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The Health 202

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

Oregon is guaranteeing kids won't get kicked off Medicaid until at least age 6

The Health 202

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

Good morning to everyone, especially these brown bears eating pounds and pounds of salmon to prepare for winter. Send your favorites to

Today’s edition: The Centers for Disease Control and Prevention is officially expanding eligibility for the monkeypox vaccine. House Republicans are probing biosafety practices overseen by two key federal agencies. But first … 

Oregon wants to keep kids covered during their critical, early-stage development

Oregon is testing out a new concept in Medicaid: Keep children continuously enrolled in the safety net program until they turn 6 years old. 

The first-of-its-kind idea, to be piloted over five years, is designed to stop children from getting kicked off their health coverage during years crucial to their development. Federal health officials signed off yesterday on the program, which more states could emulate in the coming months. 

“We have near universal health insurance coverage for senior citizens in this country,” said Bruce Lesley, the president of the First Focus on Children, an advocacy group. “Where we really would like to get with kids is that the public programs should basically assume coverage unless someone says, ‘No, I have private coverage.’”

Oregon’s pilot program comes at a critical moment for safety net coverage. Millions of children are at risk of losing their Medicaid coverage when the public health emergency for the coronavirus ends. Such a notion is already fueling a push in Congress to include policies in a year-end deal that would further maintain coverage for kids.

Joan Alker, the executive director of Georgetown’s Center for Children and Families:

The details

The idea of continuous enrollment for kids isn’t new — it’s one advocates and some Democrats have been pushing for years. Over half of states have a requirement that kids can’t be kicked off their coverage for 12 months, even if a family’s income changes. 

The point is to avoid a temporary loss of health coverage, known as churn. It occurs frequently in Medicaid and the Children’s Health Insurance Program, and is essentially when people cycle on and off the programs in a short period of time, and can happen when a person’s income fluctuates, for instance.

  • Roughly 11.2 percent of children with full benefits are disenrolled and then subsequently re-enrolled within one year, according to the Kaiser Family Foundation. 

Now, Oregon is pioneering a new approach. The state will soon allow children to remain on Medicaid until their sixth birthday. After that, children 6 years old and older, as well as adults, can stay enrolled for two years at a time, regardless of changes in their finances or other family circumstances.

Will other states follow suit? Joan Alker, the executive director of Georgetown’s Center for Children and Families, said she’s “cautiously optimistic,” and some states have already begun to propose such policies.

  • Washington state asked the federal Medicaid agency this summer for permission to cover children with Medicaid for the first six years of their lives.
  • New Mexico has drafted an application that would also provide continuous Medicaid enrollment up to age 6.
  • California lawmakers asked state officials to seek sign-off from the federal government to continuously cover children with Medi-Cal until they turn 5.
Challenges loom

Amid the coronavirus pandemic, Congress offered states a deal. They could get enhanced funding for their Medicaid programs from the federal government if they pledged not to remove anyone from the program’s rolls until the public health emergency ended.

States are already bracing for the complex process of determining who is still eligible for the programs whenever the public health emergency is over. Children and young adults are expected to be disproportionately impacted, with the Department of Health and Human Services predicting that 5.3 million could lose their Medicaid or CHIP coverage.

That’s already spurring advocates to push Congress to pass policies to keep kids covered in a year-end spending deal. A requirement that children can’t lose their coverage for a continuous 12 months was originally included in Democrats’ sweeping social spending bill but was ultimately left on the cutting room floor when the legislation was narrowed. And such a policy is a top priority for key party leaders, such as House Energy and Commerce Chair Frank Pallone Jr. (D-N.J.).

  • “We're hoping that people recognize that when the public health emergency ends, there's going to be a lot of kids kicked off,” Lesley said. “Having 12-month continuous [coverage] would really help — not completely eliminate that — but it would help mitigate the loss of coverage for lots of kids.”

Monkeypox update

Vaccines, change in behavior drive down national monkeypox cases

As new monkeypox cases continue to decline across the United States, the Biden administration is intensifying its focus on prevention in hopes of bulking up the nation’s protection against the virus that has infected more than 25,000 Americans, our colleagues Fenit Nirappil and Lena H. Sun report.

Daily U.S. infections now average around 200 after peaking around 450 in mid-August. Federal health officials attribute that change largely to vaccines and behavioral changes among gay men who have reduced sexual activity, the most common mode of transmission.

Those who haven’t received Bavarian Nordic’s Jynneos monkeypox shot were 14 times more likely to become infected — with protection seen as early as two weeks after the first shot, according to new early data from the Centers for Disease Control and Prevention. CDC Director Rochelle Walensky said the news provides “a level of cautious optimism that the vaccine is working as intended.”

Also … the agency announced yesterday that it’s expanding vaccination eligibility to include people considered to be at high risk for contracting the virus before they’ve been exposed to the disease — something that many states and local health departments have already been doing. Until now, the agency recommended vaccination for people after exposure.

But there are still key questions about the shot that remain unanswered, including how effective the vaccines are when administered under a new injection method and the duration of immunity after a single dose.

Hear more about the monkeypox vaccination effort from Fenit on Post Reports:

On the Hill

House GOP probes biosafety practices overseen by CDC, NIH

House Republicans said yesterday that they had opened a probe into biosafety practices overseen by the CDC and the National Institutes of Health, previewing a priority for the GOP if the party retakes Congress this fall, our colleague Dan Diamond reports. 

In a letter sent to the agencies, Reps. Cathy McMorris Rodgers (R-Wash.), Brett Guthrie (R-Ky.), and H. Morgan Griffith (R-Va.) argued there is too little oversight of scientists that study and experiment on viruses that could spark potential pandemic. They called for a more robust training regimen for those engaging in “virus hunting” and controls to prevent possible laboratory leaks.

The three lawmakers are the top Republicans on the House Energy and Commerce Committee, its health subcommittee and its oversight committee, respectively, which oversee the nation’s health agencies. They have repeatedly called for broader investigations into government funding for “gain-of-function research,” which may result in more lethal or transmissible versions of viruses, and whether SARS-CoV-2 originated in a laboratory. But Republicans are currently in the minority, hindering their ability to launch such investigations.

Agency alert

The FDA announces a new definition of what’s ‘healthy’

The Food and Drug Administration is planning to update the criteria that foods must meet in order for their packages to be labeled “healthy,” as the agency seeks to help consumers make more nutrition-conscious choices at the grocery store, The Post’s Laura Reiley reports.

Under the proposed rules, manufacturers can label the front of their products’ packages as “healthy” if they keep saturated fat, sodium and added sugars below certain levels, as well as contain a meaningful amount of food from at least one of the food groups or subgroups recommended by dietary guidelines. The agency said it would automatically allow whole fruits and vegetables to be considered healthy. 

The FDA is also working to create a symbol companies can put on their food products to more easily show they are “healthy.”

Yesterday’s announcement coincided with the White House Conference on Hunger, Nutrition and Health, and came on the heels of the release of the Biden administration’s national strategy to end hunger and increase healthy eating habits and physical activity by 2030.

Why it matters: Nineteen states and two territories have at least 35 percent of residents with adult obesity — more than double the number of states with a high obesity prevalence since 2018, a shift that studies show was fueled by the pandemic, according to new data from the CDC.

Agriculture Secretary Tom Vilsack with World Central Kitchen founder José Andrés:

In other health news

  • Fueled by the coronavirus pandemic, the opioid addiction and overdose crisis cost the United States nearly $1.5 trillion in 2020 alone and is expected to continue to increase, a report released yesterday by the Congressional Joint Economic Committee revealed.
  • A federal judge ruled that an Indiana law requiring abortion providers to bury or cremate fetal tissue violates the U.S. Constitution, barring prosecutors in the state from enforcing it, the Indianapolis Star reports.
  • Rep. Ami Bera (D-Calif.) has introduced legislation aimed at reducing the cost of the rabies vaccine for uninsured Americans months after a fox bit him as he was walking on Capitol Hill, The Post’s Eugene Scott writes.

Health reads

What It Costs to Get an Abortion Now (By Allison McCann | The New York Times)

Abortion, economy electrify contest between Spanberger, Vega (By Meagan Flynn | The Washington Post)

Few Places Have More Medical Debt Than Dallas-Fort Worth, but Hospitals There Are Thriving (By Noam N. Levey | Kaiser Health News)

Sugar rush

Thanks for reading! See y'all tomorrow.