HEALTH CARE BRIEFING: Easing Budget Caps for Pandemic Weighed


By Jack Fitzpatrick, Alex Ruoff and Brandon Lee

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Key lawmakers and the Trump administration are divided over a proposal to change next year’s spending limits to allow for increased funding for health programs as negotiators are seeking a long-term path for responding to the coronavirus.

A bipartisan group of House appropriators support exempting critical health-care funds from budget caps set under the Budget Control Act, which would enable big increases in biomedical spending next year without requiring offsetting cuts to other programs.

Congress has already appropriated hundreds of billions of dollars outside of the budget caps in response to the coronavirus, but the plan would allow for sustained increases for the National Institutes of Health, Centers for Disease Control and Prevention, and other agencies.

President Donald Trump’s administration, however, isn’t entertaining any proposals to alter the discretionary spending limits for fiscal 2021, a senior administration official said. The pushback is a major barrier to a deal, because any plan would require signoff from the House, Senate and White House in order to amend the Bipartisan Budget Act of 2019.

Rep. Tom Cole (R-Okla.) said at a House Appropriations Labor-HHS-Education Subcommittee hearing yesterday he supports a budget cap exemption, and that he’s discussed the issue with Subcommittee Chairwoman Rosa DeLauro (D-Conn.). Full committee Chairwoman Nita Lowey (D-N.Y.) would also support budget cap exemptions, spokesman Evan Hollander said in April.

The exemption could allow greater spending on the NIH, CDC, Strategic National Stockpile, and Infectious Diseases Rapid Response Reserve Fund, Cole said at the hearing. He added that DeLauro also proposed including the Food and Drug Administration’s food inspection network.

Former CDC Director Tom Frieden proposed a specific “Health Defense Operations” budget designation for key health programs that would exempt them from budget caps indefinitely. Frieden, former Senate majority leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), and four other former CDC directors sent a letter Tuesday to congressional leaders proposing the idea. Frieden also discussed the plan with appropriators at the hearing.

Frieden said the change could save money by forestalling future pandemics and that “sustained, baseline funding is the only way we will ensure we are prepared for the next pandemic.”

Funding the health-care programs through the normal process forces them to compete with other priorities for limited funding, Frieden told lawmakers. “If it’s in discretionary, no matter how well intentioned everyone is, there are going to be problems,” Frieden said. “If it’s in mandatory, no matter how fixed we think it is, it isn’t.” Read more from Jack Fitzpatrick and Alex Ruoff.

Senate Hearing Today on Testing: The Senate Health, Education, Labor, and Pensions Committee convenes to discuss new tests to diagnose Covid-19. NIH Director Francis Collins and Biomedical Advanced Research and Development Authority Acting Director Gary Disbrow will testify.

Democrats will likely press the witnesses over the administration’s testing readiness and leadership as it ramps up efforts to reopen the economy.

Committee ranking member Patty Murray (D-Wash.) will also raise the issue of Rick Bright, the former Biomedical Advanced Research and Development Authority director who was reassigned, according to excerpts of her remarks obtained by Bloomberg Government. Bright said he was ousted over his concerns regarding a drug pushed by the Trump administration for the coronavirus and clashed repeatedly with his superiors over other issues related to the pandemic, according to a complaint he filed on Tuesday.

More Congressional Coronavirus Efforts

Pandemic Policy—BGOV Webinar: Analysts and reporters from Bloomberg Government, Bloomberg Law, and Bloomberg Intelligence hosted a webinar yesterday examining how the federal government is responding to Covid-19, and how the pandemic has affected the broader health policy agenda. Click here for slides from the webinar.

Hoyer Floats Aid Vote Next Week: The House could vote on a Democratic plan for the next multibillion-dollar virus relief package as soon as next week, if the party can overcome some internal disagreements over what should be included, Majority Leader Steny Hoyer (D-Md.) said yesterday. Though Speaker Nancy Pelosi (D-Calif.) has said any additional relief plan would need bipartisan support, House Democrats are sorting through proposals that will articulate their own policy proposals. He said yesterday that committee chairs are collecting ideas from lawmakers, and once that’s done will finish writing the legislation. Read more from Billy House.

Republicans Want Audit of Aid to WHO: Five Republican senators introduced a bill yesterday that seeks an accounting of how U.S. aid money is spent on the World Health Organization and other multilateral groups. “It is important that the United States knows where our taxpayers’ dollars are going,” Senate Foreign Affairs Chairman Jim Risch (R-Idaho) said in a statement. Trump has said WHO took Chinese claims about the coronavirus at “face value,” and he ordered a 60-day freeze of U.S. funding for the organization in April. Read more from Daniel Flatley.

  • WHO is considering sending a mission to China, with an academic focus on finding the zoologic source of the coronavirus. “Without knowing where the animal origin is, it’s hard to prevent it from happening again,” Maria Van Kerkhove, a WHO epidemiologist, said at a press briefing yesterday.
  • Earlier yesterday Secretary of State Michael Pompeo ratcheted up his criticism of China’s handling of the outbreak, asserting that it covered up the origins of the virus even as he eased off his earlier claims of “enormous evidence” the virus escaped from a laboratory near Wuahn. Pompeo started a briefing laying out a timeline of China’s actions, saying that it had silenced doctors’ early warnings about the virus. Read more from Nick Wadhams.

Testing & the Path to Reopening

Trump to Keep Virus Task Force: Trump said he’ll keep his coronavirus task force running indefinitely, backing away from a decision that was signaled by the White House a day earlier that he planned to disband the group of public health experts. Trump yesterday said he would be adding two or three more members to the group who will be focused on opening the U.S. for business. Asked about his reversal, Trump said: “I thought we could wind it down sooner, but I had no idea how popular the task force is until actually yesterday when I started talking about winding it down.”

Trump struck up the task force in late January as the coronavirus was spreading rapidly across the globe. About a month later, he put Vice President Mike Pence in charge of the group of public health officials, including Deborah Birx and the nation’s top infectious disease expert, Anthony Fauci. Josh Wingrove has more.

Insurers Seek to Bend Curve on Testing Prices: Health insurers nationwide are seeing bills for coronavirus tests as high as $1,000 as the U.S. looks to increase dramatically the number of tests performed. Insurers say they are only just now gathering claims data for Covid-19 tests and say the $1,000 tests, almost 2,000% of what Medicare pays for the same diagnostic, aren’t the norm but show the range they’re seeing different providers charge for the same test.

Some of the biggest laboratories for Covid-19 testing, including LabCorp and the University of Washington, have a “cash price”—what a person could pay directly for the test—anywhere between $50 and $200. The huge cost variation could have long-term implications for insurers and for Americans without insurance seeking tests, particularly as states and the federal government try to ramp up testing and re-open businesses shuttered by the virus. Alex Ruoff has more.

U.S. Outbreak Worsening, Cuomo Says: The coronavirus outbreak is clearly seen to be worsening if New York is excluded from the data, according to Gov. Andrew Cuomo (D). New York, the epicenter of the U.S.’s pandemic, makes up about a fourth of cases and a third of deaths nationwide. As New York data show a decline in the spread of the disease, the situation in other states is still worsening even as they encourage business to open, Cuomo said yesterday at a press briefing. U.S. fatalities from Covid-19 have climbed 61% in two weeks, to 65,307 as of May 5. Excluding New York, deaths have spiked 78%. Read more.

  • California reported 2,603 new infections, its biggest one-day increase in cases. The number of daily deaths spiked to 95 from 63 the previous day. The jumps come as Gov. Gavin Newsom (D) takes steps to slowly restart the economy.
  • Texas recorded its biggest daily jump in fatalities in a week as the death toll rose 4.6% to 948, according to state health department data. Total cases increased by 3.2% to 34,422. The surge in Covid-19 deaths comes as Gov. Greg Abbott’s (R) reopening of the state’s economy accelerated.

Infecting Subjects to Speed Vaccine Weighed: Deliberately infecting healthy volunteers with the virus that causes Covid-19 may speed studies of vaccines against the deadly pathogen, the World Health Organization said. Such studies, which pose significant potential dangers to subjects, may be considered in dire situations and with certain disclosures and protections, a working group of the United Nations health agency said in a report posted yesterday on its website.

Researchers around the world are racing to develop vaccines to protect against the deadly coronavirus and allow countries to rebuild teetering economies. So-called challenge studies, where treatments or preventatives are tested directly against the infection in informed volunteers, might speed the path of vaccines to the public. Read more from Corinne Gretler and John Lauerman.

More Headlines:

What Else to Know Today

Roberts Queries Curbs to ACA Birth-Control Rule: Chief Justice John Roberts suggested that the Trump administration had gone too far in giving employers and universities a broad religious opt-out from the Obamacare requirement that they offer free birth-control coverage through their health plans. With the Supreme Court hearing arguments by phone for a third day, justices yesterday re-entered a fractious debate over the ACA’s contraceptive requirement.

Roberts, who could hold the swing vote, said the Trump exemption may “sweep too broadly,” going beyond what is needed to accommodate legitimate religious objections. Roberts also questioned arguments made by two states challenging the exemption, but he directed his toughest questions at two lawyers defending the White House approach. Read more from Greg Stohr and David McLaughlin.

  • Democrats are citing the pandemic in an effort to persuade the Supreme Court to save Obamacare. In the high-stakes suit that a group of Republican states led by Texas initiated to take down the law, the California-led coalition working to defend it kicked off its opening brief telling justices that many of the Affordable Care Act’s reforms “have proven indispensable in the context of the current pandemic.” That same sentiment was echoed by the House in its brief yesterday. Read more from Lydia Wheeler.

Democrats Blast Judge Over ACA: Senate Judiciary Committee Democrats said a federal district court judge allied with Senate Majority Leader Mitch McConnell (R-Ky.) and Supreme Court Justice Brett Kavanaugh is too biased and inexperienced to sit on the federal appeals court that’s been a launching pad for future Supreme Court justices. Justin Walker came under fire repeatedly at his confirmation hearing yesterday for a seat on the U.S. Court of Appeals for the District of Columbia, with Democrats pointing to his past comments criticizing a Supreme Court ruling on the Affordable Care Act. Read more from Laura Litvan.

More Headlines:

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

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

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