What’s ahead for Medicaid? Look to Arkansas.

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

Feb 27, 2023 View in browser   By Daniel Payne and Krista Mahr Presented by Driving The Day Arkansas Gov. Sarah Huckabee Sanders seeks a work requirement that will limit Medicaid eligibility in the state. | Pool photo by Al Drago (RE)DETERMINED — With pandemic protections set to expire, Arkansas is preparing to check its residents’ eligibility for Medicaid — and fast, POLITICO’s Megan Messerly reports. Though the Biden administration gives states a year to assess whether millions of people should be on the rolls, Arkansas is looking to do so in half the time. That could offer a window into what’s to come around the country, as Medicaid beneficiaries — for the first time in nearly three years — will be at risk of losing coverage. Those verifications were once routine, and their resumption nationwide could lead to as many as 15 million people, including 5.3 million children, being booted from the rolls. GOP Gov. Sarah Huckabee Sanders is pushing to remove people from “government dependency.” This month her Medicaid agency started sending letters to tens of thousands of Medicaid recipients asking for proof of income and a host of other details to show they’re still eligible for the insurance program. More than a third of the state’s 3 million people are on Medicaid, and Huckabee Sanders recently introduced a work requirement limiting who can continue on the program. While the governor’s office held up the requirements as a policy that would “move people from government dependency to a lifetime of prosperity,” some health policy experts say the fervor to check eligibility quickly and add requirements could leave some people without coverage. “This is so much bigger than the work requirements, so it could be much more devastating. Work requirements were … just a few thousand people. This is everybody,” said Loretta Alexander, health policy director of Arkansas Advocates for Children and Families. “You just know that there’s going to be some people that fall through the cracks.” WELCOME TO MONDAY PULSE. Do you know about coming Medicaid redetermination policies? What about a tip about the next big health care story? Let us know at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Erin Schumaker about research presented at a recent panel at Harvard T.H. Chan School of Public Health on the science of sleep and how nonmedical factors like race, education, socioeconomic status and Zip code can contribute to the quality of your sleep. Listen to today’s Pulse Check podcast   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.   Global Health An updated report from the Energy Department says the Covid pandemic could have been set off by a lab leak in China (pictured: the Wuhan Institute of Virology). | Ng Han Guan/AP Photo LAB LEAK REPORT REACTIONS — The Wall Street Journal reported Sunday that the Energy Department updated one of its reports to say a lab leak is the most likely explanation for Covid’s origins — noting the department made the judgment with “low confidence.” The classified report highlighted the varying answers and degrees of uncertainty from different corners of the administration, with other agencies finding natural transmission to be the most likely reason for the pandemic based on current evidence. The Energy Department didn’t respond to Pulse’s request for comment, and national security adviser Jake Sullivan declined to address the report when asked about it Sunday on CNN’s State of the Union. The article was held up by Republican lawmakers, who said it proved the need for more investigation into the pandemic, which has already resumed in the House. The GOP Oversight Committee’s Twitter account shared the Journal’s reporting, adding that more answers and accountability are needed. Sen. Josh Hawley (R-Mo.) promised to introduce legislation that, if passed, would make the intelligence reports public. More results to come: More investigations into the origins of Covid-19 are ongoing, led by the U.S. government and other groups, like the World Health Organization. Still, new information on the pandemic’s origin story is emerging, as some investigators are citing concerns that not enough information is yet being shared by China’s government to get a clear picture of what happened.   DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID.     At the Agencies TAKING IT OFFLINE — On Friday, the Drug Enforcement Administration proposed a return to pre-pandemic rules requiring patients to make in-person doctor visits to get certain prescriptions, POLITICO’s Ben Leonard reports. The rules, which — if finalized — would take effect at the Public Health Emergency’s end in May, are a significant blow to telemedicine advocates. The rule could also change the way in which many people access their medications. Patients seeking Adderall to treat attention-deficit/hyperactivity disorder or Oxycontin for pain relief must visit their doctor’s office before they can start taking the drugs. And those who take buprenorphine for opioid use disorder, testosterone for gender-affirming care or ketamine for depression could get an initial 30-day supply via telemedicine but would have to visit a doctor’s office to refill the prescriptions. The proposed policy, open to comment for 30 days, comes after the administration started investigating telehealth companies Cerebral and Done for allegedly overprescribing ADHD medications under the eased pandemic rules. THE FIVE-YEAR PLAN — The FDA’s Center for Tobacco Products, responding to the Reagan-Udall review of its regulatory operation released Friday, pledged to develop a five-year plan to clarify its focus, POLITICO’s Katherine Ellen Foley reports. The report laid out recommendations for how CTP could refocus itself, including creating an Office of Policy to outline priorities, calling on its advisory committee for help and pursuing user fees for the products it regulates, including e-cigarettes. The agency also said that CTP needs to work more efficiently with other agencies to ensure that products denied marketing orders stay off the market. “I am a strong believer that we can always benefit from examining how we can work most effectively and proactively to protect public health, support our staff and be as responsive as possible to external stakeholders,” FDA Commissioner Robert Califf said in a statement.   A message from PhRMA:   Covid TWOFER TESTING — In a first, the FDA authorized a combo at-home test for Covid and the flu, POLITICO’s David Lim reports. The test, performed using a nasal swab, can differentiate between influenza A and B as well as Covid. It’s made by Lucira Health and takes about 30 minutes to get results. “Today’s authorization of the first OTC test that can detect Influenza A and B, along with SARS-CoV-2, is a major milestone in bringing greater consumer access to diagnostic tests that can be performed entirely at home,” top FDA medical device regulator Jeff Shuren said in a statement. Public Health SAMPLES ON A PLANE — Research testing wastewater from aircraft coming from Europe found most planes had Covid-19 onboard, Krista reports. The pilot study, conducted by the Centers for Disease Control and Prevention and biotech firm Ginkgo Bioworks, tested 80 wastewater samples from 88 aircraft arriving in New York City from the Netherlands, France and the United Kingdom between Aug. 1 and Sept. 9. It found that 81 percent of the samples collected were positive for the coronavirus. The study demonstrated that it’s possible to collect wastewater from commercial aircraft and anonymously screen arriving passengers for infectious diseases. It could be used to not only continue to monitor Covid variants but also detect the beginning of other disease outbreaks, such as mpox.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Names in the News Sandra Elizabeth Ford has left the White House, where she was special assistant to the president for public health and science. She is doing healthcare consulting with her company BFT Consulting, which stands for “Built Ford Tough.” Jeff Ventura is now VP of comms at the Council for Responsible Nutrition. He previously was director of comms for HHS. What We're Reading The New Yorker reports on A.I.’s role in treating mental illness. The New York Times reports on why older Americans often aren’t screened for anxiety. The Washington Post reports on the young doctors leaving Egypt in droves.   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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