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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Inside House Democrats' tug of war over health-care expansions

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Good morning! This is The Health 202, and you may have noticed we got a makeover. What you can expect: A newsletter easier to read while on the go, better visuals and graphics, more ways to share us with your friends, and (of course) the same deep dives on health policy.

Please don’t be shy: Tell us what you think. Our other 202 newsletter pals are also looking good. Be sure to check them out, too. (Click here for The Early 202, Cybersecurity 202, Technology 202 and The Daily 202.)

Below: Biden releases pandemic aid for health providers and a plan to expand Medicare is on the move. But first:

Moderates are more focused on expanding Obamacare than on expanding Medicare

The health-care battle is on.

Democrats are tussling over which health priorities will get the most cash in President Biden’s massive social spending package. Liberals are pitching a wide-ranging agenda — one that centers on a massive expansion of Medicare for older adults. But one large faction of Democrats has gotten noticeably less attention.

Meet the crowd focused on shoring up Obamacare.

The House’s New Democrat Coalition is a moderate-leaning group of about 95 members. In conversations with White House staff as recently as Friday, the group has been hellbent on one thing: complete the work of the Affordable Care Act.

What that translates to: 

  • A permanent extension of new financial assistance for ACA enrollees. In March, Biden’s coronavirus relief bill temporarily boosted subsidies for lower-income Americans and extended financial help to many middle-income families for the first time, but the provision only lasts two years.
  • Health coverage for 2.2 million Americans. Democrats are planning to expand Medicaid in the dozen states that have refused the Obamacare program for nearly a decade, and the coalition wants a permanent fix prioritized. 

“We want to provide coverage for people who have none, and that has to be the top priority versus expanding coverage for folks who already have it,” Rep. Suzan DelBene (D-Wash.), the coalition’s chair, told The Health 202.

Valuable votes

The position is a prime example of Democrats’ delicate reconciliation dance. Those dynamics aren’t just playing out in the Senate. They’re also alive in the House, where Speaker Nancy Pelosi (D-Calif.) can only afford to lose three Democratic votes. 

So far, proposals from key House panels — which will be marked up this week — would permanently fund the enhanced ACA assistance and extend Medicaid to more poor adults, on par with the New Democrat Coalition’s requests.

The nonpartisan Kaiser Family Foundation:

Let’s take a look at the rough math:

  • It may cost about $200 billion over a decade to provide the enhanced Obamacare financial assistance, according to a committee aide. 
  • It may cost about $250 to $300 billion to plug the Medicaid coverage gap, according to a House Democratic aide. (Bear in mind, both are ballpark estimates and not official price tags from congressional scorekeepers.) 

But the Senate may go big on Medicare expansion, leaving less money for other health policies.

  • Over the summer, Sen. Bernie Sanders (I-Vt.) privately struck a deal with White House officials and Senate Majority Leader Chuck Schumer (D-N.Y.). He agreed to support a $3.5 trillion package, which was far less than what he wanted to spend, as long as at least $380 billion went toward his longtime goals — mainly expanding Medicare, The Post’s Sean Sullivan, Marianna Sotomayor, Tyler Pager and Jeff Stein write.
  • That deal “is looming heavily over the tense negotiations on the bill’s final shape,” they reported over the weekend.  

The Posts Sean Sullivan:

The House rolled out its own Medicare expansion plan last week. 

On Friday, the House Ways and Means Committee advanced a proposal to add dental, vision and hearing benefits to the federal insurance system for older adults and the disabled, per our colleague Amy Goldstein. Every Republican and one Democrat opposed the plan, in a 24-19 vote. 

  • The dental benefits long sought by many seniors would begin in 2028, with patients on Medicare required to pay 20 percent of the cost for routine care, such as teeth cleaning or having a tooth pulled, and eventually pay half the price of major services, such as crowns or dentures.
  • Starting next year, Medicare would begin to include vision care, with a 20 percent co-payment to a certain limit for yearly eye exams and coverage for glasses or contact lenses. Hearing coverage would start in 2023.

But “liberals erupted” when they saw that the proposal would begin Medicare vision and hearing benefits within two years but delay dental coverage until 2028, our colleagues noted. The Congressional Progressive Caucus wants the benefits to start “as soon as possible,” Chris Evans, a caucus spokesperson, told The Health 202.

At a news conference last week, Pelosi played down the notion that boosts to the ACA could eventually be slighted at the expense of expanding Medicare. “I think both will be present,” she said, noting that savings from a prescription drug bill will help offset the costs. “That’s not a problem.”

You can't have it all

It all comes down to one question: What are Democrats willing to sacrifice? 

Top White House and Hill aides are still in the midst of hammering that out. As for the New Democrat Coalition, DelBene didn’t nix the idea of expanding Medicare but suggested the finite pool of funding should first focus on bolstering Obamacare.

“We understand that trade-offs might need to be made to get there,” DelBene said. She added: “It doesnt help for us to do a little bit of everything with a lot of cliffs that end up not getting certainty to the American people.”

Agency alert

The Biden administration is releasing billions in aid for hospitals

The Department of Health and Human Services said it will distribute $17 billion to health-care providers to help cover the costs of extra expenses and lost revenue during the coronavirus pandemic.

The announcement follows escalating complaints from the industry that a large chunk of money was sitting unused from the $178 billion that Congress designated last year as part of pandemic-relief laws. The latest distribution represents most — but not all — of the money that had not been allotted, The Post’s Amy Goldstein reports.

An additional $8.5 billion, from Biden's covid relief bill passed this spring, will go to providers in rural areas with patients who are covered by Medicaid, Medicare and a children’s public health insurance program.


What you need to know about Biden’s vaccine mandate

President Biden announced on Sept. 9 a six-pronged plan against covid-19 that includes new vaccine mandates and expanded access to testing. (Video: The Washington Post, Photo: Demetrius Freeman/The Washington Post)

The presidents decision to require businesses with 100 or more employees to mandate coronavirus vaccines or weekly testing outraged Republicans and sparked threats of legal challenges.

  • But many in the business community seem unconcerned with this government intervention in the workplaceThe Post’s David J. Lynch reports
  • Biden’s pandemic plan means more rapid tests. The administration is leaning on manufacturers to ramp up production of quick-turnaround tests that can be used for at-home testing and sent to local clinics and schools, The Post’s Derek Hawkins and Fenit Nirappil report.

Unvaccinated people are 11 times more likely to die of covid-19

That’s the finding of a Centers for Disease Control and Prevention report published on Friday. The report also found that unvaccinated people were over 10 times more likely to be hospitalized, compared with the fully vaccinated, The Post’s Lena H. Sun and Joel Achenbach report.

  • A second CDC study on Friday found that the Moderna vaccine was the most effective in preventing hospitalization (95 percent), compared with the Pfizer-BioNTech vaccine (80 percent) or Johnson & Johnson (60 percent). One possible reason is that Moderna’s dose of mRNA is three times that of Pfizer's.

While vaccine effectiveness has eroded somewhat as the delta variant becomes dominant, it remains robustly protective against severe illness and death, albeit slightly less so among older adults.

A vaccine for kids could come as soon as October

Top health officials believe that a coronavirus vaccine for children ages 5 to 11 could get the greenlight as soon as October, Reuters’s Marisa Taylor and Dan Levine report. Pfizer is expected to seek emergency use authorization for its vaccine in that age group this month. It could then be a matter of weeks before the FDA makes a decision, sources told Reuters. Previously, health officials had suggested that a vaccine for children would not be ready until November or later.

Top health officials are clashing over boosters

Tensions are growing between the CDC and the White House over the administration’s push to begin distributing boosters widely by Sept. 20, Politico’s Erin Banco, Sarah Owermohle and Adam Cancryn report. Senior officials from the White House Covid-19 task force and the Food and Drug Administration have accused the CDC of withholding key data needed to advance the booster plan.

Medical missives

False schizophrenia diagnoses may be widespread in nursing homes

More than 1 in 9 nursing home residents have a diagnosis of schizophrenia, compared with 1 in 150 people in the general population. But many of those diagnoses are questionable, a New York Times investigation finds. Understaffed nursing homes may be turning to potent antipsychotic drugs to sedate patients, despite the dangerous side effects.


It’s another busy week in health policy. Here’s what we’re watching: 

  • Starting today, the House Energy and Commerce Committee is marking up policies like eliminating the Medicaid coverage gap; infusing $190 billion into home-care; and letting the government negotiate drug prices.
  • On Tuesday, the House Ways and Means Committee will start another round of health-care mark-ups, including a provision to permanently extend enhanced financial aid to ACA enrollees.
  • On Friday, the Food and Drug Administration’s outside advisers are holding a much-anticipated meeting to review data on a booster shot for Pfizer’s coronavirus vaccine.

Sugar rush

Thanks for reading! See y’all tomorrow.