Who’s behind Biden’s $12 billion budget bet?

The power players, latest policy developments, and intriguing whispers percolating inside the West Wing.

Mar 17, 2023 View in browser   By Adam Cancryn and Lauren Egan Welcome to POLITICO’s West Wing Playbook, your guide to the people and power centers in the Biden administration. With help from Allie Bice.   Send tips | Subscribe here| Email Eli | Email Lauren When President JOE BIDEN unveiled his budget last week, it included a startling $12 billion request for a new initiative with the lofty goal of eradicating Hepatitis C. The proposal, the size and scope of which caught even longtime Hep C researchers by surprise, represented the culmination of a relentless campaign waged primarily by one man: FRANCIS COLLINS. Collins is best known as the mustachioed, guitar-playing, motorcycle-riding longtime head of the National Institutes of Health, which he led for over a decade before taking a senior White House role in early 2022. But over the last several years, he developed a personal fascination with eliminating Hepatitis C — an eminently treatable disease that nevertheless kills more than 15,000 people a year through liver infections that lead to conditions like cirrhosis and cancer. “The development of safe and highly effective oral medicines for Hep C is one of the great achievements of medical research in the last 20 years,” Collins told West Wing Playbook. But limited access to testing and affordable treatment, he said, means those therapeutics are “simply not reaching millions of people who need the cure.” Collins’ fixation on the disease was borne in large part out of personal experience. Years before scientists found a treatment, Collins’ brother-in-law found out he had Hepatitis C. Despite receiving a liver transplant, he developed cancer, resulting in what Collins recounted recently to PBS Newshour as a “terribly awful, difficult death.” Collins studied a range of smaller Hepatitis C eradication initiatives, including programs at the VA and in states like Louisiana and Washington. When it came time to compile the White House budget, he launched what aides described as an internal crusade to get his plan prioritized. The budget-building process can be cutthroat among agencies each advocating for their own pet projects. Collins came armed with reams of data showing those smaller-scale efforts were capable of quickly expanding treatment — even among harder-to-reach populations that are disproportionately affected by Hep C. He argued that the long-term savings from fewer liver transplants and cases of liver and kidney failure would exceed the sizable up-front cost. At one point, a person familiar with the discussions said, Collins went as far as drawing up his own communications plan for how the White House might roll out the initiative. Perhaps most important to winning Biden’s approval, Collins tied Hepatitis C eradication to the president’s own Cancer Moonshot, citing the potential for preventing liver cancer. Collins’ push also extended to Capitol Hill, where he's personally tried to recruit allies on both sides of the aisle. One of his top targets was Sen. BILL CASSIDY (R-La.), who expressed support for the Hepatitis C initiative because of his own background studying the issue. “I think it’s quite plausible that we will save direct health care costs if you get the appropriate price for the drug — and by the way, you save a lot of lives,” said Cassidy, who said he’s talked “a lot” with Collins lately. “He’s asked me for insights, as well as potentially for advocacy.” Collins ultimately got his wish: a single line item on page 144 of the White House budget funding a health department-wide Hepatitis C initiative. For all that effort, however, he's still unlikely to get the bipartisan buy-in needed to turn the idea into a reality. Congress typically dismisses the White House blueprint as little more than a wish list, and there are already signs the Hepatitis C program faces insurmountable opposition from House Republicans. A senior GOP aide told West Wing Playbook there is deep skepticism over the price tag, despite the administration’s insistence that expected savings would eventually reduce the program’s net cost to roughly $5 billion over a decade. In the meantime, Republicans are preparing to use the proposal as a cudgel, arguing that Biden’s wider plan to crack down on pharmaceutical companies over their drug prices stands to hurt the very companies he wants to partner with on expanding treatments for Hepatitis C. “While the plan makes for a nice talking point, in reality the Biden administration is actively undercutting any meaningful commitment to finding cures,” said the senior GOP aide. MESSAGE US — Are you LAWRENCE TABAK, the acting NIH director? Or someone interested in becoming the next NIH director? We want to hear from you. And we’ll keep you anonymous! Email us at westwingtips@politico.com. Did someone forward this email to you? Subscribe here!    LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     POTUS PUZZLER This one’s from Allie. Who was the first U.S. president with Irish heritage? (Answer at the bottom.) Cartoon of the Week Courtesy It’s Friday, and you know what that means — cartoon time! This one is by ROB ROGERS. Our very own MATT WUERKER publishes a selection of cartoons from all over the country. The Oval WHAT THE WHITE HOUSE WANTS YOU TO READ: This piece by NYT’s ZOLAN KANNO-YOUNGS about how Vice President KAMALA HARRIS is framing “the abortion issue as part of a broader struggle for health care and privacy.” Filing from Des Moines, Iowa, Kanno-Youngs reports that during Harris’ first trip to the state as vice president, she told local lawmakers and medical officials that, “If politicians start using the court to undo doctors’ decisions, imagine where that can lead.” White House communications director BEN LABOLT shared the story on Twitter. WHAT THE WHITE HOUSE DOESN’T WANT YOU TO READ: This piece from CNN’s STEPHEN COLLINSON about how the president “could be damned if he saves the banks or damned if he doesn’t.” “While there is no suggestion yet that isolated banking upheaval could mushroom into a major systemic meltdown, any future use of public funds could hand Republicans, who are already inaccurately blasting administration moves as a ‘bailout,’ an opening to lambast Biden,” Collinson writes. WHILE WE’RE ON THE TOPIC… The president said in a statement Friday that those responsible for the bank collapse will be held accountable. “The law limits the administration’s authority to hold executives responsible,” he said. “When banks fail due to mismanagement and excessive risk taking, it should be easier for regulators to claw back compensation from executives, to impose civil penalties, and to ban executives from working in the banking industry again,” Biden added. He also called on Congress to act on the matter. Our ELEANOR MUELLER has more for Pro subscribers here. WALK THE WALK: USA Today’s ELLA LEE and ERIN MANSFIELD report that the Democratic National Committee and the president’s 2020 campaign will “return political donations tied to Silicon Valley Bank in the aftermath of the bank's collapse.” ANYTHING YOU CAN DO, I CAN DO BETTER: HUNTER BIDEN’s legal team Friday filed an answer and counterclaims “alleging invasion of privacy in response to a defamation lawsuit brought by the Delaware-based computer repairman who they say triggered the infamous laptop controversy in the weeks leading up to the 2020 presidential election,” ABC News’ LUCIEN BRUGGMAN reports. KJP ON THE WEIGHT SHE CARRIES: Press secretary KARINE JEAN-PIERRE participated in an on-cam conversation with Essence CEO CAROLINE WANGA about working in the White House. “The voice speaking for the most powerful man in the world is a Black, queer, immigrant woman,” Wanga said, celebrating Jean-Pierre. Still, Jean-Pierre said the job can be “tough.” “It takes a lot to wake up in the morning, put on my face, put on my outfit,” she said. “I have to be there for my team, I have a young team… This is a lot of weight to carry." THE BUREAUCRATS OH, THE JOYS OF PARENTHOOD: Transportation Secretary PETE BUTTIEGIEG spoke to TIME Magazine about parenthood after he and his partner CHASTEN welcomed twins in August 2022. Traveling with twins has forced him to revamp his car of choice. “Against all of my prior instincts, I am now a minivan dad,” he said. “We did a lot of long drives, including multiple drives between Michigan and DC. Sometimes it was two dogs, two dads, and two kids in their van, and that was really hard because Penelope has a reflux issue. We have not yet figured out how to do one-on-two travel. We’re gonna have to. If we’re flying, it’s both of us, or we’ve recruited a friend.” Read the full interview here. PERSONNEL MOVES: RORY BROSIUS, a top aide to JILL BIDEN who oversaw the first lady’s initiative to support military service members and thier families, is stepping down from her position later this month, NBC’s MIKE MEMOLI reports. Brosius will be replaced by SHEILA CASEY. Agenda Setting LOOK, WE KNOW THIS STUFF SUCKS….: The Environmental Protection Agency on Friday ordered states to stop blocking shipments of contaminated waste from East Palestine, Ohio as it cleans up the chemical mess from last month’s train derailment, our ALEX GUILLÉN reports for Pro subscribers. The move comes after Oklahoma Gov. KEVIN STITT blocked a shipment of that waste to a disposal facility in Waynoka, Okla, an effort EPA administrator MICHAEL REGAN said is “impermissible [and] unacceptable.” What We're Reading TikTok’s plan to stave off government intervention: flood D.C. with influencers (Politico’s Hailey Fuchs) Silicon Valley and Capitol Hill Build an Anti-China Alliance (WSJ’s Georgia Wells) New Data Links Pandemic’s Origins to Raccoon Dogs at Wuhan Market (NYT’s Benjamin Mueller) What We're Watching The first episode of MSNBC’s “Inside with Jen Psaki,” airing this Sunday at 12 p.m. EST. The Oppo Book When he’s not doing undersecretary of defense for policy stuff, COLIN KAHL may be DJing a party for national security officials. “Don’t let Secretary Austin know,” he joked on the “Early Bird Brief” podcast in February. The hobby started when he was a college student and he wanted to offset his money spending habits — as he was always buying CDs and vinyls, he explained. It continued after graduation. Kahl began DJing at “national security nerd parties,” upon getting involved in government. He even DJ’d Democratic Michigan Rep. ELISSA SLOTKIN’s wedding in 2011. The two had “bonded over working on the Iraq problem set,” when he served in the Obama administration. “I remember flying directly back from a work trip to Baghdad, landing in Michigan and going out to Elissa Slotkin’s farm to DJ her wedding,” he said.   DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID.     POTUS PUZZLER ANSWER ANDREW JACKSON, the nation’s seventh president, was the first with Irish heritage. His parents were from Antrim with parents from Antrim, in Northern Ireland, according to the Irish Emigration Museum. A CALL OUT — Do you think you have a harder trivia question? Send us your best one about the presidents with a citation and we may feature it. Edited by Eun Kyung Kim and Sam Stein.   Follow us on Twitter Eli Stokols @EliStokols Lauren Egan @Lauren_V_Egan Allie Bice @alliebice   Follow us

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