Update on GOP Medicaid negotiations

The House Rules Committee passed the budget reconciliation bill late Wednesday night, teeing it up for House floor action.

House Republicans made a few surprise revisions to the Medicaid portion of that bill, including one that would reward states for not expanding Medicaid. That measure would let nonexpansion states pay doctors and hospitals more than expansion states would be allowed to pay providers.

Another change calls for funding federal subsidies for health insurers that help pay out-of-pocket costs for low-income people who get coverage through the Affordable Care Act’s marketplaces. That’s a reversal of a policy that President Trump instituted during his first term. Trump scrapped the cost sharing reduction payments in 2017, but at the time the Congressional Budget Office estimated that terminating the subsidies actually increases government spending, and it failed to undermine the ACA marketplaces.

Insurers that cover abortions would not receive the cost sharing reduction payments under the updated bill.

The biggest change calls for starting Medicaid work requirements at the end of next year, up from the beginning of 2029. That change will likely significantly increase the projected savings from work requirements, which were already estimated at $280 billion over a decade.

Previously, the bill would’ve banned Medicaid coverage of gender-affirming care for minors. The updated bill expands that ban to adults.

Republicans also broadened a measure aimed at denying insurance to immigrants. The previous version called for penalizing states that provide coverage to undocumented immigrants with state funds. Now it would also penalize states that use a federal option available in Medicaid and the Children’s Health Insurance Program to expand coverage for lawfully residing children and pregnant people.

fda

When answers beg more questions

The new Covid-19 vaccine framework that FDA Commissioner Marty Makary announced Tuesday was supposed to clear things up, but it caused a lot of confusion, according to Lizzy Lawrence and Helen Branswell.

The FDA will limit Covid vaccines to people 65 and older and to those at risk for severe Covid outcomes going forward, and will require vaccine makers to study whether the shots benefit healthy adults and children.

Instead of writing a regulation, which gives the public a chance to chime in, Makary and top vaccine regulator Vinay Prasad seem to have hatched the framework themselves, publishing it in a medical journal. That left several gaps in the policy. Read more for the five big unanswered questions.

vaccine advisory meetings

An FDA meeting to watch

The FDA’s vaccines expert panel meets today to discuss whether Covid-19 vaccines should be updated for the coming fall, my colleague Helen Branswell reports. Vaccines experts and industry figures will be watching the meeting closely, hoping to glean more information about the FDA’s new framework for Covid vaccines.

The Vaccines and Related Biological Products Advisory Committee will likely be asked to vote on whether Covid shots should target a newer version of the virus — a move which might trigger new testing requirements from manufacturers that are laid out in the framework.

Last week, an expert panel that advises the World Health Organization said it thinks the vaccines don’t need updating; the current strains in the vaccines are still offering good protection. The FDA briefing document appears to signal the agency believes targeting a newer version of the virus would be wise, though as of Wednesday, the agency hadn’t revealed the vote that will be put before VRBPAC. FDA asks the committee for its advice, but it isn’t bound to follow it.

vaccines

Boning up on mRNA vaccines

Messenger RNA vaccines are under attack, and on Wednesday, a Senate subcommittee held a hearing advertised as an investigation into how health officials downplayed and hid side effects of Covid-19 vaccines, including inflammation of heart muscles.

Jonathan Wosen takes a step back to review how mRNA vaccines for Covid-19 were tested in double-blinded, placebo-controlled clinical trials in tens of thousands of people prior to approval, and how they were monitored around the globe once on the market, showing that they’re safe and effective at preventing the worst Covid-19 outcomes.

He explains how the vaccines work and the promise their technology holds for treating other diseases, such as cancer. He also dispells some common misperceptions – tissue from aborted fetuses is not used in mRNA vaccines, and the vaccines do not integrate into our DNA. Read more if you want to refresh your memory on the history of how the vaccines came to be.

maha

Three ideas to ‘Make America Healthy Again’

Tuesday’s newsletter highlighted an article on the many priorities the MAHA Commission could choose from as it puts together a report, expected today, on the biggest health problems facing the nation.

Isa Cueto follows that up with an article on three tactics the administration could use to actually MAHA.

STAT interviewed a broad range of health experts about chronic disease and examined reams of publicly available data, dozens of research papers, and federal health guidance. Read more to learn from Isa how the administration could reduce illness and death across the population in a relatively short time.

influence

Friends with money

Seven health tech companies met with HHS Secretary Robert F. Kennedy on Monday. Six have received funding from the top Silicon Valley venture capital firm Andreessen Horowitz. Co-founder Marc Andreessen was a vocal supporter of Donald Trump’s bid for president, according to Mario Aguilar.

Andreessen also helped recruit staff for the administration and is a major investor in Levels, the health-tracking company founded by surgeon general nominee Casey Means.

Coincidence? Maybe. But the assembled group at least gives the appearance of favoritism to an investor with ties to the administration. (Representatives for the investment firm and HHS did not respond to requests for comments.) Read more.

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What we’re reading

Maryland governor signs law to expand powers of the state’s prescription drug affordability board, STAT
Here’s what’s in the big domestic policy bill to deliver Trump’s agenda, The New York Times
Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers, STAT

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