Senate $10B deal on Covid aid comes at too high a price, critics say

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Apr 05, 2022 View in browser   By Krista Mahr and Sarah Owermohle Presented by With Adam Cancryn and Daniel Lippman 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 — Senators strike a deal on $10 billion in Covid-19 funding, but leaving out global aid may not sit well in the House. — Biden to fix Obamacare "family glitch," a move that would expand coverage and lower insurance costs for hundreds of thousands of Americans. — Hospitals and patients are confused over how to mask, citing conflicting messaging on the CDC web site. WELCOME TO TUESDAY PULSE — A man in Germany allegedly received as many as *90* Covid-19 vaccine doses in a vaccination card fraud scheme. We have questions. Send your fraudster tips and news to kmahr@politico.com and sowermohle@politico.com.   A message from PhRMA: Nearly half of insured Americans who take prescription medicines encounter barriers that delay or limit their access to medicines. In a new report , learn more about the abusive insurance practices that can stand between patients and the care they need.   Driving the Day $10 BILLION IT IS — Senators struck a deal on $10 billion in Covid-19 aid on Monday, paving the way for the bill to pass the chamber but potentially facing friction in the House, POLITICO's Burgess Everett, Erin Banco and Sarah Ferris report. The bill would deliver funding for treatment, testing and vaccines paid for with unused money from previous coronavirus bills, but leaves out global pandemic aid after negotiators couldn't figure out how to cover it. That exclusion could be a sticking point in the House, which will be under pressure to move fast on the bill if it clears the Senate quickly. The ticking clock on Covid funding is front of mind for many on the Hill. Tonight, the Health Resources and Services Administration's Covid-19 Coverage Assistance fund will stop accepting vaccination claims from providers "due to a lack of sufficient funds." It stopped reimbursing providers for testing and treatment on March 22. House Majority Leader Steny Hoyer told reporters Monday night he thinks he has the votes to pass it, despite some House lawmakers' outrage over leaving the global vaccine money out. If he does, a lot of people won't be happy. In a statement shared first with Pulse, dozens of groups slammed the exclusion of the global aid, saying if the bill passes without it, Congress will have turned its back on the world and put Americans at greater risk. "Until we commit to providing the necessary resources to combat COVID-19 globally, more variants will emerge, more people will contract the virus and the death toll will continue to rise," read the statement, signed by groups including ONE, Save the Children, and Oxfam America. BIDEN PLOTS A 'FAMILY GLITCH' FIX — The Biden administration is expected to propose new regulations aimed at fixing the Obamacare "family glitch," in a bid to eliminate the longstanding loophole that's disqualified millions of people from subsidized coverage, Adam reports. The revamped policy would expand coverage to 200,000 people and lower insurance costs for nearly 1 million more, according to administration estimates. That amounts to what Biden is expected to tout today as the most significant administration action to improve Obamacare since its passage — and comes ahead of a planned White House celebration of the 2010 health law featuring the return of former President Barack Obama. It's likely to please health coverage advocates, who have argued for years for addressing a glitch that exists because of how the Obama administration first interpreted a complicated provision in the law. Under Obamacare, people can qualify for subsidies if the cost of their employer coverage hits a certain threshold. But that cost is currently calculated only based on the premium charged to one individual — even if that person's family is also on the plan. Health law experts have contended for years that the administration could reinterpret the statute to take into account the added cost of additional family members.   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.       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.     HOSPITALS CONFUSED OVER CDC MASK GUIDANCE — Hospitals and patients alike are confused by the conflicting guidance that the Centers for Disease Control and Prevention has posted on its web site about mask use in health care facilities, POLITICO's Rachael Levy reports. The backstory: The CDC website says people shouldn't wear masks that are soiled or damaged, but POLITICO's reporting has shown that hospitals have used this to ask patients to replace their N95 masks with a less protective hospital-provided mask or to layer it over their N95. The CDC also says patients and visitors should not be asked to remove an N95 and that other masks shouldn't be layered over it, because it can affect the fit, rendering the N95 less protective. Why it matters: The mixed messaging has left immunocompromised patients feeling frustrated and vulnerable, and trade groups like the American Hospital Association unsure how to advise its members as to the best practice to prevent the spread of the virus in their hospitals. A record number of hospitalized patients in the U.S. were infected with Covid during the Omicron wave. Coronavirus BA.2 ON THE MARCH — The BA.2 Omicron subvariant continues to spread across the U.S., accounting for more than 70 percent of Covid-19 cases in the country as of April 2, according to new CDC data , up from 57 percent the previous week. The subvariant, which is more transmissible than the Omicron strain responsible for the winter wave but not more severe, continues to be most prevalent in the Northeast, where it comprises more than 80 percent of Covid-19 cases. The total number of cases and hospitalizations, meanwhile, continue to fall across the nation. Around the Agencies MEDICARE TO COVER OVER-THE-COUNTER TESTS — The Biden administration said on Monday that Medicare will cover up to eight Covid-19 tests per month for beneficiaries during the public health emergency, POLITICO's Rachel Levy and David Lim report. It's the first time the public insurance program will cover over-the-counter products, and the move could pave the way for Medicare to cover other over-the-counter medications and products, experts say. The administration came under scrutiny after it rolled out Covid test reimbursements for private insurance holders without similar coverage for those with Medicare, who represent some of the nation's most vulnerable populations. THE BOOSTER PROBLEM  — The FDA is considering using the seasonal flu vaccine as a model for how Covid-19 vaccinations are modified as new variants arise, POLITICO's Lauren Gardner reports. But it won't be easy. Ahead of a Covid-19 booster meeting scheduled for Wednesday, the FDA released a briefing document on Monday pointing out some of the practical complications of creating and manufacturing shots to keep up with an evolving virus. Among the things that can slow the process are the virus' unpredictable pattern in terms of the time of year it circulates, making it hard for manufacturers to know when the vaccine will be needed, and the fact that vaccine makers still have to get clinical data for modifications on the vaccine. The agency also flagged the fact that manufacturers need lead time to produce the vaccine, and that different manufacturers use different technology and therefore may take varying lengths of time to produce new doses.   A message from PhRMA:   In Congress FIRST IN PULSE: MENTAL HEALTH GROUPS SUPPORT PRIOR AUTHORIZATION REFORM — A coalition of 46 mental and behavioral health groups have sent a letter in support of a bipartisan bill aimed at reforming the use of prior authorization under Medicare Advantage plans. The overuse of prior authorization, in which a provider needs approval from a health insurer before seeing a patient, has come under fire for slowing down health care access. The Improving Seniors' Timely Access to Care Act, sponsored by Rep. Suzan DelBene (D-WA) and Sen. Roger Marshall (R-KS) seeks to speed up, streamline and introduce more accountability in prior authorization's use. The coalition, led by the Mental Health Liaison Group, says that given the mental health and substance abuse crisis in the country, the delays that prior authorization creates put patients at risk. "Delays and denials of care can have serious and sometimes devastating effects on patients in need of mental health/substance use treatment and services," the letter states. Names in the News FIRST IN PULSE — Jane Brown is now chief compliance officer at insurance company Avesis LLC. She most recently was COO of UHC North Carolina. National Cancer Institute Director Norman "Ned" Sharpless will step down at the end of April after leading the agency nearly five years. NCI Principal Deputy Director Douglas Lowy will serve as NCI's acting director starting April 30. It's a pivotal time for the institute as the Biden administration relaunches his passion project the cancer moonshot, aimed at halving cancer deaths and eventually preventing certain cancers entirely. What We're Reading The Washington Post reports that the CDC has hired a senior federal health official to review the workings of the troubled agency. The New Yorker dives into the disturbing health crisis of suicide in children.   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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