HEALTH CARE BRIEFING: Stronger Rules on Masks for Doctors Sought

By Alex Ruoff and Brandon Lee

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Congressional Democrats want to raise standards for protective measures used by health-care providers treating people suffering from coronavirus as part of a wide-ranging stimulus package meant to bolster the sputtering economy.

House Democratic leaders introduced yesterday stimulus measure (H.R. 6379) that includes a provision to direct the Occupational Safety and Health Administration to create standards for how workplaces must safeguard health-care employees against the spread of the virus. The move could run up against White House efforts aimed at giving providers options for protective gear amid equipment shortages.

Read the bill text here, summary here and one-pager here.

“We protect our health-care workers by requiring the administration to enforce our stronger OSHA protections,” Speaker Nancy Pelosi (D-Calif.) told reporters, contrasting her proposal with one Senate Republicans unveiled last week. Republican leaders’ attempts to advance the shell legislation (H.R. 748) for the stimulus proposal have faltered on procedural votes.

Democrats, backed by nursing unions, say that health-care providers are being asked to care after patients with the fast-spreading coronavirus without proper protection since the U.S. Centers for Disease Control and Prevention earlier this month loosened the rules around face protections for front-line health workers.

Some nurses are wearing makeshift masks, surgical masks and even bandannas rather than respirators specially designed to filter out airborne particles, nursing unions said this week.

“It is outrageous for the CDC to tell hospitals that nurses and other health care workers don’t need the maximum protective gear to prevent them from getting sick during this pandemic,” said Bonnie Castillo, executive director of National Nurses United, the country’s largest nursing union, in a statement. Read more from Alex Ruoff.

Community Health Centers: House Democrats’ proposal, mirroring Senate Republicans’ version, proposes extending federal funding for community health centers and other health programs until November of this year at the request of the White House. Health care industry lobbyists are warning such an extension will delay and likely end efforts to pass surprise medical billing and drug pricing legislation this year.

But one Republican aide said funding the programs beyond the expected life of the coronavirus outbreak will give Congress the opportunity to take on the issues when lawmakers aren’t focused on the fast-spreading coronavirus. One House Democratic aide said the White House “drew a line in the sand” demanding any coronavirus bill include funding for community health centers until November and that congressional leaders have agreed to that condition, meaning it’s likely to be part of any bipartisan agreement that might arise between Republicans and Democrats, Alex Ruoff reports.

Emergency Lab Funding: The clinical lab industry, which has asked Congress for $5 billion in emergency funding for expanded testing capacity, said all the packages under debate leave behind an industry that’s already overwhelmed with processing Covid-19 tests. Laboratories are performing more than 50,000 Covid-19 tests a day and are still waiting for reimbursements, the American Clinical Laboratory Association said, Jeannie Baumann reports.

“It is disappointing and alarming that Congress has not yet recognized the contributions of the lab industry and its response during this public health crisis,” Julie Khani, ACLA president said yesterday. “If the urgent funding and supply challenges aren’t resolved now, America’s commercial laboratories could be forced to retrench rather than keep building the capacity that is needed.”

Schumer Expects to Reach Deal With Mnuchin Today: Treasury Secretary Steven Mnuchin has agreed to “significant oversight” of a $500 billion exchange stabilization fund in Republicans’ proposed coronavirus rescue package, Politico reporter John Bresnahan said in a Twitter post, citing three sources familiar, Chelsea Mes reports.

Fund oversight had been a concern for Democrats worried about accountability of how funds will be used. Politico also said the Democrat-sought ‘Marshall plan for hospitals’ is also in the bill. Senate Minority Leader Chuck Schumer (D-N.Y.) said leaders expect to have a deal This morning, according to CNN and CQ Roll Call. Schumer added there’s still a few differences but neither expect them to be obstacles to a final deal, a CQ Roll Call reporter said in tweet.

Other Congressional Virus Efforts

Federalized U.S. Medical Supply Chain: Sen. Chris Murphy (D-Conn.) and other Democrats unveiled legislation that would federalize the U.S. medical supply chain. “Leaving it in private hands encourages hoarding and gouging, maximizes inefficiency during a crisis,” Murphy tweeted yesterday. Murphy’s bill would seek to “federalize the manufacture and distribution of scarce in-demand medical supplies” to “cure the growing inefficiencies of 50 states and thousands of hospitals competing against each other for medical supplies.”

  • Meanwhile, Trump signed an executive order yesterday to prevent hoarding and price hikes of supplies, according to the White House press secretary. “We will not let those hoarding vital supplies and price gougers to harm the health of America in this hour of need,” press secretary Stephanie Grisham tweeted yesterday. Trump signed it behind closed doors.
  • At the White House, Attorney General William Barr said that the government won’t go after a family with a big supply of toilet paper at home, but “if you have a warehouse of surgical masks, you’ll hear a knock on the door.” Barr said the federal government had already initiated investigations of activities that are disrupting supply chains and suggestive of hoarding. Read more from Saleha Mohsin.

HHS Told to Ease ACA Access: Congressional Democrats called on the Trump administration to re-open enrollment in the Obamacare exchanges, following the lead of states, so people can get health-care coverage as the coronavirus spreads. “We’ve seen many state leaders, governors, step up, offer those types of interventions, and many more,” Rep. Lauren Underwood (D-Ill.) said yesterday. Underwood called for a national special enrollment period for those who want to get health insurance during the outbreak in case they get sick. Read more from Sara Hansard.

Lawmaker Letters:

  • Democratic Sens. Elizabeth Warren (Mass.), Ed Markey (Mass.), Brian Schatz (Hawaii), Chris Murphy (Conn.), Tammy Baldwin (Wis.), and Sheldon Whitehouse (R.I.) sent a letter to the Chamber of Commerce “demanding answers as to why the organization is lobbying against President Trump’s use of the Defense Production Act” to “quickly harness and use America’s technological and manufacturing might to address” the pandemic.
  • House Homeland Security Chairman Bennie Thompson (D-Miss.) yesterday sent a letter to acting Secretary of Homeland Security Chad Wolf and HHS Secretary Alex Azar “regarding the personal protective equipment and other critical medical equipment and supplies available in the Strategic National Stockpile that FEMA is presently shipping to states,” according to a statement. Thompson also requested details on a recent $500 million HHS contract for masks to be delivered over the next 18 months.

Testing, Treatment & Research

Vaccine for Health Workers by Fall: Moderna said its experimental vaccine for Covid-19 could be available to a select few as soon as fall, ahead of expectations for a commercial release in a year. CEO Stephane Bancel told Goldman Sachs on Friday that mRNA-1273 could be made available to a few, potentially health-care workers, under emergency use authorization, according to a statement from the biotech company. Read more from Cristin Flanagan.

Boosting Production of Ventilators: The Trump administration is looking to identify manufacturers that can make up to 100,000 ventilators and how much those life-saving devices would cost, according to an information request. HHS is aiming to decide which companies can make the amount of ventilators needed and which can quickly modify their capacities to make at least 5,000 of the machines that assist people with breathing if they go into respiratory failure. Read more from Shira Stein.

Testing Capacity One Month Away: The U.S. won’t likely reach full coronavirus testing capability for at least another month due to shortages in both supplies and skilled lab workers, even though commercial labs are coming on board to perform the tests. Cindy Johnson, president of the American Society for Clinical Laboratory Science, said yesterday that those estimates stem from discussions with manufacturers making reagents—chemicals necessary to run the test—as well as shortages in swabs and vials that are needed to collect patient samples. Read more from Jeannie Baumann.

More Headlines:

Prevention Efforts & Societal Effects

Trump Weighs Easing Quarantine Advice: Trump began talking privately late last week about reopening the country, despite the quickly growing number of coronavirus cases and against the advice of health professionals, because he is worried about the economic damage from an extended shutdown, according to people familiar with his thinking. A shortage of testing kits has made it difficult to assess the full spread of the virus, but Trump and a contingent of aides, such as Treasury Secretary Steven Mnuchin, want to ensure that the U.S.’s economic damage from a nationwide “social distancing” campaign does not outweigh the potential toll from the virus itself, the people said.

Trump started discussing how to get Americans back to work around Thursday, two people said, only three days after he helped roll out a 15-day plan from the CDC to stem the rise of cases by encouraging most people to stay at home. , Jennifer Jacobs, Josh Wingrove, and Saleha Mohsin report.

  • However, a new analysis suggests that stay-at-home measures are helping to save hundreds of thousands of lives. Northwestern University’s Martin Eichenbaum wrote that keeping social-distancing measures in place before the number of new virus cases declines—in other words, before a peak in the infection rate—could limit infections and prevent as many as 600,000 additional U.S. deaths. Read more from Katia Dmitrieva.

Governors Clamp Down: Governors and mayors across the U.S. issued orders to clamp down normal human contact and commercial life, even as the Trump administration debates dialing back guidance that officials fear is smothering the economy. Yesterday, Indiana, West Virginia and Massachusetts ordered all residents to stay home while Virginia and Maryland placed restrictions on non-essential movement. The actions by the governors, Democrats and Republicans alike, show that even if Trump relaxes federal recommendations, states won’t necessarily follow. Shruti Date Singh and Jordan Fabian have more.

  • In Minnesota, Gov. Tim Walz (D) yesterday ordered all non-hospital entities to perform an inventory check of the personal protective equipment (PPE), ventilators, respirators, and anesthesia machines they’re in possession of and report their results to the state. The entities either have to donate the gear to a local coordinating entity, or preserve them, the order said.
  • In Illinois, Gov. J.B. Pritzker (D) announced yesterday state partnerships with the Illinois Manufacturers’ Association and Illinois Biotechnology Innovation Organization to bolster in-state production of essential supplies needed to combat the virus. Under the partnerships, Illinois businesses will repurpose facilities to manufacture products including medical equipment, medicine, and therapies, as well as personal gear, like N95 masks, gloves, and gowns, Stephen Joyce reports.

More Headlines:

What Else to Know

SCOTUS Urged to Hold ACA Birth Control Case: A group of states that won a ruling from the Ninth Circuit barring the Trump administration from enforcing rules exempting certain employers from the ACA’s birth control mandate asked the U.S. Supreme Court to delay acting on petitions seeking to overturn the decision.

The court already granted review of a decision from the U.S. Court of Appeals for the Third Circuit involving the same issue—if the government acted outside its authority when it added rules that allow employers with religious or moral objections to opt out of providing health plans that pay for contraceptives and related services—the states, led by California, said in a brief.

The prudent course is to hold the petitions in the Ninth Circuit case originally brought by California, New York, Delaware, Maryland, and Virginia, until after the court issues its ruling in the Third Circuit case brought by Pennsylvania and New Jersey. Read more from Mary Anne Pazanowski.

More Headlines:

To contact the reporters on this story: Alex Ruoff in Washington at aruoff@bgov.com; Brandon Lee in Washington at blee@bgov.com

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

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