HEALTH CARE BRIEFING: Democrats Eye Limit on Medicaid Expansion

By Michaela Ross

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Congressional Democrats from Republican strongholds say they expect legislation to create a federal Medicaid program for many of their states to be limited to as few as three years. The battle now, they say, is getting funding for the program for as many years as possible.

“Right now it’s pretty clear it won’t be made permanent,” Sen. Tammy Baldwin (D-Wis.) said in a hallway interview.

Democrats are debating how to shrink a $3.5 trillion domestic spending agenda that has so far included creating a permanent federally run Medicaid program to cover Americans in states that haven’t grown their public health insurance programs under the Affordable Care Act.

A House committee approved a bill earlier this month that would immediately give no-cost insurance through the ACA marketplace to people in non-Medicaid expansion states under a certain income level, then transition them starting in 2025 to a new, federal Medicaid-like program.

That plan, coupled with provisions to lower ACA premiums overall, could cost as much as $300 billion, House leaders have said. With moderates in both the House and Senate pushing to lower the price tag of the domestic spending bill, supporters of the so-called “Medicaid gap” fix say party leaders have signaled they’ll have to accept cuts.

Two senior Democratic aides, one of from the House and another from the Senate, said to cut costs the new Medicaid program could be shortened to as few as three years. However, both cautioned that Democratic leaders haven’t settled on the overall size of the package so it’s unclear what changes, if any, will be needed. Read more from Alex Ruoff.

Pelosi Regroups on Infrastructure, Budget Deals: Speaker Nancy Pelosi (D-Calif.) plans to try again today for a vote on bipartisan infrastructure legislation that’s been held up by a battle between moderate and progressive Democrats over President Joe Biden’s economic agenda.

Lawmakers will pick up where they left off late last night, when Pelosi sent them home after hours of negotiations failed to produce an agreement in a setback for Biden. Top White House officials had spent the evening shuttling around the Capitol to meet with the warring factions yet fell short of a breakthrough.

Progressives are vowing to stall the $550 billion infrastructure bill if the House and Senate don’t first vote on a tax-and-spending package worth as much as $3.5 trillion. Key moderate Sen. Joe Manchin (D-W.Va.) said late yesterday he still wants to cut the tax and spending bill by some $2 trillion. Read more from Erik Wasson, Laura Litvan and Emily Wilkins.

Happening on the Hill

Congress Averts Shutdown But Full Funding Hurdles Await: Lawmakers must overcome key hurdles to reach a full government funding deal later this year, though they managed to avert a shutdown with a stopgap measure through Dec. 3. Senators voted 65-35 in favor of the continuing resolution yesterday, followed by the House’s 254-175 vote to clear the measure (H.R. 5305). President Joe Biden signed the bill into law later in the day.

The stopgap measure buys Congress some time, but it won’t be easy to strike a deal on all 12 annual spending bills over the next nine weeks. While lawmakers have made progress negotiating a bipartisan spending level for the military, there’s been no formal bipartisan, bicameral deal on top-line spending levels for defense and non-defense programs. Jack Fitzpatrick has more.

  • The stopgap signed into law yesterday includes an array of anomalies, including a provision to re-up the government’s power to automatically restrict fentanyl-like substances. The government’s authority to ban the powerful drugs was poised to lapse on Oct. 22, but now will be extended to Jan. 28, 2022. Read more from Bloomberg Government.
  • BGOV Bill Summary: Senate Version of H.R. 5305, CR & Storm Aid

Lawmakers Tackle Antitrust, IP Barriers to Cheaper Drugs: House lawmakers advanced legislation to crack down on seemingly anti-competitive conduct aimed at lowering U.S. drug costs, the latest in a spate of activity geared toward making prescription drugs more affordable for Americans.

The House Judiciary Committee on Wednesday approved three bills honing in on drugmaker activity involving patents and communications to the Food and Drug Administration—areas that have come under scrutiny as potential factors in slowing the introduction of lower-cost generic drugs to market. The bills, introduced by House Democrats, are related to measures advanced by the Senate Judiciary Committee over the summer. Those have yet to come to the floor for a vote. Read more from Ian Lopez.

Pressley Introduces Wigs as Medical Equipment Bill: Rep. Ayanna Pressley (D-Mass.) yesterday reintroduced the “Wigs as Durable Medicap Equipment Act” for Medicare coverage for wigs for individuals undergoing cancer treatment or impacted by alopecia areata, an autoimmune skin disease that attacks the hair follicles, according to a press release. Pressley revealed her alopecia areata diagnosis in 2019, a condition that affects approximately 7 million Americans.

Senate Confirms HHS Assistant Secretary Pick: The Senate yesterday confirmed by voice vote Melanie Anne Egorin to be an assistant secretary of Health and Human Services. Egorin previously served as deputy health staff director for the House Ways and Means Committee. The Senate Finance Committee held a hearing on her nomination for the HHS post in June.

The Coronavirus Pandemic

Biden DOJ Takes On Texas School Mask Mandate Ban: The Justice Department is urging a Texas court to strike down the governor’s ban against school mask mandates, marking the first time the nation’s top law enforcement agency is taking on the issue in court. The department on last night filed a brief in support of parents’ claims that Gov. Greg Abbott‘s (R) order denies children with disabilities access to public education because they’re at high risk of illness and death from the virus. Read more from Courtney Rozen.

  • Meanwhile, escalating threats to teachers and school board members over campus mask mandates and quarantines are raising alarm among national K-12 groups. School leaders, teachers, and staff, carrying out guidance to reduce the spread of the coronavirus as students returned to classes, are encountering harassment and threats of violence both online and in person. Andrew Kreighbaum has more.

Related:

HIPAA Is No Excuse for Keeping Mum on Your Vaccination Status: Federal health privacy law doesn’t protect workers, students, or customers from most requests for information about their Covid-19 vaccination status, the Department of Health and Human Services’ Office for Civil Rights said yesterday. Privacy protections under the Health Insurance Portability and Accountability Act apply in the health-care sector only, and don’t place restrictions on most employers, schools, and businesses, the HHS said in a Sept. 30 guidance document. Read more from Christopher Brown.

Merck Says Covid-18 Antiviral Cut Hospitalization, Deaths by Half: Merck’s Covid-19 antiviral pill molnupiravir reduced the risk of hospitalization or death by 50% in an interim analysis of a late-stage trial, findings that could give doctors another potent virus-fighting tool. The company is halting the study and will seek an emergency-use authorization from the U.S. Food and Drug Administration as quickly as possible, Chief Executive Officer Rob Davis said in an interview. Merck also plans to submit applications to regulators in other countries. Read more from Emma Court.

More Than 55 Nations Have Yet to Hit 10% Vaccine Target: About nine months after the arrival of Covid-19 shots, dozens of countries have yet to vaccinate 10% of their populations, a milestone seen as crucial in narrowing a glaring gap in access. The head of the World Health Organization earlier this year called for an urgent push to hit that target by the end of September. But more than 55 countries remain short of the goal. Read more from James Paton.

G-7 Agrees to Work to Speed Travel Rebound: Transport and health ministers of the G-7 countries agreed to work toward common standards to accelerate a pickup in foreign travel as the aviation industry clamors for an end to a patchwork of rules and restrictions. In a statement issued after a virtual meeting held yesterday, officials from the G-7 said they will align their policies around principles such as fairness, protecting privacy, and relying on scientific evidence when setting travel rules. Read more from Siddharth Philip and Alan Levin.

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What Else to Know

Rule Allowing Abortion Referrals, Reversing Trump, Clears Hurdle: Federally funded doctors will soon be able to refer pregnant patients to facilities that provide abortions under a final rule that cleared White House review yesterday. The signoff from the Office of Management and Budget signals the rule can be published by the Department of Health and Human Services at any time. The HHS proposed in April reversing a Trump-era rule that prohibited federally funded doctors from referring pregnant patients to facilities that provide abortions, saying the policy “undermined the public health of the population the program is meant to serve.” Read more from Fawn Johnson.

Alito Rebuffs Notion SCOTUS Overturned Roe in Texas Case: Justice Samuel Alito defended the U.S. Supreme Court’s handling of a bid to stop a Texas law that bars most abortions after six weeks of pregnancy, accusing critics of distorting what the court did when it let the controversial ban take effect. Speaking at the University of Notre Dame, Alito rejected suggestions that the divided court used the emergency request to effectively overturn Roe v. Wade, the landmark decision that legalized abortion nationwide. Read more from Greg Stohr.

  • The U.S. Supreme Court term that starts Monday isn’t entirely about abortion. It only seems that way. The biggest abortion face-off in a generation will take place Dec. 1, when Mississippi defends its ban on the procedure after the 15th week of pregnancy. Upholding the law would require the court to gut the 1992 Planned Parenthood v. Casey ruling. Read more from Greg Stohr.
  • Separately, Texas defended its new law banning most abortions as “stimulating” interstate commerce because it’s forcing women to travel to other states. In a court filing yesterday, Texas Attorney General Ken Paxton (R) cited news reports of women driving hundreds of miles to Oklahoma and Kansas to seek abortions as proof that the law wasn’t interfering with interstate commerce. The Biden administration, which is suing to block the law, has cited its impact on interstate commerce as grounds for federal intervention. Read more from Erik Larson.

Insulin, Epinephrine Rule Rollback Finalized: The Biden administration yesterday retracted a Trump-era rule that would have required community health centers to pass all insulin and epinephrine discounts to patients or lose federal grant money. Biden’s Health and Human Services Department withdrew the rule “due to the excessive administrative costs and burdens that implementation would have imposed on health centers,” the agency said in a Federal Register filing (RIN 0906-AB30). Read more from Jacquie Lee and Ian Lopez.

Surprise Billing Arbitration Rules Set Dispute Bounds: The Biden administration released regulations yesterday specifying how billing disputes will be resolved for emergencies and other types of health care. The interim final rule (RIN 0938-AU62) from four agencies covers the independent dispute resolution process that health-care providers and health plans must use under the No Surprises Act enacted in 2020 as part of budget legislation (Public Law: 116-260). The rule is the third one issued to implement the law. Read more from Sara Hansard.

Teen Vaping Craze Continues: An estimated 2 million U.S. teens are using e-cigarettes, with many preferring flavored products and newer devices, suggesting what regulators once dubbed an epidemic of youth vaping drags on. About 1.72 million, or 11.3%, of high school students and about 320,000, or 2.8%, of middle school students said they currently use e-cigarettes, according to the annual National Youth Tobacco Survey from the Centers for Disease Control and Prevention and the Food and Drug Administration. Read more from Angelica LaVito.

‘Forever Chemicals’ Pose Health Quandaries The EPA is struggling with a dearth of data on most PFAS, as well as fears from community members about research on incinerating or destroying “forever chemicals” occurring near their neighborhoods, the agency’s scientists said this week. Environmental Protection Agency scientists detailed dozens of studies this week to better understand how per- and polyfluoroalkyl substances, or PFAS, affect people’s health. Read more from Pat Rizzuto.

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To contact the reporter on this story: Michaela Ross in Washington at mross@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Brandon Lee at blee@bgov.com

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