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The Health 202

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

Drug pricing efforts are only mostly dead

The Health 202

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

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Good morning and Happy Halloweekend everybody.

Today, we comb through under-the-radar provisions in Biden's economic package and there may be some flexibility in his vaccine mandate for federal workers. But first:

House Speaker Nancy Pelosi's still aiming for a drug pricing deal, but a slimmer one

Democrats insist they haven’t given up on their drug pricing dreams. 

Early Thursday morning, the White House unveiled a $1.75 trillion framework for Biden’s long-elusive social spending bill. But it excluded a key Democratic campaign pledge: allowing Medicare to negotiate the prices of prescription drugs. 

On Capitol Hill, eight lawmakers and aides say they’re still pushing to forge a compromise. 

The renewed push includes an effort from House Speaker Nancy Pelosi (D-Calif.), who’s working on a potential deal to allow negotiation for medicines administered by providers or bought at pharmacies once they’re no longer protected from generic competition. Stat first reported the plan, which a senior Democratic aide confirmed to The Health 202. 

Yet, any sweeping proposal is a long shot. Intraparty fighting has stymied one for weeks, and the powerful pharmaceutical industry is waging a multi-million dollar campaign aimed at thwarting Democrats’ plans. 

  • It's “nonnegotiable” to not have a path to let Medicare negotiate drug prices, Senate Finance Chairman Ron Wyden (D-Ore.) said. But he declined to say if he’d vote against the larger spending bill if the policy wasn’t included.
  • “It’s not dead,” House Ways and Means Chairman Richard Neal (D-Mass.) said. “I think that’s a fair statement.”

Finding a consensus bill is easier said than done. Democrats have razor-thin majorities on Capitol Hill, and moderates have already shown they’re willing to flex their muscles to vote down a drug pricing bill. 

The quick background:

  • In 2019, the House passed its signature drug negotiation plan, garnering the support of every Democrat and two Republicans.
  • But opposition crystallized last month. A trio of House moderates voted against advancing the legislation in the House Energy and Commerce Committee, and key senators, such as Sen. Kyrsten Sinema (D-Ariz.), had concerns with that plan.
  • A rival proposal emerges. In September, Rep. Scott Peters (D-Calif.), who led the opposition in the House, unveiled a more limited drug negotiation plan.

Kaiser Health News

The sticking points

It’s clear any drug pricing provision will be watered down from House Democrats’ more sweeping bill, H.R. 3. Let’s walk through two of the main sticking points.

What to negotiate: Peters’ bill only allows the federal government to negotiate the prices of drugs doctors administer, known as Medicare Part B. But others, such as Wyden, say that’s far too narrow. They’re demanding to let Medicare negotiate the cost of medicines bought at pharmacy counters as well, known as Medicare Part D. 

  • But where is Sinema? She’s one of the main holdouts in the Senate, but reportedly reached an agreement with President Biden to include a Medicare drug negotiation framework along the lines of what Peters has offered, Politico reported yesterday. (A person familiar confirmed the account to The Health 202.)
  • A White House official didn’t comment directly on the reported agreement, but said there’s been “some progress in recent days.” They reiterated that Democrats don’t have the votes to currently pass a drug bill, but that the administration would “keep fighting to get this done the right way.”

When to negotiate: Peters is bullish that drug price negotiation shouldn't be allowed during the period of time when a brand-name drug is protected from generic competition. His bill bans that from happening, but that’s a hard sell to some members. 

  • Pelosi’s plan is attempting to split the difference, though it’s unclear if it could muster enough support needed to pass a narrowly divided Congress.

Get ready for the messaging

Either way, Democrats are already preparing to sell their social spending bill to the American public. They’ve touted it as transformative for the country, even as the package ditches some of the party’s — and particularly more liberal members’ — ambitions. 

  • “If there's a way to get 50 senators on board for a strong drug pricing bill, then we would be thrilled," said Rep. Pramila Jayapal (D-Wash.), the head of the Congressional Progressive Caucus. "But the House, we have done our work, progressives have done our work in getting everybody to a place where we endorse the framework that the president laid out."

On the Hill

The health provisions in the spending bill you may have missed

While the pitched battles over big-ticket health-care items, like drug pricing and Medicare expansion, were dominating headlines, other health provisions have flown under the radar. Yet, some of them could spell the realization of long-held Democratic priorities.

Here are some of the other items that made it in the bill:

  • An extension of Medicaid benefits for a year after giving birth. Right now federal law only requires pregnancy-related Medicaid benefits to extend 60 days postpartum.
  • A permanent extension of the Children's Health Insurance Program. The insurance program, which offers low-cost health coverage to families who make too much to qualify for Medicaid, has been funded on a temporary basis since it was established in 1997. If Democrats get their way, the days of scrambling for last-minute extensions could end.
  • And there's more on CHIP.  Democrats are aiming to ensure kids can't be kicked off coverage for 12 months even if their family's income changes.
  • Around $10 billion aimed at shoring up public health systems and preventing the next pandemic. That’s a far cry from the $30 billion down payment the White House asked Congress for as a first investment in preparedness, much less the $65 billion the Biden administration said it would need over the next 10 years.

From the White House last night:


The White House suggested some flexibility in its vaccine mandate

The White House suggested that the federal agencies should seek to educate and counsel unvaccinated workers rather than fire them immediately if they don't comply with a federal vaccine mandate, The Post’s Andrew Jeong reports.

Federal workers face a Nov. 22 deadline — and contractors face a Dec. 8 deadline — to be fully vaccinated against the coronavirus. Jeff Zients, Biden's coronavirus coordinator, said the aim of the mandate was to protect people from the virus, not punish them. The comments come as some large companies have raised concerns about the impact of the mandate on their workforce.

“To be clear, we’re creating flexibility within the system. We’re offering people multiple opportunities to get vaccinated. There is not a cliff here,” Zients said.

More on mandates: 

  • All municipal employees in New York must receive at least one dose of a coronavirus vaccine by today.
  • Up to 12,000 Air Force personnel have rejected orders to get fully vaccinated against the coronavirus despite a Pentagon mandate, The Post’s Alex Horton reports.

Daily testing in schools faces a rocky rollout in Massachusetts

Massachusetts is using a “test to stay” approach to keep more kids in the classroom. The idea behind the policy is that it will help schools avoid shutdowns of entire classrooms or large quarantines of those who've had close contact with someone who tests positive. It's a model that's received widespread praise and has been heralded as an example for other states.

But the launch has not been easy, Stat's Maddie Bender reports. The company contracted to manage the testing has struggled to keep up with demand for personnel, forcing Gov. Charlie Baker to activate the National Guard to assist with testing. And school nurses say they are overburdened. Of the more than 2,200 schools that signed up for the program, only 1,410 schools had conducted testing in the past week, as of Oct. 17.

Medical missives

The federal government is punishing 2,499 hospitals, or 47 percent of all facilities, for having an excessive rate of readmissions. It’s part of a program that seeks to “counteract the financial incentives hospitals had in getting more business from these boomerang visits,” Kaiser Health News’s Jordan Rau reports.

  • The average punishment is a 0.64 percent payment cut for each Medicare patient stay. That can add up, however. Medicare estimates the penalties will save the government $521 million over the next fiscal year.
  • Only 547 hospitals escaped any penalty. Another 2,216 hospitals were exempt from the program because they specialized in children, psychiatric patients or veterans.

U.S. health officials lowered cutoff for lead poisoning in kids

The more stringent standard announced by the CDC will more than double the number of young kids considered to have high blood levels from about 200,000 to around 500,000, The Associated Press’s Mike Stobbe reports.

  • The reduction of lead exposure for children has been a major public health triumph. In the late 1970s, the average blood lead levels for children ages 1 to 5 was 15 micrograms per deciliter. Laws that phased out lead in paint and gasoline have caused those levels to plunge. The most recently reported average was 0.83.
  • In 1991, the blood level standard for lead was 10 micrograms per deciliter. It was reduced in 2012 to 5 micrograms, and now it will be dropped to 3.5. It’s a change that has been in the works since the Obama administration, but it stalled under Trump.

Quote of the week

Sugar rush

Thanks for reading! See y'all Monday.