Abortion issues could thwart spending bill passage

Oct 27, 2023

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By Chelsea Cirruzzo and Ben Leonard

Presented by

With Megan R. Wilson

Driving the Day

Rep. Mike Johnson exiting through a doorway

New House Speaker Mike Johnson has his work cut out for him as he tries to pass the Agriculture and FDA appropriations bill. | Justin Sullivan/Getty Images

‘ONE OF HIS EARLY TESTS’ — House Republicans finally came together for a big kumbaya moment this week. But it may be short-lived.

Enough Republican moderates remain opposed to including restrictions on the abortion pill mifepristone in the Agriculture and FDA appropriations bill to tank its passage, POLITICO’s Alice Miranda Ollstein and Meredith Lee Hill report. But conservatives say they’ll oppose the bill if the provision is removed.

The impasse threatens to derail newly elected Speaker Mike Johnson’s (R-La.) pledge to pass all 12 government spending bills and avoid a shutdown when the continuing resolution expires in mid-November.

“If mifepristone stays in the bill, it’s dead. If mifepristone comes out, it’s dead," said Rep. Kelly Armstrong (R-N.D.).

How Johnson proceeds over the next three weeks will provide one of the first looks at how he plans to navigate the pitfalls that ensnared his predecessor, Kevin McCarthy (R-Calif.), and whether he plans to make good on his promises to protect the at-risk Republicans who helped the GOP clinch its narrow majority.

“That’ll be one of his early tests,” said Rep. Buddy Carter (R-Ga.) “It is going to be important to many of us.”

WELCOME TO FRIDAY PULSE. I can’t stop thinking about how the National Zoo’s giant pandas will leave D.C. next month with around 300 pounds of bamboo on board their 19-hour flight back to China. That’s first-class treatment. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Evan Peng talks with POLITICO health care reporter Daniel Payne, who sorts through the debate in Congress over health workforce issues, including the Biden administration's proposed rules to set minimum staffing requirements for nursing homes.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Middlemen game the system at your expense. Pharmacy benefit managers (PBMs) charge fees tied to the price of medicines, which experts warn can lead to higher costs for patients and the health care system. A new survey finds 72% of voters believe PBMs should receive a fixed fee for their services instead. See the data.

In Congress

THE SPEAKER’S INNER CIRCLE — Johnson has a number of lobbyists ready to advise him on health policy, Megan reports.

Dan Ziegler at Williams & Jensen, which lobbies on behalf of drug giants including PhRMA, Eli Lilly, Pfizer and Sanofi, worked for Johnson while he served as chair of the Republican Study Committee.

The Picard Group, a lobbying firm with offices in Washington, D.C. and Louisiana, has a number of hospital clients in Johnson’s district and lobbyists with deep ties throughout the delegation — including former Rep. Rodney Alexander.

One former aide to House Majority Leader Steve Scalise, granted anonymity to discuss internal House dynamics, told Megan that the delegation is “super small and super tight” — giving a boost to a number of other firms.

Cornerstone Government Affairs, another K Street firm with a Louisiana outpost, has many health clients, including large pharmaceutical and medical device companies and the Baton Rouge, La.-based Mary Bird Perkins Cancer Center. Lobbyists Camp Kaufman and Chris Hodgson both worked for Louisiana Republicans on Capitol Hill.

Eric Zulkosky at Fierce Government Relations, who worked for Scalise, a fellow Louisiana Republican, has clients that include UnitedHealth Group and generic drug manufacturers. Former Scalise health policy aide Marty Reiser is at S-3 Group, along with former Scalise floor director Matt Bravo.

GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is proud to partner with the Milken Institute to feature a special edition of our Future Pulse newsletter at the 2023 Milken Institute Future of Health Summit from November 6-8. The newsletter takes readers inside one of the most influential gatherings of global health industry leaders and innovators solving the biggest public health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE.

Around the Agencies

The Niagara Falls Wastewater Treatment Plant is shown in Niagara Falls, N.Y.

A contract dispute between the CDC and a wastewater analysis company has put a halt to wastewater surveillance at some sites, hindering state health officials' ability to track Covid surges. | David Duprey/AP

WASTEWATER SURVEILLANCE ON ICE — A substantial portion of sites for the nation’s wastewater surveillance — one of the most dependable ways remaining to track Covid-19 surges — are shut down indefinitely, Ben reports.

State public health officials bracing for more Covid cases as cold weather arrives — and with little other surveillance data available since most people are no longer testing themselves or are doing so with unreported at-home tests — are worried.

What’s the holdup? The CDC wants to switch contractors from Massachusetts-based Biobot, which has worked with the agency since 2020, to Verily, a subsidiary of Alphabet, Google’s parent company. It awarded Verily a contract beginning last month, but Biobot formally protested it.

That means the transition is on pause. And amid the appeal, Verily can’t do its work until “further notice” from the CDC, according to a company email obtained by POLITICO.

Bradley White, the principal scientist for the Verily wastewater lab, told POLITICO that the company is ready to go, with much of its infrastructure already built.

“The thing I’m concerned about is continuity of our surveillance data while this protest is playing out,” said Chad Gubala, a wastewater official in Juneau, Alaska.

The finances: Biobot’s most recent contract was for about $31 million over less than a year and a half versus Verily’s five-year $38 million contract.

Biobot declined to comment on its protest, citing the “ongoing legal review.” CEO Mariana Matus wrote in a LinkedIn post that the company had already laid off 35 percent of its staff because of the contract decision.

Some 400 sites in “a handful of states and territories” are shut down amid the dispute, the CDC said, but 1,200 sites not covered under the disputed contract can continue work. A CDC spokesperson said the agency felt that was enough to maintain a “pretty comprehensive” picture of Covid and mpox spread.

Others are skeptical.

“The existing gap in the wastewater data will continue for possibly several months as we head into flu season and another Covid surge,” said one state health department epidemiologist who wasn’t authorized to speak publicly.

ANTITRUST PROSECUTORS ARE WATCHING — The Justice Department has a message for health care companies: It’s focused intently on the possible ill-effects of consolidation and illegal monopolies across the industry.

“We are thinking about provider and payer consolidation,” said Andrew Forman, a deputy assistant attorney general in the DOJ’s antitrust division. “We wonder whether the key justification for much of this consolidation, so-called value-based care, is delivering on the promise of lower prices and improving outcomes.”

Forman spoke Thursday at a conference in Washington focused on competition in the health care sector. In recent years, the health industry has heavily consolidated, with insurers, major pharmacy chains and benefit managers, plus providers, joining forces in mammoth companies like CVS Health and UnitedHealthcare.

“We wonder how this trend has impacted, or will impact, competition and power across the complex web of relationships in the health care ecosystem,” Forman said. “Is the integration, as the companies argue, a good thing? If done properly, it might be. Or has the consolidation led to … higher prices, less innovation and deeper moats defending sources of power?”

Forman said the industry should expect close scrutiny of any deal-making. He added that the DOJ is stepping up post-merger investigations, looking at attempts by companies to illegally monopolize health care markets.

A message from PhRMA:

DIGITAL HEALTH

PATIENTS OK WITH SOME DATA-SHARING — Most patients are comfortable with their doctors telling other doctors about their social needs, according to a new data analysis by the HHS Office of the National Coordinator for Health Information Technology.

Roughly 60 percent of Americans overall who answered the 2022 Health Information National Trends Survey said they were “very” or “somewhat” comfortable with their provider sharing with others that they were experiencing housing instability, food insecurity, or difficulty accessing transportation.

However, comfort levels varied depending on how patients experienced the health care system: Patients who said they’ve received average or poor quality care were much less likely than patients who said they received good care to be comfortable with sharing such information.

“ This has important implications for providers’ ability to address social needs through a patient-centered approach, as sharing information with other providers or social services organizations is often required to connect patients to the resources or services they need,” ONC officials wrote in a blog post.

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WHAT WE'RE READING

HHS has a new toolkit to guide health care organizations in ensuring cybersecurity.

CBS News reports on an FDA warning about giving probiotics to preterm babies.

CNN reports on a new vaccine for certain types of meningitis.

A message from PhRMA:

Middlemen can make you pay more. Newly released data show 74% of voters think health insurers and their PBMs should pass the rebates and discounts they receive to patients, so no patient pays more for their medicines than their insurer. Read the new poll.