States use obscure ACA provision to widen health insurance access – POLITICO

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— Oregon, Kentucky plan to use a little-used ACA provision to make insurance more affordable for thousands.

— Democrats on the ballot in November are staying away from mask mandates, even as cases rise.

— Political interference in public health agencies is back in lawmakers’ crosshairs after new evidence of Trump-era meddling emerged.

WELCOME TO MONDAY PULSE — Nerd Prom is back. Some celebrated the return to glamour at the WHCD; others couldn’t shake the feeling the other shoe was about to drop. Here’s our 180-second recap. Send your favorite zinger of the night, news and tips to [email protected] and [email protected].

STATES TAKE THE LEAD IN AFFORDABLE HEALTH CARE — Oregon and Kentucky are using an overlooked provision of the Affordable Care Act to provide health insurance for people who can’t afford Obamacare plans but make too much to qualify for Medicaid, POLITICO’s Megan Messerly writes.

Only New York and Minnesota took advantage of the option — called the basic health program — when it was introduced by the Centers for Medicare and Medicaid Services in 2014. The sudden interest from those two very different states speaks to the broad understanding that the Biden administration isn’t likely to expand health care and the anxiety that the end of the pandemic’s public health emergency could kick millions off of Medicaid.

The basics: A basic health program offers low-cost insurance for people who make up to twice the federal poverty level — about $55,000 a year for a family of four — and don’t qualify for Medicaid.

In Oregon, Democrats passed a bill in March to establish a program. In Kentucky, Republicans approved $4.5 million in state funds this spring to set one up. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.

The naysayers: Critics say states should focus on making exchange coverage more affordable instead of creating new basic health programs. In a letter to CMS earlier this month, Kaiser Permanente called the basic health program an “inelegant and potentially market-undermining program.” Hospitals have also voiced concerns.

COVID AND THE MIDTERMS —  Candidates for governor and other offices who are on the November ballot have two statistics to contend with these days: the rising number of Covid-19 cases and the dwindling number of days until the polls, writes POLITICO’s Shannon Young.

Increasingly, the approach to that politically inconvenient reality is to do nothing.

In New York, now awash in red on the Centers for Disease Control and Prevention community map, Gov. Kathy Hochul isn’t pushing to reinstate mask mandates or other mitigation measures and instead is encouraging vaccinations, boosters and mask-wearing, except where required.

She’s not alone. In an election year where more than 30 governors, Congress members and many state legislatures are on the ballot, politicians are ditching mandate talk for fear of angering a pandemic-weary public and becoming an easy target for political foes.

In the battleground state of Pennsylvania, Democrats running in statewide races are drawing a line when it comes to masks after Philadelphia’s attempt to reinstate an indoor mask mandate amid rising cases went up in flames days later.

“The pandemic is not the top-of-mind issue for voters,” said Steve Greenberg, a spokesperson for the Siena College Research Institute, which, in a recent poll, found only 3 percent of New Yorkers see the pandemic and vaccines as the single most important issue in deciding whom they will support for governor this November. “If the election were right now, the pandemic would not play a big part in it.”

IN CDC WE TRUST? — New evidence of political meddling in the CDC during the Trump administration has revived talk on the Hill of the need to restore trust in the nation’s premier public health agency, Krista writes.

The House Select Subcommittee on the Coronavirus Crisis released emails last week detailing how Trump officials intervened to take out “offensive” language from CDC guidance that raised “religious liberty concerns” to faith communities in May 2020. On Friday, the subcommittee held a hearing on how to ensure integrity in public health agencies.

The hearing followed the release of an April 29 report from the Government Accountability Office that found employees at four public health agencies didn’t report their concerns about the political interference they saw in their workplace. They said they failed to speak up because they “feared retaliation,” were “unsure how to report the issues” or “believed agency leaders were already aware.”

The GAO found that all four agencies — the CDC, the Food and Drug Administration, the National Institutes of Health and the Office of the Assistant Secretary for Preparedness and Response — had no procedures on how political inference in their work should be reported and handled.

MOST STATES SEE CASE INCREASE IN APRIL — Thirty-six states saw an increase over the previous week in Covid-19 cases during the week ending April 24, according to CDC data. Indiana saw the largest increase in cases, while North Carolina saw the largest decrease in cases.

See POLITICO’s Taylor Miller Thomas’ full DataPoint here.

WELCOME, BA.4 — The first cases of BA.4, the Omicron subvariant driving the rising number of cases in South Africa, have landed in the U.S, POLITICO’s Daniel Payne and Krista report.

At least 11 cases of the subvariant have been found, according to Concentric by Ginkgo Bioworks, a company partnering with the CDC in international airport viral surveillance. On April 19, the company’s program collected the most recent sample from a passenger who arrived at the Atlanta airport on a flight from South Africa.

The first BA.4 variant was found on Jan. 10 in South Africa, where early research suggests BA.4 has a 0.08 growth advantage over BA.2. Both BA.4 and BA.5 — another subvariant similar to BA.4 — have quickly become the dominant strains of Covid-19 in that country.

Other Omicron subvariants are also being tracked around the world, including BA.3 and XE — a combination of BA.1 and BA.2 that seems to spread slightly more easily than BA.2.

BIDEN’S TESTING LEAD DEPARTS — Tom Inglesby, the federal official in charge of the Biden administration’s Covid-19 testing efforts, has returned to his job as director of the Johns Hopkins Center for Health Security, POLITICO’s David Lim reports.

Inglesby previously warned that the nation could find itself in a worse situation than it experienced with the Omicron variant if new investments into the Covid testing market intended to maintain manufacturing capacity cannot be made.

The amount of turnover during the last six months on the White House Covid-19 response team could be a challenge due to the loss of continuity, says William Morice, president of Mayo Clinic Laboratories. Jeff Zients recently departed the Biden administration and was replaced by White House Covid-19 response coordinator Ashish Jha.

FLORIDA UNPREPARED FOR RISING CASES — Current and former health officials in Florida warn the state remains woefully underprepared to handle the next wave of the pandemic, POLITICO’s Arek Sarkissian writes.

A report by the Florida Hospital Association estimates 70 percent of Florida hospitals face a critical staffing shortage, and the state will be short 60,000 nurses by 2035.

The weekly rate of new Covid infections in Florida was 9.2 percent as of April 24, according to the CDC, whereas it was around 3 percent as of March 11. The state’s Covid-related hospitalizations increased slightly to 1,039 inpatients as of Thursday from the 970 the previous week.

CALIFORNIA GRAPPLES WITH FERTILITY TREATMENT COVERAGE — A bill that would require health insurers to cover fertility treatments will be amended in response to opposition from health insurance companies and other business groups, reports POLITICO’s Juhi Doshi.

Assemblymember Buffy Wicks (D-Oakland) said CA AB 2029 (21) would help remove economic barriers to fertility treatments, improve access for the LGBTQ community and aid people with cancer and others with medically induced infertility. It builds on SB 600, a law passed in 2019.

After facing opposition from the health insurance industry and other businesses over the increased costs the bill would bring, Wicks agreed to amend the bill to limit oocyte retrievals, or the removal of eggs from the ovaries, to three, exempt small businesses from having to provide the coverage for the procedure and place a $75,000 benefit limitation.

Bakul Patel, FDA chief digital health officer of global strategy and innovation, announced on LinkedIn he is leaving the agency at the start of May.

The Medicaid and CHIP Payment and Access Commission (MACPAC) named Kate Massey as its new executive director. Massey is currently the director of the Medicaid program in Michigan and will begin her new role next month.

Prescribing the wrong drug after rushed searches in computerized medicine cabinets is rare, but it happens, reports Kaiser Health News’ Brett Kelman.

This California bill would give Medi-Cal’s patients who have cancer access to better care, Precision Oncology News reports.

Pregnant workers still need better protections, writes Dina Bakst in The Washington Post’s opinion section.