HEALTH CARE BRIEFING: Covid Aid Hits Snag Amid Amendment Dispute

By Brandon Lee

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A hard-fought $10 billion emergency Covid compromise agreement hit a last-minute snag in the Senate Tuesday as Republicans demanded a deal to propose amendments. Republicans want to force a vote on the Biden administration’s repeal of “Title 42,” a pandemic-related restriction on border crossings, a move likely to create headaches in the Democratic caucus.

Other Republicans, including Sen. Joni Ernst (Iowa), said that they have amendments they want considered as well. Sen. Mitt Romney (R-Utah), the lead GOP negotiator on the pandemic funding, urged his caucus to vote against a procedural motion on the bill, essentially stalling it until the two parties can agree on the parameters for floor debate. That procedural move failed to get the 60 votes needed, but lawmakers said the standoff could be resolved quickly.

Once there is an agreement on amendments, “then I’ll be all in favor of moving ahead, again, because the underlying bill, from what I can tell is quite broadly supported in the Republican caucus as well as in the Democratic caucus,” Romney told reporters.

The White House has pushed Congress to act quickly on the Covid-19 funding bill, which is less than half of the $22.5 billion President Joe Biden initially requested. “The bill is a start. It should pass immediately, but it’s exactly that: just a start,” White House pandemic response czar Jeff Zients told reporters on Tuesday. “Congress must keep working to immediately provide additional funding for our remaining domestic needs so we are prepared for whatever comes” and “importantly, to act with urgency to fund our global Covid-19 response.” Read more from Alex Ruoff and Erik Wasson.

  • A vote on an amendment that seeks to restore Title 42 would likely stir tension in the Democratic caucus, with at least four members opposed to ending the policy. Notably, Sen. Joe Manchin (D-W.Va.), who last week called the end of Title 42 a “frightening decision,” said Title 42 wouldn’t affect his vote on the pandemic relief package. “I’m not going to hold Covid relief up and the well-being of the citizens of the United States on policy,” he said. But fellow moderates sounded less certain, Ellen M. Gilmer reports.
  • Sen. Mark Kelly, who also opposes ending Title 42, said he is open to options for border management, but Kelly (D-Ariz.) didn’t say if he would support a GOP amendment. Sen. Maggie Hassan (D-N.H.) said that she’ll “certainly” look at any proposals, referring to Republicans’ amendment plans. “But at the end of the day this is about having a plan for border security.” Separately, Sen. Jon Tester (D-Mont.) sent a letter Tuesday to the Homeland Security Department demanding details on how the policy change will be carried out, Gilmer reports.

Pfizer’s $5 Billion Bill for U.S. Takes Big Bite From Covid Aid: The Biden administration is on the hook to pay Pfizer nearly $5 billion for pills it’s already ordered to treat Covid, meaning as much as half of a scaled-back pandemic funding bill the Senate is debating is already spoken for, officials familiar with the matter said. The true purchasing power of the package will be even less because of commitments the government’s already made, the officials said. Read more from Josh Wingrove.

MORE ON THE PANDEMIC:

  • The White House plans to beef up coordination across U.S. health agencies so that patients suffering from long-term effects of Covid-19 and their medical providers have faster access to treatments and diagnostics as new research comes to the forefront. Biden issued a memorandum on Tuesday directing Health and Human Services Secretary Xavier Becerra to develop the first interagency national research action plan on long Covid. The directive calls for new research and aims to make it easier to access care covered by insurance. Jeannie Baumann has more.
  • An all-star panel of Covid-19 experts will convene this week to hash out how and when vaccines should be updated to address future variants as the virus continues to rapidly mutate. The meeting of Food and Drug Administration advisers should provide some of the first hints of its strategy to craft a more proactive plan for developing strain-specific boosters. Until now, the process has been led by drugmakers such as Moderna and Pfizer. But this is likely just the beginning. Read more from Fiona Rutherford and Robert Langreth.
  • Related: Moderna Covid Shots Turned Down by Buyers on Delivery Woes

Drug Costs Part of Senator’s Focus on FDA User Fees

A greater number of cheaper, interchangeable versions of insulin and other costly brand-name biologics can help to significantly combat rising drug costs, senators argued at a hearing Tuesday. Members of the Senate Health, Education, Labor, and Pensions Committee questioned industry representatives at a discussion on the latest round of user fee agreements between the FDA and the prescription drug, generic, biosimilar, and medical device industries. User fees make up nearly half of the FDA’s total funding.

Those agreements include additional commitments to helping generic and biosimilar manufacturers bring more products to the market. The legislation is considered must-pass. Senate leaders say the user fee bills can serve as important vehicles to lowering drug prices—a high priority issue for Congress and the American public. Senators are knee-deep in negotiations on a bipartisan agreement that could lower the list price of insulin and as well as the amount patients pay out of pocket for it.

HELP Chairwoman Patty Murray (D-Wash.) called the rise in prescription drug costs “outrageous,” citing estimates that Americans spent more than $535 billion on pharmaceuticals in 2020. Though the rise in drug costs over the past couple of years have been due in part to care related to the pandemic, Murray pointed out that Washington-based think tank the Urban Institute found that in 2018 and 2019, nearly 13 million adults delayed getting or didn’t get needed drugs due to high costs. “We have too many Americans who we know are choosing between paying their mortgage and getting life-saving medicine,” she said.

Commitments within the FDA user fee agreements and potential rider bills may ramp up generic and biosimilar approvals and ultimately bring cheaper treatment alternatives for Americans, she said. The proposal for reauthorizing the Generic Drug User Fee Amendments includes goals for the development and publication of product-specific guidance for complex generic drugs— products that use complex active ingredients, dosage forms, or drug-device combinations. Read more from Celine Castronuovo.

What Else to Know Today

Biden, Obama Tout ACA: President Joe Biden welcomed Barack Obama back to the White House on Tuesday to mark a dozen years since passage of the health care law that Biden famously called a “big f——- deal.” The former president returned to the White House for the first time since he welcomed Donald Trump the morning of his 2017 inauguration. It’s a pivotal moment in Biden’s presidency, as he struggles with poll numbers, persistent inflation and bleak prospects for Democrats in the November midterm elections.

Biden was set to sign an executive order meant to strengthen the 2010 Affordable Care Act, including by closing a loophole that prevented millions of Americans from accessing subsidies for their monthly insurance premiums. “To get the bill passed, we had to make compromises. We didn’t get everything we wanted; that wasn’t a reason not to do it,” Obama said Tuesday.

The event is part of a White House effort to focus on pocketbook issues that affect average Americans. The landmark health care law remains popular with a majority of the public, and Democrats campaigned heavily on preserving it during the 2018 midterms in which they won back the House majority from Republicans. “The Affordable Care Act has been called many things,” Biden said. “But ‘Obamacare’ is the most fitting.” Read more from Jordan Fabian and Jennifer Jacobs.

  • The future success of the Affordable Care Act will depend on Congress taking action to continue increased subsidies to Americans on individual plans, officials said Tuesday. A record 14.5 million Americans signed up for Obamacare in the most recent enrollment period, partly because of those expanded tax credits, which went to 2.8 million more people in 2022 than a year earlier. “We call on Congress to make permanent the ACA subsidies that are included in the American Rescue Plan,” Vice President Kamala Harris said at the White House event Tuesday. Read more from Shira Stein.

Abortion Costs Have Jumped as U.S. States Add Restrictions: The two most common ways to get an abortion in the U.S.—via pill and a first-trimester procedure—is costing patients 13% and 21% more, respectively, in 2020 versus 2017, according to new research published this month in the peer-reviewed healthcare journal Health Affairs. Those upticks outpaced wider health care inflation rates, the study noted. By 2020, the average cost rose above $500 for any type of abortion procedure. Pre-coronavirus, over a third of Americans didn’t have the cash or equivalent to cover a $400 unexpected expense, the Federal Reserve reported.

The costs measured in the analysis also don’t account for other financial burdens a patient might have to assume, such as travel, lost wages and childcare, some of which may be rising due to new state restrictions. Most people pay out of pocket for abortions for a slew of reasons, including because the Hyde Amendment prevents federal funds like Medicaid from being used for abortion services except in limited circumstances, and more than 30 states and Washington, D.C., also ban the use of state Medicaid funds from being used to fund an abortion. Read more from Kelsey Butler.

  • Two Republican lawmakers are calling for the cancellation of U.S. government contracts with Citigroup after the banking giant vowed to cover travel costs for employees seeking abortions. Citigroup provides the credit cards that members of the House use to pay for flights and supplies. Reps. Mike Johnson (La.) and Rodney Davis (Ill.) pressed House Chief Administrative Officer Catherine Szpindor to cancel the contract, saying the legislative branch has a longtime policy of not using taxpayer dollars to fund abortion. Read more from Jenny Surane.

California May Test Constitution by Ignoring Abortion Orders: California lawmakers are getting set to pick a fight with Texas or any other state that lets private citizens sue those who help women get abortions—just in case any future litigation crosses state lines.

Debates are happening in statehouses around the country as politicians try to get new laws on the books before the U.S. Supreme Court rules in a Mississippi case that could overturn Roe v. Wade, the 1973 decision that established a constitutional right to end a pregnancy before viability. The latest of those votes came Tuesday, when Oklahoma lawmakers gave final legislative approval to a bill that would make performing an abortion a felony punishable by up to 10 years in prison.

Californians are preparing for the possibility of groups that pay for bus fare or give out-of-state abortion-seekers a place to stay being affected by laws in Texas and Idaho that permit anyone to sue those suspected of “aiding and abetting” an abortion. Read more from Joyce E. Cutler.

IRS Moves to Guard Employees’ Payments for Health Coverage: The Internal Revenue Service Tuesday published a proposed rule to ensure its regulations are consistent with “the policy to protect and strengthen” the Affordable Care Act. The IRS proposal would amend regulations on Obamacare’s premium tax credits to require that “affordability” of company plans be based on the employees’ share plus their family members. Current regulations require that employers offer affordable coverage based on the cost of covering the employee only. Read more from Sara Hansard.

U.S. Prevails in Fight Over Medical Expert Witness: The U.S. held onto a win in a suit accusing a federal health-care provider of medical malpractice after the 10th Circuit found that the plaintiffs’ expert witness didn’t meet Kansas’ requirements for standard-of-care witnesses. To qualify as a medical expert witness under Kansas law, a professional has to have spent at least 50% of their professional time in “active clinical practice” in the two years preceding the injury, the 10th Circuit said Tuesday. That may include “indirect” patient care, such as consulting, but not time spent advising residents, it said. Mary Anne Pazanowski has more.

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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: Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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