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The Health 202

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

Congressional Democrats are still vying for health-care wins

The Health 202

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

Happy Monday morning, everyone. Here’s one story that stuck with us this weekend: How a fight over a column on coronavirus vaccines for kids could kill one of the country’s oldest alt-weeklies.

Today’s edition: The Biden administration will no longer fight a Trump-era extension of Texas’s Medicaid waiver. Former Sen. Orrin Hatch, who championed some key bipartisan health bills, died over the weekend. But first …

Covid funding, insulin price caps and Democrats' big social spending bill are on the table

Welcome back, Congress. Lawmakers are facing fierce battles over pandemic aid and other key health priorities as they return to Capitol Hill this week. 

Here’s what’s on tap:

  • Congress is wrestling with the path forward on pandemic aid after a border dispute upended swift passage of a $10 billion deal.
  • A bipartisan pair of senators is hammering out final insulin pricing legislation.
  • Democrats are hoping to finish their work on a new version of their scaled-back economic package by July 4, our colleague Tony Romm reports.

The next weeks-long stretch is crucial for Democrats’ agenda. It’s just over six months before the midterm elections, and the party wants to notch a series of concrete wins to bring to voters. But Democratic leaders are grappling with a number of obstacles, including intraparty squabbles.  

Covid cash

There’s still not a clear path forward to pass billions more dollars in pandemic aid. The snag? Bipartisan backlash to the Biden administration’s decision to relax pandemic restrictions at the U.S. border.

Republicans have demanded that they be allowed to vote on amendments to tack onto the $10 billion coronavirus package. They’ve made no secret that they want an amendment directed at Biden’s border policies.

But if a vote were allowed, there’s a chance such an amendment could be adopted. That’s because Biden has faced growing concern from Democratic candidates, including vulnerable senators, who have questioned the administration’s move to lift the pandemic public health order in late May. Yet, any effort to keep Title 42 in place would threaten passage of more covid aid in the House. 

  • “I think we are still in a stuck place, and it’s probably worse than it was when we left,” one senior Senate GOP aide said.
  • Top administration officials have repeatedly warned of the consequences of congressional inaction. As Congress returns from a two-week recess, the administration “will be focused on working with lawmakers” to secure pandemic aid as well as more funds to assist Ukraine, a White House official said in a statement.

Also looming: It’s likely Republicans would want to pursue an amendment targeting mask mandates on planes and other public transit, the GOP aide said. Many Republicans cheered a federal judge’s decision to strike down the requirement to wear face coverings on public transportation, but the administration is appealing the ruling.

Sen. John Cornyn (R-Tex.):

The insulin question

Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) are working to craft final legislation aimed at lowering the cost of insulin. But the effort faces Republican head winds.

The duo, along with leaders of the House Diabetes Caucus, released their bipartisan policy priorities earlier this month. The list included … 

  • Ensuring plans and pharmacy benefit managers can’t collect rebates on insulins that roll prices back to 2006 or similar levels
  • Increasing patient access, such as cracking down on prior authorization requirements
  • Placing a $35 per month out-of-pocket cap on insulin, which has been touted by Sen. Raphael Warnock (D-Ga.)

Senate Majority Leader Chuck Schumer (D-N.Y.) has previously said he hopes to put such a bill on the floor as soon as possible after the Easter recess. Yet, the legislation would need the support of 10 Republicans — and there’s some skepticism such a bill could muster enough GOP votes to pass. 

Republicans have blasted the $35 cap as “socialist price controls,” and the senior GOP aide said they didn’t believe it could garner enough votes to pass. One health-care lobbyist also speculated that Republicans may be wary of giving Warnock — one of Democrats’ most vulnerable members — a win to campaign on. 

The view from Shaheen/Collins: The senators “will continue engaging with fellow lawmakers to garner support for their effort,” according to an aide to Shaheen, who added that the pair have “long championed” measures to lower the cost of insulin. 

Ghosts of BBB

Democrats are seeking to refashion President Biden’s signature social spending bill — and are hoping to finalize their work on a new version by July 4. Top White House aides have revived discussions with Sen. Joe Manchin (D-W.Va.), who has long been an obstacle to passing the legislation, Tony reports.

But a deal may need to be brokered around Memorial Day, which is the end of the Senate’s upcoming work period. 

In health policy circles, there’s increasing anxiety about extending enhanced Obamacare financial aid — a policy included in the original Build Back Better Act. Last spring, Democrats passed a measure making it significantly cheaper for low- and middle-income Americans to purchase Obamacare plans. But the boosted subsidies are set to run out at the end of the year, raising the specter that Americans could learn of premium increases right before the midterms.

Agency alert

Biden administration drops its fight against Texas's Trump-era Medicaid waiver

The Biden administration is letting a Trump-era Texas Medicaid waiver extension stand, deciding the year-long court battle was no longer a good use of federal resources.

At issue: In the final days of former President Donald Trump’s term, his administration granted an unprecedented 10-year extension for Texas’s Medicaid waiver. The state has a high rate of uninsured patients, and the waiver includes substantial funding for health providers to cover the cost of caring for those without coverage. 

Biden’s Centers for Medicare and Medicaid Services rescinded the approval last April, arguing it was erroneously granted without going through the required public comment period. The revocation sparked a firestorm of opposition from Republicans, as well as a lawsuit from the Texas attorney general’s office. In August, a federal judge temporarily allowed the waiver to remain.

But on Friday, CMS said it was backing off its fight to withdraw the waiver approval. “CMS has concluded that it is not the best use of the federal government’s limited resources to continue to litigate this matter,” CMS Administrator Chiquita Brooks-LaSure wrote in a letter to Texas’s Medicaid chief.

The waiver has come under scrutiny from advocates who say the state would have vastly fewer uninsured residents if it instead took up Obamacare’s Medicaid expansion. Meanwhile, Texas Gov. Greg Abbott (R) lauded the agency’s decision, saying it would allow the state to continue maintaining “an efficient and effective Medicaid” program. 

Meanwhile … CMS proposed a rule aimed at making it easier to get Medicare coverage.

The plan would provide Medicare benefits to people the month after they enroll; create special enrollment periods in certain circumstances; and let eligible beneficiaries receive Part B coverage without a late enrollment penalty.

On the Hill

Former senator Hatch, a fixture on Capitol Hill, dies at 88

Orrin Hatch, the longest-serving Republican in Senate history, died Saturday at 88, The Post’s Michael H. Brown reports. 

A conservative Utah Republican, Hatch’s 42-year tenure included working with Democrats to pass some major health-care policies:

  • Along with Sen. Edward M. Kennedy (D-Mass.), Hatch championed the 1997 Children’s Health Insurance Program through Congress, which provided states with matching grants to cover uninsured children in working-poor families.
  • Hatch and Kennedy also worked with Iowa Democrat Sen. Tom Harkin to pass the landmark 1990 Americans With Disabilities Act prohibiting discrimination against — and requiring accommodations for — people with disabilities.
  • The lawmaker also shaped other bipartisan bills to accelerate the approval process of cheaper generic drugs and to fund care for uninsured and underinsured HIV/AIDS patients.

But while Hatch worked with Democrats on some issues, he battled them fiercely on many others, Michael writes. The Almanac of American Politics called him “consistent in his inconsistency.” 

A career-long advocate of restricting abortion, he proposed the “Hatch amendment” to the Constitution, which would have limited the procedure’s availability. Meanwhile, during the Obama White House years, he was an “untiring foe” of the Affordable Care Act, and lobbied hard in Congress to have it repealed.

  • Yet, Republicans failed to fulfill a years-long campaign pledge and overturn the health law when Hatch chaired the powerful Senate Finance Committee in 2017.

Larry Levitt, executive vice president for health policy at Kaiser Family Foundation:


It’s a busy week. 

We’re watching for action on two major issues …  

  • By the end of the month, Moderna plans to file for emergency use authorization of its coronavirus vaccine for children between 6 months to 5 years, a company spokesperson confirmed to The Health 202.
  • The White House budget office finished reviewing long-awaited proposals to ban menthol in cigars and cigarettes. That means they could come out any day now.

And back to your weekly schedule of events … 

Today: Our colleague Frances Stead Sellers will interview Sen. Tim Kaine (D-Va.) on his experience with long covid and his bill to expand research into the condition. 

Tuesday hearings: The Senate HELP Committee on FDA user fee agreements; a House Veterans' Affairs subcommittee on the agency’s health record modernization program.  

Wednesday hearings: The House Committee on Oversight and Reform on allegations of potential conflicts of interest at McKinsey & Company; a House Appropriations subcommittee on the FDA’s fiscal year 2023 budget request; a House Appropriations subcommittee on reproductive health, mental health and other programs for veterans; a House Energy and Commerce subcommittee on HHS’s budget request.

Thursday hearings: A House Natural Resources subcommittee on preventing pandemics through wildlife-borne disease surveillance; a Senate Appropriations subcommittee on the FDA’s budget request; the House Ways and Means Committee on HHS’s budget request.

Also on Thursday: The Post’s Yasmeen Abutaleb will interview Deborah Birx about her time as Trump’s coronavirus task force coordinator, as detailed in Birx’s new book “Silent Invasion.”

Friday’s hearing: The House Select Subcommittee on the Coronavirus Crisis on ensuring scientific integrity at the country’s public health agencies. 

Health reads

Some Republicans fear party overreach on LGBT measures (By Annie Linskey and Casey Parks | The Washington Post)

The Drive to Vaccinate the World Against Covid Is Losing Steam (By Rebecca Robbins and Stephanie Nolen | The New York Times)

400,000 fewer kindergarteners raises CDC concern about childhood shots (By Lena H. Sun | The Washington Post)

Sugar rush

Thanks for reading! See y'all tomorrow.