GOP fires on Bush AIDS program

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Jun 27, 2023 View in browser   By Ben Leonard and Daniel Payne Presented by With Robert King Driving The Day Rep. Chris Smith (R-N.J.) won't support a PEPFAR reauthorization unless funding is pulled from AIDS groups that back abortion rights. | Julio Cortez/AP Photos PEFAR HITS AN ABORTION WALL — Clashes over abortion have dimmed hopes for reauthorizing a program credited with saving tens of millions of lives from AIDS in the developing world, POLITICO’s Carmen Paun and Alice Miranda Ollstein report. Democrats and Republicans are fighting over whether federal funding is going to HIV/AIDS prevention groups that also back abortion rights. The impasse comes as progress against the disease slowed significantly during the pandemic.  The President’s Emergency Plan for AIDS Relief — created by then-President George W. Bush in 2003 — has been key to the global campaign against AIDS and, in the past, has enjoyed bipartisan support, including from religious conservatives. But Republicans say the Biden administration is using it to back abortion rights. “The president fired the first shot,” Rep. Chris Smith (R-N.J.) — who wrote the last PEPFAR reauthorization in 2018 — told POLITICO, accusing President Joe Biden of adding abortion to the program’s purview. Smith said he won’t write another update sans prohibitions on funding groups that back abortion rights, a dealbreaker for Democrats. U.S. law bars foreign aid from supporting abortion services, but Smith says Biden lifted Trump administration funding restrictions and added language about integrating programs with “sexual health and reproductive rights.” The Biden administration denied Smith’s claims, and, along with Democratic lawmakers and some public health advocates, said there’s no evidence PEPFAR funds have gone to providing or promoting abortion. “They’re taking what was an initiative of George Bush that has been successful across the globe, particularly in Africa, and are now trying to make it a political issue about abortion,” said Senate Foreign Relations Chair Bob Menendez (D-N.J.). No GOP lawmakers on the relevant panel have openly broken with Smith, the chair of the House Foreign Affairs subcommittee. Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University, said Biden and White House Chief of Staff Jeff Zients need “to get on the phone and twist some arms.” “They’re leaving a lot of the heavy lifting to the PEPFAR coordinator, who is fantastic, but he doesn’t have a lot of inside-the-Beltway political experience and skills,” Gostin said. WELCOME TO TUESDAY PULSE. It’s recess now for Congress, but what health policy do you expect to move once it’s back? Let me know. Reach me at bleonard@politico.com. And, as always, your regular Pulse host Daniel Payne wants to hear from you, too, at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with Erin Schumaker, who provides insight into the future of psychedelic drug research and development now that the FDA has issued its first draft guidance for designing clinical trials using the drugs. Listen to today’s Pulse Check podcast   A message from PhRMA: Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It’s time to lower costs for patients by holding middlemen accountable.   In Congress The Telehealth Expansion Act has little Democratic support. | Orlin WagnerAP Photo TELEHEALTH BILL GETS STEEP PRICE TAG — Legislation that’s a top priority of the telehealth industry took a blow Monday, when the Congressional Budget Office estimated it would cost $5.05 billion. The Telehealth Expansion Act of 2023 would permanently allow high-deductible health plans to offer telehealth before patients hit their deductible. Congress extended a pandemic-era provision allowing the plans to do so through the end of 2024. According to the CBO, the steep costs would come from lost revenue from Social Security payroll tax collections. It’s another blow for the legislation, which already faced significant Democratic opposition despite having six Democratic co-sponsors and widespread industry support. Democrats have been less enthusiastic about boosting high-deductible health plans than Republicans, arguing they amount to workarounds to the Affordable Care Act that primarily benefits wealthier people. The House Ways and Means Committee advanced the legislation with five Democrats joining Republicans earlier this month, but Democratic leadership — committee ranking member Richard Neal of Massachusetts and Health Subcommittee ranking member Lloyd Doggett of Texas — voted against it, raising concerns about cost. This score likely won’t help. More than 30 million Americans are on high-deductible plans and face uncertainty about their telehealth access after 2024. BIGGER PAHPA, PLEASE — Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) renewed on Monday his push to tackle drug shortages as a part of reauthorizing the Pandemic and All-Hazards Prevention Act. In a statement, Pallone called on the committee’s Republicans to give the FDA new authority to deal with the shortages. “Republican Committee leaders’ assertions that PAHPA shouldn’t include FDA-related policy do not make sense and defy reality considering all previous PAHPAs have included FDA policy,” Pallone said. “The initial PAHPA included a provision requiring FDA to prepare for shortage issues that might arise, and all previous reauthorizations have included FDA-related policy.” Committee Chair Cathy McMorris Rodgers (R-Wash.) has opposed Democrats’ efforts to use PAPHA to expand the FDA’s authority. "E&C Republicans are committed to reauthorizing these key all-hazards and public health security programs on time,” an Energy and Commerce GOP aide told Pulse. “Staying focused on the policies that are under the existing framework is the best way forward to see a bill signed into law before September 30th.” What’s next: Partisan tensions brewed in a subcommittee hearing last month. Lawmakers have a Sept. 30 deadline to act. Rodgers has requested information on how to address drug shortages. CMS FLOATS PEDIATRIC PAY BOOST FOR DIALYSIS — CMS proposes slightly increasing Medicare payments to dialysis centers for treating children amid other payment reforms, POLITICO’s Robert King reports. The agency released its proposed 2024 End-Stage Renal Disease Prospective Payment System rule that lays out dialysis-care payments for Medicare beneficiaries. Overall, the agency proposes a 1.6 percent increase for dialysis facilities next year, with a 2.6 percent bump for hospital-based clinics and 1.6 percent for freestanding facilities. Medicare pays for dialysis services under Part B and for eligible children. However, the agency acknowledged that treatment for such a patient population “tends to be especially complex and costly,” according to a fact sheet in the rule. The agency proposed an additional payment from 2024 through 2026 for all pediatric dialysis cases. CMS proposed to add 30 percent of the total per treatment amount to help cover the extra costs. CMS also wants to increase payments for new renal disease drugs and biologics. Currently, Medicare offers an add-on payment for new renal disease pharmaceuticals for two years after they hit the market. However, the agency wants to extend such payments for another three years.   A message from PhRMA:   Abortion HOUSE GOP HOLDS FIRM ON ABORTION — A year after Republicans took hits over abortion restrictions on the campaign trail, vulnerable Republicans don’t sound deterred by their electoral consequences, POLITICO’s Brittany Gibson reports. Democrats have said they plan to make abortion a top issue in the 2024 cycle without distinguishing between Republicans who advocate a federal ban and those who take different positions. Republicans who won in blue states say they aren’t fretting it. “They tried that in 2022, and my opponent spent $3.1 million trying to paint me as that when that’s not the case. I do believe in exceptions for rape, incest, the life of the mother. And I do not oppose abortion in the first trimester,” said Rep. Nick LaLota, a Republican from Long Island, N.Y. “We won by 11 points, so if they want to light that money on fire in 2024 again, that’s their decision.” GOP Reps. Marc Molinaro and Anthony D’Esposito, both of New York, told POLITICO they weren’t worried about failing to represent the will of voters in their districts when it comes to abortion policy and said they wouldn’t interfere with the state’s laws on the issue. New York has some of the most liberal abortion-access policies in the country.   SUBSCRIBE TO POWER SWITCH: The energy landscape is profoundly transforming. Power Switch is a daily newsletter that unlocks the most important stories driving the energy sector and the political forces shaping critical decisions about your energy future, from production to storage, distribution to consumption. Don’t miss out on Power Switch, your guide to the politics of energy transformation in America and around the world. SUBSCRIBE TODAY.     Names in the News Sarah Lovenheim is now VP of external relations at AARP. She previously was assistant secretary for public affairs at HHS. Samantha Helton is now senior director on PhRMA’s federal advocacy team. She most recently was director of government affairs at 3M. Stephen Ferrara is now the president of the American Association of Nurse Practitioners, succeeding April Kapu. He previously served as the executive director of the Nurse Practitioner Association New York State. Kofi Essel is now food as medicine director at Elevance Health. He previously was director of the culinary medicine program at George Washington University medical school.   A message from PhRMA: PBMs control your health care. Pharmacy benefit managers (PBMs) decide if medicines get covered and what you pay, regardless of what your doctor prescribes. They say they want lower prices, yet they often deny or limit coverage of lower-cost generics and biosimilars, instead covering medicines with higher prices so they make more money. This business model allows PBM profits to soar and can lead to higher costs for everyone. What else are they hiding?   What We're Reading The New York Times reports that the best use case for generative AI in health care is tied to reducing burnout. Insider reports on growing Covid-related phone scams. Stuart Wallace and Stephanie Springer takes MLB to task for not doing enough to address health misinformation in youth baseball.   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.       Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim 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

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