Americans need convincing on the broad Build Back Better agenda

Jan 26, 2022

Presented by Humana

With Tucker Doherty

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— While many Americans buy into BBB's health provisions,they're largely concerned the sweeping bill could drive inflation.

— House Majority Leader Steny Hoyer says Congress can combat those fears and is confident a form of BBB could pass.

— Federal advisers aren't convinced that heart screening gadgets have broad use, dealing a blow to industry champions like Apple.

WELCOME TO WEDNESDAY PULSE — "I played once and enjoyed it enough that I vowed never to play it again": Finally, a psycholinguist weighs in on Wordle. Send your Wordle scores and health news to sowermohle@politico.com.

A message from Humana:

In 2022, older Americans are getting more out of Medicare Advantage. Many Americans turning 65 or who are new to Medicare have access to plans that provide supplemental benefits tailored to address key social health needs like food security, transportation, and in-home support services. Learn more about how Medicare Advantage plans are helping address members' whole health.

Driving the Day

POLL: AMERICANS LIKE BBB'S HEALTH PROVISIONS BUT WORRY ABOUT COST — Democrats trying to salvage parts of the Biden social spending agenda will find a limited number of issues that resonate with voters heading into the midterm elections, according to a POLITICO-Harvard survey that shows significant concern over whether big-ticket items could lead to more inflation.

Respondents think free universal pre-K, paid family and medical leave and lower prescription drug prices would help their families and the country. But only about one in three believe President Joe Biden's entireBuild Back Better Act would help the country, and less than one in four believe it will help their own families, POLITICO's Adriel Bettelheim writes.

The numbers: The survey of 1,004 respondents, conducted from Jan. 4 to 9, also found that most are convinced the $1 trillion infrastructure plan Congress passed last year won't help the country or their personal lives. Independents tended to side with Republicans in viewing the package as inflationary, upending the conventional view that big, bipartisan public works initiatives transcend partisan politics.

The findings come as Biden continues to rally support for his domestic agenda, like calling in to the Families USA conference Tuesday to renew efforts to pass the package. But respondents to the POLITICO-Harvard survey were skeptical about the benefits when asked about five key items in the package.

On social-spending policies, 59 percent said establishing free universal pre-K for the nation's 3- and 4-year-olds would help the country, and 53 percent felt the same about providing four weeks of paid leave for U.S. workers. Just less than half believe that policies in the plan meant to lower prescription drug prices would actually reduce costs.

And more than four in 10 people believe that both the BBB and the infrastructure bill will increase inflation.

"The public is saying they aren't familiar with the Build Back Better bill and are not supportive of it as it stands," said Robert Blendon, a professor of health policy and political analysis at the Harvard T.H. Chan School of Public Health, who designed the poll. "But if you rebrand the Build Better Better plan and it only has a few things the public thinks are very important, they could reconsider and might love it."

HOYER CONFIDENT A SMALLER BBBCOULD PASS — House Majority Leader Steny Hoyer is still optimistic about Build Back Better's prospects (and the voters' rights bill) but admitted the sweeping social spending package might need to be broken down for passage as Biden suggested last week.

"I think we can, and I think we will," rally the party around narrower legislation, Hoyer told POLITICO Playbook co-author Rachael Bade in a livestreamed interview on Tuesday. "We have to look at what we can get, not what we'd like to get."

He declined to say which provisions might be shaved off in the Senate, though he said the child tax credit is "very important."

Hoyer also argued against inflation concerns, saying that the legislation, combined with measures like the Make It in America Act and the U.S. Innovation and Competition Act, would help people get back to work, thus boosting the economy and counteracting inflation.

"When the Republicans say, 'What are you going to do about inflation?' I say, 'We're doing it,'" Hoyer said. He argued supply chain shortages, not federal spending, are the leading cause of inflation.

HEART SCREENING GADGETS DON'T HAVE THE BEAT — There's not enough evidence to justify the widespread screening for irregular heartbeat using devices like the Apple Watch, a new review from the U.S. Preventive Services Task Force concludes.

It's a blow to the legions of gadget makers that have introduced consumer products aimed at detecting the condition: If the task force approved of the devices, insurers would have to cover the services without a co-pay, POLITICO's Darius Tahir writes.

"As with any screening test, the question is whether this knowledge can guide management decisions that ultimately improve outcomes. The evidence to date suggests the answer is no," an editorial in JAMA Internal Medicine concludes.

The background: Atrial fibrillation is a type of heart rhythm irregularity that can suggest a risk for strokes. Older technology to spot those irregularities was expensive, inconvenient and prescribed by a doctor, limiting its use to at-risk patients.

With the advent of consumer products like the Apple Watch, relatively healthy and young patients could get an AF diagnosis — the question is whether that's a meaningful risk for them.

What's next: Even with the task force rebuff, the question won't go away, two cardiologists argue in a JAMA editorial. Consumer-available technology will permit AF screening whether clinicians order it or not."

A message from Humana:

Coronavirus

REPUBLICANS SAY ANTIVIRAL GUIDANCE IS ANTI-WHITE — Republicans are accusing the Biden administration of racism — against white people.

Health agencies' recommendation that race and ethnicity be considered when deciding who gets the limited supply of new Covid treatments is the latest political cudgel Republicans are hammering Democrats with, looking to energize their base ahead of the midterm elections, POLITICO's Alice Miranda Ollstein and Megan Messerly report.

And Democratic strategists say those attacks, while baseless, may prove effective, further hampering the party's efforts to retain its slim congressional majorities.

What happened: The strategic germ took hold after the Food and Drug Administration released new guidance on the use of sotrovimab, the only monoclonal antibody treatment that's shown effectiveness against the Omicron variant.

Demand currently outweighs supply for the complex antibody. The Biden administration recommended that doctors can, but aren't required to, consider race or ethnicity among a series of other health factors like weight, age and comorbidities, including cancer or diabetes, when doling out the therapy.

And what could happen: A senior aide to a GOP lawmaker focused on the issue told POLITICO that Republicans are looking for ways to squeeze Democrats on the race criteria leading up to the November midterms and beyond.

"There's not a ton we can do now. But if there's another vote-a-rama, expect an amendment on this. It'll be a tough vote for Democrats," he said. "And if Republicans take back Congress, expect investigations and oversight. We will make the officials who signed off on it come up here and defend it."

In Congress

ICYMI: SENATORS WANT CONFIRMATION FOR CDC DIRECTOR — Top lawmakers on the Senate health committee are proposing a new bill to make the CDC director subject to Senate confirmation for the first time.

HELP Chair Sen. Patty Murray (D-WA) and ranking Republican Sen. Richard Burr (R-NC) introduced the PREVENT Pandemics Act Tuesday as part of a draft pandemic preparedness bill amid heightened scrutiny of the agency and Director Rochelle Walensky over mixed messages on the crisis and the direction of the pandemic response, POLITICO's Ben Leonard reports.

The draft bill proposes "specific functions" for the CDC director and requires a CDC strategic plan every four years.

It also calls for a bipartisan-appointed 9/11-style commission on the Covid-19 response and the virus' emergence and would mandate a final report be delivered within a year, with a potential six-month extension.

HOUSE DEMS PRESS FOR LONG COVID DATA — Rep. Ayanna Pressley (D-MA) and Rep. Don Beyer (D-VA) sent a letter to the CDC on Tuesday, urging the agency to publish data on long Covid, particularly demographic details that could give a picture of its public health impact.

The lawmakers highlighted studies suggesting women are more vulnerable to long COVID and noted the disproportionate affect the virus has had on people of color. "To fully confront the ongoing pandemic, Congress needs disaggregated demographic data on the prevalence of Long COVID," they wrote.

Names in the News

Mandy Cohen will become CEO of Aledade Care Solutions, Aledade's new health services segment, in March. Cohen most recently served as North Carolina's Secretary of Health and Human Services and spent years at the Centers for Medicare and Medicaid Services, where she worked as chief operating officer and chief of staff during the Obama administration.

At Aledade, Cohen will lead services for more than a thousand primary care practices in the company's network of accountable care organizations, Aledade said in a statement.

The Food and Drug Administration's Grail Sipes next month leaves her role as the Center for Drug Evaluation and Research's deputy director for regulatory policy to be assistant director for biomedical regulatory policy, a position within the FDA commissioner's office that will work with the White House's Office of Science and Technology Policy. Sipes worked in CDER for seven years.

CDER's Elizabeth Jungman will assume the role of associate director for policy after Sipes' departure and continue to serve as director of the center's Office of Regulatory Policy.

The Community Oncology Alliance tapped Nicolas Ferreyros to serve as its first managing director, where he'll oversee state policy, patient advocacy and communications for the nonprofit representing cancer practices. Ferreyros joined COA in 2015 as director of communications.

What We're Reading

Some hospitals facing short supplies are resorting to lotteries to allocate scarce COVID drugs for immunocompromised patients, NPR's Pien Huang reports.

As the federal vaccine mandate deadline looms, nursing homes are struggling with staffing shortages that could take a turn for the worse, Kaiser Health News' Eric Berger reports.

China's zero-Covid policy could be a recipe for disaster if the virus becomes globally endemic, Ezekiel J. Emanuel and Michael T. Osterholm write in The New York Times.

A message from Humana:

Medicare Advantage plans are evolving to meet the needs of Americans turning 65 or who are new to Medicare. With food insecurity and a lack of transportation making it difficult for many older Americans to seek care, supplemental benefits like transportation support and meal assistance can make a real difference in their lives. In 2022, more Medicare Advantage plans are providing meal assistance and transportation help, and the number of Medicare Advantage plans offering in-home support services doubled from 2021. Learn more about why 40% of people eligible for Medicare choose Medicare Advantage and how Medicare Advantage plans are supporting older Americans beyond the doctor's office.