| |  | The Lead Brief | We are so back, baby. Congress is heading into a packed week of health care oversight, with four committees zeroing in on some of Washington’s most persistent pain points: the growing use of AI chatbots, soaring medical costs in the individual marketplace and rising pressure to modernize care for an aging population. Here’s what you need to prepare for next week. HEALTH COSTS In its first hearing after Congress voted to reopen the government — without extending the enhanced Obamacare tax credits Democrats had demanded — the Senate Finance Committee is tackling the issue of rising health care costs. Two people familiar with the committee’s plans tell me that it will continue the spotlight on the individual insurance market — as in, people who purchase health care through the exchanges such as HealthCare.gov — that became the flash point of the shutdown. The Senate Finance Committee has jurisdiction over the Affordable Care Act. → Many Republicans on Capitol Hill are discussing a plan to give people money in health-specific accounts to spend on their care, rather than sending the premium subsidies to insurers. Sen. Roger Marshall (R-Kansas), who sits on both the finance panel and the health panel, has advocated using health savings accounts, or HSAs, which are usually paired with high-deductible insurance plans. Sen. Bill Cassidy (R-Louisiana), who leads the Senate’s health panel, has talked more recently about extending the use of flexible spending accounts, or FSAs, to spend on health expenses rather than sending premium subsidies to insurers. There are different rules around HSAs and FSAs, including how long a person has to spend the cash. → Meanwhile, most Democrats have only become more resolute in their calls to extend the enhanced premium tax credits, which expire at the end of the year. The timeline is urgent, they argue, because people are signing up for next year’s coverage right now. Republican witnesses: - Douglas Holtz-Eakin, the president of American Action Forum
- Brian Blase, the president of Paragon Health Institute
Blase has long argued for moving away from the tax credits and giving money directly to consumers, favoring the use of HSAs. Holtz-Eakin, who was chief economist for President George W. Bush’s Council of Economic Advisers, wrote a blog post this week critical of both the ACA and the idea of giving people cash in HSAs or FSAs. Democratic witnesses: - Jason Levitis, a senior fellow at the Urban Institute
- Bartley Armitage, a constituent of the panel’s top Democrat, Sen. Ron Wyden (Oregon), who buys ACA marketplace insurance.
Levitis wrote last month about the “damage” that could result from not extending the enhanced premium tax credits and about ways to reform the various health spending accounts (though not in reference to current proposals to substitute the enhanced ACA tax credits with them). Armitage and his wife’s monthly health insurance premium is set to quadruple, according to Lookout Eugene-Springfield. → Last week, the Senate Homeland Security Permanent Subcommittee on Investigations held a hearing about “the damage done by Obamacare” — inviting critics of the enhanced ACA premium tax credits to testify. Blase argued at that hearing that the tax credits are “ill-designed and inflationary.” AI CHATBOTS The House Energy and Commerce’s investigations subcommittee plans to look at the “risks and benefits” of AI chatbots. The hearing will be broader than use of the chatbots for health care purposes, according to a memo outlining the committee’s plans — but it will include a discussion around the mental health risks associated with chatbot usage and concerns about users’ privacy if they ask the tech about sensitive medical issues. The panel will hear from: - Marlynn Wei, a psychiatrist, psychotherapist, and author
- John Torous, director of digital psychiatry at the Department of Psychiatry at Beth Israel Deaconess Medical Center and psychiatry professor at Harvard Medical School
- Jennifer King, a fellow at the Stanford Institute for Human-Centered Artificial Intelligence
Here’s some background on the use of AI chatbots as therapists: - A growing number of people use AI chatbots for mental health advice and treatment. A quarter of the roughly 2,200 respondents to a recent YouGov poll conducted for the Economist said they have either used AI for therapy or would consider doing so.
- Nearly 5.5 million young people — ages 12 to 21 years — in the U.S. use AI chatbots for mental health advice, according to research published in JAMA Network Open last week. The analysis showed that more than 65.5 percent of them engaged at least monthly and almost all of them — nearly 93 percent — “found the advice helpful.” The research found that young adults over the age of 18 were more likely than younger respondents to use the platforms — which include ChatGPT, Google’s Gemini and My AI, Snapchat’s AI feature.
That widespread use concerns some experts. | "There are few standardized benchmarks for evaluating mental health advice offered by AI chatbots, and there is limited transparency about the datasets that are used to train these large language models,” Jonathan Cantor, a Rand senior policy researcher who also served as a corresponding author of the study published in JAMA, said in a statement. | | | | A Brown University study from October found that AI chatbots “systematically violate ethical standards of practice established by organizations like the American Psychological Association,” even if users ask them to utilize “evidence-based psychotherapy techniques” when giving responses. → Meanwhile, the APA released a health advisory this week on the use of AI chatbots. It includes recommendations for policymakers, including enacting legislation to ban chatbots from “posing as licensed professionals” and implement new data privacy standards to safeguard users’ personal data. While the APA notes the use of AI tools could alleviate problems in mental health care, including issues relating to patient access to care, administrative burdens and workforce shortages, they “should be regulated and implemented as a tool to augment, not replace, professional judgment.” “Prioritizing unregulated, direct-to-consumer chatbots over investing in our human health care infrastructure is not a solution; it is an abdication of our responsibility to provide genuine, evidence-based care,” the advisory reads. → Many AI chatbots are too people-pleasing and quick to agree with people in ways that can “reinforce false beliefs,” said researchers. Earlier this year, OpenAI CEO Sam Altman said the company — which makes ChatGPT — would make the chatbot less “sycophant-y and annoying.” Last month, he posted on social media that it might roll some of those changes back amid complaints from users. (The Washington Post has a content partnership with OpenAI.) ORGAN DONATION AND PROCUREMENT The Senate Health, Education, Labor and Pensions Committee hearing about the “future of the U.S. organ procurement and transplantation network” originally slated to occur on Wednesday is being rescheduled, a committee spokesperson confirmed. There isn’t a replacement date yet. → It makes sense: The hearing was scheduled for the same date and time as the Finance Committee hearing on health care costs. Cassidy also sits on the finance panel. | 
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