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Good morning. &nbsp;It’s Julie Appleby again — a senior correspondent for KFF Health News who writes about health insurance, price transparency and other topics, like this story on <a href="https://kffhealthnews.org/news/article/primary-care-health-system-changes-pcp/">the primary care shortage</a>. Send your tips to <a href="mailto:juliea@kff.org">juliea@kff.org</a>

Not a subscriber? <a href="https://www.washingtonpost.com/newsletters/the-health-202/">Sign up here.</a>

Today’s edition: The governors of California and Florida faced off in a heated debate. House Republicans grilled one of the Biden administration’s senior health officials on Capitol Hill. But first …

Depending on how 2024 goes, Biden may be putting some of his last touches on Obamacare

Patrick Semansky

The Biden administration has issued its latest official wish list for Obamacare insurance plans, potentially one of the last major Affordable Care Act health policy efforts in the president’s first term.

Changes on tap for 2025? For one, the administration wants states that run their own ACA marketplaces to crack down on what’s called “network adequacy” — how many doctors, hospitals and other providers Obamacare insurers include in their covered networks.

<a href="https://www.cms.gov/files/document/cms-9895-p-patient-protection-final.pdf">The regulatory proposal,</a> known in Washington as the payment parameters notice, came out on Nov. 15. Arriving in the run-up to a presidential election, the proposed rules could be finalized in the spring and would take effect in January 2025, not long before Inauguration Day.

Should <a href="https://www.washingtonpost.com/elections/candidates/joe-biden-2024/" target="_blank" class="contextual_link">President Biden</a> fail to fend off his likely Republican challenger, former president <a href="https://www.washingtonpost.com/donald-trump/" target="_blank" class="contextual_link">Donald Trump</a>, Obamacare and the insurance markets it created could start to look a lot different. Biden, of course, has been a staunch supporter of the ACA and has taken steps to expand the program through both rulemaking and legislation, including<a href="https://www.kff.org/policy-watch/five-things-to-know-about-renewal-of-extra-affordable-care-act-subsidies-in-inflation-reduction-act/#:~:text=As%20part%20of%20the%20Inflation,the%20Affordable%20Care%20Act%20Marketplaces."> measures that increased premium subsidies</a>. Enrollment has hit records under his watch.

But over Thanksgiving weekend, Trump posted on his Truth Social site that the GOP’s failure to repeal the ACA in his first term was<a href="https://www.axios.com/2023/11/26/trump-obamacare-affordable-care-act"> “a low point for the Republican Party.”</a>

He’s “seriously” considering alternatives, Trump added — harking back to his presidency, when he repeatedly promised he was about to reveal an Obamacare replacement plan. Spoiler alert —<a href="https://kffhealthnews.org/news/back-to-the-future-trumps-history-of-promising-a-health-plan-that-never-comes/"> he never did.</a>

“Obamacare Sucks!!!” he added in a<a href="https://truthsocial.com/@realDonaldTrump/posts/111492215056460142"> middle-of-the-night post</a> on Nov. 29.

That’s a softball for Democrats. Obamacare has<a href="https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable--Unfavorable&amp;aRange=twoYear"> grown to be largely popular</a> with Americans, according to KFF, which has long tracked public opinion of the law. Trump’s failed attempt to repeal it helped cost his party control of the House in 2018,<a href="https://www.nbcnews.com/politics/elections/midterm-exit-polls-2018-n932516"> exit polls indicated</a>.

Biden seized on Trump’s posts, saying Monday at the White House that “my predecessor once again called for cuts that could rip away health insurance for tens of millions of Americans.”&nbsp;

Behind the back and forth between the men, however, is a reality: Many of the changes made during Biden’s term, especially those in regulations, could be altered if there’s a new administration elected next year — just as Biden did when he took office, and Trump before him.

Trump, for example, rolled back ACA actions by his predecessor, President Barack Obama, including<a href="https://www.wsj.com/articles/trump-administration-slashes-funds-for-aca-outreach-1531272043"> sharply reducing funding</a> for enrollment assistance,<a href="https://www.nbcnews.com/politics/white-house/obamacare-not-dead-600-000-people-just-signed-n819351"> shortening the annual</a> sign-up period and loosening rules so<a href="https://kffhealthnews.org/news/trump-administration-loosens-restrictions-on-short-term-health-plans/"> less expensive short-term plans</a> could be sold for longer periods.

Biden’s team, in turn, expanded funding for enrollment,<a href="https://www.healthaffairs.org/content/forefront/mid-term-assessment-president-biden-s-promise-build-affordable-care-act#:~:text=In%202021%2C%20the%20Biden%20administration%20created%20a%20months%2Dlong%20COVID%2D19%20special%20enrollment%20period%2C%20extended%20the%20annual%20open%20enrollment%20period%20from%2045%20to%2075%20days%2C%20and%20created%20a%20continuous%20enrollment%20opportunity%20for%20people%20with%20incomes%20below%20150%20percent%20of%20the%20federal%20poverty%20level%2C%20effective%20in%202022."> added special enrollment periods</a>, and has a proposal awaiting final approval that would restore<a href="https://www.politico.com/news/2023/07/07/biden-short-term-health-plans-00105055"> restrictions on short-term plans,</a> which don’t cover many benefits required by the ACA and are called “junk insurance” by critics.

But the latest payment parameters notice from Health and Human Services is a modest set of tweaks that, in part, aims to address concern about whether ACA insurers cover enough doctors and hospitals to meet demand. The network adequacy provision would require states to set numerical standards, such as &nbsp;the maximum time or distance patients might have to travel to access in-network care, that are at least as tough as the rules the feds impose on insurers in its exchange. A quarter of states running their own marketplaces don’t have any such quantitative standards, according to CMS.

Seek to expand access to routine adult dental coverage by allowing states to add the care to essential benefits in their benchmark plans. That’s currently not allowed.

Standardize open enrollment periods across all states to start Nov. 1 and run at least through Jan. 15. Most states already do that, although Idaho currently opens Oct. 15 and ends Dec. 15.

“If the past is any guide, and the next administration is different, the first thing they will do is roll things back,” said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

<a href="https://kffhealthnews.org/">KFF Health News</a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at <a href="https://www.kff.org/">KFF</a> — an independent source of health policy research, polling and journalism.

DeSantis, Newsom clash in red-blue state debate

California Gov. Gavin Newsom (D) and Florida Gov. <a href="https://www.washingtonpost.com/elections/candidates/ron-desantis-2024/" target="_blank" class="contextual_link">Ron DeSantis</a> (R) <a href="https://www.foxnews.com/live-news/sean-hannity-ron-desantis-gavin-newsom-debate">squared off</a> in a Fox News debate last night where hot-button health issues took center stage.&nbsp;

Almost immediately, the Democratic firebrand and Republican presidential hopeful took swipes at each other’s pandemic response.&nbsp;

DeSantis portrayed himself as a defender of individual rights, knocking Newsom for shuttering businesses and schools for months after the initial outbreak.&nbsp;

Newsom seized on DeSantis’s record, saying he, too, had embraced vaccines and lockdowns in the early days of the public health crisis before caving “to the fringe” of the GOP.&nbsp;

<a href="https://www.washingtonpost.com/abortion/" target="_blank" class="contextual_link">Abortion</a> also got some airtime in last night’s debate. Newsom refused to specify at what stage of the procedure, if any, should be restricted, saying that the decision should be left to a woman and her doctor. He repeatedly asked DeSantis whether he would sign a federal six-week abortion ban if elected president — a closely watched question that the GOP hopeful continued to dodge.&nbsp;

GOP lawmakers grill CDC director on China’s respiratory virus spike

Win McNamee

In her first appearance before Congress as director of the Centers for Disease Control and Prevention, Mandy Cohen <a href="https://www.washingtonpost.com/health/2023/11/30/cdc-china-respiratory-virus/">faced a barrage of questions</a> from Republicans about a <a href="https://www.washingtonpost.com/health/2023/11/23/china-respiratory-diseases-children-increase/?itid=lk_inline_manual_2">new spike in respiratory illness</a> in China, our colleague Fenit Nirappil reports.&nbsp;

The hearing represented one of Cohen’s first public opportunities to <a href="https://www.washingtonpost.com/health/2023/11/12/cdc-mandy-cohen/">restore trust in the agency</a> that became a punching bag for the GOP during the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> pandemic.&nbsp;

A closer look: Republicans lawmakers on the House Energy and Commerce oversight subcommittee cast the recent spate of illnesses in China as suspicious and reminiscent of the early days of the pandemic. They argued that <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON494">assurances from the Chinese government</a> shouldn't be trusted, especially after they <a href="https://www.washingtonpost.com/world/2020/02/01/early-missteps-state-secrecy-china-likely-allowed-coronavirus-spread-farther-faster/">shared few details</a> about the emerging coronavirus threat from Wuhan.&nbsp;

Cohen told the panel that CDC staff who work in China have reported there’s no novel pathogen at play, joining other public health experts in describing the situation as the usual fluctuations of any respiratory virus season. This is corroborated by “other sources from our European Union partners and others to make sure that we are getting a complete picture.” Cohen added.&nbsp;

While the hearing remained largely cordial, Cohen also fielded sharp questions from Republicans about whether the agency had erred in its early recommendations to contain covid. She didn’t budge — noting that public health officials operated with less information and without vaccines in the early stages of the pandemic.&nbsp;

Rep. H. Morgan Griffith (R-Va.), chairman of the subcommittee on oversight and investigations:&nbsp;

Former chief White House medical adviser Anthony S. Fauci has agreed to appear before Congress as part of <a href="https://www.washingtonpost.com/us-policy/2023/01/09/house-covid-origin-investigation/">Republicans’ ongoing probe</a> into the origins of the coronavirus and the U.S. response to the pandemic.&nbsp;

Fauci &nbsp;— &nbsp;who led the National Institute of Allergy and Infectious Diseases from 1984 until <a href="https://www.washingtonpost.com/health/2022/08/22/fauci-retiring/">his retirement </a>last year — will sit for a two-day transcribed interview in early January. He will also testify at a public hearing later in 2024, Rep. Brad Wenstrup (R-Ohio), chairman of the House select subcommittee on the coronavirus pandemic, said in <a href="https://oversight.house.gov/release/dr-anthony-fauci-to-appear-for-transcribed-interview-and-public-hearing/">a statement</a>.&nbsp;

The testimony will be Fauci’s first appearance before the GOP-controlled House, where party leaders have long stated their intentions to haul him to Capitol Hill for testimony. Fauci, who served under both Republican and Democratic presidents, has pledged to cooperate with their investigation.&nbsp;

Whistleblower alleges failures in medical care at U.S. border facilities

A senior U.S. Customs and Border Protection official <a href="https://www.washingtonpost.com/immigration/2023/11/30/border-whistleblower-loyal-source-medical-migrants/">filed a whistleblower complaint</a> with Congress yesterday accusing his supervisors of failing to adequately monitor the agency’s medical service contractor before the <a href="https://www.washingtonpost.com/immigration/2023/05/18/migrant-girl-dead-us-border-custody-texas/">May death of an 8-year-old girl</a> in its custody, The Post’s Nick Miroff reports.&nbsp;

The details: Attorneys for Troy Hendrickson told lawmakers in <a href="https://whistleblower.org/wp-content/uploads/2023/11/11-30-2023-Hendrickson-Congressional-Disclosure.pdf">a letter</a> that their client was reassigned by supervisors after raising concerns about the track record of medical contractor Loyal Source Government Services. The company is <a href="https://www.washingtonpost.com/immigration/2023/11/19/border-loyal-source-medical-care-migrants/">a finalist</a> for a new five-year, $1.5 billion CBP contract.

Hendrickson’s concerns about Loyal Source include staffing shortages, employees working without proper clearances and licenses, and billing errors resulting in overpayments of millions of dollars.&nbsp;

The letter was sent to Democratic and Republican leaders of the Senate Judiciary Committee, the Senate Homeland Security and Governmental Affairs Committee and the House Homeland Security Committee. It urges lawmakers from both parties to conduct oversight of Loyal Source and the CBP contracting office, among other actions, Nick writes.&nbsp;

On tap today: North Carolina <a href="https://www.washingtonpost.com/politics/2023/10/11/north-carolinas-next-medicaid-challenge/?itid=lk_inline_manual_81">will officially launch</a> its long-awaited Medicaid expansion, extending eligibility for the safety net program to hundreds of thousands of low-income adults throughout the state.&nbsp;

On the move: Melinda Hatton, the general counsel and secretary of the American Hospital Association, is retiring. The group has tapped Chad Golder, who most recently served as AHA’s senior vice president and deputy counsel, as her replacement.&nbsp;

New this a.m.: Sen. Amy Klobuchar (Minn.) and seven other Senate Democrats are pressing the Food and Drug Administration to <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/draft-guidance-industry-action-levels-lead-food-intended-babies-and-young-children#:~:text=FDA%27s%20Closer%20to%20Zero%20action,for%20babies%20and%20young%20children.">finalize guidance</a> aimed at reducing toxic elements in foods, following a <a href="https://www.washingtonpost.com/business/2023/11/06/fruit-pouch-recall-lead-illnesses/?itid=lk_inline_manual_83">recent outbreak of lead poisoning</a> linked to applesauce pouches, according to a letter shared with The Health 202.&nbsp;

Texas Attorney General Ken Paxton (R) is suing Pfizer for allegedly misrepresenting the effectiveness of its coronavirus vaccine, according to <a href="https://www.texasattorneygeneral.gov/sites/default/files/images/press/Pfizer%20Vaccine%20Petition%20Filed.pdf">a lawsuit</a> filed yesterday in a Lubbock state district court.&nbsp;

Elizabeth Arias, a demographer with the CDC’s National Center for Health Statistics, on new life expectancy projections. 

“Even without the pandemic, <a href="https://www.washingtonpost.com/health/2023/11/29/life-expectancy-2022-united-states/">life expectancy was flat or declining</a>… This is a whole new territory that we’re in, beginning a decade ago.”

<a href="https://www.washingtonpost.com/climate-environment/2023/11/30/malaria-mosquitoes-climate-change-flooding/" target="_blank">Extreme weather helped fuel surge in malaria cases last year (By Kevin Crowe and Brady Dennis | The Washington Post)</a>

<a href="https://www.wsj.com/us-news/law/how-chinese-marijuana-operations-cropped-up-in-small-town-america-45b7b598?mod=lead_feature_below_a_pos1" target="_blank">How Chinese marijuana operations cropped up in small-town America (By Liyan Qi | The Wall Street Journal)</a>

<a href="https://www.washingtonpost.com/health/2023/11/30/salmonella-outbreak-cantaloupe-fruit-cups/" target="_blank">Precut cantaloupes linked to ‘severe’ salmonella outbreak, CDC says (By Amber Ferguson | The Washington Post)</a>

The Consult Conga Line

Julie Appleby

American University, BA in journalism

McKenzie Beard is a researcher for The Health 202, a morning newsletter and daily guide to Washington's health-care policy debate. She started at the Post as an American University practicum student on the investigative desk in 2021 and has previously reported for Voice of America and Teen Vogue.

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