HEALTH CARE BRIEFING: Progressives Want End to Medicare Pilot

Congressional Democrats and several left-leaning advocacy groups on Monday renewed their push to end a Medicare pilot program aimed at changing how the program pays doctors, Alex Ruoff reports.

Progressive groups are gathering signatures and petitioning the White House to cancel the program, which the Biden administration already agreed to redesign after pressure from Democrats and these same organizations. The groups are targeting seniors with warnings about how the program might limit their access to care.

The Democrats trying to halt the pilot say they see it as an effort to redesign all of Medicare, pushing it further toward privatization. “We need to keep up the pressure,” Rep. Katie Porter (D-Calif.) said on an online organizing call Monday. “Right now there is a battle for the future of Medicare.”

The groups involved include Physicians for a National Health Program, Public Citizen, and Social Security Works. They declared a “summer of action” meant to culminate on the anniversary of Medicare’s creation in July.

The Biden administration tried unsuccessfully to placate these Democrats and progressive groups earlier in the year by promising to transition the pilot—the global and professional direct contracting model—to one with a greater focus on boosting health equity. The administration also promised a push to lower the incidence of “upcoding,” when providers overstate the seriousness of a patient’s condition in order to get higher reimbursements.

Physician groups that support this model—to be called ACO REACH in 2023—say opponents are misleading seniors about the program, especially with claims that there are limited networks that prevent people from finding doctors and expanded use of prior authorizations, which dictate what kinds of drugs and treatments insurers will reimburse.

Ending ACO REACH will put “patients back into a system where doctors are financially rewarded with more, inefficient, duplicative, and wasteful care,” David Pittman, a senior policy advisor for the National Association of ACOs, said in an email.

Also on Lawmakers’ Radars

Tuesday’s Hearings:

• The House Appropriations Labor-HHS-Education Subcommittee holds a Tuesday Member Day hearing, where members can discuss issues of importance to their districts.
• The House Financial Services Diversity and Inclusions Subcommittee holds a Tuesday hearing on financial services inequities created by disability due to long Covid.
• BGOV Calendar: See full list of hearings this week.

Baby Formula Gets Democrats’ Antitrust Scrutiny: Democratic lawmakers have turned their latest antitrust focus to the infant formula industry amid a nationwide shortage triggered in part by the closure of a key Abbott Laboratories plant. “Longer term, we absolutely have to focus on consolidation in the food industry,” said Sen. Debbie Stabenow (D-Mich.), who helped lead legislation signed over the weekend (H.R. 7791) aiming to ease the shortage for Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, users. “We need more baby formula manufacturers competing in this space.”

The formula industry is largely dominated by just four companies: Abbott, Mead Johnson, Gerber, and Perrigo. States usually each exclusively contract with one baby formula maker to provide for WIC, although the new legislation gives lower-income parents the opportunity to use their government benefits to buy more types of formula during emergencies. The sole-contract bidding model means formula makers offer their product at a lower rate and that WIC can stretch to serve more consumers, Stabenow said. “We want to take a look at all that makes sure we can maintain the ability to negotiate the best price.”

Sen. Cory Booker (D-N.J.) led multiple Senate Democrats in a letter earlier this month, asking the Agriculture Department to address the “alarming level of corporate concentration.” Among other suggestions, they raised the possibility of revisiting the sole-source model with WIC on a more permanent basis, Maeve Sheehey reports.

• Meanwhile, a separate group of senators urged Abbott to extend WIC rebates across all infant formulas through the rest of the year without unnecessary directives. Lauren Dezenski has more.

Manchin Outlines Fiscal Priorities: Sen. Joe Manchin (D-W.Va.), a key Democrat who opposed his party’s “Build Back Better” economic agenda (H.R. 5376), at a World Economic Forum panel Monday said Democrats could still roll back parts of the Republican 2017 tax cuts bill, pass drug pricing legislation, and pass an energy and climate measure as part of a reconciliation package. Manchin said opposition to the Republican tax law is a unifying force among Democrats. Read more from Jack Fitzpatrick.

Democrats Want Permanent ACA Premium Credits: Vulnerable congressional Democrats want leadership to take another run at making expanded Affordable Care Act premium credits permanent and ensure premiums don’t spike in 2023, Alex Ruoff reports. Rep. Lauren Underwood (Ill.) and 26 other swing-district incumbent Democrats also called for the expansion of Medicaid coverage in upcoming reconciliation legislation.

Key House Appropriator Talks Covid Aid: Rep. Tom Cole (R-Okla.), the ranking Republican on the House Appropriations Labor-HHS-Education Subcommittee, is scheduled to speak tomorrow at a Center for Strategic and International Studies event on “Strengthening America’s Health Security.” Cole plans to discuss prospects for global and domestic Covid aid and pandemic preparedness. Read more.

What Else to Know Today

Monkeypox Risk Is Low And Vaccines Ready If Needed, US Says: US health officials sought to reassure the public that the risk of monkeypox is low and the country is prepared to handle its spread, though they acknowledged more cases are likely, Fiona Rutherford, Riley Griffin and Madison Muller report.

• Monkeypox Can Be Contained If People Recognize It, WHO Says

Pfizer Shot Works Well in Young Kids, Study Finds: Pfizer and BioNTech said their Covid vaccine was highly effective and prompted a strong immune response in children under age 5, based on early results from a trial likely to pave the way for infants and toddlers to finally get immunized. A three-dose regimen was 80.3% effective in a preliminary study, they said. Read more from Riley Griffin.

SCOTUS Allows N.Y. School Vaccine Mandate: The US Supreme Court turned away a challenge to New York state’s requirement that schoolchildren be vaccinated against serious diseases, refusing to question the state’s 2019 repeal of its longstanding exemption for families with religious objections. The court left in place a state court ruling saying New York wasn’t targeting religion when it ended the exemption after a measles outbreak, Greg Stohr reports.

Labor Open to Mental Health Parity Guidance: The Department of Labor may issue more guidance on how health plans can meet requirements that they cover mental health care to the same extent as other services, Ali Khawar, who leads the Employee Benefits Security Administration, said. Sara Hansard has more.

Plasma Rules Relaxed as FDA Seeks Supply Boost: People with blood pressure measurements outside of the normal range may still donate plasma without first getting a medical exam, the FDA said Monday in draft guidance. The agency said it will not enforce certain federal regulations for pulse, weight, and other factors considered to determine donor eligibility. Read more from Celine Castronuovo.

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• YouTuber Identity Kept Hidden in Planned Parenthood Case
• GSK Sued for Monopoly on Ventolin, Arnuity Ellipta Inhalers
• J&J Sues Viatris, Suppliers on Copaxone Copycats’ Method Patents
• Medicare Home-Based Care Payment Model Delivers Savings

With assistance from Alex Ruoff and Maeve Sheehey

To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com