February 22nd, 2022
The Out-of-Pocket Health News Digest
Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.
This compilation is produced by the HPSA Education Committee: Brynna Thigpen, Christopher Whitlock, Easheta Shah, Hannah Lane, Hassan Kourani, Jourdan Clements, and Lizzy Peppercorn
Health Administrators Racing to Resolve Medicaid Disenrollment Crisis Before Deadline
by Brynna Thigpen
U.S. states and the federal government are facing an unprecedented challenge bearing down on them as soon as the COVID-19 public health emergency officially ends: the disenrollment of millions of Medicaid recipients. 

Typically, beneficiaries of Medicaid - the federal-state program primarily for low-income or disabled patients - in their respective states must prove annually that they remain eligible for the program. An entitlement program that determines eligibility based on income or wealth is called “means-tested.” In a typical year, if a beneficiary is found to have made enough money to no longer be eligible for the program, they will be removed from the rolls. 

However, when the COVID-19 public health emergency was first declared, in January 2020, one key element of the declaration stipulated that Americans on Medicaid could not be removed from the rolls. Throughout the public health crisis, Medicaid patients had a guarantee of what officials called “continuous coverage” - they couldn’t be kicked off the program.

This (as well as Americans’ lost jobs) has led to dramatic increases in Medicaid enrollment. Even conservative states like Texas that have explicitly chosen not to expand their Medicaid programs saw increases of over a million patients. 

However, at the end of the public health emergency - currently slated for April 16th - each state will begin going through their beneficiaries and determining who is still technically eligible for the program. CMS officials have called the potential disruption to coverage “unprecedented,” and depending on each state’s handling of it, patients may not even know they’ve lost coverage. Politically, a decline in insurance coverage could also be risky for Democrats in an election year. Legislators in states like Oregon are trying in advance to preserve coverage on the state level, but it will remain to be seen whether these efforts will be successful. 
Senate Bill Aims to Protect Children and Teens on Social Media
by Christopher Whitlock
Social media giants like Tik Tok, YouTube, and Meta, the newly renamed parent company of Facebook and Instagram, pose an ever-increasing threat to the safety and mental well-being of children and teenagers as they outpace federal regulation, finding new ways to capture the attention spans and foster constant engagement from their users.

Establishing online safety protections for minors is a priority for both Democrat and Republican lawmakers, especially following the leak of an internal Meta report detailing how Instagram can be harmful to teens’ mental health. Following several congressional hearings on child safety and social media over the past several months, Senators Richard Blumenthal (D-Conn.) and Marsha Blackburn (R-Tenn) have introduced the Kids Online Safety Act to better protect children and teens online.

The proposed law includes three major elements:
  • Prohibiting online platforms from promoting harmful behaviors including suicide, self-harm, eating disorders, and bullying.
  • Establishing new parental controls for children under 16, including options to protect data from third parties, disable addictive features, and modify recommendation algorithms. The law would also require default settings to offer the strongest level of privacy.
  • New requirement for social media platforms to complete annual risk assessments and provide data to organizations conducting research into the online safety of minors.

Attempting to match the constantly evolving social media landscape, the Kids Online Safety Act is designed to apply to a wide range of platforms used by children under 16, including video games and streaming services. Speaking in support of this legislation, Senator Blumenthal hopes to put in place safeguards against toxic content while holding social media platforms accountable for dangerous, addictive algorithms and practices.
ACA Expansion: Record Enrollment, Coverage Disparities, and 2023 Plan Year
by Easheta Shah
Consumer enrollment in marketplace coverage has reached record-breaking numbers well into 2022 largely due to parameters set by the 2021 American Rescue Plan Act (ARPA). Enhanced ARPA subsidies for populations with lower income and newly extended coverage to middle income people explain significant enrollment gains, specifically among first-time enrollees. Data from the National Health Interview Survey before and after ACA implementation additionally reveal that ARPA updates have helped reduce disparities in insurance coverage for African Americans. Due to expansion, more African Americans qualified for the most generous subsidies and Medicaid resulting in a 9.8% increase in enrollment. 

Despite greater coverage gains for African American populations as compared to gains for white populations, experts urge for further research to sustain these improvements in enrollment. Lack of substantial literature to analyze marketplace practices and their ability to properly address coverage disparities across populations leaves future planning under the Biden administration at a disadvantage as these levels of enrollment for specific populations are unlikely to be sustained without strategic implementation. Not only must enhanced ARPA subsidies be extended into 2023 to avoid premium increases for millions of consumers, but further efforts must also focus on how such strategies can help minimize racial gaps in insurance coverage. 

The current proposed standards for the 2023 plan year include a notice of benefit and payment parameters in accordance with major changes for next year plans including Marketplaces, the risk-adjustment program, and market reforms. These standards will also require Marketplace plans to work more deliberately with essential community providers which have historically served populations of racial and ethnic minorities as well as other underserved communities. Implications of such policy changes may offer opportunities for lasting change in closing disparate gaps in insurance coverage for racial and ethnic populations, but heavy research and monitoring of these proposals must be prioritized to understand the most efficient practices in health insurance equity. 

One-Liners
  • New FDA Chief: For the first time in over a year, the FDA has a permanent head; the Senate voted 50-46 to confirm Robert Califf, an unexpectedly close vote that was controversial due to Califf’s stance on abortion and his ties to the pharmaceutical industry. (The Hill) 
  • Demand for Service Dogs Soars: Service dogs have proven useful for an increasing range of conditions including autism, diabetes, seizures, and psychiatric disorders, and demand is outpacing the supply of the non-profit service dog industry. For-profit organizations are now charging $15,000 - $40,000 for service dogs, none of which is covered by health insurance. (KHN)
  • Six Provider Lawsuits Against No Surprises Act: Latest developments against the No Surprises Act — enacted at the beginning of this year, protecting patients from surprise billing sent through specialty providers — find lawsuits filed by private providers in Texas, the District of Columbia, Georgia, Illinois, New York aggressively trying to protect their own financial interests on the grounds that the NSA’s major provisions are unconstitutional. A final independent dispute resolution rule is expected by May 2022, determining whether or not health care costs will increase even more. (Health Affairs)