with Alexandra Ellerbeck

There's a list of health reforms Democrats are hoping to load into their GOP-free budget reconciliation bill.

But last night, they publicly committed to at least one: expanding Medicare benefits to include dental, vision and hearing care.

“Senate Democrats on Tuesday reached an early agreement to pursue a sweeping $3.5 trillion reconciliation package that would expand Medicare benefits, boost federal safety net programs and combat climate change, aiming to sidestep Republican opposition and deliver on President Biden’s top economic priorities,” The Post's Tony Romm, Seung Min Kim and Jeff Stein report.

“The wide array of planned health, education and social programs would represent a historic burst of federal spending if lawmakers ultimately adopt it, as Democrats aim to seize on their slim but powerful majorities in Washington to expand the footprint of government and catalyze major changes in the economy.”

Vision, hearing and dental benefits highlight how, in some ways, traditional Medicare compares unfavorably to Medicare Advantage.

The traditional program, which covers about three-fourths of all seniors, offers only extremely limited coverage for these services. One of many reasons seniors and those with disabilities sometimes choose Medicare Advantage plans, which are government-funded but privately run, is because these plans offer more options for such care.

Seventy-nine percent of people in Medicare Advantage plans have coverage for eye glasses and exams, 74 percent have dental benefits and 72 percent have coverage for hearing aids, according to the Kaiser Family Foundation.

Democrats at the negotiating table say they'll fully pay for the $3.5 billion measure.

It’s their one shot this year to pass a bill without having to garner GOP support, so they’re hoping to cram as many policy priorities into the measure as possible. But as they haggled earlier this week over the size and scope of the package focusing on “human infrastructure” — things such as child care, health care and education — they ran up against budgetary concerns.

“The measure is smaller than the roughly $6 trillion package that some progressive-leaning lawmakers, including Sen. Bernie Sanders (I-Vt.), initially had sought earlier in the debate,” our colleagues write. “Sanders, the powerful chairman of the chamber’s budget committee, had led allied lawmakers in arguing for months that Democrats could not afford to squander their seat of power in Washington by adopting a more scaled-down package.”

A few pivotal party lawmakers stressed yesterday that the final product must be paid for.

“Everything should be paid for,” Sen. Joe Manchin III (D-W.Va.) said. “How much more debt can y’all handle?”

Now, Democrats must sell the deal to their colleagues outside the Senate Budget Committee.

“Sanders and his Democratic peers settled on a lesser amount in a move that reflects the political realities inside a party whose centrist wing has sought to temper federal spending in the aftermath of the coronavirus pandemic,” our colleagues write. “Democrats still must also sell the deal beyond those on the budget panel that helped craft it over a series of meetings in recent days. House lawmakers similarly must sync up their own aspirations with the Senate’s plans.”

“This is the most significant piece of legislation passed since the Great Depression, and I’m delighted to be part of having helped to put it together,” Sanders told reporters late Tuesday. “A lot of work remains.”

Adding dental, vision and hearing benefits to Medicare could push other priorities to the back seat.

The Congressional Budget Office estimated it would cost $358 billion over the next decade. That takes up a fair portion of the $3.5 trillion Democrats have said is the ceiling on their spending. 

And it’s not the only health expansion Democrats are eyeing. They’d also like to make permanent expanded marketplace subsidies and find a way to get Medicaid to low-income people in a handful of GOP-led states that still refuse to expand the program.

Some of this could be paid for by including a provision allowing the federal government to directly negotiate lower prices for drugs in the Medicare program — a provision that  would actually save the government $345 billion, according to the CBO.

Don’t expect to see the details in the budget resolution.

The budget resolution Democrats released last night included just overall spending numbers, leaving out details on the policies themselves. The real haggling will take place in the weeks to come, our colleagues note.

“These kinds of large negotiations, of course, are never done until it’s all done,” said Sen. Debbie Stabenow (D-Mich.).

Rep. Pramila Jayapal (D-Wash.), responding to a tweet from Jeff:

Ahh, oof and ouch

AHH: Becerra says the Biden administration will support whatever Medicare expansion Congress is willing to do.

As Democratic lawmakers in Congress grapple with different plans to add benefits to Medicare and potentially lower the eligibility age, the Biden administration has signaled it is open to any expansion it can get, Kaiser Health News’s Julie Rovner reports.

Asked if the administration has a preference on which Medicare provisions Congress takes up, Health and Human Services Secretary Xavier Becerra said, “Our preference is to get it done. What’s the ‘it’? We’ll take everything we can get.”

Becerra also spelled out other top priorities for the administration in an interview with Kaiser Health News’s “What the Health” podcast. Now that the Affordable Care Act has again been upheld by the Supreme Court, the administration is looking for ways to expand it, he said, including through an extension of subsidies for people purchasing coverage on the health law’s marketplaces.

“Now we’re playing offense,” he said. “We’ve got the ball and we’ve got to march it down the field, and we intend to because there are many Americans who still need good coverage.”

Among Becerra's other top priorities: He wants to support President Biden's efforts to lower drug prices, combat health inequalities, strengthen the Indian Health Service and reduce maternal mortality. 

OOF: A coalition of health-care organizations is calling for vaccine mandates.

“COVID-19 vaccination should be a condition of employment for all healthcare personnel,” the coalition’s statement reads, warning that “a sufficient vaccination rate is unlikely to be achieved” without a vaccine mandate.

The coalition statement and accompanying guidelines are signed by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America and five other medical groups.

“But federal officials have balked at instituting national requirements on health-care workers, and many health-care organizations have said they do not plan to require their staff members to get vaccinated against the coronavirus,” The Post's Dan Diamond reports. “Some nurses and other health-care personnel have quit or sued organizations that imposed coronavirus vaccine mandates, claiming that the measures are unethical or illegal, although a federal judge rejected one such lawsuit last month.”

While many health organizations have started requiring vaccines, others have held off, noting the fact that the vaccines have not been fully approved by the Food and Drug Administration. The American Hospital Association, which has repeatedly called for mandatory flu vaccinations, has not weighed in on mandates for the coronavirus vaccines.

Many outside experts say mandates are warranted.

“One thing that really upsets me is we’re hitting a wall,” said Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, lamenting that national vaccination rates have stalled. “What do you do then? And I think the only answer to that question is you compel people to vaccinate. It’s certainly legal. It is not your inalienable right as a U.S. citizen to catch and transmit a potentially fatal infection.”

OUCH: Coronavirus cases and hospitalizations are rising.

New daily reported cases rose by more than 100 percent in the past week, according to The Post's coronavirus tracker. The rise in cases follows the spread of the highly transmissible delta variant, which now makes up more than half of new infections in the United States.

High rates of vaccinations among the nation’s elderly have protected some of the nation’s most vulnerable, but the rates have not been enough to prevent hospitalizations and deaths from also ticking up. Both metrics are up by more than 20 percent over the past week, according to The Post’s data.

The burden of the surge in cases has fallen particularly hard on red states, where vaccination rates are generally far lower.

Senate Minority Leader Mitch McConnell (R-Ky.) urged Americans to get vaccinated amid the spread of the delta variant:

Senate Minority Leader Mitch McConnell (R-Ky.) on July 13 urged Americans to get vaccinated against the coronavirus as the delta variant continued to spread. (The Washington Post)

Filling vacancies

Biden will pick a former West Virginia health official as drug czar.

President Biden will nominate Rahul Gupta, the top health official at the maternal and child advocacy group March of Dimes, to serve as the next director of the Office of National Drug Policy Control, The Post’s Dan Diamond reports.

Gupta, a primary-care physician, formerly served as West Virginia’s health commissioner and is a close ally of Manchin. He has been favored to take the role of drug czar for months but faced opposition from some anti-addiction advocates who say that he did not do enough to ensure safe-needle exchange during a 2017 HIV outbreak in West Virginia.

If confirmed by the Senate, Gupta will be the first doctor to lead the drug policy office. His nomination comes as the United States faces an opioid crisis that has worsened during the pandemic.

The Senate Finance Committee voted to approve Melanie Egorin to HHS.

The committee voted unanimously to approve the nomination of Egorin as assistant secretary for legislation at the Department of Health and Human Services. Egorin serves as a tax staffer to the House Ways and Means Committee and as deputy staff director to the health subcommittee. Her nomination will now head to the Senate floor for final confirmation.

Hill happenings

Sen. Tim Kaine (D-Va.) is introducing a bill to address shortages in caregivers.

The legislation would authorize more than $1 billion to support the direct-care workforce and family caregivers, instructing HHS to award and support grants to states to build and train the caregiving workforce.

“Direct-care workers and family caregivers provide critical support to older Americans, people with disabilities, and other individuals with chronic conditions,” said Kaine. “Now more than ever, we must ensure they have the resources they need to continue their important work.”

The bill aligns with the Biden administration’s proposal for major investments in long-term care as the American population ages. Biden called for a $400 billion investment in home- and community-based long-term care in his initial infrastructure proposal. That funding has been left out of the most recent bipartisan infrastructure deal, but Democrats may push to include it in a separate reconciliation bill.

More in coronavirus news

  • A Tennessee health official says she was fired in retaliation for efforts to provide vaccine guidance for teenagers, The Post's Paulina Villegas reports. Michelle Fiscus said she was fired from her job as director of immunization programs at the Tennessee Department of Health after she sent a memo explaining that state legal doctrine allowed minors 14 and above to receive inoculations without permission from their parents. 

    The Tennessean reported Tuesday that the department would stop promoting all vaccinations for children and that it would stop sending reminders for teens to get their second dose of a coronavirus vaccine.

Rep. Ted Lieu (D-Calif.):

Chelsea Clinton:

  • At the beginning of 2021, the Kaiser Family Foundation interviewed Americans about their perceptions of the new coronavirus vaccines. Six months later, KFF went back and contacted those individuals again. The findings: People largely followed through with their previous intentions regarding the vaccine. Some 9 in 10 Americans who said in January 2021 that they wanted to get a vaccine as soon as possible have now received at least one dose of a vaccine. About half of those who said they wanted to wait and see have gotten a vaccine. Among those who were most reluctant in January — Americans who said they would only get a vaccine if required or would definitely not get one — a smaller share (roughly 1 in 4) now report receiving at least one dose.

A legal fight over abortion

Abortion rights advocates are seeking to block a Texas law that deputizes citizens to enforce a six-week abortion ban.

Abortion rights advocates filed a federal lawsuit aimed a blocking a new Texas state law that incentivizes individuals to sue anyone who helps a woman obtain an abortion. If their court challenges are successful, the state will award up to $10,000 to private individuals who help enforce the ban.

While federal judges have blocked bans on abortion early in a pregnancy in other states, the Texas law is enforced by private lawsuits, not the state government officials who are usually the defendants in federal constitutional challenges. 

An upcoming Supreme Court review of a Mississippi abortion law could pave the way for many other state laws that restrict or ban the procedure. (Joshua Carroll/The Washington Post)

“Instead, those behind the new federal suit are using a novel legal approach, taking aim at every state trial court judge and county court clerk in Texas, plus the attorney general and state medical boards. They are asking a federal judge to prevent any of the state’s trial court judges, potentially more than 1,000 throughout Texas, from enforcing the law and to block court clerks from accepting the lawsuits,”  The Post’s Ann E. Marimow reports.

The law could effectively ban most abortions in the state. More than 85 percent of women in Texas who obtain abortions do so after a six weeks, according to Marva Sadler, director of clinical services for Whole Woman’s Health, which operates four clinics in the state. Many women do not even know they are pregnant at that point.

Sugar rush