HEALTH CARE BRIEFING: Democrats Mull Dropping Medicare, Medicaid

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Two significant elements of Democrats’ ambitious health agenda, expanding Medicare and Medicaid, face an uphill battle after a key party moderate signaled his opposition Monday.

Sen. Joe Manchin (D-W.Va.) said yesterday he doesn’t want to expand Medicare benefits without first protecting the rest of the program from insolvency later this decade. He also rebuffed legislation to extend coverage to millions of Americans in states that have refused to expand their Medicaid programs.

Extending federally funded coverage to people in the 12 non-expansion states effectively amounts to a penalty for states such as his that have paid a portion of growing their own safety nets, Manchin told reporters. “For states that held out to get rewarded with 100% that’s not fair,” he said.

Expanding the two public health insurance programs were significant, and pricey, elements of the once-$3.5 trillion spending package Democrats (H.R. 5376) are hoping to rally around as soon as this week. Manchin said he wants to cut the total spending down to $1.5 trillion.

Supporters of expanding Medicare’s benefits to include dental, hearing, and vision coverage have been trying to save the provision from cuts or elimination. Read more from Alex Ruoff and Erik Wasson.

Groups Press Sinema on Medicare and Drug Prices: Protect Our Care Arizona is sponsoring a mobile billboard outside Sen. Kyrsten Sinema‘s (D-Ariz.) office urging her to support Medicare negotiations for lower drug prices, which Democrats are attempting to include in the reconciliation measure.

Happening on the Hill

Hearings on the Hill:

  • Nominations: The Senate Finance Committee holds a hearing on nominations including Samuel R. Bagenstos to be general counsel of the Department of Health and Human Services.
  • Health Care Bills: The House Energy and Commerce Health Subcommittee scheduled a hearing today to examine legislation to support patients, caregivers, and providers.
  • Vaccine Requirements: The House Education and Labor Workforce Protections and Civil Rights and Human Services Subcommittees will hold a joint hearing on vaccine requirements and employee accommodations.
  • VA E-Records: The House Veterans’ Affairs Subcommittee on Technology Modernization meets for a hearing on the Veterans Affairs Department’s electronic health record modernization program.

Senate Confirms First Workplace Safety Chief Since Obama-Era: The Senate signed off on California safety regulator Doug Parker taking the reins of the Department of Labor’s workplace safety arm, giving the agency its first confirmed leader since the Obama era. Parker, who played a central role in developing California’s Covid-19 workplace safety rule, will lead the Occupational Safety and Health Administration, an agency on the front lines of the federal government’s response to the coronavirus pandemic. Read more from Paige Smith.

The Coronavirus Pandemic

U.S. Issues New Pandemic Travel Rules: The Biden administration issued new rules for travelers to the U.S. yesterday requiring proof of full vaccination against Covid-19 in addition to a recent negative test for the virus. People from countries with low supplies of vaccines who aren’t traveling on tourist visas, and those under 18, will be exempt from the vaccine requirement, senior administration officials said in a briefing for reporters.

U.S. citizens and residents returning from abroad who aren’t vaccinated will have to obtain a negative Covid-19 test within a day of their flight, the officials said. The new rules taking effect Nov. 8 represent the biggest change to U.S. travel policy since the start of the pandemic. Read more from Jennifer Jacobs and Josh Wingrove.

  • Meanwhile, the U.S. Centers for Disease Control and Prevention said it is extending its pandemic-era rules for cruise ship operation until Jan. 15, after which it will move to a voluntary Covid-19 mitigation program. The rules—under the umbrella of the CDC’s so-called conditional sailing order—were set to expire on Nov. 1. The CDC said it decided to extend the protocols with a slight variation because of the spread of the more infectious delta variant, the rise of breakthrough cases and other factors. Read more from Jonathan Levin.

Moderna Says Shot for Young Kids Shows Strong Results: Moderna said that its Covid-19 vaccine showed a strong immune response in younger children in a late-stage clinical trial, paving the way for submission to regulators for clearance in those age 6 to under 12. An interim analysis showed a protective antibody response from children in the study, Cambridge, Massachusetts-based Moderna said yesterday in a statement. Participants received two 50 microgram doses—half that initially given to adults—spaced 28 days apart. Read more from Riley Griffin.

Covid-19 Bigger Risk for Brain Issues Than Vaccines: Covid-19 is more likely to cause rare neurological conditions than vaccines, according to a study published in the Nature Medicine journal. The study, led by the University of Oxford, analyzed the health records of 32 million people in England. While the vaccines were found to result in an increase of neurological complications, like Bell’s palsy and Guillain-Barré syndrome, the study found that contracting Covid presented an even bigger risk. Read more from Joel Leon.

NIH Program Aims for Cheaper At-Home Covid-19 Tests: The cost of rapid at-home Covid-19 tests could potentially come down under a $70 million expansion to an NIH Shark Tank-like program on testing, U.S. health officials said. The National Institutes of Health is setting up a new program called the Independent Test Assessment Program (ITAP) that will spot tests they think have the best potential and give them the testing tools developers need to ensure they’re providing the best submissions possible to the Food and Drug Administration, the Department of Health and Human Services announced yesterday. Read more from Jeanne Baumann.

Political Views Not Grounds for Vaccine Exemption, EEOC Says: Workplace anti-bias laws require employers to consider requests for religious exemptions to a Covid-19 vaccination requirement, but those protections don’t extend to political objections to such mandates, the federal government said in new guidance today. The U.S. Equal Employment Opportunity Commission updated its technical guidance for employers in an attempt to provide clarity about religious exemptions. Paige Smith has more.

  • The guidance came the same day the HR Policy Association, a business group that represents Fortune 500 companies, released a letter calling on the EEOC to issue guidance that would clarify how workers may qualify for medical and religious exemptions from Covid-19 vaccine mandates and what reasonable accommodations would look like. Read more from Paige Smith.

Biden to Pledge More Virus Aid in Asia Summit: Biden is set to attend a virtual meeting with leaders from the Association of Southeast Asian Nations today. At the meeting, Biden will unveil a plan to provide $40 million to strengthen health system capacity and speed up research as part of the battle against Covid-19 in a region that has just begun to recover from a wave of deadly cases. Read more from Philip J. Heijmans.

  • Meanwhile, Treasury Secretary Janet Yellen called for support at the upcoming G-20 Health and Finance Ministerial to launch a forum for health and finance coordination, according to a letter. The pandemic revealed a lack of readiness at the country level and a lack of coordination among the G-20, it said. Yellen strongly supports a forum where health and finance ministers can work on facilitating global cooperation and coordinating prevention, detection, information sharing and response, it said, Max Zimmerman reports.

More Headlines:

What Else to Know Today

States Sue HHS Over Rule Allowing Abortion Referrals: An Ohio-led group of states yesterday asked a federal trial court to vacate a new federal rule that allows family planning providers to counsel clients about abortion. The rule rolls back a Trump-era rule that required recipients of federal family planning program money to physically and financially separate abortion services from family planning services and prohibited providers from referring clients for abortion.

Title X is the only federal program that funds family planning services. It gives millions of dollars every year to programs that serve low-income people. The Biden administration’s final rule, which was released Oct. 4., isn’t in accordance with the law and is arbitrary and capricious, the complaint filed in the U.S. District Court for the Southern District of Ohio says. Read more from Mary Anne Pazanowski and Lydia Wheeler.

  • Arizona should be allowed to enforce a ban on abortions sought because a fetus has a genetic abnormality, at least until the provision’s constitutionality is determined, the state told the Ninth Circuit. Abortion providers won an order blocking the law’s enforcement in September, after the U.S. District Court for the District of Arizona found that it likely violates a woman’s constitutional right to end a pregnancy before viability by imposing an undue burden on it. Arizona appealed that decision. Read more from Mary Anne Pazanowski.

Why Abortion Soared to Top of Supreme Court Docket: The U.S. Supreme Court raised the stakes in the politically explosive fight over reproductive rights by agreeing to hear arguments on Nov. 1 on a Texas law that has largely shut down legal abortion in the state. The court won’t directly decide if the law—which bans almost all abortions after six weeks of pregnancy—violates Roe v. Wade. Nor will the justices be addressing whether to overturn its abortion-rights precedents; that’s an issue they will consider in a separate case on Dec. 1. But the decision to intervene in the Texas case—and hear arguments on a highly expedited schedule—reshapes the multifaceted legal fight. The core issues stem from the law’s delegation of enforcement power to private parties, a feature Texas included to try to thwart federal judicial review. Read more from Greg Stohr.

Drugmakers Undercut Rivals With New Patent Tactic: Pharmaceutical companies are turning to a fast-moving but rarely used patent office process to undercut their competitors’ intellectual property. Drugmakers, in a slow but steady trend, are considering post-grant reviews, a Patent and Trademark Office trial proceeding where a wide array of challenges can be brought against rivals’ drug patents. The number of post-grant reviews challenging standard drug and biologic patents rose from just one in 2014 to 10 in the first half of 2021. Read more from Perry Cooper and Ian Lopez.

Walmart, CVS Seek Opioid Mistrial After Juror Does Own Research: CVS, Giant Eagle, Walgreens, and Walmart—facing claims that they helped fuel the nationwide opioid crisis—sought a mistrial from a federal judge in Cleveland after a juror returned to court with pamphlets that allegedly contradicted their testimony. The retail pharmacy chains moved to derail a bellwether trial in the U.S. District Court for the Northern District of Ohio over pamphlets shown by “Juror 4″ to other jury members. Read more from Mike Leonard.

HIV/AIDS Patients Press Top Court to OK Suit Against CVS: Federal disability bias laws prohibit a mail-order pharmacy policy that has an unintended discriminatory effect on HIV/AIDS patients and other people with disabilities, the patients told the U.S. Supreme Court. Their arguments came in a case testing whether disparate impact claims are available in suits brought under the Rehabilitation Act’s Section 504 and, by extension, Section 1557 of the Affordable Care Act. The court’s decision in the case—set to be argued Dec. 7—will clarify the causes of action available under the laws. Read more from Mary Anne Pazanowski.

More Headlines:

To contact the reporter on this story: Michaela Ross in Washington at

To contact the editors responsible for this story: Zachary Sherwood at; Giuseppe Macri at; Brandon Lee at

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