The Washington PostDemocracy Dies in Darkness
The Health 202

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

Coverage for low-income kids and new moms is on Democrats' to-do list

The Health 202

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

Good morning! Just a little reminder that there's always a health care angle. 

Today, we highlight the FDA's inconclusive evidence for booster shots and a top health panel failing to advance Democrats' drug negotiation bill. But first:   

Permanent CHIP funding and post-partum Medicaid coverage are on the reconciliation table

House Democrats advanced sweeping expansions to government-run health programs for seniors and poor adults, as they dash to assemble their version of Biden's economic package.

Yet, several little-noticed provisions could have a huge impact on coverage for new mothers who are low income and some of the nation’s most vulnerable children. In a marathon, three-day markup, the House Energy and Commerce Committee took the first step toward making those proposals a reality. 

Here’s a quick digest of the plans:

  • A permanent extension of funding for the health-care program for low-income kids 
  • An expansion of Medicaid to provide benefits for a year after giving birth
  • A requirement that kids can’t be kicked off their coverage for 12 months, even if a family’s income changes

The new policies come as the coronavirus pandemic highlighted economic and racial disparities in the health-care system — systemic issues the Biden administration has pledged to address. But Democrats have a lengthy list of priorities to include in their $3.5 trillion bill, and anything could be on the chopping block. 

Meanwhile, the Senate is still hammering out its approach to Biden’s massive social spending package, but Senate aides say they’re hopeful these provisions will also be included in the upper chamber’s proposal. 

Covering kids

Democratic aides and advocates want to avoid a repeat of 2017, when funding lapsed for the Children’s Health Insurance Program. It took Congress several months to put more money toward the benefit; in the interim, states ran short on cash, forcing several to alert families they may need to freeze the program's enrollment. 

Created in 1997, CHIP covers over 6.8 million children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage. But unlike other government insurance programs, Congress must periodically renew its funding — causing headaches for state officials and advocates who worry the bipartisan program will get ensnared in partisan politics. 

“You would think, ‘Oh, because the program is really popular then that should make it easier to pass.’ It actually makes it harder,” said Bruce Lesley, the president of the First Focus on Children, an advocacy group. “Both parties then, to some extent, pardon the pun here, but use CHIP as a bargaining chip.” 

  • Permanently extending the program is expected to be fairly cheap, since funding for CHIP doesn’t run out for another six years, according to a House Democratic aide, who said some are trying hard to keep the policy in play.  
  • Advocates are also fighting to ensure another provision stays in the bill. They want to guarantee kids will be covered for at least a full year, so their insurance doesn’t drop during paperwork snafus or when a parent gets a new job. 

Rep. Robin Kelly (D-Ill.)

Benefits for new moms

Democrats also want to tackle maternal health disparities in the massive spending bill, believing enhanced Medicaid coverage will help reduce the country’s high rate of pregnancy-related deaths, particularly in Black and Native American communities. 

The goal is to allow new mothers to stay on the safety net program for a year after they give birth, instead of just 60 days. Biden’s coronavirus relief bill made it easier for states to increase their postpartum benefits, but the new option is only available for five years. 

“A bill like this will absolutely save lives,” Rep. Robin Kelly (D-Ill.), chair of the Congressional Black Caucus Health Braintrust, told The Health 202. 

  • The issue is a top priority for groups like the American Nurses Association, March of Dimes and Planned Parenthood. In a letter last month, they urged Democrats to include the policy in their $3.5 trillion bill, arguing it is “paramount and foundational for families.”
  • But what are its prospects? “We have a lot of groups pushing and trying to help us, so I feel good about it staying in the bill,” Kelly said. “Of course, one never knows, but I think there’s a good chance.”


An FDA review of evidence for boosters remained noncommittal

The Food and Drug Administration released its highly anticipated review of the evidence on whether Pfizer boosters are necessary for the general public, setting the stage for what could be a contentious meeting of expert advisers Friday, The Post’s Carolyn Y. Johnson, Joel Achenbach and Laurie McGinley write.

Expert reviewers struck a decidedly neutral stance, noting that some studies have suggested that vaccine efficacy decreases over time, while others have not.

It’s a tough time to be in the FDA.

The booster controversy is part of a “tumultuous season” for the FDA, Laurie and Dan Diamond write. The agency was shocked when top agency vaccine regulators co-authored a public dissent on boosters in The Lancet this week. Meanwhile, the FDA is under intense pressure from parents to approve the vaccine for their kids. And, if that weren’t enough, some Biden administration officials are saying it's going too slow, even as FDA workers are buckling under a massive workload. 

If the FDA approves boosters, they could still come into conflict with the CDC and its advisers. The FDA determines if the shots are safe and effective, but it's the CDC’s Advisory Committee on Immunization Practices that provides recommendations on who should get the shots. ACIP is set to meet Sept. 22 and 23.

From our notebook

First in The Health 202: Key senators push for a permanent fix to closing the Medicaid coverage gap

Three Democratic senators have a message for leadership: Don’t skimp on Medicaid expansion. 

Earlier this week, House panels advanced legislation that would permanently extend health insurance to roughly 2.2 million people who live in the dozen states refusing the Obamacare program. The three senators — Raphael Warnock (Ga.), Jon Ossoff (Ga.) and Tammy Baldwin (Wis.) — are calling on the Senate to follow the House’s approach.

The legislation would provide coverage to poor adults through the health law’s exchanges while the federal health department creates a new Medicaid-like program. But the Senate hasn't yet released its plan.

“Providing permanency would ensure stability for both the program and the individuals enrolled,” the trio, who are the only Senate Democrats representing nonexpansion states, wrote to Senate leaders Wednesday.

Meanwhile, the House's drug bill is off to a shaky start

A trio of House members blocked Democrats’ signature drug pricing plan, potentially thrusting the Biden administration’s $3.5 trillion package into jeopardy.

The House Energy and Commerce panel failed to advance the bill to allow Medicare to negotiate drug prices in a 29-to-29 vote. Reps. Scott Peters (D-Calif.), Kurt Schrader (D-Ore.) and Kathleen Rice (D-N.Y.) opposed the bill after introducing a more moderate — and rival — drug plan on Tuesday. 

But the bill isn’t sunk for good. The House’s tax-writing panel advanced a slew of priorities, including the drug pricing plan, in a 24-to-19 vote. That means the bill can still go to the floor for a vote, as congressional leaders pledge to continue their drug pricing work. 

“Delivering lower drug costs is a top priority of the American people and will remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill,” Henry Connelly, a spokesperson for Speaker Nancy Pelosi, said in a statement.

Chart check

Covid has killed 1 in 500 Americans

It took just 19 months for the country to reach the grim milestone, The Post’s Dan Keating, Akilah Johnson and Monica Ulmanu report. The nation’s death toll exceeded 663,000 this week and continues to grow at an alarming rate as large portions of the country remain unvaccinated.

Elderly Americans bore the brunt of the deaths caused by the virus. People older than 85 make up only 2 percent of the population, but a quarter of the total death toll. One in 35 people 85 or older died of covid, compared to 1 in 780 people age 40 to 64.

Death rates for younger groups, 40 to 64 years old, are much lower but racial inequities grow larger.

In other health news

Here's what else you need to know:

  • Democrats look to taxes on tobacco to help fund massive spending bill. A new proposal from the House would hike existing federal taxes on cigarettes and cigars and add new ones for e-cigarettes. Those changes could help the government raise $100 billion in revenue over the next 10 years, money that could help finance Democrats' $3.5 trillion spending. But Republicans argue that would violate Biden’s 2020 campaign promise not to raise rates on Americans who make less than $400,000 each year, The Post’s Tony Romm reports. 
  • 2.8 million signed up for Obamacare during Biden’s special enrollment. Some 12.2 million Americans now rely on Affordable Care Act health plans, the largest tally since the start of the ACA insurance markets. The additional enrollees took advantage of a special six-month special enrollment period ordered by Biden to help Americans get insurance during the pandemic, The Post’s Amy Goldstein reports.
  • A federal judge will hear arguments in the Texas abortion case on Oct. 1. U.S. District Judge Robert Pitman scheduled a hearing for Oct. 1 to consider temporarily blocking Texas's restrictive new abortion law, following an emergency request from the Department of Justice for a freeze on the law, which bans most abortions in the state after six weeks. Rather than ruling immediately, the judge granted Texas's request to first hear arguments in the case.
  • Parenting a kid under 12 forces constant risk calculations over routine outings. A vaccine for children ages 5 to 11 likely won’t be authorized for at least a few more months, forcing parents of young children to weigh the risks of covid against the mental health and physical consequences of social isolation, The Post’s Ariana Eunjung Cha reports.

Sugar rush

Thanks for reading! See y'all tomorrow.