| | | | |  | | By Chelsea Cirruzzo, Erin Schumaker and Carmen Paun | | | | | 
Rep. Ami Bera (D-Calif.) says Congress should take a look at how his home state is regulating AI. | Anna Moneymaker/Getty Images | A new California law requiring insurers to oversee how artificial intelligence is used when granting prior authorization requests for treatments has captured Capitol Hill's attention, our Chelsea Cirruzzo reports. Rep. Ami Bera (D-Calif.) told POLITICO the House Task Force on AI he sits on has discussed the law, which goes into effect in January, along with doctors who've met with the group. 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 POLITICO 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. Big 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.
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Azores Islands, Portugal | Erin Schumaker/POLITICO | This is where we explore the ideas and innovators shaping health care. Robert F. Kennedy Jr., Trump's pick for HHS secretary, wants to eliminate fluoride from U.S. drinking water. In the early 2000s, he used to bottle and sell his own water, the New Yorker reports. It had fluoride in it. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com, or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.
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Dr. Shereef Elnahal, the VA undersecretary for health, is a believer in psychedelic medicine. | New Jersey Department of Health | The Department of Veterans Affairs is funding a $1.5 million study into psychedelic therapy for veterans, the agency said Tuesday. It’s the first time the VA has put money into studying the medical use of the mind-altering drugs since the 1960s. Researchers affiliated with Brown and Yale universities will examine whether MDMA, also known as ecstasy, combined with therapy, is a safe and effective treatment for post-traumatic stress disorder and alcohol-use disorder. In addition to being the largest health system in the country, the VA serves a population with disproportionately high rates of PTSD and alcohol-use disorder, which frequently occur together. "VA is on the cutting edge of clinical research for Veteran health, including in the investigation of psychedelics for mental health," Dr. Shereef Elnahal, the VA undersecretary for health, said in a statement. Elnahal, who received a standing ovation at a conference of psychedelics enthusiasts in May when he delivered encouraging words about the drugs’ effectiveness as mental health treatments, has said he wants the VA to lead the way on psychedelics research. "This study will give us better insight into the potential of MDMA-assisted therapy as a treatment for Veterans," he added. Inside the study: Researchers plan to begin enrolling veterans who have PTSD and alcohol-use disorder in 2025, and will run the study at Providence VA Medical Center in Rhode Island and the West Haven VA Medical Center in Connecticut over five years. To correct for "functional unblinding," a methodological problem that arises when study participants and researchers can figure out who received the active drug and who received the placebo, participants in the placebo group will receive low-dose MDMA. Previous psychedelics research has failed partly because participants could tell they got the drugs. What's next? Although the advocates suffered a major setback this summer when the Food and Drug Administration rejected drugmaker Lykos Therapeutics’ application to treat PTSD with MDMA and talk therapy, they hope the incoming Trump administration will be more open to approving the drugs. President-elect Donald Trump’s pick for HHS secretary, Robert F. Kennedy Jr., has said ending the "aggressive suppression of psychedelics" is on his agenda. In Congress, Reps. Jack Bergman (R-Mich.), Morgan Luttrell (R-Texas) and Dan Crenshaw (R-Texas) believe the FDA should fast-track approval of MDMA-assisted therapy for veterans.
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The WHO could lose U.S. funding while it fights multiple disease outbreaks. | Fabrice Coffrini/AFP via Getty Images | If President-elect Donald Trump withdraws the United States from the World Health Organization, the group could lose its top government donor and hundreds of millions of dollars in contributions, Carmen reports. In return, the U.S. could lose access to the global network that sets the composition of the flu vaccine each year and would no longer have the WHO’s help in selling products U.S. pharmaceutical companies produce, current and former U.S. government officials say. Trump could end U.S. membership in the WHO, an arm of the United Nations, without the consent of Congress, as long as he gives a one year-notice and continues paying dues in that year, according to a 1948 resolution accepting WHO membership. He tried to do so in 2020, but his term ended before the one-year notice was complete. When President Joe Biden took office in January 2021, he reversed Trump’s decision. Why it matters: The U.S. provides about a quarter of the WHO’s core annual budget, as a mandatory membership fee, but often gives more — with the figure ranging from $163 million to $816 million in recent years, according to health policy think tank KFF. The WHO could lose all that money at a time when it finds itself stretched by health emergencies around the world, from ongoing Mpox and cholera outbreaks in parts of Africa, to the diseases spreading as a consequence of war in Gaza and Sudan, among other places. What’s next? The WHO could offset some of the financial losses if Trump decides to withdraw. This May, it launched an investment round seeking some $7 billion “to mobilize predictable and flexible resources from a broader base of donors” for WHO’s core work between 2025 and 2028. The WHO said this month that it has received pledges and funding of $3.8 billion for the next 4 years. The WHO did not respond to a request for comment on a potential U.S. withdrawal and its implications. | | | | Follow us on Twitter | | | | Follow us | | | | |
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