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The Health 202

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

Seniors won't see their Medicare premiums reduced midyear after all

The Health 202

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

Good morning, and happy unofficial summer. We have a note of caution for strawberry lovers: Organic berries sold in some popular grocery stories are likely sparking a hepatitis A outbreak.

Today’s edition: The World Health Organization says the monkeypox outbreak poses a “moderate” risk to global health, but it’s unlikely to lead to a pandemic. Coronavirus cases are five times higher than this time last year. But first …

Medicare enrollees will have to wait until next year for premium relief

Seniors won't see cheaper Medicare premiums until next year, after a steep cut in the price and expected use of a controversial Alzheimer’s drug. 

The nation’s top health official had directed the Medicare agency to rethink the monthly amount older adults and those with disabilities pay this year. But it would be too heavy a lift to reduce the cost of premiums midyear, the Centers for Medicare and Medicaid Services concluded.

“We had hoped to achieve this sooner, but CMS explains that the options to accomplish this would not be feasible,” Health and Human Services Secretary Xavier Becerra said in a statement.

It’s now possible a reduction in premiums for Medicare Part B, which covers doctor visits for seniors, could be announced before the Nov. 8 midterm elections. Last year, the agency announced the big price hike Nov. 12, but the notice sometimes comes earlier. Either way, it’s still unknown how much less seniors could pay after Part B premiums increased in 2022 by the largest dollar amount in Medicare’s nearly 60-year history.

More from CMS:

Enter Aduhelm

There’s a complex backstory behind Friday’s news dump. It starts with Aduhelm, an expensive Alzheimer’s treatment the Food and Drug Administration approved last June despite a fierce dispute over whether the drug is safe and effective. 

In November, CMS announced a roughly 14.5 percent increase to premiums for Medicare Part B, which covers doctor visits, some preventive care and other outpatient services. 

  • The standard premium went from $148.50 per month in 2021 to $170.10 this year.
  • CMS contended seniors wouldn’t feel the impact of the spike due to a 5.9 percent cost-of-living adjustment in their Social Security benefits, but still, the increase was higher than had been expected.

One major reason for the price hike: The uncertainty over whether Medicare would cover the pricey new Alzheimer’s treatment, which would have had a massive impact on the federal health insurance program’s finances. 

But then, a few things happened. 

  • In December, Biogen — the maker of Aduhelm — announced it would cut the drug’s price nearly in half to $28,200 annually per patient. The price drop prompted Becerra in January to direct the Medicare agency to consider lowering premiums in the middle of the year, the first time the program has re-examined the monthly amount after a change had already been implemented. 
  • And then in April, CMS finalized its plan to limit coverage for the new drug to those enrolled in clinical trials, which greatly restricts its use. 
‘Complex and highly risky’

The legal and operational hurdles of making a change this year were too high, CMS wrote in a May 19 report to Becerra (the document was made public Friday). 

The agency reviewed three options: 

  • Altering the monthly cost during the middle of the year
  • Directly refunding Medicare recipients a portion of their 2022 premium
  • Incorporating the savings into the 2023 premium

Here’s why they went with the latter: “CMS determined that a midyear administrative redetermination would be prohibitively complex and highly risky, requiring significant resources and unproven technical solutions,” Jonathan Blum, the agency’s principal deputy administrator, wrote in the report. 

CMS also determined it “does not have sufficient authority” to send premium refunds directly to people unless someone has paid more than the already established premium.

Changing how much people paid this year could have also set a risky precedent, said Paul Ginsburg, a professor of health policy at the University of Southern California. 

  • “I could see chaos happening down the road almost every year where someone starts a campaign to pressure the secretary to lower the premium because something went better than expected,” he said.
Looking forward

But how much will seniors pay? There’s no answer yet. 

In a news release, CMS says it expects the 2023 premiums will be lower than this year “given the information available today.” Yet, the final calculation isn’t made until the fall.

While a reduction in premiums seems likely, some experts sounded a note of caution. Unforeseen circumstances can come up, like what happened with Aduhelm’s approval and its initial $56,000 price tag. 

“Nothing is definite until it happens,” said Tricia Neuman, a senior vice president at the Kaiser Family Foundation and a Biden nominee for the Medicare Board of Trustees.

Agency alert

WHO: Monkeypox presents ‘moderate’ risk to global public health

The World Health Organization over the weekend labeled monkeypox a “moderate” risk to global public health, as cases rise in countries where the disease is not typically found and largely haven’t been linked to travel. 

But the WHO’s top monkeypox expert, Rosamund Lewis, said during a public meeting Monday that she is “not concerned” at the moment about the disease turning into a global pandemic. Yet, she said there’s not much information on whether people who are asymptomatic can spread the virus, Reuters reports. 

Key context: The WHO has confirmed a total of 257 monkeypox cases across 23 countries where the virus isn’t endemic, and is investigating 120 suspected cases. Of those, 15 confirmed cases have been detected in the United States as of Monday.  

  • The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons,” WHO said in a statement.

Coronavirus

Covid-weary Americans enter summer amid a still-raging pandemic

Coronavirus cases are at least five times higher than they were this time last year as Americans kick off the unofficial start of summer. 

The latest cases have yet to overrun the nation’s hospitals, but experts warn that could change as the transmissible strains spread among more vulnerable populations, Fenit Nirappil, Craig Pittman, and Maureen O’Hagan write in The Post. 

A nationwide snapshot: 

  • Over 100,000 infections are being reported each day, while more than half of the U.S. population is living in areas classified as having medium or high covid-19 levels by the Centers for Disease Control and Prevention.
  • Meanwhile, graduations, proms, weddings and summer travel plans are in full swing, as the coronavirus fades from the foreground for most Americans.

Experts had hoped that the explosion of the omicron variant this winter, and the spread of its subvariants this spring, would act as a buffer against future surges. But emerging research suggests those infections won't offer lasting protection against the virus’ latest iterations, which have shown a remarkable ability to evade protections. 

People recently infected who also received booster shots should be able to count on at least several months of immunity, experts say, but those unvaccinated should expect little protection. 

Chart check

Reproductive wars

Austin seeks a loophole for Texas’ abortion law if Roe is overturned

Austin officials are making the first push by a major U.S. city to bypass a red state’s rules around abortion if the Supreme Court overturns Roe v. Wade, Politico reports. 

What’s happening: An Austin council member is proposing a resolution directing the city’s police department to make criminal enforcement, arrest and investigation of abortion its lowest priority. It would aim to protect both patients and providers, and to restrict city funds and staff from being used to investigate, catalogue or report suspected abortions. 

  • Behind the move: The state’s so-called trigger law, which would go into effect 30 days after a Supreme Court ruling striking down Roe, would make performing, inducing or attempting an abortion a felony punishable by up to life in prison if “an unborn child dies as a result of the offense.” It contains an exception only to save the pregnant woman’s life.

While the resolution doesn’t explicitly decriminalize the procedure, there’s reason to believe the tactic might work to stave off future charges, Politico's Megan Messerly writes. The council passed a similar measure in 2020 that largely ended arrests for fines and low-level possessions for marijuana, which the police department has complied with

Looking ahead: More cities in Texas could be next with one progressive group saying it’s eyeing introducing similar measures in San Antonio, Houston and Dallas.

Mary Tuma, freelance reporter on reproductive rights: 

In other health news

Misinformation about coronavirus vaccines and pregnancy prevails across U.S.

A majority of women who are pregnant or planning to become pregnant report believing in or being unsure about the effects of the coronavirus vaccine on pregnancy, breastfeeding and fertility as misinformation about the shot remains widespread throughout the country, according to a new survey by the Kaiser Family Foundation. 

Key context: While the federal government recommends pregnant women get the shot, the CDC estimates that about 3 in 10 of those pregnant remain unvaccinated. 

By the numbers: 

  • Nearly a quarter of those pregnant or trying to become pregnant incorrectly believe they should not get a coronavirus vaccine, compared with 14 percent of adults overall.
  • Meanwhile, about half of adults say they are confident in the vaccines’ safety during pregnancy and those trying to conceive, far below the 72 percent who express confidence in its use for adults generally.

Sugar rush

Thanks for reading! See y'all tomorrow.

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