House call for health professionals

Oct 23, 2024

Presented by

With Erin Schumaker

Driving the day

Donald Trump (left), poses with Mayra Flores at a campaign event.

Republican Mayra Flores (right), a respiratory care therapist, is running to unseat Rep. Vicente Gonzalez (D-Texas). | John Locher/AP

IN IT TO WIN IT — Health care professionals are emerging as likely victors in competitive House races.

The new crop of candidates comes as several health policy leaders and health professionals in Congress depart after this term. Those leaving include Reps. Larry Bucshon (R-Ind.), a cardiothoracic surgeon; Michael Burgess (R-Texas), an OB-GYN; and Brad Wenstrup (R-Ohio), a podiatrist.

The exodus has led to fears on and around Capitol Hill that significant expertise and institutional knowledge are departing as Congress faces major health policy issues, including the implementation of the Inflation Reduction Act, which allows Medicare to negotiate drug prices, and the impending expiration of some Obamacare subsidies.

Kelly Morrison, an OB-GYN and most recently a Democratic Minnesota state senator, is expected to win a Minneapolis suburban district. Maxine Dexter, recently a Democratic Oregon state representative and a pulmonologist at Kaiser Permanente, is likely to win a Portland-area seat.

Here are some other health care professionals with shots at winning House seats:

Sheri Biggs (R), South Carolina’s 3rd District: The psychiatric nurse practitioner is expected to win a heavily GOP and rural district bordering Georgia and North Carolina. Rep. Jeff Duncan (R-S.C.) isn’t seeking reelection. Biggs has said America is afflicted with “mental, fiscal and spiritual problems” that she hopes to treat while zeroing in on immigration, tackling wasteful spending and protecting “the sanctity of life.”

Mayra Flores (R), Texas’ 34th District: The respiratory care therapist won a special election to serve the McAllen-area district for part of a term before Rep. Vicente Gonzalez (D-Texas) beat her in November 2022 by more than 8 points. Flores has struck a more moderate tone, touting her support for the PACT Act, which expands benefits to veterans exposed to toxins, and focusing on controlling health care costs. The Cook Political Report rates the race as leaning Democratic.

Mike Kennedy (R), Utah’s 3rd District: The family medicine doctor and recent member of the Utah Senate is running for the seat after Rep. John Curtis (R-Utah) opted not to seek reelection. Kennedy has chaired the Utah Senate’s health committee and is pushing to expand access to telehealth and strengthen cost transparency and health savings accounts. He’s expected to win the seat, which Curtis won by about 35 points last cycle.

Bob Onder (R), Missouri’s 3rd District: The allergy and asthma doctor is expected to win the deep-red seat Rep. Blaine Luetkemeyer (R-Mo.) is vacating. After leaving the Missouri Senate, Onder — who opposes abortion rights — helped pass legislation barring hormonal and surgical gender-affirming care for children.

Amish Shah (D), Arizona’s 1st District: The emergency doctor is running to unseat Rep. David Schweikert (R-Ariz.), who chairs the Ways and Means Oversight Subcommittee and has been a prominent proponent of telehealth and artificial intelligence. Shah has leaned into drug pricing and reproductive rights in his campaign. The Cook Political Report rates the race as a GOP-leaning toss-up.

Prasanth Reddy (R), Kansas’ 3rd District: The internist is trying to beat Rep. Sharice Davids (D-Kan.) in a Kansas City-area district. Davids beat a different GOP challenger by 12 points in 2022. Reddy has sought to find “common ground” on abortion but has largely focused on other non-health care issues, including securing the border. The Cook Political Report rates the race as likely Democratic.

WELCOME TO WEDNESDAY PULSE. We want to hear about any under-the-radar health care campaign stories. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

A message from PhRMA:

Drug price “negotiations?” Higher costs and less access to medicines are not what seniors were promised when the Inflation Reduction Act (IRA) was signed into law. Learn more about the IRA’s unintended consequences.

In the Courts

The Supreme Court is seen at sundown.

The Supreme Court is taking on a number of cases with health care implications this term. | J. Scott Applewhite/AP

SCOTUS CASES TO WATCH — The Supreme Court is rolling out its docket for the next term, and it’s expected to weigh several issues related to health care.

Here are some of the cases the justices will take on this term:

Gender-affirming care: The high court has scheduled oral arguments in U.S. v. Skrmetti for December. The Justice Department is challenging a Tennessee law that prohibits gender-affirming care for patients under 18. The Biden administration argues the law violates the Constitution’s Equal Protection Clause, which requires government policy to treat people the same. Tennessee has argued that it is not violating the clause, and that it’s shielding teenagers from unproven medical procedures.

E-cigarettes: Justices will hear oral arguments in early December on the FDA’s e-cigarette regulations in what could be a test case after the court overturned the Chevron doctrine granting agencies latitude in regulating. FDA v. Wages and White Lion Investments concerns whether a lower court erred in ruling the FDA's denial of applications to market new e-cigarettes was arbitrary.

Benefit rights: The high court has not set a date for oral arguments in Stanley v. City of Sanford, Florida, but has agreed to take up the case, which could have ramifications for employer health care benefits.

It involves a firefighter who was diagnosed with Parkinson’s disease and later had to take disability retirement. When she began the job, the city offered free health insurance until age 65 for those retiring due to disability but later changed it to 24 months post-retirement. At question now is whether a former employee can sue for discrimination under the Americans with Disabilities Act.

Medicare payment: The court is set to hear arguments in Advocate Christ Medical Center v. Becerra early next month. Hospitals are challenging HHS' payments to hospitals that serve a high share of low-income patients.

HEALTH INSURANCE

MEDICAID SPENDING GROWTH UPDATE — Growth in state Medicaid spending spiked in fiscal 2024 but the growth rate is set to fall significantly in fiscal 2025, according to a new analysis from health research group KFF that surveyed Medicaid directors in 49 states and D.C and used CMS data.

State spending on the health insurance program for low-income people grew nearly 20 percent between fiscal 2023 and 2024, according to KFF. That’s the result of the end of enhanced federal funding that was provided to incentivize states to keep people on their rolls during the pandemic whether they met rules or not.

A chart showing that state Medicaid spending growth has been on the rise in the past decade, especially in the last few years.

Growth in state spending is now expected to fall to 7 percent between fiscal 2024 and 2025, according to KFF. Medicaid spending overall is slated to rise about 4 percent during that period.

Florida was the lone state that opted not to participate in the survey.

Shortfall concerns: In other surveys in recent years, most states didn’t expect revenue shortfalls. But now, amid turbulence in the program, more than half of states said a Medicaid budget shortfall is “50-50”, “likely”, or “almost certain.”

“A number of state officials commented on how challenging budgeting was at this time due to the downward expenditure pressure of declining enrollment coupled with the upward pressure of increasing per enrollee costs during unwinding,” KFF wrote, referencing the post-pandemic disenrollment of ineligible people from the program.

AROUND THE AGENCIES

NEW LIFE FOR PSYCHEDELICS? Dr. Shereef Elnahal, the undersecretary for health at the Department of Veterans Affairs, said Tuesday the agency is open to helping Lykos Therapeutics pay for another Phase III trial to evaluate the company’s psychedelic therapy treatment for post-traumatic stress disorder.

"That is definitely a possibility," Elnahal said during a roundtable with reporters.

Why it matters: The FDA in August rejected Lykos’ application to use MDMA, a mind-altering drug often known as ecstasy, combined with talk therapy, to treat PTSD. FDA advisers overwhelmingly agreed that the company’s studies hadn’t proved the treatment was effective or that its benefits outweighed its risks.

Lykos subsequently laid off 75 percent of its staff and its top leaders left. The FDA told the company it would need to do an additional Phase III clinical trial to have its application reconsidered. Whether Lykos will be able to fund another expensive late-stage study isn't clear.

The backstory: In January, the VA announced it would fund research into psychedelic treatments for PTSD and depression for the first time since the 1960s. The VA is the largest health system in the country, serving a population with disproportionately high rates of PTSD.

What's next? Elnahal's chance to discuss research and funding partnerships may come soon. On Thursday, alongside Rep. Jack Bergman (R-Mich.) and former Rep. Tim Ryan (R-Ohio), Elnahal is participating in a panel on psychedelics and the role the federal government and the VA will play.

A message from PhRMA:

Mental Health

‘GHOST NETWORK’ CLASS ACTION — Law firms Pollock Cohen LLP and Walden Macht Haran & Williams filed a class action suit Tuesday against Anthem Blue Cross Blue Shield of New York claiming the insurer published an inaccurate directory of providers accepting BCBS coverage, focusing on mental health care.

It’s part of a broader trend in which plaintiffs claim insurers mislead customers. In this case, attorneys for the plaintiffs did a "secret shopper" study and found only seven of 100 doctors accepted BCBS insurance and were taking new patients. Anthem Blue Cross Blue Shield of New York declined to comment on the lawsuit.

Lawmakers on both sides of the aisle are critical of so-called “ghost networks” and have pushed to bolster directory accuracy.

Insurers have said that given the number of providers in networks and frequent changes, directories can become dated quickly, and providers don't consistently communicate with plans. Insurer lobby AHIP has called keeping directories accurate a "shared responsibility” between plans and providers.

Many mental health providers also opt not to take insurance.

Names in the News

Dr. Michelle Tarver is set to serve as the permanent director of the FDA’s Center for Devices and Radiological Health. She was previously acting director.

WHAT WE'RE READING

Healthcare Dive reports on Blue Shield of California working with Salesforce to automate prior authorization.

STAT reports on lawmakers pressing Pfizer and Eli Lilly on their relationship with telehealth prescribers.

A message from PhRMA:

Seniors are feeling the true cost of drug price “negotiations.”

Instead of saving money, some Medicare patients will pay more for medicines.

Others may not be able to get their medicines – 89% of insurers and PBMs say they plan to reduce access to medicines in Medicare Part D because of the Inflation Reduction Act.

Higher costs and less access. That’s not what seniors were promised.

Learn more.