The Out of Pocket — Health Policy Student Association

Reports on relevant local, state, and federal health policy topics

Produced by the HPSA Education Committee: Abigail Lindsay, Graceanne Horton, Olivia Rockwell, Ellie Jorling, Nia Allen, Ronnie Sharangpani, and Iulia Dobrin

What the Midterm Elections Mean for Health Policy

by Iulia Dobrin

This midterm election, the primary health policy issue at stake was abortion protections. Five states had abortion-related proposals on the ballot: Michigan, California, Kentucky, Vermont, and Montana. In each of these states, constituents voted to protect access to the procedure or stop further limitations on it. California, Michigan, and Vermont voted to add the right to reproductive freedom to their state constitution, which includes the right to an abortion and to contraceptives. Kentucky voters rejected a proposal that would have amended the state constitution to include that “nothing in the state constitution creates a right to abortion or requires government funding for abortion”. Montana voters rejected a proposal that would have required medical interventions to save infants the state deemed to be “born alive”. This measure brought concern that it would limit palliative care for infants that were born alive but had no chance of survival. The outcomes of the votes follow in the steps of Kansas’s August vote that rejected a constitutional amendment to eliminate abortion protections at the state level.

Beyond reproductive rights, voters also decided on marijuana legalization, Medicaid expansion, medical debt, dialysis regulations, tobacco regulation, and dental insurance. Recreational marijuana was legalized in Maryland and Missouri but rejected in North Dakota, South Dakota, and Arkansas. South Dakota did, however, approve an initiative to expand Medicaid eligibility to about 42,000 low-income residents. In Arizona, voters overwhelmingly chose to cap the interest rate on medical debt. For the third time in a row, California rejected tighter restrictions on dialysis clinics that provide care to patients with kidney failure. California also upheld a law banning the sale of most flavored tobacco products. Massachusetts voted to establish a loss ratio for dental insurers, requiring insurers to spend at least 83% of premium dollars on patient care. In addition, Oregon voted on Measure 111 which would amend the state constitution to add “the right to affordable health care” as a fundamental right. As of today, the measure looks likely to pass with over 95 percent of the votes counted.

Given that the Democrats have control of the Senate and the Republicans are on the cusp of controlling the House, there is a high likelihood of political gridlock during the next two years. This may cause federal health policies to be slow or impossible to push through Congress. Consequently, the focus in coming years may shift to state and local health policies to determine how this election’s results affect health policy.

Sources: AP, ADA, NYTimes, Washington Post, Ballotpedia

Biden Administration Launches National Strategy on Hunger, Nutrition, and Health

by Ronnie Sharangpani

This September, the Biden Administration’s Domestic Policy Council (DPC) assembled the first White House Conference on Hunger, Nutrition, and Health in over 50 years. The last conference, hosted by the Nixon Administration in 1969, created programs that many Americans rely on today, such as the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program, and the Supplemental Feeding Program for Women, Infants, and Children (WIC).

The recommendations call for collective action among all levels of government, academia, and the private sector to accomplish its goals. The overarching goal of the recommendation is to end hunger and increase healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases, while also reducing related health disparities.

The government’s goal was pursuant of 5 pillars:

Improving food access and affordability.
Integrating nutrition and health.
Empowering all consumers to make and have access to healthy choices.
Supporting physical activity for all.
Enhancing nutrition and food security research.

Common themes among these recommendations include expanding eligibility of existing government aid, increasing funding for research and nutrition education, incentivizing the purchase of healthier options, diversifying the nutrition workforce, and investing in economically vulnerable communities.

Necessary steps still remain to ensure that these recommendations have a comparable impact as those made over 50 years ago. Prioritization, a process required to decide the relative importance or urgency of this strategy, is a critical first step to estimating the impact of each recommendation, considering the costs, and approximating the time for implementation. Considering the many groups responsible for executing the recommendations, the DPC must determine who is responsible for what, how they intend to implement, and how to support them. As the plan is being implemented, the DPC must accurately track and periodically publish its progress. A major challenge is indicating how the private sector will be held accountable, a step that was not necessary for the 1969 plan.

While there is no shortage of excitement surrounding this ambitious public health policy, there are also substantial challenges to ensuring the goals are met. The Biden administration made a component of the strategy to increase government coordination in order to improve population outcomes long after a new administration takes office.

Sources: HealthAffairs, Whitehouse.gov

Recent Study Finds Racial & Ethnic Disparities in Prescription Addiction Treatment

by Ellie Jorling

A study published in JAMA Psychiatry on November 9th found that Black and Hispanic opioid patients are more likely to discontinue buprenorphine treatment earlier than white patients. This divide reflects the “structural barriers — such as inconsistent employment or medical care — some groups face even after they begin working toward recovery,” according to the New York Times.

Drugs such as buprenorphine, which is more commonly known as Suboxone, contain opiates, and although it is a particularly effective treatment for opiate abuse disorders, it is also contentious. Some believe that prescribing Suboxone supports drug use, though this has not been scientifically proven. Conversely, a 2017 study found that buprenorphine usage decreases mortality rates by half for individuals in addiction recovery.

Still, buprenorphine is used disproportionately by white individuals, primarily due to the fact that opioid treatment messaging has targeted working-class white people for the past fifteen years. According to Dr. Ayana Jordan of NYU’s Grossman School of Medicine, minority patients “had no idea they were part of the opioid crisis, nor did they realize buprenorphine was a treatment for them.” When patients do not receive Suboxone treatment for their addiction, their chances of recovery decrease significantly, and their outcomes tend to be far worse. More than an issue of individual recovery, this is an issue of health equity that raises questions about who gets access to the best treatments and who gets left out.

Sources: NYT, JAMA, SAMHSA, BMJ

One-Liners

Health insurance premiums through employer-based healthcare coverage are expected to rise, but employers may not pass the full cost on to workers for fear of losing them. (NYT)
Updated COVID-19 boosters that protect against the original strain and the Omicron variant are authorized and available for those who received their primary vaccination series. (CommonwealthFund)
South Dakota residents voted to expand Medicaid last week, but the rollout may be incredibly slow. (KHN)

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