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The Health 202

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

Want that free coronavirus test Biden is promising? You gotta buy it first.

The Health 202

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

Good morning, and TGIF. Was Thanksgiving just last week? Send news and tips to rachel.roubein@washpost.com.

Five states have identified cases of the omicron variant, and Congress averted a government shutdown. But first:

Biden's promise of free coronavirus testing still leaves consumer hurdles

The Biden administration promises to make rapid, at-home coronavirus tests free for the tens of millions of Americans.

But it's working through the private insurance industry to do so – and that alone presents big challenges.

“The bottom line, this winter, you’ll be able to test for free in the comfort of your home and have some peace of mind,” President Biden said during a 25-minute speech yesterday outlining his plan to fight the virus this winter.

Easier said than done

Potential hurdles stand in the way of getting these tests quickly and easily for free to those with private plans. Some experts, instead, contend the federal government should buy the tests and provide them cheaply to all Americans, mimicking the model of some countries overseas. 

The way things work right now, Americans buy rapid, at-home tests over-the-counter, meaning insurance doesn’t automatically cover it. But under the administration's plan, shoppers in most cases would need to seek reimbursement from their insurer or health plan. That may mean sending in their receipts, the administration confirmed.

This means shoppers would have to pay for the tests — at least at first. The tests have a range of prices. Two tests can cost $14, while one company charges nearly $30 per test. Those prices may be too high for some Americans and their families, especially if they frequently take at-home tests.

  • “The fact that somebody has to front the cost of the test, and then wait for reimbursement, doesn't totally resolve affordability issues,” said Lindsey Dawson, an associate director at the Kaiser Family Foundation.

Larry Levitt, Kaiser Family Foundation:

The policy

Biden directed three departments — Health and Human Services, Labor and Treasury — to issue guidance by Jan. 15 requiring private insurers reimburse Americans for buying rapid, at-home tests. 

The legal basis: Last year, Congress passed coronavirus relief bills requiring free tests during the public health emergency. The White House believes those laws also extend to at-home tests, a senior administration official told reporters Wednesday. 

The agencies will flesh out key details, such as how consumers will know to submit receipts and how many tests will be covered and at what frequency. Health plans aren’t required to cover testing for employment purposes.

The policy doesn’t apply to those on Medicare and Medicaid, which some public health experts worry creates an unfair playing field for some of the most vulnerable Americans.

  • A White House official said the administration recognizes they “must reach every American with free reliable testing,” and pointed to efforts to distribute at-home tests to community sites.
  • The administration is doubling the number of at-home tests it’s sending to places like health centers and rural clinics to 50 million, Biden announced yesterday.

Loren Adler, USC-Brookings Schaeffer Initiative for Health Policy:

The challenges

To get their money back, Americans will likely need to remember to submit their receipts. But they’ll also need to know they can get reimbursed from their insurer, raising questions about how the public will be aware of the new policy. Meanwhile, some health experts worry the process could be cumbersome. 

  • “Health plans don't often make it super easy to refer the enrollee to request reimbursement,” said Sabrina Corlette, a co-director at Georgetown University's Center on Health Insurance Reforms, who supports the new Biden administration policy. “I'm hoping not, but there could be fairly bureaucratic hoops you have to jump through to get yourself reimbursed.”

Bureaucratic hurdles aside: “I think it’s a step in the right direction,” said Loren Adler, an associate director of the USC-Brookings Schaeffer Initiative for Health Policy. 

But some public health experts were more critical. They pointed to places, like the United Kingdom and Singapore that have delivered packs of rapid tests to people’s homes. They argue the United States should subsidize many more tests, so they can be easily accessible at a low cost in places like grocery stores. 

  • The plan that’s announced isn’t going to get us where we need to be,” Eric Topol, director of the Scripps Research Translational Institute, told Alexandra. “We’ve got to get them free and distributed widely. … Dealing with insurance to get anything reimbursed is torture-like.”

The view from the administration: In response to a question on this in yesterday’s briefing, press secretary Jen Psaki said: “Our medical team looked at a range of options. We want to make testing more available and more accessible to people across the country. … So, this is a step that was, our team agreed was implementable and possible to do now, and we will continue to build on it.”

Coronavirus

More cases of omicron have been detected in the United States

Ten cases of the new variant had been identified in the United States as health officials brace for discovering more cases.

  • Half the cases were detected in New York. There’s evidence of community spread in the state, as well as in Hawaii, officials in both states said.
  • California, Minnesota and Colorado have also detected cases.
  • The Minnesota man found to have the omicron variant went to a conference at New York City’s Javits Center that tens of thousands of people attended. But it’s not yet clear if the cases in New York are linked to the event.

Biden laid out his nine-pronged plan to fight coronavirus this winter in speech yesterday. And White House press secretary Jen Psaki said Thursday that “nothing is off the table” when it comes to the administration’s approach to curbing the coronavirus pandemic. That includes vaccine mandates for domestic travel, The Post’s Amy B Wang reports. 

Meanwhile, coronavirus cases in South Africa have nearly tripled in three days, according to new figures released Thursday, Lesley Wrougton reports for The Post. Scientists say it’s too early to know if the new variant is behind the surge in cases. But the finding is raising alarm among experts who say it could be an early signal that omicron may be overtaking the delta variant.

And as all eyes are on the omicron variant, delta is overwhelming hospitals in Minnesota and other parts of the United States, The Post’s Fenit Nirappil and Brittany Shammas report. Even if omicron turns out less worrisome than feared, epidemiologists warn that the United States, particularly the Northeast and Upper Midwest, is still headed toward a delta-fueled winter surge.

On the Hill

Congress averts a government shutdown

The Senate on Dec. 2 passed a stopgap spending bill in a 69-to-28 vote to avoid a shutdown and fund the government until February 2022. (Video: The Washington Post)

House and Senate lawmakers approved a bill to fund the federal government until Feb. 18, averting a shutdown that would have furloughed many federal workers. Democrats had warned that such a disruption would be irresponsible in the middle of the pandemic, The Post’s Tony Romm and Mike DeBonis report.

Lawmakers appeared dangerously close to missing their deadline after a small group of conservative Republicans threatened to hold up the bill as part of a campaign against Biden’s testing or vaccine mandate. 

  • In the end, they reached a compromise. Senate leaders allowed a vote on an amendment that would have defunded vaccine mandates targeting private businesses, military service members and federal employees. That effort failed in a 48-50 vote, with two Republicans absent.

Notable: The stopgap spending bill didn’t include policies to avert two different cuts to Medicare amid fierce lobbying from hospital groups insisting against pay decreases.

  • Per a senior Democratic aide: There are other avenues beyond the short-term funding bill to avoid the cuts before the end of the year. “The House and Senate are working closely together to get it done,” the aide said.

Quote of the week

Reproductive wars

Abortion battles are intensifying in states ahead of Supreme Court ruling

Activists and local lawmakers on both sides of the abortion debate are gearing up in case the Supreme Court allows states to curtail abortion rights, The Post’s Sean Sullivan, Emily Wax-Thibodeaux and David Weigel report.

If the high court chips away at Roe v. Wade, or even reverses the landmark decision that guaranteed a right to abortion, it will leave individual states with more power over when to limit the controversial procedure. This comes as the justices signaled a willingness to uphold a Mississippi ban on most abortions after 15 weeks — a move that would fundamentally alter abortion rights in the U.S.

On the antiabortion side:

  • The Susan B. Anthony List, a prominent group, has drafted a list of priorities and legislative actions for states where they plan to push new restrictions, as well as those where they’re playing defense.
  • As many as 21 states could swiftly impose bans or new limits on abortion, depending on what the court decides.

Abortion rights supporters are also getting ready:

  • Democrats in Colorado are planning to introduce legislation that would codify abortion rights.
  • In Michigan, Democrats are pushing a bill that would repeal a 90-year-old abortion ban that could take effect again. But it faces long odds given that Republicans control the state legislature.
  • The abortion rights group NARAL is pushing for expanded access to abortion in liberal states.

At the federal level: More Senate Democrats say they are willing to consider structural changes to the Supreme Court after the justices heard arguments this week on Mississippi’s abortion case. 

  • “Few senators as of yet are fully endorsing ideas like mandatory retirement for the justices or expanding the number of seats on the nine-person court. But a growing faction, long hesitant to embrace structural changes, say they are now prepared to consider such moves,” The Post’s Seung Min Kim report.

Agency alert

Stay or go? Robert Califf, Biden’s nominee to lead the Food and Drug Administration, has asked acting FDA commissioner Janet Woodcock to stay on in a leadership role at the agency, Stat’s Nicholas Florko reports. While it’s not clear in what capacity Woodcock might stay on if Califf is confirmed, the most obvious role would be principal deputy commissioner.

Sugar rush

Thanks for reading! See y'all Monday.

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