Brett Kavanaugh's Health Care Views To Be Scrutinized
By DAN DIAMOND (email@example.com; @ddiamond)
09/04/2018 10:00 AM EDT
With help from Victoria Colliver and Paul Demko
President Donald Trump has weakened health and safety protections for workers, and a new coalition seeks to advance association health plans.
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But first: Judge Brett Kavanaugh prepares to take his turn in the Senate Judiciary Committee’s hot seat this week.
WELCOME BACK: IT’S (FINALLY) BRETT KAVANAUGH WEEK — The Judiciary Committee will begin multi-day confirmation hearings for Kavanaugh, who could pull the nation’s high court to the right for a generation.
Democrats are zeroing in on Kavanaugh’s health care views, given that he could determine the fate of abortion rights, the social safety net and Obamacare itself, possibly within months, POLITICO’s Adam Cancryn writes. More.
— Democrats’ goal: To box Kavanaugh into committing to preserve the Affordable Care Act and access to abortion. Or, failing that, to get the 53-year-old appellate court justice to validate Democrats’ fear he’d vote to wipe them out — a reveal they hope would prompt a wave of public outcry and the additional two Senate votes needed to sink President Donald Trump’s nominee.
— Chuck Grassley’s warning: The Judiciary Committee chairman says that Democrats shouldn’t be trying to secure guarantees on hypothetical court challenges.
“[I]t is entirely improper for a senator to vote for or against a judicial nominee, in exchange for the nominee’s promised vote on a future case,” Grassley writes in a USA Today op-ed.
— Advocates mobilize: Sen. Kirsten Gillibrand will join Planned Parenthood, NARAL, National Partnership for Women & Families and other health care organizations on a press call this morning. Their goal: To focus on the people and patients who would be affected if abortion rights, the ACA and other protections are rolled back by the court.
— Watch the livestream: The hearing begins at 9:30 a.m. Expect opening arguments and witness testimony to dominate the first day. And listen to POLITICO's bonus "Pulse Check" episode on what to watch this week.
THIS IS TUESDAY PULSE — Where we hope you're buckled up: Summer vacation is over, Congress is back and the two-month sprint to the midterm elections has begun.
Speaking of races, PULSE will continue its regular Wednesday relay through the end of the year. (Brianna Ehley will cover PULSE tomorrow; tip her at firstname.lastname@example.org.) Your usual author will return for Thursday and remains at email@example.com.
** A message from Better Medicare Alliance: HEALTH CARE POLICY ALERT: The Administration is strengthening the ability of Medicare Advantage plans to lower Part B drug prices for seniors. When Medicare Advantage prescription drug plans manage drugs to get clinically effective and affordable options to beneficiaries, everyone wins. Learn more: www.bettermedicarealliance.org **
ON TAP THIS WEEK
Wednesday: Oral arguments in Texas v. Azar. The U.S. District Court for the Northern District of Texas will hear a case brought by Republican attorneys general that seeks to undo the Affordable Care Act’s protections.
Wednesday: Medical Device Innovation Consortium public forum. FDA Commissioner Scott Gottlieb is on tap to deliver remarks. More.
Thursday: Rand Paul to speak about association health plans. Paul will address the International Franchise Association’s meeting.
THE WHITE HOUSE
Trump’s questionable record on worker safety. The president has rolled back worker safety protections affecting underground mine safety inspections, offshore oil rigs and line speeds in meat processing plants, POLITICO’s Ian Kullgren writes.
— At the Occupational Safety and Health Administration, for instance, Trump officials are seeking to loosen reporting requirements for injury and illness data from large companies. A proposed rule would relieve companies with 250 workers or more from a previous obligation to submit detailed injury and illness data, which OSHA had intended to publish online.
— The administration says it “is committed to protecting health and safety on the job while respecting the right of Americans to make their own decisions,” spokesperson Lindsay Walters said in a statement. “Too often in the past, agencies issued regulations that constricted the freedom of American workers and small business owners to work in the best way.” More.
Introducing: The ‘Coalition to Protect and Promote AHPs.’ The new group that's advocating for association health plans includes the International Franchise Association, the National Restaurant Association, NFIB and nine other associations.
The group last week asked Pennsylvania Insurance Commissioner Jessica Altman to explain how state regulators intend to handle new rules designed to make AHPs more available. In particular, they’re seeking information about how Pennsylvania will determine whether insurance rules for small or large groups will apply to association health plans, which can be offered under the new rules as of Sept. 1. Read the letter.
California: It’s a wrap for the legislative session. The 92nd session of the California Legislature ended shortly after midnight Saturday, leaving Gov. Jerry Brown with hundreds of bills to act on by Sept. 30. Key health bills under consideration include measures that would ban short-term health plans, require public universities to offer medication abortion and authorize San Francisco to set up what could be the nation’s first supervised injection site for drug users.
Lawmakers also passed a measure to require doctors on probation for certain serious offenses — such as drug abuse and sexual misconduct – to inform their patients. They also approved a contentious union-backed bill that would change how kidney dialysis payments are made through third-party payers; supporters of the measure say it will prevent patient steering for financial gain, while opponents say it will reduce payment and limit access to care.
… One theme this year: California’s resistance to the Trump administration’s agenda, including measures to prohibit California from imposing work requirements on its Medicaid recipients and limit association health plans. While some more ambitious efforts like price-setting and coverage for undocumented immigrants failed, a new governor will take the helm next year. so expect many of these concepts to resurface, POLITICO’s Victoria Colliver writes, especially if that governor is frontrunning Democrat Gavin Newsom. Meanwhile, enjoy the final round of California’s enigmatic governor’s veto messages.
NAMES IN THE NEWS
Bill Cassidy losing health policy director Matt Gallivan. Gallivan has taken a job with 3M as director of state and federal regulatory affairs for its health information systems division and will be returning to his home state of Minnesota. Last year, Gallivan was named one of POLITICO’s “emerging health care leaders.” His last day in Cassidy’s office is Sept. 14.
Enrique Martinez-Vidal joins Association for Community Affiliated Plans. Martinez-Vidal, who was previously at AcademyHealth, is now ACAP’s vice president for quality and operations.
Bill Clark heads to University of Chicago’s NORC. Clark, who was the director of CMS’ division of special population research, is now a senior health care fellow at NORC.
Alice Ollstein starts at POLITICO! Our newest health care reporter will be covering Congress and the Hill. Find her at firstname.lastname@example.org or @AliceOllstein on Twitter.
WHAT WE'RE READING
By Rachel Roubein
The cost of Obamacare plans in 2019 may rise less than 4 percent, NPR reports, citing analyst Charles Gaba. More.
If Democrats win the House, one of their first three legislative packages would focus on reigning in the cost of premiums and prescription drugs, according to Mike Allen at Axios. More.
The Medicaid expansion’s private option is dying, as Republican-led states are opting to impose work requirements instead, Vox’s Dylan Scott reports. More.
In Huffington Post, Jonathan Cohn and Kevin Robillard write that Republican Senate candidates are seemingly contradicting their record on pre-existing conditions. More.
The Chicago Tribune explores whether medical marijuana can replace opioids to relieve chronic pain. More.
The Ebola outbreak in the Democratic Republic of Congo seems to be fading, but it’s too early for health professionals to let their guard down, Donald G. McNeil Jr. writes in The New York Times. More.
** A message from Better Medicare Alliance: BETTER MEDICARE ALLIANCE PRAISES CMS MOVE TO LOWER MEDICARE PART B DRUG PRICES: 20 million seniors and people with disabilities choose Medicare Advantage because Medicare Advantage is leading the way in high-quality care and improved health outcomes in an integrated care model. Better Medicare Alliance considers the Administration’s effort to enable better negotiation of Medicare Part B drugs and patient care coordination as a positive step in the right direction to address high prescription drug prices. When Medicare Advantage prescription drug plans manage drugs to get the most clinically effective and affordable options to beneficiaries, everyone wins. Learn more: www.bettermedicarealliance.org **
How Weight Loss Is Linked To Future Health For Older Adults
Studies describing the effects of weight loss on health rarely consider age. However, weight loss during middle age likely has different effects on your health than does weight loss when you're 65-years-old or older—especially when you're older than 85.
Although some studies have found that weight loss in older adults is generally linked to an increase in illness and death, researchers say that these studies were either too short or were based on information that may have been interpreted incorrectly.
However, one study about fractures and osteoporosis (a medical condition in which bones become thin, lose density, and become increasingly fragile) looked specifically at health and weight for women who were over age 65. Reviewing more than 20 years' worth of data for study participants, the team of researchers responsible for this study had the chance to examine links between long-term weight gain/loss and health. Their findings were published in the Journal of the American Geriatrics Society.
In their new study, the research team evaluated information from the Study of Osteoporotic Fractures. The research team theorized that women with greater weight loss, greater variability in their weight, and/or abrupt declines in weight would be less able to function physically at year 20, and would be more likely to experience poorer health outcomes one to five years after year 20. This theory was based in part on an earlier, related study by the same research team also making use of the Study of Osteoporotic Fractures. In that earlier work, the researchers discovered that the rate of weight loss over 20 years was linked to developing mild cognitive impairment or dementia in women surviving past age 80. (This was not the case for participants with sudden weight loss or changes in weight).
The current study revealed that every 22 pounds of weight loss over 20 years was linked to a 23 percent increased risk of death and a 52 percent increased risk of hip fracture.
The team also said that women with moderate weight loss (20 or more pounds) over 20 years had a 74 percent increased risk of death. Their risk for hip fracture increased nearly three times, compared to women who had not lost weight. They were nearly four times more likely to have poor physical function after 20 years, compared to women with no weight loss.
Even women who had lost a small amount of weight (less than 20 pounds) over 20 years had an increased risk of death, but no increased risk of hip fracture or of poor physical function.
However, the researchers found no link between weight loss and chances for experiencing two or more falls during approximately 18 months of follow-up.
Weight variability and abrupt weight loss were not associated with poor health outcomes, such as falls, fractures, and death. However, those with the most weight variability over 20 years were two times more likely to have poor scores for measures of physical function.
As women age, they risk weight loss because of changes in senses of taste and smell, poorer digestion, and difficulty absorbing nutrients. In addition, other challenges such as loneliness, being in a long-term care facility, having mental health problems such as depression, and/or having limited ability to get around independently can lead to weight loss, said the researchers. "Our findings suggest that weight loss may contribute to the process of health decline," said Dr. Erin LeBlanc, lead author of the study at Kaiser Permanente's Center for Health Research, Portland, Oregon.
The researchers added: "Our results suggest long-term weight loss in older women may be a marker for increased risk of poor health outcomes. Therefore, we should pay attention to women who have survived into their 80s and 90s who have experienced moderate weight loss, regardless of whether there was an abrupt weight decline." Looking closely at women's nutrition, as well as social, environmental, and physical factors impacting well-being also could help preserve health and physical function into old age. However, additional research is needed, the researchers concluded.