HEALTH CARE BRIEFING: Democrats Continue Negotiations on Agenda

Congressional Democrats are at odds over both the tax and spending sides of a bill to enact the bulk of President Joe Biden’s economic agenda, even as party leaders aim to have an outline of a deal by the end of the week, Laura Davison and Erik Wasson report.

The chances for agreement — which seemed in reach late Tuesday — receded yesterday as Democratic leaders intensified a search for alternatives to the corporate and individual tax hikes they’d worked on for months. That’s amid opposition from Sen. Kyrsten Sinema (D-Ariz.). Democrats also are reworking the bill’s climate provisions, after Sen. Joe Manchin (D-W.Va.) said he can’t support a clean power program favored by Biden.

The eleventh-hour moves to appease the two senators — whose crucial votes are seen as the hardest to win — demonstrate the massive changes that lawmakers must make to the tax and spending plans the White House published in the spring.

Should Democrats nix a proposed corporate tax hike to 26.5% from 21%, they would set aside a promise to make the largest businesses shoulder more of the tax burden. It also would leave Democrats with a more than $540 billion hole in the roughly $2 trillion total they need to raise to offset the cost of spending plans that include climate, health care and early-childhood programs.

Meanwhile, Rep. Lizzie Fletcher (D-Texas) and 23 other lawmakers called on Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Chuck Schumer (D-N.Y.) to keep Medicaid expansion incentives in Biden’s economic agenda, according to a statement.

The request comes after reports that congressional leadership is “considering repealing the Medicaid expansion incentives passed in the American Rescue Plan Act” this year. Read their letter here.

Related:

• Pricey Paid Leave Proposal Forces Fine-Tuning Plans
• Pelosi Says Paid Family Leave Plans Still Not Decided

The Coronavirus Pandemic

FDA Clears Moderna, J&J Covid Boosters: The Food and Drug Administration cleared a broad path for millions of Americans to receive Covid-19 vaccine booster doses, as the nation looks to bolster its defenses and prevent another virus surge. The agency said in a statement yesterday that Moderna recipients over 65 and over can get a third shot, as can adults 18 and up with higher risk of severe illness or with frequent virus exposure. All J&J recipients are eligible for a booster dose two months after their first.

The agency also allowed each of the available coronavirus vaccines to be used as a booster dose for eligible individuals following completion of a primary vaccination. The moves will mean the U.S. has a bigger toolkit to try to limit a possible virus rebound this winter. The summer’s delta-variant spike helped increase urgency to make boosters available, and health officials across the U.S. are eager to forestall a rebound in cases that could cripple hospitals and disrupt work and school this winter.

The clearances came after a panel of expert advisers to the FDA unanimously backed the Moderna and J&J booster regimens in two days of meetings last week. Regulators have now signed off on boosters for all three coronavirus vaccines available in the U.S. Last month, the FDA said people 65 and over and others who are at heightened risk of severe Covid-19 were eligible for a booster dose of the vaccine developed by Pfizer and BioNTech. Read more from Robert Langreth.

U.S. to Start Shipping Kids’ Vaccines as Clearance Nears: The Biden administration will begin shipping vaccines for kids age 5 to 11 as soon as next week, and shots could start going into arms the following week. Biden’s Covid-19 response team held a briefing yesterday to detail plans for vaccinating young kids, a long-awaited but logistically complex milestone, the success of which could hinge on combating parental hesitancy. Kids’ shots will be largely offered by doctors’ offices, requiring a tailored distribution plan.

Shipments of Pfizer-BioNTech Covid-19 vaccines will begin after authorization from the Food and Drug Administration, which could come next week. That would allow vaccines to arrive at doctors’ offices so that they could be administered once cleared by the U.S. Centers for Disease Control and Prevention. CDC clearance may swiftly follow a panel hearing scheduled for Nov. 2 and 3. “We will ensure that vaccinations for kids ages 5 to 11 are easy, convenient and accessible,” Biden’s Covid-19 response czar, Jeff Zients said.

There are about 28 million kids in that age category, and their vaccination effort will be different from those age 12 and up, who all receive the same dose. Younger childrens’ dose is 10 micrograms, or one-third the regular Pfizer-BioNTech dose, and will be given with smaller needles. The doses will be administered at 25,000 pediatricians’ offices and primary care sites, along with pharmacies and—to a lesser extent—schools and clinics, the White House said. Read more from Josh Wingrove and Jeannie Baumann.

Vaccine Deadline Looming, Harris Meets With Federal Workers: Vice President Kamala Harris and Secretary of Labor Marty Walsh met with federal workers yesterday before the president’s deadline for federal employees to prove they are Covid-19 vaccinated. Office of Personnel Management Director Kiran Ahuja, who leads the government’s human resources office, attended. Federal employees have to be vaccinated by Nov. 8 or face unpaid suspension and eventual termination. Courtney Rozen has more.

• Lt. Gen. Jon Jensen, the director of the Army National Guard, which has been deployed frequently since 2020 to help bolster health care efforts during the pandemic, said only 47 % of the Army National Guard members have had at least one shot, Roxana Tiron reports. “There’s varying degrees of acceptance,” Jensen said at an event hosted by the Center for Strategic and International Studies, adding that the Guard would need to increase its education and leadership efforts to get its members vaccinated.

Deadlines, Costs Raised in OSHA Covid-19 Rule Meetings: Employers and labor unions meeting with White House staffers want to know who pays for testing and how quickly businesses must comply with OSHA’s impending Covid-19 vaccine-or-test standard. The White House’s Office of Information and Regulatory Affairs had scheduled 59 meetings about the rule—which would apply to firms with 100 or more workers—through today. Biden hasn’t said when it will be issued. Bruce Rolfsen and Ben Penn have more.

More Headlines:

• Appeals Court Rejects Federal Forum for Nursing Home Infections
• Fed Survey Says Vaccine Mandates Contributing to Labor Turnover
• Apple Will Mandate Unvaccinated Office Workers Get Daily Testing

What Else to Know Today

Nursing Homes Fear Financial Blow From Expanded Home Care Bill: The nursing home industry, still reeling from Covid-related declines in patients and revenue, could be facing yet another financial hit. About 1 in 5 beneficiaries in traditional Medicare recuperate in nursing homes after being released from hospitals. But some could recover at home for far less money under bipartisan legislation recently introduced in the House by Reps. Henry Cuellar (D-Texas) and James Comer (R-Ky).

The “Choose Home Recovery Act of 2021” would save Medicare more than $4,600 per beneficiary by allowing home health agencies to provide expanded nursing services in the home for up to 30 days for eligible Medicare patients, according to a study commissioned by the Partnership for Quality Home Healthcare. Read more from Tony Pugh.

Medicare Innovation Center Charts New 10-Year Course: The Center for Medicare and Medicaid Innovation charted its strategic direction for the next 10 years, releasing a white paper that outlines a variety of goals to improve and expand health-care delivery across federal programs. The Strategy Refresh by the innovation center, which develops unique health-care payment and delivery models for Medicare and Medicaid, plans to focus on accountable care, health equity, innovations, and more. Tony Pugh has more.

House Floor: The House yesterday passed the following health-related measures, including:

• By a 380-46 vote, legislation H.R. 2379 authorizing the State Opioid Response grant program to receive $1.75 billion annually through fiscal 2027. For more, see the BGOV Bill Summary by Christina Banoub;
• By a 397-22 vote legislation H.R. 3635 authorizing funding for state strategic stockpiles and changes to the Strategic National Stockpile. For more, see the BGOV Bill Summary by Brittney Washington; and
• By a 395-30 vote legislation H.R. 654 allowing the waiver of matching requirements for Drug-Free Communities Support Program grantees if the recipient couldn’t raise sufficient funds due to Covid-19. For more, see the BGOV Bill Summary by Christina Banoub.

More Headlines:

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• Holmes’ Push for Theranos Approval Drew Harsh Pfizer Response
• ‘Pharma Bro’ Shkreli Loses Push to Delay Trial Over Drug Markup
• PharmaCare Elderberry Immunity Booster False-Ad Suit Advances
• Dignity Health’s Church Plan Pension Deal Approved on Third Try

With assistance from Roxana Tiron

To contact the reporters on this story: Brandon Lee in Washington at blee@bgov.com; Alex Ruoff in Washington at aruoff@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