Hey, happy Monday — if you're in the D.C. area, and commuting via train, might want to get a head start (spoiler: Metro suspended over half of its rail cars).

Today, we dive into what the FDA's outside advisers thought about Johnson & Johnson's booster shot and whether hospital vaccine mandates are working. But first:

House progressives have planted their flag on expanding Medicare benefits

It’s not Medicare-for-all.

But for months, progressives have fiercely rallied around a push for expanding Medicare, believing they have the numbers to muscle through Congress the biggest upgrade in seniors' benefits in nearly 20 years. 

The policy is a far cry from liberals’ call to fundamentally overhaul the country’s health-care system. Yet, progressive members have used their growing numbers — and Democrats’ small congressional majority — to double down on the more incremental notion of adding dental, vision and hearing coverage to the federal insurance program for older Americans and the disabled. 

Democrats are still fighting over the size of President Biden’s social spending package — and what will go in it — as party leaders desperately try to forge an agreement. House Speaker Nancy Pelosi (D-Calif.) is a big proponent of shoring up Obamacare, and Majority Whip Jim Clyburn (D-S.C.) has spoken forcefully about extending Medicaid to 2.2 million poor adults.

Yet adding new Medicare benefits appears necessary to get progressive lawmakers on board.

  • Rep. Pramila Jayapal (D-Wash.) wants the full slate of Democrats’ health-care priorities in the sweeping package, but to limit their duration if needed to bring the price tag down. If policies are cut out entirely: “We will lose constituencies, we will lose members, if we do that,” Jayapal, the chair of the Congressional Progressive Caucus, said in an interview.
  • “This, to me, is not negotiable,” Sen. Bernie Sanders (I-Vt.) said of the Medicare benefits on a press call last week. To which Jayapal remarked, “that is the position of the House Progressive Caucus.”

Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus:

Why Medicare expansion

The idea began to crystallize during the Biden-Sanders unity task force, according to three people with knowledge of the situation, where the primary rivals teamed up to create a list of policy recommendations both camps could support.

  • What the joint report said: “Excessive prescription drug cost-sharing and voids in coverage such as dental, vision, and hearing services can lead to severe health consequences for Medicare patients. Democrats are committed to finding financially sustainable policies to strengthen Medicare and fill coverage voids.”
  • Since then, the CPC surveyed its nearly 100 members to determine the priorities it’d push for in the economic package. It used those responses to put out a list of the caucus’ five priorities in April, which included using savings from prescription drug reforms to lower the eligibility age for Medicare and expand the programs’ benefits.

They see it as a way to close some of the gaps in Medicare, while continuing to advocate for Medicare-for-all. 

  • “This is a good way to continue to make that case to the American people,” said one senior aide to a progressive member.

But what about lowering the Medicare eligibility age? That idea has largely been on the cutting room floor of the economic package for roughly two months. 

  • “For better or worse, for all these priorities, it’s sort of a 'Hunger Games’ situation,” the aide said, adding that there seemed to be more support within the Democratic caucus to expand benefits.
The numbers game

For Democrats, the last few weeks have been a lesson in the difficulty of governing with slim majorities. To pass Biden’s social spending bill, the party can’t lose a single senator’s vote. It can afford only three defections in the House. 

That gives each Democratic faction a lot of power — and has helped fuel progressives’ leverage over the legislation. But their numbers have also grown in the past decade. 

  • Back when Obamacare passed, the Congressional Progressive Caucus had 79 members, according to a progressive House aide. At the time, there were more than 250 Democrats in the House.
  • Now, the CPC has 96 members with only a three-member majority in the House.

Despite the growth of the progressives, they’re competing with other sizable groups. 

The House’s New Democrat Coalition, a moderate-leaning group, consists of 95 members. They want to go big on a few programs, rather than implement a host of new ones where funding ends in just a few years. On health care, they’re pushing for two main policies: boosting financial assistance to Obamacare shoppers and closing the Medicaid coverage gap.

And in the Senate, all eyes are on Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.). But the slim margin means Democrats also need a vote from Sanders — who is openly feuding with Manchin.  

“Ultimately, how much power progressives have in this process hinges on whether they're willing to walk away if their priorities aren’t met,” said Larry Levitt, an executive vice president at the Kaiser Family Foundation.

Coronavirus

FDA advisers recommend booster shots for Johnson & Johnson vaccine

A panel of outside experts unanimously endorsed an additional shot of the Johnson & Johnson coronavirus vaccine for those 18 and older, recommending that it be given at least two months after the first shot. The FDA is expected to make its decision within days.

  • The move gives more clarity to the roughly 15 million in the United States who received a Johnson & Johnson vaccine, “many of whom have felt left behind as widely used shots employing a different technology garner greater attention from researchers and the public,” The Post’s Carolyn Y. Johnson and Yasmeen Abutaleb write.

But still, that recommendation could be muddied. The committee was presented with data from a small National Institutes of Health study suggesting that patients who initially got the Johnson & Johnson vaccine might get a bigger antibody boost from an mRNA booster. Limitations in the study’s design made it hard to draw conclusions, and the committee did not take a vote on mixing and matching vaccines.

  • Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, left open the possibility that the agency could allow boosters from different companies in the future.

There's more: Many experts weren't surprised by the panel’s decision, pointing out that they had always expected that the single-shot vaccine would end up requiring another dose. Speaking Sunday on ABC, Anthony Fauci, Biden's chief medical adviser, said it was “very likely this should have been a two-dose vaccine to begin with.”

Hospital vaccine mandates appear to be working

This intensive care unit went down to zero patients with covid-19. But once the delta variant hit, they've seen a return of patients with the virus. (Whitney Shefte/The Washington Post)

Administrators of large health-care systems with vaccine mandates say they are seeing widespread compliance and declining coronavirus infections, The Post's Meryl Kornfield and Annabelle Timsit report.

At Houston Methodist — one of the first health systems to require employees to get vaccinated — some 98 percent of staff members are now vaccinated, and the hospital credits widespread vaccinations with protecting 300 workers from getting sick over the summer. 

Two percent of employees were exempt or allowed to defer vaccination, mostly for medical reasons, and less than 0.6 percent of employees quit or were fired.

About 41 percent of hospitals nationwide have some sort of vaccine mandate, according to data collected by the American Hospital Association. Others are expected to follow suit after Biden announced he would require most institutions that receive Medicaid or Medicare funding to mandate coronavirus vaccines.

Here's what else you need to know:

  • International travelers who are fully vaccinated will be able to come to the U.S. starting Nov. 8. Individuals will be considered fully vaccinated if they received vaccines granted full approval or emergency use authorization by the FDA or the World Health Organization, The Post’s Paulina Firozi reports.
  • Drug manufacturer Merck will allow generic manufacturers in India to sell its antiviral covid treatment at far lower prices in more than 100 poor countries, The New York Times’s Stephanie Nolen reports.
  • A new Centers for Disease Control and Prevention report finds that the unvaccinated are more than 11 times more likely to die of covid-19 than the vaccinated.

In other health news

  • Biogen reported disappointing clinical trial results for an experimental treatment for Lou Gehrig’s disease, Stat’s Adam Feuerstein reports. The results of the Phase 3 trial are a setback for a fatal disease with few treatments.
  • The Federal Exchange Commission wants to know what former health secretary Tom Price is planning to do with the $1.4 million left in his campaign account, Business Insider’s Bryan Metzger reports. Price — who resigned in the wake of a scandal over his use of taxpayer funding to travel on charter flights — can’t use the money for personal expenses, but can give it to other political causes.
  • Transportation Secretary Pete Buttigieg is striking back against Republicans who criticized him for taking parental leave after adopting two newborns, The Post reports. Buttigieg told MSNBC he is grateful that he has the kind of family leave that Biden wants to extend to more Americans.

Daybook

We’ve got a busy week ahead. Here’s what we’ll be watching.

We’re not done with boosters: The FDA’s advisers weighed in with their recommendations on booster shots for Moderna and Johnson & Johnson. Now, it’s time for advisers to the CDC to have its say. That panel will meet Thursday to discuss how booster shots should be used if authorized by the FDA.

On the Hill: On Wednesday, the Senate Finance Committee will hold a hearing on health insurance coverage and federal programs. That same day, the House Energy and Commerce panel will convene a hearing on legislation to protect public health, including measures to prevent lead poisoning and increase early detection of hearing problems in children.

Tune in: On Thursday, we’ve got a Washington Post Live event with oncologist and author Siddhartha Mukherjee and Tempus CEO Eric Lefkofsky. They’ll be talking about the future of precision medicine at 9 a.m.

  • Later that same day, we have a second Washington Post Live event on the mental health impact of domestic violence with author Rachel Louise Snyder at 12 p.m.

Sugar rush

Thanks for reading! See y'all tomorrow.