Good morning! I’m Phil Galewitz, a Washington-based reporter for KFF Health News who covers Medicaid, Medicare and the business of medicine. I used to write about craft beer, but now I visit Northern Virginia farm breweries with my dog, Leo, to enjoy their hard ciders, seltzers and mountain views. If you’ve got tips on stories, or a favorite place to take your pup, send them to [email protected]. 

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Today’s edition: Former first lady Rosalynn Carter has died after entering hospice care. President Biden tapped the next leader of the federal government’s principal cancer research agency. But first …

The Biden administration designated most hospitals that deliver babies as “birthing friendly.” Is that helpful?

Choosing where to give birth typically comes down to what hospital is most convenient to your home, where your obstetrician practices and your insurance company’s provider network.

Now, the Biden administration has given expectant parents another factor to consider: whether their hospital has won the government’s new “birthing friendly” designation.

But don’t worry — a birthing-friendly hospital won’t be hard to find: Most U.S. facilities that deliver babies won the designation, according to Centers for Medicare and Medicaid Services and March of Dimes data. And that raises some questions about the rigor of the administration’s tests for the designation. “I guess this is a good first start, but it’s a quite weak standard,” said Kathleen Simpson, editor in chief of the American Journal of Maternal/Child Nursing.

In the D.C. area, most major hospitals and health systems that offer maternity care made the list, including Georgetown University Hospital, George Washington University Hospital, Howard University Hospital, Sibley Memorial, MedStar Washington Hospital Center and Inova Health System.

The U.S. has far higher maternal and infant mortality rates than similar large and wealthy countries, especially for people of color — and the problem has gotten worse in recent years. In addition, the Supreme Court’s decision in 2022 to overturn Roe v. Wade has increased barriers to abortion in many states, putting even more pressure on the feds to improve maternal and infant health. The White House has made the crisis a priority, with Vice President Harris leading the government’s response. 

While the administration has said it’s attacking the problem on several fronts, the birthing-friendly designation is one of the more visible efforts for consumers.

The Biden administration has also successfully pushed states to offer pregnant women continuous coverage under Medicaid, the insurance program for low-income people, for up to a year after delivery. So far, the administration has approved postpartum coverage extensions for 39 states and D.C. Medicaid pays for about 4 in 10 U.S. births.

To get the birthing-friendly designation, announced Nov. 8, hospitals merely had to attest they participate in a state or national quality collaborative and attest to adhering to “evidence-based care.”

“That is the lowest bar that they could have set,” Simpson said.  “It doesn’t measure anything.”

Simpson had hoped CMS would use nurse staffing ratios in maternity or neonatal units to help consumers differentiate among hospitals.

“I’m pleased to see things happening but the designation is not something that is going to make a difference,” she said.

Erin Jones, director of legislative and strategic counsel at the March of Dimes, called the birthing designation a “positive first step.” 

She said that persuading hospitals to participate in quality-improvement collaboratives isn’t always easy. The designation, she said, may put pressure on hospitals that aren’t engaged in quality improvement in maternity care to get started.

A CMS spokesperson said 66 percent of about 3,100 hospitals that report data to a federal quality review program won the designation. But the spokesperson couldn’t say how many of the 3,100 provide obstetric care. Some hospitals nationwide — especially in rural areas — have recently shuttered their labor and delivery units.

“It looks like every hospital got the designation, or very close to it,” Simpson said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.

White House prescriptions

Rosalynn Carter dies at 96

Rosalynn Carter, a close political and policy adviser to her husband, President Jimmy Carter, who advocated for better treatment of the mentally ill, died yesterday at her home in Plains, Ga. She was 96, The Post’s Joe Holley and Kevin Sullivan report. 

The Carter Center in Atlanta, which announced her death, had revealed in May that she had dementia. On Friday, two days before her death, the center said she had joined her husband in hospice care at home.

A closer look: Rosalynn Carter developed an interest in mental health during her husband’s early political campaigns, and she made the issue her top priority when the couple reached the White House. Her efforts were instrumental in congressional approval and funding for the Mental Health Systems Act of September 1980, the first major reform of federal, publicly funded mental health programs in nearly two decades. She continued her advocacy work for four decades.

President Biden:

Agency alert

Biden picks Vanderbilt physician to lead National Cancer Institute

President Biden on Friday tapped W. Kimryn Rathmell to serve as the next director of the National Cancer Institute, our colleague Dan Diamond scooped. 

Rathmell, a kidney cancer expert and the chair of medicine at Vanderbilt University Medical Center, will assume leadership of the agency in December. She succeeds Monica Bertagnolli, whom the Senate confirmed as director of the National Institutes of Health this month. 

A closer look: As director of the cancer institute, Rathmell will play a central role in carrying out Biden’s “cancer moonshot” initiative, which is aimed at cutting the U.S. death toll from the disease in half over the next 25 years. 

In an interview with Dan, Bertagnolli said she thinks Rathmell is well positioned to run the $7.3 billion agency, having served on its board of scientific advisers since 2018.  As a board member, she helped develop and roll out the cancer institute’s April 2023 national cancer plan, which detailed eight goals to prevent cancer and save lives, Bertagnolli said. 

• “Now, she will be the one leading its execution as she steps into this job,” the NIH director added.

The American Association for Cancer Research:

Meanwhile …

A medical services company whose quality of care is a focus of a probe launched after the death of an 8-year-old girl in U.S. border custody has been selected as a finalist for a $1.5 billion government contract, The Post’s Nick Miroff reports. 

The details: Florida-based Loyal Source Government Services is among a half-dozen companies on the shortlist for a five-year contract to provide medical screening and services for the thousands of migrants detained each day along the U.S.-Mexico border, according to three U.S. Customs and Border Protection officials and records obtained by The Post.  

Officials at CBP, which is conducting the investigation, say Loyal Source is the only company currently large enough to meet the government’s needs. But medical officers and investigators have raised growing concerns about the quality and safety of that care. 

• For example: The company has struggled for years to staff border facilities with nurses and doctors, often using lower-level emergency medical technicians earning a third of the pay or less, according to two current employees who spoke to The Post on the condition of anonymity.

Reproductive wars

Haley says she would sign six-week abortion ban if still S.C. governor

Pressed on abortion at a Christian conservative gathering, GOP presidential candidate Nikki Haley said Friday that she would sign a six-week abortion ban in her home state of South Carolina if she were still governor, The Post’s Hannah Knowles reports. 

Why it matters: On the campaign trail, Haley has tried to strike a more nuanced tone on abortion than some of her fellow Republican hopefuls by calling for legislators to seek areas of “consensus” at the federal level. At the same time, she has previously said she would support any restriction on the procedure that can pass while sidestepping calls for a particular limit.

Industry Rx

China vows to crack down on fentanyl chemicals. The impact is unclear.

Policy experts remain skeptical whether China’s pledge to work with the United States to counter the illicit narcotics trade will make a lasting dent in the global supply chain for illicit drugs, our colleagues David Ovalle and John Hudson report. 

Key context: The White House announced last week that Beijing had agreed to crack down on companies that produce precursor chemicals for fentanyl, notching a political win for President Biden as he runs for reelection and is eager to show progress in addressing the nation’s enduring drug crisis. 

But some experts are questioning whether China will follow through — or even if it is even capable of rooting out shady players that use encrypted communications and cryptocurrency while peddling precursor chemicals to Mexican drug traffickers. Others say that even if Beijing holds up its end of the deal, the sale of the illicit supplies will simply migrate to other countries, such as India.

The view from the Biden administration: China’s pledge is only a first step, White House drug czar Rahul Gupta said in an interview, adding that Beijing needs to enforce regulations to ensure that shipments from China are going to legitimate customers. 

• “We also know that the criminal elements could quickly shift to countries like India,” Gupta said. “It’s time for us to double- and triple-down our efforts with India to clamp down.”

📅 Welcome back, and happy birthday President Biden! The president turns 81 today — but his reelection team would probably rather you forget that. 

The House and Senate are both out for Thanksgiving break, having skipped town last week after squeaking through a short-term spending bill to keep the federal government’s lights on through the new year. 

Health reads

Va.’s mental health system failed him. Could he fix it before the next tragedy? (By Jenna Portnoy and Justin Jouvenal | The Washington Post)

Newsom TV ad hits DeSantis on abortion as Fox debate looms (By Christopher Cadelago | Politico)

Oregon’s first-in-the-nation drug decriminalization law is facing pushback amid the fentanyl crisis (By Claire Rush | Associated Press)

Extra fees drive assisted-living profits (By Jordan Rau | New York Times)

Sugar rush