KHN’s ‘What the Health?’: Un-Trumping the ACA

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The Biden administration this week proposed a series of changes aimed at boosting insurance enrollment under the Affordable Care Act, undoing changes made by the Trump administration and adding a few new ones.

Meanwhile, Congress is launching investigations of the Food and Drug Administration’s approval of Aduhelm, a controversial drug to treat Alzheimer’s disease that may (or may not) slow its progression. The drug’s price — an estimated $56,000 per year — and the fact that most Alzheimer’s patients are on Medicare mean the federal program could end up footing most of the drug’s bill, threatening the finances of the rest of the health program.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Kimberly Leonard of Insider and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

• The Biden administration’s proposed 2022 rules for the health insurance marketplaces restore some of the policies that were in place before President Donald Trump sought to limit the effects of the Affordable Care Act — and create some new ones. Unveiled in the announcement were proposals to lengthen the window for enrollment for everyone by 30 days, provide a special enrollment period each month for low-income people, and get rid of the requirement that insurers bill separately on premiums for abortion coverage.
• Despite efforts by the new administration to bring down barriers erected by Republicans to ACA coverage, GOP messaging about the law is still impairing its effectiveness and popularity. Republicans have argued for 10 years that the federal health law has helped make health care expensive, and Democrats have had little success changing that depiction, even though costs were rising quickly years before the law was enacted and helped propel Congress to act. In addition, many people needing insurance don’t know that recent covid-19 relief bills increased premium subsidies to make coverage more affordable, and many low-income people don’t understand that the federal government provides subsidies for them to get insurance.
• The rise in U.S. cases of the covid delta variant comes at an awkward time for President Joe Biden, who encouraged people to get vaccinated and set July 4 as a day to celebrate independence from the pandemic.
• Areas of the country where vaccination rates are low are at highest risk of outbreaks of the delta variant. Some of those regions are already seeing problems developing. However, the Centers for Disease Control and Prevention has not joined groups like the World Health Organization in calling for a return to masking indoors.
• Officials have not yet said whether Medicare will cover Aduhelm. Generally, Medicare does accept drugs after FDA approval, but because of the potential cost of this medication, many experts think Medicare may take a close look at options like setting eligibility criteria and requiring proof of progress with the drug.
• Walmart announced this week that it will begin selling analog insulin at low prices to uninsured customers. It is passing along to those people the discounts generally given to insurers.
• The e-cigarette company Juul agreed to pay North Carolina $40 million to settle a lawsuit brought by the state alleging that the maker of vaping products was targeting kids.  

Also this week, Rovner interviews Marshall Allen, a reporter for ProPublica, about his new book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.”

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KQED’s “There’s Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?” by April Dembosky.  

Also: KQED’s “She Killed Her Children. Can We Forgive Her?” by April Dembosky.

Kimberly Leonard: Insider’s “Democrats Just Unveiled a $400 Billion Caregiving Bill That Would Supercharge Home Care and Boost Pay for Workers as 820,000 People Wait for Help,” by Kimberly Leonard.

Joanne Kenen: The Incidental Economist’s “Reducing Administrative Costs in US Health Care: Assessing Single Payer and Its Alternatives,” by David Scheinker, Barak Richman, Arnold Milstein, and Kevin Schulman.

Sarah Karlin-Smith: The New York Times’ “It’s Tough to Get Out’: How Caribbean Medical Schools Fail Their Students,” by Emma Goldberg.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.