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States to vote on abortion, Medicaid and marijuana

It is officially Election Day. Many of you dear readers may feel stressed as you wait for the results, so we invite you to take a break and instead consider voting on names for these newborn lion cubs at the Oklahoma City Zoo.

Today in health, we're looking at the ballot measures up for vote across the country that have the potential to drastically change the health care landscape.

Welcome to Overnight Health Care, where we're following the latest moves on policy and news affecting your health. For The Hill, we're Nathaniel Weixel and Joseph Choi. Someone forward you this newsletter? Subscribe here.

Ballot measures to watch on election night

In addition to who represents them in Congress and in state legislatures, voters on Tuesday will weigh in directly on issues including abortion, marijuana and vaping.

Here are the measures we're watching tonight:

Five states will have abortion on the ballot Tuesday, the most abortion-related ballot initiatives ever to take place in a single year.

The referendums come more than four months after the Supreme Court overturned Roe v. Wade, eliminating the constitutional right to an abortion that had been in place for nearly 50 years and kicking the issue to the states.

Voters in Vermont, California and Michigan will decide whether to enshrine abortion rights in the state constitution, while proponents of Kentucky's ballot measure are seeking to make it clear that abortion can be banned in the state.
Montana, meanwhile, would mandate health providers to give medical care for children "born alive" after an abortion, or face criminal charges.

States voting on marijuana legalization: North Dakota, where voters defeated legalization in 2018; Missouri; Maryland; Arkansas and South Dakota, which previously passed legalization only to have it overturned by the state Supreme Court.

Nineteen states and the District of Columbia have already legalized small amounts of cannabis for adult recreational use.

Medicaid expansion: South Dakotans will vote on whether to expand Medicaid coverage to more than 42,000 individuals, against the wishes of state Republicans like Gov. Kristi Noem.

If it passes, South Dakota would be the seventh GOP-led state that opposed expansion to extend coverage through a ballot measure.

Read more here.

VA to prioritize veterans with cancer for benefits

The Department of Veterans Affairs (VA) will give priority to veterans with cancer when it begins processing benefits claims under the landmark toxic exposure law signed this summer, VA Secretary Denis McDonough announced Monday.

On Jan. 1, 2023, the VA will start processing claims for benefits filed under the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act.

"I'm proud to announce for the first time today, on National Cancer Awareness Day, that we're expediting benefits delivery for veterans with cancer conditions covered by law," McDonough said during an appearance at the National Press Club.
The law, signed by President Biden in early August, expands benefits for millions of veterans who were exposed to toxins during service and are suffering illnesses as a result.
The legislation designates 23 diseases, half of them types of cancers, presumed to be linked to burn pits used in the post-9/11 era and other pollutants and environmental hazards from earlier wars such as the Vietnam War-era Agent Orange.

Part of a broader effort: McDonough's announcement to prioritize claims from veterans with cancer stems from Biden's "cancer moonshot" initiative, relaunched in February. The effort aims to cut the cancer death rate in half over the next 25 years and improve the lives of caregivers and cancer survivors.

Close to home: The program, initially launched while Biden was vice president, is personal to the commander in chief, as his son Beau Biden died of glioblastoma, an aggressive type of brain cancer, in 2015 at the age of 46.

Read more here.

BIDEN WARNED STAFFING ISSUES CAUSING EXODUS OF HEALTH WORKERS

A group of medical organizations on Monday warned President Biden that hospital emergency departments were reaching a "breaking point" as they deal with influxes of patients seeking beds that are not available.

They cautioned that the issue of "boarding" — keeping admitted patients in emergency departments due to lack of space — has been brought to a "crisis point" by staffing shortages.
"Our nation's safety net is on the verge of breaking beyond repair; EDs are gridlocked and overwhelmed with patients waiting — waiting to be seen; waiting for admission to an inpatient bed in the hospital; waiting to be transferred to psychiatric, skilled nursing, or other specialized facilities; or, waiting simply to return to their nursing home," the groups said in their letter to Biden.

These growing issues, which have gone unresolved for decades according to the groups, have led to an increase in provider burnout.

Systemic consequences: They noted that patients who require inpatient care but are placed in emergency rooms are oftentimes subject to delays and experience increased mortality. Overloaded emergency rooms also result in delays in care, such as for ambulances that are left stuck at hospitals due to a lack of beds within the actual facility.

Read more here.

PREVALENCE OF DEMENTIA IN ELDERLY PEOPLE DROPPED IN MULTI-YEAR STUDY

The prevalence of dementia decreased from 12.2 percent in 2000 to 8.5 percent in 2016 among those aged 65 and older, potentially due to increased rates of educational attainment and lower smoking rates.

The research, which is based on the nationally representative Health and Retirement Study, included data from more than 21,000 older adults.

"The reasons for the decline in the prevalence of dementia are not certain, but this trend is good news for older Americans and the systems that support them," said Péter Hudomiet, an economist and the study's lead author. "This decline may help reduce the expected strain on families, nursing homes and other support systems as the American population ages."

In addition to the overall decline, results also detailed reductions in race- and sex-based disparities. While the prevalence of dementia fell by 2.7 percentage points among white men over the 16-year window, prevalence dropped by
7.3 percentage points among Black men.
More women than men suffered from dementia over the course of the study period, but that disparity also narrowed. In 2000, 10.2 percent of men had dementia compared with 13.6 percent of women. Those totals fell to 7 percent and 9.7 percent by 2016, respectively.

Read more here.

Manchin pushes Social Security, Medicare deal

Manchin recently pointed to shoring up solvency for programs like Social Security and Medicare, pressing for action on tackling the nation's climbing debt while discussing areas for common ground in Congress.

"If we don't look at the trust funds that are going bankrupt, whether they be Medicare, Medicaid, Social Security, highway, all the ones — there are tremendous problems right now," Manchin, a key centrist, said late last week.

Warming Republican reception:

Manchin's comments are in stark contrast to recent Democratic attacks hammering GOP proposals for Social Security and Medicare in the final campaign stretch before Election Day. And it's a shift that has drawn some early positive reaction from Republicans.

"I gladly welcome any Democrat who puts aside partisan fear-mongering to work with us to ensure Medicare and Social Security return to solvency," Rep. Kevin Hern (Okla.), head of the conservative Republican Study Committee's Budget and Spending Task Force, told The Hill on Monday.
"As a longtime advocate of protecting Social Security and Medicare, Representative Smucker looks forward to working with his colleagues to save and strengthen both programs," Rep. Lloyd Smucker's (R-Pa.) office also told The Hill.

Democratic skepticism: As far as Democrats are concerned, House Majority Leader Steny Hoyer (D-Md.) said Monday that the party would work with "anyone who wants to protect Social Security, Medicare, and other programs that help Americans and their families thrive," but he cast doubt on chances of a bipartisan compromise.

"Unfortunately, I don't expect Republicans to join us in that commitment to put people over politics," he told The Hill.

Read more here.

WHAT WE'RE READING

Pfizer's Covid cash powers a 'Marketing Machine' on the hunt for new supernovas (Fortune)
FDA warns of risks from xylazine, an animal drug linked to overdoses in humans (CBS News)
Defense Department Health Plan Cuts Its Pharmacy Network by Nearly 15,000 Outlets (Kaiser Health News)

STATE BY STATE

In Arizona's race for governor, Kari Lake fans Republican fury over Fauci, fentanyl and gender-affirming care (Stat)
Nasty flu strain spreads faster, sickening many children and adults (The Atlanta Journal-Constitution)
Judges' order gives NC 10 years to provide more at-home disability services (North Carolina Health News)

THE HILL OPED