Wed. Mar 29th, 2023

Happy Congress-is-back Monday, y’all. On our radar this morning: The Food and Drug Administration will receive its first application for over-the-counter birth control today (h/t NYT).

Today’s edition: A deep dive into Biden’s two-week struggle to respond to the Supreme Court’s ruling overturning Roe v. Wade. The risk of covid-19 reinfection is growing due to the BA.5 subvariant. But first … 

Medicare solvency and drug prices have space in Democrats’ economic package

The race to pass a long-stalled economic package this month is on.

Momentum — and optimism — has picked up in recent weeks, as party leaders attempt to broker a compromise with Sen. Joe Manchin (D-W.Va.) on a package that could be brought to the floor before August recess. Several key health issues remain unresolved, though Senate Democrats recently secured agreements on efforts to lower seniors’ prescription-drug prices and improve Medicare’s financial health.

For months, there’s been growing concern among Democrats and advocates about what the failure to pass such a package could mean for the party in the midterm elections. Any such bill will be much smaller than the roughly $2 trillion package the House passed last fall, but party leaders are anxious to hand their members a win to bring back to voters before November. 

Today, we’re evaluating the status of several potential health care components of the package.

Resolved: A plan to boost Medicare solvency

Manchin has expressed alarm about the shaky financial outlook of the program for older adults and those with disabilities. Last week, Senate Democrats finalized a plan aimed at assuaging some of Manchin’s concerns, a key piece of getting a retooled package over the finish line, our colleague Tony Romm reported.

Democrats are aiming to impose taxes on high-earning Americans, who would pay a 3.8 percent tax if they own a kind of business called a pass-through. That would close a tax loophole decried by Democrats and help sustain a critical Medicare trust fund until 2031.

In motion: Democrats’ drug-pricing proposal

In a sign of a renewed push around the package, Senate Democrats sent a new version of the party’s drug-pricing bill to the Senate parliamentarian last week. That’s a crucial piece of the reconciliation puzzle, since the parliamentarian serves as the arbiter of what policies can be included in the fast-track budget maneuver that Democrats want to use to pass their economic plan without any GOP votes.

Manchin has consistently supported allowing Medicare to negotiate drug prices, which also serves as a key way of paying for the economic package. The new drug-pricing agreement would reduce the deficit by nearly $288 billion over a decade, according to a Congressional Budget Office analysis released Friday.

Unresolved: An extension of enhanced Obamacare subsidies

Rank-and-file Democrats are urging the party to avoid a major headache during the midterm elections. Millions of Americans could soon learn that their health insurance premiums will rise substantially if Democrats fail to extend enhanced Obamacare subsidies set to expire at the end of the year. 

Manchin has privately rejected initial plans to extend the financial help, Tony reports, though there are discussions about paring back eligibility for the tax credits based on a person’s income. 

Status unclear: A proposal to close the Medicaid coverage gap

Medicaid advocates are itching to ensure inclusion of a plan to extend the safety net program in a dozen states where GOP officials have long refused Obamacare’s Medicaid expansion. But it’s unclear whether such a policy will make it into the package, as Senate Majority Leader Chuck Schumer (D-N.Y.) and Manchin are still haggling over other unrelated policies. Manchin has long said he wouldn’t support legislation with a large price tag.

Some proponents of the policy are ramping up the urgency in light of the Supreme Court ruling overturning Roe v. Wade. Protect Our Care — a Democratic-aligned group — is planning to issue memos to Capitol Hill this week on the need to extend Obamacare’s beefed up tax credits and close the Medicaid coverage gap, arguing both are key to helping women access other reproductive and maternal care.

  • Abortion bans coupled with the lack of Medicaid expansion impacts women of color and their families, leaving them without coverage and at risk for severe birth outcomes,” the group wrote in one of the memos shared with The Health 202.
  • Meanwhile … five prominent groups — such as The Leadership Conference on Civil and Human Rights and the NAACP — penned a letter to Democratic leaders last week with a similar message.

Larry Levitt, of the Kaiser Family Foundation:

📅 Here’s what else we’re watching this congressional work period

This is the first week lawmakers will be back since the Supreme Court overturned Roe. The House is slated to vote this week on legislation to protect the right to travel out of state for an abortion. And the chamber will also vote on the Women’s Health Protection Act — a bill to codify Roe’s protections into federal law that the chamber already passed in September. 

  • Why another vote? The rationale, per a senior Democratic aide: It shows the commitment of House Democrats to abortion rights, while “further expos[ing] House GOP extremism” as Republicans will almost certainly vote against the measure against the backdrop of conservative states enacting their abortion bans.

Can the Senate pass a bipartisan insulin bill? Insulin measures were taken out of Democrats’ broader drug pricing proposal, such as a $35 monthly cap on the lifesaving drug for patients with private insurance or on Medicare. This comes amid a push to pass bipartisan insulin legislation from Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine). 

  • A Shaheen aide said they’re expecting floor action on the legislation this work period. Yet, the pair faces an uphill battle in the quest to secure the support of 10 Republicans.

Schumer has tested positive for the coronavirus, and will work remotely this week as lawmakers return from a two-week recess. He’s vaccinated and has had two booster shots, and has “very mild” symptoms, according to a spokesman.

“Anyone who knows Leader Schumer knows that even if he’s not physically in the Capitol, through virtual meetings and his trademark flip phone he will continue with his robust schedule and remain in near constant contact with his colleagues,” the spokesman, Justin Goodman, said in a statement. 

Inside the White House’s Roe response

Our colleagues Ashley Parker, Yasmeen Abutaleb and Tyler Pager spoke with 26 senior White House officials, Democratic lawmakers, abortion rights activists, Democratic strategists and other Biden allies to piece together what it looked like inside the White House as Roe v. Wade was overturned.

Officials took a cautious approach, staying away from any responses that might be legally vulnerable, but frustrating progressive activists, who were deeply unhappy with what they viewed as a timid response at a monumental moment:

  • On a call with activists just hours after the decision, administration officials reiterated promises Biden made earlier in the day, such as making abortion pills available and protecting women who cross state lines. It wasn’t the fiery call to action and detailed road map that activists had expected.
  • White House officials evaluated a proposal to build abortion clinics on federal lands. But they found that while they could protect federal employees who used that option, they could not protect other women or providers once they stepped off federal land, putting them at legal risk.
  • Some in the White House and Department of Health and Human Services supported the idea of declaring a public health emergency, but other aides and agency officials warned it could backfire.

But … Biden told reporters yesterday that he is weighing whether to consider declaring abortion access a public health emergency, The Post’s Matt Viser reports.

Nancy Cook, White House correspondent for Bloomberg News:

White House communications director Kate Bedingfield seemed to push back against the criticisms in this statement, given to our colleagues:

Joe Biden’s goal in responding to Dobbs is not to satisfy some activists who have been consistently out of step with the mainstream of the Democratic Party. It’s to deliver help to women who are in danger and assemble a broad-based coalition to defend a woman’s right to choose now, just as he assembled such a coalition to win during the 2020 campaign,” she said.

The White House began planning for a possible overturning of Roe last summer, Ashley, Yasmeen and Tyler write. Biden appointed Jennifer Klein, director of the Gender Policy Council, and White House counsel Dana Remus to run a response team.

As BA.5 dominates, the risk of reinfection grows

The latest omicron subvariant, BA.5, is driving a wave of cases across the country due to its elusiveness when encountering the human immune system, The Post’s Joel Achenbach reports. 

Antibodies from vaccines and previous covid infections offer limited protection against BA.5. But the scope of the latest wave is unclear, since most people are testing at home or not testing at all. The Centers for Disease Control and Prevention this past week reported over 100,000 new cases a day on average, but some infectious-disease experts say that number may be as high as a million. 

There isn’t any evidence that the new variations of the virus cause different symptoms or severity of disease. Omicron and its offshoots, such as BA.5, typically replicate higher in the respiratory tract than earlier variants, which is one reason omicron appears less likely to cause severe illnesses, Joel writes.

The Post’s Fenit Nirappil:

Have we mentioned Congress is back? Democrats will push to amplify their discontent with the Supreme Court’s decision overturning Roe with several committees planning hearings on the issue this week.

Tuesday: The Senate Judiciary Committee will convene a hearing on the legal landscape in a post-Roe America; the Senate Finance Committee will meet on the nomination of Rebecca Lee Haffajee to serve as HHS’ assistant secretary for planning and evaluation.

Wednesday: The Senate HELP Committee will discuss reproductive care in a post-Roe world.

Thursday: The House Judiciary Committee will hold a hearing titled “The Threat to Individual Freedoms in a Post-Roe World.”

Gretchen Whitmer’s abortion fight — from the porch with her daughters (By Ruby Cramer l The Washington Post)

A one-source story about a 10-year-old and an abortion goes viral (Glenn Kessler l The Washington Post)

Production resumes at troubled Abbott baby formula factory (Frank Bajak l Associated Press)

Trump-era federal Covid contract recipient has yet to meet major deadlines (Katherine Ellen Foley l Politico)

Thanks for reading! See y’all tomorrow.

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