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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 Ben Leonard and Chelsea Cirruzzo | | | With Katherine Ellen Foley and Daniel Lippman
| | |  In this April 10, 2019 file photo, a sign is shown during a news conference to reintroduce "Medicare for All" legislation, on Capitol Hill in Washington. | Susan Walsh/AP Photo | TURNAROUND ARTISTS — A decade after the ill-fated launch of 24 nonprofit insurers seeded with $2.4 billion in federal loans under Obamacare, just three co-op plans remain in business, POLITICO’s Paul Demko reports. Those unlikely survivors — Mountain Health, which operates in Montana, Idaho and Wyoming, Maine’s Community Health Options, and Wisconsin’s Common Ground Healthcare Cooperative — are in solid financial shape and providing much-needed competition in sparsely populated parts of the country with older demographics that aren’t particularly attractive to commercial insurers. “The phones are being answered, the claims are being paid, members seem relatively happy with the service we're providing,” said Mountain Health CEO Richard Miltenberger. “Right now, things feel really good.” Why it matters: The co-ops were once considered among Obamacare’s biggest failures but a decade later there’s reason for re-examination. As Paul explains, even in the states where these nonprofits have long since ceased operations, they had a significant positive impact on competition and pricing in the chaotic early years of the Obamacare markets. Looking ahead: Open enrollment is just a few weeks away and Republicans on the trail rarely speak of repealing the law, recognizing it is firmly embedded in the health care system. Enrollment this year reached record levels, boosted by the Biden administration and a Democratic Congress that provided a rash of new subsidies after the Trump administration failed to dismantle the health law. The co-ops, once viewed as emblematic of shoddy planning and overreach, now stand as a symbol of the law’s resilience. The remaining three nonprofit insurers don’t appear to be in danger. Mountain Health ran a profit of $7.3 million through the first six months of this year, while the Maine and Wisconsin co-ops were operating $3.8 million and $13.3 million in the black, respectively. WELCOME TO WEDNESDAY PULSE. What are your favorite golf courses in the DMV? I’m trying to play more before it gets too cold. Reach me at bleonard@politico.com. And send me or Chelsea (ccirruzzo@politico.com) your feedback, tips, and scoops. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST , host Daniel Payne talks with E&E’s climate science reporter Chelsea Harvey about the implications of lethal heat for policymakers and public health.
| | | | | | | A message from PhRMA: Middlemen can profit from where patients fill their prescriptions. Because insurance companies and PBMs own pharmacies, too. | | | | | A GUIDE TO COVID, FLU, RSV SHOTS — CDC Director Mandy Cohen formally endorsed updated Covid-19 shots for all individuals 6 months and older on Tuesday, following the CDC's vaccine advisory panel's recommendation earlier in the day. Here’s what you need to know about the new Covid vaccines: Who can get the updated shot and when? — mRNA Covid shots are available to anyone six months and older. Those with compromised immune systems can receive one or more updated shots. These vaccines are no longer free, so who’s paying? — Private insurers, Medicaid, and Medicare will cover the newest shot for those included in the CDC vaccine advisors’ recommendation.
— The federal Vaccines for Children program will also distribute the updated shots for uninsured children. And the White House is still working on finding funds to pay for the vaccine for other uninsured Americans. The Bridge Access Program will be updated later this week with sites where these individuals can receive free shots. Will a Covid shot protect against widely circulating variants? — Likely yes. The updated Covid-19 shots are formulated to prevent severe disease and hospitalization by the XBB1.5 strain, as well as other XBB subvariants, which make up more than 90 percent of the subvariants circulating as of Sept. 2, according to the CDC. Officials also believe the updated shots will generate neutralizing antibodies against BA.2.86, which has garnered attention due to its high number of mutations. What about flu and RSV?
— The annual flu shot is available at many pharmacies and is covered under most insurance plans. Free or low-cost shots can be found at community health centers.
— Recently authorized shots to protect against RSV are also available for people over age 60, infants and young children, as well as for pregnant people. This vaccine is covered under Medicare Part D, but coverage is less clear for private plans which may choose not to cover it.
| | | | DOWNLOAD THE POLITICO APP: Stay in the know with the 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. DOWNLOAD FOR iOS – DOWNLOAD FOR ANDROID. | | | | | | | | WHAT’S ON ANNE MILGRAM’S MIND — The Drug Enforcement Administration generally keeps its cards close to the vest on telemedicine prescribing of controlled substances, but a public session Tuesday offered new details, Ben reports. A 2008 law mandated the DEA set up a special registration process for prescribing without an in-person visit, but the agency hasn’t done so. Under the pandemic public health emergency, the agency allowed the prescribing of controlled substances sans an in-person visit, and is now weighing its future. DEA Administrator Anne Milgram’s questions at the session point to how the agency is trying to ensure access to care and appropriate prescribing, with a focus on avoiding diversion. Milgram asked presenters about reimbursement models, data collection in prescribing and clinical guidelines, as well as prescribing controls. There wasn’t a consensus among the participants on what to do about a special registration process, or even if one should exist. “DEA and public health stakeholders sometimes seem to be speaking different languages,” said Lori Uscher-Pines, senior policy researcher at the RAND Corporation, at the session. “Greater access either represents something to strive for or cause for alarm, depending on where you sit.” What’s next: Milgram said the agency will offer an additional written comment period for its telemedicine prescribing rules proposal. In February, the agency proposed rolling back eased pandemic rules ahead of the emergency expiration in May. But after pushback from telehealth advocates and both sides of Congress, it reversed course and extended pandemic rules through Nov. 11 for new patients while it reconsiders. Given the tight time frame, the DEA may have to issue another extension.
| | | | A message from PhRMA:   | | | | | UNINSURED RATE DROPS — The U.S. uninsured rate in 2022 dropped for the second year in a row from 8.3 percent in 2021 to 7.9 percent, according to a new U.S. Census Bureau report out Tuesday. The 2022 uninsured rate ties with the 2017 historic low, which was also 7.9 percent, and comes after a sharp rise from 8 percent of Americans uninsured in 2019 to 8.6 percent in 2020.
|  | | Other notable highlights from the report include: — A 0.3 percent decline in private insurance plans and a 0.4 percent increase in public insurance plans, the majority in Medicare, in 2022. — Uninsured rates declined between 2021 and 2022 for people 26 and older, but rose by 0.3 percent to 5.4 percent in children under age 19. That increase was driven largely by children who live at more than 100 percent of the federal poverty line. Census Bureau researchers told reporters that these gains in insurance coverage may have been driven by economic recovery from the 2020 recession, pandemic-era legislation to boost health insurance like the American Rescue Plan Act, and Medicaid expansions in Missouri and Oklahoma. What to watch: Uninsured and public plan coverage rates for 2023 remain to be seen in the wake of Medicaid unwinding, which knocked millions of people off coverage.
| | INSTAGRAM BLOCKS COVID INFO — Instagram’s Threads is temporarily blocking users on its new search engine from searching terms related to Covid-19, including “coronavirus” and “vaccines,” Chelsea reports. But when users search terms related to Covid-19, they’re shown a button directing them to the CDC’s website. Another button below invites the user to “see more results” and leads to a list of other users. For example, clicking “see more results” on a search of Covid-19 leads the user to a list of other users with Covid-19 in their display names. Meta, Instagram’s parent company, confirmed to POLITICO that it was blocking these search terms, and other unnamed search terms, in its engine as a temporary measure. “The search functionality temporarily doesn’t provide results for keywords that may show potentially sensitive content. People will be able to search for keywords such as ‘COVID’ in future updates once we are confident in the quality of the results,” a spokesperson said in a statement. The Washington Post first reported the news. A spokesperson also told POLITICO that misinformation is a concern, but did not comment further on what would pass the company’s integrity checks on Covid information. They also did not say how long these measures would last nor why users are directed to “see more results.” In June, Meta said it was rolling back some of its policies against spreading false information about the pandemic on its platforms. Earlier this month, a court softened an order preventing the Biden administration from contacting social media companies over controversial content on their platforms, but said the administration violated the First Amendment.
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| | The Washington Post reports on overdose deaths rising despite opioid prescribing falling. Healthcare Dive reports on Kaiser Permanente being set to pay tens of millions to California to settle HIPAA violation allegations.
| | | | A message from PhRMA: Insurance companies and pharmacy benefit managers (PBMs) are putting their profits before your health. That’s because the largest PBMs own or are owned by the largest insurance companies, and they own pharmacies, too. First the PBM can deny coverage for your medicine in favor of one that makes them more money. Then, they steer you to the pharmacy they own. Without you ever knowing why it all happens this way. See what else they do. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
