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The Health 202

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

Fiona prompts financial pleas for Puerto Rico's beleaguered Medicaid program

The Health 202

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

Good morning, y’all. Are you wondering how long you have to vote? Or where your new House district is? The legislation at stake in a Republican or Democratic controlled Congress? The Post has got you covered here.

Today’s edition: Abortion providers filed a lawsuit seeking clarity on Arizona's abortion bans. National Republicans are rallying around Herschel Walker, but Georgia GOP leaders are fretting. But first … 

Puerto Rican officials are pleading for more Medicaid dollars post-hurricane

Top Puerto Rico officials are pushing for increased federal funds to boost their fragile Medicaid program after Hurricane Fiona ripped through the island last month.

The asks come from Gov. Pedro Pierluisi (D) and Rep. Jenniffer González-Colón (R), each of whom recently sent congressional leaders separate letters obtained by The Health 202. Some of the requests are similar to funding lawmakers approved after Hurricane Maria devastated the island and put pressure on its medical system in 2017.

The demands for more cash underscore concerns that the recent hurricane could have a sustained impact on the island’s health-care safety net. And it highlights the complex financing mechanism for Puerto Rico’s Medicaid program, which officials and experts say has long been underfunded.

The storm wreaked havoc when it made landfall last month, causing severe flooding and knocking out power for more than 3 million residents. Much of the power has since been restored, and 99 percent of Level 1 hospitals are back on the electrical grid after running on generators. But the recovery efforts will take time — a reality President Biden alluded to when he told Puerto Ricans he was “committed to this island” in a visit to the territory earlier this week.

Medicaid 101

Why does Puerto Rico need more money? Medicaid funding for the U.S. territories is structured much differently than it is for the states. That can result in shortfalls, fiscal cliffs and dollars for the program getting caught in the political crosshairs.

Here’s the gist:

  • In the states: There isn’t a limit on the cash the federal government can put toward states’ Medicaid programs.
  • But such a limit exists for the territories. There’s a cap on the amount of money the territories’ Medicaid programs can receive from the federal government each year.
  • Congress has some discretion here. Lawmakers typically boost the floor for how much the federal government must match the territories’ Medicaid dollars. They also usually raise the cap on how much federal funds the safety net gets each year.

Currently, the island receives a 76 percent match from the federal government on its Medicaid dollars. Puerto Rico now must receive at least $2.9 billion in total from the feds each year, the result of a recent Biden administration increase. (Read more on how a government watchdog says such a move was wrong.)

Pleas for more cash

Top island officials say they were already anticipating a funding shortfall for its Medicaid program this year. Carmen Feliciano, the executive director of the Puerto Rico Federal Affairs Administration, said the government had estimated the deficit would amount to $400 million — and that was before Hurricane Fiona hit.

Now, they’re requesting more dollars from Congress.

Pierluisi, the governor, is asking congressional leadership for any potential disaster relief bill to include five immediate needs for the island. Topping the list: More Medicaid dollars.

  • The request consists of a temporary 100 percent match in federal funds, an additional $400 million through the end of the year and the continuation of $200 million to boost provider payment rates, according to a Sept. 26 letter obtained by The Health 202.
  • “This is very short term,” Feliciano said, adding Puerto Rico officials are seeking a long-term fix to the island’s complex Medicaid funding structure.

González-Colón, who’s a nonvoting member of Congress, sent specific funding asks to congressional leaders for the next seven years in a letter obtained by The Health 202.

  • For the next two fiscal years: She also requested a 100 percent match from the federal government — which Congress signed off on after Hurricane Maria — as well as raising the cap to $5 billion each year.
  • From fiscal year 2025 to fiscal year 2030: The congresswoman asked for a federal matching rate of 83 percent, as well as a $21.5 billion cap in total. This could help the government pay for services it typically can’t cover, like non-emergency transport and adult vaccinations, she wrote.

In an interview, González-Colón also stressed that she’s seeking a permanent solution to the frequent funding cliffs facing the island. “Resolving this permanently, or at least [for] five to seven years with the funding, will allow the island to stabilize.”

Capitol Hill will soon contend with Medicaid funding for the island. The current federal match rate for all U.S. territories is set to revert back to a lower threshold in mid-December, meaning congressional leaders will be soon faced with decisions over how much money to give Puerto Rico no matter what.

In a statement, Rep. Frank Pallone (D-N.J.) — the chair of the powerful House panel overseeing Medicaid — said he’s “reviewing Puerto Rico’s funding request and I look forward to working with congressional leaders to ensure they have the resources and support they need.”

Reproductive wars

Abortion providers sue to increase access in Arizona

Abortion rights groups filed a lawsuit in Arizona yesterday asking the courts to clarify which of the state’s overlapping restrictions governs the procedure — an 1800s-era near-total ban or a measure signed into law in March that allows an abortion through up to 15 weeks of pregnancy.

In their complaint filed in Maricopa County Superior Court, the Arizona Medical Association and a Phoenix abortion provider said doctors in the state have halted all abortion services because they are unsure which is the law, and thus, whether they could face charges for providing the procedure.

  • “State officials with enforcement power have either refused to state which abortion laws take precedence or have taken inconsistent positions on the matter,” the lawsuit states.
  • The plaintiffs urged the judge to “harmonize” the state’s two laws by allowing doctors to offer abortions through 15 weeks gestation.

Meanwhile …

No states have taken Biden up on his offer to use Medicaid to help cover costs for women traveling to receive abortions, two months after he signed an executive order encouraging them to do so, Politico reports. Some health officials are torn between whether the cumbersome and time-consuming process of obtaining a Medicaid waiver is the best way to support out-of-state patients seeking abortions. 

President Biden spoke about Arizona's strict abortion ban in his meeting yesterday with the administration’s Task Force on Reproductive Healthcare Access:

From our reporters' notebooks

Fauci says he’ll testify if GOP holds coronavirus hearings

Anthony Fauci, the government’s top infectious-disease expert, said yesterday that he would cooperate with probes led by congressional Republicans, should the GOP retake Congress this fall and hold hearings on the coronavirus next year as its members have vowed to do, our colleague Dan Diamond reports.

If they call me, of course,” Fauci said in an interview with Dan during a webinar convened by USC Annenberg’s Center for Health Journalism. “I have no problem. I’m a big believer in oversight. And I have testified before Congress literally hundreds of times.” Watch more here.

On the Hill

Republicans rally support for Herschel Walker

National Republican leaders like former president Donald Trump and Sen. Rick Scott (Fla.) are rallying behind Herschel Walker, defending the party’s nominee for the U.S. Senate in Georgia after he denied a report that he paid for a girlfriend to get an abortion in 2009, our colleagues Annie Linskey and Cleve R. Wootson Jr. report.

But Republican leaders and activists in Georgia expressed worries that the party had elevated a flawed candidate, as Walker’s personal life was yet again thrust under the national spotlight at a time when polls show a competitive race between him and Democratic Sen. Raphael G. Warnock.

Some Georgia Republicans expressed despair at the latest round of stories, and others attempted to keep their distance. One longtime state GOP strategist said that he “knew that this was a dumb idea,” and that the party “could have had Gary Black,” referring to one of Walker’s opponents.

Walker, who is running as an antiabortion candidate, has denied the accusations outlined by the Daily Beast. But the emerging dynamic complicates what many see as one of the party’s best opportunities to flip a Senate seat in hopes of regaining control of the narrowly divided chamber this November. The Washington Post hasn't independently verified the reporting from the Daily Beast.

The Post's Leigh Ann Caldwell:

State scan

Okla. GOP ties hospital’s covid funds to end of transition-related care

Republicans curtailed gender-transition care available to minors in Oklahoma yesterday, after GOP lawmakers threatened to withhold more than $108 million in federal coronavirus relief funds if one of the state’s largest hospital systems didn’t stop providing the services, our colleague Kimberly Kindy reports.

Some GOP lawmakers in Oklahoma are calling for a permanent, statewide ban on medical services that assist minors with gender transitioning. The spike in young people identifying as transgender has become a hot-button culture-war issue, as children seek treatment at pediatric gender clinics which offer services that sometimes aren't reversible or can lead to long-lasting side effects.

The legislation, which Oklahoma Gov. Kevin Stitt (R) signed into law Tuesday, required that the transgender medical care at OU Health to stop immediately. “We were not provided with a reasonable timeline to safely transition the care of our patients,” Richard Lofgren, president and CEO of OU Health, wrote in an email obtained by The Post.

Medical experts contend that OU Health’s facilities had been following best practices in its gender-affirming care. While hospital officials would not outline which services will halt as a result of the legislation, one Oklahoma pediatrician who treats transgender youth in the region said she believes all hormone therapy and surgeries will cease in the state.

More from Stitt:

In other health news

  • On the move: Biden yesterday announced his intent to nominate Surgeon General Vivek Murthy to also serve as the nation’s representative to the executive board of the World Health Organization.
  • Sheryl Sandberg, the former chief operating officer of Facebook’s parent company Meta, is donating $3 million to the American Civil Liberties Union to support the organization’s fight against state abortion bans, The Post’s Elizabeth Dwoskin and Naomi Nix report.
  • More than 40 health-care organizations are petitioning the Food and Drug Administration to add miscarriage management to the list of uses for Danco Laboratories’ mifepristone, a pill used in terminating pregnancies.

Health reads

Federal judge orders Texas Attorney General Ken Paxton to testify in an abortion lawsuit (By Allie Morris l The Dallas Morning News)

Perspective | Why a pro-abortion-rights candidate ran an ad where she gives birth (By Monica Hesse, columnist | The Washington Post)

Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers (By Susan Jaffe | Kaiser Health News)

Sugar rush

Thanks for reading! See y'all tomorrow.