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The Health 202: Obamacare advocates are pushing for more health care in the next budget bill

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with Alexandra Ellerbeck

Obamacare is significantly expanding for the first time since it became law 11 years ago. President Biden boosted subsidies for marketplace enrollees and promised states more money for expanding Medicaid as part of the coronavirus relief bill he signed late last week.

Now, Affordable Care Act advocates are eyeing the next chance probably over the summer for congressional Democrats to push through even more ambitious health policy.

Protect our Care, a well-funded Democratic-allied group, is pushing for three big goals in the next budget reconciliation bill.

Budget reconciliation — the process Democrats used to pass their $1.9 trillion coronavirus relief package — will likely be used by lawmakers again this summer. It’s a filibuster-proof way for Democrats to achieve their legislative goals without getting any votes from Republicans. 

Democrats are eyeing a range of priorities for the next reconciliation measure, including climate and immigration — and health care. 

Protect Our Care wants to see Congress make the subsidy expansions permanent (they last only two years under the stimulus) and come up with a reliable way to ensure everyone eligible for expanded Medicaid is able to enroll — moves that would build on the health-care law and could result in millions more Americans getting covered.

The group, according to its chairman, Leslie Dach, is also hoping for a major step on drug prices, one Democrats have backed for years but to which Republicans are vehemently opposed: allowing the health and human services secretary to directly negotiate lower prices from drugmakers within the Medicare program.

“Those are the three big things that would really help millions of Americans that we believe are very doable,” Dach told me last week during a phone conversation.

It’s unclear how the second goal — getting Medicaid to people in non-expansion states — might work.

Democrats already took a swipe at this issue in the stimulus package. 

A dozen states still refuse to expand Medicaid under the ACA, leaving about 4 million Americans who otherwise would qualify for the program without access to it. The stimulus bill offers a new incentive to states to expand, allowing them a 5 percent increase in their overall federal Medicaid funding if they agree to expand to adults earning up to 133 percent federal poverty level.

Yet, as we’ve written, it’s not at all clear this incentive will do the trick. The 12 holdout states, mostly clustered in the nation’s southeast corner, have already refused for years to expand their programs, even though the federal government covers 90 percent of the costs of the new enrollees.

“It’s a hugely generous offer; they should take it,” Dach said. “We don’t know if they will.”

There could be some other options for getting Medicaid to this population, perhaps by offering it through the individual marketplaces, although that would also raise tricky problems around ensuring the level of coverage is as generous as Medicaid.

One budget reconciliation bill down, two to go.

The current Congress, in which Democrats narrowly control the House and the Senate, could use three budget reconciliation bills before next year’s midterm elections. 

That’s because Congress may pass only one budget resolution a year. Lawmakers used the 2021 budget resolution for the recent relief bill. Budget resolutions for 2022 and 2023 are still available as legislative vehicles for passing Democrats’ major legislative priorities before they risk losing control of either chamber.

House Budget Chairman John Yarmuth (D-Ky.) has said he’s aiming to kick off the next effort in July by adopting reconciliation instructions for fiscal 2022. The aim, he told Roll Call, is to pass the package by the end of September.

It’s still unclear how much in the way of health care that package might contain, given Democrats’ competing priorities.

Meanwhile, federal and state health officials are working to update the marketplaces with the new subsidy thresholds.

The subsidies, which will become more generous for marketplace enrollees along the income spectrum, will be available to people at starting April 1, the Department of Health and Human Services announced Friday.

Those who already bought marketplace coverage this year will need to go back to the federal website and update their applications after April 1 to receive the enhanced subsidies. If they don’t, they won’t receive the additional assistance until they file their tax returns next year, officials said. That applies both to customers who bought plans during the regular, year-end sign up period or during the special, pandemic-related sign- up period that started Feb. 15.

Ahh, oof and ouch

AHH: The nation is on a seven-week sprint to achieve near-universal vaccine access.

Biden’s May 1 deadline for all adults to be eligible for vaccines gives the nation seven weeks to accelerate the pace of inoculations and ensure the most vulnerable are protected before access is expanded.

“Benefiting from manufacturing improvements now boosting the store of doses after months of scarcity, his team has seized the opportunity to mobilize federal resources to rush those doses to Americans whom he promised a semblance of normalcy by July Fourth,” The Post’s Isaac Stanley-Becker, Frances Stead Sellers and Dan Diamond report.

Officials also have taken steps to get shots into arms faster. The administration will make paramedics and midwives, among others, eligible to administer vaccines, and bring in an additional 4,000 active-duty troops to support vaccination efforts. It also plans to double the number of pharmacies offering vaccines and direct vaccine supply to nearly 1,000 community health centers across the country.

The president has stressed not everyone will be able to get a shot by May 1, given the patchwork nature of the rollout and gradual increases in supply. The administration is sticking with May 31 as the date by which there will be enough supply for everyone who is eligible, although it may take longer to fully vaccinate all Americans.

Some of Biden’s initiatives to ramp up vaccine production build on plans set in motion during the Trump administration. A recent collaboration between longtime rivals, Merck and Johnson & Johnson, to produce coronavirus vaccines, for example, began with deliberations during the prior administration.

OOF: Biden is expected to release new rules to curb the spread of the coronavirus in the workplace.

“The mandates — which would add enforcement powers to guidelines that are now just optional — threaten to further roil the politics around President Joe Biden’s cautious reopening strategy and ramp up tensions between the administration and the business community, particularly with industries hard-hit by closures like restaurants and entertainment and hospitality venues,” Politico’s Susannah Luthi and Rebecca Rainey report.

Today marks the deadline Biden gave the federal Occupational Safety and Health Administration to order temporary, mandatory safety rules to curb the spread of the coronavirus in the workplace. The emergency regulation is expected to mandate Centers for Disease Control and Prevention and OSHA guidelines that recommend workers wear masks and maintain at least six feet of distance. Those guidelines have so far been voluntary.

Unions and Democrats have long advocated for such a standard, which they say is crucial to protecting workers. Many governors and employers also called for uniform federal standards at the start of the pandemic, although they may be less likely to support the new rules now, as many states are loosening standards and businesses are attempting to return to normal operations. Republican governors in Texas and Mississippi recently jettisoned their states’ mask mandates, but even blue states are loosening restrictions. 

“Retailers are concerned about the [possibility] of … a rigid, one-size-fits-all emergency regulation, particularly during a global pandemic that has already imposed substantial economic hardship,” the National Retail Federation said in a letter to House Labor Committee leaders Thursday.

OUCH: New York’s “vaccine czar” called county officials to gauge their loyalty to Cuomo.

Larry Schwartz — the head of the New York’s vaccine rollout and a longtime adviser to Gov. Andrew M. Cuomo — called county officials to gauge their loyalty to the embattled governor, The Post’s Amy Brittain and Josh Dawsey report. Cuomo (D) is facing calls to resign over multiple accusations of sexual harassment. The new reports of harassment and unwanted touching come as the governor was already reeling from allegations that he had taken steps to downplay the number of covid-19 nursing home deaths in the state.

“[Schwartz’s] calls to county officials could fuel questions about an intermingling of politics with the state’s public health operation. The conversations came in advance of a March 8 announcement by the governor’s office that the state plans to open 10 new mass vaccination sites around New York — distribution hubs that have been keenly sought by local officials,” Amy and Josh write.

One Democratic county executive told The Post that he was so unsettled by the outreach from Schwartz that he filed notice of an impending ethics complaint with the public integrity unity of the state attorney general’s office. The executive said that he feared that his response could impact the county’s vaccine supply. 

Schwartz acknowledged making the calls but said that he did so as a 30-year friend of Cuomo and did not discuss vaccines in the conversations. 

Revolving door

Deborah Birx is taking a job with a Texas air purifier manufacturer.

The former White House coronavirus response coordinator under the Trump administration is taking a private-sector job with Dallas-based ActivePure, Reuters’s Jeff Mason reports. Brix will serve as chief scientific and medical adviser at the manufacturer, which advertises its ability to purify the air from the coronavirus in minutes. 

Birx will also serve as a global health fellow at the George W. Bush Institute and as a board member at Innoviva, a biopharmaceutical company.

Unlike her friend and former mentor Anthony S. Fauci, who has developed an increasingly close relationship with Biden as a medical adviser to the president, Birx was not offered a job in the new administration. Critics accuse her of not doing enough to push back against false statements made by President Donald Trump as he played down the virus.

Birx told Reuters she is still processing regrets and thinking about what could have been done differently. 

“When you have the 100,000 people we lost over the summer, and the 300,000 people we lost over the fall-winter surge, you have to ask yourself and have to know that it didn’t go as well as it should have,” she said. “All of us are responsible for that.” 

More in coronavirus news

  • Fauci called on Trump to urge people to get vaccinated after a recent poll showed that nearly half of Republican men said they would not get a vaccine, The Post’s Amy B Wang reports.
  • The coronavirus has hit immigration detention facilities hard, but Immigration and Customs Enforcement does not have a vaccination program for detainees. While the Bureau of Prisons is shipping vaccine doses directly to prisons, ICE is relying on state and local health departments to procure vaccine doses, The Post’s Maria Sacchetti reports.
  • The World Health Organization says countries should continue using AstraZeneca vaccines, even as a number of European countries have suspended vaccinations after reports that some people developed blood clots in the days following their vaccinations, The Post's Adam Taylor and Erin Cunningham report. AstraZeneca said on Sunday that a safety review based on the more than 17 million people who received its vaccines shows no evidence of an increased risk of blood clots.
  • Those infected in recent weeks reflect on the cruel timing of catching the coronavirus even as vaccines become more widely available and a return to normal is within sight, The Post’s Paul Schwartzman reports.

Elsewhere in healthcare

The House will vote on whether to prolong a temporary boost in Medicare payments.

Lawmakers are set to consider legislation this week that would extend a boost in Medicare payments through December. 

“Congress voted last year to increase health care providers’ Medicare payments by 2% to help cushion their bottom lines during the Covid-19 pandemic, but the relief is set to expire at the end of March. Hospitals have been aggressively lobbying for an extension,” Stat News’s Rachel Cohrs reports.

Sugar rush

Famed cellist Yo-Yo Ma performed at Berkshire Community College in Pittsfield, Mass., on March 13 after receiving his second dose of a coronavirus vaccine. (Video: Courtesy of Berkshire Community College)