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Premiums for ACA Health Plans Are Set to Drop in 2020

Premiums for the most popular health plans sold under the Affordable Care Act will drop for the second consecutive year, the Trump administration said Tuesday, as the law enters its 10th year and shows increasing signs of stabilizing.

Average rates for the most popular, middle-priced plan will fall 4% in 2020 for a 27-year-old buying health insurance on the federal exchange, although premiums will vary widely by location, federal health officials said Tuesday. Rates had also declined 1.5% in 2019, after years of double-digit-percentage...

Source: Premiums for ACA Health Plans Are Set to Drop in 2020

Facebook posts biggest quarterly lobby tab, as business, health interests dominate K Street

Facebook is on pace to spend more on federal lobbying this year than ever before, according to public disclosures out this week, as the social media giant’s CEO prepares to testify Wednesday on Capitol Hill.

The company — at the center of debates over the spread of false information, data privacy and others — spent $12.3 million to lobby the federal government in the first nine months of the year. In 2018, Facebook shelled out $12.6 million for 12 months of lobbying.

[Disinformation moves from fringe sites to Facebook, YouTube]

Facebook founder Mark Zuckerberg will appear Wednesday before the House Financial Services Committee, which is probing the company’s role in the housing market and in a new cryptocurrency called Libra.

The tech company’s investment in K Street, a record $4.77 million in the third quarter of this year, has catapulted it into the top 10 biggest clients in Washington, D.C.

Impeachment no impediment

Health care, pharmaceutical, and broader big-business interests, along with a liberal organization, dominated the top tier during the first three-quarters of 2019, new lobbying disclosures filed with the clerk of the House and the secretary of the Senate show.

Lobbyists say that even with Capitol Hill and the White House absorbed in House Democrats’ official impeachment inquiry, lawmakers and the executive branch have continued to fuel K Street activity, especially in health care, technology, immigration and trade policy.

“We continue to see clients ramping up their engagement in D.C., especially in trying to improve the playing fields that shape policymakers’ views of tough issues — trade, technology regulation, immigration, and travel, to name a few,” said Stewart Verdery, a GOP lobbyist who runs Monument Advocacy.


Not only are clients looking to wrap up debates in 2019, but they also are looking toward next year’s elections.

“We are also increasingly being asked to map up what 2021 looks like under various election scenarios, especially if there were to be all-left control of power,” added Verdery, whose registered lobbying clients include the drug industry’s leading trade group, Pharmaceutical Research and Manufacturers of America, as well as Starbucks and PepsiCo.

Amazon and Google

The only other tech company among the top tier for 2019 is Amazon, which disclosed lobbying on numerous policy matters including cybersecurity, trade, and the National Defense Authorization Act. Google’s spending on federal lobbying, $9.1 million so far this year, has declined, as the company has restructured its in-house roster of lobbyists and its network of outside consultants.

The U.S. Chamber of Commerce, meanwhile, continued its long run as the top spender on federal lobbying campaigns, while the National Association of Realtors came in at No. 2.

The chamber’s top legislative priority is getting the revised North American Free Trade Agreement, known as the U.S.-Mexico-Canada Agreement, passed, said Neil Bradley, executive vice president and chief policy officer at the U.S. Chamber of Commerce.

The chamber also has lobbied against a Democratic prescription drug pricing bill, but Bradley said the group does support some “compromises,” including helping patients with out-of-pocket expenses and accelerating the regulatory approval of generics, but not changing patent protections for name-brand medications.

Liberals spending too

The Open Society Policy Center, a liberal organization with ties to the big donor George Soros, disclosed spending nearly $16 million on lobbying campaigns from July 1 through Sept. 30. 

Sarah Margon, director of foreign policy advocacy at the center, said in an email that, among other matters, the group is working with “a broad, bipartisan coalition of good- government, national security, and human rights groups to persuade Congress to reassert its critical role when it comes to war powers, emergency powers, and arms sales.”

“Congress’ power to authorize war is a fundamental principle in our Constitution, which has been deeply eroded over decades,” Margon added. “Members of Congress in both parties have failed to live up to this responsibility, not only when it comes to authorizing the use of force but more generally across a range of other related national security powers and oversight obligations.”

Akin Gump Strauss Hauer & Feld, the city’s largest federal lobbying practice as measured in publicly disclosed revenue, has reported earning $31.2 million from clients so far this year.

“Contrary to conventional wisdom about legislative activity in Washington, this year has been exceptionally busy for our firm and our clients, leading to both our largest quarter and our largest back-to-back quarters in firm history,” said Akin Gump partner Hunter Bates, a former top aide to Senate Majority Leader Mitch McConnell of Kentucky.

The firm added a trio of recent lawmakers: ex-Sen. Joe Donnelly, a Democrat from Indiana, and former GOP Reps. Ileana Ros-Lehtinen of Florida and Texan Lamar Smith.

Walk and chew gum

Health care, transportation, technology and regulatory work across the executive branch have been major areas for another top federal lobbying practice, Brownstein Hyatt Farber Schreck.

“What Congress is proving to be is they can walk and chew gum,” said Marc Lampkin, who manages the firm’s Washington, D.C., office. “If you listen to all the talking heads, you’d think there was nothing going on but impeachment and oversight. There’s a lot more.”

He noted that work on the NAFTA re-do and continued interest in the congressional budget and appropriations process as the big drivers of K Street business.  

Health care, long a dominant issue on K Street, has continued to fuel the lobbying sector with PhRMA, the American Medical Association, and the American Hospital Association all reporting multimillion-dollar expenditures.

The policy debates, both in Congress and on the 2020 campaign trail, over "Medicare for All" and prescription drug prices have sparked record levels of spending among some organizations not known for big lobbying tabs.

The conservative lobbying and grassroots group FreedomWorks disclosed spending more than $2.7 million, the most it ever has reported shelling out, in just this year’s third quarter alone — more than it disclosed spending in all of last year ($1.9 million).

“I would imagine we’re going to continue doing actions on health care proposals that take the wrong approach,” said Jason Pye, FreedomWorks’ vice president of legislative affairs.

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Source: Facebook posts biggest quarterly lobby tab, as business, health interests dominate K Street

Utah’s unusual ‘premarital exams’ for women are being rebranded as sexual health visits for everyone

Physician Jennifer Gunter was startled by a post she read on Reddit “from a woman whose fiancé insisted she have some kind of premarital exam.”

“So, I Googled ‘premarital exam,’ wondering what a woman might find,” Gunter said in a Sept. 9 blog post. The first result was University of Utah Health. “I just about fell off my chair."

Gunter was troubled by some of what she read. One section was about keeping antibiotics on hand in case a bride gets a urinary tract infection from having sex during her honeymoon. Another talked about having an exam to “confirm that her body is ready for sex and take steps to reduce discomfort and frustration associated with the first few times,” such as by using sterile dilators.

Such uses of antibiotics and dilators are not considered standard or evidence-based, Gunter said. She also questioned why premarital exam information was only directed toward women. “Is the implication here from the University of Utah that heterosexual men are naturally informed about sex?” she wrote.

University of Utah Health understands that premarital exam is “not the accurate medical term,” and that a better term is “sexual health visit," said Kathy Wilets, director of public relations and content marketing. But after noticing patients specifically asking for that and searching for that term online, officials decided to meet people “where they are” to connect with and educate them, she said.

“A lot of our patients that come in for a visit prior to becoming sexually active … have misinformation and misconceptions,” said Tiffany Weber, a generalist OB-GYN at University Hospital.

The term “premarital exam” is unique to Utah, said Kristin Hodson, a sex therapist in Salt Lake City and founder and executive director of The Healing Group. Before moving to the state, Weber and Wilets said, they hadn’t heard of the practice.

Sometimes, these visits may be the only place where Utahns can learn about sexual health, Hodson said. There are restrictions on what’s allowed to be taught in public schools in Utah, where the predominant Latter-day Saint faith focuses on chastity when leaders speak about sex. Children may be encouraged to ask their parents for more information, Hodson said, but those parents may also not have been educated.

While Gunter — an OB-GYN and pain physician who has been called “Twitter’s resident gynecologist” and is often quoted by national media — is “all for education” and talking with a doctor, she wrote, a woman “doesn’t need her OB/GYN reinforcing patriarchal tropes” and providing what she described as incorrect information.

University of Utah Health and Intermountain Healthcare have started making changes to their websites on the topic. The university now calls it a “sexual health visit (often referred to as a premarital visit),” while Intermountain uses “premarital consultation.”

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University of Utah Health was aware of Gunter’s post but had begun its conversation about updates earlier, Wilets said. Intermountain Healthcare didn’t comment on what prompted it to make changes.

But Intermountain recommends "that anyone of any gender who is considering becoming sexually active or has questions or concerns about sexual health have a visit with their health care provider,” Jean Millar, Intermountain’s executive clinical director of the women and newborns clinical program, said in a statement.

After noticing people searching more recently about male sexual health visits — something it hadn’t seen in the past — University of Utah Health plans to include “language for both men and women” on its website in the next few weeks, according to Wilets.

While the premarital visits have been directed toward females, there’s a need for males to have information about how to have safe, healthy sex, too, Hodson agreed. Sexually transmitted infections have increased in Salt Lake and Utah counties in recent years. “Everybody needs this information,” Hodson said.

University physicians started working on changes after “feedback and discussion within the department that the content that we had our website might be misinterpreted,” Wilets said.

The university has updated and removed sections about the dilators and antibiotics. Both providers suggest people talk to their doctors about contraception, practicing safe sex, the HPV vaccine and any other concerns they have.

Items listed on the website before, such as the dilators and advance prescriptions for antibiotics, were not “necessarily recommendations, but … things that you can potentially discuss with your physician,” Weber said.

“It is not the recommendation to use, to require antibiotics prior to sexual intercourse to prevent UTIs,” Weber said. The same goes for dilators.

Those are just things “that are commonly brought up, or patients commonly want to discuss, that are actually not evidence-based practices,” she said.

A physical exam needs to be done only if a patient has a particular symptom or concern, Weber said. What’s more important is “to make sure that they are safe as they start a sexual relationship.” She said she might use diagrams to review anatomy with patients who may not have been comfortable discussing sex with anyone in the past.

The original webpages were created a couple of years ago, when a university physician had “a lot of patients coming to her, asking for this premarital exam," Wilets said. She "felt that enough people were asking about this that … she came to our team and asked us to prepare some content because she felt there was a real need.”

The information “was our second-highest performing content on our women’s health page,” Wilets said, and a 2017 blog post on the topic “was really broadly shared."

These pages were "intended for a very specific group of people,” whom Wilets defined as “heterosexual women who have remained abstinent from sexual activity, are about to get married and who have questions/concerns about their first sexual experience.”

She added: “All content can’t appeal to everybody. We’re trying to reach a very specific audience. But the ultimate goal is to get them accurate information and get them the health information and health care that they need.”

Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today.

Source: Utah’s unusual ‘premarital exams’ for women are being rebranded as sexual health visits for everyone

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