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Inside the political minefield for providing care

October 3, 2023
Reporter, D.C. Diagnosis Writer

Hello and happy Tuesday, D.C. Diagnosis readers — especially all you federal employees who might have been furloughed today, surprise! Of course, the shutdown is only averted for now, so continue sending news and tips about looming budget risks to me (sarah.owermohle@statnews.com) and D.C.D. co-writer Rachel (rachel.cohrs@statnews.com).

medicine across america

A new political era … for medical practicesmsb-1120142modcolor

Dr. Kevin Wang shared his viral moment for providing gender-affirming care with STAT. (M. Scott Brauer for STAT)

Whether it's approaches to Covid-19, providing gender affirming care to minors or abortion services in increasingly restrictive states, scores of practicing physicians and the national groups say they find themselves in the middle of a widening cleave between conservative America and science writ large

The gap has doctors young and old questioning how to navigate political landmines and limits in their communities — or whether they should at all, physicians and clinic directors told me over the past few months. Challenges, especially in more socially conservative states, only show signs of worsening as 2024 Republican presidential candidates make health care restrictions and a deep distrust of science tent poles in their campaigns

Physicians and advocates say the increasingly political environment could lessen the appeal of people going into the medical workforce, even as record retirements loom. On top of long hours, stressful environments,they now are defending what it means to do their job. 

"I feel like to be a provider of abortion care, gender affirming care, is a political statement," said Julie Burkhart, president of the only full-service abortion clinic in Wyoming. More on how doctors are navigating the political minefield.


order in the court

SCOTUS back in session  

The U.S. Supreme Court is back this month and slated to hear arguments this week in a disability rights case, the first in a series of thorny health care-related cases on the docket this term that will touch on everything from Purdue Pharma's bankruptcy claim to how social media platforms regulate free speech (like Covid misinformation), to a sweeping attack on federal agencies' authorities through Chevron deference.

The case this week, Acheson Hotels v. Laufer, revolves around hotels' compliance with the Americans with Disabilities Act. While Laufer targeted a Maine hotel that she argued did not provide enough ADA information on its website, a decision could reverberate for hundreds of hotels and businesses, particularly because Laufer didn't actually visit Acheson, or intend to. (SCOTUSBlog gets into more twists here).

The Justice Department this summer also asked SCOTUS to take up the mifepristone battle after a lower court partially upheld access limits that override the FDA's authority. The court hasn't agreed to take it up yet, but of course has leaned towards abortion access limits. Ahead of this session, abortion rights activists have ramped up calls for Justice Clarence Thomas — one of the most outspoken anti-abortion justices, but also mired in financial allegations — to step down.


CONGRESS

New California senator has a background in health care unions

Calif. Gov. Gavin Newsom's appointment of Laphonza Butler to fill the seat of the late Sen. Dianne Feinstein brings a healthcare labor and reproductive rights advocate to Congress, my colleague Brittany Trang reports. .

Butler's roots are in healthcare labor organizing, having spent a decade leading the SEIU and SEIU locals unions, which represent nursing home workers and in-home care providers in California. At SEIU, Butler advocated for improved staffing standards in nursing home facilities and for a $15 minimum wage, for which she was honored by President Obama. She also campaigned for a California tobacco tax that funded health care programs including Medi-Cal.

"She's dogged," said California state senator Nancy Skinner, who met Butler in 2009 when Skinner was starting out in the state assembly and Butler was starting at SEIU. "She doesn't take no for an answer but just continues to organize, stays present, and clearly puts the needs of those workers, whether they were our nursing home workers or in-home care workers, she puts [them] first."

For Butler, it was personal. Her mother cared for her father through five heart attacks, a stroke, and an eventual heart transplant. "I saw the sacrifices my mom had to make to provide the care my dad needed," she told the LA Times in 2015. "In Mississippi, there's no compensation for providing family care. Her income came from the 11-to-7 shift at a nursing home, [from being] an assistant in a classroom for special-needs children, a number of jobs."


2024 race

RFK Jr. readies independent run 

Longshot Democratic presidential candidate and infectious disease conspiracy theorist Robert F. Kennedy Jr. is expected to announce his switch to an independent run as early as Oct. 9 in a Pennsylvania campaign stop, Mediate reported this weekend

Ironically, that might be good news for Biden and bad news for Trump. Kennedy was never polling very strongly with Democrats but more than half of Republicans found him favorable, according to a Harvard poll earlier this year. Various polls also show nearly a fifth of Americans would prefer a third-party candidate to either the Democratic or GOP leader. 

However Kennedy has also sharply divided Republicans. While many voters see a kindred spirit in someone who has questioned Covid-19 vaccines' safety and pandemic safety measures, others including establishment pollsters like Karl Rove have blasted his views. I dove into it ahead of the first GOP primary debate.



the budget battle

Small potatoes PAHPA extension

In addition to averting a government shutdown, Congress extended some pandemic-preparedness programs over the weekend, my colleague John Wilkerson writes.  

The Pandemic and All-Hazards Preparedness Act created offices that run the country's stockpile of medical supplies and fund the development of biodefense products. Although the law expired over the weekend, much of its programs will keep going with left-over funding or money being moved around, a congressional aide said. 

But some programs would have gone away if Congress hadn't stepped in this weekend to temporarily extend them. They include the authorities to appoint national disaster medical system personnel, to temporarily reassign state and local personnel during public health emergencies and to maintain three advisory committees. However, Congress did not extend a program that lets drug makers earn vouchers for speeding FDA reviews in return for developing medicines for pandemics and tropical diseases. Read more from John.


drug prices

Court kills Trump-era copay accumulator rule

A federal judge late Friday struck down a Trump administration rule that allowed health insurers not to count copay assistance offered by drug companies toward out-of-pocket costs, a victory for advocacy groups that argued the rule harmed patient health, STAT's Ed Silverman reports.

At the heart of the yearslong fight are copay assistance programs, which drugmakers have offered for years to help patients curb out-of-pocket costs for medicines. Insurers argue those programs encourage consumers to opt for high-cost drugs and have introduced copay "accumulators" that don't let those coupons go towards patients' deductibles. 

Trump's HHS proposed the rule one day before his presidential term ended, but it went into effect under Biden, spurring patient groups to file a suit last year. More from Ed on their arguments and the players in the fight.


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