HEALTH CARE BRIEFING: Biden Taps Ron Klain as Chief of Staff

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President-elect Joe Biden has selected long-time aide Ron Klain, who played a leading role during the economic and public health crises of the Obama administration, as his White House chief of staff, according to two people familiar with the decision.

Biden offered Klain the top job this week and he has accepted, the people said.

Klain will manage the incoming White House through a pandemic that is surging across the country, once again filling hospital beds and threatening the economy. Biden has said bringing the coronavirus outbreak under control will be his top priority.

White House chief of staff has long been one of the most powerful jobs in Washington. The person is the gatekeeper for the president, deciding who gets to speak with him and who doesn’t, and is often one of the last advisers in the room before major decisions. It’s generally one of the first jobs that a president-elect fills, setting the tone for a new administration.

Klain twice served as chief of staff to vice presidents — Biden at the beginning of the Obama presidency and Al Gore at the end of Bill Clinton’s administration. He also has experience on Capitol Hill that could prove important as the new administration contends with a potential Republican majority in the Senate.

Klain’s experience with Biden on implementing the American Recovery and Reinvestment Act in 2009, and his role leading the federal government’s response to the 2014 Ebola epidemic, will be relevant to the work that the new administration will face in tackling coronavirus and the resulting economic downturn. Read more from Tyler Pager and Jennifer Epstein.

Biden Transition Teams: Biden has also picked key members from the Obama administration to lead his Health and Human Services Department transition team. The agency review team, in the past known as beachhead teams, at HHS will be directed by Chiquita Brooks-LaSure, who helped to pass and implement the Affordable Care Act as part of the Democratic staff for the House Ways and Means Committee. She then served as deputy director for policy at the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services.

Her co-leader is Robert Gordon, director of the Michigan Department of Health and Human Services who was acting deputy director for the White House’s Office of Management and Budget under Obama. The agency review team will work to allow Biden’s administration’s personnel to manage the transfer of power on Jan. 20, Alex Ruoff reports.

Read the full list of transition teams across agencies and departments here.

Biden has also formed a team specifically dedicated to coordinating the coronavirus response across the government, Politico reported yesterday, citing documents it obtained and people familiar with the decision. The group is separate from the coronavirus task force Biden announced last week, and consists of dozens of transition officials to work across federal agencies, Politico reports.

Biden Draws Trump Contrast With Virus Task Panel: Biden’s panel of coronavirus advisers will be led by two veterans of fierce political fights in the past, and one seen as a rising star in addressing inequities of the health-care system. The three—David Kessler, Vivek Murthy, and Marcella Nunez-Smith—are all physicians with established careers. Kessler, a former head of the Food and Drug Administration, and Murthy, a former U.S. surgeon general, together have served under four presidents. While Nunez-Smith is less known in political circles, her role in creating a leading program to promote health equity will hearten those fearful about Covid-19’s impact on communities of color. Read more from John Tozzi and Michelle Fay Cortez.

More on the Pandemic:

Kavanaugh, Roberts Signal Inclination to Keep Obamacare Alive

Two key U.S. Supreme Court justices indicated they are inclined to uphold the bulk of the Affordable Care Act as the court weighed the fate of a landmark law that provides health-insurance to 20 million people.

Chief Justice John Roberts and Justice Brett Kavanaugh both suggested during oral arguments that they won’t vote to strike down the entire law even if the court invalidates a provision that requires people to acquire insurance. A key question is whether the high court would “sever” that so-called individual mandate so that the rest of the law remains intact.

Kavanaugh, speaking to a lawyer defending the law on behalf of the U.S. House, said “I tend to agree with you that it’s a very straightforward case for severability under our precedents, meaning that we would excise the mandate and leave the rest of the act in place.”

The Trump administration is joining Republican-led states in challenging Obamacare, which the GOP has been vying to repeal since it was enacted in 2010. The mandate originally carried a tax penalty for noncompliance, a provision that was central to a 2012 Supreme Court ruling that upheld the law. A Republican-controlled Congress zeroed-out the tax in 2017. Opponents now say the whole ACA must be invalidated.

Roberts, who wrote the 2012 ruling, signaled he disagreed. “I think it’s hard for you to argue that Congress intended the entire act to fall if the mandate were struck down when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act,” said Roberts, an appointee of George W. Bush. Greg Stohr, Lydia Wheeler, and Kimberly Robinson have more.

Biden Promises to Protect ACA: Meanwhile, Biden promised on Tuesday he would defend the Affordable Care Act. “These ideologues are once again try to strip health coverage away from millions of people,” he said of GOP lawmakers at a speech in Wilmington, Del. He said that his incoming administration would start in January to work with Congress to increase protections for coverage. “We will not abandon you. That’s a promise,” Biden said. Read more from Jennifer Epstein.

Happening on the Hill

Senate GOP Unveils Spending Bills: Senate Republicans released 12 bills to fund the federal government until next September, the first move toward negotiations with House Democrats that will be vital to avoiding a shutdown Dec. 12. Successful talks would remove one element of uncertainty for the U.S. economy, with Biden’s victory still being disputed by Trump and a continuing stalemate in separate negotiations on a fiscal stimulus bill. Senate Majority Leader Mitch McConnell (R-Ky.) said funding the government with complete 2021 fiscal year spending bills is a top priority in the post-election lame duck session.

Patrick Leahy (D-Vt.), the senior Democrat on the Senate Appropriations Committee, swiftly highlighted several objections to the Republicans’ proposals, which he said would need to be addressed in talks with the House. Among them were the absence of emergency funds to combat Covid-19. Read more from Erik Wasson and Jack Fitzpatrick.

Coronavirus funds may be one of the biggest hurdles for negotiators to overcome as they hammer out differences in spending discussions. The Senate measure wouldn’t exempt any coronavirus-related funding from the statutory spending caps agreed to in 2019, which conflicts with House Democrats’ decision to provide more than $200 billion in cap-exempt funds broadly related to the virus response. Read more from Jack Fitzpatrick.

Agriculture-FDA: The Senate GOP’s $153 billion Agriculture Department spending bill for fiscal 2021 carries funding increases for nutrition assistance—a crucial selling point for Democrats as many Americans go hungry through the pandemic. The spending bill offers $23.3 billion in discretionary funding, including $3.2 billion for the Food and Drug Administration. It also would allot $68.3 billion to the Supplemental Nutrition Assistance Program. Read more from Megan U. Boyanton.
Labor-HHS-Education: Senate Republican leaders are proposing a nearly $2 billion hike in federal spending for the Health and Human Services Department, a move Democratic leaders called “woefully inadequate” amid an ongoing pandemic. The draft measure for fiscal 2021 would increase federal spending on health-care research and drug treatment programs but doesn’t include money specifically for dealing with the coronavirus. Read more from Alex Ruoff.
BGOV OnPoint: Appropriations Update for Nov. 10

Warren Blasts Virus-Aid Watchdog: Sen. Elizabeth Warren (D-Mass.) blasted the inspector general tasked with monitoring a $2.2 trillion coronavirus relief package for failing to fulfill his mandate, after a spat over investigating the role of lobbyists in the allocation of funds. Warren, who had pushed to set up the aid oversight office and has long criticized the lobbying industry, in July pressed Brian Miller, the special inspector general for coronavirus recovery, to see whether lobbyists had impacted decisionmaking in any specific cases. Read more from Laura Davison.

What Else to Know Today

Latest on the Virus Surge: The American pandemic’s most sustained increase in Covid-19 infections appears poised to get even longer, a worrisome indicator for overworked doctors and nurses. The nationwide uptick in cases that became noticeable around mid-September is now in its ninth week, counting from the previous low point in the seven-day average. That’s a longer run than the March-April tragedy that unfolded largely in the Northeast, and the June-July upswing that hit the Sun Belt hardest. The latest upswing may not have initially been the most dramatic, but it started from a much higher base. Read more from Jonathan Levin.

The same U.S. explosion of Covid-19 cases that helped Pfizer get results for its vaccine trial earlier this week is helping speed along Moderna’s trial. Moderna said yesterday its study has accumulated more than 53 infections, allowing a preliminary analysis of the shot’s effectiveness to begin. Moderna didn’t predict how long it could take an independent monitoring committee to analyze the data, but said the company could get the data to the committee within days. The company said it is still blinded to the data. Read more from Robert Langreth.

Top-to-Bottom Rule Tests HHS’ Staff and Resolve: Ambitious plans to review all HHS regulations every decade would demand thousands of hours of staff time and open the agency up to a rash of new legal challenges, health-care attorneys and regulatory researchers say. The goal of the top-to-bottom review is to improve policies that are outdated or aren’t working as intended—with the threat of regulations expiring if they aren’t reviewed in time. This would be the broadest audit of the department’s regulations ever undertaken and could allow for changes health-care industry groups and attorneys have long wanted but been unable to get Congress to pass. Read more from Shira Stein.

U.S. Opposes Redo of States’ Provider Fee Fight: The Fifth Circuit should reject a request for rehearing in a case alleging that a health insurer premium fee imposed on for-profit Medicaid managed care organizations by the Affordable Care Act is really a tax illegally imposed on the states, the government said. The states seek to get back almost $500 million in fees they paid to make sure their contracts with MCOs were “actuarially sound” under policies and principles set by a private panel. But the six states raised issues that weren’t presented when requesting review, the U.S. said, Mary Anne Pazanowski reports.

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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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