Medical debt is on the November ballot in Arizona

Medical debt is on the November ballot in Arizona

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good morning, and TGIF everybody. 

Today’s edition: The CDC is now recommending only high-risk groups get the monkeypox antiviral. California’s Democratic governor is renting billboards in red states to highlight abortion access in his state. But first … 

Get the full experience.Choose your plan

Arizona is trying to take on medical debt with a ballot initiative

A measure to crack down on medical debt collection is on the ballot in Arizona this fall — a first-of-its kind initiative that, if successful, states across the country may seek to replicate. 

In November, Arizona voters will decide whether to pass a ballot measure limiting the interest rate on medical debt to 3 percent. Other provisions include raising the amount of equity in accounts, homes, vehicles or more that’s shielded from being sold to pay off medical or any other consumer debt. 

  • “Arizona definitely serves as a test case,” said Kelly Hall, the executive director of the Fairness Project, a group that funds and organizes state ballot measure efforts across the country. “We do expect this to go on the ballot in other places, assuming this succeeds in Arizona.”

Opponents of the initiative argue the focus by supporters on health care is misleading, since many of the ballot measure’s provisions impact all consumer debt. They contend costs could get passed down to other consumers, while also making it more difficult for small-business owners to collect the money they’re owed.

The measure wouldn’t wipe out medical debt. But it’s aimed at keeping it from growing, which supporters of the campaign say is key to protecting state residents from predatory debt collection. Roughly 40 percent have some form of health-care debt, which disproportionately impacts Black and Hispanic adults, women and lower-income Americans, according to a Kaiser Family Foundation survey. Simply having health insurance doesn’t shield someone from being saddled with medical debt.

The details

The group leading support for the ballot measure — Healthcare Rising Arizona — has less than two months to ramp up its efforts ahead of November’s midterm elections. It’s a grass-roots organization with 1,500 members, with funders including SEIU-United Healthcare Workers West, according to Rodd McLeod, a spokesperson for Healthcare Rising Arizona. 

Here’s their message to voters: “Nobody should lose their home or their car or their way to get to work in order to pay a medical bill.”

Beyond the interest rate cap, the ballot measure would also protect certain equity and accounts from being taken by creditors for medical and other consumer debt. For instance: It would raise vehicle protection from $6,000 to $15,000. The amount of money protected in bank accounts would increase from $300 to $5,000.

The issue of medical debt has captured the attention of some state legislatures and President Biden, who recently released actions aimed at decreasing medical debt and bolstering consumer protections. High interest rates on medical debt can stymie Americans’ ability to reduce the amount they owe. 

“We've seen instances where people are paying off their medical bills each and every month, but because of the fees and the rates of interest, the balance doesn't really go down,” said Mark Rukavina, a program director at Community Catalyst, a health-care advocacy group.

In recent years, ballot measures have become a key tool to attempt to implement more progressive policies in purple and red states. Voters in six red states, including Oklahoma and Missouri, have passed citizen-led petitions to adopt Medicaid expansion in their states. Meanwhile, the abortion rights movement is eyeing the tool as one of the only ways to reshape access to the procedure in a post-Roe America.

The opposition

Amber Russo said it’s not the cap on the interest rate for medical debt that’s the problem, but rather it's that many of the policies apply broadly. She’s a spokesperson for Protect Our Arizona, a political action committee opposing the measure. The PAC was created to be a vehicle to oppose the measure and has the support of some members of the Arizona Creditor Bar Association.

She’s planning to tell voters that this is a “misnamed proposition.” “It’s a very pay-for-your-neighbor sort of initiative, right? Because now it will take folks that don't pay their debts — and those of us that do, or those people that need credit — pay a higher price for it.”

Other opponents of the ballot measure include groups like Tucson Metro Chamber and Greater Phoenix Chamber.

Agency alert

CDC recommends only high-risk groups should get monkeypox antiviral

The Centers for Disease Control and Prevention issued new guidance yesterday recommending that TPoxx, the only drug available to treat monkeypox, be limited to people at high risk for severe disease, our colleagues Lena H. Sun and Dan Diamond report.

The updated guidance comes as the outbreak that has infected more than 23,000 Americans shows signs of plateauing in the United States. 

Federal health officials became concerned with the frequency at which physicians prescribe TPoxx — which is approved for the related smallpox virus — after the Food and Drug Administration released new data suggesting that broad use of the drug could “promote resistance and render the antivirals ineffective for some patients.” 

At a White House monkeypox briefing yesterday, Anthony Fauci, chief medical adviser to President Biden, said resistance is always a risk when using antiviral drugs. He said a recently launched study of TPoxx will track signs of mutation that could lead to resistance. The study is expected to enroll more than 500 patients across 60 U.S. sites.

The other side: The calls to scale back the antiviral drug’s use have been sharply rebuked by HIV advocates and other patient groups, who for weeks have pressed the Biden administration to make TPoxx more widely available. They’ve criticized the government’s guidance as hasty, given ongoing disparities in vaccinations and treatment for a disease that continues to disproportionately impact gay and bisexual men.

Lawrence Gostin, director of Georgetown University’s O’Neill Institute:

Reproductive wars

Newsom advertises California as an abortion sanctuary

California Gov. Gavin Newsom’s reelection campaign has rented billboards in six states with abortion bans, escalating the Democrat’s battle with conservative Republican governors and courting a First Amendment fight with Mississippi, The Post’s Dave Weigel writes. 

The ads on the billboards direct women to a California state website that provides users instructions on how and where to get an abortion, including for pregnant women from out-of-state. 

The ads began appearing yesterday in Indiana, Mississippi, Ohio, South Carolina, South Dakota and​​ Texas, most of which have dramatically restricted access to the procedure since the Supreme Court overturned constitutional abortion rights. Governors in the latter four states are up for reelection in November. The funding comes from Newsom's reelection war chest, which could signal he feels confident in his own campaign.

The details: One ad portrays a woman with her hands chained behind her back. “Texas doesn’t own your body. You do,” it reads. Another ad says that “California is ready to help” anyone who needs an abortion, adding a verse from the Gospel of Mark: “Love your neighbor as yourself. There is no greater commandment than these.”

Newsom, whose own position in California was strengthened when he defeated a 2021 recall campaign, has been critical of Republican governors in several policy areas. His actions have sparked speculation about a potential run for president, which he has rebuffed, saying he supports President Biden for reelection. 

South Dakota Gov. Kristi Noem (R):

On the Hill

House Democrats introduce Pro-Life Act

Twenty-six House Democrats introduced a package of health-care and family-aid bills aimed at addressing the nation’s maternal mortality crisis and extending federal safety net programs for low-income Americans. 

The Providing Real Opportunities and Lifelong Investments for Everyone Act, which its architects refer to as the Pro-Life Act in an attempt to reclaim the moniker adopted by the antiabortion movement, was unveiled days after Sen. Lindsey Graham (R-S.C.) introduced a bill that would nationally ban abortions after 15 weeks. 

The package includes several measures that have previously been blocked by the Senate in reconciliation negotiations, such as national minimums for paid family and medical leave and an enhanced child tax credit. 

  • I’m ready to work with anyone in Congress who is serious about supporting children and families,” said Rep. Dean Phillips (D-Minn.), co-lead on the legislation. “And ask my colleagues to stop using women’s bodies, freedoms and futures to score political points.”

Meanwhile …

The House Energy and Commerce health subcommittee advanced bipartisan legislation by Reps. Lloyd Doggett (D-Tex.) and Fred Upton (R-Mich.) aimed at increasing transparency and modernizing a federal program established to compensate Americans for vaccine injuries. 

In other health news

  • On tap today: Second gentleman Doug Emhoff will become the first of the four White House principals to receive his updated omicron-specific coronavirus booster. He will be joined by coronavirus czar Ashish Jha, who will also be getting the shot, per Axios.
  • The CDC opened applications yesterday for its monkeypox vaccine equity pilot program to reach disproportionately affected populations who may face barriers accessing the shot.
  • The Drug Enforcement Administration launched inquiries into telehealth company Done Global Inc.’s alleged practice of prescribing stimulants like Adderall for the treatment of attention-deficit/hyperactivity disorder — drugs the U.S. government classifies as controlled substances, the Wall Street Journal reports.
  • Some patients who seek medical care after sexual assault are being forced to pay out of pocket for their treatment, despite a federal mandate against such charges for the evidence-gathering portion of their care, according to a new report published in the New England Journal of Medicine.