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The Health 202

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

North Carolina just took a big step forward on Medicaid expansion

The Health 202

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

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Today’s edition: Walgreens won’t dispense abortion pills in several states where they’re legal. House Republicans are demanding the administration declassify all reports on covid-19’s origins. But first … 

North Carolina could become the 40th state to expand Medicaid

Medicaid expansion in North Carolina just got a major boost. 

Republican leaders clinched an agreement yesterday to expand the safety net program to roughly 600,000 people — a compromise that could put an end to an over-a-decade-long political battle.

The agreement from Senate leader Phil Berger and House Speaker Tim Moore won praise from Democrats and advocates alike, who argue it’s long past time for North Carolina to take up Obamacare’s Medicaid expansion. The new version of the legislation is still being drafted, and the two Republican leaders briefed the state’s Democratic governor on their plan after announcing the deal in a news conference yesterday morning. 

“I support it,” Gov. Roy Cooper (D) said in a phone interview yesterday after he discussed the agreement with Berger and Moore. “We’re just working to try to see if we can change the timing on it a bit. … But overall, it is a monumental step for our state.”

The deal marks a stark turnaround for Republican leaders that played out over years in North Carolina and in states across the country, as more and more governors and legislatures expanded Medicaid to low-income residents. When that stopped working years ago, advocates put the measures on the ballot in seven conservative-leaning states, and voters approved expansion in every one. 

North Carolina is one of just 11 states that have long refused Medicaid expansion, which was originally included in the 2010 Affordable Care, but made voluntary for states by the Supreme Court. Doing so in the rest of the holdout states is a tough climb for supporters of the program.

More from Cooper:

The deal

Last year, both the North Carolina Senate and House passed competing bills to expand Medicaid. But they failed to reach a consensus in part because of disagreements over easing “certificate of need” laws, which are regulatory mechanisms for approving major expansions and projects for certain health facilities. 

That set the stage for this year’s deal. The House sent a Medicaid expansion bill over to the Senate last month. Now, that legislation has momentum after Berger and Moore announced yesterday that they’d worked out their differences in a few key ways, including eliminating certificate of need laws for behavioral health beds, ambulatory surgical centers in certain counties and more. 

The timing: Even if the law is approved in the coming weeks, the Republican leaders said it wouldn’t go into effect until lawmakers pass a budget, which is expected to happen over the summer. Some Democrats, like Cooper, want the law to go into effect earlier. Coverage would then kick in for people months later, perhaps Jan. 1.

The political battle

North Carolina is on the precipice of ending a fight over health coverage that waged for years. 

For instance: In 2013, Republican state lawmakers passed a bill opposing expansion and preventing any governor from expanding Medicaid unilaterally. In 2019, Cooper vetoed a budget agreement sent to his desk in part because it didn’t expand Medicaid.

But since then, some fierce opponents of expansion have reversed their opinion. “If there’s a person in the state of North Carolina that has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Berger said at a news conference last May where he announced he now believed expanding the program was “the right thing” to do, per the Associated Press.

For Moore, his support was partly due to federal funds available, such as dollars boosting reimbursement to certain hospitals that see Medicaid patients. A covid aid bill passed in 2021 also includes additional funds for two years for newly expanded states. Both will help the state pay for expansion.

  • “When you put a pen to the back of a napkin, it’s a net break-even at worst, a net positive frankly if you do the math on it,” Moore said in the news conference yesterday. 
  • In the interview, Cooper said he was “very optimistic” about the deal, saying he “commend[ed] the Republican leaders for being willing to change their mind.”

The Democrats’ take? “Is this the version I or my colleagues in the Democratic caucus would have put forth? No,” said state Rep. Ashton Wheeler Clemmons (D), the House deputy minority leader, adding she would have preferred a clean Medicaid expansion without the other health-care provisions. “But I am certainly supportive of moving forward.”

Reproductive wars

Walgreens backs away from dispensing abortion pills in some states

The large pharmacy chain won’t dispense abortion pills in several states where the medication is legal, such as Alaska, Iowa, Kansas and Montana, Politico reports.

This comes as nearly two dozen Republican state attorneys general threatened legal action in a letter to Walgreens if the company started distributing the drug. The company has since responded to all the officials and said it won’t dispense the pills either by mail or at their brick-and-mortar locations in those states, Politico’s Alice Miranda Ollstein reports.

How we got here: Earlier this year, the Food and Drug Administration permitted some retail pharmacies to dispense abortion pills for the first time, a major step toward potentially easing access to medication abortion in states where it’s legal. A day later, two large pharmacy chains, CVS and Walgreens, said they intended to seek certification to offer the medication in states where they could. 

Meanwhile …

Nearly 200 human rights organizations across the world issued an “urgent appeal” to the United Nations to intervene to ensure that women in the United States have access to abortion, after the Supreme Court overturned Roe v. Wade last year, The Post’s Adela Suliman reports.

Akila Radhakrishnan, president of the Global Justice Center:

On the Hill

House Republicans demand declassification of covid origin reports

Top Republicans on the House Energy and Commerce Committee are calling on the Biden administration to declassify all reports related to the origins of covid-19. 

Their demands come a day after the Senate passed without objection legislation that would require the director of national intelligence to declassify information about the source of the outbreak — ramping up pressure on the White House to do so voluntarily. The push for information follows a new assessment where the Energy Department concluded with “low confidence” that a lab leak most likely triggered the worst pandemic in a century.

  • The statement released yesterday came from Cathy McMorris Rodgers (R-Wash.), the committee’s chair; H. Morgan Griffith (R-Va.), chair of the subcommittee on oversight and investigations; Brett Guthrie (R-Ky.), chair of the subcommittee on health; and Jeff Duncan (R-S.C.), chair of the subcommittee on energy, climate, and grid security.  

Read more on what fueled this week’s debate over covid-19’s origins.

And The Post’s Joel Achenbach breaks down what we know about the virus’s origins — and what we don’t.

More from Rodgers:

There were a bit of sparks in the Senate health committee

The Senate HELP Committee held a hearing on community health centers yesterday — an issue that has bipartisan support. But at the beginning, Sen. Bill Cassidy (La.), the panel’s top Republican, expressed some frustrations.

The details: Cassidy alleged that the majority party didn’t work with Republicans in developing the hearing. “Calling partisan hearings is the prerogative of the chair, but for issues like this, there’s no reason our staff should not be working together from square one,” he said in his opening remarks. 

But the committee’s chair, Sen. Bernie Sanders (I-Vt.), pushed back. “I don’t see it that way. … I don’t want you to have to clear your witnesses with me; we aren’t going to clear our witnesses with you,” Sanders said. “I think that’s the way we should proceed.”

Why it matters: Both Sanders and Cassidy are new leaders of the Senate’s sweeping health panel, and don’t have a lengthy history of working together. There are several issues that they are collaborating on, and they put out a bipartisan request that same day for information from health-care providers on ways to address the workforce shortage. But we’re keeping a close eye on how their relationship unfolds, as that could be the key to unlocking major legislation in a committee with a long history of bipartisanship.

In other health news

  • Sen. Dianne Feinstein (D-Calif.), the oldest member of the Senate, has been hospitalized in California after being diagnosed with shingles. In a statement, Feinstein, who turns 90 in June, said that she is expected to make a full recovery and hopes to return to the Senate later this month, The Post’s Liz Goodwin reports. 
  • The Federal Trade Commission is poised to ban the online mental health app BetterHelp from sharing its users medical data with online advertisers. The proposed order issued yesterday also includes a $7.8 million fine over allegations that it shared customers’ sensitive health information with third parties despite telling customers it would keep such data private. 
  • Ohio’s Republican Attorney General Dave Yost certified the proposed language for an amendment enshrining abortion rights into the state constitution yesterday, clearing an early hurdle for supporters as they navigate the long process to put the measure on the ballot this November. 
  • Roughly 20,000 people may have been exposed to measles during a 24-hour spiritual revival that spanned nearly two weeks at a Kentucky university, after an unvaccinated worshiper was found to have the highly contagious virus that causes the illness, our colleague Anumita Kaur writes. 

Quote of the week

Health reads

Advocates, lawmakers warn that Biden telehealth rule will worsen opioid crisis (By Lev Facher | Stat)

Street teams and clubhouses: A new plan to help mentally ill New Yorkers (By Andy Newman and Emma G. Fitzsimmons | The New York Times)

After people on Medicaid die, some states aggressively seek repayment from their estates (By Tony Leys | Kaiser Health News)

Sugar rush

Thanks for reading! See y’all Monday.