HEALTH CARE BRIEFING: Democrats Push Home-Care Plan Via Medicaid

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Senate Democrats will unveil legislation as soon as today to meet President Joe Biden‘s promise to strengthen in-home care for the elderly and disabled while boosting caregivers’ wages and unionizing opportunities, a draft bill obtained by Bloomberg Law shows.

States would implement the proposal using a major influx of federal funding through Medicaid. The bill would condition the funds on states’ ability to shift people to home-based care from nursing homes, recruit and train more home health workers, provide caregiver pay increases, and establish oversight capacity.

The bill’s goal is to deliver on Biden’s pledge—from the “human capital” portion of his infrastructure plan—to put $400 billion toward reducing the sizable waiting lists facing people who wish to receive support in their homes rather than in institutional settings, and also to improve the quality of life for a predominantly female, minority workforce.

Congress would initially authorize $100 billion for state grants, but the ultimate price tag may wind up much higher, depending on how many states elect to participate.

Sources briefed on the legislation said the draft bill is in its near-final form ahead of its official introduction, tentatively planned for today. It offers the first-known details of a critical piece of a package congressional Democrats aim to pass this year using the budget reconciliation process, which would avoid the need for Republican votes in the Senate.

The bill was drafted with the intention of meeting reconciliation rules, but it remains to be seen whether it’s actually in compliance, as determined by the Senate parliamentarian. Reconciliation may only be used for provisions with budget effects that are more than just incidental, among other requirements.

The bill’s architect and lead sponsor, Sen. Bob Casey (D-Pa.), briefed his caucus on the details Tuesday, along with Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Finance Chair Ron Wyden (D-Ore.), said three sources familiar with the process. Read more from Ben Penn and Alex Ruoff.

Happening on the Hill

Hearings on the Hill:

Covid-19 Survivors Push 9/11-Style Commission: A bipartisan Senate duo has enlisted the help of Covid-19 survivors to gather support for their bill to create a 9/11-style commission to study the Covid-19 pandemic. Those who suffer from the lingering effects of Covid-19 months after first contracting the virus—or whose loved ones died from the disease—see the commission as a path to improving the U.S. health system. They’re hoping a review of how the U.S. responded to the pandemic will bring better care to people with long-term Covid-19.

Sens. Bob Menendez (D-N.J.) and Susan Collins (R-Maine) enlisted the help of support groups and others to build momentum for their bill (S. 412) to establish an independent commission to investigate the U.S. response to the pandemic, and provide recommendations for preparing for future ones. Read more from Alex Ruoff.

Medicare Covers More Research Under Biomedical Bill: Medicare beneficiaries could participate in more clinical trials without worrying about bills for lab tests and other routine costs as part of draft follow-up legislation to a landmark law on biomedical innovation. The draft bill, known as Cures 2.0, marks the latest effort on Capitol Hill to broaden access to clinical trials. Read more from Jeannie Baumann.

Pressure Mounts to Cover Those in Medicaid Gap: The next major legislation package moving through Congress will include provisions to extend insurance coverage to people caught in the “Medicaid gap,” key congressional Democrats say. House Majority Whip Jim Clyburn (D-S.C.) said he’s been in White House talks on including in Biden’s jobs and infrastructure legislation an extension of federal insurance to people in the 12 states that haven’t opted to expand their Medicaid programs. Read more from Alex Ruoff.

  • Still, the administration can act on its own to further Biden’s campaign promise to get more Americans affordable health coverage and shrink the number of uninsured, even though Congress is mulling broader measures. Tweaks to regulations under the Affordable Care Act and other health laws can be implemented while lawmakers debate major proposals to expand coverage, such as forcing several states to expand for Medicaid, the low-income health program. Read more from Shira Stein.
  • Related: Missouri Refusal to Enact Voter-Approved Medicaid Expansion OK’d

FDA Chief Ties Juul to Youth Vaping: The head of the Food and Drug Administration suggested to lawmakers that e-cigarette maker Juul Labs has played a significant role in creating a youth vaping epidemic. Acting FDA Commissioner Janet Woodcock was asked at a hearing yesterday of the House Oversight Subcommittee on Economic and Consumer Policy about whether Juul was “the e-cigarette company most responsible for creating this epidemic.” Woodcock answered that it does “appear” so. Read more from Rebecca Torrence.

  • Woodcock also said continued youth use of e-cigarette products is still at “unacceptable levels.” Survey results show youth vaping was lower overall in 2020 compared to 2019, but use of flavored disposable e-cigarettes rose substantially. Those products were excluded from the 2020 Food and Drug Administration ban, which pulled cartridge-based products in fruity and mint flavors from the market because they were alluring to teenagers. Some flavors like menthol remained. Read more from Jacquie Lee.

Eshoo Wants Diversity Targets in Drug Trials: Drug companies would be required to set targets and develop action plans for diversifying their clinical trial populations under a bill in the works by a key House lawmaker in health policy. Rep. Anna Eshoo (D-Calif.) said the bill ultimately would boost confidence among Black, Hispanic, and other groups historically underrepresented in studies used by the FDA to decide whether to approve these products. Read more from Jeannie Baumann.

Group Launches Ad Campaign Against Pro-Choice Lawmakers: The Susan B. Anthony List, an anti-abortion group, launched a major ad campaign supporting the Hyde amendment, which blocks federal taxpayer funding for abortion services in most cases. The group is vying to pressure vulnerable Democrats in swing states, like Sens. Mark Kelly (Ariz.) and Raphael Warnock (Ga.). Find the ads here.

The Coronavirus Pandemic

Health Officials Tout Vaccines After Heart Issue Reports: Public health leaders sought to reassure Americans that Covid-19 shots are safe and to get vaccinated after reports that a small number of mostly young men had suffered a heart problem after being immunized. About 1,200 cases of heart inflammation were reported in those who received messenger RNA Covid-19 vaccines, according to the Centers for Disease Control and Prevention.

After the figures were made public, top U.S. health officials, regulators and doctors said that the risk potentially posed by shots developed by the Pfizer-BioNTech partnership and Moderna is extremely low, and that it is far more likely that the coronavirus itself would pose a serious threat to people’s health. More than 130 million Americans have been fully vaccinated with Pfizer-BioNTech and Moderna shots using the mRNA technology, the CDC says. Riley Griffin has more.

Delta Strain Seen in a Fifth of Covid-19 Cases: The delta variant is spreading rapidly in the U.S. and now accounts for a fifth of recent coronavirus cases, the head of the CDC said. Rochelle Walensky said at the Milken Institute Future of Health Summit that the rapid growth in the delta variant was seen after the strain accounted for just 3% of cases analyzed several weeks ago. Read more from Elaine Chen.

Drug Companies Broaden Pitch for Covid-19 Therapy: As Covid-19 cases decline, Regeneron Pharmaceuticals and Vir Biotechnology are seeking new life for their monoclonal antibody therapies as preventative drugs, targeting millions of people worldwide with compromised immune systems. The list of conditions is long, ranging from blood cancers to HIV to transplants. In every case, this group is left wide open for dangerous opportunistic infections. Elaine Chen has more.

U.S. Confirms Removal of Wuhan Virus Sequences From Database: Details of the genetic makeup of some of the earliest samples of coronavirus in China were removed from an American database where they were initially stored at the request of Chinese researchers, U.S. officials confirmed, adding to concerns over secrecy surrounding the outbreak and its origins.

The data, first submitted to the U.S.-based Sequence Read Archive in March 2020, were “requested to be withdrawn” by the same researcher three months later in June, the U.S. National Institutes of Health said in a statement yesterday. Biden has ordered American intelligence agencies to probe the issue again, while China has strenuously denied that the Wuhan laboratory had any link to the outbreak. Read more from Rachel Chang and Robert Langreth.

More U.S. Headlines:

Canada Races Toward Milestone for Border Reopening: Canada’s accelerating vaccination effort has put the country on track to reach key benchmarks for reopening the U.S. border as early as next month. Prime Minister Justin Trudeau’s government has begun citing a 75% two-dose vaccination rate as the threshold to lift border restrictions. That figure is about 20% now. As wide as that gap is, the latest delivery schedule suggests it could close next month. Read more from Erik Hertzberg and Kait Bolongaro.

More Global Headlines:

What Else to Know Today

HHS Can’t Ditch Drug Suits by Disavowing Letter, Attorneys Say: The Biden administration’s withdrawal of a Trump-era policy on prescription drug price cuts for low-income patients sets the stage for new tactics to incentivize cheaper medicines. Pharmaceutical companies vow to keep fighting. The Health and Human Services Department is standing its ground in pushing drugmakers to pass along federal discounts to contract pharmacies that work with health-care providers for at-risk patients. Read more from Ian Lopez.

Food Aid Recipients Face Barriers to Healthy Eating: Almost nine out of 10 Americans getting federal food aid face obstacles in maintaining a nutritious diet for their households, according to a study from the Agriculture Department. Eighty-eight percent of participants in the Supplemental Nutrition Assistance Program, formerly called “food stamps,” said that they encounter some type of hurdle to a healthy diet, according to the study. Read more from Kim Chipman.

More Headlines:

To contact the reporter on this story: Brandon Lee in Washington at

To contact the editors responsible for this story: Zachary Sherwood at; Giuseppe Macri at; Michaela Ross at

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