WHEN YOU SAVE A LIFE — Hospitals in states with abortion bans are caught between state laws that threaten their doctors with criminal prosecution if they perform an abortion, and federal laws that require them to offer the procedure to stabilize a patient in crisis, Alice Miranda Ollstein and Megan report Messerly of POLITICO.
The conflict is a key part of an upcoming Supreme Court case that focuses on the clash between federal protections for patients in medical emergencies, called the Emergency Medical Treatment and Labor Act, or EMTALA, and Idaho’s near-total abortion ban.
Lower courts, attorneys general, lawmakers and medical boards are also grappling with how to give doctors and hospitals the space to save the lives of pregnant patients while complying with state laws, many of which contain vague and unscientific terms like ‘severe’, ‘large-scale’. ‘ or ‘substantial’.
State officials are trying to ease doctors’ concerns with guidance on what counts as a life-threatening medical emergency. But doctors say such information — and even a Supreme Court ruling against Idaho — won’t completely solve the problem as long as the bans remain in place.
“If you make standard medical care a crime when people are in all kinds of difficult medical situations, especially emergency situations, we’re always going to see some form of delay,” Dr. Caitlin Gustafson, a gynecologist in Idaho, told reporters during a recent phone call. “Because it is criminalized care, doctors will obviously hesitate.”
Anti-abortion groups, meanwhile, accuse doctors of deliberately misinterpreting laws and say giving more discretion over emergency abortions would open the door to more procedures that aren’t medically necessary. As medical groups push state lawmakers to broaden their abortion exemptions, conservative activists are calling on them to leave the bans intact.
“The problem is not the law, but its implementation,” said Rebecca Weaver, legislative director of Texas Right to Life.
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PRIVACY RULE FOR ABORTION FINISHED — The Biden administration on Monday finalized rules to strengthen protections for personal health records related to abortion.
The final rules prevent providers and insurers from disclosing information to state officials investigating or prosecuting someone who requests or offers a legal abortion under the federal privacy law HIPAA.
In some cases, a presumption of legality is also applied, meaning that if law enforcement authorities ask health care providers in one state to turn over information about a patient who may have traveled out of state to receive health care, the care provided to the patient in a other state received was likely lawful – which protects patient health information under the rules.
The final regulations come as President Joe Biden is set to reaffirm his support for access to reproductive health care during a campaign speech in Florida today. His campaign told reporters on Monday that Biden is expected to blame former President Donald Trump for the appointment of Supreme Court justices that sparked the election’s end. Roe v. Wade.
BECERRA’S GOVERNOR PLANS IN MOTION – Although HHS Secretary Xavier Becerra has been publicly quiet about his future plans, they are further along than previously known regarding his intention to run for governor of California, POLITICO’s Christopher Cadelago and Daniel Lippman report.
POLITICO reported earlier this month that Becerra is exploring the idea of leaving the Biden administration after the November election and running for governor in his home state.
Now it appears those plans are in progress. Two people briefed on the discussions tell POLITICO that Becerra or emissaries have approached political firms about mounting a gubernatorial campaign to succeed Gavin Newsom in 2026.
Becerra also spent more than $130,000 last year on “campaign consultants,” activities not previously reported in the media. The political outreach and payments occurred while Becerra continued to say he was focused on his Cabinet job in Washington.
Becerra sidestepped questions about plans for governor in his home state when initially contacted by POLITICO. But he did acknowledge the strict legal parameters he must meet in his current position.
“I am the secretary of HHS, and by law I am supposed to be the secretary of HHS and nothing else,” he said recently at an event in San Francisco. “So I’m going to do my job the best I can.”
Becerra’s state commission, funded with the balance of more than $1.5 million from his time as attorney general, clearly outlined the consulting fees and selected the code “CNS.” Other expenses were listed as ‘PRO’, for professional services (such as legal and accounting matters) or office administrative matters.
A campaign attorney for Becerra’s state committee characterized the $10,000 a month in payments as intended for account monitoring — and not traditional consulting work for candidates.
A senior Biden administration official said they were not aware of Becerra’s efforts to reach campaigners and political spenders. Asked about the legal implications of his moves, the official added: “Good question.”
A White House spokesperson did not answer questions about Becerra.
CATCHMENT AREAS NEED TO SUPPLEMENT STAFF — CMS has finalized a new staffing requirement for nursing homes despite widespread opposition from the industry, according to the report by POLITICO’s Robert King and Daniel Payne.
The rule, released Monday, will result in nearly 8 in 10 homes being forced to hire additional staff, according to a senior Biden administration official who is not authorized to speak publicly.
However, CMS is giving nursing homes some leeway to meet the requirements, including having an on-site nurse available 24/7. A house in the countryside has three years to meet the requirements, and a house in the city five years.
Facilities that do not comply may face escalating penalties.
Some changes have been made to last year’s original proposal. A nursing home can now apply for an exemption from the 24/7 obligation if it proves difficult to hire additional staff.
The waiver would provide an eight-hour reprieve from the requirement, but other personnel, such as a physician assistant, would still be required to be present.
“We believe that our final rule is a response to all these comments from different voices,” said another official, granted anonymity because they were not authorized to be quoted by name.
CMS followed this rule to improve care in nursing homes, which were hit hard during the Covid-19 pandemic.
The rule was widely opposed by the nursing home industry.
“Our residents and our families will have to go further to access care,” said Nate Schema, president and CEO of the Good Samaritan Society, which operates nursing homes.
But patient advocates, health care worker unions and government officials said the rule would help improve care for older Americans.
“The provisions that make up the nursing home staffing rule mark a long-overdue change,” Mary Kay Henry, president of the SEIU International union, said in a statement.
MEDICAID RULES FINISHED – In line with Monday’s results, the Biden administration finalized two rules to strengthen Medicaid.
One rule, which applies to Medicaid managed care plans and the Children’s Health Insurance Program, sets maximum appointment wait times for patients, which will be monitored through surveys. In addition, states’ websites, where quality ratings of managed care plans are publicly posted, should include information to help people compare plans.
The second rule, which applies to Medicaid reimbursement for services, sets minimum thresholds for payments to direct care providers: States must ensure that at least 80 percent of Medicaid payments for direct care providers such as home health aides and personal care services are used for workers’ compensation in instead of overhead costs. It also expands requirements for state boards that advise on Medicaid managed care, including posting meeting minutes and making their membership lists available.
While the progressive group Protect Our Care praised the rule, Rep. Cathy McMorris Rodgers (R-Wash.), chairman of the House Energy and Commerce Committee, said the rules “create unsustainable standards for home health care agencies to meet.”
Laurie McGraw is now executive vice president of digital healthcare company Transcarent. She previously served as chief customer officer and then president of AllScripts.
Paul W. Estes is now president of Cognivue, Inc., an innovator in neuroscience technology. He previously served as the company’s Chief Operating Officer.
STAT reports on the small number of hospitals that will talk about how maternal health care has changed since then Dobbs.
The New York Times reports on what it means that more mammals are getting bird flu.
Correction: This newsletter has been updated to correct the number of years that urban nursing homes must comply with a new staffing rule that CMS finalized Monday.