Doctors want clarity on emergency abortions

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Apr 23, 2024 View in browser   By Chelsea Cirruzzo and Ben Leonard Driving the Day In 2022, doctors from across the U.S. rallied to protect abortion access and demand an end to the criminalization of providers who perform lifesaving abortion care. | Paul Morigi/Getty Images WHEN TO SAVE A LIFE — Hospitals in states with abortion bans are caught between state laws threatening their doctors with criminal charges if they perform an abortion and federal laws requiring them to offer the procedure to stabilize a patient in crisis, POLITICO’s Alice Miranda Ollstein and Megan Messerly report. The conflict is a key part of an upcoming Supreme Court case focusing on the clash between federal protections for patients in medical emergencies, called the Emergency Medical Treatment and Labor Act, or EMTALA, and Idaho’s near-total abortion ban. Lower courts, state attorneys general, legislators and medical boards are also grappling with how to give doctors and hospitals the leeway to save pregnant patients’ lives while complying with state laws, many of which include vague and unscientific terms like “serious,” “major” or “substantial.” State officials are attempting to assuage doctors’ concerns with guidance about what counts as a life-threatening medical emergency. But doctors say such information — and even a Supreme Court ruling against Idaho — won’t fully solve the problem as long as the bans remain in place. “If you make standard medical care a crime when folks in all kinds of difficult medical situations present, especially in emergency situations, we are always going to see some type of delay,” Dr. Caitlin Gustafson, an OB-GYN in Idaho, told reporters on a recent call. “Because it’s criminalized care, physicians are going to naturally hesitate.” Anti-abortion groups, meanwhile, accuse doctors of willfully misinterpreting laws and say giving them greater discretion on emergency abortions would open the door to more procedures that aren’t medically necessary. As medical groups push state legislatures to broaden their abortion exemptions, conservative activists are calling on them to leave the bans untouched. “It’s not the law that’s the problem, it’s the implementation,” said Rebecca Weaver, the legislative director for Texas Right to Life. WELCOME TO TUESDAY PULSE. I’m eagerly awaiting the “Shōgun” series finale tonight, but in the meantime, please keep me busy with your tips, scoops and feedback sent to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.   THE GOLD STANDARD OF HEALTHCARE POLICY REPORTING & INTELLIGENCE: POLITICO has more than 500 journalists delivering unrivaled reporting and illuminating the policy and regulatory landscape for those who need to know what’s next. Throughout the election and the legislative and regulatory pushes that will follow, POLITICO Pro is indispensable to those who need to make informed decisions fast. The Pro platform dives deeper into critical and quickly evolving sectors and industries, like healthcare, equipping policymakers and those who shape legislation and regulation with essential news and intelligence from the world’s best politics and policy journalists. Our newsroom is deeper, more experienced and better sourced than any other. Our healthcare reporting team—including Alice Miranda Ollstein, Megan Messerly and Robert King—is embedded with the market-moving legislative committees and agencies in Washington and across states, delivering unparalleled coverage of health policy and the healthcare industry. We bring subscribers inside the conversations that determine policy outcomes and the future of industries, providing insight that cannot be found anywhere else. Get the premier news and policy intelligence service, SUBSCRIBE TO POLITICO PRO TODAY.     Abortion Rules to protect the health records of people who have an abortion were finalized on Monday. | M. Scott Mahaskey/POLITICO ABORTION PRIVACY RULE FINALIZED — The Biden administration finalized rules Monday to bolster protections of personal health records related to abortion. The final rules prevent providers and insurers from turning over information to state officials investigating or prosecuting anyone who seeks or provides a legal abortion under the federal privacy law HIPAA. It also applies a presumption of legality in some cases, meaning if law enforcement asks providers in one state to hand over information on a patient who might have traveled out of state to receive health care, it’s assumed that the care the patient received in another state was likely lawful — which protects the patient’s health information under the rules. The finalized regulations come as President Joe Biden is set to reaffirm his support of reproductive health care access during a campaign speech in Florida today. His campaign told reporters Monday that Biden is expected to blame former President Donald Trump for appointing the Supreme Court judges who gave rise to the end of Roe v. Wade. Elections BECERRA’S GOVERNOR PLANS IN MOTION — While HHS Secretary Xavier Becerra has publicly been quiet on his future plans, they're more advanced than previously known on his intent to run for California governor, POLITICO’s Christopher Cadelago and Daniel Lippman report. POLITICO reported earlier this month that Becerra has been exploring the idea of leaving the Biden administration after the November election and running for governor in his home state. Now, it seems like those plans are in motion. Two people briefed on the discussions tell POLITICO that Becerra or emissaries have approached political firms about standing up a gubernatorial campaign to succeed Gavin Newsom in 2026. Becerra has also spent more than $130,000 over the last year for “campaign consultants,” activity not previously reported in the media. The political outreach and payments have occurred even as Becerra has continued to say he’s focused on his Cabinet job in Washington. Becerra sidestepped questions about plotting for a gubernatorial run in his home state when initially approached by POLITICO. But he did acknowledge the strict legal parameters he’s under in his current role. “I am secretary of HHS, and by law, I have to be secretary of HHS and nothing else,” he said at a recent event in San Francisco. “So I’m gonna do my job as best I can.” Becerra’s state committee, funded with the more than $1.5 million balance from his time as attorney general, clearly delineated the consulting expenses, selecting the code “CNS.” Other expenses were listed as “PRO,” for professional services (such as legal and accounting) or office administrative matters. A campaign attorney for Becerra’s state committee characterized the $10,000-a-month in payments as for account oversight — not traditional candidate consulting work. A senior Biden administration official said they were unaware of Becerra’s outreach to campaign operatives and political spending. Asked about the legal implications of his moves, the official added, “Good question.” A White House spokesperson did not answer questions about Becerra.   POLITICO IS BACK AT THE 2024 MILKEN GLOBAL CONFERENCE: POLITICO will again be your eyes and ears at the 27th Annual Milken Institute Global Conference in Los Angeles from May 5-8 with exclusive, daily, reporting in our Global Playbook newsletter. Suzanne Lynch will be on the ground covering the biggest moments, behind-the-scenes buzz and on-stage insights from global leaders in health, finance, tech, philanthropy and beyond. Get a front-row seat to where the most interesting minds and top global leaders confront the world’s most pressing and complex challenges — subscribe today.     AROUND THE AGENCIES NURSING HOMES NEED TO STAFF UP — CMS has finalized a new staffing requirement for nursing homes despite broad opposition from the industry, POLITICO’s Robert King and Daniel Payne report. The rule, released Monday, will lead to nearly 8 in 10 homes being forced to hire additional staff, according to a senior Biden administration official not authorized to speak publicly. CMS, however, gives nursing homes some leeway to comply with requirements that include an on-site nurse 24/7. A rural home has three years to comply, and an urban home has three years. Facilities that don’t comply could face escalating penalties. Some changes have been made to last year's original proposal. A nursing home can now apply for an exemption to the 24/7 requirement if it can prove difficulty in hiring additional staff. The exemption would give an eight-hour reprieve from the requirement, but other staff such as a physician’s assistant must still be on hand. “We believe our final rule is responsive to all of those comments received from a variety of different voices,” said another official granted anonymity because they were not authorized to be quoted by name. CMS pursued the rule to improve care in nursing homes, which were hit hard during the Covid-19 pandemic. The rule garnered significant opposition from the nursing home industry. “Our residents and our families are going to have to go further to access care,” said Nate Schema, president and CEO of the Good Samaritan Society, which operates nursing homes. But patient advocates, health worker unions and administration officials said that the rule would help improve care for older Americans. “The provisions that make up the nursing home staffing rule mark a long-overdue sea change,” Mary Kay Henry, president of SEIU International, a labor union, said in a statement. MEDICAID RULES FINALIZED — In keeping with its Monday output, the Biden administration finalized two rules to strengthen Medicaid. One rule, which applies to Medicaid managed care plans and the Children’s Health Insurance Program, sets maximum appointment wait-time standards for patients, which will be monitored through surveys. Additionally, states’ websites, where managed care plans’ quality ratings are publicly posted, must include information to help people compare plans. The second rule, which applies to Medicaid fee-for-service, sets minimum thresholds for payments to direct care providers: States must ensure that a minimum of 80 percent of Medicaid payments for direct care providers like home health aides and personal care services be used for worker compensation instead of overhead costs. It also expands requirements for state committees that advise on Medicaid managed care, including posting meeting minutes and making their membership lists available. While progressive group Protect Our Care praised the rule, Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, said the rules create “untenable standards for home health agencies to meet.” Names in the News Laurie McGraw is now executive vice president for digital health company Transcarent. She was previously a client chief officer and then president of AllScripts. Paul W. Estes is now president of neuroscience technology innovator Cognivue, Inc. He was previously the company’s chief operating officer. WHAT WE'RE READING STAT reports on the small number of hospitals that will say how maternal health care has changed after Dobbs.  The New York Times reports on what it means that more mammals are getting avian flu.   Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim 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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