HEALTH CARE BRIEFING: Democratic Schism Seen on Dental Benefits

By Brandon Lee

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Centrist House Democrats are pushing to shrink their party’s health-care wish list to focus more on low-income Americans, a move backed by industry groups including dentists who say a narrower focus is better policy.

The group of Democrats blocked one panel from advancing their party’s drug-pricing bill, with two members arguing it was too far-reaching and could stymie innovation in the pharmaceutical industry. Some of those Democrats also want to rein in a proposal that seeks to expand Medicare to include dental coverage, a priority for progressives such as Sen. Bernie Sanders (I-Vt.).

The push opens another divide that may compromise Democrats’ proposed domestic legislation that was expected to cost as much as $3.5 trillion and include adding vision, hearing and dental benefits for every senior on Medicare. Dental groups have welcomed the call for focusing the benefits on low-income seniors or those who might currently lack supplemental coverage.

“If you have scarce dollars, if there’s less money to spend, then you can spend it wisely,” Mike Graham, the senior vice president of public affairs for the American Dental Association said. “That’s our message.” The ADA wants to give the new dental benefit just to people in Medicare who make under 300% of the poverty level, which would be under $40,000 per year for an individual. This would extend the new benefit to almost half of seniors in Medicare, according to a 2018 report from the Kaiser family Foundation.

  • Separately, a slate of progressive groups sent a letter to Senate leaders yesterday asking them to go further on expanding the program and cutting drug prices than the House’s proposed reconciliation package. Groups such as Indivisible and the Center for Popular Democracy called on leaders to “not cave to the pharmaceutical lobby’s demands” by “protecting the prescription drug pricing reforms, including comprehensive dental, vision and hearing benefits in Medicare.” See the letter to leaders here.

Two House panels last week approved legislation adding vision, hearing and dental coverage to Medicare. Dental is by far the most expensive and complicated of the three to roll out: the nonpartisan Congressional Budget Office has previously estimated that such coverage would cost $238 billion over 10 years, compared with $30 billion for vision and $89 billion for hearing coverage.

To lower the expected cost of these new benefits, House Democrats have proposed introducing the new dental benefits starting in 2028, ramping up the coverage over five years. Sanders has promised to give seniors new benefits faster than the House envisions, but has yet to release a competing proposal. Alex Ruoff has more.

Yarmuth on Timing, Health Provisions: Democrats hope to resolve key differences in talks between the House, Senate, and White House on their reconciliation bill over the next 48 hours, House Budget Chair John Yarmuth (D-Ky.) told reporters yesterday. Disagreements on taxes, Medicaid, drug pricing, and school construction funds are among the topics of discussion, he said. Lawmakers hope to make late changes via a manager’s amendment sent to the House Rules Committee, he said.

On the issue of drug pricing specifically, Yarmuth said he had talked to a few of the members who had voted against the provision in committee markups. While he didn’t believe Rep. Kurt Schrader (D-Ore.) would vote for the final reconciliation bill, Yarmuth predicted the others, including Rep. Scott Peters (D-Calif.), would ultimately support it despite previous complaints, Jack Fitzpatrick reports.

“I’ve been herding cats now for four months or so, and my message to all of them has been, posture all you want on all your priorities,” Yarmuth said. “You should, that’s appropriate. Fight for what you believe in. But ultimately, you’re all going to vote for this, because you’re not going to vote against childcare, you’re not going to vote against paid family leave, yada yada yada. And by the way, have you met Nancy?”

Speaker Nancy Pelosi (D-Calif.) said yesterday that Democrats must be prepared for adjustments to the reconciliation legislation and to an agreed to top-line spending number with the Senate, according to a letter sent to House Democrats. Pelosi said the adjustments may need to be made according to the Byrd rule. House and Senate Budget Committees are reviewing the legislation now for possible Byrd violations in order to narrow exposure to such challenges, Max Zimmerman and Billy House report.

Also Happening on the Hill

Senators Eye Higher Penalties for Hiking Drug Prices: A Senate panel is expanding plans to penalize drug makers that increase drug prices faster than inflation, Stat reports, citing a description of an internal Senate document. The description of policies were included in a slide deck presented to Senate Democrats on Sept. 14. The legislation has not been finalized. “The bill prohibits price gouging by requiring drug companies to pay the difference” when drug prices rise faster than inflation, it says, Stat reports.

Bipartisan Support for Price Transparency in Hospitals: House Energy and Commerce Chair Frank Pallone (D-N.J.) and ranking member Cathy McMorris Rodgers (R-Wash.) sent a letter to HHS Secretary Xavier Becerra “in support of the 2022 Medicare Outpatient Hospital Prospective Payment Rule’s provisions to increase penalties for hospitals not in compliance” with the Hospital Price Transparency Final Rule, citing “troubling reports for low hospital compliance.” Read the letter here.

House Panel to Hold Hearing on Pandemic Aid Programs: The House Select Subcommittee on the Coronavirus Crisis will hold a hearing tomorrow on pandemic relief programs, Chair James Clyburn (D-S.C.) announced. It will examine outcomes of the measures and “identify further action needed” to build a post-pandemic economy, according to a statement. Pandemic aid laws have offered assistance to millions of Americans, but they “were only designed as temporary stopgap measures,” the statement says.

Lawmakers Want Swine Fever Text in Stopgap: Farm state lawmakers from both sides of the aisle are pressing to combat African swine fever, with Democrats eyeing a stopgap spending bill as a way to secure funds to combat the disease. The highly contagious disease—which the lawmakers fear will spread to the U.S. from an outbreak in the Dominican Republic—can cause fever, coughing, and other symptoms in hogs. It’s also threatening the nation’s pork industry. Read more from Megan U. Boyanton.

House Passes VA Program Extensions: The House passed a bill by a 423-0 vote yesterday that would extend Veterans Affairs Department health-care initiatives and a property donation pilot program. Lawmakers passed the measure (H.R. 5293) from Rep. Frank Mrvan (D-Ind.) under suspension of the rules. For more, see the BGOV Bill Summary by Brittney Washington.

The Coronavirus Pandemic

U.S. to Allow Most Vaccinated Foreign Passengers: The U.S. will soon allow entry to most foreign air travelers as long as they are fully vaccinated against Covid-19—while adding a testing requirement for unvaccinated Americans and barring entry for foreigners who haven’t gotten shots. The measures are the most sweeping change to U.S. travel policies in months and widen the gap in rules between the vaccinated and unvaccinated. They replace existing bans on foreign travel to the U.S. from certain regions, like Europe.

While the move will open the U.S. to millions of vaccinated people, the White House cast the measure as a crackdown, pointing to stricter testing rules and a new contact tracing regime. The new policy will take effect in “early November,” according to the White House, though the precise date isn’t yet clear. “This vaccination requirement deploys the best tool we have in our arsenal to keep people safe and prevent the spread of the virus,” Biden’s pandemic czar Jeff Zients said. Josh Wingrove has more.

Pfizer Shot Safely Boosts Antibodies in Kids: Pfizer-BioNTech said their Covid-19 vaccine was safe and produced strong antibody responses in children ages 5 to 11 in a large-scale trial, findings that could pave the way to begin vaccinating grade-school kids in a matter of months. The long-awaited results offer one of the first looks at how well a Covid-19 vaccine could work for younger children. Pressure to immunize kids has mounted in the U.S., as the school year begins. Read more from Robert Langreth.

  • Meanwhile, Anthony Fauci, Biden’s chief medical adviser, said in an interview on MSNBC that a vaccine for children ages 5 to 11 will likely be available before Halloween, Bloomberg News reports.

Religious Lawsuits Over Shots Reveal Private-Public Divide: Companies have broad power to overcome religious objections to Covid-19 vaccine mandates while an early ruling shows potential limitations to government authority to require the shot. Even though federal anti-bias law requires companies to accommodate workers’ religious objections to vaccine mandates, the U.S. Supreme Court’s 1977 decision in TWA v. Hardison gives them the leeway to deny such exemptions if they would impose more than a trivial burden on their operations. Read more from Robert Iafolla.

U.S. Buys $646 Million in Rapid Covid-19 Tests: Four companies—Quidel, OraSure, Intrivio, and Abbott—will deliver 60 million over-the-counter rapid Covid-19 test kits to the federal government under a new contract to increase testing availability. $647 million in kits will begin being delivered in October, and the federal government will be able to continue ordering kits until September 2022, according to an announcement from the Defense Department. Read more from Shira Stein and Emma Court.

Covid-19 Toll Surpasses 1918 Flu Deaths: The Covid-19 pandemic surpassed the the 1918 influenza pandemic yesterday by death toll, a milestone many experts lament was preventable after the arrival of vaccines. The U.S. has reported 675,446 deaths since the start of the pandemic, according to Johns Hopkins University data, more than the 675,000 estimated to have died a century earlier. Still, the comparisons between the two pandemics are imperfect. Jonathan Levin and Kristen Brown have more.

More Headlines:

What Else to Know Today

SCOTUS to Take Up Abortion Case Dec. 1: The U.S. Supreme Court scheduled arguments for Dec. 1 on its biggest abortion case in a generation: a Mississippi appeal that seeks to overturn the landmark Roe v. Wade ruling. The case, which the court will resolve by late June, centers on a law that would ban abortion in almost all circumstances after 15 weeks of pregnancy. The court will consider it amid a push by GOP-led states for even tighter rules, including Texas’s new six-week ban. Greg Stohr has more.

  • And though Texas and Mississippi have grabbed the spotlight lately, other meaningful challenges to state GOP abortion laws are still winding their way through the federal courts. The validity of states’ laws banning abortions after six weeks’ gestation and those sought because of a prenatal diagnosis of Down Syndrome will be considered this week in the Eleventh and Eighth Circuits. Read more from Mary Anne Pazanowski.
  • Related: Apple, Amazon Duck Texas Abortion Fight as Startups Leap In

Also From the Courts:

Biden Drug Price Pressure on Patent Office Draws Skeptics: The Biden administration’s approach to bring down drug costs by challenging aspects of the U.S. patent system lines up with a push from Democrats and Republicans in Congress, but skeptics say it’s looking in the wrong direction. Biden, working through the Food and Drug Administration, has asked the Patent and Trademark Office to reconsider practices often criticized as vehicles for pharmaceutical companies to block generic competition, effectively extending their drug monopolies. Read more from Ian Lopez.

More Headlines:

Industry Headlines:

With assistance from Jack Fitzpatrick and Alex Ruoff

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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