Analysis | The Health 202: Washington is at war over block granting Medicaid – The Washington Post

THE PROGNOSIS

It’s all-out war in Washington over the Trump administration’s pursuit of Medicaid block grants.

House Democrats passed a resolution yesterday — with no support from Republicans — disapproving of the administration’s new block grant rules, which would allow states to significantly reshape how they run their Medicaid programs.

Rep. Marc Veasey (D-Tx.), the resolution’s sponsor:

Meanwhile, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, was in full-on defense mode, insisting in a Washington Post op-ed that block grants don’t amount to spending cuts for the health insurance program that covers 1 in 5 Americans.

“Unfortunately, it hasn’t taken long — even by Washington’s standards — for talking points with a dubious relationship to reality to start circulating among defenders of the status quo,” Verma wrote.

Block grants are the latest chapter in an unfolding fight between the Trump administration and Democrats over the future of Medicaid. Last week, Verma and Health and Human Services Secretary Alex Azar announced a program called “Healthy Adult Opportunity,” in which states can agree to receive a lump-sum payment to finance care for adults who become eligible for Medicaid when the 2010 health-care law expanded it.

As with many health policy debates of the day, the rhetoric around this issue is heated and emotional. 

Republicans have long complained that the safety-net program is overly burdensome to state budgets and doesn’t contain enough incentives for people to better their own lives. Verma says the block grants will give states more control over their own spending and allow them to more nimbly respond to the needs of their enrollees.

Rep. Paul Mitchell (R-Mich.) apparently ripped up the House resolution, per C-SPAN’s Jeremy Art:

But Democrats fear that setting up too many barriers and rules around the program will make it too hard for those who need it to enroll. They’ve been attacking the block grant rules, accusing Verma of giving states leeway to limit benefits and setting them up for future financial disaster by limiting the flow of federal dollars.

Rep. Eddie Bernice Johnson (D-Tex.):

Annie Shoup, communications director for the Democrat-aligned group Protect Our Care:

The truth of how all this would work is — shockingly — more nuanced than either side is charging. Here are a few things to keep in mind:

— States would have to request permission. Because CMS is doing this through what’s known as a “waiver” process, states would have to apply for block grants the same way they’ve always applied for waivers to modify how they run Medicaid or the Obamacare marketplaces.

If every state participated, nearly 30 million adults would be affected. That includes 13 million adults newly covered under the Affordable Care Act’s Medicaid expansion, 10 million adults covered through other state options and nearly 5 million low-income adults in states that didn’t expand Medicaid, according to this brief by the Kaiser Family Foundation.

But many states, particularly those run by Democrats, won’t pursue block grants. The most likely states to jump at the opportunity would be the 10 or so that have also pursued work requirements. And no states could make children, pregnant women with incomes up to 138 percent of the federal poverty level, parents that fit certain income thresholds, and those with disabilities subject to the new requirements or funding restrictions under a block grant approach.

— If states agree to block grants, they could limit covered benefits compared to current law. They could scrap services including non-emergency medical transportation and certain screenings for 19- and 20-year-olds. But they would still have to cover 10 benefits considered “essential” under the ACA.

— States could also create lists of drugs that are covered by Medicaid plans — meaning they could exclude some drugs. 

Under current rules, Medicaid is required to cover all drugs approved by the Food and Drug Administration. But with a block grant, states could duck those rules for every condition except medications that treat HIV, opioid use and mental illness. They could decide to cover just one drug for each clinical category.

— States could also require most enrollees to pay higher cost-sharing for medications and doctors visits. The cost-sharing could exceed the nominal amounts currently allowed, although no more than 5 percent of enrollees’ income.

Researchers at the Kaiser Family Foundation summarized the block grants this way: While states “would be given greater flexibility compared to current law, they would also face fiscal risks in accepting capped federal funding. The breadth of the new flexibility could also result in limits on coverage and access to care for current enrollees,” they wrote.

AHH, OOF and OUCH

— Yesterday Trump echoed what he declared at his State of the Union speech two days previously: His administration was to thank for decreased drug prices. 

“Secretary Azar is here, and I want to thank him for this, but we had for the first time in 51 years where drug prices actually came down last year. First time in 51 years,” Trump declared to a room of reporters, taking a victory lap after he was acquitted of impeachment charges.

Trump’s claims, which The Health 202 reported were exaggerated, infuriated Democrats. 

House Democrats have proposed legislation to address drug prices, but it differs from that offered by Republicans and the Senate Finance Committee. Democrats chanted “H.R. 3,” a reference to the House bill, during Trump’s address and tweeted Thursday after his news conference.

Sen. Tammy Baldwin (D-Wis.):

OOF: The doctor who sounded the alarm on the coronavirus died of the illness on Thursday, The Post‘s Simon Denyer and Adam Taylor report. Li Wenliang was previously detained by authorities when he noticed people were becoming infected and told other medical professionals in a group chat.

— In China, there are more than 31,000 confirmed cases. More than 630 people have died in China, and two died abroad, in Hong Kong and the Philippines.

Dozens more people tested positive for the coronavirus on the quarantined Carnival’s Diamond Princess cruise ship, anchored in Japan’s Yokohama harbor. The total now is more than 60 infected passengers. Struggling with the outbreak aboard the vessel, Japan declined to let passengers on the cruise ship Westerdam sailing from Hong Kong disembark in the port, Simon writes. 

— After evacuating Wuhan at the start of the epidemic, 195 people were flown to the March Air Reserve Base on Jan. 29 and are the furthest along of a required 14-day confinement, our colleagues William Wan, Lena H. Sun and Neena Satija report.

What have they been up to while quarantined? 

“Many in the March Air Reserve group have started offering classes in their areas of expertise: boxing classes led by a boxing enthusiast, ” our colleagues write. “A seminar on preparing income taxes by an accountant. Zumba classes from a workout fiend. McCoy, who worked as a theme park designer in China, has experience drawing murals. So he’s planning a class for children on how to doodle with chalk using the barracks’s sidewalk as their canvas.”

— The Department of Defense announced Thursday it will provide 11 military installations to house 20 quarantined travelers each near airports if the additional capacity is needed, our colleague Marisa Iati reports. 

— The Bill and Melinda Gates Foundation committed $100 million to detecting and treating the coronavirus globally, our Post colleague Miriam Berger reports. Funds will be distributed to the World Health Organization, the Centers for Disease Control and Prevention, and health authorities in China and other high-risk countries.

— Chinese citizens are accustomed to strict censorship, but the epidemic has put the government’s censors and security forces on the defensive, our Post colleague Gerry Shih reports. 

“Citizen bloggers, dissidents and gadflies who post criticism or negative news of the government are being spared tough punishment that authorities might have otherwise meted out in ordinary times,” Gerry writes. “Meanwhile, the country’s dwindling ranks of independent-minded journalists are also enjoying an unusual level of freedom to aggressively report in the outbreak’s epicenter — at least for now.”

“The basic narrative that Chinese journalism is dead was accepted as fact before this outbreak,” Yuan Zeng, who studies media in China at the University of Leeds, told Gerry. “But it’s been surprising to see the space allowed for this wave of investigative reporting.”

— The coronavirus is weighing on China’s economy. Yet the country announced it would halve tariffs on $75 billion of U.S. goods, moving forward in its promise to quell a protracted trade conflict with the United States, Taylor Telford reports.

“The widely expected move comes as China is paralyzed by the coronavirus,” Taylor writes, adding that it has “brought China’s powerful manufacturing industry to a standstill as travel restrictions freeze the country’s workforce and major companies such as Boeing, Apple and Nike have been forced to close factories until at least mid-February. McDonald’s, Starbucks, KFC, Levi Strauss, H&M and Samsung have closed stores across China. Casinos in Macao, the world’s biggest gambling market, are shutting down for two weeks.”

— In other ‘viral’ news, four Los Angeles residents contracted measles after an infected international traveler visited, public health officials told the Los Angeles Times on Wednesday. The five cases are the second time the infection has popped up in the city. In 2019, there were 1,282 cases of measles confirmed in 31 states, according to federal data. 

OUCH: Thursday marked the start of a government ban on flavored e-cigarettes that is aimed at curbing underage vaping. One problem: The ban doesn’t include disposable e-cigarettes. 

Youth have seized on the loophole, the Associated Press reports. Disposable e-cigarettes come in fruity flavors and colorful packaging. 

“They are very accessible and seem to be the new buzzy product,” Karen Wilson, a tobacco researcher and pediatrician at Mount Sinai’s medical school in New York, told the AP.

With the ban now in place, the FDA will monitor if flavored cartridges are for sale on shelves or online, CNN reports. 

Regarding disposable products, FDA’s director of the FDA’s Center for Tobacco Products Mitch Zeller told CNN the agency would “continue to closely monitor data regarding youth usage of all e-cigarette products and adjust our enforcement priorities to address youth use as necessary.”

— Leaked audio from a meeting of Juul Labs employees highlights the frustrations within the company, BuzzFeed News reports. Layoffs and cutbacks have worsened moral. 

The company, and others, must submit an exhaustive application to the FDA by May 12 to makes the case for why their vapes should continue to be sold. An employee told BuzzFeed that at least half the company was contributing to the application.

“As so much hangs in the balance, many of the other employees are unsure of how to spend their days — or what will happen if the FDA turns them down,” BuzzFeed writes. 

— Despite the negativity from its employees, lawsuits and investigations, Juul has raised more than $700 million in convertible debt, mostly from existing investors, the Wall Street Journal reports. 

INDUSTRY RX

— Johnson & Johnson must pay $186.5 million in punitive damages to four plaintiffs who said the company’s talcum powders caused mesothelioma, the Wall Street Journal reports. 

The New Jersey state jury who heard the case originally proposed a $750 million penalty, which the judge planned to reduce in accordance with state law. The company said it will appeal.

Still, the company faces mounting legal challenges. 

“About 16,800 plaintiffs have filed lawsuits against J&J in U.S. state and federal courts alleging the company’s talcum powders caused ovarian cancer or mesothelioma, and J&J failed to properly warn consumers of this risk,” the Journal writes.

OPIOID OPTICS

— A federal panel remanded two cases from the multidistrict lawsuit against opioid companies to their respective federal courts on Wednesday, per court records. The Cherokee Nation and the city and county of San Francisco will face off with companies including Purdue Pharma and McKesson.

The plaintiffs, who hope to battle with the companies in as many jurisdictions as they can, called the order “a significant step forward for the litigation.”

“This latest group of test trials will continue to demonstrate the strength of community claims against the opioid industry and culpability of each defendant in court,” the co-lead plaintiff attorneys said in a statement emailed to The Health 202.

The next scheduled trial will take place in Summit and Cuyahoga counties in Ohio on Nov. 9.

— The top 1 percent of opioid prescribers in the United States are responsible for more than a quarter of all prescriptions, Reuters reports. 

Researchers found that the most effective way to combat the overuse of prescription painkillers should be to concentrate on the heaviest prescribers.

The Centers for Disease Control and Prevention recommends prescribers give no more than 50 morphine-milligram equivalents (MMEs), a standard of describing opioid doses, a day for less than seven days, but researchers calculated the top 1 percent of prescribers give more than 120 MMEs daily per patient.

SECOND OPINION

— Corteva, the world’s largest manufacturer of the agricultural pesticide chlorpyrifos, announced Thursday that it would stop producing it, citing declining sales, Reuters reports. However, environmentalists and public health advocates have pushed to stop the sale of the chemical after it was reported to cause health problems in children. 

“Children and farm workers in California will no longer be exposed to this neurotoxic pesticide that can permanently impair the brain and nervous systems,” said Ken Cook, president of Environmental Working Group, told Reuters.

DAYBOOK

Coming up

• The New Hampshire Democratic debate will be held Friday.
• The Supreme Court will considering hearing a case that could settle the face of the Affordable Care Act at its conference on Feb. 21.

SUGAR RUSH

The spread of coronavirus could threaten the 2020 Olympics in Tokyo, which start July 24. Toshiro Muto, CEO of the host committee, said the virus, which has had confirmed cases in Japan, could throw “cold water over the [Games’] growing momentum.”

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