with Alexandra Ellerbeck

Chances for any significant health-care initiatives are pretty much out the window for the next two years, even in a best-case electoral scenario for Democrats. 

Even if Joe Biden wins the presidency and Senate Democrats manage to flip two Georgia seats, there will be little margin in the upper chamber to further expand Obamacare, add a public option or allow the federal government to negotiate lower drug prices – some of the core proposals Biden had promised during his campaign. 

At this point, the most Biden can hope for is a 50-50 Senate. That scenario smacks of gridlock. 

Kamala Harris would be the tie-breaking vote. But even with her help, Democrats would have to get every single one of their members in line – or get the help of some Republicans to pass legislation. And unless they’re passing a budget reconciliation bill, which requires a simple majority to pass, they’d need 60 votes to get around any filibusters.

The composition of the Senate now depends on the results of one and perhaps two run-off elections on January 5. 

No candidates running for the state’s two Senate seats have yet received a simple majority of the vote – a requirement under state law in general elections. 

Republican Sen. Kelly Loeffler, appointed last year to replace retired Sen. Johnny Isakson, will compete in the runoff against Democrat Raphael Warnock. Georgia’s senior senator, David Perdue, would also be forced into a runoff against Democrat Jon Ossoff if he fails to gain 50 percent of the general election vote.

This means public option or direct drug price negotiations are likely shelved. 

Had the election resulted in a blue sweep as they’d hoped for, these ideas may have at least been on the table. 

Biden’s core health insurance proposal was to offer a government-backed plan to compete in the marketplaces among private options. It’s not the bold and dramatic Medicare-for-all plan many of his primary opponents advocated, but the Democratic nominee argued it would be a less disruptive way to give Americans access to more affordable insurance options.

But it’s a non-starter for Republicans, who argue it would be too hard for private insurers to compete against government premiums set artificially low. The health-care industry hates public option too because the government pays lower rates for medical services than private plans pay.

As for allowing the government to negotiate lower prices for drugs in the Medicare program – that is also likely to remain a pipe dream for Democrats.

The same goes for a House-passed bill allowing the federal government to negotiate lower drug prices with pharmaceutical companies – a proposal Republicans and the health-industry detest.

Smaller changes to the marketplaces might not be off the table.

The most likely is expanding the law’s subsidies that help lower-income people buy coverage. Some Republicans – including Sen. Susan Collins (R-Maine) have shown willingness in the past to build on the ACA – and that could be an easier vote in a Biden administration. 

There could also be room for a compromise on modest drug pricing reforms. Before the coronavirus pandemic struck, passing legislation to lower drug prices and resolve surprise medical bills was the top health policy priority for the politically divided Congress and the Trump administration.

There’s a bipartisan drug pricing bill written by the leaders of the Senate Finance Committee, which stalled last year as Trump aides and the staff of House Speaker Nancy Pelosi tried to work out a deal. Senate Majority Mitch McConnell has frowned on the measure, but it contains a number of bipartisan reforms that could be in play if Congress makes it a priority once again.

“The impetus to do so has to come from all four leaders in the capitol,” said Rodney Whitlock, former health advisor to Sen. Chuck Grassley (R-Iowa).

Democrats will have a sense of urgency to chalk up some wins on health care.

They’ve made it their top policy issue in the last two election cycles. And the House is still controlled by Democrats, albeit more narrowly after Tuesday's elections.

Earlier this week, House Speaker Nancy Pelosi said her chamber will use the budget reconciliation process to build on the ACA and provide additional pandemic relief if Democrats hold the Senate narrowly. 

Yet using budget reconciliation bills for other ends is unwieldy process, subject to lots of obscure Senate rules, and senators also might want to use the once-a-year vehicle for other policy ends. Plus, having only 50 votes would leave Democrats zero wiggle room and any single senator could sabotage everything.

“There will be some people who want to do a couple quick things and then there will be other people who say we’re going to put our wish list in here and then there will be people who are not voting for that,” a former GOP Senate aide told me. “You can’t lose one person.”

Ahh, oof and ouch

AHH: House Democrats lashed out at each other on a three-hour private phone call yesterday.

Severely disappointed by the results of the elections, centrist members who nearly lost their seats blasted their liberal colleagues for pushing far-left positions – such as Medicare-for-all – that Republicans were easily able to label socialist.

“Party leaders had expressed certainty that Trump’s divisiveness and mishandling of the pandemic would help them expand their majority with wins in GOP-held districts — and yet they lost at least a half-dozen seats and failed to retake the Senate,” Rachael Bade and Erica Werner report. “The explanation laid out by centrists…is that Republicans were easily able to paint them all as socialists and radical leftists who endorse far-left positions such as defunding the police.”

“We need to not ever use the word ‘socialist’ or ‘socialism’ ever again. . . . We lost good members because of that,” Rep. Abigail Spanberger (D-Va.), who narrowly leads in her reelection bid, said heatedly. “If we are classifying Tuesday as a success . . . we will get f---ing torn apart in 2022.”

Rep. Abigail Spanberger (D-Va.) criticized her party's strategy during a Democratic caucus call, saying the election "was a failure" for House Democrats. (Obtained by The Washington Post)

Several moderate Democrats also told Erica they think Pelosi should have made a deal with the Trump administration on a coronavirus relief package. Many moderates had been pushing her to compromise, worried constituents would blame Democrats for being unwilling to give Trump a legislative victory before the election.

Pelosi has said she was holding out for a better deal and that politics had nothing to do with it. Trump, she argued, wasn’t backing policies that address voters’ needs — but to centrists, that was just an excuse to say no.

“It made us look like obstructionists instead of those up for the challenge the country needs,” one lawmaker told Erica. “That was a huge mistake. Trump was like, ‘I’m ready for a deal, make it bigger!’ and Pelosi was obstructing.”

OOF: Counties with the worst virus surges overwhelmingly backed President Trump.

“An Associated Press analysis reveals that in 376 counties with the highest number of new cases per capita, the overwhelming majority — 93% of those counties — went for Trump, a rate above other less severely hit areas,” the Associated Press’s Carla K. Johnson, Hannah Fingerhut and Pia Deshpande report. “Most were rural counties in Montana, the Dakotas, Nebraska, Kansas, Iowa and Wisconsin — the kinds of areas that often have lower rates of adherence to social distancing, mask-wearing and other public health measures, and have been a focal point for much of the latest surge in cases.”

Reported coronavirus cases hit a record on Wednesday, but in many red states the pandemic was considered at least somewhat under control by slim majorities of voters, according to a survey of more than 110,000 voters conducted for the AP by NORC at the University of Chicago. Republicans were much more likely than Democrats to consider the pandemic under control.

“State health officials are pausing for a moment of introspection. Even as they worry about rising numbers of hospitalizations and deaths, they hope to reframe their messages and aim for a reset on public sentiment now that the election is over,” Johnson, Fingerhut and Desphpande write.

“Public health officials need to step back, listen to and understand the people who aren’t taking the same stance” on mask-wearing and other public health guidance, said Marcus Plescia of the Association of State and Territorial Health Officials. “I think there’s the potential for things to get less charged and divisive.” 

OUCH: Steve Bannon was blocked by Twitter after calling for beheading Anthony Fauci.

During a recent episode of his podcast, Bannon, Trump's former chief strategist, called for medieval execution for Fauci, director of the Institute for Allergy and Infectious Diseases.

I'd put the heads on pikes, said Bannon, who is out on $5 million in bail, facing charges that he defrauded donors to a fund promoted to build a wall along the U.S.-Mexico border. I'd put them at the two corners of the White House as a warning to federal bureaucrats. You either get with the program or you're gone — time to stop playing games. Blow it all up."

Bannon started by calling the president “a kindhearted man and a good man” before suggesting that harsher action was warranted toward Fauci and FBI Director Chris Wray. Bannon added that the stakes bearing their decapitated heads should be placed “at the two corners of the White House as a warning to federal bureaucrats: you either get with the program or you’re gone," our Post colleagues write.

Twitter permanently suspended Bannon’s @WarRoomPandemic account on Thursday after he posted the clip, a spokeswoman told The Post, citing the service’s prohibition on “the glorification of violence.” The move makes Bannon one of the most high-profile political figures to be banned.

Fauci, who has urged more-stringent measures to protect against the spread of the coronavirus, is under the protection of a security detail after receiving threats. Trump has suggested he hopes to fire Fauci after the election.

Elsewhere in healthcare

Health-care stocks rose on Wednesday as prospects of a blue election sweep faded.

While Biden has a clear path to secure the 270 electoral votes needed to claim the presidency, the prospects for a Democratic Senate have narrowed as the party fell short of expectations in several key races. On Wednesday, health-care industry stocks rose 4 percent.

“Industry investors certainly wouldn’t mind a little gridlock in Washington. During the presidential campaign, Democratic nominee Joe Biden advocated for some policies that the industry has long resisted. Those included creating a government panel to review prices of new prescription drugs that don’t have existing competition, and enabling Medicare to directly negotiate drug prices with manufacturers,” the Wall Street Journal's Charley Grant reports.

“Mr. Biden was an architect of the 2010 Affordable Care Act, which has been a favorable regulatory framework for the industry as it expanded access to insurance while also doing relatively little to control prices. But a Democratic Senate could theoretically open the door for far bigger policy changes, such as universal access to Medicare. Drug companies are highly profitable, so their stock prices are vulnerable to the prospect of higher corporate tax rates,” Grant writes.

The health-care industry took a major hit earlier this year as hospitals canceled elective surgeries in the middle of the coronavirus pandemic. But better preparations and treatment protocols may prevent this scenario from repeating, even as coronavirus cases surge across the country.

A new study finds that a psychedelic treatment helped people with major depression.

“The substance that makes some mushrooms ‘magic’ also appears to help people with major depressive disorder,” NPR’s Jon Hamilton reports. “A study of 27 people found that a treatment featuring the hallucinogen psilocybin worked better than the usual antidepressant medications, a team reported Wednesday in the journal JAMA Psychiatry.”

“The effect was more than four times greater,” Alan Davis, an author of the study and a faculty member at both Johns Hopkins University and Ohio State University, told NPR. “The effect happened within one day after the first session and sustained at that reduced level through the second psilocybin session all the way up to the one-month follow-up.”

Participants in the study received two doses of psilocybin on different days and about 11 hours of therapy. Davis told NPR that the drug was delivered in homey settings and that participants wore blindfolds and listened to music. 

One possible limitation from the study comes from the fact that all of the participants knew that they would receive the drug, although one comparison group of patients received it after an eight-week waiting period. Charles F. Reynolds III, a professor of psychiatry at the University of Pittsburgh’s School of Medicine, praised the scientific rigor of the study but said that expectancy effects could account for some of the rapid improvement. Reynolds said that the treatment was promising and called for the National Institutes of Health to fund further research.

“Federal law makes it illegal to grow or possess psilocybin without a special license from the Drug Enforcement Administration. But on Tuesday, voters in Oregon approved a measure directing the Oregon Health Authority to create a program to offer psilocybin-assisted therapy,” Hamilton writes. D.C. also voted to move toward decriminalizing psychedelic plants, including magic mushrooms.

Denmark will kill 15 million minks after a coronavirus mutation spreads to humans.

“Denmark, one of the largest fur producers in the world, plans to kill every mink in the country to contain a coronavirus mutation that had begun spreading back to humans,” Loveday Morris writes. “Although the virus mutates constantly, this variation prompted particular concern, according to scientists at Denmark’s Statens Serum Institut, because 12 of the people infected showed less ability to produce antibodies, which could reduce the potential effectiveness of a vaccine.”

Prime Minister Mette Frederiksen described the call to put down all of the country’s 15 million minks as a “heavy decision” but said “resolute action” was needed after genomic analysis linked 400 coronavirus cases in northern Denmark to mink farms. About 5 percent of the infections were estimated to involve the new mutation.

“In a worst-case scenario, there could be a new pandemic that starts all over again from Denmark, warned Kare Molbak, director of the division of infectious-diseases preparedness at Statens Serum Institut. Independent scientists, however, urged caution, as the institute has not yet publicly released details of the sequencing of the mutation,” Loveday writes.

While covid-19 is a zoonotic disease, believed to have jumped to humans from animals, the U.S. Centers for Disease Control and Prevention has said that animals don't appear to play a major role in the ongoing transmission of the virus, although minks may be a possible exception.

Sugar rush