The Health 202: ACB helped save the ACA after all

In yesterday’s 7-2 decision — which brought a huge sigh of relief for anxious ACA advocates — Barrett and six of her colleagues dismissed the high-stakes lawsuit, handing the health-care law its third major legal victory since being passed in 2010.

The court's majority didn’t even wade into the case’s dubious legal arguments that the ACA is unconstitutional without its penalty for being uninsured. 

Instead, in a majority ruling written by Justice Stephen G. Breyer, the court dismissed the challenge brought by Texas, saying it and the other Republican-led states don’t have legal standing to try to upend the law.

Politico's Joanne Kenen:

Georgetown University's Dania Palanker:

“The decision meant the attempt to derail President Barack Obama’s landmark domestic achievement met the fate of previous legal challenges, in 2012 and 2015,” wrote The Post’s Supreme Court reporter Bob Barnes.

Democrats had confidently predicted the opposite scenario during Barrett’s confirmation hearings. 

Infuriated that former President Trump was trying to ram through a third Supreme Court nominee before potentially leaving office — but unable to do anything to stop it — Democrats focused their opposition strategy on the legal threat to the ACA, during the hearings in October.

“Democratic senator after Democratic senator shared stories of constituents who rely on Obamacare — a woman needing expensive kidney treatment, or a child with a heart defect who both require expensive health care and protections for coverage with preexisting conditions,” my colleague Amber Phillips wrote at the time.

More than one Democrat brought up how Trump had hinted he wants his Supreme Court justices to knock down Obamacare — although none of them were able to pin Barrett down on how she’d vote on the ACA lawsuit.

“Republicans finally realized that the Affordable Care Act is too popular to repeal in Congress,” said then-senator Kamala D. Harris. “So now they are trying to bypass the will of the voters and have the Supreme Court do their dirty work.”

Ed Whelan, senior fellow at the Ethics and Public Policy Center and Florida State University law professor Mary Ziegler:

A vote to confirm Barrett was a vote to ditch health care for millions of Americans, they warned.

“If you don’t trust Republicans on health care, you shouldn’t trust them on this Supreme Court nominee,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said at the time. “That’s the ballgame to me.”

Senate Majority Leader Charles E. Schumer said this: “The American people should make no mistake—a vote by any Senator for Judge Amy Coney Barrett is a vote to strike down the Affordable Care Act and eliminate protections for millions of Americans with preexisting conditions.”

That didn’t transpire, but the ACA is hardly the only health-care issue Barrett will face.

Next up is a Mississippi ban on abortions past 15 weeks of pregnancy. The conservative-majority court is slated to hear the case next term, with a decision likely coming next spring. 

It’s a chance for the court to majorly shift the limits on how far states can go in placing regulations or limits around women seeking abortions — and many legal experts say Barrett could be willing to reconsider the abortion protections embedded in the 1973 Roe v. Wade decision.

But for now, Democrats and health-care advocates can toast the ACA.

The law has proven mostly resilient, after nearly countless repeal attempts by Republicans and lawsuits trying to dismantle it. 

The Post's Dave Weigel:

Politico reporter Alex Guillen and The Post's Dan Diamond:

Anthony Wright, executive director of Health Access California:

Health and Human Services Secretary Xavier Becerra called the court’s decision “a victory for all Americans, especially people with a preexisting condition or anyone who was worried they could be forced to choose between their health and making ends meet.”

“Before becoming the Biden administration’s top health official, Becerra was the California attorney general and led a coalition of Democratic state attorneys general who were the main group fighting to preserve the law as the case worked its way through federal courts,” Bob noted.

“Today’s decision means that all Americans continue to have a right to access affordable care, free of discrimination,” Becerra said in a statement. 

From President Biden's Twitter account:

And from Biden's Chief of Staff Ron Klain:

Most of the health-care industry was popping the champagne, too.

“With yet another court decision upholding the ACA now behind us, we remain committed to strengthening the current law and look forward to policymakers advancing solutions to improve the ACA,” said Gerald E. Harmon, president of the American Medical Association.

“The AMA will continue working to expand access to health care and ensure that all Americans have meaningful, comprehensive, and affordable health coverage to improve the health of the nation,” he added.

Ahh, oof and ouch

AHH: The Biden administration is investing in antiviral research before the next pandemic.

“Borrowing from the model used to create drugs that transformed HIV from a death sentence into a manageable disease, the Biden administration announced Thursday a $3.2 billion plan to stock the medicine cabinet with drugs that would be ready to treat future viral threats — whether a hemorrhagic fever, influenza or another coronavirus,” The Post’s Carolyn Y. Johnson reports.

Anthony S. Fauci, chief medical adviser to the administration, and David Kessler, chief science officer for the covid-19 response, began brainstorming late last year a big push for antivirals to help stop the next pandemic. But as variants spread, and it becomes clear that the vaccination campaign alone won’t eradicate the novel coronavirus, the scientists have pushed up the deadline. The initial focus of the multiyear investment in antiviral research will focus on the coronavirus, but it will expand into discovering drugs for other viruses.

“The focus was to reinvigorate the nation’s antiviral program over the next three to five years. What’s become more clear, as the pandemic has come into focus, is we have to do it this fall,” Kessler said. “We need this set of tools to close out this pandemic. … The hard thing is to recognize with all the success, there’s still several hundred deaths a day.”

OOF: The debate over the FDA’s controversial Alzheimer’s approval continues.

Critics have blasted the Food and Drug Administration’s decision to approve a new Alzheimer’s drug, called Aduhelm. While the drug is touted to slow cognitive decline, the evidence of its effectiveness is unclear. 

Three members of an advisory board that recommended the FDA against approval have quit. One of those members write in the New York Times that the approval constituted a low-point for the FDA. Other scientists and experts have taken to op-ed pages to argue that the drug will raise false hopes in patients, hinder clinical trials and result in dangerous side effects.

“Much of the debate centers on the FDA’s surprise decision to approve a broad label for the treatment, which theoretically means any of the more than 6 million people with Alzheimer’s could receive it. As a practical matter, doctors and insurers will be left to decide whether to restrict the drug to the population studied in the clinical trials — people with mild cognitive impairment and early dementia, both caused by Alzheimer’s. That’s a job many physicians and insurers are unhappy to be stuck with, saying more FDA guidance is needed,” The Post’s Laurie McGinley reports.

For patients on Medicare, the drug could result in cost sharing of more than $11,000 a year if they don’t have supplemental insurance.

Acting FDA commissioner Janet Woodcock said she wasn’t involved in the decision but defended it as meeting the agency’s standards for accelerated approval. Many advocates have welcomed the agency’s accelerated approval process, which has helped bring new cancer drugs to market. But some critics say the process has allowed expensive, unproven treatments on the market and that it can be difficult to remove them once they are approved.

OUCH: A CDC advisory council will meet today to discuss link between vaccines and myocarditis.

There have been more than 300 cases of heart inflammation reported among 20 million teens and young adults who have received one of the vaccines made by Moderna or Pfizer, NPR’s Joanne Silberner reports. A causal relationship between the vaccines and the cases of heart inflammation has not been established, but evidence for a potential link is growing. An advisory council on vaccines will meet today to discuss those cases. 

Pfizer’s vaccine has been authorized for children as young as 12 for over a month, and Moderna is in the process of seeking approval for its vaccine in adolescents. Both companies are also pursuing trials of their vaccines in younger children.

Even with the rare risk of heart inflammation, most experts think the benefits of vaccines for adolescents and young adults far outweigh any risks. Cases of heart inflammation can often be easily resolved with treatment. And infection with covid-19 can also cause myocarditis. 

Paul Offit, professor of pediatrics at the Children's Hospital of Philadelphia and a member of an FDA vaccine advisory committee, told NPR that if you vaccinated a stadium full of 100,000 people between the ages of 16 and 39, only two would be expected to get myocarditis. If none were vaccinated, around 1,300 would eventually get covid-19. Those people would almost certainly suffer more illnesses related to covid-19, including the risk of developing long covid or developing myocarditis from the infection.

Elsewhere in health care

Officials are turning to home-testing for STDs.

“The pandemic brought widespread Covid testing into people’s homes. Now, public health officials across the country are seeing whether the convenience and privacy of similar easy-to-use kits can help them track the spread of sexually transmitted disease,” Politico’s Alice Miranda Ollstein reports.

Officials in Los Angeles, Washington, D.C. and Idaho are mailing thousands of free HIV tests to people who request them online. Health departments report that they are reaching people who would not otherwise be tested and might be catching STDs at an earlier stage.

“But regulatory obstacles and concerns over cost and human error could keep the at-home tests from becoming the new norm. Most tests designed for at-home sample collection haven’t been authorized by the Food and Drug Administration,” Alice writes.

State employee health plans can drive down health care costs, according to a new report.

The agencies purchasing health benefits for state employees may be uniquely positioned to tackle high health care costs, according to a new report from the Center for Health Insurance reforms at Georgetown University. Around 1 in 10 people with employer-sponsored health care are employed by the state. These public sector employees tend to receive more generous health benefits than their counterparts in the private sector.

• State administrators have introduced incentives to steer employees to lower cost providers, introduced greater cost-sharing and added employee wellness benefits. 
• But state efforts to contain costs don’t always align with the drivers of high costs, the report found. 
• Hospital prices are the largest driver of increasing costs for state employee health benefits but are not the most common target for state efforts to control costs in their health plans.

Sugar rush