Debt deal retains new VA health benefits

May 31, 2023

WASHINGTON WATCH

Comedian and activist Jon Stewart speaks to the media.

Comedian Jon Stewart lobbied for the new veterans' benefits last year. | Francis Chung/POLITICO

The Department of Veterans Affairs and its health care programs were winners in the debt ceiling deal between President Joe Biden and House Speaker Kevin McCarthy, presuming Congress is able to pass it.

Other non-defense agencies are looking at nearly flat budgets in 2024, but VA health care programs will get the increase Biden proposed in March, to a total of $121.1 billion.

That includes $20.3 billion to cover benefits and other costs of a 2022 law tasking the VA with compensating veterans sickened by exposure to toxic chemicals during their service.

The 2022 law authorized $280 billion to cover 10 years of costs.

The department is now implementing it. Nearly 600,000 veterans have submitted claims and the government has paid $1.1 billion in benefits.

The debt deal ensures the money keeps flowing.

“It’s a good show of faith,” VA Press Secretary Terrence Hayes told Ben. “This was a promise that Congress made to veterans.”

“We’re in a full court press to encourage them to enroll,” Hayes said.

The VA is staffing up to handle the influx of claims, Hayes said. It’s hired more than 3,100 new employees to aid in processing and plans to hire more.

The overall workforce for the Veterans Benefits Administration has grown 15 percent since fiscal year 2022, Under Secretary for Benefits Joshua Jacobs said in recent congressional testimony.

Still, the agency expects its claims backlog to increase in the summer, he said. The agency has projected the backlog of claims to rise beyond 400,000 between 2023 and 2024, and for it to become more stable in 2025.

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POLICY PUZZLE

Packets of buprenorphine.

With buprenorphine, policymakers are struggling to figure out how much prescriber training is needed. | Elise Amendola/AP Photo

When Congress in December lifted a requirement that doctors receive specialized training and register to prescribe buprenorphine for opioid use disorder, the aim was to increase the number of patients using the effective treatment.

But a new study in JAMA Health Forum by researchers from RAND Corporation and Johns Hopkins, among other institutions found that prescribers who received additional training beyond what was required under the so-called X-waiver rules Congress rescinded were more willing to write scripts for buprenorphine.

“We found it a little counterintuitive,” Bradley Stein, lead author and director of the RAND-USC Schaeffer Opioid Policy Tools and Information Center, told Ben. “The general narrative has been that ‘we’ve got to get rid of the X-waiver because this training is a barrier.’”

How’s that? Stein and his colleagues found that additional education made doctors more comfortable prescribing the drug, given that buprenorphine is itself an opioid and is used to treat a highly stigmatized condition.

What’s next? The law that ended the X-waiver included a provision mandating new training for prescribing controlled substances like buprenorphine, but it’s unclear what that will entail.

"There may be an opportunity here if they do that well," Stein said. "There's a lot of misunderstanding about buprenorphine and how it works."

Still unsolved: A number of other barriers remain for prescribing the drug, including Drug Enforcement Administration regulation.

Doctors told POLITICO they've struggled to fill prescriptions as pharmacies and distributors try to avoid running afoul of a DEA system tracking suspicious orders.

The DEA has said it’s working to address distribution bottlenecks.

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CHECKUP

Identifying people at risk of postpartum depression could help accelerate treatment.

Identifying people at risk of postpartum depression could help accelerate treatment. | AP Photo/Jae C. Hong

Depression associated with hormonal birth control may indicate an increased risk of postpartum depression.

That was the finding of a study by researchers at the University of Copenhagen, who analyzed Danish health registry data from more than 188,600 first-time mothers between 1995 and 2017.

The researchers suggest it could help identify people at risk and improve treatment.

At a glance:

— Postpartum depression mirrors regular depression, according to the Centers for Disease Control and Prevention, but may include additional symptoms, such as doubting your ability to care for your baby.

— Compared to the so-called baby blues, postpartum depression is more intense and lasts longer than the tiredness, sadness or worry many people experience after giving birth, the CDC says.

— Thirteen percent of women reported having symptoms of depression after childbirth, according to the 2018 CDC data.

— Untreated postpartum depression is associated with health problems for the mother and poorer mother-infant bonding, the CDC says.

— The pandemic might have intensified the problem. A third of women in a University of Michigan study conducted during the first year of the pandemic reported postpartum depression symptoms.

In the study, a depressive episode linked to birth control was defined as a patient being prescribed antidepressants or receiving a depression diagnosis within six months of starting hormonal contraception.

Since the researchers could only identify severe depression, there could potentially be implications for women who have less severe symptoms that don’t reach the level of a formal diagnosis or that they don’t seek treatment for.

Takeaways: “It’s important to know that there’s a subgroup of people who are particularly susceptible to hormonal transitions and the mood changes related to it," Lucy Hutner, a reproductive psychiatrist in New York not associated with the study, told Erin.

Ultimately, the goal of identifying at-risk patients is to treat them faster.

“If we catch these positive cases, it’s not like they’re just going to sit there and have severe depression, and there’s nothing that we can do about it,” Hutner said, adding, “This is a treatable condition.”

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