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The Health 202
The Health 202

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

Three kinds of health measures red states are pursuing this year

Analysis by

with research by Rachel Roubein

February 9, 2023 at 8:00 a.m. EST
The Health 202

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

Welcome back to The Health 202, where we’ve been spending way too much time reading #healthpolicyvalentines on Twitter. Send your favorites to mckenzie.beard@washpost.com. 

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Today’s edition: President Biden will deliver remarks in Florida today on protecting Social Security and Medicare. The federal government may have misspent $191 billion in pandemic unemployment benefits. But first …

GOP-led states are focusing on post-partum Medicaid coverage, gender transition and vaccine freedom

There’s a lot of gridlock in the nation’s capital right now. But there’s plenty of action happening in states.  

The 2023 state legislative season is in full swing, and lawmakers in red and blue states have started to push their health priorities. They’ve put forward a flurry of bills that, taken together, offer a microcosm of the complex social issues facing America today and the intensely partisan divides on how to address them.

Today, we’re diving into three issues that have quickly taken center stage in Republican-led state legislatures: Extending postpartum Medicaid coverage, restricting gender transition care for minors, and rolling back vaccine requirements. Next week, we’ll be back with a similar look at states with Democratic majorities.

Here are some of the early GOP trends we’re watching and why they matter:

Postpartum coverage

Republican lawmakers in at least nine states are looking to extend postpartum health coverage for Medicaid beneficiaries.

Arkansas, Iowa, Utah, and Wyoming are among the conservative-led states considering legislation that would allow low-income women to continue receiving Medicaid and Children’s Health Insurance Program (CHIP) benefits for a full year after birth, instead of the 60 days required by federal law.

If passed, they would join 35 states and D.C. that have already extended their postpartum Medicaid coverage, with the goal of reducing the risk of pregnancy-related deaths and illnesses by ensuring continuous coverage for new mothers.

The bigger picture: The push to extend Medicaid benefits comes amid a renewed focus on maternal mortality in GOP-led states. Many of the same conservative-led states considering expanding the safety net program have also restricted abortion access since the Supreme Court overturned Roe v. Wade last year — a move that is expected to lead to more new mothers needing coverage.

Gender transition for minors

More than 80 bills putting guardrails around transition care for young people have been introduced this year across nearly two dozen states, the majority of which are controlled by Republicans.

Most of the pending legislation would criminalize doctors for providing gender transition care — which can include puberty blockers and hormone therapy, and, in limited cases, surgery — to children and teenagers under the age of 18. There has been a rise in minors seeking gender transition in recent years, fueling a heated public debate over what types of treatments should be made available and under what circumstances youth should be able to access them.

  • “If you're going to do something like this, we want you at an adult status in your life where you can fully understand the risks and give informed consent,” said Oklahoma state Rep. Jim Olsen (R), the primary sponsor of a bill that would ban transition care for minors in the state.
  • Major U.S. medical associations disagree, including those in the fields of pediatrics, endocrinology, psychiatry and psychology. But in Europe, countries including Sweden, Finland and the U.K. have recently pulled back on the use of blockers and hormones given a lack of research on their long term effects.

Last month, Utah became the first state this legislative season to ban doctors from providing certain forms of transition care for most youth. In previous years, Tennessee, Alabama, Arkansas and Arizona have passed similar restrictions, although Arkansas’ and Alabama’s laws are temporarily blocked as challenges against them play out in court.

One interesting thing to watch: At least six states are considering banning transition care for some adults in 2023, marking a notable escalation in the fight over transgender health care. Bills proposed in Kansas and Virginia aim to bar state health-care providers from recommending or administering transition care for patients younger than 21. South Carolina and Oklahoma have similar measures that would extend the age up to 26.

Rolling back vaccine requirements

Republican lawmakers in at least eight states have introduced legislation to roll back vaccine requirements, in a growing movement that was sparked by the coronavirus pandemic.  

Utah and Missouri are among the states seeking to ban coronavirus vaccine mandates for private and public workers. Texas and Florida are looking to bar state agencies, local governments, schools and colleges from requiring proof of vaccination against the virus.

While many of the bills prefiled for the session focus on covid-19, some Republican lawmakers are looking to relax other vaccine requirements. A bill pending before lawmakers in West Virginia would eliminate all routine immunization requirements for children entering public school or care.

  • “This really comes down to an issue of freedom,” said West Virginia state Del. Chris Pritt (R), primary sponsor of the bill.

Resistance to routine vaccinations for children has increased since the pandemic began. A recent study from the Kaiser Family Foundation suggests that the shift has largely occurred along partisan lines: about 44 percent of Republicans and Republican-leaning independents now say that parents should be able to opt their child out of the vaccines, up from 20 percent who said the same in an October 2019 Pew Research Center poll.

White House prescriptions

Biden names Republicans seeking changes to Medicare, Social Security

President Biden will deliver remarks in Tampa, Fla., today on protecting Social Security and Medicare, an issue that sparked one of the most acrimonious moments during his State of the Union address.  

But even beforehand, Biden used his speech at a labor training center in Wisconsin yesterday to identify the Republicans he was talking about, reading direct comments the lawmakers have made when proposing changes, our colleagues Mariana Alfaro and Timothy Bella write. (And to hammer the point, the White House also put out a fact sheet this morning.)

Biden called out lawmakers like Sen. Rick Scott (R-Fla.), who proposed to require all legislation — including entitlement programs such as Social Security and Medicare — to be “sunset,” which would require votes every five years to continue them. 

Others include Sen. Mike Lee (R-Utah), who was captured in a recently resurfaced 2010 video saying that it is his “objective to phase out Social Security” and that “Medicare and Medicaid … need to be pulled up” by their roots. Lee’s defenders have pushed back against the edited video and say that a longer version has him eventually saying, “We have to hold harmless those who are current beneficiaries,” per the Salt Lake Tribune. 

Read more on the brawl over the two entitlements facing Washington, even if not this year.

Scott pushed back on Twitter:

More from Lee:

Coronavirus

Suspected pandemic unemployment fraud jumps to $191 billion

The U.S. government may have misspent roughly $191 billion in pandemic unemployment benefits, a top federal watchdog told the House Ways and Means Committee yesterday during the panel’s second hearing probing the waste, fraud and abuse targeting coronavirus aid, The Post’s Tony Romm reports.

The new estimate issued by Larry Turner, inspector general of the Labor Department, is a substantial leap from the roughly $163 billion in questionable payments that his office identified last year. Even with the upward shift, officials said that they cannot compute the total amount of federal pandemic aid subject to fraud and abuse. But Turner’s testimony noted that the country’s misspending on unemployment benefits, in particular, may be far greater than previously known.

The nearly $30 billion increase in the estimated amount of funds lost to waste and fraud further galvanized House Republicans as they intensified their scrutiny of the roughly $5 trillion in emergency funds approved since the start of the crisis, Tony notes.

Rep. Jason Smith (R-Mo.), chairman of the House Ways and Means Committee:

Reproductive wars

Texas attorney general sues HHS over abortion pill guidance

Texas Attorney General Ken Paxton (R) filed a lawsuit against the federal health department’s July guidance warning pharmacies they could violate federal civil rights law if they turn away women with legal prescriptions for abortion medication.

Paxton is arguing that the administration is requiring pharmacies to dispense abortion pills “in violation of state law.”

The guidance from the Department of Health and Human Services came several weeks after the Supreme Court overturned Roe v. Wade. The department pointed to federal civil rights law, including parts of Obamacare, to caution pharmacies against denying legal prescriptions for the medication — which can be used to manage a miscarriage or a long-standing health condition — and the document doesn’t ensure universal access to the pills. A spokesperson said HHS doesn’t comment on pending litigation. 

Texas Attorney General Ken Paxton (R):

In other health news

  • Freshman Sen. John Fetterman (D-Pa.) was hospitalized overnight after suffering from lightheadedness while attending a Senate Democratic retreat. Fetterman, 53, suffered a stroke last year, and his office said that initial tests don’t show evidence of a new stroke, The Post’s By Adela Suliman reports. 
  • Congressional Republicans on the House Energy and Commerce oversight and health subcommittees grilled senior Biden administration health officials on their response to covid-19 yesterday in the first of a series of hearings examining the federal government’s actions during the pandemic.
  • On the move: Vas Narasimhan, CEO of Novartis, will serve as chairman of the Pharmaceutical Research and Manufacturers of America board of directors. He will replace Ramona Sequeira, president of Takeda’s global portfolio division, the lobbying group announced yesterday.
  • Seven Democrats joined Republicans yesterday to pass a measure that would end the Centers for Disease Control and Prevention’s requirement that most foreign air travelers coming to the United States must be vaccinated against the coronavirus. In yesterday’s edition, we erroneously mischaracterized Tuesday’s vote on the bill. We regret the error.  

Health reads

Thanks to covid, half of kids were below grade level in at least one subject (By Donna St. George | The Washington Post)

The health risks for Ohioans after derailment of train with toxic chemicals (By Anna Phillips | The Washington Post)

‘The Country Is Watching’: California Homeless Crisis Looms as Gov. Newsom Eyes Political Future (By Angela Hart | Kaiser Health News)

Sugar rush

Thanks for reading! See y'all tomorrow.

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