More than half (54%) of these currently uninsured adults cited cost as the reason keeping them from having coverage.

The survey of 1227 adults was conducted this February and March by KFF (formerly known as the Kaiser Family Foundation). It included people who said they had Medicaid coverage in early 2023; prior to the repeal of pandemic-era eligibility rules on April 1, 2023.

About 1 in 5 (19%) of all people who had been on Medicaid in early 2023 were disenrolled at some point later that year, the survey found.

Seventy percent of that group said they subsequently went through a temporary period of being uninsured.

Most did eventually gain insurance: Forty-seven percent managed to re-apply and get reinstated on Medicaid, while another 28% said they found insurance via their work, Medicare, the Affordable Care Act’s marketplace or military-based health care.

More than a third of people who sought to regain some kind of coverage said they found the process difficult, the survey found, and nearly half (48%) called it stressful.

Long phone call wait times, excessive paperwork and trouble figuring out what paperwork was needed were common complaints.

Speaking to CBS News, Kate McEvoy, executive director of the National Association of Medicaid Directors, said that millions of people are currently being redetermined for eligibility, and that has swamped some state call centers.

According to McEvoy, states did try to reach out to enrollees prior to the post-pandemic changes in eligibility, using media campaigns, texts, emails, and apps.

However, “until the moment your coverage is at stake, it’s hard to penetrate people’s busy lives,” she said.

Interruptions in coverage can have an almost immediate impact on health: More than half (56%) of those polled by KFF said they’d missed needed health care or skipped prescriptions as they waited to regain coverage.

Among people who have found a form of health insurance other than Medicaid, worries around cost remain.

More than three-quarters (76%) of people with insurance say “they are worried about affording the cost of health care services,” according to a KFF news release. Only 47% of people who retained Medicaid felt the same.

More information

Find out how you can help maintain your coverage at medicaid.gov

SOURCES: KFF, news release, April 12, 2024; CBS News

This is the second lawsuit that the plaintiffs, the African American Tobacco Control Leadership Council, Action on Smoking and Health and the National Medical Association, have filed against the US Food and Drug Administration over delays in banning menthol cigarettes.

The first lawsuit, filed in 2020, demanded that the FDA add menthol to its list of prohibited flavors for public health reasons. Once the agency began to take action on the issue, that lawsuit was dismissed.

In the latest lawsuit, the groups claim the agency missed a March deadline for issuing a final rule on a menthol ban. Menthol cigarettes are particularly popular in the Black community.

“Because of defendants’ inaction, tobacco companies have continued to use menthol cigarettes to target youth, women and the Black community, all to the detriment of public health,” the lawsuit stated.

“As African American physicians, we are deeply disturbed at the continuing delays in FDA’s finalizing of the ban on menthol cigarettes,” Dr Yolanda Lawson, president of the National Medical Association, said in a news release announcing the lawsuit. “Our patients, more than any other group, become disabled and die prematurely due to the continued use of these cigarettes.”

All flavored cigarettes except menthols were first banned in 2009. The FDA has been considering a menthol ban for more than a decade, CNN reported.

“We’re extremely disappointed to be forced to file this second lawsuit against the FDA in support of protecting Americans from menthol cigarettes,” Laurent Huber, executive director of Action on Smoking and Health, said in the news release. “The FDA’s own research confirms that a menthol ban would save lives; there is no scientific reason to delay finalizing this rule.”

The FDA told CNN that it does not comment on pending litigation, but “remains committed to issuing the tobacco product standards for menthol in cigarettes and characterizing flavors in cigars as expeditiously as possible; these rules have been submitted to [the Office of Management and Budget] for review, which is the final step in the rule-making process.”

But the plaintiffs said the time for action is long past due.

“The relentless and racist tobacco industry targeting has killed too many members of the Black community,” Carol McGruder, co-chair of the African American Tobacco Control Leadership Council, said in the news release. “If Black lives truly matter, then we must end the sale of menthol cigarettes and do it now!”

Studies on the benefits of a menthol ban are plentiful.

Over a 20-year period, it could lower health care costs among all adult smokers by about $1.62 billion, a recent study found. It would also save up to 654,000 lives within 40 years, including 255,000 Black lives, a 2022 study found.

Meanwhile, a 2020 study showed that while 43% of all adult smokers smoked menthols, more than 83% of Black smokers did. But within five years, the elimination of menthol cigarettes could close the gap in lung cancer deaths, another report found.

“The administration continues to miss the opportunity to leave a significant, lasting public health legacy, save lives and reach their Cancer Moonshot goals by not finalizing these rules,” Dr Karen Knudsen, CEO of the American Cancer Society and the Cancer Action Network, said in a news release supporting the move.

The American Lung Association (ALA) is also not part of the lawsuit, but expressed its support.

“The FDA’s findings show that menthol cigarettes are not appropriate for the protection of public health. It is frustrating that the continued delay of the menthol rules compelled our partners to go back to court,” ALA President and CEO Harold Wimmer said in a news release.

The FDA will likely have about two months to respond to the lawsuit in court, the groups’ attorney, Christopher Leung, told CNN.

The White House did not respond to a request for comment on the lawsuit, CNN reported.

More information

The American Lung Association has more on menthol cigarettes.

SOURCES: African American Tobacco Control Leadership Council, Action on Smoking and Health and the National Medical Association, news release, April 1, 2024; CNN

The agency noted that it “is aware of media reports, as well as medical and scientific literature, highlighting instances where, as part of medical students’ courses of study and training, patients have been subjected to sensitive and intimate examinations, including pelvic, breast, prostate or rectal examinations, while under anesthesia without proper informed consent being obtained prior to the examination.”

“It is critically important that hospitals set clear guidelines to ensure providers and trainees performing these examinations first obtain and document informed consent from patients before performing sensitive examinations in all circumstances,” the agency stressed in its letter.

The HHS also issued a new set of guidelines clarifying a longstanding requirement that hospitals must obtain written informed consent as a condition for being reimbursed by Medicare and Medicaid.

“While we recognize that medical training on patients is an important aspect of medical education, this guidance aligns with the standard of care of many major medical organizations, as well as state laws that have enacted explicit protections as well,” the HHS noted. “Informed consent is the law and essential to maintaining trust in the patient-provider relationship and respecting patients’ autonomy.”

But that hasn’t always been happening.

In 2020, a New York Times investigation found that hospitals, doctors and doctors in training sometimes conducted pelvic exams on women who were under anesthesia, even when those exams were not medically necessary and when the patient had not authorized them. Sometimes these exams were done solely to educate medical trainees.

“Patients who are participating in future clinicians’ education should be aware, should have the opportunity to consent, should be given the same opportunity to participate in that education that they would be given if they were awake and fully clothed,” Ashley Weitz, who underwent an unauthorized pelvic exam while she was under sedation in an emergency room, told the Times. “We can only expect to have better trust in medicine when both patients and providers can expect a standard of care that prioritizes patient consent.”

More information

The U.S. Department of Health and Human Services has more on patient privacy under HIPAA (Health Insurance Portability and Accountability Act).

SOURCES: U.S. Department of Health and Human Services, letter, April 1, 2024; New York Times

The order “will direct the most comprehensive set of executive actions ever taken to expand and improve research on women’s health,” the White House said in a news release announcing the move. “These directives will ensure women’s health is integrated and prioritized across the federal research portfolio and budget, and will galvanize new research on a wide range of topics, including women’s midlife health.”

While women comprise half of the US population, research into their health is lacking. In fact, the federal government only began mandating women be included in federally funded medical research in the 1990s, the Associated Press reported.

“We still know too little about how to effectively prevent, diagnose and treat a wide array of health conditions in women,” Dr Carolyn Mazure, head of the White House initiative on women’s health, told the AP.

The move comes as women’s reproductive rights across the country are being threatened following the Supreme Court’s overruling of Roe v. Wade.

President Biden and First Lady Jill Biden, who announced an initial $100 million in funding last month for women’s health, plan to announce the latest measures at a Women’s History Month reception at the White House on Monday. The measures will include the launch of a new effort at the National Institutes of Health (NIH) that will direct $200 million in 2025 to fund new, interdisciplinary women’s health research.

The NIH effort will also focus on identifying and rectifying research gaps in studying menopause and the treatment of menopausal symptoms, White House adviser Jennifer Klein told the AP.

The NIH tends to fund a lot of biomedical research, which helps doctors figure out how medications affect the human body and how to dose drugs safely, but that equation differs depending on gender.

Some conditions have different symptoms for men and women, such as heart disease. Others are more common in women, like Alzheimer’s disease, and some are unique to women, such as endometriosis, uterine cancers and fibroids found in the uterus. Regardless, it all needs to be studied further, Mazure said.

More information

The Office on Women’s Health has more on women’s health.

SOURCE: White House, news release, March 18, 2024; Associated Press

Govenor Kay Ivey, a Republican, signed the bill into law shortly after it was passed by the Senate on Wednesday.

Following the signing, 2 major fertility clinics said they will restart IVF treatments while another clinic said the scope of protections was unclear and it would wait for “legal clarification,” the New York Times reported.

Lawmaker support for the bill was strong, 81 to 12, with 9 abstentions, in the House and 29 to 1 in the Senate, the Times reported.

Why was the legislation passed so quickly?

The state Supreme Court ruling raised fears about civil and criminal liability among infertility doctors and clinics.

Shortly after the ruling was issued, at least three major clinics stopped IVF treatments and an embryo shipping company paused its business in the state, the Times reported. Meanwhile, IVF patients pleaded with lawmakers and protested to preserve their right to grow their families.

The new law stops short of addressing whether a frozen embryo conceived outside of the womb should be considered a person. Instead, it broadly shields clinics and IVF providers from civil and criminal liability.

“The problem we’re trying to solve right now is to get those families back on a track to be moving forward as they try to have children,” said State Rep. Terri Collins, who sponsored the measure in the House. “Will we need to address that issue? Probably.”

“I don’t want to define life, that’s too important to me, to my faith,” Collins told the Times. “But we do have to decide where we begin protection, and that’s what I think we’ll have to talk about.”

Meanwhile, Infirmary Health Systems and the Center for Reproductive Medicine, the targets in the wrongful death lawsuit that led to the state Supreme Court ruling, said it would not yet resume IVF treatments, the Times reported.

“At this time, we believe the law falls short of addressing the fertilized eggs currently stored across the state and leaves challenges for physicians and fertility clinics trying to help deserving families have children of their own,” a statement from the clinic said.

Experts agreed that the legal picture on IVF is still murky.

“The question that’s answered by this bill is, are our fertility clinics liable?” Clare Ryan, a professor of family law at the University of Alabama, told the Times. “It doesn’t address these bigger questions about, what is the child? When does the act of conception occur? What is the role of uterine implantation?”

“Republicans created this mess for themselves, and now they’re trying to contain the damage from it without dealing with the mess itself,” said Susan Pace Hamill, a University of Alabama law professor who specializes in the state Constitution, told the Times. “They are doing back somersaults to avoid disturbing directly anything the Alabama Supreme Court said.”

More information

Visit Yale Medicine for more on IVF.

SOURCE: New York Times

In the decision, judges turned to what it called anti-abortion language in that state’s constitution and concluded that an 1872 state law that allows parents to sue over the death of a minor child “applies to all unborn children.”

“Unborn children are ‘children’ … without exception based on developmental stage, physical location, or any other ancillary characteristics,” Associate Justice Jay Mitchell wrote in the ruling.

Reaction to the decision was swift and strident, as infertility experts stressed the ruling ultimately threatens the use of IVF treatments.

“By insisting that these very different biological entities are legally equivalent, the best state-of-the-art fertility care will be made unavailable to the people of Alabama. No health care provider will be willing to provide treatments if those treatments may lead to civil or criminal charges,” Dr Paula Amato, president of the American Society for Reproductive Medicine, told the Associated Press.

“This ruling is stating that a fertilized egg, which is a clump of cells, is now a person. It really puts into question the practice of IVF,” Barbara Collura, CEO of RESOLVE: The National Infertility Association, told the AP.

The decision is a “terrifying development for the 1-in-6 people impacted by infertility” who need in-vitro fertilization, she said.

Following the ruling, it isn’t clear whether future embryos created during fertility treatments can be frozen or if patients could ever donate or destroy unused embryos.

But Sean Tipton, a spokesman with the American Society for Reproductive Medicine, told the AP that at least one Alabama fertility clinic has been instructed by their affiliated hospital to pause IVF treatment for now.

The plaintiffs in the Alabama case had IVF treatments that created several embryos, some of which were implanted and led to healthy births, the AP reported. The couples paid to keep the unused embryos frozen in a storage facility, but a patient managed to wander into the area in 2020 and removed several embryos, dropping them on the floor and “killing them,” the ruling said.

The justices ruled that the wrongful death lawsuits brought by the couples could proceed, although the clinic and hospital named as defendants in the case could appeal.

Michael Upchurch, a lawyer for the fertility clinic in the lawsuit, the Center for Reproductive Medicine, told the AP they are “evaluating the consequences of the decision and have no further comment at this time.”

Meanwhile, an anti-abortion group applauded the decision.

“This ruling, which involved a wrongful-death claim brought by parents against a fertility clinic that negligently caused the death of their children, rightly acknowledged the humanity of unborn children created through in vitro fertilization [IVF] and is an important step towards applying equal protection for all,” Lila Rose, president and founder of Live Action said in a statement.

Justice Greg Cook, who filed the only full dissent to the ruling, said the 1872 law was being stretched from its original intent to cover frozen embryos.

“No court, anywhere in the country, has reached the conclusion the main opinion reaches,” he wrote, adding the ruling “almost certainly ends the creation of frozen embryos through in vitro fertilization [IVF] in Alabama.”

White House press secretary Karine Jean-Pierre said Tuesday that the Alabama decision was yet another consequence of the US Supreme Court overturning Roe v. Wade in June 2022, the AP reported.

“This president and this vice president will continue to fight to protect access to reproductive health care and call on Congress to restore the protections of Roe v. Wade in federal law for all women in every state,” Jean-Pierre told reporters.

More information

The World Health Organization has more on abortion.

SOURCE: Associated Press

K. John McConnell, PhD, from Oregon Health & Science University in Portland, and colleagues assessed the association of the transition to integrated managed care in Washington Medicaid with health services use, quality, health-related outcomes, and measures associated with social determinants of health. Analysis included about 1.45 million Medicaid enrollees in Washington State between 2014 and 2019.

The researchers found that financial integration was not associated with changes in claims-based measures of utilization and quality. While enrollees with mild or moderate mental illness experienced a slight decrease in cardiac events (−0.8%), most claims-based measures of outcomes were also unchanged. Enrollees with serious mental illness experienced small decreases in employment (−1.2%) and small increases in arrests (0.5%). Financial integration was perceived by key informants as an administrative change and did not have substantial implications for how practices delivered care. Behavioral health agencies reported lacking guidance on how to integrate care in behavioral health settings and struggled with new contracts and regulatory policies that may have inhibited the ability to provide integrated care.

“There was a hope that this would be a significant catalyst,” McConnell said in a statement. “The idea was that integrating care within managed care organizations would drive positive changes at the clinical level, and that didn’t really happen — at least not yet.”

One author disclosed personal fees from Omada Health.

Abstract/Full Text

Vishal R. Patel, from the Dell Medical School in Austin, Texas, and colleagues evaluated trends in per-capita surgeon supply from 2010 to 2020 at the US county level.

The researchers found that surgeon supply per 100,000 population decreased in rural counties (9.97 vs 9.03), while increasing in urban counties (22.7 vs 23.6), thus widening the rural-urban disparity in surgeon supply over time (difference-in-difference, −1.78). For socially vulnerable counties, the number of surgeons per 100,000 population decreased between 2010 and 2020 (12.4 vs 11.5), while remaining unchanged in other counties (15.4 vs 15.4), thus widening the disparity in surgeon supply (difference-in-difference, −0.87).

“These findings suggest that existing federal programs have not addressed the unequal distribution of the surgical workforce,” the authors write. “Policy solutions are needed to reduce health inequities and mitigate underlying factors of surgical workforce disparities, including unequal compensation, working conditions, and access to training.”

Abstract/Full Text (subscription or payment may be required)

The ban would prohibit most uses of trichloroethylene (TCE) within one year. Limited remaining commercial and industrial uses would be phased out over a longer period and would require stringent worker protections.

In addition to liver and kidney cancer, health risks associated with the toxin include disruption of the nervous and reproductive systems and damage to fetal development, the EPA said.

The proposal was made under the Toxic Substances Control Act. It would ban manufacturing, processing, and distributing TCE for any use.

TCE is used in cleaning and furniture care products, degreasers, brake cleaners, and tire repair sealants. The EPA says safer alternatives exist. A longer transition to phasing out TCE would be allowed for critical uses by federal agencies, in battery separators used to make electric vehicle batteries, and for manufacturing certain refrigerants while the industry transitions to more climate-friendly refrigerants.

The agency will take public comments on the proposed rule for 45 days after it is published in the Federal Register. The EPA also plans to host a public webinar for employers and workers. Anyone can attend. The date, time and registration information will be announced soon.

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“We know that these products are very poorly regulated by the federal government in terms of what goes in there,” said Kimberly Bertrand, an associate professor of medicine at Boston University School of Medicine and the lead author of a recently published study on the dangers of relaxers. “You can’t look at an ingredient label and know that it contains these endocrine disruptors. They don’t list phthalates and parabens on the box, they say fragrance and preservative. So, women don’t really know what they’re being exposed to.”

In that study, data from Boston University’s Black Women’s Health Study, which began in 1995 and tracks the health of 59,000 Black women, showed that postmenopausal Black women who used chemical hair straighteners had a higher risk of developing uterine cancer, NBC News reported.

Another study published recently by the American Journal of Epidemiology found lower fertility in current and former users of hair straighteners.

Women who used hair-straightening chemicals more than four times in the previous year were more than twice as likely to develop uterine cancer, according to a study published last year by the U.S. National Institutes of Health.

A number of cosmetics companies, including Revlon and L’Oréal, have also faced lawsuits over claims that their straightening products have led Black women to develop uterine and breast cancer, infertility, and other health issues, NBC News reported.

NBC News Article

HealthDay News — A proposed rule from federal regulators that would ban menthol cigarettes and flavored cigars has been sent to the White House Office of Management and Budget for final review.

The U.S. Food and Drug Administration first announced the proposed rule in April. The agency said then that the rule had “the potential to significantly reduce disease and death,” reduce “youth experimentation and addiction,” and increase the numbers of smokers who quit.

“Once finalized, rules to end the sale of menthol cigarettes and flavored cigars rule will be the most significant actions that the FDA’s Center for Tobacco Products has taken in its 14-year history. The American Lung Association [ALA] is eager for these lifesaving rules to be implemented and urges the White House to finalize these rules before the end of the year,” ALA President and CEO Harold Wimmer said in a statement. “The science and data are clear. Ending the sale of menthol cigarettes and flavored cigars will save lives. It will also help reduce the unjust disparities in tobacco use caused by the tobacco companies targeting certain communities with menthol cigarettes.”

While the numbers of smokers have dropped, the numbers of those who smoke menthols have increased, according to the US Centers for Disease Control and Prevention. The menthol flavor is appealing to new smokers, making cigarettes more addictive, according to scientists. It has also been blamed for health disparities in smoking. About 43% of all adult smokers smoked menthols, but more than 83% of Black smokers did so, according to a 2020 study. Only 30% of White smokers smoke menthols.

States have been enacting their own menthol bans, specifically Massachusetts in 2020 and California in 2022, CNN reported. Meanwhile, tobacco companies have already created a potential workaround to any menthol ban, formulating a synthetic menthol-like cooling agent and then marketing those products to menthol smokers. A study published last week revealed that some of these brands are providing even more cooling than actual menthol.

Still, the final rule may incorporate language that addresses that issue, also. “It’s a big deal for them because it is how they attract and sustain people’s addiction,” Erika Sward, assistant vice president of national advocacy with the ALA, told CNN. “So if this stands, they will have lost a major tool that they’ve used to addict and sustain an addiction for millions of people.”

CNN Article

Electronic prescriptions for schedules II-V controlled substances can be transferred between registered retail pharmacies for initial filling effective August 28, 2023, according to the Drug Enforcement Administration (DEA). The transfer is permissible only if allowable under existing State or other applicable law.

The final rule requires that the transfer of a controlled substance prescription in schedule II-V be communicated between 2 licensed pharmacists and that the prescription remains in electronic form with no changes during the transmission. The transfer can only be done once; any refills on the prescription (schedule III, IV, or V drugs) will be transferred to the receiving pharmacy as well. Electronic records of the transfer must be maintained by both pharmacies for 2 years from the date of the transfer.

Prior to the amendment, a pharmacy that could not fill an electronic prescription for a controlled substance could only inform the patient that it could not be filled. Since an electronic prescription cannot be printed and given to the patient by the pharmacist, the patient would need to call their doctor and request another prescription be sent to a different pharmacy. The DEA revised its regulations in an effort to reduce the potential for duplicate controlled substance prescriptions.

The final rule has been published in the Federal Register and provides additional information on the regulations, including procedures for proper documentation of the transfer.

HealthDay News — The President’s Emergency Program for AIDS Relief (PEPFAR), a program that has long successfully provided relief to people with AIDS around the world, will now be housed within the US State Department.

The move comes after years of pressure by antiabortion groups and some Republican members of Congress to attach abortion-related limits on US health support overseas, including PEPFAR.

The program was started by President George W. Bush in 2003 and has received about $100 billion in US funding during the past 2 decades. But PEPFAR will now be included within the new Bureau of Global Health Security and Diplomacy, part of the State Department, the Associated Press reported.

The newly created bureau is meant to make health security a global priority while building the capacity of US diplomats and local health systems to curb future outbreaks, according to Secretary of State Antony Blinken.

PEPFAR has maintained bipartisan support, but the new move to the State Department occurs as the program continues to be targeted as part of the abortion battle.

The newly created bureau will be led by John Nkengasong, who was born in Cameroon and is a founder of the US Centers for Disease Control and Prevention operations in Africa. Under Nkengasong’s guidance, the CDC helped set up the first sophisticated labs for HIV/AIDS work in that region, the AP reported. Nkengasong said the lessons learned from the US HIV program “are applied daily” with regard to other health threats.

Associated Press Article

HealthDay News — As Americans continue to grapple with the effects of long COVID, the Biden administration on Monday announced the creation of a new office focused on research about the condition that will be part of the US Department of Health and Human Services.

The Office of Long COVID Research and Practice will lead the US response to long COVID, which includes trials that have already been launched, the HHS said in an agency news release.

“As our nation continues to make strides in combating COVID-19, it is crucial that we address the impact of long COVID and provide resources to those in need,” said HHS Secretary Xavier Becerra. “Last year, President Biden called on HHS to coordinate the response to long COVID. The official establishment of the Long COVID Coordinating office and the launch of the RECOVER clinical trials solidifies this issue as an ongoing priority.”

The $1.15 billion RECOVER research program is meant to better understand, treat, and prevent long COVID; as many as 23 million Americans have developed the condition, according to HHS estimates.

Research has identified 12 possible symptoms of long COVID, including worsening of health after mental or physical activity, fatigue, brain fog and dizziness, changes in taste or smell, thirst, and changes in sexual desire or capacity. It can also include gastrointestinal symptoms, heart palpitations, chronic cough, chest pain, and abnormal movements. These are among more than 200 symptoms that have been associated with long COVID.

“The Office of Long COVID Research and Practice will enhance efforts being undertaken across the US government to improve the lives of those who continue to experience the long-term impacts of the worst public health crisis in a century,” said HHS Assistant Secretary of Health Adm. Rachel Levine, M.D., who will lead the new research effort.

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HealthDay News — Large numbers of Americans who were dropped from Medicaid this spring lost their coverage because of paperwork problems and not because they were not still eligible for the public health insurance program.

“I am deeply concerned about high rates of procedural terminations due to ‘red tape’ and other paperwork issues,” Health and Human Services Secretary Xavier Becerra wrote in a letter sent Friday to all governors, the Associated Press reported.

The changes are happening now because a prohibition on removing Medicaid coverage during the pandemic has now been lifted. States have now begun doing annual eligibility redeterminations. Among 18 states that began this review in April, about 1 million people continued to receive their health coverage, the AP reported. Another 715,000 lost that coverage, but in four of five cases, that was for procedural reasons, according to data from the federal US Centers for Medicare and Medicaid Services.

Becerra encouraged governors to make efforts to keep people on Medicaid, including by using electronic information from federal programs, such as food stamps, to confirm eligibility.

Data suggest that some states did a better job than others of answering questions about Medicaid coverage, the AP reported. The average call center wait time was a minute or less in April in 19 states and Washington, DC Conversely, it was 51 minutes in Idaho, 44 minutes in Missouri, and 40 minutes in Florida.

The AP and health care advocacy groups gathered data showing that about 3.7 million people already have lost Medicaid coverage, including about 500,000 in Texas, 400,000 in Florida, and 225,000 in California. In California, 89% of those cuts were for procedural reasons. That was true also for 81% in Texas and 59% in Florida, according to the AP.

Some states are voluntarily slowing cuts while working with CMS. South Carolina extended its eligibility renewal deadline from 60 days to 90 days. Michigan renewed more than 103,000 Medicaid recipients in June, while removing 12,000. Yet, more than 100,000 people have incomplete June eligibility cases.

Meanwhile, the insurance companies that run the Medicaid programs for the states are working to ensure people still have some health coverage. Officials from Molina Healthcare, a multistate insurer, said the company is working to enroll those dropped from Medicaid in individual insurance plans sold through state-based marketplaces, the AP reported.

Associated Press Article

HealthDay News — President Joe Biden announced Tuesday that his administration is seeking new rules to push insurance companies to increase coverage of mental health treatment.

The new rules, which still must go through a public comment period, would require insurers to study if customers have the same medical and mental health benefits and fix any disparities if they do not.

“You know, we can all agree mental health care is health care,” Biden said in a White House news release. “It is health care. It’s essential to people’s well-being and their ability to lead a full and productive life, to find joy, to find purpose, to take care of themselves and their loved ones. It’s about dignity. Think about this.”

The Mental Health Parity and Addiction Equity Act, passed in 2008, requires insurers to offer the same mental and physical health care coverage, which is not the case now.

“Folks, it shouldn’t be this way. It doesn’t need to be this way,” Biden said at a White House event highlighting the announcement. “But, right now, for millions of Americans, mental health care and treatment for substance abuse is out of reach. It’s out of reach. In 2020, less than half — less than half of all adults with mental illness diagnosis received care for it. Less than half.”

If finalized, the new rules would change that. “I don’t know what the difference between breaking your arm and having a mental breakdown is — it’s health,” Biden added. “We must fulfill the promise of true mental health parity for all Americans now.”

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HealthDay News — The Biden administration on Monday awarded $58 million in grants to help schools and daycare centers remove lead from drinking water. The announcement came during an event in Boston.

“I am excited to join local leaders in Boston to announce $58 million in grant funding that can be used to test for lead in drinking water, identify potential sources, and remove those sources to better protect our nation’s children,” EPA Assistant Administrator for Water Radhika Fox said in an agency news release. “Reducing lead in drinking water is a top priority for the Biden-Harris Administration and EPA is taking a holistic approach — harmonizing drinking water standards with historic infrastructure investments under the Bipartisan Infrastructure Law while providing technical assistance to disadvantaged communities to protect all our children from lead in drinking water.”

The grants will help test for lead in drinking water, identify sources of contamination, and help fix the problem, Fox said.

“During his first year in office, President Biden announced a bold plan to replace every lead pipe in America. Today’s announcement is another step toward making that vision a reality,” House Democratic Whip Katherine Clark said in the EPA news release. “Schools and child care centers across the country will have the resources to ensure students are safe to learn, play, and grow alongside their friends.”

Lead in water is a serious problem throughout the US. According to the EPA, lead can cause brain damage, and no amount of lead is safe for children.

The Biden administration’s goal is to remove all of the nation’s lead water pipes. The $15 billion from the Bipartisan Infrastructure Law for lead pipe removal will help, but it is not enough, the Associated Press reported. This includes installing and replacing lead pipes or connectors in faucets, water fountains, and water stations with lead-free parts.

Associated Press Article

HealthDay News — Medicaid expansion is associated with increased use of palliative care for patients with advanced cancer, according to a study published in the July issue of Health Affairs.

Xuesong Han, PhD, from the American Cancer Society in Kennesaw, Georgia, and colleagues examined the association between Medicaid expansion under the Affordable Care Act and receipt of palliative care among patients newly diagnosed with advanced-stage cancers. The analysis included data from the National Cancer Database (2010 to 2019; >1200 Commission on Cancer-accredited hospitals).

The researchers found that the percentage of eligible patients who received palliative care as part of first-course treatment increased from 17.0% pre-expansion to 18.9% postexpansion in Medicaid expansion states and from 15.7 to 16.7%, respectively, in nonexpansion states. In adjusted analyses, this yielded a net increase of 1.3 percentage points in expansion states. Patients with advanced pancreatic, colorectal, lung, and oral cavity and pharynx cancers and non-Hodgkin lymphoma saw the largest increases in receipt of palliative care associated with Medicaid expansion.

“These findings are consistent with earlier reports that indicate a promising role for expanding Medicaid eligibility in improving access to high-quality cancer care, and they support efforts to improve access to palliative care for patients with advanced-stage cancers at the patient, provider, organizational, and policy levels,” the authors write.

Abstract/Full Text (subscription or payment may be required)

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed with the goals of making health care more efficient and increasing the number of Americans with health insurance coverage. A few years later, the Department of Health and Human Services (HHS) instituted the HIPAA Privacy Rule, whose aim was to protect personally identifiable health information. Unfortunately, the HIPAA Privacy Rule is poorly understood by most, and that, combined with the explosive growth of social media and online review platforms, has led some practitioners and their practices to land in hot water.

Facts of the Case

A mental health practice in New Jersey found itself in trouble when its response to a critical online review was reported to the Office of Civil Rights (OCR), the enforcement arm of HHS. According to OCR, it received a complaint in April 2020 alleging that the mental health center had impermissibly disclosed the protected health information of a patient when it posted a response to the patient’s negative review. The patient alleged that in its response, the mental health center had disclosed specific information about the patient’s mental health diagnosis and treatment.

The OCR launched an investigation which turned up another 3 instances where patients had posted negative online reviews of the mental health center, and the center had impermissibly disclosed protected personal information in its response. The investigation also revealed that the mental health center had failed to implement HIPAA Privacy policies and procedures.

Over 3 years later, the mental health center and OCR reached an agreement. The mental health center must pay a $30,000 fine and implement a corrective action plan and will be monitored by OCR for the next 2 years. The corrective action plan included 2 very important provisions: 1) the development, maintenance, and revision of the mental health center’s policies and procedures to ensure it complies with the HIPAA Privacy rule, and 2) training all staff members, including owners, managers, billing clerks, etc, on the policies and how to comply with them.

The mental health center was also ordered to issue breach notices to any patient whose information had been disclosed on any internet platform, and to submit a breach report to HHS.

How Did the Breach Occur?

HHS does not disclose this information, but it is easy to speculate how this sort of thing could easily happen. Take, for example, an office manager or receptionist of a medical practice who manages the practice’s social media as part of her job. She hasn’t been trained in the HIPAA privacy regulations and so isn’t thinking about those as she is monitoring the practice’s online reviews. When she sees a negative review from a patient, she instinctively answers it, including information about the patient’s diagnosis or treatment, not realizing the privacy violation implications. After all, thinks the employee, the patient is the one that put the review up in the first place, so it’s not like they were hiding the fact they were being seen at the practice.

Obviously, such thinking is completely misguided. But it can give a glimpse into how easily such a thing can happen. The office manager is thinking she is helping the practice. She’s not thinking about HIPAA. Or perhaps it was simply carelessness, and an employee of the practice responded to the patient’s negative review online when they intended to do so privately.

This sort of enforcement action by OCR is not a one off: there have been several instances in the last few years where medical and dental practices were fined for online disclosures of patient information on social media and online review platforms.

“OCR continues to receive complaints about health care providers disclosing their patients’ protected health information on social media or on the internet in response to negative reviews. Simply put, this is not allowed,” said OCR Director Melanie Fontes Rainer in a statement.

HealthDay News — The US Supreme Court on Friday let stand a federal appeals court ruling that found people with gender dysphoria should be protected against discrimination under the Americans With Disabilities Act (ADA).

“By declining to hear this case, the Supreme Court implicitly acknowledges what those who have seriously examined the issue have concluded: the ADA protects people who experience gender dysphoria, including transgender and nonbinary people, from being discriminated against on that basis,” Olivia Hunt, policy director for the National Center for Transgender Equality, told the Associated Press.

Justices Samuel Alito and Clarence Thomas dissented.

“The Fourth Circuit’s decision makes an important provision of a federal law inoperative and, given the broad reach of the ADA and the Rehabilitation Act, will have far-reaching and important effects across much of civil society in that Circuit,” Alito wrote. “Voters in the affected States and the legislators they elect will lose the authority to decide how best to address the needs of transgender persons in single-sex facilities, dormitory housing, college sports, and the like.”

The 4th Circuit was the first federal appellate court to determine that the federal disabilities law protects transgender people who experience anguish because of the disparity between their assigned sex and their gender identity, the AP reported. The decision is only binding in certain states, those covered by the 4th Circuit. They are Maryland, North Carolina, South Carolina, Virginia, and West Virginia.

Some LGBTQ advocates see the ruling as potentially helpful for challenging legislation that would restrict access to gender-affirming medical care for transgender people, the AP reported. “The overwhelming majority of Americans support nondiscrimination protections for LGBTQIA+ people, and today’s decision means the ADA remains a mechanism that can help our communities secure those protections,” Hunt said.

Associated Press Article

HealthDay News — Large numbers of people are losing their Medicaid health coverage as pandemic relief measures end, and the federal government is asking states to slow down the purging of rolls.

Some people losing coverage could still be eligible and are being cut only for administrative reasons, such as not responding in time with their forms or not understanding the renewal process, the Biden administration contended.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that state Medicaid offices have the power to prevent or mitigate,” Health and Human Services Secretary Xavier Becerra wrote in a letter Monday to governors. Nobody “should lose coverage simply because they changed addresses, didn’t receive a form or didn’t have enough information about the renewal process,” Becerra stressed.

States are now reevaluating Medicaid eligibility after having been prohibited from dropping people during the early years of the pandemic, the Associated Press reported. While some states have not removed anyone yet, others are moving more swiftly, cutting tens of thousands of people.

Arkansas was among those that had officials particularly concerned, according to the US Centers for Medicare & Medicaid Services (CMS). More than 100,000 people in that state lost their Medicaid coverage, mostly for procedural reasons, the AP reported. Officials in Arkansas countered that they were following the timeline dictated for states and noted numerous attempts to contact recipients, with Gov. Sarah Huckabee Sanders saying the program was returning to what had been intended. Half or more of those whose cases were reviewed in April or May in Florida, Idaho, New Hampshire, and Oklahoma also lost coverage, according to the AP.

A total of 18 states sent preliminary data to CMS revealing that, among those whose renewals were due in April, about 45% retained coverage. Another 31% lost coverage, with about 80% of those losing their health care because of procedural reasons, according to the US Department of Health and Human Services, the AP said. About 24% of forms were still being processed, so final outcomes were not yet known.

Associated Press Article

HealthDay News — Medicare will soon cover a new class of drugs for Alzheimer disease if they receive full approval from the US Food and Drug Administration, with some key limits.

Along with full approval, drug makers will also have to gather and keep data in a registry showing how the drugs are working in the real world, the US Centers for Medicare & Medicaid Services announced Thursday.

“Alzheimer’s disease takes a toll on not just the people suffering from the disease but also on their loved ones and caregivers in a way that almost no other illness does. CMS has always been committed to helping people obtain timely access to innovative treatments that meaningfully improve care and outcomes for this disease,” CMS Administrator Chiquita Brooks-LaSure said in a statement announcing the change. “If the FDA grants traditional approval, CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered.”

The drugs in question, lecanemab (Leqembi) and aducanumab (Aduhelm), have already been given accelerated approval to “fill an unmet medical need” while drug makers continue research on their effectiveness and safety. But neither drug has received full, traditional approval.

Not everyone was thrilled with the idea of collecting real-world data in a registry. In a statement, the Alzheimer’s Association called the registry requirement “an unnecessary barrier,” adding that the registry “should not be a requirement for coverage” of an FDA-approved treatment.

However, the CMS said there is a “strong precedent” for using registries.

More Information

To reduce the risk of transfusion-transmitted HIV, the Food and Drug Administration (FDA) has finalized a set of individual risk-based questions to assess blood donor eligibility.

Under the updated policy, all prospective blood donors would be asked the same risk-based questions, regardless of sexual orientation, sex or gender, in order to determine eligibility. The time-based deferrals and screening questions for men who have sex with men (MSM) and women who have sex with MSM have been eliminated.

To reduce the likelihood of donations from individuals with new or recent HIV infection, potential donors who report having a new sexual partner, or more than 1 sexual partner in the past 3 months, and anal sex in the past 3 months, would be deferred. Individuals taking antiretroviral therapy to treat or prevent HIV, preexposure prophylaxis (PrEP) or postexposure prophylaxis (PEP) would also be deferred. Use of these medications may delay detection of HIV by currently licensed screening tests for blood donations, which may potentially give false negative results.

“The FDA has worked diligently to evaluate our policies and ensure we had the scientific evidence to support individual risk assessment for donor eligibility while maintaining appropriate safeguards to protect recipients of blood products,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “The implementation of these recommendations will represent a significant milestone for the agency and the LGBTQI+ community.”

Both the United Kingdom and Canada have similar blood donation policies in place.

“The FDA is committed to working closely with the blood collection industry to help ensure timely implementation of the new recommendations and we will continue to monitor the safety of the blood supply once this individual risk-based approach is in place,” added Marks.

HealthDay News — The US Supreme Court ruled on Friday that the abortion pill mifepristone can remain widely available while litigation over its fate winds its way through the court system.

In the meantime, the order effectively halts a ruling from a federal judge in Texas that said the US Food and Drug Administration’s approval of the pill more than two decades ago was invalid.

Following the Supreme Court ruling, President Joe Biden issued a statement saying, “As a result of the Supreme Court’s stay, mifepristone remains available and approved for safe and effective use while we continue this fight in the courts. I continue to stand by FDA’s evidence-based approval of mifepristone, and my Administration will continue to defend FDA’s independent, expert authority to review, approve, and regulate a wide range of prescription drugs.”

Friday’s order is the second time in a year that the Supreme Court has considered slashing access to abortion in the United States. In overturning Roe v. Wade last June, a conservative majority said it was leaving the issue of abortion to elected officials.

It was only last Wednesday when a federal appeals court partially overruled Judge Matthew Kacsmaryk’s April 7 ruling made in Texas, which said the US Food and Drug Administration’s approval of mifepristone back in 2000 was invalid and the drug should not be used. While the three-judge appeals court panel said mifepristone could remain available for now, it blocked mailing the pill to patients, as well as other measures the federal government has taken recently to boost access to the medication.

Even if the decision to rescind mifepristone’s FDA approval is ultimately upheld, experts believe most American women could still access medical abortion, since misoprostol would remain legal.

More Information

HealthDay News — Masking policies are an important infection prevention strategy, which played a role early in the COVID-19 pandemic, but universal masking in health care settings is no longer appropriate, according to an ideas and opinions piece published online April 18 in the Annals of Internal Medicine.

Noting that despite the evolution of the COVID-19 pandemic and transition to endemicity, widespread masking requirements continue in health care settings, Erica S. Shenoy, MD, PhD, from Harvard Medical School in Boston, reviewed the utility of universal masking in this setting and the potential downsides of maintaining such policies.

The authors note that the implementation of masking along with other strategies to limit transmission was supported by public health guidelines and health care epidemiology experts and was appropriate during the early pandemic response given the limited knowledge and lack of preventive and therapeutic options. However, the burden of SARS-CoV-2 has been mitigated over time, and an imminent end to the public health emergency has been announced. Consequently, many pandemic interventions have been deimplemented, with masking requirements in health care settings a notable exception. Maintaining masking may have marginal benefit in terms of reducing the risk for transmission, but these benefits need to be weighed against costs, including impeded communication, increased cognitive load due to the increase in listening effort required, and obscuring of facial expression, which may negatively impact human connection, trust, and perception of empathy.

“We have achieved major advancements in the prevention and management of SARS-CoV-2 since the pathogen was initially identified in 2019,” the authors write. “In recognition of these achievements, the time has come to deimplement policies that are not appropriate for an endemic pathogen when the expected benefits of such policies are low.”

Abstract/Full Text