Editorial note: The Read on Washington is a monthly column on happenings in DC that affect the field of health services research. In addition, AcademyHealth recently began offering ad hoc updates via the Situation Report series. The Situation Report can be found on our blog and is also emailed directly to our members. All of AcademyHealth’s advocacy work is supported by member dues.
Senate Republicans want deeper Medicaid cuts
Senate Republicans are preparing to slice deeper into Medicaid to finance President Donald Trump’s agenda, proposing legislation that analysts say could deal a greater financial blow to hospitals and result in millions more uninsured Americans. The measure reflects Republicans’ willingness to cut the nation’s safety-net health insurance program, despite qualms expressed by some moderates and populists within their ranks. Last month, House Republicans passed massive tax-and-spending legislation projected to result in 7.8 million fewer Medicaid enrollees. The Senate Finance Committee’s revisions to the bill released Monday could prompt even steeper coverage losses, sharply reining in a Medicaid financing maneuver that hospital groups say would slash payments to their facilities. Hospitals stand to lose $321 billion over the next 10 years under the House version, and would face another $63 billion in costs from serving a larger uninsured population, according to an analysis by the Urban Institute and the Robert Wood Johnson Foundation.
Trump Administration rescinds hospital guidance on emergency abortions
The Trump administration announced that it is rescinding Biden-era guidance that uses a federal law to require hospitals to stabilize patients in need of emergency care -- including by providing an abortion. In July 2022, the Department of Health and Human Services (HHS) issued guidance that, under the Emergency Medical Treatment and Labor Act (EMTALA), doctors must perform abortions in emergency departments -- even in states where the procedure is illegal -- particularly if it serves as a "stabilizing medical treatment" for an emergency medical condition. EMTALA, which was passed in 1986, ensures that emergency patients receive services and treatment regardless of ability to pay. Hospitals that refuse to provide "necessary stabilizing care" or "an appropriate transfer" can face civil monetary penalties. The HHS guidance was one of the attempts of the Biden administration to preserve abortion access after the U.S. Supreme Court overruled Roe v. Wade, ending federal protections for abortion rights.
Fired HHS employees are suing over error-ridden RIF process
A group of terminated HHS staffers are suing HHS over the “hopelessly error-ridden” personnel records that were used to underpin the cuts. Performance ratings, which range from 1 to 5 and are assigned to federal staff to appraise their performance, were frequently wrong on RIF notices, the workers allege in their suit. In addition, employees’ paperwork had seemingly random codes determining their eligibility for the RIF, and informed them that their entire division was being terminated when it wasn’t. Such errors are a major point of concern, given that data affects whether a specific employee should have been caught up in a RIF, their severance pay and the availability of stopgap healthcare coverage — and can affect future career prospects.
Supreme Court rules against gender-affirming medical care for minors
The U.S. Supreme Court backed a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people. The court, in a 6-3 ruling powered by its conservative justices, decided that the ban does not violate the U.S. Constitution's 14th Amendment promise of equal protection, as challengers to the law had argued. The ruling affirmed a lower court's decision upholding Tennessee's law barring medical treatments such as puberty blockers and hormones for people under age 18 experiencing gender dysphoria. Gender dysphoria is the clinical diagnosis for significant distress that can result from an incongruence between a person's gender identity and the sex assigned at birth.
NIH workers send “dissent” letter to Bhattacharya
Almost 350 NIH staff sent a letter to NIH Administrator Jay Bhattacharya to note their “dissent” of his leadership, challenging “policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe.” The signers went public in the face of a “culture of fear and suppression” they say Trump’s administration has spread through the federal civil service. “We are compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources,” the declaration says. Bhattacharya responded to the declaration by saying it “has some fundamental misconceptions about the policy directions the NIH has taken in recent months,” such as suggestions that NIH has ended international collaboration.
GAO rules on unlawful impoundments
The Government Accountability Office (GAO) ruled that the Trump administration violated the Impoundment Act by withholding congressionally appropriated funds to the agency responsible for supporting libraries and museums across the country. The congressional watchdog found that funds were withheld by the Institute of Museum and Library Services, with the GAO calling the act a violation of a law that blocks presidents from withholding funding Congress has approved. Similar impoundments have been levied against HHS, leading to significant conflicts in Congress, the Administration, and the courts.
Children’s Hospital Los Angeles shutting down gender-affirming care clinic
Children’s Hospital Los Angeles will shut down its gender-affirming care clinic next month, shuttering one of the largest and oldest clinics of its kind in the face of opposition from the Trump Administration to programs that assist children with gender transition. Hospital leadership said it was no longer possible to keep the Center for Transyouth Health and Development and the Gender-Affirming Care surgical program running in the current political climate. This announcement came before the Supreme Court’s ruling on
What we are reading
The life expectancy of American Indian and Alaskan Native (AI/AN) populations appears to be worse than expected due to systemic undercounting in the National Vital Statistics System. Bor et al found that the life expectancy for this population is 72.7 years, 6.5 years less than the US average, and the gap was almost 3 times larger than previously observed. In the sample that the authors analyzed, over 40 percent of AI/AN deaths were falsely marked as “white”.
After working at CDC for 13 years, Dr. Fiona Havers – senior advisor on vaccine policy – resigned. She said that she could no longer work with Secretary Kennedy due to the dismantling of the processes used to formulate vaccine standards, saying: “[i]f it isn’t stopped, and some of this isn’t reversed, like, immediately, a lot of Americans are going to die as a result of vaccine-preventable diseases.”
Before the 1970s, nearly all children diagnosed with leukemia would quickly die from it, with only 14% surviving at least five years. By the 2010s, the chances of survival had increased dramatically, with 94% of children surviving at least five years. Our World in Data investigated these shifts, and found that rather that one single breakthrough, this represents achievements in better tailored treatments, larger clinical trials, and advancements in genetic and molecular research.
NORC at the University of Chicago wrote up their methodology on how to improve surveys through enhancing residential address lists from the US Postal Service with data from a variety of sources, including satellite imagery, building footprint maps, and property records. NORC’s method uses digital mapping tools to overlay and integrate data from these multiple sources to enhance the coverage of address frames, thereby improving the potential inclusion of rural, low-income, or high-growth areas in NORC surveys.