Breaking News

Judge strikes down Obamacare provision, what telehealth changes may mean for trans people, & a clue to disparities in breast cancer

March 31, 2023
Reporter, Morning Rounds Writer
Good morning. Today we have news on Obamacare, public health emergencies (yes, more than one), and clues to racial disparities in breast cancer.

Policy

Texas judge strikes down key element of Obamacare

Thirteen years after its passage, a federal judge yesterday struck down a provision of Obamacare that required insurance plans to cover preventive care, from cancer and chronic disease screening to pregnancy care and certain drugs. The ruling threatens efforts to lower maternal and infant mortality rates and could affect coverage of vaccines, statins, and drugs preventing HIV transmission known as PrEP.

Texas Judge Reed O'Connor said the Affordable Care Act requirement for insurers to cover care and products recommended by the U.S. Preventive Services Task Force is unconstitutional because its members were not appointed by the president and approved by the Senate. The lawsuit was brought on behalf of Christian-owned businesses in Texas that argued they should not be required to cover birth control and PreP. STAT's Sarah Owermohle has more.


politics

What will Congress' new law to end a Covid-19 emergency declaration actually do?

The Senate this week passed a House measure to end a Covid-19 national emergency declaration about a month before President Biden planned to end it. But that doesn't necessarily mean that all the government's emergency powers will end, my colleague Rachel Cohrs reports. The new law ends the emergency declaration under only one law, and not the public health emergency declared by the HHS secretary — that one is still slated to end on May 11, said Nicholas Diamond, a partner at Jackson Walker.

Diamond said ending the national emergency isn't necessarily a light switch, and more review is needed to determine exactly which programs will need to wind down and when.


Health

Changing telehealth policies would limit trans health care

It's not just states across the U.S. introducing anti-trans legislation that threatens transgender and nonbinary people. It's also the prospect of greater restrictions on gender-affirming care due to potential telehealth changes after the Covid public health emergency ends. "These targeted political attacks … are another public health emergency," Crystal Beal, a physician and founder and CEO of telemedicine provider QueerDoc, said at a media briefing yesterday. "Couple these with the end of the public health emergency, and more trans people will die."

One example: During the pandemic, telehealth providers could prescribe gender-affirming testosterone. Now, an in-person visit could be required after 30 days. And finding in-person gender-affirming care can be challenging in many parts of the country. "The lack of access to affirming care steals hope, but telehealth could keep that hope alive," said Debi Jackson, an activist and parent of a trans child, at the media briefing. STAT's Theresa Gaffney has more



Closer Look

Certain mutations linked to racial disparities in breast cancer

Photo of a woman standing in front of an x-ray machineAdobe

For all the advances in treating breast cancer in recent decades, Black patients still face worse outcomes than other patients. They are more likely to develop the most aggressive subtype — triple-negative — than white patients, and when they do, their outcomes are worse. Researchers studying the survival gap between racial and ethnic groups have cited different access to high-quality care, but a large new study in JAMA Network Open also finds biological differences in tumors.

Analyzing records of more than 107,000 patients, they found that ancestry correlates with key mutations that can shape the biology of certain tumors — and how they respond to treatments. Black patients tended to have worse responses to pre-surgical chemotherapy in nearly every subtype of breast cancer, but the disparity was most dramatic in hormone receptor-negative and HER2-positive tumors. And Black patients were more likely to have tumors with mutations associated with treatment resistance. STAT's Angus Chen has more.


drug pricing
In a switch, drug middlemen target generics

In the often opaque world of drug pricing, prescription drug middlemen known as pharmacy benefit managers have been blamed for wielding rebates that lead to higher list prices for drugs. But at a Senate Finance Committee hearing yesterday, new tactics came to light, including overcharging for generics. In the past generics had been spared while PBMs have been singled out for contributing to higher brand drug prices. 

Now the nonprofit generic drug maker CivicaRx says that PBMs are responsible for hiking prices of specialty generics, too. Case in point: Civica makes the generic oral prostate cancer drug abiraterone, competing with several other companies, yet the average cost to Medicare Part D for a month's supply is $3,000. Civica sells the drug for around $160, but cannot get PBMs to buy abiraterone, CivicaScript President Gina Guinasso wrote to Finance Chair Ron Wyden (D-Ore.) before the hearing. STAT's John Wilkerson has more.


Public health

ED visits for gun injuries climbed each pandemic year

There have been so many mass shootings in the U.S. it's become hard to count them, whether in schools like Monday's in Nashville or in a ballroom in California's Monterey Park earlier this year. A new CDC report tracking emergency visits for gunshot wounds says compared to 2019, such visits jumped 37% in 2020, 36% in 2021, and 20% in 2022. Weekly numbers of patients seeking care for gunshot wounds began to climb in March 2020, even as overall ED visits fell. 

The researchers link firearm injuries to both the pandemic's sudden surge in that month, and the months and years that followed, when suicide and homicides involving guns rose substantially. ED visits also increased sharply in late May 2020, and stayed high the rest of the year. While the authors didn't explore a cause, they note the spike coincided with the public outcry after the May 25 murder of George Floyd, changes in some states' Covid-19 prevention strategies, and reported increases in some types of crime. The Associated Press has more.


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What we're reading

  • There's no such thing as a casual interaction with your doctor anymore, The Atlantic

  • U.S. Navy deploys more chaplains for suicide prevention, Associated Press
  • FDA proposes a new plan to streamline updates to medical devices that use AI, STAT
  • How English football got hooked on snus: 'Players don't understand the threat of it,' The Athletic
  • Opinion: 3 keys to successful biopharma-academia drug development collaborations, STAT

Thanks for reading! More Monday,


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