Good morning! Today we're wondering, when was the last time you pulled an all-nighter? Be honest. Below: Biden wants to stave off a shortage of a critical coronavirus therapy, and Trump advisers privately warned the country wasn’t ready for the pandemic. But first:

Democrats' quest for drug price negotiation is getting messier

Cracks are starting to emerge. 

Yesterday afternoon, a trio of House Democrats announced they would oppose the party’s signature proposal to lower drug prices, potentially throwing a major wrench into President Biden’s social spending bill, The Post’s Dan Diamond, Amy Goldstein and your Health 202 host report.

The issue will come to a head today, as a powerful House panel is still considering its pieces of the massive package ahead of today's deadline to wrap their work.

The episode puts the schism between moderate and liberal members of the party on full display — and underscores the tightrope congressional leadership must walk to pass the $3.5 trillion legislation. 

The drug pricing plan — essentially the same as a bill the House passed easily in 2019 — is widely viewed as a linchpin to the party’s broader health-care goals and is the key to charting a path forward on the package. The savings would help pay for huge new health expansions, like adding more benefits to Medicare and extending health care to poor adults. 

What happened: 

  • Reps. Scott Peters (D-Calif.), Kathleen Rice (D-N.Y.) and Kurt Schrader (D-Ore.) said they would oppose legislation allowing Medicare to broadly negotiate lower prices on drugs. All are members of the House Energy and Commerce Committee, and their statements yesterday — less than two hours apart — came in the middle of the panel’s debate over its portion of the massive economic package.
  • The opposition put the committees’ leaders in a bind, and thrust that part of the bill into uncertainty. As the lengthy markup drew on, Chairman Frank Pallone (D-N.J.) remarked that he hoped to finish the committee’s work by 6 a.m. today (he didn't end up making lawmakers pull an all-nighter; the panel recessed at roughly 1:40 a.m.).
  • It's still not clear what will happen. The committee is re-convening this morning to finish its health care work with the drug bill looming large.

The Hill's Peter Sullivan

There's still time

But one thing is clear: no matter what happens in E&C today, it's not over yet. Democrats can still bring their drug pricing plan up for a vote on the House floor, since the Ways and Means Committee will likely advance it as soon as today. 

But they can’t afford to lose a fourth vote. And other centrists are also telegraphing they have concerns. Five lawmakers — including Peters, Schrader and Rice — unveiled a rival proposal Tuesday that would instead limit Medicare’s power to negotiating the cost of the most expensive drugs on the market.

Spokespeople for the other members, Reps. Lou Correa (D-Calif.) and Stephanie Murphy (D-Fla.), didn’t respond to a request for comment. 

Meanwhile, Democrats are trying to tamp down any appearance of disarray. “Democrats are committed to leveling the playing field and reining in the soaring cost of prescription drug prices for the American people,” C.J. Young, a spokesman for the E&C Committee, told my colleagues.

Both sides of the fight are lining up for battle. 

  • Patients for Affordable Drugs Now just released polling data, commissioned by the group, showing strong support for Democrats’ bill in the three holdout lawmakers’ districts. 
  • PhRMA — the major drug trade lobby — is launching a seven-figure ad buy this week, which includes a letter from over 30 pharmaceutical executives contending the policy could thwart drug development.
Political tides

The rift is also a tale of how votes can change in Washington when a bill could really become a law. All three members voted for the drug pricing bill back in December 2019, when it passed the House in a 230-to-192 vote. 

“The vote in 2019, it was clear that that bill was not going to move in the Senate … and so I think there were members that recognized that and voted for the bill then understanding it was dead on arrival in the Senate,” a pharmaceutical industry source said. “The dynamic has changed and members are recognizing that now.”

Earlier this spring, a group of 10 moderate Democrats called for more modest — and bipartisan — policies to overhaul the nation's drug pricing system, Politico reported. Peters, who led the letter, said he cast his 2019 vote for the bill only to “start a conversation about lowering the cost of prescription drugs.”

In the courts

Breaking last night: The Justice Department asked a federal judge to grant a temporary restraining order or injunction to prevent Texas from enacting its law banning nearly all abortions, an escalation of the battle between Biden and Texas Republicans, The Post's Rachel Pannett reports. The move comes less than a week after the administration sued Texas to try to block the nation's most restrictive abortion law. 

Coronavirus

The Biden administration is moving to stave off shortages of a critical covid-19 therapy

The Department of Health and Human Services is, at least temporarily, taking over distribution of monoclonal antibodies instead of allowing states, medical facilities and doctors to order them directly, The Post’s Lenny Bernstein reports. The move could result in cuts for states in the Deep South — Alabama, Florida, Texas, Mississippi, Tennessee, Georgia and Louisiana — that have been using roughly 70 percent of the nation’s monoclonal antibody supply.

“Soaring demand for the therapy represents a sharp turn from just two months ago, when monoclonal antibodies were widely available and awareness of them was low,” Lenny writes. “Since then, however, word of the highly effective therapy — which is free to patients — has spread, with federal officials and Republicans including Florida Gov. Ron DeSantis urging their use.”

Trump said the country was prepared for covid, even as advisers warned it was not

Senior advisers in the Trump administration in February 2020 privately discussed “critical mistakes” as the coronavirus pandemic loomed, according to emails obtained by the House select subcommittee on the pandemic, The Post's Dan Diamond reports.

  • On Feb. 29, 2020, adviser Steven Hatfill warned that the administration had “no clue” of how many were infected with the coronavirus and predicted an impending wave of cases in an email to Peter Navarro, the president’s trade director. “From now on the Government must be honest about the situation,” he wrote.
  • On March 1, 2020, Navarro privately warned Trump that the federal response was “NOT fast enough.”

Those statements counter a rosy outlook from then-President Donald Trump.

  • On March 6, 2020, Trump said: “We are, really, very highly prepared for anything,” and inaccurately claimed that “anybody that wants a test can get a test” — amid testing shortages that would persist for weeks.

Here's what else you need to know:

  • The Army is giving its nearly half a million soldiers on active duty until Dec. 15 to receive a full vaccination or qualify for an exemption if they have a “legitimate medical, religious or administrative reason.” National Guard members and Army Reserve soldiers will get more time — until June 30, 2022, The Post’s Alex Horton reports.
  • As the White House shaped last week’s sweeping vaccine mandates, officials considered requiring international air passengers to be vaccinated. The plan was shelved, but top White House officials say that proposal and similar ones are still under consideration, The Post’s Annie Linskey and Yasmeen Abutaleb report.
  • Sixty percent of Americans support Biden’s new vaccine mandates for federal employees and businesses with 100 or more employees, according to an Axios/Ipsos poll released Tuesday.
  • The Biden administration’s push for vaccine boosters has been largely shaped by unpublished data from Israel, which could be made public as soon as this week, Politico’s Erin Banco reports.
  • Hospitalizations of unvaccinated covid patients cost an estimated $5.7 billion over the past three months, The Post’s Meryl Kornfield reports.

Medical missives

The number of people without health coverage increased by two million in 2020

That increase was twice as large as 2019 but not as bad as some experts feared in the early days of the pandemic. In fact, the 8.6 percent of people lacking health insurance throughout 2020 was close to 2018 levels, The Post’s Heather Long and Amy Goldstein report.

“The main effect on coverage was that the pandemic lowered the number of Americans with private insurance while expanding the numbers who had some form of public coverage,” Heather and Amy write.

Here are some key findings from the census:

  • The proportion of Americans with private insurance was 54.5 percent, a full percentage-point drop from the prior year.
  • The proportion covered by Medicaid increased from 17.2 percent in 2019 to 17.8 percent in 2020.
  • Disparities in insurance coverage between racial and ethnic groups widened. The proportion of White residents without insurance rose from 7.8 percent in 2019 to 8.3 percent last year; for Hispanic residents, the rate of the uninsured rose from 16.7 to 18.3; among Blacks it rose from 9.6 to 10.4 percent.

Industry Rx

Patients and doctors fear telehealth may become harder to access

Federal and state health officials have issued scores of waivers to make telehealth easier to access during the pandemic, but many of those flexibilities could expire once the public health emergency ends. 

There’s a bipartisan push in Congress to make the shift to telehealth permanent. But many states have already rescinded licensing waivers that allowed clinicians and some other providers to practice across state lines, The Post’s Frances Stead Sellers reports.

Agency alert

Biden’s drug czar nominee testified in the Senate

Rahul Gupta, Biden’s pick for director of the Office of National Drug Control Policy, appeared before the Senate Judiciary Committee yesterday. Gupta previously served as health commissioner of West Virginia, and is an ally of Sen. Joe Manchin (D-W.Va.), who introduced Gupta by praising his work combating drug overdose deaths in the state.

Sugar rush

Thanks for reading. See y'all tomorrow!