

Here's what expiring Obamacare subsidies could mean for consumers

The Health 202

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

Good morning, and happy Friday before a long weekend ☀️ The Health 202 won’t be around on Memorial Day, but we’ll be back in your inbox on Tuesday. 

Today’s edition: The CDC has identified at least nine cases of monkeypox as health officials closely monitor the virus. Mass violence is taking a toll on Americans’ mental and physical health. But first … 

Democrats set up a health insurance cliff they're now trying to avoid

In California, officials estimate 220,000 people could drop their Obamacare plans next year. Premium payments may more than double for roughly 1 million low-income consumers in the state, and costs could spike for older Americans. 

That’s if Congress doesn’t extend enhanced subsidies helping lower costs for millions of people on the Affordable Care Act’s insurance marketplaces. A document detailing these estimates — shared with The Health 202 — was also shared with administration officials and California lawmakers.

It’s a snapshot of the headache Democrats may face right before the midterm elections. There’s increasing anxiety within Democratic circles about the prospect of Congress failing to renew the temporary benefit — and the costs Americans would learn about just weeks before they head to the voting booths. 

The past two weeks

Two left-leaning groups released reports detailing the potential impact. More than two dozen vulnerable House Democrats pressed party leadership for action. State marketplace officials stumped for an extension. And a Democrat-aligned group has been holding news conference and events pushing the issue.

Last week, we detailed how the leaders of the state-run insurance marketplaces are pressing Congress and administration officials to ensure the enhanced subsidies don’t lapse. This week, we’re taking a deeper dive into estimates of how premiums and insurance coverage could be affected if Congress doesn’t keep the increased tax credits around.

The politics

Democrats’ dilemma: Last year, the party’s coronavirus relief package boosted tax credits for low-income Obamacare shoppers and granted them to middle-income Americans for the first time. That led to record-breaking enrollment numbers, in part because it was these middle-income earners who had long found the marketplace options unaffordable. But the financial help runs out at the end of this year.

Democrats would need to extend the assistance through a reconciliation bill, which allows the party to bypass GOP opposition to the beefed-up tax credits. But a broader economic package has languished in the Senate for months. Lawmakers are aware of the stakes and continue to push for the measure to be included in any such bill, per a Senate Democratic aide. 

If Congress doesn’t act in the next few months … “Everyone is going to hear the news about how their premiums are going up, some by thousands of dollars a year,” said Leslie Dach, who founded Protect Our Care, a Democratic-aligned health-care advocacy group. “That’s horrible policy and horrible politics.”

Kaiser Family Foundation's Cynthia Cox: 

By the numbers

What would a lapse actually look like? An array of reports have come out over the past few months projecting the impact.

For one, the number of uninsured Americans could increase. That’d be bad news for President Biden, whose administration has frequently touted gains in insurance enrollment since he took office. An estimated 3 million people with plans on the Obamacare marketplaces could become uninsured if the increased tax credits expire, according to a March report from the Department of Health and Human Services. 

  • The federal health department estimates that 8.9 million people remaining in the marketplace would see decreases in the amount of financial help they receive to the tune of an average of $406 per person annually.
  • Another 1.5 million would lose their subsidies altogether — an average reduction of $3,277 per person per year — but stay insured through some source of coverage.

Katherine Hempstead, of the Robert Wood Johnson Foundation:

State by state

Before we go further, it’s worth noting that these are predictions. Yet, some experts believe increases in premiums could be even higher in general, due to rising inflation and increased labor costs. 

  • “It is sort of a double whammy, when you have maybe the loss of this pretty significant subsidy, and then combined with a really big premium increase,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. 
  • Some who leave the marketplaces could find other sources of health coverage, but many will not, Hempstead wrote this month.

All eyes are on West Virginia. The state could experience the country’s steepest spike in premiums — an average increase of $1,536 per person — of the 33 states where residents buy ACA plans on, according to a recent analysis from Families USA, a left-leaning consumer health lobby. The state is also home to Sen. Joe Manchin (D-W.Va.), who has been an obstacle to passing Democrats’ broader economic package.

Other states that could be hit hard include Wyoming, Delaware, Nebraska and Alaska. 

As for the states with their own insurance exchanges … The National Academy for State Health Policy has a tracker on its website detailing various projections if the enhanced subsidies don’t continue. 

  • It shows that Connecticut estimates over 65,000 marketplace enrollees could see their financial support reduced or eliminated.
  • Washington, D.C., predicts roughly 8 percent of enrollees may drop coverage.
  • And Maryland projects that spending on premiums could rise by 47 percent.

Agency alert

CDC identifies nine monkeypox cases in U.S.

The Centers for Disease Control and Prevention has detected nine cases of monkeypox across seven states as of Wednesday, as global health authorities confront an unprecedented spread of the virus, our colleague Fenit Nirappil reports. 

Not all of the presumed cases had recently traveled to countries where the virus has been detected, a sign that monkeypox is spreading within the United States. But authorities say the public risk is low because the virus is difficult to transmit and its symptoms are easier to detect. Monkeypox is much different than covid-19, experts say.

U.S. officials say the current cases are concentrated among men who have sex with men, mirroring similar trends in European countries where the outbreak began. Experts say the early concentration of cases in gay and bisexual men appears to be a coincidental result of the first patients infecting others in their social networks.

Now, federal officials are working with gay social networking apps and LGBTQ organizations to spread the word about monkeypox ahead of Pride festivities next month. They are also urging Americans against stigmatizing gay men as carriers of the disease or assuming they are the only ones susceptible to the virus

  • One of the cases identified this week was a Northern Virginia woman who had recently traveled to an African country.
  • Another presumptive case announced yesterday in Colorado is currently awaiting CDC confirmation, state health officials said yesterday.

Gregg Gonsalves, epidemiologist:


CDC may stop collecting hospital data on suspected covid cases

The CDC is planning to scale back the covid-19 data it collects from hospitals as the pandemic evolves and some of the information is no longer useful or has become redundant, according to a draft of the plan reviewed by Bloomberg News

Covid-19 guidance for hospitals has been regularly reviewed by U.S. health officials throughout the pandemic and has been revised several times already. 

Here’s what might change:

  • Hospitals may no longer be asked to report suspected coronavirus cases, a practice the agency encouraged in the early days of the pandemic when coronavirus tests were sparse and turnaround time was lengthy.
  • Health-care facilities may be permitted to stop collecting coronavirus vaccination data because it isn’t required to be reported and the information isn’t widely used.
  • The frequency in which hospitals report their data could also be rolled back, possibly to three days a week or just once per week.

Mental health

Mass violence takes toll on Americans’ psyches

After several mass shootings in less than two weeks, experts are warning that repeated exposure to acts of violence is taking a toll on the mental and physical health of Americans, The Post’s Lenny Bernstein, Ariana Eunjung Cha and Joel Achenbach report. 

The effect mass violence has on Americans’ psyches is also compounded by things like the covid-19 pandemic, political and social upheaval, and violence overseas. “We cannot see any one of these events in isolation. We are seeing a cascade of collective traumas,” said Roxane Cohen Silver, a University of California at Irvine psychologist. 

  • Research on collective trauma shows some people can develop conditions like short-term anxiety, depression and post-traumatic stress disorder.
  • Studies into the health consequences of repeated media exposure to mass violence have found evidence that some individuals developed new cardiovascular illnesses as a result.

In other health news

  • Food and Drug Administration Commissioner Robert Califf said in a Senate HELP Committee hearing yesterday that he expects the country will have a surplus of infant formula in about two months, the Wall Street Journal reports.
  • Julie Beckett died of a heart attack earlier this month at 72. The mother of a disabled child fought for changes to Medicaid that allowed her daughter and more than half a million American children with disabilities to live at home and grow up outside of hospitals, The Post’s Emily Langer reports.
  • The World Health Assembly yesterday voted in favor of a resolution that condemned Russian attacks on the health-care system in Ukraine, a move that raises the possibility that Russia could be suspended from the assembly if the attacks on hospitals and clinics continue, per The Post’s Adam Taylor.

Quote of the week

Health reads

There may be a backdoor way for hospitals to get paid for uninsured Covid-19 care (By Rachel Cohrs | Stat)

Patients Face Long Delays for Imaging of Cancers and Other Diseases (By Reed Abelson | The New York Times)

What to say to kids about school shootings to ease their stress (By Allison Aubrey | NPR)

Sugar rush

Thanks for reading! See y'all Tuesday.