These three states could again shift the nation’s abortion landscape

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TGIF, everybody. Today’s newsletter top is adapted from a story out this morning from Caroline Kitchener and your Health 202 host. Was this forwarded to you? Sign up here.

Today’s edition: Sen. Bill Cassidy (R-La.) officially became the ranking member of the Senate’s sweeping health panel. ProPublica exposes the inner-workings of how one leading insurer tried to deny coverage to a chronically ill patient. Medicare Advantage appeals are rare but often successful. But first … 

Battles over abortion legality are heating up in North Carolina, Florida and Nebraska

A showdown over abortion is brewing in three conservative-leaning states that have become destinations for the procedure in a post-Roe America.

In North Carolina, pressure is building on a handful of Democratic legislators with a history of voting for antiabortion legislation. In Florida, a push for further restrictions could pit Gov. Ron DeSantis (R) against the Republican leader of the state Senate. And in Nebraska, the author of a bill to ban the majority of abortions is trying to shore up the support of just one more lawmaker.

Taken together, the looming battles could dramatically reshape the national abortion landscape once again. Legal abortions increased in all three states after the Supreme Court overturned the constitutional right to an abortion in June, ranging from a 10 percent jump in Florida to a 37 percent increase in North Carolina, Caroline Kitchener and I report this morning.

In recent weeks, conservatives in Raleigh have launched a plan to override a future veto from Democratic Gov. Roy Cooper and ban abortions as soon as fetal cardiac activity is detected, around six weeks. If they can win over just one Democrat, antiabortion leaders say they’ll likely have the votes to replace the state’s current 20-week limit. 

But the unusual dynamics of the state legislature were on full display this week. Every Democratic state lawmaker signed onto a bill that would codify Roe v. Wade into law, which leaders had intended to be a show of unity, though nobody expects it to pass in the GOP-dominated legislature. 

• “Republicans have been crowing for months that they have a path to abortion restrictions,” said Morgan Jackson, an adviser to Cooper. “The Democrats closed the door on that.”

But Democratic state Rep. Garland Pierce — who leads the congregation at Bright Hopewell Missionary Baptist Church in Laurinburg, N.C. — made clear that, despite the appearance of party unity, the door to an abortion ban remains open. He told The Post that he had been under enormous pressure and that he signed onto the bill with Democrats this week to “stop the bleeding.”

“Everybody changes their mind about things, and we’ll see how it goes,” he said.

“The process has just started,” he added. “This is the first quarter.”

NC Values Coalition, one of the leading antiabortion groups in North Carolina, has drafted a ban after fetal cardiac activity has been detected that they are offering to legislators “as a starting point,” said Tami Fitzgerald, the group’s executive director. She said they’re beginning the process of reaching out to Democrats who’ve previously voted for antiabortion legislation.

The state passed a 15-week ban on abortion last year, and DeSantis has thus far avoided publicly endorsing a specific proposal to further restrict abortions. While some Republicans fear losing moderate voters if they embrace strict limits, DeSantis faces a different calculation since he won reelection in a landslide and is said to be eyeing a White House bid. 

But that could lead to a fight with state Senate President Kathleen Passidomo, a Republican. At a November news conference, she said her hands were tied until the state Supreme Court ruled on the constitutionality of the 15-week ban passed last year. And she later told the Tampa Bay Times that she would support a 12-week ban with exceptions for rape and incest. 

In a vacuum, Passidomo would prefer not to place more limits on abortion, said state Senate Minority Leader Lauren Book (D), who says she is close with Passidomo and that she speaks to her regularly about abortion. Yet, Passidomo would struggle to stop a roughly six-week ban if DeSantis throws his full support behind the measure, which would likely boost his standing with evangelical voters critical in a GOP presidential primary. 

• “It appears that the governor and the House support a heartbeat bill,” said John Stemberger, president of the Florida Family Policy Council, the state’s largest antiabortion group. “The question is will that pass out with or without exceptions.”

In Nebraska, a ban after fetal cardiac activity has been detected that includes exceptions for rape and incest has already been introduced by state Sen. Joni Albrecht, who identifies as a Republican in Nebraska’s unique legislature where lawmakers are technically nonpartisan.

By Albrecht’s informal whip count, she is one lawmaker shy of feeling confident she can lock up the votes needed to overcome a filibuster and pass legislation representing a significant departure from the state’s current prohibition on abortion after 22 weeks of pregnancy. One Democrat has already signed onto the legislation, and Albrecht said she’s in discussions with one Republican lawmaker who didn’t co-sponsor the bill. 

• “I can’t say that I’m confident,” she said in an interview Wednesday just hours before a nearly eight-hour committee hearing on the legislation, “but I am very hopeful that this is what the floor of the legislature will come to know as being what is right for Nebraska.”

Read the full story here.

Sen. Bill Cassidy (R-La.) was officially seated yesterday as the ranking Republican of the Senate HELP Committee, where his counterpart will be independent firebrand Sen. Bernie Sanders (I-Vt.). Want to know what they may work on first? Or what the areas of disagreement may be? Stay tuned next week for our interview with Cassidy.

White House prescriptions

Biden calls for expanded benefits under family leave law

President Biden marked the 30th anniversary of the Family and Medical Leave Act yesterday by calling for an expansion of the provisions guaranteed under the law. He also invited former president Bill Clinton, who signed the legislation early in his tenure in 1993, to speak at the White House.

The details: Biden issued a memorandum urging federal agencies to support access to unpaid family and medical leave for new workers, who currently aren’t entitled to the benefits in their first year on the job. 

He also directed the Office of Personnel Management to provide recommendations on paid and unpaid leave for federal workers recovering from domestic violence, dating violence, sexual assault or stalking. Such situations aren’t covered by the act, which guarantees many American workers up to 12 unpaid weeks off to recover from major illness or childbirth or to take care of sick family members.

Inside one chronically ill patient’s fight for coverage

It took Penn State University student Christopher McNaughton years to find a drug regimen that provided some relief for his crippling case of ulcerative colitis, a chronic inflammatory bowel disease that caused him to develop arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. 

But after a physician contracted by his student health plan, UnitedHealthcare, deemed that his treatment wasn’t “medically necessary,” the insurance giant stopped footing the bill for his costly medications, ProPublica reports.  

McNaughton isn’t alone. More than 200 million Americans nationwide are covered by private health insurance, but data from state and federal regulators suggest that insurers reject about 1 in 7 claims for treatment. That’s because health plans have wide discretion to decide what they’ll cover beyond basic services mandated by state and federal law. 

While most Americans faced with an insurance fight give up, McNaughton’s family responded with a lawsuit. The legal battle that followed would go on to expose the inner-workings of one of the nation’s leading insurers and how it relentlessly fought to reduce spending on patient care, even as its profits soared, David Armstrong, Patrick Rucker and Maya Miller write for ProPublica. 

A company spokesperson sent The Health 202 the following response: “Cases like Mr. McNaughton’s are always difficult as his treatment involves medication doses that far exceed FDA guidelines. However, we strive to provide a better member experience than what Mr. McNaughton described. While he has not missed or been delayed in receiving any treatment since becoming a member with us, we regret the stress our review caused Mr. McNaughton and his family.”

Read more from ProPublica’s deep dive here. 

Most Medicare Advantage appeals are successful, but few apply

More than 2 million prior authorization requests were fully or partially denied by Medicare Advantage insurers in 2021. That’s roughly 6 percent of the 35 million requests submitted on behalf of senior enrollees that year, according to a new survey from the Kaiser Family Foundation. 

Of those denials, just 11 percent were appealed. However, of the appeals that were filed, over 80 percent resulted in fully or partially overturning the initial ruling. 

Why it matters: The high rate of successful appeals raises questions about whether more authorization requests should have been greenlit on the first go-round. It could also reflect problems with documentation that were fixed during the appeal process, researchers note. 

Physicians have long asserted that prior authorization — the need to get approval from a patient’s insurer before providing treatment — is a time consuming one that creates barriers and delays to medically necessary care. Our colleague Carolyn Y. Johnson detailed her experience navigating the complex process in a story out earlier this week.

• The White House isn’t actively considering declaring a public health emergency to expand abortion access, White House Gender Policy Council director Jennifer Klein said yesterday, believing the declaration wouldn’t “provide meaningful new resources.”
• More than half of American adults support a blanket ban on the sale of menthol cigarettes and other tobacco products, according to a new report from the Centers for Disease Control and Prevention.
• The future of abortion rights in Wisconsin is likely up to voters this April who will be asked to decide whether to extend the 14-year conservative stronghold on the state’s high court or usher in a new era of liberal majority as the panel prepares to weigh in on the state’s near total abortion ban in the coming years, The Post’s Patrick Marley reports. 
• The manufacturer of a brand of over-the-counter eye drops announced yesterday that it is voluntarily recalling the product because it might be linked to an outbreak of a drug-resistant bacterial infection.

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As Long-Term Care Staffing Crisis Worsens, Immigrants Can Bridge the Gaps (By Michelle Andrews l Kasier Health News)

Thanks for reading! See y’all Monday.

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