| | | | |  | | By Krista Mahr and Daniel Payne | | | With Alice Miranda Ollstein
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Democratic governors in North Carolina and Kansas are set to take another run at expanding Medicaid next year. | AP Photo | NEW MOMENTUM FOR MEDICAID EXPANSION? Democratic governors in North Carolina and Kansas are set to take another run at expanding Medicaid next year, POLITICO's Megan Messerly reports . It won't be easy in either state, but proponents of the Obama-era health insurance program believe a growing body of data on the program's success in other red states has persuaded an increasing number of holdouts — and the additional federal money that comes with expansion could tip the scales with lawmakers staring down a possible recession. The backstory: The latest round of Medicaid expansion negotiations comes as states prepare for the eventual end of the Covid-19 public health emergency, which helped millions of people stay on Medicaid during the pandemic , and as nearly a third of rural hospitals are at risk of closure , two factors Medicaid experts believe could persuade conservative lawmakers. Citizen-led ballot initiatives have so far forced red states, including Missouri, Oklahoma and South Dakota, to expand Medicaid, leaving 11 states without an expansion program. The prospects : Policy experts who follow Medicaid expansion efforts believe North Carolina has the best chance now that the state's Republican legislative leadership is on board with the proposal after years of opposition. But legislation in North Carolina that would have expanded coverage to 600,000 people didn't pass this year. In Kansas, Democratic Gov. Laura Kelly, fresh off of winning a second term, is taking another swing at expansion, which she pushed in each of her first four years. The state appeared on the cusp of a deal in 2020, but talks broke down when the issue became entangled in a separate debate over abortion restrictions. The following year, Kelly proposed legalizing medical marijuana and using the tax revenue to pay for Medicaid expansion, a move that also failed. And in 2022, efforts similarly fell flat. WELCOME TO WEDNESDAY PULSE — Less than half of men are happy with their friendships, a new survey shows . Send us your best guess as to why, along with news and tips, to kmahr@politico.com and dpayne@politico.com . TODAY ON OUR PULSE CHECK PODCAST, Daniel talks with Lauren Gardner about the lobbying from health care providers trying to convince lawmakers to extend the telehealth rules that were passed during the pandemic — and that would expire after the lifting of the Covid-19 public health emergency.
| | | | | | | 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. | | | | | | | 
Sen. Roger Marshall will use today's HELP Committee hearing to highlight his bill that would overhaul the prior authorization process within Medicare Advantage. | Alex Brandon/AP Photo | SENATORS TO USE MENTAL HEALTH HEARING TO STUMP FOR PRIOR AUTHORIZATION BILL — The Senate HELP Committee is holding a hearing this morning on the mental health crisis facing teens that the pandemic's exacerbated, but lawmakers on the panel also plan to use the event to push for broader health care reforms, Alice reports. In particular, Sen. Roger Marshall (R-Kan.) will use the hearing to highlight his bill that would overhaul the prior authorization process within Medicare Advantage. Though the bill would apply only to older adults and wouldn't help the adolescents who are the focus of the hearing, Marshall will argue that the cumbersome process doctors currently use to get insurers' approval before rendering treatment is "a barrier to care" across the board and is particularly damaging in the mental health space. The bipartisan bill was passed out of the House on a voice vote and is backed by some of the health care industry's most powerful players, including the American Medical Association and the American Hospital Association. The current holdup? Cost. The Congressional Budget Office reported in September that the bill would cost about $16 billion over 10 years. It's a high price tag when leaders are already trying to push through other expensive health care measures like delaying cuts to providers' reimbursement rates. TELEHEALTH PUSH CONTINUES — The Connected Health Initiative is lobbying congressional leaders to extend a provision that allows high-deductible health insurance plans to cover telehealth before patients hit their deductibles, POLITICO's Ben Leonard reports. The initiative, whose steering committee includes Apple, Microsoft, the American Medical Association and UnitedHealth Group, wrote to House and Senate leaders on Monday, asking them to extend the provision before it expires at year's end. The group called for "at least" a two-year extension to avoid the issue resurfacing next year.
| | | | GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is featuring a special edition of our "Future Pulse" newsletter at the 2022 Milken Institute Future of Health Summit from Dec. 6 to 8. The newsletter takes readers inside one of the most influential gatherings of health industry leaders and innovators solving the biggest global health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE . | | | | | | | | TOBACCO COMPANIES ASK SCOTUS FOR INJUNCTION ON CA LAW — R.J. Reynolds and other tobacco and vape companies on Tuesday asked the Supreme Court for an emergency injunction that would stop a flavored-tobacco ban set to go into effect in California later this month, POLITICO's Katherine Ellen Foley reports. The high court filing comes after two lower courts, including the 9th U.S. Circuit Court of Appeals, denied stay requests from the industry. The group first requested a preliminary injunction in the District Court of the Southern District of California the day after 62 percent of Californians voted to uphold a statewide ban on flavored-tobacco products in stores and vending machines. The ban would prohibit the sale of Newport menthol cigarettes, which R.J. Reynolds manufactures, and the latest filing claims that the companies would lose millions of dollars in revenue while any litigation winds its way through the courts. HIV IN NYC ON THE RISE — Nearly 1,600 New York City residents were newly diagnosed with HIV in 2021 — a 14 percent increase over 2021, POLITICO's Shannon Young reports. The City Department of Health and Mental Hygiene's 2021 HIV Surveillance Annual Report released Tuesday noted the "atypical" yearly increase in new diagnoses in New York City. It attributed the 14-percent rise to "a rebounding from the unexpectedly steeper drop during the first waves of the COVID-19 pandemic," which affected access to HIV testing services.
| | | | A message from PhRMA:   | | | | | | NEW ALZHEIMER'S THERAPY IN SPOTLIGHT — A new therapy for Alzheimer's disease under FDA review modestly slowed the progression of cognitive decline, while doubts about the drug's safety persist, Katherine reports. The drug: Lecanemab is the second monoclonal antibody from Biogen and Eisai that targets amyloid — malformed proteins in the brains of patients with Alzheimer's disease. The drug binds to the proteins in a different way than Aduhelm, the companies' first Alzheimer's antibody treatment, which was granted accelerated approval in 2021 amid controversy after contradictory study results raised questions about its safety and efficacy. Biogen and Eisai had asked the FDA to grant lecanemab accelerated approval based on data from a Phase IIb trial. What's new: New trial data published in The New England Journal of Medicine on Tuesday showed that in a Phase III clinical trial, lecanemab modestly reduced amounts of amyloid and slowed the onset of cognitive decline compared to a placebo. But adverse events potentially caused by the drug were reported, leading the study's authors to call for further investigation. The trial results showed that of the nearly 1,500 people with mild Alzheimer's disease who completed the 18-month trial, 14 percent of patients who took the drug developed side effects — which included brain swelling and bleeding — compared to 11.3 percent who took the placebo. The FDA is slated to make a decision on lecanemab's accelerated approval by Jan. 6.
| | | | POLITICO APP USERS: UPGRADE YOUR APP BY DECEMBER 19! We recently upgraded the POLITICO app with a fresh look and improved features for easier access to POLITICO's scoops and groundbreaking reporting. Starting December 19, users will no longer have access to the previous version of the app. Update your app today to stay on top of essential political news, insights, and analysis from the best journalists in the business. UPDATE iOS APP – UPDATE ANDROID APP . | | | | | | | | MISINFORMATION AND THE RANDOM DUDES OF TWITTER— According to an update on its content-moderation policies, Twitter will no longer stop users from spreading false information about the Covid-19 virus or vaccines, POLITICO's Rebecca Kern reports . Twitter's Covid misinformation page has been updated with a note saying that as of Nov. 23 , the platform would no longer enforce its policies against spreading misleading virus and vaccine information — which had led to more than 11,000 account suspensions since 2020. Why, exactly? The move, first reported by CNN, appears to be part of new owner Elon Musk's plans to grant "general amnesty" to previously banned accounts — like that of former President Donald Trump. It could mean the 11,230 accounts suspended since Twitter's Covid misinformation policy went into effect in early 2020 may soon be or are in the process of being reinstated. Making the administration's job harder: At a White House briefing last week, Ashish Jha, White House Covid-19 response coordinator, commented on the increasing spread of Covid misinformation on Twitter under Musk's leadership. Americans, he said, could choose to "trust America's physicians or you can trust some random dude on Twitter."
| | | | 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. | | | | | | Kripa Sreepada is now a health policy adviser with the Senate Finance Committee under Chair Ron Wyden (D-Ore.). She was previously a health policy adviser for Sen. Tina Smith (D-Minn.). ATI Advisory announced that Anna Kaltenboeck will lead its new drug reimbursement group. She most recently served as a senior health adviser for the Senate Committee on Finance. Dwayne Carson is joining the lobbying team at Wine and Spirits Wholesalers of America. He most recently lobbied on behalf of the Blue Cross Blue Shield Association. The PhRMA Foundation has announced four new members to its board: Aida Habtezion, chief medical officer at Pfizer; Maha Radhakrishnan, chief medical officer at Biogen; George Addona, senior vice president and head of discovery, preclinical and translational medicine at Merck Research Laboratories; and Lori Reilly, chief operating officer at PhRMA.
| | | Insider reports on the pharmacy startup Medly, one of the many healthcare startups fueled by venture dollars that grew fast during the last two years only to come crashing down. The New York Times explores how a compulsive liar is being treated for his disease. STAT reports on whether PhRMA has lost its edge in Washington, D.C. | | | | Follow us on Twitter | | | | Follow us | | | | |
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