Gavin Newsom’s government may have been prudent when he acknowledged free speech concerns by signing the California Accord. covid disinformation bill Last failure. V appeal to deputiesThe governor warned of “the chilling effect of other potential laws” on doctors’ ability to speak frankly with patients, but expressed confidence that the one he signs does not cross that line.

However, a law meant to punish doctors who give patients false information about covid-19 is currently in limbo after two federal judges issued conflicting rulings in recent lawsuits that say it violates freedom of speech and too vague for doctors to know what he forbids. tell them to patients.

In two trials, Senior U.S. District Judge William Schubb in Sacramento ruled. temporary stop on the application of the law, but it applies only to plaintiffs in these cases. Schubb said the law was “unconstitutionally vague”, in part because it “fails to provide a person of ordinary intelligence with fair notice of what is prohibited”. His decision last month clashed with the Santa Ana decision in December; in this case, U.S. District Judge Fred Slaughter refused to obey the law and said it is “likely to promote the health and safety of covid-19 patients in California.”

The legal fight in the nation’s most populous state is, to some extent, a continuation of the pandemic-era struggle, in which supporters of public health guidelines are opposing groups and individuals who have resisted masking orders, school closures and vaccination bans.

California’s covid disinformation law, which went into effect Jan. 1, is being challenged by vaccine skeptics and civil liberties groups. Among those suing Get the Law Declared Unconstitutional is a group founded by Robert F. Kennedy Jr., who has been questioning the science and safety of vaccines for years.

But doubts about the law are not limited to those who have fought the scientific mainstream.

Dr. Leana Wen, Professor of Health Policy at George Washington University, who previously served as President of Planned Parenthood and Health Commissioner of Baltimore, wrote in a review weeks before Newsom signed into law that it would have “a chilling effect on medical practice, with wide-ranging implications that could paradoxically impair patient care.”

Northern California branch of the American Civil Liberties Union suspended against the law on the basis of freedom of speech, although the national organization confirmed constitutionality of covid vaccination mandates.

“If doctors are afraid of losing their licenses for giving advice they find helpful and relevant, but they don’t fully understand what the law means, they are less likely to speak openly and frankly with their patients,” said Hanna Kischnik. , an attorney for the ACLU of Northern California.

The law states that physicians who provide false information to patients about covid are acting in an unprofessional manner, which could result in disciplinary action from the California Medical Board or California Osteopathic Medical Board.

Supporters of the law tried to crack down about what they think is the most obvious: doctors advertising treatments such as ivermectin, an antiparasitic that has not been proven effective in treating covid and may be dangerous; who exaggerates the risk of vaccination compared to the risk of disease; or who spread unsubstantiated theories about vaccines, including that they can cause of infertility or damage DNA.

But there is no such specificity in the law, defining disinformation only as “false information that is contrary to modern scientific consensus that is contrary to the standard of medical care.”

Michelle Mello, professor of health law and policy at Stanford University, said the wording was confusing.

“On a subject like covid, science is changing all the time, so what does it mean to talk about scientific consensus?” she asked. “To me, there are many examples of statements that clearly, without any vagueness, meet the definition of the behavior that the legislature adheres to. The problem is that there are a lot of other hypothetical things that people can say that clearly don’t violate it.”

Dr. Christine Cassel, professor of medicine at the University of California, San Francisco, said she expects the law to be enforced only in the most egregious cases. “I trust scientists enough to know where there is a legitimate dispute,” she said.

Kassel’s opinion reflects Newsom’s rationale for signing the law, despite being aware of the potential problems with free speech. “I am confident,” he wrote in his message to legislators, “that the discussion of new ideas or treatments, including the subsequent risks and benefits, does not constitute disinformation or misinformation under the criteria of this bill.”

Plaintiffs in Santa Ana case, two physicians who have sometimes deviated from public health guidelines have appealed Slaughter’s decision allowing the law to remain in place. The case was joined in the 9th U.S. Circuit Court of Appeals with another case in which a San Diego judge declined to rule on a similar request for a temporary suspension of the law.

Newsom spokesman Brandon Richards said in early February that the administration would not appeal two Sacramento cases in which Shubb issued a narrow injunction. Lawyers for the plaintiffs expected the state to appeal the decision, believing that all four claims would then be decided by an appellate court, providing greater clarity for all parties.

Richard Jaffe, lead attorney in one of the Sacramento cases brought by Kennedy’s Children’s Health Physician and a group called Physicians for Informed Consent, said Newsom’s decision not to appeal “will just increase the level of chaos in terms of who the law applies to.” “.

But the Newsom administration has decided to wait for the appeals court to rule on the decisions of the other two judges, who have upheld the law for now.

Janine Younes, New Civil Liberties Alliance lawyer, lead counsel other Sacramento cases in which Schubb issued his injunction, Newsom said, perhaps calculating that “you’re in a stronger position to raise your winnings on a win than on a loss.”

Newsom’s victory in the appeals court could dampen the impact of the two Sacramento cases, according to Jaffe and others.

Opponents of California’s COVID Disinformation Act are wondering why it’s needed at all, given that medical boards already have the power to punish doctors for unprofessional behavior. However, only about 3% of the nearly 90,000 complaints received by the California Medical Board in a decade resulted in physician disciplinary action. 2021 investigation from Los Angeles Times.

This may be good news for physicians, who fear the new law could limit their ability to counsel patients.

“I don’t see medical boards being particularly active about the competence of physicians in general,” Stanford’s Mello said. “You have to be really bad to get their attention.”

This story was produced by KHN who publishes California Health Lineto an editorial independent service California Health Foundation.

Due to pandemic-related continuous enrollment provisions, Medicaid lists have grown to over 90 million members. On April 1, for the first time in 3 years, states will begin to remove these provisions and exclude individuals who are no longer eligible for the program.

While most states have taken numerous steps to ensure those who are still eligible for coverage do not lose it due to procedural reasons such as renewal letters sent to the wrong address, experts and lawmakers who have spoken in discussions in America’s 2023 Health Plans Medicare, Medicaid, Duals and Commercial Markets Forum Thursday is still worried.

Arkansas State Rep. Deborah Ferguson (D-51), a dentist, said her biggest concern is people with chronic conditions who are “moving from Medicaid to Employer Insurance or the Affordable Care Act … pre-approval for treatment, whether they need to get more one pre-approval for medicines, will the formulary change… Will they have such a huge gap in care that it will really create problems?”

Generally, Medicaid processes renewals on an annual basis. Under the provisions of the Families First Coronavirus Response Act and the Coronavirus Relief, Relief, and Economic Security Act, states were required to maintain continuous enrollment for all Medicaid participants until the end of the Public Health Emergency (PHE) , and in return they were given 6.2 percentage points Percentage of federal medical care. (For every dollar a state spends on Medicaid, the federal government posts a compliance rate that varies from year to year.)

As a result of these provisions, Medicaid and the Children’s Health Insurance Program (CHIP) will increase by 30% or 23.3 million by March 31, according to estimates from the Kaiser Family Foundation (KFF).

Starting April 1, all 92 million registered members will be renewed and increased federal assistance will end.

This change came as a result of a provision in the Consolidated Appropriations Act passed in December 2022 that separated the continuous enrollment provision from PHE and named March 31 as the end of the continuous enrollment period.

While Ann Marie Costello, MD, Associate Director of the Center for Medicaid Services and CHIP CMS, said she was impressed by the states’ “massive investment” in enrollment, she noted that processing renewals for 92 million people over a period of 12 to 14 months is “an insurmountable task”.

And that’s the challenge government agencies face in trying to keep their workforce, like most other industries, she added.

Joan Alker, Ph.D., executive director and co-founder of the Center for Children and Families at Georgetown University in Washington, D.C., said she found some insights from KFF report based on a nationwide poll released on Thursday is “encouraging.”

However, “I don’t see any way we don’t lose millions of people,” she said, noting “the potential for hundreds of thousands, if not millions, of children to lose insurance when they are still eligible.”

In the survey, more than one-third of reporting states indicated that about 18% of Medicaid enrollees would be disenrolled at the end of the continuous enrollment period—predictions range from 7% to 33%.

More than half of the states plan to wait until April to begin implementing the “roll-up process,” while another 15 states have said they will start in March and eight more states plan to start in February.

In terms of the projected length of renewal, 43 states intend to use the full 12-14 months to complete the renewal process, five states plan to take 9 to 12 months, and one state intends to complete the process in less than 9 months. Two states declined to respond.

Stretching the workload over an extended period can help states balance renewals, but will also increase government spending, said Trisha Brooks, MBA, senior fellow at Georgetown University’s Center for Children and Families and lead author of the KFF report, and her co-authors.

Other findings from the report include:

• About half of the states have flagged individuals they suspect are no longer eligible or have not responded to renewal requests.
• In 16 of the 26 states that responded, the vacancy rate among eligible workers is over 10%, and in seven of the 16 states it is over 20%.
• Forty-three states use unilaterally renewal process (which uses government wage or unemployment benefit data before the enrolled member is asked to fill out a form or provide information)
• Approximately 34 states are seeking updates through the Supplemental Food Assistance Program (SNAP) and other programs; 33 states are asking Medicaid managed care organizations to contact members; and 13 states have launched an online change of address form.
• Most states (40) will attempt to contact subscribers when mail is returned.

Brooks et al noted that all 50 states and the District of Columbia have taken steps to update enrollee contact information.

CMS released guidance for states in 2021 with detailed guidance on how to respond to returned mail. In addition, all states are required to “make good-faith attempts to contact an enrollee in at least two ways prior to refusing to register for return mail,” the authors write.

Alker said she is concerned that adults in non-Medicaid states (states that have not extended eligibility for all adults to 138% of the federal poverty level) will not be eligible for Medicaid because their income is being forfeited. their rights. These adults will fall into a “coverage gap,” meaning they don’t have an affordable insurance option.

This coverage gap has always been a major problem, but losing coverage for children is a new problem, Alker said. Mississippi today in a recent interview in front of the panel.

Between 15 million and 18 million people are still expected to lose coverage during the renewal process, and HHS estimates that around 6.8 million might still fit.