Happy Wednesday! We don't just follow health news here. We also follow the effort to capture two zebras on the loose in Maryland. The latest plot twist: They're going to need the help of… two more zebras.

Today, the Supreme Court didn't immediately block Maine's mask mandate and hearing aids could soon be available without a prescription. But first:

Medicaid expansion advocates want more attention from progressives

Advocates from Medicaid expansion holdout states are ratcheting up the pressure. Their latest target: progressives in Congress.

A coalition of over a dozen groups, known as Southerners for Medicaid Expansion, is pushing the Congressional Progressive Caucus (CPC) to prioritize expanding the safety net program in the dozen mostly GOP-led states that have refused it for nearly a decade. 

The CPC laid out its priorities for President Biden’s massive social spending bill, in an Oct. 13 letter to House Speaker Nancy Pelosi (D-Calif.) The letter didn’t mention Medicaid expansion — and that struck a nerve with the advocates who say they want progressive caucus leaders to be stronger allies in the fight to close the Medicaid coverage gap. 

The gap was created after a 2012 Supreme Court ruling, which said states could rejected Obamacare's offer of expanding Medicaid to those earning up to 133 percent of the federal poverty level. States mostly in the south have rejected the offer, sticking with their narrow eligiblity thresholds and leaving a couple million people ineligible for the program who otherwise would be.

  • In a letter sent to CPC leaders yesterday, the coalition wrote it was “disappointed” the progressive caucus didn’t mention extending Medicaid to 2.2 million poor adults in their note to Pelosi.
  • “Given our shared commitment to universal health care, economic and justice and racial equity, we urge you to add closing the Medicaid coverage gap to your priorities — it’s one of the most straightforward policies we can adopt to fulfill those commitments,” Southerners for Medicaid Expansion wrote in the letter shared with The Health 202.

The episode is the latest example of the tug-of-war over the health priorities in Democrats’ sweeping economic package as negotiations reach a fever pitch. Biden privately told Democrats yesterday that he believed a deal could be secured on a proposal between $1.75 trillion and $1.9 trillion — far less than what some lawmakers originally wanted, our colleagues report. 

The Post's Jeff Stein

Those fighting for the Medicaid policy argue it’s crucial to closing the stark racial inequities in the country’s health care system. Some individual progressive lawmakers are championing a federal fix to the Medicaid coverage gap, said multiple advocates, who added they want more buy-in from the caucus writ large. 

In a statement, Rep. Pramila Jayapal (D-Wash.) — CPC’s chair — countered with her caucus’ rationale on its priorities for Biden’s social spending bill. 

  • In the spring, the Congressional Progressive Caucus surveyed its 96 members, asking them to rank their top five priorities for the upcoming package. (In the health care bucket, the CPC landed on using savings from prescription drug reforms to lower the eligibility age for Medicare and expand the programs’ benefits.)
  • That doesn’t preclude the caucus from supporting programs outside those priorities, such as Medicaid expansion. “That's why we have continually called for bold, universal, and robust investments that will deliver funding to communities historically left behind, rather than a narrow bill that will benefit only the few,” Jayapal said in a statement.

The official response: Within a few hours, Jayapal’s staff wrote back to the Southerners for Medicaid Expansion coalition, and asked for a meeting, according to Laura Guerra-Cardus, Texas deputy director for Children’s Defense Fund. A CPC spokesperson confirmed the congresswoman’s team reached out and that CPC staff would join the meeting as well. 

Hashing out a deal

But just how the policy — and Democrats’ broader health agenda — will shake out is still up in the air. Biden held a series of meetings with moderate and progressive members yesterday, and all parties appear closer to a deal. 

  • “Jayapal and other members of her bloc said that there is still hope for a final package to include an expansion to Medicare to cover dental, vision and hearing benefits … Other sources later said that Biden had signaled other critical health care programs, including some money for elder care, extended insurance tax credits and fixes to Medicaid also remain in the mix,” report Tony Romm, Marianna Sotomayor, Seung Min Kim and Jeff Stein.
  • But some potential changes have frustrated liberal lawmakers. To some in the room, Biden seemed to underestimate the cost of expanding Medicare, our colleagues report.

Medicaid advocates are pushing for a permanent extension of the safety net program. But the contours of all the policies are getting dialed up and down depending on the topline number. 

One potential option that's been on the table for weeks: A fix as short as three years that lets people who fall into the gap get free plans on Obamacare’s insurance marketplaces, according to multiple people familiar, though negotiations are extremely fluid. (Rep. Ro Khanna (D-Calif.), who went to the White House yesterday, told The Health 202 he believes the Medicaid coverage gap will be included in the bill.)

Coronavirus

The Supreme Court won’t immediately block a Maine vaccine mandate

The high court declined to immediately stop enforcement of a vaccine mandate for health-care workers in Maine that does not include an exemption based on religious objections, The Post’s Ann E. Marimow reports.

The brief order from Justice Stephen G. Breyer did not include an explanation. However, it says health-care workers challenging the mandate can renew their request to the high court after the U.S. Court of Appeals for the 1st Circuit issues a decision on the merits of the case or if it does not issue a decision before the state begins enforcing the requirement on Oct. 29.

Here's what else you need to know:

  • Homeland Security Secretary Alejandro Mayorkas tested positive for the coronavirus. He is fully vaccinated and only experiencing mild congestion, The Post’s Felicia Sonmez and Maria Sacchetti report.
  • A Centers for Disease Control and Prevention report finds the Pfizer-BioNTech vaccine is 93 percent effective in preventing coronavirus-related hospitalizations in adolescents between ages 12 and 18, The Post’s Lateshia Beachum reports.
  • Hundreds of San Diego area students skipped school Monday in protest of plans to impose a statewide vaccine mandate, The San Diego Union-Tribune’s Kristen Taketa reports. California was the first state to announce that it intends to require coronavirus vaccines for all schoolchildren once the shots are given full FDA approval.
  • Pfizer attempted to minimize its risk and maintain secrecy in contracts it negotiated with countries for coronavirus vaccines, according to a new report from Public Citizen, an advocacy organization. Some contract demands appear to have slowed vaccine rollouts in other countries, The Post’s Adam Taylor reports.

Chart check

Northern states are seeing an uptick in coronavirus cases. While cases overall are waning nationally, infections in Alaska, Montana, Wyoming, Idaho and North Dakota are rising as cold weather sets in.

On the Hill

CBO releases price estimates for Democrats’ health-care ambitions

  • Nearly 4 million uninsured people would gain coverage under policies advanced in key House committees, according to projections from the nonpartisan congressional scorekeepers.
  • The health provisions would cost $553.2 billion over the next 10 years.

CBO’s estimates can be notoriously divisive. Gideon Lukens, with the left-leaning Center on Budget and Policy Priorities, indicated the number of people who would gain insurance under Democrats’ plans could be higher. 

Sinema has close ties to Arizona’s biotech industry

Arizona’s biotech industry may be seeing a payoff from its years of courting Sen. Kyrsten Sinema (D), as the Arizona lawmaker emerges as one of the biggest obstacles to Democrats’ push to pass drug pricing reforms, Stat’s Nicholas Florko reports

Advocacy organizations like the Biotechnology Innovation Organization and AZBio have developed close ties with the lawmaker, granting her a number of public service awards over the years. The state’s small biotech companies have been making the case that pricing reform will dry up venture capital investment. 

While Arizona’s biotech sector is growing faster than the overall national industry, it only takes home a fraction of the investment dollars of Massachusetts and other industry hotspots.

Medical missives

Private insurance markups vary by physician specialty

Private insurers generally pay doctors more than they receive for the same service under Medicare. But the markups vary significantly depending on the physician’s specialty. That’s according to a new report from Urban Institute, which analyzed data from a claims database.

What the report found: 

  • Family medicine, obstetrics and gynecology, dermatology, ophthalmology, and psychiatry had the lowest markups for commercial insurance. 
  • Anesthesia received the highest markup at 330 percent of Medicare rates.
  • Cardiologists, gastroenterologists and emergency medicine doctors also saw big price differences between private and public insurance.

Agency alert

Hearing aids could soon be available without a prescription

The Food and Drug Administration proposed a new category of hearing aids that would be available without a prescription or medical exam, a measure that could increase affordability and access for millions of consumers, The Post’s Katie Shepherd reports.

Consumers with mild-to-moderate hearing loss may be able to get devices without a prescription as soon as next fall. Advocates say it's a long time coming. It’s been more than four years since Congress instructed the agency to come up with regulations for over-the-counter devices.

  • More than 38 million adults in America have hearing loss, but only around 1 in 3 people over age 70 with hearing loss has ever worn a hearing aid.

Rachel Levine is the first transgender four-star officer 

Levine is the U.S. assistant secretary for health and the highest ranking openly transgender official. She was sworn in as an admiral of the U.S. Public Health Service Commissioned Corps, a 6,000-person force that responds to health crises around the country, The Post's Dan Diamond reports. She is the sixth four-star admiral in the history of the corps.

The Post's Dan Diamond

Sugar rush

Thanks for reading! See y'all tomorrow.