Good morning. I’m Julie Rovner, chief Washington correspondent at KFF Health News and host of its weekly news podcast, “What the Health?” Send tips on the American Care Act or other health policy issues to julier@kff.org. Not a subscriber? Sign up here.
Today’s edition: Supreme Court justices appeared split over whether a federal emergency law can require abortions in states where the procedure is banned. Why some experts are worried about federal agencies’ response to an outbreak of bird flu in cows. But first …
After record enrollment, Biden aims to expand Obamacare’s benefits to Americans’ teeth
The Biden administration wants to make it easier for Americans to get dental care. But don’t try booking an appointment just yet.
A new regulation out this month allows states to include adult dental care as a benefit that health insurers must cover under the Affordable Care Act. Following record ACA enrollment this year, the proposal represents an election-year aspiration for the future of Obamacare: It doesn’t require states to do anything, even as it shows off President Biden’s intention to make the ACA a more robust safety net.
“It’s huge, really significant,” said Colin Reusch, director of policy at Community Catalyst, a health coverage advocacy group. He said the new Biden administration rule represents “one of the first real changes” to coverage provisions of the law since it passed in 2010.
But like so much in health care, expanding access to dental services is a lot more complicated than it sounds.
An estimated 68.5 million U.S. adults lacked dental insurance in 2023, according to the nonprofit CareQuest Institute for Oral Health. That’s more than 2.5 times the roughly 26 million Americans of all ages who lack health insurance.
And millions of Americans lost dental coverage in the past year as part of the Medicaid “unwinding” that dropped low-income people who had been covered by the program during the pandemic.
At the same time, untreated dental disease is estimated to cost the United States more than $45 billion in lost productivity annually, according to the Centers for Disease Control and Prevention, and it’s linked to a long list of even more serious health problems, including heart disease and diabetes.
Still, efforts to expand U.S. dental coverage have long foundered on the shoals of cost. When people have dental insurance, they tend to use it. So including the coverage in a health insurance policy can raise overall premiums.
That’s one reason traditional Medicare coverage explicitly excludes most dental care. (Many private Medicare Advantage plans offer some dental coverage as an enticement for seniors to join.)
An effort to add a dental benefit to Medicare was stripped from Biden’s “Build Back Better” legislation before it was passed in 2022 as the Inflation Reduction Act. Instead, the administration clarified and expanded the limited circumstances in which Medicare can cover dental care. Any progress on oral health — including giving states the option to require coverage for adults — is seen by advocates as a victory. Dental coverage for children is already an essential benefit under the ACA.
But whether they actually get coverage depends on states affirmatively adding dental benefits to benchmark plans in the ACA’s insurance marketplaces. Those plans not only determine what services Affordable Care Act insurance has to cover, but also set parameters for state-employee and many private-employer health plans.
Reusch said a few states are considering the change, but it will be a while until anything is certain. States have until May 2025 to decide whether to add dental care to benchmark ACA plans; the benefit wouldn’t be effective until the 2027 plan year.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.
In the courts
Supreme Court justices split in emergency abortion case
A divided Supreme Court seemed skeptical yesterday that federal law can require hospitals to provide emergency abortion care in states with strict bans on the procedure, The Post’s Ann E. Marimow and Caroline Kitchener report.
Throughout the two hours of argument, only the court’s three liberal justices strongly backed the Biden administration’s view that the Emergency Medical Treatment and Labor Act (EMTALA) preempts Idaho’s abortion ban, which penalizes doctors performing the procedure with up to five years in prison.
- They cited harrowing examples of pregnant women facing health emergencies short of death and suggested those women would not be permitted to obtain an abortion under Idaho’s law.
But the court’s conservative majority pushed back on the Biden administration’s interpretation of the statute and indicated the federal government cannot force private hospitals that receive federal funds to violate a state’s law. Justices Neil M. Gorsuch and Samuel A. Alito Jr. noted that EMTALA doesn’t mention abortion but includes the term “unborn child” when defining what constitutes a patient.
Next steps: The case is set to be decided before the end of the court’s term in late June or early July.
The Post’s Caroline Kitchener:
Sotomayor tells the story of a Florida woman whose water broke at 16 weeks and was turned away from the hospital. “She was horrified, went home…. The next day, she bled.”
This is likely the story of Anya Cook, which we reported in The Post last year: https://t.co/xHAErKbDmi
— Caroline Kitchener (@CAKitchener) April 24, 2024
Meanwhile …
The Arizona House voted to repeal a Civil War-era ban on nearly all abortions that is set to take effect as early as June 8. The measure now heads to the state Senate, which could grant final passage next week, Caroline and Yvonne Wingett Sanchez report.
Inside the room: Three Republicans sided with all Democrats, breaking ranks after weeks of high-level pressure following the state Supreme Court’s revival of the 1864 abortion law this month. GOP leaders had blocked two prior attempts to repeal the ban.
- After the vote, several Republicans who support the law expressed extreme frustration with their colleagues who crossed party lines. “I am disgusted today,” state Rep. Rachel Jones (R) said.
Yes, but: Even if the Senate approves the repeal measure and the governor signs it, the near-total ban could still be in effect for several months. Typically, bills take effect 90 days after the legislative session concludes. At that point, a 2022 law permitting abortions through 15 weeks of pregnancy would be reinstated.
The Post’s Yvonne Wingett Sanchez:
Agency alert
As bird flu spreads in cows, fractured U.S. response has echoes of early covid
New this a.m.: Federal agencies with competing interests are slowing the country’s ability to track and control an outbreak of highly virulent bird flu that is infecting U.S. cows for the first time, our colleagues Lena H. Sun and Rachel Roubein report.
Some officials and experts are expressing frustration that more livestock herds aren’t being tested for avian flu, and that when testing occurs, the results aren’t shared quickly or with enough detail. They point, in particular, to a failure to provide more information publicly about how the H5N1 virus is spreading in cows and the safety of the milk supply.
- Until yesterday, testing dairy herds was voluntary and limited to cows with certain symptoms. With growing evidence that the virus is more widespread than feared among cows, the Biden administration ordered all lactating dairy cows to be screened for bird flu before moving across state lines, starting Monday.
Flashback: For some, the response echoes the early days of the coronavirus outbreak in 2020 and similar communication missteps at the start of the pandemic. These experts fear that the delays could allow the pathogen to move unchecked — and potentially acquire the genetic machinery needed to spread swiftly among people.
The view from the White House: A senior administration official said there have been “no competing interests.” The White House’s Office of Pandemic Preparedness and Response Policy is coordinating the outbreak response with relevant agencies “that are working quickly and methodically.”
On the Hill
Fauci to return to Capitol Hill
Anthony S. Fauci has agreed to testify before the House panel investigating the nation’s coronavirus response, marking the first time the prominent infectious-disease expert will publicly face Congress since leaving the government nearly 1½ years ago, our colleague Dan Diamond scooped.
Fauci — who helped steer the Trump and Biden administrations’ efforts to fight the virus — is scheduled to testify June 3. Lawmakers are expected to press him on the still-unknown origins of the pandemic, the government’s vaccine mandates and other issues that remain politically divisive more than four years after the initial outbreak.
On our radar: The GOP-led panel includes some of Fauci’s most persistent critics in Congress, such as Reps. Marjorie Taylor Greene (R-Ga.) and Ronny Jackson (R-Tex.), who have repeatedly alleged that the pandemic began with an accident at a lab in China funded by Fauci’s agency and covered up by U.S. officials.
- Fauci has denied wrongdoing. Public health leaders have praised his work and said Republicans have unfairly targeted him.
Meanwhile …
Sen. Bernie Sanders (I-Vt.) is launching an investigation into the U.S. prices of Novo Nordisk’s diabetes and weight loss drugs Ozempic and Wegovy, which exceed those in similar countries.
The Senate Health, Education, Labor and Pensions Committee chairman sent a letter to Novo’s CEO yesterday asking whether the company intends to “substantially reduce” the prices of Ozempic and Wegovy, which ring in at about $969 and $1,350 for a month’s supply without insurance, respectively. Sanders is also seeking information on the company’s profits from these drugs, research and development costs, and pricing strategies.
The view from the industry: “Novo Nordisk remains committed to working with policymakers to advance solutions to support access and affordability for all patients, and we reiterated this commitment in our conversation with Chairman Sanders,” a company spokesperson said in a statement to The Health 202.
Senate HELP Committee Chair Bernie Sanders (I-Vt.):
We cannot allow Novo Nordisk to continue to charge $969 for Ozempic in the US when it sells for just $59 in Germany & costs $5 to manufacture. The Senate HELP Committee that I chair is investigating the outrageous prices of Ozempic & Wegovy in the US.https://t.co/BFs5j6ZOOi
— Bernie Sanders (@SenSanders) April 24, 2024
In other health news
- New this a.m.: The provisional number of U.S. births totaled 3,591,328 in 2023, representing a 2 percent decrease from the previous year, according to data from the CDC’s National Center for Health Statistics.
- The Justice Department has launched a criminal investigation into McKinsey & Co. over allegations that the consulting firm helped fuel the national opioid crisis by advising OxyContin maker Purdue Pharma and other drugmakers, Mike Spector, Nate Raymond and Chris Prentice report for Reuters.
- The Agriculture Department announced yesterday that children’s school lunches will limit sugar for the first time, and cut sodium — though less than initially planned due to a congressional directive, per The Post’s Lauren Weber. Last fall, The Post examined how big food companies have succeeded through congressional lobbying in watering down nutritional requirements for school lunches.
