With Katherine Ellen Foley and Robert King

LESSONS OF ROE — As the one-year anniversary of the Supreme Court ruling overturning Roe v. Wade approaches, our Alice Miranda Ollstein and Megan Messerly took a look back on what’s happened nationwide since then — and found 10 surprises from the past year that defied conventional wisdom. Here are some of those unforeseen effects:

— Neither side unified around a strategy in the months following the ruling. Conservative lawmakers at the state and federal levels have struggled to agree on the parameters of abortion bans, while progressive groups have clashed over how far to go in expanding access.

— Doctors have proven far more cautious than some abortion-rights advocates hoped, fearful of running afoul of the law or running across an overzealous prosecutor for even performing something that is ostensibly legal.

— And the Supreme Court, which hoped to wash its hands of abortion and send the issue to the states, was forced back into the fray, intervening in a high-profile lawsuit challenging the abortion drug mifepristone — freezing a lower court order that could have banned its use nationwide.

Megan took a closer look at how abortion laws stack up in all 50 states and the District of Columbia one year after Roe. She reports that abortion is illegal in almost all circumstances in nearly a third of the country.

WELCOME TO THURSDAY PULSE, where the news isn’t always bad: The World Health Organization certified Belize as malaria-free after decades of efforts to fight the disease.

What other health news should I be watching? Drop me a line at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Robert King, who explains Georgia’s plan to implement work requirements for Medicaid beneficiaries — and how some conservative states are looking to Georgia’s program as a possible model for their own Medicaid programs.

SANCTIONS AHEAD FOR FENTANYL TRAFFICKING — A Senate Committee unanimously approved a bill Wednesday aimed at cracking down on criminal organizations, including Mexican drug cartels, involved in trafficking illicit fentanyl, POLITICO’s Carmen Paun reports.

The FEND Off Fentanyl Act, advanced by the Senate Banking, Housing and Urban Affairs Committee, would allow the president to block and prohibit all U.S. transactions involving property and interests of foreign persons and organizations engaged in “significant trafficking” of illicit fentanyl, raw materials used to manufacture the synthetic opioid and other related opioids.

Sen. Tim Scott (R-S.C.) introduced the bill, which has nearly 60 co-sponsors from both parties, including Banking Chair Sherrod Brown (D-Ohio).

Why it matters: The bill is the latest bipartisan effort to disrupt the supply chain of fentanyl, a powerful synthetic opioid that’s become the top killer of young adults in the United States. Some 70,000 people died last year from fentanyl overdose or poisoning, according to the CDC.

What’s next? The full Senate can now take up the bill.

A ‘LONG OVERDUE’ MACRA HEARING — The House Energy and Commerce Committee is expected today to review Medicare doctor pay for the first time since 2019, Robert and your host report.

“This hearing is long overdue,” Committee member Rep. Michael Burgess (R-Texas) told Pulse earlier this week. “It’s like four and a half years overdue.”

The Investigations and Oversight Subcommittee will hear from advocacy groups, experts and provider executives to get an update on the Medicare Access and CHIP Reauthorization Act of 2015. Lawmakers have been concerned the law meant to stabilize doctor payments hasn’t kept pace with the costs of running a practice, especially with high inflation.

The inflation spike has eroded the earning potential for doctors, and the “costs of increasing their practices has increased year over year, and we’ve not done anything to mitigate that,” Burgess said.

MACRA eliminated a controversial payment formula called Sustainable Growth Rate that paid doctors under Medicare based partly on how the U.S. economy fared. However, once put into practice, the formula resulted in steep cuts to practices, spurring lawmakers to pass MACRA after instituting a series of patches to prevent the cuts from taking effect.

Several members of the House E&C Committee have told Robert the hearing will be the first step toward reform. Burgess added that he hopes for legislation in the second half of the year.

But Burgess, a doctor and major MACRA proponent, was realistic about the chances of getting something done this year. If legislation isn’t ready, a short-term fix for doctors should be implemented before the end of the year to avoid another cut, he said.

FIRST IN PULSE: DOC CAUCUS EYES MACRA REFORM — Before this morning’s hearing, members of the GOP Doctors Caucus are holding a closed-door meeting to discuss MACRA reform efforts, a congressional staffer told Pulse.

A group of policy leaders will join the meeting – including Brett Baker with the Nickles Group, James Paluskiewicz with Alston & Bird, Brian Sutter with Capitol Hill Consulting Group, Nick Uehlecke with Todd Strategy Group, and Joel White with Horizon Government Affairs.

ENDORSEMENT FOR RSV VACCINE FOR OLDER ADULTS — Advisers to the CDC voted 9-5 that adults 65 and older should receive a single respiratory syncytial virus vaccine from either Pfizer or GSK this fall, POLITICO’s Katherine Ellen Foley reports. Additionally, 13 members, with one abstention, voted in favor of people 60 to 64 receiving the shot.

If the CDC follows the recommendations, most insurers would cover these vaccines for their beneficiaries.

Both shots were approved by the FDA earlier this year, but advisers had concerns about whether the vaccine would be appropriate for the oldest adults and the safety of administering the vaccine at the same time as other shots, like those for Covid or the flu.

What’s next: Today, the committee will discuss Pfizer’s maternal RSV vaccine, which can provide protection for infants, as well as nirsevimab, an antibody for infants from Sanofi and AstraZeneca, that could also protect them from severe cases of the virus. The committee won’t vote on those products because neither has been approved yet, but the FDA is slated to decide on them in the next few months.

COMPETING ON NONCOMPETES — The American Medical Association has emerged as a powerful new voice to a debate at the Federal Trade Commission about whether to ban noncompete agreements, POLITICO’s Erin Schumaker reports.

The physician group said it opposes contracts barring doctors from quitting and joining rival hospitals.

Hospitals have asked the FTC to exempt them from the agency’s proposed rule. The hospitals say the rule, if finalized, would harm patients and threaten hospitals’ competitiveness. They’ve also challenged the FTC’s authority to ban the agreements.

Why it matters: Many individual doctors submitted comments supporting the FTC’s proposal, but the AMA didn’t take sides.

The group’s membership includes physician practice owners who could benefit from noncompetes, as well as doctors who are often bound by the contracts at the hospitals or private staffing companies where they work.

At its annual meeting, the AMA’s House of Delegates voted to oppose noncompetes imposed by hospitals and staffing companies.

Even so: The AMA will continue to oppose only “unreasonable” noncompetes imposed by private practice physicians.

The AMA also called for a study of private practice contracts so it can make policy recommendations for balancing business interests, employment mobility and patient access to care.

What’s next: The FTC is reviewing more than 26,000 comments on its proposed rule, as well as a recent Government Accountability Office report.

Paul Rothman, former dean of Johns Hopkins Medical School and CEO of Johns Hopkins Medicine, and Andrew Trister, Gates Foundation deputy director of digital health, have joined AI startup System as health care advisers.

Mary Tolan, founder of health care investment firm Chicago Pacific Founders, hosts a fundraiser today to support Nikki Haley’s presidential campaign, POLITICO’s Daniel Lippman reports.

POLITICO’s Megan R. Wilson reports on the Pharmaceutical Research and Manufacturers of America joining the trend of suing the Biden administration over Medicare drug price negotiations.

The Tennessean reports Vanderbilt University Medical Center turned over a transgender patient’s records to the state’s attorney general.

Nature reports on how the Y chromosome can make cancer more deadly for men.