HEALTH CARE BRIEFING: Democrats Eye Ways to Trim Medicare Agenda

House Democrats left a meeting with President Joe Biden Friday with a unified message: it’s time to compromise. The question now is who compromises.

Biden signaled that his party’s once $3.5 trillion domestic policy package will likely shrink, according to lawmakers at the Friday meeting. Speaker Nancy Pelosi (D-Calif.) backed off a pledge to bring the bipartisan infrastructure package to the floor last week as it became clear progressives would vote down the measure as the larger domestic package’s fate remained unclear.

Democrats now face the tough task of trimming their sweeping domestic policy agenda, potentially giving up on major priorities such as adding new benefits to Medicare or expanding Medicaid in Republican-controlled states.

Some Democrats say it’s up to the moderates demanding a trimmed down package to explicitly say which policies get jettisoned. “My question for them is what do you think is unworthy of investment,” asked Rep. David Cicilline (D-R.I.) after the meeting. “It’s on them to make that case to the balance of the caucus.”

Rep. John Yarmuth (D-Ky.), chair of the House Budget Committee, said it makes sense to cut the proposal to add hearing, vision and dental benefits to Medicare because it’s costly—estimated at more than $350 billion—and won’t be available right away, Alex Ruoff reports.

Read more on the state of play of Democrats’ agenda.

• Rep. Jimmy Gomez (D-Calif.) said Biden on Friday threw out $2 trillion as a hypothetical range for a potential deal. According to another participant in the meeting, the president talked about a range of $1.9 trillion to $2.3 trillion based on discussions with Sens. Kyrsten Sinema (D-Ariz.) and Joe Manchin (D-W.Va.). Read more from Erik Wasson, Laura Litvan and Laura Davison.
• House progressives looking for ways to scale back some of the more ambitious social spending are eyeing having those programs expire rather than be permanent. “One of the ideas out there is to fully fund what we can fully fund, but instead of funding it for 10 years, fund it for five years,” said Rep. Alexandria Ocasio-Cortez (D-N.Y.), a leading progressive voice, on CBS’s “Face the Nation.” Read more from Greg Korte.
• Pelosi provided House Democrats with a new Oct. 31 target date to pass the stalled bipartisan infrastructure bill. “We must pass BIF well before then—the sooner the better, to get the jobs out there,” wrote Pelosi in a letter to her caucus on Saturday, referring to the $550 billion package in new infrastructure spending, Billy House reports.
• Biden himself has lashed together the fate of the infrastructure plan and the much larger social-spending and tax package. He planned to continue engaging with lawmakers over the weekend and to take his case to the American public, White House Press Secretary Jen Psaki said in a statement on Saturday. Read more from Nancy Cook.
• Related: Biden Heads to Michigan Tuesday to Pitch Agenda Amid Democrats’ Gridlock

Sinema Denounces House Liberals: Sinema criticized House liberals on Saturday for delaying a vote on the bipartisan infrastructure bill she helped negotiate, blaming them for eroding trust in elected officials. The unusually withering public statement from Sinema, who has sought to keep her negotiations with Biden private, shows the depth of mistrust that has developed between factions of the Democratic Party. “I have never, and would never, agree to any bargain that would hold one piece of legislation hostage to another,” Sinema said on Saturday, Peter Martin reports.

The Coronavirus Pandemic

Biden Mourns 700,000 Deaths: Biden marked the “painful milestone” of 700,000 U.S. deaths from Covid-19, saying it’s a reminder for Americans to get vaccinated. He said “we must not become numb to the sorrow.”

“On this day, and every day, we remember all those we have lost to this pandemic and we pray for their loved ones left behind who are missing a piece of their soul,” Biden said in a statement Saturday. “As we do, the astonishing death toll is yet another reminder of just how important it is to get vaccinated.”

FDA Panels for Moderna, J&J Boosters, Pfizer Kids’ Shot Set: The U.S. Food and Drug Administration said its advisory committee will meet on Oct. 14 and 15 to discuss the use of booster doses of Moderna and Johnson & Johnson’s Covid-19 vaccines. On Oct. 26 the committee will discuss an anticipated request from Pfizer to amend its emergency use authorization for the use of its Covid-19 vaccine in children ages 5-11 Read more from Anna Edney.

• If authorized for children 5-11, Pfizer’s shot would be the first Covid-19 vaccine that’s administered at a different dosage. Everyone 12 and up gets the same two-dose regimen of 30 micrograms three weeks apart. The pediatric vaccine is a third of the adult shot with a two-dose regimen of 10 micrograms that’s also administered three weeks apart. With that difference in dosage, some parents started asking what they should do with kids who are closer to the upper age range for kids or the lower age range of adult doses. Read more from Jeannie Baumann.

Biden Sets Nov. 8 Deadline for Federal Worker Shots: Federal workers will have to prove they’re vaccinated by Nov. 8 or face unpaid suspension followed by termination, according to new guidance for Biden‘s Covid-19 directive for the federal workforce. The guidance, published by the Office of Personnel Management on Friday, encourages agencies to collect vaccine cards from their workers. Enforcement of Biden’s federal vaccination requirements is to begin Nov. 9. Read more from Courtney Rozen.

• The White House is also pressing major U.S. airlines to require vaccines for employees by Dec. 8, Reuters reports, citing four sources. White House Covid-19 czar Jeff Zients spoke to the chief executives of American Airlines, Delta Air Lines and Southwest Airlines to ensure they were working to develop and enforce vaccine requirements, Reuters reports.
• Delta hasn’t decided yet how it will handle a federal mandate for coronavirus vaccinations for workers at certain companies, saying there are “different ways” to make sure 100% of its employees get the shots. “Our goal, clearly, is to get to 100%,” CEO Ed Bastian told reporters in Boston. “There are different ways to get there, and we’re going to do it our way.” Read more from Mary Schlangenstein.

Sotomayor Lets NYC Schools Enforce Vaccine Mandate: U.S. Supreme Court Justice Sonia Sotomayor let New York City start enforcing its requirement that school employees be vaccinated against Covid-19 or lose their jobs, rejecting a bid by four teachers and staff members who sought to block the mandate. Sotomayor, who is assigned to consider emergency requests out of the New York-based 2nd U.S. Circuit Court of Appeals, made no comment in turning down the emergency request. The city can now enforce the requirement, which was scheduled to take effect Friday, for its 148,000 teachers and staff.

The challengers told the court the mandate will cause thousands of unvaccinated public school employees to lose their jobs. One of their lawyers, Mark J. Fonte, said in an emailed statement the group was “extremely disappointed” with the decision. Read more from Kimberly Robinson and Greg Stohr.

• Related: Supreme Court’s Kavanaugh Tests Covid-19 Positive Ahead of New Term
• What some are calling the worst U.S. health-care labor crisis in memory is sharpening concerns about attrition from resistance to vaccine mandates—even in the medical mecca of Massachusetts, where Covid-19 cases remain well within hospital capacity. About 16% of American hospitals had critical staffing shortages as of Oct. 1, according to the U.S. Department of Health and Human Services. The uptick initially coincided with a surge in Covid-19 hospitalizations, but shortages have persisted even as the virus ebbs, suggesting other factors. Read more from Carey Goldberg and Jonathan Levin.
• Related: Courts Refuse to Block Two Health-Care Worker Vaccine Mandates

More Headlines:

• J&J to Ask Regulators Early This Week to Authorize Booster: NYT
• Fauci Says U.S. Is Turning the Corner on Latest Covid-19 Surge
• FDA May Extend Shelf Life of Millions of Moderna Shots: NBC News
• Singapore Says in Talks With Europe, U.S. on Vaccinated Travel

What Else to Know

Texas Abortion Law Seems Designed to Avoid Challenge, Judge Says: A federal judge weighing whether to temporarily halt a Texas law limiting abortions said it appears to have been crafted to avoid lawsuits against the state. “In fact, I think that’s what this whole statute was designed to do—to find a proxy for the state that would insulate the state from this sort of judicial oversight that ordinarily would exist,” U.S. District Judge Robert Pitman in Austin said today during a hearing on Zoom. Read more from Erik Larson.

Employers, Hospitals Dueling Takes on Surprise Billing Rule: Hospitals reacted sharply toward a Biden administration regulation implementing legislation barring “surprise billing” of patients while health insurers and employers’ groups praised it for guarding against health-care price inflation. The rule is a “windfall for insurers,” Stacey Hughes, executive vice president of the American Hospital Association, said. “The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients.”

Hughes made her remarks in a statement after four agencies on Thursday released an interim final rule (RIN 0938-AU62) that details the process for settling billing disputes between health-care providers and entities that pay the bills—health insurers and employers that sponsor employee health plans. Read more from Sara Hansard.

More Hospitals Warned on Price Transparency: The Centers for Medicare and Medicaid Services have issued about a hundred more warnings to hospitals deemed out of compliance with its price transparency rule, up from about 165 in July to roughly 256 as of late September. Hospitals are required to disclose their typical charges for items and services under a Trump-era final rule that the Biden administration has doubled down on in a proposed rule. Read more from Allie Reed.

More Headlines:

• Scientists Working on Heat, Touch Will Share Nobel for Medicine
• Court Upholds Rejection of Pfizer Medicare Co-Pay Assistance
• Mentor Tells SCOTUS Breast Implant Suits Were Properly Barred
• Riddell Helmets Says Football Players Haven’t Shown Brain Injury
• ‘Bad Blood’ Writer Says Holmes Is Stymieing His Trial Coverage
• 3M Liable for Veteran’s Hearing Loss in New Earplug Test Trial

With assistance from Alex Ruoff

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