HEALTH CARE BRIEFING: Health Agenda Consensus Eluding Democrats

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Democrats remain at odds over three key elements of their health-care agenda: expanding Medicaid, adding new Medicare benefits, and empowering the government to negotiate with drugmakers.

Party members are weighing those proposals as they seek to narrow their sweeping domestic policy bill, searching for a path that appeases both moderates and progressives. Leaders had planned action on the bill by Oct. 31, but look increasingly unlikely to meet that deadline.

Speaker Nancy Pelosi (D-Calif.) said Democrats “are close to agreement on the priorities and the topline of the legislation,” in a letter to colleagues yesterday. “Great progress has been made to address the coverage gap in states that have not enacted the Medicaid expansion,” Pelosi wrote. “This expansion of the Affordable Care Act takes us to nearly universal coverage, hopefully with expanded benefits for Medicare.”

As negotiations sharpen, here’s where key health proposals stand, as reported by Alex Ruoff:

  • Drug Prices: Democrats are likely to narrow their once-sweeping proposal to give the government the authority to negotiate with drug companies. They remain at an impasse around what medicines would be subject to negotiations, lawmakers said yesterday. Sen. Chris Murphy (D-Conn.) said there’s not yet agreement on whether the bill should limit the number of medicines subject to negotiations and what kinds of medicines would be covered.
  • Medicare Benefits: Supporters of adding dental, hearing, and vision benefits to Medicare say they’re not giving up despite opposition from Sen. Joe Manchin (D-W.Va.). Sen. Bernie Sanders (I-Vt.) said yesterday he believes it’s a key provision for the package.
  • Medicaid Expansion: Manchin is also a key opponent of expanding Medicaid in the 12 state that have refused to open their health public insurance programs to lower-income people under the Affordable Care Act. Georgia’s two Democratic senators were key supporters in the Senate for creating a federal Medicaid-like program in non-expansion states like theirs.

Democrats Ditch Paid Family Leave From Biden Agenda: Democrats were set to abandon plans to include paid family leave in Biden’s sweeping economic plan amid opposition from Sen. Manchin, according to two people familiar with the talks. The action comes as Democrats rush to strike a deal between progressives and moderates on Biden’s agenda. Providing workers with as much as 12 weeks of family leave was a key component of Biden’s plan and one that among the central goals of progressive Democrats. Read more from Erik Wasson and Laura Litvan.

Biden Preps Liberals for Letdown: While the White House scrambles for a deal with Congress on its economic agenda, President Joe Biden and top aides have put almost as much time into preparing progressives to get far less than they wanted from his tax-and-spending plan. The message from the president, Vice President Kamala Harris and top aides to groups like the Congressional Black Caucus and Women’s Caucus and key individual lawmakers such as Senator Bernie Sanders (I-Vt.) has been: a lesser bill is better than no bill at all. Read more from Nancy Cook and Jarrell Dillard.

Happening on the Hill

Meatpacking Giants Cite Covid Response, Vaccination After Report: Some of the biggest meatpacking corporations say they shelled out millions to combat the Covid-19 crisis while their workers were on the front lines, pushing back against Democrats and labor advocates who say they’re to blame for worker deaths. At least 59,000 meatpacking plant workers suffered infections during Covid-19 outbreaks at corporate plants — and 269 died between March 2020 and February 2021, a new report by the House Select Subcommittee on the Coronavirus Crisis details. Read more from Megan U. Boyanton.

EPA Research Arm Nominee Pledges to Measure PFAS: Christopher Frey, the Biden administration’s nominee to head up the Environmental Protection Agency’s Office of Research and Development, promised the Senate Environment and Public Works Committee yesterday that if he’s confirmed, he would work on developing more ways of measuring “forever chemicals” in the environment. Read more from Stephen Lee.

  • Meanwhile, companies making 20 PFAS will receive orders before the end of this year requiring them to provide the EPA information about ways those chemicals may affect human health, Michal Ilana Freedhoff, assistant EPA administrator for chemical safety and pollution prevention, told the House Energy and Commerce Environment and Climate Change panel yesterday. Read more from Pat Rizzuto.

BGOV OnPoint: Drug Approvals in Spotlight, Lawmakers Prep Bills

The Coronavirus Pandemic

White House Says Vaccine Rule Won’t Strain Supply Chains: A requirement for federal workers and contractors to be fully vaccinated for Covid-19—which would affect a number of transportation companies that work with the U.S. government—won’t exacerbate a backlog of shipping and deliveries, according to the Biden administration. “The requirements for federal workers and contractors will not cause disruption,” Jeff Zients, Biden’s coronavirus response coordinator, said. Read more from Josh Wingrove and Lillianna Byington.

Vaccine for Kids Wins NIH Chief’s Support: The NIH chief said he agreed with a scientific advisory panel’s decision to back Pfizer’s Covid-19 vaccine for kids, although he acknowledged gaps in data leave important questions looming. “I side with the majority of the 17 people who voted yes. I would have voted that way too,” Francis S. Collins said in an interview yesterday. The comments from the longtime director of the National Institutes of Health—who’s stepping down by the end of the year—follow a recommendation from the FDA’s vaccine advisory committee. Read more from Jeannie Baumann.

Nursing Homes Try to Block Covid-19 Cases’ Return to State Courts: The Ninth Circuit should decline to become the second federal appeals court to hold that Covid-related wrongful death claims against nursing homes must be tried in state, not federal, court, a California-based facility said. The issue of whether the federal officer removal law or the Public Readiness and Emergency Preparedness Act gives federal courts exclusive jurisdiction over Covid-related personal injury and wrongful death claims is likely to go to the U.S. Supreme Court, especially if there is disagreement among the appeals courts. Read more from Mary Anne Pazanowski.

  • The delta variant drove the share of nursing homes reporting staff shortages to the highest level ever in September—and the situation could worsen in coming months, according to new research. As the Centers for Medicare & Medicaid Services prepares to unveil guidelines requiring all health-care workers to be vaccinated against Covid-19, the data has illuminated lingering concerns that the mandate will further exacerbate the nursing home staffing problem. Read more from Tony Pugh.

OSHA Virus Enforcement Slowed by Lack of Rules, Report Says: OSHA inspectors on assignments related to Covid-19 were sometimes hindered by the lack of specific safety rules covering the virus and changing guidance from the agency, a new Government Accountability Office report found. The report, released yesterday, also found that because inspectors and supervisors couldn’t work from their usual offices as part of measures to protect agency staff, there was confusion on how to conduct inspections. Read more from Bruce Rolfsen.

More Headlines:

What Else to Know

Texas Spars with DOJ on Court Power to Block Strict Abortion Law: Advocates for and against Texas’ strict abortion law painted starkly different portraits of the power of federal judges to protect constitutional rights as each side made its case in advance of next week’s U.S. Supreme Court showdown.

Texas and its allies yesterday urged the court to reject challenges to the law, which has largely shut down legal abortion in the nation’s second-largest state. The measure authorizes enforcement only by private lawsuits, and state officials said that novel provision means federal judges lack any means of throwing out the law. “The Constitution does not guarantee pre-enforcement review of state (or federal) laws in federal court,” Texas Attorney General Ken Paxton argued. Read more from Greg Stohr.

Biden‘s HHS Rolls Out Sweeping Opioid Plan: The Department of Health and Human Services yesterday unveiled a four-pronged, treatment-focused strategy for combating rising opioid addiction numbers amid the coronavirus pandemic. Harm reduction, evidence-based treatment, recovery support, and primary prevention are the “four key target areas” the HHS outlined in a brief chronicling the agency’s efforts to curb overdoses. Almost 97,000 deaths were reported in the 12 months up to March 2021, according to Centers for Disease Control and Prevention data. Read more from Ian Lopez.

FDA Official Says Tobacco Product Reviews Coming: The Food and Drug Administration is close to wrapping up a sweeping review of tobacco products sold in the U.S., though it faces a round of lawsuits challenging actions it has taken. “Many of the reviews are in final stages,” said Mitch Zeller, director of the agency’s Center for Tobacco Products, speaking at a virtual conference hosted by the Food and Drug Law Institute yesterday. Zeller said the agency has already refused to allow 200,000 products to continue being sold, has authorized only three, and has around 80,000 products pending. Tiffany Kary has more.

Rare Gene Therapies Get Boost From Alliance: Customized therapies that aim to treat rare diseases will reach patients who need them more easily under a public-private partnership announced yesterday. The NIH and FDA are teaming up with nonprofits and 10 drug companies—including Biogen, Pfizer, and Novartis Pharma—to speed up development of gene therapies under the partnership called the Bespoke Gene Therapy Consortium. Rare diseases have patients populations that are so small, so such therapies may not be commercially viable. Read more from Jeannie Baumann.

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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