HEALTH CARE BRIEFING: Biden Boosts Home Health in Economic Plan

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President Joe Biden’s call to spend $400 billion to expand home and community-based care is raising advocates’ hopes that lawmakers might finally address long-standing challenges the industry, the elderly and people with disabilities face.

Biden’s multi-trillion-dollar infrastructure proposal unveiled yesterday included the new funds over eight years to boost access to long-term care under Medicaid, the federal government’s public health insurance program for the poor and disabled. Many Americans suffer on waiting lists for home care under Medicaid, the main payer for home- and community-based support. Wages remain low for home-care workers in demanding jobs. Biden has signaled he wants to handle these costly issues side-by-side.

“This is a bigger investment than anything we’ve seen in recent years and it’s probably not enough,” Robert Espinoza, vice president of policy for PHI, a nonprofit research group that tracks the home-care sector, said. “It’s promising and could be a big step.”

The U.S. spent $379 billion in 2018 for long-term services and support—which are used to help seniors and those with disabilities with anything from cooking meals to bathing and dressing, and managing medication or mobility, the Kaiser Family Foundation found. Medicaid paid for more than half of this, which includes nursing home and home health services.

Demand for these services is increasing. Home-health aides and personal-care aides make up the sixth-fastest growing occupation in the country, according to Labor Department data, and pay about $12.15 per hour, or $25,280 per year. In many areas that’s not enough: Most home-health aides qualify for federal help like food assistance and Medicaid, research by PHI shows.

Biden’s plan, scant on details, explicitly calls for addressing the industry’s low wages. A White House outline of the infrastructure proposal calls for extending Medicaid’s Money Follows the Person program, and expanding home care workers’ capacity to bargain collectively. Espinoza said funds should go to raising wages for home care workers as well to employers to improve training. States also need funds for Medicaid if they’re to expand home-care services, he said.

Members of Congress crafting the final details likely will need to meet the demand of budget reconciliation, which allows the Senate to pass legislation with a simple majority. Republicans have scoffed at the high price tag for Biden’s infrastructure plan and his call for raising some taxes to pay for it. Read more from Alex Ruoff.

BGOV OnPoint: Biden Unveils $2.25 Trillion Infrastructure Plan

Preventing Future Pandemics: Also in Biden’s proposal is $30 billion over the next four years to help prevent the next pandemic, just as the U.S. just starts to see the light at the end of the Covid-19 tunnel. The funds would be directed to the Strategic National Stockpile, development of testing and therapies for emerging diseases, prototype vaccines, and improved technology for faster vaccine production.

Public health scientists and researchers expect pandemics to become more common in the coming decades and say that preparing against diseases is more a necessity than an option. “Our national health security is as vital to our national defense as buying tanks and planes,” said Greg Burel, director of the Strategic National Stockpile from 2007 to January 2020. The nation’s Covid-19 response has only amplified the issues that have been brewing in the U.S. health-care system for decades.

“Outbreaks of SARS, Ebola, influenza, Zika and others have cost billions in lost productivity,” the administration said. “The risk of catastrophic biological threats is increasing due to our interconnected world, heightened risk of spillover from animals to humans, ease of making and modifying pandemic agents, and an eroding norm against the development and use of biological weapons.” Shira Stein has more.

Happening on the Hill

Cornyn Eyes Probe of Avantor Sales in Mexico: Sen. John Cornyn (R-Texas) said he wants the chamber to investigate Avantor and other drug companies that sold internationally controlled drugmaking chemicals into Mexico’s “unregulated and corrupt market” amid a U.S. narcotics epidemic. Cornyn, who sits on the Judiciary Committee and the bipartisan Caucus on International Narcotics Control, cited an investigation by Bloomberg exposing how Avantor’s Mexican sales of an essential heroin-making chemical were easily diverted by drug syndicates. Read more from Cam Simpson.

Clyburn Says Memos Show Trump-Era Pandemic Failures: House Select Subcommittee on the Coronavirus Crisis Chair James Clyburn (D-S.C.) sent letters yesterday to the Health and Human Services and Homeland Security departments as part of an ongoing investigation into the Trump administration’s efforts “to procure and distribute personal protective equipment and other critical supplies during the pandemic,” according to a statement, citing documents suggesting that Trump’s administration “failed to react quickly” to the novel virus last spring “despite urgent warnings.” Read the documents here.

Disability Rights Groups Concerned by Opioid Bills: A coalition of 100 nationwide and state disability rights organizations will deliver a joint letter to Congress next week “voicing unified concern” over recently introduced legislation “that risk endangering the health and safety of people with disabilities who require prescribed opioids to manage pain,” the groups said in a statement yesterday. Key aspects of the legislation distort guidance issued by the Centers for Disease Control and Prevention by establishing “inflexible pill limits that the agency itself has publicly warned against due to the risk such limits pose to patients,” they wrote. Read it here.

More on the Pandemic

Moderna Starts Human Tests of South Africa Variant Shot: Moderna’s experimental booster shot to protect against the Covid-19 variant first identified in South Africa has moved into human testing, the NIH announced yesterday. The trial, which the the National Institute of Allergy and Infectious Diseases is leading and funding at four sites across the U.S., comes as nine states have identified the B.1.351 variant of the SARS-Cov-2 virus in patients.

Moderna’s vaccine, authorized in December, appears to protect against Covid-19 variants that have developed over the past several months. Its overall high protection level (94%) makes it effective—although perhaps not as effective—against different versions of the virus. Moderna’s variant vaccine differs from one now authorized for emergency use because it delivers genetic instructions that incorporate key mutations in the B.1.351 variant, the NIH said. Read more from Jeannie Baumann.

  • J&J Manufacturing Error: A manufacturing error at a plant involved in Covid-19 vaccine production affected 15 million doses worth of an ingredient for Johnson & Johnson’s vaccine, according to two sources familiar with the matter, though the company downplayed the situation and said it met its most recent vaccine delivery target. Read more from Josh Wingrove, Riley Griffin and Emma Court.

B.1.1.7 Variant Now Top Strain in Five Regions: A more contagious strain of the coronavirus is now predominant in five U.S. regions and accounts for one-quarter of new cases nationally, the head of the Centers for Disease Control and Prevention said. The B.1.1.7 variant, first seen in the U.K., makes up between 4% and 35% of cases depending on the area, and 26% of cases across the country, Rochelle Walensky said at a press briefing yesterday. U.S. officials warned earlier this year it might become the predominant strain of the virus in the U.S. by early April.

“We are starting to see it creep up. We do know it’s more transmissible, somewhere between 50% and 70% more transmissible than the wild-type strain,” Walensky said. “So, to the extent people are not practicing the standard mitigation strategies, we do think that more infections will result because of B.1.1.7.” Walensky didn’t specify in which U.S. regions that strain is now predominant. Read more from Josh Wingrove.

  • The variant’s rapid spread comes as the CDC found Covid-19 was the third-leading cause of death in the U.S. last year, contributing to a 15.9% increase in the nationwide mortality rate from a year earlier. The disease was the underlying or contributing cause of 377,883 deaths in the country last year, according to the CDC National Vital Statistics System. Just heart disease and cancer were deadlier. Riley Griffin and Robert Langreth have more.

Pfizer Vaccine 100% Effective in Youth: Pfizer said its Covid-19 vaccine was 100% effective in a final-stage trial in adolescents ages 12 to 15, a finding that could pave the way for teens and pre-teens to get shots before the next school year. Pfizer and partner BioNTech said that they planned to submit the data to regulators in the U.S and Europe as soon as possible, seeking to amend their vaccine authorizations to include the younger age group. In people 16 and older, Pfizer’s mRNA vaccine was 95% effective at preventing symptomatic cases in a final-stage trial. Read more from Robert Langreth.

Self-Test Pilot Aims to Reduce Community Spread: Residents of an eastern North Carolina county will have access to rapid at-home coronavirus tests over the next month under a new initiative that seeks to determine if frequent self-testing helps curb community spread of the virus. The federal initiative called “Say Yes! COVID Test” will give Pitt County residents access to free, rapid antigen tests that they can administer themselves three times per week for one month. Read more from Jeannie Baumann.

FDA Oks Rapid Covid Tests For Use at Home Without a Prescription: U.S. regulators authorized rapid Covid-19 tests made by Abbott Laboratories and Quidel for use at home without a prescription, making self-monitoring for the disease even more accessible. The Food and Drug Administration clearance of the tests opens the door to their wide availability at retail stores, allowing consumers to keep them on hand for routine use. The move will help solidify Abbott and Quidel’s positions in the rapid test space, where only a few small companies have won over-the-counter authorizations. Read more from Emma Court and Michelle Fay Cortez.

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What Else to Know

HHS Doubles ACA Ad Spending After Boost: The Biden administration will spend $50 million to promote new Obamacare subsidies made available through the latest pandemic relief law, doubling the amount it’s put toward encouraging people to sign up for health-care coverage. The new subsidies, which are available for the first time to those with incomes above 400% of the federal poverty level, means an average of four out of five customers will be able to buy a plan for $10 or less per month, the HHS said in a statement announcing the new ad campaign, which will begin today. Read more from Sara Hansard.

HHS Asked to Shield Drug Discounts Despite Patient Shift: America’s hospitals are calling on the Biden White House to continue letting health-care providers access discounted drugs in spite of coronavirus-stirred changes to the number of patients they treat with low-income health coverage. The pandemic pushed U.S. hospitals to halt “non-urgent services” and shift resources to treat those suffering from Covid-19, reducing the amount of poor patients, the American Hospital Association told HHS Secretary Xavier Becerra. Read more from Ian Lopez.

DOD Announces Updated Transgender Policy: Defense Secretary Lloyd Austin on yesterday announced the Pentagon has updated its policies regarding the military service of transgender people, Roxana Tiron reports. The policy update reinforces the Biden administration’s reversal of a ban instituted by former President Donald Trump and will support recruitment, retention and the care of qualified transgender individuals, Austin said in a Tweet.

The policies provide a path for those in service for medical treatment, gender transition, and recognition in one’s self-identified gender, according to a release issued by the Defense Department. The policy also addresses the transition and approval process, including the roles of the service member, commander, and medical community.

  • 1,000 to 8,000 troops self-identify as transgender and an additional 2,200 are diagnosed with gender dysphoria, an associated medical condition, the Pentagon said yesterday, Travis Tritten reports.


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With assistance from Roxana Tiron

To contact the reporter on this story: Brandon Lee in Washington at

To contact the editors responsible for this story: Zachary Sherwood at; Giuseppe Macri at; Michaela Ross at

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