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Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Ben Leonard and Chelsea Cirruzzo | With Megan Messerly and Alice Miranda Ollstein
| | |  Democratic lawmakers are warning that Medicaid coverage will end for millions of Americans, but state officials say that's not a complete picture of what will happen with the program's enrollees. | David Goldman/AP Photo | BOSTON — Health care advocates and Democratic lawmakers have been raising the alarm about the millions of people losing Medicaid benefits — many because of paperwork problems — as states determine who's still eligible for the state-run health insurance program for the first time since the pandemic. But state health officials, during a session at the National Academy for State Health Policy’s preconference in Boston on Monday, cautioned that those numbers don’t tell the whole story, POLITICO’s Megan Messerly reports. “What I see in terms of the broader metanarrative that’s taking hold about unwinding is, ‘This many people lost Medicaid. Period. End of story moving on to the next conversation,’” said Audrey Gasteier, executive director of the Massachusetts Health Connector, the state’s health insurance exchange. “People are hearing these stories, and they think, ‘If I lose Medicaid, that’s it for me.’ And I don’t think that’s helpful for the public.” In Idaho, 30 percent of people who have been determined Medicaid ineligible have made the jump to the state’s health insurance exchange. In Massachusetts, it’s 25 percent. And in Kentucky, it’s 13 percent — and health officials there have also determined, with the help of the state’s managed care organizations, that roughly 40 percent of people disenrolled from Medicaid have other coverage, such as employer-sponsored health insurance. “I think there’s a misperception that everybody who loses Medicaid is just uninsured, and that’s not the case,” said Lisa Lee, commissioner of the Kentucky Department for Medicaid Services. Though limited, the data shared by states during the Monday session sheds some light on whether the more than 4 million people disenrolled across the country from Medicaid since April are finding other health insurance coverage or are going uninsured. WELCOME TO TUESDAY PULSE. Do you know when health care bills could get a floor vote in the House post-recess? Let me know at bleonard@politico.com. I can keep you anonymous. And reach out to me and Chelsea (ccirruzzo@politico.com) with other tips, feedback and scoops. Follow along @_BenLeonard and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with Madison Fernandez, author of POLITICO’s Weekly Score, about the momentum building among Virginia Democrats, who are betting that defending abortion rights will lead to wins in the state’s fall elections despite their 2021 losses on the issue in the state.
| | | | | REDETERMINATION AND CHARITY CARE — The growing number of Medicaid enrollees being booted from rolls as a result of the end of continuous coverage requirements is leading to an “uptick” in uncompensated care that goes unpaid, American Hospital Association spokesperson Ben Teicher told Ben. The AHA will continue to monitor the situation, though it’s not clear how significant the uptick in charity care is yet, he said. Nearly three-quarters of those who’ve lost coverage have done so because of paperwork problems. Latest on unwinding: Last week, CMS ratcheted up pressure on states that could be falling short of federal requirements as they renew Medicaid coverage for millions for the first time since the pandemic began. The agency sent letters to all 50 states saying it was concerned about high rates of people losing Medicaid because of paperwork issues, long call-center wait times and slow application processing. Thirty-six states were flagged as falling short on at least one of the criteria, including five — Alaska, Florida, Montana, New Mexico and Rhode Island — that fell short on all three.
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Texas claims that Planned Parenthood hasn't repaid funds it received from the state's Medicaid program. | Jeff Roberson/ AP Photo | TEXAS-SIZED CASE — Texas’ claim that Planned Parenthood fraudulently billed the state’s Medicaid program over several years will go before a Texas District Court today, the latest legal battle over reproductive health care in a state that’s banned nearly all abortions, Alice reports. Judge Matthew Kacsmaryk, who’s overseeing the case, is a Trump appointee who ruled earlier this year to ban abortion pills nationwide. Texas contends Planned Parenthood “knowingly and improperly avoided its obligation to repay” funds it received from the state’s Medicaid program. Planned Parenthood argues they did nothing wrong and the case is an ideologically driven attempt to bankrupt them — noting that the state is demanding nearly $2 billion and naming their national advocacy arm plus their state medical providers as defendants. How we got here: Texas and several other states have tried to kick Planned Parenthood out of their Medicaid programs for years, attempting to block low-income patients from going to their clinics for non-abortion services like testing for sexually transited diseases and treatment and contraception. Federal and state courts initially sided with Planned Parenthood, whose clinics continued to provide services and bill the state for reimbursement. Then, in 2020, the 5th Circuit ruled that the state could remove Planned Parenthood from its Medicaid network, which the state moved to do over the next few years. Now, the state is demanding the clinics pay back the roughly $17 million the state gave them during the years they were still a sanctioned Medicaid provider — plus more than a billion dollars in additional penalties. What’s next: Kacsmaryk is expected to side with the state. No matter the outcome, the case will likely be appealed to the 5th Circuit and possibly the Supreme Court. MED STUDENTS SNUB STATES WITH ABORTION BANS — Fewer medical residents are applying to family medicine residency programs in states banning abortion, the American Academy of Family Physicians says in a new policy brief, Chelsea writes. The organization argues that, while many reasons impact residency decisions, abortion bans interfere “with the patient-physician relationship.” “Residency curricula are required to include family planning and counseling in pregnancy, and may include abortion training,” the brief says — but in states with bans, this type of education becomes limited. In 2023, the number of senior medical students applying to family medicine programs declined by 7.4 percent in states with abortion bans compared with 3.6 percent in states where abortion remains legal, the group found through an analysis of data from the American Association of Medical Colleges. Overall, residency applications in 2023 decreased by 3 percent compared with the previous cycle.
| | | | YOUR TICKET INSIDE THE GOLDEN STATE POLITICAL ARENA: California Playbook delivers the latest intel, buzzy scoops and exclusive coverage from Sacramento and Los Angeles to Silicon Valley and across the state. Don't miss out on the daily must-read for political aficionados and professionals with an outsized interest in California politics, policy and power. Subscribe today. | | | | | | | | | ACO REACH CHANGES — CMS said on Monday it will update a key measure it uses to determine payments to groups of providers to better account for patients who live in urban areas and face barriers to accessing health care, POLITICO’s Robert King reports. The agency is adding two measures to its ACO REACH program, a Biden administration Medicare pilot that offers provider groups a set amount of money annually to improve care coordination and treat a roster of underserved patients. The changes, set to take effect next year, come amid criticism that CMS’ current approach is skewed toward patients who live in rural areas, which tend to be less racially and ethnically diverse. CMS has partly relied on the Area Deprivation Index to help determine which patients are most likely to be in need of medical care and which providers should receive a pay bump for treating them. The problem: That metric incorporates home values, often higher in urban areas, even in low-income communities, compared to rural areas. The new formula will take into account the number of beneficiaries who get a Medicare Part D low-income subsidy and the state-based version of the ADI, not just a national version, according to the announcement.
| | JHA: DON’T WORRY ABOUT NEW VARIANT — Recently departed Covid-19 Response Coordinator Ashish Jha is calling for calm about EG.5, a subvariant of Omicron, echoing the Biden administration and other public health experts. The World Health Organization has begun tracking the EG.5 variant — nicknamed Eris by some health watchers. Last week, the WHO labeled it as a “variant of interest” but not a “variant of concern,” meaning it doesn’t seem to be more of a danger than other variants. The strain has become the most common in the U.S. “Don’t worry about every new variant,” Jha wrote in a post on X, formerly known as Twitter. “We will get new variants. They will cause increases in infections.” He called for staying up to date on vaccines and masking and testing “if you wish.” What the data says: The latest CDC data shows hospital admissions on the rise, though overall levels remain relatively low.
| | The Washington Post dives into the Smithsonian’s “racial brain collection.” The Wall Street Journal reports that weight-loss drugs have “transform[ed]” our understanding of obesity. It’s less about willpower and more about biology, WSJ reports.
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