Senate Appropriations Committee calls for increase in AHRQ funding
The Senate Appropriations Committee released and passed their FY25 Labor-HHS funding bills, and it included a $7 million increase to the Agency for Healthcare Research and Quality (AHRQ), bringing the Agency up to a potential $376 million. Due to the tight budget caps for FY25 from last year’s Fiscal Responsibility Act, the expectation for all programs is that flat funding would be a huge achievement. This is still a bit less than the President’s request of $387.3 million and the Friends of AHRQ request of $500 million, but provides advocates with solid footing for supporting health services research. The Committee passed this bill 25-3, and it now heads to the Senate Floor. It is possible that the Senate will consider these bills after the August recess but before they leave for fall campaigning, but we expect any final legislation being negotiated closer to the end of the calendar year.
On the other side of the Hill, the House plan to pass all of their appropriations bills on the Floor before leaving for the August recess collapsed due to a lack of support among their Majority, including for the Labor-HHS bill. The House is writing bills at a deep cut in funding, which is proving difficult for moderate Republican and all Democratic offices to support, creating significant challenges with the narrow House Majority. The House Appropriations Committee was able to pass the Labor-HHS bill that zeroed out AHRQ out of Committee on a party line vote on July 10, which was something they were unable to do in FY24.
Our expectation is that Congress will pass a continuing resolution (CR) that keeps funding level later in September to avoid a government shutdown on Oct 1. Due to the election, we expect that CR to likely go to early December, at which point we would expect FY25 funding to likely pass in some form of omnibus. The most important factor for FY25 funding is what power dynamic the election creates.
Biden Administration announced first round of Medicare drug negotiations
The Biden Administration formally announced the results of a new Medicare initiative to negotiate with pharmaceutical companies over some of the priciest drugs used by older Americans, resulting in about $6 billion in initial savings. The new, negotiated prices ranged from 38 to 79 percent lower compared with the drugs’ list prices in 2023.
AcademyHealth’s CEO and President Aaron Carroll wrote in the New York Times about how while this milestone in Medicare’s negotiating power is a significant step, but it’s just the start. The cost of drugs is a big concern for seniors and a major barrier to health care access. To the extent that the current administration can rein in costs, it could be a major step to greater health equity. Women, Black and Latino people, L.G.B.T.Q. individuals and those with disabilities are more likely to report difficulties affording prescription medications, particularly when managing chronic conditions like diabetes and heart disease.
First post-Chevron lawsuit on administrative statute interpretation filed
A molecular pathology group has filed a lawsuit over FDA’s decision to regulate lab-developed tests, marking the first legal case to cite the Loper Bright Enterprises v. Raimondo ruling following the Supreme Court's overturn of the Chevron doctrine that did away with courts’ deference to agencies’ interpretation of ambiguous laws. The suit, filed in Texas by the Association for Molecular Pathology and University of Texas pathologist Michael Laposata, claims that the FDA overstepped its regulatory bounds when deciding to regulate lab-developed tests.
House Democrats release a report on the corrosive effect of Dobbs on medical training
The Democratic minority on the House Energy and Commerce Committee released a report on an investigation into how the Dobbs decision will impact reproductive health care. They conducted focus groups and interviews with OBGYN educators and residency program directors and found that restrictive abortion care laws have led to sicker patients, limits on abortion training, and a workforce less equipped to provide comprehensive reproductive health care. In more restrictive states, training has been practically eliminated or limited to simulations and textbooks, requiring students to travel out of state.
National Center for Health Statistics announced a 2 percent decrease in US birth rates
The National Center for Health Statistics (NCHS) announced that the number of births in the United States declined 2% from 2022 to 2023 according to birth certificate data. The general fertility rate declined 3% in 2023 to 54.5 births per 1,000 females ages 15–44. Since the most recent high in 2007, the number of births has declined 17%, and the general fertility rate has declined 21%. The percentage of mothers receiving prenatal care in the first trimester of pregnancy declined 1% from 2022 to 2023, while the percentage of mothers with no prenatal care increased 5%.
NIH censoring “off-topic” messages on social media ruled unconstitutional
A federal appeals court found that when the National Institutes of Health put filters on the comment sections of social media posts to restrict “off-topic” messages, it violated the First Amendment’s guarantee of a right to free speech. The case arose when animal rights activists repeatedly posted comments challenging NIH programs that tested drugs or medical procedures on animals. NIH used keyword filters to automatically block all comments containing words such as “animals,” “cruelty,” “monkeys,” “testing” and “torture.” But the U.S. Court of Appeals for the D.C. Circuit said NIH had not articulated “some sensible basis for distinguishing what [comments] may come in from what must stay out,” and its lack of sensitivity to the context of public comments “reinforces its unreasonableness.”
What we are reading
The newest generation of weight-loss drugs seem like a miracle, but for many patients they might as well be a mirage. The Washington Post reported on how the evidence is building that drugs like Ozempic have economic and racial disparities creating barriers to access. Black and Hispanic patients and those with lower incomes are more likely to suffer from obesity and are at higher risk for Type 2 diabetes. Yet a number of recent analyses found that these populations are less likely to be prescribed the new generation of weight-loss drugs.
Lack of research into miscarriage in the U.S. — its prevalence, its causes, and how best to treat people who’ve experienced pregnancy loss — has helped to reinforce what has long been a culture of silence and shame around miscarriage. That knowledge gap means that people who miscarry, and miscarry repeatedly, aren’t given the emotional support they need at a time when they are most vulnerable. Equally important, they aren’t given the medical treatment, screening, and support from the health care system that might help them avert future miscarriages. The dearth of knowledge about pregnancy loss and miscarriage is far greater in the United States than in other industrialized countries, according to physicians, policymakers, and researchers who spoke with STAT.
Maternal health outcomes in rural communities are in crisis, and the implications of additional health restrictions in the ongoing aftermath of Dobbs adds more pressure on faltering health systems. This is especially true for Black women, who are twice as likely as white Georgians to die from pregnancy related causes. KFF published a report on how more doulas may be part of the answer in these communities. The presence of a doula, along with regular nursing care, is associated with improved labor and delivery outcomes, reduced stress, and higher rates of patient satisfaction, according to the American College of Obstetricians and Gynecologists. This report discusses the efforts of the Morehouse School of Medicine in building up a doula workforce.