Mea culpa

In Tuesday's newsletter, I wrote that Trump had reversed his position on ACA premium subsidies by threatening to veto legislation extending them. However, Trump was responding to a question specifically about a clean, three-year extension. That's an idea that Republicans generally oppose, though some voted for it in the House in the hopes of spurring the Senate to negotiate a compromise.

Lawmakers had said the Senate might release an ACA compromise bill early this week, but the target now is when the Senate returns from recess after next week, according to Sen. Jeanne Shaheen (N.H.), who is leading negotiations for Democrats.

Two of the hangups seem to be zero-dollar premiums and abortion restrictions. There are others, Shaheen said, but she declined to elaborate.

Republicans want to set a minimum premium amount for ACA plans to make it more difficult to defraud the program by enrolling people without their knowledge. About 15% of ACA enrollees in the states that used the HealthCare.gov platform paid no premiums even before Democrats provided extra credits in 2021, and zero-dollar premiums are also common in other programs like Medicare Advantage and Medicaid.

Multiple studies have found that even a nominal premium payment lowers enrollment because it adds an additional administrative step to enrolling and staying enrolled. For example, when monthly premium payments of less than $10 were introduced to some marketplace plans in Massachusetts, enrollment dropped 14% compared to plans that retained zero-dollar premium payments, according to one study. Another study on Colorado's marketplace estimated that when enrollees lost eligibility for $0 bronze plans, enrollment dropped 8% to 16% compared to those with slightly lower incomes who kept plans with no premium payments.

Additional abortion restrictions are another hard sell for Democrats. The law already bans the use of tax credits for health plans that pay for abortions, except when a woman's life is endangered or for pregnancies that are a result of rape or incest. Republicans seek additional restrictions, including possible penalties for plans to violate that restriction.

addiction

A speedy reversal of cuts to addiction, mental health programs

The Trump administration planned to cut nearly $2 billion from programs for treating opioid addiction, curbing homelessness, and other behavioral health services. Then, after an outcry from lawmakers and advocates, it reversed course, Lev Facher reports.

The administration did not consult the Substance Abuse and Mental Health Services Administration, the agency that oversees mental health and addiction treatment, or announce the planned cuts internally.

The administration had already cut about $2 billion from SAMHSA grants to states and cut more than half the agency's staff.

vaccine advisers

Plus two, minus two

Health secretary Robert F. Kennedy Jr. appointed two more vaccine skeptics to a federal advisory board that recommends which vaccines people should get, according to Daniel Payne and Lizzy Lawrence. Separately, Chelsea Cirruzzo reports that Kennedy prematurely ended the terms of at least two members of another committee that advises the federal government on its vaccine injury compensation program.

The new members of the Advisory Committee on Immunization Practices are OB-GYNs, one of whom describes herself as an anti-vaxxer, according to The Washington Post. An ACIP working group is reviewing the vaccines recommended for women during pregnancy. Read more about the newly appointed members.

Kennedy has said vaccine liability protections disincentivize manufacturers from making vaccines safe. But the programs aim to encourage companies to develop vaccines by protecting them against massive legal costs, while compensating people who are hurt by vaccines.

Read more about the similarities between how Kennedy is handling both advisory panels.

vaccines

Following RFK Jr.'s advice to ignore his medical advice

The health secretary said last year that people should not follow his medical advice. Doctors and hospitals agree, Daniel reports.

Last week, the Trump administration cut the number of recommended pediatric vaccines, without so much as consulting Kennedy's hand-picked advisers first.

Kennedy said the changes are intended to restore trust in public health, but major health systems and clinicians plan to ignore the new federal guidelines, placing their trust instead in guidance from the American Academy of Pediatrics.

abortion pill

Cassidy says Kennedy, Makary might soon testify

At a Senate hearing on the safety of the abortion drug mifepristone, Sen. Bill Cassidy (R-La.) said he hopes to have FDA Commissioner Marty Makary speak before the committee "very soon," Lizzy Lawrence reports. Cassidy and several other Republican senators expressed concerns about reporting that Makary and Kennedy might be slow-walking a promised safety review of mifepristone until after the midterm elections.

"I was hoping that Dr. Makary would be here today so we could ask him some of these questions and clear up those rumors," said Sen. Jon Husted (R-Ohio).

Medical experts have said there is no reason to conduct another safety review of mifepristone, as decades of research have shown that the drug is safe and that complications are rare.

Cassidy said he has been talking to the FDA to facilitate a conversation on mifepristone, and on "other issues." A hearing with Kennedy is "in the process," he said.

medical devices

Breaking through to faster Medicare coverage

Katie Palmer has an article on the status, and potential impact, of legislation making Medicare automatically cover medical devices deemed "breakthroughs."

Industry is lobbying for automatic coverage. Devicemakers can struggle to stay afloat in the sometimes years-long gap between when FDA authorizes a product and Medicare pays for it.

But the bill has its detractors, who say breakthrough devices are sometimes authorized with limited evidence. Read more.

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What we're reading

Kaiser Permanente, DOJ reach $556 million Medicare Advantage fraud settlement, the largest of its kind, STAT
Pharma CEOs vent vaccine anger during largest industry gathering, Bloomberg
Opinion: States no longer have to report Medicaid, CHIP vaccination rates to CMS, further undermining immunization, STAT
FBI executes search warrant at Washington Post reporter's home, The Washington Post
Initial Obamacare enrollment drops by 1.4 million, The New York Times