Doctors’ debt ceiling fears

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

May 26, 2023 View in browser   By Daniel Payne Presented by Programming note: We’ll be off this Monday for Memorial Day but will be back in your inboxes on Tuesday. Driving the day Health providers are hoping for the best but preparing for the worst if the debt ceiling isn't lifted. | Stefani Reynolds /AFP via Getty Images FEAR AND LENDING — Fearing government funding — often a huge portion of hospitals’ and clinics’ budgets — could slow down or stop next month if the U.S. defaults on its debt, providers are looking for possible ways to fill a gap in payments. Some have been reviewing their credit lines and cash on hand to see how long they could go without federal dollars. “We’re talking about a substantial amount of money that won’t be coming,” Jim Mangia, president and CEO of St. John’s Community Health, a network of clinics in Los Angeles, told Pulse about the possibility of default. “We’re going to be dipping into any cash reserves and lines of credit.” Some are holding onto faith that a deal to raise the debt ceiling will be made in time, as has happened in similar standoffs. Still others, with little cash on hand and few details about when a default would begin to impact their bottom line, said they have few options. “This is just uncharted territory for us,” said Brock Slabach, COO of the National Rural Health Association, which advocates for rural providers. “We don’t have any analogues or guides to let us know what to expect. It’s unfathomable for many of us.” But many providers — and government officials — acknowledge the damage a default would do to the health system. That impact would be particularly apparent among hospitals and clinics already facing challenges — like those that are smaller, are more rural, have tighter margins and have smaller cash reserves. “While the precise impact on CMS’ programs depends on many uncertain factors, it is clear that if the federal government is prevented from making good on its promises, there would be significant consequences for Medicaid, Medicare, and the Affordable Care Act Marketplaces,” a CMS spokesperson told Pulse in an email. In the meantime, providers across the country are watching Washington and hoping for an assurance of payments. “There’s not a whole lot we can do about it except go to our banks and let them know — see if we can increase our lines of credit,” Mangia said. “It's a tremendous burden and cost to the nonprofit health centers that are actually providing critical health care services on the front lines.” WELCOME TO FRIDAY PULSE, where we’re thankful for a holiday weekend. Send me a scoop to start next week off right — along with other health news — at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with Carmen Paun, who explains why some Democrats say the HALT Fentanyl Act that the House passed yesterday is a distraction. Listen to today’s Pulse Check podcast     In Congress The House voted to pass the Halt Fentanyl Act, which would classify street versions of fentanyl as a Schedule 1 drug. | Courtesy of the Department of the Interior FENTANYL BILL BREAKS UP DEMS — The House voted on Thursday to pass legislation that would classify street versions of the synthetic opioid fentanyl as Schedule 1 substances subject to enhanced regulation and law enforcement, POLITICO’s Carmen Paun reports. And despite some Democrats condemning the measure during floor debate, 74 party members joined Republicans in casting ballots for the measure, which passed 289-133. The Democrats in favor of the bill included both progressives and Hispanic and Black representatives, indicating the seriousness of the fentanyl problem and the reluctance of members to vote against measures aimed at curtailing it. Democrats, including House Energy and Commerce ranking member Frank Pallone (D-N.J.), condemned the measure during floor debate. Pallone called it a “partisan distraction” from the hard work needed to combat opioid addiction and said its increased mandatory penalties for fentanyl distributors would “disproportionately impact communities of color.” But the White House all but endorsed the measure, clearing the way for other Democrats to support it on the floor. What’s in the bill? The HALT Fentanyl Act would make permanent the temporary scheduling of street versions of fentanyl under Schedule 1, which covers substances with no currently accepted medical use and a high potential for abuse. A temporary scheduling by former president Donald Trump’s administration is due to expire in December 2024. Medical-grade fentanyl, the commonly prescribed painkiller, is a Schedule 2 substance.   GET READY FOR GLOBAL TECH DAY: Join POLITICO Live as we launch our first Global Tech Day alongside London Tech Week on Thursday, June 15. Register now for continuing updates and to be a part of this momentous and program-packed day! From the blockchain, to AI, and autonomous vehicles, technology is changing how power is exercised around the world, so who will write the rules? REGISTER HERE.     Abortion TAKING IT TO THE POLLS — Abortion remains a key issue for voters as the 2024 presidential election comes to life, according to new polling from KFF. Nearly 30 percent of voters said they would only vote only for a candidate who shares their views on abortion, including those who want abortion to be legal or illegal in almost all cases. And Democrats’ views on the issue resonated more with voters — 42 percent of them — compared with Republicans — whose views mirrored about 26 percent of voters. Though independents lean toward Democrats’ stances, many said neither party represented their views. Government institutions that have gotten entangled in abortion debates were also considered in the polling. Two-thirds of adults said they had “some” or “a lot” of confidence in the FDA to ensure safe and effective medicines are sold in the U.S. But the Supreme Court didn’t fare as well post-Roe, with most of the public — including 69 percent of women — trusting the court “not too much” or “not at all” to make the right decision on abortion.   A message from PhRMA:   Providers A HISTORIC STRIKE — A strike of 130 doctors that lasted three days was the first of its kind in over three decades, POLITICO’s Maya Kaufman reports. Resident physicians at Elmhurst Hospital, a public hospital in Queens that serves one of the world’s most ethnically diverse communities, went on strike this week — marking the first doctors’ strike in New York City in recent memory. Such strikes are relatively rare in the U.S. because many doctors are self-employed or work at hospitals as independent contractors instead of employees, which prevents them from joining a union. Only about 7 percent of practicing physicians across the U.S. belong to unions, census data indicate. But across the country, the pandemic has spurred a rapid rise in unionization among residents, the term for recent medical school graduates working at a hospital under other doctors’ supervision. It’s a phenomenon that’s reaching beyond doctors, with labor leaders telling Pulse in recent months that worker shortages and burnout from the pandemic could be tipping the balance of power toward health workers and away from managers and large institutions.   DON’T MISS POLITICO’S HEALTH CARE SUMMIT: The Covid-19 pandemic helped spur innovation in health care, from the wide adoption of telemedicine, health apps and online pharmacies to mRNA vaccines. But what will the next health care innovations look like? Join POLITICO on Wednesday June 7 for our Health Care Summit to explore how tech and innovation are transforming care and the challenges ahead for access and delivery in the United States. REGISTER NOW.     At the Agencies PAXLOVID’S GREEN LIGHT — On Thursday, the FDA approved Paxlovid for treating adults at high risk of severe Covid-19, POLITICO’s David Lim reports. The antiviral used to treat Covid-19 received emergency use authorization from the FDA in December 2021, but yesterday’s announcement signaled even greater confidence in the drug’s safety and efficacy now that more data on its use is available. HHS will continue to distribute the doses of Paxlovid the U.S. government acquired “to ensure continued access for adults, as well as treatment of eligible children ages 12-18 who are not covered by today’s approval,” according to the FDA. An HHS spokesperson said in an email that the action “will change nothing regarding access to Paxlovid.” What We're Reading Our Katherine Ellen Foley reports on the first data from a federal long Covid study. Reuters reports on how doctors sometimes buy their way out of trouble. KFF Health News reports on California hospitals seeking big bailouts — even when they don’t all need them.   A message from PhRMA: Middlemen say they want lower prices, yet they often deny or limit coverage of lower-cost generics and biosimilars while giving preferential coverage to medicines with higher prices. This might be good for PBM’s bottom line, but it can lead to higher costs for patients. What else are they hiding?     Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

To change your alert settings, please log in at https://www.politico.com/_login?base=https%3A%2F%2Fwww.politico.com/settings This email was sent to rouf@idiot.cloudns.cc by: POLITICO, LLC 1000 Wilson Blvd. Arlington, VA, 22209, USA Please click here and follow the steps to unsubscribe.