This Week in Congress

House and Senate

Lawmakers will return to Washington for legislative business in September. The Senate returns on the 5^th and the House will be back in session on the 12^th.

Appropriations

Continuing Resolution (CR)

When the House and Senate return next month they will only have a few weeks to pass a CR to avoid a government shutdown when the current fiscal year ends on September 30. But passage will be complicated because of House Freedom Caucus demands. The Caucus objects to a CR if the legislation does not address three policy areas: extending the wall on the Southern border; the “unprecedented weaponization” of the Department of Justice and FBI to conduct political “witch hunts”; and “woke” policies in the military. Both House and Senate leaders have expressed support for a short-term CR which could extend funding until December 8, 2023, but passage depends on reaching common ground with all parties.

Supplemental

The President’s original $12 billion supplemental request for disaster assistance is expected to increase as more dollars will be needed due to the Maui fires, storms in California, and other natural disasters expected over the next few months. Another issue that will need to be addressed is the Republicans’ opposition to the Administration’s supplemental request of $24 billion in humanitarian relief and military funding for Ukraine. It is expected that the supplemental will be included in the CR.

Federal News

Dr. Mandy Cohen

Dr. Cohen, the new CDC Director, just one month into her new job, spoke with TIME magazine about what we can expect next in the ongoing government response to COVID-19, the legal battles currently surrounding women’s health, and her vision for the embattled public health agency. The interview has been edited for length and clarity. The interview can be found here

Other Legislation and Happenings Around the Nation

NEW HIV Prevention Drugs

The U.S. Preventive Services Task Force expanded the list of drugs it recommends to prevent HIV infection, triggering an Obamacare provision that will require insurers to provide a new long-acting injectable to patients without a co-pay or deductible starting a year from now. Recommended PrEP options now include Apretude from British drugmaker ViiV Healthcare, which is administered bimonthly.

PrEP

The Health Resources and Services Administration will provide funding to  community health centers to expand access to testing for HIV, treat infections and prescribe PrEP. HRSA will award $18 million to 46 community health centers and another $17 million will go to health centers awarded grants in previous years to sustain their programs.

Abortion

Mifepristone

Any restrictions on mifepristone would have ripple effects for the entire abortion-care system. In 2020, 53% of all facility-based U.S. abortions used medication, rather than surgical methods. If mifepristone becomes harder or impossible to access, providers would either have to change their standards of care to continue offering medication abortions or find a way for an already overburdened clinical network to squeeze in hundreds of thousands of extra procedural-abortion appointments.

Arizona

The Arizona Supreme Court has agreed to review a lower court’s conclusion that abortion doctors can’t be prosecuted under a pre-statehood law that bans the procedure in nearly all cases. The high court decided on Tuesday that it would review the Arizona Court of Appeals ruling that said doctors couldn’t be charged for performing abortions in the first 15 weeks of pregnancy because other Arizona laws passed over the years allow them to perform the procedure. Abortions are currently allowed in Arizona in the first 15 weeks of pregnancy under a 2022 law. (8/23)

Florida

This week health regulators ordered an Orlando abortion clinic to pay a $193,000 fine for violating a law that requires women to wait 24 hours before having abortions, nearly three times the fine recommended by an administrative law judge. The state Agency for Health Care Administration issued a final order requiring the Center of Orlando for Women to pay a $1,000 fine for each of 193 violations shortly after the law took effect in April 2022. Administrative Law Judge Culpepper earlier this year issued a recommended order that said the clinic should pay a $67,550 fine — $350 for each violation. But under administrative law, the recommended order had to go to AHCA for a final decision.

Indiana

Indiana’s near-total abortion ban is set to take effect within days after the Indiana Supreme Court denied a rehearing in the case brought by the American Civil Liberties Union of Indiana. The denial of the rehearing means the ban will take effect once a June 30 ruling upholding the ban is certified.

Nebraska

Planned Parenthood of the Heartland has appealed a judge’s ruling that left a new Nebraska law intact that bans abortions after 12 weeks of pregnancy, and imposes restrictions on gender-affirming surgery. Planned Parenthood filed its appeal with help from the American Civil Liberties Union of Nebraska one week after a judge sided with the state and rejected the challenge to the law Nebraska lawmakers approved earlier this year.

South Carolina

Just months after the exit of its sole female justice, the South Carolina Supreme Court upheld restrictions that would ban most abortions after around six weeks of pregnancy. The decision brings an end to the brief relief abortion rights advocates found in January when then-Justice Kaye Hearn wrote a majority opinion striking down a separate six-week ban tied to a 2021 state law, arguing it violated the state’s constitutional right to privacy. After Hearn’s mandatory retirement, South Carolina was left with an all-male high court.

Texas

Governor Abbott signed a law giving doctors leeway to provide abortions in Texas when a patient’s water breaks too early and for ectopic pregnancies.

West Virginia

West Virginia has the right to block the sale of the abortion drug mifepristone, even though federal regulators have decided the medication is safe, a federal judge ruled this week.  The decision by a U.S. District Judge is a blow to abortion rights groups that had hoped to strike down state bans using a novel and somewhat arcane legal argument invoking an idea known as “federal preemption.”

LBGTQ

Transgender Medical Records (Tennessee/Indiana)

As the HHS Office for Civil Rights investigates the Tennessee Attorney General’s request for transgender patients’ medical records, federal regulators appear to have their eyes on a similar scenario unfolding in Indiana. The personal data leaks occur as the Biden administration struggles to protect personal health information using a confusing maze of regulatory actions without a national data privacy framework in place. OCR is proposing to update its health privacy rules to shield certain personal health data from being used by state law enforcers. The Indiana Attorney General has issued at least three civil investigative demands to health care providers to obtain gender-affirming care information from practices across the state. Indiana state lawmakers passed a medical care ban for transgender minors that no longer allows parents to authorize gender-affirming care for their children, including medications like puberty blockers, hormone replacement therapy and surgeries. The ban on transition-related care for minors partially took effect in July.

Alabama

A U.S. appeals court on Monday revived a Republican-backed Alabama law banning the use of puberty blocking drugs and hormones to treat gender dysphoria in transgender minors. A three-judge panel of the Atlanta-based 11th U.S. Circuit Court of Appeals said that the families and physicians challenging the law “have not presented any authority that supports the existence of a constitutional right” for parents to treat their children with “transitioning medications subject to medically accepted standards.”

Florida

This week the Florida State Board of Education voted to approve new rules at state colleges for transgender employees and students that are intended to comply with a law passed in May restricting access to bathrooms. Colleges will be forced to fire employees who twice use a bathroom other than the one assigned to their sex at birth, despite being asked to leave. And bathroom restrictions also now apply to student housing operated by the colleges.

Georgia

A Georgia state senator is trying to revive a proposal aimed at stopping teachers from talking to students about gender identity without parental permission.

Missouri

Missouri’s Republican Attorney General and the families of transgender children are in court fighting over whether a new law banning minors from receiving gender-affirming health care will take effect as scheduled next week. Lawyers last month sued to overturn the law on behalf of three families of transgender minors, doctors and two LGBTQ+ organizations. They asked a county judge to temporarily block the law as the court challenge against it plays out.

340B

The American Hospital Association has put CMS on notice that its attempts to recoup $7.8 billion from hospitals in order to keep a lump sum repayment and cuts to 340B drugs budget neutral, could open the agency up to additional lawsuits and risk continuing a years-long legal battle that otherwise could be ended with the Supreme Court’s recent decision. CMS in July proposed to repay 1,600 340B hospitals $9 billion to make up for the almost 30% cuts to 340B drug reimbursements that the Supreme Court deemed unlawful — but the agency also proposed an estimated 16 years of 0.5% cuts to the non-drug aspects of the hospital outpatient pay system starting in 2025 to keep the overall payments budget neutral.

Vaccines

Annual Flu Shots

This year’s seasonal flu shot is not yet available but is expected in early September.

RSV

The vaccine is expected to be available in the fall of 2023, when RSV is more common. FDA approved two vaccines for adults 60 and up and another vaccine to protect infants and toddlers who are at high risk for severe disease. In August the FDA ruled that one of the vaccines could be given to pregnant mothers in order to protect their newborns. CDC is recommending a new immunization starting this fall to help protect all infants under 8 months and some older babies at increased risk of severe illness caused by RSV.

COVID-19

The first new COVID-19 vaccines updated for this fall season are now expected to be available by mid-September.

Booster in the Same Arm

When you go to get your newly updated COVID-19 booster this fall, the immune response may be stronger if your booster goes in the same arm as your last COVID-19 shot. The researchers used the data of 303 people who received the mRNA vaccine as well as a booster and found that two weeks after the booster, the number of “killer T cells” was significantly higher in those who had both shots in the same arm, according to the study. Those cells, which attack and destroy the other cells they target, were present in 67% of the same-arm cases and only 43% in people who had their injections in different arms, according to the study.