{"id":1097,"date":"2023-04-11T07:55:46","date_gmt":"2023-04-11T07:55:46","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=1097"},"modified":"2023-04-11T07:55:46","modified_gmt":"2023-04-11T07:55:46","slug":"gop-house-opens-with-abortion-agenda-2","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=1097","title":{"rendered":"GOP House Opens With Abortion Agenda"},"content":{"rendered":"

\n

\n\t\tThe Host\t<\/h3>\n
\tJulie Rovner
\n\tKHN<\/p>\n
\t\t\t
\n\t\t\t\t@jrovner\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Julie’s stories.\t\t\t<\/a><\/p>\n
\t\t\tJulie Rovner is Chief Washington Correspondent and host of KHN\u2019s weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A-Z,\u201d now in its third edition.\t\t<\/p>\n
Having spent its entire first week choosing a speaker, the Republican-led U.S. House finally got down to legislative business, including passing two bills backed by anti-abortion groups. Neither is likely to become law, because they won\u2019t pass the Senate nor be signed by President Joe Biden. But the move highlights how abortion is sure to remain a high-visibility issue in the nation\u2019s capital.<\/p>\n
Meanwhile, as open enrollment for the Affordable Care Act nears its Jan. 15 close, a record number of people have signed up, taking advantage of renewed subsidies and other help with medical costs.<\/p>\n
This week\u2019s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Sarah Karlin-Smith of the Pink Sheet.<\/p>\n

\n\t\tPanelists\t<\/h3>\n
\tSarah Karlin-Smith
\n\tPink Sheet<\/p>\n
\t\t\t
\n\t\t\t\t@SarahKarlin\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Sarah’s stories\t\t\t<\/a><\/p>\n
\tAlice Miranda Ollstein
\n\tPolitico<\/p>\n
\t\t\t
\n\t\t\t\t@AliceOllstein\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Alice’s stories\t\t\t<\/a><\/p>\n
\tMargot Sanger-Katz
\n\tThe New York Times<\/p>\n
\t\t\t
\n\t\t\t\t@sangerkatz\t\t\t<\/a><\/p>\n
\t\t\t
\n\t\t\t\tRead Margot’s stories\t\t\t<\/a><\/p>\n
Among the takeaways from this week\u2019s episode:<\/p>\n
\n
The House now has a speaker after 15 rounds of full-chamber roll call votes. That paved the way for members to be sworn in, committee assignments to be made, and new committee chairs to be named. Cathy McMorris Rodgers (R-Wash.) and Jason Smith (R-Mo.) will be taking the helm of major health committees.<\/li>\n
McMorris Rodgers will lead the House Energy and Commerce Committee; Smith will be the chairman of Ways and Means. Unlike McMorris Rodgers, Smith has little background in health issues and has mostly focused on tax issues in his public talking points. But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees.<\/li>\n
One thing is certain: The new GOP-controlled House will do a lot of investigations. Republicans have already reconstituted a committee to investigate covid-19, although, unlike the Democrats\u2019 panel, this one is likely to spend time trying to find the origin of the virus and track where federal dollars may have been misspent.<\/li>\n
The House this week began considering a series of abortion-related bills \u2014 \u201cstatement\u201d or \u201cmessaging\u201d bills \u2014 that are unlikely to see the light of day in the Senate. However, some in the caucus question the wisdom of holding votes on issues like these that could make their more moderate members more vulnerable. So far, bills have had mostly unanimous support from the GOP. Divisions are more likely to emerge on topics like a national abortion ban. Meanwhile, the Title X program, which pays for things like contraception and testing for sexually transmitted infections, is becoming a hot topic at the state level and in some lawsuits. A case in Texas would restrict contraception availability for minors through this program.<\/li>\n
It\u2019s increasingly clear that abortion pills are going to become an even bigger part of the abortion debate. On one hand, the FDA has relaxed some of the risk evaluation and mitigation strategies (REMS) from the prescribing rules surrounding abortion pills. The FDA puts these extra restrictions or safeguards in place for certain drugs to add additional protection. Some advocates say these pills simply do not bring that level or risk.<\/li>\n
Anti-abortion groups are planning protests in early February at large pharmacies such as CVS and Walgreens to try to get them to walk back plans to distribute abortion pills in states where they are legal.<\/li>\n
A growing number of states are pressuring the Department of Health and Human Services to allow them to import cheaper prescription drugs from Canada \u2014 or, more accurately, importing Canada\u2019s price controls. While this has long been a bipartisan issue, it has also long been controversial. Officials at the FDA remain concerned about breaking the closed supply chain between drugs being manufactured and delivered to approved U.S. buyers. The policy is popular, however, because it promises lower prices on at least some drugs.<\/li>\n
Also in the news from the FDA: The agency granted accelerated approval for Leqembi for the treatment of Alzheimer\u2019s disease. Leqembi is another expensive drug that appears to work, but also carries big risks. However, it is generally viewed as an improvement over the even more controversial Alzheimer\u2019s drug Aduhelm. Still to be determined is whether Medicare \u2014 which provides insurance to most people with Alzheimer\u2019s \u2014 will cover the drug.<\/li>\n
As the Affordable Care Act enrolls a record number of Americans, it is notable that repealing the law has not been mentioned as a priority for the new GOP majority in the House. Rather, the top health issue is likely to be how to reduce the price of Medicare and other health \u201centitlement\u201d programs.<\/li>\n<\/ul>\n
Plus, for extra credit, the panelists recommend their favorite health policy stories of the week that they think you should read, too:<\/p>\n
Julie Rovner:<\/strong> The Washington Post\u2019s \u201cSocial Security Denies Disability Benefits Based on List With Jobs From 1977<\/a>,\u201d by Lisa Rein<\/p>\n
Margot Sanger-Katz:<\/strong> Roll Call\u2019s \u201cProviders Say Medicare Advantage Hinders New Methadone Benefit<\/a>,\u201d by Jessie Hellmann<\/p>\n
Alice Miranda Ollstein:<\/strong> The New York Times\u2019 \u201cGrant Wahl Was a Loving Husband. I Will Always Protect His Legacy.<\/a>\u201d By C\u00e9line Gounder<\/p>\n
Sarah Karlin-Smith:<\/strong> KHN\u2019s \u201cHospitals\u2019 Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say<\/a>,\u201d by Lauren Sausser<\/p>\n
Also mentioned in this week\u2019s podcast:<\/p>\n
\t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript: GOP House Opens With Abortion Agenda\t\t\t\t<\/p>\n
KHN\u2019s \u2018What the Health?\u2019Episode Title:<\/strong> GOP House Opens With Abortion AgendaEpisode Number:<\/strong> 279Published:<\/strong> Jan. 12, 2023<\/p>\n
Tamar Haspel:<\/strong> A lot of us want to eat better for the planet, but we\u2019re not always sure how to do it. I\u2019m Tamar Haspel.<\/p>\n
Michael Grunwald:<\/strong> And I\u2019m Michael Grunwald. And this is \u201cClimavores,\u201d a show about eating on a changing planet.<\/p>\n
Haspel:<\/strong> We\u2019re here to answer all kinds of questions. Questions like: Is fake meat really a good alternative to beef? Does local food actually matter?<\/p>\n
Grunwald:<\/strong> You can follow us or subscribe on Stitcher, Apple Podcasts, Spotify, or wherever you listen.<\/p>\n
Julie Rovner:<\/strong> Hello and welcome back to KHN\u2019s \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, Jan. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico.<\/p>\n
Alice Miranda Ollstein:<\/strong> Good morning.<\/p>\n
Rovner:<\/strong> Margot Sanger-Katz of The New York Times.<\/p>\n
Margot Sanger-Katz:<\/strong> Hello.<\/p>\n
Rovner:<\/strong> And Sarah Karlin-Smith of the Pink Sheet.<\/p>\n
Sarah Karlin-Smith:<\/strong> Hi, everybody.<\/p>\n
Rovner:<\/strong> So no interview this week, but lots of news, so we will get right to it. We\u2019re going to start with the new Congress, where the House finally has a speaker after 15 rounds of full-chamber roll calls. Settling the speaker meant that the rest of the House could be sworn in and things like committee chairs elected. Two key health committees, Energy and Commerce and Ways and Means, will both have new chairs, not just new because they\u2019re Republican, but new because they have not chaired the committee previously. Energy and Commerce will be headed by a woman for the first time, Cathy McMorris Rodgers of Washington state, who\u2019s had a longtime interest in health policy and was also in the Republican leadership. Over at Ways and Means, the new chairman is Jason Smith of Missouri, who I confess I had never heard of before this. Does anyone know anything about him? And does he have any interest in health care?<\/p>\n
Ollstein:<\/strong> Most of what he said about chairing the committee has been about things other than health care. It\u2019s been a lot on taxes, for instance. The new House majority is very \u201cexorcised\u201d about the IRS funding that the previous Congress approved and trying to get rid of that. But he has shown some interest in some telehealth provisions. And so I think also I\u2019m sure we\u2019re going to discuss some interest in, shall we say, revisiting Medicare\u2019s benefits and funding \u2026<\/p>\n
Rovner:<\/strong> Yeah, we\u2019re going to get to that next.<\/p>\n
Ollstein:<\/strong> So there could be some things, but it doesn\u2019t seem that he\u2019s been a big health care guy or will be a big health care guy going forward.<\/p>\n
Rovner:<\/strong> In the olden days, when I started covering this, the chairman of the Ways and Means Committee frequently did not have either an interest or an expertise in health care. But the chairman of the Ways and Means health subcommittee did. That\u2019s where pretty much everything came from. Do we know yet who is going to chair the Ways and Means health subcommittee \u2026? We do not. So we\u2019ll wait to see that. But yes \u2026. even though I read Chairman Smith\u2019s little introduction about what he\u2019s interested in \u2014 and I know he mentioned rural health \u2014 but he did not anywhere mention Medicare. And of course, the Ways and Means Committee has jurisdiction over most of Medicare in the House. It is going to come up, as far as we can tell, right?<\/p>\n
Sanger-Katz:<\/strong> One imagines so because some of the promises that leadership has made to its members to think about how to balance the budget in the long term, to consider entitlement reform, whatever that may mean. And, you know, Medicare is where the money is. So you would think that the Ways and Means Committee would want to be looking seriously at how to reform the program, if that\u2019s the interest of leadership on this policy area.<\/p>\n
Rovner:<\/strong> And they\u2019ve already said that they want to tie any debt ceiling vote, which [is] one of those things that Congress absolutely has to do to reforms, quote-unquote, of the Medicare and Social Security programs. Because, again, as Margot said, that\u2019s where the money goes. So we expect to see Medicare as an issue, regardless of what the Ways and Means Committee does, right?<\/p>\n
Ollstein:<\/strong> That\u2019s right. There were a lot of calls for Democrats to address the debt ceiling issue during their final months in power. They did not do so. That means that it\u2019s going to be a big, messy fight this year. One of the biggest things to watch. This is an instance where the Republican House majority will be able to flex its muscles even though they don\u2019t have the Senate and White House, because they can trigger a budget standoff that puts the faith and credit of the country in jeopardy and demand concessions, including cuts to Medicare. So we\u2019ll see how that goes.<\/p>\n
Rovner:<\/strong> Although I will say, Sen. Brian Schatz of Hawaii was on Twitter, and he didn\u2019t ask me anything much to the horror of his communications staff. But one of the questions that somebody asked him was, \u201cWhy didn\u2019t you do the debt ceiling?\u201d And he just said: We didn\u2019t have the votes. So that at least answers the question of why didn\u2019t they take care of this before the Republicans took the majority back? Well, one thing we do know is going to happen is that the new Republican-controlled House is going to do a lot of investigations. Indeed, one of the first orders of business in the new Congress was the re-establishment of a committee on the covid pandemic with a new focus on investigating the origins of the virus and the government\u2019s response to it. What are we expecting out of that?<\/p>\n
Karlin-Smith:<\/strong> As you said, Julie, I think two of the things is, one, they\u2019re going to do more investigation into the origin of the virus. Republicans have pushed the potential theory that this was borne out of a lab in China, not necessarily something more naturally occurring. And I think a lot of scientists have said this theory has been fairly close to disproven and find that the focus on it distracts from really dealing with the current pandemic. But I think we should expect a lot of that. And that will include, I think, a lot of relitigation of Anthony Fauci and his particular role in the NIH [National Institutes of Health] and funding different types of research on viruses, both in the U.S. and abroad. The second thing I think they\u2019re going to look very closely at is how the U.S. has spent the covid funding that Congress has doled out and appropriated. That\u2019s certainly a lot of money. And I think, again, oversight is always probably \u2026 it\u2019s a good thing to see if Congress gives money, are we spending it? \u2026 Does it actually get to where it needs to go? Does it go to where it\u2019s supposed to go? I think that \u2026 in general, I think most people think that\u2019s a good thing. Sometimes what ends up happening is it gets taken a little bit to \u2026 \u00a0this disingenuous step forward in Washington, where everything gets questioned or they pick on jurisdictions for not spending the money fast enough when it\u2019s just not realistic. So you have to read between the lines really carefully when you\u2019re looking at some of the findings from that type of work. Because sometimes, again, when you give a state $1,000,000 to do something, they\u2019re not often able to make that change in two months.<\/p>\n
Rovner:<\/strong> And then if they do, they get criticized for spending it on the wrong thing, so \u2026<\/p>\n
Karlin-Smith:<\/strong> Right.<\/p>\n
Sanger-Katz:<\/strong> But I will say, speaking as a journalist, not as a congressional investigator, I do think that the covid funding is really ripe for a lot of investigation. There\u2019s already been very good reporting that a lot of the small-business programs were broadly defrauded. I think there was a real emphasis by Congress and \u2014 in a bipartisan way, Republicans obviously voted for these bills as well. But I think there was a real emphasis on just getting money out the door. People were so scared of a catastrophic economic collapse that, unlike a lot of programs that Congress designs that fund various things, there weren\u2019t a lot of initial safeguards, there wasn\u2019t a lot of process or administrative burden associated with getting money. And so that means it really is valuable to look and see where did it go, who may have defrauded the program, what are ways that in the next crisis it might be possible to do these kinds of programs in a way that is more efficient. You know, it occurs to me that in addition to the small-business money, hospitals got a whole lot of money as part of these programs. And again, there\u2019s been some journalism about this, but I do think I\u2019m all for more oversight, trying to learn some real lessons. I agree with Sarah that there is probably some of this that\u2019s going to veer into the disingenuous and kind of \u201cgotcha.\u201d But there may be some useful and interesting findings as a result of this process as well.<\/p>\n
Rovner:<\/strong> And as we saw with the Jan. 6 committee, Congress has powers that journalists don\u2019t. As we know, the Justice Department has powers that Congress doesn\u2019t. But Congress has pretty good investigatory powers. They can subpoena things when they need to. So, yes, I imagine we\u2019re going to learn something about the fate of all of those dollars that went out the door.<\/p>\n
Ollstein:<\/strong> Just to be fair, Republicans have sort of claimed that the Democrat-led effort to investigate covid didn\u2019t have any financial accountability aspect. That\u2019s not true. It did. They really scrutinized a lot of government contracts \u2014 like no-bid government contracts that funneled lots and lots of money to things that did not pan out or help anybody. There has been some of that already. But I agree that there\u2019s definitely more to look at.<\/p>\n
Rovner:<\/strong> And there \u2026 obviously, there was a Republican and<\/em> a Democratic administration handling the covid pandemic. So one presumes there are things to investigate on both sides. Well, even while the House committees are gearing up, Republicans are bringing \u201cstatement\u201d bills to the floor, bills that we know the Senate won\u2019t take up and the president won\u2019t sign. And despite the fact that abortion rights drove a lot of the midterm elections in the other direction, two of the first bills brought to the floor by the new Republican majority seek to do the bidding of anti-<\/em>abortion groups. This, apparently, making Republican moderates, particularly those in swing districts, not so happy. Alice, are we looking at pretty much the same split in the Republicans in the House as in a lot of states \u2014 the people who think that the Republicans didn\u2019t do well because they should have done more and people who think the Republicans didn\u2019t do well because they should have done less?<\/p>\n
Ollstein:<\/strong> Yeah, absolutely. And there\u2019s a split on how to talk about it or whether to talk about it as well. It\u2019s not just the actions, it\u2019s the messaging in addition. And so, yes, there are some in the House who are, like, why are we doing this? Why are we taking these votes that have no chance of becoming law? It just puts our members from swing districts in a more vulnerable position. The things they voted on so far this week have pretty unanimous support on the Republican side, I would say. I think where you could start to see some bigger divides are when they get into votes on an actual national abortion restriction that would put a gestational limit on the procedure, or something like that, which absolutely some members want to do and want to take a vote on. I think that\u2019s where you could start to see some Republicans being, like, wait, wait, wait, wait, why are we doing this? But the things so far are, like you said, they\u2019re \u201cmessaging\u201d bills, but they\u2019re ones that have pretty broad support on the conservative side.<\/p>\n
Rovner:<\/strong> And we should mention, I mean, one of them was just a sense of Congress that, you know, that bombing pregnancy crisis centers is bad. Or that violence against pregnancy centers \u2026<\/p>\n
Sanger-Katz:<\/strong> I\u2019m not going to give credit for this correctly, but I saw a tweet on this topic last week when the list of demands and the list of these bills that we\u2019re going to get a vote on was released where someone asked, Oh, did D-Triple-C [the Democratic Congressional Campaign Committee] co-author this list? Where I do think there is an interesting tension, as Alice said, where the particular message bills that the most conservative members of the House Republican caucus want to vote on are those issues where we see in public opinion polling, where we see in the last election that the majority of Americans are not really with those most conservative Republicans. And I think a lot of moderate Republicans would just prefer not to vote on those issues, particularly because they know that they can\u2019t make them policy. And we were talking about changes to Medicare and Social Security, and I think that also falls very much in that category where there might be a situation in which if Republicans really thought that they could reform these programs, maybe they would want to take the political risk, because I do think it\u2019s an important long-term goal of many Republicans. But I think there\u2019s also a frustration, you know, why would we take all these votes on something that is generally unpopular? Everyone knows that both Social Security and Medicare are really, really popular programs and people are very wary of changes to them. There is a political risk in taking a bunch of votes saying that you want to pull money out of those programs or change them structurally when you can\u2019t even achieve it.<\/p>\n
Rovner:<\/strong> Yeah. Well, speaking of that, during Wednesday\u2019s abortion debate on the House floor, Republican moderate Nancy Mace of South Carolina kept saying to any cable outlet that would put a microphone in front of her that Congress should be making birth control more widely available instead of voting on abortion. But we are also seeing the first shots fired in an effort to restrict birth control. Well, last month, a Trump-appointed judge ruled that the Title X family planning program is illegally providing contraception to minors. Now, this is a fight that dates back to even before I started covering it. It was called \u201cthe Squeal Rule\u201d in the early 1980s, an effort by the Reagan administration to require parental involvement before teens could use Title X family planning services. It was eventually struck down in federal court, but now it\u2019s back. Is this where we\u2019re headed?<\/p>\n
Ollstein:<\/strong> I think it\u2019s really important to watch things in law and policy that are just directed at minors because inevitably it does not stop there. Like, that\u2019s sort of the testing ground. It\u2019s where people are more comfortable with more restrictions and more hoops to jump through. But as we\u2019ve seen with gender-affirming care, it doesn\u2019t stop there. What\u2019s tested out as a policy for minors is inevitably proposed for adults as well, and so \u2026<\/p>\n
Sanger-Katz:<\/strong> What\u2019s the adult version of this, Alice? Like who? Like spousal consent?<\/p>\n
Rovner:<\/strong> Yes, there had been \u2014 I was just going to say \u2014 not so much in contraception, although originally it was, but also on abortion that, yeah, if there\u2019s a partner that the partner would have to consent.<\/p>\n
Ollstein:<\/strong> But there\u2019s also been spousal consent stuff for more permanent \u2026 getting your tubes tied, those kinds of things. That\u2019s been a debate as well. And, I mean, in the abortion space we\u2019ve seen this for, in terms of like traveling across state lines for an abortion. That\u2019s been a restriction for minors that\u2019s also been proposed for adults. So it\u2019s just this phase we should absolutely watch \u2014 as well as Title X program continues to be a space for proposed restrictions. It\u2019s a lever that they\u2019re able to hold because it does have federal funding and it does have constraints that other pots of money don\u2019t have.<\/p>\n
Rovner:<\/strong> My favorite piece of trivia is that the Title X program has not been reauthorized since 1984 because Congress has never been able to find the votes. You know, when the Democrats were in charge and wanted to do it, the Republicans would have all of these amendments that the Democrats probably couldn\u2019t fight off. The Republicans wanted to do it and put all these stringent rules that the Democrats wouldn\u2019t have. So, literally, this program has been \u2026 it gets funded every year, but it\u2019s been marching along for now several decades without Congress having formally reauthorized it.<\/p>\n
Ollstein:<\/strong> Yeah, that\u2019s why you keep seeing different presidential administrations trying to put their stamp on it through rulemaking, which, of course, can be rolled back by the subsequent president, as we\u2019ve seen with [Donald] Trump and [Joe] Biden. And so it just keeps going back and forth. And these clinics that are out there getting this funding, which, again, can\u2019t be used for abortion, for contraception, STD testing, fertility stuff, all kinds of stuff, but not abortion. But they keep having to comply with these wildly different rules. It\u2019s really difficult.<\/p>\n
Rovner:<\/strong> Yeah, it is. All right. Well, last week we talked about the Biden administration\u2019s effort to make abortion pills more available through both pharmacies and the mail. On the one hand, some abortion rights advocates say that the FDA is still overregulating the abortion pill by requiring extra hoops for both pharmacies and doctors to jump through in order to offer or write prescriptions for a medication that\u2019s proved safe and effective over two decades. On the other hand, we now have the specter of abortion opponents protesting at CVSes or Walgreens<\/a> near you. And Alice, they\u2019re already planning to do that, right?<\/p>\n
Ollstein:<\/strong> Yeah, that\u2019s right. They would have done it sooner, but they didn\u2019t want to step on the March for Life, which is coming up in a couple of weeks. And so they\u2019re planning these protests at CVS and Walgreens around the country for early February, trying to pressure the company to walk back its announcement that they will participate in the distribution of abortion pills in states where they remain legal, which is, by our count, currently 18 can\u2019t do this either because abortion is banned entirely or because there are laws specifically restricting how people get the pills.<\/p>\n
Rovner:<\/strong> Sarah, I want you to talk about some of these extra hoops that have to be jumped through because a lot of people think it\u2019s just for this pill and it\u2019s not. This is something that the FDA has for any drug that\u2019s potentially abusable, right?<\/p>\n
Karlin-Smith:<\/strong> Yeah, I wouldn\u2019t say abusable is the right word, but basically people call this a REMS. It stands for risk evaluation and mitigation strategy. And it\u2019s actually an authority Congress gave the FDA to \u2014 we use this term \u201csafe and effective,\u201d but we know all drugs, even when we say that \u201csafe\u201d term, will come with risks. And the idea here is that when the benefit-risk balance would be \u2026 so that it would be \u2026 FDA might say, OK, this is actually too risky to approve. However, we think we could make it kind of safe enough if we put in a little extra safeguards instead of just letting it go out there. Here\u2019s a drug, doctors, you can prescribe it, follow the normal pathway, which is that the federal government, or at least the FDA, doesn\u2019t really have a lot of say in exactly how the practice of medicine works. That\u2019s left up to states. And, you know, doctors individually. They implement other practices to help ensure that safety balance is there. So one famous example is Accutane, which is an acne drug. It\u2019s incredibly harmful to a developing fetus and birth defects. So women of pregnancy, bearing age are usually required to take regular pregnancy tests and so forth and monitor the status of that. And you\u2019re not supposed to use the drug while pregnant because of the incredible harm you do to a baby. So there\u2019s everything from things like that to just simply more written literature might be provided for certain drugs. Sometimes in the cases of the abortion pill, you know, who could actually dispense it and when was restricted. Sometimes there are particular sorts of trainings doctors have to take to get that extra authority to prescribe the drug. And again, the idea is that just to provide a little extra safeguard. Again, the controversy over the years with this pill is that people feel like it doesn\u2019t meet that standard to have a REMS, that it can be safe and effective through our normal prescribing systems. Actually, Stat this week had an interesting interview with Jane Henney<\/a>, who was the FDA commissioner when they first approved this drug. And she \u2026<\/p>\n
Rovner:<\/strong> Yeah, in the year 2000.<\/p>\n
Karlin-Smith:<\/strong> Right. Which is actually \u2026<\/p>\n
Rovner:<\/strong> Right at the end of the Clinton administration.<\/p>\n
Karlin-Smith:<\/strong> Actually predates this formal REMS authority. But there were others, different authorities that then evolved into REMS. But she said she thought that a lot of these restrictions would be gone by now and that what, at the time, what they were waiting for was more U.S.-specific experience with the drug, because what they were basing the original approval on was a lot of use of the drug in France, which had such a different health system than the U.S., they were a little bit uncomfortable, I guess, opening the floodgates in a way. So I thought that was an interesting historical point that came out this week.<\/p>\n
Rovner:<\/strong> But clearly, Alice, I mean, this is going to be the next big fight in abortion, right, is trying to restrict the abortion pill?<\/p>\n
Ollstein:<\/strong> Absolutely. I\u2019ve been writing about this since before Roe v. Wade<\/em> was overturned. The pills were already becoming one of the most popular and now are the most popular way to terminate a pregnancy in the U.S., which makes sense. You can take them in the comfort of your home with the people that you want to be with you, not in a scary medical environment. It\u2019s also a lot cheaper than having a surgical procedure. So but then, of course, with the pandemic, people started using them even more because it was more dangerous to go to a clinical setting. And so this has been a big focus of both sides of this fight for a long time: either how to increase access to the pills or restrict them. Also, now that Roe v. Wade<\/em> has been overturned, the pills and the ability to order them online from overseas in this legal gray area, that\u2019s been a major way people have been getting around state bans, and the anti-abortion groups know that. And so they want to look at any way they can to crack down on this. And so with the Biden administration opening up a new potential pathway with these local retail pharmacies, they\u2019re of course going to try to crack down on that as well.<\/p>\n
Karlin-Smith:<\/strong> I mean, we talked about this before in the podcast, but I think this issue of federal preemption, if it gets teed up, is going to be a big thing that\u2019s beyond just abortion, in terms of when does FDA\u2019s approval of a drug trump state regulations around how it\u2019s going to be used? And, you know, I feel like some people have not been satisfied on the \u2026 who want more access to abortion drugs in terms of how FDA has handled the rollback of the REMS. But you also have to wonder if they\u2019re operating in this setting where, again, if you push things too far and you get a legal challenge, given how our courts are, right? And how politically it can backfire. And so it\u2019s a complicated balance there.<\/p>\n
Rovner:<\/strong> Well, speaking of drugs that are in gray areas that people order online, my KHN colleague Phil Galewitz reports that four states \u2014 Florida, Colorado, New Hampshire, and New Mexico \u2014 are now pressuring the Biden administration to allow them to import prescription drugs from Canada<\/a> in an effort to reduce the cost of drugs for their residents. Now, despite the fact that this has been and remains a very bipartisan ask, the FDA, under both Republican and Democratic commissioners, has strongly objected to it over the years. Somebody remind us why this is so controversial.<\/p>\n
Karlin-Smith:<\/strong> I think the big thing FDA has objected to is that when you allow importation in the way states have often asked for it, you basically often give up the supply chain oversight that we have in the U.S. that ensures people are not getting drugs that are counterfeit and have somehow been tampered with as they\u2019ve gotten through the supply chain. And so, actually, I was refreshing my memory, and I can\u2019t believe how long ago it is. When the Trump administration first became the first administration to say, Oh, actually, OK, we are going to agree that we think this could be come safely. Then they put out regulations that tried to \u2026 basically like made it so that to do importation, you would almost have to mimic the same supply-chain safety measures we already have for the FDA. So it became this double-edged sword of, sure, you can do the importation, but you\u2019re going to have to jump to this level of hurdles that then makes it unusable. And so I think that\u2019s the key barrier here, is that can a state actually propose a program that would get sign-off? And I think it\u2019s not really surprising to me that the Trump team tried to thread the needle in that way of giving people the win of saying, Oh, we\u2019ll allow it without actually making it feasible.<\/p>\n
Sanger-Katz:<\/strong> I think it also highlights what a weird ask this is in some ways because what the states are looking to do is they are not looking to import drugs from other countries because they think that other countries have better manufacturing, have better safety protocols, have different drugs. They just want to import the lower prices that other countries pay for the same drugs. And so this is, in some ways, a very cludgy workaround that the states are basically asking for price regulation of drugs. But that obviously is a very difficult political act. So instead they\u2019re saying, well, can we just import the prices that some other country has negotiated. And then it raises all these other issues about, Well, you know, there is like a reason why, in general, the United States has regulatory control over the drug supply.<\/p>\n
Rovner:<\/strong> Also, Canada doesn\u2019t have enough drugs to serve all of these states. I mean, that\u2019s the thing that I\u2019ve never managed to get over. And, in fact, Canada has said that they\u2019re not anxious to do this because they don\u2019t have enough drugs to serve both Canada and the United States. I mean, it also seems just literally impractical.<\/p>\n
Sanger-Katz:<\/strong> I mean, we are seeing, of course, like in the Inflation Reduction Act, there were new measures that would allow Medicare, in particular, to start negotiating for lower prices for certain drugs. Obviously, that policy has a fair number of limitations, including that it\u2019s only for Medicare, it\u2019s only for certain drugs, and it\u2019s not going to be instant. But while we did get some new timeline from the Biden administration this week, and it looks like that policy is going to start rolling out. So I think states are asking for this now because they want to import prices from other countries. But also, for the first time, Medicare, or the federal government is starting to take on drug prices directly. And we\u2019re going to see how that looks relatively soon.<\/p>\n
Rovner:<\/strong> Yes, this ship turns very slowly, but it does seem to be turning a little bit. Well, as we previewed last week, the FDA has approved another controversial Alzheimer\u2019s disease drug, Leqembi. I think that\u2019s how you say it, which has a Q without a U. Sarah, you\u2019ve been following this. Are we headed down potentially the same road we traveled with Aduhelm? It feels kind of familiar. It\u2019s a drug that we think works, but we don\u2019t really know, and it has some big risks and will be expensive.<\/p>\n
Karlin-Smith:<\/strong> Yeah, I mean, similar, but slightly different. And perhaps the analogy that things slowly make their way in a different direction is also right here. This drug, I think most people see it as an improvement on Aduhelm because it has, in one major clinical trial, shown some benefit on people\u2019s cognitive decline slowing a bit. However, the big debate there is that \u2026 how meaningful the change that was seen in the trial is. Is it really going to be meaningful in people\u2019s lives and is that worth the price? The company is \u2026 actually a similar company is involved here, but they priced it quite a bit lower than the original Aduhelm price, even lower than the price of Aduhelm now. It\u2019s still seen as on the very high end of what a lot of cost-effective watchdogs say is a fair price. And as of right now, CMS [the Centers for Medicare & Medicaid Services] or Medicare is not going to be covering it at all because right now the drug only has what\u2019s known as an accelerated approval. So we\u2019re going to, over the next probably less than a year, in about nine months or so, FDA will have to weigh in on whether it gives the drug a full formal approval. And at that point, we\u2019ll see if Medicare also gives the sign-off that they think this drug might actually be effective for people and are willing to pay for it. I think my bottom line on this drug is, you know, it provides some hope and some improvement for people, but it looks like to be a small clinical benefit for a big trade-off in risks. So I think as more data comes out over time, we\u2019ll see again if that benefit-risk trade-off for most people falls on the right side of the coin.<\/p>\n
Rovner:<\/strong> And we\u2019ll watch this whole process go forward again. All right. Finally this week, but not least, there\u2019s also news on the health insurance coverage front. With the end of open enrollment for the Affordable Care Act coverage rapidly approaching in most states, by Jan. 15, officials at the Department of Health and Human Services this week reported that enrollment is already up 13% from last year to almost 16 million people, including about 3.1 million people who are new enrollees. In the meantime, though, my colleagues over the firewall at KFF report<\/a> that some 5 million more uninsured Americans are actually eligible for free health care coverage under the ACA. It feels ironic because this is not the first year of expanded subsidies and there\u2019s been relatively little media coverage of open enrollment. Is it just that it takes time for knowledge of these offers to trickle down to people? Or that the Biden administration put a lot more effort into outreach this year?<\/p>\n
Sanger-Katz:<\/strong> I think it\u2019s all of the above. I think for the first few years of the Obamacare program, there were a lot of complaints that this insurance really wasn\u2019t affordable enough for people. And, obviously, that\u2019s why Congress, first in part of the pandemic stimulus bill and now again in the Inflation Reduction Act, really jacked up the subsidies and made the plans cheaper and, in many cases, have more wraparound benefits so that low-income people could get insurance that was either free or relatively low-premium and also didn\u2019t ask them to pay a lot out-of-pocket for their own care. And we can see also that the Biden administration did a lot of outreach. I mean, it\u2019s definitely the case that they both, through Congress, made the plans cheaper and also, through various administrative actions, made the plans more widely publicized. And I just want to highlight, I think last year was the record year for Obamacare enrollment. And now we\u2019re seeing this huge increase on top of a record year. So these things seem to matter. I think the affordability of plans, the availability of free plans for a lot of uninsured Americans is very appealing. And yet the people who are uninsured and poor, I think, are difficult to reach. There is a lot of long-standing opposition to Obamacare. There are a lot of places where there are a lot of uninsured Americans, where there\u2019s not particularly effective and robust outreach. People don\u2019t know how to find these things, how to sign up. And it is really administratively complex to sign up for these plans. I mean, I don\u2019t know how many of our listeners have tried to do it. It\u2019s not impossible. It is on the internet. You know, anyone can do it. And you don\u2019t have to have someone holding your hand. But I think in many cases you probably do want someone holding your hand if it\u2019s your first time doing it. There are, in many markets, lots of choices. It\u2019s confusing. It\u2019s hard to know what the best option is, sometimes it\u2019s a little bit hard to figure out what it\u2019s going to cost you until you enter in a lot of information about your income. And you might also be scared that if you\u2019re not sure or you put something in wrong, you could get in trouble. So I think this is just an ongoing challenge of getting all these people who are now eligible for these really low-cost plans to actually interact with the system and get insurance.<\/p>\n
Rovner:<\/strong> One thing I guess bears mentioning is that with the Republicans just, you know, plan to do all of these things like try to repeal the Inflation Reduction Act because they don\u2019t like the drug price provisions \u2026 [but] they are not talking about repealing the Affordable Care Act anymore, right? Have we finally come to the end of that particular fight?<\/p>\n
Sanger-Katz:<\/strong> It sure looks that way.<\/p>\n
Ollstein:<\/strong> Yeah. The right the writing has been on the wall in terms of the lack of that talk on the campaign trail for a few years now. I was joking with some colleagues that, you know, the \u201crepeal Obamacare\u201d is tired; the \u201crepeal the drug price negotiation provisions\u201d is wired. That\u2019s the new talking point, although that\u2019s not going to happen either, obviously, because of the control of the Senate and because of how insanely expensive it would be to repeal that. But the Republicans definitely have moved on to other targets.<\/p>\n
Sanger-Katz:<\/strong> Although I will say, you know, once again, the fact that House leadership has committed to proposing cuts to health entitlement programs, the fact that they have committed to proposing a budget that balances in 10 years means that, I think, it will be extremely difficult for them to avoid talking about particular cuts or changes to Affordable Care Act programs. You know, again, it\u2019s just like this is where the dollars are. They can take a lot of dollars out of Medicare, that is very politically unpopular. They can take some dollars out of Medicaid, you know, the largest expansion of which is part of ACA. They can take money out of these subsidies, which, you know, have been supercharged in recent years beyond even what Congress initially passed in 2010. And I do think, as Alice said, you know, this is not a popular talking point. I don\u2019t think Republicans, by and large, want to be talking about repealing Obamacare anymore. And yet I think they are backed into this corner where they\u2019re going to have to make and propose specific modifications and cuts to these programs in order to achieve these high-level philosophical goals that they\u2019ve signed up for. And so I think it will be interesting to see what does it look like, maybe they\u2019re not going to call it Obamacare repeal anymore, but they might still be sucking $1,000,000,000,000 out of Medicaid, like some of the Trump administration budgets did.<\/p>\n
Rovner:<\/strong> Yeah. And it\u2019s important to mention, again, I mean, the Republicans talk about all these things they\u2019re going to do and people are thinking, Oh, my God, if they vote for this balanced budget, in 10 years it\u2019s going to happen. They can\u2019t do most of these things without the Senate and\/or the president unless they have two-thirds to override, which they don\u2019t. The one place that we do think they could exercise some leverage, obviously, is this debt ceiling vote where the Congress has to vote to raise the debt ceiling or the U.S. will default on things that it has already bought but not paid for \u2014 basically paying the credit card bill. And that, certainly, they\u2019re going to try to make some entitlement changes. But all of these other things that they say they\u2019re, quote-unquote, \u201cgoing to do,\u201d they\u2019re mostly just quote-unquote, \u201cmaking political statements,\u201d right?<\/p>\n
Sanger-Katz:<\/strong> But they\u2019re going to have to talk about them. They\u2019re going to have to write things down. They\u2019re going to have to have specific dollars attached to this. I do think that it will be politically salient and that it will create some visibility into, like, well, how do<\/em> you balance the budget in 10 years? What does<\/em> entitlement reform look like? And they\u2019re not saying Obamacare repeal anymore and they don\u2019t want to, they understand that they don\u2019t want to. And yet I think they\u2019re going to be in this position where they\u2019re going to effectively have to lay out something that looks like Obamacare repeal, something that looks like Social Security reform, something that looks like big changes to Medicare. And we will have a political debate about that because Democrats are just salivating to have those conversations. I think they feel like that is very strong political ground on them. They think that voters trust them to protect those very popular programs if they\u2019re under assault. And, you know, which is very similar to the political dynamic we saw when Republicans were really trying in earnest, when they had full control of government and wanted to repeal Obamacare.<\/p>\n
Rovner:<\/strong> Yes. And I would say, as we absolutely saw in 2017, when they failed to repeal it, Republicans very much agree on their goals, but they very much disagree on how to get there. There is no unified Republican plan for either reforming, you know, the Affordable Care Act or Medicare or Medicaid, I mean, except for basically cutting money out of it. So I will be interested, as Margot says, to see what they actually put down on paper.<\/p>\n
Sanger-Katz:<\/strong> And, sorry, just one more thing on this point, which is, again, I think that the kinds of show votes that the Republican House leadership is going to have to put on these issues are probably not going to be particularly politically productive and may be politically damaging to them. But I do think, setting that aside for the moment, I do think we are entering in an environment of much higher interest rates, of really more accelerating federal debt. You know, there are a lot of conditions right now that are potentially ripe for thinking about government spending and particularly thinking about these big categories of government spending that are our federal health care programs. I think the last few years there\u2019s been this sense that, you know, debt is free and the deficit doesn\u2019t matter. And I think inflation is high, interest rates are rising. I do think that we\u2019re in a moment where there may be a greater sense of a need to confront this problem. And I\u2019m interested in what that conversation looks like, which may be a little bit different than the kind of highly ideological conversation that we\u2019re going to see in the very near term.<\/p>\n
Rovner:<\/strong> I was going to say that that would require actually having substantive talks about what might work, which we don\u2019t know is going to happen, but we can cross our fingers and hope. All right. That is the news for this week. Now it is time for our extra-credit segment where we each recommend a story we read this week we think you should read, too. Don\u2019t worry if you miss it; we will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Sarah, why don\u2019t you go first this week?<\/p>\n
Karlin-Smith:<\/strong> Sure. I took a look at a story by Kaiser Health News\u2019 Lauren Sausser: \u201cHospitals\u2019 Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say<\/a>.\u201d I thought this was a fascinating story about hospitals\u2019 reliance on volunteers, not for the types of activities I usually associate hospital volunteers with, which would be \u2026<\/p>\n
Rovner:<\/strong> Like candy stripers.<\/p>\n
Karlin-Smith:<\/strong> Right. Like light \u2026 I don\u2019t know, \u201clight\u201d is not the right word, but, you know, visiting people, comforting them in some way, providing added benefit of sorts. And this is really people that are being asked to do medical care and the basics, some of the basic care you need when you are in a hospital. And I think her story cites about $5 billion maybe in the U.S. of free labor through these types of volunteers. And the question becomes, you know, is this violating labor laws? And should these people be getting paid for the work, or should they \u2026 are they basically, because they\u2019re using volunteers, taking money and job opportunities away from other people? And I thought it was a fascinating story just because I had no idea of all of this, you know, volunteer labor was being used and the impacts on these hospitals during the pandemic, when they couldn\u2019t have volunteers. And just, I think, important to think about, too, how this impacts the quality of care as well people receive.<\/p>\n
Rovner:<\/strong> Hospitals are very clever. Margot.<\/p>\n
Sanger-Katz:<\/strong> I wanted to recommend an article from Jessie Hellman at Roll Call called \u201cProviders Say Medicare Advantage Hinders New Methadone Benefit<\/a>.\u201d And I\u2019ve been doing a lot of reporting on the Medicare Advantage program lately. And so I was a little bit jealous of this story. Congress just recently required Medicare to pay for methadone. You know, a very evidence-based treatment for opioid addiction that it hadn\u2019t been covering before. And what this article found is that these Medicare Advantage plans, or private competitors to the government Medicare program, have been enacting a lot of roadblocks that make it hard for people to get this treatment. So they technically cover it, but they require often what\u2019s called prior authorization, where you have to \u2026 doctors and others have to jump through a lot of hoops to prove that the person really needs it. And when I saw this article, I put out a bat signal on my Twitter and I said, Can anyone think of the medical reason why you would want to have \u2026 restrict access to methadone treatment? And, you know, this is just a Twitter poll, but no one could come up with the reason. They could think of lots of reasons why the insurance company might not want to cover it, because it\u2019s expensive, because patients who have opioid addiction probably are pretty expensive in general. And so, you know, this could be a way to avoid paying for a complex treatment or a way to discourage patients who have complex health care needs from choosing a Medicare Advantage plan. Anyway, so just a good story and just, you know, another illustration of, you know, even after Congress does something like add a new benefit, there\u2019s always value in doing oversight to see how is that actually working in the real world and is it giving patients the care that was intended?<\/p>\n
Rovner:<\/strong> Yes. And we will be talking, I think, much more about Medicare Advantage this year. Alice.<\/p>\n
Ollstein:<\/strong> So I have a very sad piece to recommend. It is an op-ed by C\u00e9line Gounder, who is a public health expert that we all know well, as well as the widow of Grant Wahl, the soccer journalist who died covering the World Cup. And she wrote about how her husband\u2019s death has been co-opted by anti-vax conspiracy theorists who are trying to draw some connection to what happened to him and being vaccinated for covid. But she really smartly walks through the misinformation playbook because it is a very sort of predictable playbook with very predictable points and, you know, dismantles them one by one. And I think it\u2019s really helpful for the inevitable next time we see this come up to be prepared in advance and be able to refute those points. Very tragic but very helpful thing to know.<\/p>\n
Rovner:<\/strong> Yeah. C\u00e9line is our colleague now at KHN, in addition to everything else that she does, and I can just say to these trolls: Don\u2019t mess with C\u00e9line. It really was a very good piece. Well, my extra credit this week is from The Washington Post, and it\u2019s a great story that ran in the dead week between Christmas and New Year\u2019s. So I \u2026 gave it an extra week. It\u2019s called \u201cSocial Security Denies Disability Benefits Based on List With Jobs From 1977<\/a>,\u201d by Lisa Rein. And while I\u2019ve known for a long time that the Social Security disability program has a multiyear backlog, one thing I didn\u2019t know until I read this story is that a lot of otherwise likely eligible people get their benefits denied because they could theoretically do jobs that largely no longer exist. Among the jobs the government says people who are disabled might be able to do are nuts sorter, dowel inspector, or egg processor. That\u2019s because the last time the labor market data used to determine if a disabled person might be able to do a job was last updated 45 years ago. The agency has been working since 2012 to update its listing of jobs that could be done by sedentary individuals. But somehow the new directory of jobs has not made it into use yet. Meanwhile, thousands of people deserving of disability benefits are being steered to jobs that are now largely automated, offshored, or otherwise obsolete, something that clearly needs to be fixed.<\/p>\n
OK, that is our show for this week. As always, if you enjoy the podcast, you could subscribe wherever you get your podcasts. We\u2019d appreciate it if you\u2019ve left us a review \u2014 that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. As always, you can email us your comments or questions. We\u2019re at whatthehealth \u2014 all one word \u2014 @kff.org. Or you can tweet me. I\u2019m still at Twitter for now: @jrovner. Sarah?<\/p>\n
Karlin-Smith:<\/strong> I\u2019m @SarahKarlin<\/p>\n
Rovner:<\/strong> Margot?<\/p>\n
Sanger-Katz:<\/strong> @sangerkatz<\/p>\n
Rovner:<\/strong> Alice.<\/p>\n
Ollstein:<\/strong> @AliceOllstein<\/p>\n
Rovner:<\/strong> We will be back in your feed next week. In the meantime, be healthy.<\/p>\n
\n\t\tCredits\t<\/h3>\n
\tFrancis Ying
\n\tAudio Producer<\/p>\n
\tStephanie Stapleton
\n\tEditor <\/p>\n
To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n
And subscribe to KHN\u2019s What the Health? on\u00a0Spotify<\/a>,\u00a0 Apple Podcasts<\/a>,\u00a0 Stitcher<\/a>,\u00a0 Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n<\/div>\n