How the Covid-19 funding stalemate threatens health equity gains- POLITICO

With Alice Miranda Ollstein 

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Congressional impasse over Covid-19 could worsen racial disparities, reversing the impact of early federal dollars during the pandemic.

The 2023 budget landed yesterday, and with it came plenty of lofty goals for tackling America’s health care crises.

CMS expects health spending to slow down after federal spending spiked during the height of the pandemic in 2020.

WELCOME TO TUESDAY PULSE — We were still processing the slap-heard-round-the-world when the budget dropped this morning. In the end, we mostly feel bad for this guy. Send your own personal trials with mistaken identity, tips and news to [email protected] and [email protected].

POLITICO will host its inaugural health care summit on Thursday, March 31, as the U.S. enters its third year of the Covid-19 pandemic. Through a series of interviews and panel discussions, summit participants — including providers, policymakers, regulators and patient representatives — will discuss the policies, political dynamics and tech trends shaping the sector. For details, or to attend in person or watch online, click here.

FUNDING STALL COULD EXACERBATE RACIAL DISPARITIESThe stalemate in Congress over replenishing funds to continue Covid-19 testing, treatment and vaccines could end up hitting communities of color the hardest, report POLITICO’s Megan Messerly and Alice.

The White House says if Congress doesn’t approve the $22.5 billion it’s requesting for Covid-19 aid, it will have to scale back or suspend programs that provide free testing, treatments and vaccinations, a move that would disproportionately affect the tens of millions of uninsured Americans — most of whom are people of color.

Racial and ethnic gaps have narrowed considerably since the pandemic began. The federal government’s decision to make Covid interventions available to everyone at no cost temporarily helped level the playing field.

The current impasse threatens to upend that fragile progress in a nation where health care access is usually tied to employment and income and often correlated with race.

“I’m concerned that we’ll go back to the status quo, which we know carries with it great disparities and suffering,” Rep. Raul Ruiz (D-Calif.), the leader of the Congressional Hispanic Caucus and an emergency physician, told POLITICO. “And the hardest-to-reach communities will be the first to suffer and the most to suffer from the lack of funds.”

THE BUDGET BREAKDOWN  — The Biden Administration asked for a 15 percent hike for the Department of Health and Human Services in its 2023 budget released Monday, stressing the need for the nation to be ready for the next pandemic, address the nation’s glaring health inequities and support programs related to other public health crises like gender violence and substance abuse.

In total, Biden’s asked for $127 billion for HHS next year, which would include $81.7 billion to boost pandemic preparedness and biodefense.

Notably, that figure does not include the money the White House has already requested from Congress to address pressing Covid-19 needs today. HHS Secretary Xavier Becerra characterized the funding requests as designed for “long-term preparedness … What we need to finish the job on Covid, we need immediately,” he said.

Here are more budget requests we’ll be watching:

  • $28 billion for the Centers for Disease Control and Prevention to bolster pandemic preparedness
  • $12.1 billion to research and develop vaccines, tests and treatments for biological threats
  • $10.7 billion for the Substance Abuse and Mental Health Services Administration 
  • A Vaccines for Adults program, which the CDC estimates would cost $25 million over 10 years to target uninsured individuals 
  • $500 million for the Centers for Medicare and Medicaid Services to support safety inspections at nursing homes, some of which became deadly for many seniors during the Covid-19 pandemic
  • $470 million to reduce maternal mortality and morbidity rates, including expanding maternal health programs in rural areas and implementing  implicit bias training for health care providers
  • An increase in funding for the Indian Health Service to $9.1 million
  • $1 billion to support programs in the Violence Against Women Act of 1994
  • $850 million to reduce new HIV cases 
  • $663 million for the VA’s opioid prevention and treatment programs 

CMS EXPECTS SPENDING SLOWDOWNThe Centers for Medicare and Medicaid Services anticipates that health care spending will slow down, reports POLITICO’s Rachael Levy.

The agency’s actuary office estimates growth in spending slowed to 4.2 percent last year after more than doubling during the pandemic’s first year to 9.7 percent. Most of that increase, the biggest jump in nearly two decades, came from the burst of federal spending as the government mobilized to contain the virus’ spread.

CMS projects that the government’s share of national health spending will fall to 46 percent by 2024, down from a record high of 51 percent in 2020, compared to spending by consumers.

HOUSE OVERSIGHT PUTS SPOTLIGHT BACK ON MEDICARE FOR ALLThe House Committee on Oversight and Reform will hold a hearing this morning on how to achieve universal health coverage in the U.S., with testimony from patient advocates who have chronic health conditions, doctors and academic experts.

The hearing comes amid mounting frustration among the Democratic left that the Covid-19 pandemic hasn’t been the boost to the movement for single-payer government health care that advocates had predicted. They’re also unhappy that even more moderate proposals like creating a public insurance option, lowering the Medicare age or adding new benefits to Medicare have fallen by the wayside.

Committee Chair Carolyn Maloney (D-N.Y.), according to prepared remarks shared with Alice, will also use the hearing to contrast the two parties’ health care policies, well aware that this November’s midterm election could see Democrats lose control of one or both chambers of Congress.

“My Democratic colleagues and I will continue to fight for every bit of progress we can make in moving our nation toward universal coverage,” she’s expected to say. “While Republicans raise barriers to affordable health care, Democrats will continue working tirelessly to ensure that no person’s financial circumstances keep them from obtaining quality care.”

FINANCE COMMITTEE RELEASES MENTAL HEALTH REPORT, LAWMAKERS CRAFT REFORMS — The Senate Finance Committee released a bipartisan report today outlining problems and potential solutions on mental health care access as the committee’s leaders begin working on a package of bills they hope to roll out later this year, Alice reports.

Covid-19’s toll on mental health — starkly visible in the surges in opioid overdoses, emergency room visits for mental health among children and other grim markers — is top of mind for lawmakers. A 2021 report from the Government Accountability Office found that while 11 percent of adults reported symptoms of anxiety or depression before the pandemic, that number had spiked to 40 percent from April through February 2021.

Yet lawmakers are already getting pushback from health care industry power players on some reforms they want to enact, like tougher enforcement of existing laws that require insurance companies to cover mental health care the same as they do physical health.

The report presents a slate of serious challenges to mental health care in America, including the uneven geographic distribution of health care providers around the country, too few providers trying to field a dramatic spike in requests for care during the pandemic and, as a result, nearly 80 percent of psychiatrists reporting burnout.

Americans seeking mental health care wait an average of 11 years for treatment, the report says.

HOSPITALS ASK HHS TO EXTEND EMERGENCYSeveral national hospital associations are asking the Biden administration to renew the Covid-19 public health emergency, saying that hospitals are “still dealing with Covid-19 cases and deaths on a daily basis” and raising concerns about a possible surge as cases in Europe rise.

The letter to Becerra, signed by nine parties, including the American Hospital Association and Children’s Hospital Association, says that keeping the PHE in place allows their members “the flexibility and resources” to continue to deal with the pandemic. It cites federal action, including waivers of certain Medicare, Medicaid, Children’s Health Insurance Program and HIPAA Privacy Rule requirements.

“We understand the desire to move on from the pandemic,” the letter reads. “Yet it is important to be prepared for potential disruptions to the health care delivery system.”

The pharmaceutical industry is looking for allies, and it sees one in Sen. Tim Scott (R-S.C.), Kaiser Health News reports. He was the top recipient of pharma campaign cash during the second half of 2021.

The Washington Post is tracking the many abortion restrictions and protections taking hold across the country.

Shanghai goes into lockdown, and France’s Covid-19 numbers jump from 467 to 21,073 overnight, Reuters reports.


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