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The Health 202

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

Medicaid maneuvering in the lame-duck

The Health 202

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

Good morning and TGIF, everybody. We’re not sure how it’s December already. Send warm vibes our way: rachel.roubein@washpost.com🥶

Today’s edition: The details on how fintech firms allegedly fueled covid aid fraud. The stories of how three pregnant women navigated the post-Roe landscape. But first … 

Pandemic-era Medicaid rules are central to year-end health negotiations on Capitol Hill

On the docket in a potential year-end package: Jockeying over the safety net program providing coverage to millions of poor adults.

Lawmakers are weighing ending a measure that has prevented states from kicking people off Medicaid during the pandemic — and coupling the change with guardrails and other policies aimed at avoiding coverage losses, according to seven people on and off Capitol Hill with knowledge of the discussions.

Such a measure could include a gradual phaseout of enhanced funds the federal government has paid to state Medicaid programs for nearly three years. The conversations are extremely fluid, the people cautioned, given that congressional negotiators are still wrangling over a top-line spending agreement. 

But the prospect may serve as a critical negotiating tool as the two parties haggle over what health policies could wind up in any year-end package. 

Republicans have been itching to unwind pandemic-era Medicaid rules, which would save the government money and help pay for other health provisions. Axios first reported that an earlier rollback was in play. Meanwhile, Democrats have sought to impose guardrails on states when they reevaluate who is still eligible for the safety net program as well as other policies aimed at ensuring new moms and children have health coverage.

Here’s the deal

In March 2020, Congress passed a law that essentially offered states an option aimed at helping them cope with Americans losing jobs and health benefits. The federal government would give states 6.2 percent more federal funds to help pay for their Medicaid programs as long as they pledged not to kick anyone off the program.

Every state and territory jumped at the deal. The funding bump was designed to last until the end of the quarter in which the Biden administration gets rid of the public health emergency for the coronavirus. Though federal health officials have continued to renew the emergency declaration, state Medicaid officials are on edge about when it could end and are seeking some certainty. That’s because they’ll then have to begin the monumental task of determining which beneficiaries are no longer eligible because their incomes have risen. 

Meanwhile, Medicaid advocates are fretting that millions of people who lose their health insurance may not know that they could qualify for private plans.

What’s new

Republicans have been seeking to unwind the provision that incentives states to avoid touching their Medicaid rolls. One idea on the table is phasing out the enhanced federal funding while allowing states to begin redetermining who is eligible to stay on Medicaid, according to people familiar with discussions who spoke on the condition of anonymity to be candid.  

But to secure an agreement, Democrats would likely need to get some priorities of their own into the package. 

  • Several people pointed to potential guardrails around states’ processes for reevaluating who’s still eligible for Medicaid, which Democrats have pushed for in the past. This could perhaps consist of data reporting requirements or limits on how many changes a state can process per month, though again this is all very fluid. 
  • Some leading Democrats have also been pressing to make 12 months of postpartum Medicaid mandatory and permanent for states, as well as a requirement that children can’t be kicked off their coverage for a continuous 12 months even if a family’s income fluctuates.

Republican staff confirmed that they would consider guardrail offers in negotiations over how quickly re-evaluations over Medicaid coverage can begin. 

In a letter sent to the Hill in recent weeks, the National Association of Medicaid Directors stumped for decoupling Medicaid re-evaluations from the end of the public health emergency. They pressed for a firm timeline for when such redeterminations will start and asked for the 6.2 percent bump in federal funds to be gradually phased out over time. 

“The things that we are most eager for is certainty around what this is all going to look like and getting away from the guessing game around the future of the public health emergency, and having to continually revise operational plans, revise budgeting assumptions, revise messaging and communications,” said Jack Rollins, NAMD’s director of federal policy.

On the Hill

How fintech fueled coronavirus aid fraud

A handful of financial technology companies raked in billions of dollars for their work reviewing applications for a federal program designed to help small businesses at the height of the coronavirus pandemic, but allegedly overlooked signs of fraud plaguing the relief program, The Post’s Tony Romm reports. 

The allegations are laid out in a sprawling, 120-page report released yesterday by the House select subcommittee on the coronavirus crisis. It’s the latest chapter in a saga that highlights how lax government oversight and a rush to deliver cash to pandemic-ravaged businesses created ripe conditions for abuse.

The companies were supposed to serve as middlemen — helping applicants complete paperwork and processing their requests for aid from the Paycheck Protection Program on behalf of banks and other large financial institutions. But the report contends that the firms failed to hire adequate staff to thwart fraud and allegedly used questionable business practices in reviewing the loans.

For instance: One little-known company, Blueacorn, directed employees at the height of the pandemic to “push through” applications, even if they appeared suspicious. Employees and contractors would later tell congressional investigators they were ill-equipped for the task, with one witness claiming they submitted 300 PPP loans to the Small Business Administration before they even received training.

In doing so, Blueacorn often prioritized the highest-dollar applications, the report stated, and went as far as creating an internal “VIPPP” label to ensure the biggest borrowers — which carried the promise of great fees — could receive expedited treatment, Tony writes. The firm raked in $1 billion in taxpayer-funded fees for its work.

Reached by The Post, a contractor that worked with Blueacorn rejected the conclusions of the report. The company didn’t respond to The Post’s requests for comment nor did one of its co-founders.

House select subcommittee on the coronavirus crisis:

Coronavirus

How China’s vaccine strategy stoked its looming ‘zero covid’ crisis

President Xi Jinping and his advisers have so far declined to use the messenger RNA vaccines developed in the West, which experts believe are the most effective and flexible vaccine technology, The Post’s Carolyn Y. JohnsonCate Cadell and Joel Achenbach report.

The lower efficacy of the two key Chinese-made vaccines became a concern early in the pandemic, when global health experts suggested adding a third shot to protect older people. This adds another layer of complication to the country’s moves to potentially relax its stringent pursuit of “zero covid,” especially since the population has low natural immunity.

Three years into the global health emergency, experts largely agree that bringing in a foreign booster, even one that’s tailored to fight the omicron variant, wouldn’t address the core problem China is facing: convincing its elderly population to get a third shot of any vaccine. Earlier this week, health officials announced a new plan to increase the rate of boosters among the elderly. 

Reproductive wars

Pregnant and desperate in post-Roe America

In polarized, post-Roe America, the experiences that draw widespread attention are usually the most harrowing, with more routine stories often lost in the discussion. Our colleague Caroline Kitchener had a deep dive yesterday into the personal lives of three women seeking abortions while living in states with strict bans on the procedure. Here are three standout details from the story:

A teenage girl in Oklahoma: “Lilith waited until her dad went to sleep that night to start researching abortion clinics. She would have to drive three hours to Kansas or eight hours to New Mexico, the closest states where abortion was legal. At 20 weeks along, a surgical procedure would cost over $1,000, on top of the price of gas and a hotel. Her job at a sandwich shop paid $9.25 an hour,” Caroline writes. 

One-week delay: Kae, 24, scheduled an ultrasound as soon as she found out she was pregnant, well aware that Ohio outlawed the procedure after fetal cardiac activity can be detected, or around six weeks into pregnancy. By her estimate, she had a few days to get an abortion.

At the appointment, the sonographer said the vaginal ultrasound wasn’t clear enough to date the pregnancy and told her to come back in a week. 

At her next appointment — which had turned out to be at a crisis pregnancy center — the sonographer played a sound she identified as a heartbeat. “A one week delay was the difference between a legal and an illegal abortion,” Caroline writes. 

Second thoughts: When Taylor, 27, of Georgia, first found out she was pregnant, she didn’t consider keeping the baby. It wasn’t until the ultrasound that she started to doubt her decision, as a nurse in Florida walked her through a script of state-mandated information describing the procedure and handed her an ultrasound photo of the fetus. 

She was conflicted in the hours before the scheduled abortion. “Then it was 7:30 a.m. on the day of her appointment, and she finally accepted that she wasn’t going to get out of bed,” Caroline writes.

More from Caroline: 

In other health news

  • The country’s new 988 mental health hotline experienced a “widespread national system outage” yesterday. Text and chat support remained available as an alternative, according to HHS spokesperson Sarah Lovenheim
  • Pocket Naloxone Corp. is planning to apply next year for FDA approval of its overdose-reversal nasal swab for over-the-counter use, with preliminary data showing that its drug works more quickly than prescription-only versions, the Wall Street Journal reports. 
  • The Texas Medical Association filed its third lawsuit against the Biden administration on the implementation of a law to protect consumers from surprise medical bills. The association argues in its latest suit that portions of its final rule are too favorable for insurers. 

Quote of the week

Health reads

Many nursing homes are poorly staffed. How do they get away with it? (By Jayme Fraser and Nick Penzenstadler with Jeff Kelly Lowenstein | USA Today)

Alabama case over mistaken pregnancy highlights risks in a post-Roe world (By Hassan Kanu | Reuters)

Addiction Treatment Proponents Urge Rural Clinicians to Pitch In by Prescribing Medication (By Tony Leys | Kaiser Health News)

Sugar rush

Thanks for reading! See y’all Monday.

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