April 24th, 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
Closing the Vaping Loophole
by Lizzy Peppercorn
The Federal Drug Administration (FDA) has now closed the vaping loophole that permitted so many nicotine products to be manufactured, marketed and sold without the regulations that apply to tobacco products. In 2020, the FDA attempted to crackdown on e-cigarette manufacturers. However, the increased regulation and the removal of many manufacturers from the industry, such as Puff Bar, only resulted in the development of synthetic nicotine that did not have the same regulations. For example, Puff Bar was kicked out of the market in 2020 but returned in 2021 with its new “tobacco-free” nicotine products. 

CDC sales data shows that since the FDA increased its e-cigarette regulation in February of 2020, there has been an increase in the sale of disposable flavored devices by 280% and an overall increase in e-cigarette sales of 50%. Some public health experts speculate that this increase could in part be also due to loneliness and stress from the COVID-19 pandemic. 

By avoiding the FDA regulations, disposable vapes that use “synthetic nicotine” were able to avoid many public health provisions, including premarket review requirements, the nationwide tobacco sale age of 21 and the requirement of giving health warnings. Now, all manufacturers and sellers of “non-tobacco nicotine” must also comply with the FDA standards and regulations that apply to tobacco derived products. Companies also must register their products with the FDA with a review that looks at marketing and youth uptake. 

The dangers of synthetic vaping are not completely known and are still being studied, allowing many adolescents to use them without having to think of the possible consequences. One difference we do know is that while 99% of tobacco-derived nicotine is a psychoactive molecule called S-nicotine, 50% of synthetic nicotine is R-nicotine. It appears to be slightly less addictive but there is very limited evidence on its impact on animals or humans and it could alter neurotransmission in the brain differently. 

Further, the many flavors are proven to be more addictive. Manufacturers of these tobacco free products have been marketing their products as more clean and pure. However, there is not enough research on whether they are actually safer than tobacco products. It is known that nicotine use during adolescence can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. Earlier ages of smoking and positive experiences are correlated with eventual daily use and lifetime addiction. 
New Biden Administration Proposed Rule Could Help Families Get More Help Paying for Health Insurance
by Brynna Thigpen
The Biden Administration, adhering to the President’s campaign promise to build on and strengthen the Affordable Care Act (ACA), proposed a recent rule to fix the so-called “family glitch” that kept up to 5.1 million Americans from getting subsidies on their health care coverage. 

What is the “Family Glitch”? Under the ACA, individuals who don’t qualify for Medicare, Medicaid, or health coverage at work could receive subsidies from the government to purchase health insurance on the “individual market.” Subsidies would vary based on the individual’s income, and the total cost of the insurance was capped at around 10% of the individual’s income. However, if the individual wanted to purchase coverage for themselves and their family, the additional expense of covering their family was not counted in the 10% cost calculation. Therefore, some were forced not to cover their family because the cost was too great without proportionate subsidies. Those who decided to cover their families on the individual market frequently had to pay much greater shares of their incomes on health insurance than intended. 

What is Biden Doing About It? Under a new proposed IRS rule to address this “glitch,” the cost of the whole family’s coverage will be factored into the calculation determining health insurance’s share of the policyholder’s income. This would make more people eligible for subsidies to help them pay for coverage, extending access to a disproportionate number of women and children. Experts estimate that 200,000 uninsured family members will be able to gain coverage, and 1 million Americans will see decreases in what they pay for health insurance. 

Attack on Abortion
by Hannah Lane
In 1973, the Supreme Court passed Roe v. Wade established the legal right to an abortion. Under Roe v. Wade, an abortion could be performed until a fetus was viable outside of the womb. Although, the landmark court case did not stop those against to continue to restrict access to abortion, especially to more vulnerable communities. The Hyde Amendment, passed in 1976, bars federal dollars from being used for abortion restricting abortion more significantly for Black and Latino people. Research shows, however, that restricting abortion access does not decrease the number of abortions, but it does decrease the number of safe abortions sometimes resulting in severe complications or even death. Restricting abortion access also significantly increases pregnancy related deaths. In some cases, staying pregnant is more dangerous than getting an abortion.

Although those against abortion having been trying to restrict access since the passage of Roe v. Wade, in recent years, we have seen legislatures make bold moves threatening the right to abortion.

An overview of recent moves
In 2018, Mississippi state government enacted a law that would make abortion illegal after 15 weeks of pregnancy, about two months earlier than Roe allows. This law never went into effect because it was immediately challenged and eventually was blocked from being enforced. This case has been repealed and is currently being heard by the Supreme Court, and if upheld, poses a direct threat to Roe. The current law in place in Mississippi allows abortion up to 20 weeks of pregnancy. 

Modeled after the Mississippi law, Texas implemented Senate Bill 8 in September 2021 which bans most abortions after approximately 6 weeks of pregnancy, before many women even know they are pregnant. Additionally, it invites private parties to file civil lawsuits against anyone performing or “aiding and abetting” an abortion. This restrictive law will go into effect July 1st, and patients are having doubts about if there is an end in sight.

Oklahoma recently took a similar move to Texas as banned all abortions after 6 weeks of pregnancy and made performing an abortion a felony with a sentence of up to ten years in prison. This law not only has devastating effects for those that live in Oklahoma, but also for those that have been traveling from Texas to receive care. This law has been signed and is expected to go into effect this summer. 

Florida Governor Ron Desantis signed into law earlier this month an abortion ban after 15 weeks of pregnancy with an exception for life-threatening cases for both the mother and fetus. A similar law was also just passed in Arizona. These laws are expected to go into effect this summer.

Blocked moves
A law scheduled to go into effect April 22nd in Idaho was temporarily blocked by the Idaho supreme court. The law was modeled after the Texas law that relies on ordinary citizens to enforce a ban on abortion after about 6 weeks of pregnancy. Additionally, an extremely restrictive ban on nearly all in-state abortions was recently blocked in Kentucky. 

Abortion-banning legislation has been passed in at least one legislative chamber in seven states: Arizona, Idaho, Wyoming, Florida, Kentucky, Oklahoma, and West Virginia. Bans have been enacted in six of those states: Florida, Oklahoma, Kentucky, Arizona, Idaho, and Wyoming.

Companies taking a stand
Yelp is the latest of companies offering employees pay to travel out of state for abortion treatment. Executives find that they have to take a stand on divisive social issues and also find that issues such as abortion rights have implications for recruitment. They speculate that those that may need access to abortions may not want to work in a state that does not offer them. Other companies that are offering similar services include Citigroup, Match, Bumble, Lyft, and Uber. 

Abortion education
For many years, abortion procedures have been a standard in physician education. As new restrictions pile up, bills have been proposed or enacted in at least 8 states seeking to limit abortion education. For example, abortion training is not offered at Oklahoma's two medical schools and education on the topic is limited. Additionally, an Idaho law passed last year bars tuition dollars from being used for abortion education for any school that receives state funds. Similar bans have been seen in Wisconsin, Missouri, and Ohio. 

A recent study by Stanford found that half of medical schools included no formal abortion training and only a single lecture. Abortion is one of the most common medical procedues, yet education is absent from medical school curricula. 

Important considerations and implications
While we continue to see news stories about restrictions and bans being passed all over the country, it is important to remember that abortion bans are not affecting everyone the same. These bans are affecting low-income, minority populations that do not have the means to simply fly to another state to get an aboriton. These bans affect specific populations and continue to disenfranchise our most vulnerable. 
One-Liners
  • No SMS, Thx: Millions of Medicaid members are slated to lose coverage following the end of the continuous coverage requirement that held throughout the pandemic, but states have decided not to use text messaging to tell members about the upcoming status change, opting instead for email or snail mail. (NPR) 
  • First Breath Covid Test: The Federal Drug Administration just issued an emergency authorization for the first COVID-19 test that uses breath samples. The test uses a COVID-19 Breatalyzer and can now be used in doctor’s offices, hospitals and mobile testing sites. (USNews)
  • Hepatitis outbreak: There have been at least 169 cases of acute hepatitis identified in children aged one month to 16 years old in an outbreak that now involved 11 countries. At least one child has died and 17 children have required liver transplants. It is not yet clear what the cause of the outbreak is yet. (CNN).