| | | | |  | | By Chelsea Cirruzzo and Ben Leonard | With Carmen Paun and Kelly Hooper
| | THE STATE OF TELEHEALTH — As lawmakers weigh telehealth’s future with broad bipartisan support, it’s becoming clear that it hasn’t yet made the impact on cost and access that some thought it would. Usage has fallen — to the disappointment of Congressional leaders and the investment and tech sectors, some of whom thought it could fundamentally transform the U.S. health care system. In 2021, former Rep. Fred Upton (R-Mich.), a leading voice in Congress on health care until his retirement last year, called telemedicine “one of the best things, probably, since sliced bread.” Now, evidence is growing that telehealth hasn’t delivered the anticipated broad cost savings, and that trend isn’t expected to change soon. In rural areas, which many believed would disproportionately benefit from virtual care expansion, usage has also been lower than in other areas. “It hasn’t taken off like we thought,” Upton, who chaired the Energy and Commerce Committee, told POLITICO. “It can be [transformational], but progress is not as fast as we thought it could have been.” Harvard researcher Dr. Ateev Mehrotra, who Congress often calls to testify on virtual care, has found that expanded telehealth has led to slight increases in visits and spending and “modest” improvements in quality. Still, despite negative headlines and falling stock prices on Wall Street, it’s certainly not all doom and gloom for virtual care. Telehealth kept the health care system afloat in the pandemic’s early days, and it’s continued to broaden access and boosted outcomes in some areas, particularly in mental health and substance use disorder treatment. Telehealth advocates argue that comparing early pandemic usage levels — when in-person care was limited — to the present isn’t fair. Overall, telehealth appointments represented about 6 percent of visits in late 2023, according to Epic Research. That’s up from 0.2 percent in mid-2019.
|  | | “When you’re dealing with a health care system for hundreds of millions of people, any improvement in outcomes is definitionally transformational,” said Sen. Brian Schatz (D-Hawaii), one of virtual care’s longest-running backers. “It’s quietly one of the most important stories in health care in the last decade.” Outlook in Congress: Lawmakers are poised for a temporary extension of pandemic-era eased Medicare rules but still have questions about cost and fraud and seek more data. “I’ve never said it’s going to reinvent health care,” said Rep. Mike Thompson (D-Calif.), one of the House’s strongest telehealth supporters. “I have plenty of examples where it’s saved lives and money. … It’s still in that trial phase.” WELCOME TO THURSDAY PULSE. I spent my day off at the pool reading Dr. Anthony Fauci’s new memoir — which included some nuance about his strained relationship with former President Trump. And unlike Fauci in a 2022 interview, I did wear sunscreen! Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
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Still on the Supreme Court's docket are the Chevron doctrine and emergency abortion access. | Francis Chung/POLITICO | KEY DECISIONS LOOMING — Major Supreme Court rulings with potential implications for agency power and access to abortion could come as soon as today, Ben reports. Here’s what’s at stake: Agency power: The court seems poised to lessen the power of federal agencies by overturning or blunting the power of the so-called Chevron doctrine, which holds that when statutes are ambiguous and an agency regulates based on a “reasonable” reading, judges must uphold the regulation. If the court overturns Chevron, many parts of Medicare that are explicitly precluded from judicial review could be at a heightened risk of legal challenges. FDA regulations around pharmaceuticals and medical devices could also be at risk. Congress might opt to be more specific in legislation to direct agencies on implementing laws to avert challenges. Emergency abortion access: The Biden administration has used federal law to protect abortion access in medical emergencies in states that have banned the procedure. The Supreme Court could opt to narrow its already limited impact. Still, a ruling isn't likely to be the end of the battle. Medical groups say providers will be confused about when patients can receive abortion care regardless of how the court comes down.
| | FIRST IN PULSE: A HOSPITAL PRICING TACTIC — Hospitals are increasingly threatening to leave health coverage networks when insurers don’t agree to price increases for medical care, according to a report published today from Third Way, a center-left think tank, Kelly reports. The group alleges hospitals are partaking in a “hostage-taking” strategy as health systems become increasingly consolidated. Hospitals that dominate markets in some geographic regions have the power to raise prices and demand that insurers accept those prices in contract negotiations. If health plans don’t accept the higher prices, hospitals are, in some cases, threatening to leave insurers’ coverage networks, according to Third Way. The American Hospital Association rebuked the report’s findings, arguing that health insurers “with market share and scope well beyond hospitals” aren’t helpless in contract negotiations. “Hospitals’ decisions to leave a health plan network are a last resort when failing to do so would further jeopardize their ability to maintain the quality and access to care their communities deserve,” an AHA spokesperson said. Background: Contract disputes between health plans and hospitals have shot up in recent years. In the third quarter of 2023, at least 21 of these disputes were public, a 91 percent increase from the same time in 2022, according to data from FTI Consulting. Why it matters: Consolidation of hospital systems is hindering employers’ leverage to negotiate fair prices for their employee health plans, which cover more than 178 million Americans, says Third Way. For patients, losing in-network access to large hospital systems in certain geographic areas might prevent them from receiving the care they need, the group says. What’s next: Third Way is urging Congress to take three steps to address industry consolidation and prevent hospitals from threatening to leave coverage networks: — Eliminate incentives that encourage hospitals to consolidate. — Increase the budget for the FTC and the DOJ Antitrust Division and allocate new funding toward curbing hospital market consolidation. — Ban hospitals from using anticompetitive contracting terms.
| | MORE PREMIUMS THAN QUALIFIED ENROLLEES — An estimated 5 million people who received premium health insurance subsidies don’t meet qualifications for them, per a report by right-leaning health policy think tank Paragon Health Institute. Background: Enhanced premium subsidies, which lower or eliminate the cost of out-of-pocket premiums for people who report income between 100 and 150 of the federal poverty line, are available through 2025 under provisions in the American Rescue Plan Act and the Inflation Reduction Act. President Joe Biden has called on Congress to further extend those subsidies. According to the Paragon report, nearly half of the exchange sign-ups during the 2024 enrollment period reported income levels that qualified enrollees for subsidies. But the group said not everyone who reported those income levels actually qualify, equating to an estimated $20 billion in improper spending in 2024. How we got here: According to the report, enrollees estimate their income for the following year when signing up for a plan, with a reconciliation process later when a person files their taxes. But the IRS is limited in the amount it can recoup from people whose income no longer qualifies them for an enhanced subsidy. According to Paragon, in nine states where Medicaid hasn’t been expanded, a higher rate of enrollees report income in the range to meet the requirement for premium subsidies. Why it matters: The group said that — while it likely was an honest mistake made on the part of enrollees underestimating their income — health insurers receive large subsidy payments from improper enrollments. “The administration, seeking to inflate coverage numbers, has prioritized enrollment over the program’s integrity,” Paragon President Brian Blase wrote in a Wall Street Journal op-ed published Wednesday.
| | | | SUBSCRIBE TO GLOBAL PLAYBOOK: Don’t miss out on POLITICO’s Global Playbook, our newsletter taking you inside pivotal discussions at the most influential gatherings in the world. Suzanne Lynch delivers the world's elite and influential moments directly to you. Stay in the global loop. SUBSCRIBE NOW. | | | | | | | | | STRENGTH IN NUMBERS: Coordination with China and Mexico has led to indictments unsealed Tuesday of two dozen individuals allegedly involved in a money-laundering scheme for Mexico’s Sinaloa drug cartel, Carmen reports. China told the U.S. it took one of those indicted into custody and is pursuing its own charges against them, and Mexico has taken another indicted person into custody, Liz Sherwood-Randall, Homeland Security adviser, said in a statement Tuesday. Why it matters: The U.S. has seen record drug overdose deaths in recent years, mostly driven by fentanyl, which U.S. authorities say is primarily manufactured in Mexico with Chinese raw materials. The Biden administration hopes cooperation from the two countries could help it decrease the supply of illicit fentanyl into the U.S. and thus lead to a decrease in fatal overdoses. The case: The Justice Department said it had indicted associates of the Sinaloa cartel based in the Los Angeles area for conspiring with money-laundering groups linked to Chinese underground banking to launder drug-trafficking proceeds. More than $50 million in drug proceeds flowed between the Sinaloa Cartel associates and Chinese underground money exchanges during the conspiracy, it said. The indictments are part of a yearslong investigation into the cooperation between cartel associates and Chinese money launderers, dubbed Operation Fortune Runner, the DOJ said.
| | The New York Times asks experts to weigh in on the surgeon general’s call for a social media warning label. The Washington Post reports on an unusual rise of a deadly bacterial infection in Japan. | | | | Follow us on Twitter | | | | Follow us | | | | |
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