March 21st, 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
Texas Supreme Court Blocks Challenge to Vigilante Abortion Ban
by Brynna Thigpen
Texas’ vigilante-style abortion ban faced a legal challenge in the state until last week, when the Texas Supreme Court effectively dismissed the suits with a unanimous decision. 

The Texas law was unique in that it both banned abortion after around 6 weeks (when most women aren’t yet aware they’re pregnant), and allowed private citizens to enforce it by suing  anyone who “aids and abets” abortion. The state offered $10,000 to anyone who successfully pursued such a lawsuit. 

This private citizen enforcement model creates a challenging legal structure. The U.S. Supreme Court declined to take up any legal challenges to the law because state officials in Texas don’t directly enforce the law - private citizens do. This new model of law enforcement has not been tested before, but is already being copied in similarly-minded states like Idaho and Oklahoma. On the other side of the political spectrum, the governor of California has suggested he may pursue a similar style of law around gun restrictions. 

Texas’ law contradicts the precedent set by the famous 1973 Supreme Court ruling in Roe v. Wade, which allowed women across the U.S. to get an abortion up to about 23 weeks of pregnancy. 

Pro-choice advocates are disheartened by the ruling, and they have company. About 60% of Americans believe that abortion should be legal in all or most cases, and only 19% of Americans think it should be illegal in all cases. Corporate entities are tentatively wading in, the largest of which is Citigroup. Texas is home to more than a quarter of Citi’s employees, and the company (along with several other newer and smaller companies) has offered to pay for transportation costs for Texan employees who are seeking an abortion. 
Senate Bill Aims to Protect Children and Teens on Social Media
by Easheta Shah
The effects of institutional racism in the fields of medicine and health insurance have exacerbated health disparities among different racial and ethnic groups, especially in light of the pandemic. While these disparities are complex, the DC Health Benefit Exchange Authority (DCHBX) offers a solution at the health care system level through their online insurance Marketplace, DC Health Link. Established in 2013, DCHBX partners with the private health insurance market to promote competition and transparency while helping the public understand prices and benefits to affordable, quality insurance. 

In an effort to address inequities in health care, the DCHBX executive board established the Social Justice and Health Disparities Working group – made up of health insurance companies, patient advocates, health equity experts, doctors, and hospitals – to issue recommendations focused on expanded access and equitable treatment for patients and communities otherwise marginalized and misrepresented in health care settings.

As of July 2021, the working group and the executive board adopted two immediate actions to enforce through health insurance policy and treatment practice:

  1. Eliminating cost barriers to care for conditions that disproportionately impact communities of color, starting with type 2 diabetes. 
  2. Prohibiting race adjustment in blood tests that estimate glomerular filtration rate (GFR), a test used to monitor kidney function. 

2023 standard plans under DCHBX will no longer have cost sharing for physician visits, blood tests, vision and foot exams, prescription medications, and supplies and will work to prohibit race-adjusted GFR. While the 2022 DC Health Link insurance Marketplace plan has eliminated cost sharing for insulin and diabetic supplies, subsequent years also plan to examine other conditions that disproportionately impact communities of color. No cost-sharing plans may extend to pediatric mental and behavioral health services, adult cardiovascular disease, cerebrovascular disease, mental health, HIV, and some cancers. 

DCHBX’s method of implementing changes to coverage design works to address health disparities within ACA Marketplaces by eliminating certain out-of-pocket costs for state-based health insurance, and this work should continue at all levels of the healthcare system.

Sources: Health Affairs
Will we need another COVID-19 Booster?
by Lizzy Peppercorn
Just last week, Moderna requested approval of all adults to get a fourth dose of its COVID-19 vaccine so that federal agencies can determine the appropriate use. Pfizer also requested approval for a fourth dose right before; however, their request was limited to adults age 65 and older. These requests have raised debate over whether or not a fourth dose will be necessary/recommended in the near future. 

CDC studies have shown that the effectiveness of two doses of Moderna or Pfizer drops to 58% after four to five months. They have also shown that the vaccine is 91% effective at preventing hospitalizations after the booster and that this drops to 78% after four or five months, which is still considered protective. In a preprint study released in February, researchers at the Sheba Medical Center in Israel studied 274 health care workers after they received a fourth dose of Moderna or Pfizer. They found that while the fourth shot did increase antibody levels to the same peak levels they were at after the third dose, the shot was not effective at preventing mild or asymptomatic Omicron infections. 

Ultimately, it will be up to the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) whether a fourth shot is recommended/approved for everyone or only certain higher risk groups. It is also unclear how many American citizens would be willing to get a fourth shot, even if it was recommended and approved. Under half of the Americans eligible for a first booster (third shot) now have gotten one. However, there are little foreseen drawbacks to getting a fourth vaccine if it does become available. The only possible harm is that it could blunt the ability of the immune system to respond to new variants in the future. The general consensus among public health officials, including chief White House medical adviser Anthony Fauci, MD, is that more data is necessary and that as of right now, a single booster shot is considered effective enough that a fourth shot is not necessary. 

Source: USNews, Webmd
One-Liners
  • Medical Debt: Despite the health insurance coverage gains achieved over the past decade, medical debt is still high and inequitably spread, with 1 in 10 Americans owing a significant amount, 3 million owing over $10K, and Americans who are Black, live in the South, or live in a state that hasn’t expanded Medicaid being more likely to have medical debt. (Peterson KFF Health System Tracker)
  • More Medicaid Discrepancies from Missouri: Planned Parenthood is suing the state of Missouri for unlawfully restricting Medicaid payments that go toward funding abortion. (Missouri Independent)
  • Cannabis Use Disorder: A new Massachusetts General Hospital study shows using cannabis to treat pain, anxiety, and depression failed to improve symptoms and doubled the risk of developing addictive symptoms of cannabis use disorder. (Science Daily)