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The Health 202
The Health 202

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

The covid national health emergencies will officially end in three months

Analysis by

with research by McKenzie Beard

January 31, 2023 at 7:45 a.m. EST
The Health 202

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

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Today’s edition: The federal health department is seeking to recoup $4.7 billion from Medicare Advantage plans. The Republican National Committee is urging the GOP to “go on offense” on abortion in 2024. But first … 

It will soon be time to unwind pandemic-era flexibilities

President Biden will end the national emergencies to combat the coronavirus on May 11, setting off a massive bureaucratic effort to halt critical tools the country has used to fight the pandemic for roughly three years. 

The administration announced its decision as it denounced House Republican efforts to vote on bills this week to end the emergency declarations immediately. The White House argued that doing so would “create wide-ranging chaos and uncertainty” throughout the health-care system and disrupt the orderly wind-down the administration had envisioned. 

Since Biden entered office, his administration has pledged to give governors 60 days’ notice before terminating the public health emergency, as health groups fretted about an abrupt termination. An end to the public health emergency appeared likely to come this spring — unless there was a major change in the pandemic’s trajectory — but the notice yesterday afternoon in response to two Republican bills came unexpectedly. 

The looming expiration of the orders signifies a new phase of the pandemic response, as U.S. officials get rid of flexibilities used during the earliest and darkest days of the coronavirus, our colleagues Tyler Pager and Lena H. Sun note. 

The details

House Republicans had already planned votes this week on four bills aimed at moving the country past the pandemic. The party immediately took a victory lap after the White House said the covid-19 emergencies would end in a few months, claiming the administration had caved to pressure from the party.

Specifically, lawmakers are slated to vote on legislation today to immediately end the public health emergency (PHE) declaration for covid-19, which the nation’s top federal health official has renewed every 90 days since January 2020. And as soon as Wednesday, the House is expected to vote on a resolution to terminate a separate covid-19 national emergency first declared in March 2020. 

In a notice to Congress, the White House announced its opposition to House Republicans’ approach and said it would briefly extend both declarations before officially terminating them on May 11. 

In a sign of the fights to come … The White House said ending the emergencies would also terminate Title 42, a pandemic-era policy allowing the quick expulsion of migrants from the U.S. borders for public health reasons, Tyler and Lena write. Because Title 42 is a public health order, the Centers for Disease Control and Prevention determined there would no longer be a need for the measure once the coronavirus no longer presents a public health emergency, according to an administration official. 

But some House Republicans pushed back. They argued that Title 42 is not tied to the public health emergency and is at the president’s discretion. Rep. Brett Guthrie (R-Ky.), who authored the bill to end the PHE, told The Health 202 that his bill “doesn’t touch anything on Title 42.” 

House Majority Leader Steve Scalise (R-La.):

What’s next

Unwinding pandemic-era flexibilities isn’t an easy task. Some of them have become so ingrained in the health system that lawmakers extended the benefits, such as keeping critical Medicare telehealth policies through 2024. And Congress recently told states they can begin to kick people off Medicaid who are no longer eligible starting April 1 — a rule that was originally tied to the end of the PHE. 

But the emergency status came with an array of powers that would still be impacted, such as granting flexibility for health providers in a number of areas, including hospital bed capacity and billing procedures — and medical systems will need to make adjustments, Tyler and Lena note.

One of the biggest concerns to Jen Kates, a senior vice president at the Kaiser Family Foundation, is access to critical pandemic tools for those without health coverage could go away.

  • “To me, that’s the biggest issue for the general public to think about,” she told The Post. “The uninsured and underinsured have no guaranteed access to covid vaccines, tests or treatments.”

Lawrence Gostin, director of Georgetown’s O’Neill Institute for National and Global Health Law:

Agency alert

CMS aims to claw back billions from Medicare Advantage plans under newly finalized rule

The Centers for Medicare and Medicaid Services will audit Medicare Advantage plans aggressively under a highly anticipated rule that was finalized yesterday, as the Biden administration seeks to crack down on insurers that have overcharged the federal government, Stat reports.

The agency estimates that it will claw back about $4.7 billion over the next decade under the new auditing system. The rule, which was proposed in 2018 and has been part of a decade-long feud between health insurers and regulators, is already drawing blowback from industry groups.

The details: Under the current rules, the agency selects a sample of beneficiaries enrolled in a Medicare Advantage plan and compares the patient diagnoses that the insurer submits to the government with their actual medical records. In the past, some insurers have been accused of fraud for inflating the number of health conditions their members have, or making them out to be sicker than they actually are, to collect extra payments.

Under the new policy, CMS will extrapolate the error rate found in the samples across the plan’s entire membership to recoup improper charges or overpayments. However, in a significant break for insurers, the agency said it won’t extrapolate any errors found in audits of Medicare Advantage plans between 2011 and 2017, cutting down on how much the companies would have to pay back for those years, Stat’s Bob Herman and Tara Bannow note.

Ted Doolittle, a former senior Medicare official:

Biden administration moves to strengthen Obamacare’s birth control mandate

The Biden administration is seeking to reverse a Trump-era rule allowing employer and school sponsored health plans to opt out of the Affordable Care Act’s requirement that they cover contraceptive services at no additional charge on moral grounds.

The proposed rule, released yesterday by the departments of Health and Human Services, Labor and Treasury, would eliminate the moral exemption while retaining an existing religious one. It would also set up a new pathway for people enrolled in health plans offered by employers with religious exemptions to obtain contraceptive services through a willing provider at no cost.

The bigger picture: The push to strengthen Obamacare’s free contraception requirement is the latest move by the administration aimed at expanding reproductive health services in the wake of the Supreme Court’s decision rolling back federal abortion rights.

Families USA, a left-leaning consumer health lobby:

Reproductive wars

RNC urges GOP candidates to ‘go on offense’ on abortion in 2024

The Republican National Committee is formally urging GOP lawmakers and campaigns to “go on offense in the 2024 election cycle” on abortion and pass the strictest restrictions on the procedure as possible as the party looks to bounce back from its lackluster midterm results, The Post’s Amy B Wang reports.

The committee passed a resolution at its winter meeting on Friday directing lawmakers in Congress and state legislatures to pass antiabortion laws, referring to proposals that include outlawing the procedure after cardiac activity is detected, at about six weeks of pregnancy.

The resolution alluded to Republicans’ disappointing performance in the November elections, months after the Supreme Court overturned Roe v. Wade, but appeared to place the blame on GOP candidates who did not sufficiently publicize their antiabortion views. This time around, Republican candidates should work to draw a clear distinction between themselves and Democrats’ “extreme” position on abortion, the RNC resolution states. 

Susan B. Anthony Pro-Life America:

On the Hill

ICYMI: These Democrats will help lead the House Ways and Means Committee

Rep. Lloyd Doggett (Tex.) is slated to serve as the ranking Democrat of the health subcommittee, after serving as the panel’s chair when Democrats had control of the chamber. Rep. Bill Pascrell Jr. (N.J.) was reappointed as the top Democrat on the oversight subcommittee. Rep. Richard Neal (Mass.) will be the ranking Democrat of the full committee, alongside Rep. Judy Chu (Calif.) as vice ranking minority-party member. Read the full roster here.

In other health news

  • On tap today: Minnesota Gov. Tim Walz (D) is slated to sign the Protect Reproductive Options Act, which codifies resident’s right to an abortion and reproductive health care like fertility treatments and contraception into state law, his office confirmed to The Health 202.
  • A federal appeals court ruled yesterday that drugmakers enrolled in the federal drug discount program aren’t required to supply discounted medications to an unlimited number of contract pharmacies, handing a major victory to the pharmaceutical industry.
  • The coronavirus pandemic is still a global health emergency, the World Health Organization announced yesterday. But the international agency acknowledged that the pandemic is likely at an inflection point where higher levels of immunity may soon lead to lower virus-related deaths.
  • The FDA has tapped Troy Tazbaz to serve as its new head of digital health. Tazbaz, who was most recently a senior vice president at Oracle, will take over for Brendan O’Leary, who has been acting director of the agency’s Digital Health Center of Excellence since February, Stat’s Lizzy Lawrence reports.

Health reads

$5.4 billion in covid aid may have gone to firms using suspect Social Security numbers (By Tony Romm | The Washington Post)

A Baby Spent 36 Days in an In-Network NICU. Why Did the Hospital Next Door Send a Bill? (By Harris Meyer | Kaiser Health News)

Dems launch new abortion ads in battle for state governments (By Zach Montellaro | Politico)

Sugar rush

Thanks for reading! See y'all tomorrow.

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