Long Covid plan lays out breadth of challenge

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Apr 06, 2022 View in browser   By Sarah Owermohle and Krista Mahr Presented by With Ben Leonard Editor's Note: POLITICO Pulse is a free version of POLITICO Pro Health Care's morning newsletter, which is delivered to our subscribers each morning at 6 a.m. The POLITICO Pro platform combines the news you need with tools you can use to take action on the day's biggest stories.  Act on the news with POLITICO Pro. QUICK FIX — At the heart of Biden's long Covid plan is the reality that coronavirus funding needs could persist for years. — Lawmakers are already talking about the next relief package, concerned about apathy following an upcoming vote on a fraction of the need. —Doctors and patients want telehealth to continue across state lines, new polling shows, as states continue to cut off the practice. WELCOME TO WEDNESDAY PULSE, where we're disappointed to see that the U.S. health care system still ranks so poorly on maternal and women's health care compared to peers. Send news and tips to sowermohle@politico.com and kmahr@politico.com.   A message from PhRMA: New data show that 35% of insured Americans spent more on out-of-pocket costs than they could afford in the past month. Read more about how insurance is leaving patients exposed to deepening inequities.   Driving the Day BIDEN'S 'LONG COVID' PLAN BUILDS THE FUNDING CASE — The president's order that the Health and Human Services Department assemble a cross-government long Covid strategy consolidates a rapidly growing plan under the health secretary. But in many ways, the plan is another reprise of the same song: We need more coronavirus funds, because this isn't going away soon. What's happening: The effort launched Tuesday afternoon aims to broaden research, detection and treatment access to fight lingering or late-emerging effects of coronavirus infection that impacts between seven and 23 million Americans, according to some estimates. Those symptoms can range from brain fog to shortness of breath, heart irregularities and kidney problems, making it difficult for doctors to categorize and track long Covid prevalence and needs. What they're asking for: Many of the initiatives the plan lays out are built into the $82 billion the White House has requested for coronavirus efforts in fiscal year 2023. That includes $25 million to build on CDC's surveillance program and $20 million to establish a Centers of Excellence. There's also an effort to set up long Covid clinics, accelerate trial enrollment and boost provider education to properly identify and bill long Covid cases (as opposed to a range of chronic conditions it can resemble). The consolidated plan comes amid building anxiety among federal health officials and patient advocates that Congress is losing interest in short-term funding needs, let alone preparedness efforts and sprawling long-term initiatives without defined parameters — like tackling long Covid. More on that in a moment... In the meantime, hospital groups have urged HHS to better define long Covid and how to treat it before ending the public health emergency, an early sign of potential coverage and billing battles to come. BURSTS OF COVID CASH AREN'T ENOUGH — That's the concern of many Democrats and public health advocates as senators near a vote on $10 billion in pandemic aid that the administration has warned won't last through October, POLITICO's Alice Miranda Ollstein and Erin Banco write. That means bitterly divided lawmakers will have to debate again soon. This round of funding — if it can pass the House and Senate — would help restart key Covid-19 programs that recently ran out of resources, including the development of future variant-specific vaccines and purchasing more treatments. But it's a fraction of the administration's original $30 billion request. "I would think they'd have to be back in 60 to 90 days," Sen. Roy Blunt of Missouri, the Senate's top GOP health care appropriator, told POLITICO. "I don't think anyone thinks it will last through the summer, and maybe doesn't last until the summer." Yet building a coalition for more funding is getting harder with a tight congressional calendar heading into the midterms, ongoing pandemic fatigue and partisan disagreements over whether and how much to spend on both the domestic and international public health emergency, Alice and Erin write. Senate Majority Leader Chuck Schumer was quick to note the need for more "later this spring," saying this deal "is well short of what is truly needed to keep us safe." That next bill, Schumer argued, should also meet international needs, and combine global Covid aid with more funding for Ukraine and to address food insecurity around the world. DOCTORS, PATIENTS WANT TELEHEALTH TO CONTINUE ACROSS STATE BORDERS — A Morning Consult poll on telehealth published today finds that health care providers and patients alike support telehealth practitioners being able to operate across state lines as the pandemic moves into a less critical phase. Many states have ended or are planning to end waivers they enacted during the health crisis that allowed health care providers to care for patients in other states. One in five practitioners polled say they have provided health care services across state lines under an emergency waiver program. Now eight in 10 health care providers support being able to practice telehealth across state lines, and the majority also believe cutting off that ability will have a negative impact on patients' health, access to care, and safety. More than 75 percent of patients also support the option to seek telehealth care outside their state.   SUBSCRIBE TO NATIONAL SECURITY DAILY : Keep up with the latest critical developments from Ukraine and across Europe in our daily newsletter, National Security Daily. The Russian invasion of Ukraine could disrupt the established world order and result in a refugee crisis, increased cyberattacks, rising energy costs and additional disruption to global supply chains. Go inside the top national security and foreign-policymaking shops for insight on the global threats faced by the U.S. and its allies and what actions world leaders are taking to address them. Subscribe today.     In Congress FIRST IN PULSE: BEHAVIORAL IT BILL — Reps. Doris Matsui (D-Calif.) and Markwayne Mullin (R-Okla.) are introducing a bill Wednesday that would incentivize health IT use by behavioral health providers, POLITICO's Ben Leonard reports. The bill, dubbed the BHIT NOW Act, would direct the CMS Innovation Center to set up a $250 million program funding providers' maintenance, training and startup costs over three fiscal years. It would also tap the Substance Abuse and Mental Health Services Administration and Office of the National Coordinator for Health IT to put together voluntary tech standards. "This legislation will open up the door for more behavioral health providers to get their hands on the hardware, software and training they need to leverage vital technology that supports coordinated, high-value care," Matsui said. Coronavirus THE SHRINKING TREATMENT POOL — The FDA pulled its emergency use authorization for the monoclonal antibody treatment drug sotrovimab on Tuesday, reports POLITICO's Lauren Gardner , as the BA.2 subvariant dominates U.S. infections. The decision shrinks the pool of Covid treatments intended to keep vulnerable patients with mild to moderate disease out of the hospital, after two other monoclonals have proven ineffective against Omicron. After finding the authorized dose of sotrovimab was unlikely to be effective against BA.2, FDA began restricting its use to areas of the country where the subvariant was linked to fewer than half of all infections. Three drugs — Paxlovid, molnupiravir, and remdesivir — are still authorized for use in high-risk U.S. Covid patients.   A message from PhRMA:   Around the Agencies FORMER CDC HEADS GO HEAD TO HEAD — Former CDC Director Robert Redfield said that he still had the "shrapnel in his back" from the criticism he took as head of the agency during a panel hosted by the Harvard T.H. Chan School of Public Health. And he made sure a fellow panelists, former CDC Director Bill Foege, knew he was talking about him. "I was actually very disappointed in Bill and his decision to publicly criticize me fairly aggressively, but that's water under the bridge," Redfield said, and then added: "The one thing I've gained by being CDC director for three years in the Trump administration is every time that I go through a a airport now I trigger the metal detector because of all the shrapnel that's in my back." Redfield was referring to a 2020 letter from Foege, addressed to Redfield, that ran in the national media, urging Redfield to stand up to former President Donald Trump's meddling in the CDC's coronavirus response. Foege defended himself to Redfield, saying he had sent it to him privately and it was leaked. The back-and-forth took place in the context of a broader conversation about political interference in the CDC, a problem that all four former CDC directors present agreed was a problem that needed to be fixed. Bill Roper, who ran the agency from 1990 to 1993, said the idea that you can take the politics out of public health is "never going to happen." But he said, "we have way too many White House advisers on everything," which disempowers the HHS secretary and CDC director. "Unless you're very careful, the White House staff ends up doing what they did in the Vietnam War: selecting the bombing targets and telling the generals where to drop the bombs." Redfield agreed that White House involvement has complicated the CDC's ability to lead the nation's public health response during the pandemic. "I think that they should have the CDC director on and be driving the train," he said. "I have a lot of respect for Tony Fauci. But my own view is that should be the CDC director." CDC ROLLS OUT PLAN TO BOOST PUBLIC HEALTH WORKFORCE — CDC Director Rochelle Walensky announced a tranche of grants on Tuesday aimed at building up the U.S. public health workforce through an initiative called Public Health AmeriCorps. Paid for by the American Rescue Plan , the partnership between the CDC and AmeriCorps will fund up to 5,000 positions over the next five years, bolstering an under-resourced workforce that public health experts widely agree puts Americans' health at risk. This week, 82 grant recipients will be announced, amounting to about $65 million, to help recruit some 3,000 AmeriCorps members. "During the decade prior to Covid-19, the public health workforce lost an estimated 60,000 jobs nationwide, despite the continued demands to respond to multiple chronic public health threats, like H1N1, Zika and Ebola," Walensky said during a press briefing on Tuesday. "The work of these initial members will help to address public health needs in our nation's inner cities, to build tribal public health capacity, to address health disparities in rural America and to bolster public health resources and our U.S. territories."   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Names in the News Kristina Schake has joined Walt Disney as executive vice president of global communications. Schake most recently worked on Biden's Covid-19 vaccine education campaign and previously was deputy communications director for Hillary Clinton's 2016 presidential campaign and communication director for former first lady Michelle Obama. What We're Reading The Oklahoma House voted overwhelmingly for a Republican bill that would make performing an abortion illegal and punishable by up to 10 years in prison, The Washington Post's Caroline Kitchener reports. Juli Min writes for The New York Times about life inside Shanghai's lock down. The pandemic's forced remote work model helped 'night owls' thrive, Kaiser Health News reports. "Why don't such people just go to bed earlier? The answer is complicated."   A message from PhRMA: According to data just released, insurance isn't working for too many patients. Despite paying premiums each month, Americans continue to face insurmountable affordability and access issues: Roughly half (49%) of insured patients who take prescription medicines report facing insurance barriers like prior authorization and "fail first" when trying to access their medicines. More than a third (35%) of insured Americans report spending more in out-of-pocket costs in the last 30 days than they could afford. Americans need better coverage that puts patients first. Read more in PhRMA's latest Patient Experience Survey.     Follow us on Twitter Tucker Doherty @tucker_doherty Dan Goldberg @dancgoldberg Erin Banco @ErinBanco Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ Rachael Levy @rachael_levy David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Sarah Owermohle @owermohle Carmen Paun @carmenpaun Megan R. Wilson @misswilson   Follow us

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