HEALTH CARE BRIEFING: House to Vote on Biden’s Economic Agenda

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The House plans to vote today on President Joe Biden’s $1.75 trillion economic package and a separate infrastructure bill, after intense 11th-hour negotiations by Speaker Nancy Pelosi (D-Calif.) appeared to settle lingering differences.

A vote on the massive tax and spending measure follows months of intra-party tension and disputes that carried into late yesterday night. Although much of the bill had been written, there were last- minute changes on modifying the state and local income tax deduction and a provision allowing Medicare to negotiate drug prices. Approval of the infrastructure measure, already passed by the Senate, will send it directly to Biden’s desk.

House passage of both measures would deliver a much-needed victory for the president, whose approval ratings have plummeted. A stunning loss for Democrats in the Virginia gubernatorial race and an unexpectedly close call for the incumbent governor of New Jersey generated fresh impetus for the party’s lawmakers to finish work on both the economic package, known as Build Back Better, and an infrastructure measure.

Biden has been directly involved in negotiating with House and Senate Democrats and he made calls to House members yesterday asking them to vote yes when the bill comes to the floor, a White House official said. Read more from Billy House and Erik Wasson.

  • Democrats agreed to give some drugs an extra year of exemption from their proposed drug price negotiations after party moderates sought changes, according to a person familiar with the matter, Alex Ruoff reports. The move means biologic drugs won’t face government negotiation until 13 years post approval, one year longer than previously agreed to. Small molecule drugs remain at nine years post-approval until negotiation. The change was made after Reps. Scott Peters (D-Calif.) and Kathleen Rice (D-N.Y.) met with Pelosi.
  • The $1.75 trillion package marks a dramatic shift toward boosting support for families with children after decades of government benefits being skewed toward the elderly. The turn reflects new attention among Democrats to the lasting damage growing up in poverty does to someone’s lifelong prospects, and a growing recognition across party lines of how the financial squeeze on many working- and middle-class families often hits hardest when parents confront the costs of caring for younger children. Read more from Mike Dorning.
  • The House version of the tax and social spending bill raises nearly $1.48 trillion in new tax revenue, the Joint Committee on Taxation found. The plan also includes $24.8 billion for a fee on businesses that pollute, pushing the total of new revenue to around $1.5 trillion. Still, the money from tax increases on the wealthy and corporations falls short of the $1.75 trillion that Democrats say they want to spend on new social programs. Read more from Laura Davison.
  • The JCT’s calculations don’t include additional savings from the drug-pricing deal struck by Democrats this week, which the White House estimates would generate about $250 billion in savings to offset the cost of the agenda. The Congressional Budget Office made a $150 billion estimate prior to Democrats’ latest deal to let Medicare negotiate lower prescription costs. The administration claims the deal would generate a further $100 billion in savings on top of the CBO’s $150 billion estimate.

GOP Warns Safety-Net Hospitals Face Cuts: Republican lawmakers took aim at a Democratic proposal in Biden’s agenda that would expand Medicaid in a dozen holdout states, saying it means deep cuts for safety-net hospitals. At issue are proposed cuts in disproportionate share hospital payments, also known as DSH payments. The funds support hospitals that provide a large amount of care to Medicaid patients and the uninsured, for which they receive no payment or less than the full cost of services provided.

“In order to strong arm Medicaid expansion on the whole country Democrats are threatening the lives of patients who rely on care from hospitals in these 12 states,” Rep. Cathy McMorris Rodgers (R-Wash.), ranking member of the House Energy and Commerce Committee, said at a Health Subcommittee markup of a slate of unrelated bills.

The cuts could be as much as $7.8 billion over 10 years, according to the American Hospital Association and other hospital groups that are urging the congressional leaders to remove them from the bill. Read more from Christopher Brown and Alex Ruoff.

Happening on the Hill

House Bills Address Doctors’ Mental Health: The federal government would start a campaign to combat physician suicide and improve the mental health of health-care providers stressed by the nearly two-year-long pandemic, under nine bills advanced yesterday by the House Energy and Commerce Health Subcommittee. The subcommittee approved the slate of public health bills that largely authorize grants to open programs to support health-care providers and researchers, including one (H.R. 1667) for mental and behavioral health training for doctors.

The Dr. Lorna Breen Health Care Provider Protection Act was passed the Senate in August and would be a rare effort by lawmakers to deal with deaths by suicide among providers. Breen was a long-time New York emergency room physician who died by suicide in April 2020, after spending weeks treating Covid-19 patients, then contracting the virus herself. Lawmakers have cited her story as evidence of increased burnout and stress among health-care providers dealing with the pandemic, which has killed over 750,000 people in the U.S. since the start of 2020.

The bill and eight others were sent to the full Energy and Commerce Committee for markup. If approved by the full committee, they can go to the House floor for a vote. “America’s health care workers have been and continue to face a deadly crisis,” Rep. Anna Eshoo (D-Calif.), chair of the subcommittee, said, Alex Ruoff reports.

Republicans to Force Vote on Blocking Vaccine Mandate: Senate Republicans plan to force a vote to block Biden’s new vaccine mandates for workers, an effort that is all but certain to fail in the Democratic-controlled Congress. Under the Congressional Review Act, a Senate minority can force votes to stop regulations like the new vaccine mandates scheduled to take effect Jan. 4, but it would take many Democratic defections to override the president’s veto. Read more from Steven T. Dennis.

The Coronavirus Pandemic

Jan. 4 Shots-or-Tests Deadline Set for Private Firms: The U.S. government issued a federal rule requiring Covid-19 vaccinations or at least weekly testing for workers at U.S. companies with 100 or more employees. The rules from the Occupational Safety and Health Administration are a key pillar of Biden’s push to use employer mandates to drive up vaccination totals nationwide. Biden already has expanded the rules for federal workers and contractors, which will take effect over the next five weeks, requiring the vaccine and offering no alternative for regular testing.

Biden—elected in part on a pledge to quell the pandemic—views mass vaccinations as the fastest path to reopening society and the economy, including employer mandates, booster shots and vaccines for children aged 5 to 11 that started this week. Around 80% of U.S. adults have received at least one dose, but several Republican states’ attorneys general have vowed to sue in a push to stop the initiative. Conservative groups such as the Job Creators Network and news website the Daily Wire also said yesterday they’ll challenge the rule. Read more from Bruce Rolfsen.

  • The administration’s goal of cultivating business alliances to offset conservative resistance to its vaccination-or-testing rule for the private sector was evident in the employer-focused carveouts it provided. So far, that strategy has produced mixed results. Some business trade groups were considering filing a legal challenge as of yesterday night. Other industry organizations were frustrated with the requirements but committed to helping member companies meet the compliance schedule. Read more from Ben Penn.
  • Arizona, Florida, and Missouri have vowed to sue the administration today to block the emergency rule mandating workplace Covid-19 vaccination or testing, with more lawsuits expected from Republican-led states and industry groups. Attorneys general in those three states said they’ll file lawsuits early today, when the rule is officially published and will take effect. Ohio and Indiana’s attorneys general also have pledged to challenge the regulation in court. Alabama and Georgia are expected to join Florida’s suit. Read more from Robert Iafolla.
  • Firms preferring the testing option face wildly variable costs that can run into the thousands of dollars. The testing cost issue stands to become more important under the Biden administration’s latest rule. Workers are expected to pay for their own masks and tests unless an employer chooses to pay or is required to by other laws or collective bargaining agreements. The provision is likely to prompt more employees to get free vaccinations instead of pricey tests. The “vast majority” of self-insured employers have paid about $100 per PCR test, Sara Hansard reports.
  • Since Biden announced in September that OSHA would issue a mandate for all U.S. employers with 100 or more workers, businesses and advocates have been seeking clarification over which workers would add up to that number. The unveiling of OSHA emergency temporary rule yesterday reveals there’s little wiggle room for how those people are counted: The federal safety agency standard applies to businesses with a total of 100 or more employees at any time the new measure is in effect. Read more from Bruce Rolfsen.
  • As the administration prepped its mandate, anti-vaccine activists rallied followers on Facebook, Twitter, and right-wing blogs to flood the White House with requests to meet with federal regulators. “If anyone wants to jam up the OSHA vaccine mandate rule, you can go to this page and request a meeting,” one post on a gun advocacy website in mid-October said. “If a few hundred thousand people request meetings, this rule will be tied up.” The White House called their bluff. Read more from Courtney Rozen.

Vaccination Mandated for 17 Million Health Workers: Millions of U.S. health-care workers at facilities funded by Medicare and Medicaid will be required to get a Covid-19 vaccination after an interim final rule was published yesterday—a major prong of the Biden administration’s sweeping plan to crack down on unvaccinated workers. The rule will extend to over 17 million health-care workers who have fought the coronavirus pandemic from the front lines of about 76,000 facilities. Like the rule for employees at private companies, workers will have to be fully vaccinated by Jan. 4. Allie Reed has more.

  • The health-care community praised the rule’s aim but bemoaned omissions in the directive. Most of the nursing home industry’s recommendations for the new rule didn’t materialize. Most importantly, the mandate doesn’t allow unvaccinated workers to be regularly tested in order to remain on the job. In addition, the interim rule could also permit some workers in the home health industry who don’t want the jab to seek employment at other agencies that may not be subject to the rule. Read more from Tony Pugh.

Biden to Provide Federal Workers Time to Vaccinate Kids: Federal workers with young children will receive paid time off to take them to get a Covid-19 vaccine under a memo released by the government’s HR agency yesterday night. Federal agencies already gave employees time off to accompany a family member to a vaccine appointment. The policy now applies to parents of kids age 5 to 11, after the Centers for Disease Control and Prevention authorized vaccines for those children Tuesday. Employees can receive up to four hours off per dose for each child, according to the memo. Read more from Courtney Rozen.

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What Else to Know

Unlicensed Stem Cell Clinics Flourish: Stem cell clinics selling unlicensed, unproven treatments have increased four-fold in the last five years, in new findings that indicate the threat of federal enforcement isn’t discouraging these companies. An analysis in the journal Cell Stem Cell published yesterday found as of March 31, 1,480 businesses were operating 2,754 clinics, compared to 351 businesses operating 570 clinics in 2016. The study comes about five months after the FDA lifted a three-and-half year grace period to allow these clinics to comply with regulations on human cells. Read more from Jeannie Baumann.

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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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