Congress reaches major health policy deal on Medicare, Medicaid, and pandemic preparedness

It’s not a done deal yet, but sources have confirmed to STAT’s Rachel Cohrs and Sarah Owermohle some details of a sweeping health care policy package that lawmakers hope to pass, along with legislation to fund the federal government, by Friday. The details include:

Medicare policy: Doctors were facing 4.5% Medicare pay cuts at the end of the year but lawmakers met them halfway: in 2023, a 2% cut, and in 2024, a 3.5% cut.
Medicaid policy: Lawmakers also agreed to allow states to begin kicking ineligible people off their Medicaid rolls in April, regardless of when the Covid-19 public health emergency ends. But a tie to post-pregnancy care was weaker than hoped (see below).
Pandemic preparedness: The package has narrowed, but how much is unclear. It might require Senate confirmation of the CDC director.
Telehealth: Pandemic-era flexibilities are expected to be extended for two years.

A year of post-pregnancy health care falls out of policy package

U.S. maternal mortality rates are the highest among wealthy countries — and they’ve worsened in the pandemic. The remedy is familiar: Ensure at least a year of post-pregnancy health care. Democrats in Washington scrambled this month to make that a federal requirement for every state’s Medicaid program. They didn’t quite make it.

As part of a sweeping end-of-year package (see above), Democrats struck a deal with Republicans to let states kick ineligible people out of the Medicaid program beginning in April — before a freeze linked to the public health emergency ends — as long as children in the program were covered for a year after the change and recent states’ moves to cover people for a year after childbirth were included. But the ultimate agreement is a far cry from Democrats’ desire to require every state, including 17 holdouts, to cover postpartum care through Medicaid for a year. STAT’s Sarah Owermohle explains.

Severe childhood obesity is linked to a single genetic mutation

Imagine feeling a constant craving for food from infancy through childhood, a desire dimmed only after very large meals. That was life for a girl whose BMI measured 47.6 at age 12, when she underwent bariatric surgery. Now, researchers have found a new genetic mechanism that likely explains her condition as a rare type of severe obesity caused by a defect in a single gene.

Tissue samples removed during the girl’s surgery revealed a genetic mutation that leads to high expression of a gene called ASIP in the brain region that helps manage metabolism, scientists reported yesterday in Nature Metabolism. ASIP blocks a receptor called MC4R that regulates food intake and energy balance. While only 5% of severe obesity is explained by monogenic causes, such discoveries could also help unravel common obesity, Ruth Loos of the University of Copenhagen told STAT’s Elaine Chen. Read more.

Closer look: Overlooking structural causes of poor sleep is putting Black Americans' health at risk

(MOLLY FERGUSON FOR STAT)

We all know the sleep hygiene list: less screen time, more exercise, earlier bedtime. But many restless nights are more complicated than that. On average, Black Americans get worse sleep than white adults — often for reasons outside of their control. A growing number of experts argue that in order to address such racial disparities, health professionals need to start discussing sleep within the complex tapestry of a person’s life and surroundings.

That can mean everyday (and night) social and environmental conditions like noise pollution, chronic stress, income inequities, and more legacies of racism. The cost of poor sleep is high: Some researchers have estimated that at least half of the racial disparities in cardiometabolic disease risk can be traced back to differences in the sleep patterns of Black and white Americans, STAT contributor Katherine Harmon Courage reports. Read more.

Audit highlights FDA tobacco center's struggle to regulate vaping

In a stinging outside review ordered by FDA Commissioner Robert Califf, the agency’s Center for Tobacco Products was faulted for its lack of clear goals and impaired ability to regulate millions of tobacco products on the market. “The Center’s current goals and priorities are unclear in communication and practice,” the review, conducted by the independent Reagan-Udall Foundation and a panel of five former regulators and released yesterday, says.

The audit singled out the center’s struggle to enforce its existing rules and clear illegal products from the market. STAT’s Nicholas Florko reported in August that vape companies were regularly flouting the agency’s rules and refusing to pull their products off the market, despite FDA warnings. Yesterday’s report said that “failure to take timely enforcement action jeopardizes public health and undermines FDA’s credibility and effectiveness in tobacco product regulation.” Nick has more here.

Child homicide rates differ across populations

We’ll start with this grim statistic: Firearm injuries now exceed motor vehicle crashes as the leading cause of death among children. Two new studies in JAMA Pediatrics trace how homicide rates have changed for children under 18 during the last two decades, rising since 2013 and surging in the pandemic’s first year. From 1999 to 2020, more than 38,000 children died by homicide in the U.S., the first study says, with geographic and demographic differences.

Homicide rates fell for girls, children identified as Asian or Pacific Islander, or white, and those in the Northeast. There was a disproportionate rise in homicides among boys, Black and Hispanic children, and those living in the South. In 2020, rates of firearm-related injuries for children jumped 47.7% from 2019, the second study found. These results “highlight child homicide as a public health concern,” the authors write.

What we're reading

Mental health of incarcerated LGBTQ+ youth is understudied — but new analysis shows kids are in crisis, The 19th
In North Carolina, more people are training to support patients through an abortion, WFAE
Madrigal experimental drug delivers strong results in fatty liver disease known as NASH, STAT
How dyslexia became a social justice issue for Black parents, Washington Post
The list of the worst biopharma CEOs of 2022: No ‘winner,’ just accountability, STAT