Analysis | Stacey Abrams wants to leverage an Atlanta hospital’s closure in her race for governor

Helloo, good morning. Are we in for another Elizabeth Holmes court trial? Send your best Holmes content to rachel.roubein@washpost.com. 

Today’s edition: Coronavirus booster shots will now likely be annual, just like the flu vaccine. The Food and Drug Administration is convening independent experts to discuss an experimental ALS drug, in a meeting likely to be contentious. But first … 

A major Atlanta medical center is being weaponized in the Georgia governor’s race

In Georgia, Democrats are attempting to weaponize the looming closure of a major Atlanta-based hospital into a potent midterms message.

Gubernatorial candidate Stacey Abrams, a Democrat, is using the moment to bash Republican Gov. Brian Kemp for refusing to expand Medicaid to roughly 269,000 poor adults stuck in the coverage gap. 

The fight is a perennial reminder of the politics of Medicaid expansion — and how Democrats believe it’s a winning issue. For years, party officials have argued the policy provides critical funds to cash-strapped hospitals. Since 2017, it has proven popular at the ballot box, with voters approving measures to expand the safety net program in six mostly red states, including Oklahoma, Missouri and Idaho. 

The health system denies Medicaid expansion would have turned around the fortunes of Atlanta Medical Center, a major hospital serving some of the city’s most vulnerable residents. Yet, some Medicaid advocates argue expansion could have delayed the hospital’s closure — and say it gives Abrams a salient message to take to voters. Polling generally shows Kemp with a slight lead over Abrams in one of the nation’s most closely watched gubernatorial contests.

More from Abrams:

How we got here

Last week, Wellstar Health System announced it would close Atlanta Medical Center on Nov. 1, citing roughly $107 million in losses over the past year. The news was first reported by the Atlanta Journal-Constitution. 

The announcement quickly ignited a political firestorm.

• Atlanta Mayor Andre Dickens demanded more information from the health system, writing in a letter that the decision will have “deep and reverberating consequences.”
• Georgia Sen. Raphael Warnock, a vulnerable Democrat up for reelection, led a letter imploring the hospital’s ownership to reverse course.
• Abrams convened a news conference outside the hospital, touting the benefits of expanding Medicaid and arguing doing so would help the finances of Georgia’s hospitals.

The view from Wellstar: “While expanding Medicaid may have helped Atlanta Medical Center’s financial sustainability, it would not have changed this outcome,” per a statement sent to The Health 202. The hospital has faced a “unique set of challenges,” such as low utilization, aging infrastructure and operating losses.

The Kemp campaign has seized on this sentiment. “Wellstar has been abundantly clear that Medicaid expansion would not have prevented the AMC closure. But that doesn’t fit Stacey Abrams’ political narrative, so she’s falsely blaming Governor Kemp,” spokesman Tate Mitchell told the AJC. (Mitchell didn’t respond to a request for comment.)

But the Abrams campaign says expanding Medicaid will reduce the financial strain on hospitals like Atlanta Medical Center that serve a sizable share of uninsured patients. 

• “Unfortunately, we don’t know what the financial outlook for Georgia’s hospitals could have looked like for the past four years if Kemp had not repeatedly blocked efforts to expand Medicaid and relieve this financial strain on health care providers,” Alex Floyd, an Abrams spokesperson, said in a statement to The Health 202.

Greg Bluestein, the Atlanta Journal-Constitution:

Will Georgia expand Medicaid?

Georgia is one of a dozen Republican-led states that haven’t expanded Medicaid. But it’s hard to see a full expansion happening any time soon. Even if Abrams wins, the Republican-dominated legislature would need to sign off on any such plan, which would be a tall order.

Meanwhile … Kemp has been battling the Biden administration over a limited expansion of the safety net program. In fall 2020, Trump officials approved a partial expansion of Medicaid to those at the federal poverty line, which is short of Obamacare’s 138 percent threshold for expansion and wouldn’t come with the health law’s robust boost in federal funds. 

The details: The program would grant coverage to roughly 52,000 state residents as long as they work or volunteer, and Kemp has touted it as a better solution “rather than rely on a one-size-fits-none broken system.” However, it would still cover far fewer people than traditional expansion under the Affordable Care Act, and Democrats have blasted the plan as inadequate. 

The Biden administration rescinded the Trump-era approval of the work requirement late last year. Kemp argued the move was illegal — and a district judge ruled in his favor last month. Now, Kemp is working to get the program up and running in the first quarter of next year, according to Andrew Isenhour, a Kemp spokesperson who blamed the Biden administration for the delay. 

The Department of Health and Human Services and the Centers for Medicare and Medicaid Services declined to comment on whether they would appeal the ruling. 

Coronavirus

U.S. plans to shift to annual coronavirus shots, akin to flu vaccine

White House coronavirus coordinator Ashish Jha said yesterday that the public will likely need an annual coronavirus booster shot, which should provide “a high degree of protection against serious illnesses all year,” our colleague Lena H. Sun reports. 

The messaging from the White House marks an important shift in the Biden administration’s current practice of urging Americans to get boosters every few months. Barring any new curveball variants, Jha said the government hopes to transition people to get the vaccine yearly similar to the flu shot, which could be administered at the same time. 

• “I really believe this is why God gave us two arms — one for the flu shot and the other one for the covid-19 shot,” Jha said.
• Vulnerable groups, like the elderly and immunocompromised, may have to get more frequent coronavirus doses, he added.

Heading into the third fall of the pandemic, Jha and other Biden administration health officials called on all people age 12 and up to get the newly authorized omicron-targeting booster shots that will become widely available within the next week. Like other coronavirus shots, these boosters are free. 

The big picture: If the public embraces the boosters early this fall at a rate similar to that of annual flu shots, about 100,000 hospitalizations, 9,000 deaths and billions of dollars in direct medical costs could be prevented, according to Centers for Disease Control and Prevention Director Rochelle Walensky. 

HHS Secretary Xavier Becerra:

Agency alert

There’s a showdown today at the FDA over a new ALS drug

On tap today: The Food and Drug Administration will convene its panel of independent experts to give the drugmaker behind an experimental treatment for the neurodegenerative disease ALS a rare second chance to make its case for the therapy, our colleague Laurie McGinley reports. 

Amylyx Pharmaceuticals’ AMX0035 is the latest drug to land at the center of an intense debate over how the agency should handle potential therapies for devastating diseases, including ALS and Alzheimer’s, that lack effective treatments. 

What they’re saying: The federal agency has expressed skepticism about the drug and its single small clinical trial, as have its advisers who voted narrowly against recommending approval in March. On Friday, the FDA repeated many of its earlier concerns about the treatment’s effectiveness, saying additional analyses submitted by the company were flawed and didn’t have any new information. 

Skeptics of the drug warn that if the FDA approves AMX0035, it would repeat the same mistakes it made last year when it cleared the controversial Alzheimer’s drug Aduhelm that critics said had little data showing it worked. They argue the agency should wait to approve the ALS drug until the manufacturer completes a larger trial with 600 patients in late 2023 or early 2024.

The flip side: ALS patients say they often don’t have time to wait; the debilitating illness typically kills patients within two to five years of diagnosis. And while AMX0035 isn’t a cure, it has potential to slow the disease while serving as a building block for the kind of combination therapies used for cancer and HIV, said Brian Wallach, a former staffer in the Obama White House who was diagnosed with ALS five years ago.

More from Brian: 

Juul settles with dozens of states over youth vaping investigation

E-cigarette manufacturer Juul Labs has agreed to pay more than $438.5 million to settle claims with over 30 states and one territory that the company helped ignite the teenage vaping crisis by marketing its products to underage users, The Post’s Lateshia Beachum and Laurie McGinley report. 

The settlement, which includes numerous restrictions on how Juul can market its products, ends one of the largest legal threats against the company. Juul still faces hundreds of other lawsuits making similar claims. 

What they found: An investigation, led by Connecticut, Oregon and Texas, revealed that Juul allegedly intentionally marketed to underage users by hiring young models, using social media to attract teenagers and offering free samples. According to Connecticut Attorney General William Tong, the company also allegedly manipulated their products’ chemical composition to be palatable to inexperienced users and relied on ineffective age verification techniques to preserve its client base. 

Juul did not acknowledge wrongdoing in the settlement but called the deal “a significant part of our ongoing commitment to resolve issues from the past” while it awaits a decision from the FDA on whether it will be allowed to continue to sell its products in the United States. 

Senator Dick Durbin (D-Ill.):

In other health news

• Out today: Telehealth use increased dramatically during the first year of the covid-19 pandemic, with urban, Hispanic, female and younger Medicare beneficiaries among the most likely to use the service, according to a new report that will come out today from the HHS’s Office of Inspector General.
• Key Senate backers of a same-sex marriage bill are pressing Democratic leadership to avoid attaching the measure to a temporary bill to fund the government, Punchbowl News reports.
• HHS announced that it’s awarding AmerisourceBergen with a nearly $20 million contract to significantly expand the number of distribution sites for monkeypox vaccines and treatments nationwide.

Health reads

The fight to keep little-known bacteria out of powdered baby formula (By Laura Reiley and Jacob Bogage | The Washington Post)

“The Human Psyche Was Not Built for This” (By Marilyn W. Thompson and Jenny Deam | ProPublica)

Meet Mary Wakefield, the Nurse Administrator Tasked With Revamping the CDC (By Sam Whitehead | Kaiser Health News)

Sugar rush

Thanks for reading! See y’all tomorrow.