News: Becerra’s Medicaid pleas

Tuesday, December 19, 2023

Becerra’s Medicaid pleas

Dec 19, 2023

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By Ben Leonard and Chelsea Cirruzzo

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9 states are responsible for 60 percent of child Medicaid coverage losses

ASKING STATES TO DO MORE — HHS is pleading with states that have the highest rates of children disenrolled from Medicaid to adopt certain federal rules to make it easier to bring them back onto coverage, Chelsea reports.

On Monday, HHS Secretary Xavier Becerra sent letters to the governors of nine states — Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas — which the Biden administration says are responsible for 60 percent of children’s coverage losses between March and September.

In the letters, Becerra urged the states to adopt more of the options CMS has offered to ensure kids are covered, such as allowing states to use enrollee information they have to auto-renew coverage.

HHS also introduced new guidance for states on Monday, which includes giving kids who haven’t started the renewal process an additional 12 months to get back on the rolls. Those options are available through 2024, CMS Administrator Chiquita Brooks-LaSure told reporters.

“State choices matter,” CMS Deputy Administrator Daniel Tsai said. “States that have taken up the historic number of new policy flexibilities that CMS has put on the table are better able to protect kids' coverage.”

State response: Three of the nine states cited by HHS — Florida, Georgia and Texas — responded to requests for comment.

"A reminder that the Medicaid redetermination process is simply setting normal operations back in motion, like how it was before the pandemic, to ensure those accessing a safety net program in our state are those who truly qualify," Mallory McManus, deputy chief of staff for Florida's Department of Children and Families, wrote in an email.

Tiffany Young, a spokesperson for Texas' health department, said the state was meeting regularly with federal partners on the redetermination process and staggered the unwinding over several months.

Garrison Douglas, a spokesperson for Georgia's governor, said the Biden administration "once again missed an opportunity to urge families to fill out their paperwork" and said the state has taken steps to ease unwinding, including reaching families at back-to-school events and doing auto-renewals.

How we got here: After the public health emergency ended in May, states were required to review the eligibility of Medicaid enrollees. The subsequent unwinding has seen nearly 3 million children to date kicked off the rolls, according to the Georgetown University Center for Children and Families.

In September, CMS said half a million people, including kids, who lost coverage mistakenly did so due to errors by the states. Those states were told to pause disenrollments and reinstate individuals who lost coverage or risk losing federal funding.

WELCOME TO TUESDAY PULSE. More than 100 organizations are calling for Congress to reauthorize the Pandemic and All-Hazards Preparedness Act. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with POLITICO global health reporter Carmen Paun, who takes stock of the fentanyl epidemic and its devastating and fatal impact over the past year.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It’s time to lower costs by holding middlemen accountable.

Cybersecurity

A ransomware message on a computer screen.

Publicly traded companies must now report cyberattacks and other data breaches within four days of the incident. | Rob Engelaar/AFP via Getty Images

NEW CYBER REPORTING RULES — New rules from the Securities and Exchange Commission are now in effect that require publicly traded companies, including health care firms, to quickly disclose cyber incidents.

Any breaches deemed “material” — like ransomware attacks and data breaches — must be reported on forms in four business days. Companies must also release an annual cyber report akin to a public report card. The new rules come as cyberattacks on corporations, including many large health care organizations, have skyrocketed.

Companies have pushed for more time to report incidents, but administration officials have said exemptions to the four-day requirement will be rare.

The health care angle: Health care groups, including the Federation of American Hospitals, have raised concerns that the regulations would conflict with HIPAA, the law that protects patient information. They argue the rules could make it more difficult for law enforcement to investigate incidents and find cybercriminals. The Chamber of Commerce warned that moving too quickly to disclose vulnerabilities in the medical device sector could cause "unmerited panic.”

“Premature disclosure could cause individuals to make safety-related decisions based on incomplete information, such as deferring medical procedures,” the group wrote.

The SEC has said it doesn’t think the breach reporting requirements under HIPAA conflict with the rules, arguing the regulations focus on the breach’s consequences for those impacted. The SEC argued that its rule focuses on “consequences for the company that are material to investors.”

A message from PhRMA:

Antitrust

FTC, DOJ FINALIZED MERGER GUIDANCE — The Federal Trade Commission and the Justice Department on Monday finalized new merger guidelines that will apply across the economy, including the health care sector.

The rules largely align with the agencies’ proposal this summer aimed to prevent excessive concentration and bar mergers that eliminate competition or entrench a dominant position. The FTC-DOJ move has drawn fire from the pharmaceutical industry, which argued the rules would stifle innovation.

Courts have the final say after the FTC and the DOJ take on mergers.

Pharmaceutical companies have argued that given the substantial cost of drug development, mergers and acquisitions are key to getting new treatments across the finish line and that the proposed guidelines created a “chilling effect” for mergers and acquisitions.

The Partnership for the U.S. Life Science Ecosystem, a coalition of pharmaceutical and life science companies that has pushed back on the FTC and the DOJ’s merger moves, said in a statement it’s still reviewing the guidance but “significant concerns” remain.

“The latest merger guidelines introduce unclear standards of competition that create uncertainty, inconsistent application and potential impediments to pro-innovation mergers,” the group said.

The group’s members include Merck, AbbVie and Amgen, which have faced antitrust scrutiny, and state trade associations that represent smaller firms.

The FTC in health care: In the pharmaceutical sector, the FTC has focused on bundled discounts for products, which it argues could cement market dominance. The agency has also taken a hard line against hospital mergers and sought to block Illumina’s takeover of multicancer testing company Grail.

HEALTH TECH

APPLE WATCH LIST — Apple will stop selling some of its watches in the U.S. beginning this week amid a patent dispute, the company told Pulse.

The U.S. International Trade Commission ruled this fall that the company violated medical device company Masimo's patents on technology measuring blood oxygen levels. Apple’s move comes ahead of the end of a review period before a ban could go into place.

Apple said it’s taking preemptive action in case the ruling goes into effect after the review window ends Dec. 25. Such a ruling, if allowed to go into effect, would apply to two of its newest Apple Watch products.

“Apple strongly disagrees with the order and is pursuing a range of legal and technical options to ensure that Apple Watch is available to customers,” the company said in a statement.

Presidential overrides are rare, but former President Barack Obama used his authority to stop an import ban on certain iPhones and iPads in 2013.

Zooming out: If the order goes through, it would be a blow to one of the largest makers of wearable technology, which is increasingly being used as a tool in health care. A bipartisan group of lawmakers in Congress is looking to allow people with health savings or flexible spending accounts to use those funds for wearable devices.

At the White House

THE HARRIS TOUR — Vice President Kamala Harris is set to go on a “nationwide” tour to support reproductive freedom and condemn “extreme” attacks on it, the White House said Tuesday.

The events will “bring together thousands of people to fight for the freedom of every American to make decisions about their own body,” the White House said in a release.

She’ll launch the tour next month in Wisconsin.

Democrats, including President Joe Biden, have seized on abortion post-Dobbs as a campaign issue that’s proved potent in several states. It plays to figure a major role in the presidential race.

Names in the News

Kevin Klauer will become CEO of the American Health Information Management Association next month. He has served as chief medical officer at HCA Florida Ocala and West Marion Hospitals. He’ll replace Amy Mosser, who has served as interim CEO since June.

Christian Nguyen of Eli Lilly has been elected chair of the National Pharmaceutical Council's board. Jan Hansen of Genentech has been elected vice chair, Rekha Ramesh of Gilead Sciences treasurer, Christine Marsh of Boehringer Ingelheim immediate past chair and Jeremy Allen of Spark Therapeutics member-at-large.