Presented by

With Carmen Paun

THE HEALTH CARE DOWNSIDES OF A MINING BOOM — Health systems in mining towns thrive off the robust health plans the mining industry offers.

But because that insurance is often so much better than coverage in the rest of the community, it can counterintuitively impede health care access, worsen health outcomes in populations often predisposed to poor physical and mental health and leave communities vulnerable when mines go bust, POLITICO’s Megan Messerly reports.

Six months of interviews with more than 90 patients, providers, retired miners, community leaders and health care experts across the U.S. has revealed a range of unintended perils, from retired miners grappling with limited health care access to communities left with beleaguered or shuttered health facilities.

Why it matters: Health systems can grow dependent on those insurance plans to survive, and the benefits are in some cases so comprehensive that providers are reluctant to serve others in the community. The ripple effects are the result of a health care system that relies on employer-sponsored health insurance to turn a profit. And as the Biden administration pushes for increased domestic sourcing of essential resources like copper, lithium and cobalt, more communities will likely face those challenges.

“It’s unclear yet how many new mines we’ll get in the United States. But we’ll get several, at least,” Mark Haggerty, senior fellow on the energy and environment team at the left-leaning Center for American Progress, said. “Maybe a lot, and every one of those mines is going to be located in a community that’s going to have a pretty similar set of struggles,” said. “They’re all going to have struggling health care, rural hospitals, potentially.”

What’s next: Some mining associations acknowledge the chain reaction their good benefit plans set off and want to be a part of the solution.

“Each community is different, as is each health care provider, mining company, benefits package, etc. There is no one-size-fits-all solution,” Matt Vincent, executive director of the Montana Mining Association, said in an email.

Medicaid expansion, extra federal funding to support health centers and critical access hospitals and other policy solutions targeted at rural communities have in some cases helped. In other communities, they haven’t been enough.

“It’s a huge, hidden sector of the American economy,” Michael Topchik, national leader at the Chartis Center for Rural Health, said. “These are communities that are meeting vital needs. But guess what? They have vital needs. Health care is one of those vital needs, and it’s failing.”

WELCOME TO MONDAY PULSE. Your host is distraught over Shoehei Ohtani’s decision to join the Dodgers but is grateful for a parrot that gave him hope — at least for a couple days — that he might sign with the Giants. Reach us at [email protected] or [email protected]. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with POLITICO global health reporter Carmen Paun, who explains why abortion has Congress deadlocked over the reauthorization of the President’s Emergency Plan for AIDS Relief, or PEPFAR, a program credited with saving 25 million lives.

TRANSPARENCY VOTE IN THE CARDS — The House is slated to vote today on a sweeping health care package that would increase transparency requirements for health insurers, hospitals and the pharmacy benefit managers that negotiate drug prices for insurers.

The move comes after the bill — negotiated by the Energy and Commerce, Ways and Means, and Education and the Workforce committees — was abruptly yanked from consideration in September amid government funding talks and questions about support from both parties.

The legislation appears to have more momentum than it had earlier this year, with at least 5 of 6 of the relevant committee chairs and ranking members supporting it. Rep. Bobby Scott (D-Va.), ranking member of the Committee on Education and the Workforce, is on board after previously not supporting it, according to a person familiar with the negotiations.

Still, it will require a two-thirds vote to pass the House, as it’s being considered under suspension of the rules. A spokesperson for Rep. Richard Neal (D-Mass.), ranking member of the Ways and Means Committee, confirmed he still opposes the legislation. He previously did so because it didn’t include private equity reporting requirements.

The legislation, which would ban spread pricing in Medicaid and add site-neutral policies in Medicare, has drawn opposition from PBMs and hospitals.

A NO-GO FOR CIGNA-HUMANA MERGER — A potential merger between insurance giants Cigna and Humana is off, according to The Wall Street Journal.

Such a deal would have created a health care behemoth. The Journal reported Sunday that shareholders’ reaction was tepid, with Cigna stock falling about 10 percent since reports of the discussions.

A merger was expected to draw significant antitrust scrutiny. A potential deal would have given the insurers more pricing power and Cigna more legs in the Medicare Advantage market.

Cigna and Humana didn’t respond to requests for comment.

TEXAS ABORTION BATTLE STAKES — A showdown in Texas over one woman’s right to terminate a nonviable pregnancy could keep abortion at the center of the 2024 election and change the trajectory of legal challenges to state bans, POLITICO’s Alice Miranda Ollstein and Adam Cancryn report.

The latest: Dallas-area mother Kate Cox, who’s about 20 weeks pregnant, recently learned her fetus had a likely fatal condition and that continuing the pregnancy could put her at risk. Her doctors, fearing prosecution or the loss of their medical licenses under the state’s near-total ban, said they wouldn’t provide an abortion until the fetus died.

On Friday, the Texas Supreme Court temporarily blocked a previous court ruling that she could obtain an abortion and the doctor performing it could not be criminally charged.

After the first ruling, Texas Attorney General Ken Paxton told providers they could still be prosecuted if they were to go forward with the procedure.

The bigger picture: The case underscores the legal and ethical gray areas doctors have faced since the Supreme Court overturned Roe v. Wade. It’s also amplified a debate over who is exempt from abortion bans, who has legal standing to challenge the bans and the liabilities doctors risk in interpreting vague laws with stiff penalties.

ZAMBIA REPORTS ANTHRAX OUTBREAK — An anthrax outbreak in the southern African country of Zambia is suspected to have sickened nearly 700 people, out of which four died, Carmen reports.

The risk of it spreading to other countries in the region is high, the WHO said, because of the frequent movement of animals and people between the country and its neighbors, which include Angola, Botswana, the Democratic Republic of the Congo, Tanzania, Uganda and Zimbabwe. The WHO, however, advised on Friday against any travel or trade restrictions against Zambia.

Background: Anthrax, used in what the FBI deems the worst biological attack in U.S. history soon after 9/11, is a disease caused by a spore-forming bacteria that sickens cows, sheep and goats. It doesn’t typically spread among animals or people.

Anthrax is endemic in Zambia, but this is the first large-scale outbreak since 2011, the WHO said.

NEW TB PREVENTION FOR KIDS — A new child-friendly formulation of the antibiotic rifapentine for short-course tuberculosis prevention treatment will reach the market at a price ranging between $6.53 and $15.80, depending on a child’s weight, global health organization Unitaid and others announced today.

The new price makes the treatment more affordable than alternative prevention therapy for children, Unitaid said.

Why it matters: The new pediatric formulation is expected to improve access to treatment preventing children exposed to TB from developing the disease, Carmen reports.

Drugs for children are typically a neglected area, said Dr. Philippe Duneton, Unitaid’s executive director.

“A fruit-flavoured, dispersible medicine can make the difference between a child taking their medicine or not,” he said in a statement.

NEW ADVAMED WING — The largest medical device lobby, AdvaMed, is establishing a new medical imaging technology division.

Patrick Hope, former executive director of the Medical Imaging and Technology Alliance, will lead the division, AdvaMed said. MITA member companies will be under the AdvaMed umbrella.

The move comes as interest in artificial intelligence booms in the sector and imaging technology often leans on AI.

Dr. Pamela McShane has been elected chair of the Bronchiectasis and NTM Research Registry Consortium. She’s a professor of medicine at the University of Texas Tyler School of Medicine.

CNN reports on teledentistry firm SmileDirectClub closing its doors.

POLITICO’s Joe Gould and Anthony Adragna report on the closed-door meeting when Sen. Tommy Tuberville (R-Ala.) caved on his military promotion blockade.