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The Health 202

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

Health industry is still agitating for changes to Democrats' economic package

The Health 202

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

Good morning, and TGIF. Send tips and good fall hiking spots to

Today, tensions over booster shots are rising between the CDC and Biden health officials. And uptake of boosters is highest in poorly vaccinated states. But first:

Here's what the health industry is lobbying for behind the scenes

The lobbying war is hardly over.

The health industry is rushing to shape President Biden’s massive economic package, even as the House barrels toward a vote as soon as next week. The calls to tweak, change or kill certain provisions are coming from various corners — on everything from drug pricing to hospital payments. 

Congress often has trouble defying the powerful health industry, which spends tens of millions of dollars in lobbying and campaign contributions each year. The dynamic has, in part, helped fuel the rising cost of care, as the government shies away from implementing policies that would fundamentally alter the system. 

It’s a critical moment for lawmakers and lobbyists alike. 

  • Last week, the House voted to begin debate on the $1.75 trillion legislation, in a deal struck between moderates and progressives aimed at ensuring a final vote no later than next week. But — assuming that happens — the package would then move to the Senate, where some changes may be made.

Here’s the chatter The Health 202 has picked up around 11th-hour industry asks. 

1. Hospitals are furiously fighting a cut to payments in a dozen states. 

Democrats’ social spending bill would extend coverage to roughly 2.2 million people living in states that have refused Obamacare’s Medicaid expansion. 

  • In doing so, the legislation includes a 12.5 percent reduction in dollars the federal government gives states to compensate hospitals for serving a large number of uninsured and Medicaid patients. (This policy only impacts non-expansion states.)
  • Closing the so-called Medicaid coverage gap will improve hospital margins — and will more than make up for the reductions in payments for uncompensated care, according to a white paper from the USC-Brookings Schaeffer Initiative for Health Policy.

But major hospital groups are up in arms. The American Hospital Association blasted the paper in a blog post. The trade group sent talking points to its members in non-expansion states urging them to tell lawmakers the policy will result in billions of dollars less to hospitals and could hurt their ability to serve the most vulnerable patients. And eight hospital groups sent a letter to leadership earlier this month echoing that same message. 

They’ve found an ally in Georgia’s Democratic congressional delegation. Sen. Raphael Warnock (D-Ga.) led a letter to leadership urging the proposal be removed from the bill. 

  • “It really comes down to them being able to leverage this,” said one provider lobbyist who spoke on the condition of anonymity to discuss strategy.

2. Drug makers are still trying to change Democrats' drug pricing deal.

The drug industry’s influential lobby wants the compromise — which would allow Medicare to negotiate the price of prescription drugs for the first time — spiked. 

  • “Congress should reject this flawed drug pricing plan that's being jammed through a flawed process and instead work to advance commonsense, patient-centered solutions that we know enjoy bipartisan support,” Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, said in a statement.

Some groups are going for tweaks to the language as it stands. Take the Association for Accessible Medicines, the generic and biosimilars lobby: They believe a provision in the bill penalizing drugmakers for hiking prices faster than inflation shouldn’t apply to generics and biosimilars. 

Meanwhile, pharmacy benefit managers want to ensure a policy fully repealing a Trump-era ban on prescription drug rebates isn't, in their view, undercut.

  • “It is crucially important that Congress does not undo the progress made by eliminating the rebate rule by including policies in the reconciliation bill, like some form of point-of-sale rebate policy, that would undoubtedly increase premiums on Medicare beneficiaries,” JC Scott, the president of Pharmaceutical Care Management Association, said in a statement.

The reality: Any changes the drug industry is able to make is going to have to be around the edges of the compromise, according to a Democratic lobbyist who works for some pharmaceutical companies.

3. Employers want an under-the-radar policy gone.

The Affordable Care Act lets a person ditch their job-based insurance when it’s unaffordable. 

  • What that means: A worker can buy subsidized health coverage on the law’s insurance marketplaces if over roughly 9.5 percent of their household income goes toward their premium.
  • But that number may change. The economic package lowers that threshold to 8.5 percent of household income.

But major employer groups — like the National Retail Foundation and the The ERISA Industry Committee — aren’t a fan. They argue the change would be “unnecessarily disruptive and expensive for employers, while not resulting in meaningful improvements for individuals.”


Biden officials are pushing boosters for all adults but CDC director urges caution

The F.D.A. authorized booster shots for millions of Americans who received two doses of the Pfizer-BioNTech vaccine. Here's what you need to know. (Video: Drea Cornejo/The Washington Post)

Concerned about a wave of infections in Europe and an uptick in cases in the United States, top Biden health officials are pushing to make booster shots available to all adults. But inside the administration, the support is not unanimous, The Post’s Laurie McGinley, Lena H. Sun and Tyler Pager report.

Tension is rising: CDC Director Rochelle Walensky has expressed concerns about making shots so widely available now, several officials told The Post. In a meeting on Sunday with other high-ranking health officials, Walensky said she and her advisers want to scrutinize the drug companies’ data and may not make such a broad recommendation. Some CDC officials and advisers are not convinced young, healthy people need boosters.

  • “The debate comes at a critical time for the Biden administration, with top advisers growing increasingly fearful the country could slide backward into a fifth pandemic wave amid colder weather and declining vaccine protection,” our colleagues write.

Colorado Gov. Jared Polis isn’t waiting for the FDA’s go-ahead

The governor signed an executive order yesterday allowing any resident 18 and over to get a booster shot. The order comes as surging coronavirus cases in the state are sending hospitals into crisis.

Under the federal government’s policy, people who received two doses of the Pfizer or Moderna vaccines are eligible for a booster only if they are 65 and over, have an underlying condition or are at high risk of infection due to their work or living conditions.

  • But Polis’s order declares all Coloradans at high risk of infection. “The entire State of Colorado is in a significant wave of disease spread. With an estimated 1 in 67 Coloradans infected, it is likely that nearly all Coloradans are exposed to COVID-19 where they live or work,” the governor’s order states.

Booster shot uptake is highest in states where many are unvaccinated

The rate at which fully vaccinated people are getting additional booster shots is highest in several mostly rural northern states that have low vaccination rates and few mask mandates. Booster uptake is also highest in states with high rates of new cases, including Alaska, North Dakota and Montana, according to data from The Post. 

  • “In swaths of the country where health officials will not impose mask and vaccine mandates to curb the virus’s spread, or have had their powers stripped away by Republican state lawmakers or governors, boosters are one of the few shields left for those worried about contracting and spreading the virus,” The Post’s Dan Keating, Fenit Nirappil and Katie Shepherd report.

Quote of the week

White House prescriptions

Marking Veterans Day: The White House unveiled a slew of actions yesterday aimed at helping troops exposed to environmental hazards.

  • For instance: The Department of Veterans Affairs is tasked with assessing whether there’s a link between certain toxins and lung problems or cancers. Other efforts include training providers how to treat veterans with concerns about exposures to toxins.
  • Biden has suggested a potential link between the death of his son, Beau, who served in Iraq, from brain cancer and exposure to toxins in the air, The Associated Press reports. However, there's no scientific evidence establishing such a connection.

Medical missives

  • Veterans have become unlikely advocates in the push to legalize psychedelic medicine, which they say can help relieve post-traumatic stress and other mental health issues tied to their time in the military, The New York Times’s Andrew Jacobs reports.
  • The New Yorker’s Lizzie Widdicombe takes a look at the network of activists and providers who connect people to mail-order abortion pills online, including in U.S. states with restrictive abortion laws. Abortion rights advocates are urging the FDA to make permanent a pandemic-era loosening of restrictions on telemedicine abortions.
  • Scammers are taking advantage of Medicare's open enrollment to trick seniors into signing up for Medicare Advantage or drug plans that often lack the benefits promised in the sales pitch, Kaiser Health News’s Susan Jaffe reports.
  • A new Monmouth University poll finds that majorities of Americans support mask mandates in school and vaccine mandates for teachers and health-care workers. The poll found that 53 percent of Americans believe Biden has done a good job handling the pandemic, up one percentage point from September. His overall job approval rating, however, has dropped from 46 to 42 percent over the last month, The Post’s Mariana Alfaro reports.

Sugar rush

Thanks for reading! See y'all tomorrow.