A roadblock to health care for undocumented immigrants

Presented by Kaiser Permanente

With Ben Leonard and David Lim

Driving the day

BLUE STATE LAWMAKERS VS. IMMIGRATION ADVOCATES — Democrats are putting a damper on health care for undocumented immigrants. While Democratic state lawmakers support the concept of offering coverage, some don’t want to fund it.

Erin asked POLITICO’s Megan Messerly about her reporting on the issue and what the nearly dozen Democratic state lawmakers and immigration advocates she spoke with had to say.

The interview has been edited for length and clarity.

Democratic lawmakers say they support health care for low-income immigrants, but some remain wary of committing the money. What’s going on?

It really depends on who you talk to. Democratic state lawmakers will say they support expanding Medicaid to cover at least some undocumented immigrants but point out their states don’t have unlimited dollars to spend. Most states have at least some sort of balanced budget requirement, meaning they can’t run up the federal deficit the way Congress can.

Talk to immigration advocates, though, and many of them are frustrated. They see these huge budget surpluses that states are deciding how to spend — and then they see lawmakers debating whether to spend an extra $5 million a year to cover all undocumented kids, or an extra $39 million a year to cover all undocumented adults — amounts that are, in the grander scheme of state budgets, fairly small.

What’s happening on the state level?

Some Connecticut state lawmakers, for example, told me they’re trying to be fiscally responsible with their bit-by-bit approach. They don’t want to dramatically expand the program and then see the state budget balloon — or inundate the state’s Medicaid program with a wave of applications they can’t handle. Other lawmakers, however, would like to see the state at least expand up to age 18 this year, if not to 26, as other states have done.

Some lawmakers say they’re worried about the so-called magnet effect. What are they talking about?

The magnet effect is the idea that people will leave one state and move to another to get more or better government benefits. For example, undocumented residents in, say, Iowa, might move to neighboring Illinois to get health coverage or a new immigrant might choose to settle in a state they know has better benefits.

Studies on the magnet effect of health care benefits, however, have shown that people move primarily for family, housing and jobs, not for health plans.

WELCOME TO WEDNESDAY PULSE, where we just learned that Australian scientists are going to try vaccinating koalas to protect them from chlamydia. Send tips, feedback and well wishes to [email protected] and [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with Daniel Payne about how the lifting of the U.S.’ Covid-19 public health emergency and its pandemic-era rules and waivers on Thursday might affect the costs of Covid tests, vaccines and treatment; Title 42; Medicare; telehealth; and more.

PHARMA WATCH

MERGER INVESTIGATION — The FTC is investigating a merger between pharmaceutical data giant IQVIA and an advertising platform called Propel Media, POLITICO’s Josh Sisco and Ruth Reader report.

What to know: IQVIA, known for its oodles of de-identified patient records, medical claims, drug sales, marketing campaign data and social media intel, is believed to have bought Propel for $700 million to $800 million. The company is a market leader in health data analytics. The FTC is concerned that IQVIA, with a targeted advertising platform, will monopolize digital advertising for pharmaceuticals, shutting down rivals and increasing costs for drugmakers.

Why it matters: Advertising for drugs is big business, amounting to at least $11.5 billion, based on data collected by advertising analytics company Standard Media Index.

What’s next: The FTC is wrapping up its investigation and leaning toward bringing a case to block the deal. IQVIA has come under FTC scrutiny before. The company was previously investigated by the agency’s lawyers for how it bundles various products and its unwillingness to allow competing software companies to access its data.

Covid

JHA: U.S. IS READY FOR END OF PHE — The U.S.’ ability to manage the Covid-19 pandemic continues to improve despite the pending end of the public health emergency, the White House’s top Covid official told reporters yesterday.

“People will have to do their own individual kind of risk assessment, but the bottom line is we’re at a point where things that people value [are] largely safe for most,” said Ashish Jha, the White House Covid-19 response coordinator.

And while the U.S. government still has stockpiles of Paxlovid and vaccines that it will continue to distribute after the PHE ends, “it’s critical that those tools that have been so central to our progress and to our response continue to be broadly available for Americans,” Jha said.

But the public health expert lamented that the PHE’s end will deleteriously affect the CDC’s ability to track infections.

What’s next? The White House Covid-19 team will wind down soon after the public health emergency ends. It’s unclear who will be tapped to lead the new Office of Pandemic Preparedness and Response.

Public Health

ABOUT FACE — Starting at age 40, women should get mammograms every other year, new draft guidance issued by the U.S. Preventive Services Task Force recommends.

That’s a change from previous guidance issued by the group, which in 2016 recommended that women start screening at age 50.

The 10-year change is controversial because of concerns that overscreening might lead to false positives, unnecessary treatments like biopsies, overtreatment of cancers that wouldn’t have progressed and anxiety over false alarms.

Another POV: “I am concerned that their full recommendations miss the mark,” Rep. Debbie Wasserman Schultz (D-Fla.) said in a press statement. Women should be tested more frequently than every other year, she added. Wasserman Schultz was diagnosed with breast cancer at age 41.

“This two-year period between screenings will allow many cancers to go undetected; these recommendations essentially write off many women,” she said, noting that breast cancer is the second leading cause of cancer deaths among U.S. women.

At the Agencies

MEDICARE OVERPAYMENT — Providers received $580 million in improper payments that didn’t comply with Medicare requirements, a new report from the Department of Health and Human Services’ Office of the Inspector General finds.

Of those improper payments, $348 million were for telehealth services.

Inspector General Christi Grimm pointed to the public health emergency’s role in the lapse. “CMS’s oversight was partially affected by the unprecedented challenges of the PHE because CMS’s focus was to ensure that Medicare enrollees had access to health care,” she wrote in the report.

REP SLAMS VA EHR PHARMACY SYSTEM — On Tuesday, lawmakers on the House Veterans’ Affairs Technology Modernization Subcommittee grilled officials from the VA and Oracle Cerner, the vendor deploying the new system, in a hearing on the troubled VA’s electronic health records modernization rollout, honing in on pharmacy issues, Ben reports.

Chair Matt Rosendale (R-Mont.) said the subcommittee sent questionnaires to medical centers using the EHR system, and what the lawmakers learned was “outrageous.”

“The pharmacists cannot trust the system, so they have to work in a constant state of hypervigilance,” Rosendale said.

The GAO testified at the hearing on its recent review that surveyed the system’s users, who said it had incorrect medication orders and increased the time it took to fill prescriptions, adding to safety risks.

Oracle vice president James Ellzy said a system change is always uncomfortable for pharmacists and takes time to learn. But he acknowledged that the pharmacy software isn’t “satisfactory” as of now.

The VA announced last month that it was indefinitely delaying the deployment of the EHR system to new sites. Agency officials said they’ll use the time to get the system up to speed.

Lobby Watch

FLY-IN — The Alliance for Regenerative Medicine, an advocacy organization, is in Washington today to meet with lawmakers during the group’s two-day Cell & Gene Congressional Fly-in. They’ll lobby policymakers to support cell and gene therapy, including asking them to cosponsor the Medicaid VBPs for Patients Act, which would expand Medicaid access to gene therapy, and to join the Congressional Personalized Medicine Caucus.

Names in the News

Sen. Dianne Feinstein (D-Calif.) is headed back to Washington following a serious illness that’s kept her out of the Senate since February … HHS Deputy Secretary Andrea Palm wrapped her official trip to Alaska, where she visited health facilities and heard from leaders and community members on behavioral health and nutrition issues … and Derick Elliott was named chief commercial officer at health tech company SpendMend.

What We're Reading

The New York Times reports on multibillion-dollar corporations, including large health insurers, gobbling up primary care practices.

NBC News reports on an American Psychological Association recommendation that teens be trained in media literacy.

The Associated Press reports on the case of a hospital denying an unmarried woman in China egg-freezing services, which could have reproductive health implications for other unmarried women.