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| By Chelsea Cirruzzo and Ben Leonard | Presented by the Coalition to Strengthen America’s Healthcare | |
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Rep. Ami Bera, who sits on the House Task Force on AI, said he has discussed the California law with doctors who’ve met with the group. | Drew Angerer/Getty Images | GOING NATIONAL? Capitol Hill has its eye on California’s new law that regulates how artificial intelligence is used by insurers in granting prior authorization for treatments, Chelsea reports. Rep. Ami Bera (D-Calif.) told Pulse the House Task Force on AI he sits on has discussed the law, along with doctors who’ve met with the group. What the California law does: Starting in January, it will require insurers to oversee prior authorization requests processed using AI. Why it matters: Health plans have used AI in recent years to streamline processing claims and prior authorization requests, but concerns have arisen about wrongful denials. Last year, insurers like United Healthcare and Cigna were hit by class-action lawsuits claiming they were using AI without doctor oversight, leading to improper denials of medical coverage. A staffer for state Sen. Josh Becker, a Democrat from a district just south of San Francisco who introduced the bill, told Pulse that the American Medical Association backed the measure. The staffer added that Becker’s office has spoken with congressional offices, as well as a member of the Task Force on AI, about possibly introducing legislation that mirrors the state law.
“We will probably approach it by seeing the impact of the law,” Bera told Pulse. “Does it streamline lower costs? Does it not hinder lower costs? If it does all of those things, it could be a model nationwide or in the other 49 states.” Task force co-chair Rep. Jay Obernolte (R-Calif.) didn’t comment directly on the California legislation. But his office said he supports consistent, nationwide standards for AI that also allow smaller AI companies to thrive. The office of co-chair Rep. Ted Lieu
(D-Calif.) declined to comment. Gaining traction: The AMA’s House of Delegates adopted a policy on AI’s use in prior authorization in October that’s similar to California’s. It says a doctor should review any care denials recommended by AI and asks insurers to provide evidence that their algorithms don’t discriminate or increase inequities. The bigger picture: Lawmakers have scrutinized prior authorization in recent years, concerned it’s being used too readily to deny care, particularly in Medicare Advantage, the privately run alternative to traditional Medicare. A growing number of hospitals have dropped MA plans, citing the denials. A bicameral, bipartisan bill reintroduced in June would mandate insurers more quickly approve requests for routine care. What’s next? The task force is expected to issue a report on its recommendations for regulating AI, including in health care, later this month — which Bera said could contain a proposal to elevate the task force into a select committee. WELCOME TO TUESDAY PULSE. A recent study suggests that people on weight-loss drugs lose their appetite for alcohol. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard.
| | | | A message from the Coalition to Strengthen America’s Healthcare:
Hospitals are there for you and your family every hour of every day, ensuring you receive the appropriate level of care. Nearly half of all hospitals offer a trauma center that includes a multi-disciplinary team of surgeons, physicians and caregivers ready to help patients facing life-threatening injuries such as falls, motor vehicle collisions or gunshot wounds. GET THE FACTS. | | | | | VAPING ARGUMENT — The Supreme Court appears open to siding with the FDA in a case involving the agency’s decision to deny authorization for a flavored e-cigarette product, POLITICO’s David Lim reports. How we got here: The FDA denied Texas-based Triton Distribution’s application to sell the flavored e-liquids out of concern that they appeal to children. A 2009 law gave the agency power to regulate tobacco products. In 2016, it issued rules deeming e-cigarettes within its regulatory powers. The 2009 law banned cigarette flavorings, with the exception of menthol. Triton’s case: During Monday's oral arguments in FDA v. Wages and White Lion Investments, Triton argued that the court should affirm a lower court's ruling that the agency reconsider its applications to sell flavored liquids containing nicotine that e-cigarettes heat for a user to inhale. Eric Heyer, the attorney for Triton, argued that if the FDA is directed to reevaluate the applications, the incoming Trump administration could take a friendlier approach to the e-cigarette, or vaping, industry. He noted that President-elect Donald Trump pledged on his Truth Social site in September to save vaping. But the justices seemed unsympathetic, with liberal justices reiterating FDA concerns about the flavorings’ appeal to youth. “Everybody basically knows that flavors are particularly dangerous in terms of kids starting the use of smoking products,” Justice Elena Kagan said. Conservatives on the court questioned whether there would be any point in asking the agency to reconsider its decision. Justice Brett Kavanaugh said Triton has the option to reapply for approval.
Why it matters: Health officials in Trump’s first administration had sought to keep the products away from kids, but Trump suggested he could both permit flavored e-cigarettes to help smokers of combustible cigarettes, which are thought to be more unhealthy, and keep children from getting hooked on them. What’s next? A decision is expected by the end of the Supreme Court term in June.
| | | | REGISTER NOW: As the 118th Congress ends, major decisions loom, including healthcare appropriations. Key focus: site neutrality. Can aligning hospital and clinic costs cut federal spending, reflect physician costs, and lower patient expenses? Join policymakers and providers to discuss. | | | | | | |
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“The Covid-19 pandemic highlighted a distrust in leadership,” Rep. Brad Wenstrup said in a statement on the report. | Drew Angerer/Getty Images | INSIDE COVID REPORT — A House Republican-backed report calls nearly 2 million reports from the public about adverse impacts of the Covid-19 vaccine “alarming” while reiterating Republicans’ views that the disease leaked from a Chinese lab, POLITICO’s Robert King reports. That’s all in a report released Monday by Brad Wenstrup (R-Ohio), who chairs a committee tasked with examining the pandemic. What’s inside: The report defends doctors who were “reprimanded, threatened, censored, or even fired” because they prescribed unproven treatments like the anti-parasite drug ivermectin, which is often used to treat animals. The report cites an FDA tweet from August 2021 that warned against taking the drug: “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” Earlier this year, the FDA agreed to settle with doctors who sued, alleging the agency had harmed their reputations with the missive, and deleted the post.
“The Covid-19 pandemic highlighted a distrust in leadership,” Wenstrup said in a statement. “Trust is earned. Accountability, transparency, honesty, and integrity will regain this trust.” What’s next? The panel plans to meet on Wednesday to vote on approving the report. That’s likely to be partisan. Democrats on the panel have accused Republicans of trying to settle scores rather than fairly examine the pandemic and prepare for the next one. “Instead of taking steps forward to prevent and prepare our nation for future pandemics, this [House Select Subcommittee on the Coronavirus Pandemic] has spent two years fanning the flames of people’s mistrust in public health,” ranking member Raul Ruiz (D-Calif.) said in a statement before a hearing last month. Ruiz did not return a request for comment on the report.
| | | | A message from the Coalition to Strengthen America’s Healthcare:   | | | | | FIRST IN PULSE: DISASTER-RELIEF PITCH — A major hospital lobbying group is launching a six-figure ad campaign to convince Congress to extend tax credits to hospitals as lawmakers consider disaster relief funding, Ben reports. “Hospitals went above and beyond to ensure 24/7 quality care and provide basic necessities for patients, employees, and communities during Hurricanes Helene and Milton,” the Federation of American Hospitals’ Charlene MacDonald said in a statement. “As hospitals work to recover, rebuild, and prepare for future natural disasters, it's critical that Congress provides meaningful support … ”
FAH is calling for tax credits for its members, including reinstating Hurricane Katrina-era employee retention tax credits and bolstering work opportunity tax credits for hospitals hiring people from groups that have historically faced obstacles in getting jobs, to help hospitals retain workers as they rebuild. The group also wants tax credits for hospitals that offer employees housing. Zooming out: Hospitals are pushing to get their priorities into a broader disaster-relief package that would replenish funds after a slew of disasters drained cash earmarked to help. The Biden administration has requested close to $100 billion for the package. Top lawmakers are targeting a deal by Dec. 20, when government funding runs out.
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POLITICO’s Jennifer Scholtes and Katherine Tully-McManus report that Congress is readying another funding punt ahead of Christmas. POLITICO’s Natalie Fertig reports on a DEA hearing to consider rescheduling marijuana. The New York Times reports on confusion over which organs to remove during hysterectomies. The Associated Press reports on challenges to getting a twice-annual AIDS shot to patients.
| | | | A message from the Coalition to Strengthen America’s Healthcare:
When tragedy strikes, you want to receive the best care possible for yourself and your loved ones. Nearly 85% of all trauma patients require the highest levels of complex, life-saving care that only hospitals are equipped to provide. It’s essential to protect these critical access points and the unique care they provide to patients in their communities 24 hours a day, 7 days a week, 365 days a year.
GET THE FACTS. | | | | |
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