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The Health 202

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

Biden's unlikely to get his full funding ask for home health care

The Health 202

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

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Below: Departing FDA officials argue booster shots aren't needed yet, and the delta variant is testing Biden's back-to-school pledge. But first: 

Other health priorities are crowding out home-care funding

President Biden called for a $400 billion investment in home-care for the elderly and the disabled. But signs point to Congress missing the mark — and by a lot.

Last week, a key House committee pitched spending less than half of what Biden wanted. Privately, some lawmakers and advocates are pushing Congress for more funding, asks that range from $250 billion to $400 billion. 

Democrats are wrestling with how to stuff all of their health-care priorities into a massive social spending bill. And the home-care dynamic is yet another example of how funding for a key policy, even one Biden himself pitched, could be scaled back significantly. As one Democratic aide put it, “tough choices have to be made.”

Yet, now is a critical moment for changing how the country cares for older adults and the disabled, supporters of robust funding argue. The coronavirus pandemic swept through nursing homes, killing nearly 135,000 residents and sparking fresh demands for the government to put more dollars into helping people stay out of institutional settings. 

Competing priorities

Lawmakers are learning it’s easier said than done. 

Here’s the state of play: 

  • Earlier this summer, the thinking in the Senate was that the in-home care policy may dip as low as $150 billion to fit within the $3.5 trillion budget agreement, according to four sources familiar with the negotiations. But there's a push to increase that number.
  • The House Energy and Commerce panel, which will mark up its plan today, put $190 billion toward Medicaid’s home and community-based services. That came as a pleasant surprise to some advocates, and even Hill aides, who were anticipating a number closer to $150 billion, according to multiple sources.
  • The Senate is still hashing out its plan. Negotiations are still very much in flux on a wide range of key health-care policies in the upper chamber. The White House declined to comment.

MaryBeth Musumeci, an associate director at the Kaiser Family Foundation:

Moving home

States have historically used their Medicaid dollars to pay for nursing homes, rather than care inside the home — which can include everything from help eating and dressing, to physical therapy and nursing care. Waitlists for these services are often long, and finding care can be a complex process. 

Lawmakers see a need for a shift. Sen. Bob Casey (D-Pa.), who chairs Congress’ aging committee, is the leading champion of the call for change in the Senate. He authored a bicameral bill with Rep. Debbie Dingell (D-Mich.), who’s a vocal advocate for expanding in-home care after her husband, a longtime congressman, was able to receive care at home.

  • Casey is pushing for Democrats’ $3.5 trillion package to put roughly $250 billion toward Medicaid’s in-home services, according to a Senate aide. He believes that amount of cash could be enough to implement the changes to the system his bill envisions.

But some advocacy groups contend more money is needed to be able to clear waitlist backlogs and pass on wage increases to underpaid staff. 

The issue is top of mind for the Service Employees International Union, a labor giant whose membership includes home-care workers and is fighting for the full $400 billion. Mary Kay Henry, SEIU’s international president, said those members “are the most politically active part of our membership” and give the most to the union’s political action fund. 

  • SEIU is piling on the pressure in a new $3.5 million TV and digital ad buy, shared first with The Health 202. The campaign will go to the end of the month and run TV ads in places like Arizona, West Virginia and Washington, D.C.
  • In an interview, Henry threatened to withhold funding from politicians who don’t back a robust infusion of cash. "We don't intend to give one penny, one phone call, one door knock, any mobilization of our members to support anybody's re-election that doesn’t back a strong investment on care,” she said.


Departing FDA officials argue boosters aren't yet necessary

An international group of scientists came out against booster shots in a review published Monday in The Lancet.

Among the co-authors of the paper are two outgoing Food and Drug Administration vaccine regulators: Marion Gruber, who leads the Office of Vaccines Research and Review, and Philip Krause, her deputy, The Post’s Ben Guarino and Laurie McGinley report.

The authors argue there is not yet enough evidence that vaccines are showing a substantial decline in their ability to protect against severe disease. They point out that boosters could increase the risks of side effects, which could strengthen resistance to the shots among the unvaccinated. But they acknowledged booster shots may be needed, should future evidence support that.

Yet, there are people who need the shots more, said study author Ana-Maria Henao-Restrepo, a World Health Organization epidemiologist.

“Even if some gain can ultimately be obtained from boosting,” Henao-Restrepo said, “it will not outweigh the benefits of providing initial protection to the unvaccinated.”

The delta variant is scrambling the start of the school year

Biden promised to get kids back in the classroom, but the highly transmissible delta variant has put that promise to the test, The Post’s Yasmeen Abutaleb, Laura Meckler and Valerie Strauss report.

  • Schools have undergone 1,700 temporary closures, according to Burbio, a data firm that tracks school reopenings. 

Health officials say it’s possible for kids to return to in-person schooling safely as long as precautions are in place. But it’s not clear that schools are adhering to public health recommendations.

  • A Washington Post survey of the nation’s 20 largest school districts found that few are offering robust coronavirus screening. Meanwhile, a quarter of the nation’s largest 200 school districts are ignoring the Centers for Disease Control and Prevention’s recommendation to mandate masks.

Rapid coronavirus tests are way more expensive in the U.S.

Biden has promised to make it easier to get at-home, rapid coronavirus tests, and a deal with major retailers could knock 35 percent off the price of tests. But even after the discount, Abbott’s popular BinaxNOW two-pack will sell for more than $15.

Those prices put frequent, at-home testing out of reach for many consumers, Kaiser Health News’s Hannah Norman reports.

In Germany, grocery stores sell tests for $1 per test. The United Kingdom provides 14 free tests per person, and Canada is giving out free rapid tests to businesses. 

Regulators in the U.S. have approved far fewer tests than their European counterparts, which may make it harder for new companies to enter the market and drive prices down.

Other top coronavirus news:

  • President Biden is calling on global leaders to commit to vaccinating 70 percent of the world by next September, The Post’s Dan Diamond reports. The goals were shared with global public health leaders ahead of a virtual summit the White House is scheduled to convene next week. 
  • Top infectious-disease expert Anthony Fauci told The Post’s Hannah Sampson that he supports a vaccine mandate for air travel, although he said he was not proposing one. “It’s on the table; we haven’t decided yet,” he said.
  • Some public health officials worry that the GOP’s rejection of Biden’s plan to force more coronavirus vaccinations could turn into opposition to other long-standing vaccine requirements, including mandates in schools or the military, The Post’s Felicia Sonmez, Marianna Sotomayor and Mariana Alfaro report.
  • Britain has been lagging behind other wealthy countries in vaccinating teenagers, but on Monday, U.K. health officials said children ages 12 to 15 will be eligible for one dose of a coronavirus vaccine, The Post’s William Booth reports. The decision comes despite a recommendation from Britain’s top vaccine task force that the shots were of only “marginal” benefit to youths. 


Medical missives

  • College students are reporting record-high marijuana use and record-low consumption of alcohol in 2020, according to a new study. Researchers wonder if disruptions caused by the coronavirus pandemic could explain part of the shift, The Post’s María Luisa Paúl reports.
  • Physicians are raising awareness about high rates of infertility for those in the profession, a toll they attribute to the high-stress and years of training that come with a medical career, Jacqueline Mroz writes for The New York Times. A 2016 survey of female physicians found nearly 1 in 4 who tried to have a baby had been diagnosed with infertility, nearly double the rate of the general public.
  • In the wake of a new law passed in Texas that has banned most abortions there, interest in abortion pills is on the rise, experts and providers told The Post's Samantha Schmidt and Sammy Westfall. In some places around the world where abortions are hard to get or illegal, pills, often obtained over national borders or through underground networks, have filled much of the demand to terminate pregnancies in the first few months of gestation.

Sugar rush

Thanks for reading! See y'all tomorrow.