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Presented by Better Medicare Alliance: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Daniel Payne and Krista Mahr | | | With Megan Messerly, Alice Miranda Ollstein and Megan R. Wilson
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Death rates of U.S. women who are pregnant are rising. | Rogelio V. Solis/AP Photo | ‘MOVING BACKWARDS’ — Maternal mortality is going in the wrong direction in the U.S., Krista reports. New data showing a significant increase in deaths among pregnant people in 2021 cemented America as the most dangerous wealthy country to live in when you’re pregnant or give birth. Though Covid-19 has been suggested as a cause for the national uptick, Black individuals saw a larger rise than white people, pointing to deep-rooted inequities in medical treatment and access to care further exacerbated by the pandemic. The CDC’s figures for 2021 show the stark contrast in the U.S.: — 1,205 women died of maternal causes — equivalent to a rate of 32.9 deaths per 100,000 live births — compared with 861 deaths in 2020, or 23.8 deaths per 100,000 live births. — For Black women, the death rate was 69.9 — 2.6 times higher than the rate for white women. — Death rates among white women were 26.6 — 1.4 times higher than in 2020 — and 28 among Hispanic women, which was 1.5 times higher than in 2020. “We are not moving forward. We are moving backwards — and Covid definitely didn't help,” said Andreea Creanga, an associate professor at Johns Hopkins University. The federal government is noticing, too, with the Biden administration looking to act. In December, President Joe Biden signed a new law requiring the FCC to incorporate maternal health outcomes into its broadband maps with the goal to expand broadband access — and, theoretically, telehealth services — in areas with poor maternal health outcomes. The CDC, for its part, has ramped up a campaign to encourage patients and practitioners to be aware of early warning signs that might indicate a problem during and after pregnancy. The CDC also funds states’ surveillance of maternal mortality and teams across the country trying to improve the quality of pre- and postnatal care. WELCOME TO THURSDAY PULSE, where we’re a little unnerved by ChatGPT’s high test scores — from medical knowledge tests to the SAT and most everything in between. One thing AI can’t (yet) do: send us tips about the next big health story. Drop us a line at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, Ben Leonard talks with Krista about the new CDC figures showing a sharp rise in U.S. maternal deaths, cementing America’s status as one of the most dangerous wealthy nations to live in if you're pregnant or giving birth.
| | | | | A message from Better Medicare Alliance: Leading organizations representing physicians, nurses and patients have raised concerns about CMS rushing through major changes to risk adjustment in Medicare Advantage before the proposal has been properly analyzed and the impact on seniors and those who care for them is fully understood. Tell the White House to slow down and protect the 30 million seniors who count on Medicare Advantage. | | | | | | | 
Medicaid is on the line for many of its beneficiaries as states reevaluate their criteria for the program. | Joe Raedle/Getty Images | UNWINDING MEDICAID — States are beginning to redetermine eligibility for tens of millions of Medicaid recipients for the first time since the pandemic began, Megan Messerly writes. New survey results released this morning by KFF and the Georgetown University Center for Children and Families reveal the hydralike nature of the unwinding process, as each state completes its work on its own timetable, using its own strategies and, likely, encounters its own challenges. It also underscores the diverging approaches states are taking, some moving more slowly and implementing more strategies to ease the process, while others speed through the process over budgetary concerns. The details: Though states can’t disenroll anyone from their Medicaid programs until April 1, eight states — Arizona, Arkansas, Idaho, Iowa, New Hampshire, Ohio, South Dakota and West Virginia — began initiating renewals in February, the survey found. As we previously reported, Arkansas plans to complete its work in less than nine months (faster than CMS has recommended), five states are taking nine to 12 months and the rest will take between 12 and 14 months. Coverage losses: The goal of unwinding is to remove ineligible Medicaid recipients while renewing those still eligible. The fears, though, are that eligible people will fall through the cracks and ineligible people won’t make the transition to appropriate forms of coverage, such as low- or no-cost marketplace plans. According to the survey, nearly 1 in 5 Medicaid enrollees will be disenrolled when the continuous coverage requirement ends. States at the low end expect to lose 7 percent of recipients, while those at the high end project losing a third.
| | | | DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID. | | | | | | | | FIRST IN PULSE: NEW BILL TO BOOST HEALTH WORKFORCE — Sens. Dick Durbin (D-Ill.) and Marco Rubio(R-Fla.) are working on legislation that would more than double the budget of the National Health Service Corps, which offers scholarships and loan repayment for health providers who work in underserved areas. The bill would reauthorize the program through 2026 and significantly grow its mandatory funding — from $310 million to $625 million in 2024. That amount would continue to grow in 2025 and 2026 to $675 million and $825 million, respectively. It’s the latest in a series of efforts in Congress to address the health workforce shortages affecting providers across the board. FIRST IN PULSE (II): A PLAN TO EXPAND COVERAGE — Sens. Bob Casey (D-Pa.) and Ben Cardin (D-Md.) plan to unveil a new bill today aimed at expanding dental, vision and hearing coverage to more people on public health insurance programs, Alice reports. It’s a big piece of unfinished business for Democrats after an expansion of those programs within Medicare was dropped from the party’s social spending package in the last Congress over objections about the provision’s cost from more conservative Democrats. Casey and Cardin’s new bill, first shared with Alice, would repeal the statute barring Medicare coverage of those services, which would include routine dental cleanings, eye exams and hearing aids. Another provision in the bill, which has little chance of passing a GOP House, would allow states to opt in to provide those services to Medicaid recipients with the incentive of a higher Federal Medical Assistance Percentage rate. THEY CALL IT ‘BIG PAHPA’ — The Senate HELP Committee sent a request for information to health stakeholders as lawmakers figure out how this year’s reauthorization of the Pandemic and All-Hazards Preparedness Act will take shape, Megan R. Wilson reports. The legislation, known as PAHPA, funds programs that enable the federal government to respond to natural disasters and threats from emerging infectious diseases and chemical or biological agents. Originally passed in 2006, it must be reauthorized every five years. Most of its programs are set to expire on Sept. 30, the end of the fiscal year. Sen. Mitt Romney (R-Utah) will work with Sen. Bob Casey (D-Pa.), who helped lead PAHPA through its last reauthorization in 2018, to shepherd the bill through the process.
| | | DRUG NEGOTIATION DOCS — On Wednesday, CMS released initial guidance outlining how Medicare intends to implement the Medicare Drug Price Negotiation Program in the coming months for the first year of negotiated prices in 2026, POLITICO’s David Lim reports. The policy document provides context on the CMS criteria for selecting the 10 Medicare Part D drugs for the negotiation program’s first year. The agency plans to announce the list on Sept. 1 but not before it collects public comments on the policy, due April 14. The criteria are complex and include a variety of factors, such as annual revenue and sales volume, and research and development costs.
| | | BRACING FOR AN ABORTION PILL RULING — Trump-appointed U.S. District Judge Matthew Kacsmaryk heard more than four hours of oral arguments in Amarillo, Texas, on Wednesday in the high-stakes case that could determine access to the abortion pill mifepristone nationwide. According to reports, Kacsmaryk seemed sympathetic to the arguments from the lawyers representing anti-abortion doctors that the FDA erred in approving mifepristone for market more than 20 years ago and further erred in its more recent decisions making the pills available via telemedicine, mail delivery and pharmacy pickup. After making that case to the judge, attorney Erik Baptist with the conservative religious group Alliance Defending Freedom said in a statement that the FDA’s approval of the drug “has always stood on shaky legal and moral ground,” arguing the government should “protect the health and safety” of women. Attorneys for the Biden administration defended the FDA’s process and mifepristone’s safety record and warned that a ruling for the challengers would open the door to lawsuits targeting approval of a range of other drugs. A ruling could come at any time.
| | | | A message from Better Medicare Alliance:   | | | | | | Richard Boxer, co-founder and partner of American Center for Cures, has been appointed by the White House to the National Cancer Advisory Board. American Society of Tropical Medicine and Hygiene CEO Karen A. Goraleski will step down in October. Noland Joiner is now vice president and chief technology officer of health care at Mathematica. He was most recently a professional services executive for Amazon Web Services. Ken Field has joined Hogan Lovells to lead its antitrust practice and is a partner in its global regulatory and intellectual property, media and technology practice group.
| | | | 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. | | | | | | | | STAT reports on climate change’s role in the rise of West Nile, Lyme and other diseases. KHN and NBC report on the opioid guidelines that have left some with chronic pain behind.
| | A message from Better Medicare Alliance: If proposed changes to risk adjustment in Medicare Advantage are rushed through, 30 million seniors could see unintended consequences. Low-income and chronically ill seniors could be disproportionally impacted, especially those with conditions such as diabetes and depression. Tell the White House to slow down and protect the 30 million seniors who count on Medicare Advantage. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
