Breaking News

What the debt ceiling deal means for NIH, Nuance's wildly different prices, & what doctors think about advocacy

June 1, 2023
Reporter, Morning Rounds Writer
Good morning. The debt-ceiling cliffhanger has moved closer to resolution, with implications for biomedical research. Meanwhile, Medicaid coverage is unwinding, teen pregnancies are dropping, and an AI company's prices are swinging wildly. Buckle up.

politics

Debt-ceiling deal could squeeze biomedical research

The good news is the U.S. is set to avoid defaulting on its debts, thanks to an agreement hammered out over the weekend and expected to make its way through Congress before a June 5 deadline. The bad news is biomedical research and health care may suffer harsh cuts under the debt ceiling deal, scientists and health care advocates warn. NIH could be vulnerable, including its various arms focusing on needs from mental health to children's diseases and from heart health to dental care.

After years of growing budgets — nearly doubling from $25.8 billion in 2003 to $42.9 billion in 2022 — NIH will face fierce competition for funding. Also vying for billions are two programs that fall under the HHS umbrella: President Biden's longtime personal goal, the Cancer Moonshot, and a new agency, the Advanced Research Projects Agency for Health. STAT's Sarah Owermohle has more.


health insurance

Unwinding Medicaid coverage varies by state

Screen Shot 2023-05-31 at 5.53.43 PM

When the Covid-19 public health emergency lapsed last month, so did a freeze on removing people from Medicaid coverage. Enrollment had grown by 18 million, and nearly that many people might lose coverage, according to a KFF survey of state programs last month. In an update yesterday, the organization said Medicaid coverage is unwinding in different ways across the 11 states KFF monitors. It's not clear if people don't know they need to renew, haven't been able to do so for technical reasons, or are no longer eligible.

More than half a million people have been disenrolled, including 250,000 in Florida. Disenrollment as a share of completed renewals varies from 54% in Florida to 10% in Pennsylvania and Virginia. Last week a KFF survey found that nearly two-thirds of Medicaid enrollees are not aware that states are now permitted to resume cutting people from the Medicaid program.


Health

Teen pregnancies continue to plummet

Teen birth rates in the U.S. continued their fall last year, a decline that has paused only twice since 1991. The drop reached 3% among 15- to 19-year-olds but was unchanged for ages 10 to 14. The CDC report also said overall birth and fertility rates slid less than 1%. Birth rates for women 20 to 24 also marked a new low while the rate for women 40 to 44 continued an upward trend recorded nearly every year since 1985. Also:

  • Births declined 3% for American Indian or Alaska Native and white women and by 1% for Black women; they rose 2% for Asian women and 6% for Native Hawaiian or other Pacific Islander and Hispanic women. 
  • The cesarean delivery rate increased for the third year in a row, to 32.2%.
  • The preterm birth rate declined 1% in 2022, after rising 4% in 2021 to the highest since 2007.


Closer Look

Hospitals want to buy doctors' happiness with Nuance's AI scribe. The price is anyone's guess

Adobe

Doctors are desperate to escape the numbing documentation their jobs require. Microsoft's Nuance Communications sells an AI medical scribe platform to health systems willing to buy their doctors' happiness and, along with avoiding burnout, allowing them to see more patients. But the software's price tag is both hefty and hidden. Executives at four health systems using the software, called DAX, told STAT's Brittany Trang that while the software might make it possible to see more patients or justify higher charges to insurers, the high price tag means it's not boosting their bottom lines.

What's more, they're frustrated by not just with the steep costs, but also by high and inconsistently applied onboarding fees plus a lack of transparency about how much peer institutions are paying for the same service. None of the four executives, who requested anonymity, said they are paying the same amount. Read more, including Nuance's response.


pandemic

Two years after Covid infection, 1 in 7 unvaccinated people report related symptoms

This deep into the pandemic, there are few conclusions about who is more vulnerable to long Covid, although evidence is growing that being unvaccinated heightens risk. But how many people does that mean? A new study in BMJ followed unvaccinated people for two years and found 17% hadn't regained their pre-Covid health and 18% had lingering symptoms. That litany includes the now-familiar altered taste or smell, malaise after exertion, shortness of breath, brain fog, and anxiety.

The researchers compared 1,106 people who were infected with the original viral strain (through January 2021) to 628 people who weren't. They acknowledge the study was observational and relied on people's reports of their health, but suggest their work narrows other estimates for long Covid ranging between 22% and 75%. Still, "our findings imply that a sizable number of people might be affected by post-Covid-19 condition and have protracted health issues," they write.


reproductive health

Opinion: Indiana doctors rally around advocacy after abortion reprimand

Last week OB-GYN Caitlin Bernard was fined and reprimanded by ​​the Indiana State Licensing board for violating patient privacy laws by discussing the case of a 10-year-old girl who traveled from Ohio for an abortion. Four of her friends and colleagues call on more physicians to follow her lead and advocate for public health, saying they see how the "political determinants of health" directly affect patients. Such advocacy may lead to professional or personal repercussions, but they argue that not speaking out would be far worse.

"If physicians don't stand up to protect patient decision-making, legislative bodies will continue to pass laws to limit care in ways that put individual and public health at risk," Katie McHugh, Gabriel Bosslet, Caroline Rouse, and Tracey Wilkinson write in a STAT First Opinion. "Make no mistake that this represents a threat to the medical profession and public health." Read more.


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What we're reading

  • FDA approves Pfizer's RSV vaccine for older adults, STAT
  • Can Americans really make a free choice about dying? The 19th

  • India cuts periodic table and evolution from school textbooks — experts are baffled, Nature
  • Dobbs decision now a factor in med school residency picks, Roll Call
  • House Republicans demand career scientist explain pathogen research, STAT
  • How a medical recoding may limit cancer patients' options for breast reconstruction, KFF Health News


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