HEALTH CARE BRIEFING: Democrats Push for Post-Pandemic Insurance

The rewrite of Medicaid rules included in House Democrats’ sweeping social spending and tax package would make safety-net programs in red states look closer to their blue-state counterparts.

This $270 billion expansion of public health insurance programs for lower income and disabled Americans—which accounts for more than 80% of the health care-related spending in the package—includes measures to stop states from tightening restrictions on their Medicaid programs whenever the Biden administration declares an end to the Covid-19 public-health emergency.

Those changes would forestall a sudden drop in coverage for millions of Americans when the federal government’s contributions to state Medicaid programs return to pre-pandemic levels. They’re aimed at people who see increases to their income that might disqualify them from Medicaid in several states but aren’t enough to afford many private plans.

“These are all incredible changes to our health care system that will save lives,” Rep. Frank Pallone Jr. (D-N.J.), chair of the House Energy and Commerce Committee, told reporters recently.

The Medicaid-related spending goes largely toward two priorities: bolstering home- and community-based care and expanding the Affordable Care Act’s tax credits to allow residents of the dozen states that didn’t expand Medicaid to get subsidized private health plans that mimic the program’s no-cost benefits. Those policies are coupled with major changes to how states cover pregnant women and children.

The package awaits action in the Senate, where Democrats have the slimmest-possible majority. Republicans say the spending package is too costly and warn it may exacerbate the cost of health services. But Pallone said the changes are long overdue, though Democrats haven’t been able to strike bipartisan agreements on them this year. Alex Ruoff has more.

  • One little-noticed provision of the House-passed Build Back Better Act that would lower the share of health-care premiums employees have to pay could jeopardize company-sponsored plans, pushing millions of workers into Medicaid or Obamacare coverage, employer groups and the Congressional Budget Office warn. The roughly $2 trillion bill would lower the share of premiums employees have to pay for coverage deemed affordable under the Affordable Care Act to 8.5% of household income for 2022-25. Read more from Sara Hansard.

Drug, Insulin Price Caps Head for Showdown: Senate Democrats also expect to defend key portions of their drug-pricing agenda against a technical challenge by Republicans as soon as this week, potentially curtailing key parts of the social spending package. Democrats expect to go before the Senate’s parliamentarian—a nonpartisan official who oversees that chamber’s rules—in the coming days to get guidance on whether many of the health policy items qualify under the budget reconciliation process, two senior Democratic aides told Bloomberg Government.

Two aides and one health industry lobbyist familiar with the discussions say three major drug-pricing proposals are most in peril of failing to qualify—caps on drug-price increases, new transparency requirements for pharmaceutical industry middlemen, and a $35 per-month cap on insulin. These items are expected to face challenges because they would make changes to private insurance plans, according to sources familiar with the discussions. Alex Ruoff has more.

The Omicron Variant

Biden to Provide Omicron Update Today: President Joe Biden will provide an update about the new omicron variant and the U.S. response today after meeting with his Covid-19 response team last night. Covid-19 vaccines are likely to provide a degree of protection against severe cases of Covid-19 by the omicron variant, Chief Medical Adviser Anthony Fauci told Biden, according to a readout of the meeting. It will take two more weeks to have definitive information on the transmissibility, severity, and other characteristics of the variant, Fauci told Biden, Max Zimmerman reports.

Biden imposed fresh travel restrictions on nations in southern Africa on Friday, joining efforts by other countries to try slowing the spread of a new, potentially aggressive SARS-Cov-2 strain. The White House will restrict travel from South Africa and seven other nations starting today, U.S. officials said on Friday. In a statement, Biden called the decision a “precautionary measure until we have more information.” In addition to South Africa, the restrictions affect Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique and Malawi. Read more from Josh Wingrove and Alan Levin.

  • Medical experts tend to say that partial border closures are typically ineffective, in part because they affect only a sliver of travel volume. Andy Slavitt, who served as a Covid-19 adviser to Biden for several months this year, is among the critics and said energy should instead be focused on inoculations in Africa. Read more from Josh Wingrove.
  • Fauci said the novel variant may well already have arrived in the U.S. “I would not be surprised if it is,” Fauci told NBC on Saturday. “We have not detected yet,” but when a virus shows “this degree of transmissibility” it “almost invariably ultimately is going to go essentially all over,” he said. Read more from Tony Czuczka.
  • Francis Collins, director of the National Institutes of Health, said there’s no reason to panic due to the strain just yet, but its spread reinforces the importance of getting a booster. Collins said vaccines have worked against mutations before, and may do so again this time, he said on Fox News. “Given that history, we expect that most likely the current vaccines will be sufficient to provide protection,” he said. Read more from Augusta Saraiva.

Variant’s Spread Spurs Search for Answers: The World Health Organization is working with researchers around the globe to better understand the new coronavirus variant, warning that its divergent design could fuel Covid-19 surges with severe consequences. While health experts in South Africa, where omicron was first detected, said it appeared to cause only mild symptoms, the Geneva-based WHO assessed the variant’s risk as “extremely high” and called on member states to test widely. Understanding the new strain will take several days or weeks, the agency said. Read more from Loni Prinsloo and Jason Gale.

Related:

BioNTech Sees Data on Omicron in Two Weeks: BioNTech said it’s begun studying omicron and expects the first data from laboratory tests on how it interacts with its vaccine in the next two weeks. The lab data will shed light on whether the new variant, called B.1.1.529, can escape the vaccine it makes together with Pfizer, it said Friday. Pfizer and BioNTech put plans in place months ago to be able to ship a new version of their mRNA shot within 100 days if necessary, a BioNTech spokeswoman said. Read more from Naomi Kresge.

  • Moderna Chief Medical Officer Paul Burton said he suspects the new omicron coronavirus variant may elude current vaccines, and if so, a reformulated shot could be available early next year. “We should know about the ability of the current vaccine to provide protection in the next couple of weeks,” Burton said on BBC. “The remarkable thing about the mRNA vaccines, the Moderna platform, is that we can move very fast,” he said. Read more from Joe Easton.

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More on the Pandemic

Vaccine Mandate Yields 92% of Federal Workers With a Shot: About 92% of federal government employees have had at least one Covid-19 shot, according to data released by the administration following Biden’s vaccine mandate for the workforce. An agency-by-agency breakdown of uptake rates showed a range of outcomes. Across the federal government, 4.5% of the workforce—over 157,000 people—either have requested or been granted exemptions from the mandate, the report also found.

The Agency for International Development has the highest vaccination rate, with 97.8% of its workforce receiving at least one shot, while the Agriculture Department has the lowest, with 86.1%. The administration deemed nearly 96% of Agriculture workers in compliance, suggesting a large number of exemptions. Other agencies found large shares of workers seeking exemptions. The Veterans Affairs Department, for instance, reported 98% “compliance” with the mandate, but only 87.8% of its staff have at least one shot. Read more from Josh Wingrove.

Michigan Lawmakers Seek Biden’s Help as Covid-19 Surges: Michigan lawmakers wrote to the president to “urgently request” help in combating a Covid-19 outbreak that’s overwhelming the state’s health system as the administration said it’s sending aid requested by Gov. Gretchen Whitmer (D). Reps. Debbie Dingell (D) and Fred Upton (R) on Wednesday asked Biden to provide more treatments, including Regeneron Pharmaceuticals’ antibody therapy, testing supplies and military medical personnel to support hospitals. Keith Naughton and Josh Wingrove have more.

NYC May Be at Start of Winter Surge of Covid-19: New York City may already be seeing signs of a winter spike in Covid-19. The city’s positive test rate rose to a two-month high as hospitals admitted more than 100 new virus patients on Friday, contributing to a 25% jump in hospitalizations in just two weeks. Governor Kathy Hochul (D) declared a state of emergency late Friday with concerns of omicron rising. On Saturday, she also ordered nursing homes and adult-care facilities to make boosters available to all residents as hospitalizations across the state spiked. Read more from Stacie Sherman and Linus Chua.

Merck Slumps on Pill’s Lower Effectiveness, FDA Scrutiny: New data from Merck showed its Covid-19 pill was less effective than previously reported and federal regulators raised concerns over its safety and long-term effectiveness. Merck’s latest trial results, reported on Friday from a larger population than its initial study, show that its pill reduced the risk of hospitalization or death among adults with mild to moderate disease by 30%. That was less than a previous estimate of 48%. Still, FDA staff called the pill effective for those at risk for severe disease. Fiona Rutherford has more.

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What Else to Know Today

Abortion’s Future Belongs to Court Reshaped by Trump: U.S. Supreme Court Justices Brett Kavanaugh and Amy Coney Barrett ducked questions on Roe v. Wade during their Senate confirmation hearings. Now, with the court set to reconsider the landmark ruling, abortion-rights supporters are bracing to finally hear the answers. And they have reason to worry.

Kavanaugh and Barrett will be key votes as the Supreme Court Wednesday takes up Mississippi’s abortion ban after 15 weeks of pregnancy. The restrictions are far more stringent than any the court has previously upheld, and are all but impossible to square with Roe, which legalized abortion nationwide in 1973. A ruling upholding the law would give states new license to slash abortion access. A dozen states already have laws that would largely bar abortion—and automatically take effect—if Roe is overturned.

The fact that the court took the Mississippi case, rather than one involving a narrower restriction, means at least four of the nine justices want to reconsider the core holdings of Roe and the 1992 Planned Parenthood v. Casey decision. Casey protects abortion rights until the fetus becomes viable, sometime after the 20th week of pregnancy.

Kavanaugh and Barrett were both nominated by President Donald Trump to replace justices who had backed abortion rights. Kavanaugh succeeded the former swing vote Anthony Kennedy in 2018, while Barrett took the seat of the late liberal icon Ruth Bader Ginsburg just before the 2020 election. Their arrival gave the high court a 6-3 conservative majority and three members selected by Trump, who had vowed to appoint only anti-abortion justices. That put the conservative legal movement in striking distance of its long-held dream of overturning Roe. Read more from Greg Stohr.

House Panel to Explore Fentanyl Crisis: Energy and Commerce Chair Pallone and Health Subcommittee Chair Anna Eshoo (D-Calif.) announced last week that the subcommittee will hold a hearing on Dec. 2 to examine the federal response to combat “illicit fentanyl-related substances.” The subcommittee will hear from public health and law enforcement officials for the Biden White House “as we consider the interagency proposal to regulate fentanyl-related substances,” the lawmakers said in a statement. Read it here.

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

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