Applications for the AcademyHealth Health Policy Fellowship is now open!
AcademyHealth is hiring a Health Policy Fellow for this fall. We are looking for a current or recent graduate student who wants hands-on experience in applying their health policy and health systems knowledge and research skills to federal advocacy. The applicants should be passionate about promoting a health system that focuses on providing the best health outcomes for all through support for evidence-based policymaking, and are interested in learning new skills to further their future career. The fellow would work alongside the Director of Advocacy to advance the mission and objectives of AcademyHealth through advocacy, public policy, education, and policy communication.
This position can be done remotely and compensation is $20/hr. Apply by emailing a resume and cover letter to Advocacy [at] academyhealth.org. Learn more about the position here.
House Appropriators intend to fund health bill at FY2006 level.
Days after the legislation resolving the debt limit crisis was signed into law and created capped total discretionary levels for FY24, the House Appropriations Committee Majority has announced their intention to mark up legislation that is lower than the caps, including a $60 billion cut, or 30 percent, to the Labor-HHS allocation. These cuts would bring the funding level for this bill from $207.4 billion in FY23 to $147 billion in FY24; to put that in perspective, this bill was last at this level in FY06, erasing nearly twenty years of investments in health, education, and labor protections. The Committee is intending to fund all of the bills by $119 billion less than the debt limit agreement called for, with all of the cuts coming to the nondefense discretionary accounts. The Senate Appropriations Committee has announced that they are working on bipartisan bills that meet the debt limit cap, setting up a significant clash with the House and raising the likelihood of a government shutdown.
Federal court stayed attempt to roll back ACA preventative care rollback.
Lawyers on both sides of the case reached a deal to keep the Affordable Care Act’s mandate requiring plants to cover preventative care at no cost to patients largely intact while the case works through appeals. A district judge, who has previously ruled that the ACA is unconstitutional, ruled in March that the preventative care mandate was unconstitutional because the United States Preventive Service Task Force which recommends which procedures should be included was unconstitutional. Before the ACA, many patients could not access preventative care like vaccinations, birth control, colonoscopies, and other life saving interventions due to cost. The case remains to be heard by the Fifth Circuit of Appeals and likely the Supreme Court.
CMS predicts health spending to hit $7.2 trillion by 2031.
Health care spending will make up roughly 20 percent of the American economy, or $7.2 trillion, by 2031, according to estimates from the Centers for Medicare and Medicaid Services. Health care expenditures are expected to grow 5.4 percent on average from 2022 to 2031 compared with an average of 4.6 percent for the nominal gross domestic product, which is projected at 4.6 percent a year, according to the study from CMS’ Office of the Actuary.
Senate HELP Committee calls on NIH to limit prices companies set for funded products.
The Senate HELP Committee released a report on the costs of medical devices and drugs that were developed with NIH funding and called on the agency to reinstate requirements that companies must set reasonable prices when they license NIH inventions. With few exceptions, private corporations have the unilateral power to set the price of publicly funded medicines. The government asks for nothing in return for its investment. The HELP Committee found that the median price of new treatments that NIH helped invent over the past 20 years is $111,000, with U.S. taxpayers paying more than people in other countries for access to treatments that NIH scientists invented.
FDA announces intent to regulate diagnostic tests.
The FDA announced plans to explicitly authorize its authority over medical tests that come from a single laboratory. This announcement comes after decades of intense debate and stalled legislation over the ability of the FDA to oversee a vast category of lab tests that reach patients without any federal agency checking to ensure they work as developers claim. Types of tests that are not reviewed currently include popular prenatal genetic screenings, many cancer screenings, and tests for rare diseases. The agency’s hands-off approach to lab-developed tests — which are designed, manufactured and used by a single lab — traced back to a time when they were deployed at a small scale. The idea was to spare hospital labs, for example, from the time, money and hassle of getting approval in Washington whenever they needed to create a simple test for their own patients. Nowadays, so-called LDTs are an enormous part of the health care system, including a number of high-stakes tests made by commercial companies. Because they aren’t registered with the federal government, nobody knows how many exist.
What I’m reading…
Black maternal mortality is an outrageous and preventable crisis in our country. Tori Bowie, an American Olympian that competed in the 2016 Rio de Janeiro Games died from childbirth complications. Bowie was 8 months pregnant and in labor when she died from respiratory distress and eclampsia. In fact, out of the four Black women on the relay team, three of them have either died or nearly died from pregnancy related causes, showing that the structural racism within our health system does not prevent athletes from suffering terrible health outcomes. Bowie’s teammate Allyson Felix testified before the House Ways and Means Committee to talk about how racial biases led to her and her baby nearly dying in 2019. The evidence is clear – even the most well-off Black mothers still have worse outcomes than the poorest white mothers, clearly exemplified by the challenges faced even by Beyonce and Serena Williams. Felix had written for the Robert Wood Johnson Foundation in March of this year about how to achieve a healthy and joyful birth process for Black mothers and the necessary restructuring of the health system that this will require. We absolutely cannot let this rolling crisis continue.
In the aftermath of Dobbs and the explosion in anti-abortion legislation we are beginning to see what it means for the health care workforce. Dr. Atul Grover wrote in JAMA about the implications of these laws and the rural healthcare workforce crisis. He points out that on a recent poll of physicians, medical residents, and medical students that 82 percent reported that they would prefer to work or train in a state that preserved access to abortion services. He notes that laws that criminalize abortion and intrude into patient-physician relationships will further dissuade providers. Considering the highly litigious environment, physicians understandably have a strong desire to avoid litigation, and an even stronger desire to avoid criminal prosecution or risking their medical licenses while attempting to care for their patients and communities.
People concerned about the safety of patients often compare health care to aviation. Why, they ask, can’t hospitals learn from medical errors the way airlines learn from plane crashes? That’s the rationale behind calls to create a “National Patient Safety Board,” an independent federal agency that would be loosely modeled after the National Transportation Safety Board, which is credited with increasing the safety of skies, railways, and highways by investigating why accidents occur and recommending steps to avoid future mishaps. Efforts at creating a patient safety board have been long stymied by concerns about buy-in, data privacy, and investigative authorities.
A report by the Leapfrog Group found that Black patients are at increased risk for certain adverse events compared to White patients, regardless of high hospital safety ratings. Additionally, across all hospitals, patients covered by Medicare or Medicaid experienced higher rates of adverse safety events when compared to patients covered by private insurance coverage. The report found that the Hospital Safety Grade accurately predicted which hospitals put patients most at risk for adverse events. However, for Black or Hispanic patients, or patients without private insurance, the risks were higher in each grade category. This shows a systemic issue impacting the quality of care for Black and Hispanic patients and those with public insurance plans.
As the Supreme Court again sets its eyes on race-based affirmative action in colleges, I appreciated the words of Dr. Sylvester James Gates Jr. in Science about the importance of these programs in creating an equitable future for all. The end of the consideration of race, ethnicity, or sex for the enrollment in public institutions may lead to a dramatic decrease in under-represented minority students in the most elite campuses. Science dug into the implications of college diversity and the pipeline into the scientific workforce if the Supreme Court does restrict or eliminate these programs.
Supreme Court decisions, and policymaking more generally, has real life or death implications for people who never step foot in a courtroom or a capitol building. Gaffney et al investigated the probable health consequences of just three Supreme Court decisions in 2022 that invalidated COVID-19 workplace protections, voided state laws on handgun-carry restrictions, and revoked the constitutional right to abortion. They found that through decision analytical modeling they found that these decisions could lead to nearly 3,000 excess deaths over the next decade, along with thousands of cases of peripartum morbidity.
Access to appropriate medical care is critical for overcoming opioid addictions, especially for adolescents. Research by King et al in JAMA found that just one out of every eight residential treatment facilities open to patients ages 16 or 17 offers full access to buprenorphine, a common and highly effective addiction medication. Just 10.6 percent of facilities offered and continued this medication to adolescents, compared with 25 percent offering equine therapy that seeks to treat addiction with horse-related activities. There is no evidence supporting horse therapy as an effective treatment.
Former FDA Commissioner Scott Gottlieb wrote about the challenges facing the FDA with the proliferation of artificial intelligence (AI) tools in JAMA. The emergence of AI tools ushers in a groundbreaking opportunity in medicine, with potential to dramatically streamline drug development and enhance the accuracy of diagnoses and treatment. However, integrating these technologies into the current regulatory frameworks presents a considerable challenge. Global regulatory bodies, including the US Food and Drug Administration (FDA), will grapple with the task of applying their established norms to these novel entities. Consequently, new policies are needed to ensure the safety and efficacy of these tools for patients. These fitted solutions must balance the need for innovation with that of patient safety and benefit. For example, the FDA could establish a framework for determining the appropriateness of the data sets on which AI tools would be trained. The agency could develop specific criteria for creating suitable data sets, assessing them for the breadth and reliability of the inputted data, the completeness of longitudinal phenotypic data, and the representativeness of the data set. It is essential to ensure that such data sets have been carefully curated to be broad and inclusive, representing the natural diversity of the general population.