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Morning Briefing: Tuesday, Aug. 27, 2024

Open enrollment, opioid settlement funds, Medicare Advantage overbilling, weight loss drugs, extreme heat, mosquito-borne diseases, and more
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Tuesday, August 27, 2024
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Morning Briefing

  Note To Readers

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In This Edition:

From KFF Health News:

KFF Health News Original Stories

5. Political Cartoon: 'I Toad You!'

KFF Health News provides a fresh take on health policy developments with "Political Cartoon: 'I Toad You!'" by Hagen.

Here's today's health policy haiku:

NOT ALL HEROES WEAR CAPES

As summer winds down,
the Red Cross still needs donors.
You could save a life.

If you have a health policy haiku to share, please Contact Us and let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.

Opinions expressed in haikus and cartoons are solely the author's and do not reflect the opinions of KFF Health News or KFF.

Summaries Of The News:

Coverage And Access

6. CMS Designates $100M For Navigators To Aid 2025 Open Enrollment

The Centers for Medicare and Medicaid Services will distribute the money to 44 organizations in 28 states that work on outreach and help people to sign up for health insurance during open enrollment for the Affordable Care Act exchanges.

More health insurance news —

Modern Healthcare: Where Medicare, Medicaid DSH Payment Lawsuits Stand
Hospitals and the federal government have been engaged in years of back-and-forth legal battles over billions of dollars in Medicare and Medicaid payments meant to support providers that treat large numbers of low-income patients. These disputes about Medicare and Medicaid disproportionate share hospital, or DSH, payments have found their way to the Supreme Court before and will again as different judges reach different conclusions. (Early, 8/26)

KFF Health News: Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition
A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an "uproar" from the industry, newly released court filings show. The Centers for Medicare & Medicaid Services published the draft regulation in January 2014. The rule would have required health plans, when examining patient's medical records, to identify overpayments by CMS and refund them to the government. (Schulte, 8/27)

Health insurance updates from Florida and Texas —

WGCU: NCH May Become Out Of Network Without A New Agreement With Florida Blue
Florida Blue has alerted patients in second region of the state about the potential of them losing coverage Oct. 1 due to an impasse with a major health system. Florida Blue is telling patients the Naples-based NCH be out of network if a new insurer-hospital agreement can't be reached. This would include hospitals, physician groups and other specialty care services. (Barbor, 8/26)

AP: Judge Orders Pause On Biden Program That Offers Legal Status To Spouses Of US Citizens
A federal judge in Texas on Monday paused a Biden administration policy that would give spouses of U.S. citizens legal status without having to first leave the country, dealing at least a temporary setback to one of the biggest presidential actions to ease a path to citizenship in years. ... One of the states leading the challenge is Texas, which in the lawsuit claimed the state has had to pay tens of millions of dollars annually from health care to law enforcement because of immigrants living in the state without legal status. (Gonzalez, 8/26)

Pharmaceuticals

7. Eli Lilly To Offer Lower Cost, Low-Dose Zepbound; It Comes With Conditions

Patients will have to fill their own vials before they give themselves shots. They also will have to order supplies directly from the company, and they'll have to pay in cash. Separately, researchers find GLP-1 drugs may work differently than they thought.

NBC News: Lilly Slashes Prices On Two Lowest Doses Of Zepbound — If You're Willing To Give Up Injector Pen
Drugmaker Eli Lilly is significantly lowering the prices of the two lowest doses of its blockbuster weight loss drug Zepbound, it said Tuesday, in a move to expand access and ease supply constraints. Two key changes to how people get and use the cheaper medicine, however, might not be appealing to some patients. Under the new pricing plan, a month's supply of the lowest dose, 2.5 milligrams, will cost $399, while a month's supply of the 5 mg dose will cost $549. That's down from a monthly list price of $1,059, regardless of the dosage. (Lovelace Jr., 8/27)

In related news about weight loss and diabetes —

Newsweek: Ozempic Works Differently Than Previously Thought
Weight loss drugs such as Ozempic, Wegovy and Mounjaro seem to directly impact metabolism, not just appetite, according to a new study. It was previously thought these drugs — collectively called glucagon-like peptide 1 (GLP-1) analogs — worked by making people feel fuller so they eat less. But the results of a recent clinical trial suggest it's not as simple as that. People who took GLP-1 daily for 24 weeks experienced both weight loss and an increased metabolism. (Willmoth, 8/23)

Stat: Continuous Glucose Monitoring For The Masses Is Here. Are We Ready?
Glucose tracking is the future, Dexcom executives gushed at a glitzy launch event for their new, over-the-counter continuous glucose monitor on Wednesday evening. Surrounded by champagne, new celebrity ambassador and "Parks and Rec" actress Retta, and a mini-pickleball court, CEO Kevin Sayer declared victory. (Palmer and Lawrence, 8/26)

More pharmaceutical news —

Reuters: Cigna To Remove AbbVie's Humira From Some Drug Reimbursement Lists Next Year
Cigna said on Monday it will remove AbbVie's blockbuster rheumatoid arthritis drug Humira from some of its lists of preferred drugs for reimbursement in 2025, and recommend less pricey biosimilar versions of the medicine instead. Cigna said Boehringer Ingelheim's Cyltezo, Simlandi from Teva and Alvotech and an unbranded version of Hyrimoz from Sandoz will be covered on some lists that are managed by its pharmacy benefits unit Express Scripts. (Wingrove, 8/26)

Modern Healthcare: Walgreens' Ramita Tandon On Clinical Trials, BARDA Partnership
Walgreens' clinical trials unit is shaping up to play a critical role in the retail pharmacy's transformation strategy. This past year has been recovery mode for Walgreens, and more changes are coming. The company plans to shutter hundreds more of its drugstores over the next few years, in addition to rethinking its healthcare services portfolio, which includes primary and urgent care, specialty pharmacy and home care services. (Hudson, 8/26)

Reproductive Health

8. Planned Parenthood Files Complaints Against Missouri's Medicaid Law

Missouri Planned Parenthoods are challenging a new law in Missouri that bans any funding — including for preventive care like cancer screenings or pap smears — from going to the reproductive health care organization. Related news comes from Oklahoma, Arkansas, and elsewhere.

AP: Planned Parenthood Challenges Missouri Law That Kicked Area Clinics Off Of Medicaid
Missouri Planned Parenthoods filed legal challenges Monday against a new law that kicked the organizations off the federal Medicaid health insurance program. Planned Parenthood Great Plains and Planned Parenthood Great Rivers said they are filing complaints with the state's Administrative Hearing Commission, which functions as a court to hear disputes between Missouri government and private organizations. (Ballentine, 8/26)

Vox: The Huge Stakes In The Supreme Court's New Abortion Case, Oklahoma V. HHS
Oklahoma v. Department of Health and Human Services is the sort of case that keeps health policy wonks up late at night. On the surface, it involves a relatively low-stakes fight over abortion. The Biden administration requires recipients of federal Title X grants — a federal program that funds family-planning services — to present patients with "neutral, factual information" about all of their family-planning options, including abortion. Grant recipients can comply with this requirement by giving patients a national call-in number that can inform those patients about abortion providers. Now, however, Oklahoma wants the Supreme Court to allow it to receive Title X funds without complying with the call-in number rule. Oklahoma raises two arguments to justify its preferred outcome, one of which could potentially sabotage much of Medicare and Medicaid. (Millhiser, 8/26)

State Watch

9. 2,325 People Died From Heat Last Year, Mostly In The Desert Southwest

The lead author of the report, which was published Monday in JAMA, told USA Today that the deaths were overwhelmingly concentrated in Arizona, California, Nevada, and Texas. The death toll is likely an undercount.

USA Today: Heat Deaths In The US Reached Record Level In 2023, Study Finds
More Americans died from heat in 2023 than any year in over two decades of records, according to the findings published Monday. Last year was also the globe's hottest year on record, the latest grim milestone in a warming trend fueled by climate change. The study, published in the American Medical Association journal JAMA, found that 2,325 people died from heat in 2023. Researchers admit that number is likely an undercount. (Cuevas and Voyles Pulver, 8/26)

In news from Florida —

AP: US Appeals Court Clears Way For Florida Ban On Transgender Care For Minors
A federal appeals court Monday cleared the way for Florida to enforce a ban on gender-affirming care for minors, blocking a lower court order against the ban while the matter is appealed. The 2-1 decision was issued by the 11th U.S. Circuit Court of Appeals in Atlanta. The law revived by the ruling prohibits transgender minors from being prescribed puberty blockers and hormonal treatments, even with their parents' permission. It also required that transgender adults only receive treatment from a doctor and not from a registered nurse or other qualified medical practitioner. Adults who want the treatment must be in the room with the physician when signing the consent form. (8/26)

Politico: Group Of Florida Doctors Says Leading Medicaid Operator Slow To Pay
Hundreds of Florida's most vulnerable children are stuck in the middle of a long-running financial dispute between doctors and the state's largest Medicaid operator. A group of physicians affiliated with Privia Medical Group, a Virginia-based network of health care providers that has a branch in Florida serving doctors' offices statewide, says it is owed $781,000 from Sunshine State Health Plan, a Medicaid managed care plan that oversees the most patients in the state. (Sarkissian, 8/27)

More news from across the U.S. —

The Hill: Lawmakers Press USDA Head On 'Food Shortage Crisis' Facing Tribes Nationwide
Congressional funding chiefs on Monday pressed U.S. Agriculture Secretary Tom Vilsack for more information on what they're describing as a "food shortage crisis" facing tribes nationwide. House Appropriations Chair Tom Cole (R-Okla.) and Senate Appropriations Chair Patty Murray (D-Wash.) led the letter requesting the information, along with the ranking members on each committee and subcommittee heads on both sides. (Folley, 8/26)

The New York Times: Why California Is Considering Banning Food Dyes In Schools
For decades, researchers have been trying to answer a hotly contested question: Do the synthetic dyes used to add vibrant colors to foods like certain breakfast cereals, candies, snacks and baked goods cause behavioral issues in children? A bill before the California Senate, which is expected to come to a vote this week, has reignited the debate. If passed, it would prohibit K-12 public schools in California from offering foods containing six dyes — Blue No. 1, Blue No. 2, Green No. 3, Yellow No. 5, Yellow No. 6 and Red No. 40. (Callahan, 8/26)

Covid-19

10. Democrats Celebrated At Convention, And Some Went Home With Covid

Members of Democratic presidential nominee Kamala Harris' campaign staff are among those fighting the virus. People aren't letting the virus keep them down, The New York Times reports: Folks are shunning covid protocols.

NBC News: The Democratic Convention's Surprise Guest: Covid
Fresh off of a jam-packed week of Democratic National Convention events, reports of attendees' testing positive for Covid are rolling in. They include members of Vice President Kamala Harris' campaign staff, who are now contending with sickness from Covid, according to two sources close to the campaign with knowledge of the cases. There is at least some concern the developments could affect staffing at events this week, they added. (Korecki and Perlmutter-Gumbiner, 8/26)

Covid news about Meta and Google —

Reuters: Zuckerberg Says Biden Administration Pressured Meta To Censor COVID-19 Content
Meta Platforms CEO Mark Zuckerberg said senior officials in the Biden administration had pressured his social media company to censor COVID-19 content during the pandemic, adding that he would push back if this were to happen again. In a letter dated Aug. 26, Zuckerberg told the judiciary committee of the U.S. House of Representatives that he regretted not speaking up about this pressure earlier, as well as some decisions the owner of Facebook, Instagram and WhatsApp had made around removing certain content. (8/27)

Reuters: Google Defeats RFK Jr's Appeal To Restore Anti-Vaccine Videos, For Now
Former U.S. presidential hopeful and vaccine skeptic Robert F. Kennedy Jr on Monday lost his bid in a U.S. court to force Google's YouTube to restore two videos the platform removed for allegedly violating its policies on medical misinformation. In a brief order, a three-judge panel of the 9th U.S. Circuit Court of Appeals in San Francisco said a lower court judge properly denied Kennedy's request for a court order compelling the Alphabet unit to restore the videos it removed in 2023. (Scarcella, 8/26)

More on vaccine hesitancy —

Axios: Vaccine Hesitancy Eats Into Back-To-School Shots
A recent measles outbreak in Oregon is refocusing attention on declining childhood vaccination rates as kids head back to school. Lingering vaccine hesitancy from the pandemic is evident in pediatricians' offices as more parents opt out of the shots for measles, chicken pox, and whooping cough, among others, using non-medical religious exemptions. (Reed, 8/27)

Minnesota Public Radio: As School Nears, Doctors Worry About Minnesota's Undervaccinated Kids
The school year starts next week for many Minnesota families and physicians are concerned about children being undervaccinated. Right now, there's a global outbreak of measles, with 34 cases reported in Minnesota; there have been more than 500 cases of whooping cough so far this year. Minnesota is also experiencing a summertime COVID-19 surge, with cases on the rise following Fourth of July celebrations. (Wurzer and Stockton, 8/26)

Side Effects Public Media: The Checkup: Busting Popular Vaccine Misconceptions Around Childhood Immunizations
Some say vaccines are a victim of their own success. Because vaccines have been so effective at eradicating some of the most dangerous diseases, most of us have actually never experienced what it is like to live in a world where you can contract diseases like measles at the grocery store or where your child can get polio and be paralyzed. It's a radically different world than we know right now. And it's sometimes hard to comprehend that, especially with a lot of misconceptions about vaccines floating around. (Yousry, 8/26)

Outbreaks and Health Threats

11. Eastern Equine Encephalitis Case Confirmed In Houston County, Texas

As Texas animal health officials urge vets and owners to vaccinate horses against the mosquito-borne virus, officials in Massachusetts begin spraying in hopes of curbing the spread of the disease. West Nile virus, bird flu, and mpox also are in the news.

CIDRAP: Massachusetts To Start Spraying For Eastern Equine Encephalitis
Massachusetts officials over the weekend announced plans to start spraying for mosquitoes in two counties to reduce the risk from eastern equine encephalitis (EEE). Officials from the Massachusetts Department of Health (DPH) and the Massachusetts Department of Agricultural Resources said they will conduct aerial spraying in parts of Plymouth County and truck-mounted spraying in parts of Worcester County to target mosquitoes carrying the virus. (Dall, 8/26)

The Boston Globe: Triple E, Dengue, And West Nile: Tropical Diseases Are Here In Mass. Climate Change Will Probably Make Them Worse.
Mosquitoes thrive in warm, moist air. If it gets too cold, they get sleepy and can't do what mosquitoes do best: bite. Lucky for mosquitoes, climate change is making more places, including Massachusetts, a lot more appealing. That means a longer time to breed, better chances at survival — and an increased ability to spread disease. That's unlucky for us. (Shankman and Piore, 8/27)

On West Nile virus —

On bird flu —

CIDRAP: Avian Flu Virus Confirmed In Michigan Dairy Herd
Highly pathogenic avian influenza (HPAI) virus has been confirmed in a dairy herd in Van Buren County, Michigan — the nation's first detection for almost 2 weeks. The last detection in Michigan was on July 26, also in Van Buren County. (Soucheray, 8/26)

KFF Health News: With Only Gloves To Protect Them, Farmworkers Say They Tend Sick Cows Amid Bird Flu
In early August, farmworkers gathered under a pavilion at a park here for a picnic to celebrate Farmworker Appreciation Day. One sign that this year was different from the others was the menu: Beef fajitas, tortillas, pico de gallo, chips, beans — but no chicken. Farms in Colorado had culled millions of chickens in recent months to stem the transmission of bird flu. Organizers filled out the spread with hot dogs. (Bichell, 8/27)

On mpox —

Reuters: DR Congo No Longer Expects To Receive Mpox Vaccines This Week
Democratic Republic of Congo no longer expects to receive its first delivery of mpox vaccines this week, the head of its response team said on Monday, as Congo battles a new variant of the virus that has spread beyond its borders. On Aug. 19, Congo's health minister said the Central African country hoped to receive its first doses of a vaccine by this week, following promises from the United States and Japan to help it fight its outbreak. But asked whether Congo would begin receiving the doses this week, Cris Kacita, the head of Congo's response team, told Reuters: "No. There are still several processes to follow." (Rolley, 8/26)

Health Industry

12. Northwell Health Promises 5 Years Of Birth Services At Connecticut Hospital

In the wake of an antitrust probe into Northwell Health's merger with Nuvance Health, Connecticut Attorney General William Tong has reached an agreement with Northwell to preserve labor and delivery services for five years at Sharon Hospital. In other news, McLaren Health Care says it's recovered from a cyberattack earlier this month.

CBS News: McLaren Health Care Says It's Fully Operational After Cyberattack
McLaren Health Care announced on Monday that it is fully operational after experiencing a cyberattack earlier this month. In an update, the health system said its information technology platforms have been restored, and all temporary procedures that were enacted have been lifted. Officials said patient health records that were manually charted during the cyberattack will be put in the electronic system, which is expected to take several weeks. (Booth-Singleton, 8/26)

Crain's New York Business: NYC Health + Hospitals To Cut Primary Care Appointment Times
New York City Health + Hospitals is cutting new adult and pediatric primary care appointment times in half to move more patients through the door as wait times pile up. Doctors say the change will be untenable and could harm patient health. Beginning in September, the public hospital system plans to bring the time allotted for primary care intake appointments from 40 minutes to 20 minutes, according to doctors who have been briefed on the changes and internal documents reviewed by Crain's. (Geringer-Sameth, 8/26)

Military.com: In The Past Decade, VA Has Recouped $2.4 Billion In Separation Pay, Bonuses From Disabled Vets
In the past decade, the Department of Veterans Affairs has recouped more than $2 billion from veterans who received separation pay from the Defense Department and later filed for disability compensation, an effort that has resulted in financial hardship for some former service members. According to data provided by the VA, the department has collected $2.44 billion from 112,834 veterans since 2013 under a law that department officials say prohibits it from paying disability compensation to those who received voluntary or involuntary separation pay or bonuses until the money has been recouped. (Kime, 8/26)

NPR: People Die Waiting For A Kidney Transplant. Should Donors Be Compensated?
More than 90,000 people in the U.S. are waiting for a kidney transplant. But an ongoing kidney shortage means a thousand people a month are removed from the waitlist, either because they die while waiting for a kidney or become too sick for a transplant. Elaine Perlman wants to change that. "Enough is enough," she says. "The kidney shortage is a solvable problem." Perlman is executive director of Waitlist Zero, a coalition supporting newly proposed federal legislation that would create a 10-year pilot program called the End Kidney Deaths Act. (O'Neill, 8/26)

Mental Health

13. San Francisco Offers Antipsychotic Drugs To Unhoused Meth Users

In extending aid to help users deal with symptoms like paranoia and delusions, the city hopes to reduce pressure on psych emergency services. Other reports shine a light on how wastewater monitoring could be used to track drug use in the country.

The Atlantic: A New Way To Track Americans' Drug Use
Not long ago, tracking the spread of a virus by sampling wastewater counted as a novelty in the United States. Today, wastewater monitoring offers one of the most comprehensive pictures anyone has of COVID-19's summer surge. This type of surveillance has been so effective at forecasting the risks of the virus's rise and fall that local governments are now looking for other ways to use it. That has meant turning from tracking infections to tracking illicit and high-risk drug use. (Ouyang, 8/26)

KFF Health News: Public Voices Often Ignored In States' Opioid Settlement Money Decisions
The conversation wasn't sounding good for Kensington residents on June 20. The Philadelphia neighborhood is a critical center of the nation's opioid crisis, and the city had decided to spend $7.5 million in opioid settlement money to improve the quality of life there. But on that day, a Pennsylvania oversight board was about to vote on whether to reject the city's decision. (Pattani, Larweh and Mahon, 8/27)

In mental health news —

CBS News: Mental Health Team Responding To Nonviolent 911 Calls Expands Through Los Angeles
A program using mental health workers to respond to non-violent 911 calls focusing on issues with the homeless is expanding through Los Angeles, targeting areas where the need is the greatest. The Crisis and Incident Response through Community-led Engagement (CIRCLE) program, launched in 2022, dispatches mental health workers and individuals with lived experience, instead of armed police officers, to provide help and assistance for the homeless. (Sharp, 8/26)

AP: Philadelphia Airport Celebrates Its Brigade Of Stress-Busting Therapy Dogs
A pack of four-legged therapists got a break of their own on Monday when they were honored at the airport where they dutifully work to ease stress and calm travelers. The event at Philadelphia International Airport marked five years since the 23 members of the Wagging Tails Brigade began greeting people and serving as therapy dogs. (Vejpongsa, 8/26)

Editorials And Opinions

14. Viewpoints: Wealthy Countries Must Stop Hoarding Vaccines; Is AI The Answer To Health Care Inequality?

Editorial writers tackle these public health topics.

Stat: Wealthy Countries Must Share Their Mpox Vaccines Now
In early 2022, I cared for one of the first patients with mpox in Massachusetts. As an infectious diseases physician, I remember the deep uncertainty I felt, and the fear in my patient's eyes as a painful rash spread over their body. We were in uncharted territory — there were no proven treatments, and the number of cases was rapidly increasing. We decided to use tecovirimat (TPOXX), an antiviral developed for smallpox, to slow the disease's progression. When patients began to recover, it felt like a breakthrough — a moment of hope in the midst of yet another epidemic. (Wilfredo R. Matias, 8/27)

Newsweek: Artificial Intelligence Can Help Bridge The Health Care Gap Reducing Inequality
Health care has long been marked by disparities that affect different groups of people in various ways. Whether due to race, income, or geography, these disparities lead to unequal access to care and varying health outcomes. However, there is growing hope that artificial intelligence (AI) could be the tool we need to address these long-standing issues and create a more equitable health care system for all. (Zack Cass, 8/27)

Newsweek: Artificial Intelligence's Ambiguous Role In Combatting Health Care Disparities
No one can deny that health inequities are a global issue. The United States, despite decades of progress, has one of the highest rates of health disparities in the world. Our health care system is deeply flawed, and we must find solutions quickly. Artificial intelligence (AI) is being heralded as a way to democratize access to health care. (Tamer Rajai Hage, 8/27)

Stat: Clinical Trial Participants Deserve More Financial Support
Scientific advancements have helped millions of people living with cancer, heart disease, arthritis, obesity, and other diseases. Essential for the development of new therapies are the thousands of people who volunteer to participate in clinical trials every year, helping to characterize the safety and effectiveness of treatments and vaccines. (Jim Murphy and Lisa Lacasse, 8/27)

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. (c) 2024 KFF Health News. All rights reserved.

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