National

More than 92% of Americans live in a region with unsafe air pollution, which could lead to reduced life expectancy, according to the latest University of Chicago Air Quality Life Index.

Why it matters: Some Americans could add more than a year to their lives if they lived in a place with cleaner air.

Air pollution can affect not only the lungs but also the heart, upper airways and many other organs.

What they're saying: "Don't light things on fire and breathe it into your lungs," Erika Moseson, a pulmonologist on the American Thoracic Society Environmental Health Policy Committee, told Axios.

The details: The most polluted counties in the U.S. are in California.

In Mariposa County, which makes up part of Yosemite National Park; residents could gain 1.7 years of life expectancy if air quality there met new WHO standards, researchers concluded.

The big picture: Improving air quality is tantamount to improving health outcomes, and the U.S. still has a long way to go. 

Most Americans live with unsafe air pollution levels

Some Americans could add more than a year to their lives if they lived in a place with cleaner air.

Illustration of a smokestack with an American flag on it.

Air pollution

More than 92% of Americans live in a region with unsafe air pollution, which could lead to reduced life expectancy, according to the latest University of Chicago <a class="gtmContentClick" data-vars-link-text="Air Quality Life Index" data-vars-click-url="https://aqli.epic.uchicago.edu/news/most-of-the-world-breathes-unsafe-air-taking-more-than-2-years-off-global-life-expectancy/" data-vars-content-id="152de5ce-7616-471d-b263-3853467665f3" data-vars-headline="Most Americans live with unsafe air pollution levels" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://aqli.epic.uchicago.edu/news/most-of-the-world-breathes-unsafe-air-taking-more-than-2-years-off-global-life-expectancy/" target="_blank">Air Quality Life Index</a>.Why it matters: Some Americans could add more than a year to their lives if they lived in a place with cleaner air.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Colorado is reviving an old progressive health care goal with a new twist, creating a public health insurance option that could be a model for other states trying to expand affordable coverage as they move past the pandemic.

Why it matters: Using flexibilities the Biden administration granted on Thursday, the state is trying to prove a government-run health plan can attract more consumers and save money while avoiding the political pitfalls associated with single-payer systems.

Driving the news: Colorado on Thursday became the first state to get a federal waiver to create a plan called the "Colorado Option" that will be offered on the state's Affordable Care Act exchange starting in 2023.

The plan would compete with private plans on the exchange with premiums that are on average 22.3% lower. 

That's projected to save the federal government $214 million in spending on premium tax credit subsidies next year.

Colorado would also expand a state subsidy program to lower costs for people who aren't eligible for ACA subsidies.

An estimated 32,000 residents could gain coverage through the option by 2027, when the waiver expires. 

The big picture: Washington state is the only state with a public option, but Nevada, Oregon and Connecticut are weighing whether to follow suit.

"We encourage all states to consider innovative ways to use section 1332 waivers in the future to expand and improve coverage and lower costs for their residents," CMS administrator Chiquita Brooks-LaSure said in a statement.

Yes, but: Washington's plan, which dates to 2019, has run into snags, including hospitals unwilling to voluntarily participate because of low payments and policies that tie reimbursements to Medicare rates. 

Private insurers have also balked at contracting with the state and participating in the plan, in part because hospitals were wary.

Washington officials are trying to fill coverage gaps in some underserved areas and set rates for next year to ensure every county in the state will have a public option plan.

Data from the Washington Health Benefit Exchange show that more Washington residents chose public option plans, called Cascade Care, in 2022 than in 2021.

In 2021, just 12% of people with plans on the exchange chose a Cascade Care plan, but in 2022, nearly a third of exchange plan customers chose a state-designed plan.

The intrigue: Colorado is trying to avoid some of the biggest problems that Washington encountered hit.

The biggest difference is insurers that offer ACA exchange plans in a county will also have to offer a Colorado Option for both individual and small-group coverage at the outset. 

"That means everyone essentially will have a Colorado Option which makes their presence more significant," Krutika Amin, associate director of the ACA program at the Kaiser Family Foundation, told Axios.

Colorado public options plans will also need to meet network adequacy requirements, to ensure there are enough providers.

Flashback: Centrist Democrats in Congress rejected putting a public option in the Affordable Care Act more than a decade ago.

The idea began to enjoy a revival before the pandemic, and Colorado Gov. Jared Polis signed legislation last year to set in motion his state's version of a government-run plan. 

President Biden touted a public option during his 2020 campaign, to build on the coverage gains of Obamacare.

What we're watching: The end of the COVID-19 public health emergency could alter prospects for state-based health plans, as thousands of people who have stayed on Medicaid plans throughout the pandemic might no longer qualify. 

It remains to be seen whether that population can find affordable coverage on state marketplaces.

States like Colorado are hoping to bridge that gap with subsidies for those at certain income levels who enroll in the Colorado Option.

The bottom line: Other states will be closely watching the experience in Colorado and Washington as the nation transitions away from the public health crisis and the uninsured population is expected to grow.

Colorado bets on a public option to grow health coverage

CMS approved Colorado's waiver to offer a 'Colorado option' state health plan, starting in 2023.

Illustration of a stethoscope in the shape of a Colorado flag

Health insurance marketplaces

Health care costs

Affordable Care Act

Colorado is reviving an old progressive health care goal with a new twist, creating a public health insurance option that could be a model for other states trying to expand affordable coverage as they move past the pandemic.Why it matters: Using flexibilities the Biden administration granted on Thursday, the state is trying to prove a government-run health plan can attract more consumers and save money while avoiding the political pitfalls associated with single-payer systems.

The Food and Drug Administration is poised to sweep Juul e-cigarette products off store shelves, the Wall Street Journal reported on Wednesday, in what could be a major turning point for an agency that's taken a sluggish, at times disjointed approach to regulating the vaping industry.

Why it matters: The move, coming amid a push to cap nicotine in cigarettes, may signal the Biden administration is ready to try to put tobacco use behind us.

Where it stands: The FDA is ready to deny Juul a marketing order for its menthol and tobacco-flavored products after a two-year review that weighed the products' benefits for adult smokers against risks to teens, the WSJ reported, citing people familiar with the matter.

Juul has been in regulatory limbo for several years, even while its market share swelled, driven in part by flavored products popular among teens.

Now, all e-cigarette products must go through pre-marketing reviews at the FDA, which missed a court-ordered deadline last fall to decide which products could be sold. 

The agency reviewed many smaller manufacturers' products, denying close to 1 million, but hasn't yet ruled on Juul. 

What they're saying: The FDA wouldn't confirm or deny the WSJ report or provide a status on its Juul deliberations. 

Juul did not respond to emailed request for comment.

Groups that oppose youth smoking say taking the company off the market would mark a dramatic step to discourage youth smoking.

"This is a most-welcomed and a long-overdue decision," Erika Sward, assistant vice president of advocacy for the American Lung Association, told Axios.

"FDA should have acted years ago, but if it acts now and we do more to educate young people, this is a reversible epidemic," Matt Myers, president of the Campaign for Tobacco-Free Kids, told Axios.

Background: A 2016 FDA rule required makers of tobacco products to submit applications for products made after 2007.

A court ordered the FDA to make decisions by September 2021. After the agency missed the deadline, the American Lung Association and other advocacy groups and pediatricians successfully sued to speed up the process. 

Now, all e-cigarette manufacturers have to show products are "appropriate for the protection of public health," per the FDA.

Congress also recently gave the FDA the authority to regulate synthetic nicotine products, which are subject to the same application requirements.

Flashback: The FDA banned Juul flavored products as part of a bigger crackdown on flavored vapes, prompting many teens to use disposable e-cigarettes and menthol-flavored products that are still sold.

From February 2020 to February 2022, disposable e-cigarette sales increased by 215.4%, data from the CDC Foundation show, and more than half of youth who reported smoking in 2021 used disposable e-cigs.

Public health groups say it's important for the FDA to finally have a clear, consistent policy on vaping, without loopholes.

The other side: The e-cigarette industry is worried regulators will take a carte blanche approach to policing its products.

Juul's application process involved nearly two years of submitting data and evidence to the FDA, WSJ reported, and industry leaders say its data was sound.

"If that level of science isn't sufficient, it begs the question of what is," Tony Abboud, executive director of the Vapor Technology Association, told Axios.

E-cigarette industry groups are calling on the FDA to go after bad actors that are skirting the review process.

The industry also claims its products are used successfully to wean adult smokers off cigarettes, and that removing e-cigarettes from the market will force people to return to cigarettes again.

"FDA's staggering indifference to ordinary Americans and their right to switch to the vastly safer alternative of vaping will surely rank as one of the greatest episodes of regulatory malpractice in American history," American Vapor Manufacturers Association President Amanda Wheeler said in a statement.

Context: Juul's rise in popularity from 2017 to 2019 coincided with more than a million teens getting hooked on nicotine, while flavored vape cartridges and pods were still available.

A study in Pediatrics assessed found most new tobacco use during that time was among teens using e-cigs.

"There was no evidence that [older] smokers were using them," John Pierce, one of the study authors, told Axios.

What's next: The FDA still has many products to review and a bipartisan group of lawmakers in Congress is calling on the agency to expedite the process and take aim at addictive products marketed towards teens.

The bottom line: If Juul is pulled from the market, health risks to youths will have trumped arguments for using e-cigarettes as cessation products.

FDA may toss Juul e-cigs from store shelves

With pressure from Congress and health groups mounting, FDA may order Juul to take its products off the market this week.

Illustration of a juul device forming a "no" symbol with a cloud of vapor around it

Vaping

Public health

The Food and Drug Administration is poised to sweep Juul e-cigarette products off store shelves, <a class="gtmContentClick" data-vars-link-text="the Wall Street Journal reported on Wednesday" data-vars-click-url="https://www.wsj.com/articles/fda-to-order-juul-e-cigarettes-off-u-s-market-11655904689?mod=hp_lead_pos3" data-vars-content-id="4c02a3ee-8336-4386-a125-ca6944b7e57b" data-vars-headline="FDA may toss Juul e-cigs from store shelves" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.wsj.com/articles/fda-to-order-juul-e-cigarettes-off-u-s-market-11655904689?mod=hp_lead_pos3" target="_blank">the Wall Street Journal reported on Wednesday</a>, in what could be a major turning point for an agency that&#x27;s taken a sluggish, at times disjointed approach to regulating the vaping industry.Why it matters: The move, coming amid a push <a class="gtmContentClick" data-vars-link-text="to cap nicotine" data-vars-click-url="https://www.axios.com/2022/06/22/biden-administration-take-buzz-cigarettes" data-vars-content-id="4c02a3ee-8336-4386-a125-ca6944b7e57b" data-vars-headline="FDA may toss Juul e-cigs from store shelves" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/06/22/biden-administration-take-buzz-cigarettes" target="_self">to cap nicotine</a> in cigarettes, may signal the Biden administration is ready to try to put tobacco use behind us.

The nation's biggest physicians group is joining calls for the FDA to make birth control pills accessible over the counter.

Why it matters: With abortion rights in flux, physicians are joining reproductive health advocates in urging increased access to oral contraceptives, which could join already approved emergency contraceptives, like Plan B, on pharmacy shelves.

"It takes on a new urgency as we look down the path of having the loss of the right to abortion in this country," Dana Singiser, co-founder of the Contraceptive Access Initiative, told Axios.

Details: The American Medical Association at its annual meeting opted to follow the American College of Obstetricians and Gynecologists and urge the FDA to make birth control pills available over-the-counter to Americans, without an age restriction.

Two drug companies have been in discussions with the FDA for years to bring their birth control pills to this point, the New York Times reported last year.

The AMA expects HRA Pharma to formally apply to the FDA for over-the-counter clearance before the end of the year. It completed its final testing phase in 2021.

Doctors push to make birth control available without prescription

Physicians are joining reproductive health advocates in urging increased access to oral contraceptives on pharmacy shelves.

Illustration of contraceptive pills with an inequality sign overlaid on top.

Birth control

The nation&#x27;s biggest physicians group is joining calls for the FDA to make birth control pills accessible over the counter.Why it matters: With abortion rights in flux, physicians are joining reproductive health advocates in urging increased access to oral contraceptives, which could join already approved emergency contraceptives, like Plan B, on pharmacy shelves.

Data: CDC National Center for Health Statistics; Chart: Kavya Beheraj/Axios

Extreme heat is increasingly taking a toll on children, pregnant people and other vulnerable populations, forcing authorities to roll out new strategies against an environmental threat that dwarfs floods, earthquakes and other natural disasters.

Why it matters: Summers are becoming deadlier as climate change blankets millions in heat waves whose public health consequences were until recently not fully understood.

“The problem with heat and drought is that until they get extreme, we don't really see the impact on the landscape that would typically trigger our risk response,” said Ashley Ward, senior policy associate at Nicholas Institute for Environmental Policy Solutions at Duke University.

Go deeper: Heat-related illness develops when the body can't sufficiently cool down or when a person’s temperature exceeds 106 degrees F — a point at which organs can shut down and people can become permanently disabled.

From 2018 to 2020, 3,066 people died from heat-related causes in the United States, per the CDC, with the highest toll among persons aged 55 and older.

Children will experience 35 times more life-threatening extreme heat events than kids born about 60 years ago, according to research published this year that tracked heat exposure and emergency department visits. 

Pregnant women exposed to heat for extended periods are also at increased risk for miscarriages, premature births and other complications, an analysis in the British Medical Journal found. 

Between the lines: Social determinants of health like income and health literacy heavily factor in who's most at risk as heat waves increase in intensity, duration, and frequency.

In Miami, communities with less shade and more heat-retaining building materials that experience the worst impacts tend to have been "redlined."

A new CDC report detailed barriers older adults and other vulnerable residents in Maricopa and Yuma counties in Arizona faced accessing cooling centers, noting the disproportionate burden on the homeless, nonnative English speakers and communities of color.

Poverty also plays a role, with those unable to afford air conditioning, including mobile home residents, at increased risk of heat-related illness, researchers who mapped Miami's extreme heat map found.

What's happening: OSHA in April published new guidance that provides a framework for protecting agricultural workers and others who may experience sustained exposure to heat while on the job.

Federal inspectors could for the first time make unannounced visits to ensure workers are safe, per E&E News.

OSHA offices in parts of the Midwest that were swamped by a recent heat wave issued warnings to protect workers, including training on the hazards of heat exposure and having an emergency plan when a worker shows signs of heat-related illness.

Local response: More local health departments are preparing extreme heat plans for residential areas, targeting "heat islands" and directing messaging at the most at-risk locales. 

"We created a whole toolkit that we're going to start alerting community organizations, talking about what we have available," Cheryl Holder, co-chair of the heat health task force in Miami, said.

Health officials also are enlisting local physicians and other providers in raising awareness about heat-related conditions.

In Los Angeles, the local health department partnered with a regional climate action collaborative to launch a social media campaign around the health risks of heat, said Elizabeth Rhoades, climate change program director at Los Angeles County Department of Public Health.

It's about "how to get people to think about the fact that the extreme heat their experiencing is linked to climate change," Rhoades told Axios.

Don't forget: Beyond the messaging, experts say extreme heat has consequences for local health care systems.

Heat-related emergency department visits in Los Angeles County have steadily increased in recent years, data from the health department show.

In 2015, there were 456 visits to Los Angeles County emergency departments for heat stroke, exhaustion or cramps; by 2018, there were 1,349 visits for heat-related illness.

The bottom line: Efforts to address the health impacts of extreme heat are not confined to the Sun Belt.

Most of the country has already experienced the first big heat wave of the summer, and things are projected to only get hotter, Axios' Andrew Freedman writes.

Areas unaccustomed to the threat of extreme heat like the Pacific Northwest have learned the hard way in recent years how heat waves can bring excess deaths and hospital visits.

"We do have to have structural change, the OSHA guidelines are a good example," Duke University's Ward said. "But there's also a role for communities and public servants to play."

Extreme heat's health consequences

Rising temperatures can lead to hospitalizations and deaths, particularly among the most vulnerable.

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Arielle Dreher

Stories

Colorado bets on a public option to grow health coverage

FDA may toss Juul e-cigs from store shelves

Extreme heat's health consequences

Doctors push to make birth control available without prescription

Most Americans live with unsafe air pollution levels