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In health news, the federal government will soon stop paying for COVID-19 tests, treatments and vaccines, and it will likely be a sticker shock for people who don’t realize it’s coming.
Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Nathaniel Weixel and Joseph Choi. Someone forward you this newsletter?
Why you may soon have to pay for that COVID test
The federal government is poised to stop paying for COVID-19 vaccines, tests and treatments in the coming months, shifting the costs from taxpayers onto individual patients.
Experts say most Americans are not aware that this will happen and will be in for a major case of sticker shock. They warn without additional protections or funding, the transition to commercialized treatments and preventive services will lead to health barriers.
Instead of free access to tests and treatments like Paxlovid, insurance companies and manufacturers will set the price.
The days of free, easily accessible COVID-19 tests will also likely end. Private insurance may not cover over-the-counter tests anymore, and patients may need a prescription first for a PCR test.
Vaccines will still be free to people with private insurance, though the cost will likely be reflected in premiums. Even with insurance, patients will likely see costs if they go to an out-of-network provider.
But the biggest impact will be on uninsured or underinsured Americans, many of whom have jobs that put them at greater risk of COVID-19 exposure.
Reflective of broader system: “The way that it works in the U.S. [right now] is actually more similar to how a lot of health care works in other countries too,” said Cynthia Cox, an insurance expert and vice president at the Kaiser Family Foundation.
“But when the public health emergency ends, it’s going to start looking like health care in the U.S does, which is that it’s complicated and it costs a lot of money.”
Surging RSV hits children’s hospitals across the US
Children’s hospitals across the country are dealing with a surge in cases of respiratory syncytial virus (RSV), stressing health care services and millions of parents with ailing children.
RSV is a common and generally mild illness, but millions of children are being exposed later in life because of the coronavirus pandemic. Babies walled off during the pandemic didn’t get RSV, and now children born just before or during the pandemic are getting it in droves.
What providers are seeing:
“We’re seeing older patients that are being admitted with RSV because they’ve just never seen it before. And your first illness is usually the worst and it’s leading to some more people being hospitalized,” said Jason Newland, a pediatric infectious diseases specialist at Washington University in St. Louis.
“The cases continue to rise and we have not seen a peak yet,” said Caroline Njau, senior vice president of patient care services and chief nursing officer at Children’s Minnesota. “And RSV itself makes up about two-thirds of the respiratory viral illnesses that we’re seeing.”
Systemic issues: The health care providers who spoke with The Hill agreed that this recent RSV surge has highlighted issues within the U.S. pediatric health care system, both old and new.
Newland said there are concerns that staffing at children’s hospitals may not be enough, which could lead to situation where some services like non-emergency surgeries are delayed, similar to what occurred during the hardest parts of the COVID-19 pandemic.
Another issue that providers are citing is the lack of capacity at children’s hospitals. Stephen Dolter, division chief of pediatric hospital medicine at Children’s Hospital & Medical Center in Nebraska, said his primary concern during this viral surge was running out of space.
“We’ll stretch however we can to get them into the hospital, whether that’s repurposing hospital space playrooms into treatment patient rooms, or repurposing our emergency department into an inpatient unit,” said Dolter.
PFIZER: NEW BOOSTER PROTECTS BETTER THAN ORIGINAL IN SENIORS
The companies said the data showed clinical trial participants over age 55 who received the bivalent booster targeting omicron BA.4/BA.5 had antibody levels nearly four times as high as those who received the original booster.
The results are based on blood samples taken from adults one month after they received single doses of either the updated booster shot or the first version of the vaccine.
Flashback: The shot was authorized without human data.
The number of participants in the study was small. Only 36 people received the new booster, and 40 received the old one.
Federal health officials are banking on the updated vaccine as a crucial part of the administration’s COVID-19 response. As the weather turns colder, officials are trying to convince people to get the updated vaccine to stave off a new wave of serious infections and death.
But two months after the administration first authorized the shots, uptake has been poor. According to federal data, fewer than 9 percent of Americans have received one. Officials blame pandemic fatigue and a lack of resources to fully promote the shots.
MANCHIN CALLS FOR DEAL ON SOCIAL SECURITY, MEDICARE, MEDICAID
Centrist Sen. Joe Manchin (D-W.Va.) on Thursday called for a broad bipartisan deal to protect the solvency of Social Security, Medicare and Medicaid, popular programs that face serious funding issues over the next few decades.
“You’re going to get your financial house in order. We cannot live with this crippling debt,” Manchin, whose pivotal vote both delayed and helped pass big pieces of President Biden’s agenda, told Fortune’s Alan Murray at a CEO conference.
“If we don’t look at the trust funds that are going bankrupt, whether they be Medicare, Medicaid, Social Security, highway, all the ones — there are tremendous problems right now,” Manchin said when asked where he sees areas of potential compromise in Washington after the Nov. 8 midterm elections.
If Manchin continues to push for a bipartisan deal to shore up the finances of Social Security and Medicare, he could have a negotiating partner in Senate Minority Leader Mitch McConnell (R-Ky.), who has proposed broad entitlement reform on several previous occasions.
Lawmakers push to end maternal health crisis
The Black Maternal Health Caucus has been leading legislation talks. The caucus was established in 2019 to fight the drastic racial disparities that exist for pregnant Black people. Despite proposing a 12-package act of protections for pregnant people, most of the caucus’s legislation hasn’t passed.
The Black Maternal Health Momnibus Act of 2021 called for recognizing and fighting against the social determinants of health, funding for community-based organizations, diversifying the perinatal workforce and other key provisions. But so far, only one part of the package has been signed into law by President Biden — the Protecting Moms Who Served Act.
That particular act commissions the first-ever comprehensive study on America’s maternal health crisis among women veterans while also supporting maternal care programs at Department of Veterans Affairs facilities.
Still, Rep. Lauren Underwood (D-Ill.), a lead sponsor of the “Momnibus” bill and founder and co-chair of the Black Maternal Health Caucus, said the caucus is happy with the progress they’ve made so far.
“We have incredible momentum,” Underwood told The Hill. “Eighty percent of the rest of the Momnibus was included in Build Back Better and we’ve been working with our Senate colleagues to find an avenue for a vehicle for the Momnibus to get enacted. And I feel very optimistic at this point in time.”
Recently, the Maternal Vaccination Act, which would provide funding for programs to increase maternal vaccination rates, was passed with bipartisan support in the House.
But with midterms just days away, legislative talks have been put on hold, though the caucus has been working with Sen. Cory Booker (D-N.J.), the Senate lead on the bill, to attach the rest of the package to another vehicle in the hopes of passing.
WHAT WE’RE READING
A ‘blank check’: Bill to boost antibiotic development blasted as a ‘flawed’ giveaway to pharma (Stat)
Treatment approved in Europe to prevent RSV in infants could be coming to the US soon (CNN)
For Republican candidates, talk about moms and babies is a thorny issue (Kaiser Health News)
STATE BY STATE
Rio Grande Valley abortion clinic bought by anti-abortion pregnancy center (Texas Tribune)
Florida could surpass record Affordable Care Act enrollment in 2023 (Tampa Bay Times)
Colorado, Idaho opt out of national survey that tracks teen mental health (KUNC)
🏎 Lighter click: The Hill’s Photos of the Week
That’s it for today, thanks for reading. Check out The Hill’s Health Care page for the latest news and coverage. See you next week.