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The ideas and innovators shaping health care | | | | |  | | By Carmen Paun, Ben Leonard, Ruth Reader and Erin Schumaker | | | | | 
Places mandating masks have dwindled. | AP | The Covid public health emergency’s end, which President Joe Biden says is coming on May 11, will mean new costs and hassles for many Americans. But it could also give a psychological boost to those weary of the three years of disruption Covid-19 has brought. Here are the key changes Americans can expect: — Many will have to pay for Covid vaccines, tests and treatments. People without health insurance will have to pay out of pocket, while those with private plans could see more costs depending on the terms of their insurance. Insurers typically cover the costs of preventive care, such as vaccines, but often charge deductibles or require cost-sharing for drugs. — Beneficiaries of Medicare, Medicaid and the Children’s Health Insurance Program could face more cost-sharing for tests and some Covid antivirals, though vaccines will remain free. — Employers will no longer be able to offer telehealth access as a premium, tax-free benefit separate from other health plans. — Eased rules for prescribing controlled substances without an in-person doctor’s visit could end unless the Drug Enforcement Administration moves to extend them. That could affect people seeking mental health care, transgender care, treatment for opioid use disorder and even remedies for severe coughs. DEA, however, says it’s working to get rules out soon. — Medicare coverage requirements waived during the emergency will resume. For example, Medicare patients seeking admission to a skilled nursing facility will first have to spend three days in a hospital. — The Medicare prescription drug benefit will no longer let patients get extended supplies of many drugs. — Hospitals will lose the 20 percent increase in Medicare payments they’ve received for treating Covid patients. And here’s what won’t change: — Medicare patients and people in high-deductible health plans will continue to have eased access to telehealth through the end of 2024 because of an extension Congress included in the year-end spending bill. — Congress has already agreed to end in April a requirement that states allow people to stay enrolled in Medicaid regardless of their eligibility for the program, allowing states to kick millions off the rolls. Many of those affected, whose incomes are too high to qualify for Medicaid, will be eligible for low-cost Obamacare plans. — The FDA will continue to have the power to authorize vaccines, tests and drugs on an emergency basis.
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Stowe, Vt. | Sam Oates | This is where we explore the ideas and innovators shaping health care. Researchers have identified a new target for non-hormonal birth control for men. Attempts to make hormonal birth control targeting sperm have been slowed because of unwanted side effects similar to those women experience with hormonal birth control: weight gain, acne, and depression. Share any other thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, Ruth talks with Daniel Payne about the Biden administration's plan to end the Covid-19 national and public health emergencies and the action's implications. Plus, Katherine Ellen Foley on the four biggest takeaways from Pfizer’s earnings call on Tuesday.
| | | | | | |  PEPFAR is up for reauthorization and the State Department has a plan. | AP | | | “Every time I hear an American politician or commentator talk about our country’s poor image in the world, I think about the tens of thousands of Africans who lined the roadsides to wave at our motorcade and express their gratitude to the United States.” George W. Bush on the appreciation he felt for his President’s Emergency Plan for AIDS Relief | | PEPFAR turns 20 this year, and the $7 billion-a-year program is up for congressional reauthorization. Though Congress could choose to fund the program without passing a reauthorization bill, global health advocates such as Chris Collins, the president and CEO of Friends of the Global Fight, which lobbies the U.S. government for the Global Fund to Fight AIDS, Tuberculosis and Malaria, said that approach would be a bad signal. He and other advocates want Congress to restate its support for the program through reauthorization while keeping PEPFAR's structure and funding in place. Congressional review comes at a crucial time, they say. The Covid pandemic threatens some gains the world has made against HIV due to a decrease in access to prevention, testing and treatment. In 2021, 1.5 million people were infected with HIV, a million more than public health officials’ target, according to a United Nations estimate. On the positive side, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, recently called for reauthorization and predicted a cure for AIDS could be a decade away. In the administration: The State Department's five-year PEPFAR strategy commits to improving prevention and bending the curve of new infections. State also wants to close equity gaps for the affected groups and integrate large parts of the HIV effort into countries’ health programs. The latter is premature, as it could end up hurting LGBTQ populations that are criminalized in some countries and remain at high risk of HIV infection, said Richard Lusimbo, an LGBTQ activist who coordinates the Uganda Key Populations Consortium. Plus, HIV would compete with other health priorities in those countries and funding for it may lose out, he said. On the Hill: Rep. Chris Smith (R-N.J.), the chair of the House Foreign Affairs subcommittee on Africa, Global Health and Global Human Rights, will author a reauthorization bill, he said Saturday. Smith said he would maintain his 2003 amendment that prevents PEPFAR from funding organizations that don’t have an explicit policy opposing prostitution and sex trafficking. The Supreme Court rejected a challenge to that amendment in 2020.
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The VA's rollout of a new electronic health records system has run into glitches and cost overruns. | AP Photo | The troubled rollout of a new electronic health records system at the Veterans Health Administration – which has seen cost estimates explode and glitches in data processing – could go on pause if Congress passes new legislation by House Veterans Affairs Chair Mike Bost (R-Ill.). Bost’s bill would: — Bar the VA from rolling out the system at any more of its medical centers until it demonstrates “significant improvement” — Require the VA secretary to certify that the system from contractor Oracle Cerner is functional 99.9 percent of the time over four consecutive months before more facilities move forward with the software — Mandate that several officials at each VA medical center implementing the system, including the chief of staff, certify that the facilities are prepared for it and that it won’t have “significant, sustained adverse effects” on patient safety, care quality or wait times Why the concern? The massive project began in 2018 with an estimated cost of $10 billion over 10 years but has since ballooned to more than $50 billion over 28 years, according to a recent estimate from the Institute for Defense Analyses that the VA commissioned. The VA hopes the system will help it better care for some 9 million veterans at its 171 medical centers, but it’s now in place for only a small fraction of them. The system has also had dangerous glitches. Last summer, the VA inspector general found 60 safety issues at a medical center in Spokane, Wash., including one that harmed 149 patients after prescription orders were never filled and requests for exams and services never scheduled because the system sent them to an unknown queue. | | | | Follow us on Twitter | | | | Follow us | | | | |  |
