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The Health 202

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

Here are the likely mental health components of a gun legislation deal

The Health 202

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

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Welcome to Monday’s Health 202 — your author's mind is blown after seeing “Everything Everywhere All at Once.” Send us your best takes and tips at rachel.roubein@washpost.com

Today’s edition: Both vaccines for the youngest children are safe and effective, FDA said, clearing a major hurdle that could give way to a potential authorization by the end of the week. Public health officials are navigating a delicate but familiar balancing act in attempts to warn gay men about monkeypox without fueling hate. But first …

Much of the new mental health funding may come through Medicaid

The Senate is a major step closer to enacting the most significant response to gun violence in decades.

A bipartisan group of lawmakers clinched a deal on a framework for modest new gun restrictions, as well as new spending on mental health and school security. 

The agreement could have enough GOP support to advance in the Democratic-controlled Senate. But lawmakers aren’t finished hammering out the legislative text, and they haven’t announced an agreed upon funding level. That process could take at least a few days — and is often when new disagreements arise, our colleagues Mike DeBonis and Leigh Ann Caldwell report.

Some parts of the framework — which 20 senators signed on to — were vague on details. Here’s the top line of what we know so far about the mental health components of the deal: 

  • A nationwide expansion of a key way of funding community behavioral health clinics
  • Funds for programs helping families and youth access mental health services via telehealth
  • Funding to encourage states to implement so-called “red flag” laws that let authorities keep guns away from those deemed by a judge to represent a potential threat
  • Beefing up mental health services in schools, such as through early identification and intervention programs

Sen. Chris Murphy (Conn.), the lead Democratic negotiator: 

Diving deeper

On mental health, one major plank of the agreement centers on legislation from Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) to extend a key funding mechanism for certified community behavioral health clinics to all states. Such clinics provide 24/7 crisis care; outpatient mental health and addiction treatment; care coordination with emergency rooms; and more. 

The backstory: In 2014, lawmakers passed legislation creating a demonstration program in eight states where enhanced Medicaid funds reimburse clinics for the cost of care. Proponents of the program argue this funding stream provides clinics with greater financial stability than one-time grants.

The expansion: As of now, Congress only allows 10 states to fully participate in the program. But the new gun deal would let every state participate. 

  • “Our work has been to recognize and make sure that health care above the neck is funded the same way as health care below the neck,” Stabenow said in an interview yesterday.
  • She estimated the cost at roughly $8 billion, give or take. Stabenow said she and Blunt are “fine-tuning” the legislation but don’t expect substantive changes.

Details were minimal on other parts of the framework, such as on telehealth, mental health services in schools and other supports. A congressional aide — who spoke on the condition of anonymity to detail the negotiations — said the framework is also intended to expand trauma-based programs, as well as those focused on community violence intervention.

The estimated price tag of the full package is not yet clear, and Republicans want any new spending to be offset with cuts elsewhere in the federal budget.

Kaiser Family Foundation:

The deal's prospects

Sens. Chris Murphy (D-Conn.), John Cornyn (R-Tex.) and others had set an informal goal of passing the bill before June 24, when senators skip town for a two-week recess. But since the legislation isn’t fully written, that could be a tall order.

The framework falls short of President Biden’s wish list. And it excludes a provision to raise the minimum age to buy some rifles from 18 to 21, which congressional Democrats and some Republicans support, Mike and Leigh Ann note. 

But still, some advocates and senators touted the agreement as historic, saying it could break a decades-long impasse. Ten Republican senators signed onto the statement unveiling the deal, a critical number that overcomes a GOP filibuster if every Democrat is on board. 

And it received a warm reception from Washington’s political leaders. 

  • Senate Majority Leader Chuck Schumer (D-N.Y.) announced plans to “put this bill on the floor as soon as possible” once everything is finalized.
  • Senate Minority Leader Mitch McConnell (R-Ky.) offered encouraging words for the effort, though he didn’t formally endorse the framework.
  • House Speaker Nancy Pelosi (D-Calif.) suggested she’d put whatever the Senate passes before a vote in the Democratic-controlled House.
  • Biden indicated his support in a statement, saying it reflects “important steps in the right direction” even though it fails to encompass “everything that I think is needed.”

More from Mike:

Agency alert

Federal regulators gear up to decide fate of coronavirus shots for young children

By next week, children under 5 years old may be able to get the coronavirus vaccine. But first, both Moderna and Pfizer-BioNTech will defend their shots — the first for children younger than 5 — before a panel of independent advisers for two of the nation’s top federal health agencies. 

The key dates:

  • Wednesday: The Food and Drug Administration’s vaccine advisory committee will meet to consider both vaccines.
  • Friday and Saturday: The Centers for Disease Control and Prevention’s advisers will gather to debate whether to recommend the shots.

If all goes as expected, the FDA will authorize the Moderna and Pfizer-BioNTech vaccines for the youngest children soon after the advisory meeting. Assuming the CDC and its advisers sign off on the shots, the vaccines could be available beginning next week.

Over the last few days, the FDA deemed both shots safe and effective.

  • Preliminary data indicated Pfizer’s shot was 75.6 percent effective in preventing symptomatic covid-19 for babies and toddlers six to 23 months old, and 82.4 percent effective for children 2 to 4 years old.
  • Moderna’s vaccine was shown to be 51 percent effective in preventing illness in toddlers aged 6 months to 2 years old, and 37 percent effective in children 2 to 5 years old. Officials said they expect the vaccine will provide stronger protections against severe disease and hospitalization.

Meanwhile … Moderna is also seeking authorization for its vaccine for children 6 to 17 years old, which the agency gave similarly favorable reviews. The FDA’s independent advisers will review the company’s request on Tuesday. 

Monkeypox

Officials grapple with how to warn gay men about monkeypox

Public health officials nationwide are navigating a delicate but familiar balancing act as the country confronts its largest-ever monkeypox outbreak. They’re attempting to alert gay and bisexual men that they seem to be at higher risk for exposure without creating a false impression that heterosexuals aren’t susceptible, our colleague Fenit Nirappil reports. 

Public health authorities say they are shaping their response to monkeypox using lessons learned from the early days of the AIDS epidemic — when activists said officials failed to act with urgency as HIV decimated gay communities, who were subsequently blamed for the crisis. 

Now, officials are working to get the message out to gay and bisexual men. They’ve distributed prevention information at Pride festivities and worked with dating apps like Grindr to issue alerts about the virus.

As of Friday, the CDC has confirmed 49 cases of monkeypox across 16 states and the District of Columbia. In the 17 cases in which the sexual behavior of the patient is known, all but one involve men who have sex with men, mirroring trends in Europe. 

  • Monkeypox had never been associated with men who have sex with men until the latest outbreak, which experts say is likely a result of the virus first spreading through gay social networks and frequent testing for sexually transmitted disease within the community.

Jim Downs, a history professor at Gettysburg College:

In other health news

  • As of yesterday, international travelers no longer need to show proof of a negative coronavirus test before boarding flights to the United States, ending one of the nation’s last pandemic-related travel requirements, The Post’s Lori Aratani writes.
  • About 1.6 million people in the U.S. identify as transgender, and almost half of them are teenagers and young adults, according to a new report based on government health surveys by UCLA that captures a sharp rise in diverse gender identities.
  • The antiparasitic drug ivermectin doesn’t meaningfully reduce the time needed to recover from covid-19, according to a large study posted yesterday. It’s the latest to show that the drug, popularized as an alternative treatment, is ineffective against the virus, the New York Times reports.
  • New York lawmakers have tried — and failed — to enshrine abortion rights into the state’s constitution. Democrats haven’t found language they’ve agreed on for a state-level equal rights amendment that would have implications beyond just abortion protections, Politico’s Shannon Young reports.

Daybook

It’s another jam-packed week in Washington. 

On tap this week: The Food and Drug Administration today and Wednesday will hold listening sessions on its proposed ban on menthol cigarettes and flavors in cigars, which could be finalized sometime after the public comment period ends July 5. 

Tuesday: A House panel probing the federal coronavirus response will meet to discuss pandemic relief fraud; the Senate HELP Committee will mark up its FDA user fee reauthorization package, among other legislation. 

Wednesday: A Senate Judiciary subcommittee will discuss how consolidation may have impacted the baby formula shortage; a House Veterans Affairs subcommittee will review Biden’s strategy to reduce veteran suicide. 

Thursday: Top federal health officials will testify before the Senate HELP Committee on the federal response to covid-19.

Health reads

Lessons from Poland, the other developed country curtailing abortion rights (By Gordon F. Sander | The Washington Post)

The Billionaire Funding a Battle Against Hospital Monopolies (By Melanie Evans | Wall Street Journal)

Retired general resigns as head of Brookings amid federal probe (By Reis Thebault, Caroline Kitchener and Alex Horton | The Washington Post)

Biden Administration to Pursue Rule Requiring Less Nicotine in U.S. Cigarettes (Jennifer Maloney l The Wall Street Journal)

Sugar rush

Thanks for reading! See y'all tomorrow.

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