Monday, December 21, 2020

Surprise! Those bills are banned — Marshallese will get Medicaid back — CDC panel: prioritize frontline workers, seniors with shots

Presented by The Great Courses Plus: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.
Dec 21, 2020 View in browser
 
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By Dan Diamond and Adam Cancryn

Presented by The Great Courses Plus

With Susannah Luthi and Rachel Roubein

PROGRAMMING NOTE: Morning PULSE will not publish from Thurs. Dec. 24-Friday Jan. 1. We'll be back on our normal schedule on Monday Jan. 4.

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Quick Fix

— Congress will ban 'surprise' medical bills as part of the year-end funding package finalized Sunday night.

Congress also agreed to restore Medicaid coverage for the Marshallese and other Pacific Islanders after nearly 25 years, following a POLITICO investigation.

— Frontline workers and seniors should be prioritized in the next wave of Covid-19 vaccines, a CDC advisory panel recommended on Sunday.

THIS IS MONDAY PULSE — Where it's that time of year where we ask: What was your favorite health care journalism of 2020? Send picks and other tips to ddiamond@politico.com and acancryn@politico.com.

 

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Driving the Day

SURPRISE! CONGRESS AGREED … to end "surprise" medical bills after a two-year lobbying brawl, POLITICO's Susannah Luthi reports.

— How we got here: There's been bipartisan support to protect patients from such bills — and it was a priority for retiring Senate HELP Chair Sen. Lamar Alexander (R-Tenn.) — and yet the legislative effort looked all but dead just a few weeks ago, Susannah notes.

But then key committees got to a deal earlier this month, winning over hold-out Ways and Means Committee chair Rep. Richard Neal (D-Mass.) by agreeing that any payment dispute with insurers would go straight to arbitration. Hospitals and doctors had sought that provision, favoring it over government-set payment rates.

— The gist of Sunday's deal: Out-of-network doctors will no longer be able to send exorbitant bills to patients they've seen at in-network hospitals. That practice has boomed in recent years, and it's also been a key part of the business model of private equity-backed physician staffing firms, Susannah notes.

— What's new: Another hospital- and doctor-friendly amendment in the final package would bar arbiters from basing their billing decisions on Medicare and Medicaid rates, which are typically much lower than what commercial insurers pay.

Insurers, employers and patient advocates had argued for using Medicare and Medicaid rates as a barometer for payments, arguing that it could tamp down spending, Susannah writes.

— Other provisions got watered down too: The legislation weakens a measure proposed by Alexander and Sen. Patty Murray , his Democratic counterpart on the HELP committee, that would have required insurers to disclose detailed information to employers about their drug costs and rebates, Susannah writes.

The final version calls for insurers to submit more general information on medical costs and prescription drug spending to relevant federal agencies, and that data would inform a government report on drug pricing trends.

 

KEEP UP WITH THE PEOPLE AND POLITICS DRIVING GLOBAL HEALTH IN 2021: The pandemic revealed just how critical it is to keep up with the politics, policy and people driving global health. The Covid-19 vaccine is here — now what? What will the distribution look like globally? Our Global Pulse newsletter connects leaders, policymakers and advocates to the politics impacting our global health. Join the conversation and subscribe today.

 
 

THE MARSHALLESE WILL GET THEIR MEDICAID BACK — Congress on Sunday night also agreed to restore Medicaid coverage for Marshall Islanders and other islanders covered by the Compact of Free Association, almost 25 years after accidentally stripping them of coverage during welfare reform, Dan first reported.

"THIS IS ENORMOUS!!," tweeted Kathy Ko Chin, the former head of the Asian & Pacific Islander American Health Forum. "This makes my heart sing."

In a series of stories that began in January, POLITICO detailed how the United States promised Medicaid to the islanders after using the Marshall Islands to test nuclear bombs — before Congress accidentally barred COFA migrants from the safety-net health program. The loss of Medicaid access was a major factor in the islanders' worse health outcomes, researchers concluded, and the Marshallese and other COFA migrants disproportionately suffered during this year's pandemic, POLITICO wrote last week.

The Covid-19 infection, hospitalization and death rates in one Marshallese community studied by the CDC were "staggering," the scientist who led the study told POLITICO.

Advocates, lawmakers and researchers had spent years trying to fix the Medicaid policy, which also affects citizens of Micronesia and Palau. Democrats like Sens. Mazie Hirono and Brian Schatz and Rep. Tony Cardenas worked to build a legislative coalition, winning over Republicans like Reps. Steve Womack, Don Young and Cathy McMorris Rodgers this year.

"My ultimate goal in life before I die is that we get Medicaid restored for Marshallese and that we improve health equity," Pearl McElfish, the vice chancellor of the University of Arkansas for Medical Sciences and a prominent researcher on Marshallese health, told POLITICO earlier this month.

"Well, I guess now I can die, but there's still more work to do," McElfish texted PULSE on Sunday night.

The view from across the nation: "When reached by phone Sunday, Hawaii resident Josie Howard said she was crying tears of joy," Anita Hofschneider writes for CivilBeat. Howard co-founded a local organization, We Are Oceania, to boost health access for the islanders.

CDC PANEL: FRONTLINE WORKERS, 75-YEAR-OLDS AND UP SHOULD GET SHOTS NEXT — The CDC's Advisory Committee on Immunization Practices on Sunday overwhelmingly made the recommendations, following a robust debate about whether more seniors and high-risk groups should be given priority over some essential workers, POLITICO's Brianna Ehley reports.

The recommendations aren't binding, but states have been looking to ACIP recommendations to help them settle challenging ethical questions over how to fairly divvy up the scarce supply of doses.

"This isn't black and white," Amanda Cohn, ACIP's executive secretary, said of the recommendations. "It will vary by local context."

LAWMAKERS BEGIN TO GET VACCINATED — A steady stream of officials are receiving the vaccine under continuity-of-government protocols, including House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell, who got their shots on Friday.

"I'm feeling good," said Rep. Lauren Underwood (D-Ill.), a nurse who broadcast her vaccination — and made sure to praise the nurses who gave her the shot.

BUT NIH, TONY FAUCI STILL WAITING — As of Friday, the agency hadn't received a single shipment of vaccine, despite playing a key role in the effort to develop them and having an on-site hospital, POLITICO's Dan Diamond scooped.

The agency is "hopeful" that its frontline staff around the country will soon get access to vaccines, NIH Director Francis Collins wrote in an email to staff on Friday, obtained by POLITICO. "For other NIH staff, vaccinations will not be possible until 2021, and it is not yet clear how vaccines will be provided — whether through NIH or through community sites."

NIH didn't respond to requests for comment on Friday.

 

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WARP SPEED OFFICIAL TAKES BLAME FOR OVERCOUNT OF COVID SHOTS The chief operating officer of the government's vaccine accelerator on Saturday took sole responsibility for overstating the estimated number of Pfizer-BioNTech coronavirus shots that states would get next week, POLITICO's Rachel Roubein reports.

— The discrepancy: Operation Warp Speed originally estimated up to 7.3 million doses could be available in the second week of vaccine distribution. Instead, about 4.3 million shots are ready — a significant difference that left governors scrambling to revise their vaccination plans.

— Army Gen. GUSTAVE PERNA gave a mea culpa Saturday morning, putting an end to days of confusion among state officials.

"The mistake I made is not understanding with exactness — again, my responsibility — on all the steps that have to occur to make sure the vaccine is releasable," Perna said at a press conference. See video.

Perna said millions of the doses he originally identified were not ready to be shipped out, as the vaccine must be "releasable in accordance with the FDA."

— What that means: An FDA spokesperson pointed to language in the letter authorizing Pfizer's vaccine for emergency use, which states that the company must submit a certificate of analysis for each product at least 48 hours before the vaccine is distributed. The agency does not have to sign off on the paperwork before the company can ship the vaccine.

But Perna's mea culpa didn't cut it with state officials who brawled with the Trump administration last week, with an HHS spokesperson claiming that "reports that jurisdictions' allocations are being reduced are incorrect." HHS Secretary Alex Azar also blamed Pfizer for production problems, a claim that Pfizer CEO Albert Bourla refuted.

"Now it's time for HHS to apologize for wasting the time of state government officials across the nation who had to defend math and the truth when HHS tried to say we were lying," tweeted Jordan Abudayyeh, the press secretary for Illinois Gov. JB Pritzker, who raised concerns about the changing allocations.

 

A NEW YEAR, A NEW HUDDLE: Huddle, our daily must-read in congressional offices, will have a new author in 2021! Olivia Beavers will take the reins on Jan. 4, and she has some big plans in store. Don't miss out, subscribe to our Huddle newsletter, the essential guide to all things Capitol Hill. Subscribe today.

 
 


HOW ELVIS PRESLEY HELPED BUILD VACCINE CONFIDENCE — The young singer got vaccinated against polio on camera in 1956, becoming a prominent face in public health officials' effort to shore up support back then, POLITICO's Joanne Kenen reports.

"Hey kids can I talk to you? This is Elvis Presley," he said in a March of Dimes PSA recorded around then. "If you believe polio is beaten, I ask you to listen. The fight against polio is as tough as it ever was."

— It was part of a broader campaign to boost confidence in the vaccine after an early batch of bad shots had sickened, paralyzed and killed children, Joanne writes. The singer had undeniable impact amid a broader effort to boost teen immunization, experts conclude.

So do we need an Elvis today? The new Covid-19 vaccines are meant to end the worst health crisis in a century, and despite the rise of anti-vaccination rhetoric in recent years, there's evidence that most Americans are clamoring for shots of their own.

"They will get this," predicted Paul Offit, a vaccine expert and polio historian at the Children's Hospital of Philadelphia. "They will want it."


 

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What We're Reading

Meet the journalist who wrote about "pharma bro" Martin Shkreli — and then fell in love with him, Stefanie Clifford writes in ELLE Magazine.

"It's a mess": Nursing homes are grappling with delays in getting consent for Covid-19 vaccines, Fenit Nirappil and Yasmeen Abutaleb write for the Washington Post.

Even as she warned against Thanksgiving travel, White House coronavirus coordinator Deborah Birx traveled with her family to Delaware over Thanksgiving weekend, the AP's Aamer Madhani and Brian Slodoysko report.

 

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