THIS WEEK IN REVIEW: Monday, Nov. 4th – Friday, Nov. 8th

November 8, 2019 by B. Cameron Webb, MD, JD

THIS WEEK IN REVIEW: Monday, November 4th – Friday, November 8th

Welcome back to another edition of Viewpoints! We hope you participated in our democracy this Tuesday and spent some time at the polls. Now a look into how the turnout will affect health policy…

In the wake of Election Day on Tuesday, the roadmap in crafting health care access has never been clearer for Democrats in various states. In our very own Virginia, a new Democratic majority in the House of Delegates means that Governor Ralph Northam (D) can potentially move forward with Virginia’s recently voted-on Medicaid expansion without work requirements. Similarly, in Kentucky, Governor-Elect Andy Beshear (D) announced his intention to revoke a similar work requirement Medicaid waiver, passed by now-outgoing Gov. Matt Bevin (R), in his first week of office. And, in states such as Utah, Nebraska, and Maine, voters approved expanding Medicaid for additional low-income adults.

Work requirements might not be disappearing in every state, however, as in Georgia, Governor Brian Kemp (R) has just presented a proposal that would expand Medicaid with requirements still in tow. The proposal, entitled “Georgia Pathways”, would provide Medicaid up to 100% of the federal poverty level, so long as recipients are working, volunteering, or attending a job training 80 hours per month. Gov. Kemp and other Georgia legislators have cautioned against a full expansion in the past, out of concerns about how much it would cost the state. Utah had a similar proposal blocked by HHS this past August, who said they would only cover the standard 90% of the cost if it was a full expansion of Medicaid (up to the 138% FPL), so it remains to be seen if Gov. Kemp’s plan will be enacted at some point.

On Wednesday our nation’s capital became the first locality to be approved for assistance under a new federal rule. The rule allows for federal funding to match state Medicaid payments spent towards short-term residential care for persons with severe mental illness. Such care is expensive – including things such as bathing, feeding, and intensive direct care. Federal matching will ease the burden on states, and should ultimately encourage service accessibility.

In a move benefiting another high-need population, a federal judge declared on Tuesday that undocumented immigrants who were separated from their families through a2017-2018 Trump Administration policy must be provided mental health care. The judge made the decision after identifying a precedent that governments can be found guilty of “deliberate indifference” by forcing individuals into dangerous situations. By happenstance, another federal judge ruled three days prior for a temporary block on a Trump administration order that would have required immigrants to prove that they could obtain health insurance within 30 days after entering the country. 

A quick update on drug pricing legislation: nothing has happened. The House has postponed voting on Speaker Nancy Pelosi’s (D-Calif.) plan to lower pharmaceutical costs until December. The Congressional Budget Office needs two more weeks to analyze the legislation, which doesn’t leave enough time before Thanksgiving recess. Two bipartisan attempts from the senate were also derailed this week. Sens. John Cornyn (R-Texas) and Richard Blumenthal (D-Conn.) proposed a bill that would prevent drug companies from gaming the patent system to delay competition. Another measure proposed by Sens. Chuck Grassley (R-Iowa) and Dick Durbin (D-Ill.), would require drug companies to list prices in TV advertisements. In general, the bills are criticized because they don’t go far enough, because they don’t address the problem properly, or because some representatives may be influenced by the pharmaceutical industry.

On Wednesday the Trump administration sued Gilead Sciences, accusing the pharmaceutical company of wrongfully earning billions from two HIV prevention drugs, Truvada and Descovy, whose research was funded by taxpayers. The patents are owned by the Department of Health and Human Services (HHS), but Gilead has refused to pay royalties. Gilead previously said the patents granted to HHS are “not valid”. HIV prevention is especially important as a new strain of HIV was discovered. A recent study sequenced the genome of a new sub-type, called HIV-1 subtype L. There are few known cases, but this means the effects of the sub-type are unknown.

The Trump Administration’s Conscience Rule has come under fire this week after judges in New York and Washington struck down the policy, labeling it as unconstitutional and discriminatory. Originally proposed by the Department of Health and Human Services’ Office of Civil Rights, the Conscience Rule granted health insurers and providers the right to opt-out of care that violates their personal beliefs, such as contraceptive services, abortion, and gender transition procedures. Both rulings stemmed from a lawsuit filed last May against the Trump Administration’s policy on the grounds that it disproportionately affected women, members of the LGBTQ community, and the working poor. 

In a similar vein, the Center for Reproductive Rights secured a temporary block in the Oklahoma Supreme Court on a ban that prohibited physicians from performing dilation and evacuation abortions. The law, initially passed in 2015, threatened physicians who participated in abortions with prison time and a fine of up to $10,000. According to the Center for Reproductive Rights, this ruling ensures that “Oklahomans can continue receiving high-quality, evidence-based abortion care.”

And finally, the Centers for Disease Control and Prevention (CDC) has just released an update on their findings regarding the vaping-related illnesses that have taken the lives of dozens of Americans and caused hundreds to fall ill. Vitamin E acetate has been identified as a “very strong culprit of concern” by CDC principal deputy director, Anne Schuchat. While it’s still too soon to rule out other potential causes, the results are being described as a “breakthrough.”

 


This Week’s Viewpoints Writing Team:
Avery Bullock, Carina Clawson, Jo McClain, Steven Moore and Nana Owusu