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Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Krista Mahr and Daniel Payne | | | With help from Megan Messerly and Ben Leonard
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Forty states have voted to expand Medicaid. | AP Photo | WILL MORE STATES PASS MEDICAID EXPANSION? On Thursday, North Carolina voted to become the 40th state to expand Medicaid, potentially growing the government insurance program by more than half a million recipients. That leaves 10 holdout states that have resisted expanding the program, which has reduced overall deaths, protected low-income individuals during the pandemic and increased hospitals’ financial performance, among other benefits. Anyone next? Virginia was the last state to expand the program through the legislature five years ago, though several states have done so through the ballot box since then. South Dakota, the most recent, enacted the policy in November with 56 percent of voters supporting the measure. Kansas Gov. Laura Kelly, a Democrat, continues to press for Medicaid expansion this year and included funding for the policy in her budget. The state’s GOP-controlled legislature, however, remains skeptical. Expansion proponents in Wyoming were hopeful they’d be able to pass the policy this year. A bill passed out of committee in January, but the proposal died on the House floor without a vote. And expansion advocates had their hopes crushed in Mississippi on Thursday after a bill that would have restored the state’s ballot measure process — thereby giving Medicaid expansion a shot at the ballot box — died amid disagreements between the House and Senate. Even in North Carolina, expansion isn’t a done deal. Republican lawmakers, in an agreement announced earlier this month, tied Medicaid expansion’s start date to the budget, which has long been a point of friction between the legislature and Democratic Gov. Roy Cooper. That means Medicaid expansion, a signature issue for the term-limited governor, could be hostage to fights over the state’s finances and other policy issues, including abortion, that GOP lawmakers attach to the budget. WELCOME TO FRIDAY PULSE — Here’s a Friday morning palette cleanser for you: a meditation on the Joy of Letting Loose. If you do one thing today, please watch Christopher Walken dance to “Weapon of Choice.” Any special lawmaker who you’d like to see let it all out? Send your nominations, news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Ruth Reader, who breaks down TikTok CEO Shou Chew’s grilling on Capitol Hill yesterday and lawmakers’ concerns about national security threats and what they see as the site’s corrupting influence on young people.
| | | | | | | A message from PhRMA: Did you know that the three largest PBMs blocked access to more than 1,150 medicines last year? That includes medicines that could lower your costs at the pharmacy. Pharmacy benefit managers are putting their profits before you. Haven't heard about this? That’s by design. | | | | | | | 
An executive order requiring federal workers to be vaccinated against Covid is being challenged in the courts. | Helen H. Richardson/The Denver Post via AP | COURT UPHOLDS INJUNCTION ON FED VAX MANDATE — The Fifth Circuit Court of Appeals in New Orleans upheld a Texas district court’s nationwide injunction against President Joe Biden’s Covid-19 vaccine mandate for federal workers Thursday. Biden’s 2021 executive order that required federal workers to get Covid-19 vaccines or face termination has been winding through the courts. It was quickly challenged by the nonprofit Feds for Medical Freedom, a chapter of the American Federation of Government Employees and dozens of individual plaintiffs who said it was unconstitutional and violated the Administrative Procedure Act. A district court in Texas granted the plaintiffs a preliminary injunction against the federal employee mandate in January 2022. When the government appealed, a three-judge panel of the Fifth Circuit ruled against the injunction — upholding Biden’s requirement. The court later voted to vacate that ruling and grant the case a new hearing en banc, or before the appeals court’s full, active bench. In the meantime, Feds for Medical Freedom has brought a separate lawsuit against the federal government over the employee mandate, saying it violates the Civil Rights Act. Why it matters: Most federal employees are already vaccinated, the White House said back in 2021, after the order was issued. But to critics of vaccine requirements in the country, Thursday’s ruling will be a victory over what they’ve characterized as federal overreach into individuals’ lives during the pandemic. To most public health experts, on the other hand, it will represent a fresh blow against the feds’ ability to issue public health orders during an emergency as the country looks toward being better prepared for the next pandemic.
| | | MORE EVIDENCE OF THE COVID PARTY GAP — A new study found that governors’ political affiliation didn’t have any correlation with their state’s Covid death rates, but the share of Republican voters in the state did, Ben reports. States where more residents voted for President Donald Trump in 2020 had relatively worse Covid outcomes, according to a large study published Thursday in the Lancet. The study found that vaccination was strongly associated with states that had lower Covid-19 death and infection rates. States that had the most stringent masking policies and reduced mobility reported lower infection rates but not necessarily lower death rates. There was a wide difference in death rates across states. The state with the lowest death rate was Hawaii at 147 deaths per 100,000 people compared with 581 per 100,000 for Arizona, the highest state death rate. “That difference is important because there’s hope in that,” study author Thomas Bollyky, senior fellow at the Council on Foreign Relations, told Ben. “If we can have some of the more poorly performing states come a little closer to performing like their better-performing neighbors, we might do better in the next pandemic.” IMPACT OF COVID ON BABIES — A new study found that male babies exposed to Covid in the uterus were more likely to be diagnosed with neurodevelopmental issues during their first year. In a study published in JAMA on Thursday, researchers identified a “statistically significant elevation in risk” among male infants delivered after February 2020 to mothers who had a positive Covid PCR test. They found the higher level of risk wasn’t attributable to a preterm delivery, also more common among infants exposed to Covid before being born, and was consistent with “abundant evidence that the developing male brain is more vulnerable to in utero environmental effects.”
| | | | 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. | | | | | | | | LAWMAKERS GO AFTER TIKTOK ON MENTAL HEALTH — Members of the House Energy and Commerce grilled TikTok CEO Shou Chew on Thursday about what they see as the video-sharing site’s corrupting — and sometimes deadly — influence on young people, POLITICO’s Ruth Reader reports. “Within minutes of creating an account, your algorithm can promote suicide, self-harm and eating disorders to children,” the panel’s chair, Cathy McMorris Rodgers (R-Wash.), told Chew. Lawmakers have discussed legislation aimed at increasing protections for kids online, including barring them from opening accounts on social media sites, but neither chamber has passed a bill. Biden hasn’t proposed a mechanism for banning Americans from accessing the app on their private phones, even as he’s blocked federal employees from having TikTok on their work devices. IN HELP’S EAR — Sens. Bernie Sanders (I-Vt.) and Bill Cassidy (R-La.) asked the public for feedback on how to solve health workforce shortages — and health groups haven’t been shy about sending proposed solutions, Daniel reports. From provider associations and patient advocates, stakeholders raised some key issues across their responses, which include pleas to: — Boost funding for training programs, with an emphasis on diversifying the health workforce and increasing loan repayment programs for those who work in underserved areas — Reduce burnout and address violence at hospitals and clinics — Use telehealth to offer more care in less time — Encourage continued education for those currently working in health care
| | | | A message from PhRMA:   | | | | | | JUDGE BLOCKS NEW WYOMING ABORTION LAW — A Wyoming state judge on Wednesday evening temporarily blocked enforcement of the state’s new abortion ban, Megan reports. The law took effect in Wyoming on Sunday without the signature of Republican Gov. Mark Gordon, who expressed concern that litigation over the new law would only delay the resolution of an ongoing lawsuit against the state’s trigger ban.
| | | | 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. | | | | | | | | Black women are 60 percent more likely to get drug tested while pregnant than white women, MedPage Today reports. Most trans adults say transitioning has made them feel better about their lives, according to a new poll from the Washington Post and KFF. Can Ozempic and other new drugs help us stop putting a moral spin on being fat or thin? The New Yorker reports.
| | | | A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter.
They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.
PBMs and insurance practices are shrouded in secrecy, they need to be held accountable. | | | This newsletter has been corrected to reflect that several states are considering expanding the Medicaid program. | | | | Follow us on Twitter | | | | Follow us | | | | |  |
