Deciding the fate of millions of Medicaid recipients

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Feb 01, 2023 View in browser   By Krista Mahr and Daniel Payne Presented by With Megan Messerly, Katherine Ellen Foley, Megan R. Wilson and Alice Miranda Ollstein  States will start reevaluating whether the millions of Americans who have remained covered by Medicaid during the pandemic are still eligible for those benefits. | AP Photo/Julie Jacobson THE BEGINNING OF THE END — As of today, states can start reevaluating whether the millions of Americans who have remained covered by Medicaid during the pandemic are still eligible for those health insurance benefits, Megan Messerly reports. How we got here: Since March 2020, the so-called continuous coverage requirement has caused Medicaid rolls to swell as states agreed not to remove anyone from the program during the pandemic in exchange for extra federal dollars. But in December, the requirement was uncoupled from the federal public health emergency. Congress selected an end date for the requirement, setting states’ redetermination work in motion. States can officially start kicking people off their Medicaid rolls on April 1. State split screen: Some GOP-led states are more than ready to pare down the program. In December, 25 Republican governors, in a letter to President Joe Biden, said the continuous coverage requirement left them paying “hundreds of thousands of dollars” to cover people who now have other health insurance coverage and no longer need Medicaid. In Arkansas, for instance, the Department of Human Services is beginning to send renewal letters to Medicaid recipients this month. The roughly 130,000 people who are part of the Medicaid expansion population in the state will be the first to have their eligibility in the program redetermined, with all redeterminations required to be completed within six months under a law passed by state lawmakers in 2021. “The program was originally designed for the aged, blind, disabled and children, and that’s who we are working to protect,” Arkansas Department of Human Services spokesperson Gavin Lesnick told POLITICO. “The number one goal is to protect taxpayers.” Other states — especially blue states — plan to take their time. Illinois won’t start initiating renewals until April 1, and even then, those who are part of that early group of redeterminations won’t lose coverage until July 1 at the earliest. Colorado will start sending renewal packets in mid-March to people whose renewal date is in May. And in Washington state, the earliest date ineligible people could lose their coverage is April 30. WELCOME TO WEDNESDAY PULSE — Outdoor dining — the pandemic invention that spawned cabanas and ate up sidewalks round the world — may finally have peaked. Are you ready to see it go? Send your favorite outdoor dining spot inside or outside the Beltway, news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, Ruth Reader talks with Daniel Payne about the Biden administration's plan to end the Covid-19 national and public health emergencies on May 11 and the action's implications. Plus, Katherine Ellen Foley on the four biggest takeaways from Pfizer’s earnings call on Tuesday.   A message from PhRMA: Costly out-of-pocket expenses tied to deductible and coinsurance requirements are a leading concern for patients with commercial insurance. These harmful practices put in place by insurers and pharmacy benefit managers (PBMs) are even causing patients to abandon their medicines. New IQVIA data break down how insurers and their PBMs are impacting how patients access and afford their medicines.   Listen to today’s Pulse Check podcast Public Health Americans can expect a long list of changes when the emergencies end this spring. | Mario Tama/Getty Images TURNS OUT IT'S A HASSLE TO END AN EMERGENCY— The White House’s announcement that it will end the Covid-19 public health emergency — and a separate Covid national emergency — on May 11 will mean new costs and more hassles for Americans seeking health care, Daniel reports. A few key changes Americans can expect: — An end to free Covid-19 vaccines, tests and treatments. People without health insurance will have to pay out of pocket, while those with private plans could see more costs depending on the terms of their insurance. Insurers typically cover the costs of preventive care, such as vaccines, but often charge deductibles or require cost-sharing for drugs. — Cost-sharing for tests and medicine. Beneficiaries of Medicare, Medicaid and the Children’s Health Insurance Program could face more cost-sharing for tests and some Covid antivirals, though vaccines will remain free. — Restricted access to controlled substance prescriptions. Eased rules for prescribing controlled substances without an in-person doctor’s visit could end unless the Drug Enforcement Administration moves to extend them. That could affect people seeking mental health care, transgender care, treatment for opioid use disorder and even remedies for severe coughs. — Resumed Medicare coverage requirements. Requirements waived during the emergency will resume. For example, Medicare patients seeking admission to a skilled nursing facility will first have to spend three days in a hospital.   JOIN POLITICO ON 2/9 TO HEAR FROM AMERICA’S GOVERNORS: In a divided Congress, more legislative and policy enforcement will shift to the states, meaning governors will take a leading role in setting the agenda for the nation. Join POLITICO on Thursday, Feb. 9 at World Wide Technology's D.C. Innovation Center for The Fifty: America's Governors, where we will examine where innovations are taking shape and new regulatory red lines, the future of reproductive health, and how climate change is being addressed across a series of one-on-one interviews. REGISTER HERE.     In Congress DEMS PROPOSE TAKING THE ‘MEDICARE’ OUT OF MEDICARE ADVANTAGE — House Democrats unveiled a new bill on Tuesday that would bar private insurance plans from calling themselves “Medicare Advantage,” an attempt to crack down on what they view as deceptive tactics insurers use to confuse patients and steer them away traditional Medicare. The Save Medicare Act proposes a $100,000 penalty every time an insurance company uses the word “Medicare.” Its introduction comes amid an enrollment period in which the private insurance industry is blanketing the airwaves with celebrity spokespeople pitching plans to older adults. The bill has little chance of passing the Republican-controlled House, but it’s indicative of a broader, ongoing push by progressive lawmakers to target what they see as the corporatization of Medicare as private health insurance companies reap huge profits off the program. On Tuesday, CMS released its latest enrollment report showing more than 30 million Americans are in a Medicare Advantage plan. Progressive advocacy groups, including the Center for Health and Democracy, Social Security Works and People’s Action, recently briefed the Progressive Caucus on their concerns about the Medicare Advantage program. “Only Medicare is Medicare,” Rep. Mark Pocan (D-Wis.) told reporters, adding that his mother, while in her 90s, signed up for a Medicare Advantage plan, mistaking it for traditional Medicare. FIRST IN PULSE: SENATORS ASK HHS TO IMPROVE FDA’S VAPE REGULATION — In a bipartisan letter to HHS Secretary Xavier Becerra this morning, 13 senators, including long-time anti-youth-vaping advocate Dick Durbin (D-Ill.), slammed the “repeated failures” of the FDA’s tobacco regulatory authority to take e-cigarettes that appeal to minors off the market, Katherine reports. The lawmakers criticized the agency’s recent court-ordered update that estimates it won’t finish reviewing marketing applications from major e-cigarette market players until the end of December — six months later than it previously estimated. Those delays, the senators argue, lead to more children using e-cigarettes. A federal survey from 2022 estimated that 2.6 million minors used an e-cigarette product in the last 30 days. An update from the FDA: On Tuesday, Brian King, the head of the FDA’s tobacco regulatory division, published an update on progress from the Center for Tobacco Products in the last year. He said the center would respond to a December report on the center from the Reagan-Udall Foundation in the coming month. LET THE COVID OVERSIGHT BEGIN — Rep. James Comer (R-Ky.), chair of the House Oversight and Accountability Committee, will lead the charge today as an oversight hearing begins on waste, fraud and abuse in the Covid relief programs, Megan R. Wilson reports. “The Biden Administration faced little to no scrutiny under unchecked, one-party Democrat rule in Washington. This Committee conducted almost no oversight of federal government agencies, programs, or policies,” Comer plans to say in his opening remarks, according to a copy obtained by Megan. “That is why we are having our first hearing of the new Congress on waste, fraud, and abuse in pandemic spending programs. We will hold many more hearings on this important issue.” The witnesses at the 10 a.m. hearing include Gene Dodaro, who leads the Government Accountability Office; Roy Dotson, the National Pandemic Fraud Recovery coordinator; and Michael Horowitz, the chair of the Pandemic Response Accountability Committee and inspector general of the Justice Department. They each plan to discuss improper or fraudulent pandemic payments, which likely total hundreds of billions of dollars based on estimates from government agencies and law enforcement proceedings, as well as what has been done to identify or get the payments back and what more needs to be done.   A message from PhRMA:   Providers ANOTHER ONE — The Texas Medical Association filed another lawsuit to change government rules for enforcing the No Surprises Act — particularly over the increase in price for an independent dispute resolution, part of the process for determining how much providers get paid in surprise billing cases, Daniel reports. The TMA argues that the nonrefundable administrative fee for resolving disputes between payers and providers through the process — $350, up from $50 last year — is illegal because it effectively keeps many providers from being able to engage in the process, especially those filing claims smaller than the new fee. The suit also said the rule for “batching” claims, or submitting them together under one dispute resolution, is unlawful because it also restricts access to the process for some providers. It’s one of the many cases the group has brought against the government to challenge the implementation of the No Surprises Act. The TMA is critical of the way agencies laid out the independent dispute process for claims, arguing the calculations tip the scales in favor of insurers.   JOIN TUESDAY TO HEAR FROM MAYORS AROUND AMERICA: 2022 brought in a new class of mayors leading “majority minority” cities, reshaping who is at the nation’s power tables and what their priorities are. Join POLITICO to hear from local leaders on how they’re responding to being tested by unequal Covid-19 outcomes, upticks in hate crimes, homelessness, lack of affordable housing, inflation and a potential recession. REGISTER HERE.     Names in the News Megan L. Ranney has been named the next dean of the Yale School of Public Health, starting on July 1. Ranney currently serves as the deputy dean of the Brown University School of Public Health, where she has been on the faculty since 2008. What We're Reading Navy researchers are studying geriatric dolphins to learn more about the human aging process, The New York Times reports. Scientists are bracing themselves for tighter federal controls over risky lab research, Science reports.   A message from PhRMA: Every day, patients at the pharmacy counter discover their commercial insurance coverage does not provide the level of access and affordability they need. New data from a study by IQVIA reveal the harmful practices of insurers and their pharmacy benefit managers (PBMs) can lead to significantly higher out-of-pocket costs for medicines — causing some patients to abandon their medicines completely. Learn more.     Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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