Obamacare premiums continue pandemic-era decline

By Sarah Owermohle and Krista Mahr

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— Obamacare premiums fell this year as enrollment and competition surged, supported by federal aid.

— More people are getting sexually transmitted diseases amid federal funding cuts for sexual health clinics.

— Covid cases are rising across the country, with the BA.2 subvariant now dominant.

WELCOME TO WEDNESDAY PULSE, where we’re cringing over Nicholas Kristof’s (untrue) “ pinot noir alcoholism” theory that affluent people aren’t dying from a disease seeing record surges. Send tips and news to sowermohle@politico.com and kmahr@politico.com.

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Americans have flocked to the individual marketplace amid federal aid and lower rates during the pandemic. | Joe Raedle/Getty Images

ACA PREMIUM RATES CONTINUE TO FALL — Affordable Care Act premiums have been declining for three years, particularly in areas where the number of competing insurers has grown, according to an Urban Institute study funded by the Robert Wood Johnson Foundation.

Obamacare premiums fell 1.8 percent nationwide in 2022, though that percentage varied significantly from region to region. That’s after a 1.7 percent decline in 2021 and a 3.2 percent drop in 2020.

Competition helped drive the trend. ACA premiums increased in areas with high unemployment rates, while they dropped in regions with insurer competition. The number of participating insurers nearly doubled from 198 in 2020 to 288 in 2022.

But the Robert Wood Johnson Foundation said the American Rescue Plan, which extended ACA subsidies to consumers, also played a key role “as evidenced by record enrollment,” said Kathy Hempstead, the health nonprofit’s senior program officer. Roughly 14.5 million people enrolled in the marketplace this year, dwarfing previous rates.

Ultimately, 32 states saw premium reductions while 18 had increases, and one, Florida, saw no change.

Meanwhile, employer-sponsored insurance inched up by 3.6 percent last year and 3.9 percent in 2020.  

STDS HAVE A FUNDING PROBLEM — Gonorrhea and syphilis cases reached record levels during the pandemic’s first year, according to Centers and Disease Control and Prevention data released Tuesday, reports POLITICO’s Alice Miranda Ollstein.

Gonorrhea cases increased 10 percent in 2020, and syphilis infections were up 7 percent. Congenital syphilis, which had all but disappeared in the U.S., increased 15 percent in 2020, contributing to at least 149 stillbirths and infant deaths that year.

The alarming figures come weeks after Congress decided to give less money to sexual health clinics that provide free testing and other critical services to stop the spread of sexually transmitted diseases.

President Joe Biden moved last year to roll back Trump administration restrictions on the federal Title X family-planning program, clearing the way for hundreds of Planned Parenthood clinics, several state health departments and groups that had dropped out in protest of the ban on abortion referrals to rejoin.

But Congress’ most recent spending bill kept funding for the program flat at about $286 million. HHS says that means it had to shift resources around to try to address the areas of the country with the most pressing needs, resulting in deep cuts to some providers in states with high STD rates.

CASES RISE IN 31 STATES — The Omicron subvariant BA.2 now accounts for nearly 86 percent of Covid-19 cases across the country, up from just over 75 percent last week, as the highly transmissible strain continues its spread.

New case numbers also rose in more than half of states during the first full week of April, contributing to a 12 percent increase in the average number of new cases. Mississippi saw the steepest rise from April 3 to 10, with a 76 percent spike, according to POLITICO’s Annette Choi.

See the full DataPoint here.

At no point in the pandemic has there ever been a perfect snapshot of what the virus is up to in America. But today, given the widespread use of at-home tests and the end of testing for many uninsured Americans, an accurate picture of the nation’s caseload seems even more elusive.

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THE UNDERWHELMING CHARITY OF NONPROFIT HOSPITALS — A new report from the Lown Institute found that hundreds of nonprofit hospitals in the U.S., which get big tax breaks to give back to their communities, are often spending less on their charity care and community investment than the value of their tax exemption.

The group calls the gap “the fair share deficit,” which amounted to $18.4 billion in 2019 across 275 nonprofit hospital systems they evaluated in the study.

The 10 nonprofit systems with the highest fair-share deficits accounted for 30 percent of the total, some of which received millions in CARES Act funds.

You can see the breakdown of the 25 hospital systems with the largest deficits and the 25 systems that spent the most on charity and community investment relative to their tax breaks and the rest of the report here.

FIRST IN PULSE: HEALTH CAMPAIGN SUPPORTS HOUSE DEMS — The pro-Obamacare advocacy group Protect Our Care is launching a multimillion-dollar TV and digital ad campaign to support eight House Democrats in swing districts: Reps. Cindy Axne (Iowa), Angie Craig (Minn.), Sharice Davids (Kan.), Andy Kim (N.J.), Susie Lee (Nev.), Elissa Slotkin (Mich.), Abigail Spanberger (Va.) and Susan Wild (Pa.).

The ads will highlight accomplishments — like passing a ban on surprise medical bills — and House-passed legislation that stalled in the Senate, including capping out-of-pocket insulin costs and allowing Medicare to negotiate drug prices, our Alice Miranda Ollstein writes.

The investment follows on the heels of recent polling showing health care costs remain among the top issues for Democratic voters.

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CMS PUSHES BACK ON ADULHELM CONCERNS — Lee Fleisher, the Centers for Medicare and Medicaid's chief medical officer, said Tuesday that the agency’s decision last week to limit coverage of the Alzheimer’s drug Aduhelm for patients enrolled in randomized clinical trials “should not be viewed as setting a new direction on therapies that receive FDA accelerated approval.”

The CMS decision sparked concerns that it would undermine confidence in the FDA’s drug approval process and might limit future treatment options for older patients.

Fleisher pushed back against that critique in comments at the Duke-Margolis Policy Conference in Washington, D.C. He said it was a rare event and “a unique situation where we were looking at a drug in this class that received accelerated approval based on evidence that it reduces plaque on the brain, which was tested on relatively healthy patients.

“What we’re looking to ensure is that drugs in this class are reasonable and necessary for the treatment of an illness for the Medicare population, who — as you know — often have multiple comorbidities,” Fleisher said.

STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.

Rachel Stauffer has joined the Partnership to Advance Virtual Care as executive director, advocating to permanently extend Medicare coverage of telehealth and other services. Stauffer previously worked as lead legislative liaison at HHS’s Health IT office and a health policy aide for Rep. Diana DeGette (D-Colo.).

Cynthia Smith will start as the American College of Physicians’ chief membership and engagement officer on May 2. Smith, an internal medicine physician, is currently ACP’s vice president for clinical education and the group’s representative to the National Academy of Medicine’s Action Collaborative on Clinician Well-Being.

Kirsten Bibbins-Domingo is the next editor-in-chief of the Journal of the American Medical Association. Bibbins-Domingo is a UCSF professor of medicine and chair of the university’s epidemiology and biostatistics department. She was also UCSF’s inaugural vice dean for population health and health equity.

KHN’s Katheryn Houghton scoops that the Biden administration has awarded $43 billion in grants to 93 rural health care providers and community groups in 22 states to improve health care access.

Reuters reports on the new law in Oklahoma that makes it illegal to perform an abortion except in medical emergencies and enacts steep fines and prison sentences for offenders.

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Now is the time to change the trajectory of racial health disparities and create a more equitable health care system. This Black Maternal Health Week, see how Blue Cross and Blue Shield companies are advancing maternal health equity nationwide.

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