Obamacare turns 12. Its struggles aren’t over.- POLITICO | #macos | #macsecurity

With Daniel Lippman, Katherine Ellen Foley and Rachael Levy

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The Affordable Care Act has survived a string of GOP challenges, but now its foe is caucus divides.

Health data breaches spiked last year, posing a sharp threat to patients.

Psaki’s new coronavirus case speaks to larger questions about reinfection and distancing guidelines.

WELCOME TO WEDNESDAY PULSENo health chatter today, just a really cool picture. Send equally cool pics, news and tips to [email protected] and [email protected].

OBAMACARE AWAITS ITS RELAUNCHIt’s the Affordable Care Act’s 12th birthday today. No anniversary is inconspicuous for the sweeping law, which survived a slew of repeal attempts but now rests in limbo with a president who promised to realize its full potential.

President Joe Biden vowed during his presidential campaign to expand and strengthen the law, distinguishing himself notably from further-left candidates such as Bernie Sanders, who called for scrapping ACA and instituting a so-called “Medicare for All” model. Biden instead kept to the center of the debate, arguing to fortify the existing law.

Even that incremental progress is elusive. The president had some early successes getting more Americans covered — but his efforts have since stalled out, Joanne Kenen writes in POLITICO Magazine.

The pandemic has, of course, played a major factor, relegating other health issues to the back burner in Biden’s first year. But that’s not all. Biden’s bigger obstacle has been the sharp divisions in Congress, including among Democrats.

Neither Biden nor his allies have been able to move ahead on creating a government-run “public option” within Obamacare insurance markets, a counterpoint to the single-payer movement and a top priority of his 2020 campaign.

Then came the collapse of the Build Back Better plan, which was the Democrats’ main vehicle for strengthening the ACA along with a host of other social programs, Joanne writes. The House-passed version — which would expand Medicaid and extend insurance subsidies — faltered with moderate Democratic senators like Joe Manchin (D-W.Va.). The party is now trying to cobble together a slimmed-down bill, but it’s not clear what can pass muster in a razor-thin yet splintered majority.

Meanwhile: More than a thousand doctors are using the ACA anniversary to rally for the Biden administration to bolster the law and fix problems in Medicaid expansion that still leave people in a coverage gap because of unaffordable ACA premiums.  

“In our clinics and exam rooms, we see firsthand how gaps in health care coverage can put people at risk — and how expanding Medicaid can improve health, inspire hope and even save lives,” physicians wrote in a letter organized by the Committee to Protect Health Care first shared with Pulse. “While they may qualify for financial support, health care premiums available on the marketplace through the Affordable Care Act are still unaffordable for some.”

MAJOR SPIKE IN 2021 HEALTH DATA BREACHES — Nearly 50 million people in the U.S. had their sensitive health data breached in 2021, a threefold increase in three years, POLITICO’S Ben Leonard reports.

The breaches happened in every state except South Dakota, according to health care organizations reports, and about half of states and Washington, D.C., saw more than 1 in 10 residents directly affected by unauthorized access to their health information, according to the analysis.

The health care industry’s rapid move to digital is to blame for the increase, experts say, along with an increase in remote work and better reporting, among other factors. The widespread breaches raise serious privacy and security concerns for consumers and the industry — costing billions every year — and highlight the potential consequences as health care modernizes.

“Unfortunately, the industry is pretty much easy pickings, and they’re hitting it because they’re getting paid,” said Mac McMillan, CEO of cybersecurity company CynergisTek. “It’s [not] gonna slow down until we either get more serious about stopping it, or blocking it, or being more effective at it.”

PSAKI TESTS POSITIVE, AGAIN — White House press secretary Jen Psaki announced Tuesday that she has Covid-19 once more.

Remember: Psaki first tested positive last fall, just before a Biden visit to Europe but said at the time that she’d had no recent close contact to be a risk to the president.

This time: Psaki tweeted she had two “social-distanced meetings” with the president on Monday, but he “is not considered a close contact as defined by CDC guidance.” Biden tested negative on Tuesday.

Psaki’s reinfection raises multiple questions, not least how long immunity lasts against the evolving virus. For instance, it isn’t known if Psaki or the president wore masks during their Monday meetings. A White House spokesperson didn’t immediately comment, Rachael writes.

What’s next? As POLITICO’s Jonathan Lemire noted Tuesday: “This is the third time the virus has touched the West Wing in just over a week.” The pandemic isn’t over, even as the risk assessment evolves.

Meanwhile: Former Secretary of State and presidential candidate Hillary Clinton announced late Tuesday she tested positive for Covid-19. “I’ve got some mild cold symptoms but am feeling fine,” she wrote on Twitter, adding that former president Bill Clinton has so far tested negative.

SANDERS WANTS TO TACKLE EMS ‘CRISIS’Sen. Bernie Sanders (I-Vt.), joined by Sen. Tina Smith (D-Minn.), will introduce legislation today to address nationwide Emergency Medical Services staffing shortages that have worsened during the pandemic.

“In too many communities across our country, ambulance and emergency medical services are not getting the support from the federal government that they need to do their jobs,” said Sanders in a statement.

The EMS Staffing and Support Act would establish a $500 million grant program in the Health Resources and Services Administration that would enable EMS to hire more personnel, provide training and purchase new equipment, vehicles and medical supplies, among other measures.

JACKSON CALLS ROE V. WADE ‘SETTLED LAW’ Judge Ketanji Brown Jackson briefly addressed the hot-button abortion issue during the second day of her confirmation hearing on Tuesday, POLITICO’s Alice Miranda Ollstein reports.

During questioning from Sen. Dianne Feinstein (D-Calif.), she said: “Roe and Casey are the settled law of the Supreme Court concerning the right to terminate a woman’s pregnancy. They have established a framework that the court has reaffirmed.”

The Supreme Court is currently considering a Mississippi law that would prohibit abortion after 15 weeks, a case that could prove pivotal to the fate of Roe v. Wade. Jackson will not take part in the decision, which is expected to come down before the end of June, even if she’s confirmed.

GOP WAYS AND MEANS COMMITTEE MEMBERS HOLD HEARING ON PATIENT DRUG ACCESS — Rep. Kevin Brady (R-Texas), the Republican ranking member of the House Ways and Means Committee, and Vern Buchanan (R-Fla.), the health subcommittee leader, chaired a hearing on new drug development and patient access to therapies on Tuesday, Katherine writes.

Biogen’s Aduhelm, a novel Alzheimer’s therapy, took center stage as lawmakers criticized the Centers for Medicare and Medicaid Services proposal to limit coverage of the drug and others like it to patients enrolled in randomized clinical trials — a move they say would harm patients and future drug innovation.

Expert witness: Harry Johns, head of the Alzheimer’s Association, said the proposed coverage plan “duplicates” the FDA’s authority. Patient advocacy groups like the Alzheimer’s Association, which receives some funding from Biogen, and drugmakers have been among the loudest critics of CMS’ proposed coverage plan.

Ball in CMS’ court: The agency is slated to solidify its coverage decision for Aduhelm by April 11.

FIRST IN PULSE: GROUPS URGE CMS TO ENFORCE MEDICAID’S FREE CHOICE REQUIREMENT — Nearly three dozen groups are calling on leaders at CMS to enforce Medicaid’s free choice of provider requirement in states that aren’t complying with the rule.

In a March 23 letter to HHS’ Chiquita Brooks-LaSure and Daniel Tsai, provided exclusively to Pulse, more than 35 groups write that nearly half a dozen states are blocking beneficiaries’ access to the family planning providers of their choice in an “ideologically motivated” campaign.

It says state Medicaid programs in Missouri, Texas, Arkansas and Mississippi have terminated certain family planning providers, including Planned Parenthood centers.

“People with Medicaid coverage who seek family planning and reproductive health services should not be denied access to the providers they trust,” the groups write.

Catherine Lenz is now director of health policy at the Picard Group. She previously was senior health policy adviser for Rep. Michael Burgess (R-Texas).

Sarah Aillon is now director of digital media and communications at the Federation of American Hospitals. She was most recently a program administrator for the Conference of State Bank Supervisors.

Dolly Moorhead has joined the team at Canadian telehealth startup iHealthOX as its director of U.S. business development. She started a consulting LLC, Limenitis, through which she works with clients across the healthcare and biotech industries and is a former senior adviser to the U.S. Surgeon General in the Trump administration.

A cure for sickle cell anemia, which primarily affects individuals of African descent, is on the horizon thanks to genetic medicine — but systemic racism in the U.S. may still prevent patients from benefiting from it, Dhruv Khullar writes for the New Yorker.

The Wall Street Journal reports on the trial of Ramesh “Sunny” Balwani, whose defense said the former Theranos president did not start or run the disgraced firm.

Former CDC director Tom Frieden writes in The New York Times that the next Covid-19 wave is probably already on its way.

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