Debt deal retains new VA health benefits

The ideas and innovators shaping health care

May 31, 2023 View in browser   By Ben Leonard and Erin Schumaker WASHINGTON WATCH Comedian Jon Stewart lobbied for the new veterans' benefits last year. | Francis Chung/POLITICO The Department of Veterans Affairs and its health care programs were winners in the debt ceiling deal between President Joe Biden and House Speaker Kevin McCarthy, presuming Congress is able to pass it. Other non-defense agencies are looking at nearly flat budgets in 2024, but VA health care programs will get the increase Biden proposed in March, to a total of $121.1 billion. That includes $20.3 billion to cover benefits and other costs of a 2022 law tasking the VA with compensating veterans sickened by exposure to toxic chemicals during their service. The 2022 law authorized $280 billion to cover 10 years of costs. The department is now implementing it. Nearly 600,000 veterans have submitted claims and the government has paid $1.1 billion in benefits. The debt deal ensures the money keeps flowing. “It’s a good show of faith,” VA Press Secretary Terrence Hayes told Ben. “This was a promise that Congress made to veterans.” “We’re in a full court press to encourage them to enroll,” Hayes said. The VA is staffing up to handle the influx of claims, Hayes said. It’s hired more than 3,100 new employees to aid in processing and plans to hire more. The overall workforce for the Veterans Benefits Administration has grown 15 percent since fiscal year 2022, Under Secretary for Benefits Joshua Jacobs said in recent congressional testimony. Still, the agency expects its claims backlog to increase in the summer, he said. The agency has projected the backlog of claims to rise beyond 400,000 between 2023 and 2024, and for it to become more stable in 2025.   DON’T MISS POLITICO’S HEALTH CARE SUMMIT: The Covid-19 pandemic helped spur innovation in health care, from the wide adoption of telemedicine, health apps and online pharmacies to mRNA vaccines. But what will the next health care innovations look like? Join POLITICO on Wednesday June 7 for our Health Care Summit to explore how tech and innovation are transforming care and the challenges ahead for access and delivery in the United States. REGISTER NOW.     WELCOME TO FUTURE PULSE Camden Yards, Baltimore, Md. | Ben Leonard This is where we explore the ideas and innovators shaping health care. Could moving to Everest Base Camp be good for you? A new Harvard study found that mice forced to live in a low-oxygen environment lived 50 percent longer than expected. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, your host Ben chats with POLITICO's Victoria Guida about her data analysis revealing how low-income workers saw significant wage gains during the pandemic as a result of market changes and government policies. Plus: What the data shows about health care workers. Listen to today’s Pulse Check podcast POLICY PUZZLE With buprenorphine, policymakers are struggling to figure out how much prescriber training is needed. | Elise Amendola/AP Photo When Congress in December lifted a requirement that doctors receive specialized training and register to prescribe buprenorphine for opioid use disorder, the aim was to increase the number of patients using the effective treatment. But a new study in JAMA Health Forum by researchers from RAND Corporation and Johns Hopkins, among other institutions found that prescribers who received additional training beyond what was required under the so-called X-waiver rules Congress rescinded were more willing to write scripts for buprenorphine. “We found it a little counterintuitive,” Bradley Stein, lead author and director of the RAND-USC Schaeffer Opioid Policy Tools and Information Center, told Ben. “The general narrative has been that ‘we’ve got to get rid of the X-waiver because this training is a barrier.’” How’s that? Stein and his colleagues found that additional education made doctors more comfortable prescribing the drug, given that buprenorphine is itself an opioid and is used to treat a highly stigmatized condition. What’s next? The law that ended the X-waiver included a provision mandating new training for prescribing controlled substances like buprenorphine, but it’s unclear what that will entail. "There may be an opportunity here if they do that well," Stein said. "There's a lot of misunderstanding about buprenorphine and how it works." Still unsolved: A number of other barriers remain for prescribing the drug, including Drug Enforcement Administration regulation. Doctors told POLITICO they've struggled to fill prescriptions as pharmacies and distributors try to avoid running afoul of a DEA system tracking suspicious orders. The DEA has said it’s working to address distribution bottlenecks.   GET READY FOR GLOBAL TECH DAY: Join POLITICO Live as we launch our first Global Tech Day alongside London Tech Week on Thursday, June 15. Register now for continuing updates and to be a part of this momentous and program-packed day! From the blockchain, to AI, and autonomous vehicles, technology is changing how power is exercised around the world, so who will write the rules? REGISTER HERE.     CHECKUP Identifying people at risk of postpartum depression could help accelerate treatment. | AP Photo/Jae C. Hong Depression associated with hormonal birth control may indicate an increased risk of postpartum depression. That was the finding of a study by researchers at the University of Copenhagen, who analyzed Danish health registry data from more than 188,600 first-time mothers between 1995 and 2017. The researchers suggest it could help identify people at risk and improve treatment. At a glance:  — Postpartum depression mirrors regular depression, according to the Centers for Disease Control and Prevention, but may include additional symptoms, such as doubting your ability to care for your baby. — Compared to the so-called baby blues, postpartum depression is more intense and lasts longer than the tiredness, sadness or worry many people experience after giving birth, the CDC says. — Thirteen percent of women reported having symptoms of depression after childbirth, according to the 2018 CDC data. — Untreated postpartum depression is associated with health problems for the mother and poorer mother-infant bonding, the CDC says. — The pandemic might have intensified the problem. A third of women in a University of Michigan study conducted during the first year of the pandemic reported postpartum depression symptoms. In the study, a depressive episode linked to birth control was defined as a patient being prescribed antidepressants or receiving a depression diagnosis within six months of starting hormonal contraception. Since the researchers could only identify severe depression, there could potentially be implications for women who have less severe symptoms that don’t reach the level of a formal diagnosis or that they don’t seek treatment for. Takeaways: “It’s important to know that there’s a subgroup of people who are particularly susceptible to hormonal transitions and the mood changes related to it," Lucy Hutner, a reproductive psychiatrist in New York not associated with the study, told Erin. Ultimately, the goal of identifying at-risk patients is to treat them faster. “If we catch these positive cases, it’s not like they’re just going to sit there and have severe depression, and there’s nothing that we can do about it,” Hutner said, adding, “This is a treatable condition.”   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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