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The Health 202

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

Medicare chief vows to implement drug pricing reforms on time

The Health 202

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

Welcome to Tuesday’s Health 202, where we’re fascinated by the most changed baby names of the past few years (spoiler: this list includes spelling mistakes). Send tips and spelling regrets to

Today’s edition: State officials are frustrated with the Biden administration’s rollout of the monkeypox vaccine. Inside the effort to expand Medicaid in two holdout states. But first … 

Chiquita Brooks-LaSure intends to hit the health-care deadlines in the economic package

President Biden’s Medicare chief is pledging to meet critical deadlines for implementing the policies in Democrats’ spending package aimed at lowering seniors’ drug costs.

“We are very comfortable with the timelines that are outlined in the law,” Chiquita Brooks-LaSure, the head of the Centers for Medicare and Medicaid Services, told The Health 202. “We absolutely intend to hit all of them.” 

This afternoon, Biden will sign the long-delayed legislation, which won the support of every House Democrat on Friday. The Department of Health and Human Services plans to begin work on standing up the law as soon as it receives Biden’s official green light. That lets hiring and contracting begin — and CMS is planning to bring on more staff particularly to help out with efforts around letting Medicare negotiate the price of drugs for the first time.

But executing sweeping changes to the health system is no easy task. The challenges of turning legislative text into action were on full display in 2013, when the Obama administration botched the rollout of 

Many high-level CMS staff, as well as the No. 2 HHS official, helped implement various aspects of the Affordable Care Act. Last year, CMS leadership had conversations around lessons learned from ACA implementation as they geared up for the notion that they would once again be tasked with overseeing a new health law.

Two big changes

When it comes to health policy, there are two main facets of Democrats’ spending bill.

The first: Extending enhanced Obamacare subsidies for another three years. That’s relatively simple to do, since the beefed-up tax credits are already in effect.

The second: Changes to seniors’ drug costs. Some of the new policies build on existing systems, such as redesigning parts of Medicare’s voluntary prescription drug benefit. 

The most complex part of the law will be creating a way for Medicare to negotiate drug prices — which the federal program for older adults and those with disabilities has never done before. CMS will be charged with implementing the Medicare drug provisions, according to HHS. 

Next year, Medicare will announce the first 10 drugs it will negotiate, and those prices will be in effect starting in 2026. The program will gradually scale up to negotiating 20 drugs by 2029.

Brooks-LaSure said the agency has been working closely with Congress, though declined to detail private conversations. A person familiar with the discussions said the agency did a lot of technical assistance with Capitol Hill on the operational side of standing up the programs. Rep. Scott Peters (D-Calif.), who was intimately involved in crafting the drug provisions, said he was on the phone with CMS often to ensure the agency would be able to execute potential policies.

More from Brooks-LaSure:

Lessons from Obamacare

Implementing Democrats’ biggest changes to health care in over a decade won’t be exactly the same as implementing Obamacare. 

For one, three departments had to weigh in on some of the ACA’s regulations and creating major parts of the law involved communicating with all 50 states. That’s not the case for the new package, known as the Inflation Reduction Act. Meanwhile, the Department of Veterans Affairs negotiates drug prices, so there are already contractors and government officials who have expertise in this area. 

“Because it's starting small with 10 drugs and the process is rolling out over a few years, there is certainly time to work out any unanticipated concerns,” said Rachel Sachs, a professor at the Washington University in St. Louis School of Law.

Yet, the 2010 health law implementation is on the minds of senior government officials. And there are a plethora of Obama alumni working in Biden’s health department.

  • This list includes Brooks-LaSure; Andrea Palm, the deputy secretary of HHS; Jonathan Blum, the CMS principal deputy and chief operating officer; Meena Seshamani, the director of the Center for Medicare; Ellen Montz, the head of the Center for Consumer Information and Insurance Oversight; and more.
  • “They will be very, very familiar with what worked really well, and what didn’t work so well, which is certainly a great advantage as you start to look at a big new puzzle piece,” said Kathleen Sebelius, who served as HHS secretary during the first years of Obamacare’s implementation.

Last year, when federal officials discussed lessons learned from ACA implementation, they focused on several takeaways. This included thinking through operational implications, engaging with the industry and making decisions in a timely and transparent way. 

“It always takes, when you are doing something different, a lot of work to make sure that you engage the right stakeholders and design a new system,” Brooks-LaSure said. “But we are confident in the plan.”

Monkeypox update

‘Frustration and stress’ mark federal rollout of monkeypox vaccine

The Biden administration isn’t relying on an established system to distribute the monkeypox vaccine — a fact that has slowed immunizations and overwhelmed local health departments as the virus spreads, the New York Times reports. 

Officials in at least 20 states and jurisdictions, more than half of which are led by Democrats, have complained about the federal rollout of the Jynneos vaccine.

Key context: In previous public health emergencies, including the covid-19 pandemic, vaccines were delivered to health-care providers through a system run by the Centers for Disease Control and Prevention. That system, called VTrckS, regularly moves billions of vaccine doses for annual immunizations and is integrated with state databases that track vaccinations and doses. 

But Jynneos is being dispersed out of the National Strategic Stockpile by a different government agency. That agency isn’t set up to take ongoing orders, arrange deliveries, track shipments or integrate with state systems, the New York Times’s Apoorva Mandavilli writes.

As a result … the stockpile is shipping monkeypox vaccines to just five sites in each state, regardless of size. Local officials must order vaccines, distribute doses, track them manually and enter the data into their databases — none of which is necessary under the CDC’s system. 

HHS said in a statement to NYT that it had considered several options for delivering the vaccine, but that it isn’t using VTrckS because it would take months to integrate it with the stockpile. The Department is seeking a commercial partner to improve delivery. 

The sharp criticisms came hours before HHS announced that the Biden administration’s new strategy to split monkeypox vaccine doses will allow states to order up to 442,000 doses of Bavarian Nordic’s Jynneos shot — double the number originally anticipated.

Theresa Chapple, epidemiologist: 

State scan

The battle to close the Medicaid coverage gap continues

Democrats failed to plug one of the Affordable Care Act’s biggest holes in their sweeping health-and-climate bill. That means all eyes are back on the states, where Medicaid advocates are continuing to push reluctant Republican officials to extend the safety net program in the dozen states that have refused to do so for years. 

In Georgia, some state Republican lawmakers have quietly changed their minds. Discussions about a potential path forward are occurring behind the scenes, Axios Atlanta reports, citing conversations with nearly a dozen lawmakers and lobbyists.

Why the shift? Brian Robinson — spokesman for former governor Nathan Deal (R), the first to reject Medicaid expansion — said Republicans’ initial fear that the federal government would pull its 90 percent funding match hasn’t happened. Meanwhile, the “repeal and replace” movement against the ACA is dead.

“There are many conversations happening in many rooms about how Medicaid could be expanded in Georgia, regardless of who is elected governor,” state House Rep. Mary Margaret Oliver (D) told Axios’s Emma Hurt. Talks are happening among Democrats and Republicans, she added, in a way that feels new.

In North Carolina, state Republican leaders were on the cusp of securing a deal. But in the final hours of the state’s legislative session, negotiations crumbled, Axios Raleigh reports. 

Outside influence: Both Democrats and Republicans said the North Carolina Healthcare Association, a group that represents the state’s hospitals, was a driving force behind the latest failure to expand Medicaid. 

Earlier this year, the state House and Senate passed different versions of plans to expand Medicaid, but neither bill ultimately moved forward. That’s in part because the hospital association fought to block a provision in the Senate’s bill that would loosen the state’s “certificate of needs” laws, arguing such a move would be a blow to facilities’ revenue. (The hospital association argues it’s not at fault and that it supports expansion.)

The failed measure points to the hospital association’s sweeping influence over the state’s legislative process. Yet Medicaid expansion still has a shot at becoming law in North Carolina, where political leaders and the hospital associations say discussions are ongoing, Axios’ Lucille Sherman writes. 

North Carolina State Rep. Wesley Harris (D):

In other health news

  • A Michigan antiabortion group has reserved nearly $16 million in TV ads from the end of August to Election Day, a sign of the expensive battle over the procedure to come this fall in a key swing state, our colleague Hannah Knowles reports.
  • Defense Secretary Lloyd Austin has tested positive for the coronavirus for a second time and is experiencing mild symptoms.
  • Novavax is seeking emergency use authorization of its coronavirus booster shot from the Food and Drug Administration, the company announced yesterday.
  • The median annual price for 13 drugs the FDA approved for chronic conditions is $257,000 so far this year, according to Reuters. The news outlet’s analysis highlights the pricing power of drugmakers as the federal government moves to cut the $500 billion-plus annual bill for prescription drugs in the United States.

Health reads

Most abortions are done at home. Antiabortion groups are taking aim. (By Kimberly Kindy | The Washington Post)

Colleges warn students about monkeypox risk as fall term approaches (By Nick Anderson | The Washington Post)

Post-Roe, more Americans want their tubes tied. It isn’t easy. (By Meena Venkataramanan | The Washington Post)

Sugar rush

Thanks for reading! See y'all tomorrow.