Monday, November 9, 2020

Biden names Covid advisers as he speeds health agenda — Coronavirus cases hit 10 million in U.S. — Private insurers owe nearly $2.5 billion in rebates

Presented by the Partnership for America's Health Care Future: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.
Nov 09, 2020 View in browser
 
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By Dan Diamond and Adam Cancryn

Presented by

With Susannah Luthi and Dan Goldberg

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Quick Fix

— President-elect Joe Biden is naming a team of coronavirus advisers as he moves quickly on his health agenda.

— About 10 million Americans have been confirmed to contract Covid-19, and the pace of infections is quickening.

— Private insurers owe almost $2.5 billion in rebates to consumers under Obamacare, according to CMS.

WELCOME BACK TO PULSE — Where this week promises to be a doozy: a flurry of Biden moves on health care, the Trump team's own efforts to keep pushing health policy and the Supreme Court set to hear the latest challenge to the Affordable Care Act.

PULSE doesn't have access to a magic map board, so help us stay current: Tips to ddiamond@politico.com and acancryn@politico.com.

A message from the Partnership for America's Health Care Future:

Let's build on and improve what's working in health care where private coverage, Medicare and Medicaid work together to provide the coverage and care American families need – not start over with a one-size-fits-all new government health insurance system we can't afford. Learn more.

 
Driving the Day

HHS WILL BE GROUND ZERO FOR THE BIDEN-HARRIS AGENDA — As a new president in February 2017, Trump infamously said that "nobody knew that health care could be so complicated." And while many of his key policies ran through the Humphrey building, Trump was always more interested in priorities like trade and finance that drew on his experience as a businessman.

We won't know how Biden will govern for another two-plus months, barring some surprise, although Republicans and health industry lobbies are already preparing to do battle , POLITICO's Susannah Luthi writes. But as a president-elect, Biden is already zeroing in on HHS and its portfolio, including reaching out to constituencies that felt locked out of the Humphrey building under Trump.

— Some of those changes are in rhetoric. Five years ago, then-candidate Donald Trump appeared to mock a reporter with a congenital disability, an episode that his team spent months trying to explain away. Later as president, Trump rolled back Obama-era protections for transgender patients.

On Saturday, Biden shouted out the disability community in his victory speech, a moment that trended on social media alongside #CripTheVote, and similarly thanked the transgender community in a remark that broke new ground.

— Other changes will come in policy, and who's shaping it. For the past four years, Vice President Mike Pence has put his fingerprints on HHS, partly because Trump had such little interest in health policy of his own. Pence pushed for Indiana ally Seema Verma as chief of CMS; he supported efforts like the creation of a conscience and religious freedom division inside the civil rights office; and he worked to restrict funding for Planned Parenthood.

Biden and his team are far more interested in shaping health policy than Trump was in 2016, which means that Vice President-elect Kamala Harris won't have the same free hand at HHS that Pence did. But Harris is surely the first vice president-elect who's also introduced a bill trying to improve care for uterine fibroids — a reminder that her historic election will bring a perspective on health policy to the White House that none of her predecessors ever shared.

Meanwhile, Biden's showiest policy move since Election Day is coming on Monday…

 

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SCOOP: MEET BIDEN's COVID ADVISERSThe transition team is announcing its advisory panel on Monday, which includes about a half-dozen unreported names that POLITICO's Dan Diamond scooped on Sunday night.

The panel includes:

RICK BRIGHT, who was ousted as chief of BARDA and became a major critic of the Trump administration before leaving government last month.

ATUL GAWANDE, the high-profile surgeon and New Yorker writer who most recently led Haven, the joint venture between Amazon, Berkshire Hathaway and JPM. Gawande also served as an HHS senior adviser during the Clinton administration, a role that he discussed on POLITICO's "Pulse Check" podcast in 2017.

LUCIANA BORIO, who served as the FDA's acting chief scientist and on the National Security Council during the Trump administration.

MICHAEL OSTERHOLM, who's achieved renown as an infectious disease specialist at the University of Minnesota.

The task force also includes UCSF's Eric Goosby, who helped shape HIV/AIDS policy during the Clinton and Obama administration; UCSF emergency physician Robert Rodriguez; and Loyce Pace of the Global Health Council.

POLITICO's Alice Miranda Ollstein, Theodoric Meyer and Alex Thompson scooped the planned task force last week. Its co-chairs are former Surgeon General Vivek Murthy, former FDA Commissioner David Kessler and Yale's Marcella Nunez-Smith.

MEANWHILE: THE WHITE HOUSE COVID TASK FORCE is set to meet today, led by Pence. The panel has languished in recent weeks as Trump played down the raging pandemic ahead of Election Day, and Pence has been absent from key planning calls.

Speaking of the pandemic …

BIDEN INHERITS RAGING VIRUS — The United States' coronavirus outbreak is on pace to hit nearly 1 million new cases a week by the end of the year — a scenario that could overwhelm health systems across much of the country and further complicate Biden's attempts to coordinate a response, POLITICO's Dan Goldberg and Alice Miranda Ollstein report.

Biden and his allies have vowed to confront looming shortages of protective gear for health workers and oversee distribution of masks, test kits and vaccines while beefing up contact tracing and reengaging with the World Health Organization. But all of these actions — a sharp departure from the Trump administration's patchwork response that put the burden on states— will have to wait until Biden takes office.

— The nation's health system is buckling under the load of the resurgent outbreak. The number of Americans hospitalized with Covid-19 has spiked to 57,000, up from 33,000 one month ago. In many areas of the country, shortages of ICU beds and staff are leaving patients piled up in emergency rooms. And nearly 1,200 people died on Friday alone, according to the Covid Tracking Project.

The University of Washington's Institute for Health Metrics and Evaluation predicts 370,000 Americans will be dead by Inauguration Day, exactly one year after the first U.S. case of Covid-19 was reported.

"November is going to be really rough on all of us," New Mexico Gov. Michelle Lujan Grisham, a contender to lead HHS in Biden's administration, said Thursday. "There's nothing we can do, nothing, that will change the trajectory. … It is too late to dramatically reduce the number of deaths. November is done."

LOOKING FORWARD: WHAT DOES A BIDEN HHS LOOK LIKE? — PULSE has heard the Biden team weighing myriad names for senior roles, including Obama alums who have gone off to run state health departments like North Carolina's Mandy Cohen, Wisconsin's Andrea Palm and Michigan's Robert Gordon . Former FDA principal deputy commissioner Josh Sharfstein is also well-positioned for a top health job in the Biden administration, alongside fellow Obama alums like Murthy and Emanuel.

There's also a push to have a demographically diverse group of appointees at HHS, reflecting a message that animated the Biden-Harris campaign.

"In health policy, there's a deep bench of dozens of people, immensely qualified and diverse — all the flowers coming to bloom from the seeds that Obama and Biden planted," said Ken Baer, who was a senior OMB official under Obama.

— It's a notable contrast with the situation the Trump transition team faced in late 2016. Some well-known conservative health policy wonks were turned off by Trump's rhetoric; others weren't able to pass the White House's purity tests, having criticized Trump before the election. As a result, the early Trump HHS ended up staffed with an eclectic mix of political appointees, including some with little or no prior experience in health care.

Among the additional HHS questions that PULSE is weighing this week:

— How quickly does the Biden team move to fill senior roles, given the Senate uncertainty? With the Georgia run-offs still two months away, it's not clear who will control the chamber — and what that means for jobs that require confirmation, like HHS secretary or CMS administrator.

But unlike other senior health positions, CDC director doesn't require Senate confirmation, and that could be an early priority.

— Do ousted Democratic pols land at the Humphrey building too? Former GOP members like Renee Ellmers and John Fleming found homes in the Trump-era HHS, and PULSE is wondering if Democrats who lost their recent congressional races could follow that path. (Or in Rep. Donna Shalala's case, return to HHS in some role, 20 years after she served as secretary.)

A person who's spoken with Rep. Joe Kennedy, who's been outspoken on mental health issues and a critic of Trump's health department, said he's open to serving in the Biden administration, if asked.

— Who's going to be the public face? After promising to reverse the pandemic's problems, the Biden team will face a messaging challenge. And while Biden has promised to embrace infectious disease expert Anthony Fauci, even Fauci, renowned for his work ethic, can't do media around the clock.

So who to tap for reinforcements? Ashish Jha, the recently installed dean of Brown's public health school, told PULSE he wasn't looking to leave Rhode Island. But the telegenic Jha, who's gained a high profile during the Covid crisis, acknowledged that "it's a critical time in our country."

"I am happy to help from either the inside or outside — we are in a very bad place as a country and we need to get through it," Jha said.

— What happens at HHS for the next 10 weeks? There's still much left unfinished under Trump, with appointees working to finalize a slew of rules and policies. (Some officials are also tight-lipped about next steps, given Trump's efforts to fight the election results and the White House refusing to concede.)

PULSE will take a closer look at where the department stands later this week.

 

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Eye on Insurers

INSURERS OWE BILLIONS IN REBATES FROM 2019 — Health plans owe their 2019 customers nearly $2.5 billion, according to new CMS data. That's almost twice as much as the previous record, according to Cynthia Cox of the Kaiser Family Foundation.

— How it breaks down: On average, Obamacare customers are slated to get about $332 each, POLITICO's Susannah Luthi writes. But the range of what's owed to each person swings wildly. In Kansas, individual market health plans have to pay an average of $1,291 each to roughly 18,000 people, while plans in other states owe nothing. The individual exchanges, where premiums have remained high since Obamacare was implemented, account for the largest share of the total tally at $1.7 billion, Susannah writes.

— About those rebates … Obamacare subsidizes insurers but also seeks to cap their profits, requiring health plans to spend at least 80 to 85 cents on the dollar on health care. If they've ended up overcharging people on premiums, they have to rebate the excess money back to customers.

A message from the Partnership for America's Health Care Future:

Every American family deserves access to affordable, high-quality health coverage and care.

And, as health care remains top of mind for many Americans, let's commit to building on and improving what's working in health care, where today hundreds of millions of Americans have access to health care plans that cover essential benefits – like preventive care, prescription drugs and emergency services – regardless of pre-existing conditions. Learn more.

 


What We're Reading

Democrats likely lost their shot at big health care legislation based on last week's election results, Paige Winfield Cunningham writes for the Washington Post.

"60 Minutes" took a close look at Operation Warp Speed's efforts to rush coronavirus treatments and vaccines.

Europe is grappling with a hospital Covid-19 crunch that exceeds the spring peak, Allison McCann and Lauren Leatherby write for the New York Times.

Physicians are pressing Nebraska Gov. Pete Ricketts to introduce stricter coronavirus measures amid the state's surging outbreak, Julie Anderson writes for the Omaha World-Herald. Amid the public pressure, Taylor Gage, a spokesperson for the GOP governor, singled out doctors' political affiliations. Gage didn't respond to PULSE's request for comment.

 

KEEP UP WITH THE GLOBAL HEALTH AGENDA: If nothing else, 2020 revealed how critical it is to keep up with the politics, policy, and people driving global health. How are governments working to improve the health of their citizens? What role are NGOs playing? Who is driving the agenda? Our Global Pulse newsletter connects leaders, policymakers, and advocates to the people, and politics impacting our global health. Join the conversation and subscribe today.

 
 
 

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