Policy News Roundup: October 17, 2024

CDC highlights youth behavior risks and protections

The Centers for Disease Control and Prevention released a series of reports based on the Youth Behavior Surveillance System, a set of surveys that tracks a broad range of behaviors, experiences and conditions that can lead to poor health among high school students.

The findings:

• Caretaker engagement and school connectedness: Among American Indian/Alaska Native students, having an adult in the household who always tried to meet their basic needs was associated with lower prevalence of current electronic vapor product use. High parental monitoring was associated with lower prevalence of cigarette use, current electronic vapor product use and current prescription opioid misuse. High school connectedness was associated with lower prevalence of current electronic vapor product use.
• Adverse Childhood Experiences (ACEs): 76.1% experienced one or more ACEs, and 18.5% experienced 4 or more. For most health conditions/risk behaviors studied, those experiencing ACEs had significantly higher prevalence than those experiencing none. The strongest associations were observed between experiencing 4+ ACEs and attempted suicide, seriously considering suicide, and current prescription opioid misuse. Substantial reductions associated with preventing all ACEs were estimated for suicide attempts, seriously considering suicide, prescription opioid misuse, alcohol or drug use before last sexual intercourse, current electronic vapor product use, persistent feelings of sadness of hopelessness, and current binge drinking.
• Racism: Among Black, Hispanic and White students, the prevalence of current use of any tobacco product, alcohol, marijuana and prescription opioid misuse was higher among students who ever experienced racism in school. Multiracial students who reported racism in school also had a higher prevalence of current use of any tobacco product, marijuana and prescription opioid misuse.
• Unfair discipline: Unfair discipline at school was associated with health risk behaviors including being bullied, skipping school due to feeling unsafe, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide.
• Protective factors: Protective factors (i.e., physical activity, sleep, household adult tried to meet their basic needs, parental monitoring, school connectedness, sports teams) were associated with lower prevalence of risk indicators.
• Transgender and questioning: Transgender and questioning students reported higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing and a lower prevalence of school connectedness than their cisgender peers.
• Social media: 77% of students reported frequent social media use. Frequent social media use was associated with a higher prevalence of bullying victimization at school and electronically, persistent feelings of sadness or hopelessness, and some suicide risk.
• Breakfast: 72.6% missed breakfast at least once in the past 7 days, and 17.9% skipped breakfast every day. Students who experienced persistent feelings of sadness or hopelessness were more likely to skip breakfast every day. Greater levels of school connectedness and earning mostly As or Bs were inversely associated with skipping breakfast. Students who had higher school connectedness were approximately 30% less likely to skip breakfast every day.

The main takeaway: Findings show the prevalence of and risks posed by ACEs, racism and other risk factors and the importance of engaged household adults, school connectedness and other protective factors. Preventing risk factors and supporting protective factors are both critical in promoting emotional wellbeing and preventing substance use.

Source: Youth Risk Behavior Surveillance — United States, 2023 (Centers for Disease Control and Prevention)

Nearly immediately after the new parity rules were released, health plans threatened potential legal action to block them. Inseparable’s David Lloyd explores why in his op-ed, New mental health parity laws are already under threat.

The details:

• In crafting the new rules, federal agencies considered all points of view during the comment period. Well over 95% of all stakeholders voiced support for the rules, but the agencies took opponents’ concerns seriously, withdrawing a proposal that insurance companies opposed.
• Health plans have until Jan. 1, 2026 before key parts of the rule take effect, giving them ample time to come into compliance.

But: Threats of legal action do not reflect disagreements over the rulemaking or implementation processes, but rather flat rejection of parity.

The bigger picture: This helps explain the 16 years of noncompliance with parity and why health plans have squeezed mental health and substance use disorder (MH/SUD) providers with unfairly low reimbursements and administrative burdens.

The data: In rejecting parity, insurers are blocking billions in potential savings that would serve their own financial interests.

• People with MH/SUD had physical health care costs 2.8-6.2 times higher, and treating mental and physical health conditions on par would save commercial insurers $19-38 billion each year.

Why it’s important: Health plans seem determined to chase short-term profits on mental health by delaying and denying valid claims, while their beneficiaries grow sicker without needed care or bankrupt themselves trying to pay for it.

• Insurers are passing up an opportunity to heal their own discriminatory practices after years of delay and denial. Parity saves money and serves the interests of all stakeholders, insurers included.

Source: New mental health parity laws are already under threat (STAT)

What’s new: The Drug Enforcement Administration (DEA) is signaling it will again extend temporary rules allowing the prescribing of controlled substances via telehealth. A final rule for the third temporary extension of the COVID prescribing flexibilities reached the White House for review last week.

But:

• It is not clear how long the extension would be for.
• It is unclear when, or if, the extension rule will clear White House review and be published.

The push for rules:

• Telemedicine providers have been pushing for clarity as soon as possible to avoid disruptions. They say the sector is in a state of frustration and chaos as the flexibilities have been set to end with no new rules in sight. They claim planning amid uncertainty consumes time and resources that could be devoted to growing businesses or improving patient care.
• Lawmakers, telehealth organizations and patient advocates have called for continued access to telehealth in recent weeks, especially in the case of buprenorphine.
• Some companies say a draft DEA rule leaked in August would make it virtually impossible for their businesses to continue. If the extension is finalized, it would be the second time the DEA floated tightened rules and retreated amid backlash.

Why it’s important: Telehealth flexibilities have allowed more people to access medications for opioid use disorder, and patients are at risk of discontinued care if new rules don’t support continued access.

Source: DEA poised to extend telehealth prescribing rules again (Politico); Frustrated telehealth providers say their businesses face ‘doom and gloom’ (STAT)

The news: The Biden administration announced that over 250 organizations, businesses and stakeholders across the country have made commitments to the White House Challenge to Save Lives from Overdose.

• The White House Challenge to Save Lives from Overdose is a nationwide call-to-action launched earlier this year to increase training on, and access to, naloxone.

The details: New commitments came from groups including Amazon, several professional societies/unions, several local school districts and colleges/universities, local police departments and transit systems, Deloitte and the National Hockey League.

Source: FACT SHEET: Biden-⁠Harris Administration Announces Over 250 Organizations Made Voluntary Commitments to White House Challenge to Save Lives from Overdose (White House)