Rural hospitals plan to reject Congress’ program

By Daniel Payne and Krista Mahr

Many rural hospitals have struggled financially, forcing some to close. | Orlin Wagner/AP Photo

THE TROUBLE WITH REH — A new payment model for rural hospitals will take effect in January, but many hospitals aren’t interested.

The Rural Emergency Hospital designation would offer a new way for rural hospitals to be paid, but many rural hospitals and communities are put off by the requirements, including ceasing inpatient services, Daniel reports.

Amid a growing wave of closures in the last decade (and fears of more on the way), rural hospitals were hopeful the program would provide them with a solution that would help them survive.

But the law that was passed, and the rules proposed by the Centers for Medicare and Medicaid, surprised many hospital administrators, who said the program wouldn’t work for their facilities.

Rural hospitals sometimes find their inpatient services key to gaining community trust — and revenue. And states often found them pivotal in handling waves of Covid-19 patients over the past two years.

But lawmakers said the REH model will work as intended by creating a new option for hospitals on the brink of closure.

It will effectively allow an emergency room to exist where any hospital wouldn’t have previously been able to survive.

That still leaves most rural hospitals, an increasingly endangered group, without a bigger fix.

Staffing issues, increasing costs and unsustainable reimbursements will continue to keep most rural facilities worried about their future financial viability.

But Congress isn’t expected to release a more comprehensive solution anytime soon, according to staffers on the Hill.

Researchers have emphasized that the final number of hospitals that will apply for the designation is uncertain, partly because the final rule has yet to be released. (A CMS spokesperson said it’s expected to be released next week). And some working in rural health care for decades said other programs had low uptake at first, growing over time as they were adapted and tailored to hospital needs.

Even so, many hospitals are already saying they aren’t interested — unless the legislation is updated to include more flexibility and financial incentives.

WELCOME TO THURSDAY PULSE, where we’re sad to report that your Thanksgiving turkey will likely be more expensive because of the worst-ever outbreak of bird flu .

Have good turkey alternatives for Thanksgiving? Send them our way — along with news and tips — at dpayne@politico.com and kmahr@politico.com .

TODAY ON OUR PULSE CHECK PODCAST, Daniel talks with Alice Miranda Ollstein about why the overwhelming majority of rural hospitals are rejecting a plan Congress passed to stop closures. Plus, Katherine Ellen Foley breaks down the CDC’s newest Morbidity and Mortality Weekly Report on monkeypox.

President Joe Biden is downplaying any political motive for urging Americans to get their Covid booster. | John Locher/AP Photo

TAKING THE POLITICS OUT OF THE PANDEMIC — The Biden administration, facing the midterms and another winter of Covid-19, is trying to make the pandemic apolitical, POLITICO’s Adam Cancryn reports .

On Tuesday, President Joe Biden hosted an event during which he tried to convince voters that vaccines — regardless of a person’s political affiliation — were the way to get out of the pandemic.

“None of this is about politics,” he said. “It’s about your health and the health of your loved ones.”

The efforts within the White House to tone down emotions around the vaccination campaign come as just 7 percent of Americans have gotten the updated booster in the two months since its rollout.

They also come amid concerns that focusing on the pandemic could hamper Democrats’ chances in the midterms, with some in the administration skeptical of pushing work on the pandemic into the spotlight.

Top White House advisers have maintained that the Covid-19 response has been key to the administration’s success and should remain a top priority.

But Biden’s focus going into the midterms has revolved around health care costs more than Covid-19, emphasizing the specter of GOP demands for cuts to Medicare in the hopes of compelling voters in the final days of campaigns.

TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO’s must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING .

INSURANCE DISPARITIES BETWEEN SMALL AND LARGE COMPANIES — Employees at small businesses pay, on average, about $2,000 more on family health insurance compared with their counterparts at larger companies, according to a new report from the Kaiser Family Foundation .

Deductibles are also up significantly — about $1,000 — for small business employees.

Average annual family premiums for companies across the country are more than $22,000, with workers contributing about $6,000, the survey of employers found.

For single coverage, the average annual deductible stands at more than $1,700 — up 61 percent from 2021.

The report also highlighted the growing demand for mental health services and how insurance networks are stacking up against that demand.

Nearly half of large employers reported mental health care usage increasing, with over a quarter saying workers are asking for family leave because of mental health issues.

But even with more large employers adding mental health services, 3 in 10 say their networks don’t have enough behavioral health access.

FDA DENIES MENTHOL VAPE MARKETING ORDERS — In a first, the FDA issued marketing denial orders on Wednesday for e-cigarette manufacturer Logic’s menthol vape capsules, POLITICO’s Katherine Ellen Foley reports.

The FDA said the products’ application didn’t meet the standard of being appropriate for the protection of public health (or less harmful for adult smokers and unappealing to minors).

The capsules work with e-cigarettes that are currently authorized, but the agency pointed to a recent National Youth Tobacco Survey published earlier this month, in which 84.9 percent of middle and high school students who vaped regularly reported using nontobacco flavors — with more than a quarter saying they specifically used menthol products.

USAID COVID TASK FORCE’S EXEC DIRECTOR STEPS DOWN — Jeremy Konyndyk, executive director of the U.S. Agency for International Development’s program responsible for delivering hundreds of millions of Covid-19 vaccinations across the world, said Wednesday he’s leaving the agency, POLITICO’s Katherine Ellen Foley reports.

Under Konyndyk, the program sent Covid-19 shots around the world through the pandemic, focusing on increasing the vaccination rate in dozens of countries.

In recent months, though, concerns about the program’s funding have caused several on the task force to look for an exit — especially as Congress slashed $5 billion from global pandemic response funding earlier this year.

Konyndyk is taking on a role as president of Refugees International, an independent group focused on assisting displaced individuals.

EUROPE LOOKS TO TIGHTEN AIR QUALITY RULES — The European Commission proposed stricter air-quality guidelines Wednesday, a move that would require countries to cut exposure to major pollutants, POLITICO’s Antonia Zimmermann reports .

The proposal for EU member states suggests tightening limit values for several key air pollutants by 2030 — part of a larger goal of reaching “zero pollution” by mid-century.

But pushback is probably coming. Governments across Europe are already failing to meet current targets, and conservative members of the European Parliament have called for a pause of new environmental legislation, especially amid the war in Ukraine.

GERMAN GOVERNMENT BACKS LEGAL CANNABIS PLAN — The German cabinet has signaled support for a plan to legalize cannabis, POLITICO’s Wilhelmine Preussen reports .

But the European Commission will now get a say on whether the measure will become law.

Karl Lauterbach, Germany’s health minister, proposed the plan as a way to protect health and begin to regulate a flourishing black market.

STAY AHEAD OF THE CURVE: Our Future Pulse newsletter will continue to bring you the biggest stories at the intersection of technology and healthcare, but now five times a week. Want to know what’s next in health care? Sign up for our Future Pulse newsletter. If you aren’t already subscribed, follow this link to start receiving Future Pulse .

Kevin L. Miller and Jason B. Caron join Latham & Watkins to further expand the firm’s health care offerings. Miller brings skills in private equity in health care, while Caron will contribute experience in regulatory compliance, the company announced.

Kaiser Health News’ Arthur Allen writes about the forces behind the price of a decades-old $40,000 cancer drug.

The Washington Post’s Lena H. Sun and Fenit Nirappil write that monkeypox could have devastating effects on men with weak immune systems.

USA Today’s Ken Alltucker writes that most Americans aren’t “thriving,” according to a new survey on vitality.

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