HEALTH CARE BRIEFING: Democrats’ Health Plans Hinge on Drug Bill

By Brandon Lee

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Democrats’ ambitious plans to add new benefits to Medicare and bolster Obamacare this year hinge on delivering a major drug pricing package, putting pressure on committee leaders to find legislation the entire party can embrace.

Democratic leaders in the House and Senate are trying to shape a multi-trillion-dollar legislative package that includes expanding Medicare and Medicaid as well as extending enhanced insurance subsidies for people on the Affordable Care Act’s exchanges. To offset at least some of the cost, lawmakers have proposed empowering the government to negotiate with drugmakers, and other changes to lower the price of medicines.

A failure to win big on drug pricing means Democrats won’t deliver much of their promised health agenda, lawmakers say.

“Lowering drug prices is something that families need, and it’s something Congress needs as a payoff,” Sen. Elizabeth Warren (D-Mass.) said. “It’s pretty hard to get rid of it and see how the whole package still comes together.”

Progressives have long urged both growing public health insurance programs and tackling drug prices in concert—but they’ll have to win over some in their party who’ve been reluctant to treat the drug industry as a piggy bank for their policy goals.

Democrats plan to pass a $3.5 trillion legislative package that includes their main health care priorities via a reconciliation budget process that permits legislation to clear both chambers of Congress by a simple majority. Democrats don’t expect any Republican support for this package, so they can’t lose any of their members in the Senate. Read more from Alex Ruoff.

Infrastructure Talks Near Finish Line: Senators negotiating a $579 billion infrastructure package are aiming to finish negotiations early this week, under pressure from colleagues to salvage an August recess and to allow the Senate to turn to preventing a government shutdown and debt ceiling default in the fall. A pending five-week break scheduled to begin Aug. 9 is motivating the 22-member bipartisan group to end dickering over relatively minor components of their plan.

Finishing a bipartisan infrastructure plan also is pivotal to getting all Democrats on board with a budget outline setting up a $3.5 trillion tax and spending package that will carry most of Biden’s agenda through Congress without Republican votes. Erik Wasson lays out the state of play heading into the week.

Also Happening on the Hill

Health Bills on Tap: The House today is scheduled to consider some health care-related bills under suspension of the rules, which limits debate, requires a two-third majority for passage, and bars amendments:

  • Help for Havana Syndrome Victims: The CIA and State Department could provide financial aid to U.S. personnel and family members who develop brain injuries under S. 1828. The neurological illness dubbed “Havana Syndrome” was first seen in 40 U.S. Embassy staff in Cuba in 2016 and was likely caused by directed energy attacks. Since then more cases have been identified at the U.S. Consulate in Guangzhou, China, and in the U.S.
  • VA Drug Disposals: The Veterans Affairs Department would have to designate times and allow any individual to dispose of controlled substance medications at covered VA medical facilities under S. 957 . The VA was given a deadline of Jan. 1, 2022, to ensure that there are drop-off locations at VA medical facilities that have an onsite pharmacy or a physical location dedicated for law enforcement purposes. Read the BGOV Bill Summary by Brittney Washington.
  • VA Medical Facility Authorization: The Veterans Affairs Department would be authorized to carry out specific major medical facility projects in fiscal 2021 by S. 1910. The bill would authorize $2.08 billion for major VA construction and renovation projects. Read the BGOV Bill Summary by Brittney Washington.
  • Agency Covid-19 Safety Plans: Federal agencies would have to publish plans to protect employees and contractors who return to the office during the Covid-19 pandemic under H.R. 978. For more, see the BGOV Bill Summary by Michael Smallberg.

House Panel Prepares Minibus: The House Rules Committee is set to meet today to agree on the terms of debate for a seven-bill spending package (H.R. 4502) that includes the Agriculture-FDA, Energy and Water, Financial Services, Interior-Environment, Labor-HHS-Education, Military Construction-VA, and Transportation-HUD spending bills. The House plans to consider the measure later this week. Read the BGOV Bill Summary by Adam Schank and the BGOV OnPoint: Appropriations Update for July 23.

Hearings on the Hill:

Vaping Crisis Targeted Again in User Fees Bill: Makers of e-cigarettes would be charged user fees to pay for more FDA oversight under legislation that was reintroduced in Congress Friday. A bipartisan group of lawmakers in the Senate and House are pitching the legislation as a way to combat vaping among younger Americans. “It’s outrageous that e-cigarette manufacturers are directly marketing their harmful products to young people,” Sen. Jeanne Shaheen (D-N.H.) said, Brody Ford reports.

The Coronavirus Pandemic

CDC Pressured to Revise Mask Guidance: A growing number of public-health experts are urging the Centers for Disease Control and Prevention to recommend that even fully vaccinated people wear face masks in public amid the resurgence of virus cases fed by the Delta variant. Doctors including former surgeon general Jerome Adams say that the CDC acted prematurely in May when it announced that fully inoculated Americans would no longer need to wear a mask in most situations.

That move was widely seen as part of efforts to incentivize jabs. The different rules for the vaccinated and unvaccinated and the impression that Americans could let down their guard sowed confusion that has led to a higher infection rate, Adams said. “The execution was poor, and the results speak for themselves,” he said.

Covid-19 fatalities in the U.S. surged 48% in the past week to a daily average of 239 and hospitalizations are also on the rise as the more transmittable version of the virus spreads rapidly. The CDC says the Delta variant now makes up 83% of all sequenced Covid-19 cases in the U.S., up from 50% at the beginning of the month. Unvaccinated people account for 99.5% of Covid-19 deaths in the U.S. and 97% of hospitalizations. Read more from Fiona Rutherford.

  • The U.S. is moving in the “wrong direction” in combating a new wave of Covid-19, and a booster vaccine shot may be needed especially for the most vulnerable, said Anthony Fauci, the nation’s leading infectious disease expert. With half of the country still not fully vaccinated and with a new spread fueled by the Delta strain, the U.S. faces a worst-case scenario of daily deaths reaching 4,000, Fauci said. Read more from Linus Chua and Yueqi Yang.

CDC Lacks Authority on Evictions, Court Says: The Centers for Disease Control and Prevention lacks the authority to impose its ten-month-old pandemic eviction moratorium, the Sixth Circuit said Friday, concluding that Congress’s one-time extension of the agency’s order did not augment its rulemaking power. Although the CDC has some rulemaking authority under the Public Health Service Act of 1944, it doesn’t include interfering with landlord-tenant relationships, the Sixth Circuit ruled. Holly Barker has more.

U.S. Declines to Probe N.Y. Nursing Home Deaths: The U.S. Justice Department has decided not to investigate New York state’s handling of the coronavirus in its nursing homes, the department said in a letter Friday to a Republican opponent of Gov. Andrew Cuomo. Deputy Assistant General Joe Gaeta told Rep. Lee Zeldin (R-N.Y.) that the DOJ received information from Cuomo last August regarding nursing facilities run by the state, and based on its findings decided against a probe. John Harney has more.

Pfizer Preps Vaccines for Young Kids: Pfizer and BioNTech will supply the U.S. with another 200 million doses of their Covid-19 shot, setting up a stream of vaccine deliveries through next April in a push to protect kids and potentially provide boosters. The White House is setting its sights on immunizing children under the age of 12, who are not yet eligible, and potentially deploying booster doses if new data indicates they’re needed, a Biden official familiar with the contract said. Read more from Riley Griffin.

WTO’s Holiday From Vaccine Equity Talks Draws Calls for Action: An urgent global effort to rebalance the inequity between rich, vaccinated nations and poor nations sliding further into pandemic misery is colliding with an immovable calendar conflict: the European summer holiday. Next week World Trade Organization delegates are planning to depart Geneva for their August break and, in doing so, pause their fractious debate over a proposal to waive intellectual-property protections for Covid-19 shots until the second week of September. Before they leave, members will adopt a report that acknowledges they’ve made scant headway on the proposal aimed at making doses more widely available, which the world’s top health expert says is critical to ending a “moral failure.” Read more from Bryce Baschuk.

More U.S. Headlines:

More Global Headlines:

What Else to Know

Big Pharma’s Cross-Contamination Problem: The trillion-dollar prescription-drug industry has a problem it doesn’t like to talk about and doesn’t fully understand. Manufacturers stamp out pills for one condition on the same machines they use to stamp out pills for a different one, and while they’re supposed to clean between production rounds, trace contamination is common and, some argue, inevitable.

Current and former Food and Drug Administration inspectors, who spoke on condition of anonymity, say the extent of the contamination is unclear, because companies largely police themselves, workers get sloppy, and supervisors are lax. More should be done, they say, but how much and at what cost are a matter of keen debate. Read more from Anna Edney.

DHS Watchdog Cites Inadequate Migrant Medical Care: Migrants at the U.S.-Mexico border have received inadequate medical care due to poor training, procedures, and oversight in U.S. Customs and Border Protection, an internal watchdog said on Friday. House members requested the report from the Homeland Security Department’s IG last year after another investigation cleared the agency of misconduct in the 2018 deaths of two minors in U.S. Customs and Border Protection custody. The new report says CBP’s medical care policies don’t ensure sufficient screening for at-risk individuals and teenagers. Read the report here.

  • In a separate report, the IG addressed a 2020 complaint that a migrant woman was forced to give birth while standing and wearing pants in a border station in California. The IG said the probe didn’t substantiate claims that agents mistreated the woman. But, it did call for a better system to speed the release of newborns from custody, noting that that the infant slept on a bench in a cell with the mother after both received medical care at a hospital. The report also raised broader concerns, which Border Patrol has committed to addressing, about how the agency tracks the number of pregnant detainees and childbirths in custody, Ellen M. Gilmer reports.

$26 Billion Opioid Litigation Explained: State attorneys general say they have a $26 billion dollar plan to resolve the bulk of the liability for the three biggest drug distributors and one major drugmaker that are entangled in the national opioid litigation. The opioid crisis killed nearly 841,000 people since 1999, including 69,710 last year alone. Plaintiffs claim drugmakers and distributors pushed the painkillers for a massive profit, not heeding their addictive qualities. Valerie Bauman explains the litigation.

More Headlines:

With assistance from Ellen M. Gilmer

To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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