Is nationwide Medicaid expansion inevitable? Presented by

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Quick Fix

— Just 13 states have yet to move forward on Medicaid expansion after Kansas leaders announced a deal to do so.

— A ban on menthol tobacco is gaining steam in Congress despite longstanding concern about the unintended consequences on African Americans.

— A three-judge panel seemed wary of lifting a freeze on President Donald Trump's insurance mandate for legal immigrants, although the lone Trump-appointed judge on the panel questioned the need for a broad freeze.

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

THANK GOODNESS IT's FRIDAY PULSE — Where another football weekend brings mixed emotions for your author. On the one hand, the NFL's physical toll is relentless, as detailed by this Slate piece on retired great Rob Gronkowski's chronic pain. On the other hand, Lamar Jackson is just so exciting. And after years of extensive reporting on health risks, don't all players know what they're getting into?

PULSE will ponder the ethical conundrum while watching the Ravens game. Pass moral judgments and other tips to [email protected].

Driving the Day

THE MARCH TOWARD MEDICAID EXPANSION CONTINUES — Kansas leaders on Thursday announced a deal to expand the safety-net health program, after years of near-misses. Gov. Laura Kelly, a Democrat elected in 2018, had vowed to find a compromise to cover the estimated 150,000 state residents in the coverage gap.

The deal still needs to navigate the state legislature, but it has the support of top Republicans. “My top priority is to lower the cost of healthcare for Kansans across the board. We want to give as many Kansans health care coverage as we can, in the Medicaid market and the non-Medicaid market,” said Jim Denning, the GOP state Senate majority leader — and a longtime critic of Medicaid expansion.

See the bill summary | Read POLITICO Pro's coverage

— Kansas would be the 37th state to expand Medicaid. Another way to put that: As Obamacare's 10-year anniversary approaches in March, nearly three-quarters of states have now said yes to its Medicaid expansion. (The expansion was originally mandatory before the Supreme Court in 2012 ruled that states could choose to opt in.)

— PULSE's question: Is there any reason to believe that expansion isn't inevitable, nationally? Opposition has long been ideological, above all else: Of the 13 states besides Kansas that haven't expanded Medicaid, 11 are led by Republicans, and the other two have GOP-led legislatures that have stymied expansion efforts. There's also a financial argument: Conservative critics of expansion have recently argued that the initiative has worsened the Medicaid program and led to cost overruns.

But if Medicaid expansion can move forward in Kansas, which has been among the nation's more conservative states in recent years, it can presumably succeed in other GOP strongholds. Leaders in Mississippi have quietly explored expansion; voters in Oklahoma are moving to get the issue on this year's ballot.

— Medicaid advocates argue that expansion means more funding and fewer preventable deaths. Lauren Beatty, a spokesperson for the Alliance for a Healthy Kansas, told PULSE that the state has forfeited an estimated $3.7 billion in federal funds — at least — by failing to opt into Obamacare's expansion. "A number that grows by $1.8 million each day," Beatty added.

The alliance also estimates that 288 lives were lost between 2014 and 2017 because of failure to expand Medicaid in the state, Beatty said, citing recent analysis from the Center on Budget and Policy Priorities.

MENTHOL BAN GAINS STEAM AMONG BLACK LAWMAKERS — House leaders say they are likely to bring up the ban later this year as part of a push for further tobacco regulation, POLITICO's Sarah Owermohle reports, and they've got some African American lawmakers on board.

“The tobacco industry targets the African American population with menthol. Menthol should be banned,” Congressional Black Caucus Chairwoman Karen Bass (D-Calif.) said Wednesday.

— For years, the industry has warned of unintended consequences of a menthol ban. Opponents had long argued that a ban on menthol cigarettes would single out black smokers and lead to over-policing of black communities, where menthol constitutes a disproportionate share of the tobacco market.

But the over-policing argument is industry rhetoric, said Valerie Yerger, a health policy expert at UCSF and a founding member of the African American Tobacco Control Leadership Council. “They are using something very intimately tied to the emotional experience as black folks,” she said. “And that is the only argument they have.”

In the Courts

TRUMP's INSURANCE MANDATE ON IMMIGRANTS MAY STAY FROZEN, FOR NOW — An appeals court panel on Thursday appeared skeptical of the Trump administration's claim that halting the president's insurance mandate on legal immigrants has caused irreparable harm to the United States, POLITICO's Susannah Luthi reports.

A federal judge in Oregon blocked the mandate from taking effect nationwide in November, saying that the president's proclamation — requiring legal immigrants to obtain health insurance or prove they could cover their health costs — could affect about 60 percent of all immigrant visa applicants. The Trump administration wants the 9th Circuit to lift the freeze while a legal fight on the underlying policy continues.

— One of the judges on the 9th Circuit panel, Marsha Berzon, a Bill Clinton appointee, criticized DOJ claims that uninsured immigrants load uncompensated care costs onto the U.S. health system, saying the amount of charity care immigrants consume is "something miniscule."

But the panel's Trump-appointed judge, Daniel Bress, questioned if a broad freeze on the policy was appropriate, because immigrants and their families who are challenging the mandate have yet to secure class action status, which would help justify a nationwide injunction, Susannah writes.

Public Health

RECORD NUMBER OF ORGAN DONATIONS LAST YEAR — The Association of Organ Procurement Organizations on Thursday trumpeted new data that showed 11,870 deceased organ donors provided organs for transplant in 2019, a nearly 11 percent increase from 2018. It's the ninth straight year the number of organ donors went up.

"Organ procurement organizations are proud to help facilitate these gifts and to see that efforts to improve and increase donation are paying off in more lives saved," said Kelly Ranum, the association's president and CEO of Louisiana Organ Procurement Agency.

— Organ procurement organizations have been under fire from critics who say that the groups have failed to recover thousands of viable organs even as more than 110,000 people are on the organ-transplant waiting list.

HHS in December proposed new rules overhauling organ donation.

A message from PhRMA: America’s biopharmaceutical companies are making great progress against a common enemy – COVID-19. They’re learning from successful vaccines for other diseases, developing new treatments and collaborating like never before. Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. America’s biopharmaceutical companies are working day and night until they defeat COVID-19. Because science is how we get back to normal.

Names in the News

JENNIFER RODRIGUEZ, former FDA spokesperson, starts at Walmart. Rodriguez, who spent seven years at FDA and became the agency's chief spokesperson and assistant commissioner for the office of media affairs, is now leading communications for Walmart's global responsibility work, which includes issues like workforce and disaster relief.

ALSTON & BIRD names two new health care partners. Brendan Carroll counsels on pharma, biotech, medical devices and other FDA-related issues. Elise Paeffgen counsels on the intersection of FDA, DEA and EPA regulations.

ALLIANCE FOR HEALTH POLICY names new board members. Adaeze Enekwechi, president of IMPAQ, and Ronald Williams, chairman and CEO of RW2 Enterprises, were elected to serve as members on the organization’s Board of Directors.



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