with Alexandra Ellerbeck

President Biden steered clear of sweeping changes to health insurance and drug prices in his speech to Congress last night.

Yet he still proposed hundreds of billions in new health-related spending.

Biden asked Congress for $200 billion for expanding Obamacare subsidies.

The spending is a sizeable slice of the $1.8 trillion “American Families Plan,” Biden’s sweeping proposal to provide universal preschool, free community college and new tax breaks for families, much of it paid for by higher taxes on the richest Americans.

Biden laid it out in a joint address last night, in a socially distanced chamber: “While he also renewed calls for an array of priorities — including immigration changes, gun control and police reform — Biden more broadly portrayed a country that is rapidly emerging from the depths of a global pandemic and has survived events that, in his view, tested American democracy as rarely before,” Matt Viser and Tyler Pager write.

“We have stared into an abyss of insurrection and autocracy — of pandemic and pain — and ‘we the people’ did not flinch,” Biden said toward the end of his 65-minute speech.

In the last pandemic relief bill, Congress expanded for two years the federal subsidies people can use to buy individual private health plans on Healthcare.gov and state-run marketplaces. Now Biden wants to make those expansions permanent, as a way of further whittling down the country’s still-sizeable uninsured population.

“The American Rescue Plan lowered health care premiums for 9 million Americans who buy their coverage under the Affordable Care Act,” Biden said. “Let’s make that provision permanent so their premiums don’t go back up.”

New York Times's Margot Sanger Katz:

It’s a massively expensive way to expand health insurance. 

As we previously explained, the cost is more per person than the government spends to insure people through its major insurance programs, Medicare and Medicaid — and illustrates just how expensive it is to rely on the nation’s for-profit insurance industry to get Americans covered. The $200 billion price tag is around one-fifth the cost of the entire 2010 Affordable Care Act, in which the subsidies were first created.

Under the revised benchmarks, someone at 200 percent of the federal poverty level wouldn’t have to spend more than 2 percent of their income on premiums. Those earning 150 percent or less wouldn’t have to pay anything. And, for the first time, earners at or above 400 percent of the federal poverty level would be eligible for income-pegged subsidies.

The more-generous subsidies will undoubtedly result in some uninsured Americans deciding to buy coverage. But the Congressional Budget Office estimates that number at 1.3 million over two years – only a fraction of the country’s remaining uninsured.

Biden also wants $225 billion for paid medical leave.

The president mentioned this only in passing during his speech.

“The American Families Plan will finally provide up to 12 weeks of paid family and medical leave,” he said. “No one should have to choose between a job and paycheck or taking care of themselves and a loved one – a parent, spouse, or child.”

But the White House is proposing an ambitious new program, operated by the Social Security Administration. 

The idea is for the federal government to eventually fund 12 weeks of paid leave for having or adopting a new baby, being seriously ill or caring for someone who is seriously ill. The administration also wants to add two new categories that are not currently covered by the Family and Medical Leave Act: victims of sexual violence and those with recent bereavement.

“It would be much more expansive than what we have now,” said Kathleen Romig, senior policy analyst at the Center on Budget and Policy Priorities.

But the administration has left many details unclarified. Congress would need to fill in a lot of blanks – most pressingly, what to do about existing state medical leave plans. There’s also the question of how employers that already voluntarily provide paid medical leave might respond.

Biden gave a brief nod to high drug prices last night.

He called on Congress to pass legislation allowing the federal government to directly negotiate lower prices for some drugs in Medicare – a proposal the White House backed away from including in the American Families Plan.
“Let’s get it done this year,” Biden said. “This is all about a simple premise: Health care should be a right, not a privilege in America.”

Biden also talked about cancer.

He said the National Institutes of Health should create a new agency focused on developing breakthrough cures. It should function, Biden said, like the Defense Department’s Defense Advanced Research Projects Agency, which he said led to innovations like the Internet and GPS.

This new NIH agency should “develop breakthroughs – to prevent, detect, and treat diseases like Alzheimer’s, diabetes, and cancer,” he said.

President Biden spoke about advances in medicine he wanted the United States to achieve during his first joint address to Congress on April 28. (The Washington Post)

“This is personal to so many of us,” added Biden, who lost his son Beau to brain cancer a few years ago. “I can think of no more worthy investment. And I know of nothing that is more bipartisan. Let’s end cancer as we know it. It’s within our power.”

CBS News's Ed O'Keefe:

PBS Newshour correspondent Lisa Desjardins:

Ahh, oof and ouch

AHH: Biden is expected to propose a ban on menthol cigarettes.

The administration is poised to announce the ban this week, along with a ban on menthol and other flavors in mass-produced cigars, The Post’s Laurie McGinley reports.

“The administration is still considering another long-sought goal of antismoking activists: requiring tobacco companies to lower the amount of nicotine in cigarettes to nonaddictive levels. But it will not announce action on that issue this week, said the people with knowledge of the situation,” Laurie reports.

The Food and Drug Administration has until today to respond to a 2013 citizen petition seeking a ban on menthol cigarettes. But it could take years for a ban to go into effect, and the tobacco industry is likely to challenge any final regulation in court.

The menthol ban has been a priority for Black health advocates who cite the industry’s targeting of African American communities. Only 29 percent of White smokers use menthol cigarettes, as opposed to 85 percent of African American smokers, according to a National Survey on Drug Use and Health

OOF: An ambitious new experiment will assess the impact of routine at-home testing for the coronavirus.

“Sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, it aims to distribute 2 million free at-home test kits to 80,000 families in Greenville, N.C. and the rest of Pitt County, and in Chattanooga, Tenn., to conduct regular testing from now until around June,” The Post’s Ariana Eunjung Cha reports.

Researchers will analyze whether encouraging people to test themselves, even if they don’t feel any symptoms, decreases community transmission. They will monitor the level of virus in wastewater, track hospitalizations and measure other indicators for community spread.

“We could really change the game here,” said NIH Director Francis Collins. “Even after we get to a high level of vaccination, we will still not be 100 percent, so testing is going to be with us for quite a long time.”

Congress allocated $50 billion to a large-scale expansion of testing in its recent relief package. That money, combined with the improving efficacy of rapid tests, could help make routine home-testing a reality.

OUCH: GOP lawmakers are touting a coronavirus relief provision that they voted against.

Rep. Greg Pence (Ind.) promised that “help is on the way” for the restaurant industry, while his colleague from Washington, Rep. Jaime Herrera Beutler promoted a virtual briefing about the Restaurant Revitalization Fund, a new emergency assistance program for the industry. Beth Van Duyne (Texas) tweeted a link directing constituents to more information about the fund, which opens May 3.

“The trio of Republicans are now among a number of lawmakers who have touted a piece of President Biden’s coronavirus relief bill — even though they voted against it,” The Post’s Reis Thebault reports. “The Republicans’ embrace of this part of Biden’s stimulus bill, which passed last month on an almost entirely party-line vote, came in the days and hours leading up to the president’s first address to a joint session of Congress.”

House Speaker Nancy Pelosi (D-Calif.) released a statement Wednesday accusing the Republican representatives of political maneuvering: “BREAKING: Two More House Republicans Exposed for Voting No, But Taking the Dough,” the release’s headline read.

More in coronavirus news

  • Fully vaccinated seniors are 94 percent less likely to be hospitalized with coronavirus compared to unvaccinated people, according to a Centers for Disease Control and Prevention study. The analysis confirmed the efficacy of vaccines in real-world settings, even as more transmissible variants of the virus circulate, The Post’s Lena H. Sun reports.
  • The Biden administration is more than six weeks late in its self-imposed deadline to issue new workplace safety standards for the coronavirus, The Post’s Eli Rosenberg reports.
  • Virginia schools are turning to outdoor classrooms to reduce the risk of virus transmission and help restore confidence and in-person learning. A bonus: Many of the kids seem to enjoy outdoor learning, Hannah Natanson reports.
  • Chicago Mayor Mayor Lori Lightfoot (D) said Wednesday that the city is considering potential “vax” passes that would grant preferential seating and admissions to events for fully vaccinated residents, Chicago Tribune’s Gregory Pratt reports.

Health and environment

A deadly air pollutant disproportionately harms Americans of color, according to a new study.

“The analysis of fine-particle matter, which includes soot, shows how decisions made decades ago about where to build highways and industrial plants continue to harm the health of Black, Latino and Asian Americans today,” The Post’s Juliet Eilperin and Darryl Fears report.

While the country has made huge strides in combating air pollution, Black, Latino, Asian and Americans continue to suffer greater exposure to fine-particle pollution, which can become embedded in the lungs. The pollution comes from industry, power plants, agriculture and vehicle exhaust. 

“The study found that Black people are exposed to 21 percent more fine-particle pollution compared to average Americans, while exposure was 18 percent greater for Asian Americans and 11 percent more for Hispanics. White Americans, by contrast, have 8 percent less pollution exposure than the average,” our colleagues write.

Elsewhere in health care

CMS hospital star ratings are out.

The Center for Medicare & Medicaid Services rates hospital quality based on 48 measures related to mortality, safety of care, readmission, patient experience or timeliness and effectiveness of care. This year’s ratings are based on a revised methodology launched in January. 

Overall, 50 percent of hospitals received the same rating as last year; 45 percent moved up or down by one star; and 5 percent shifted by two or more stars, Becker Hospital Review’s Erica Carbajal reports. A breakdown shows that 455 hospitals received a five-star rating, 988 received four stars, 1,018 received three stars, 690 received two stars, and 204 received one star.

The majority of employers say the government needs to take action to control health-care costs.

Nearly 90 percent of corporate executives say that the cost of providing health benefits to employees will become unsustainable in the next five to 10 years, and 85 percent say that the government will need to intervene to control costs, according to a new survey from the Purchaser Business Group on Health (PBGH) and KFF (Kaiser Family Foundation). The survey respondents included more than 300 executive leaders at companies with over 5,000 employees.

Sugar rush


Frenemies part 4. Keeping up with the vaccines. #ItsOurHome

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