A record number of Americans have health insurance, but churn is likely on the way

A record number of Americans are enrolled in marketplace coverage, but others could soon get kicked off Medicaid

President Biden has staked his health agenda on lowering the cost of care and building on the Affordable Care Act. 

He got some good news yesterday: A record-breaking 16.3 million Americans signed up for Obamacare plans during the health law’s 10th enrollment season — a figure that comes after the country’s uninsured rate dipped to its lowest level early last year. 

Separately, state health officials will soon be faced with the herculean task of determining who is no longer eligible for Medicaid after three years of being allowed to stay on the program amid the pandemic. And several experts — as well as groups involved in the effort — are worried the number of Americans without insurance could begin to rise. They fear some who lose Medicaid won’t know where to turn to get health insurance next, posing a new challenge for both federal and state health officials.

“What I’m worried about is that we may have hit the high-water mark on our nation’s coverage rates,” said Sabrina Corlette, a co-director at Georgetown University’s Center on Health Insurance Reforms.

Health and Human Services Secretary Xavier Becerra:

Last year’s sweeping government funding bill marked the beginning of the end for pandemic-era Medicaid rules, which have prevented states from kicking people off their coverage. The spending package gave states the greenlight to begin booting people no longer eligible for the safety net program off their coverage beginning in April. 

“We absolutely as an administration are committed to working with states and other entities to make sure that we get people redetermined in a way that either helps them retain coverage, whether it’s Medicaid, whether it’s marketplace, or whether it’s moving into employer-sponsored insurance,” Chiquita Brooks-LaSure, the head of the Centers for Medicare and Medicaid Services, said on a press call yesterday. 

She noted that top federal marketplace and Medicaid officials — such as Ellen Montz and Daniel Tsai — are having conversations together with states to discuss the issue.

There are varying estimates about what could happen over the course of the next year-plus. In an August report, the federal health department predicted that roughly 15 million people could lose their Medicaid or Children’s Health Insurance Program coverage when the continuous enrollment provisions came to an end. 

• Roughly 2.7 million are expected to qualify for financial aid on the ACA health exchanges, and of those, 1.7 million are likely to be eligible for marketplace plans without any premiums. 
• About 5 million are expected to obtain other coverage, particularly through employer-sponsored plans. 

In 2021, Democrats’ coronavirus relief package boosted tax credits for low-income shoppers and granted them to middle-income Americans for the first time. The party avoided a major headache when it passed a measure to extend the new subsidies through 2025 in last year’s Inflation Reduction Act. 

Biden officials have largely attributed the roughly 13 percent jump in Obamacare enrollment to the extra financial aid. And the Department of Health and Human Services believes the enhanced tax credits will provide “a key source of alternative coverage” for some who will no longer be eligible for Medicaid. 

But for such a fallback plan to work, Americans who can hop on the Obamacare exchanges will need to know about the option. 

“There’s a big concern that people won’t know that that’s the next place to go,” said Cynthia Cox, a vice president at the Kaiser Family Foundation. “There’s a role for states, there’s a role for insurers, there’s a role for the federal government to do more marketing and outreach.”

Sharing those concerns is Jodi Ray, the program director for Florida Covering Kids and Families, which operates a large navigator program that helps people sign up for coverage. She says her group has been preparing for this moment for over a year, and that increased funding from the Biden administration has helped keep her staffing at a high level year-round, instead of just during the ACA enrollment season. 

On the Medicaid front, states have been developing transition plans required by the federal government, said Kate McEvoy, the executive director of the National Association of Medicaid Directors. State Medicaid officials are prepping public education campaigns, partnering with navigator organizations and asking enrollees to update their contact information.  

• “States want to be as deliberate about this as they can,” she said, “so they’re looking to be careful about how fast this process moves, and just be really conscious of how to do that fairly.”

On tap today: Biden will deliver his first major economic speech of the year in Virginia, where he’s expected to blast the GOP over its economic agenda, including over some Republican lawmakers’ interest in changes to entitlement programs, like Social Security and Medicare, per a White House official.

Rodgers lays out House Energy and Commerce leadership

Rep. Brett Guthrie (R-Ky.) has been named chair of the House Energy and Commerce health subcommittee, the full panel’s chair, Rep. Cathy McMorris Rodgers (R-Wash.), announced yesterday.

The news isn’t exactly a surprise. Guthrie was the subcommittee’s top Republican in the last Congress as well as co-leader of the House GOP’s Healthy Future Task Force. As subcommittee chair, Guthrie said he plans to prioritize combating the overdose epidemic, making health care more affordable and increasing the development of and access to lifesaving treatments.

• “A new wave of oversight and accountability in health care is coming for the Biden administration to improve health care agencies and prevent future crises,” Guthrie said in a statement.

Rodgers also announced that she tapped Rep. Morgan Griffith (R-Va.) to helm the committee’s oversight and investigations subcommittee, of which he had previously been a ranking member. Rep. Kelly Armstrong (R-N.D.) will serve as vice chair of the full committee.

More from Rep. Cathy McMorris Rodgers (R-Wash.): 

FDA food safety official resigns, cites flaws in agency’s crisis response

The Food and Drug Administration’s top food safety official resigned yesterday, citing shortcomings in the agency’s ability to handle foodborne illnesses, including last year’s nationwide infant formula shortage, our colleagues Laura Reiley and Jacob Bogage report.

Frank Yiannas, the agency’s deputy commissioner for the office of food policy and response, will leave his post next month. The FDA is expected to announce more changes within its food safety division in the coming days.

The details: “The decentralized structure of the foods program that you and I both inherited significantly impaired FDA’s ability to operate as an integrated food team and protect the public,” Yiannas wrote in a resignation letter to FDA Commissioner Robert Califf, which was obtained by The Post. He recommended that Califf restructure the agency to include a “fully empowered and experienced” deputy commissioner for foods, with direct oversight of the centers and offices responsible for human and animal products.

His advice isn’t far off from recommendations of a recent independent review of the agency by the Reagan-Udall Foundation, which concluded that the FDA’s hobbled response to the infant formula shortage — of which Yiannas was at the center — was hampered by flaws in the leadership structure and poor communication.

CDC: Bivalent booster offers similar protection against latest variants

Data released yesterday by the Centers for Disease Control and Prevention suggests that the protection offered by Pfizer-BioNTech and Moderna’s updated coronavirus booster shots hold up against the new subvariants fueling infections across the country, The Post’s Fenit Nirappil and Lena H. Sun report.

According to the study, which looked at data from coronavirus tests conducted at pharmacies from Dec. 1 to Jan. 13, bivalent boosters cut the risk of symptomatic infection caused by the now dominant XBB.1.5 subvariant by about half for most adults, and by more than one-third for people 65 and older.

“Bottom line: We did not see reduced vaccine protection against symptomatic illness for XBB/XBB.1.5 compared with recent BA. 5-related variants, which is reassuring,” said Brendan Jackson, who heads CDC’s coronavirus response.

Why it matters: Earlier lab studies had raised concerns because the bivalent booster produced lower levels of virus-fighting antibodies against the XBB-related subvariants than the BA.5 omicron subvariant it was designed to target. But that does not seem to be the case in the real world, CDC officials and experts said.

Also … Additional data posted by the agency yesterday shows that the updated booster reduced the risk of death from covid-19 by more than twofold compared with people who had only received the monovalent vaccine. It cut the risk of death by nearly 13 times in those who are unvaccinated.

• Sen. Joe Manchin (D-W.Va.) said yesterday that House Speaker Kevin McCarthy (R-Calif.) privately agreed to leave cuts to Medicare and Social Security off the table in debt ceiling negotiations, Forbes reports.
• The Justice Department filed federal charges yesterday against a man accused of setting fire to an Illinois Planned Parenthood. The announcement comes a day after a federal grand jury indicted two Florida residents for allegedly spray-painting threatening messages on crisis pregnancy centers in the state.
• A North Carolina OB/GYN is suing the state over its restrictions on medication abortion, arguing that the FDA’s federal authority to regulate mifepristone preempts the state’s restrictions on the drug and that the law should be declared invalid.
• Tennessee rejected millions of dollars from the federal government for HIV/AIDS prevention, which critics say was triggered due to the inclusion of transgender and abortion rights groups as grant recipients, The Post’s Ariana Eunjung Cha and Fenit Nirappil report this morning.

Unmet Needs: Critics Cite Failures in Health Care for Vulnerable Foster Children (By Andy Miller and Rebecca Grapevine | Kaiser Health News)

California enacts new abortion laws, expecting copycats (By Alice Miranda Ollstein | Politico)

The drug was meant to save children’s lives. Instead, they’re dying (By Rosa Furneaux and Laura Margottini | Bureau of Investigative Journalism and Stat)

Thanks for reading! See y’all tomorrow.