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The Health 202

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

Democrats are making a final play for Obamacare expansion this year

The Health 202

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

Helloo, good morning. A Jetsons-style home flew off the real estate market in your author’s hometown. Send news on other futuristic homes, and otherwise, to rachel.roubein@washpost.com

Today’s edition: The Department of Justice unveils a task force to fight state overreach on abortion bans. Over 80 House Democrats are pushing Biden to declare a public health emergency on abortion. But first … 

Democrats hope to extend Obamacare subsidies but Medicaid expansion is probably out

This could be Democrats’ last chance this year to fill the Affordable Care Act’s biggest holes.

Roughly 13 million Americans could see their health insurance costs rise next year — and millions more wouldn't gain coverage — unless congressional Democrats reach an agreement on a critical part of their long-stalled economic spending package, Tony Romm and I report this morning. 

That reality loomed large yesterday as lawmakers huddled again as they attempt to forge a wide-ranging deal with Sen. Joe Manchin (D-W.Va.) before the midterm elections, when the party could lose one or both chambers of Congress. Democrats’ efforts to fulfill the Affordable Care Act’s goals — and make good on their campaign promises —center on two main policies.

  • Closing the Medicaid coverage gap. The proposal has largely faded from the renewed negotiations, according to sources familiar with the matter, as Senate Majority Leader Chuck Schumer (D-N.Y.) and Manchin focus on other policies and eye ways to keep down the costs of the legislation. Some congressional aides confide the odds are low that it makes it in the package, though caution nothing has been decided.
  • Extending enhanced Obamacare subsidies. Manchin is aiming to further limit the subsidies by income level, with the senator broadly believing that federal benefits should be means-tested to focus on the poorest Americans.

Today, we’re diving deeper into the state-of-play on both policies, which Democrats initially sought to address last year before Manchin opposed the package. (Read the full story with Tony here.)

Closing the coverage gap

This Democratic priority has received considerably less attention in recent months. As drafted, the ACA required states to expand Medicaid to those earning up to 133 percent of the federal poverty level. But the Supreme Court made such a move optional for states — and Republican leaders in a dozen states have refused to expand the program.

Democrats first attempted last year to provide premium-free health coverage to the 2.2 million affected adults through the insurance exchanges through 2025. But now, the overall package’s price tag will be much lower, increasing proponents of the policy’s concerns that it may not be included.

Rep. Robin Kelly (D-Ill.), the leader of the Congressional Black Caucus Health Braintrust, told Tony that inaction could thwart efforts to improve the country’s maternal mortality. She said she directly brought up the issue with Schumer, pointing out the “importance of Medicaid postpartum coverage and closing the gap.”

One group — Southerners for Medicaid Expansion — sounded the alarm in a blistering statement putting pressure on Democrats to circumvent Republican officials and extend the safety-net program in their states. 

  • “The need to close the Medicaid coverage gap is greater than ever,” according to the coalition, which is comprised of leaders and groups across eight states that haven’t taken up the ACA’s Medicaid expansion. “Failing to do so would be a moral failure on the part of Senate Democrats and the Biden Administration. It would be an unconscionable abandonment of over two million of the poorest Americans, mostly in the South.”
Continuing enhanced subsidies

An urgent concern for Democrats is the fate of the tax credits that help Americans afford health coverage on the ACA’s insurance marketplaces. The coronavirus package passed last year boosted the financial help for low-income Americans and extended it to middle-income earners for the first time. 

But the beefed-up subsidies expire at the end of the year. Unless Congress extends them, roughly 13 million people could see their monthly premiums spike come January. 

Yet all eyes are on Manchin here. While many Democrats have wanted to make the enhanced tax credits permanent, Manchin has sought to scale them back. Talks to rework the proposal are ongoing, and there’s optimism a solution could be found, according to multiple sources familiar with the matter.

Sam Runyon, a spokeswoman for Manchin, pointed to his past comments, noting the senator remains concerned about “rising inflation, a pending recession and the state of American energy security.”

“He continues to work in good faith to see if there is a pathway forward to shore up domestic energy production and reduce emissions, lower health care costs for seniors and working families, and ensure everyone is paying their fair share of taxes,” she said in a statement.

Reproductive wars

Justice Department announces task force to fight overreach on abortion bans

The Department of Justice is launching a “reproductive rights task force” to marshal federal legal resources aimed at preventing overreach from state and local governments seeking to impose new bans on abortion access, David Nakamura and I report. 

The move essentially consolidates work already underway in the months before the Supreme Court nixed Roe v. Wade’s decades-old protections. 

About the task force: It will be led by Associate Attorney General Vanita Gupta, who will be charged with monitoring and evaluating state and local legislation, as well as weighing potential legal action. The effort includes dedicated staff and representatives from the Justice Department, including the civil division, U.S. attorneys’ offices, the civil rights division, the Office of Legal Counsel, the Office of Access to Justice and the Office of the Solicitor General.

Abortion rights advocates applauded the effort, though it falls short of the more robust actions sought by some Democratic lawmakers and activists. Nancy Northup, the head of the Center for Reproductive Rights — which has been involved in more than three dozen lawsuits — welcomed the additional legal firepower. But antiabortion groups hit back, arguing the federal government shouldn’t attempt to block states’ efforts. 

On the Hill

Lawmakers push Biden to declare public health emergency on abortion

More than 80 Democratic lawmakers are planning to send a letter urging President Biden to issue a national emergency and public health emergency declaration in response to the Supreme Court’s decision striking Roe, our colleague Yasmeen Abutaleb reports.

The move further adds pressure on Biden to invoke emergency powers and swing for the fences in his administration’s response to the Supreme Court's overturning of nearly five decades of abortion rights. 

“As we have experienced during the COVID-19 pandemic, a public health emergency declaration can provide significant new authority and flexibility for a federal emergency response," the lawmakers, led by Reps. Lloyd Doggett (D-Tex.) and Lizzie Fletcher (D-Tex.), wrote in the letter addressed to Biden and Becerra.

Biden said on Sunday he was weighing whether to consider declaring abortion access a public health emergency after several Democratic lawmakers called on him to do so, but some in his administration have expressed reservations about such a step.

The Congressional Black Caucus:

Meanwhile …Some Biden donors are upset with the administration’s response to the overturning of Roe, as well as a statement White House communications director, Kate Bedingfield, gave to The Post this weekend where she said Biden’s goal “is not to satisfy some activists,” the Daily Beast reports.The issue won’t singlehandedly push donors away from Democrats, but it doesn’t help make the case for investing in Biden’s political future. And frustration with the handling of any issue makes fundraising in general more difficult, even if high-level donors are still on board, the Daily Beast’s Scott Bixby writes.

Coronavirus

Biden officials urge use of booster shots, antivirals against BA.5

Biden administration officials are warning that the latest coronavirus subvariants are driving a new wave of cases across the country — and urged Americans to take precautions to protect themselves against infection, reinfection and serious illness, The Post’s Lena H. Sun reports. 

The BA.4 and BA.5 variants now make up 80 percent of cases circulating in the United States. The sub-lineages’ greater transmissibility and immune-evading ability are leading to doubled hospitalization rates since early May. 

What’s old is still new: The administration’s strategy revolves around vaccines, antiviral treatments, testing, masking and improved indoor ventilation — measures that “continue to work” against severe infection, White House coronavirus czar Ashish Jha said at a briefing yesterday.

👀 : The Food and Drug Administration is expected to authorize Novavax’s coronavirus vaccine as early as today, Politico reports. The shot, which relies on decades-old technology, would provide another option for people allergic to components in the mRNA vaccines currently available or those who refuse to receive one. 

Xavier Becerra, Health and Human Services secretary:

Chart check

New coronavirus cases are up 23 percent across the United States in the past week, according to The Post’s tracker. 

Agency alert

Pandemic fueled surge in superbug infections and deaths, CDC says

Infections and deaths from antibiotic-resistant bacteria in U.S. hospitals increased by about 15 percent during the first year of the pandemic, reversing years of progress fighting one of the gravest public health challenges in modern medicine, Lena writes.

The pandemic pushed hospitals, health departments and committees “near their breaking points,” Rochelle Walensky, the head of the Centers for Disease Control and Prevention, wrote in the agency’s new analysis out yesterday. 

Let’s break down what happened:

  • Almost 80 percent of patients hospitalized with covid-19 in the early months of the pandemic received an antibiotic, which are effective against bacteria, not viruses.
  • High-levels of antibiotic prescribing subsequently allowed drug resistance to develop and spread.
  • Meanwhile, hospitals facing severe staffing and personal protective equipment shortages had difficulty following infection prevention and control protocols. And personnel were taken away from infection control to help take care of patients with covid-19.
  • That created a double whammy: Fewer staff members to prevent infections treating more patients at risk for them.

Andrew Pavia, infectious-disease specialist:

In other health news

  • Ukraine will receive another $1.7 billion in assistance from the United States and the World Bank to pay health-care workers’ salaries and provide other essential services, the Associated Press reports.
  • The pandemic remains a global public health emergency, the World Health Organization said yesterday, per the New York Times.
  • The Democratic National Committee launched a digital ad campaign warning that Republicans are pushing to ban abortion nationally in an effort to galvanize its base in the wake of the Supreme Court’s ruling.

Health reads

Pennsylvania GOP aims to bypass governor’s veto on abortion restrictions (By Katie Shepherd | The Washington Post)

A Culture Warrior Goes Quiet: DeSantis Dodges Questions on Abortion Plans (by Maggie Haberman, Patricia Mazzei and Michael C. Bender | The New York Times)

Doctor proposes floating abortion clinic in Gulf of Mexico to avoid bans (By Brittany Shammas | The Washington Post)

Sugar rush

Thanks for reading! See y’all tomorrow.

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