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The Health 202

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

The administration wants billions from Congress for its new pandemic plan

The Health 202

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

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Happy Thursday morning, where we're looking forward to Friday morning. Send us good hiking spots for the (fingers crossed) warm weather this weekend at rachel.roubein@washpost.com. 

Today's edition: Biden's Medicare and Medicaid chief told us there hasn't been a “mass exodus” of health care workers due to the vaccine mandate. And could there be traction from Sen. Joe Manchin (D-W.Va.) on Build Back Better? But first … 

The Biden administration wants more pandemic funding but Republicans are skeptical

The White House unveiled a sweeping 96-page road map charting the next phase of its pandemic response, an effort to convince Americans that their lives can begin returning to normal.

But the plan needs billions of dollars from Congress. The funding fight for more coronavirus aid is ramping up on Capitol Hill this week — and there are likely to be more rounds in the months ahead. Some Republicans signaled yesterday they may be unwilling to approve new aid until they have a fuller accounting of how the government has spent the $6 trillion dollars approved over the course of the pandemic.

🚨 Most immediately: The Biden administration is requesting about $22.5 billion from Congress to restock key public health programs as a protection against future coronavirus variants, our colleague Tony Romm reports in a story out this morning. 

  • The timeline: Government funding is set to run out after March 11. The official request — which also includes $10 billion to aid Ukraine — comes as the two parties are struggling over an aid package that many lawmakers want to add to the still-forming, long-term deal to fund the government.

Yet: The administration could still seek more funds in the weeks ahead, Tony writes. 

  • At a coronavirus briefing yesterday, Jeff Zients — the White House coronavirus response coordinator — alluded to that possibility. Same with Shalanda Young, acting director of the Office of Management and Budget, who wrote to lawmakers that she “anticipate[s] that additional funding will be needed to support the covid-19 response” in a letter Tony obtained.

The Post's Tony Romm

New pandemic plan

The new funding request comes as the administration seeks to reset its pandemic response. The effort is a balancing act of attempting to reassure Americans that vaccines and treatments have made the virus more manageable, while being cautious to avoid a victory lap.

The White House unveiled that new plan yesterday. 

The initiative contains an array of measures, from dispensing antiviral pills in “one-stop” locations when people test positive to launching new centers to better care for those experiencing long covid. It contains plans to reliably produce an additional 1 billion vaccine doses per year; bolster wastewater surveillance capabilities; and help businesses provide sick leave to employees who miss work because of an infection.

The plan was weeks in the making. In early January, federal officials started crafting the road map, along with input from experts, governors and local officials and former advisers. It won praise from multiple experts who the administration consulted, and who told The Health 202 that their feedback was included in the plan.

  • “In [the] past, where we might think they're listening, you might wonder if they're really hearing you. And it's clear that they not only listened, but they heard advice from external experts, and they incorporated a lot of that input into their plan,” said Rick Bright, the CEO of the Rockefeller Foundation’s Pandemic Prevention Institute and former Biden transition adviser.

But during a press briefing yesterday, administration officials repeatedly warned the efforts were contingent on new dollars from Congress. That same message is peppered throughout the document called the “National Covid-19 Preparedness Plan.”

  • One senior health official told The Post that the administration lacks the dollars to cover purchases beyond its current orders for vaccines, antiviral drugs and monoclonal antibodies — orders which won’t cover the entire year. That’s per a dive into the plan by our colleagues Yasmeen Abutaleb, Lena H. Sun, Dan Diamond and Katie Shepherd.
  • In Young’s letter, she wrote that a failure for Congress to act could prevent agencies from carrying out some coronavirus efforts, like the new initiative to bolster the delivery of tests and antiviral drugs, Tony writes.
The dollars

Last month, the Biden administration briefed lawmakers on a need for roughly $30 billion in additional covid-19 funding to weather the surge of future variants and restock key public health programs. 

The administration ultimately settled on a formal request of $22.5 billion. About $18.25 would go toward public health and $4.25 for global vaccine deployment. 

Before the news emerged, Zients declined to lay out a full accounting of how much the administration ultimately believes it needs. 

  • “HHS has laid out some immediate funding needs for Congress,” Zients said at a press briefing yesterday. “We’ll need additional funding for medium- and longer-term priorities, and we’ll be working with Congress in the weeks ahead.”

Agency alert

CMS chief: No ‘mass exodus’ of health care workers due to vaccine mandate

Biden’s Medicare and Medicaid chief said the warnings of medical staff leaving hospitals due to the coronavirus vaccine mandate haven’t borne out. 

  • “We have not seen anywhere near the mass exodus that was warned about,” Chiquita Brooks-LaSure, the head of the Centers for Medicare and Medicaid Services, told The Health 202. “We’ve been working with facilities, and the conversations have been extremely encouraging in terms of how much facilities understand the importance of the requirements.”

Her comments came hours before the Senate passed a measure aimed at nixing Biden’s vaccine mandate for health care workers — a key messaging moment for Republicans who have railed against the requirements. 

But the effort is destined to die in the Senate. The White House already issued a veto threat, and a senior House Democratic aide said the chamber doesn’t plan to take up the resolution. 

  • The 49 to 44 vote fell strictly along party lines. The vote was able to pass, in part, because six Democrats were absent.
  • The Supreme Court allowed the mandate for health-care workers to go forward in facilities receiving Medicare and Medicaid funds. Staff in roughly half the states must be fully vaccinated by now, while workers in the other half are required to have gotten at least one shot. 

And more from our interview with Brooks-LaSure …

On increasing nursing home wages: Roughly 420,000 employees in nursing homes and long-term care facilities have departed during the pandemic, some of whom have complained of low pay. Earlier this week, the Biden administration rolled out a plan to crack down on poor-performing nursing homes, which directed CMS to unveil minimum staffing levels for facilities within one year. 

  • “A staffing requirement is going to encourage higher wages, if that's what the workers are asking for,” Brooks-LaSure said. “It really puts higher value on the work that the workers are doing.”

On private equity ownership: Brooks-LaSure said the agency has seen “some concerning results in nursing homes that are owned by private equity.”

  • “Whatever the entity is, we need to make sure that they are able to take care of the people that they're serving, and they're using the dollars well,” she said.
  • The American Investment Council, which represents the private equity industry, has refuted this notion, arguing its ownership leads to improved management of the facilities.

On the Hill

Manchin signals he's ready to negotiate with Democrats

Sen. Joe Manchin (D-W.Va.) laid out guidelines for legislation that could earn his vote as Democrats scramble to pass facets of their agenda ahead of the midterm elections, Politico reports.

  • If Democrats want to cut a deal along party lines, Manchin said they’ll need to use revenue generated from lowering prescription drug costs and reforming the tax code. Those savings would be put toward reducing the deficit and inflation, and also creating new climate and social programs. 

Manchin’s comments come after Biden’s State of the Union address, where the president called for congressional action on individual pieces of his $1.7 trillion social spending package that has been stalled on the Hill since December. 

Something’s got to give: To move forward on a reconciliation package with only 50 Democrats in the Senate and a slight majority in the House, progressives may have to concede on key issues — like an expanded child tax credit — to squeak a vote through Congress.

Coronavirus

Suicide rates dropped amid the pandemic

After increasing steadily from 2000 through 2018, suicide rates declined for the next two years despite the pandemic’s emergence in 2020, according to new data released this morning from the CDC’s National Center for Health Statistics. 

  • In 2018, the age-adjusted suicide rate was 14.2 per 100,000 people. In 2020, the number declined to 13.5.
  • In 2020, suicide was the 12th leading cause of death in the United States, changing from the 10th leading cause in 2019. Researchers say the emergence of the deadly coronavirus and a spike in deaths from chronic liver disease and cirrhosis contributed to the shift.
  • This comes after initial reporting suggested the rates could rise, including in The Post.

Meanwhile, lawmakers and the administration have a renewed focus on addressing the country’s mental health crisis. Yesterday, Health and Human Services Secretary Xavier Becerra announced he’d travel across the country to hear about challenges Americans face and speak with local leaders to improve and expand mental health and crisis services.

In other health news

  • On the move: The Senate Finance Committee advanced three of Biden’s nominees for roles at the Department of Health and Human Services for full consideration on the Senate floor: Robert M. Gordon for assistant secretary for financial resources; January Contreras for assistant secretary for family support; Rebecca Gaston for commissioner on children, youth and families
  • What we’re watching: Former Food and Drug Administration commissioner Margaret Hamburg will lead a new commission of health experts seeking to reimagine and reform the country’s public health system based on lessons learned during the coronavirus pandemic, the Commonwealth Fund announced Thursday.
  • A personal effort: Sens. Tim Kaine (D-Va.), Edward J. Markey (D-Mass.) and Tammy Duckworth (D-Ill.) introduced new legislation to fund research into the effects of long covid and expand resources for people experiencing them, our colleague Meagan Flynn reports. For Kaine, the effort is personal, since he says he still has mild symptoms nearly two years after getting the coronavirus.

More from Sen. Tim Kaine (D-Va.):

Sugar rush

Thanks for reading! See y'all tomorrow.

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