The beginning of the end for ‘surprise’ medical bills — The vaccine sprint gives way to a marathon — J&J vaccine holds promise against Delta variant

From: POLITICO Pulse - Friday Jul 02,2021 02:07 pm

Jul 02, 2021

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With Rachel Roubein

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Quick Fix

— The Biden administration has begun implementing a much-anticipated ban on "surprise" medical bills.

— As President Joe Biden celebrates the nation's pandemic progress, his vaccination campaign is slowing to a crawl.

— New studies indicate Johnson & Johnson's coronavirus vaccine could offer strong protection against the more transmissible Delta variant.

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Driving the Day

THE BEGINNING OF THE END FOR ‘SURPRISE’ MEDICAL BILLS — Biden’s HHS is out with its first of several rules for enforcing a long-awaited ban on “surprise” bills — a complex undertaking that will have far-reaching consequences for health care in the U.S.

Over 411 pages of regulations, HHS details how federal departments should help keep patients from unknowingly signing away their new protections and how patients should challenge unexpected charges, POLITICO’s Rachel Roubein reports.

Under the policy, which is to take effect Jan. 1, health providers must publicly post rules banning surprise bills on their websites and in notices given to patients. The administration is also creating a complaint review process for patients who think they’ve been surprise-billed anyway.

Those protections are the result of years of stops and starts in Congress, before lawmakers finally managed to pass a ban on surprise out-of-network bills late last year. Yet even then, they left some of the most politically fraught details for the Biden administration to sort out.

Among them: How mediators should determine the payments that health plans owe providers, a question that influences how much patients will ultimately have to pay — and one federal officials are only just beginning to sort out.

The administration also needs to settle on how to resolve disputes between insurers and providers that can’t agree on payment in specific cases. That element bedeviled Congress for years and fueled intense lobbying from all corners of the health industry — attention that corporations are now expected to instead focus on the federal agencies writing the rules.

One final fine-print detail: In early June, UnitedHealthcare said it would start retroactively denying emergency room claims it later deemed to not be actual emergencies. But the administration sought to head off that practice on Thursday, spelling out that it would be disallowed under both the surprise billing ban and the broader Affordable Care Act.

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THE VACCINE SPRINT GIVES WAY TO A MARATHON — When Biden gathers 1,000 guests on the South Lawn this weekend, it’ll be a celebration of the undeniable progress the U.S. has made toward beating back the coronavirus. Nearly a year-and-a-half in, vaccinations are rising, cases are falling and people in much of the country are going back to normal.

But the Independence Day festivities will also finalize a shift in the national vaccination strategy that’s become apparent in recent weeks. The frantic, high-energy push that consumed Biden’s first months has reached nearly everyone who was eager for a shot — but has yet to convince the more than 90 million resistant or harder-to-reach adults who still need to be vaccinated.

And despite the campaign’s avowed emphasis on equity, African American vaccination rates significantly trail rates in comparable white populations.

Even as the White House touts the dozen-plus states that have partially vaccinated 70 percent of their residents, it will fail to hit Biden‘s national July 4 goal. Several states, like Mississippi and Alabama, continue to lag well behind on vaccinations.

In short, this won’t be Biden’s ‘mission accomplished’ moment. In the White House’s “wartime effort” parlance, it’s simply the start of a siege on the virus that could take months to finish off, especially as — new threats such as the fast-spreading Delta variant emerge.

Still, it’s a phase of the response that will only grow more critical to stamping out the pandemic and ensuring that — even as most of the country moves on — a small minority aren’t left to bear the outsized burden of disease.

“It is clear,” CDC Director Rochelle Walensky said in cautious Thursday remarks, “that communities where people remain unvaccinated are communities that remain vulnerable.”

J&J TOUTS VACCINE's PROMISE AGAINST DELTA — A small study found the J&J vaccine performed well against the Delta variant of Covid-19, a promising sign that comes amid debate over whether that vaccine’s recipients need a booster shot from Pfizer or Moderna.

The study showed strong levels of neutralizing antibodies in eight people who got the J&J vaccine, POLITICO’s Lauren Morello reports. Those levels were higher than levels seen for the Beta variant that emerged in South Africa. J&J has also highlighted a second study that found immunity from its vaccine lasts at least eight months.

Neither study has been peer-reviewed yet. But in addition to suggesting how much protection J&J offers against the Delta strain, they could also help inform questions around whether J&J vaccine recipients should also receive a booster to reinforce their protections against the virus — an approach that some health experts have endorsed, even as the CDC has so far declined to definitively weigh in.

Coronavirus

FACEBOOK SUBPOENAED IN COVID PROBE — D.C. Attorney General Karl Racine is seeking records tied to the tech giant’s handling of Covid-19 misinformation, POLITICO’s Cristiano Lima reports.

The subpoena is part of an investigation into whether Facebook is violating consumer protection laws, with Racine calling on the company to release an internal study on vaccine hesitancy among its users.

Facebook has vowed to fight vaccine misinformation on its site, with a spokesperson saying it’s taken down more than 18 million pieces of content across Facebook and Instagram. But an increasing number of Democrats argue the company should be doing more.

HOUSE ALLOTS $4M FOR CONGRESSIONAL BOOSTER SHOTS — Language included in a spending bill this week would funnel $4 million to support Covid-19 booster shots for members of Congress, POLITICO’s Alice Miranda Ollstein reports.

The provision tucked this week into a broader Legislative Branch appropriations bill orders the Office of the Attending Physician to draw up a booster shot plan, assuming the CDC recommends it within the next year.

— Appropriators also sought to roll back abortion funding restrictions. A foreign operations spending bill advanced Thursday would lift a ban on funding organizations that provide or refer people for abortion abroad. It also increases global family planning funds and would repeal an abortion coverage ban for Peace Corps volunteers.

The legislation is likely to pass the House, but it faces an uncertain path in the Senate, where some centrist Democrats have opposed taxpayer funding for abortion services.

PANDEMIC RESPONSE WIDENS BUDGET GAP — The federal deficit is on pace to hit $3 trillion, driven largely by the massive Covid-19 relief package Democrats passed along party lines in March, POLITICO’s Caitlin Emma reports.

That gap is nearly triple the shortfall recorded two years ago, and at 13.4 percent of GDP, marks the second-largest deficit relative to the size of the economy since World War II. (2020 was even higher, with the deficit totaling 14.9 percent of GDP.)

Those figures could balloon even more; the Congressional Budget Office projections released Thursday account only for legislation passed through May 18, which excludes Democrats’ current efforts to pass trillions more in spending.

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What We're Reading

Cases of a common (and thankfully, milder) respiratory virus more typically seen in fall and winter are rising as people take fewer coronavirus precautions, The Wall Street Journal’s Brianna Abbott writes.

It could take more than nine years to determine whether the controversial Alzheimer’s drug approved last month actually works, the Associated Press’ Matthew Perrone reports.

Needle exchanges outlawed in West Virginia are just what are needed to stop the state’s HIV outbreak, according to a CDC investigation obtained by BuzzFeed News’ Dan Vergano.

A message from UnitedHealth Group:

UnitedHealth Group believes that all individuals should have access to high-quality, affordable health care that meets their unique needs. We are committed to advancing health equity by delivering personalized care, building a diverse health workforce, improving the health of underserved communities and providing insights and analyses to address disparities in care. Learn more about our commitment to sustainability in our recently released 2020 Sustainability Report.