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 | | By Ben Leonard and
Chelsea Cirruzzo | Presented by CareQuest Institute for Oral Health | |
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The future of Obamacare hangs in the balance of the 2024 presidential election, with former President Donald Trump and Vice President Kamala Harris representing different approaches. | Joe Raedle/Getty Images |
WHAT’S AT STAKE FOR THE ACA — Obamacare is stronger than ever ahead of this year’s open enrollment period, which kicks off Friday. But the presidential election could upend that, POLITICO’s Robert King and Kelly Hooper report. Trump’s take:
Former President Donald Trump has said he has the “concepts of a plan” to replace or improve the Affordable Care Act. His campaign said in a statement that he doesn’t want to “terminate” the ACA, and he hopes to bring down costs by “increasing transparency, promoting choice and competition, and expanding access to new health care and prescription drug options.”
Trump’s term in office offers clues to how he might approach the popular health insurance program, which has seen record enrollment during President Joe Biden’s term. In 2017, Trump cut marketing funding for open enrollment, and his administration refused to defend the law in court. He expanded options for short-term plans and association health plans, a move conservatives praised and Democrats derided as “junk insurance.”
Republican health care strategists hope that a Trump administration would tighten eligibility reviews and crack down on what they say is pervasive fraud in Obamacare, which they fear would expand under a Harris administration. Harris’ take: Vice President Kamala Harris would likely build on the Biden administration’s efforts to expand insurance networks and offer greater protections for consumers, according to six state exchange directors.
“There’s going to be a change in administration, no matter who wins. The question is, which direction do we go and what speed does it move?” said Kevin Patterson, CEO of Connect for Health Colorado, the state’s exchange. “For me, it’s really preparing for two very different approaches on what you’re trying to do with the Affordable Care Act.” The subsidy fight:
The most pressing issue at stake for Obamacare is the enhanced subsidies created under the 2021 American Rescue Plan Act. The subsidies, which expire next year, provide financial support for middle-class families, small-business owners and others to purchase health insurance. Even if Harris wins, there’s no guarantee a Republican-controlled Senate or House would extend the benefit. The Trump campaign and former Trump officials have signaled opposition to the program. Its end could force millions of people off the rolls, according to insurance executives and exchange directors.
WELCOME TO TUESDAY PULSE. We want to hear about your health care-themed Halloween costumes. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and
@ChelseaCirruzzo.
| | | | A message from CareQuest Institute for Oral Health:
Drug prices, mental health, abortion — all health care topics the presidential candidates are debating. But neither is focused on the topic that has support from both parties: extending dental care to millions in the US who lack insurance. A new national poll commissioned by CareQuest Institute and the Oral Health Progress and Equity Network (OPEN) shows voters want better dental coverage in Medicare. Learn more and take action to improve the oral health system.
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Congress must address several expiring health care and public health programs when they return after the election. | Andrew Harnik/AP |
REAUTHORIZATIONS TO WATCH — Congress will return in two weeks after a contentious election and have a number of expiring — and already expired — programs to grapple with.
Lawmakers are expected to extend rules expiring at the end of the year that allow expanded access to telehealth for Medicare patients, but several other programs are set to expire at the end of the year, too. Below are some other programs we expect lawmakers to take a hard look at in the coming months: Older Americans Act:
The legislation, which pays for meals and medical services such as health screenings and transportation to doctors’ offices, expired at the end of September. The Senate Health, Education, Labor and Pensions Committee has advanced its version of legislation, but the House Committee on Education and the Workforce hasn’t released or marked up reauthorization legislation. It’s unclear whether it will be or when the issue might be addressed.
Pandemic preparedness: Lawmakers have temporarily reauthorized some portions of the Pandemic and All-Hazards Preparedness Act through the end of the year. Many portions expired at the end of September 2023. Parties have been divided over whether to include legislation addressing drug shortages in a longer-term reauthorization of the pandemic preparedness bill known as PAHPA. Health centers:
A major form of funding for community health centers is set to expire at the end of the year. A wide coalition of groups including Advocates for Community Health, which represents health centers, is pushing for an extension of at least three years with a minimum of $5.8 billion a year. Earlier this year, Congress passed a spending package that extended funding for the centers at an annualized rate of $4.27 billion — up $270 million from the previous year. Private-plan telehealth:
Pandemic-era rules allowing telehealth coverage in high-deductible health plans before deductibles are met expire at the end of the year. Key Democrats have been skeptical of continuing them, though a potential extension has bipartisan support. PEPFAR:
The United States President’s Emergency Plan for AIDS Relief, a global HIV/AIDS program credited with saving 25 million lives, authorization is set to expire March 25. The program has long had bipartisan support, but it’s been tangled up in a dispute over abortion.
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POSSIBLE LASSA FEVER CASE — The CDC and the Iowa Department of Health are investigating a suspected case of Lassa fever, which is spread by rats in West Africa, the agency said Monday. The illness is uncommon in the U.S. The case was found in an Iowa resident who recently visited West Africa, but the CDC noted that the person wasn’t sick when they traveled and the risk to fellow airline passengers is low.
The patient died at the University of Iowa Health Care Medical Center on Monday, the agency said, though it didn’t note whether there were other contributing factors. The illness often has typical fever symptoms, including general weakness, headaches, and a sore throat. Severe cases include facial swelling, fluid in the lung cavity and deafness, though the majority of cases are asymptomatic. Among patients hospitalized with severe cases, the fatality rate is around 15 percent
, according to the World Health Organization.
| | | | A message from CareQuest Institute for Oral Health:
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IV FLUID EXPIRATION EXTENDED — A key manufacturer of IV fluid solutions said Monday that it’s received federal authorization to extend the expiration dates of some of its products, Chelsea reports. Baxter International, which maintains a North Carolina factory that was damaged during Hurricane Helene in September, said in a press release that some products manufactured before the end of September now expire 24 months after the manufacture date. The company also said it will soon begin ramping up production of IV solutions.
“Barring any unanticipated developments, Baxter anticipates restarting the highest-throughput IV solutions manufacturing line this week,” the company said in a statement. Helene forced the temporary closure of the factory last month and left hospitals scrambling to preserve their IV fluid supplies. Baxter on Monday encouraged hospitals to continue to ration their IV fluid supply. Staffing at the plant has since returned to pre-hurricane levels, and the company hopes to restore the allocation of the IV solution to 100 percent by the end of the year.
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MIXED REVIEW FOR DIGITAL BP TOOLS — The Peterson Health Technology Institute, a nonprofit aiming to provide independent evaluations of emerging health technologies, found varying results
for digital solutions to lower high blood pressure. PHTI partnered with the Institute for Clinical and Economic Review, a prominent independent, nonpartisan expert review panel, to create a framework for assessing health technology to help separate effective tools from ineffective tools amid the hype.
Providers and tech companies increasingly use tools like remote blood pressure monitoring and virtual coaching to help patients manage high blood pressure. Nearly half of U.S. adults have hypertension, and the condition caused or contributed to more than 685,000 deaths in 2022, according to the CDC. The findings:
The group found that drug management tools had a positive impact on clinical results with the potential to offset initial costs over the long term due to savings from averted cardiovascular complications, saying evidence backs wider adoption. But PHTI didn’t endorse broad adoption of blood pressure monitoring and behavior change systems. Blood pressure monitoring tools
increase net health spending at current payment rates and don’t produce significant declines in systolic blood pressure compared to typical care, the group said, arguing the evidence supports adoption for providers who use the data produced appropriately. Behavior change tools like those offering educational content or virtual coaching raise net health spending because “limited health improvements do not offset” the price, PHTI found, saying the evidence doesn’t suggest most patients should adopt it.
The methodology: The institute sought input from digital health companies whose products were being evaluated, providers, clinical advisers and economists and included a slew of comparative studies and 10-year estimates of cardiovascular risk from the American College of Cardiology and the American Heart Association. ANOTHER BIG ADD FOR TEFCA —
Oracle Health said Tuesday it will begin the process of becoming a qualified health information network under the HHS-led data-sharing framework known as TEFCA. It’s another potential major addition to the Trusted Exchange Framework and Common Agreement, run by HHS and nonprofit partner the Sequoia Project. It joins electronic health record giant Epic and data-sharing trade group the CommonWell Health Alliance, among others. A major concern about TEFCA had been industry buy-in, since it’s voluntary.
The initiative aims to better connect providers, public health agencies, researchers and others in medicine through a nationwide network to facilitate sharing of patient information.
| | The Wall Street Journal reports
on the Biden administration’s cancer moonshot tackling pediatric drug shortages. Modern Healthcare reports on some major health systems running into challenges with hospital-at-home programs.
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| A message from CareQuest Institute for Oral Health: A national poll shows that adding dental benefits to Medicare is a top health issue for US voters, even over abortion and the ACA. More specifically:
· 9 out of 10 voters want a Medicare dental benefit.
· More than 4 out of 5 voters for Trump in 2016 and 2020 want a dental benefit added to Medicare.
· 99% of those who voted for the Democrat candidate in the last two elections want a dental benefit added to Medicare.
“Far too many people have discovered oral health care is too expensive and out of reach,” says Melissa Burroughs, CareQuest Institute director of public policy. “Yet this issue has been on the back burner when it comes to policy conversations and the political commitment to address it.”
It’s simple: the American people want dental care included in Medicare.
It’s time to make this policy change a top priority — our health depends on it. | | | | |
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