Health Affairs This Week

On the 100th episode of Health Affairs This Week, Ellen Bayer and Kathleen Haddad go over major policy developments in health care this year, including COVID-19, abortion, gun violence, drug prices, and more.

Show Notes

On the 100th episode of Health Affairs This Week, Ellen Bayer and Kathleen Haddad go over major policy developments in health care this year, including COVID-19, abortion, gun violence, drug prices, and more.

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What is Health Affairs This Week?

Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.

00;00;36;27 - 00;00;46;02
Ellen Bayer
Hello and welcome to another episode of Health Affairs This Week, the podcast where Health Affairs editors go beyond the headlines to explore the health policy news of the week. I'm Ellen Bayer.

00;00;46;19 - 00;01;06;21
Kathleen Haddad
And I'm Kathleen Haddad. So, Ellen, it's been a busy year in the world of health policy. And this being our last podcast of the year, let's look back at some of the major events of the year. But before we get rolling on a retrospective, I just want to point out that today is a special day because it's the 100th episode of “Health Affairs This Week”.

00;01;06;26 - 00;01;35;27
Ellen Bayer
That's right, Kathleen. And just a quick note to our listeners who may look at their episode lists and see this one showing up as number 102, that's because we had two weeks when we aired “A Health Podyssey”, which is the Health Affairs podcast featuring our editor-in-chief, Alan Weil in this space. So even though this is week 102, it's episode 100, and all of us on the Health Affairs team want to say how grateful we are to you, our listeners, and to everyone who's made this podcast possible.

00;01;35;27 - 00;01;39;06
Ellen Bayer
So a big thank you and happy 100th episode, Kathleen.

00;01;39;16 - 00;01;40;29
Kathleen Haddad
Happy 100th Ellen.

00;01;41;16 - 00;01;55;10
Ellen Bayer
So Kathleen, a lot has happened this year in health policy. Let's start off with COVID. In fact, our very first episode was on COVID and it was called, “Is A COVID-19 Vaccine Within Reach?”.

00;01;55;18 - 00;02;26;05
Kathleen Haddad
Yes, the answer was yes, Ellen. And for most of the year, we've had a period of normalcy, but now we're in an upswing. In the most recent two week period, daily COVID cases increased 44% in the US and hospitalizations are up 18%. We have vaccines and treatment now, and the Biden administration has basically said mask optional. President Biden even declared the pandemic was over a few months ago that we had to walk that back.

00;02;26;19 - 00;02;49;17
Kathleen Haddad
Both the CDC and state and local governments have lifted mask mandates, though some counties are recommending indoor masking again. The administration is still trying to get Congress to approve more pandemic relief funding and funding for nasal spray vaccine development, which is actually hung up in the end of year congressional negotiations going on now to continue funding the government.

00;02;50;03 - 00;03;20;17
Kathleen Haddad
And the Biden administration said it will be lifting the public health emergency in 2023. The administration has adopted a position basically that with vaccines and treatments available, mandates are no longer needed, even with increasing cases. I do wonder, Ellen, if mask optional is a new normal, what will happen when another pandemic strikes as we wait for new vaccines? Will public officials be willing to impose mandates next time, or has that ship sailed?

00;03;20;29 - 00;03;24;25
Kathleen Haddad
Will employers be willing to mandate vaccines?

00;03;25;14 - 00;03;50;12
Ellen Bayer
Great questions, Kathleen. So now let's turn to another major event of the year. In June, the Supreme Court eliminated the nearly 50 year old constitutional right to abortion. In The Dobbs versus Jackson Women's Health Organization case, which essentially turned abortion policymaking back to the states. So what's been going on in the states on that issue now?

00;03;50;26 - 00;04;16;23
Kathleen Haddad
Ellen, in the aftermath of the decision, as of today, according to The New York Times tracker, 13 states have enacted complete abortion bans. These generally include medication abortions as well. Ten more states have moved to ban or restrict abortion, but courts have blocked these efforts and litigation is ongoing in many states. In about half the states, abortion is legal or legal but limited.

00;04;17;14 - 00;04;35;04
Kathleen Haddad
The Dobbs ruling created a lot of legal chaos as some states tried to restrict women from accessing abortions across state lines. Some states, on the other hand, have tried to protect abortion providers by making them immune to abortion laws of other states. The landscape is evolving, Ellen.

00;04;35;05 - 00;04;49;17
Ellen Bayer
So the Dobbs decision focused a lot of the state health policy discussion on abortion rights. But I understand there was also a lot of legislative activity in the states this year on efforts to ban gender-affirming health care. Is that right?

00;04;49;27 - 00;05;27;20
Kathleen Haddad
Yeah, Ellen, that is right. We've heard a lot about Texas and Florida, but 14 states have passed or attempted to pass laws this year prohibiting gender-affirming medical care for minors. Some of this care is in fact, much of this care is therapy or it is hormone-blocking medications to give youth time. Most of these laws put the enforcement penalty on health care providers. For example, Alabama. In Alabama providers are subject to ten years in prison, but some levy abuse charges on parents as well.

00;05;28;04 - 00;05;59;04
Kathleen Haddad
These laws have been blocked by legal action and so another morass in the courts persists. But in addition to efforts that directly affect health care, states introduced a record number of laws this year targeting transgender people, youth and adults, restricting public funds for gender affirming care, or in venues such as education, prohibiting classroom discussion of sexual orientation or gender identity, or prohibiting insurance reimbursement for gender-affirming care.

00;05;59;21 - 00;06;07;05
Ellen Bayer
And I'm hearing more and more about protests against clinicians and organizations that provide gender affirming care. Can you say a little bit more about that?

00;06;07;10 - 00;06;40;18
Kathleen Haddad
Yes, Ellen. In addition, this year brought a proliferation of online and in-person protests of providers, particularly at children's hospitals with gender clinics. There are reports of providers curtailing care or moving to Zoom appointments. And hospitals are devoting resources to protecting the safety of staff rather than patient care. It's interesting, Ellen, that for decades state legislatures have protected health care providers or looked out for their interests, particularly physician interests, in areas like malpractice.

00;06;41;02 - 00;07;10;17
Kathleen Haddad
But these days, state legislatures don't seem to be listening to the many mainstream physician and other clinician providers groups who are protesting these restrictions as interference in the physician-patient relationship and detrimental to the mental and physical health of their patients. When the president signed the Marriage Equality Act this week codifying same sex and cross race marriage, I wondered what the future might bring for congressional action that would codify abortion rights.

00;07;10;18 - 00;07;30;21
Kathleen Haddad
And then I wonder the same thing about extending protection against discrimination to people based on sexual orientation and gender identity. So I looked into it and found that bills doing both of these things passed the House this year, but stopped in the Senate because they couldn't get 60 votes needed to break a filibuster.

00;07;31;07 - 00;08;01;24
Ellen Bayer
So another issue that stands out in my mind from the headlines this year, unfortunately, is the issue of gun violence with more horrific mass shootings in Buffalo, New York. And Uvalde, Texas, Highland Park, Illinois, Colorado Springs and Chesapeake, Virginia, just to name a few, and unfortunately does doesn't even scratch the surface. And this week is the 10th anniversary of the heartbreaking mass shooting at Sandy Hook Elementary School in Newtown, Connecticut.

00;08;02;12 - 00;08;29;17
Ellen Bayer
And so this year, after almost a decade since that shooting and after periodic efforts by some members of Congress to pass legislation to address gun violence after the Uvalde shooting, there was again another call to action on the federal level. And this time a bipartisan group of senators actually succeeded in getting the ball rolling. And soon after that, in late June, the bipartisan Safer Communities Act was signed into law.

00;08;29;26 - 00;08;40;27
Ellen Bayer
And as we talked about on an episode of this podcast over the summer, Kathleen, the law really has just as much, if not more, to do with addressing mental health as it does with gun policy.

00;08;41;15 - 00;08;44;03
Kathleen Haddad
So, Ellen, what were some of the important parts of that law?

00;08;44;15 - 00;09;20;17
Ellen Bayer
So the law includes funding to help states implement and run crisis intervention programs, as well as so-called red flag programs, which through court orders can temporarily prevent people at risk of harming themselves or others from having access to firearms. And the law closes what's been referred to as the boyfriend loophole, so that anyone convicted of a domestic violence crime against someone with whom they've had a serious romantic relationship will be prohibited from owning a gun for at least five years, whether or not they were living together or married at the time.

00;09;21;00 - 00;09;44;15
Ellen Bayer
And the law modifies background check requirements by expanding the definition of a licensed firearm dealer to include anyone who sells guns, turn a profit so that everyone in that category has to run background checks and keep records of sales. And the law expands background checks to include consideration of juvenile, criminal or mental health records that would disqualify someone from owning a gun.

00;09;44;26 - 00;09;56;02
Kathleen Haddad
So, Ellen, let's move on to another important health policy issue that's been discussed for years and finally saw some major congressional action this year, prescription drug costs.

00;09;56;22 - 00;10;26;03
Ellen Bayer
That's right. The Inflation Reduction Act that was enacted this year includes some big changes to address the high cost of prescription drugs for Medicare beneficiaries. So beginning in 2023, manufacturers will have to pay rebates to the Medicare program if drug prices for Medicare beneficiaries go up faster than inflation. And Medicare beneficiaries monthly cost sharing for insulin will be limited to $35 a month, which will be a huge help to the millions of beneficiaries with diabetes.

00;10;26;15 - 00;10;51;14
Ellen Bayer
Beginning in 2025, there'll be a $2,000 annual cap on out-of-pocket prescription drug payments for beneficiaries in Medicare Part D, which will be a tremendous savings for people with high drug costs. And in 2026, the federal government will begin negotiating prices for ten high-cost drugs in the Medicare program. And the number of drugs with prices subject to negotiation will will increase to 20 by the year 2029.

00;10;51;28 - 00;11;22;20
Kathleen Haddad
So Ellen, in addition to the prescription drug parts of that of the law, it also extends the through 2025, the premium subsidies for people purchasing ACA coverage. These subsidies were originally set to last for just two years. So this change helps make ACA marketplace coverage more affordable for low- and middle-income people through 2025. And Ellen, we'd be remiss if we didn't mention some major action underway on the federal agency side this year.

00;11;23;01 - 00;11;33;13
Kathleen Haddad
We talked in previous podcast about the reorganization of the CDC, and now it looks like there will be big changes coming to the FDA. What can you tell us about that?

00;11;33;26 - 00;11;57;15
Ellen Bayer
That's right. Earlier this month, an independent review that was commissioned by the FDA recommended a major overhaul of the agency's structure and processes to oversee the country's food supply. This is in response to problems became painfully obvious during the infant formula shortage earlier this year. Among the many recommendations of the report, there are options to reorganize the oversight of food safety to make it more effective.

00;11;58;10 - 00;12;19;20
Ellen Bayer
The report calls for stronger enforcement actions, like using mandatory recall authority more often. It also recommends increased funding and resources to protect food safety. So FDA Commissioner Robert Califf said he was putting together an advisory group to help them determine the best way to implement these recommendations. So that's definitely something we want to keep an eye on for next year.

00;12;20;10 - 00;12;26;11
Kathleen Haddad
So Ellen, it's been an action packed year in health policy. Can we keep up this pace next year?

00;12;26;25 - 00;12;43;29
Ellen Bayer
Great question, Kathleen. To our listeners, we hope you'll tune in next year to find out. Thanks, everyone, for joining us for our 100th episode. Please leave us a review. And if you like the show, please tell a friend and subscribe to “Health Affairs This Week” wherever you get your podcasts. Thanks, Kathleen.

00;12;44;06 - 00;12;45;01
Kathleen Haddad
Thanks, Ellen.