South’s cancer care gap widens without Medicaid

Oct 30, 2024

Presented by CareQuest Institute for Oral Health

With Carmen Paun

Driving The Day

A breast cancer patient receives a chemotherapy drip

People with cancer in rural areas of some Southern states are losing access to chemotherapy treatment. | Chris Hondros/Getty Images

THE COMMON DENOMINATOR — People with cancer across the Deep South are finding it increasingly difficult to access chemotherapy thanks to treatment costs soaring and states rejecting Medicaid expansion, POLITICO’s Gregory Svirnovskiy reports.

In Alabama, Florida, Mississippi, Tennessee and Texas, nearly half of the rural hospitals that offered the service in 2014 had stopped by 2022.

When many uninsured patients can’t pay, hospitals often cut chemotherapy because it requires specialized staff, costly drugs and intensive case management.

The bigger picture: When hospitals drop cancer care, even people with insurance must travel longer distances for treatment. And when Medicaid isn’t expanded, more people die.

Research links Medicaid expansion to higher overall cancer survival rates in rural areas and positive outcomes in the treatment of young adults with breast cancer overall. It can often mean the disease is caught at an early stage when it’s more treatable.

Politics gets in the way: Republicans fear electoral blowback, Medicaid expansion advocates say.

“They very much link it to [former President Barack] Obama still,” said Tennessee state Rep. Sam Whitson, a Republican who has long pushed his colleagues to pursue expansion. “And in case you haven’t heard, they don’t like Obama.”

Without expansion, Medicaid programs in all but one of the five states — Tennessee — cover only parents with children at home who have incomes well below the poverty line . Tennessee covers parents earning up to a level just above the poverty line. With limited exceptions for pregnancy and disability, none cover adults without dependent children.

Overall, 30 percent of low-income, nonelderly adults in the states that hadn’t expanded their Medicaid programs didn’t have health insurance in 2022, compared with 15 percent in expansion states. And among citizens, the uninsurance rate for working-age adults is more than twice as high in nonexpansion states (14.6 percent) than in their expansion counterparts (7.2 percent). Obamacare’s private market, which provides generous subsidies to low-income people, doesn’t help because its subsidies are available only to those whose earnings are at or above the poverty line.

Chemo is particularly vulnerable, several experts told POLITICO, owing to the high cost of service.

“You need to maintain nursing credentials who can give chemotherapy,” said Dr. Neil Hayes, director of the University of Tennessee Health Science Center for Cancer Research. “You need to maintain pharmacists who are comfortable administering chemotherapy, maintaining inventories, just all those costs associated with doing business.”

WELCOME TO WEDNESDAY PULSE. The election is less than a week away and, of course, there are some D.C. area food and drink deals. My election night fuel? Peanut butter cups. Send your favorite snacks, tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

A message from CareQuest Institute for Oral Health:

Drug prices, mental health, abortion — all health care topics the presidential candidates are debating. But neither is focused on the topic that has support from both parties: extending dental care to millions in the US who lack insurance. A new national poll commissioned by CareQuest Institute and the Oral Health Progress and Equity Network (OPEN) shows voters want better dental coverage in Medicare. Learn more and take action to improve the oral health system.

A sicker is seen on a table during that says Don't Let Republicans turn Pennsylvania into Texas.

Democrats in Pennsylvania are banking on abortion rights as their main strategy to win suburban voters in the upcoming elections. | Angela Weiss/AFP via Getty Images

PA DEMS CLOSING ABORTION ARGUMENT — BUCKS COUNTY, Pennsylvania — Pennsylvania Democrats are making their final pitch to suburban voters to clinch power in the state legislature: Vote for them to protect reproductive rights, POLITICO’s Liz Crampton reports.

Why it matters: While Democrats are running on abortion throughout the country, Pennsylvania is the only state with a divided Legislature, underscoring its status as a coveted battleground.

Democrats are targeting suburban women outside Philadelphia and Pittsburgh as the linchpin of their coalition for holding the state House and gaining seats in the Senate. Their argument rests on being the backstop against Republican attempts to tighten Pennsylvania’s abortion laws, which allow the procedure up to 24 weeks of pregnancy.

But those relatively robust protections could undermine the issue’s urgency.

“In Pennsylvania, it’s not like Tennessee,” said Anna Thomas, a Democratic challenger in a competitive House district held by a Republican in the Lehigh Valley. “It’s not like that many people know someone who has had to leave the state to get medical care. Making sure they understand the risk is a huge part of what we have to do to get out the vote.”

Democrats are confident that — as in 2022, when they flipped the state House — the post-election autopsies will credit abortion as the reason they won on Election Day.

Republicans are largely ignoring abortion and centering their campaigns on fixing the economy and combating illegal immigration, potentially dampening the salience of abortion as the main reason people head to the polls.

GOP strategist Mark Harris said it’s inaccurate for Democrats to portray Republicans as wanting to send Pennsylvanians “back to the dark ages.”

“Democrats are absolutely mischaracterizing the vast majority of Republicans’ position on this issue,” he said, emphasizing that most support the state’s current law and have no interest in changing it.

What to watch: As the distance from Dobbs increases, there are questions about whether Democrats can summon the same political energy around protecting abortion access. They’ll also have to overcome a presidential election that has caused intense election fatigue among Pennsylvanians — underscoring the struggle for candidates to convince voters to care about this level of the ballot.

HARRIS’ FINAL PITCH — In her closing argument to voters Tuesday evening, Democratic presidential candidate Kamala Harris touted her Medicare home care plan and support for abortion rights in a sweeping address that highlighted several of her marquee health policies.

“If you need home care and you don’t have some money to hire someone, you and your family need to deplete your savings to qualify for help. That’s just not right,” Harris said on the National Mall.

“So we’re going to change the approach and allow Medicare to cover the cost of home care,” she added, pointing to a proposal she laid out earlier this month, which would help families afford the cost of caring for older adults at home instead of in a health care setting. She also leaned into a Biden administration proposal to expand insulin costs and out-of-pocket caps under Medicare to the commercial market.

“I will enact the first-ever federal ban on price gouging on groceries, cap the price of insulin and limit out-of-pocket prescription costs for all Americans,” Harris said.

She also reiterated her messaging on abortion rights, criticizing [former President Donald] “Trump abortion bans,” particularly those with no exceptions for rape or incest.

“[Trump] would ban abortion nationwide, restrict access to birth control and put [in vitro ferilization] treatments at risk and force states to monitor women’s pregnancies,” she said.

In Congress

CONCEPTS OF A REFORM — House Speaker Mike Johnson promised voters “massive” health care changes if former President Donald Trump wins the election, according to a video first obtained by NBC News.

Johnson quipped that Obamacare would need “massive reforms,” per NBC, but offered no further details at a Louisiana campaign event for a GOP House candidate.

His comments come after Trump has renewed calls to replace the Affordable Care Act with something he’s promised to improve while on the campaign trail. In the September presidential debate, Trump said he had “concepts of a plan” for what a replacement would entail and has yet to provide details.

Johnson’s office didn’t immediately respond to a request for comment.

A message from CareQuest Institute for Oral Health:

AROUND THE AGENCIES

NO COMPOUNDING FOR PRETERM DRUG — The FDA’s outside advisers have recommended that the agency forbid a preterm birth drug pulled from the market last year from being compounded, POLITICO’s Lauren Gardner reports.

If the FDA follows the advice, pharmacies and manufacturers would no longer be able to make bespoke formulations of the drug for pregnant patients.

Why it matters: The unanimous vote by the Pharmacy Compounding Advisory Committee backs up the FDA’s Office of New Drugs’ finding that hydroxyprogesterone caproate products intended for reducing preterm birth risks for certain pregnant people should be on the agency’s withdrawn or removed list.

The recommendation won’t affect the status of hydroxyprogesterone caproate drugs for other indications, such as managing abnormal periods.

Background: The FDA revoked its approval of Makena, the drug’s brand name, and three generics in April 2023.

The FDA initially granted Makena accelerated approval in 2011. But confirmatory trial results from 2019 showed the drug — intended for people carrying one fetus who have a history of going into early labor — wasn’t effective at either preventing delivery before 35 weeks of pregnancy or lowering the risk of adverse conditions in premature newborns.

Names in the News

Marnie Conway is now CEO of women’s wellness company Ajenda. She previously was an associate at Burch Creative Capital.

Jeff Leibach has joined Berkeley Research Group ’s Chicago office as managing director. He previously co-led Guidehouse’s (formerly Navigant) managed care practice.

WHAT WE'RE READING

The Wall Street Journal reports on the use of ultrasound waves to combat addiction.

Reuters reports that Pfizer’s CEO defended the company’s turnaround against pressure from activists critical of management.

Modern Healthcare reports on another round of layoffs at Walgreens amid challenges for the retail pharmacy.

A message from CareQuest Institute for Oral Health:

A national poll shows that adding dental benefits to Medicare is a top health issue for US voters, even over abortion and the ACA. More specifically:

· 9 out of 10 voters want a Medicare dental benefit.
· More than 4 out of 5 voters for Trump in 2016 and 2020 want a dental benefit added to Medicare.
· 99% of those who voted for the Democrat candidate in the last two elections want a dental benefit added to Medicare.

“Far too many people have discovered oral health care is too expensive and out of reach,” says Melissa Burroughs, CareQuest Institute director of public policy. “Yet this issue has been on the back burner when it comes to policy conversations and the political commitment to address it.”

It’s simple: the American people want dental care included in Medicare. It’s time to make this policy change a top priority — our health depends on it.