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The Health 202: Biden narrows picks to lead Medicare and Medicaid down to two choices

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with Alexandra Ellerbeck

The Biden administration has narrowed its search for Centers for Medicare and Medicaid Services administrator to two people – former Obama administration appointee Chiquita Brooks-LaSure and North Carolina Health Secretary Mandy Cohen, five people with connections to the administration tell me. 

The eventual pick to lead the federal agency that oversees the government’s major health insurance programs will play a central role in reshaping how the government manages safety-net programs that provide tens of millions of Americans with health coverage, after some controversial and unprecedented reconfigurations by the previous administration. CMS is a trillion-dollar agency that oversees Medicare, Medicaid and the Affordable Care Act. 

Both women worked at the sweeping agency during the Obama administration.

Cohen, as chief operating officer and chief of staff, and Brooks-LaSure as deputy director in the office that oversees the ACA's insurance marketplaces and regulations. Brooks-LaSure is currently a managing director at consulting firm Manatt. In the years immediately after 2010 law was passed, Brooks-LaSure worked as director of coverage policy in the Office of Health Reform at the Department of Health and Human Services.

“They would both be great, and they are both really well-liked,” said a person with close ties to the administration who spoke on the condition of anonymity to discuss the personnel matter.

Brooks-LaSure is now favored for the spot, three of the sources said. 

She was more involved in Biden’s campaign and headed up his HHS transition team. That could put her in a better spot to immediately start working with civil servants within CMS.

“She is very calm and very measured,” said Dan Mendelson, whose firm Avalere Health employed Brooks-LaSure from 2003 to 2007. “She doesn’t react too quickly and I think that kind of thoughtfulness will be really useful given the range of issues they have to deal with right now.”

There's another potential benefit to picking Brooks-LaSure: she has previously worked alongside California Attorney Xavier Becerra, who is Biden's nominee for HHS secretary. She served as a staffer on the House Ways and Means Committee while Becerra was a member of that committee.

The well-documented acrimony between former HHS secretary Alex Azar and former CMS administrator Seema Verma under the Trump administration serves as a recent warning of the dysfunction that can occur when these two influential appointees don't work harmoniously.

The White House declined to comment on the status of the CMS nomination. Neither Brooks-LaSure nor Cohen responded to emailed questions.

The next CMS director will have a lot on their plate.

Top on the agenda will be unraveling changes the Trump administration made to the Obamacare marketplaces and the Medicaid program. 

As we’ve reported, the new administration is likely to crack down on short-term plans that can offer skimpy benefits and tighten up rules around the insurance products that are sold on HealthCare.gov and the state-run exchanges. Officials will also be looking at ways to walk back what amount to permission slips the previous administration gave states to enact new requirements for Medicaid enrollment.

At the same time, the part of Medicare that covers hospital costs for seniors is running dangerously short on funds. It’s projected to become insolvent by 2024, two years earlier than expected. That’s closest to insolvency Medicare has been since 1971, when its trustees projected a two-year insolvency window.

But picking a CMS leader isn’t the administration’s top priority at the moment.

Becerra is still awaiting Senate confirmation, a process which has been delayed as Senate leaders fought over how to divide party control of the 50-50 Senate.

Confirmation hearings for Becerra aren’t expected to start until the week of Feb. 15 and could be pushed even later. 

And the CMS position isn’t the only top health-care slot Biden has yet to fill. He hasn’t yet named a nominee to lead the Food and Drug Administration, or nominees for more than a dozen other key posts at HHS.

Ahh, oof and ouch

AHH: Rates of coronavirus hospitalizations, infections and deaths are declining, and the rate of vaccinations is accelerating.

It’s too early to say the U.S. is turning the corner on the coronavirus pandemic, but there are some positive signs. The total number of people who have received at least one dose of a coronavirus vaccine is now greater that the total number of reported infections.

Still, the number of deaths is staggering. About 50,000 Americans have died of the coronavirus in the past two weeks alone. The country is also starting to see the spread of new, more transmissible variants that have been implicated in surges of infections in the United Kingdom and South Africa. 

Public health officials also worry Super Bowl gatherings could fuel the spread of the coronavirus. Some experts have called on the National Football League to amplify public health messages and urge people not to gather indoors with people outside of their households to watch the game. The Kansas City Chiefs, who will be playing in the game, recently had their own close call with the virus after a barber who was giving haircuts to the team tested positive.

The Chiefs' Daniel Kilgore was reportedly mid-haircut when the barber was notified that he tested positive for the virus:

Anthony Fauci, the nation's leading infectious-disease expert, warned people against Super Bowl parties. You don't want parties with people that you haven't had much contact with, you just don't know if they're infected, he told “Good Morning America.” “So as difficult as that is, at least this time around, just lay low and cool it.”

OOF: Johnson & Johnson is seeking emergency authorization for its single-shot coronavirus vaccine.

The pharmaceutical giant submitted its vaccine to U.S. regulators after a global trial showed it to be effective at preventing serious illness and death from the coronavirus. FDA officials said that outside experts will discuss the vaccine in a meeting on Feb. 26, Carolyn Y. Johnson and Laurie McGinley reports.

“In a news release last week, the company announced its vaccine was 66 percent effective overall at preventing moderate to severe illness in a global clinical trial. It offered the best protection against severe cases of disease, proving 85 percent effective. There were no hospitalizations or deaths among people who received the vaccine,” Carolyn and Laurie write. “That result held up even in the South Africa portion of its trial, where a concerning virus variant that has shown the ability to evade some immunity has become dominant.”

If approved, the Johnson & Johnson vaccine would be the third authorized vaccine in the United States. The vaccine requires only a single shot and can be stored at refrigerator temperatures for several months, promising easier logistics compared to the two other vaccines currently authorized in the U.S.

It appears to be less effective than the vaccines made by Pfizer-BioNTech and Moderna, which were both more than 90 percent effective. But it was tested in parts of the world were virus variants can elude parts of the immune response, and public health experts have stressed that it prevents the worst outcomes from the disease.

Ashish K. Jha, dean of the Brown University School of Public Health:

OUCH: The FDA will release new standards for coronavirus booster shots in an effort to combat fast-spreading virus variants. 

The FDA said that it is planning to propose guidelines on how manufacturers of coronavirus vaccines, therapeutics and diagnostic tests should respond to new variants of the virus, some of which appear to be more transmissible and less susceptible to existing vaccines. 

“FDA’s new strategy for adapting drugs, tests and vaccines for the variants is a cornerstone of the administration’s battle plan, drawn in part from years of experience fighting the fast-mutating flu virus,” Politico’s Sarah Owermohle and David Lim report. “Meanwhile, officials at the National Institutes of Health — the sprawling scientific campus where Anthony Fauci leads infectious-disease research — are working with at least two vaccine manufacturers, including Moderna, to start human trials next month of variant-targeting vaccines.”

Pharmaceutical companies and regulators alter flu vaccines to respond to new variants each season. Instead of enrolling thousands of people for months-long trials, researchers prove safety and effectiveness in smaller trials. 

The FDA has indicated it probably will take a similar approach with new vaccines and therapeutics aimed at coronavirus variants: “We do not believe there will be the need to start at square one with any of these product,” the agency’s acting director, Janet Woodcock, said in the statement.

More in coronavirus

  • A contractor lied to get nearly $40 million in N95 contracts from the government, Rachel Weiner reports.
  • Iowa's House speaker has said he can't enforce a mask mandate, but that did not stop him from enforcing a ban on jeans, Teo Armus reports.
  • Transit agencies are ramping up mask enforcement, as federal lawmakers raise concerns about the safety of transportation workers, Michael Laris reports.

On the Hill

Sen. Mitt Romney (R-Utah) unveiled a plan to provide families with at least $3,000 a year for each child.

“Romney’s proposal would provide $4,200 per year for every child up to the age of 6, as well as $3,000 per year for every child age 6 to 17,” Jeff Stein reports. 

Romney’s proposal could help Biden incorporate policies with bipartisan support into his relief package. Senior Democrats have also pushed for direct financial stimulus for children as part of their $1.9 trillion stimulus proposal. 

Romney’s plan would be paid for, in part, by eliminating a welfare program known as Temporary Assistance for Needy Families, which could spark opposition among Democrats. But the plan has also gained praise from some unlikely quarters, with some on the left saying that it would be easier to navigate than existing programs. 

Proponents of increased aid for children say that it could help reduce child poverty, which is closely linked to a number of worse health outcomes. 

“The United States currently has among the highest rates of child poverty in the developed world, a trend exacerbated by the coronavirus pandemic. The nation provides less financial support to families with children than all but a handful of developed countries,” Jeff writes.

Elsewhere in health care

Biden’s acting drug czar is emphasizing treatment and harm reduction in combating the opioid epidemic.

“The new focus marks a change from the Trump administration, which was more skeptical of harm-reduction approaches to treatment, like needle exchanges,” Bloomberg News’s Ian Lopez and Valerie Bauman report.

Regina LaBelle, acting director of the Office of National Drug Control Policy, told Bloomberg Law that the Biden administration will endorse needle exchange programs, which provide clean needles to reduce disease transmission. She’s also said that the administration may consider fentanyl test strips, which can be used to detect the deadly synthetic opioid in illicit drugs.

“The acting drug policy chief’s comments came as the administration announced top policy initiatives for combating the U.S. overdose crisis. Among those initiatives are addiction workforce expansion and prevention efforts, plans widely heralded by treatment experts as effective for grappling with drug misuse,” Ian and Valerie write.

The new administration disappointed some health advocates, however, with its recent decision to rescind guidelines that would have made it easier for doctors to prescribe an opioid-treatment drug. The Biden administration said that the guidelines, issued in the final days of the Trump administration, did not pass legal muster, although officials have indicated that they are looking at alternative approaches.

A congressional report found toxic heavy metals in baby foods.

The report from the House Oversight Committee’s subcommittee on economic and consumer policy found high levels of arsenic, lead, cadmium and mercury in some of the most trusted baby food brands. The committee said that the FDA had failed to warn consumers of the risks, Laura Reiley reports

The FDA has said that toxic elements are present in the environment and enter the food supply through soil, water or air; they cannot be completely removed. But some lawmakers want are calling for more-rigorous regulation.

“The FDA must set standards and regulate this industry much more closely, starting now. It’s shocking that parents are basically being completely left in the lurch by their government,” subcommittee Chair Raja Krishnamoorthi (D-Ill.) told The Washington Post. 

Sugar rush

Super Bowl Sunday is going to look a lot different this year. Here’s how the NFL is pulling off one of the biggest sporting events during a global pandemic. (Video: Monica Akhtar, Sarah Hashemi/The Washington Post)
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