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The Health 202

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

Supporting abortion rights is a litmus test for more Democratic voters

The Health 202

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

Good morning, and a special thanks to Nick Mourtoupalas for making us graphics for this newsletter. Congress is out, and so are we on Friday. See you back in your inbox bright and early Monday ☀️ 

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Today’s edition: A key Nebraska committee advances a bill to ban most abortions after fetal cardiac activity is detected. The Centers for Medicare and Medicaid Services is sticking to its guns (again) on its decision to restrict coverage of Alzheimer’s drugs. But first … 

The share of Democrats who will only vote for a candidate supporting abortion rights is rising

Abortion rights are increasingly driving the decisions of those who vote for Democrats.

It’s not the case for abortion-opposing Republican voters.

That’s according to a new survey from the Public Religion Research Institute (PRRI), a nonpartisan group that surveyed Americans’ attitudes toward abortion last year. 

The results underscore how motivating the issue has become to Democratic voters since the Supreme Court overturned the constitutional right to an abortion, which was evident during the November midterm elections. Now, the party is hoping to sustain that public backlash through 2024. 

Candidate requirements

The survey found a significant shift among abortion rights-supporting Democrats between 2020 (when Roe v. Wade was still in place) and 2022 (after it was overturned). 

The share of Democrats who said they’ll only vote for a candidate who supports abortion rights doubled between those years. Roughly 34 percent of Democrats surveyed last year will only support a candidate who believes most or all abortions should be legal compared with 17 percent in 2020. 

The rate also rose for independent voters, from 12 percent surveyed in 2020 saying they will only vote for a candidate who believes most or all abortions should be legal compared to 21 percent last year. But the rate held steady at 12 percent for Republicans who support abortion rights.

Why? The Supreme Court’s decision changed the calculus for Democrats, many of whom previously saw no reason to be a single-issue voter on abortion because Roe v. Wade was the law of the land, said Celinda Lake, a Democratic pollster who has worked for President Biden. 

  • “I think what you’ve seen is the Democrats become completely unified and energized,” she said, "and therefore you have more single-issue voters, particularly in Democratic primaries, and the Republicans are becoming more cross-pressured.” But, she added, there aren’t many antiabortion Democrats left in the party. 

The reverse happpened among Republicans who oppose abortion. They have become less insistent that their candidates oppose it in most or all circumstances.

A significantly higher number of Republicans said they’d only back a candidate who shares this view in 2020 — 42 percent — compared with the 30 percent who said so last year. 

Diving deeper

The overall numbers: More Americans now say abortion should be legal in most or all cases than over a decade ago.

  • Specifically, nearly two-thirds of those surveyed last year say abortion should be legal in most or all cases, up from 55 percent in 2010.
  • Meanwhile, roughly one-third of Americans say abortion should be illegal in most or all cases, down from 42 percent in 2010. 
  • No surprise here: The issue still falls along party lines. Nearly 9 in 10 Democrats want abortion to be legal in most or all cases, while 63 percent of Republicans say it should be illegal in most or all cases.
Eye on the states

The abortion landscape quickly shifted once the Supreme Court overturned Roe with the procedure now mostly banned in over a dozen states. But, according to the PRRI survey, prohibitions on abortion run counter to public opinion in some of these states.

The majority of Americans in 43 states and D.C. say that abortion should be legal in most or all cases. 

There are only seven states where less than half of residents agree with this sentiment: South Dakota (42 percent), Utah (42 percent), Arkansas (43 percent), Oklahoma (45 percent), Idaho (49 percent), Mississippi (49 percent) and Tennessee (49 percent). In all those states, abortion is severely restricted or a near-total ban has been blocked by the courts.

This comes as lawmakers in several conservative-leaning states — Florida, North Carolina and Nebraska — are expected this year to weigh restrictions on the procedure that could once again reshape the national abortion landscape. Meanwhile, abortion rights groups in a number of states, including Colorado, Oklahoma and Missouri, have been exploring whether to launch ballot measure campaigns to enshrine abortion access into the state constitution. 

PRRI surveyed 22,984 adults between March 11 and Dec. 14. The margin of error for the national survey is plus or minus 0.8 percentage points at the 95 percent level of confidence.

Reproductive wars

Nebraska panel advances antiabortion bill

A key Nebraska committee advanced a bill to ban most abortions after fetal cardiac activity is detected at roughly six weeks, the panel’s chair, Sen. Ben Hansen, confirmed to The Health 202.

While the outcome was expected, this is still a big step forward for the legislation. Nebraska is the only state in the country with a one-chamber legislature, meaning the committee vote now sets the stage for a showdown on the floor. The legislature is technically nonpartisan, but lawmakers generally have a party affiliation, and the vote to break a filibuster is expected to be tight. 

If passed, the new restrictions would be a seismic shift in how early in pregnancy women in Nebraska can get an abortion. The state currently allows the procedure up to 20 weeks postfertilization, and the legislature tried — and failed — to pass a near-total ban last spring. 

Agency alert

CMS won’t rethink Medicare coverage for Alzheimer’s drugs

The Centers for Medicare and Medicaid Services will not reconsider its restrictive national coverage determination for FDA-approved monoclonal antibodies that target amyloid beta, a sticky protein in the brain that is thought to be one of the main causes of Alzheimer’s disease. 

The announcement yesterday follows a request from the Alzheimer’s Association to make it easier for people with the memory-robbing illness to access the class of treatments. The recent accelerated approval of a new therapy from drugmakers Biogen and Eisai, called lecanemab, underscores the group’s effort.

Last month, CMS Administrator Chiquita Brooks-LaSure said that the agency is willing to reevaluate its coverage of the treatments as new products hit the market. But in a statement yesterday, the agency said that there isn’t enough evidence to meet its criteria for reconsideration after reviewing the association’s request. 

Doctors had sharply debated the safety of lecanemab and whether it provides significant benefit. In a statement provided to The Health 202, the Alzheimer’s Association said it’s “appalled” by the decision. 

The coverage issue began with lecanemab’s controversial predecessor Aduhelm, which was granted accelerated approval by the FDA in 2021 despite concerns about its efficacy. The episode prompted Medicare to limit its coverage for the drug to patients enrolled in carefully controlled tests of the medication’s effectiveness for the progressive neurological disease. That coverage determination applied to other medications in its class, including lecanemab.

In other news … in a first, FDA fines tobacco companies for selling illegal vapes

The Food and Drug Administration is fining four tobacco product manufacturers for ignoring its orders to stop selling unapproved vapes. 

The move marks the first time the agency has filed civil money penalty complaints against vape manufacturers for selling illegal goods, as it seeks to ramp up enforcement of its premarket review requirements for new tobacco products. 

The companies that failed to heed the FDA’s warnings and are facing fines are VapEscape, Great American Vapes, Vapor Corner Inc. and 13 Vapor. None of the manufacturers immediately responded to requests for comment. 

It’s unclear how much, if anything, the companies will wind up paying to federal regulators. The manufacturers have the option of paying the fine, entering into a settlement agreement or requesting a hearing to challenge the penalty. The FDA said it is seeking the maximum fine per violation in each case, which is $19,192 for a single violation.

Sen. Dick Durbin (D-Ill.):

On the Hill

Ryan slams Biden, Trump for swearing off changes to Medicare, Social Security

Former House speaker Paul Ryan (R-Wis.) says President Biden and former president Donald Trump is putting the country at financial risk by vowing not to make changes to Medicare and Social Security, our colleague Patrick Marley reports. 

Ryan said lawmakers need to address the cost of Medicare and Social Security now because the fiscal problem will become more difficult to solve as time passes. He also criticized the now abandoned plan by Sen. Rick Scott (R-Fla.) to force votes on authorizing the two entitlement programs every five years. Instead, he said Medicare and Social Security should be modified, not put at risk of elimination. 

Ryan, the 2012 GOP vice-presidential nominee and former chairman of the House Budget Committee, was a champion of economic policies that called for raising the eligibility age for Medicare from 65 to 67 and giving future beneficiaries set amounts of money to cover their health-care costs. Democrats campaigned against those ideas, and Biden renewed that strategy this month in his State of the Union address when he charged that some Republicans want to cut Medicare and Social Security.  

More from Patrick:

In other health news

  • This year’s influenza vaccine reduced the risk of hospitalization for flu illness or related complications among children by nearly three quarters and among adults by nearly half, according to preliminary data released yesterday by the Centers for Disease Control and Prevention
  • Bavarian Nordic’s vaccine for mpox, also known as monkeypox, worked well at preventing symptoms and shortening the course of the disease and it should continue to be used in future outbreaks, a panel of independent advisers to the CDC said yesterday, according to USA Today’s Karen Weintraub
  • CMS’s recent proposals to modify Medicare Advantage’s risk adjustment model and increase the government’s ability to audit the plans and recover past overpayments can’t be accurately called “cuts” to the program as some Republican lawmakers have alleged, according to PolitiFact.

Health reads

Raskin tells supporters he’s midway through cancer treatment (By Meagan Flynn | The Washington Post)

A Bitter Battle Over the ‘Orphan Drug’ Program Leaves Patients’ Pocketbooks at Risk (By Sarah Jane Tribble | Kaiser Health News)

Regulators Overhaul Inspections of Hospice Providers (By Ava Kofman | ProPublica)

Sugar rush

Thanks for reading! See y'all tomorrow.