Medication abortion, also known as medical abortion or abortion with pills, is an FDA approved pregnancy termination protocol that involves taking two different drugs, mifepristone and misoprostol, for use up to the first 70 days (10 weeks) of pregnancy. Studies show that medication abortion care is safe and effective. This infographic highlights data and policies regarding the availability and effectiveness of medication abortion in the United States. Medication abortion accounts for more than half (54%) of all abortions before nine weeks gestation in the United States.

On April 12, 2021 , the FDA’s Center for Drug Evaluation and Research notified the American College of Obstetricians and Gynecologists (ACOG) that they are suspending enforcement of the Risk Evaluation and Mitigation Strategy (REMS) requirement for mifepristone that requires prescribers to dispense to patients in-person during the COVID-19 emergency. This temporarily allows providers in the 32 states and DC that do not have laws that otherwise ban this practice to dispense mifepristone using the telehealth protocol for medication abortion. The FDA has also undertaken a full review of the REMS for mifepristone and the results of that review are expected later in 2021..

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The Medicare open enrollment period is now underway, and beneficiaries are encouraged to review their coverage options to see if they can get better coverage or lower costs by switching plans. However, about 7 in 10 (71%) beneficiaries say they did not compare plans during a recent open enrollment period, and some groups were even less likely to do so.

Our recent analysis found that among beneficiaries who could be most affected by plan changes from year to year, like beneficiaries in relatively poor health, age 75 and older or under age 65 with long-term disabilities, a larger percentage reported that they did not compare plans during the 2018 open enrollment period. Additionally, a larger percentage of people on Medicare who are Black and Hispanic, with low income, with fewer years of education, or enrolled in Medicaid did not compare plans during a recent open enrollment period. While this could indicate that many enrollees are satisfied with their existing coverage, past KFF analysis has found that many Medicare beneficiaries reported that the process of choosing their Medicare plan was frustrating and difficult, and most do not switch plans.

Source

Seven in Ten Medicare Beneficiaries Did Not Compare Plans During Past Open Enrollment Period

The Senate Appropriations Committee released its FY 2022 State, Foreign Operations, and Related Programs (SFOPs) (links to bill and report) and Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) (links to bill and report) appropriations bills and accompanying reports on October 18, 2021. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID), while the Labor HHS bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).[i] Key highlights are as follows (see table for additional detail):

State, Foreign Operations, and Related Programs (SFOPs):

• Funding provided to the State Department and USAID under the SFOPs bill and through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totals $10.4 billion in the bill, $1.2 billion above the FY21 enacted level, $303 million above the President’s FY22 request, but $288 million below the FY22 House level. Funding for all global health programs at State and USAID either increased or remained flat compared to the FY21 enacted level (the largest increase is for global health security). Several program areas in the Senate bill are below House levels, including bilateral HIV/AIDS, tuberculosis, malaria, and family planning and reproductive health. Details on specific programs are as follows (unless otherwise specified, totals represent funding through the Global Health Programs account):
  • Funding for global health security totals $1 billion in the bill, which is $810 million (426%) above the FY21 enacted level ($190 million), $87 million (10%) above the FY22 Request ($913 million[ii]), and matches the FY22 House level.
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4.7 billion in the Senate FY22 bill, matching the FY21 enacted and FY22 Request levels, but $150 million (3%) below the FY22 House bill ($4.85 billion).
  • The bill includes $1.56 billion as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY21 enacted, FY22 Request, and FY22 House level.
  • Funding for tuberculosis (TB) totals $400 million, $81 million (25%) above the FY21 enacted and FY22 Request level ($319 million), and $69 million (15%) below the FY22 House ($469 million).
  • Funding for malaria through the President’s Malaria Initiative (PMI) totals $800 million, $30 million (4%) above the FY21 enacted and FY22 request level ($770 million), and $20 million (2%) below the FY22 House level ($820 million).
  • The bill includes $941 million for maternal and child health (MCH) programs, an increase of $85.5 million (10%) above the FY21 enacted level ($855.5 million), $61.5 million (7%) above the FY22 Request ($879.5 million), and $61 million (7%) above the FY22 House level ($880 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY21 enacted, FY22 Request, and FY22 House level.
    • Polio funding through the GHP account totals $101 million, $36 million (55%) above the FY21 enacted, FY22 Request, and FY22 House level ($65 million).
    • $139 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, matching the FY21 enacted, FY22 Request, and FY22 House level.
  • Funding for nutrition totals $160 million, $10 million (7%) above the FY21 enacted and FY22 Request level ($150 million), and matching the FY22 House level.
  • Bilateral family planning and reproductive health (FP/RH) funding totals $650 million, $75 million (13%) above the FY21 enacted level ($575 million), $66 million (11%) above the FY22 Request ($584 million), but $110 million (15%) below the FY22 House level ($760 million).
  • Funding for the United Nations Population Fund (UNFPA) totals $55 million, $22.5 million (69%) above the FY21 enacted level ($32.5 million), $1 million (2%) below the FY22 Request ($56 million), and $15 million (21%) below the FY22 House level ($70 million).
  • Funding for the vulnerable children program totals $30.5 million, $5.5 million (22%) above the FY21 enacted and FY22 Request level ($25 million) and $0.5 million (2%) above the FY22 House level ($30 million).
  • Funding for neglected tropical diseases (NTDs) totals $112.5 million, $10 million (10%) above the FY21 enacted and FY22 Request level ($102.5 million), and matching the FY22 House level.
  • The SFOPs bill also includes the following policy provisions and transfer authorities:
    • A permanent repeal of the Mexico City Policy, representing the first time it has been included in the underlying bill in the Senate.
    • A provision directing USAID and the U.S. Global AIDS Coordinator that, for operating units implementing more than one global health program area, at least 10% of each GHP program line is spent on “cross-cutting health systems strengthening activities.”
    • States that up to $100 million be made available under the GHP account for the Emergency Reserve Fund, which is a mechanism that is used to quickly respond to emerging infectious disease outbreaks.
    • Provides the authority to transfer an amount “not to exceed an aggregate total of $200,000,000 of the funds appropriated by this Act” for international infectious disease outbreaks.
    • States that up to $250 million of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.”

Labor, Health and Human Services, Education, and Related Agencies (Labor HHS):

• Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. [iii] Of the known amounts[iv], the Senate bill totals $694 million, which is $17 million above the FY21 enacted level, but $100 million below the FY22 Request and $246 million below the FY22 House level. Funding for all global health programs at CDC and NIH in the Senate bill either increased or remained flat compared to the FY21 enacted level. Several program areas in the Senate bill are below House levels, including parasitic diseases and global public health protection at CDC. Details on specific programs are as follows:
  • Funding provided to CDC for global health through the Labor HHS bill totals $598 million, an increase of $5 million (1%) above the FY21 enacted level ($593 million), $250 million (42%) above the FY22 Request ($698 million), but $245 million (29%) below the House FY22 level ($843 million). All of the increase at CDC compared to FY21 is for polio. Global health funding at CDC includes:
    • $128.4 million for global HIV/AIDS, matching the FY21 enacted, FY22 Request, and FY22 House level.
    • $9.2 million for global tuberculosis (TB), matching the FY21 enacted, FY22 Request, and FY22 House level.
    • $231 million for global immunization, $5 million (2%) above the FY21 enacted, FY22 Request, and FY22 House level ($226 million). Within this total are the following:
      • Funding for polio totals $181 million, $5 million (3%) above the FY21 enacted, FY22 Request, and FY22 House level ($176 million).
      • Funding for CDC’s other global vaccines/measles program totals $50 million, matching the FY21 enacted, FY22 Request, and FY22 House level.
    • $26 million for parasitic diseases and malaria, matching the FY21 enacted level and $5 million (16%) below the FY22 Request and FY22 House level ($31 million).
    • $203 million for the global public health protection program, matching the FY21 enacted level, $100 million (33%) below the FY22 Request ($303 million), and $245 million (55%) below the FY22 House ($448 million).
  • Funding for the Fogarty International Center (FIC) at NIH totals $96.3 million, $12.2 million (15%) above the FY21 enacted level ($84 million) and essentially matching the FY22 Request and FY22 House level.

Resources:

• FY2022 State, Foreign Operations, and Related Programs Appropriations Bill – Bill
• FY2022 State, Foreign Operations, and Related Programs Appropriations Bill – Report
• FY2022 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Bill
• FY2022 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Report

The table (.xlsx) below compares global health funding in the FY 2022 Senate SFOPs and Labor HHS appropriations bills to the FY 2021 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2021” (P.L. 116-260; KFF summary here), the President’s FY 2022 request (KFF summary here), and the House FY 2022 SFOPs and LHHS bills (KFF summaries here and here).

See the KFF budget tracker for details on historical annual appropriations for global health programs.

[i] Total funding for global health is not currently available as some funding provided through USAID and DoD is not yet available.

[ii] The FY22 Request provided $913 million for global health security, of which $905 million was through the GHP account and $8.3 million through the ESF account.

[iii] Funding for global HIV/AIDS and malaria research programs provided through the NIH is not yet known.

[iv] Known amounts include total global health funding at CDC and funding for the Fogarty International Center at NIH.

The Online News Association has named KFF’s Kaiser Health News and The Associated Press winners of its 2021 University of Florida Award in Investigative Data Journalism for their joint project “Underfunded and Under Threat.” The award is one of the highest honors in data journalism.

The joint KHN-AP investigation revealed that public health departments around the country had become understaffed and poorly equipped to confront the worst pandemic in a century. Their analysis found that at least 38,000 state and local public health jobs disappeared since 2008, and spending for local public health departments dropped by 18% per capita since 2010.

The joint KHN-AP investigation revealed that public health departments around the country had become understaffed and poorly equipped to confront the worst pandemic in a century. Their analysis found that at least 38,000 state and local public health jobs disappeared since 2008, and spending for local public health departments dropped by 18% per capita since 2010.

Journalists from both news organizations drew upon more than a dozen data sources to assess hundreds of state and local health departments. Reporters interviewed more than 150 people, surveyed all 50 statehouses, filed dozens of records requests and sorted through legislation across the country.

Even during the height of the coronavirus crisis, many states spent little of their federal covid-19 relief funding on public health departments, and state legislatures continued to undermine the public health system with budget cuts.

KHN and AP also followed the story throughout the pandemic, showing how the politicization of public health measures prompted physical threats against public health workers, with the backlash triggering the largest exodus of public health leaders in American history and a massive legislative rollback of public health powers.

AP and KHN also routinely shared data and offered guidance to news organizations to help them localize the findings of the investigation for their communities. The award — one of many KHN has received over the years — honors work that effectively uses data to tell a story, presents that data well to users and has relevance and journalistic impact.

About KFF and KHN

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

About AP

The Associated Press is an independent global news organization dedicated to factual reporting. Founded in 1846, AP today remains the most trusted source of fast, accurate, unbiased news in all formats and the essential provider of the technology and services vital to the news business. More than half the world’s population sees AP journalism every day.

Hulu’s new miniseries “Dopesick” was built on journalism, and its creators hope it will spark a renewed public discussion about the nation’s opioid crisis, show executives said during a recent panel discussion hosted by KFF’s Kaiser Health News and Hulu.

The event brought together the lead creative powers behind the show along with a journalist from KHN and a policy expert from KFF to unpack the making of “Dopesick” and what the show has to say about the origins of the opioid crisis. KFF’s journalists and policy experts have been tracking the devastating epidemic with on-the-ground stories as well as data-driven analyses for a number of years. The panelists brought their different lenses — creative, journalistic and policy — to focus on the devastating impact of opioids on ordinary Americans and the often ineffective efforts to combat this continuing public health emergency.

The panel discussion, moderated by Chaseedaw Giles, KHN’s digital strategy and audience engagement editor, featured executive producer, writer and showrunner Danny Strong; journalist Beth Macy, who authored the book on which the show is based; KHN correspondent Aneri Pattani, who has reported extensively on opioid policy, substance use and mental health; and KFF senior policy analyst Nirmita Panchal, whose analytical work focuses on mental health and substance use.

“What was unique about my collaboration with Beth is that the journalism side of the process never ended,” Strong said. “We would do interviews together, people would leak documents to us. … It was this unusual process in which we were writing a scripted drama and then simultaneously doing active investigative journalism.”

Macy, who was in the show’s writers’ room full time, said writers would incorporate into scripts revelations from newly released court filings in ongoing cases against Purdue Pharma, the company behind the drug OxyContin, which features prominently in the eight-episode miniseries.

“New documents were coming out all the time,” Macy said. “We would take turns — you go through this, I’ll go through this. And then we would all report back to Danny and decide what the best highlights were.”

In a 40-minute discussion, the panelists explored a wide range of topics about the show and the real-life opioid crisis it depicts, weaving in stories from people Pattani has interviewed for KHN radio and print pieces and findings from Panchal’s analyses. Topics included:

• How the show employed the tools of fiction, such as composite characters, to tell a larger truth

• The important role played by medication-assisted treatment, which combines medications with counseling and behavioral therapy in the treatment of opioid addiction

• The current state of the opioid crisis, marked by a record-high 93,000 deaths from drug overdoses in 2020; the expansion of the problem beyond largely rural, white communities; and the rise of highly addictive synthetic opioids like fentanyl

• The role of politics in the funding for, and availability of, different types of treatment

The economic fallout and social isolation of the COVID-19 pandemic have exacerbated the opioid epidemic, Panchal said. She noted that about 1 in 3 people now say they are experiencing anxiety and depression, compared to about 1 in 10 before the pandemic.

“The job loss, financial hardship, poor mental health — these are things that can often go hand in hand with substance use,” Panchal said.

Pattani noted that there are divisions among political leaders at all levels about how best to tackle the opioid crisis, with some pushing for more medication-assisted treatment, others favoring traditional rehab centers and some emphasizing a criminal justice approach to the problem.

Everyone is representing a district that has constituents affected by this,” she said. “I haven’t talked to a politician who says we don’t need to address the opioid epidemic, but I think they all disagree on how.”

“Dopesick” premiered on Hulu Oct. 13, with new installments of the miniseries available on Hulu every Wednesday. The panel discussion, recorded in KFF’s Washington, D.C., offices without a live audience due to COVID-19, can be viewed anytime on kff.org.

About KFF and KHN

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

About Hulu and “Dopesick”

From Executive Producer Danny Strong and starring and executive-produced by Michael Keaton, “Dopesick” examines how one company triggered the worst drug epidemic in American history. The series takes viewers to the epicenter of America’s struggle with opioid addiction, from the boardrooms of Big Pharma to a distressed Virginia mining community, to the hallways of the Drug Enforcement Administration. Defying all odds, heroes will emerge in an intense and thrilling ride to take down the craven corporate forces behind this national crisis and their allies. The limited series is inspired by The New York Times bestseller by Beth Macy.

The eight-episode series stars Michael Keaton, Peter Sarsgaard, Michael Stuhlbarg, Will Poulter and John Hoogenakker, with Kaitlyn Dever and Rosario Dawson. Guest stars include Phillipa Soo and Jake McDorman.

“Dopesick” is written by Emmy winner Danny Strong (“Empire,” “Recount,” “Game Change”) and directed by Oscar winner Barry Levinson (“Paterno,” “Rain Man”). Executive producers for “Dopesick” include Strong, John Goldwyn (“Dexter”), Keaton, Levinson, Warren Littlefield (“The Handmaid’s Tale,” “Fargo,” “The Old Man”), Beth Macy (“Dopesick”) and Karen Rosenfelt (“Twilight”).

This brief reviews final 2022 premium rate filings for Marketplace-participating individual market insurers in all 50 states and the District of Columbia. Although the ACA individual market represents a small share of the privately insured population, the rate filings for this market are detailed and publicly accessible, making them a useful source of information on how health insurers are thinking about their likely costs for the next year.

Most of the 311 rate filings reviewed,We find that most insurers expect spending and utilization to return to pre-pandemic levels in 2022 and do not expect COVID-19 to affect costs in the individual market. A majority of rate changes for 2022 are moderate, with most insurers posting premium increases or decreases of a few percentage points.

The brief is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

In this column for the JAMA Health Forum, Larry Levitt explores why the Medicaid “coverage gap” still exists in 12 states that have not expanded their Medicaid programs under the Affordable Care Act, why it matters, and why eliminating it could prove challenging.

Most people will need to take time off work to care for themselves or their families at some point, but only one in five (21%) workers have access to paid family leave through their employer. That share is even lower for low-wage and part-time workers, and in certain occupations.

Congress is considering creating a universal paid family and medical leave program as part of the Build Back Better Act, which Democrats are looking to pass through the budget reconciliation process relying on Democratic votes. The proposal guarantees 12 weeks of paid family and medical leave annually to all workers in the United States for several qualifying reasons, including welcoming a new child, recovering from a serious illness, and caring for a seriously ill family member. It’s unclear how the program would be financed or whether more changes will be made as pressure to reduce the cost of the social spending package could limit the bill’s scope.

Source

Universal Paid Family and Medical Leave Under Consideration in Congress

With the Medicare open enrollment period set to begin October 15, a new KFF analysis finds that 7 in 10 beneficiaries (71%) say that they didn’t compare their coverage options during a recent open enrollment season. Twenty-nine percent said they did compare Medicare plans.

But not shopping around can have a big impact on enrollees’ coverage and costs. The Centers for Medicare & Medicaid Services (CMS) recommends that beneficiaries review and compare Medicare plans each year.

The new analysis examines the share of Medicare beneficiaries who compared plans during the 2018 open enrollment period for coverage in 2019, the share who compared drug coverage in Medicare Advantage and stand-alone drug plans, and variation by demographic characteristics, based on an analysis of the 2019 Medicare Current Beneficiary Survey (the most recent year available).

Other key findings include:

• The share of beneficiaries who said they did not compare their options was higher among beneficiaries who are Black (74%) and Hispanic (79%), ages 85 and older (84%), with low incomes (85%), and those enrolled in both Medicare and Medicaid (87%).

• When it comes to Part D drug coverage, 81 percent of Medicare Advantage drug plan enrollees and 72 percent of Medicare stand-alone drug plan enrollees said they did not compare drug coverage offered by their current plan to other plans.

• Nearly half (47%) of all beneficiaries with Medicare said they had never visited the official Medicare website for information, 53 percent reported they had never called the 1-800-MEDICARE helpline and 31 percent said they did not read the Medicare & You handbook.

Medicare beneficiaries with traditional Medicare can compare and switch Medicare Part D stand-alone prescription drug plans or join a Medicare Advantage plan, the privately run alternative to traditional Medicare. At the same time, enrollees in Medicare Advantage can compare and switch Medicare Advantage plans or elect coverage under traditional Medicare with or without a stand-alone drug plan.

Coverage and costs vary widely among both Medicare Advantage plans and Part D prescription drug plans. Plans can change from one year to the next, as can beneficiaries’ health care needs, which could lead to unexpected and avoidable costs, and disruptions in care for beneficiaries who stay put and do not at least review their options annually.

For other Medicare-related data and analyses, including our Medicare Open Enrollment FAQs and our updated Overview of the Medicare Part D Prescription Drug Benefit, visit kff.org. The Medicare open enrollment period runs through December 7.