with Alexandra Ellerbeck

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Get ready for a frenzied few weeks on Capitol Hill.

Lawmakers and staffers are in the throes of hashing out legislation on Democrats’ top health-care priorities, as they race to make a Sept. 15 deadline to write their pieces of Biden's massive social spending bill. 

It won’t be easy. 

Democrats have $3.5 trillion dollars to play with, but a long list of health policies they want to mark as mission complete before the midterms. They’re hashing out how long new programs should last, mechanisms to pay for them and what can pass muster under a legislative maneuver that bypasses GOP opposition.

“It’s going to be hectic. … I think there’s going to be a lot of horse-trading,” said one lobbyist. “In the end, it feels like the entire caucus is on board with the idea that failure is not an option.”

Technically, Biden’s social spending package isn’t a health-care bill. But it'd still amount to the biggest health expansion since Obamacare.

Here’s the latest on the effort to draw it up, according to eight sources on and off the Hill. 

Expanding Medicare to cover vision, dental and hearing seems a foregone conclusion. 

Progressives, including Sen. Bernie Sanders (I-Vt.), are leading this charge, though adding the new benefits into the federal health program will probably take years to stand up. In the meantime, a Senate Democratic aide said the chamber is crafting a stopgap policy to help seniors afford these services right away. 

Democrats are also coalescing around a plan to extend Medicaid to 2.2 million poor adults.

For months, momentum has grown for a federal effort to extend the safety-net program in the dozen states where Republican officials have resisted Obamacare’s Medicaid expansion for nearly a decade. The measure has key champions, such as Sen. Raphael Warnock (D-Ga.), who helped deliver the Senate to Democrats and is up for reelection next year.

Behind the scenes, a leading option for closing the coverage gap has emerged. Under the policy, people would get free coverage on Obamacare’s marketplaces for several years, giving time for federal officials to create a new Medicaid-like program providing more robust benefits, according to four sources with knowledge of the situation.

A prescription drug bill is key to paying for the package’s health provisions.

In late 2019, House Democrats passed a bill allowing the federal government to directly negotiate with drugmakers for lower prices on some medicines. Now, Senate Finance Committee Chairman Ron Wyden (D-Ore.) is fleshing out his own drug pricing legislation.

The House bill tied Medicare drug negotiations to prices for selected drugs overseas — a plan that has faced pushback from moderates. Instead, Wyden is eyeing a new route: tying price negotiations to a domestic benchmark, according to three lobbyists familiar with the discussions. There are also questions around whether applying certain drug pricing reforms to the private market is allowed under the fast-track budget maneuver Democrats are using to pass their bill, according to two of the sources. 

Wyden will have to walk a fine line to get all of the Democratic caucus on board. 

“The gates are pretty narrow for any substantive drug pricing reforms,” said one health policy lobbyist. “It’s going to be subject to some pretty fierce negotiations.”

Rep. Cori Bush, a Missouri Democrat:

The length of two other major policies is still being fleshed out. 

Biden has pledged an infusion of cash into home care for seniors and the disabled, and lawmakers — especially those who drafted Obamacare — want to permanently bolster financial aid for those buying plans on the insurance marketplaces. But such investments may wind up being temporary, leaving lawmakers to contend with renewing them in the future.

Meanwhile, one major progressive demand is probably on the cutting-room floor.

Democrats aren’t expected to include a measure lowering Medicare’s eligibility age in the package, first reported by Politico, and confirmed by a Senate Democratic aide and multiple sources off the Hill. Progressives including Rep. Pramila Jayapal (D-Wash.) have been pushing hard for the policy, but probably to no avail. 

Ahh, oof and ouch

AHH: The administration may consider booster shots after six months, rather than eight.

When Biden announced plans for coronavirus boosters, he said Americans who received mRNA vaccines would be able to get an extra shot eight months after receiving their second dose. 

But that gap may end up being shorter. The Wall Street Journal reported that federal regulators are looking to approve a booster for vaccinated adults starting six months after the previous dose, rather than eight months. A person familiar with the booster plans told the Journal that the data under review from vaccine manufacturers and other countries is based on boosters at six months.

The exact timing of the booster shots was always going to be a judgment call.

“There’s no magic here about this eight months,” National Institutes of Health Director Francis Collins told The Health 202 last week. “Maybe we could have said seven, maybe we could have said nine. So, let’s try to pick a place that makes sense.”

OOF: Republicans are divided in their response to employer mandates from private businesses.

Republicans who have vehemently opposed government-ordered vaccine mandates seem less sure of how to respond when it comes to employer mandates, The Post’s Aaron Blake reports

While several states prohibit public institutions from requiring vaccines, so far only one state, Montana, has a ban on vaccine mandates that extends to private employers. Some Republicans state leaders are looking to follow suit. 

In South Dakota, state legislators are pushing for a special session on a bill that would ban employer vaccine mandates. But Gov. Kristi L. Noem (R) has come out against it, arguing that it would be too much government regulation of business. “It is not conservative to grow government and to tell businesses what to do and how to treat their employees,” she said in an Instagram post.

Ohio Gov. Mike DeWine (R) has also come out in opposition to a similar bill in his state, calling it a “mistake.”

Other governors are more open to involving the government in business issues. Texas Gov. Greg Abbott (R) has moved to ban cruise lines from requiring passengers to show proof of vaccination. Abbott also issued an executive order Wednesday expanding his ban on government vaccine mandates to all vaccines, regardless of approval status. The previous order had only prohibited government entities from requiring vaccines under emergency use authorization.

OUCH: The FDA's approval of Pfizer's vaccine is not swaying some holdouts.

Many public health experts are hoping that the Food and Drug Administration’s recent decision to grant full approval to Pfizer’s coronavirus vaccine will spur more Americans to get shots.

“But hopes that many of those skeptics would be swayed by vaccine approval appear to have been unrealistic, according to interviews with 16 unvaccinated Americans — including six who said earlier this year that they would be more likely to get vaccinated if the FDA approved the shots,” The Post’s Dan Diamond reports.

“Only a single unvaccinated person interviewed by The Post said the FDA approval had changed his mind — but he’s not eligible to get vaccinated until November because he received Regeneron’s monoclonal antibody treatment for a recent coronavirus infection,” Dan writes.

A widely touted Kaiser Family Foundation poll earlier this summer found that 30 percent of unvaccinated Americans said they’d be more likely to get vaccinated if the FDA approved the shots. But an expert who oversaw the poll said she didn’t expect FDA approval alone to change minds. “Most people have multiple reasons and concerns about getting vaccinated — it’s not just one thing,” said Liz Hamel, a Kaiser Family Foundation director.

Vaccine distribution

Pfizer vaccines will no longer come in smaller packs of doses — at least for now. 

The drugmaker was letting states order boxes of 450 shots, smaller amounts that made it easier for some providers to get shipments. But that ordering configuration has been phased out, according to a document obtained by The Health 202. Instead, shipments will consist of 1,170 doses.

A Pfizer spokesperson said the company fulfilled its contract with the government to deliver 35 million shots in the 450-shot configuration, but is considering reducing the size of its packaging in the future. The administration anticipates smaller Pfizer pack sizes becoming available this fall, according to a health official who spoke on the condition of anonymity to discuss planning. 

New York's covid count

New York’s new governor said the state had 12,000 more covid-19 deaths than publicized by the Cuomo administration.

New York Gov. Kathy Hochul’s new administration reported 55,395 covid-19 deaths in its first daily update on the pandemic Tuesday. That's a big shift from the 43,400 that her predecessor, Andrew Cuomo, reported on his last day in office Monday.

Experts have long complained that the data on coronavirus deaths published by the Cuomo administration was different from what the state was reporting to the Centers for Disease Control and Prevention. The count used by Cuomo in his news briefings was limited to laboratory-confirmed covid-19 deaths reported to a system that collected data from hospitals, nursing homes and adult care facilities. It excluded people who died at home, in hospice, in prisons or at state-run homes for people with disabilities, the Associated Press's Marina Villeneuve reports.

More in coronavirus news

  • More than 100,000 people are hospitalized with covid-19 in the U.S., a level not seen since Jan. 30, before vaccines were widely available.
  • The Pentagon is ordering all active-duty and reserve service members to get vaccinated against the coronavirus, The Post reports. Defense Secretary Lloyd Austin said in a letter that service leaders should “impose ambitious timelines for implementation” but did not set out a specific deadline. About 65 percent of the 1.3 million service members on active duty have been vaccinated, according to Pentagon data from earlier this month.
  • More than half of Florida students are enrolled in schools that require masks in defiance of Gov. Ron DeSantis (R), The Post’s Valerie Strauss reports. The school districts have followed advice from public health experts on masking, despite threats of sanction from state officials.
  • The CDC may be using unreliable data to track breakthrough infections, Politico's Erin Banco reports. More than a dozen states told Politico that they do not have the capacity to match patients’ hospital admission data with their immunization records, a fact that could lead to inaccurate reports that omit data.
  • An array of activists, scientists and politicians are calling for further probes into the origins of the coronavirus in the wake of an inconclusive intelligence report, The Post's Dan Diamond, Yasmeen Abutaleb, Joel Achenbach and Lenny Bernstein report. The classified report, parts of which will be publicly released as soon as this week, did not rule out that the virus emerged in the wild or that it leaked from a laboratory.

Moves to watch

Peter Fise joined the Senate Finance Committee's health-care team.

Fise's focus will be on Medicare Part B, telehealth, delivery and payment of mental health care and chronic care in the fee-for-service program, according to a statement from the committee's chairman, Ron Wyden (D-Ore.). Fise previously worked as health counsel in the office of Sen. Jeanne Shaheen (D-N.H.).

Abortion battles

A Mississippi clinic is at the center of the nation’s fight over abortion.

The Post’s Emily Wax-Thibodeaux and Ariana Eunjung Cha take an in-depth look at Mississippi’s last abortion clinic, known as the “Pink House” for its bubble-gum color. The Jackson Women’s Health Organization is the site of frequent run-ins between its supporters and antiabortion protesters. Soon it will be at the center of a Supreme Court case that could reshape abortion access in the country.

“Later this year, the court will hear arguments about a Mississippi law that if allowed to take effect would ban nearly all abortions after 15 weeks. If the court’s conservative majority permits the law to stand, it could deal a major blow to abortion rights,” our colleagues write.

Sugar rush