The U.S. Department of Health and Human Services (HHS) Office for Civil Rights and the Centers for Medicare & Medicaid Services (CMS) recently issued a final rule under Section 1557 of the Affordable Care Act to strengthen nondiscrimination protections and advance civil rights in health care. This rule offers protections against discrimination based on race, color, national origin, sex, age, and disability. This rule also reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

Among other provisions, the 1557 final rule:

• Holds HHS health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
• Requires covered health care providers, insurers, grantees, and others to let people know that language assistance and accessibility services are available to patients at no cost.
• Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency and individuals with disabilities.
• Protects patients from discriminatory health insurance benefit designs made by insurers.
• Clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools.

For more information about this new rule and how it may affect consumers, visit the resources below:

• Fact sheet and FAQ
• Press release
• Final rule in the Federal Register

The $20 million Digital Connectivity Technology Program, which will distribute laptops to community institutions to help connect Pennsylvanians who lack digital technology, will accept applications beginning June 20 through August 19. The Pennsylvania Governor Shapiro Administration is committed to closing the digital divide in the Commonwealth.

 The Pennsylvania Broadband Development Authority (PBDA) Executive Director Brandon Carson announced that the application period for the new Digital Connectivity Technology Program will be open beginning Thursday, June 20 through Monday, August 19, 2024. Online applications can be made through the PBDA website starting June 20.

Through the new program, the PBDA will purchase and distribute $20 million in laptops for eligible public-facing institutions such as libraries, municipalities, workforce training organizations, not-for-profit organizations, and other community anchor institutions located in areas where affordability has been identified as a barrier to broadband adoption and use who will then make them available to individuals who lack the technology needed to access the internet.

The PBDA will begin reviewing Digital Connectivity Technology Program applications on August 20 and anticipates announcing the grant awards in November. Projects are expected to begin in early 2025. Grant recipients are required to make digital skills training available through their own program or the free options on the PBDA website, however end users are not required to participate in a training program.

“We are working hard to provide the resources Pennsylvanians need to make ‘internet for all’ a reality across the Commonwealth,” said Executive Director Brandon Carson. “The Digital Connectivity Technology Program will provide libraries and other community institutions with the technology required to give Pennsylvanians the internet access they need to have better health, education, and economic outcomes.”

Across Pennsylvania there are currently 286,000 households, businesses, schools, and libraries that either have no access or insufficient access to broadband. The funding for the Digital Connectivity Technology Program was made available through the American Rescue Plan Capital Projects Funding, announced by the PBDA in March 2024.

Through the federal Broadband Equity, Access, and Deployment (BEAD) Program the Commonwealth will receive more than $1.16 billion in federal funding to expand broadband in unserved and underserved areas to make sure every Pennsylvanian has access to affordable, high-speed internet. In May, the PBDA received federal approval of its Volume II BEAD Initial Proposal, an important step forward in Pennsylvania’s efforts to invest $1.16 billion in federal funding. The Volume II BEAD Initial Proposal outlines the Commonwealth’s plan to expand internet service for unserved and underserved Pennsylvanians.

In addition to the Digital Connectivity Technology Program and BEAD funding, the Commonwealth also received:

• $204 million in funding through the Capital Projects Fund Broadband Infrastructure Program to connect unserved/underserved areas, and
• $45 million through the Multi-Purpose Community Facilities Program for community projects to construct, acquire, or improve facilities that are open to the public and will directly enable work, education, and health monitoring.

These significant investments are providing the Shapiro Administration with the resources it needs to connect Pennsylvanians to the internet and ensure that no matter where they live across the Commonwealth, they can go to school, start and grow businesses, and access telemedicine.

For a detailed look at the Digital Connectivity Technology Program, please view this helpful program overview and this video presentation.

Visit the Pennsylvania Broadband Development Authority’s website to learn more about its work to close the digital divide in the Commonwealth.

From Becker’s Leadership & Management

President Joe Biden and former President Donald Trump spent a small portion of their 90-minute presidential debate June 27 highlighting issues affecting healthcare leaders, from prescription drug costs to the opioid crisis.

The candidates spent relatively little time discussing healthcare issues or policies to reduce costs, which voters have indicated as a key election issue.

Here are four key healthcare takeaways from the debate, which aired on CNN, with context:

Prescription drug costs: The cost of prescription drugs — which nearly 40% of Americans struggle to afford — came up briefly in the first question of the evening when candidates were asked about the state of the economy and inflation.

The two sparred briefly over who is responsible for lowering the cost of insulin. After Mr. Biden touted capping insulin costs at $35 per month as a win for his administration, Mr. Trump argued he was the one that brought down insulin costs for seniors.

CBS News broke down the claims in a fact check: In 2020, during Mr. Trump’s presidency, Medicare created a voluntary program in which some health plans and insulin manufacturers agreed to cap out-of-pocket costs at $35 per month. By the end of 2021, about half of Medicare Advantage or stand-alone prescription medication plans were participating. When Mr. Biden signed the Inflation Reduction Act into law, insulin costs were capped at $35 per month for Medicare beneficiaries, ending the voluntary program.

In February, drugmakers were selected to begin price negotiations with CMS for 10 of the most expensive drugs in the U.S. Under the Inflation Reduction Act, Medicare Parts B and D have negotiation powers that will apply to the price of a limited number of drugs with no generic or biosimilar competition. Lower prices for the first 10 drugs are slated to take effect in 2026.

Medicare is limited to negotiating prices for 20 drugs per year, though Mr. Biden has said he will work with Congress in a bid to boost those negotiation powers to 50 drugs if he is re-elected.

During the debate, Mr. Trump did not comment directly on the Inflation Reduction Act. He has previously criticized the legislation and said his administration would look to dismantle many of the law’s provisions if he returns to the White House. While speaking at Milken Institute’s Future of Health Summit last fall, Alex Azar, who served as HHS secretary under the Trump administration, criticized Medicare’s drug pricing negotiation powers, citing concerns about stifled innovation and delays in bringing new drugs to the market.

Abortion: The candidates spent around 10 minutes on the topic of abortion, with Mr. Trump reinforcing his view that the legality of abortion belongs in the hands of states to decide, and Mr. Biden vowing to restore the federal right to abortion if reelected.

In June 2022, the Supreme Court overturned Roe v. Wade. Since then, 14 states have enacted a total abortion ban and seven states have gestational limits of 18 weeks or less in place, according to a tracker by the Guttmacher Institute. Mr. Trump said he supports exceptions for “rape, incest and the life of the mother,” and Mr. Biden said he believes decisions about care should be left to physicians.

The Biden administration issued guidance to hospitals following the overturn of Roe v. Wade to clarify that abortion is covered under the Emergency Medical Treatment and Labor Act. The decades-old federal law — which requires hospitals to provide all patients appropriate emergency care, including a medical screening examination and stabilizing treatment, if necessary — has been at the center of legal disputes over whether it preempts state law where abortion is prohibited and does not make exceptions for the health or life of a pregnant person.

Most abortion bans include some kind of exceptions for emergencies, though language in many cases is vague, leaving physicians uncertain of the circumstances in which they should perform the procedures. Lawyers and hospital administrators have said the Biden administration’s focus on EMTALA has done little to clarify guidance for healthcare providers, who feel stuck between the repercussions they face if they violate their state laws and complying with federal law.

Hours before the debate June 27, the Supreme Court ruled in favor of permitting emergency abortions in Idaho — for now. The justices did not settle the larger question of whether EMTALA covers abortions when deemed necessary by physicians to protect the health of a pregnant woman, only that abortions in emergency cases may resume temporarily in Idaho. The case now returns to the U.S. Court of Appeals for the 9th Circuit.

“This is not a victory, it’s a delay,” Nisha Verma, MD, an OB-GYN who works at a hospital in Georgia and often treats women with high-risk pregnancy complications, told The Washington Post in response to the Idaho ruling. “With all this back-and-forth, we aren’t just able to practice medicine. … We have to analyze what the court is saying, which leaves us with more uncertainty.”

Earlier this month, the Supreme Court ruled in favor of the FDA when it upheld the approval of mifepristone, a drug used in about two-thirds of all abortions. When asked whether he would block abortion medication, Mr. Trump said he agrees with the court’s recent decision and that he, “will not block it.”

Medicare: Medicare came up roughly 12 minutes into the debate, including its future under their policy aims.

Mr. Trump made the statement that Mr. Biden’s administration is “destroying Medicare because [undocumented immigrants] are coming in, they’re putting them on Medicare. They’re putting them on Social Security. They’re going to destroy Social Security.”

The Washington Post addressed the claims in a fact check, noting the payroll taxes paid by undocumented immigrants. The Post roughly calculated Social Security payments made by undocumented immigrants at about $27 billion per year recently.

“For Medicare, it should be at least $6 billion, as the Medicare tax is about 23% of the Social Security tax,” the fact check said.

Mr. Biden also accused Mr. Trump of trying to enact cuts to Medicare.

“He wants to get rid of Social Security; he thinks that there’s plenty to cut in Social Security. He’s wanting to cut Social Security and Medicare,” Mr. Biden said, according to CNN.

The New York Times fact checked this claim, noting that Mr. Trump, while previously suggesting he may be open to cuts, has repeatedly pledged to protect Social Security and Medicare.

Medicare’s hospital insurance trust fund is projected to reach insolvency in 2036.

Opioid crisis: Toward the end of the debate, the candidates were asked about the opioid overdose epidemic. According to provisional data from the CDC, there were more than 93,000 overdose deaths in 2020, an increase of more than 30% from the year prior. Overdose deaths remained near record highs in 2023 despite a slight 3% year-over-year decline, the first decrease in five years, according to preliminary CDC data.

Within the opioid class, fentanyl’s potency and increasing presence in the illicit drug market have made it a significant factor in the overdose epidemic. The highly potent synthetic opioid has been a primary driver in the rise of drug-related deaths in recent years. From 2015 to 2022, synthetic opioids, mainly fentanyl, were the leading cause of overdose deaths, increasing more than 7.5 times, according to data from the National Institutes of Health.

Mr. Trump and Mr. Biden were prompted to answer the question: What will you do to help Americans right now in the throes of addiction, who are struggling to get the treatment they need? In asking the question, CNN’s Jake Tapper noted that overdose deaths rose under both of their presidencies.

In his response, Mr. Trump said the country had been making progress in combating drug addiction, and pointed to the COVID-19 pandemic as disrupting progress. He also referenced equipment and drug-detecting dogs at the border.

Mr. Biden said the U.S. needs more machinery at the border that can detect fentanyl and more agents. He added that the U.S. is “coming down very hard in every country in Asia in terms of precursors for fentanyl.”

Neither candidate offered a direct answer on how they will improve access to treatment for those struggling with addiction.

The ultrasound in February that found a mass growing in her uterus and abnormally thick uterine lining brought Jonell Anderson more than anxiety over diagnosis and treatment.

For Anderson and other patients in the rural community of Sandpoint, Idaho who need gynecological care, stress over discovering an illness is compounded by the challenges they face getting to a doctor.

After that initial ultrasound, Anderson’s primary care provider referred her to an OB-GYN nearly an hour’s drive away in Coeur d’Alene for more testing.

Getting care for more serious gynecological issues, like a hysteroscopy, endometriosis, or polycystic ovary syndrome, has become much more difficult in Sandpoint, a town of about 10,000 people in Idaho’s panhandle region. A state law criminalizing abortions drove multiple OB-GYNs to leave town about a year ago.

The effects have been far-reaching. The OB-GYNs who left Sandpoint were also providing care to patients in nearby outlying areas, like Bonners Ferry, a roughly 40-minute drive into Idaho’s northernmost county. Doctors have spoken out about not feeling safe practicing medicine where they could face criminal charges for providing care to their patients. Republican lawmakers in Idaho contend doctors are being used in an effort to roll back the ban, and they declined to amend the law this year.

According to the Idaho Coalition for Safe Healthcare, a group advocating for a rollback of the state’s strict abortion ban, at least two hospitals, including Bonner General Health in Sandpoint, ended labor and delivery services in the 15 months after the state criminalized abortion in 2022. During that same time period, the number of OB-GYNs practicing in Idaho dropped by 22%. The report’s authors noted that many rural residents rely on consultations from medical specialists in urban parts of the state that are already struggling to provide care.

Read more.