Post-Roe, more abortions will be virtual

Presented by the American Heart Association: The collision of health care and technology.

Jun 29, 2022 View in browser   By Ben Leonard and Ruth Reader Presented by the American Heart Association The Big Idea ROE V. WADE HAS FALLEN. Last week's landmark Supreme Court decision has not only sent the abortion issue back to the states but has also created a patchwork legal system across the nation. Telemedicine will now play an even more crucial role for people seeking abortions, especially in states that ban or restrict the procedure. People seeking abortions who live in those places will travel to states that permit doctors to prescribe abortion pills. But the decision has spawned uncharted legal territory over telemedicine's role. So what's next for telemedicine abortion? We have the answers to these questions and plenty more, including how states may crack down with digital surveillance. How does virtual abortion care work?  Providers typically prescribe two pills — mifepristone and misoprostol — via virtual visits, which are often mailed to patients. Mifepristone blocks a pregnancy-supporting hormone, while misoprostol causes uterine contractions. In states where the drugs are legal, abortion-rights supporters say the virtual option reduces access barriers like the need to travel to a clinic, which can be expensive and time-consuming. How does the Roe decision change access to virtual abortion? State laws govern access to telemedicine abortion. Before Roe was overturned, 19 states required doctors to prescribe abortion pills in person, effectively banning the use of telehealth for abortion, according to the Guttmacher Institute, a research organization that supports abortion rights. With Roe's fall, states looking to restrict virtual abortions are more likely to ban abortion altogether than restrict telemedicine abortion, said Greer Donley, an assistant law professor at the University of Pittsburgh. "Telehealth will be available in the states that seek to protect abortion. And it won't be legally available in the states that seek to ban abortion," said Laurie Sobel, associate director for women's health policy at the Kaiser Family Foundation. According to a POLITICO analysis, abortion is illegal, or soon will be, in more than a dozen states. Will state abortion bans stop people from getting medication abortion via telehealth? People won't stop getting abortions virtually, experts said, though it may become more cumbersome — and risky. People who live in states that prohibit abortion will have to travel across state lines for appointments, and they will have to find a place, like a P.O. Box, where their medication can be delivered. Patients also could turn to groups like Austria-based Aid Access, which offers online consultations and sends pills to all states. Because it's based overseas, legal experts said it would be difficult for states that ban abortion to hold it legally accountable. Since POLITICO first reported in early May that the Supreme Court planned to overturn Roe v. Wade, Aid Access has seen a surge in interest in the abortion pills, particularly in obtaining an "advance provision" or getting them now for possible later use. Welcome back to Future Pulse , where we explore the convergence of health care and technology. Last week, Ruth went to hang with the techies in Toronto for the Collision Conference. They discussed period tracking apps and abortion surveillance — and it was standing-room only for a discussion on the future of fertility. Share your news, tips and feedback with Ben at bleonard@politico.com or Ruth at rreader@politico.com and follow us on Twitter for the latest @_BenLeonard_ and @RuthReader. Send tips securely through SecureDrop, Signal, Telegram or Whatsapp here.   A message from the American Heart Association: The No Surprises Act is protecting millions of families from surprise medical billing. It is an important step in making health care more affordable by protecting patients from surprise medical bills in the thousands and even tens of thousands of dollars. Now, special interest groups are trying to weaken it and put families at risk again. Congress needs to keep the No Surprises Act strong.   Tweet of the Week Eva Galperin @evacide: "The difference between now and the last time that abortion was illegal in the United States is that we live in an era of unprecedented digital surveillance … If tech companies don't want to have their data turned into a dragnet against people seeking abortions and people providing abortion support, they need to stop collecting that data now." Washington Watch WHITE HOUSE WANTS MORE VIRTUAL OPIOID TREATMENT — The White House's Office of National Drug Control Policy pushed the Drug Enforcement Administration last week to consider permanently expanding online prescribing of a drug used to treat opioid use disorder. The DEA has missed multiple deadlines to bolster access to buprenorphine via telemedicine after pledging in 2009 to do so. The agency won't explain why, but some experts say it's concerned that buprenorphine could be sold illegally. The DEA, which regulates controlled substances, said in March that it's working to make pandemic regulations that permitted online prescribing permanent. The White House's nudge came less than two days after POLITICO reported that thousands of patients won't be able to get a prescription for the drug without an in-person visit as soon as October when the public health emergency easing telehealth rules could expire. COULD PRIVACY BILL LIMIT PUBLIC HEALTH INNOVATION? What: A proposed billwould limit the data that internet companies and data brokers can collect and store and require firms to obtain customers' consent to share their health information. The draft is backed by Mississippi Republican and ranking member of the Senate Commerce, Science and Transportation Committee, Roger Wicker, New Jersey DemocratFrank Pallone, and Washington Republican Cathy McMorris Rodgers, the chair and the ranking member of the House Energy and Commerce Committee. Why it matters: The Centers for Disease Control and Prevention and other public health agencies rely on private companies to conduct disease- surveillance projects. The CDC seeks to improve its modeling through a new Center for Forecasting and Outbreak Analytics. The takeaway: Experts warn that, if the bill doesn't account for data potentially needed for public health surveillance data, legislators will inadvertently make future disease forecasting more difficult. The sponsors will have to make changes to get the bill enacted because Senate Commerce Chair Maria Cantwell (D-Wash.) opposes it.   A message from the American Heart Association:   Sen. Maria Cantwell, who chairs the Senate Commerce Committee, has opposed the bill. | Amanda Andrade-Rhoades/AP Photo Data Dive Telehealth skeptics have long feared that allowing more access to virtual care would drive up health care use and thus Medicare spending. But preprint data from University of Michigan researchers that hasn't yet undergone peer review found that outpatient visits declined amid the pandemic even as regulators eased rules to allow for more virtual visits. Virtual care accounted for about 9 percent of visits during the second half of 2021, the researchers found. Around the Nation DRUGS TAKE FLIGHT — Zipline, an on-demand service that ships medications and vaccines via drone, is working with pharmaceutical manufacturer and distributor Cardinal Health and North Carolina health system Novant Health to send medicines to patients within 7,800 square miles of its Kannapolis, N.C., distribution center. The service is also now working with pharmacy benefit manager Magellan Rx to send drugs and medical supplies to regional pharmacies. The FAA certified Zipline for on-demand delivery on June 17. Founded in 2011, the company has participated in numerous public health projects transporting vaccines, medications and even blood. Earlier this year, the Ghana Ministry of Health said it had distributed a million Covid-19 vaccine doses using Zipline. Several other pharmacies, including CVS, Walgreens and Walmart, have piloted drone delivery with partners like UPS, DroneUp and Alphabet's Wing. Amazon has also begun its own drone delivery. Drones have been used previously to deliver Covid-19 test kits from Walmart. | Getty Images HEALTH SYSTEMS WANT GOV'T HELP WITH HACKERS — Hospitals are having an increasingly difficult time fending off hackers, and now they're asking for federal help, Ruth reports. In 2021, cyberattacks on health systems mushroomed and data from the Department of Health and Human Services' Office of Civil Rights shows that, so far this year, reports of hacks and data breaches have grown. Hacks jeopardize patient care and strain clinicians. They're also expensive. Health systems have spent millions to repair their computers. In light of the unrelenting rise in attacks, insurers are hiking prices and pulling back on coverage. Now, health system chief information officers are asking the government to step in and provide more security, arguing that hospitals are critical infrastructure. "It blows my mind that, ultimately, it's on the individual hospital systems to attempt to — essentially in isolation — figure it out," Lee Milligan, the CIO at Asante Health System in Oregon, told Ruth. Ideas Lab EXECS EXCITED ABOUT METAVERSE — More than four in five health care executives think the metaverse will be a net positive for the health care sector, according to a report from Accenture. The metaverse, which aims to turn the internet into an immersive 3D experience, has been touted as a way to potentially improve health care. The report envisions a future in which, for example, a patient may "seamlessly carry her personal health data to a physical therapist who demonstrates exercises in an immersive environment simulating a tropical beach setting," the report said. Brian Kalis, Accenture digital health lead and one of the report's authors, told Ben the potential use cases include a metaverse meeting space, patient education and a digital "twin" of a patient to prepare for surgery. Concerns linger about the metaverse in health care, particularly regarding privacy. Experts have compared being in virtual space to "having a drone following you around in real life." "It's going to be really important that we think through interoperability, as well as data privacy and security out of the gate," Kalis said. What We're Clicking Rebecca Torrence, Insider — Investors are pushing healthcare startups to take on debt. It's a risky move that could lead to the startups'' demise   Natasha Mascarenhas, Techcrunch —  Ro cuts 18% of staff despite narrowing focus, raising additional capital  JMIR Mhealth Uhealth — Privacy, data sharing, and data security policies of omen's mHealth apps: Scoping review and content analysis   A message from the American Heart Association: 90% of Americans support the bipartisan No Surprises Act, which is protecting millions of patients from the burden of surprise medical bills and helping them afford the care they need. Now, special interest groups are spending millions of dollars to weaken the law's protections. If they succeed, patients will again be put at risk of receiving medical bills they did not expect – and often cannot afford. At a time when consumers are paying more for just about everything, Washington cannot backtrack on protecting patients from surprise medical bills. Congress and the White House must commit to doing everything they can to keep the No Surprises Act strong for patients.     Follow us

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