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Only in Washington Can $27 Billion Be Forgotten. How to Spend It Now

By Matt Cover

One of the best things to come out of the recent debt ceiling deal was that Congress clawed back $27 billion in COVID-19 relief money. Much of that funding, according to the Congressional Budget Office, was intended for health care programs — and it is still sitting unused while Congress moves on to other matters like defense authorization and the August recess.

Only in Washington can $27 billion be secured — and then left to sit once again.

The White House has made it clear that it will let Congress take the lead. Budget Director Shalanda Young said, “appropriators will use some of that money to spread around, as they see fit.” Appropriators should do just that by directing agencies to fund proven solutions to two public health epidemics that COVID-19 and lockdowns exacerbated — obesity and mental health.

One way Congress could redirect unspent COVID-19 funds is to require the Department of Health & Human Services to provide promising new weight loss medication to Medicare and Medicaid patients.

Science shows that while eating healthy and regular exercise are two keys to weight loss, some people just need extra help. Medicaid and Medicare recipients — those with low income and the elderly, respectively — are two of the groups most likely to suffer expensive complications from obesity like diabetes, heart disease and musculoskeletal conditions like knee and hip failures. Yet, therapies like Wegovy and Ozempic – appetite suppressants that have become wildly popular due to their success — are not covered by Medicaid or Medicare. 

These drugs work by mimicking the hormone that signals fullness after eating. Many obese people fail to successfully diet because they have developed a resistance to this hormone, resulting in them continuing to feel hungry even after eating a large meal. Unfortunately, the viral popularity of these therapies has created a near-term shortage. However, new drugs, such as Mounjaro, will soon hit the market and may help fill the immense demand for weight loss therapies.

While paying for injections outright would cost far more than $27 billion, the Department of Health & Human Services could launch a pilot program where Medicare and Medicaid pay for such weight-loss therapies, in limited instances and at reduced prices. One estimate has shown that such a pilot program would likely only use some of the recouped money — between $13.6 billion and $26.8 billion.

Another solution is to fund additional inpatient psychiatric beds. A Gallup survey shows mental health is at an all-time low, and we currently use an estimated 144% of current inpatient mental health care capacity, causing mentally ill patients to be treated in emergency rooms and jail cells. One survey of emergency room physicians found that 38% of patients wait between one and five days before they can be admitted to a mental health facility.

But the financing system for inpatient mental health has been broken since the federal government took it over during the Great Society initiatives in the 1960s. Traditionally, inpatient mental health care was funded by a combination of state funding and private philanthropy. However, Medicare and Medicaid turned the federal government into the lead source of funding for mental health, resulting in an ever-worsening shortage of inpatient mental health capacity. As federal reimbursements for other kinds of care, like orthopedic and intensive care, outpaced mental health, hospitals scaled back on mental health care services in favor of other more-profitable types of care. 

Members of Congress of both parties could claim a victory by directing the administration to use unspent COVID-19 funding to fund additional inpatient psychiatric beds. This would alleviate a considerable amount of suffering, although not all; just as reducing obesity won’t solve everyone’s heart problems, it still would be a good start. 

A final — and low-cost — intervention for a variety of health issues is the use of sugar-free gum. A meta-analysis of randomized controlled trials found that chewing sugar-free gum can reduce stress and anxiety, two of the key factors in positive mental health. Any licensed therapist will tell you that stress can often lead to worse sleep, less emotional control, and inflammation because the body isn’t getting the rest it needs.

The act of chewing can also help control appetite and weight. Chewing reduces the production of cortisol — the hormone your body produces under stress, and which is directly linked to weight-gain. It also makes the body feel more full, while reducing one of the primary reasons for overeating — stress. 

A campaign encouraging people, of all ages, to chew sugar-free gum would be a low-cost, effective health intervention that could easily be funded with a portion of unspent COVID-19 funds.

In years past, Congress has allowed unused funds to just sit in the bank. That shouldn’t happen to unspent COVID-19 money. Lawmakers should work with the administration and use the money to address other urgent public health problems — problems that aren’t going to be solved by a vaccine or a mask.

Originally published in The Messenger.


Matt Cover is a health care consultant whose work relates to employer-sponsored health benefit plans, wellness, disease management, mental health, finance, and regulatory compliance. He is a former journalist who covered health care and federal budget issues in Washington, D.C.