Daily on Healthcare: Maryland attempts to boost protections for live kidney donors

MARYLAND ATTEMPTS TO BOOST PROTECTIONS FOR LIVE KIDNEY DONORS: Maryland state legislators are looking to help people desperate for kidney transplants by enacting new protections for donors.

The bill, the Organ Donation – Prohibition on Discrimination by Insurer and Unpaid Leave, would prevent life and disability insurers from denying or canceling living organ donors’ policies on the basis of health. The legislation also stipulates that living organ donors must receive up to 60 business days in unpaid leave.

“We should be in the business of removing obstacles, whatever obstacles exist,” said Democratic state Sen. Brian Feldman, who co-sponsored the bill. “If we can have any benefit here and save some lives … even if it’s five people or 10 people who otherwise would like to donate an organ but are deterred from doing so because they’re concerned about being fired.”

Many states have enacted paid leave for state employees to recover from donating organs. Some states also mandate that private sector employees be given unpaid leave after donations. Feldman’s legislation would go further, and he hopes it will set an example for other states to follow.

More than 3,500 people are on the organ transplant wait list in Maryland, 2,558 of whom need kidneys. Last year, only 830 organ transplants were performed, and 200 Maryland residents died while waiting for an organ. The state has struggled to find people to donate organs. There were only 129 living donor transplants in 2018, and the past three years have seen the fewest donations since 1997.

“Our hope is that things would change immediately after passage of the bill,” said Melanie Kahn, director of state policy and advocacy at the American Kidney Fund, which has endorsed the legislation. “I don’t know how realistic that is. People need time to learn about these new protections. The whole reason behind trying to move this bill into law is to remove those financial barriers that, unfortunately, living donors currently do face.”

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MORE DETAILS FROM TRUMP’S BUDGET REQUEST:

The Obamacare grace period would get trimmed: Under current Obamacare rules, people who are on the plans and who do not pay their premiums have a grace period of 90 days before they get kicked off their coverage. The Trump administration wants to cut that period to 30 days, for a savings of $85 million to the government in 2020. Trimming the grace period is something that insurers have asked for, and alterations could be done through rulemaking. The grace period was designed to help people who are struggling financially or who just fall behind by accident, but it does allow for people to continue using medical care for 90 days and to incur large medical expenses. Under the current rule, when a patient stops paying premiums, insurers must cover medical expenses for the first 30 days, but doctors and hospitals are left holding the bag for the next 60 days.

People would lose access to no-cost premiums: The Trump administration wants everyone on the Obamacare exchange to pay between 1 percent and 5 percent of their income on health insurance coverage. The proposal is meant to prevent insurers from structuring to shift more costs onto the federal government. Insurers used the arrangement to make up the difference for the cost-sharing reduction subsidies that Trump ended in 2017, and it ended up helping certain customers find plans for $0 a month because the federal government’s subsidies pick up the cost of premiums. Making customers pay for premiums would save the government $230 million a year in 2020 and $115 million a year in 2021, according to the budget documents.

MORE DETAILS OF THE ADMINISTRATION HIV EFFORTS:

Azar endorses needle exchange to fight HIV: Health and Human Services Secretary Alex Azar said that the administration would encourage syringe exchange programs as part of its efforts to end HIV transmission in a decade. Exchanges are controversial, but studies have consistently shown that they work to stop the spread of infectious diseases. “Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican health secretary, but we’re in a battle between sickness and health, between life and death,” said Azar, speaking at the National HIV Prevention Conference in Atlanta.

Supervised injection sites will not be part of the strategy: Azar said that supervised injection sites, which provide rooms for people to use illegal drugs under the supervision of healthcare providers who are ready to revive them if they overdose, will not be part of the HIV initiatives. The Department of Justice has sued to stop a Philadelphia non-profit from setting up such a program, which also helps to direct people to treatment and provides clean needles. According to Azar, the sites “raise entirely different legal concerns.” DOJ has sued under the Controlled Substances Act, saying a provision in the law makes it illegal to have a place that is used to make, store, or distribute illegal drugs.

Most HIV infections spread by people who aren’t diagnosed or aren’t getting treatment: More than 80 percent of the 40,000 new HIV infections each year are spread by people who didn’t know they had the virus or were diagnosed but never received treatment, according to the Centers for Disease Control and Prevention. The study, published Monday in the CDC’s Vital Signs report, indicates that the healthcare system will have to improve not just at identifying who has HIV, but at making sure people who are infected are consistently getting medical care.

A breakdown of the numbers: The study, which used data from 2016, found that 15 percent of people who have HIV in the U.S. do not know their status, and they are responsible for spreading roughly 40 percent of new infections. Another 23 percent of people with HIV have received their diagnosis but are not getting treatment. As a result, they spread roughly 43 percent of new infections every year. Another 11 percent of people who are receiving care, but did not achieve viral suppression, account for 20 percent of all HIV transmissions.

FEWER PEOPLE ARE SKIPPING DOSES TO CUT DRUG COSTS: About 11 percent of adults between the ages of 18 to 64 who took prescription drugs in 2017 said they did not take the drug as prescribed as a way to reduce the costs of their medication, according to a new CDC study. That’s a drop from nearly 15 percent in 2013, or before the health coverage expansions of Obamacare took effect. The percentage of people asking their doctors for a lower-cost drug decreased from nearly 26 percent in 2013 to 19.8 percent in 2017.

HEALTH INSURERS, HOSPITALS SPAR OVER SURPRISE MEDICAL BILLS: America’s Health Insurance Plans teamed up with 16 other businesses, providers, and brokers to write to Congress asking for legislation that would protect Americans from receiving surprise medical bills. They want a law that would set more specific payments rates, possibly in line with what Medicare pays. At this, the Federation of American Hospitals and the American Hospital Association hit back in a statement of their own, saying that “it is a dangerous precedent for the government to star setting rates in the private sector.”

Hospitals had shifted the blame to insurers in earlier statements, and insurers on Monday blamed hospitals for many of the issues patients face when they get medical bills they didn’t expect following a hospital state. Insurers want a law that would prohibit doctors from sending a surprise medical bill to patients in cases of emergency, involuntary care, or instances in which the patient had no choice in provider, and they want to require hospitals and clinics to tell patients when a medical provider won’t be in their network so they can have the option of getting care elsewhere.

DINGELL BILL WOULD MANDATE TOXIN WARNING LABELS FOR KIDS COSMETICS: Rep. Debbie Dingell, D-Mich, introduced a bill requiring makers of cosmetics marketed to children to demonstrate to the Food and Drug Administration that they’re free of asbestos or include a written warning alerting parents to the potential risk. The bill comes amid an investigation by the Department of Justice and the Securities and Exchange Commission into claims that Johnson & Johnson concealed asbestos contamination in its popular baby powder for decades as well as a recall by the retailer Claire’s of possibly tainted makeup marketed to teenage girls. Americans, who use 10 cosmetic or personal care products a day, are typically shocked to find out that they’re among the least-regulated items on the market, added Rep. Jan Schakowsky, D-Ill., a co-sponsor of the bill. Because of a loophole in existing law, the FDA lacks the authority to force the makers of such products to recall them.

MEDICARE EXPANSION WOULD FORCE HOSPITALS TO CLOSE, STUDY SAYS: Navigant Consulting conducted a study finding that a Medicare buy-in or a government healthcare system could force hospitals to limit the care they provide, drive significant layoffs and “potentially force the closure of essential hospitals.” It predicts with a buy-in that because hospitals would turn to private insurers to make up cost differences, then insurers in turn would create more limited networks of providers.

MANCHIN QUESTIONS IMPACT OF TRANSGENDER RIGHTS BILL ON LOCAL SCHOOLS: Sen. Joe Manchin, D-W.Va., said that West Virginia officials have warned him away from backing the Equality Act, which would appear to allow students the right to use bathroom facilities and locker rooms based on their gender identity. “I am not convinced that the Equality Act as written provides sufficient guidance to the local officials who will be responsible for implementing it, particularly with respect to students transitioning between genders in public schools,” Manchin said in a statement.

ANDREW YANG TAKES A HARD STANCE AGAINST CIRCUMCISION: Democratic presidential hopeful Andrew Yang wants to cut circumcision in the U.S. so American parents don’t feel pressured to have the practice performed on their sons. Yang, who tweeted last week that he was “against the practice” of circumcision, said if he were president he would work to “inform parents that it is entirely up to them whether their infant gets circumcised, and that there are costs and benefits either way.”

OPINION: Brexit is turning into the British conservative equivalent of Obamacare repeal and replace

The Rundown

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The New York Times Trump plans to end the AIDS epidemic. In places like Mississippi, obstacles are everywhere.

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Calendar

TUESDAY | March 19

House and Senate in recess all week.

March 18-21. National HIV Prevention conference. Program.

2:30 p.m. 1775 Massachusetts Ave. NW. Brookings interview with departing Food and Drug Administration Commissioner Scott Gottlieb. Details.

THURSDAY | March 21

10:30 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Overcoming Health Care Challenges in Immigrant Communities.” Details.