HEALTH CARE BRIEFING: Senate Democrats See Slim Health-Care Wins

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Democrats, holding the slimmest-possible majority in the Senate, will set the health-care agenda in the new Congress but face an uphill battle in sending major legislation to the president’s desk.

President-elect Joe Biden has vowed to build on the Affordable Care Act by expanding its insurance subsidies and creating a government-run insurance plan. Those ideas face strong political headwinds.

Election runoff victories by Jon Ossoff and Raphael Warnock give Democrats control of Senate confirmations of political and judicial nominees. The bar is higher for passing legislation: Democrats must keep their caucus unified and win the support of 10 Republicans, unless they turn to budget tricks or change Senate rules.

Ossoff and Warnock both back Biden’s health plans. Recently, Biden and congressional Democrats have largely focused on responding to the Covid-19 pandemic and improving the rollout of a vaccine to stop the spread of the virus. As the new Congress gets underway, Senate Democrats’ agenda will shift to confirmation of Biden’s pick to lead the Department of Health and Human Services, and finding ways to advance their health-care agenda without a commanding majority.

A Senate majority means key members of Biden’s Cabinet, like his HHS pick, Xavier Becerra, will be easier to approve. Only 51 votes are required to confirm political appointees when there are no Senate vacancies. With the upcoming Senate split 50-50 between Senate Republicans and those who vote Democratic, Vice President-elect Kamala Harris will break any tie votes.

Becerra has already started meeting with key Democrats ahead of confirmation hearings, according to a congressional aide. Becerra has spoken with the Senate Finance Committee’s top Democrat, Ron Wyden (Ore.). Wyden, in a statement, said he wants to confirm Becerra “as soon as possible so he can get on the job and start helping people during this unprecedented crisis.”

Meanwhile, big-ticket legislation such as a public health insurance option and expanding on the ACA aren’t likely to pass the Senate through regular order. Democrats have signaled they are interested in using a congressional budget tool known as reconciliation that allows them to pass certain types of legislation by a simple majority.

There are limits to relying on reconciliation rules: Only provisions that have a budgetary effect can be passed under that process, according to the Byrd Rule. Some provisions that fail to meet that requirement may be pulled out of the legislation under recommendation by the Senate Parliamentarian. Those restrictions could be especially challenging for health-care legislation. Read more from Alex Ruoff.

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Centrist Democrat Floats Return of Individual Mandate: With Democratic control of both chambers, Rep. Stephanie Murphy (D-Fla.) said her party may restore Obamacare’s penalty for not having health insurance as part of a larger measure to improve on the health care law. “That is part of a conversation we’re going to have to have about how we shore up the ACA,” she told reporters yesterday. She said Democrats should look at how effective the penalty was before it was ended. “At the end of the day what we’re trying to do is make sure every American has access to quality, affordable health care,” Murphy said.

Republicans had effectively eliminated what’s known as the Affordable Care Act’s individual mandate as part of their major tax overhaul. That move lead to a challenge of the legality of the ACA by GOP attorneys general currently pending at the Supreme Court, Ruoff reports.

The Coronavirus Pandemic

States Get $22 Billion for Distribution, Testing: States will receive an infusion of $22 billion in the coming weeks to get the vaccine to more people and improve testing, the Department of Health and Human Services announced yesterday. About $19 billion will be awarded for testing, tracing, and other actions to stymie the spread of the virus, according to the HHS. Another $3 billion will be awarded to get the vaccine distributed, and funds will be delivered to states and cities based on their population. Read more from Shira Stein.

States Urged to Widen Vaccination Pool: Top U.S. health officials encouraged states to start vaccinating people more widely, acknowledging that the U.S.’s immunization rollout has been slower than anticipated and opening the spigot for a broader range of Americans to begin to get shots. HHS Secretary Alex Azar on a call with reporters yesterday blamed the introduction of Covid-19 shots around the holidays and overly detailed state plans for hindering the vaccination campaign. Read more from Angelica LaVito.

  • Meanwhile, about 1 in 100,000 people have suffered a severe allergic reaction to the first Covid-19 vaccine, a rate that’s higher than the flu vaccine but still quite rare, U.S. health officials said. A study by the Centers for Disease Control and Prevention published yesterday outlined 21 cases of anaphylaxis among the first 1.9 million recipients of the Pfizer shot, a rate of 11.1 per million doses administered. No allergy deaths have been reported, the CDC said. Read more from Robert Langreth and Emma Court.

Vermont Keeps Case Count Lowest in U.S.: After months of unchecked virus growth in the U.S., tiny Vermont has emerged as an unlikely, early victor in the fight against Covid-19 spread. The state, whose 624,000 residents make it more populous than only Wyoming, has managed to maintain the lowest per-capita share of cases of any state in the U.S. since the beginning of the pandemic. It’s remarkable given Vermont neighbors New York, an early epicenter now grappling with a renewed surge that drove positivity rates to 9% in New York City over the weekend. Read more from Nic Querolo.

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What Else to Know Today

Trump Offers Assurance of Orderly Transition to Biden Presidency: President Donald Trump, minutes after Congress certified President-elect Joe Biden’s Electoral College Victory and hours after Trump supporters broke into the Capitol, pledged “an orderly transition.” “Even though I totally disagree with the outcome of the election, and the facts bear me out, nevertheless there will be an orderly transition on January 20th,” Trump said in a statement posted on Twitter by his aide Dan Scavino early this morning.

Trump’s statement came as staff resigned and as congressional allies abandoned him in the aftermath of a mob of his supporters laying siege to the Capitol yesterday. Read more from Josh Wingrove.

HIV Bias Suit Against CVS Tests Bounds of ACA: Californians with HIV and AIDS are taking on their drug plan middleman in a fight over how they get the medications they need to survive. Their proposed class action against CVS Caremark—green-lighted by a federal appeals court last month—is testing the bounds of the Affordable Care Act’s antidiscrimination protections and could open the door to more litigation against powerful pharmacy benefit managers that control how drug benefit plans operate. Read more from Lydia Wheeler.

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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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