HEALTH CARE BRIEFING: Medicare Income Caps Sought in Budget Bill

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Centrist Democrats are weighing whether new Medicare benefits should go only to lower-income Americans as they look for ways to cut the cost of their party’s sweeping domestic spending bill.

Sen. Joe Manchin (D-W.Va.) told reporters he wants to means-test “everything we can” to reduce the size of the once-$3.5 trillion spending package being debated by congressional Democrats. Other centrists have said new Medicare benefits—vision, dental, and hearing coverage—specifically need to be limited by income.

“We have to have means-testing to bring it in,” Rep. Henry Cuellar (D-Texas) said.

Cuellar said he has been in talks with Manchin and Sen. Kyrsten Sinema (D-Ariz.) about the domestic spending package and believes means-testing new programs, including new Medicare benefits, could win their support. The reconciliation process being used for the legislation allows Democrats to advance the bill without Republican votes in the Senate, though all 50 Democrats have to back the proposal.

Rep. Kurt Schrader (D-Ore.), a moderate who voted against the Energy and Commerce Committee’s provision to expand Medicare benefits, said he wants dental coverage to be means-tested. “There are those who can’t afford this right now, let’s focus it on them,” Schrader said. “It’s less costly to the taxpayer and it gives help to the people who really need it.”

The lawmakers’ comments come as Democrats increasingly concede that not all of their health proposals, which top $1 trillion, will make it into the final package. They are debating which proposals to shelve or trim to appeal to Manchin and Sinema — two crucial votes in the Senate as they aim to advance the package along party lines. “The Senate’s not going to go along with $3.5 trillion,” Rep. Steve Cohen (D-Tenn.) told reporters. Read more from Alex Ruoff.

Progressives Defy Pelosi, Vow to Vote No on Infrastructure: House progressives are lining up to defy Speaker Nancy Pelosi (D-Calif.) and oppose a bipartisan infrastructure bill tomorrow, dealing a blow to the $550 billion measure’s chances and potentially endangering Biden’s economic agenda. She was banking on progressive Democrats settling for an agreement — rather than a vote — this week on the topline figure for the larger separate package of social programs and climate measures that encompasses the bulk of Biden’s agenda. Read more from Jarrell Dillard, Erik Wasson and Laura Litvan.

Happening on the Hill

Senate Democrats Nix Push to Tie Stopgap, Debt: Senate Democrats are eyeing a vote today on a stopgap funding bill to avert a government shutdown, but without a provision to raise the federal debt limit. Democrats are seeking consent from all senators to bring the bill to the floor as a way to expedite passage before funding for the government runs out after the Sept. 30 end of the fiscal year. The bill extends funding through Dec. 3. Read more from Erik Wasson.

  • Still, the threat of a shutdown—even one where the Health and Human Services Department would be forced to furlough 43% of its staff—wouldn’t have paused federal work on Covid-19 research. The FDA would continue to authorize vaccines, therapeutics, and diagnostics; the CDC’s labs and its 24/7 emergency operations center would stay open; and the NIH would sustain its support for priority Covid-19 research and development, according to an HHS contingency plan. Read more from Shira Stein and Jeannie Baumann.
  • However, U.S. biomedical innovation would face a blowback under a shutdown that could halt thousands of NIH laboratories when the agency is already grappling with billions of dollars in lost and delayed research. The National Institutes of Health would have to furlough roughly 75% of its staff, or more than 14,000 employees, if Congress doesn’t pass a spending bill to keep the government open before the Sept. 30 deadline, according to the plan. Jeannie Baumann has more.

Drug Bills Markup: The House Judiciary Committee is scheduled to mark up 12 bills including:

  • H.R. 2883, to enable the Federal Trade Commission to deter filing of sham citizen petitions to cover an attempt to interfere with approval of a competing generic drug or biosimilar; and
  • H.R. 2891, to prohibit prescription drug companies from compensating other prescription drug companies to delay the entry of a generic drug, biosimilar biological product, or interchangeable biological product into the market.

Addiction Task Force to Unveil Bills Targeting Overdoses: The House’s bipartisan task force tackling addiction will unveil a list of 67 bills they want to pass this Congress to tackle the ongoing overdose crisis, Alex Ruoff reports. Reps. Annie Kuster (D-N.H.), Brian Fitzpatrick (R-Pa.), David Trone (D-Md.) and Jamie Herrera Beutler (R-Wash.) plan to unveil their agenda for the rest of this Congress today at 11 a.m., according to a statement.

Crack Cocaine Sentencing Disparity Measure Passed: The House yesterday on a 361-66 vote passed legislation (H.R. 1693) that would repeal prison sentences and fines for drug crimes involving crack cocaine that are greater than those for powder cocaine, Adam M. Taylor reports.

State & Local Health: The House Select Subcommittee on the Coronavirus Crisis convenes for a hearing on strengthening state and local health departments.

The Coronavirus Pandemic

Virus Tests Hit Employers’ Wallets as Biden Pushes Shots: Coronavirus tests for unvaccinated workers will come out of some employers’ pockets even if President Joe Biden’s mandate doesn’t explicitly require it, creating one more incentive for companies to get employees shots. The tests themselves will likely fall under state laws in places like California and Illinois that require employers to reimburse workers for job-related expenses, employment lawyers said. Read more from Robert Iafolla, Lydia Wheeler, and David Hood.

Over 400,000 Americans Got Booster at Pharmacies Last Weekend: White House Covid-19 Coordinator Jeff Zients said the booster campaign is off to a “strong start” with more than 400,000 Americans getting a booster at pharmacies last weekend. One million people have boosters scheduled at pharmacies, Zients said at a White House Covid-19 briefing. The U.S. will hit a milestone last week with 200 million adults with at least one shot, he said, Catherine Larkin and Josh Wingrove report.

  • People who got Covid-19 vaccine boosters after the shots were cleared for people with weakened immune systems had mostly mild to moderate reactions, according to the U.S. Centers for Disease Control and Prevention. Some 22,191 booster recipients registered with a federal monitoring system starting Aug. 12, when the doses were first authorized on an emergency basis by U.S. regulators, through Sept. 19, the CDC said in a report yesterday, Anushree Dave reports.
  • White House Covid-19 Chief Medical Adviser Anthony S. Fauci said he supports the actions of his sister health agencies to allow boosters for limited populations, describing CDC Director Rochelle Walensky’s decision to modify the recommendation of her scientific advisers as “courageous.” A panel of advisers for the CDC had recommended boosters only for older Americans and those in long-term care facilities, splitting on boosters due to workplace risk. Walenksy aligned herself with the FDA’s authorization. “She took the advice of the committee under advisement, and she made a modification,” Fauci said. Read more from Jeannie Baumann.
  • The Food and Drug Administration is leaning toward authorizing half-dose booster shots of the Moderna coronavirus vaccine, satisfied that it’s effective in shoring up protection, people familiar with the matter said. The authorization would set the stage to further widen the U.S. booster campaign after earlier authorization of the Pfizer Inc.-BioNTech shot. About 170 million fully vaccinated people in the U.S. received the Moderna or Pfizer shots, or 92% of the total inoculated so far. Read more from Josh Wingrove and Jennifer Jacobs.

NIH Sets $36 Million For ‘Pan-Coronavirus’ Vaccine Research: Coronavirus vaccine research and development is getting a $36.3 million dollar investment surge from the Biden administration, with funds going to three academic institutions to focus primarily on creating a jab that protects against multiple strains. The funds, from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, add to the $1.2 billion NIAID has already directed to research into coronavirus vaccines since the onslaught of the Covid-19 pandemic. Read more from Ian Lopez.

Pfizer, BioNTech Submit Initial Data for Shot in Kids: Pfizer and partner BioNTech said they have submitted initial data to U.S. regulators about the use of their Covid-19 vaccine in children ages 5 to 11, one step closer to bringing shots to school-age kids. The companies said in a statement that they expect to make a formal request for emergency authorization in the coming weeks. Submissions to regulators in Europe and elsewhere are also planned. Read more from Robert Langreth.

More Headlines:

What Else to Know

Federal Health Centers Get $1 Billion for Construction: Nearly 1,300 federally funded health centers will be able to advance construction and renovation projects with nearly $1 billion in new funding from the Biden administration. The American Rescue Plan funds will be awarded to centers that help the medically underserved and other vulnerable populations that are disproportionately affected by the Covid-19 pandemic and other health conditions. Read more from Tony Pugh.

Disparate Patient Care Found in Medicare Managed Care Plans: Low-income Medicare beneficiaries and “dual eligibles,” who also qualify for Medicaid, appear to receive sub-optimal care through their private Medicare Advantage plans, a new government report has found. Dual eligibles, or DE, who have complex medical needs, and Medicare beneficiaries eligible for the program’s low-income subsidy (LIS) to help purchase prescription drugs “often received worse clinical care than” other beneficiaries, the report found. Additional research is needed to “understand the causes of this pattern,” the report added. Read more from Tony Pugh.

Health-Care Deals Stay Strong in August Amid Covid-19 Surge: The pace of mergers and acquisitions in health care remained brisk in August and appears likely to continue or accelerate for the rest of what could be a record-setting year. Overall, August saw 252 deals, bringing the monthly average for the year to 243, a sharp increase over 2020’s average of 161, said Larry Kocot of KPMG in Washington. But the recent surge in Covid-19 cases could present short-term headwinds for health-care sector investments amid over-strapped hospitals and disruptions in staffing and care, Kocot said. Read more from Christopher Brown.

Georgia’s Six-Week Abortion Law Ruling Delayed: A federal appeals court’s decision on the constitutionality of a Georgia law banning abortions after six weeks’ gestation has been delayed pending the U.S. Supreme Court’s ruling on the validity of a 15-week ban in Mississippi. The U.S. Court of Appeals for the Eleventh Circuit halted the case pending a decision in Dobbs v. Jackson Women’s Health Org., which is set to be argued in the nation’s top court on Dec. 1. Read more from Mary Anne Pazanowski.

More Headlines:

With assistance from Alex Ruoff

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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