KHN’s ‘What the Health?’: News You Might Have Missed

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It’s been extra busy on the health policy beat lately, so a congressional recess provides a chance to explore some of the important stories that people might have missed, like Medicare’s decision to dramatically limit coverage of Aduhelm, the controversial new drug to treat Alzheimer’s disease. And even with Congress out, states are rushing to either restrict or expand access to abortion, ahead of a key Supreme Court ruling expected later this spring or summer.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s episode:

The decision by the Centers for Medicare & Medicaid Services to limit Medicare’s coverage of Aduhelm only to beneficiaries who also enroll in clinical studies of the new Alzheimer’s drug came despite intense pressure from patients and advocacy groups who are frustrated by the lack of new therapies for this devastating disease. But the federal agency also appears to have been swayed by arguments by some researchers and public health experts that the earlier research on the drug was faulty.The dust-up over Medicare coverage for Aduhelm points to a source of tension in the U.S. health system: Different government agencies have overlapping authorities. This dispute is between the FDA, which approved the drug despite serious questions about its effectiveness and safety, and CMS, which had to decide whether to cover the cost of a very controversial drug that is also very expensive. But similar tensions also have played out between the FDA and the Centers for Disease Control and Prevention over covid-19 vaccine schedules and eligibility.A recent Bloomberg report looked at concerns that the federal government is overpaying for beneficiaries enrolled in private Medicare Advantage plans. More progressive Democratic members of Congress have long complained about this, but Republicans are strong supporters of the Medicare Advantage program.Despite the complaints of some on the left about the excess funding of these Medicare plans, they have been growing. That is, in part, because the traditional Medicare program has many holes and cost-sharing responsibilities that people with modest incomes are nervous about shouldering, and Medicare Advantage has become attractive to them. That has complicated the formerly partisan politics over the program.The Biden administration is reportedly in discussions with several states about setting up programs to import cheaper drugs from Canada. For the Democrats, this could be a strong campaign talking point — much like efforts on Capitol Hill to cap the price of insulin — about trying to help people with a serious pocketbook issue. Drug prices have consistently been a consumer concern.However, it’s not clear whether Canada is interested in helping the U.S. with a drug import program and, even if it did, there’s no indication that the amount of drugs Canadians could provide would significantly influence prices in this country.Oklahoma’s governor has signed a bill that would make it a felony to perform an abortion, and Florida’s governor on Thursday approved a bill moving the limit for an abortion from 24 weeks to 15 weeks. As the country waits for the Supreme Court to rule on a case this summer that could overturn or weaken the landmark Roe v. Wade decision, conservative states are racing to find ways to limit or ban abortions.If the Supreme Court does upend protections guaranteed under the Roe decision, it is unlikely that clinics in states that are preserving the right to an abortion will be able to fill the need.Yet even with the growing movement in conservative states, abortion-rights supporters were stunned this week when a Texas prosecutor filed murder charges against a woman who had an abortion. The charges, however, were quickly dismissed.The CDC this week released new data showing a rise in 2020 in the number of cases of gonorrhea and syphilis — likely the byproduct of less access to health care during the early stages of the pandemic. Although the diseases can easily be cured with antibiotics, the public may not realize the need to seek medical care or the devastating consequences of letting the diseases go untreated.The CDC also reported that drug overdose deaths reached a record high last year.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Politico’s “Mice Occupy FDA Offices After Food Left Behind in Pandemic,” by David Lim and Lauren Gardner

Margot Sanger-Katz: Health Affairs’ “Many Medicare Beneficiaries Do Not Fill High-Price Specialty Drug Prescriptions,” by Stacie B. Dusetzina et. al

Joanne Kenen: Vox’s “America Needs More Doctors and Nurses to Survive the Next Pandemic,” by Dylan Scott

Alice Miranda Ollstein: Politico’s “Republicans See CDC’s Policy Change as ‘Massive Political Loser for Democrats,’” by Alice Miranda Ollstein and Krista Mahr

Also discussed on this week’s podcast:

Bloomberg’s “Major Insurers Are Scamming Billions From Medicare, Whistle-Blowers Say,” by John Tozzi

KHN’s “Researcher: Medicare Advantage Plans Costing Billions More Than They Should,” by Fred Schulte

KHN’s “‘What the Health?’: The Drug Price Dilemma,” featuring Stacie B. Dusetzina

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