What we know about the virus that's spreading across the globe.

Coronavirus

What's ahead in a post-Roe v. Wade world.

Axios Explains: Abortion

The developments that matter in how Americans are paying for drugs, treatment, insurance and more.

Health care costs

Opioids

The developments that matter in the fight over Obama's landmark health care law.

Affordable Care Act

The latest in the debate over whether the U.S. should shift to government-funded health care.

Medicare for All

The developments that matter in the fight over e-cigarette use.

Vaping

The developments that matter on issues that affect our immediate safety and health.

Public health

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

National

California Gov. Gavin Newsom (D) continued his pledge to protect abortion access for people both in and outside of California with a new slate of bills signed into law on Tuesday.

The big picture: California is one of several blue states that have rushed to expand abortion access and prepare for an influx in patients following the Supreme Court's decision to overturn Roe v. Wade.

Ensure that pregnancy loss is not criminalized.

Protect people from criminal and civil liabilities in cases of miscarriage, stillbirth, abortion or perinatal death due to causes that occurred in utero.

Prohibits a health care provider from releasing abortion seekers' medical records in response to a subpoena or out-of-state request.

Bars law enforcement and California corporations from cooperating with out-of-state entities in regard to abortion in the state.

Requires health plans to cover certain over-the-counter birth control without cost sharing.

Prohibits employment-related discrimination based on reproductive health decisions.

Expands training options for abortion care.

What he's saying: "An alarming number of states continue to outlaw abortion and criminalize women, and it’s more important than ever to fight like hell for those who need these essential services," Newsom said in a statement that praised the state legislature for being "on the frontlines of this fight."

"We’re doing everything we can to protect people from any retaliation for accessing abortion care while also making it more affordable to get contraceptives," he added.

Worth noting: Newsom previously signed into law a bill to protect abortion providers and patients from bans, lawsuits and penalties in other states.

He recently announced that the state has launched a website to help people access information about abortions, their legal rights and where to find providers.

Go deeper: Abortion looms over 2022 state ballots

San Francisco

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A daily look at the most significant and interesting stories affecting San Francisco.

Axios San Francisco Thought Bubble

Axios San Francisco

Newsom signs another slate of abortion protections into law

The new laws ensure medical records stay private and prevent law enforcement from working with out-of-state entities on abortion.

Photo of Gavin Newsom speaking while gesturing with his hands

California Gov. Gavin Newsom speaks during the United Nations Climate Action: Race to Zero and Resilience Forum in New York on Sept. 21, 2022. Photo: Michael Nagle/Bloomberg via Getty Images

Abortion

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

President Biden doubled down on his pledge to lower health care costs on Tuesday, touting a Medicare premium drop for 2023 while slamming Republicans for opposing the Inflation Reduction Act and its drug cost controls.

Driving the news: The Biden administration announced Tuesday that the monthly premium for outpatient care coverage under Medicare will drop roughly 3% in 2023.

Medicare imposed a steep premium hike this year, in large part due to the high price of an Alzheimer's drug for which it wound up only offering limited coverage.

What he's saying: Pointing to limited drug price negotiations authorized by the IRA, Biden said, "For years many of us have been trying to fix this problem, but for years, Big Pharma has stood in the way."

"This year, the American people won ... Medicare will finally get the power to negotiate lower prescription drugs." 

"Under Donald Trump, my Republican friends had no problem enacting a $2 trillion tax cut that overwhelmingly benefited the wealthiest Americans, the biggest corporations ... and massively increased the federal debt."

"I wish I could say Republicans supported this progress and reducing health care costs and strengthening Medicare ... But they have a very different idea," he said.

Worth noting: Senate Republicans blocked the $35 cap on out-of-pocket spending on insulin for patients enrolled in private insurance.

Biden lauds drop in Medicare monthly premiums

"For years, Big Pharma has stood in the way ... This year, the American people won."

President Biden speaks at a meeting at the White House on Sept. 26, 2022 in Washington, D.C. Photo: Kevin Dietsch via Getty Images)

Medicare

Joe Biden

Reporting on the physical and psychological harms from cancer screenings is inconsistent, making it hard to compare risks with rewards and potentially exposing patients to unnecessary hazards, according to new research published Monday in the Annals of Internal Medicine.

Why it matters: Assessing the tradeoffs is critical, because most of the people screened won't have a detectable disease at the time of screening and will not benefit from early detection.

"If the potential for severe harm is great, or there is a low likelihood of detecting a cancer earlier when it can be treated more successfully, then screening may do more harm than good," said study co-author Paul Doria-Rose, chief of the health care assessment research branch at the National Cancer Institute.

State of play: Guidance on screenings has generally played up the health benefits, the authors wrote.

But they noted there also are immediate and longer-term burdens, including the potential for diagnoses or additional procedures. For example, a biopsy may be accompanied by risk of bleeding, infection, or by patient anxiety over a possible future illness.

Details: The study focused on screenings for breast, cervical, colorectal, lung and prostate cancer and compared guidelines from multiple health organizations.

When looking at the frequency of risk reporting, researchers "saw inconsistency" in how harms were reported for different organ types.

Minor and moderate harms like dizziness, fainting, bleeding and bruising were mentioned in less than 50% of guidelines for breast, lung and prostate cancer. 

At the same time, serious harms — such as hospitalization and death — from screenings were mentioned in less than 50% of guidelines for breast, colorectal or lung cancer.

Reporting on consequences was most complete for prostate cancer screening and least complete for colorectal cancer screening.

Zoom in: The study also considered whether the magnitude of the consequences were recorded and if numerical measures were used.

Researchers recommend that cancer screening guidelines include quantitative estimates because they are "more informative and precise than terms like "high" or "low."

What they're saying: "Thorough reporting of harms alongside benefits provides clinicians and patients with more complete information to support decisions about screening," Doria-Rose said.

Study finds gaps in reporting harms from U.S. cancer screenings

Poor harm reporting from cancer screenings could lead to patients being exposed to unnecessary risks.

Picture of a doctor and patient during a cancer screening

Photo: Heather Charles/Chicago Tribune/Tribune News Service via Getty Images

Cancer

Axios Vitals

The first White House nutrition summit in a half-century is due to kick off on Wednesday at a difficult political moment, with President Biden eager to put his imprint on food policy but areas for bipartisan cooperation scant.

Why it matters: The gathering, patterned on the summit former President Richard Nixon convened in 1969, comes after America's health vulnerabilities were laid bare by the pandemic.

Obesity and other food-related diseases like diabetes were closely linked with a far higher risk of serious illness and death from COVID.

The COVID public health emergency also allowed more families to access food via safety net programs like the Women, Infants, Children program and the Supplemental Nutrition Assistance Program, as well as free or reduced-price school lunches. Food insecurity, especially in children, has been found to be associated with worse health outcomes, such as asthma and diabetes. 

Biden has said he wants to end hunger and food insecurity by 2030. 

The big picture: Nixon's summit wound up shaping decades of food policy —  even sparking the creation of such programs as WIC and SNAP.

"The 1969 conference was considered a huge success, but many factors contributed to the success including strong political will from the White House and from Congress," Frank Hu, a Harvard professor of nutrition and epidemiology told Axios. "I think we are at another historical crossroads facing unprecedented challenges but it may take some years to achieve a similar impact." 

What to expect: Sodium warnings and medically tailored meals are among the topics that will likely surface.

While many proposals are built around executive branch actions, there's a long wish list for Congress in a plan the White House released this morning. 

The 40-page document calls for for school meals for all, nutrition and obesity counseling for Medicare beneficiaries, a permanent extension of the child tax credit and expansion of SNAP, WIC and summer EBT programs.

It envisions the FDA developing a front-of-package food labeling scheme, bringing WIC and SNAP shopping online and screening individuals for food insecurity at federal health facilities. 

 Senior administration officials during a Monday press call expressed the hope there would be some areas for some bipartisan consensus.

Between the lines: As we saw with COVID, this will be an opportunity for the administration to highlight pledges for assistance from private companies.

"It's one of the first times the White House has taken obesity seriously," Andres Acosta, CEO of Mayo Clinic spinout Phenomix Sciences, which specializes in obesity treatment, told Axios. 

Acosta is most interested in promoting what's come to be known as precision nutrition. "We need to stop saying one thing fits all. That 'We should all do the 'MyPlate, we should all do my MyPyramid. We should all do the same.' We need to find personalized nutrition: What's right for me?" 

Our thought bubble: It's possible a few of the least controversial requests could be tucked into a year-end spending deal.  

Biden revives the nutrition summit — but don't expect as much this time

White House nutrition summit might not result in as many policy changes.

Illustration of a silver cloche being lifted to reveal the capitol building

Nutrition

A deal to renew funding for Food and Drug Administration drug and device evaluations will move forward this week, but without additional reforms to increase oversight of dietary supplements, lab-developed tests and other areas, congressional aides said Monday.

Why it matters: The "clean" extension of FDA user fees for five years means the agency will avoid having to send out furlough notices to its staff. But it indefinitely forfeits the chance to expand the FDA's regulatory purview.

Between the lines: The deal, first reported by STAT, follows the wishes of top Republicans like Senate Minority Leader Mitch McConnell (R-Ky.) and Senate HELP Committee Ranking Member Richard Burr (R-N.C.), who had pushed for the "clean" extension ahead of a Sept. 30 deadline. It will be passed with a stopgap spending bill to keep the government running.

Still, Democrats set up the prospect for a year-end showdown, renewing smaller FDA programs only through Dec. 16, meaning agency issues would have to be revisited in an end-of-year funding package. 

Bigger policy changes could include increased oversight of supplements and cosmetics, as well as reforms to a fast-track drug approval process that has come under scrutiny after the approval of a controversial Alzheimer's drug.   

The bottom line: At least for now, funding for the FDA's work is continuing without efforts to increase oversight. 

"It's difficult not to note that the effect of reauthorizing only the fees is to move forward those parts of the bill negotiated privately with industry ... and to sideline reforms that mostly would increase oversight and could benefit patients," tweeted Rachel Sachs, a health law expert at Washington University in St. Louis. 

Congress moves forward with "clean" deal to fund FDA

The deal follows the wishes of top Republicans like Senate Minority Leader Mitch McConnell.

Illustration of falling pills surrounded by abstract shapes and sections of dollars.

Health care

A Supreme Court case that takes up Medicaid recipients’ ability to sue providers is providing a new battleground over patients’ rights and could potentially open the door to erosion of the program's benefits.

Why it matters: The outcome could decide if tens of millions of people in public welfare programs can go to court if essentials like health care and food are endangered, experts say. That option is generally more efficient than waiting for the federal government to intervene.

Catch up quick: Justices last May agreed to review the case, Health and Hospital Corp. v. Talevski, which was brought by the wife of a Medicaid patient with dementia who sued his nursing home, alleging abuse and violations of his rights.

The nursing home successfully argued in a lower court that federal rules for Medicare and Medicaid recipients originate from the government's spending powers and amount to contracts between the government and providers. By that reasoning, individuals can't sue for the entitlements the program promises, per Reuters.

But the 7th U.S. Circuit Court of Appeals last year reversed the decision, finding precedent for a right to sue, including situations in which hospitals took states to court over Medicaid reimbursement rates. 

A ruling limiting or overturning the right to go to court could extend beyond Medicaid, to CHIP, the Supplemental Nutrition Assistance Program, Head Start and other programs, congressional Democratic leaders wrote in a brief filed Monday. 

The big picture: Conservative judges and lawyers have long argued that health providers or individuals shouldn't be able to sue over Medicaid coverage decisions.

Arguments in the Medicaid case, set for Nov. 8, will come at a volatile time, after the conservative supermajority struck a federal right to abortion and touched off a fierce national debate about equity, both in the health system and in the courts, experts say.

"The Supreme Court has put the nation at a crossroads where access to abortion and reproductive rights are concerned. Now, it appears, we are also at a turning point on equal justice, looking at a time when state officials will be able to simply suspend Medicaid enrollment or deny covered treatments without having to face the prospects of a court injunction," health law professors Sara Rosenbaum and Timothy Jost wrote earlier this year in Health Affairs.  

What they're saying: "Eliminating Congress's right to establish these private enforcement mechanisms will leave federal-state programs with limited oversight. And individual violators will be effectively immunized from suit," the Democratic lawmakers wrote in their amicus brief.

The other side: Indiana is leading 22 states in arguing the court should block private citizens from using the courts to enforce contractual conditions that stem from federal spending laws.

"Permitting private actions to enforce federal conditions based on implied rights erodes that foundational limitation on Congress's Spending Clause power," the states wrote. 

SCOTUS' latest health care tempest

The outcome could decide if people in public programs can go to court if essentials like health care are endangered.

Illustration of a caduceus with a gavel in the center. 

Medicaid

Axios Finish Line

It’s often easy and quick to do something small to help someone, but we rarely do it.

Why it matters: We underestimate the value of small and random acts of kindness until we’re on the receiving end of one.

Let's hear from Axios readers who paid it forward recently...

"I was next up in a long, slow line at a service desk with a single clerk. The person being waited on was harrumphing his displeasure at the speed of resolving his complicated transaction. After a few minutes it was my turn, and I said, 'I have all the time in the world, would you like to take a moment to breathe?'" –Key H., Jackson, Mississippi

"Last night, a lady I don’t know was lugging laundry and supplies to the laundry room at Oceanside RV Resort. I offered to put in the code to unlock and open the door for her. She was pleasantly surprised and said, 'A thousand blessings to you!'" –Jackie R., Mesa, Arizona

"I was out on a morning run around Queen Elizabeth Park in Vancouver, when I was stopped by an elderly woman asking for directions. She struggled to speak English, but was acting as the lead and translator for her group of friends. ... I paused my run and volunteered to walk them. The experience highlighted how easy it is to make positive connections with others, despite age, language, and cultural barriers." –Georgia M., Vancouver, British Columbia

"It was late in the evening; I stopped at a local Wawa to grab a sweet treat. There were about 5 people in the store. I got my milkshake, and asked the cashier to ring up everyone behind me in line on my tab. For a mere $21 dollars, the gesture appeared to invoke great joy — and some bewilderment." –Lisa C., Ortley Beach, New Jersey

"I stopped at Sierra College in Rocklin, one of the evacuation centers for the Mosquito Fire. Some said they really needed food for their pets, so I went to Costco and bought a couple hundred pounds of dog food and brought it back for distribution. My dogs eat well and theirs should too." –Beth Ann G., Rocklin, California

"My wife and I took our single mom friend out on Saturday night for dinner, drinks and dancing. She's struggling to make ends meet and deal with her boys' upbringing. So she was happy to get out and dance and relax a bit." –Dave M., Scottsdale, Arizona

"A lady with two small children in front of me in the checkout line was unable to pay for her groceries. I told the cashier to add her items to my bill. The kids were happy, and their mom thanked me several times. We all left the store with a smile on our face." –Tom S., Mahtomedi, Minnesota

"Waiting in line at the pharmacy, I was feeling irritated. The woman in front of me asked if I could hold her place for a minute, and I overheard her asking an employee if they had any masks as she forgot hers. It occurred to me that I had stashed one in my bag, and I remember reading about 'pay-it-forward' in Axios Finish Line, so I offered it to her and she was so grateful." –Heather N., Portland, Oregon

"We were in the drive-thru of a fast-food restaurant, [and] I noticed [the passenger behind me] was wearing a "Navy Veteran" hat. I paid for his order and asked the cashier to just tell him it was from one veteran to another. The Navy vet gave me a thumbs-up when he got to the pay window." –Robert T., Rock Hill, South Carolina

This is the culmination of a three-part Axios Finish Line series on kindness: 

Check out Part 1 on the scientific case for random acts of kindness, and Part 2, where readers shared the small favors and gestures that have brightened their days over the years.

The bottom line: Let's all keep spreading the good — and that kindness will reverberate back to us.

Axios Finish Line: Spreading kindness

Illustration of a pointed finger reaching out and poking a smile face

Mental health

Providers hit Biden admin with new surprise billing court challenge

Almost 10 months after the law protecting patients from unexpected medical bills took effect, key details have yet to be settled.

Illustration of an opened envelope with a billing statement inside and confetti spilling out.  

Overdoses per 100k users of medical services,&nbsp2021

Data: FAIR Health; Map: Erin Davis/Axios Visuals

While men were far likelier to be diagnosed with a substance use disorder during the pandemic, women were more likely to overdose, according to a new FAIR Health analysis provided to Axios.

Why it matters: The study of private insurance claims shows the rising burden of substance use across the U.S.

The percentage of patients with a substance use disorder diagnosis decreased from 3.5% of all patients in 2019 before the pandemic to 3.4% in 2021.

Yes, but: The number of patients with an overdose diagnosis increased 4.3%.

From 2019 to 2021, 42 states saw an increase in the proportion of patients with opioid and opioid-like drug overdoses compared to the total number of patients using medical services, ranging from 148.4% in Pennsylvania to 0.7% in Minnesota.

New Mexico and Oklahoma had the highest proportion of patients with an overdose diagnosis over that period.

Between 2016 and 2021, about 62% of substance use disorder diagnoses were among males. 

In that same period, about 60% of overdose diagnoses were among females.

Women were more likely to overdose during COVID pandemic

The study of private insurance claims shows the rising burden of substance use across the U.S.

A map showing overdoses per 100K users of medical services by state

Canada announced Monday it will drop all of its COVID-19 pandemic travel and border restrictions starting Oct. 1. 

Why it matters: The decision to drop the restrictions stemmed from the country's vaccination, hospitalization and death rates and the availability of vaccine boosters.

What they're saying: "Thanks largely to Canadians who have rolled up their sleeves to get vaccinated, we have reached the point where we can safely lift the sanitary measures at the border," Jean-Yves Duclos, Canada's minister of health, said in a statement.

"However, we expect COVID-19 and other respiratory viruses will continue to circulate over the cold months, so I encourage everyone to stay up-to-date with their COVID-19 vaccination, including booster doses and exercise individual public health measures," Duclos added.

Details: Starting Oct. 1, travelers will no longer be required to submit public health information through a government app or website, provide proof of vaccination, take pre- or on-arrival tests or quarantine or isolate.

People will also no longer have to wear masks on planes and trains, though they are "strongly recommended" to still wear one, the Canadian government said.

Go deeper ... WHO official: "Blood on your hands" if world stops tackling COVID

Canada to drop all COVID-19 travel and border restrictions

People will no longer have to wear masks on planes and trains in the country.

People waiting for flights in the Toronto Pearson International Airport in July 2022.

People waiting for flights in the Toronto Pearson International Airport in July 2022. Photo: Steve Russell/Toronto Star via Getty Images

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