New House Speaker identifies path on appropriations
The House of Representatives has been in gridlock for much of the last month as the Speakership has remained vacant. The lack of a Speaker and Committee-level negotiations around supplemental appropriations related to the conflicts in Ukraine and Israel had largely frozen discussions on the FY24 appropriations process. With the election of Speaker Mike Johnson, new movement is being seen. Current funding is set to run out on November 17, and the Speaker has proposed a new continuing resolution (CR) that stretches from sometime between January and April 15. He has also suggested that the House Labor-HHS Appropriations bill, which envisions drastic cuts and the elimination of numerous health agencies, public health funding, and research, skip Committee markup and be brought straight to the Floor. This would potentially lead to Floor votes for Labor-HHS and the Agriculture-FDA bills the week of November 13. All of the House Appropriations bills are funded at levels significantly below the debt ceiling deal and contain highly partisan policy priorities, setting up fierce conflicts with the Senate and White House.
Speaker Johnson has previously called for block granting Medicaid funding
Speaker Johnson previously led the Republican Study Committee, which at the time released a health care plan as part of efforts to repeal the Affordable Care Act. The plan included creating “federally-funded, state-administered Guaranteed Coverage Pools” for patients with high-cost illnesses, turning Affordable Care Act subsidies and Medicaid expansion funding into block grants for states, allowing HSAs to be used to cover more expenses, eliminating “mandates” to pay for coverage they don’t want, enhancing HSAs to enable people to carry health coverage from job to job, and promoting telehealth, association health plans, direct primary care, and health sharing ministries.
Monica Bertagnolli gets one step closer to leading the NIH
The Senate Health, Education, Labor, and Pension Committee advanced the nomination of Dr. Monica Bertagnolli to lead the National Institutes of Health by a vote of 15-6, with ranking member Bill Cassidy, R-La., voting for President Joe Biden’s nominee and Chairman Bernie Sanders, I-Vt., opposing it. Sanders has long used Bertagnolli’s nomination to make a point about the Biden administration’s prescription drug policy. When Biden first announced plans to nominate Bertagnolli in May, Sanders delayed her confirmation hearing for months because of concerns that the Biden administration was not doing enough to lower the cost of prescription drugs.
NIMHD designates people with disabilities as a population with health disparities.
The National Institute on Minority Health and Health Disparities (NIMHD) and the Agency for Healthcare Research and Quality (AHRQ) designated people with disabilities as a population experiencing health disparities for NIH research. People with disabilities often experience a wide and varying range of health conditions that lead to poorer health and shorter lifespan. In addition, discrimination, inequality, and exclusionary structural practices, programs, and policies create barriers to timely and comprehensive health care, which further results in poorer health outcomes.
Nursing homes call CMS nurse staffing guidelines impossible
Eighty-one percent of nursing home facilities nationwide and 90% of for-profit facilities would need to hire additional registered nurses or nurse aides to meet the minimum nursing staff hours standards proposed by the CMS. Nursing home workers left positions in record numbers due to burnout, low wages and increased stress associated with caring for vulnerable populations during a public health emergency. The rule would require nursing homes to have a minimum of 0.55 RN and 2.45 nurse aide hours per resident day, and an RN on staff 24 hours per day, 7 days per week. In over half of states, less than a quarter of nursing facilities would meet the requirements under the proposed rule.
CMS will monitor Medicare Part D plans to ensure they don’t raise costs for negotiated drugs
CMS announced that it will keep a close eye on Medicare Part D plans to ensure they don’t raise out-of-pocket costs for older adults on any of the 10 drugs chosen for price negotiations when negotiated rates come online in 2026. Plans in Medicare Part D, the program’s prescription drug benefit, must cover any drug chosen by CMS for price negotiation. The agency said that it will monitor whether plans increase the use of tools like prior authorization, which requires insurer approval before prescribing a pharmaceutical, on any of the drugs. CMS also plans to clamp down on other practices such as formulary management, referring to the list of generic and brand name drugs a Part D plan covers.
CDC finds racial disparities in PrEP prescriptions
The Centers for Disease Control and Prevention published preliminary data showing that more than one-third of individuals eligible for a commonly used HIV prevention drug received a prescription, as funding for a critical HIV program grew 16-fold between fiscal years 2019-2023. But the reach of this strategy is highly inconsistent among racial groups. The percentage of eligible white individuals who were prescribed PrEP grew from 60 percent in 2019 to 94 percent in 22. Among Hispanic/Latino individuals that number only grew from 15 percent to 24 percent, and in Black individuals it grew from 8 percent to 13 percent.
Only 3 percent of Americans have gotten an updated covid shot, CDC projects confidence on more
CDC Director Mandy Cohen said in an interview that about 12 million people, or about 3.6 percent of the population, have gotten the shot in the five weeks since it became available. She said that she was confident that total vaccinations will approach the same number as last year, which was about 17 percent of the population.
ARPA-H celebrates its first year
The Advanced Research Projects Agency for Health (ARPA-H) celebrated its first year with Director Renee Wegryzn leading it. ARPA-H has in recent months announced a growing list of research awards for efforts the agency says are more ambitious, and less certain to succeed, than what NIH would typically support. The agency has hired 390 staffers, some of whom will take an unusually active role in shaping research without the outside peer-review NIH projects typically get. By the end of September, ARPA-H had already tentatively obligated close to $1 billion of its initial $2.5 billion budget. Wegrzyn’s chief goal in her second year is to keep hiring program managers, whom she sees as the most important element of the agency. She hopes to have 20 on board by the end of the year and at least double that number in 2024.
Ransomware attacks have cost healthcare organizations $77.5 billion in downtime alone
New research by Comparitech indicates that since 2016, 539 ransomware attacks on healthcare organizations in the US have been confirmed. These attacks impacted more than 52 million patient records and have had an often devastating impact on 10,000 separate facilities. In total, the researchers estimate the cost of these attacks to be around US$77.5 billion in downtime alone.
National Academy of Sciences, Engineering and Medicine holds workshop on Dobbs data needs
On October 5, the National Academy of Sciences, Engineering and Medicine held a workshop to Explore Data Needs in the wake of the Dobbs v Jackson Women's Health Organization which was organized by the Standing Committee on Reproductive Health, Equity, and Society. The workshop delved into national and state data collections on abortion access as well as the role of other data in identifying the full impact of the Dobbs decision. You can see the full agenda here and the video of the sessions here.
What I’m reading…
The HHS Office of the National Coordinator for Health Information Technology (ONC) released a new report on the comfort of patients in sharing their social needs data. The research found that most patients are comfortable with their doctors telling other doctors about their needs, with roughly 60 percent of those surveyed feeling “very” or “somewhat” comfortable with their provider sharing that they were experiencing housing instability, food insecurity, or difficulty accessing transportation.
I appreciated the work that Levitt and Altman provided in JAMA, where they discussed how the complexity of the US health care system is a driver of its low accessibility and affordability. In a study involving over 3600 insured adults, they found that 6 in 10 people with insurance reported a problem with using their health insurance during the past year. The share increases to two-thirds for people in fair or poor health, three-fourths for those who need mental health services, and almost 8 in 10 for people who use the health system the most. About half of consumers say they do not understand some aspect of their coverage, including about one-third who do not understand what costs their plan covers or what costs they will owe. Simplification of the health care system could address a problem that frustrates patients.
Mensah et al wrote in JAMA about the dire implications of the Supreme Court’s rulings rolling back affirmative action plans. They find that the ruling threatens access to care, quality of care, and inclusive leadership for the health care system writ large. Understanding the implications of this ruling on health care access and racial and ethnic disparities is a priority at AcademyHealth (see here, here, and here for examples).
As we see the expansion of AI-based chatbots in medical care, we need to be aware of the risks that these largely unregulated programs can cause. Research published in Digital Medicine by Omiye et al tested a series of AI chatbots with a series of medical questions. All of the models used debunked race-based information when asked about kidney and lung capacity. This research shows that large language models and AI programs need more adjustments to eradicate race-based themes and are not ready for clinical use.