News : Biden, Trump’s dueling Covid visions on display — America heads for the vaccine cliff — ’Surprise’ billing legislation looks dead

Wednesday, December 9, 2020

Biden, Trump’s dueling Covid visions on display — America heads for the vaccine cliff — ’Surprise’ billing legislation looks dead

Dec 09, 2020

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By Adam Cancryn and Dan Diamond

Presented by

With Rachel Roubein and Susannah Luthi

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Quick Fix

— President-elect Joe Biden and President Donald Trump presented dueling visions of the coronavirus pandemic in high-profile events on Tuesday.

— The U.S. could face months of Covid-19 vaccine shortages that jeopardize its goal of immunizing most Americans by spring.

— Congress is unlikely to pass a surprise billing fix this year, after failing to resolve divisions that have held up the effort for over a year.

WELCOME TO WEDNESDAY PULSE — Where it's fair to ask who the more famous headliner of this upcoming Duke University event is: Alan Alda or Anthony Fauci?

There's a Freaky Friday-style screenplay starring Alda and Fauci just waiting to be written. Send tips and plot points to acancryn@politico.com and ddiamond@politico.com.

A message from PhRMA:

Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

Driving the Day

A SPLIT SCREEN ON COVID-19 — Is the United States entering its darkest winter, or about to have a miraculous spring?

PULSE notes: Both can be true. But the incoming Biden administration and the outgoing Trump administration, which presented very different messages in simultaneous events on Tuesday afternoon, are jockeying to shape Americans' perceptions about the ever-worsening coronavirus pandemic.

— "Help is on the way. And it is long overdue," said Vice President-elect Kamala Harris , as Biden rolled out multiple members of his health team in Delaware.

Biden himself warned that "things may well get worse before they get better," even as he vowed fast action after Inauguration Day.

— "Speed was able to be achieved. But specifically, why were we so fast?" said MONCEF SLAOUI at the White House's vaccine summit, at nearly the same moment that Harris spoke.

The Operation Warp Speed scientific adviser joined other Trump officials to tout record-fast vaccine development and plans to quickly distribute tens of millions of doses in the coming weeks.

"We think by spring we will be in a position nobody would have believed possible just a few months ago," Trump vowed. "They say it's somewhat of a miracle, and I think that's true."

— With light at the end of the tunnel on Covid-19, Biden and Trump's teams are working hard on both planning and narratives. For the president-elect, it's essential to preserve that the coronavirus problems rest on Trump while projecting that his own team will promptly deliver a solution.

Among that team, which publicly debuted on Tuesday: HHS secretary-designate Xavier Becerra — whose name and title Biden briefly bungled — as well as incoming CDC director Rochelle Walensky and Vivek Murthy, tapped to be surgeon general for a second time.

Biden vowed to get 100 million Americans vaccinated in his first 100 days — a timeline that roughly aligns with Trump's own goals — and laid out his other ambitions to reopen schools and again call on Americans to wear masks.

"My first 100 days won't end the Covid-19 virus," Biden said. "But I'm absolutely convinced that in 100 days we can change the course of the disease and change life in America for the better."

Meanwhile, the Trump team has presided over one of the world's worst Covid-19 outbreaks, and the stakes of delivering on the vaccine are especially high for the president's legacy. And while the message in some corners of the White House and at Tuesday's vaccine summit was closer to Mission Accomplished, some of Trump's top advisers continue to sound a note of caution.

"While great progress has been made… we still have a lot to do," said Slaoui.

— More: "On eve of U.S. vaccine approval, Trump cranks up the politics," POLITICO's Nick Niedzwiadek writes.

— ICYMI: SLAOUI voices confidence in vaccine distribution plans. The federal government is so well-prepared to distribute its Covid-19 vaccines that an emerging worry is the process might happen too fast, he said earlier Tuesday.

"If the FDA approves the vaccine on Saturday morning and we ship it right after approval … are we sure there will be people to receive them appropriately on a Sunday?" Slaoui said during the Milken Future of Health Summit. "We're at that level of planning."

He did not directly address concerns that the U.S. has not secured enough doses of the vaccines. But Slaoui did acknowledge there would likely be "hiccups" in the effort to get hundreds of millions of doses out to Americans, adding that he's focused on minimizing any issues. "I hope the hiccups will be 1 percent and we'll be perfect 99 percent of the time," Slaoui said.

KEEP UP WITH THE GLOBAL HEALTH AGENDA IN 2021 : As hopeful Covid-19 vaccine news continues to emerge, the focus is on how different countries plan to prioritize distribution. If nothing else, the past year has revealed how critical it is to keep up with the politics, policy, and people driving global health. Our Global Pulse newsletter connects leaders, policymakers, and advocates to the people and politics impacting our global health. Join the conversation and subscribe today.

AMERICA HEADS FOR THE VACCINE CLIFF — The government is poised to ship out 100 million doses of each coronavirus vaccine as soon as the FDA gives the green light. Yet once that initial supply is gone, health experts worry the nation's mass immunization campaign will hit a wall , POLITICO's Sarah Owermohle reports.

That so-called vaccine cliff could leave the U.S. reliant on other vaccines not yet proven to work to fill the gap next spring, when most of America will be eligible for the shots.

— The Trump administration reserved 800 million doses total, but most of that supply is of vaccines still in clinical trials. The two frontrunners – Moderna and Pfizer – have already inked deals with other countries that are stretching early supplies of their vaccines. And the government already turned down prior opportunities to buy up to 40 million additional Pfizer shots.

— What that means: Getting most Americans vaccinated by spring or summer will rest on the additional vaccine candidates proving effective, and on the companies scaling up production fast enough to avert supply shortages.

— The Trump administration dismissed worries of a vaccine cliff. "We are absolutely confident we'll have enough doses to vaccinate the American people by the end of second quarter 2021," a senior administration official told reporters on Monday.

'SURPRISE' BILLING LEGISLATION LOOKS DEAD — It's increasingly unlikely Congress will pass a billing fix that holds patients harmless from sometimes staggering bills for out-of-network or emergency services after House Speaker Nancy Pelosi failed to bring a powerful committee chairman on board.

— The state of play: Ways and Means Chair Richard Neal (D-Mass.) this week turned down a compromise billing fix after Pelosi tried to push for a deal, according to a senior committee aide, who bemoaned that "Neal just has no interest in a fix."

The House Energy and Commerce and Education and Labor Committees, as well as the Senate HELP Committee, had all agreed on the legislation, according to the aide.

"We have made concession after concession" to try and get Ways and Means on board, the aide said. One lawmaker involved in the negotiations said the compromise would have moved closer to a proposal Neal championed that was seen as more favorable to powerful hospital and physicians groups who don't want disputes settled by payments they say smack of price controls.

— A Ways and Means Committee spokesperson countered that the chairman is "open to finding a compromise" and wrote in an email that the other committees "repeatedly" have not provided the legislative text detailing the changes. Earlier this week, Neal told POLITICO that he wanted to punt the issue into next year.

— A senior Democratic aide conceded the path forward is dim. "Never say never, but unclear for now what the next step would be."

— Congress' inability to pass surprise billing legislation may have a lasting impact. Two key lawmakers who have championed billing reforms — HELP Chair Lamar Alexander (R-Tenn.) and Energy and Commerce ranking member Greg Walden (R-Ore.) — are retiring at the end of the year. It's far from clear that a new Congress would be willing to tackle the issue again after two years, big-dollar ad campaigns and massive lobbying.

In Congress

COVID RELIEF TALKS ARE GETTING COMPLICATED — Congress' fresh effort to strike a coronavirus aid deal is getting bogged down again, with negotiators juggling three increasingly complex options.

Senate Majority Leader on Tuesday offered perhaps the simplest approach: Just abandon the couple of issues that have deadlocked Capitol Hill for months, POLITICO's Marianne LeVine and Burgess Everett report. But that plan for excluding Democrats' demand for state and local funding and GOP-backed liability protections lasted barely an hour before Democratic leaders shot it down.

— Democrats are still pushing for a bipartisan option. The $908 billion proposal developed by a small group of lawmakers is close to being finalized, and would set aside roughly $160 billion for states and localities. Yet it remains unclear whether it can win widespread support.

— The White House is back in the fray now, too. Trump wants any relief package to send stimulus checks directly to Americans, Sen. Josh Hawley told Burgess on Tuesday, adding another wrinkle to the talks.

Further confusing matters, Treasury Secretary Steven Mnuchin on the same day pitched Democrats on a separate plan for a $916 billion bill.

THE RACE FOR E&C IS HEATING UP — Reps. Alexandria Ocasio-Cortez and Kathleen Rice are among the roughly dozen Democrats vying for limited slots on the powerful Energy and Commerce Committee, POLITICO's Heather Caygle, Sarah Ferris and Susannah Luthi report.

The jockeying by the two high-profile New Yorkers — seeking a slot being vacated by outgoing Rep. Eliot Engel (D-N.Y.) — risks shutting the state out of a seat on the panel completely if the delegation fails to coalesce behind a single candidate. It's a scenario playing out among Texas lawmakers as well, where two members are also competing for one of the E&C seats.

— Why it matters: E&C has sweeping jurisdiction over health care issues, as well as other areas like climate and technology that could be central to the Biden administration's agenda. That gives committee members outsize influence on major pieces of legislation.

— AOC touted her endorsements, arguing that she's won her full region's backing – including the support of the New York delegation's dean, Jerry Nadler. But some senior Democrats are privately hoping Ocasio-Cortez doesn't get it, over fears her aggressive style of politics could complicate the panel's work.

A message from PhRMA:

America's biopharmaceutical companies are making great progress against a common enemy – COVID-19. They're learning from successful vaccines for other diseases, developing new treatments and collaborating like never before.

Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives.

America's biopharmaceutical companies are working day and night until they defeat COVID-19. Because science is how we get back to normal.

Biden World

A LOOK AT BIDEN ADVISERS' PROVIDER PRIORITIES — An informal advisory group created by Biden's campaign drafted recommendations that could raise Medicare rates for primary care providers and expanding value-based payment schemes, according to documents scooped by POLITICO's Tucker Doherty.

The proposals were submitted to the campaign in October, with the belief that some could be adopted by the incoming administration.

— What the advisers pitched: New incentives for providers to join accountable care models, the broadening of a model that lets primary care doctors receive a mix of capitated and fee-for-service payments, and a goal of connecting all Americans with a primary care provider by 2025.

Committee participants also described a fourth proposal that would create an expert panel charged with simplifying and reforming Medicare pay rates.

HAPPENING THURSDAY - CLOSING THE ORAL HEALTH CARE GAP : Oral health care remains out of reach or limited for millions of people living in the United States, particularly for those with low income, those living in rural communities, and in communities of color. What will it take to improve access and quality of oral care for Americans, especially for the most vulnerable? Join POLITICO for a virtual conversation exploring the challenges in oral care disparities and the policies and strategies that can help solve them. REGISTER HERE.

What We're Reading

The New York Times' health team investigates the "pattern of communication blunders" that cost AstraZeneca credibility with regulators and raised doubts about its Covid-19 vaccine.

For Business Insider, David Levinthal takes a closer look at the lobbying powerhouses that vaccine developers Pfizer, AstraZeneca and Moderna have built in Washington.

A Senate committee hearing featuring GOP-invited witnesses who have pushed unproven Covid-19 cures faced boycotts from Democrats and criticism from even some Republicans, BuzzFeed News' Paul McLeod reports.

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